Absence Of Retinal Detachment Research Articles

The Association of Intraocular Efavirenz Concentrations and HIV-1 Viral Load Among Persons With HIV.

Efavirenz (EFV) is commonly used in combination antiretroviral therapy. However, in our previous study, many persons living with HIV exhibited ocular complications despite undergoing effective combination antiretroviral therapy. Here, we aimed to determine the intraocular EFV concentrations in the vitreous and analyze the factors affecting viral load in the vitreous in patients with HIV-associated retinopathies. Observational, retrospective study. Fourteen patients receiving EFV in combination with an antiretroviral therapy who underwent pars plana vitrectomy were enrolled between January 2019 and August 2022. The patients were divided into 2 groups based on presence or absence of retinal detachment (RD). Patient characteristics and HIV-1 RNA levels in plasma and vitreous were recorded during pars plana vitrectomy. Paired blood plasma and vitreous samples were obtained for EFV concentration analysis using ultra-high-performance liquid chromatography/tandem mass spectrometry. The median age of the enrolled patients was 48 years (interquartile range, 32.25-53.25), including 12 men and 2 women. Median vitreous and plasma EFV concentrations were 141.5 (interquartile range, 69.63-323.75) and 2620 ng/mL (1680-4207.5), respectively. Median ratio of vitreous/plasma EFV concentrations in the paired samples among all participants was 0.053 (0.018-0.118). Median vitreous/plasma EFV concentrations significantly differed between the non-RD and RD groups (0.04 vs 0.12, P = 0.042). The vitreous EFV concentrations were insufficient to inhibit viral replication in intraocular tissues, which may be because of poor penetration of the blood-retinal barrier. High vitreous EFV concentrations were associated with RD, indicating a correlation between the EFV concentration and the severity of blood-retinal barrier disruption. It implied that EFV was not a suitable antiviral drug to inhibit HIV-1 replication in ocular tissues.

Clinical Presentations, Management, and Factors Affecting Outcomes in Posterior Segment Open Globe Injuries: An Analysis of 2,360 Eyes

Introduction: The aim of the study was to report the clinical presentations, management, and factors affecting the outcomes of posterior segment open globe injuries in 2,360 consecutive eyes. Methods: This was a retrospective, consecutive, non-comparative interventional case series. All cases with scleral and corneoscleral wounds presenting to these centers from January 2014 to January 2021 were included. The cases were defined according to the Birmingham Eye Traumatology Terminology system (BETTs) classification. The Ocular Trauma Score (OTS) was applied to the dataset. Results: Mean age of presentation was 36.63 ± 19.92 years (median 35 years). Penetrating trauma accounted for 70.92%, rupture for 18.6%, perforation for 4.60%, and IOFB in 5.88% eyes. In 76.60%, the location of injury involved zone 1 extending till zone 2, while in 23.40% it involved zone 2 and/or zone 3. Vision at presentation was logMAR 3.03 ± 0.99 and at the last visit was logMAR 2.47 ± 1.42 (p < 0.0001). Time interval between presentation to the treatment center and globe repair was 13.93 ± 19.56 h (median 7.60 h). Favorable functional outcomes were seen in 29.20% eyes and favorable anatomic outcomes in 66.90%. Decreasing age at presentation, penetrating injury instead of rupture or perforating injury, a higher OTS, absence of corneal involvement, absence of retinal detachment at presentation, and absence of concurrent orbital fracture were associated with a favorable functional outcome (>20/200). Final visual acuity in logMAR correlated with the OTS value calculated at presentation. Conclusions: In the absence of retinal detachment and orbital fracture, posterior open globe injuries typically have a favorable functional outcome. OTS correlated with the final visual acuity.

EPHA2, EPHA4, and EPHA6 Expression in Uveal Melanomas: Searching for the Culprits of Neoplasia.

Uveal melanomas (UMs) comprise the most common primary intraocular malignancies in adults, with the eye representing the second most common site for melanoma, following the skin. Prognosis remains poor, with approximately half of the cases presenting with metastatic disease at the time of diagnosis. Erythropoietin-producing human hepatocellular receptors (EPHs) comprise the largest known family of tyrosine receptors, in which, along with their ligands, ephrins, play an important role in a plethora of processes in human physiology, and are implicated in key steps of carcinogenesis. In the present study, EPHA2, EPHA4, and EPHA6 immunohistochemical expressions were investigated in UM tissues and further correlated to a multitude of clinicopathological parameters, including disease stage and patients’ overall survival (OS). High levels of EPHA2 expression were significantly associated with increased tumor vertical thickness (p = 0.03) and the presence of intrascleral involvement (p = 0.05), whereas high EPHA6 nuclear expression was associated with older age at diagnosis (p = 0.03) and absence of retinal detachment (p = 0.05). In a multivariate survival analysis, increased EPHA4 expression was associated with shortened OS along with the presence of metastasis (p < 0.001) and monosomy 3 (p = 0.02). In a separate model, the concurrent overexpression of at least two of the investigated EPHs (HR = 14.7, p = 0.03) also proved to be an independent poor prognostic factor. In conclusion, our results implicate these specific members of the EPHA group as potential biomarkers for disease prognosis as well as possible targets for the development of novel therapeutic interventions.

Результаты лечения серозной отслойки сетчатки при ямке зрительного нерва. Клинический случай

Purpose. Demonstration of our own case of treatment of serous retinal detachment with a fossa of the optic nerve disc (OND). Material and methods. We observed patient B. at the age of 24 years with a diagnosis of optic nerve disc anomaly, central serous retinal detachment. Visual acuity on admission: 0.1, does not correct. A 25G endovitreal intervention was performed. With the help of tweezers, a flap of the internal limiting membrane (ILM) with a wide base was formed from the temporal part of the macula, within the vascular arcades. Then, liquid-air replacement was carried out, followed by placing the inverted flap of the ILM in the area of the OND fossa. Result. On the 5th day after the operation, visual acuity improved to 0.2, metamorphopsias decreased. According to the data of optical coherence tomography (OCT), a significant decrease in the height of neuroepithelial detachment was noted. After 4 months visual acuity reached 0.4. Complaints about metamorphopsia were stopped. The OCT picture showed a complete absence of retinal detachment. In this case, the inverted flap of the ILM in the area of the OND fossa was clearly visualized. Conclusion. 1. The displaced inverted flap of the ILM can be used to close the defect in the OND fossa. 2. This method made it possible to stop serous retinal detachment and significantly improve visual functions. 3. Given the rather rare occurrence of this pathology, further replication of this method is necessary to test its effectiveness. Key words: serous retinal detachment, fossa of the optic nerve disc, inverted flap of the internal limiting membrane.

Sensitivity, Specificity, and Accuracy of Color Doppler Ultrasonography for Diagnosis of Retinal Detachment.

PurposeThis study evaluated the sensitivity, specificity, and diagnostic accuracy of Color Doppler Ultrasonography (CDUS) in patients with suspected retinal detachment (RD) who underwent surgery.Methods In this prospective, observational clinical study, 65 eyes of 65 consecutive patients with suspected RD with opaque media were included. Following a standardized protocol, CDUS of the retina of the affected eye was performed. The sensitivity, specificity, and diagnostic accuracy of CDUS were determined and compared to the findings during surgery.ResultsThe mean age of patients (18 men and 47 women) was 52.36 years (range: 8–77 years). The sensitivity, specificity, and overall accuracy of ocular CDUS were 91.3%, 88.1%, and 89.2%, respectively. The false-negative rate (negative CDUS images but presence of RD at operation) was 3.1% (2/65) and the false-positive rate (positive CDUS images but absence of RD at operation) was 7.7% (5/65).ConclusionCDUS of the retina could be considered as a promising tool in the diagnosis of RD in patients with opaque media.

Surgical management of Acute Retinal Necrosis (ARN): timing and outcomes

PurposeTo evaluate the demographics, etiology, clinical and surgical management, and functional outcomes of an Acute Retinal Necrosis (ARN) series from a referral Italian Centre. Both clinical characteristics and treatment strategies of ARN are valid and debated issues. Several dedicated articles appear every year in highly impacted medical journals.MethodsObservational series of biopsy‐proven ARN cases between January 2010 and March 2017. All the considered patients had the last visit in 2017. Soon after diagnosis patients had received systemic antiviral therapy according to the specific guidelines. No intravitreal injections or “early” (i.e. in the absence of retinal detachment, RD) pars plana vitrectomy (PPV) were adopted.ResultsSeven patients (5 men) were included with a mean age of 52 ± 18 years (range 31–78 years). HZV was detected in 4 cases, HSV in 2 cases, CMV in 1 case (the sole with positive serology for HIV). PPV was performed in 6/7 subjects, with a mean delay of 43±33 days since diagnosis. Only in 1 case silicone tamponade removal was successfully reached. A second PPV was required in 4/6 patients, because of RD recurrence or posterior bleeding. In one HSV case a complete healing was achieved with medical treatment. Visual acuity (VA) averagely improved in the whole cohort either between diagnosis (0.91 ± 0.25 logMAR) and the end of follow up (0.77±0.51 logMAR); or between preoperatively (1.15 ± 0.03 logMAR) and the end of follow up. In both cases, however, statistic was not significant (p &gt; 0.05).ConclusionsThe efficacy of prophylactic laser in our series, as in the literature, remains unclear. VA improvement was achieved even without early PPV. This evidence, along with the possible adjuvant effect of intravitreal antivirals, warrant comparative discussion with literature data.

P047: Test characteristics of point of care ultrasound for the diagnosis of retinal detachment in the emergency department

Introduction: The acute onset of flashes and floaters is a common presentation to the emergency department (ED). The most emergent etiology is retinal detachment (RD), which requires prompt ophthalmologic assessment. Previous studies of point of care ultrasound (POCUS) have reported high sensitivity and specificity for RD, but are limited by small sample size, use of highly trained and experienced sonographers, and referral bias. Our primary objective was to assess the test characteristics of POCUS performed by a large heterogeneous group of emergency physicians (EPs) for the diagnosis of RD. Methods: This was a prospective diagnostic test assessment of POCUS performed by EPs with varying ultrasound experience on a convenience sample of ED patients presenting with the complaint of flashes or floaters in one or both eyes. Participating EPs completed a one hour didactic lecture and were expected to demonstrate appropriate performance of one practice scan before enrolling patients. After standard ED assessment, patients underwent an ocular POCUS scan targeted to detect RD. EPs recorded the presence or absence of RD on the data collection instrument based on their POCUS scan. After completing their ED visit, all patients were assessed by a retina specialist who was blinded to the results of the POCUS scan. We calculated sensitivity and specificity with associated exact binomial confidence intervals (CI) using the retina specialist’s determination of the final diagnosis as the criterion standard. Results: A total of 30 EPs, consisting of 21 staff physicians and 9 residents, participated in this study. These EPs performed a total of 128 POCUS scans. Of these scans, 13 were excluded. Of the remaining 115 enrolled patients, median age was 60 years, and 64% were female. The retina specialist diagnosed RD in 16 (14%) cases. The sensitivity and specificity of POCUS for detecting RD was 75% (95% CI 48% to 93%) and 94% (95% CI 87% to 98%), respectively. The positive likelihood ratio was 12.4 (95% CI 5.4 to 28.3), and negative likelihood ratio was 0.27 (95% CI 0.11 to 0.62). Conclusion: In a heterogeneous group of EPs with varying ultrasound experience, POCUS demonstrates high specificity but only intermediate sensitivity for the detection of RD. A negative POCUS scan is not sufficiently sensitive to rule out RD in a patient with new onset flashes or floaters.

Six-year clinical study of firework-related eye injuries in North China

PurposeTo analyse the demographic data, clinical characteristics, management and prognosis of patients with firework-related eye injuries.MethodsA retrospective review was performed of patients with eye injuries related to fireworks referred to...

Vitreous hemorrhage in pediatric age group.

Purpose. To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes. Procedure. A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010. Results. A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases. Conclusion. Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases.

A multicentre prospective study of post‐traumatic endophthalmitis

Study the clinical and microbiological characteristics and the prognostic factors of post-traumatic endophthalmitis. Seventeen eyes were included between 2004 and 2010, with clinical and microbiological data collected prospectively. Conventional cultures and panbacterial PCR were performed on aqueous and vitreous samples. Clinical signs of endophthalmitis were observed soon after trauma (1.5 ± 2.5 days). Laceration with an intraocular foreign body (IOFB) was noted in 53% of the patients. At admission, all patients had aqueous humour (71%) and/or vitreous (53%) samples. Fifteen patients (88%) underwent a pars plana vitrectomy. Bacteria were identified in 77% of the cases: Staphylococcus epidermidis (n = 5), Streptococcus (n = 4), Bacillus (n = 2), Pseudomonas stuzeri (n = 1), and Streptococcus salivarius and Gemella haemolysans (multibacterial infection, n = 1). Progression toward phthisis was observed in 35% of the cases; 41% of the patients recuperated visual acuity (VA) ≥20/40. A good final visual prognosis (≥20/40) was significantly associated with initial VA better than light perception (0% versus 70%, p = 0.01) and absence of pupillary fibrin membrane (80% versus 20%, p = 0.05). There was no correlation between visual prognosis and age, the type of laceration (corneal or scleral) or presence of an IOFB. We found a statistical trend toward an association between bacterial virulence and poor final VA. This series showed that better final VA outcomes were associated with initial VA better than light perception, S. epidermidis or culture-negative cases and absence of retinal detachment during the clinical course.

Effects of Intraocular Ranibizumab and Bevacizumab in Transgenic Mice Expressing Human Vascular Endothelial Growth Factor

This study compared the effects of intraocular injections of ranibizumab (RBZ) and bevacizumab (BVZ) in transgenic mouse models in which human vascular endothelial growth factor (VEGF) causes subretinal neovascularization (NV) or exudative retinal detachment. Randomized trials in animal models. Transgenic mice in which the rhodopsin promoter drives expression of human VEGF in photoreceptors (rho/VEGF mice) and double transgenic mice with doxycycline-inducible expression of human VEGF in photoreceptors (Tet/opsin/VEGF mice). Rho/VEGF mice received intraocular injections of RBZ, BVZ, or vehicle, and after various time periods the area of subretinal NV was measured. Tet/opsin/VEGF mice were given an intraocular injection of RBZ, BVZ, or vehicle, and after 5 days of doxycycline treatment the presence or absence of retinal detachment was determined. Area of subretinal NV per retina in rho/VEGF mice and the occurrence of retinal detachment in Tet/opsin/VEGF mice. In rho/VEGF mice, intraocular injections of RBZ or BVZ strongly suppressed subretinal NV, but the duration of effect was greater for BVZ. Three injections of 10 microg of BVZ over the course of 2 weeks not only suppressed subretinal NV in the injected eye but also caused significant suppression in the fellow eye, indicating a systemic effect. In doxycycline-treated Tet/opsin/VEGF mice, intraocular injection of 10 microg of BVZ significantly reduced the incidence of exudative retinal detachment compared with injection of 10 microg of RBZ. Injection of 25 microg of BVZ reduced the incidence of retinal detachment in both eyes. Intraocular injections of RBZ and BVZ had similar efficacy in rho/VEGF mice, but the duration of effect was greater for BVZ. In Tet/opsin/VEGF mice, in which expression levels of human VEGF are very high and the phenotype is severe, BVZ showed greater efficacy than RBZ. In both models, higher doses or repeated injections of BVZ, but not RBZ, resulted in a systemic effect. These data suggest that BVZ is not inferior to RBZ for treatment of subretinal NV in mice and is superior in a severe model. The systemic effects of BVZ after intraocular injection deserve further study and consideration of their potential consequences. Proprietary or commercial disclosure may be found after the references.

Ultraschalldiagnostik vor Vitrektomie

In ophthalmology it is of increasing importance to assess intraocular pathology prior to vitroretinal surgery by means of B- and A-mode ultrasound. Even for the experienced examiner with advanced instrumentation, major problems can arise as to whether retinal detachment has developed or not. This task involves the ability for acoustical differentiation of thin tissue membranes. The authors compared preoperative ultrasonic results obtained in 51 cases with the surgical findings during vitrectomy. The presence or absence of retinal detachment was evaluated correctly in 33 cases (91.7%) using high resolution contact B-mode alone. In difficult cases maximal echo amplitudes reflected from the suspected membranes were evaluated using a hand-held A-mode transducer (level difference A-mode echography) in addition to contact B-mode. Even the combined technique, though helpful in most cases, could not detect the presence or absence of retinal detachment in all cases.

The use of colour Doppler imaging in the diagnosis of retinal detachment

Prospective study. To evaluate real-time duplex colour Doppler examination with colour and pulse Doppler ultrasonography (US) (colour Doppler imaging (CDI)) for detection of the retinal detachment from membranous structures in the posterior segment. In 33 consecutive patients with ophthalmoscopically invisible eyes (34 eyes), CDI was performed to detect the presence or absence of retinal detachment. The diagnostic criterion for retinal detachment was whether or not spectral waveforms were detected in membranous structures with colour and pulse Doppler US. In all cases, the absence or presence of retinal detachment was confirmed by surgery. In 27 of 34 eyes, membranes and/or opacities were observed in the vitreous cavity with CDI. In 12 of these 27 eyes, blood flow in those structures was detected by CDI. In all of these 12 eyes, retinal detachment was confirmed at surgery, and in 14 of the 15 eyes in which blood flow was not detected by CDI, absence of retinal detachment was confirmed at surgery. When a diagnosis confirmed by surgery was used as the definitive finding, CDI had a sensitivity of 92.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 93.3%, and an accuracy in the detection of retinal detachment from membranes and/or opacities in the vitreous cavity of 96.3%. Real-time duplex colour Doppler examination with colour and pulse Doppler US (CDI) is a noninvasive method useful for the detection of retinal detachment from vitreous opacity and/or membrane in the posterior segment.

Current trends in the treatment of ocular melanoma by radiotherapy.

The Collaborative Ocular Melanoma Study (COMS) has recently confirmed once and for all that it is safe to attempt to preserve an eye with a posterior uveal melanoma by demonstrating no survival advantage of enucleation over plaque radiotherapy. While COMS has been under way, we have set out in London to define the selection criteria for conservative therapy versus enucleation for the various categories of melanoma in terms of size, location within the eye, and presence or absence of retinal detachment. The evolution of this approach has culminated in an overall ocular survival rate of 94% in 597 patients following radiation therapy combined with a mean loss of visual acuity of only 2.4 Snellen lines in the eyes preserved.

Management of intraretinal Metallic Foreign Bodies without Retinopexy in the Absence of Retinal Detachment

In the management of intraocular metallic foreign bodies impacting or embedded in the posterior retina but without retinal detachment, retinopexy can be difficult or dangerous because of surrounding retinal, subretinal, or choroidal hemorrhage, or the proximity of the foreign body to the optic disc and macula. The authors prospectively managed five such cases by pars plana vitrectomy and foreign body removal without intraoperative or postoperative retinopexy. Fluid gas exchange was performed in only one case. No attempt was made to create a posterior vitreous detachment in any of the cases. After follow-up, ranging between 8 and 35 months, all cases had attached retinas and chorioretinal adhesion around the foreign body site. None of the cases had preretinal macular fibrosis. Four of the five cases had a best corrected visual acuity of 20/20 or better. The other, an aphakic 3-year-old patient, was amblyopic. Spontaneous chorioretinal adhesion appears to obviate the need for retinopexy in these selected cases. The avoidance of retinopexy and fluid gas exchange may decrease the risk of retinal detachment and preretinal macular fibrosis.

Significance of various systemic and ocular parameters in the long-term prognosis after diabetic vitrectomy

The presence or absence of retinal detachment, especially detachment of the macula, was the most critical parameter predicting visual outcome, and long duration of detachment worsened the prognosis (P = 0.0084). In contrast, the time interval from vitreous haemorrhage to surgery did not associate with the long-term visual outcome. Pre-operative visual acuity of counting fingers 1 m or better was associated with favourable visual outcome (P = 0.0032). Other pre- or per-operative parameters (e.g. aphakia, iris rubeosis, extent of photocoagulation, retinal breaks) did not associate with visual prognosis significantly. Significant association between general parameters and visual outcome was found only in the group of traction retinal detachment where loss of vision was related to shorter duration of diabetes (P = 0.0213), and shorter duration of background retinopathy (P = 0.0300), and proliferative retinopathy (P = 0.0072).