Cases Of Proliferative Vitreoretinopathy Research Articles

Long-Term Safety and Efficacy of Siluron2000 with Pars Plana Vitrectomy in the Treatment of Patients with Severe Vitreoretinopathy and Chronic Macular Holes.

PurposeSilicone oil intraocular retinal tamponade is a useful adjunct to pars plana vitrectomy (PPV) in the treatment of complex vitreoretinal conditions. Siluron2000, a modified silicone oil product containing an additional small, high molecular weight and low viscosity, very-long-chain silicone molecule, was developed to reduce post-operative silicone oil emulsification, a non-infrequent complication that occurs with low molecular weight silicone oil. This study was designed to assess the safety and efficacy of long-term Siluron2000.Patients and MethodsThis was a single-center, retrospective, observational study. All consecutive patients undergoing PPV with intravitreal Siluron2000 injection between January 2017 and September 2019 with at least 6-month follow-up were identified based on billing codes.ResultsA total of 57 eyes of 57 consecutive patients comprising 51 cases of proliferative vitreoretinopathy and 6 cases of recurrent full thickness macular hole were included. Median follow-up was 18 months. Emulsification occurred in 9 patients (15%). Retinal re-attachment was achieved in 47 patients (82%). The median time without silicone oil emulsification was 17 months. Of the cases with residual retinal detachment (RD) despite intravitreal Siluron2000, 4 (7%) were total RDs and 6 (10%) were inferior RDs with attached macula. The most common complications were glaucoma 12 (21%), cataract 11 (19%), and epiretinal membrane 2 (3.5%). There was no association between the duration of Siluron2000 and visual outcomes.ConclusionSiluron2000 is an effective long-term tamponade agent in the treatment of complex vitreoretinopathy. Visual and anatomical outcomes are similar to those reported with higher mw silicone oil tamponade agents but with a lower emulsification rate.

Autologous Retinal Transplant for Refractory Macular Holes: Multicenter International Collaborative Study Group

To report the structural and functional outcomes of autologous neurosensory retinal transplant for closure of refractory large macular holes (MHs). Multicenter, retrospective, consecutive case series. A total of 41 eyes of 41 patients with a full-thickness MH refractory to prior vitrectomy with internal limiting membrane (ILM) peel and tamponade. All patients underwent pars plana vitrectomy, autologous neurosensory retinal transplant with gas, silicone oil tamponade, or short-term perfluoro-n-octane heavy-liquid tamponade. All patients had at least 6 months' follow-up. Anatomic closure of MH, change in ellipsoid zone (EZ) and external limiting membrane (ELM) defect on OCT, visual acuity (VA) recovery, and surgical complications were analyzed. Mean number of prior surgeries was 1.5±0.94 (range, 1-3), and patients were followed for a mean of 11.1±7.7 months (range, 6-36 months). Complete anatomic closure of MH by OCT was achieved in 36 of 41 eyes (87.8%). Mean corrected VA (logarithm of the minimum angle of resolution [logMAR]) improved (P= 0.03) from 1.11±0.66 (range, 0.48-3) to 1.03±0.51 (range, 0.1-2) at the last postoperative visit. The VA improved (≥0.3 logMAR units) in 15 eyes (36.6%), was stable in 17 eyes (41.5%), and worsened in 9 eyes (21.9%). Among eyes with anatomic closure, VA improved in 52.3% and worsened in 13.8%, whereas in those without closure, VA worsened in 40% and improved in none. Mean preoperative largest basal diameter was 1468.1±656.4 μm (range, 621-2600 μm), and mean inner-opening diameter was 825±422.5 μm (range, 336-1649 μm). Mean preoperative EZ defect was 1777.3±513.8 μm (range, 963-2808 μm), which decreased to 1370±556.9 μm (range, 288-2000 μm) at final follow-up (P= 0.007). Mean preoperative ELM was 1681.5±429 μm (range, 1172-2606 μm), which decreased to 1408.5±571.2 μm (range, 200-2000 μm) at final follow-up (P= 0.017). Major postoperative complications were retinal detachment (n= 1) and vitreous hemorrhage (n= 1). There were no cases of proliferative vitreoretinopathy, endophthalmitis, suprachoroidal hemorrhage, or choroidal neovascularization. The autologous retinal transplant technique offers a high degree of anatomic success and proved safe in this initial experience for closure of refractory MHs.

OCT angiography documented reperfusion of translocated autologous full thickness RPE-choroid graft for complicated neovascular age-related macular degeneration.

PurposeThe purpose of this study is to investigate the reperfusion of translocated retinal pigment epithelium (RPE)-choroid graft in the treatment of patients with neovascular age-related macular degeneration (nAMD), using OCT angiography (OCTA), a novel non-invasive, high-resolution imaging modality.Patients and methodsEighteen eyes of 18 consecutive patients suffering from complicated nAMD underwent RPE-choroid patch graft translocation surgery using a peripheral retinotomy and flap-over technique. We analyzed functional and anatomical outcome using visual acuity, Spectral Domain OCT and OCTA.ResultsWith a mean follow-up of 11 months, out of 18 patients, 15 gained vision, 1 remained stable, and 2 lost vision. Overall, the visual acuity improved with a mean of 30 letters. Perfusion of the graft tissue was confirmed in all patients. Two patients developed signs of a recurrent neovascular membrane during follow-up. No cases of proliferative vitreoretinopathy occurred in this series.ConclusionsOCTA images show signs of perfusion in all grafts. Encouraging functional results and low risk of severe complications suggest that RPE-choroid graft translocation is a valid option in patients with complicated nAMD.

Proliferative Vitreoretinopathy in Treated Retinoblastoma

To evaluate the clinical and histopathologic characteristics of patients who develop proliferative vitreoretinopathy after retinoblastoma treatment. Retrospective review of three cases of proliferative vitreoretinopathy (PVR) that developed after successful treatment of retinoblastoma from 2003 to 2015. Three patients with treated retinoblastoma who developed severe PVR and required enucleation. Review of clinical charts, fundus drawings, Ret-Cam 3 images, and histopathology specimens. Clinical and histopathologic characterization of PVR in treated retinoblastoma. Three patients developed severe PVR after sequential thermal laser combined with systemic chemotherapy for retinoblastoma. At presentation patients were 6, 7, and 9 months of age, and all had bilateral retinoblastoma. Time to development of proliferative tissue was 9, 12, and 20 months after initial treatment. Proliferation was characterized by progressive growth of white vascularized tissue with associated traction on the retina and sometimes hemorrhage. All patients underwent enucleation. Histopathologic evaluation revealed treated retinoblastoma tumor with a Type 3 regression pattern, pre- and subretinal fibrovascular tissue consistent with PVR, and reactive changes in the retinal pigment epithelium. None of the patients developed recurrence of retinoblastoma or systemic metastasis. PVR uncommonly develops after successful treatment of retinoblastoma and may result in traction or rhegmatogenous retinal detachment along with vitreous hemorrhage. Early stages of proliferation may be difficult to distinguish from recurrent tumor. Enucleation may be required due to poor vision and inability to adequately monitor for tumor recurrence.

Pars plana vitrectomy with silicone oil tamponade in failed scleral buckle surgery

ObjectiveThis study aimed to evaluate the anatomical and functional outcomes of secondary pars plana vitrectomy (PPV) after failed scleral buckling (SB) surgery and to compare it with primary PPV for rhegmatogenous retinal detachment (RRD), including complicated proliferative vitreoretinopathy cases. DesignRetrospective series in a tertiary care centre. ParticipantsOne hundred and twenty consecutive patients. MethodsThe medical records of patients who underwent PPV with silicone oil tamponade for RRD were reviewed. Forty-four eyes were operated on for primary RRD (primary PPV group), and 76 eyes were operated on for failed SB surgery (secondary PPV group). The single-operation anatomical success rate, final anatomical success rate, and best-corrected visual acuity preoperatively, at 6 months, at 1 year, and at final follow-up were analyzed. ResultsThe single-operation anatomical success rate was 74.2% in the primary PPV group and 77% in the secondary PPV group (p = 0.48). The final anatomical success rate was 90.3% in the primary PPV group and 91.8% in the secondary PPV group (p = 0.55). The number of cases with visual acuities of 3 visual categories (20/50 or better, 20/200 to 20/50, less than 20/200) was not statistically different at each time point. ConclusionsConsequent PPV with silicone oil tamponade for failed SB surgery seems not to have inferior anatomical and functional outcomes when compared with primary PPV for RRD.

EXTERNAL VALIDATION OF EXISTING FORMULAS TO PREDICT THE RISK OF DEVELOPING PROLIFERATIVE VITREORETINOPATHY

To externally validate the accuracy of previously published formulas for predicting proliferative vitreoretinopathy development after retinal detachment surgery. Clinical variables from consecutive retinal detachment patients (n = 1,047) were collected from the Retina 1 Project conducted in 17 Spanish and Portuguese centers. These data were used for external validation of four previously published formulas, F1 to F4. Receiver-operating characteristic curves were used to validate the quality of formulas, and measures of discrimination, precision, and calibration were calculated for each. Concordance among the formulas was determined by Cohen kappa index. The areas under the receiver-operating characteristic curves were as follows: F1, 0.5809; F2, 0.5398; F3, 0.5964; and F4, 0.4617. F1 had the highest accuracy, 74.21%. Almost 19% of proliferative vitreoretinopathy cases were correctly classified by F1 compared with 13%, 15%, and 10% for F2, F3, and F4, respectively. There was moderate concordance between F2 and F3 but little between the other formulas. After external validation, none of the formulas were accurate enough for routine clinical use. To increase its usefulness, other factors besides the clinical ones considered here should be incorporated into future formulas for predicting risk of developing proliferative vitreoretinopathy.

Retinotomy with retinal turnover to remove subretinal membranes under direct visualization for proliferative vitreoretinopathy

PurposeThe purpose of the study was to report the outcomes for cases of proliferative vitreoretinopathy (PVR) that received retinotomy and removal of subretinal proliferative tissue under direct visualization using retinal turnover.MethodsNineteen eyes with posterior and/or anterior grade C1–12 PVR that had undergone retinotomy and retinal turnover were reviewed. Main outcomes included the retinal reattachment rate, final best-corrected visual acuity (BCVA), postoperative intraocular pressure, extent of retinotomy, and complications.ResultsFinal retinal reattachment rates with silicone oil tamponade were 100%. The mean logarithm of the minimal angle of resolution (logMAR) BCVA was significantly improved (P = 0.001). Positive correlation was found between the extent of retinotomy and both preoperative logMAR BCVA (r = 0.663, P = 0.002) and postoperative logMAR BCVA (r = 0.619, P = 0.005). There was no correlation between the extent of retinotomy and the change in preoperative and postoperative logMAR BCVA (r = −0.267, P = 0.268). Negative correlation was found between preoperative logMAR BCVA and the change in logMAR BCVA (r = −0.587, P = 0.008). There was no correlation between the extent of retinotomy and the intraocular pressure at the final visit (r = −0.316, P = 0.188). Corneal decompensation due to silicone oil in the anterior chamber occurred in one eye.ConclusionRemoval of subretinal proliferative tissue with retinal turnover seems to be an effective procedure.

Gelatinase B in proliferative vitreoretinal disorders

Purpose: To investigate whether gelatinases A and B are involved in the pathogenesis of proliferative vitreoretinal disorders. Methods: In a prospective study of 101 consecutive patients, vitreous and paired serum samples were obtained from 38 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy, 25 patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy, and 38 patients with proliferative diabetic retinopathy. Gelatinase activities were determined by quantitative zymography. Results: All vitreous samples contained comparable levels of the constitutive gelatinase A. Inducible gelatinase B was detected in eight (32%) of 25 vitreous samples from patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy (mean ± SD, 319.5 ± 521.0 scanning units), in 17 (44.7%) of 38 vitreous samples from patients with proliferative vitreoretinopathy (560.6 ± 718.9 scanning units), and in 34 (89.5%) of 38 vitreous samples from patients with proliferative diabetic retinopathy (1,707.2 ± 1,220.3 scanning units). The incidence of detection of gelatinase B in proliferative diabetic retinopathy cases was significantly higher than it was in rhegmatogenous retinal detachment with no proliferative vitreoretinopathy and proliferative vitreoretinopathy cases ( P < .001). Gelatinase B levels in the vitreous samples of patients with proliferative diabetic retinopathy were higher than the levels found in patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy and in patients with proliferative vitreoretinopathy ( P = .0152). Gelatinase A was detected in all the tested sera, whereas none of the tested paired serum samples contained detectable gelatinase B activity. Conclusions: Gelatinase B may play an important role in extracellular matrix degradation associated with neovascularization in proliferative diabetic retinopathy.

Extensive Peripheral Retinectomy Combined with Posterior 360 degrees Retinotomy for Retinal Reattachment in Advanced Proliferative Vitreoretinopathy Cases

Extensive Peripheral Retinectomy Combined with Posterior 360 degrees Retinotomy for Retinal Reattachment in Advanced Proliferative Vitreoretinopathy Cases

Extensive Peripheral Retinectomy Combined with Posterior 360° Retinotomy for Retinal Reattachment in Advanced Proliferative Vitreoretinopathy Cases

Posterior 360° retinotomy in conjunction with extensive peripheral retinectomy was necessary for retinal reattachment in 18 eyes. A visual acuity of 20/400 or better was achieved in 22% of the patients; in patients with rubeosis, regression was found in 89%. Of the hypotonus eyes, preoperatively 78% were normotensive postoperatively after removal of anterior proliferative vitreoretinopathy (PVR) covering ciliary epithelium. The major intraoperative complication was hemorrhage, which could be readily controlled. Recurrent retinal detachment (RD) occurred in 39% and reproliferation in 50% of the patients.

Tissue Plasminogen Activator for Postvitrectomy Fibrin Formation

The authors injected 25,ug of recombinant tissue plasminogen activator (tPA) into the anterior chamber or vitreous cavity of 23 eyes of 22 patients with severe intraocular fibrin formation that developed after vitrectomy surgery for complicated cases of proliferative vitreoretinopathy (PVR) (13 eyes), diabetic traction retinal detachment (TRD) (7 eyes), or endophthalmitis (3 eyes). Tissue plasminogen activator injected an average (± standard deviation) of 73 ± 63 hours after vitrectomy surgery resulted in complete fibrinolysis in 21 of 23 eyes and partial fibrinolysis in one eye. The mean time to fibrin resolution was 3.0 ± 1.0 hours. Four eyes required repeat tPA injection for recurrent fibrin formation; repeat injection resulted in complete fibrinolysis in each case. The mean followup duration after tPA administration was 6 months. At the final follow-up examination, the retina was totally attached in 18 of 23 eyes and was partially attached in 2. Visual acuity improved in 12 eyes (52%); it was at least 20/400 in 8. Complications of tPA injection included hyphema (2 patients) and corneal stromal thickening (2 patients). Mild, transient, periocular pain that was easily managed with non-narcotic analgesia developed in three patients.

Cell Components in Proliferative Vitreoretinopathy: Immunofluorescent Double Staining of Cultured Cells from Proliferative Tissues

Intermediate filament proteins in cultured cells from epiretinal membranes of 5 cases of proliferative vitreoretinopathy and subretinal strands of 2 cases were immunohistologically characterized. Double staining technique after colcemid treatment revealed that either keratin-positive or vimentin-positive cells were found with different ratios depending on the cases. Both positive and both negative cells were also observed. Desmin and glial fibrillary acidic protein were totally negative.

Healon as intravitreal substitute in retinal detachment surgery in 40 patients.

Forty patients with hypotony during retinal detachment surgery were treated with intravitreal Healon. Healon was very well tolerated, except for a transient rise in the intra-ocular pressure in 19 out of 40 patients. A relationship between the rise in intra-ocular pressure and the mount of Healon used was not found. Temporal corneal decompensation occurred in two patients. Early cases of proliferative vitreo-retinopathy with retinal detachment were treated successfully with external retinal-detachment surgery and intravitreal Healon.

Spontaneous Reattachment of the Retina Despite Proliferative Vitreoretinopathy

In six cases of spontaneous retinal reattachment despite severe proliferative vitreoretinopathy, the retina was initially attached after a buckling procedure or vitreous surgery for proliferative vitreoretinopathy. However, each retina suddenly detached several weeks later. Surprisingly, the retinas settled slowly during the following weeks without further treatment. One case was marked by repeated episodes of detachment and reattachment. In none of the cases could an open retinal break be detected. In certain cases of proliferative vitreoretinopathy in which no open break is apparent and the detachment appears to be tractional, an observation period of several weeks may allow the retina to reattach spontaneously without further surgery.