Complex Retinal Detachment Research Articles

Final anatomic and visual outcomes appear independent of duration of silicone oil intraocular tamponade in complex retinal detachment surgery.

To report anatomic and visual outcomes following silicone oil removal in a cohort of patients with complex retinal detachment, to determine association between duration of tamponade and outcomes and to compare patients with oil removed and those with oil in situ in terms of demographic, surgical and visual factors. We reported a four years retrospective case series of 143 patients with complex retinal detachments who underwent intraocular silicone oil tamponade. Analysis between anatomic and visual outcomes, baseline demographics, duration of tamponade and number of surgical procedures were carried out using Fisher's exact test and unpaired two-tailed t-test. One hundred and six patients (76.2%) had undergone silicone oil removal at the time of review with 96 patients (90.6%) showing retinal reattachment following oil removal. Duration of tamponade was not associated with final reattachment rate or with a deterioration in best corrected visual acuity (BCVA). Patients with oil removed had a significantly better baseline and final BCVA compared to those under oil tamponade (P=0.0001, <0.0001 respectively). Anatomic and visual outcomes in this cohort are in keeping with those reported in the literature. Favorable outcomes were seen with oil removal but duration of oil tamponade does not affect final attachment rate with modern surgical techniques and should be managed on a case by case basis.

Feasibility of using experimental high viscosity silicone oils: a pilot study

Background Polydimethyl silicones (silicone oils) are used in complex retinal surgeries, including difficult or recurrent retinal detachments, severe eye trauma, and other indications for long term tamponade. Two major problems with currently available silicone oils are emulsification and recurrent retinal detachment. The primary endpoint of this study was to evaluate the toxicity and safety of high viscosity silicone oils and second, the feasibility of using them with currently available vitrectomy systems.MethodsIn this experimental study, 8 eyes of 8 New Zealand White rabbits underwent vitrectomy. The vitreous cavities of 2 eyes were filled with medical grade 5500 cS silicone oil, 4 eyes with 12,500 cS oil, and 2 eyes with 30,000 cS oil for 3 months, after which the animals were sacrificed and the eyes sent for histopathological examination. The duration required to inject 5 cc each of 1300, 12,500 and 30,000 cS oils, using a commercially available system (Alcon VFC Pac) were also evaluated.ResultsRetinal histopathology was comparable in all eyes, with no excess toxic effect or damage seen in eyes with experimental oils. All oils were readily injectable with the VFC Pac system.ConclusionsHigh viscosity experimental silicone oils have similar chemical and physical properties to lower viscosity oils currently used. Therefore, toxicities are expected to be similar. In a small pilot sample of 8 rabbit eyes filled with silicone oil for 3 months, histopathology in eyes with 12,500, 30,000 cS or medical grade 5500 cS silicone oil were similar. Injecting these oils using available vitrectomy equipment is feasible. New, high viscosity silicone oils may offer several advantages over currently available oils for some patients.

Ratios for double silicone oil Endotamponade \u2013 in vitro observations may assist with ratio selection

BackgroundSilicone oil tamponade is more frequently reserved for cases of complex retinal detachment. We describe the effects of different variations in oil ratios with the relatively unknown technique of double oil tamponade.MethodsRetrospective case note review of nine patients with complex rhegmatogenous retinal detachment (RD). All cases had both superior and inferior breaks, mostly with associated proliferative vitreoretinopathy (PVR). All cases were treated with pars plana vitrectomy (PPV) and a double silicone oil endotamponade (DSOE) of both heavy silicone oil and conventional ‘light’ silicone oil. Ratios were varied to suit different RD configurations. In vitro observations were studied to help direct these decisions.ResultsAnatomical success was achieved in all cases. Common complications were the same as those seen in single oil tamponade (elevated intraocular pressure, cystoid macular oedema (CMO), cataract and posterior capsule opacification. No single case of recurrent RD was seen whilst mixed oil remained in situ.ConclusionsDouble silicone oil endotamponade is a safe and effective treatment for complex retinal detachments with superior and inferior breaks. Differences in oil ratios can be tailored to best fit the distribution of retinal pathology. In vitro observations may help to inform these choices.

Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease

To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease. Multicenter, retrospective, interventional case series. A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication. Three-port, transconjunctival, 27-gauge PPV. Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days. Mean follow-up was 715±332 days (median, 514; range, 365-1440 days). Surgical indications included epiretinal membrane (ERM) (n= 121), vitreous floaters (n= 69), diabetic tractional retinal detachment (n= 49), vitreous hemorrhage (n= 40), full-thickness macular hole (n= 33), recurrent proliferative vitreoretinopathy (PVR)-related retinal detachment (n= 18), primary rhegmatogenous retinal detachment (RRD) (n= 17), silicone oil removal (n= 16), dislocated intraocular lens (n= 10), submacular hemorrhage (n= 7), endophthalmitis (n= 6), and retained lens material (n= 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n= 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%). At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates ofpostoperative complications across varied surgical indications, including primary and complex retinal detachment.

Giant retinal tear after intra-arterial chemotherapy for advanced unilateral retinoblastoma

BackgroundRetinoblastoma is considered the most common intraocular malignancy in childhood, comprising 4% of all pediatric cancers. Management of retinoblastoma has evolved over the past two decades and intra-ophthalmic artery chemotherapy has emerged as a new modality of globe-conserving treatment with excellent results. This treatment achieves effective tumor reduction by delivering localized chemotherapy, decreases enucleation rate, and minimizes systemic and local side effects.Case presentationWe report the case of an 8-year-old girl with a late presentation of an advanced unilateral retinoblastoma associated to diffuse exudative retinal detachment in the right eye, classified as group E by the International Classification of Retinoblastoma. The initial therapeutic proposal for the patient was five sessions of intra-ophthalmic artery chemotherapy (IAC) associated to large spot diode laser therapy. After undergoing four sessions of IAC, the fundus exam revealed a giant retinal tear associated to a total retinal detachment in the affected eye. The IAC treatment was concluded and enucleation was considered the best treatment option at that moment, since IAC was unable to control the tumor’s activity and the patient’s eye presented with a complex rhegmatogenous retinal detachment (RRD). However, family left for a second opinion and never returned.ConclusionsThe usage of IAC for retinoblastoma management may lead to important local complications. Despite rare, RRD secondary to IAC may occur. We postulate that the giant tear observed in this case was caused by the rapid tumor necrosis using this route of treatment.

STICKY SILICONE OIL.

To report and analyze the phenomenon of sticky silicone oil on the retina at the time of its removal. Silicone oil has been used for more than 25 years as a long-term retinal tamponade in the surgical management of patients with complex retinal detachments. When a decision to remove silicone oil was made at the end of the tamponade period, the system involved a number of different materials: silicone oil, aqueous solution with or without remnants of perfluorocarbon liquid plus the material of the cannula used to aspirate Silicone oil. This, in effect, may lead to an abnormal adherence of large bubbles of residual silicone oil to the posterior pole of the retina. A retrospective, interventional case study was performed. We consecutively reviewed 796 patients of silicone oil removal (5,000 or 5,500 centistokes) after primary pars plana vitrectomy at one vitreoretinal center operated by a single surgeon (HG). Chart review was performed to identify potential patients or procedural factors that could predispose to sticky silicone oil formation at the macular area. Large silicone oil bubbles were sticky to the macula in eight out of 796 silicone oil removal procedures between January 2014 and August 2015. The use of perfluorooctane was related to the occurrence of the phenomenon (P < 0.001). The sticky silicone oil bubble at the macular region was not related to internal limiting membrane peeling, epiretinal membrane, viscosity, duration, or brand of silicone oil used, but to the use of perfluorooctane.

Outcomes of 23-gauge pars plana vitrectomy combined with phacoemulsification and capsulotomy without intraocular lens implantation in rhegmatogenous retinal detachment associated with choroidal detachment.

Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is a special type of complex retinal detachment, and usually has a poor prognosis. This study aimed to assess the anatomical outcomes of 23-gauge pars plana vitrectomy (23G PPV) combined with phacoemulsification (phaco) and capsulotomy without intraocular lens (IOL) implantation in patients with RRDCD.Seventy-six consecutive patients with RRDCD, who underwent retinal repair surgery from January 2010 to December 2014, were retrospectively analyzed. Forty patients underwent 23G PPV + phaco + IOL implantation, and 36 underwent 23G PPV + phaco + capsulotomy without IOL implantation (i.e., aphakia). All cases were filled with silicone oil. The follow-up time was 6 months after silicone oil was removed. Multivariate logistic regression analysis was the statistical method used.The overall retinal anatomical reattachment rate was 58% (44/76): 40% (16/40) of patients receiving 23G PPV + phaco + IOL implantation; and 78% (28/36) of patients receiving 23G PPV + phaco + capsulotomy + aphakia (P = .007).Surgical repair using 23G PPV + phaco + capsulotomy without IOL implantation can improve anatomical reattachment rates in patients with RRDCD.

Polydimethyl Siloxane as an Internal Tamponade for Vitreoretinal Surgery

Purpose: To report the efficacy and safety of polydimethyl siloxane (Siluron Xtra®) as an internal tamponade. Design: Audit and adverse event screening of procedures (March 2014-2015). Methods: Patients who had undergone vitreoretinal procedures with Siluron Xtra® tamponade were retrospectively analysed with respect to anatomical outcome, visual outcomes, and perioperative complications, in particular intraocular pressure. Inclusion Criteria: all patients who had undergone Siluron Xtra® tamponade. Exclusion Criteria: No cases were excluded; however, there were no paediatric or pregnant patients within this cohort. All vitreoretinal cases were included, including retinal detachments, but also trauma, endophthalmitis, and intraocular foreign bodies. Results: Twenty-eight patients had polydimethyl siloxane as an intraocular tamponade; 24 retinal detachments (83% complicated by proliferative vitreoretinopathy ≥grade C), 12 had previous failed surgery, and 4 had procedures for intraocular lymphoma, endophthalmitis, or trauma. Follow-up was 14-20 months, and mean duration of tamponade was 6.8 months (3-12 months). Anatomical success was 79% after polydimethyl siloxane injection, 58% 3 months following removal (14/24), 5 remain with long-term tamponade, and 5 with redetachment under tamponade required further intervention. Five required topical anti-glaucomatous agents, and 1 following trauma required glaucoma surgery. Cataract developed in 3/6 phakic patients, and visible emulsification occurred in a single patient. Conclusion: Polydimethyl siloxane seems to be an acceptable alternative tamponade agent for the management of complex retinal detachments with comparable anatomical success and comparable rates of raised intraocular pressure to other low-viscosity silicone oil agents, but more importantly, with a lower rate of emulsified oil-related complications, which is important particularly for cases requiring long-term tamponade.

Anatomical results and complications after silicone oil removal

Retrospective, interventional study evaluating consecutive cases with ambulatory SIO removal after vitrectomy for complex retinal detachments. The anatomical result was the main followed parameter. Intra and postoperative complications and also intraocular pressure changes were evaluated. Cases were followed-up for at least 12 months. A total of 98 consecutive cases were reviewed. The main duration of oil endotamponade was 5.46 months (3-16 months). In 15 cases (15.30%) signs of SIO emulsification were noted at the time of removal. A stable anatomical result after SIO removal was obtained in 94 out of 98 cases (95.91%). Retinal detachment recurrence appeared in first month postoperatively (1 case) and between the 3rd and 4th month postoperatively (3 cases). Main indications for 5000cs SIO endotamponade during ambulatory 23G vitrectomy were represented by proliferative vitreoretinopathy (PVR) (78 cases - 79.59%), proliferative diabetic retinopathy (17 cases - 17.34%) and giant retinal tears (3 cases - 3.06%). 29 eyes (29.59%) were pseudophakic at primary surgery. However, most phakic eyes showed cataract appearance and progression during SIO endotamponade and also after SIO removal. Intraocular pressure significantly decreased after SIO removal with the occurrence of various choroidal detachments in 8 cases (8.16%), resolving spontaneously within the first week postoperatively. In our experience, the retinal detachment recurrence rate after SIO removal was 4.08%. This promising anatomical result confirms the need for an accurate primary surgery and also for a safe moment of SIO removal according to the severity of primary pathology.

This issue of Acta

This issue of Acta

Clinical and Ultrastructural Studies of Epiretinal Pigmentary Deposits after Retinectomy with Silicone Oil

Large relaxing retinectomies have become increasingly used in the repair of retinal detachment related to proliferative vitreoretinopathy (PVR). Retinectomies expose the retinal pigment epithelium (RPE) to the vitreous cavity; the direct effects of silicone oil on the RPE are only beginning to be understood. Retrospective case series. Twelve patients noted to develop pigmented epiretinal deposits at regularly scheduled follow-up visits after repair of complex retinal detachments using silicone oil tamponade and retinectomy. Epiretinal pigment deposits were characterized clinically by wide-field color photography, fundus autofluorescence imaging, and spectral-domain optical coherence tomography (SD OCT). At the time of silicone oil removal, the pigmented membranes were preserved in fixative and analyzed by light microscopy/immunostaining or electron microscopy for histologic characterization. Not applicable. We describe the development of diffuse preretinal pigmentary deposits in 12 eyes after surgery for complicated PVR detachments using retinectomies with oil, with an average onset of 3.2 months postoperatively. These pigment clumps produced a striking leopard-spot pattern on fundus autofluorescence imaging. Histopathologic and ultrastructural analysis of these epiretinal proliferations peeled at the time of silicone oil removal revealed RPE cells with intracellular silicone oil droplets, singly dispersed membrane-bound melanin granules, glial tissue (1 case), and a fibrous stroma. Although invitro studies have suggested that RPE cells can phagocytose emulsified oil droplets, this report represents the first invivo documentation by electron microscopy of this phenomenon in patients. These findings underscore that direct contact with silicone oil may affect the behavior of the RPE, which may be clinically relevant in patients who have undergone large relaxing retinectomies with silicone oil tamponade for PVR-related retinal detachments.

Unexplained vision loss with intra‐ocular silicone oil tamponade in situ: a case series

PurposeSilicone oil provides a long‐lasting retinal tamponade which is of particular benefit when attempting to repair complex retinal detachments associated with proliferative retinopathy and giant retinal tears. There have been reports of sudden unexplained visual loss secondary to the use of silicone oil tamponade, often after removal of silicone oil, which is typically severe and permanent. We report a case series of patients who lost vision with silicone oil tamponade in situ.MethodsObservational report and analysis of three cases of unexplained vision loss with silicone oil tamponade in situ for retinal detachment surgery.ResultsThree cases of unexplained vision loss with silicon oil tamponade were analysed. Two were male and the average age was 55 (51–62 years). 2 cases were macular on retinal detachments. 3 months post operatively, visual acuity was 6/9 in two cases and 6/12 in the third case with silicone oil in situ. Silicone oil 2000cs was used in all cases and the primary success rate was 100%. All had normal intra ocular pressure, fundal examination and optical coherence tomography at 3 months. Loss of vision occurred at 5 months post‐surgery with silicone oil in situ in all three cases. Visual acuities dropped to 6/60, 6/36 and 6/36 respectively. Silicone oil was removed in all cases and visual acuities were 6/36, 6/60 and 2/60 at 1 year following silicon oil removal. Electro‐diagnostic tests confirmed reduced macular function in the affected eyes.ConclusionsUnexplained vision loss secondary to silicone oil tamponade is severe and permanent. The etiology is still unknown and further work is required to identify the incidence and potential risk factors for this devastating phenomena. A better understanding of this condition would enable us to manage these cases more appropriately and reduce the likelihood of it occurring.

The accuracy of ultrasonography in 5 500 mPas silicone-tamponade eyes

Background The ultrasonography for silicone tamponade eye is a problem in diagnosis and treatment of eye diseases, especially for the calculation of intraocular lens (IOL) power.IOL Master is usually used to the biometric measurement of the silicone tamponade eye in well-equipped hospital, but it is still disabled in serious cataractous eyes.Corrective B or A-type ultrasound methods have been used for a fewer years, but these measured results are incomparable probably due to the difference of viscosity of silicone oils. Objective This study attempted to investigate the accuracy of B-type ultrasonography for ocular axial length (AL) measurement in silicone tamponade eyes. Methods The transmitting speed of ultrasonic wave in the silicone oil was determined by comparing the outcomes between balance solution mesuring and 5 500 mPas silicone oil, and a calculating formula for corrective ocular AL in 5 500 mPas silicone filled eyes was further established.Thirty-two eyes of 30 patients who received 5 500 mPas silicone oil tamponade due to complex retinal detachment were enrolled in Qingdao Hiser Medical Group from May 2012 to March 2014.The eyes were assigned to the AL<26 mm group (18 eyes of 16 patients) and AL≥26 mm group (14 eyes of 14 patients). B-scan ultrasound and IOL Master were used to measure the AL before the removal of the silicone oil, and the Als were measured again using A-scan ultrasound and B-scan ultrasound 3 months after the removal of the silicone oil.The outcomes were compared and the correlations were evaluated among different measuring methods.The vitrous length values before and after removal of the oils, and the diopters before and after intraocular pressure (IOP) implantation were compared to varify the results of B-type sonography for 5 500 mPas silicone-tamponade eyes. Results The transmitting speed of sound wave in 5 500 mPas silicone oil was 1 023 m/second with the conversion factor 0.668 between silicon oil eyes and vitreous cavity, and the corrected formula for AL measurement was: the length form cornea apex to the posterior pole of lens or the center of the capsular membrane+ 0.668×the length form posterior pole of lens or the center of the capsular membrane to the macular area.No significnant differences were found in the AL values among the corrective-B scan, IOL Master method, postoperative B-scan method and A-scan method both in the AL<26 mm group and the AL≥26 mm group (AL<26 mm: F=0.108, P=0.955; AL≥26 mm: F=0.011, P=0.998), and the AL values by corrective B-scan was significantly correlated with that by IOL Master, postoperative B-scan and A-scan, respectively (AL<26 mm group: r=0.876, 0.921, 0.809, all at P<0.01; AL≥26 mm group: r=0.943, 0.956, 0.955, all at P<0.01). The vitreous cavity depth was (20.78±2.13)mm by corrective B-scan in 1 day before the removal of silicone, and that in 3 months after removal of silicone was (20.89±2.16)mm, without statistical diference between them (t=0.795, P=0.219). The actual postoperative refraction in 16 eyes with IOL was (-1.25±1.69)D, and preoperative refrection was (-1.50±0.00)D, the difference was not statistically significant (t=0.585, P=0.284). Conclusions The biometry of B-scan ultrasonography for silicone-tamponade eye is accurate and simple, with a good feasibility in clinical measurement. Key words: Biometry/methods; Eye/ultrasonography; Lenses, intraocular; Silicone oils/therapeutic use; Viscosity; Axial length, ocular; Diagnostic techniques, ophthalmological/instrumentation; Humans

Visual outcome after removal of silicone oil in patients undergoing retinectomy for complex retinal detachment.

To evaluate the functional outcome after removal of silicone oil (ROSO) in patients undergoing retinectomy for complex retinal detachment. We performed a retrospective case note review of patients who underwent ROSO after retinectomy for complex retinal detachment. Patients with less than 6mo follow up and recurrent retinal detachment following ROSO were excluded. Thirty-six patients were included. The mean best corrected visual acuity (BCVA) pre-ROSO was 1.13 logMAR (SD 0.5). The mean BCVA 3mo following ROSO was 1.16 logMAR (SD 0.53), 6mo following ROSO 1.13 (SD 0.63), and 12mo following ROSO 1.18 (SD 0.69). At 12mo after ROSO, the BCVA improved in 38.9% of patients, remained unchanged in 25%, and deteriorated in 36.1%, although there was no statistical significant difference in BCVA after ROSO at 3, 6 and 12mo (P=0.93). The size of retinectomy ranged from 15° to 270° (SD 53) and did not influence the visual outcome (P=0.11). There was no statistically significanT difference in BCVA between pre- and post- ROSO following retinectomy for complex retinal detachment. There was no statistical difference in visual outcome related to the size of the retinectomy.

Peripheral 360 Degree Retinotomy, Anterior Flap Retinectomy, and Radial Retinotomy in the Management of Complex Retinal Detachment

To compare the outcomes for patients with rhegmatogenous retinal detachment (RRD) and patients with retinal detachment (RD) following penetrating injury after combined 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced proliferative vitreoretinopathy (PVR). Retrospective, comparative, interventional case series. Twenty-four eyes (60%) of 24 patients diagnosed with RRD and 16 eyes (40%) of 16 patients diagnosed with RD after penetrating injury whose surgery involved 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy for the management of advanced PVR (grade D) were included in the analysis. The primary outcome was anatomic surgical success. Secondary outcomes were change in visual acuity (VA) and postoperative complications. The mean number of previous interventions in the RRD and trauma groups were 1.04 and 1.31, respectively (P = .13). After 51.5 (± 52.7) months of mean follow-up, the complete retinal reattachment rates for the RRD and trauma groups were 79% (19/24) and 75% (12/16), respectively (P > .99). The final mean VA was 2.2 logMAR (20/2000) in both groups, with improvement in the RRD group (P = .04). The most common postoperative complications in the RRD and trauma groups, respectively, were persistent hypotony in 6 eyes (25%) and 5 eyes (31%) (P = .73), corneal damage in 8 eyes (29%) and 6 eyes (38%) (P = .34), and epiretinal membrane in 5 eyes (20.8%) and 4 eyes (25%) (P > .99). Only 25% of the eyes (10/40) had VA of 20/200 or better. The aim of peripheral 360 degree retinotomy, anterior flap retinectomy, and radial retinotomy is to obtain retinal reattachment, which is otherwise unachievable.

Neuronal complications of intravitreal SiO

SummaryIntraocular silicone oil (SiO) complications include keratopathy, glaucoma, cataract and subretinal migration of the oil droplets, and can also lead to a severe optic neuropathy caused by retrolaminar migration. Intracranial migration of the SiO through the optic nerve posterior to the lamina cribrosa to the optic chiasm and brain is, however, uncommon. The mechanism is still under debate. Moreover, central scotoma may develop in eyes with SiO not only at the time of oil removal, but also during the period of tamponade. This review summarizes our current understanding of the specific pathogenic mechanisms of intraocular SiO neuronal side effects, concluding that pre‐existing glaucoma and optic nerve abnormalities are the main risk factors associated with this damage. In their absence, the risk of extraocular SiO penetration is so low that the use of SiO endotamponade in complex retinal detachment patients does not need to be modified. MRI images to assess extraocular SiO migration are only necessary in very few and special cases, such as patients with optic nerve abnormalities and glaucoma.

TGF-β1 induced transdifferentiation of rpe cells is mediated by TAK1.

Background and AimProliferative vitreoretinopathy (PVR) is an active process that develops as a complication upon retinal detachment (RD), accompanied by formation of fibrotic tissue. The main cells involved in the development of fibrotic tissue during PVR are the retinal pigment epithelial (RPE) cells. The RPE cells undergo epithelial-mesenchymal transition (EMT) which leads to complex retinal detachment and loss of vision. Transforming growth factor-β1 (TGF-β1) is considered as the main player in the EMT of RPE cells, even though the mechanism is not fully understood. This study was performed to determine the possible involvement of transforming growth factor β activated kinase 1 (TAK1) in the EMT process of the RPE cells.MethodologyARPE-19 Cells were treated with 5Z-7 oxozeaenol (TAK1 inhibitor) or SB431542 (TGF-β1 receptor kinase inhibitor) followed by TGF-β1 stimulation. Immunofluorescence, scratch assay Real time PCR and collagen contraction assay assessed the EMT features. The phosphorylation of Smad2/3 and p38 was examined using western blots analysis.ResultsThis study demonstrates that stimulation of RPE cells with TGF-β1 increases α-SMA expression, cell migration and cell contractility, all of which are EMT features. Remarkably, addition of TAK1 inhibitor abolishes all these processes. Furthermore, we show hereby that TAK1 regulates not only the activation of the non-canonical cascade of TGF-β1 (p38), but also the canonical cascade, the Smad2/3 activation. Thus, the outcome of the TGF-β response in RPE cells is TAK1 dependent.Conclusions/SignificanceThis work demonstrated TAK1, a component of the non-canonical pathway of TGF-β1, is a key player in the EMT process, thus provides deep insight into the pathogenesis of PVR. The ability to halt the process of EMT in RPE cells may reduce the severity of the fibrotic response that occurs upon PVR, leading to a better prognosis and increase the probability of success in RD treatment.

Spontaneous resolution of subfoveal perfluorocarbon

Perfluorocarbon liquids (PFCL) have transformed the surgical approach to complex retinal detachments, but their use can be complicated by subretinal retention. Migration of peripherally located subretinal PFCL towards the fovea is well established, but spontaneous resolution of subfoveal PFCL without surgical evacuation or displacement has rarely been described. We present a case of a large single retained subfoveal PFCL droplet following vitrectomy with membrane peeling, inferior relaxing retinectomy, and silicone oil tamponade that demonstrated spontaneous resolution 3 weeks postoperatively, with subsequent anatomic and visual improvement. No residual subretinal PFCL was noted, and we hypothesize that the PFCL droplet spontaneously extruded through a transient hole created in the thinned retina overlying the droplet, which subsequently closed spontaneously. Further understanding of the mechanisms of PFCL migration and resolution may facilitate improved treatments for this complication.

Perfluoro-n-octane as a temporary intraocular tamponade in a staged approach to manage complex retinal detachments.

PurposeTo evaluate outcomes in patients with complex retinal detachments (RD) with proliferative vitreoretinopathy (PVR) requiring retinectomy using a staged approach utilizing perfluoro-n-octane (PFO) as a short-term postoperative intraocular tamponade.MethodsRetrospective analysis. Patients who underwent 23G pars plana vitrectomy for the management of complicated RD where PFO was used as a primary temporary intraocular tamponade. Only eyes with PVR in rhegmatogenous RD or eyes with penetrating injuries or globe ruptures (ocular trauma) and subsequent RD with PVR were included. Analysis of 17 eyes of 17 consecutive patients with a minimum follow-up of 12 months during a period of 5 years. The primary outcome measure was the reattachment rate after at least 12 months of follow-up after the PFO removal. Secondary outcome measures were changes in visual acuity, complications due to PFO use, and necessity for further surgeries.ResultsEight eyes with prior penetrating injuries or globe rupture and nine eyes with rhegmatogenous pathology were included. All eyes had PFO as temporary tamponade for 14 days (median), which was replaced by silicon oil. Sixteen eyes (94%) had complete and one eye partial reattachment. No redetachments occurred. All eyes retained or improved visual acuity. On average, only 2.5 procedures, including silicon oil removal, were performed. Two eyes had long-term intraocular pressure of 5 mmHg and no eye had intraocular pressure of ≥21 mmHg. No long-term inflammation was observed.ConclusionPFO seems to be beneficial in a staged approach to repair complex detachments when used as short-term tamponade. A median period of 14 days allowed for both sufficient retinal support plus a reduction in side effects seen in long-term endotamponades.

Spontaneous resolution of macular edema after silicone oil removal.

To investigate the macular changes in eyes filled with silicone oil (SO) and course of these changes after SO removal. A retrospective optical coherence tomography scan review was conducted for twenty-four patients who underwent uncomplicated pars plana vitrectomy with SO tamponade for complex retinal detachments were detected with optical coherence tomography before, and one week, one month and three months after SO removal. Mean duration of SO tamponade was 3.6±1.0mo (range: 3-7mo). Cystoid macular edema (CME) was detected in 3 eyes before SO removal. Submacular fluid was represented in 1 eye before silicone SO removal. Resolution of CME and submacular fluid was achieved 1mo after SO removal in all eyes. Mean best corrected visual acuity (BCVA) was 1.15±0.65 (range, hand movement to 0.2) before SO removal in the eyes without macular changes. After SO removal, the mean BCVA values at 1wk and 1 and 3mo, and 0.82±0.23, 0.76±0.21, and 0.70±0.19, all of which were significantly better than baseline (P=0.030, 0.017, 0.006 respectively). In the eyes with macular CME and subretinal fluid the mean BCVA was significantly improved at 3mo after SO removal compared with baseline (P=0.037). Decreased visual acuity in eyes filled with SO could be caused by macular complications due to SO. CME and subretinal fluid may resolve without any additional macular surgery after SO removal.