Epiretinal Membrane Research Articles

Proportion and risk factors of epiretinal membrane in residents of Brussels with versus without diabetes mellitus.

To compare the proportion of epiretinal membrane (ERM) between individuals with diabetes mellitus (DM) and without DM, who live in Brussels, to investigate possible risk factors for ERM formation and to compare the results with the ones of large population studies. Participants were divided into two groups; 99 patients with DM (group A) and 103 individuals without DM (group B). All participants underwent an undilated 7-field color fundus photography and a spectral domain optical coherence tomography (SD-OCT). Age, gender, race, type of diabetes, duration of medical treatment of diabetes, HbA1C rate, smoking, previous cataract surgery and educational level were investigated as possible risk factors. Epiretinal membrane was detected in 17.2% of group A and in 11.7% of group B participants. The difference is not statistically significant (χ2 (1) = 1.252, p = 0.263). The proportion of ERM was significantly associated with age in both groups (p = .009 and p < .001 respectively), as well as with smoking (p = .023) and previous cataract surgery (p = .028) in patients with DM. There is no statistically significant difference of ERM proportion between the two groups of the study. Age was recognized as a risk factor for both groups, while smoking and previous cataract surgery were identified as predictors only for diabetics.

COMPLEX MACULAR HOLE CLOSURE BY TEMPORAL INTERNAL LIMITING MEMBRANE FLAP WITHOUT ENDOTAMPONADE.

To evaluate the safety, efficacy, and imaging features of a novel surgical technique without endotamponade in repairing complex macular hole (MH). Retrospective review of consecutive cases with complex MH underwent pars plana vitrectomy with temporal internal limiting membrane flap, which was stabilized using perfluorocarbon liquid and viscoelastics. At the conclusion of surgery, perfluorocarbon liquid was removed, and no endotamponade agent would be used. Complex MH was defined as a basal linear diameter of ≥400 µm and/or associated with high myopia. Visual acuity, pattern of MH closure on optical coherence tomography, formation of epiretinal membrane, and operative complications were reported. Twenty-four eyes were included, and the mean basal linear diameter was 988.3 µm. MH closure was achieved in 24 (100%), of which, 8 (33%) achieved type 1A closure. The mean postoperative logarithm of the minimum angle of resolution visual acuity improved from 0.93 at baseline to 0.74, 0.51, 0.55, and 0.52 at 1-month, 3-month, 6-month, and last follow-up, respectively. Foveal gliosis was observed in 3 eyes (12.5%), and 10 (41.7%) developed nasal epiretinal membrane. One eye developed vitreous hemorrhage, which resolved spontaneously. This novel surgical technique that requires no endotamponade is effective in achieving complex MH closure. A substantial proportion of patients developed epiretinal membrane, and its clinical significance requires further investigation.

Preoperative, Intraoperative and Post-Operative Optical Coherence Tomography for Pediatric Epiretinal Membranes Presenting with Strabismus

Abstract Purpose To highlight the value of optical coherence tomography (OCT) in the surgical decision making process of pediatric epiretinal membranes (ERMs). Methods A retrospective interventional case series that included the review of records of pediatric cases with ERMs presenting with strabismus who underwent pars plana vitrectomy by a single surgeon from March 2018 till June 2022. Demographic, clinical, and surgical details were extracted, as well as follow-up visits and outcomes. Results Five eyes of 5 cases with unilateral squint secondary to ERM were included. Age at presentation ranged from 2-7 years (mean 3.6 +/- 1.9), The male to female ration was 4:1. Two cases (40%) were idiopathic, 2 (40%) were secondary to familial exudative vitreoretinopathy (FEVR) and 1 (20%) was secondary to traumatic rupture globe. Preoperative and postoperative OCT was obtained in all cases, while preoperative fundus fluorescein angiography was obtained in 4 cases (80%). Intraoperative OCT was used in 4 cases (80%) to confirm complete release of the membrane from the fovea, and ILM was peeled in 3 cases (60%). The decision for surgical intervention and plan of surgery was totally dependent on preoperative OCT to confirm the extent of the ERM and the plane of cleavage. Intraoperative OCT helped assess areas of strong adherence of the membrane to avoid iatrogenic retinal injury. Initial restoration of the foveal anatomy with appearance of the fovea was seen after 3.6 +/- 2.8 months from the surgery with a range of 1-8 months. Squint improvement was seen in all cases. Time range to squint improvement was 1-4 months (mean 2.8 +/- 1.6). One case (20%) continued 4 years of follow up and two cases (40%) terminated follow up at 6 months due to squint improvement. Only one case (20%) showed progressive myopia post-surgery and one case did not achieve complete restoration of the fovea. Conclusion Surgical removal of pediatric epiretinal membranes presenting with strabismus leads to squint and visual improvement even if complete restoration of the foveal anatomy has not been reached yet. Combined use of preoperative, intraoperative and postoperative OCT in those cases helps better surgical and anatomical outcomes.

Primary Internal Limiting Membrane Peel and Its Effects on Epiretinal Membrane After Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: To determine the effect of internal limiting membrane (ILM) peel in post-operative development of epiretinal membrane and to see visual outcomes of patients undergoing pars plana vitrectomy with and without ILM peel. Study Design: Quasi experimental study. Place and Duration of Study: Retina clinic of Al-Ibrahim Eye Hospital from July, 2022 to Dec, 2022. Methods: A total of 60 eyes which underwent pars plana vitrectomy (PPV) with silicone oil for Rhegmatogenous retinal detachment (RRD) were included. Patients with previous vitreoretinal surgery or ocular trauma, macular diseases or coexisting conditions that could affect the outcomes or complicate the surgery were excluded. Group A included patients with ILM peel and Group B included patients with no ILM peel (30 eyes each). Frequency was calculated for gender, epiretinal membrane formation. and was compared between both groups using chi square. Results: Mean age in group A was 47.63 ± 8.61 years and in group B was 45.36 ± 6.63 years. Gender distribution showed 66.6% males in group A and 43.3% in group B. After 3 months the group A had significantly lower frequency of ERM formation (3.33%) as compared to group B (16.67%) with p &lt;0.05. However, post operativevisual acuity was not significantly different between the two groups (p &gt; 0.05). Conclusion: This study shows that primary ILM peel diminishes the development of ERM and decreases the need for second surgical procedure. However, postsurgical visual acuity between the two groups showed no significant difference.

Macular Hole Surgery as a Historical Perspective.

To evaluate the outcomes of macular hole (MH) surgery as a historical perspective after its inception in 1991. Retrospective review of 1032 eyes of 949 patients with an idiopathic MH who were followed for at least one year after the initial surgery. All surgeries were performed from 1990 to 2016 by one surgeon (NO) and included phacovitrectomy for patients of ≥40-years-of-age, a removal of the posterior hyaloid and epiretinal membrane, and SF6 gas tamponade with a 1-week face-down. After 1998, internal limiting membrane (ILM) peeling became the conventional procedure. All surgeries were classified into four periods based on the year of the initial surgery. The first period was 1990~1995 (n = 222), the second period was 1996~1999 (n=327), the third period was 2000~2004 (n = 234), and the last period was 2005~2016 (n=249). The mean follow-up period was 81.3, 79.8, 88.4, and 77.3 months; hole size was 0.33, 0.28, 0.25, and 0.24 disk diameter; hole duration was 15.1, 10.6, 8.2, and 6.1 months; the decimal visual acuity (VA) was 0.13, 0.15, 0.17, and 0.19. The initial closure rate was 61.3, 78.0, 96.6, and 96.4%. The final decimal visual acuity was 0.33, 0.50, 0.66, and 0.79. The rate of a final decimal VA of 0.5 or better was 48.2, 66.4, 82.1, and 88.8%. The rate of a final decimal visual acuity of 1.0 or more was 17.6, 29.3, 43.6, and 58.2%. Multiple regression analyses showed that hole duration and ILM peeling were significantly associated with both the anatomic and functional outcomes. The favorable outcomes of MH surgery was primarily achieved by earlier surgery and conventional ILM peeling. Favorable results might be obtained using only conventional ILM peeling.

Clinical evidence of autologous platelet-rich plasma as treatment in macular holes

Abstract Background: A prospective observational study was conducted with the purpose of evaluating the role of autologous platelet-rich plasma (PRP) in the form of a clot as an adjunct in surgery for the closure of large full-thickness macular holes (&gt;400 μm). Methodology: Thirteen patients with a diagnosis of full-thickness macular hole larger than 400 μm, without associated pathologies or previous vitreoretinal surgeries, were selected. Each patient underwent a complete ophthalmological evaluation, including visual acuity (uncorrected or best corrected), optical coherence tomography (OCT Optovue), and in some cases, retinal photographs. On the day of the procedure, blood samples were taken to prepare PRP and form a clot according to institutional protocol. Patients were followed for 1 year with periodic evaluations that included OCT, retinal photographs, and assessments by a retina specialist and optometry. Results: Of the 13 patients, 46% (6 cases) had an epiretinal membrane as the triggering factor for the macular hole and 54% (7 cases) had vitreomacular traction. Complete closure of the macular hole was achieved in 92.31% (12 cases) and partial closure in 7.69% (1 case). Postoperative best-corrected visual acuity ranged from 20/30 to 20/200 according to the Snellen chart. No patient experienced a deterioration in visual acuity after the procedure. Conclusions: The use of PRP as an adjunct treatment for macular hole surgery in patients without previous vitreoretinal surgeries has proven to be effective in achieving complete or partial closure in a high percentage of cases. Pre-and postoperative changes in visual acuity, hole size, and type of closure provide valuable information on the efficacy of PRP treatment in these patients.

Cryotherapy of infective foci in metastatic endophthalmitis

A man in his 20s presented with complaints of diminution of vision in both eyes for the past 15 days. He had a history of carcinoma colon for which he underwent hemicolectomy 2 months ago. There was vitritis with white fluffy exudate lesion suggestive of infective foci along the superior arcade, which was noted on fundus examination. A provisional diagnosis of endogenous endophthalmitis was made in both eyes, and pars plana vitrectomy with cryotherapy of infective foci was done. The vision of patient improved at 1-week follow-up. However, it dropped at 1 month due to macular pucker formation at the site of cryotherapy. Cryotherapy should be used with caution in lesions away from the posterior pole and in recalcitrant, nonresolving lesions.

Морфофункциональные параметры диабетического макулярного отека после витреоретинальной хирургии

Background. Diabetic macular edema (DME) is a socially significant disease of our time. At the moment, intravitreal administration of antivasoproliferative drugs is the “gold standard” for the treatment of DME. Currently, indication for vitrectomy and membrane peeling for macular edema is the presence of an epiretinal membrane or vitreoretinal traction syndrome. Some authors consider use of vitrectomy with internal limiting membrane peeling to be justified in patients with DME. Purpose. To evaluate changes in the morphofunctional parameters of the retina in patients after vitreoretinal intervention for resistant diabetic macular edema. Methods. 44 patients diagnosed with DME with no response to previous conservative treatment (laser coagulation, angiogenesis inhibitors) underwent surgery at the ophthalmology center of the National Medical Research Center named after N. I. Pirogov. Results When analyzing BCVA after vitreoretinal surgery, a significant increase in functional parameters was revealed in patients of group 2 (vitrectomy) compared with similar parameters in patients of group 1 (continuing treatment) within 6 months from the date of surgery (p = 0.027). There is also a statistically significant decrease in retinal thickness in patients of group 2 compared with patients of group 1 within 1 month (p = 0.035). When assessing photosensitivity, there was a significant increase in parameters in patients of group 2 compared with preoperative parameters and with similar parameters in patients of group 1 within 1 week from the moment of surgery (p = 0.023). Conclusion. It was found that vitreoretinal surgery with membrane peeling provides a higher functional result compared to the group where only angiogenesis inhibitors and retinal laser coagulation were used from 6 to 12 months of observation. By the 1st week of observation, in patients of group 2, in comparison with the results of patients in group 1, there was a more pronounced positive dynamics of photosensitivity which persisted for 12 months. More pronounced edema resorption was also observed in the group in which vitrectomy with internal limiting membrane peeling was used. Thus, these data confirm that use of vitreoretinal surgery is possible in the treatment of diabetic macular edema. Further study of this issue is required. This study was conducted on a small sample of patients. To confirm the statistical reliability of the results, it is necessary to study the data when examining a larger sample in groups. Key words: DME; diabetic macular edema; vitrectomy; membrane peeling.

Clinical trial to test the safety of the EVA Nexus surgical platform

BackgroundThe EVA Nexus system offers several technical improvements over its predecessor. The newly designed Aveta cannula system for vitrectomy surgery avoids the need for removal of the valve from the infusion cannula. The chamfered leading edge of the cannula also reduces the insertion force needed. The new EquiPhaco needles in combination with SmartIOP provide excellent anterior chamber stability during phaco-emulsification surgery, enabling to work at lower infusion pressures, and the multiburst phaco mode allows easier removal of hard cataracts. The system offers a secondary active infusion line for independent control of pressure to the anterior and posterior chambers, monitoring of flow rate/reflux and warning of infusion bottle emptying. This study evaluated whether these technical improvements result in improved surgical safety.MethodsIn total, 250 eyes that underwent vitrectomy (53%) or phaco-vitrectomy (47%) using the EVA Nexus system were prospectively included. The occurrence of intraoperative adverse events was compared to that of historically operated eyes using the EVA system.ResultsThe average age of the patients was 63 years. A total of 33% of the patients were operated on for retinal detachment, 17% for macular pucker, 11% for treating floaters, 9% for removing silicone oil, 8% for macular hole repair and 22% for other diseases. In 75% of surgeries, 23 G instruments were used, and 27 G instruments were used in 25% of cases. Device issues that occurred included priming cycle issues (n = 4), eye pressure stability problems (n = 6) and vitrectome performance issues (n = 1), all of which in the first 100 patients who were included and were fixed with software updates. The frequency of surgical complications in the anterior segment was lower than that in the historically recorded surgical reports. Intraoperative events in the posterior segment included hemorrhage from retinal vessels, choroidal hematoma, iatrogenic retinal damage/tear, and subchoroidal infusion. Again, these events occurred rarely and less frequently than in the historical surgical reports.ConclusionsThe EVA Nexus provides a surgical platform that reduces the incidence of intraoperative adverse events and iatrogenic complications in both anterior and posterior segment surgery. This could increase surgical safety during cataract and vitrectomy surgery.Trial Registration number Clinicaltrials.gov: NCT05229094 Data 22/5/2021.

Pars Plana Vitrectomy Without Intravenous Anesthesia: Technique, Safety, and Outcomes.

Introduction: To describe the technique, safety profile, and outcomes of performing pars plana vitrectomy (PPV) without intravenous (IV) anesthesia. Methods: This retrospective single-surgeon study comprised patients who had PPV without IV sedation between September 2018 and April 2022. Patients elected to undergo PPV without sedation or with oral sedation via sublingual triazolam administered 30 minutes preoperatively. Sub-Tenon bupivacaine and lidocaine were administered at the initiation of each case. A circulating nurse monitored patient vitals and electrocardiogram tracings without anesthesiologist support. Adverse events (AEs), visual acuity (VA), supplemental block administration, and reoperation rates were documented. Results: A total of 357 PPVs in 319 patients (mean age 68.75 ± 11.17 years [SD]; range, 36.82-98.57) were performed for surgical indications including vitreous floaters, intraocular lens or cataract surgery complications, retinal detachment, vitreous hemorrhage, and epiretinal membrane. Twenty-three cases were performed without sedation, and 334 were performed with oral sedation. For eyes with a follow-up longer than 1 month (n = 324), the preoperative VA of 0.68 ± 0.77 logMAR improved to 0.31 ± 0.46 logMAR postoperatively (P < .01). No intraoperative complications, systemic AEs, need to cease surgery prematurely, or conversion to IV sedation occurred. Five eyes (1.77%) required intraoperative supplemental sub-Tenon block administration, and 95% of patients who had a reoperation (n = 10) or fellow-eye surgery (n = 28) requested the same method of anesthesia without IV sedation. Conclusions: Vitreoretinal surgery with a sub-Tenon block and oral sedation can be safely performed without the support of an anesthesiologist. Additional trials are needed to further quantify patient comfort, surgeon experience, and complication rates.

Treatment Impact on the Long-Term Ocular Outcomes in Behçet’s-Related Uveitis

ABSTRACT Purpose To examine the demographic characteristics, findings and complication rates in patients with Behçet’s uveitis (BU) and to investigate the effect of early biological therapy on the development of complications. Methods Medical records of 94 patients with BU were retrospectively reviewed. Demographic data, ocular findings and complications at presentation, complications during follow-up, and treatments received during follow-up were analyzed. Patients who were followed for at least 24 months were divided into two groups according to the time of presentation as Group 1 (between 2009 and 2015) and Group 2 (between 2016 and 2021). Complications at the time of presentation and during follow-up, and treatments were compared. Results We enrolled 94 patients with a male-to-female ratio of 1.94 with a mean age of 30 ± 12 years. Median follow-up was 58.1(12–163) months. There were 35 patients (66 eyes) in Group 1 and 33 patients (61 eyes) in Group 2. At the time of presentation, end-stage disease, cataract, epiretinal membrane, and optic atrophy were significantly more common in Group 1 than in Group 2 (p < 0.05). A significantly higher proportion of eyes in Group 1 developed macular edema, cataract, epiretinal membrane, and macular atrophy during-follow-up (p < 0.05). Median time to initiation of biological treatment was 17.29 months in Group 1 and 3.33 months in Group 2 (p < 0.001). The overall complication rate was significantly lower in Group 2. Conclusions Prognosis of BU is improved after the introduction of biological treatment. Early use of biological agents in BU is effective in decreasing sight-threatening ocular complications.

Combined Brilliant and Trypan Blue As Vital Dyes for Chromovitrectomy.

Brilliant blue 0.05% and trypan blue 0.1% were mixed in a proportion of 1:1 in a 1-mL syringe. This combination produced a waterfall effect with the fast sinking of the dye to the posterior pole and little diffusion through the vitreous cavity. Therefore, it can effectively stain the internal limiting membrane and the epiretinal membrane with a good contrast during surgeries for a macular hole, myopic foveoschisis, and macular pucker.

Evaluation of combined epiretinal membrane removal with intravitreal triamcinolone injection utilizing ectopic inner foveal layer staging scheme.

To investigate the macular morphological and visual outcomes of combined idiopathic epiretinal membrane (iERM) removal with triamcinolone acetonide (TA) injection based on consideration of the ectopic inner foveal layer (EIFL) staging scheme. Retrospective case-control study. The clinical data of 84 eyes of 84 patients who underwent vitrectomy for iERM between 2018 and 2022 were reviewed. The enrolled subjects were divided into the TA and non-TA groups. Fifty-one eyes received intravitreal TA injection following vitrectomy and ERM peeling (TA group), and 33 were only treated by standard vitrectomy and ERM peeling (non-TA group). Preoperative and postoperative EIFL stages, central foveal thickness (CFT), and best-corrected visual acuity (BCVA) were compared between both groups. After a mean follow-up of 7.69 ± 3.68months, both groups exhibited significant improvement in EIFL stages (P < 0.01), with no discernible advantage observed in the TA group. The TA and non-TA groups demonstrated improvement in the EIFL stages in 56.86 and 63.64% of eyes, respectively (P = 0.43). The CFT and BCVA significantly improved in both groups at the final visit (P < 0.01). However, CFT in the non-TA group displayed a more significant reduction during the follow-up (P < 0.03). Subgroup analysis revealed no significant differences in postoperative CFT and BCVA between the two groups in cases with or without continuous EIFL (P > 0.10). Our findings indicate that combined intravitreal TA injection following ERM removal conferred no significant benefits in alleviating macular thickening or improving visual acuity in iERM.

GUNN DOTS IN CHILDREN AGED 11-12 YEARS FROM THE GENERAL COMMUNITY SAMPLE COPENHAGEN CHILD COHORT 2000 STUDY.

To study characteristics and associations of Gunn dots in a cohort of healthy children aged 11 to 12 years. As part of the Copenhagen Child Cohort 2000 Study, red-free fundus photographs were taken on 761 healthy children aged 11 to 12 years. The photographs were centered on the optic disk. Gunn dots were annotated and counted within a disk-centered circular grid of 6 mm diameter. Data were analyzed in relation to age, sex, axial length, and retinal nerve fiber layer thickness. Gunn dots were found in 716 of the 761 participants (94%). The majority of dots were located both inferior and superior to the optic disk, situated within a distance of 3 mm from its center. The median number of Gunn dots was 64 (range 0-574) in right eyes and 68 (range 0-532) in left eyes. Having more than the median number of Gunn dots in the right eye was associated with older age (odds ratio 2.12, 95% CI 1.56 to 2.89, P < 0.0001, adjusted for sex, axial length, and retinal nerve fiber layer thickness) and was less common among the children with a thinner retinal nerve fiber layer (odds ratio 0.40, 95% CI 0.26-0.60, P < 0.0001 comparing bottom and top quartiles). Gunn dots were visible in the majority of healthy children aged 11 to 12 years, and large numbers of dots were associated with a thicker nerve fiber layer and with older age, within the limited age range of 1 year. The clinical significance of Gunn dots is unknown. Their location at the vitreoretinal interface makes them a parameter of interest in the study of aging, epiretinal fibrosis, macular pucker and retinal detachment.

Role of Vitreous Detachment in Epiretinal Membrane Peeling: A Multimodal Imaging and Microperimetry Study.

Background: To investigate anatomical and functional changes of the macula caused by epiretinal membrane (ERM) peeling procedures in patients with or without posterior vitreous detachment (PVD). Methods: This is a multicentric prospective observational study on thirty-seven (37) patients affected by symptomatic ERM who underwent 25-gauge pars plana vitrectomy (PPV), induction of a PVD (as needed) and peeling of both the internal limiting membrane (ILM) and ERM. Optical coherence tomography-angiography (OCT-A) (RS 3000, Nidek, Japan) and microperimetry (MP-3, Nidek, Japan) were performed; central retinal thickness (CRT), foveal avascular zone (FAZ) area and perimeter, vessel density and perfusion density, retinal sensitivity and fixation stability (as a total mean retinal sensitivity (MRS), and MRS in the ellipse area and bivariate contour ellipse area (BCEA)) were recorded at baseline and up to postoperative month 3. Results: Eyes were classified as having complete PVD (51.4%) or incomplete PVD (48.6%). At baseline, patients with incomplete PVD had worse best-corrected distance visual acuity (BCDVA), total MRS, MRS in the ellipse area and BCEA, and higher CRT than patients with complete PVD. At month 3, the differences in BCDVA between the two groups remained statistically significant, with patients with incomplete PVD having worse results (difference: 0.199 logMAR, p < 0.001). The difference in the MRS in the ellipse area was statistically significant at month 3 (-3.378 Db, p = 0.035), with greater improvement in patients with complete PVD. Conclusions: Our study shows that patients with incomplete PVD have worse conditions at baseline than patients with complete PVD, and the differences in visual acuity and retinal sensitivity were maintained postoperatively.

Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage.

To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME). Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient's diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed. Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported. The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Прогностические критерии функциональных исходов хирургического лечения идиопатического эпиретинального фиброза, основанные на оптической когерентной томографии

Abstrakt Prognostic criteria of epiretinal membrane surgery functional outcomes, based on optical coherencetomography A.A. Shpak, A.S. Zhuravlev, S.V. Kolesnik, A.I. Kolesnik, F.A. Avakyan, E.A. Shikhalieva S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation Relevance. Surgery for epiretinal fibrosis is currently a routineprocedure in vitreoretinal surgery. However, in some cases, the functionalresults of the surgery are unsatisfactory. With the widespread introductionof optical coherence tomography (OCT) into clinical practice, manyprognostic criteria for the functional outcomes of surgery for thispathology have been proposed, the description of which is the purposeof this review. Purpose. To describe prognostic criteria of idiopathicepiretinal fibrosis surgery functional outcomes based on opticalcoherence tomography data. Material and methods. To perform thisreview, clinical studies were searched through the eLibrary, PubMed, andScopus database, using the keywords «epiretinal fibrosis», «prognosticcriteria», «optical coherence tomography» (in the eLibrary database),«prognostic criteria», «epiretinal membrane» and «optical coherencetomography» (in the PubMed and Scopus databases). A total of 39 articlesrelevant to the topic of the review were selected. Results. A large numberof OCT criteria have been proposed to predict functional outcomes ofepiretinal membrane surgery, some of which remain understudied. Conclusion. Сone outer segment tips and ellipsoid zone appear to be the most informative and easy-to-use prognostic criteria. Further studiesare needed to determine the best set of prognostic parameters. Key words: optical coherence tomography, epiretinal fibrosis, epiretinalmembrane, classification, prognostic criteria

Optical coherence tomography features in vitreoretinal lymphoma compared with non-infectious uveitis

BackgroundVitreoretinal lymphoma (VRL) is a rare intraocular malignancy that poses a diagnostic challenge due to the non-specific clinical presentation that resembles uveitis. The use of spectral domain optical coherence tomography (SD-OCT) has emerged as a valuable imaging tool to characterize VRL. Therefore, we sought to determine the specific OCT features in VRL compared to the uveitides.MethodsRetrospective chart review of patients who were seen at Mayo Clinic from January 1, 2010 through December 31, 2022.The medical records and SD-OCT images at time of initial presentation were reviewed in patients with biopsy-proven VRL, intermediate uveitis, or biopsy-confirmed sarcoid posterior uveitis. Patients with VRL or similar uveitides including intermediate uveitis or sarcoid posterior uveitis were included.ResultsThere were 95 eyes of 56 patients in the VRL group and 86 eyes of 45 patients in the uveitis group, of whom 15 (33.3%) were diagnosed with intermediate uveitis and 30 (66.7%) with sarcoid chorioretinitis. The SD-OCT features more commonly seen at initial presentation in VRL patients (vs. uveitis) included preretinal deposits (31.6% vs. 9.3%, p = 0.002), intraretinal infiltrates (34% vs. 3.5%, p < 0.001), inner retinal hyperreflective spots (15.8% vs. 0%, p < 0.001), outer retinal atrophy (22.1% vs. 2.3%, p < 0.001), subretinal focal deposits (21.1% vs. 4.7%, p = 0.001), retinal pigmented epithelium (RPE) changes (49.5% vs. 3.5%, p < 0.001), and sub-RPE deposits (34.7% vs. 0%, p < 0.001). Features more frequently seen in uveitis included epiretinal membrane (ERM) (82.6% vs. 44.2%, p < 0.001), central macular thickening (95.3% vs. 51.6%, p < 0.001), cystoid macular edema (36% vs. 11.7%, p < 0.001), subretinal fluid (16.3% vs 6.4%, p = 0.04), and subfoveal fluid (16.3% vs. 3.2%, p = 0.003). Multivariate regression analysis controlling for age and sex showed absence of ERM (OR 0.14 [0.04,0.41], p < 0.001) and absence of central macular thickening (OR 0.03 [0,0.15], p = 0.02) were associated with VRL as opposed to uveitis.ConclusionOCT features most predictive of VRL (vs. uveitis) included absence of ERM and central macular thickening.

LL37/FPR2 regulates neutrophil mPTP promoting the development of neutrophil extracellular traps in diabetic retinopathy.

Diabetic retinopathy (DR) is characterized by chronic, low-grade inflammation. This state may be related to the heightened production of neutrophil extracellular traps (NETs) induced by high glucose (HG). Human cathelicidin antimicrobial peptide (LL37) is an endogenous ligand of G protein-coupled chemoattractant receptor formyl peptide receptor 2 (FPR2), expressed on neutrophils and facilitating the formation and stabilization of the structure of NETs. In this study, we detected neutrophils cultured under different conditions, the retinal tissue of diabetic mice, and fibrovascular epiretinal membranes (FVM) samples of patients with proliferative diabetic retinopathy (PDR) to explore the regulating effect of LL37/FPR2 on neutrophil in the development of NETs during the process of DR. Specifically, HG or NG with LL37 upregulates the expression of FPR2 in neutrophils, induces the opening of mitochondrial permeability transition pore (mPTP), promotes the increase of reactive oxygen species and mitochondrial ROS, and then leads to the rise of NET production, which is mainly manifested by the release of DNA reticular structure and the increased expression of NETs-related markers. The PI3K/AKT signaling pathway was activated in neutrophils, and the phosphorylation level was enhanced by FPR2 agonists invitro. Invivo, increased expression of NETs markers was detected in the retina of diabetic mice and in FVM, vitreous fluid, and serum of PDR patients. Transgenic FPR2 deletion led to decreased NETs in the retina of diabetic mice. Furthermore, invitro, inhibition of the LL37/FPR2/mPTP axis and PI3K/AKT signaling pathway decreased NET production induced by high glucose. These results suggested that FPR2 plays an essential role in regulating the production of NETs induced by HG, thus may be considered as one of the potential therapeutic targets.

Relationships between causative genes and epiretinal membrane formation in Japanese patients with retinitis pigmentosa.

To investigate the relationships between macular complications and causative genes frequently found in Japanese patients with retinitis pigmentosa (RP). In the retrospective and observational study, we analyzed the data of 75 patients with RP (EYS-RP: 42 patients; USH2A-RP: 19 patients; RHO-RP: 14 patients) who were followed-up at Kyushu University Hospital and whose causative genes had been identified. Macular complications including epiretinal membrane (ERM), macular edema (ME), and macular hole (MH) were evaluated using optical coherence tomography and fundus photography. Main outcome was the proportion of macular complications. The proportion of ERM was 35.7% in the EYS group, 10.5% in the USH2A group and 14.3% in the RHO group. The proportion of ME was 7.1% in the EYS group, 5.3% in the USH2A group and 14.3% in the RHO group, and that of MH was 2.4% in the EYS group, 5.3% in the USH2A group and 0% in the RHO group. In the EYS group, the proportion of ERM was relatively higher (p = 0.06), and the presence of EYS was significantly associated with a higher age- and sex-adjusted OR for ERM (OR = 5.67, 95% CI = 1.59-25.20). There was no significant difference in the proportion of MH or ME among causative genes. EYS causative gene may be associated with higher rate of ERM complication in RP.