Macular Retinal Detachment Research Articles

Treatment of Myopia – Current Status and Recent Advances

The incidence of myopia is increasing and represents a major global economic and social burden. In addition to its disadvantages in terms of vision, myopia increases the risk of myopic macular degeneration, retinal detachment, glaucoma and cataract and is a leading cause of visual impairment and blindness worldwide. Pharmacological, environmental and optical interventions have been used to try to slow the progress of myopia. While spectacles and contact lenses have a long history in controlling accommodative responses, they do not slow progression. In an expert interview conducted at EURETINA 2017, Andrzej Grzybowski of the Institute for Research in Ophthalmology, Poznan, Poland discusses the current status of myopia and its treatment, as well as discussing new technologies aimed at delaying progression of the condition.

Research progress of autophagy in age-related macular degeneration and retinal detachment

As a critical self-protection mechanism to maintain the cellular homeostasis and functions, autophagy plays a significant role in growth, adaptation, tumor suppression, aging, innate and acquired immunity.Recent studies have indicated that autophagy is associated with the occurrence and development of many eye diseases including corneal dystrophy, cataract, glaucoma and retinal diseases.In age-related macular degeneration (AMD), abnormal autophagy injures the function of retinal pigment epithelium (RPE) cells, leads to the formation of lipofuscin and participates in drusen's accumulation.In retinal detachment (RD), autophagy can be both protective and harmful for photoreceptor cells.The effect and level of autophagy variation correlates with the time, strength and character of the injury.This review analyzed the relationship between autophagy and AMD or RD, and the influence of autophagy variation in these diseases. Key words: Autophagy; Retinal diseases; Age-related macular degeneration; Retinal detachment

Subfoveal perfluorocarbon liquid. Removal after three months

Abstract Clinical case A case of surgical removal of a subfoveal perfluorocarbon liquid (PFCL) bubble that remained trapped inside the subretinal space. PFCL bubble extraction was performed by performing a therapeutic and vacuum PFCL bubble macular retinal detachment. Discussion The elapsed time before subfoveal PFCL extraction seems to influence the visual result. There are other factors which could influence the final visual acuity significantly, nevertheless it is possible to achieve useful vision, as long as the fovea is not damaged and iatrogenic injuries are avoided during PFCL bubble extraction.

Plenoptic Ophthalmoscopy: A Novel Imaging Technique.

This prospective retinal imaging case series was designed to establish feasibility of plenoptic ophthalmoscopy (PO), a novel mydriatic fundus imaging technique. A custom variable intensity LED array light source adapter was created for the Lytro Gen1 light-field camera (Lytro, Mountain View, CA). Initial PO testing was performed on a model eye and rabbit fundi. PO image acquisition was then performed on dilated human subjects with a variety of retinal pathology and images were subjected to computational enhancement. The Lytro Gen1 light-field camera with custom LED array captured fundus images of eyes with diabetic retinopathy, age-related macular degeneration, retinal detachment, and other diagnoses. Post-acquisition computational processing allowed for refocusing and perspective shifting of retinal PO images, resulting in improved image quality. The application of PO to image the ocular fundus is feasible. Additional studies are needed to determine its potential clinical utility. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:1038-1043.].

Surgical Outcome of Traumatic Cataract Following Corneal Perforation in Children in a Tertiary Eye Care Centre in Nepal

Introduction: Traumatic paediatric cataract is challenging and its management is difficult. It is associated with other distortion of ocular anatomy and subsequent post- operative complication poses more problems. It is mostly unilateral. The purpose of this study is to assess the outcome of traumatic cataract following corneal perforation in Nepalese children in a tertiary eye hospital in Nepal.Material and Methods: It was a retrospective review of medical records of children who developed cataract following perforating corneal injuries. The study included 69 cases diagnosed as unilateral traumatic cataract over a period of 70 months (January 2010 till October 2015) at Tilganga Institute of Ophthalmology (TIO). Traumatic cataracts caused by other than the perforating corneal injuries were excluded from the study.Results: Children between 6 to 10 years of age had highest percentage of ocular trauma. Boys were more commonly affected than girls. Forty two percentages of children had visual outcome of better than or equal to 6/18.Poor visual outcome was mainly due to anterior segment pathology- corneal scar (14.49%).Posterior segment pathology like macular scar, vitreous haemorrhage and retinal detachment contributed to 7.34% of the cause.Conclusion: Outcome of the traumatic cataract surgery varied. Visual outcome of post traumatic cataract after corneal perforation was dependent on multiple factors like co- existence of the anterior and posterior segment trauma, per –operative and post-operative challenges. Prompt and good management of traumatic cataract can result in good visual outcome.J Nepal Paediatr Soc 2016;36(1):50-55

Antihistamines for the treatment of serous macular retinal detachment

Antihistamines for the treatment of serous macular retinal detachment

Historical Perspectives on the Management of Macular Degeneration, Diabetic Retinopathy, and Retinal Detachment: Personal Reminiscences

We were challenged and delighted when Dr. Sharon Solomon, guest editor of this Retina Supplement, invited us to reminisce about caring for patients with common retinal disorders before there was access to the diagnostic and therapeutic tools that are readily available today. We agreed to confine our remarks to 3 common, but serious, conditions: age-related macular degeneration (Dr. Fine), diabetic retinopathy (Dr. Goldberg), and retinal detachment (Dr. Tasman). Each of us completed our ophthalmology training about half a century ago. At that time, a patient who received any 1 of the 3 diagnoses was at considerable risk of severe and irreversible loss of vision. Most readers today will have little if any experience in evaluating and treating such patients without access to a plethora of diagnostic and therapeutic technologies, including intravenous fluorescein angiography, laser photocoagulation, optical coherence tomography, ophthalmic ultrasound, angioinhibitory drugs, vitrectomy, intraocular gases, and many others. We are both pleased and privileged that each of us has practiced our profession long enough to enjoy what the enormous technological developments of the past half century, as described in this article, have meant for our patients.

Human neural progenitor cells decrease photoreceptor degeneration, normalize opsin distribution and support synapse structure in cultured porcine retina

Retinal neurodegenerative disorders like retinitis pigmentosa, age-related macular degeneration, diabetic retinopathy and retinal detachment decrease retinal functionality leading to visual impairment. The pathological events are characterized by photoreceptor degeneration, synaptic disassembly, remodeling of postsynaptic neurons and activation of glial cells. Despite intense research, no effective treatment has been found for these disorders. The current study explores the potential of human neural progenitor cell (hNPC) derived factors to slow the degenerative processes in adult porcine retinal explants. Retinas were cultured for 3 days with or without hNPCs as a feeder layer and investigated by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), immunohistochemical, western blot and quantitative real time-polymerase chain reaction (qRT-PCR) techniques. TUNEL showed that hNPCs had the capacity to limit photoreceptor cell death. Among cone photoreceptors, hNPC coculture resulted in better maintenance of cone outer segments and reduced opsin mislocalization. Additionally, maintained synaptic structural integrity and preservation of second order calbindin positive horizontal cells was also observed. However, Müller cell gliosis only seemed to be alleviated in terms of reduced Müller cell density. Our observations indicate that at 3 days of coculture, hNPC derived factors had the capacity to protect photoreceptors, maintain synaptic integrity and support horizontal cell survival. Human neural progenitor cell applied treatment modalities may be an effective strategy to help maintain retinal functionality in neurodegenerative pathologies. Whether hNPCs can independently hinder Müller cell gliosis by utilizing higher concentrations or by combination with other pharmacological agents still needs to be determined.

Revisiting the role of erythropoietin for treatment of ocular disorders.

Erythropoietin (EPO) is a glycoprotein hormone conventionally thought to be responsible only in producing red blood cells in our body. However, with the discovery of the presence of EPO and EPO receptors in the retinal layers, the EPO seems to have physiological roles in the eye. In this review, we revisit the role of EPO in the eye. We look into the biological role of EPO in the development of the eye and the physiologic roles that it has. Apart from that, we seek to understand the mechanisms and pathways of EPO that contributes to the therapeutic and pathological conditions of the various ocular disorders such as diabetic retinopathy, retinopathy of prematurity, glaucoma, age-related macular degeneration, optic neuritis, and retinal detachment. With these understandings, we discuss the clinical applications of EPO for treatment of ocular disorders, modes of administration, EPO formulations, current clinical trials, and its future directions.

Perfluorocarbono líquido subfoveal. Extracción después de 3 meses

Clinical caseA case of surgical removal of a subfoveal perfluorocarbon liquid (PFCL) bubble that remained trapped inside the subretinal space. PFCL bubble extraction was performed by performing a therapeutic and vacuum PFCL bubble macular retinal detachment. DiscussionThe elapsed time before subfoveal PFCL extraction seems to influence the visual result. There are other factors which could influence the final visual acuity significantly, nevertheless it is possible to achieve useful vision, as long as the fovea is not damaged and iatrogenic injuries are avoided during PFCL bubble extraction.

Research advancement on necroptosis in retinal cell death

Retinal pigment epithelium cells, retinal ganglial cells and photoreceptor cells play vital roles in maintaining the function of retina and choroid.Retinal cell death is the main cause of vision loss in ocular diseases.Necroptosis is a newly found way of programmed cell death.This article presented the mechanism of necroptosis and its research progess in different retinal diseases such as age-related macular degeneration and retinal detachment, which may provide new approaches for retinal diseases treatment. Key words: Retinal cells; Necroptosis; Retinal diseases

Bilateral macular neurosensory retinal detachment secondary to systemic Dabrafenib and Trametinib therapy

Bilateral macular neurosensory retinal detachment secondary to systemic Dabrafenib and Trametinib therapy

Retinal Macroglial Responses in Health and Disease.

Due to their permanent and close proximity to neurons, glial cells perform essential tasks for the normal physiology of the retina. Astrocytes and Müller cells (retinal macroglia) provide physical support to neurons and supplement them with several metabolites and growth factors. Macroglia are involved in maintaining the homeostasis of extracellular ions and neurotransmitters, are essential for information processing in neural circuits, participate in retinal glucose metabolism and in removing metabolic waste products, regulate local blood flow, induce the blood-retinal barrier (BRB), play fundamental roles in local immune response, and protect neurons from oxidative damage. In response to polyetiological insults, glia cells react with a process called reactive gliosis, seeking to maintain retinal homeostasis. When malfunctioning, macroglial cells can become primary pathogenic elements. A reactive gliosis has been described in different retinal pathologies, including age-related macular degeneration (AMD), diabetes, glaucoma, retinal detachment, or retinitis pigmentosa. A better understanding of the dual, neuroprotective, or cytotoxic effect of macroglial involvement in retinal pathologies would help in treating the physiopathology of these diseases. The extensive participation of the macroglia in retinal diseases points to these cells as innovative targets for new drug therapies.

Peripapillary Retinoschisis in Glaucoma Patients.

Purpose. To investigate peripapillary retinoschisis and its effect on retinal nerve fiber layer (RNFL) thickness measurements by using spectral-domain optical coherence tomography (SD-OCT) in glaucomatous eyes. Methods. Circumpapillary RNFL (cpRNFL) B-scan images of 940 glaucoma patients (Group 1) and 801 glaucoma-suspect patients (Group 2) obtained by SD-OCT were reviewed. The structural and clinical characteristics of the retinoschisis were investigated. The RNFL thickness measurements taken at the time of retinoschisis diagnosis and at the follow-up visits were also compared. Results. Twenty-nine retinoschisis areas were found in 26 of the 940 glaucoma patients (3.1%) in Group 1 and seven areas were found in 801 patients (0.87%) in Group 2. In glaucomatous eyes, the retinoschisis was attached to the optic disc and overlapped with the RNFL defect. At the time of retinoschisis, the RNFL thickness was statistically greater in the inferior temporal quadrant when compared with the follow-up scans (p < 0.001). No macular involvement or retinal detachment was observed. Conclusion. The present study investigated 33 peripapillary retinoschisis patients. Increase in RNFL thickness measurements was observed at the time of retinoschisis. It is important to examine the cpRNFL B-scan images of glaucoma patients so that the RNFL thickness is not overestimated.

LONG-TERM OUTCOMES OF 23-GAUGE PARS PLANA VITRECTOMY WITH INTERNAL LIMITING MEMBRANE PEELING AND GAS TAMPONADE FOR MYOPIC TRACTION MACULOPATHY: A Prospective Study.

To investigate the long-term safety and efficacy of microincisional 23-gauge pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of myopic traction maculopathy. A prospective nonrandomized multicenter study was designed. Patients with myopic traction maculopathy without macular hole and retinal detachment were included in the study between January 2009 and May 2012. All patients underwent microincisional 23-gauge pars plana vitrectomy with ILM peeling and 12% C3F8 gas tamponade. In all cases, brilliant blue G staining of the ILM was performed. All patients were prospectively evaluated. The evolution of best-corrected visual acuity (BCVA) and macular thickness were recorded. Myopic traction maculopathy resolved in 28 of the 30 patients (93%) included. Mean follow-up was 33.8 ± 13 months (range, 24-60 months). Mean time of myopic traction maculopathy resolution after surgery was 2.65 ± 1.4 months. At 1 month after surgery, one patient developed a macular hole and another one a rhegmatogenous retinal detachment. After 2 years, another patient developed a retinal detachment. Statistically significant improvements in macular thickness compared with baseline were found at all follow-up visits (P < 0.001, Student's t-test). At final visit, BCVA improved significantly compared with baseline (P = 0.044, Wilcoxon's test). However, a statistically significant improvement in visual acuity was achieved only in eyes with a preoperative Snellen visual acuity ≥ 20/63 (P = 0.027). In contrast, the final BCVA of eyes with worse preoperative visual acuity (<20/63) did not improve significantly (P = 0.41, Wilcoxon's test). Microincisional 23-gauge pars plana vitrectomy with ILM peeling and gas tamponade is effective in the treatment of myopic traction maculopathy, with low postoperative complications. Globally, both BCVA and macular thickness improved significantly during the follow-up period. However, greater visual acuity improvements were only seen in eyes with preoperative BCVA equal to or better than 20/63 Snellen equivalent. Some concerns remain about the risk of macular hole formation after ILM peeling. Further studies are necessary to investigate this issue.

Vitrectomy with internal limiting membrane peeling vs no peeling for Macular Hole-induced Retinal Detachment (MHRD): a meta-analysis.

Backgroundwe conducted our meta-analysis of published studies to assess existing evidence about the efficacy and safety of vitrectomy with ILM peeling vs. that of vitrectomy with no ILM peeling for Macular hole-induced retinal detachment.MethodsDatabases, including Pubmed, Cochrane Library, Ovid, Web of Science, Wanfang and CNKI, were searched to identify studies comparing outcomes following vitrectomy with ILM peeling and that with no ILM peeling for macular hole-induced retinal detachment. The meta-analysis was performed by RevMan 5.1.ResultsSix comparative studies comprising 180 eyes were identified. It was indicated that the rate of retinal reattachment (Odds ratio (OR) = 3.03, 95 % Confidence interval (CI):1.35 to 6.78; P = 0.007) and macular hole closure (OR = 6.74, 95 % CI:3.26 to 13.93; P < 0.001) after initial surgery was higher and the rate of recurrent retinal detachment (OR = 0.08, 95 % CI:0.02 to 0.30; P = 0.0002) was lower in the group of vitrectomy with ILM peeling than that in the group of vitrectomy with no ILM peeling. However, the improved BCVA (Weighted mean difference (WMD) = 0.14, 95 % CI: −0.20 to 0.47; P = 0.42) and the rate of postoperative complications were similar between the two groups.ConclusionVitrectomy with internal limiting membrane peeling is an efficient and safe procedure for macular hole-induced retinal detachment.

Bilateral hearing impairment as the initial symptom of sympathetic ophthalmia

ImportanceSympathetic ophthalmia (SO), a rare bilateral panuveitis following penetrating ocular trauma or ocular surgery to one eye, shares a strikingly similar ocular pathology to that of Vogt–Koyanagi–Harada disease (VKH). Audiovestibular dysfunction is a major extraocular manifestation of VKH; however, to date, only a few cases of sympathetic ophthalmia associated with hearing loss have been reported from ophthalmologists, but not otolaryngologists. Accordingly, little is known about the audiovestibular findings in patients with SO. We herein present two cases of SO with preceding bilateral hearing loss. ObservationsThe patient in Case 1, an 80-year-old female, experienced acute bilateral hearing loss. Five days after the onset of hearing loss, she presented with sudden bilateral blurred vision. In Case 2, a 32-year-old female noticed acute bilateral hearing loss and also experienced acute bilateral blurred vision the subsequent day. Patient 1 had a history of a penetrating injury to the right eye 25 days before the onset of hearing loss, while patient 2 had previously undergone right vitreous surgery twice for the treatment of a myopic macular hole and retinal detachment 36 and 43 days prior to the current symptom onset. Both cases were diagnosed as SO based on ocular findings of bilateral panuveitis and the history of ocular insult. Patient 1 carried HLA-DR4, HLA-DR15, HLA-A33, HLA-A24, HLA-B44 and HLA-B52, and patient 2 carried HLA-DR4. Audiograms showed bilateral mild to moderate sensorineural hearing loss in both cases, with normal auditory brainstem responses and deteriorated distortion product otoacoustic emission amplitudes. In addition, the significant recruitment phenomenon observed in case 1 suggested a cochlear origin of the hearing loss. Both patients received corticosteroid therapy, and the cochlear signs and symptoms recovered within one month. Conclusions and relevanceThis is the first report to describe the comprehensive audiovestibular findings in patients with SO. In the present study, acute bilateral hearing loss developed a couple of days prior to the onset of bilateral visual loss and auditory examinations suggested a cochlear etiology in both cases.

Application of 23-gauge transconjunctival vitrectomy system in pediatric cataract surgery

Objective To evaluate the effect of lensectomy and anterior vitrectomy with 23-gauge transconjunctival vitrectomy system for pediatric cataract. Methods Seventy-one eyes of 71 cases with pediatric cataract in our hospital from January 2009 to December 2013 were retrospectively studied. The age range was 0.5 to 2.0 years old and all cases were randomly divided into two groups: group A(control group) received posterior continuous curvilinear capsularhexis combined with anterior vitrectomy; lensectomy with 23-gauge vitrectomy system was performed to group B(observation group). The visual acuity, posterior capsular opacification and other complications after operation were compared between two groups. Results There was significant difference in the improvement of best corrected visual acuity between two groups after operation (t=2.334, P<0.05). The incidence of corneal edema, iris prolapse, cystoid macular edema and retinal detachment of group B were less than those of group A (P<0.05). Conclusion 23 G vitrectomy system for lensectomy is a safe, effective and minimally invasive method for the treatment of pediatric cataract. Key words: Vitrectomy, 23-G; Cataract, congenital; Opacity, posterior capsular

Long-Term Follow-Up of Adverse Consequences after Nd:YAG Laser Treatment for Posterior Capsular Opacification

Purpose: To evaluate the long-term follow-up of adverse effects after neodymium: yttrium-aluminum-garne (Nd:YAG) laser treatment for posterior capsular opacification (PCO). Methods: In this study, 152 patients (184 eyes) diagnosed with PCO and who received Nd:YAG laser posterior capsulotomy with at least 5 years of follow-up were retrospectively analyzed to evaluate the clinical adverse consequences after Nd:YAG laser posterior capsulotomy. Results: The mean age in the study group was 63.2 ± 4.2 years and the mean follow-up period was 6.2 ± 0.6 years. Vitreous floaters (8.1%) were the most common complication followed by reactive anterior uveitis (5.9%) and transient increase in intraocular pressure of more than 30 mm Hg (5.4%). Other complications included primary Nd:YAG laser failure (2.7%), recurrent lens epithelial remnant proliferation (1.6%), cystoid macular edema (1.1%), corneal edema (0.5%), retinal tear (0.5%), and rhegmatogenous retinal detachment (0.5%). Conclusions: Although Nd:YAG laser treatment is the most effective and safe method, surgeons should be aware of the occasional complications such as recurrent lens epithelial remnant proliferation, retinal tear, and rhegmatogenous retinal detachment through long-term follow-up. J Korean Ophthalmol Soc 2015;56(11):1706-1711

Contribution of "en face" SD‐OCT in retinal surgical diseases

AbstractEn face OCT is complementary Imaging procedure useful for the analysis of vitreoretinal disorders, including macular hole, epiretinal membrane, or retinal detachment. This procedure is informative before and after vitreoretinal surgery. Before surgery, characteristics of the retinal surface may be defined. After vitrectomy, en face OCT reveals changes in the retinal nerve fibers layer (dimples), residual epiretinal tissue, cystic changes, disruption of external limiting membrane and/or outer segment layer, or persistent subretinal fluid. This procedure helps us to refine high resolution imaging of each layer of the retina during the healing process of macular hole or retinal detachment.