Retinal Tears Research Articles

VITREORETINAL OUTCOMES FOLLOWING SECONDARY INTRAOCULAR LENS IMPLANTATION WITH PARS PLANA VITRECTOMY.

Retrospective cohort study of 561 adult patients undergoing secondary intraocular lens (IOL) implantation by vitreoretinal surgeons at a single institution from April 2015 to December 2020. Patient historical factors, intraoperative/postoperative complications, and outcomes of IOL type (anterior chamber IOL versus scleral sutured IOL versus scleral fixated IOL versus. sulcus) were assessed. Primary outcomes were rates of postoperative retinal tears and rhegmatogenous retinal detachment. Secondary outcomes were rates of intraoperative endolaser, intraoperative retinal tear, and further IOL surgery. The incidence of intraoperative retinal tears was 7.3% and not significantly different between techniques. Rates of intraoperative endolaser use were 17.5% among all techniques and not significantly different between techniques. Rates of postoperative retinal tear were low (0%-2.7%). Rates of postoperative rhegmatogenous retinal detachment were not significantly different between techniques (anterior chamber IOL 9/198 [4.5%], SFIOL 1/54 [1.9%], scleral sutured IOL 14/274 [5.1%], sulcus 2/35 [5.7%], total 26/561 [4.6%], P = 0.79). Rates of repeat IOL surgery trended higher in sulcus lenses (anterior chamber IOL 5/198 [2.5%], SFIOL 4/54 [7.4%], scleral sutured IOL 16/274 [5.8%], sulcus 5/35 [14.3%], total 30/561 [5.3%], P = 0.12). Intraoperative endolaser use and intraoperative retinal tear are not uncommon in secondary IOL surgery and underscore the importance of careful vitreoretinal management among these patients.

The factors associated with retinal pigment epithelium tear development in the early phase after treatment initiation for age-related macular degeneration.

This study aimed to evaluate the factors associated with retinal pigment epithelium (RPE) tear development in the early phase after anti-vascular endothelial growth factor (VEGF) drug initiation in eyes with neovascular age-related macular degeneration (nAMD) and retinal pigment epithelial detachment (PED). Treatment-naive eyes with nAMD and PED for which anti-VEGF drug injections had been initiated and followed up for at least 3months after the 1st anti-VEGF drug injection, were retrospectively investigated. Baseline characteristics of the PEDs, including type, height, and area, were evaluated using fundus photographs, fluorescein angiography, and optical coherence tomography images. The association between patient age, sex, medical history, PED characteristics, and the development of RPE tears within 3months of starting anti-VEGF therapy was examined. This study included 244 eyes (230 patients; mean age 75.0years, 159 males and 71 females). RPE tears occurred in 13 eyes (5.3%) within 3months of the start of anti-VEGF therapy. Multivariate analysis showed an association of the development of RPE tears with PED height (every 100µm, odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.07-2.12, p = 0.019), PED area (every 10 mm2, OR: 3.02, CI: 1.22-7.46, p = 0.016), and the presence of fibrovascular PED (OR: 59.22, CI: 4.12-850.59, p = 0.002). Eyes with cleft (the hypo-reflective space beneath the fibrovascular PED) were more likely to develop an RPE tear (p = 0.01, χ-square test). Fibrovascular PED, large PED area, high PED height, and the cleft finding are independent risk factors for the development of RPE tears early after the administration of anti-VEGF drugs.

From injury back to ice: Examining return to sport after retinal injuries in the national hockey league

PurposeTo forecast the recovery time and likelihood of return to active play for National Hockey League (NHL) players who sustained retinal tears or detachments. MethodsThis retrospective study identified players who experienced a retinal injury while on an NHL roster between January 1, 2000 and January 1, 2022. The type of injury was identified from publicly available press releases and injury reports. Return to sport was defined as the number of days between injury and participation in a subsequent NHL game. ResultsOver the 22-year study period, 95 eye injuries were reported in the NHL. Of these injuries, 16 players experienced 17 retinal injuries (18 %). Fifteen of those players were able to return to sport (94 %). Experiencing a retinal detachment was associated with more days out of play (median 151 days [interquartile range [IQR], 85 to 231.5 days]) compared with a retinal tear or similar injury (median 28 days [IQR, 13 to 31 days]; P = 0.003). Finally, an examination of the impact of a retinal injury on player performance in the season after the injury found that the average time on ice (ATOI) per game decreased for players who suffered an injury compared with a matched cohort (P = 0.010). ConclusionsRetinal injuries often occur in high-impact sports. Our study reveals that retinal detachments resulted in longer disability compared with retinal tears or lesser injuries and were more likely to prevent a return-to-sport. This information aids ophthalmologists in counseling patients on surgical recovery timelines and the likelihood of resuming athletic activities.

Management of macula-on giant retinal tear detachments– outcome of pars-plana-vitrectomy with silicone oil versus gas tamponade

BackgroundTo compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.MethodsAll consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.ResultsOverall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).ConclusionsSurgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.Trial registrationThe trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).

Giant retinal pigment epithelium tears with membranous nephropathy: a case report and literature review

BackgroundKidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy and light-chain deposition disease. However, pigment epithelium tears associated with membranous nephropathy have not been reported or systematically analysed.Case presentationA 68-year-old man presented with decreased right eye visual acuity. Optical coherence tomography (OCT) revealed cystic macular edema, localized serous detachment of the retina and loss of the outer retinal structure in the right eye and retinal pigment epithelium detachment (PED) combined with serous detachment of the retina in the left eye. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) revealed giant RPE tears in the right eye and exudative age-related macular degeneration in the left eye. The patient also suffered from severe membranous nephropathy-autoimmune glomerulonephritis. Renal biopsy immunofluorescence revealed a roughly granular pattern, with immunoglobulin G (IgA), immunoglobulin G (IgG), IgM, complement C3(Components 3), λ light chain and κ light chain subepithelial staining.ConclusionsIt is hypothesized that severe membranous nephropathy caused immune complex deposition on the surface of Bruch membrane, resulting in weakened adhesion between the RPE and Bruch membrane and impaired RPE pump function, combined with age-related macular degeneration, leading to giant RPE tears in the right eye. Close attention should be given to the ocular condition of patients with membranous nephropathy to facilitate timely treatment and avoid serious consequences.

Syndromic myopia in marfan’s disease: about a case with review of the literature

Objective: To describe a case of myopic syndrome in Marfan disease. Results: The patient was 45 years old, with high myopia and wearing corrective lenses, with no previous history of any particular problem. She was seen for the management of a progressive bilateral decrease in visual acuity in a white, painless eye, with no history of trauma and no other associated signs. On the clinical examination, the corrected visual acuity was estimated at 02/10 in both eyes. The refraction revealed strong myopia at -11D. The examination of the lens after pupillary dilatation reveals a cortical cataract and upward crystalline ectopia in both eyes. At the posterior pole, there was a myopic cone, chorioretinal atrophy and poor macular reflex, with vessels of normal caliber. The retina was flat with no peripheral retinal tears

Perfluorocarbon Liquid-Silicone Oil Exchange: The Simplicity and Reliability of the Single Port Technique and a Review of Literature

Purpose: To report the “Single Port Technique” for perfluorocarbon liquid (PFCL)-silicone oil (SO) exchange for the management of giant retinal tear detachments (GRTD). Methods: The previously reported techniques of direct PFCL-SO exchange used 2 ports to achieve the influx and outflux of fluid. The term 'Single Port' refers to the use of only one port as the exclusive port for the inflow of SO and the outflow of fluid meniscus and PFCL, performed alternately. This technique is proposed, with illustrated instructions and a surgical video. Results: The newly proposed “Single Port Technique” offers a straightforward step using a switch between active aspiration by the vitreous cutter and active silicone oil injection through a single port without the need for assistance. This method has been performed by the authors on 29 patients, including 22 GRTD patients and 7 patients with rhegmatogenous retinal detachment caused by dialysis, and it has demonstrated its simplicity and reliability for use with only standard vitrectomy tools and machine settings. Conclusion: The Single Port Technique for PFCL-SO exchange for the management of GRTD and rhegmatogenous retinal detachment caused by dialysis has been tried and tested, and it is a valuable tool that can be easily used by any vitreoretinal surgeon.

Surgical outcomes of intraocular lens iris suture fixation in eyes with residual capsule support

Purpose: To evaluate the safety and refractive outcomes of eyes after intraocular lens (IOL) iris suture fixation (ISF). Setting: Private practice, Los Angeles, California. Design: Nonrandomized and unmasked retrospective chart review. Methods: Eyes that underwent IOL exchange or repositioning with ISF with at least 270 degrees of capsular support were included. Eyes with less than 270 degrees of capsular support and eyes with iris damage were excluded. The primary outcome measures included incidence of cystoid macular edema (CME), IOL dislocation requiring refixation, and chronic inflammation. Secondary outcome measures included worsening intraocular pressure (IOP) control, retinal tear or detachment, worsening of corrected distance visual acuity (CDVA), and corneal decompensation. Refractive outcomes for 26 subgrouped eyes included mean and median spherical equivalent refraction accuracy (SERA), and percentage of eyes within 0.5 diopter (D) and 1 D of the refractive target. Results: The study included 53 eyes of 50 patients. CME: 2/53 (3.8%), IOL dislocation requiring refixation: 2/53 (3.8%), chronic inflammation: 1/53 (1.9%), worsening IOP control: 5/53 (9.4%), retinal tear or detachment: 2/53 (3.8%). No patient experienced worsening of CDVA from baseline or corneal decompensation. Mean SERA ± SD −0.35 ± 0.29 D, median SERA −0.37 D. Of the 26 eyes subgrouped for refractive analysis, 73% were within 0.5 D and 100% were within 1 D of the desired refractive outcome. Conclusions: ISF can offer stability for sulcus-fixated IOLs provided there is some residual capsule support. Although there are measurable complications, there is a relatively low side effect profile. The refractive error tended to be myopic, indicating the need for further refinement of IOL power predictive formulas.

The role of ultra-widefield imaging with navigated central and peripheral cross-sectional and three-dimensional swept source optical coherence tomography in ophthalmology: Clinical applications.

To assess central and peripheral retinal and choroidal diseases using ultra-widefield (UWF) fundus imaging in combination with navigated central and peripheral cross-sectional and three-dimensional (3D) swept source optical coherence tomography (SS-OCT) scans. Retrospective study involving 332 consecutive patients, with a nearly equal distribution of males and females. The mean age of patients was 52 years (range 18-92 years). Average refractive error was -3.80 D (range +7.75 to -20.75 D). The observations in this study demonstrate the efficacy of peripheral navigated SS-OCT in assessing various ocular conditions. The technology provides high-quality images of the peripheral vitreous, vitreoretinal interface, retina, and choroid, enabling visualization of vitreous floaters and opacities, retinal holes and tears, pigmented lesions, and peripheral retinal degenerations. 3D OCT scans enhance the visualization of these abnormalities and improve diagnostic and therapeutic decisions. Navigated central and peripheral cross-sectional and 3D SS-OCT scans offer significant complementary benefits in the assessment and management of retinal diseases. Their addition to UWF imaging provides a comprehensive view of central and peripheral ocular structures, aiding in early detection, precise anatomical measurements, and objective monitoring of disease progression. In addition, this technology serves as a valuable tool for patient education, a teaching tool for trainees, and documentation for medico-legal purposes.

Анализ результатов витрэктомии с эндотампонадой витреальной полости воздухом, ПФОС и эндолазерной коагуляцией ретинальных разрывов в хирургии отслойки сетчатки

The results of rhegmatogenous retinal detachment (RRD) surgery in 233 patients (233 eyes) without silicone oil application were analyzed. The first group included 76 patients (76 eyes) after vitrectomy with vitreous cavity air endotamponade and retinal tears endolasercoagulation. The second group consisted of 157 patients (157 eyes) after vitrectomy with vitreous cavity perfluorocarbon liquid (PFCL) endotamponade, endolasercoagulation of retinal tears followed by PFCL removal or replacement with air. Results. Similar comparable results were received postoperatively. Conclusion. Vitrectomy with vitreous cavity air endotamponade allows to perform effective surgical treatment of subtotal retinal detachment in case of upper retinal tears localization, and PFCL tamponade – in case of both upper and lower retinal tears localization with subsequent endolaser coagulation, and also to exclude cases with secondary glaucoma development. Keywords: rhegmatogenous retinal detachment, vitrectomy, air tamponade, PFCL.

Расширение интраоперационных диагностических возможностей в хирургии регматогенной отслойки сетчатки методом двойного контрастирования

On average, the risk of recurrence increased in the postoperative period varies from 3 to 30 %. Among the relapses of ROS after successful surgical treatment, the progression of PVR is an established cause in 60 % of cases, being one of the most serious complications encountered in the postoperative period. It is also often the cause of a recurrence of retinal detachment after resorption of the tamponing agent, or after its removal (with endotamponade with silicone oil) is the banal failure to detect a retinal rupture during surgery. Objective. To compare intraoperative diagnostic techniques in surgery of regmatogenic retinal detachment. Material and methods. The study included 68 patients of different sexes with up to 1 month of age and different detachment configurations. After the standard stages of central vitrectomy, the patients were divided into 2 equal groups: the 1st (main) group consisted of patients who underwent the double-cauterization method, the 2nd (control) group consisted of patients operated in the standard way. Results and discussions. We have recorded a significantly frequent occurrence of relapses in patients in the control group. It was also found that an increase in the number of retinal tears increases the likelihood of ROS involving the macular zone, it was possible to statistically reliably confirm that the absence of ZOST and tight adhesion of the posterior hyaloid membrane to the retina, as well as the lower localization of retinal tears, increases the likelihood of recurrence of ROS due to the development of PVR. Keywords: retinal surface staining, double contrast, proliferative vitreoretinopathy, silicone oil, avitria, retinal detachment

Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review.

It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

Результаты хирургической реабилитации больных с открытой травмой глаза

Purpose. To study the effectiveness of early surgical rehabilitation of patients with openglobe injury type C. Material and methods. The clinical effectiveness of the proposed tactics was studied in 103 eyes with open-globe injury (OGI) type C. Associated traumatic complications included traumatic cataract of varying intensity (55.3 %), peripheral retinal tears (52.4 %), partial hemophthalmos (73.8 %) and traumatic retinal detachment (35.9 %). Depending on the timing of IOL implantation, patients were divided into 2 groups. In the main group (28 eyes), IOL implantation was carried out within a period of 24 hours to 3 days or in the volume of primary surgical treatment (PST), while in the comparison group (29 eyes) delayed IOL implantation was performed for 1–3 months. after vitreoretinal surgery. Results. In both groups, anatomical reattachment of the retina was achieved, an increase in visual functions was established with restoration of peripheral and improvement of central vision, regardless of the timing of IOL implantation, while BCVA after surgery in the main group ranged from 0.05 to 0.3 (0.2 ± 0.05), while in the comparison group BCVA was 0.15 ± 0.05 (from 0.05 to 0.2) respectively. Conclusion The use of the proposed tactics for early surgical rehabilitation of patients with open eye trauma with the presence of an intraocular foreign body (IOFB) can increase the effectiveness of treatment, reduce the number of stages of surgical intervention, improve clinical and functional results and increase their rehabilitation effect. Keywords: open-globe injury type C, early surgical rehabilitation

Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated With Epiretinal Membrane Formation.

Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:326-333.].

ULTRA-WIDEFIELD IMAGING DETECTION RATE IN IDENTIFYING PERIPHERAL RETINAL TEARS IN SINGLE VERSUS MONTAGE OF PERIPHERAL STEERING.

To compare the detection rate of orthogonal, directed peripheral steering, and automontaged images with ultra-widefield imaging and the factors influencing the ability to identify retinal breaks. Retrospective cohort study. Three hundred and seventy-six treatment-naive eyes (349 patients) that underwent laser retinopexy for retinal breaks between 2015 and 2021 were included. Pretreatment ultra-widefield orthogonal, peripheral steering, and automontage were cross-referenced to scleral-depressed examination to determine whether images successfully visualized all retinal breaks. Total relative retinal area (RRA) visualized was divided by its optic disk area (pixels) to calculate relative retinal area. Potential associations were assessed by linear regression analysis. One hundred and sixty two eyes (154 patients) met inclusion criteria. Orthogonal, peripheral steering, and automontage images showed detection rates of 47.5%, 90.7%, and 80.0%, respectively. Relative retinal area increased from orthogonal versus montage by 34.7% ± 26.5% (mean ± SD), which increased the detection rate by 90.8% ( P = 0.006). In linear probability models, vertical meridian tears decreased probability of identification in orthogonal, peripheral steering, and automontage by -26.6%, -86.2%, and -68.7%, respectively ( P < 0.001), and horizontal meridian tears increased the probability by 62.2%, 92.9%, and 85.5%, respectively, ( P < 0.001). Tears posterior to the equator in orthogonal images increased the probability (91.4%, P < 0.001). Artifacts such as lids/lashes, reflection, and face guard decreased the probability in directed peripheral steering by -28.6%, -50.0%, and -66.7%, respectively, ( P = 0.020, P = 0.049, and P = 0.016). Using directed peripheral steering and automontage increases RRA and detection rate of identifying peripheral retinal breaks. Tears in horizontal meridians or posterior to the equator increase the probability of identification. Common ultra-widefield imaging artifacts can significantly limit the probability of identifying retinal tears.

Evaluating referrals of flashing lights and floaters coming into secondary care from primary care

ABSTRACT Clinical Relevance Optometrists should look to take every opportunity to expand their knowledge, understanding and skills pertaining to vitreoretinal conditions. Background Despite the existence of acute eye care schemes and the up-skilling of optometrists, many units are still noticing large numbers of poor-quality referrals with high false positive rates. The authors pondered whether these schemes are effective. Methods At two different time points, a prospective analysis of patients took place, of all the flashing lights and floaters referrals coming into secondary care at the Royal Glamorgan Hospital, Wales, UK. The following data was captured: the exact source of the primary care referral, the diagnosis being queried, the secondary care diagnoses made and the secondary care management decisions. The accuracy of retinal break and Shafer’s sign detection were also directly compared between primary care and secondary care using Cohen’s Kappa Coefficient. Results For the 2018 period, n = 51 patients were included. For the 2022–23 period n = 100 patients were included. The majority of referrals during both periods were from optometrists (>80%) via the WECS pathway. The most common diagnoses being queried were retinal breaks (~50%), followed by retinal detachments (~20%). Interestingly up to 20% of patients seen in secondary care were diagnosed as normal examinations and ~ 20%. Over 1/3 of patients were discharged after their first visit to the EEC. Statistically significant differences were found between the accuracy of retinal tear and Shafer’s identification between the primary and secondary care settings. Conclusion A high number of false positive referrals are coming into secondary care from the WECS pathway and clear training and education needs have been identified.

Serum and Vitreous Levels of Placenta Growth Factor in Diabetic Retinopathy Patients: Correlation With Disease Severity and Optical Coherence Tomographic Parameters.

Purpose The primary objective of this study was to compare placenta growth factor (PlGF) levels in the serum and vitreous of diabetic retinopathy (DR) patients to non-diabetic controls. Additionally, the study aimed to establish associations between serum and vitreous PlGF concentrations and to examine the correlation between vitreous PlGF in DR patients and morphological parameters. Methods This study included serum and vitreous samples from 38 patients, including 21 patients with DR and 17 non-diabetic controls. The control group included non-diabetic patients with rhegmatogenous retinal detachment with retinal tears secondary to posterior vitreous detachment or trauma. PlGF levels were quantified in vitreous and serum samples using an enzyme-linked immunosorbent assay (ELISA). Optical coherence tomography (OCT) scans from DR patients were evaluated to measure the central retinal thickness (CRT) and macular volume (MV). Results DR patients had significantly higher mean vitreous PlGF levels compared to non-DR patients (70.0±39.2 vs. 46.47±9.7 pg/mL, p-value=0.004). However, no significant increase in mean serum PlGF levels was observed in DR patients (p-value=0.232). Within the DR group, proliferative DR (PDR) patients presented significantly higher vitreous PlGF levels than non-PDR (NPDR) patients (76.5±41.0 vs. 42.5±5.0 pg/mL, p-value=0.009). There was no association between serum and vitreous PlGF levels. The correlation between vitreous PlGF levels and morphological parameters was rsp=0.175, p-value=0.488 for CRT, and rsp=0.288, p-value=0.262 for MV. Conclusion This study emphasizes the important role of PlGF in neovascularization, specifically highlighting its overexpression exclusively in vitreous from PDR patients. The observed increase in PlGF levels may be indicative of disease severity. The lack of correlation between vitreous and serum PlGF levels suggests a potential dissociation between intravitreal and systemic PlGF synthesis. Consequently, targeting PlGF in therapeutic approaches may offer an additional strategy for ocular pathologies with a neovascular component.

Association of Ocular Manifestations of Marfan Syndrome With Cardiovascular Complications

To evaluate associations between ocular manifestations of Marfan syndrome and cardiovascular complications. Retrospective cohort study. The TriNetX Analytics platform, a federated health research network of aggregated deidentified electronic health record data of more than 119 million patients, was used to identify patients diagnosed with Marfan syndrome. Univariate logistic regression models were used to evaluate the association of ocular manifestations of Marfan syndrome (such as retinal tears/detachment, lens dislocation, and myopia), with cardiovascular comorbidities. Additional sensitivity analyses were performed using propensity matching. Odds ratios and 95% CIs were calculated for incidence of cardiovascular comorbidities (including aortic dissection, valvular disease, and arrhythmias) following diagnosis of Marfan syndrome. A total of 19,105 patients were identified who were diagnosed with Marfan disease without ocular manifestations, and an additional 3887 Marfan patients with ocular comorbidities. Patients who were diagnosed with ocular disease included 883 with ectopic lens, 417 with retinal tear or detachment, 683 with aphakia, 534 with pseudophakia, and 2465 with myopia. Patients with any ocular manifestations of Marfan were significantly more likely to be diagnosed with all cardiovascular comorbidities modeled including aortic aneurysm and dissection (OR 2.035; P < .0001), mitral valve prolapse (OR 2.725; P < .0001), tricuspid valve disorders (OR 2.142; P < .0001), cardiac arrhythmias (OR 1.836; P < .0001), and all cardiovascular outcomes combined (OR 2.194; P < .0001). In a large and diverse cohort of patients with Marfan syndrome, ocular manifestations of the disorder appear strongly associated with cardiovascular comorbidities.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens.

To investigate the clinical characteristics, treatment methods and outcomes of rhegmatogenous retinal detachment (RRD) in highly myopic eyes with implantable collamer lens (ICL). High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed. Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient. A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included. The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo (range, 1-60mo). At the initial visit for RRD, giant retinal tear (GRT), horseshoe tear, simple round hole, and horseshoe tear combined with round hole were detected in 3, 3, 2, and 1 eye(s), respectively, with macula-off in eyes. Eight patients received surgical treatment, and one patient was treated by retinal laser photocoagulation alone. The ICL was preserved in 7 eyes. At the last follow-up, the mean best corrected visual acuity (BCVA) improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR (P=0.035), and no case of recurrent retinal detachment was found. The morphological presentation of retinal breaks is diverse in this study. The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data, companied with acceptable visual and anatomical outcomes.

Lens injury as acomplication of intravitreal medication injection

Intravitreal medication injections are an efficient and low-risk delivery technique for treating various retinal diseases. Rare serious complications include increased intraocular pressure, vitreous hemorrhage, retinal tears and detachment, intraocular inflammation and endophthalmitis. In the case series presented here, we report iatrogenic lens injuries caused by inadequate performance of intravitreal injections. Amulticenter data collection of patients treated with intravitreal injections with visible iatrogenic lens defects from 2016 to 2023 was retrospectively performed. Lens trauma after intravitreal injections was identified in six cases (69.3±6.5 years). While five cases were observed after anti-VEGF therapy, we identified lens injury after dexamethasone implantation in one patient. Iatrogenic lens injury during intravitreal injection is preventable with the correct injection technique. Knowledge of individual axis length and lens status also helps to avoid this complication.