Risk Of Proliferative Vitreoretinopathy Research Articles

ORAL CURCUMIN TO REDUCE RISK OF PROLIFERATIVE VITREORETINOPATHY FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To evaluate outcomes of patients who underwent rhegmatogenous retinal detachment repair and were started on oral curcumin for proliferative vitreoretinopathy (PVR) prevention. Retrospective, observational case series of eyes of patients undergoing high-risk rhegmatogenous retinal detachment repair that was started on curcumin postoperatively. Recommended dosage was 500 mg twice daily for 30 days followed by 500 mg daily for 60 days. The primary outcome was recurrent PVR-related rhegmatogenous retinal detachment within 6 months and a single-surgery retinal reattachment rate. Secondary outcomes included epiretinal membrane formation, visual acuity, and curcumin safety profile. Thirty-two eyes of 31 patients met the study inclusion criteria. Postoperatively, 2 eyes developed a PVR-related detachment (6.3%), and 2 eyes redetached due to new breaks without PVR (6.3%). Overall, single-surgery retinal reattachment rate was 87.5%. Single-surgery retinal reattachment rate without silicone oil was 92.6% (25/27). Of the 12 cases with Grade C PVR-related retinal detachment, the single-surgery retinal reattachment rate was 91.7%. Postoperatively, 7 eyes developed an epiretinal membrane (21.9%), of which 3 underwent epiretinal membrane removal (9.4%). No patient had gastrointestinal upset or anemia. This proof-of-concept clinical study suggests that oral curcumin is well tolerated and warrants further investigation for its potential to reduce the risk of PVR after rhegmatogenous retinal detachment repair in eyes at higher risk of PVR.

Risk of Proliferative Vitreoretinopathy in the Second Eye in Adult Patients with Bilateral Retinal Detachment

To examine the incidence and risk factors of proliferative vitreoretinopathy (PVR) in the patients who develop rhegmatogenous retinal detachment (RRD) in their fellow eye after having a prior RRD complicated by PVR. Multicenter, retrospective observational study. Eyes with retinal detachment and PVR between 2015 and 2023 were identified through the Vestrum Health Database METHODS: Risk factors for PVR development, specifically documented PVR in the fellow eye, gender, age, lens status, and presenting and final visual acuity, were evaluated. Odds ratio for PVR development during 6 months post-operative period. Of 57,264 patients, 11% had PVR in at least one eye. Of the 50,989 patients who did not develop PVR after the initial RRD, 4,834 developed RRD in the fellow eye. 166 of these patients developed PVR in their second eye for a PVR rate of 3% in the fellow eye. Of the 6,275 patients who developed PVR after primary RRD repair, 406 of these patients went on to develop RRD in their fellow eye. 42 of these patients developed PVR in their second eye for a PVR rate of 10%. A regression model that also included age, gender and visual acuity led to an odds ratio of 3.42 (p<0.001). The odds ratio of PVR development generally decreased with age. Pseudophakic patients had a higher odds ratio for PVR development, 1.48 (p=0.017). Initial patients with VA 20/40-20/80 had an odds ratio of 2.15 (p=0.003). Patients with VA worse than 20/200 had an odds ratio of 2.89 for PVR development (p<0.001). Patients with a history RRD with PVR in one eye, have approximately 3.5 times higher rate of PVR in their second eye after RRD compared with patients without a history of PVR. This finding potential impacts surgical decisions and use of prophylactic anti-PVR therapy if the patient's second eye has RRD. The final visual acuity in second eye of patients with history PVR is better than for the second eye of patients with no history of PVR which may indicate surgeons are already taking steps to prevent PVR in the patient's second eye.

Inflammation and Oxidative Stress Gene Variability in Retinal Detachment Patients with and without Proliferative Vitreoretinopathy.

This study investigated the association between certain genetic variations and the risk of developing proliferative vitreoretinopathy (PVR) after surgery. The study was conducted on 192 patients with primary rhegmatogenous retinal detachment (RRD) who underwent 3-port pars plana vitrectomy (PPV). The distribution of single nucleotide polymorphisms (SNPs) located in genes involved in inflammation and oxidative stress associated with PVR pathways were analyzed among patients with and without postoperative PVR grade C1 or higher. A total of 7 defined SNPs of 5 genes were selected for genotyping: rs4880 (SOD2); rs1001179 (CAT); rs1050450 (GPX1); rs1143623, rs16944, rs1071676 (IL1B); rs2910164 (MIR146A) using competitive allele-specific polymerase chain reaction. The association of SNPs with PVR risk was evaluated using logistic regression. Furthermore, the possible association of SNPs with postoperative clinical parameters was evaluated using non-parametric tests. The difference between two genotype frequencies between patients with or without PVR grade C1 or higher was found to be statistically significant: SOD2 rs4880 and IL1B rs1071676. Carriers of at least one polymorphic IL1B rs1071676 GG allele appeared to have better postoperative best-corrected visual acuity only in patients without PVR (p = 0.070). Our study suggests that certain genetic variations may play a role in the development of PVR after surgery. These findings may have important implications for identifying patients at higher risk for PVR and developing new treatments.

Steroid Drugs as an Adjunct for Reducing the Incidence of Proliferative Vitreoretinopathy after Rhegmatogenous Retinal Detachment Surgery: A Meta-Analysis of Randomized Controlled Studies

Introduction: The efficacy and influence of steroids for reducing the incidence of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) surgery remain controversial. Systematic review and meta-analysis were conducted to explore the effect of steroids versus placebo on risk of PVR. Methods: We searched PubMed, Embase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs), assessing the effect of steroid drugs as an adjunct for reducing the incidence of PVR after RRD surgery. This meta-analysis was performed using the random-effect model. Data were extracted by two reviewers independently; the quality of RCTs was assessed by the Cochrane risk-of-bias tool. We calculated risk ratio (RR) and the 95% confidence intervals (CIs) of all outcomes and plotted on forest plots. I2 accessed using the χ2 test was applied to quantify the degree of heterogeneity. Results: Four RCTs involving 478 patients (478 eyes) are included in the meta-analysis. There was no significant difference in the incidence of PVR recurrence between steroid groups and control groups (RR: 0.87, 95% CI: 0.70–1.08, p = 0.19). However, the incidence of recurrent PVR was lower in the steroid group (RR: 0.67, 95% CI: 0.46–0.99, p = 0.04) than in the control group when only PVR grades A and B were taken into consideration. Besides, steroids could significantly reduce the incidence of macular edema after surgery (RR: 0.64, 95% CI: 0.47–0.88, p = 0.007). The steroid group and control group had comparable outcomes of retinal reattachment rate and reoperation rate after primary surgery. Additionally, there was no significant difference of the incidence of epiretinal membrane, and the incidence of surgery required by epiretinal membrane. Conclusion: This meta-analysis reveals that RRD surgery combined with steroid drugs administration could significantly reduce the recurrence in PVR grade A and B subgroup, as well as the incidence of macular edema after surgery.

Intravitreal Methotrexate for the Prevention and Treatment of Proliferative Vitreoretinopathy in Rhegmatogenous Retinal Detachment: A Systematic Review.

This systematic review evaluates the role of methotrexate (MTX) as an adjunctive intravitreal agent for the prevention and treatment of proliferative vitreoretinopathy (PVR) in rhegmatogenous retinal detachment. Articles investigating the use of MTX in ≥5 patients with PVR or high risk of PVR were identified via searches of OVID MED-LINE, EMBASE, and Cochrane Library. Eight studies and 240 eyes were included. Patients received an average 2.2 MTX injections with doses ranging from 250 to 400 µg. After 10 months of follow-up in the three controlled trials, there was an 80% retinal re-attachment rate and 0.63 logMAR improvement in visual acuity for patients receiving MTX (<i>n</i> = 106), compared to an 83% reattachment rate and 0.30 logMAR improvement for controls (<i>n</i> = 91). Three mild complications related to MTX were reported. Further research is required given the low number of studies and quality of evidence, heterogenous case selection and treatment regimens, high risk of bias, and lack of randomization. <b>[<i>Ophthalmic Surg Lasers Imaging Retina</i> 2022;53:561-568.]</b>.

TNF-α and NF-κB signaling play a critical role in cigarette smoke-induced epithelial-mesenchymal transition of retinal pigment epithelial cells in proliferative vitreoretinopathy.

Proliferative vitreoretinopathy (PVR) is characterized by the growth and contraction of cellular membranes within the vitreous cavity and on both surfaces of the retina, resulting in recurrent retinal detachments and poor visual outcomes. Proinflammatory cytokines like tumor necrosis factor alpha (TNFα) have been associated with PVR and the epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells. Cigarette smoke is the only known modifiable risk factor for PVR, but the mechanisms are unclear. The purpose of this study was to examine the impact of cigarette smoke on the proinflammatory TNFα/NF-κB/Snail pathway in RPE cells to better understand the mechanisms through which cigarette smoke increases the risk of PVR. Human ARPE-19 cells were exposed to cigarette smoke extract (CSE), for 4 to 24-hours and TNFα, Snail, IL-6, IL-8, and α-SMA levels were analyzed by qPCR and/or Western blot. The severity of PVR formation was assessed in a murine model of PVR after intravitreal injection of ARPE-19 cells pre-treated with CSE or not. Fundus imaging, OCT imaging, and histologic analysis 4 weeks after injection were used to examine PVR severity. ARPE-19 cells exposed to CSE expressed higher levels of TNFα, SNAIL, IL6 and IL8 mRNA as well as SNAIL, Vimentin and α-SMA protein. Inhibition of TNFα and NF-κB pathways blocked the effect of CSE. In vivo, intravitreal injection of ARPE-19 cells treated with CSE resulted in more severe PVR compared to mice injected with untreated RPE cells. These studies suggest that the TNFα pathway is involved in the mechanism whereby cigarette smoke increases PVR. Further investigation into the role of TNFα/NF-κB/Snail in driving PVR and pharmacological targeting of these pathways in disease are warranted.

Intravitreal 5-Fluorouracil and Heparin to Prevent Proliferative Vitreoretinopathy: Results from a Randomized Clinical Trial

Proliferative vitreoretinopathy (PVR) is the major cause for surgical failure after primary rhegmatogenous retinal detachment (RRD). So far, no therapy has been proven to prevent PVR. Promising results for 5-fluorouracil (5-FU) and low-molecular weight heparin (LMWH) in high-risk eyes have been reported previously. The objective of this trial was to examine the effect of adjuvant intravitreal therapy with 5-FU and LMWH compared with placebo on incidence of PVR in high-risk patients with primary RRD. Randomized, double-blind, controlled, multicenter, interventional trial with 1 interim analysis. Patients with RRD who were considered to be at high risk for PVR were included. Risk of PVR was assessed by noninvasive aqueous flare measurement using laser flare photometry. Patients were randomized 1:1 to verum (200 mg/ml 5-FU and 5 IU/ml dalteparin) and placebo (balanced salt solution) intravitreally applied during routine pars plana vitrectomy. Primary end point was the development of PVR grade CP (full-thickness retinal folds or subretinal strands in clock hours located posterior to equator) 1 or higher within 12 weeks after surgery. For grading, an end point committee assessed fundus photographs. Secondary end points included best-corrected visual acuity and redetachment rate. A group sequential design with 1 interim analysis was applied using the O'Brien and Fleming boundaries. Proliferative vitreoretinopathy grade CP incidence was compared using a Mantel-Haenszel test stratified by surgeon. A total of 325 patients in 13 German trial sites had been randomized (verum, n= 163; placebo, n=162). In study eyes, mean laser flare was 31 ± 26 pc/ms. No significant difference was found in PVR rate. Primary analysis in the modified intention-to-treat population results were: verum 28% vs. placebo 23% (including not assessable cases as failures); odds ratio [OR], 1.25; 95% confidence interval [CI], 0.76-2.08; P=0.77. Those in the per-protocol population were: 12% vs. 12%; OR, 1.05; 95% CI, 0.47-2.34; P= 0.47. None of the secondary end points showed any significant difference between treatment groups. During the study period, no relevant safety risks were identified. Rate of PVR did not differ between adjuvant therapy with 5-FU and LMWH and placebo treatment in eyes with RRD.

Anatomical and Functional Outcomes of Vitrectomy with/without Intravitreal Methotrexate Infusion for Management of Proliferative Vitreoretinopathy Secondary to Rhegmatogenous Retinal Detachment.

Purpose To assess the anatomical and functional outcomes of intravitreal infusion of methotrexate (MTX) during pars plana vitrectomy (PPV) for proliferative vitreoretinopathy (PVR) associated with rhegmatogenous retinal detachment (RRD). Methods Comparative interventional nonrandomized study including consecutive patients who had vitrectomy for RRD. The study included six groups. Groups I (established PVR), II (high risk of PVR), and III (no risk of PVR) comprised prospectively recruited study eyes, which received PPV and adjuvant intravitreal MTX infusion equivalent to 400 μg/0.1 mL. Groups IA, IIA, and IIIA comprised retrospectively recruited control groups. Main outcome measures were retinal reattachment at the end of 6 months, visual outcome, and complications. Chi-square test or Fisher's exact test analyzed categorical variables. ANOVA test and Kruskal–Wallis test analyzed quantitative variables. Mann–Whitney U-test and independent t-test evaluated the difference between each group and its control. Comparison between two paired groups was done by Wilcoxon Rank test. The Kaplan–Meier method was used for survival analysis and the log-rank test estimated differences in event-free survival across the groups. P was significant at <0.05. Results The study included 190 eyes of 188 patients. Study Groups I, II, and III included 42, 35, and 24 eyes, respectively. Mean age was 45 years. Male gender constituted 70% of patients. Mean follow-up period was 6 months. Control Groups IA, IIA, and IIIA included 30, 30, and 29 eyes, respectively. Mean age was 50 years. Male gender constituted 50%. Mean follow-up period was 7 months. Median rate of retinal reattachment was 82% in the study eyes versus 86% in the control eyes. The difference in the retinal reattachment rates between each study group and its respective control was not statistically significant, Group I-IA (p= 0.2), Group II-IIA (p=0.07), and Group III-IIIA (p=0.07). BCVA improved by a mean of 4 lines in the study eyes versus 3 lines in the control eyes. The difference in visual outcome between each study group and its respective control was statistically significant between Groups II-IIA and III-IIIA, p=0.03, but not between Groups I-IA, p=0.07. We did not detect complications attributed to MTX use in the study eyes. Conclusion Intravitreal infusion of MTX during PPV is a safe adjuvant therapy in RRD patients with and without PVR. MTX yields superior functional outcomes in patients at high risk of PVR and in patients with no risk of PVR compared to PPV without MTX, but not in cases with established PVR. MTX did not confer an additional advantage in terms of retinal reattachment rate. Summary. Proliferative vitreoretinopathy is a major cause of failure in surgery for rhegmatogenous retinal detachment. Methotrexate as an adjuvant therapy blocks essential drivers in the pathogenetic cascade leading to PVR. Intravitreal infusion has the advantage of blocking the pathology in its nascence and obviates the need for repeated intravitreal injections of the drug.

Підвищення клінічної ефективності хірургічного лікування регматогенного відшарування сітківки шляхом оцінювання імунологічних та анатомо-морфологічних показників: огляд літератури

Introduction. Closed subtotal vitrectomy (CSV) is used to treat rhegmatogenous retinal detachment (RRD), but even with successful surgery performed at a relatively early stage, some patients still have low visual acuity and persistent color perception defects. Therefore, the combination of CVS with the internal limiting membrane (ILM) peeling in RRD can improve clinical outcomes in the postoperative period. The aim. To determine the role of ILM peeling and its influence on the functional and morphological state of the macula after RRD surgery in order to maximize the results of visual acuity after retinal detachment and clarify the indications for ILM removal in RRD. Materials and methods. Analysis of the literature shows that in many cases, despite the full ft of the detached retina, visual acuity is not restored in full. There are almost no data comparing the effect on visual acuity of ILM removal during vitrectomy in the remote period, hemodynamic disorders in the macular area according to optical coherence tomography (OCT) angiography in patients with RRD. Results. Despite the fact that ILM peeling in RRD significantly reduces the incidence of epiretinal fibrosis the anatomical and morphological changes of the retina after ILM peeling and their impact on postoperative clinical outcomes should be taken into account. The determination of blood biomarkers has the potential to better predict the risk of proliferative vitreoretinopathy (PVR) after surgery to inhibit the pathological reaction that causes the formation of fibrous films on the retina, which in turn significantly worsen the clinical outcomes in the postoperative period. Conclusions. Thus, a combination of appropriate surgical techniques and new diagnostic markers, both clinical and immunological, can help to improve the diagnosis and prognosis of RRD.

A novel technique to avoid intraoperative giant tear slippage: the bimanual double aspiration technique

BackgroundThe aim of this paper is to present a novel bimanual double aspiration technique to avoid intraoperative giant tear slippage. The major problem of giant retinal tears (GRT) surgery is the mobility of the posterior flap (slippage), which has been classically solved by the use of intraoperative perfluorocarbon liquid (PFCL). However, avoiding slippage of the posterior flap can be a serious technical challenge when the PFCL is removed, especially when a GRT circumference is > 180°.MethodsConventional three-port 23-gauge pars plana vitrectomy (PPV) plus chandelier was performed in three patients with giant retinal tears (GRT), using the “bimanual double aspiration technique” with non-contact wide field viewing systems. All surgeries were performed by the same surgeon.ResultsNone of the three cases presented with a retinal slippage after the bimanual aspiration technique.DiscussionGRT are full thickness retinal tears that extend circumferentially more than 90° of the retina. Management of GRT is a challenge for the vitreoretinal surgeons because the higher risk of proliferative vitreoretinopathy (PVR), re-detachment and increased risk of retinal slippage; this last can occur intraoperative or postoperative. Retinal slippage is not uncommon but far under-reported and can lead to various complications such as hypotony, retinal folds, and may exacerbate PVR formation. We performed bimanual double aspiration technique to avoid intraoperative giant tear slippage. We believe that this maneuver may avoid slippage by drying the posterior edge of the GRT. There were no complications related with the technique, and no additional equipment was needed.ConclusionIn summary, “bimanual double aspiration technique”, is a simple, effective, safe and economic maneuver that could be a good option to avoid intraoperative slippage in giant retinal detachment surgery, thus achieving the stabilization of the posterior retinal flap.

Improving outcomes in retinal detachment: the potential role of rho-kinase inhibitors.

Retinal detachment initiates a series of events that lead to degenerative changes in retinal synaptic architecture as well as the well-known phenomena of gliosis and photoreceptor apoptosis. Retinal reattachment does not always result in complete visual recovery, even if the fovea is not directly involved in the detachment. Rho-kinase (ROCK) inhibitors may mitigate some of these deleterious changes including disruption of synaptic architecture, photoreceptor apoptosis, and initiation of the epithelial-mesenchymal transition that characterizes proliferative vitreoretinopathy (PVR). This review focuses on the use of ROCK inhibitors to modulate synaptic disjunction. ROCK inhibition prevents retinal detachment-induced photoreceptor synaptic terminal retraction (i.e., synaptic disjunction), thereby diminishing the damage of the first synapse in the visual pathway. ROCK inhibition also reduces retinal detachment-induced photoreceptor apoptosis and suppresses PVR progression in preclinical models. Inhibition of ROCK may help to optimize visual recovery after retinal detachment surgery or iatrogenic detachments during cell transplantation or viral subretinal injection and might play a role in reducing the risk of PVR after retinal detachment surgery.

Laser flare photometry for identification of high-risk patients for proliferative vitreoretinopathy

Proliferative vitreoretinopathy (PVR) is acomplication of rhegmatogenous retinal detachment and trauma, which occurs in approximately 10% following vitreoretinal surgery. The visual prognosis for established PVR is poor and so far there is no established conservative treatment for PVR. In the currently recruiting PRIVENT trial the aim is to find a prophylactic treatment possibility for PVR. The PRIVENT study examines the influence of intraoperative adjuvant pharmacotherapy on reducing the incidence of PVR; however, this requires the identification of eyes with increased risk for PVR. Laser flare photometry is asimple method to predict the individual risk for PVR. It is anon-invasive technique that objectifies the Tyndall effect. Various laser flare meter devices are available on the market. In previous studies it could be shown that laser flare photometry can predict the development of PVR in eyes with primary rhegmatogenous retinal detachment with asensitivity of 80%. The identification of these high-risk eyes for PVR could be the first step towards solving the problem of PVR.

EFFICACY OF INTRAVITREAL INJECTION OF BEVACIZUMAB IN VITRECTOMY FOR PATIENTS WITH PROLIFERATIVE VITREORETINOPATHY RETINAL DETACHMENT: A Meta-analysis of Prospective Studies.

To evaluate the effect of intravitreal injection of bevacizumab in vitrectomy for patients with proliferative vitreoretinopathy (PVR)-related retinal detachment. The PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from their earliest entries through October, 2016, to identify the studies that had evaluated the effects of intravitreal injection of bevacizumab in vitrectomy for eyes with PVR-related retinal detachment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The relevant data were analyzed using Stata 12.0 software. The weighted mean difference, relative risk, and their 95% confidence intervals were used to assess the strength of the association. The authors' search yielded 133 records from which 3 studies that have examined the effects of intravitreal injection of bevacizumab (120 eyes with PVR-related retinal detachment) were included for review and analysis. Their meta-analyses showed that neither the best-corrected visual acuity nor retinal redetachment rate showed any clinically or statistically important difference between the nonbevacizumab and bevacizumab groups (P > 0.05). In addition, bevacizumab did not influence the interval between vitrectomy and retinal redetachment (P > 0.05). Based on the available evidence, intravitreal injection of bevacizumab in vitrectomy for patients with PVR-related retinal detachment did not decrease retinal redetachment rate or improve visual acuity. Better-designed studies with larger simple sizes and longer follow-up periods are required to reach valid conclusions regarding benefits and harms. Moreover, evaluation of anti-vascular endothelial growth factor therapy on surgical outcomes in eyes with milder subtypes of PVR or no PVR, but deemed at high risk of PVR, may be worthy of future consideration.

ASSOCIATION STUDY BETWEEN POLYMORPHISMS OF THE p53 AND LYMPHOTOXIN ALPHA (LTA) GENES AND THE RISK OF PROLIFERATIVE VITREORETINOPATHY/RETINAL DETACHMENT IN A MEXICAN POPULATION.

To report the results of an association study between single-nucleotide polymorphisms of the p53 and LTA genes and the risk of proliferative vitreoretinopathy (PVR)/retinal detachment (RD) in a Mexican cohort. A total of 380 unrelated subjects were studied, including 98 patients with primary rhegmatogenous RD without PVR, 82 patients with PVR after RD surgery, and 200 healthy, ethnically matched subjects. Genotyping of single-nucleotide polymorphisms rs1042522 (p53 gene) and rs2229094 (LTA gene) was performed by direct nucleotide sequencing. Allele frequencies, genotype frequencies, and Hardy-Weinberg equilibrium were assessed with HaploView software. No significant differences in the allelic distributions of the previously identified risk C allele for LTA rs2229094 were observed between RD subjects and controls (odds ratio [95% confidence interval] = 0.8 [0.5-1.2]; P = 0.3). Conversely, the C allele for rs1042522 in p53 was positively associated with an increased risk for RD (odds ratio [95% confidence interval] = 1.4 [1.01-1.9]; P = 0.04). No significant differences were observed when the subgroup of 82 RD + PVR subjects was compared with the subgroup of 98 patients with RD. The C allele for rs1042522 in p53 was genetically associated with a higher risk for RD but not for PVR in this cohort. This is the first association study attempting replication of PVR-associated risk alleles in a nonwhite population.

Prophylactic chorioretinectomy for eye injuries with high proliferative-vitreoretinopathy risk.

With its incidence exceeding 60%, proliferative vitreoretinopathy (PVR) remains the most important pathology responsible for loss of vision, even the eyeball, after certain types of severe trauma. In this article, we present results obtained using our novel surgical technique, prophylactic chorioretinectomy (PCR), to prevent the development of PVR. Data on severely injured eyes at high risk for PVR [rupture, posterior laceration, deep-impact intraocular foreign body (IOFB) trauma, perforating injury] were collected prospectively. All eyes underwent vitrectomy (PPV) by PCR within 100 hr of the trauma. Eyes were excluded if they presented with endophthalmitis or if the reconstructive surgery was performed outside this time frame. Forty eyes of 40 consecutive patients were analyzed; full follow-up information was obtained for all of them. The injury was rupture in 27%, penetrating in 15%, (deep-impact) IOFB in 35%, and perforating in 23%. PPV-PCR was performed during primary (wound closure) surgery in 59% of cases. All eyes had at least minimal vitreous hemorrhage, and none had a true posterior vitreous detachment. At the time of PPV, 30% of the eyes had a retinal detachment. Sixteen percent developed PVR, but none from the site of the PCR procedure. In 20%, silicone oil remained in the eye at the last follow-up. The visual acuity improved in 93% of eyes and worsened in none; the improvement was mostly due to surgical clearing of the media opacity. In this subgroup of eyes with severe open-globe trauma, over 60% are expected to develop PVR. PPV/PCR performed within 100 hr reduced the PVR risk significantly, so currently it remains the best option for the surgeon. Clin. Anat. 31:28-38, 2018. © 2017 Wiley Periodicals, Inc.

Surgical treatment of rhegmatogenous retinal detachments with high risk of proliferative vitreoretinopathy

to analyze the effect of internal limiting membrane (ILM) peeling in patients undergoing 23-gauge pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) with a high risk of proliferative vitreoretinopathy (PVR). This was a prospective consecutive study of 231 eyes of 227 patients. All eyes underwent vitrectomy with silicone oil/gas tamponade for RRD with a high risk of PVR: in 42 eyes the ILM was peeled (group 1) and in the remaining 189 eyes - was not (group 2). The follow-up period was at least 3 months. In group 1, single-surgery anatomic success was achieved in 85.4% and definitive reattachment - in 95.2% of patients. In group 2, single-surgery anatomic success was achieved in 67.2% and definitive reattachment - in 89.4% of patients. None of the patients from group 1, who had their ILM peeled, developed epiretinal membrane. Final BCVA in groups 1 and 2 was 1.2±0.5 logMAR and 1.34±0.82 logMAR respectively (p=0.297). ILM peeling during vitrectomy in RRD patients at high risk of PVR provides high primary anatomic success rate.

Intravitreal methotrexate infusion for proliferative vitreoretinopathy.

PurposeThe purpose of this study was to evaluate intravitreal methotrexate infusion (IMI) during pars plana vitrectomy (PPV) for retinal detachment in patients with high risk for the development of proliferative vitreoretinopathy (PVR).MethodsPatients presenting with severe recurrent PVR with tractional retinal detachment and/or a history of severe ocular inflammation were treated with IMI. Clinical outcomes were determined from a retrospective medical chart review.ResultsTwenty-nine eyes presenting with either tractional retinal detachment and recurrent PVR (n=22) or a history of severe inflammation associated with high PVR risk (n=7) received IMI during PPV. Best-corrected visual acuity at 6 months was ≥20/200 in 19 of 29 eyes (66%) and remained stable or improved compared with initial presentation in 24 of 29 eyes (83%). At the last follow-up examination, the retinas of 26 of 29 eyes (90%) remained attached after IMI while three eyes required another reattachment procedure. Three additional eyes (10%) developed recurrent limited PVR without recurrent RD and were observed. No complications attributable to IMI occurred during a mean follow-up of 27 months.ConclusionEyes at high risk for PVR development due to a history of prior PVR or intraocular inflammation had a low incidence of PVR following IMI at the time of PPV for RD repair. No significant safety issues from IMI were observed in this series.

The diseased vitreous body: Malformations, developmental disorders and opacities

Remnants of a persistent hyaloid artery can occasionally cause cataracts and traction on the retina at the posterior pole of the eye.It is the task of the ophthalmologist to weigh up the risk of amblyopia against the risks of vitrectomy and lensectomy. The retina is primarily intact. This is different from the group of hereditary vitreoretinal dystrophies where defects in the retina and vitreous body contribute equally to the overall clinical manifestations. Familial exudative vitreoretinopathy (FEVR) of childhood is sometimes misdiagnosed as uveitis. Retinal exudates leak from enormously permeable retinal vessels and it is necessary to completely remove such abnormal vessels to stop progression. The peculiar vitreous opacities consist of paper-like veils which are stacked like onion skins. The FEVR simulates retinopathy of prematurity and other exudative vitreoretinopathies. Stickler and Wagner syndromes are associated with a high risk of rhegmatogenous retinal detachment, similar to giant retinal tears. Occasionally, extraocular manifestations, such as hyperextensive joints are indicative of a systemic connective tissue disease.The peripheral retina is mechanically weak and susceptible to tears and giant or multiple tears can occur. The prognosis is further aggravated by an elevated risk of proliferative vitreoretinopathy (PVR). It is, therefore, essential to identify the risk profile in this constellation and bear the risk of PVR in mind when selecting a treatment regimen, similar to that for giant tear retinal detachment.

Intravitreal low molecular weight heparin and 5-Fluorouracil for the prevention of proliferative vitreoretinopathy following retinal reattachment surgery

Proliferative vitreoretinopathy (PVR) is a significant cause of failure in retinal reattachment surgery. Various pharmacological agents have shown potential benefit in reducing postoperative PVR risk. This review aimed to compare the use of intravitreal low molecular weight heparin (LMWH) alone or with 5-Fluorouracil (5-FU) versus placebo, as an adjunct in the prevention of PVR following retinal reattachment surgery. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 9), MEDLINE (January 1950 to October 2012), EMBASE (January 1980 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 October 2012. We only included randomised controlled trials (RCTs) that compared intravitreal LMWH alone or with 5-FU, versus placebo for the prevention of postoperative PVR in patients undergoing primary vitrectomy for rhegmatogenous retinal detachment repair. Two review authors independently assessed trial quality and extracted data. The review authors contacted study authors for additional information. We included two RCTs (with a total of 789 participants) comparing LMWH with 5-FU infusion and placebo. However, we did not perform a meta-analysis because of significant heterogeneity between these studies. One study found a significant beneficial effect of LMWH with 5-FU in reducing postoperative PVR compared to placebo (RR: 0.48, 95% confidence interval: 0.25 to 0.92), in 174 patients who were viewed at high-risk of developing postoperative PVR. The other study included 615 unselected cases of rhegmatogenous retinal detachment and could not show a difference between LMWH with 5-FU infusion and placebo in reducing PVR rates (RR:1.45, 95% confidence interval: 0.76 to 2.76). Results from this review indicate that there is inconsistent evidence from two studies on patients at different risk of PVR on the effect of LMWH and 5-FU used during vitrectomy to prevent PVR. Future research should be conducted on high risk patients only, until a benefit is confirmed at least in this patient subgroup.

The p53 Codon 72 Polymorphism (rs1042522) Is Associated with Proliferative Vitreoretinopathy: The Retina 4 Project

To compare the distribution of a p53 gene polymorphism among European subjects undergoing primary retinal detachment (RD) surgery in relation to the development of proliferative vitreoretinopathy (PVR). Case-controlled gene association study conducted as a component of the Retina 4 Project (a European multicenter study). Five hundred fifty DNA samples, 134 with PVR secondary to primary RD and 416 with RD without PVR. The p53 codon 72 polymorphism (rs1042522) was analyzed using allele-specific primer polymerase chain reaction. Proportions of genotypes and the proline (Pro-P) homozygote groups between subsamples from different countries were analyzed in 2 phases. In the first, subsamples from Spain and Portugal were analyzed. After significant results were found, samples from the United Kingdom (UK) and The Netherlands were analyzed (second phase). Genotypic and allelic frequencies were compared between cases and controls in the global sample. Single significant associations with PVR. A significant difference (P<0.05, Fisher exact test) was observed regarding the p53 genotype frequencies at codon 72 between the PVR cases and the non-PVR controls in Spain and Portugal (phase I), but not in the UK or The Netherlands (phase II). Analysis of Pro homozygote carriers between cases and controls revealed differences in Spain (29.01-42.18 and 2.29-10.20, respectively), Portugal (10.49-29.50 and 1.35-8.89, respectively), and The Netherlands (16.49-31.70 and 4.51-15.09, respectively), but no differences in the UK (7.68-18.1 and 4.85-13.94, respectively). The odds ratio of Pro carriers from Spain and Portugal together was 8.12 (95% confidence interval [CI], 3.72-17.69; P<0.05), whereas the odds ratio of Pro carriers from the UK and The Netherlands was 2.12 (95% CI, 0.96-4.68; P = 0.07). All control samples were in Hardy-Weinberg equilibrium. Considering the entire sample, significant differences were found in genotype frequencies between cases (RR, 30.59%; RP, 43.28%; PP, 26.11% [R = Arg; P = Pro]) and controls (RR, 39.66%; RP, 52.64%; PP, 7.69%) and in Pro homozygote carriers between controls (Pro homozygote 95% CI, 18.67-33.52) and cases (Pro homozygote 95% CI, 5.1-10.2). Results indicate that the Pro variant of p53 codon 72 polymorphism is associated with a higher risk of PVR developing after a primary RD. Further studies are necessary to understand the role of this polymorphism in the development of PVR.