Vitreoretinal Complications Research Articles

Vitreoretinal Surgery in Pediatric Patients with Vitreoretinal Pathology Secondary to Uveitis

In pediatric uveitis, as with all forms of uveitis, the primary treatment modality involves achieving systemic and local immunosuppression through pharmacotherapy. However, due to the challenge of articulating symptoms by patients in the younger age group, resulting in delayed presentation to clinicians, or the tendency for uveitis to manifest more quietly in this age group, pediatric uveitis cases can be diagnosed late, unfortunately presenting with secondary complications at the time of diagnosis. In these patients, after appropriate immunosuppression is achieved, vitreoretinal surgery may be necessary to address vitreoretinal complications. Additionally, in cases where etiology cannot be determined by non-invasive methods, or when there is inadequate response or no response to treatment, rapid progression of inflammation threatening the optic nerve and macula, or suspicion of malignancy, diagnostic vitreous sampling or chorioretinal biopsy via vitreoretinal surgery may be pursued. The aim of this review is to evaluate the role and significance of vitreoretinal surgery in pediatric uveitic eyes.

Managing vitreoretinal complications in uveal melanoma: Surgical treatment and practical considerations.

In the past few decades, the primary management for uveal melanoma has evolved from enucleation to eye-preservingtreatments. However, despite achieving ahigh rate of local tumour control, complications following eye-preservingtreatments still occur and are partly responsible for functional loss and secondary enucleation. A literature review by a broad international panel. We summarised the current literature on utilizing vitreoretinal (VR) surgery for managing the complications of uveal melanoma. We also provided insights from the authors' personal experience and practical recommendations for clinical care. With the advancement of VR instruments and surgical techniques and the combination of VR and ocular oncology knowledge ("Onco-VR"), it is now possible to manage or even prevent complications such as vitreous haemorrhage, retinal detachment, and toxic tumour syndrome.

Neurodegeneration in diabetic retinopathy: An insight on its main signalling pathways

Aims/Purpose: In the latest years neurodegeneration has been considered as one of the main pathological processes involved in proliferative diabetic retinopathy's (PDR) onset and progression. We aimed to increase the understanding on the role of the main signalling molecules that participate in this phenomenon, including apoptotic, excitotoxic and neurotrophic factor pathways.Methods: Participants of both sexes were selected and programmed for vitrectomy by its diabetes mellitus 2 (DM2)‐derived vitreoretinal complications (PDR group, PDRG; n = 20), or by suffering macular hole, epiretinal membrane or rhegmatogenous retinal detachment (as the surrogate control group, SCG; n = 26). Vitreous body (VIT) and plasma (PLS) samples were collected and processed to determine the glutamate, caspase‐3 (CAS‐3) and brain‐derived neurotrophic factor (BDNF) levels. Next‐Generation Sequencing (NGS) techniques were applied to characterize the miRNA expression pattern in both groups.Results: Significantly higher VIT glutamate (p < 0.05) and CAS‐3 (p < 0.05), and significantly lower BDNF (p < 0.05) levels were detected in the PDRG. Significantly higher PLS glutamate (p < 0.05) and CAS‐3 (p < 0.05) levels were found in diabetics. However, PLS levels of BDNF showed no differences between groups (p = 0.80). NGS analysis showed a different miRNA expression pattern between both groups.Conclusions: Diabetes‐induced changes in retinal neurons/glia may be the key to discover preclinical biomarkers for better managing diabetic eyes. Glutamate, caspase‐3 and BDNF, playing important roles in the neurodegenerative processes occurring in PDR, are pivotal candidates to identify diabetics at high risk of sight‐threatening complications. Additionally, certain miRNAs could be playing an important role in these signalling pathways, being involved in PDR's neurodegenerative phenomenon.

Outcomes of Vitreoretinal Complications Requiring Operation after Abusive Head Trauma.

Abusive head trauma (AHT) can result in retinal complications that require operative intervention. There is no review evaluating the outcomes of vitreoretinal operations in aggregate or on the timing of vitreoretinal intervention. This systematic review aims to fill this knowledge gap. A literature search between 2011 and 2021 was performed with PubMed, Web of Science, and Embase. Included articles described outcomes of vitreoretinal operations after AHT either in aggregate or as individual cases. Nine articles met criteria; the direct outcomes of operations were collected to minimize bias. Visual acuity (VA) and anatomic outcomes were compared between patients who received operations within 4 weeks of diagnosis and those who had delayed intervention. This review found that vitreoretinal surgery after AHT has excellent anatomical success rates, but there is a trend toward improved VA outcomes when performed within 4 weeks of diagnosis. This highlights the importance of urgent referral to a pediatric retina surgeon for non-clearing vitreous hemorrhage, retinal detachment, and retinal tears after AHT.

Исходы самопроизвольного регресса благоприятного типа течения ретинопатии недоношенных

Purpose. To analyze the structural changes in the fundus of the eye of children as a result of spontaneous regression of a favorable course of stages 1, 2 and 3 of active retinopathy of prematurity. Material and methods. There were 38 children with a favorable course of active ROP. The first stage of the disease was detected in 26 eyes, the second in 39, and the third stage in 11 eyes. All children underwent a comprehensive ophthalmological examination upon reaching the age of 6 months. Twenty-six of these children (22 cases at the outcome of stage 1, 23 at stage 2, 4 at stage 3) underwent annual follow-up examinations when they reached the age of 1 to 4 years. At the age of 6 months, incomplete retinal vascularization was detected at any stage of the disease: in patients who underwent stage 1 ROP in 46.1 % of cases, stage 2 – in 79.5 % of cases. At the 3rd stage of ROP, the completion of complete vascularization of the retina up to the dentate line occurred only in 2 cases (18.2 %). Results. In the children who were observed in the age period of 1–4 years, the previously identified avascular zone was preserved on the periphery of the fundus. According to SOCT data of the peripheral parts of the retina in the first and second stages of ROP, areas of local compaction of the inner limiting membrane were detected in 9.1 % and 8.7 % of cases, respectively. At the end of the 3rd stage, areas of local epi- and preretinal fibrosis were determined in 42.8 % of cases. Conclusion. All children with retinopathy of prematurity, regardless of the type of course, should undergo regular ophthalmological examination, paying special attention to the condition of the peripheral parts of the retina in order to timely detect distant vitreoretinal complications. Keywords: retinopathy of prematurity, spontaneous regression.

Late Vitreoretinal Complications of Regressed Retinopathy of Prematurity: Retinal Break, Vitreous Hemorrhage, and Retinal Detachment

To investigate late vitreoretinal complications and visual outcomes in patients with regressed retinopathy of prematurity (ROP) with or without prior treatment. International, multicenter, noncomparative retrospective case series. We analyzed 264 eyes of 238 patients from 13 centers worldwide who developed vitreoretinal complications (retinal detachment [RD], vitreous hemorrhage [VH], or retinal break) ≥ 2 years after resolution of acute ROP. Each participant was assigned to 1 of 3 groups (the RD, VH, and retinal break groups) according to their primary diagnosis. The average age at presentation, visual acuities, refractive error, axial length, gestational age, birth weight, acute ROP classification, prior treatments for acute ROP, postoperative visual acuity (VA), and concomitant eye conditions in the 3 groups were documented and compared. Clinical features and visual outcomes of late vitreoretinal complications in patients with regressed ROP. A total of 264 eyes of 238 patients were included. The prior acute ROP status was comparable among the 3 groups, except that the VH group had a higher proportion of patients with type 1 ROP (P= 0.03) and prior treatment (P < 0.001) than the other groups. The average age at presentation was earlier in the RD (20.3 ± 15.5 years) and VH (21.4 ± 18.9 years) groups than in the retinal break group (31.9 ± 18.2 years; P < 0.001). The retinal break group had the best presenting best-corrected VA, followed by the RD and VH groups (P < 0.001). Surgical intervention improved VA in both the RD and VH groups (both P < 0.05). The overall trend of VA was the most favorable in the retinal break group, followed by that in the VH and RD groups. Cicatricial changes in the fellow retina were observed in > 90% of patients with unilateral involvement. Infants with acute ROP remain at a high risk of vision-threatening complications throughout childhood and adulthood. Continual follow-up of patients with ROP is important. When severe complications, such as RD or VH, are detected, timely surgical intervention is necessary to ensure favorable visual outcomes in these patients.

Short-term perfluorocarbon liquid tamponade in choroidal melanoma endoresection

PurposeTo report the use of short-term perfluorocarbon liquid (ST-PFCL) tamponade following choroidal melanoma endoresection.MethodsPatients with medium to large choroidal melanomas not amenable to primary Ruthenium-106 brachytherapy underwent choroidal melanoma endoresection following gamma knife radiosurgery. During surgery, a complete vitrectomy was performed followed by PFCL injection, then a retinectomy with endoresection of the melanoma and underlying choroid was done. Complete PFCL filling was then achieved, and laser barrage surrounding the retinectomy was done. A Ruthenium-106 plaque was then inserted. Postoperatively, supine positioning was maintained for three days followed by plaque and PFCL removal with silicone oil injection. Several months later, silicone oil was removed.ResultsFour eyes of 4 patients underwent endoresection with ST-PFCL tamponade. Mean height of tumor was 8.6 ± 0.85 mm, while mean maximal basal diameter was 11.5 ± 1.1 mm. Mean preoperative logMAR best corrected visual acuity (BCVA) was 1.76 ± 0.18. All patients underwent preoperative gamma knife radiosurgery and postoperative brachytherapy. There were no major intraoperative or postoperative complications. All patients underwent silicone oil injection with PFCL/plaque removal after 3 days, while silicone oil was removed after 4 ± 1.2 months. Mean postoperative logMAR BCVA 3 months following oil removal was 0.89 ± 0.22 (p = 0.02). Mean follow-up duration was 17 ± 2.8 months. No patient developed local tumor recurrence, distant metastases, or vitreoretinal complications by final visit.ConclusionST-PFCL tamponade may reduce the risk of intraoperative and postoperative complications associated with choroidal melanoma endoresection.

Boston type I keratoprosthesis versus penetrating keratoplasty following a single failed corneal graft.

To compare long-term outcomes of the Boston type 1 keratoprosthesis (KPro) with penetrating keratoplasty (PKP) in patients with a failed first PKP. In this retrospective comparative case series, 48 eyes of 48 patients who underwent a second corneal replacement procedure after a first failed PKP at the Centre Hospitalier de l'Université de Montréal from 2008 to 2020 were included. Minimum follow-up duration was 5 years, and patients with keratoconus were excluded since such subjects are not candidates for KPro. Main outcome measures included best-corrected visual acuity (BCVA), postoperative complications, graft survival and subsequent interventions. Mean follow-up was 6.4 years for PKP and 9.6 years for KPro (p < 0.001). Preoperative BCVA was better in PKP patients (means 1.67 vs 2.13, p = 0.041). Visual outcomes were similar between groups. KPro patients developed 0.263 complication per patient-year (ppy) compared to 0.245 ppy or PKP. The most common complications for PKP were corneal complications (0.088 ppy) and glaucoma worsening (0.041 ppy). In KPro, glaucoma worsening (0.046 ppy), vitreoretinal complications (0.042 ppy) and retroprosthetic membrane (0.042 ppy) were the most frequent. Graft failure (69.6 vs 20.0%, p < 0.001) and reoperation rates (56.5 vs 12.0%, p = 0.001) were significantly higher for PKP. Failure mainly resulted from decompensation or rejection in PKP, while all five failures in KPro were caused by melt and/or extrusion. Both interventions showed similar visual outcomes. Complication profiles were different, with more posterior segment complications in the KPro group, and more corneal complications in the PKP group, often necessitating regraft.

Vitreoretinal Complications in Boston Keratoprosthesis Type 1

To evaluate the incidence of vitreoretinal complications, treatment modalities, and the visual outcomes in a large cohort of eyes that underwent Boston Keratoprosthesis (KPro) implantation. Retrospective, interventional case series. 132 eyes of 114 patients who underwent KPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1 year follow-up. Charts were reviewed and data was collected, including demographics, initial corneal indication for surgery, posterior segment complications, preoperative and postoperative visual acuity. Mean follow-up was 68.2 months and 61.4% of eyes developed postoperative vitreoretinal complications (VRC). The most common VRC was RPM formation (38.6%, n=51) followed by RD (15.2%, n=20), CME (12.1%, n=16), ERM (9.8%, n=13), endophthalmitis (9.1%, n=12), sterile vitritis (7.6%, n=10), vitreous hemorrhage (6.8%, n=9), choroidal detachment (3.0%, n=4) and central retinal vein occlusion (0.7%, n=1). BCVA improved in the no VRC group from 1.74 ± 0.33 logMAR to 1.33±0.83 logMAR and in the VRC group from 1.74±0.36 logMAR to 1.52±0.83 logMAR, without any statistically significant intergroup differences (p=0.231). RD was the only significant complication associated with poorer visual outcomes (p=0.001). Potentially blinding secondary complications occur in the majority of patients and frequent monitoring is necessary, specifically in the early and intermediate postoperative periods. This study evidenced significant improvements in visual outcomes of KPro eyes, including those that developed postoperative vitreoretinal complications.

Surgical management and outcomes of pediatric open globe injuries requiring vitrectomy

To describe surgical management and establish visual outcomes of open globe injury (OGI) in pediatric patients requiring vitrectomy. Forty-eight eyes of 48 pediatric patients underwent vitrectomy for OGI with secondary vitreoretinal complications in the eye center of Jilin University were included. Characteristics of patients, details of ocular examination and operation, presenting and final visual acuity were recorded. Presenting visual acuity less than 20/400 was found in 44 eyes (91.7%), which included no light perception (NLP) in four eyes. At last visit, there was no eyes with visual acuity of NLP, and 19 eyes (39.6%) had a vision recovery to 20/400 or better. Mechanisms of injury, intraocular contents prolapse, presence of hyphema, intraocular foreign body, vitreous hemorrhage, retinal detachment, and total time from injury to PPV > 2 weeks were significant predictors of visual prognosis. Logistic regression analysis showed that hyphema was a significant predictive factor for poor visual outcome. Visual acuity was improved in most of the patients with OGI in this study. Hyphema is an important presenting ocular sign in estimating the post-vitrectomy visual outcome for OGI in children. Proper timing of vitrectomy is suggested, and in this study patients may benefit more with early vitrectomy as less proliferative vitreoretinopathy (PVR) was found together with a better visual acuity.

Surgical treatment of vitreoretinal complications in a patient with Stickler syndrome type 1: a case report

We present the clinical case of an 8-years-old male patient with a genetic diagnosis of Stickler syndrome type 1 and the management of associated vitreoretinal complications. The patient had an antecedent of no light perception in his left eye secondary to retinal detachment treated in another health centre. He consulted with a history of blunt trauma in his head with an unremarkable anterior segment and fundus exam. Scleral indentation showed no lesions to be treated in the right eye. We recommended follow-up every six months. The patient did not come to controls. He was consulted three years later because of visual loss in his right eye. Fundus showed a total retinal detachment secondary to a giant retinal tear of 320o with macular involvement and choroidal detachments. Therefore, scleral buckling, lensectomy, pars plana vitrectomy, inferior retinectomy, endovenous laser treatment (endolaser), and silicone oil tamponade were performed. After six weeks of follow-up, the patient presented an inferior re-detachment with grade C3 vitreoretinal proliferation. A new procedure of silicone oil removal, epiretinal membrane removal, enlargement of inferior retinectomy, endolaser, and silicone oil tamponade was indicated. After 6-months of follow-up, no new retinal detachment was presented, and the best-corrected visual acuity was 20/100.

Surgical Outcome of Refixation versus Exchange of Dislocated Intraocular Lens: A Retrospective Cohort Study.

We compared the surgical outcomes and complications of refixation vs. exchange of dislocated intraocular lenses (IOLs) in patients who underwent transscleral suture fixation combined with pars plana vitrectomy for the treatment of IOL dislocation. A total of 83 eyes (n = 83 patients) with postoperative follow-up of ≥6 months were evaluated: 40 received refixation of dislocated IOL (refixation group) while 43 received IOL exchange (exchange group) treatment. Treatment outcomes, including best-corrected visual acuity (BCVA), spherical equivalent, corneal cylinder, intraocular pressure (IOP), central macular thickness (CMT), and corneal endothelial cell density (ECD), and postoperative complications were retrospectively reviewed. BCVA improvement at 6 months after surgery was comparable between the groups. Postoperative decrease in corneal ECD was significantly greater in the exchange group than in the refixation group, but no significant differences were found in spherical equivalent, corneal cylinder, IOP, or CMT changes. The exchange group experienced significantly more frequent postoperative vitreoretinal complications, such as retinal detachment, choroidal effusion, cystoid macular edema, and secondary epiretinal membrane, than the refixation group. Without any reason to extract the dislocated IOL, reuse of the dislocated IOL would be a better surgical option for transscleral suture fixation to protect corneal endothelial cells and prevent postoperative vitreoretinal complications.

SURGICAL MANAGEMENT ON POSTERIOR UVEITIS WITH VITREOUS OPACITY SUSPECTED RETINAL DETACHMENT

Introduction: Posterior uveitis entities are varies between infective or non-infective in aetiology. It can affect the adjacent structures such as retina, vitreous, optic nerve head and retinal blood vessels. Vitreous opacity is the most common features of posterior uveitis and posterior segment evaluation is critical to determine the aetiology and management. &#x0D; Methods: Case report of 32-year-old male with gradual visual loss on right eye since 2 years ago and getting worse 1.5 months before admission. Visual acuity (VA) was hand movement. Posterior segment evaluation revealed vitreous opacity and ultrasound examination showed membrane shaped lesion attached to the optic nerve suggested retinal detachment. &#x0D; Result: Vitrectomy was done for diagnostic and therapeutic purpose. VA was remarkably improved by 6/6 and persist until 6 months post vitrectomy, and progressive improvement on posterior segment. &#x0D; Conclusion: Surgery in the management of posterior uveitis can be divided based on indication, either for therapeutic or diagnostic purposes or to manage its complications. Vitrectomy is one of the modality to manage vitreoretinal complications associated with uveitis

THE SURGICAL TREATMENT OF DIABETIC MACULOTHE SURGICAL TREATMENT OF DIABETIC MACULOPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2: EFFECTIVENESS, COMPLICATIONS, RELAPSEPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2: EFFECTIVENESS, COMPLICATIONS, RELAPSES

Relevance. It’s known a number of surgical treatment methods of diabetic maculopathy (DMP) in diabetes mellitus (DM) type 2: closed subtotal vitrectomy (CSV), which according to the testimony combined with peeling of the inner limiting membrane of the retina (ILM), panretinal laser coagulation of the retina (PRLC) and phacoemulsification of cataract (PEC).&#x0D; Objective. To study the effectiveness of different variants of vitreoretinal interventions, complications and frequency of DMP relapses in patients with type 2 diabetes.&#x0D; To study the effectiveness of different options for vitreoretinal interventions by the number of relapses of the DMP for patients with type 2 DM.&#x0D; Materials and methods. Observed 313 patients with type 2 DM (313 eyes) with DMP and primary (group 1; n=40), moderate or severe non-proliferative diabetic retinopathy (NPDR; group 2; n=92) and proliferative diabetic retinopathy (PDR; group 3; n=181). The severity of retinopathy and DMP was established under the International clinical scale of the American Academy of Ophthalmology (2002). 78 patients underwent CSV; 85 patients in addition to performing the vitrectomy was further held peeling of ILM in the macular region; 81 patient in addition to the CSV and peeling of the ILM was performed PRLC of the retina and in 69 patients additionally to all these interventions were made PEK. For statistical processing of obtained data was performed using the program Statistica 10 (StatSoft, Inc., USA).&#x0D; Results. The effectiveness of surgical treatment DMP was 70.3%; in 1st month follow-up, recurrence was observed in 23.0%; 3 months – 18.2%; 6 months – from 10.2% a year monitoring – 24.9% of patients. Efficiency of used methods was as follows: CSV – 67.9%; CSV + ILM peeling – 72.9%; CSV + ILM peeling + PRLC – 71.6%; CSV + ILM peeling + PLC + PEK – 68.1%. These differences had no statistical significance (p=0.87). Methods of treatment the recurrence rate at different periods of observation did not differ significantly; only after 1 month was more frequent relapses in patients who fulfilled the maximum number of types of operations (CSV, ILM peeling, PRLC and PEK) were 31.9% (p=0.025). When using only the CSV, and in complex use of all surgeries (CSV, ILM peeling, PRLC &amp; FEK) all recurrences were early, of which the majority (77.3 and 80.0%, respectively) had persistent. In other types of surgery, most recurrences (91-96%) were in the early persistent and late. The effectiveness of DMP surgical treatment decreased with worsening of retinopathy and was 72.5% at the primary NPDR; 77.2% at moderate or severe NPDR and 66.3% in the DPR. DPR patients had a greater frequency (33.7%) and greater severity of relapses (the number of late relapses in patients of the 3rd group was higher than that in patients of the 1st and 2nd groups in 2.3 times; p=0.001).&#x0D; Conclusion. The study showed the high effectiveness of all techniques that increasingly depended on the severity of retinopathy was the worst with PDR.

Solitary retinal capillary hemangioma with combined retinal detachment- rare presentation

Objective. To report a rare presentation of solitary retinal capillary hemangioma manifesting with combined retinal detachment as initial presentation and its successful management. Methods. A 35-year-old healthy Indian male presented with combined retinal detachment associated with solitary retinal capillary hemangioma as initial presentation; a clinical entity still not reported in literature. Patient was managed with pars plana vitrectomy combined with retinectomy, endolaser, & silicon oil tamponade with good visual & anatomical recovery. Results. Patient had good clinical outcome with final best-corrected visual acuity (BCVA) of 6/ 24 and well attached retina at last follow-up. Conclusion. Solitary retinal capillary hemangiomas can rarely present with advanced vitreo-retinal complications like combined retinal detachment as initial manifestation that can be effectively managed with skilled & appropriate surgical intervention.

Витреоретинальные осложнения ретинопатии недоношенных в отдаленный период

Витреоретинальные осложнения ретинопатии недоношенных в отдаленный период

A Case Report of Conservative Management for a Roller-Coaster-Related Vitreous Haemorrhage.

The purpose of this report is to describe the case and management of an unexplained vitreous haemorrhage that occurred after repeated roller-coaster riding. The authors inadvertently demonstrate the value of observation over immediate surgery in certain situations and review the literature on vitreoretinal and other ocular complications after roller-coaster riding. A 26-year-old male presented 12 h after riding high-velocity roller-coasters with a left vitreous haemorrhage. A hazy view of the retina and B-scan revealed a bullous area of superior-temporal retinal lifting. A diagnosis of a presumed macula-on retinal detachment was made and the patient was listed for a pars plana vitrectomy retinal detachment repair. An abnormal clotting result, which was subsequently found out to be erroneous, ultimately delayed the procedure. During this delay the vision and retinal view improved to an extent whereby the diagnosis of a retinoschisis with an intraretinal cyst was made and surgery was avoided. The patient regained 6/6 vision, without the need to undergo surgery. Historically the management of an unexplained vitreous haemorrhage was observation with serial B-scans. The current evidence and practice for treating unexplained vitreous haemorrhage have since moved towards early surgical intervention. The authors highlight that despite the current trend, a place remains for conservative management for selected cases.

Vitreoretinal Complications and Outcomes in 92 Eyes Undergoing Surgery for Modified Osteo-Odonto-Keratoprosthesis: A 10-Year Review

To analyze vitreoretinal (VR) complications and treatment outcomes in eyes undergoing modified osteo-odonto-keratoprosthesis (OOKP) surgery. Retrospective case series. All patients who underwent modified OOKP (mOOKP) surgery at a tertiary eye-care center from March 2003 to February 2013 were included. Medical records were reviewed for relevant medical history, best-corrected visual acuity (BCVA), slit-lamp examination, ultrasound scan, oral examination findings, and VR complications. The BCVA at the last visit. Optimal anatomic outcome was attached retina with a normal intraocular pressure at the last visit. A total of 92 eyes of 90 patients were included. Indications for OOKP included Stevens-Johnson syndrome (n= 53), chemical injury (n= 36), and ocular cicatricial pemphigoid (n= 3). A total of 41 eyes of 39 patients developed VR complications, including vitritis (n= 21), retinal detachment (RD) (n= 12; primary RD= 5), retroprosthetic membrane (RPM) (n= 10; primary RPM= 2), endophthalmitis (n= 8), vitreous hemorrhage (VH) (n= 5; primary VH= 1), serous choroidal detachment (n= 5), hemorrhagic choroidal detachment (n= 2), and leak-related hypotony (n= 1). Mean interval from mOOKP surgery to occurrence of VR complication(s) was 43.8 months (median, 41.9 months; range, 0.2-95.5 months). After treatment of VR complication, visual improvement was seen in 17 eyes (42%) (mean improvement= 1.2 logarithm of the minimum angle of resolution [logMAR]; median, 0.8 logMAR; range, 0.1-2.5 logMAR), visual decline in 7 eyes (14%) (mean decline in BCVA= 0.6 logMAR; median, 0.4 logMAR; range, 0.3-1.8 logMAR), and no change in BCVA in 17 eyes (42%). However, BCVA ≥6/60 was retained in 19 eyes and ≥6/18 was retained in 9 eyes after final VR treatment. Vitreoretinal complications constitute a significant cause of visual morbidity in eyes undergoing mOOKP surgery and pose a challenging situation to manage. However, appropriate and timely intervention can achieve encouraging results.

Role of Intravitreal Bevacizumab in Management of Eale's Disease.

Objective:To investigate the role of Intravitreal Bevacizumab (IVB), in preventing vitreo-retinal complications in patients of Eale’s Disease (ED).Methods:This randomized control trial was conducted at Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi from May 2015 to December 2016. A total of 52 eyes of 26 patients, diagnosed with stage I or II of ED were randomly divided in two groups. Group A received monthly injections of IVB for 3 months, with steroids and laser photocoagulation. Group B received only steroids and laser treatment. Patients were followed for three months, and were analyzed for different clinical parameters.Results:Mean age of study population was 28.5±2.64 years. Difference in frequency of patients requiring PPV and showing regression in neovascularization was statistically significant between both groups (p=0.005 for both). However, difference in frequency of patients showing progression in stage of ED, regression of vasculitis and best corrected visual acuity at 12 weeks between two groups was not statistically significant (p= 0.012, 0.579, 0.046 respectively).Conclusion:Intravitreal Bevacizumab injection, given monthly in patients of ED results in significantly more regression in neovascularization, and less requirement for PPV, as compared to those receiving standard steroids and laser photocoagulation treatment.

Prognosis, Prophylaxis and Treatment of the Postoperative Complications in Diabеtic Cataract Patients

The concept of "metabolic syndrome" in ophthalmology can include the entire set of interrelated metabolic abnormalities predisposing to the development of vitreoretinal complications of type 2 diabetes and coronary heart disease (CHD). Based on the definition, the researches of local changes in markers of metabolic processes, particularly in complicated cataract, are relevant for the prediction of the results of surgical treatment. Such a method for detecting marker proteins in tear was introduced by us in clinical practice for the differential diagnosis of local changes in metabolism in complicated (cataract caused by changes of the lens in response to background disturbances of metabolism) and age-related cataract. The mechanism of development of complicated cataracts is similar to cataractogenesis with age-related cataracts, but in complicated cataract processes of change in the lens is more intensive and faster under the influence of a violation of the immunological balance, oxidative processes and biochemical changes that occur in the body and locally on a background of concomitant diseases and diseases of the eye.&#x0D; At the present stage it is believed that one of the triggers is cataractogenesis depletion of the antioxidant capacity of the lens and the development of oxidative stress. This manifests itself in the early stages cataractogenesis fluctuations in the level of glutathione in the lens and the accumulation of free radical oxidation products. Following this, a reduction in the number of negative charges on the main protein of lens fiber - crystallin. This fact is interpreted as a violation of protein phosphorylation within the fibers of the lens due to discoordination cascade regulation systems due to their free radical damage. In turn, decrease the water solubility of proteins leads to the adsorption of proteins on the uncharged cell membranes, resulting in increasing lens violation regular stacking membranes. Light scattering by surfaces of folded membranes lens fiber is considered as the main cause of lens opacity with cataract.&#x0D; We examined 136 patients with cataracts of various origins (272 eyes) aged 62 ± 3,2 years. Among those surveyed were women (74 people). All patients underwent detailed clinical, ophthalmological examination of the complex and as a result were divided into groups with a diagnosis of cataracts of&#x0D; various origins. We have developed an algorithm for determining the prognosis of outcome of surgical intervention in the oxidative stress on the content of antioxidant enzymes tears justified selective choice of preparations of local and systemic antioxidant action to prevent and stabilize the clouding of the lens.&#x0D; The greatest number of complications arise in the extraction of complicated cataract, because its development is already associated with the presence of an underlying disease (a disorder of metabolism, endocrine disorders), additional ocular pathology (uveitis syndrome Fuchs, secondary glaucoma), the influence of external factors. This kind of state characterized by the presence of pathological changes in the immune, circulatory system, metabolic disorders, entailing and cause various postoperative complications (hyphema, postoperative iridocyclitis, exudative inflammatory response (EVR), epithelial-endothelial corneal dystrophy, macular edema with the outcome in macular degeneration). It becomes apparent that the creation of methods of forecasting and prevention of post-operative complications, as well as specific algorithm scheme of preoperative preparation, at various kinds of complicated cataract, is an important and urgent problem of modern ophthalmology.