Retina-The Journal of Retinal and Vitreous Diseases最新文献

Purpose: In October 2023, other cases with early silicone oil opacification within hours after intraocular implantation in the absence of emulsification occurred. While multiple, small series of this phenomenon are now documented during the last decade, the cause was never unmasked. In this study, we analyzed explanted patient samples, unused samples of the affected, and a control batch of the same silicone oil.

Methods: The oils were examined on their optical and viscosimetric properties, interfacial tension and for presence of particles. Contamination was investigated using Inductively Coupled Plasma - Mass Spectrometry, thermogravimetric analyses, and Raman-spectroscopy. Cytotoxicity examination in ARPE-19 cells was performed. The oil's effect on pH-changes of aqueous solutions and the oil's defoaming ability were analyzed.

Results: The affected batch passed all regulatory limits. However, the affected batch showed an elevated turbidity already before implantation. 3000-fold magnification revealed dispersed particles only in the affected batch. Contamination analyses revealed the absence of other elements indicating a silicon-containing contamination. The affected batch showed no in-vitro cytotoxicity but altered viscosimetric properties and a lower pH of the hydrophilic phase after inducing emulsification. Both batches did not show relevant defoaming properties.

Conclusion: The results obtained combined with information from suppliers and the manufacturer suggest an elevated level of silica particles as the cause of the opacification. Based on these results, the manufacturer and suppliers of the latest affected batch adjusted cut-off values for turbidity measurements and introduced turbidity measurements of the raw material prior to distillation. Other manufacturers should follow these preventive measures.

Purpose: To present a novel intraoperative technique using a flute needle to induce posterior vitreous detachment (PVD) in pediatric retinal cases.

Methods: Following 23-gauge pars plana vitrectomy in pediatric eyes with complex vitreoretinal disease, triamcinolone is applied for staining, and vitreous hydro-dissection is performed. A flute needle containing basic salt solution (BSS) is introduced to separate the thin residual posterior vitreous cortex from the retina near the vascular arcades. Gentle taps allow balanced salt solution (BSS) to enter the vitreous crevice, with controlled oscillation facilitating separation. PVD is then induced, and the vitrector is used to lift and complete the detachment.

Results: Vitreous hydro-dissection with a flute needle was effective in inducing PVD in pediatric eyes with complex vitreoretinal disease. We report no intraoperative or postoperative complications.

Conclusion: This adjuvant vitreous hydro-dissection technique facilitates PVD induction and may reduce the associated risk of iatrogenic retinal damage.

Purpose: To describe the clinical characteristics of choroidal metastasis (CM) in non-small cell lung carcinoma (NSCLC) patients and report treatment outcomes following targeted therapy versus conventional radiotherapy and/or chemotherapy.

Methods: A retrospective review was conducted in two hospitals in Hong Kong between 2013-2023. Outcomes included tumor response and visual function following treatment.

Results: A total of 25 eyes of 21 Chinese patients with CM secondary to metastatic NSCLC were identified. The majority of patients were non-smokers. At the time of diagnosis, 88% of eyes were visually symptomatic with a mean visual acuity of 20/100. There were 52% of tumors locating within the macula. TKI monotherapy, TKI with radiotherapy and radiotherapy and/or chemotherapy groups were observed to demonstrate similar tumor response from 1 month, and comparable ocular progression-free indices. Untreated patients had deteriorated vision without any tumor response. Tyrosine kinase inhibitor (TKI) monotherapy group achieved the most rapid and differential vision gain than other groups.

Conclusion: TKI achieved durable disease control in epidermal growth factor receptor mutation positive NSCLC patients with CM, while improving visual function. TKI can be considered as an alternative to conventional orbital radiotherapy or chemotherapy for these patients in view of the rapid visual recovery.

Purpose: To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL).

Methods: Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery.

Results: 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion.

Conclusions: In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

Purpose: To study the effectiveness and safety of pneumatic vitreolysis (PVL) for the treatment of symptomatic vitreomacular traction (VMT) and macular holes (MHs) with VMT.

Methods: This was a retrospective, monocentric analysis of 92 consecutive VMT (±MH) patients treated with PVL at University Hospitals Leuven between January 2022 and March 2024.

Results: Release of VMT occurred in 60% of the patients who had VMT and in 86% of the patients who had MHs. MH closure occurred in 29% of the small MHs. Lens status was the only predictor of VMT release, with an odds ratio of 0.232 for pseudophakia (p = 0.013). Successful PVL was associated with significant improvements in the best-corrected visual acuity (BCVA) in patients with VMT (p = 0.007) and in patients with MHs (p = 0.034). Two patients (2.2%) suffered a retinal tear, one of which led to retinal detachment. Two patients with VMT (3.17%) developed a MH.

Conclusions: PVL using the injection of 0.2 cc of C2F6 and subsequent posturing appears to be beneficial with limited complications for symptomatic focal VMT and for (very) small MHs with VMT, especially in phakic patients. The complication rate in this study was lower than that previously reported.

Purpose: The objective of this study is to report on the incidence and the characteristics of eccentric macular hole (EMH) as a complication of macular surgery with internal limiting membrane (ILM) peeling in a black African population.

Methods: This is a retrospective consecutive case series. Files of 125 patients that received macular surgery were reviewed and 14 eyes of 14 patients were included in this study. Intervention consisted of pars plana vitrectomy with ILM peeling for full-thickness macular hole or epiretinal membrane. The main outcome measures were the development of EMH, their characteristics (location, number) and best-corrected visual acuity (BCVA).

Results: EMH developed in 14 eyes of 14 patients with a mean age of 64.5±9.4 years and a female predominance of 64%. The incidence of EMH was 11.2%. EMH developed on average 4.4±1.2 weeks following surgery. In 9 eyes (65%) location was temporal, in 3 eyes (21%) superotemporal and in 2 eyes (14%) inferotemporal. Multiple holes were observed in 12 eyes (86%), and 5 eyes (35%) had confluent holes. 9 eyes (64%) had only full-thickness holes, 4 eyes (29%) had both full-thickness and lamellar holes, and 1 eye (7%) had only lamellar holes. BCVA improved from 1.1±0.33logMAR to 0.89±0.26logMAR (p=0.017).

Conclusion: EMH formation showed a very high incidence in our setting and represents a main complication for macular surgery. In all cases, EMH formed in the temporal macula and in the majority of cases they were multiple and full-thickness.

Purpose: To characterize changes in macular structure and vascularity seen in premature-birth adults.

Methods: Retrospective review of adult patients seen in our clinic from July 2018 to November 2020 with history of premature birth not requiring treatment for retinopathy of prematurity (ROP), as well as healthy controls. Swept-source OCT-angiography (OCT-A) scans were analyzed for various parameters related to macular structure and vascularity. Statistical analysis was performed using univariate linear regression.

Results: Thirty-four eyes were included (17 eyes from 10 premature-birth adults, 17 eyes from 11 control patients). Prematurity was associated with vascular changes on OCT-A: decreased foveal avascular zone (FAZ) area (p=0.001), decreased FAZ circularity index (p<0.001), decreased superficial capillary plexus vessel (CPV) density (p=0.02), and decreased deep CPV density (p<0.001). Prematurity was also associated with structural changes: shallower foveal pit depth (p<0.001), decreased cube average thickness (CAT) (p=0.005), and increased central subfield thickness-to-CAT ratio (p=0.002).

Conclusions: This is the largest published series of OCT-A data for premature-birth adults. Even without a history of ROP treatment, premature birth is associated with multiple changes to macular structure and vascularity that persist into adulthood. These include a smaller, more irregularly shaped FAZ, decreased juxtafoveal vascular density, and a shallower foveal pit.