Central retinal vessel blood flow after surgical treatment for central retinal vein occlusion.

Item does not contain fulltextPURPOSE: The purpose of this study was to determine the effect of radial optic neurotomy and retinal endovascular surgery on retinal blood flow velocity in patients with central retinal vein occlusion. METHODS: A prospective interventional case series. RESULTS: Six patients with a central retinal vein occlusion of <12 months' duration were included. Three patients were treated with radial optic neurotomy and three with retinal endovascular surgery. Five patients had decreased central venous blood flow velocity compared with the fellow eye, and one patient had similar central venous blood flow in both eyes at baseline. All study eyes had decreased central venous blood flow velocity compared with the fellow eye at 24 weeks after treatment. Two patients had a further decrease in central venous blood flow during the study. Three patients had no minimal change in central venous blood flow, and 1 patient showed a minimal increase from 3 cm/s at baseline to 4 cm/s 24 weeks after surgery. CONCLUSION: Radial optic neurotomy and retinal endovascular surgery do not alter central retinal blood flow velocity. The place of these therapies in the treatment for central retinal vein occlusion should be questioned

Silicone oil versus gas tamponade for giant retinal tear-associated fovea-sparing retinal detachment: A comparison of outcome

PurposeSilicone oil is the most common choice of tamponade agent used when managing a giant retinal tear (GRT). Concern exists regarding its potential detrimental effect on vision. We herein report on visual and surgical outcomes of all patients treated at Moorfields Eye Hospital for a GRT over a five year period. We further analysed a subgroup of fovea-sparing retinal detachments (RD) treated by pars plana vitrectomy (PPV) with either silicone oil or gas tamponade.MethodsRetrospective comparative, non-randomised, cross-sectional review of patients with a new diagnosis of GRT from 1 September 2005 to 31 August 2010ResultsOne hundred twenty four eyes of 118 patients were identified with mean age of 45.5 years and median follow-up of 24 months. Subgroup analysis of fovea-sparing RDs (Silicone Oil n=49, Gas n=15) revealed visual loss (≥2 Snellen Lines of vision) in 49.0% (n=24) of patients managed with oil compared to 13.3% (n=2) of gas patients (P=0.019). In all, 73.3% (n=11) in the gas group achieved a final vision of 6/12 or better, compared to 36.7% (n=18) in the oil group (P=0.031). No difference was observed in eventual or primary anatomical success rate (100 vs 93.9%, and 66.7 vs 79.6%, gas vs oil, respectively, (P&gt;0.1)). Postoperative complications were absent in 66.7% (n=10) of gas patients compared with 14.3% (n=7) of oil patients (P=0.002). Multiple variable linear regression determined tamponade choice as the only variable predictive of final visual acuity (P=0.046).ConclusionEyes with fovea-sparing GRT-related RDs managed with gas achieved a better visual outcome with fewer postoperative complications and no significant difference in anatomical success. A multicentre approach to investigate this further is advised. © 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved

Pars Plana Vitrectomy and Lensectomy for Ectopia Lentis with and without the Induction of a Posterior Vitreous Detachment

Purpose: Posterior hyaloid removal during pars plana vitrectomy and lensectomy for ectopia lentis is commonly performed, but may increase the risk of intraoperative retinal breaks and postoperative retinal detachment. This study evaluated outcomes after pars plana vitrectomy and lensectomy with or without posterior hyaloid removal. Methods: This retrospective observational cohort study included ectopia lentis cases that underwent pars plana vitrectomy and lensectomy (2005-2014), with or without intraoperative induction of a posterior vitreous detachment (PVD). The primary outcome was postoperative retinal detachment. The secondary outcomes were the incidence of iatrogenic retinal breaks, and change in visual acuity. Results: Twenty-six cases were included. The posterior hyaloid was preserved intraoperatively in 11 cases (non-PVD group). In the remainder (15 cases), the vitreous was removed completely (PVD group). Postoperative retinal detachment occurred in 2 cases in each group (18.2% non-PVD vs.13.3% PVD, P = 0.7). Intraoperative breaks occurred more frequently in the PVD group (2 vs. 9 cases; P = 0.03). There was no difference in mean improvement in visual acuity (7 [PVD] vs. 3 [non-PVD] ETDRS lines; P = 0.2). Conclusion: The preservation of posterior hyaloid attachment during vitreolensectomy for ectopia lentis was associated with fewer iatrogenic retinal breaks. Postoperative retinal detachment did not seem to be influenced by the choice of surgical technique. © Ophthalmic Communications Society, Inc

The role of internal limiting membrane peeling in epiretinal membrane surgery: A randomised controlled trial

Purpose To compare the anatomical and functional outcomes after primary idiopathic epiretinal membrane (ERM) peeling with or without internal limiting membrane (ILM) peeling. Design A two-centre randomised, controlled clinical trial with 12 months of follow-up. Methods One hundred and two eyes of 102 patients were included in the analysis and were randomised into two groups (ILM peeling (P) and non-ILM peeling (NP) group). Inclusion criteria were: Idiopathic ERM confirmed on optical coherence tomography, age ≥18 years, binocular distortion, best-corrected visual acuity (BCVA) ≤90 ETDRS letters, intraocular pressure ≤23 mm Hg and informed consent. The primary outcome measure was the mean change in the ETDRS distance BCVA at 12 months&apos; follow-up for each group. Results The mean change in distance BCVA at 12 months was 0.30±0.24 logMAR (15 ETDRS letters) in the P group and 0.31±0.23 logMAR (14 ETDRS letters) in the NP group, a change that was not statistically significant (p=0.84). No statistically significant differences were observed when comparing the changes in distance BCVA, the changes in metamorphopsia (Amsler grid) and the changes in central retinal thickness between the two groups at any of the time points studied. Conclusions Our analysis suggests that ILM peeling in idiopathic ERM surgery does not result in better visual improvement. The more frequent presence of an uninterrupted interdigitation zone in the P group did not result in a better functional outcome of our patients. No recurrent ERMs were noted in either group. © 2016 Published by the BMJ Publishing Group Limited

Pars Plana Vitrectomy for Vitreomacular Traction Syndrome: Analysing the Preoperative Prognostic Factors

Purpose: To identify the prognostic factors affecting the surgical outcomes in patients with vitreomacular traction syndrome undergoing pars plana vitrectomy. Methods: This was a retrospective clinical study of 67 eyes of 67 patients with vitreomacular traction syndrome who underwent pars plana vitrectomy. Demographic, clinical, and optical coherence tomography (OCT) characteristics were collected and analyzed. Univariate and multivariate linear regression analysis were used to examine the effect of parameters on change in best-corrected visual acuity (BCVA). Results: At a mean follow-up period of 15.9±12 months (mean±SD), the BCVA improved from 0.7±0.3 LogMAR (mean±SD) to 0.5±0.3. Seven patients developed full-thickness macular hole intraoperatively and tamponade (air, 20% SF6 or 12% C3F8) was used in 41 patients. Retinal breaks were identified intraoperatively in four patients. Regression analysis demonstrated that the preoperative BCVA was the only parameter affecting the postoperative visual outcome. Conclusion: In the present study, the preoperative BCVA plays a predictive role in the surgical outcome of patients with VMT undergoing pars plana vitrectomy. No other preoperative OCT characteristics demonstrated prognostic potential. Further prospective studies are needed in order to examine the role of several factors that could potentially facilitate preoperative patient counselling. © Taylor &amp; Francis

Genome-wide association study identifies genetic risk underlying primary rhegmatogenous retinal detachment

Item does not contain fulltextRhegmatogenous retinal detachment (RRD) is an important cause of vision loss and can potentially lead to blindness. The underlying pathogenesis is complex and incompletely understood. We applied a two-stage genetic association discovery phase followed by a replication phase in a combined total of 2833 RRD cases and 7871 controls. The discovery phase involved a genome-wide association scan of 867 affected individuals and 1953 controls from Scotland, followed by genotyping and testing 4347 highest ranking or candidate single nucleotide polymorphisms (SNPs) in independent sets of cases (1000) and controls (2912) of Dutch and British origin. None of the SNPs selected reached a Bonferroni-corrected threshold for significance (P < 1.27 x 10(-7)). The strongest association, for rs12960119 (P = 1.58 x 10(-7)) located within an intron of the SS18 gene. Further testing was carried out in independent case-control series from London (846 cases) and Croatia (120 cases). The combined meta-analysis identified one association reaching genome-wide significance for rs267738 (OR = 1.29, P = 2.11 x 10(-8)), a missense coding SNP and eQTL for CERS2 encoding the protein ceramide synthase 2. Several of the top signals showing suggestive significance in the combined meta-analysis encompassed genes with a documented role in cell adhesion or migration, including SS18, TIAM1, TSTA3 and LDB2, which warrant further investigation. This first genetic association study of RRD supports a polygenic component underlying RRD risk since 27.4% of the underlying RRD liability could be explained by the collective additive effects of the genotyped SNP from the discovery genome-wide scan