Electroretinogram changes before and after silicone oil removal in eyes with macula-off rhegmatogenous retinal detachment

Background: Pars plana vitrectomy (PPV) with silicone oil (SO) injection for rhegmatogenous retinal detachment (RRD) repair may adversely affect electroretinographic responses. This study was aimed at assessing retinal function using electrodiagnostic testing after successful PPV with SO tamponade in the eyes with macula-off RRD. Methods: In this interventional comparative study, eligible participants were recruited prospectively over 1 year. We included the eyes that underwent a single successful three-port PPV with SO tamponade for the primary repair of macula-off RRD. Full-field electroretinogram (ffERG) and multifocal electroretinogram (mfERG) were recorded 1 day before and 3 days after SO removal. The amplitude and implicit time of the a- and b-waves for ffERG and P1 and N1 waves for mfERG were evaluated. The unaffected fellow eyes of the patients were selected as controls. Results: We included the ten eyes of ten patients (seven men and three women) with a mean (standard deviation) age of 58.8 (6.2) years. The mean (SD) interval between the diagnoses of macula-off RRD and PPV was 11.7 (3.6) days. The mean (SD) duration of SO tamponade was 147.8 (34.9) days. Using ffERG, significantly lower a- and b-wave amplitudes were found in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P < 0.05). Using the mfERG, treated eyes had significantly lower P1 amplitudes in the central R1+R2+R3 rings and in the R4 and-R5 peripheral rings of the macular area in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P < 0.05). The wave implicit time in ffERG and mfERG did not differ significantly in the eyes before and after SO removal or compared to the unaffected fellow eyes (all P > 0.05). Conclusions: The electrical retinal response density in ERG waveforms increased following SO removal, indicating amelioration of the electrical activity of the retina and macula. These results indicate that the adverse effects of SO tamponade on electroretinography responses may be reversible with removal. In addition, ffERG and mfERG can be used to monitor retinal function in the eyes with macula-off RRD and SO tamponade. Further clinical trials are required to verify the preliminary findings of this study

Living with satisfactory vision and no comorbidity 28 years after bilateral retinoblastoma: a case report and mini literature review

Background: Retinoblastoma is the most common primary intraocular malignancy in children, although it is a rare neural retinal tumor. Improving the quality of life is the next goal after the primary medical goal of life preservation. The genotype-phenotype correlation may vary with the progression of retinoblastoma. Expressivity is determined by different RB1 gene mutations among individuals. Herein, we share our experience on the evaluation of the long-term progression of retinoblastoma, its treatment consequences, its impact on the quality of life, and how the underlying genotypes are related to the phenotypes. We provide a review of the relevant literature and present a case of a sporadic heritable bilateral retinoblastoma. Case Presentation: We report the outcomes of a 28-year follow-up of a female diagnosed with an infantile disease. The patient’s best eye, according to the tumor classification and genetic results, was treated conservatively whereas the worst eye was enucleated. On re-examinations, she had complications of the treatment she received. Therefore, another intervention was administered for several years. The patient’s pathogenic variant and RB1 gene mutational inactivation were predispositions to the recurrence of the tumor and non-ocular primary malignancy. Nevertheless, the disease had no progression. The patient is stable despite her type of retinoblastoma, which is the sporadic heritable bilateral form. Conclusions: Each phenotype of bilateral retinoblastoma varies in progression. The nature of the genetic mutation may determine its expressivity. It is of great significance to individualize every decision. In each case, the sequelae of the disease and treatment-induced complications may have an impact on the quality of the patient’s life

Radial peripapillary capillary density as a predictive factor for glaucoma in eyes with ocular hypertension. An observational, comparative, single-centred study [version 1; peer review: 1 approved, 2 approved with reservations]

Background: Ocular hypertension (OH) is a condition characterized by elevated intraocular pressure (IOP) exceeding the normal range, without any evident damage to the optic nerve or visual field defects characteristic of glaucoma. It constitutes a significant precursor to the development of glaucoma, a leading cause of irreversible vision loss worldwide. Emerging evidence has shown that microcirculation alterations in eyes with OH could serve as predicting factors to identify eyes at high risk for progression to glaucoma. In view of the above, the purpose of our study is to investigate microcirculation alterations of the radial peripapillary capillary plexus using optical coherence tomography angiography (OCT-A) in patients with ocular hypertension (OH). Methods: A total of 192 eyes were included in this observational, comparative, single-centre study and were divided in two groups: OH eyes and healthy controls. OCT-A was performed to analyze microcirculation characteristics at the peripapillary area. Radial peripapillary capillary density was measured at the total area of the optic disc and at each separate region (superior, inferior, inside). The parameters of age, medical treatment for ocular hypertension, sex and retinal fiber layer thickness were evaluated.  Results: Total radial peripapillary capillary density was significantly lower in patients with OH than in healthy controls Concerning the microcirculation characteristics at each separate region of the peripapillary area, the results were as follows: inferior radial peripapillary capillary density was significantly decreased in individuals with OH than in controls, while measurements in the superior peripapillary area and internal optic disc were similar in both groups.   Conclusions: Our study indicates decreased radial peripapillary capillary density in eyes with OH. Microcirculation alterations in the inferior peripapillary area could potentially comprise biomarkers for OH progression to glaucoma

The contribution of the current imaging technology to the study of morphological and microcirculation characteristics of chorioretinal surgical pathology and their association with functional outcomes

Purpose: To evaluate macular capillary plexus changes with OCT-Angiography of eyes undergoing pars plana vitrectomy with gas tamponade for rhegmatogenous retinal detachment repair.Methods: Retrospective, case-control study of eyes following vitrectomy for rhegmatogenous retinal detachment examined at the Vitreoretinal Department of the Ophthalmology Clinic at the University Hospital of Ioannina (Greece). 63 eyes of 63 patients were included in the analysis. The patients were divided in three groups with regards to the macular condition and the retinal detachment duration before surgery. Group A included 17 cases of rhegmatogenous retinal detachment without macular involvement (macula-on), group B and C included cases of retinal detachment with macular involvement (macula-off) and duration of 0-10 days (21 eyes) and of 11-30 days (25 eyes), respectively. All eyes underwent a single successful pars plana vitrectomy with gas tamponade. We analyzed the OCT-Angiography characteristics with regards to macular miscrostructural and microcirculation changes, and visual outcomes at 12 and 48 weeks postoperatively. The fellow eye was used as control for comparisons.Results: Vessel density and flow density in the superficial capillary plexus were significantly higher (p<0.001) in group A compared to group B and C at the full macular area and at each separate region (fovea, parafovea, perifovea). Foveal avascular zone area and perimeter were significantly smaller (p<0.001) with higher circularity in group A as compared to group B and C. There was a significantly positive correlation of flow density at the superficial capillary plexus with postoperative visual acuity in group A (p=0.028). There was a significantly positive correlation of vessel density and flow density at the superficial capillary plexus with postoperative visual acuity in group C (p<0.001), though not in group B. All the above results were identified at both 12 and at 48 weeks after vitrectomy. Conclusions: Analyzing microcirculation characteristics of the macula after rhegmatogenous retinal detachment utilizing OCT-Angiography may lead to significant observations that contribute to pivotal decisions concerning management and treatment options for these patients. Macula-off rhegmatogenous retinal detachment may cause functional retinal changes even after successful anatomical reattachment. The macular detachment duration could be a predicting factor of flow density in macular capillary plexus which in turn may be an indicator of visual outcomes in chronic cases.Σκοπός: Η παρούσα διατριβή αφορά στη συμβολή της σύγχρονης τεχνολογίας, και συγκεκριμένα της OCT-Aγγειογραφίας στην απεικόνιση των μορφολογικών χαρακτηριστικών και των μεταβολών της αγγείωσης του αμφιβληστροειδούς στην περιοχή της ωχράς σε περιπτώσεις ρηγματογενούς αποκόλλησης αμφιβληστροειδούς. Οι ασθενείς που συμπεριλήφθηκαν στη μελέτη μας είχαν υποβληθεί σε χειρουργική θεραπεία με υαλοειδεκτομή δια της pars plana με επιπωματισμό με διαστελλόμενο αέριο για ανατομική αποκατάσταση του αμφιβληστροειδούς. Πραγματοποιήθηκε λεπτομερής εξέταση των παραμέτρων της μικροκυκλοφορίας στην περιοχή της ωχράς και συσχέτιση των αποτελεσμάτων με τη λειτουργικότητα όσον αφορά την όραση.Υλικό και μέθοδοι: Μελετήθηκαν αναδρομικά 63 ασθενείς με ρηγματογενή αποκόλληση αμφιβληστροειδούς που είχαν υποβληθεί σε υαλοειδεκτομή δια της pars plana με επιπωματισμό με τη χρήση διαστελλόμενου αερίου. Οι οφθαλμοί που συμπεριλήφθηκαν στη μελέτη διαχωρίστηκαν σε υποομάδες ανάλογα με τη συμμετοχή της ωχράς στην αποκόλληση και την προεγχειρητική διάρκεια της αποκόλλησης αμφιβληστροειδούς. Η πρώτη (Α) ομάδα περιλάμβανε 17 οφθαλμούς με ρηγματογενή αποκόλληση αμφιβληστροειδούς χωρίς συμμετοχή της ωχράς, ενώ όλοι οι ασθενείς σε αυτή την ομάδα είχαν διάρκεια αποκόλλησης αμφιβληστροειδούς έως 10 ημέρες. Η δεύτερη (Β) και Τρίτη (Γ) ομάδα περιλάμβανε συνολικά 46 οφθαλμούς (Β: 21 οφθαλμοί, Γ: 25 οφθαλμοί) με ρηγματογενή αποκόλληση αμφιβληστροειδούς με συμμετοχή της ωχράς, ενώ η προεγχειρητική διάρκεια της αποκόλλησης ήταν 0-10 ημέρες για τη δεύτερη και 11-30 ημέρες για την τρίτη ομάδα πριν τη χειρουργική αποκατάσταση. Μετεγχειρητικά, πραγματοποιήθηκε πλήρης απεικονιστικός έλεγχος με τη χρήση της OCT-Αγγειογραφίας στις 12 και στις 48 εβδομάδες. Οι σαρώσεις της αγγειογραφίας λήφθηκαν σε διαστάσεις 6x6 mm με κέντρο την ωχρά. Στο επιπολής τριχοειδικό αγγειακό δίκτυο, μελετήθηκε η πυκνότητα των αγγείων και η πυκνότητα της αιμάτωσης των τριχοειδών στην περιοχή της ωχράς και στις επιμέρους ανατομικές ζώνες της (κεντρικό βοθρίο, παραωχρική, περιωχρική περιοχή). Επιπλέον, καταγράφηκαν οι παράμετροι που σχετίζονται με την περιοχή της βοθρικής αναγγείου ζώνης (εμβαδόν, περίμετρος, κυκλικότητα). Στο εν τω βάθει τριχοειδικό αγγειακό δίκτυο, μετρήθηκε η περιοχή της αναγγείου ζώνης και η πυκνότητα της αγγείωσης με τη χρήση ειδικού λογισμικού προγράμματος (Image J). Ο έτερος ασυμπτωματικός οφθαλμός χρησιμοποιήθηκε για συγκρίσεις. Αποτελέσματα: Οι μετρήσεις της πυκνότητας αγγείωσης και της πυκνότητας αιμάτωσης τριχοειδών στην περιοχή της ωχράς καθώς και στις επιμέρους περιοχές της (κεντρικά, παραωχρικά, περιωχρικά) είναι στατιστικώς σημαντικά υψηλότερες (p<0.001) στους οφθαλμούς της ομάδας Α σε σύγκριση με τους οφθαλμούς της ομάδας Β, των οποίων οι τιμές είναι στατιστικώς σημαντικά υψηλότερες από τις τιμές της ομάδας Γ. Επιπλέον, η ανάγγειος ζώνη της ωχράς έχει στατιστικώς σημαντικά χαμηλότερες τιμές (p<0.001) της έκτασης και της περιμέτρου της με υψηλότερη κυκλικότητα στην ομάδα Α, σε σύγκριση με την ομάδα Β και Γ. Παρατηρήθηκε στατιστικώς σημαντική θετική συσχέτιση (p=0.028) της τριχοειδικής αιμάτωσης του επιπολής τριχοειδικού αγγειακού δικτύου με τη μετεγχειρητική οπτική οξύτητα στους οφθαλμούς της Α ομάδας. Επιπλέον, παρατηρήθηκε στατιστικώς σημαντική θετική συσχέτιση της τριχοειδικής πυκνότητας και αιμάτωσης του επιπολής τριχοειδικού αγγειακού δικτύου με τη μετεγχειρητική οπτική οξύτητα στους οφθαλμούς της Γ ομάδας (p<0.001), το οποίο δεν επιβεβαιώθηκε για τους οφθαλμούς της ομάδας Β. Τα ανωτέρω αποτελέσματα επιβεβαιώθηκαν τόσο για τις 12, όσο και για τις 48 εβδομάδες μετεγχειρητικά.Συμπεράσματα: Η έρευνα και η ανάλυση παραγόντων που σχετίζονται με την αγγείωση και τη μορφολογία της περιοχής της ωχράς θα μπορούσαν μελλοντικά να χρησιμοποιηθούν ως προγνωστικοί βιοδείκτες για την πρόγνωση της πάθησης και την πορεία της μετεγχειρητικής οπτικής οξύτητας, αλλά και να φανούν χρήσιμοι στη λήψη έγκαιρων και κατάλληλων θεραπευτικών αποφάσεων. Οι διαταραχές της λειτουργικότητας αλλά και της αρχιτεκτονικής των ανωτέρω δομών επηρεάζουν την έκβαση της όρασης σε βαθμό ανάλογο με τη βαρύτητα της προσβολής και της χρονιότητας της πάθησης και καθορίζουν την ποιότητα ζωής των ασθενών

Multiple Types Late-Onset Postoperative Retinal Folds following Vitrectomy for Retinal Detachment Repair with Silicone Oil: Morphologic Variability and Optical Coherence Tomography Angiography Features – A Case Report

Introduction: Retinal folds (RFs) may develop following rhegmatogenous retinal detachment (RRD) repair, though it consists an uncommon complication. Case Presentation: Herein, we present a case of late-onset postoperative outer RFs with aggravating characteristics following vitrectomy with silicone oil (SO) tamponade for RRD repair; early clinical findings, complications, anatomical and functional status during a 12-month follow-up period are described. Retinal imaging by acquiring optical coherence tomography scans and angiograms indicates detailed morphological and angiographic characteristics of the evolution of RFs over time. Our case provides insight into a combination of various types of RFs along with retinal disorganization with appearance in the late postoperative period after RRD repair with SO tamponade. Conclusion: Our aim was to raise awareness of the pathological processes that may be associated with the development and evolution of RFs after successful RRD repair, indicating that it is critical to accurately diagnose the type of RFs and closely monitor their progression in an attempt to provide prognostication for future visual outcomes

Effect of silicone oil on retinal microcirculation after vitrectomy for rhegmatogenous retinal detachment evaluated by OCT angiography: a literature review

Silicone oil (SO) has been widely used as intravitreal tamponade agent for rhegmatogenous retinal detachment (RRD) and has been occasionally associated with incomplete retinal structural and functional recovery. The use of Optical Coherence Tomography Angiography (OCT-A) has recently attracted significant attention for detailed analysis of retinal capillary plexus and blood flow changes as predicting factors for postoperative outcomes. A detailed literature search was performed in PubMed database until October 2022. The following keywords were used: rhegmatogenous retinal detachment, silicone oil, optical coherence tomography angiography, macular microvasculature, peripapillary capillary plexus, vessel density, and foveal avascular zone. We identified and reviewed 19 studies referring to microcirculation alterations of the retinal capillary plexus as seen on OCT-A in eyes treated by vitrectomy with intravitreal SO for RRD. A comprehensive update revealed variability of microcirculation characteristics of the retinal capillary plexus including the macular and the peripapillary capillaries. Further studies are warranted to clarify the OCT-A values in an attempt to identify the potential effect of SO on retinal tissue in clinical practice. A review of the existing literature sheds light on the effect of SO on retinal capillary plexus and the potential impact on functional outcomes after vitrectomy for RRD. This article discusses important aspects of key publications on the topic, highlights the importance to identify distinct alterations of the microvasculature status, and proposes the need for further future research in this field

Sensitivity of spectral domain optical coherence tomography in the diagnosis of posterior vitreous detachment in vitreomacular interface disorders: A prospective cohort study

Purpose: To evaluate the sensitivity of Spectral Domain Optical Coherence Tomography (SD-OCT) regarding the diagnosis of posterior vitreous detachment (PVD) in vitreomacular interface disorders (VID). Methods: A total of 48 eyes of 48 patients were included in this prospective cohort study. PVD in eyes with VID was investigated. We determined the status of posterior vitreous cortex using slit lamp (SL) biomicroscopy and SD-OCT preoperatively, during vitrectomy and on the intraoperative video recording. Sensitivity and specificity of the examining methods were analysed. Four masked independent examiners participated in this study. Results: PVD was diagnosed in 16 eyes (33.3%) on SD-OCT, 20 eyes (41.7%) on SL examination and 28 eyes (58.3%) during vitrectomy. Sensitivity and specificity for diagnosis of PVD was 37.5% and 31.3% using SD-OCT, 90% and 64.3% on the SL examination, 92.9% and 90% on the video recording respectively, compared to the intraoperative PVD diagnosis. Conclusion: SD-OCT shows a relatively low detection sensitivity of PVD in VID. Thorough OCT investigation is necessary to establish an appropriate diagnosis of PVD and treatment in VID