La chirurgie combinée phacoémulsification/pelage de membrane épirétinienne et oedème maculaire [Combined phacoemulsification/membrane resection and macular edema].

PURPOSE: To evaluate the occurrence of macular edema (ME) after epiretinal membrane resection, managed either with simple vitrectomy or with combined vitrectomy and phacoemulsification. MATERIAL AND METHODS: Two groups of 12 patients had a vitrectomy for epiretinal membrane associated or not to a phacoemulsification. A fundus fluorescein angiography was performed pre and postoperatively and at least 3 months after the surgery. RESULTS: In the group of patients who had a simple vitrectomy, a ME was observed in 50% of the cases preoperatively and in 25% of the cases at the end of follow-up. In 3 cases, preoperative ME was worsened after the surgery. In the group of patients who were treated by a combined vitrectomy and phacoemulsification, a ME was observed in 25% of the cases preoperatively and in 50% of the cases at the end of follow-up. A de novo ME was observed in 3 cases. CONCLUSION: Combined vitrectomy and cataract surgery could allow a rapid recovery of visual acuity but might increase the occurrence of ME.

Freshwater sponge spicules: a new agent of ocular pathology

In a recent outbreak of human ocular injuries that occurred in the town of Araguatins, at the right bank of Araguaia river, state of Tocantins, Brazil, along the low water period of 2005, two patients (8 and 12-year-old boys) presented inferior adherent leukoma in the left eye (OS), and peripherical uveites, with snowbanking in the inferior pars plana. The third one (13-year-old girl) showed posterior uveites in OS, also with snowbanking. Histopathological analysis of lensectomy material from the three patients and vitrectomy from the last one revealed several silicious spicules (gemmoscleres) of the freshwater sponges Drulia uruguayensis and D. ctenosclera. This work brings material evidences, for the first time in the literature, that freshwater sponge spicules may be a surprising new etiological agent of ocular pathology.

Modern cataract surgery for radiation-induced cataracts in retinoblastoma.

Background Surgery of radiation-induced cataracts in children with retinoblastoma (RB) is a challenge as early intervention is weighted against the need to delay surgery until complete tumour control is obtained. This study analyses the safety and functional results of such surgery. Methods In a retrospective, non-comparative, consecutive case series, we reviewed medical records of RB patients </=14 y of age who underwent either external beam radiotherapy or plaque treatment and were operated for radiation-induced cataract between 1985 and 2008. Results In total, 21 eyes of 20 RB patients were included and 18 out of the 21 eyes had Reese-Ellsworth stage V or ABC classification group D/E RB. Median interval between last treatment for RB and cataract surgery was 21.5 months, range 3-164 months. Phacoaspiration was performed in 13 eyes (61%), extra-capsular cataract extraction in 8 (39%) and intraocular lens implantation in 19 eyes (90%). The majority of cases, 11/21 (52%), underwent posterior capsulorhexis or capsulotomy and 6/21 (28%) an anterior vitrectomy. Postoperative visual acuity was >/=20/200 in 13 eyes and <20/200 in 5 eyes. Intraocular tumour recurrence was noted in three eyes. Mean postoperative follow up was 90 months+/-69 months. Conclusions Modern cataract surgery, including clear cornea approach, lens aspiration with posterior capsulotomy, anterior vitrectomy and IOL implantation is a safe procedure for radiation-induced cataract as long as RB is controlled. The visual prognosis is limited by initial tumour involvement of the macula and by corneal complications of radiotherapy. We recommend a minimal interval of 9 months between completion of treatment of retinoblastoma and cataract surgery.

Vitreoretinal surgery for complications of choroidal tumor biopsy.

OBJECTIVE: To determine the outcomes of vitreoretinal surgery after choroidal tumor biopsy. DESIGN: Retrospective, single-center, consecutive case series. PARTICIPANTS: A total of 739 consecutive patients undergoing choroidal tumor biopsy. METHODS: All subjects who underwent transretinal or transscleral choroidal tumor biopsy for diagnostic or prognostic purposes between May 1993 and May 2013 were identified in our database. We then reviewed patients who subsequently required secondary vitreoretinal surgery for complications arising from such biopsies. MAIN OUTCOME MEASURES: Reason for vitreoretinal surgery, association with biopsy procedure, best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]), intraocular or extrascleral tumor dissemination, resolution of vitreous hemorrhage, reattachment of the retina with a single vitreoretinal procedure, number of additional vitrectomies undertaken, and number of enucleations. RESULTS: A total of 20 of 739 eyes (2.7%) underwent vitreoretinal surgery for complications arising from choroidal tumor biopsy. The tumors consisted of choroidal melanoma in all 20 eyes. The reasons for the secondary surgery included persistent vitreous hemorrhage in 1.9% (14/739), rhegmatogenous retinal detachment in 0.7% (5/739), and endophthalmitis in 0.14% (1/739). Median BCVA improved from 2.0 logMAR (mean, 1.92 logMAR; range, 0.8-2.7 logMAR) before vitrectomy to 0.72 logMAR (mean, 0.88 logMAR; range, -0.14 to 2.7 logMAR) after vitrectomy and 0.76 logMAR (mean, 1.14 logMAR; range, 0.1-3.0 logMAR) at the final visit (P < 0.0001, t test). Permanent resolution of vitreous hemorrhage was achieved in 6 of 14 patients, and reattachment of the retina was achieved in 2 of 5 patients after the first vitrectomy. A median of 1 (mean, 1.5; range, 1-3) additional vitrectomy was performed. Enucleation was necessary in 3 of 20 eyes (15%). There were no cases of intraocular invasion or extrascleral extension after vitrectomy. CONCLUSIONS: Vitrectomy for complications of choroidal tumor biopsy is rare. Such corrective surgery is complex and is best undertaken by specialized ocular oncologists or vitreoretinal surgeons with experience in managing this problem.

Tearing and folding of the retinal internal limiting membrane associated with macular epiretinal membrane

PURPOSE: To describe the clinical and histologic features of a particular form of macular epiretinal membrane. METHODS: The charts of all patients operated for macular epiretinal membrane by a single surgeon (E.H.B.) between June 2001 and January 2005 were retrospectively reviewed. Patients with macular epiretinal membrane associated with tearing and folding of the internal limiting membrane (ILM) were identified and the following parameters were recorded when available: age, gender, best-corrected visual acuity before and after vitrectomy; optical coherence tomography; pre-, intra-, and postoperative macular status; intraoperative staining by indocyanine green; histology. RESULTS: Twenty-three of 268 eyes (8.6%) with macular epiretinal membrane were associated with tearing and folding of the ILM, forming a whitish prominent band on the surface of the retina. The mean age of the patients was 68.6 years with a significant female predominance (78.3%). The vitreous was completely detached in 21 eyes. After surgical peeling, the mean visual gain was 3.2 Early Treatment Diabetic Retinopathy Study lines. No recurrence was observed. CONCLUSION: Tearing and folding of the ILM was associated with macular epiretinal membranes in 8.6% of cases. The ILM was probably torn during posterior hyaloid detachment, but the pathogenesis has not been clearly elucidated. The surgeon should begin to peel the macular epiretinal membrane by grasping the folded ILM to ensure complete removal of the ILM together with the epiretinal membrane. The postoperative visual prognosis was good

Traitement au laser des trous maculaires [Laser treatment of macular holes]

OBJECTIVE: To study a new technic of laser treatment of macular holes. METHODS: 21 eyes with stage II-IV macular hole were treated with Argon-green laser. Pigment epithelium in the area of the hole was whitened with spots of 100-200 microns, 100-300 mW. We expected this treatment to create a cellular proliferation that could close and contract the hole. Follow-up after treatment ranged from 3 to 24 months (mean: 9.3 months). RESULTS: Within one month after treatment, the macular hole was closed in 7 eyes (33%) and partially closed in 5 eyes (24%). The visual acuity increased from 1 to 5 lignes (ETDRS chart) in 9 eyes (43%), it remained the same in 9 eyes (43%) and decreased from 1 to 2 lignes in 3 eyes (14%). CONCLUSION: Laser treatment of macular holes seems to be effective and could be proposed as an alternative to the patients who cannot be operated on by vitrectomy and gas tamponade.

Surgical treatment of lamellar macular hole associated with epimacular membrane.

BACKGROUND:: Although the surgical treatment of full-thickness macular hole is well established, the utility of pars plana vitrectomy in the treatment of lamellar macular hole (LMH) remains less clear. The purpose of the study is to report functional results of surgical treatment of LMH associated with epiretinal membrane. METHODS:: Retrospective chart review of patients undergoing pars plana vitrectomy and peeling of epiretinal membrane and internal limiting membrane, with or without air or gas tamponade, for symptomatic LMH associated with epimacular membrane. RESULTS:: Forty-five eyes of 44 patients were operated for LMH associated with epimacular membrane between May 2000 and July 2009. Pars plana vitrectomy and membrane peeling were combined with air or gas tamponade in 43 of 45 cases. Mean logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.4 preoperatively to 0.13 postoperatively (P < 0.0001). Improvement in visual acuity ranged from 0 Early Treatment Diabetic Retinopathy Study (ETDRS) lines to 8.9 ETDRS lines (mean, 2.65 ETDRS lines). Visual acuity improved by ≥1 ETDRS line(s) in 40 of 45 eyes (89%) and by ≥2 ETDRS lines in 26 of 45 eyes (58%) after the surgical procedure. No patient lost vision. CONCLUSION:: This small retrospective study suggests that surgical treatment of LMH associated with epimacular membrane may improve visual acuity in symptomatic patients.

Ultrastructural changes of the internal limiting membrane removed during indocyanine green assisted peeling versus conventional surgery for an idiopathic epimacular membrane

Purpose:To evaluate the histological features of cellular retinal fragments on the internal limiting membrane (ILM) removed during epiretinal membrane peeling surgery with and without the aid of ICG diluted in 5% glucose Methods:ILM specimens removed from 88 eyes undergoing vitrectomy and membrane peeling surgery for idiopathic epiretinal membrane between 1995 and 2003 were reviewed retrospectively. Surgery was performed in all cases by the same surgeon using the same technique. ICG was diluted with 5% glucose. Histological analysis focused on the presence and characteristics of retinal structures on the retinal surface of the ILM. Statistical analysis compared the results between group I (conventional surgery without ICG) and group II (ICG-assisted peeling) Results:Seventy-one eyes underwent EMM surgery without the aid of ICG (group I) and seventeen underwent EMM ICG-assisted surgery assisted using ICG (group II). The amount of Muller cell debris on the retinal surface of the ILM was more significant in the group I (no ICG) than in the group II (ICG) (40.8 versus 11.8; p = 0.024). Large fragments of Muller cells were more frequently observed in the group I (no ICG) than in the group II (ICG) (63.4% versus 23.5%; p= 0.003).The presence of larger retinal elements such as neural axons and vessels were observed attached to retinal face of the ILM in 5 (7%) cases of the no-ICG group. No such retinal elements were detected in any of the histological ILM specimens of the ICG-assisted group Conclusions:The use of ICG diluted with 5% glucose in the aid of ILM removal during epiretinal membrane surgery was associated with less retinal debris attached to retinal face of the ILM compared to surgery in which ICG was not used. Our findings contradict previous reports in the literature, in which use of ICG diluted with balanced salt solution (BSS) was associated with more retinal fragments attached to the retinal face of the ILM. According to our results, we hypothesize that diluting ICG with 5% glucose may decrease the adhesion of the ILM to the underlying retinal layers such that less retinal debris is removed with peeling of the ILM.

Methylprednisolone concentrations in the vitreous and the serum after pulse therapy.

PURPOSE: Intravenous (i.v.) pulse of corticosteroids has been used to treat severe eye inflammation from different origins. Whether such large doses result in vitreous levels that differ either in magnitude or duration from more conventional corticotherapy remain unsolved issues. The authors therefore determined levels of methylprednisolone hemisuccinate and methylprednisolone in the vitreous and serum of patients at different times after a single i.v. perfusion of methylprednisolone hemisuccinate. METHODS: Fifty patients scheduled for a first vitrectomy received an i.v. injection of 500 mg hemisuccinate methylprednisolone at different times before surgery (from 15-24 hours). Patients were divided into two groups: those with (n = 21) and without (n = 29) retinal detachment (RD). Pure vitreous samples were analyzed by high-pressure liquid chromatography. RESULTS: Both the ester and the nonester methylprednisolone forms were sampled in the vitreous, showing a slower rate of hydrolysis compared to the serum. On average, the highest concentration of total methylprednisolone in the vitreous was found at 2.5 hours and rapidly decreased for the group of patients with RD. In the group of patients without RD, the highest concentration was reached at 6 hours and then slowly decreased. The antiinflammatory potency in the nondetached retina eyes was approximately 500 times more than in the physiologic vitreous, but despite the route of administration (i.v. or oral), only 1/10 of the corticosteroid serum concentration was measured in the vitreous. CONCLUSION: High concentration of methylprednisolone is achieved by i.v. pulse therapy without changing the kinetic of entry in the vitreous of nondetached retina eyes when compared to conventional oral corticotherapy. Hydrolysis occurs in the vitreous resulting in high rate of active form. Pulse therapy could be considered in cases of severe ocular inflammation involving the posterior segment of the eye.

Análisis comparativo de remoción de la membrana limitante interna en agujeros maculares con y sin azul tripan

Objetivo: comparar los resultados anatómicos y funcionales de los pacientes con Agujero Macular idiopático estadíos II, III y IV de Gass, quienes fueron sometidos a cirugía vitreoretiniana, con y sin uso de Azul Tripan, para la remoción de la Membrana Limitante Interna, en la Fundación Oftalmológica Nacional, Bogotá, Colombia, a partir de la revisión de historias clínicas de pacientes operados entre Enero de 2006 y Noviembre de 2009 Métodos: se realizó un estudio de cohorte retrospectivo, Los registros de historias clínicas de 32 pacientes operados de agujero macular idiopático fueron recolectados retrospectivamente a partir de 3 cirujanos. A todos los pacientes se les había realizado vitrectomía vía pars plana, se dividieron en 2 grupos aquellos con remoción de la MLI asistida con azul tripan y sin ésta. Se evaluaron variables, preoperatorias, intraoperatorias y postoperatorias. Resultados: la edad media de presentación del agujero macular fue de 61,33 años, la agudeza visual postoperatoria presentó diferencia entre los 2 grupos (p=0,008), la obtención del cierre del agujero macular utilizando azul tripan para la remoción de la membrana limitante interna no fue estadísticamente significativa (p=0,383) Conclusiones: la agudeza visual postoperatoria mejora, en los pacientes en quienes se utiliza el azul tripan para asistir la remoción de la MLI, en pacientes con agujeros maculares, en nuestro estudio la mejoría de la agudeza visual fue en promedio de 0,143. 2. No hubo diferencias entre los grupos estudiados con respecto al cierre anatómico primario del agujero macular. Se recomienda realizar estudios prospectivos, longitudinales para evaluar la asociación entre agujeros maculares, cierre anatómico primario y agudeza visual con el uso de azul tripan.

Hiperautofluorescencia foveal como factor predictor de recuperación visual en pacientes con desprendimiento regmatógeno de retina

Introducción: una de las causas de pobre ganancia visual luego de un tratamiento exitoso de desprendimiento de retina, sin complicaciones, es el daño de los fotoreceptores, reflejada en una disrupción de la capa de la zona elipsoide y membrana limitante externa (MLE). En otras patologías se ha demostrado que la hiperautofluorescencia foveal se correlaciona con la integridad de la zona elipsoide y MLE y una mejor recuperación visual. Objetivos: evaluar la asociación entre la hiperautofluorescencia foveal, la integridad de la capa de la zona elipsoide y recuperación visual luego de desprendimiento de retina regmatógeno (DRR) exitosamente tratado. Evaluar la concordancia inter-evaluador de estos exámenes. Metodología: estudio de corte transversal de autofluorescencia foveal y tomografía óptica coherente macular de dominio espectral en 65 pacientes con DRR evaluados por 3 evaluadores independientes. La concordancia inter-evaluador se estudio mediante Kappa de Cohen y la asociación entre las diferentes variables mediante la prueba chi cuadrado y pruebas Z para comparación de proporciones. Resultados: La concordancia de la autofluorescencia fue razonable y la de la tomografía óptica coherente macular buena a muy buena. Sujetos que presentaron hiperautofluorescencia foveal asociada a integridad de la capa de la zona elipsoide tuvieron 20% más de posibilidad de recuperar agudeza visual final mejor a 20/50 que los que no cumplieron éstas características. Conclusión: Existe una asociación clínicamente importante entre la hiperautofluorescencia foveal, la integridad de la capa de zona elipsoide y la mejor agudeza visual final, sin embargo ésta no fue estadísticamente significativa (p=0.39)

Factores asociados a recuperación visual deficiente después de cirugía exitosa para desprendimiento de retina regmatógeno

Introducción: Varias características pueden afectar el pronóstico visual después de resolver quirúrgicamente el desprendimiento de retina. Existen características no observables por el ojo humano por si solo pero si por tomografía óptica coherente que se relacionan con la recuperación visual. Objetivo: Describir las características clínicas y topográfica en los periodos pre y postquirúrgico de ojos que ha sufrido DR regmatógeno con compromiso macular y su relación con la calidad de recuperación visual después de una cirugía considerada exitosa desde el punto de vista anatómico. Materiales y métodos: Estudio descriptivo en el que se comparan algunas características en tres periodos perioeperatorios, uno antes y dos después de cirugía (3 y 6 meses) de 24 ojos con DRregmatógeno y compromiso macular intervenidos mediante retinopexia combinada con vitrectomía pars plana. Resultados: La recuperación visual mejor o igual que logMAR 0,397 (20/50) se dió en 41,7% de ojos y 16,7%. alcanzaron agudeza visual logMAR 0,301 (20/40). Cinco ojos no alcanzaron una ganancia de líneas de visión mayor a cinco. El líquido submacular ausente se observó en la mayoría de ojos que recuperaron más de cinco líneas al igual que aquellos con elipsoide conservado. La regularidad del neuroepitelio y el edema en el periodo posquirúrgico no mostraron comportamientos claros respecto a recuperación visual al igual que la altura del desprendimiento y el número de cuadrantes afectados. Una mejor recuperación visual fue más frecuente en aquellos con menos de cinco semanas de desprendimiento de retina. Conclusiones: El retraso menor a cinco semanas en la resolución del desprendimiento de retina, la conservación del elipsoide y la ausencia de líquido submacular en el periodo postquirúrgico se observó más frecuentemente en ojos con mejor recuperación visual.

Cambios maculares y de capa de fibras nerviosas ganglionares posterior a la vitrectomía pars plana y sus factores pronósticos en la fundación oftalmológica nacional

OBJETIVOS: Determinar los factores pronóstico, cambios maculares morfológicos y de capa de fibras nerviosas ganglionares posterior a vitrectomía pars plana, en la Fundación Oftalmológica Nacional. MATERIALES Y MÉTODOS: Estudio longitudinal de antes y después (3y6 meses) de la vitrectomía pars plana (VPP) en pacientes con membrana epirretiniana, agujero macular, síndrome de tracción vítreo macular y opacidades vítreas no-inflamatorias. Se realizó seguimiento clínico y con tomografía de coherencia óptica. RESULTADOS: Grupo de 60 pacientes (mujeres 65.0%), edad promedio 65.45+9.49años y tiempo de enfermedad promedio 23+29.79meses. Las indicaciones de VPP (n=60ojos) fueron agujero macular (38.3%) y membrana epirretiniana (36.7%). Se encontró diferencia significativa entre grosor del complejo capa de células ganglionares (CCG)+capa plexiforme interna (CPI) inicial y 3 meses (p=0.039), correlación entre grosor del complejo CCG+CPI al tercer y sexto mes (r=0.704,p<0.001) y grosor del complejo CCG+CPI al tercer mes con grosor foveal central (CFT) al tercer y sexto mes (r=–0.594,p<0.001 y r=–0.595,p=0.001). Mayores de 65años tenían menor grosor de CFNG a 6meses (r=-0.528,p=0.007). El grosor de CFNG promedio y la presencia de la zona elipsoide inicial fueron factores pronósticos de buena agudeza visual al tercer mes de VPP (r2=0.414,p=0.018, y r2=0.414,p=0.010). CONCLUSIÓN: El grosor de CFNG y la presencia de la zona elipsoide inicial tienen alta capacidad predictiva de buena agudeza visual al tercer mes de VPP, y, correlación inversa entre grosor del complejo CCG+CPI con CFT al tercer y sexto mes de VPP.

Implante primário de lente-intraocular para o tratamento da catarata congênita e do desenvolvimento

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB