RESUMEN
PURPOSE OF REVIEW: Vitreous floaters, characterized by the perception of spots or shadows in the visual field, commonly result from posterior vitreous detachment and can cause chronic symptoms in affected patients. The diagnosis of posterior vitreous detachment is typically determined clinically and can sometimes be confirmed with optical coherence topography (OCT) [1 âªâª ] . The objective of this review is to review management options for symptomatic vitreous floaters. RECENT FINDINGS: Symptoms of vitreous floaters may be mild or may significantly affect patient quality of life. Observation is the most common management strategy. Procedural management options include pars plana vitrectomy (PPV) and neodymium-doped yttrium aluminium garnet (Nd:YAG) vitreolysis. PPV is considered the most definitive management option for vitreous floaters. PPV, however, carries inherent risks, notably infection, cataract formation, and retinal detachment [2] . Nd:YAG laser vitreolysis is a less invasive alternative with studies demonstrating varied success [1 âªâª ,3,4] . SUMMARY: This review provides insights into the current state of knowledge regarding the management of vitreous floaters and can guide clinical decision-making.
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Trastornos de la Visión , Vitrectomía , Cuerpo Vítreo , Desprendimiento del Vítreo , Humanos , Terapia por Láser/métodos , Láseres de Estado Sólido/uso terapéutico , Tomografía de Coherencia Óptica , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/patología , Trastornos de la Visión/cirugía , Vitrectomía/métodos , Cuerpo Vítreo/cirugía , Cuerpo Vítreo/patología , Desprendimiento del Vítreo/diagnóstico , Desprendimiento del Vítreo/patología , Desprendimiento del Vítreo/terapiaRESUMEN
Background: To investigate association between optic disc parameters analyzed by optical coherence tomography (OCT) and occurrence of peripheral retinal tears in patients with symptomatic posterior vitreous detachment (PVD). Methods: This cross-sectional study enrolled 75 patients with symptoms of acute PVD, who were allocated into two groups based on whether a peripheral retinal tear occurred or not. Results: When comparing the average retinal nerve fiber layer (RNFL) thickness (µm) between retinal tear and control groups, it was shown that patients with a retinal tear have a significantly higher (87.18 [95% confidence interval (CI), 84.47 to 89.9] vs 81.14 [95% CI, 77.81 to 84.46], P = 0.005) average RNFL thickness. Furthermore, we observed a significant difference (0.13, 0.06 to 0.22 vs 0.07, 0.04 to 0.1, P = 0.036, Mann-Whitney U-test) in the size of cup volume (mm3) between the tear and control groups, respectively. Linear regression showed a significant decrease (P = 0.029) in average RNFL thickness with increasing age, but without a significant difference between the two groups. There was no statistically significant difference between the tear and control groups in terms of rim area, disc area, and average cup-to-disc ratio. Conclusion: Patients with a higher average RNFL thickness and larger cup volume measured by OCT were more prone to develop a peripheral retinal tear. Increased peripapillary average RNFL thickness due to trauma and subsequent inflammation, possibly related to the more adherent posterior hyaloid membrane to the retina, may also indicate strengthened adhesions in the areas of the peripheral retina where retinal tears occur. OCT analysis of the optic nerve head may be used in everyday clinical practice as a predictor of the development of peripheral retinal tears in patients with symptomatic PVD.
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Fibras Nerviosas , Disco Óptico , Perforaciones de la Retina , Tomografía de Coherencia Óptica , Desprendimiento del Vítreo , Humanos , Estudios Transversales , Masculino , Femenino , Desprendimiento del Vítreo/diagnóstico por imagen , Persona de Mediana Edad , Disco Óptico/diagnóstico por imagen , Perforaciones de la Retina/diagnóstico por imagen , Anciano , Fibras Nerviosas/patología , Adulto , Modelos LinealesRESUMEN
To compare the effectiveness and safety of scleral buckling and pars plana vitrectomy in treating retinal detachment without posterior vitreous detachment. A total of 88 eyes of 83 patients with retinal detachment without prior posterior vitreous detachment were investigated retrospectively. Group A comprised patients who underwent scleral buckling (n = 47) and Group B (n = 36) patients who were treated with pars plana vitrectomy. Anatomical success, postoperative visual acuity, and ocular adverse events were evaluated. The primary and final anatomical success rate showed a nonsignificant difference (p = 0.465 and p = 0.37 respectively). No significant difference was observed in the reoperation rate or development of epiretinal membrane between the groups (p = 0.254 and p = 0.254 respectively). However, scleral buckling resulted in significantly better visual acuity at the last follow-up (0.12 ± 0.23) compared to pars plana vitrectomy (0.37 ± 0.46, p = 0.001). The incidence of cataract progression was also significantly higher in the pars plana vitrectomy group (46%) compared to the scleral buckling group (10%, p < 0.001). Scleral buckling and pars plana vitrectomy show similar success rates in treating retinal detachment without vitreous detachment. However, due to less cataract progression and better visual acuity outcomes, scleral buckling is recommended for these cases. Determining vitreous status before surgery is crucial for optimal outcomes.
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Desprendimiento de Retina , Curvatura de la Esclerótica , Agudeza Visual , Vitrectomía , Desprendimiento del Vítreo , Humanos , Desprendimiento de Retina/cirugía , Vitrectomía/métodos , Curvatura de la Esclerótica/métodos , Masculino , Femenino , Persona de Mediana Edad , Desprendimiento del Vítreo/cirugía , Estudios Retrospectivos , Adulto , Anciano , Resultado del TratamientoRESUMEN
PURPOSE: Evaluation of the effectiveness of pneumatic vitreolysis in disrupting vitreomacular traction in our own cohort of patients. METHODOLOGY: Prospective follow-up of 21 eyes of 18 patients with focal VMT (adhesion width < 1500 µm) who underwent intravitreal injection of 0.3 ml of 100% perfluoropropane between January 2015 and December 2020. The patients were observed for 90 days. RESULTS: Release of VMT was achieved on the 28th day of observation in 15 out of 21 eyes (71.4%), and by the 90th day in 19 out of 21 eyes (90.5%). The average width of adhesion in our patients was 382 µm (±212 µm). Average best corrected visual acuity in our cohort was initially 0.77 (±0.21), after 28 days 0.74 (±0.30), and after 3 months 0.82 (±0.21). At the end of the follow-up period, we did not observe a statistically significant improvement in vision. Macular holes developed in two eyes, but spontaneously closed within 1 month of observation, and no more complications were observed in the cohort. CONCLUSION: Pneumatic vitreolysis by intravitreal injection of C3F8 gas is an effective and inexpensive option for the management of symptomatic vitreomacular traction. The incidence of serious adverse events in our follow-up was significantly lower than in recently published series. The method of management should be selected individually according to the parameters of adhesion, macular hole and associated ocular pathologies.
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Fluorocarburos , Inyecciones Intravítreas , Humanos , Fluorocarburos/administración & dosificación , Masculino , Femenino , Anciano , Estudios Prospectivos , Agudeza Visual , Persona de Mediana Edad , Cuerpo Vítreo , Desprendimiento del Vítreo , Estudios de Seguimiento , Anciano de 80 o más Años , Enfermedades de la RetinaRESUMEN
PURPOSE: This study was designed to investigate retinal nerve fiber layer circumpapillary optical coherence tomography to determine posterior vitreous detachment (PVD) status and to develop a clinically relevant PVD grading scale based on retinal nerve fiber layer circumpapillary optical coherence tomography to determine the incidence of PVD by age and association with vitreomacular traction disorders. METHODS: Ophthalmic images and medical records of patients with retinal diseases were retrospectively analyzed by three masked graders using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography. Based on PVD status, eyes were categorized into five newly defined PVD stages. RESULTS: Among 2002 eyes, PVD stages were as follows: A) 25 (1.25%); B) 725 (36.21%); C-) 248 (12.39%); C+) 151 (7.54%); D) 851 (42.51%); X) 2 (0.1%). Posterior vitreous detachment was correlated with advanced age (P < 0.0001). Limited separation or partial separation between lamella within the posterior vitreous cortex (Stage B) was noted early (68% of eyes <18 years). Overall, 34% of eyes >70 years did not exhibit complete PVD. Of 75 eyes with tractional vitreoretinal disorders, 64 (85.3%) were Stage C-/C+, identifying Stage C as the high-risk "complication" stage. CONCLUSION: Imaging analyses using retinal nerve fiber layer circumpapillary optical coherence tomography and macular optical coherence tomography scans in conjunction allow rapid assessment of the PVD stage. These techniques can assist clinicians and surgeons in counseling patients and planning surgical approaches. Observations confirmed the progression of PVD through predictable stages and the progression of PVD with age.
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Mácula Lútea , Fibras Nerviosas , Tomografía de Coherencia Óptica , Desprendimiento del Vítreo , Humanos , Tomografía de Coherencia Óptica/métodos , Desprendimiento del Vítreo/diagnóstico , Desprendimiento del Vítreo/diagnóstico por imagen , Estudios Retrospectivos , Persona de Mediana Edad , Femenino , Masculino , Anciano , Adulto , Fibras Nerviosas/patología , Mácula Lútea/patología , Mácula Lútea/diagnóstico por imagen , Anciano de 80 o más Años , Adolescente , Células Ganglionares de la Retina/patología , Adulto Joven , Niño , Cuerpo Vítreo/patología , Cuerpo Vítreo/diagnóstico por imagenRESUMEN
BACKGROUND: A lamellar macular hole (LMH) is characterized by a distinct morphologic configuration and can be distinguished from related entities such as macular pseudohole (MPH) and epiretinal membrane with foveoschisis (ERM-FS) by clear morphologic features. PURPOSE: Based on current knowledge, the pathophysiologic function of LMH in the spectrum of vitreomacular interface diseases will be described and therapeutic concepts will be presented. METHODS: Current studies are supplemented by case reports to provide a schematic overview of the natural history and therapeutic concepts at the vitreomacular interface. RESULTS: The LMH is as a retrospective marker for pathologic posterior vitreous detachment in adult patients and may be interpreted as the pathophysiologic center of tractional maculopathies. Various vitreomacular pathologies can result in LMH: a detached vitreomacular traction, a spontaneously closed penetrating macular hole, or an epiretinal membrane with foveoschisis. Pathophysiologically, a degenerative, progressive loss of the architecture of the foveal muller cell cone may be the underlaying mechanism, resulting in the typical undermining of the hole edges and occasionally in a full thickness macular hole. The optimal timing and the appropriate surgical method are the focus of current clinical studies. CONCLUSION: The pathophysiology of LMH indicates a smooth transition of tractive maculopathies. These should be prospectively evaluated in order to develop evidence-based treatment strategies for LMH.
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Perforaciones de la Retina , Humanos , Perforaciones de la Retina/fisiopatología , Perforaciones de la Retina/terapia , Perforaciones de la Retina/patología , Cuerpo Vítreo/patología , Cuerpo Vítreo/fisiopatología , Desprendimiento del Vítreo/fisiopatología , Desprendimiento del Vítreo/terapia , Desprendimiento del Vítreo/diagnósticoRESUMEN
This case report describes a woman aged 43 years with Stickler syndrome and bilateral vitreopapillary traction who presented with shadows and ghosting of vision in both eyes.
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Desprendimiento de Retina , Humanos , Masculino , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/cirugía , Colágeno Tipo IV/genética , Cuerpo Vítreo/patología , Cuerpo Vítreo/diagnóstico por imagen , Vitrectomía , Femenino , Oftalmopatías/diagnóstico , Desprendimiento del Vítreo/diagnósticoRESUMEN
PURPOSE: To evaluate the importance of the status of posterior vitreous in eyes with endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF). METHODS: The absence or existence of posterior vitreous detachment (PVD) was elicited in 23 eyes of 23 patients with injection related endophthalmitis, during pars plana vitrectomy (PPV) and compared with 24 control eyes of 24 patients who received intravitreal anti-VEGF without any complication. RESULTS: Thirtten (54.2%) out of 24 patients in the control group had full PVD, whereas only 2 (9.5%) out of 23 eyes in endophthalmitis group (p < 0.001) had full PVD. In all eyes without PVD, posterior vitreous was inducted to be detached at least from optic nerve and macular area without any iatrogenic tear. CONCLUSION: The absence of PVD is a factor that increases the risk of endophthalmitis after intravitreal injections. Uncomplicated separation of the posterior vitreous from the retina in PPV contributes to better prognosis.
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Endoftalmitis , Inyecciones Intravítreas , Factor A de Crecimiento Endotelial Vascular , Vitrectomía , Desprendimiento del Vítreo , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Angiogénesis/administración & dosificación , Inhibidores de la Angiogénesis/efectos adversos , Bevacizumab/administración & dosificación , Bevacizumab/efectos adversos , Endoftalmitis/etiología , Endoftalmitis/diagnóstico , Endoftalmitis/epidemiología , Inyecciones Intravítreas/efectos adversos , Ranibizumab/administración & dosificación , Ranibizumab/efectos adversos , Factores de Riesgo , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Vitrectomía/efectos adversos , Vitrectomía/métodos , Cuerpo VítreoRESUMEN
Vitreomacular traction is a tractive foveolar adhesion of the posterior vitreous limiting membrane, resulting in pathological structural alterations of the vitreomacular interface. This must be differentiated from physiological vitreomacular adhesion, which exhibits a completely preserved foveolar depression. Symptoms depend on the severity of the macular changes and typically include reduced visual acuity, reading problems and metamorphopsia. High-resolution spectral domain optical coherence tomography (SDOCT) imaging enables classification of the sometimes only subtle morphological changes. If pronounced vitreomacular traction is accompanied by epiretinal gliosis and alterations to the outer retina, it is referred to as a vitreomacular traction syndrome. Vitreomacular traction has a high probability of spontaneous resolution within 12 months. Therefore, treatment should only be carried out in cases of undue suffering of the patient and with symptoms during bilateral vision and a lack of spontaneous resolution. In addition to pars plana vitrectomy, alternative treatment options, such as intravitreal injection of ocriplasmin and pneumatic vitreolysis are discussed for vitreomacular traction with an associated macular hole; however, ocriplasmin is no longer available in Germany. The best anatomical results in comparative investigations were achieved by vitrectomy. Pneumatic vitreolysis is controversially discussed due to the increased risk of retinal tears. In one of the current S1 guidelines of the German ophthalmological societies evidence-based recommendations for the diagnostics and treatment of vitreomacular traction are summarized.
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Guías de Práctica Clínica como Asunto , Tomografía de Coherencia Óptica , Humanos , Enfermedades de la Retina/terapia , Enfermedades de la Retina/diagnóstico , Vitrectomía/métodos , Desprendimiento del Vítreo/terapia , Desprendimiento del Vítreo/diagnóstico , Oftalmología/métodos , Cuerpo Vítreo/patología , Cuerpo Vítreo/diagnóstico por imagen , Alemania , Medicina Basada en la Evidencia , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/terapiaRESUMEN
PURPOSE: To evaluate the levels of anxiety and depression in patients with symptomatic vitreous floaters and to determine the possible correlations of psychological implications with the symptoms duration and possible improvement, the degree of posterior vitreous detachment, and the discomfort severity. METHODS: Ninety patients complaining for floaters and fifty-seven age- and gender-matched healthy-control subjects were recruited. Every participant underwent a complete ophthalmological examination, including funduscopy and optical coherence tomography scans, while clinical and demographic data were also gathered. The Patient Health Questionnaire-9 (PHQ-9), the Zung Depression Inventory-Self-Rating Depression Scale (Zung SDS), and the Hospital Anxiety and Depression Scale (HADS) were completed by everyone. RESULTS: Between the studied groups, no significant differences were detected regarding the clinical and demographic data (p > 0.05). The patients with floaters had significantly higher scores of PHQ-9, Zung SDS, HADS Anxiety, and HADS Depression (p < 0.001). After adjustment for several confounders, PHQ-9 (p = 0.041), Zung SDS (p = 0.003), and HADS Anxiety (p = 0.036) values remained significantly impaired. Among the patients, PHQ-9 and Zung SDS scores were significantly elevated in the patients with floaters duration less than 4 weeks (p < 0.05). Finally, anxiety and depression were significantly correlated with the symptoms duration and intensity, with the floater-associated discomfort, and with the stage of posterior vitreous detachment. CONCLUSION: Vitreous floaters have a negative impact on patients' psychological status, by the terms of enhanced depressive and anxiety levels. To the best of our knowledge, our study is the first in the literature to elaborate the aforementioned association, by assessing three different questionnaires simultaneously.
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Ansiedad , Depresión , Trastornos de la Visión , Cuerpo Vítreo , Humanos , Masculino , Femenino , Persona de Mediana Edad , Cuerpo Vítreo/diagnóstico por imagen , Cuerpo Vítreo/patología , Depresión/etiología , Depresión/diagnóstico , Adulto , Ansiedad/diagnóstico , Ansiedad/etiología , Oftalmopatías/diagnóstico , Oftalmopatías/psicología , Tomografía de Coherencia Óptica/métodos , Encuestas y Cuestionarios , Anciano , Estudios de Casos y Controles , Desprendimiento del Vítreo/diagnóstico , Desprendimiento del Vítreo/psicología , Desprendimiento del Vítreo/complicacionesRESUMEN
Purpose: The purpose of this study was to evaluate the effects of posterior vitreous detachment (PVD) on visual quality in patients with high myopia, as well as investigate the associated factors of photopic and mesopic contrast sensitivity function (CSF) in high myopia. Methods: Visual quality was comprehensively assessed in patients with high myopia. Visual acuity, contrast sensitivity (CS) at four spatial frequencies (3, 6, 12, and 18 cycles per degree [c.p.d.]) under photopic and mesopic conditions, as well as the modulation transfer function cutoff value (MTFcutoff), the objective scatter index (OSI), the Strehl ratio (SR), and internal aberrations, were measured in this cross-sectional study. Results: This study included 94 eyes from 47 subjects with bilateral high myopia, including 23 eyes with complete PVD (cPVD), 21 eyes with partial PVD (pPVD), and 50 eyes without PVD (nPVD). There was no significant difference in visual quality between the cPVD group and the nPVD group. Whereas in eyes with pPVD, there was a degradation of overall photopic CSF (versus nPVD, P = 0.048), photopic CS at 3 c.p.d. (versus cPVD, P = 0.009 and versus nPVD, P = 0.032), photopic CS at 18 c.p.d. (versus nPVD, P = 0.033), overall mesopic CSF (versus nPVD, P = 0.033), and secondary astigmatism (versus cPVD, P = 0.044). Under photopic conditions, the factors affecting CSF were pPVD and SR, whereas the factors affecting mesopic CSF were pPVD, OSI, and ganglion cell-inner plexiform layer thickness. Conclusions: The pPVD impaired visual quality in patients with high myopia compared to nPVD or cPVD, and pPVD could be a factor explaining CSF at both photopic and mesopic illumination. Translational Relevance: Clinicians need to closely monitor patients with high myopia with pPVD due to the potential decline in visual quality and the development of vitreoretinal disorders.
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Miopía , Desprendimiento del Vítreo , Humanos , Sensibilidad de Contraste , Estudios Transversales , Miopía/complicaciones , Miopía/diagnóstico , RetinaAsunto(s)
Enfermedades de la Retina , Tomografía de Coherencia Óptica , Agudeza Visual , Cuerpo Vítreo , Femenino , Humanos , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Lesiones Oculares/diagnóstico , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Síndrome , Adherencias Tisulares/diagnóstico , Tomografía de Coherencia Óptica/métodos , Agudeza Visual/fisiología , Cuerpo Vítreo/patología , Desprendimiento del Vítreo/diagnóstico , Persona de Mediana EdadRESUMEN
PURPOSE: It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. METHODS: A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. RESULTS: A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. CONCLUSIONS: The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.
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Facoemulsificación , Desprendimiento del Vítreo , Humanos , Facoemulsificación/efectos adversos , Desprendimiento del Vítreo/etiología , Desprendimiento del Vítreo/diagnóstico , Incidencia , Complicaciones Posoperatorias/epidemiología , Factores de Riesgo , Salud GlobalRESUMEN
Antecedentes: La complicación más común tras la vitrectomía en pacientes es el resangrado en cavidad vítrea. Es importante detectar los distintos factores que pueden incrementar la tasa de resangrado vítreo en estos pacientes. Objetivo: Realizar una revisión retrospectiva de la tasa de resangrado de cavidad vítrea posterior a vitrectomía o facovitrectomía. Método: Estudio retrospectivo, descriptivo y comparativo de pacientes con diagnóstico de retinopatía diabética proliferativa con procedimiento de facovitrectomía o vitrectomía. Se obtuvieron datos de antecedentes personales patológicos, tipo de intervención quirúrgica y grado del cirujano que realizó el procedimiento. Resultados: Se revisaron 1.227 expedientes de pacientes diabéticos sometidos a vitrectomía o facovitrectomía. El 65% presentaron hipertensión arterial sistémica. La tasa de filtración glomerular promedio fue del 63,50 (±32,36) ml/min/1,73m2 y la de hemoglobina glucosilada (HbA1c) del 8% (4,6 al 15%). En la comparación de variables se obtuvo una diferencia significativa de la tasa de resangrado vítreo comparando la facovitrectomía con la vitrectomía (p=0,003), y al relacionar la vitrectomía con el resangrado, se obtuvo una razón de momios de 1,44. Conclusión: Los resultados obtenidos muestran una menor tasa de resangrado en los pacientes con retinopatía diabética proliferativa sometidos a facovitrectomía.(AU)
Background: The most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. Objective: To carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. Method: Retrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. Results: One thousand two hundred twenty-seven files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. Sixty-five percent presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36)ml/min/1.73m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6-15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy (P=.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. Conclusion: The results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.(AU)
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Humanos , Masculino , Femenino , Infecciones del Ojo , Desprendimiento del Vítreo , Retinopatía Diabética , Vitrectomía , Hemorragia , Oftalmología , Ojo , Lesiones Oculares , Estudios Retrospectivos , Epidemiología DescriptivaRESUMEN
BACKGROUND: Stickler syndrome (STL) is a collagenopathy caused by pathogenic variants in collagen-coding genes, mainly COL2A1 or COL11A1 associated with Stickler syndrome type 1 (STL1) or type 2 (STL2), respectively. Affected individuals manifest ocular, auditory, articular, and craniofacial findings in varying degrees. Previous literature and case reports describe high variability in clinical findings for patients with STL. With this case report, we broaden the clinical spectrum of the phenotype. MATERIALS AND METHODS: Case report on two members of a family (mother and son) including clinical examination and genetic testing using targeted trio whole exome sequencing (trio-WES). RESULTS: A boy and his mother presented with microphthalmia, congenital cataract, ptosis, and moderate-to-severe sensorineural hearing loss. Trio-WES found a novel heterozygote missense variant, c.4526A>G; p(Gln1509Arg) in COL11A1 in both affected individuals. CONCLUSIONS: We report a previously undescribed phenotype associated with a COL11A1-variant in a mother and son, expanding the spectrum for phenotype-genotype correlation in STL2, presenting with microphthalmia, congenital cataract, and ptosis not normally associated with Stickler syndrome.
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Artritis , Catarata , Colágeno Tipo XI , Enfermedades del Tejido Conjuntivo , Pérdida Auditiva Sensorineural , Microftalmía , Mutación Missense , Linaje , Humanos , Catarata/genética , Catarata/congénito , Catarata/diagnóstico , Microftalmía/genética , Masculino , Pérdida Auditiva Sensorineural/genética , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/patología , Enfermedades del Tejido Conjuntivo/genética , Enfermedades del Tejido Conjuntivo/diagnóstico , Femenino , Colágeno Tipo XI/genética , Colágeno Tipo XI/deficiencia , Artritis/genética , Artritis/diagnóstico , Desprendimiento de Retina/genética , Desprendimiento de Retina/diagnóstico , Adulto , Fenotipo , Niño , Secuenciación del Exoma , Desprendimiento del VítreoRESUMEN
PURPOSE: Removing transparent vitreous tissues, such as a residual vitreous cortex (VC) or proliferative membrane, without damaging the retina is often problematic in vitrectomy. We examined the feasibility of an injectable in situ cross-linking hyaluronan hydrogel (XL-HA) for vitrectomy. STUDY DESIGN: Experiments using ex vivo and in vivo animal models. METHODS: HA-dibenzocyclooctyne and HA-azidoethylamine solutions were mixed to form XL-HA, which then gradually formed a hydrogel. We tested the function of XL-HA in ex vivo porcine eyes. We then examined the performance of XL-HA in in vivo rabbit models of posterior vitreous detachment, posterior VC removal, and proliferative vitreoretinopathy. RESULTS: The ex vivo study showed that XL-HA rapidly embedded triamcinolone acetonide, mimicking VC attached to the retina, and became hard enough to be pinched with tweezers within 3 minutes, allowing us to remove only the triamcinolone acetonide without impairing the internal limiting membrane. In the in vivo rabbit models, XL-HA injection improved posterior vitreous detachment, and the thin and fragile posterior VC or fibrous proliferative membrane was readily peeled off without any damage to the underlying retina as compared with untreated controls. A short-term intraocular biocompatibility test demonstrated that the intraocular pressure remained normal with XL-HA injected into the eye. In addition, transmission electron microscopy showed no obvious abnormalities in the cornea or in the inner and outer retina. CONCLUSION: The results indicate that XL-HA is a potential adjunctive device to help make vitrectomy safe, effective, and successful.
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Vitrectomía , Desprendimiento del Vítreo , Animales , Conejos , Porcinos , Vitrectomía/métodos , Triamcinolona Acetonida , Glucocorticoides , Ácido Hialurónico , Cuerpo Vítreo/cirugía , HidrogelesRESUMEN
PURPOSE: To determine the cut-off points of minimum linear diameter (MLD) and base diameter (BD) at which the progression rate of idiopathic full-thickness macular holes (MHs) decreases before vitrectomy. STUDY DESIGN: A retrospective study. METHODS: We investigated the differences in MLD and BD between baseline and operation days in patients with stages 2, 3, and 4 MHs using optical coherence tomography (OCT). Each difference in OCT parameters was divided by the time interval to calculate the MH progression rates and the cut-off points of MLD and BD. RESULTS: Overall, 269 patients (282 eyes) were included. It took an average of 36.02 ± 24.69 (7-197) days from baseline to operation. MLD and BD progressed faster in stages 2 and 3 without posterior vitreous detachment (PVD) than in stage 4 with PVD (MLD: p < 0.001 and p = 0.007; BD: p < 0.001 and p = 0.019, respectively). Simple linear regression showed the relationship between baseline MLD and BD, and the progression rate; the progression rate decreased as baseline MLD (p = 0.004) and BD increased ( p < 0.001). For baseline MLD and BD, the cut-off points where the progression rate decreased were 306.0 and 470.0 µm, respectively. CONCLUSION: The group without PVD progressed faster than the group with PVD. Moreover, the progression rates were faster in MHs with MLD < 306.0 µm and BD < 470.0 µm. In these patients, vitrectomy without delay is expected to improve the visual prognosis.
Asunto(s)
Perforaciones de la Retina , Desprendimiento del Vítreo , Humanos , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/cirugía , Estudios Retrospectivos , Agudeza Visual , Retina , Vitrectomía/métodos , Tomografía de Coherencia Óptica/métodosRESUMEN
In this report, two rare cases of large atrophic peripheral retinal holes are described. Both patients presented during a routine visit without reporting any ocular symptoms. The holes did not exhibit significant risk factors for progression to rhegmatogenous retinal detachment: No signs of posterior vitreous detachment, vitreoretinal tractions, or retinal degeneration were visible. For such asymptomatic cases, international guidelines recommend a strict follow-up schedule; however, the unusual size of the holes raised significant concerns about the management of these retinal breaks. The advantages and disadvantages of laser photo-coagulation treatment were discussed, ultimately favoring a watch-and-wait strategy. [Ophthalmic Surg Lasers Imaging Retina 2024;55:176-178.].