RESUMO
PURPOSE: Epithelial-mesenchymal transition (EMT) is a crucial pathological process that contributes to proliferative vitreoretinopathy (PVR), and research indicates that factors present in the vitreous that target cells play pivotal roles in regulating EMT. Experimental studies have confirmed that rabbit vitreous (RV) promotes EMT in human retinal pigment epithelial (RPE) cells. The long noncoding RNA (lncRNA) MALAT1 has been implicated in EMT in various diseases. Thus, this study aimed to investigate the involvement of lncRNA MALAT1 in vitreous-induced EMT in RPE cells. METHODS: MALAT1 was knocked down in ARPE-19 cells by short hairpin RNA (shRNA) transfection. Reverse transcription PCR (RTâPCR) was used to evaluate MALAT1 expression, and Western blotting analysis was used to measure the expression of EMT-related proteins. Wound-healing, Transwell, and cell contraction assays were conducted to assess cell migration, invasion, and contraction, respectively. Additionally, cell proliferation was assessed using the CCK-8 assay, and cytoskeletal changes were examined by immunofluorescence. RESULTS: MALAT1 expression was significantly increased in ARPE-19 cells cultured with RV. Silencing MALAT1 effectively suppressed EMT and downregulated the associated factors snail1 and E-cadherin. Furthermore, silencing MALAT1 inhibited the RV-induced migration, invasion, proliferation, and contraction of ARPE-19 cells. Silencing MALAT1 also decreased RV-induced AKT and P53 phosphorylation. CONCLUSIONS: In conclusion, lncRNA MALAT1 participates in regulating vitreous-induced EMT in human RPE cells; these results provide new insight into the pathogenesis of PVR and offer a potential direction for the development of antiproliferative drugs.
Assuntos
Movimento Celular , Proliferação de Células , Transição Epitelial-Mesenquimal , Proteínas Proto-Oncogênicas c-akt , RNA Longo não Codificante , Epitélio Pigmentado da Retina , RNA Longo não Codificante/genética , Transição Epitelial-Mesenquimal/genética , Epitélio Pigmentado da Retina/metabolismo , Epitélio Pigmentado da Retina/patologia , Humanos , Proteínas Proto-Oncogênicas c-akt/metabolismo , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Coelhos , Animais , Células Cultivadas , Vitreorretinopatia Proliferativa/genética , Vitreorretinopatia Proliferativa/metabolismo , Vitreorretinopatia Proliferativa/patologia , Transdução de Sinais , Regulação da Expressão Gênica , Western BlottingRESUMO
BACKGROUND: This study aimed to precisely predict the size and silicone oil injection of a foldable capsular vitreous body (FCVB) via computerized three-dimensional (3D) ocular reconstruction in the treatment of severe retinal detachment in China. METHODS: The 3D software Unigraphics NX was applied to determine the volume of the inner cavity with 16-30 mm axial length, assigning the anterior and posterior chambers, the FCVB sizes, and the silicone oil injection volume, and modeling the data between the axial length and the FCVB size. In clinical practice, IOL Master was applied to accurately measure the axial length of the contralateral healthy eye to anchor the anterior-posterior and horizontal diameters of the operated eye in horizontal position CT, and compared with the model to recommend the FCVB size and silicone oil amount, and the clinical effect was validated in cases across five hospitals in China. RESULTS: For the axial length of 16-30 mm, the volume of the inner cavity is 1.2 ml-8.4 ml. FCVB size and silicone oil volume were recommended based on this volume of the inner cavity. Of 253 cases, we noted 11 cases implanted with AV-10P and 1.05 ± 0.21 ml of silicone oil, 41 with AV-12P and 1.58 ± 0.18 ml of silicone oil, 163 with AV-13.5P and 2.48 ± 0.29 ml of silicone oil, 31 with AV-15P and 3.57 ± 0.39 ml of silicone oil, and 7 with AV-17P and 5.71 ± 0.81 ml of silicone oil. There was no significant difference in postoperative visual acuity scores compared with preoperative (P = 0.097), postoperative IOP(10.29 ± 0.57mmHg)was slightly higher than preoperative IOP (9.76 ± 0.48 mmHg), but there was still no statistically significant difference between the two comparisons (P = 0.405). CONCLUSION: Three-dimensional reconstruction prediction is a good solution for eyeballs with obvious individualized changes in severe retinal detachment, and this method helps doctors standardize FCVB size selection and the silicone oil amount for patients.
Assuntos
Imageamento Tridimensional , Descolamento Retiniano , Óleos de Silicone , Corpo Vítreo , Humanos , Descolamento Retiniano/cirurgia , Óleos de Silicone/administração & dosagem , Pessoa de Meia-Idade , Masculino , Feminino , Adulto , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagem , Vitrectomia/métodos , Idoso , Adulto Jovem , Tamponamento Interno/métodos , Adolescente , Acuidade Visual/fisiologiaRESUMO
Proliferative diabetic retinopathy (PDR) is a vision-threatening complication of diabetes mellitus (DM). Anterior chamber (AC) flare and intraocular cytokines are potent biomarkers reflecting the intraocular immune status in PDR. This study aimed to elucidate the complex interrelationship between AC flare and intraocular cytokines in PDR eyes. A retrospective observational study was conducted on 19 PDR eyes of 19 patients with type 2 DM, and on 19 eyes of 19 patients with idiopathic macular hole or epiretinal membrane as controls. AC flare was measured before pars plana vitrectomy (PPV). Aqueous humor (AH) and vitreous fluid (VF) samples were collected at the time of PPV, and the quantities of 27 cytokines in both intraocular fluids were analyzed. In the PDR and control groups, Spearman's rank correlation analysis revealed a positive correlation between AC flare and IL-8 level in both AH and VF. Additionally, IL-8 levels in AH correlated positively with IL-8 levels in VF. In the PDR group, receiver operating characteristic curve analysis identified IL-8 level in AH as a significant predictor for both diabetic macular edema (DME) and vitreous hemorrhage (VH) complications. The cut-off values of IL-8 were established at ≥26.6 pg/mL for DME and ≥7.96 pg/mL for VH. Given the positive correlation between AC flare and AH IL-8 level, the present findings suggest that AC flare value may potentially be a non-invasive biomarker for predicting DME.
Assuntos
Câmara Anterior , Humor Aquoso , Retinopatia Diabética , Corpo Vítreo , Humanos , Retinopatia Diabética/imunologia , Retinopatia Diabética/metabolismo , Retinopatia Diabética/patologia , Retinopatia Diabética/etiologia , Masculino , Feminino , Câmara Anterior/patologia , Câmara Anterior/metabolismo , Câmara Anterior/imunologia , Pessoa de Meia-Idade , Idoso , Humor Aquoso/metabolismo , Humor Aquoso/imunologia , Estudos Retrospectivos , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Edema Macular/etiologia , Edema Macular/metabolismo , Edema Macular/imunologia , Edema Macular/patologia , Vitrectomia , Biomarcadores , Citocinas/metabolismo , Interleucina-8/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/imunologia , Curva ROCRESUMO
PURPOSE: To identify demographic and clinical factors associated with delayed diagnosis in patients with primary vitreoretinal lymphoma (VRL). METHODS: Retrospective, tertiary referral center-based cohort study of all patients at Mayo Clinic in Rochester, Minnesota, with a biopsy-proven diagnosis of VRL from January 1, 2000, to October 31, 2022. RESULTS: There were 87 patients included during the 22-year study period with 73 patients (83.9%) diagnosed with VRL upon initial evaluation at the tertiary center, with the other 14 patients (16.1%) diagnosed later. The median referral time was 4.8 months (range: 0-113 months). Patients who received an initial diagnosis of inflammatory uveitis or another incorrect diagnosis elsewhere were referred slower than those initially diagnosed with VRL (P = 0.04). The most common incorrect initial diagnosis from an outside institution was inflammatory uveitis (n = 35, 40.2%). When patients were split into four groups based on referral time, prior use of corticosteroids was associated with a significant delay in referral (P = 0.03). CONCLUSION: Diagnosing VRL continues to be challenging, as months-long delays from initial evaluation to expert referral center evaluation are common. Prior use of corticosteroids was associated with delay in diagnosis and referral time, underscoring the need to increase awareness regarding differences between VRL and uveitis.
Assuntos
Diagnóstico Tardio , Neoplasias da Retina , Corpo Vítreo , Humanos , Estudos Retrospectivos , Masculino , Feminino , Neoplasias da Retina/diagnóstico , Idoso , Pessoa de Meia-Idade , Corpo Vítreo/patologia , Idoso de 80 Anos ou mais , Adulto , Linfoma Intraocular/diagnóstico , Linfoma Intraocular/tratamento farmacológico , Encaminhamento e ConsultaRESUMO
PURPOSE: To investigate the variation of interleukin-10 (IL-10) levels in the aqueous humor (AH) of patients with vitreoretinal lymphoma (VRL) throughout therapy and follow-up and analyze the relation of these variations with VRL clinical course and relapse. METHODS: This study retrospectively included consecutive patients diagnosed with VRL in a single center. AH IL-10 samples and patient clinical course were evaluated. The response to treatment was evaluated according to the criteria set by the International Primary Central Nervous System Lymphoma Collaborative Group. RESULTS: A total of 59 eyes of 34 patients were included. Interleukin-10 levels decreased significantly at first AH sample after therapy induction (median [IQR] 3.0 [2.8-3.6] months) among patients in complete clinical remission (P < 0.001). Among patients in complete clinical remission with residual detectable IL-10 in AH after therapy induction (85.3% systemic chemotherapy, 11.8% intravitreal methotrexate, 2.9% palliative care), 87.5% experienced ocular relapse within 5 years. The detection of IL-10 in AH at the first visit after induction for complete clinical remission obtained a sensitivity of 77.8% (95% CI 0.45-0.96) and a specificity of 96.4% (95% CI 0.82-0.99) to predict ocular relapse. For relapsing eyes (N = 26), IL-10 significantly increased between the last IL-10 measurement and the time of the first ocular relapse (P < 0.001). In 76.0% of cases, an increase in IL-10 was detected earlier than clinical relapse with a mean (SD) of 4.0 (2.4) months. CONCLUSION: The present study suggested the usefulness of IL-10 in the prognosis of VRL. This study showed a relation between IL-10 in AH and tumoral activity, and for the first time with disease relapse.
Assuntos
Humor Aquoso , Interleucina-10 , Neoplasias da Retina , Corpo Vítreo , Humanos , Humor Aquoso/metabolismo , Interleucina-10/metabolismo , Feminino , Masculino , Estudos Retrospectivos , Neoplasias da Retina/metabolismo , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/tratamento farmacológico , Idoso , Pessoa de Meia-Idade , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Linfoma Intraocular/metabolismo , Linfoma Intraocular/tratamento farmacológico , Linfoma Intraocular/diagnóstico , Seguimentos , Biomarcadores Tumorais/metabolismo , Idoso de 80 Anos ou mais , AdultoRESUMO
PURPOSE: The aim of this study is to investigate the effect of vitreomacular interface disorders (VMID) on treatment response in patients treated with anti-vascular endothelial growth factor (anti-VEGF) due to diabetic macular edema (DME). METHODS: Three hundred seventy-seven eyes of 239 patients in the MARMASIA Study Group who received intravitreal anti-VEGF treatment (IVT) due to DME were included in the study. The group 1 consisted of 44 eyes of the patients who had not received any treatment before, were followed up regularly for 24 months after at least a 3-month loading dose, and suffered from VMID such as epiretinal membrane, vitreomacular adhesion or traction, and lamellar hole. The group 2 consisted of 333 eyes of the patients without VMID. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients at baseline, 3rd month, 6th month, 1st year and 2nd year follow-ups were measured. RESULTS: The mean age of the Groups 1 and 2 was 67.1 ± 11.3 and 61.9 ± 10.2 years, respectively. 61.3% of the group 1 and 58.8% of the group 2 were female (p > 0.05). The duration of diabetes was 19.2 ± 3.7 and 15.8 ± 3.2 years, respectively, and the number of follow-ups was 16.09 ± 4.68 and 12.06 ± 4.58, respectively in the groups (p < 0.001, 0.001, respectively). The number of IVT was 7.13 ± 2.71 and 7.20 ± 2.22, respectively in the groups 1 and 2 and no statistically significant difference was observed between them (p = 0.860). According to logMAR, BCVA values at baseline were 0.63 ± 0.24 and 0.59 ± 0.26 (p = 0.29), respectively, in the groups and the amount of change in BCVA at the end of the 2nd year was - 0.02 ± 0.48 in the group 1 and - 0.12 ± 0.48 in the group 2. It was observed as 0.48 (p = 0.13). Although the increase in BCVA was greater at all follow-ups in the group 2 compared to their initial examination, no significant difference was observed between the groups in terms of BCVA change. The CMT values of the groups at baseline were 442.5 ± 131.3 µm and 590.9 ± 170.6 µm, respectively (p = 0.03) The decrease in CMT after IVT was significantly greater in the group 2 at all follow-ups when compared to the first group (p < 0.05). CONCLUSION: While the presence of VMID in DME patients receiving IVT did not affect visual results, it negatively affected the anatomical response and macular edema morphology. The presence of VMID at baseline affected the success of IVT. It should be taken into consideration that VMID may resolve spontaneously or with IVT, and new cases of VMID may occur in patients during the treatment process.
Assuntos
Inibidores da Angiogênese , Retinopatia Diabética , Injeções Intravítreas , Edema Macular , Tomografia de Coerência Óptica , Fator A de Crescimento do Endotélio Vascular , Acuidade Visual , Humanos , Edema Macular/tratamento farmacológico , Edema Macular/diagnóstico , Edema Macular/etiologia , Feminino , Retinopatia Diabética/tratamento farmacológico , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/complicações , Masculino , Pessoa de Meia-Idade , Inibidores da Angiogênese/administração & dosagem , Idoso , Tomografia de Coerência Óptica/métodos , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Seguimentos , Macula Lutea/patologia , Estudos Retrospectivos , Ranibizumab/administração & dosagem , Bevacizumab/administração & dosagem , Corpo Vítreo/patologia , Resultado do TratamentoRESUMO
CONTEXT: Vitreoretinal large B- cell lymphoma (VR- LBCL) is a type of non- Hodgkin lymphoma confined to the eye and central nervous system (CNS). The clinical manifestations of intraocular lymphoma can precede, occur simultaneously with, or follow disease at CNS sites. It differs from other forms of extra-nodal lymphoma; in that it does not involve systemic sites other than CNS. OBJECTIVES: To analyse the clinical and pathological features, and treatment outcomes of a cohort of patients diagnosed with vitreoretinal lymphoma (VRL) in Royal Victoria Eye and Ear Hospital, Ireland between 2010 and 2024. METHOD: Retrospective review of medical records and pathology specimens of patients with ocular involvement in VR- LBCL over 14-year period and a review of the literature. RESULTS: Eight patients were included. All of them underwent pars plana vitrectomy and were confirmed to have VR- LBCL. The median age at diagnosis was 71 years. Three were men and five were women. Six had bilateral disease and two unilateral. Four of four patients had MYD88 L265P mutation present. Four patients showed a high interleukin-10 (IL-10) to interleukins-6 (IL-6) ratio in keeping with the diagnosis of VRL. Three patients had primary CNS lymphoma with subsequent eye involvement, despite systemic chemotherapy treatment. Of the five patients who presented with ocular lymphoma, two patients had CNS involvement after primary vitreoretinal lymphoma was diagnosed. Of those, one was initially treated with local intravitreal chemotherapy. Three patients had no CNS recurrence. At the time of this study, seven patients of eight are alive, four are disease free and two are on a first- line local chemotherapy treatment. One underwent treatment for CNS relapse. One patient died of the disease before commencing targeted therapy. CONCLUSION: This case series demonstrated excellent treatment outcomes for seven patients, alive at the time of the study. Both local radiotherapy and intravitreal chemotherapy achieved good ocular control with acceptable side effects and no significant difference in visual outcome. VRL is a difficult diagnosis and vitreous cytology should be prioritised in cases of vitritis unresponsive to treatment. Analysis of MYD88 L265P mutation and IL- 10: IL- 6 ratio >1 are useful adjuncts in the diagnosis of VR- LBCL, particularly in cases where limited vitreous material makes cytological evaluation challenging.
Assuntos
Neoplasias da Retina , Humanos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Retina/patologia , Neoplasias da Retina/terapia , Neoplasias da Retina/genética , Idoso de 80 Anos ou mais , Corpo Vítreo/patologia , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Linfoma Difuso de Grandes Células B/genética , Linfoma Intraocular/patologia , Linfoma Intraocular/terapia , Linfoma Intraocular/genética , Linfoma Intraocular/diagnóstico , Vitrectomia , Neoplasias Oculares/patologia , Neoplasias Oculares/terapia , Neoplasias Oculares/genéticaRESUMO
PURPOSE: To compare the pathological characteristics of the vitreomacular interface of the idiopathic epiretinal membrane with and without disorganization of retinal inner layers (DRIL) and to correlate with clinical data. METHODS: In this clinicopathologic study, the samples of epiretinal membrane and internal limiting membrane were extracted from DRIL(+) (19 eyes) and DRIL(-) (22 eyes) idiopathic epiretinal membrane eyes. Ultrathin series sectioning for transmission electron microscopy was observed and correlated with surgery status and prognosis. RESULTS: All idiopathic epiretinal membrane eyes presented fibrocellular membranes accompanied by vitreous collagen, glial cells, and myofibroblasts, regardless of association with DRIL. A robust signal indicative of Collagen Type VI was observed in eyes DRIL(-), whereas Collagen Type I was discovered in DRIL eyes. Cell debris and microvascular basement membrane were seen on the retinal side of DRIL eyes and a larger cell count on the vitreous side. These have more intraoperative complications and less surgery benefit. CONCLUSION: Although internal limiting membrane peeling seems important, the histopathologic findings underscore the potential for retinal injury in DRIL(+) idiopathic epiretinal membrane eyes. This suggests that further research is needed to investigate individual preoperative assessment and to modify surgical procedures.
Assuntos
Membrana Epirretiniana , Vitrectomia , Corpo Vítreo , Humanos , Membrana Epirretiniana/cirurgia , Membrana Epirretiniana/metabolismo , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/patologia , Idoso , Masculino , Feminino , Corpo Vítreo/patologia , Corpo Vítreo/metabolismo , Pessoa de Meia-Idade , Microscopia Eletrônica de Transmissão , Membrana Basal/patologia , Membrana Basal/cirurgia , Membrana Basal/metabolismo , Idoso de 80 Anos ou mais , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Macula Lutea/patologia , Retina/patologiaRESUMO
PURPOSE: To describe a 41-gauge silicone fine-needle aspiration biopsy (S-FNAB) technique and assess its value in diagnosing primary vitreoretinal lymphoma (PVRL). METHODS: Retrospective review of seven consecutive patients who underwent vitreous biopsy (VB) and 41-gauge S-FNAB of retinal/subretinal lesions in a single tertiary center between January 2012 and March 2023. RESULTS: Of seven patients, S-FNAB confirmed the diagnosis of PVRL in six patients. In five of those patients, both VB and retinal/subretinal S-FNAB (performed at the same procedure) yielded positive results, with the retinal thickness at the biopsy site as small as 231 µm. Four of these five patients had one or more previous negative VB. In one patient, S-FNAB yielded positive results despite a negative VB. Silicone fine-needle aspiration biopsy failed to confirm positive VB for PVRL in the remaining patient. The time from symptom onset to diagnosis of PVRL ranged from 18 days to 26 months. There were no severe complications associated with the procedure. CONCLUSION: Silicone fine-needle aspiration biopsy might be a valuable method for obtaining a sufficient sample of viable cells to diagnose PVRL. It can be performed as a primary procedure along with VB. Further studies are warranted to determine where this technique could be most advantageous.
Assuntos
Neoplasias da Retina , Corpo Vítreo , Humanos , Estudos Retrospectivos , Neoplasias da Retina/cirurgia , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/patologia , Masculino , Feminino , Biópsia por Agulha Fina/métodos , Corpo Vítreo/patologia , Corpo Vítreo/cirurgia , Idoso , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Retina/patologia , Silicones , Linfoma Intraocular/diagnóstico , Linfoma Intraocular/cirurgia , Linfoma Intraocular/patologia , Vitrectomia/métodos , Linfoma/diagnóstico , Linfoma/cirurgia , Linfoma/patologia , Idoso de 80 Anos ou mais , AdultoRESUMO
PURPOSE: To investigate changes to the vitreoretinal interface in uveitis with multimodal imaging including adaptive optics. METHODS: Four eyes (four patients) affected by fovea-attached (subtype 1A) or fovea-sparing epiretinal membranes (ERMs) on spectral-domain optical coherence tomography or visible internal limiting membrane (ILM) on infrared scanning laser ophthalmoscope (SLO) fundus imaging were recruited in this pilot study. The microstructure of the vitreoretinal interface was imaged using flood-illumination adaptive optics (FIAO), and the images were compared with the cross-sectional spectral-domain optical coherence tomography data. RESULTS: Adaptive optics images revealed multiple abnormalities of the vitreoretinal interface, such as deep linear striae in ERM, and hyperreflective microstructures at the location of ERMs and ILMs. The cone mosaic was imaged by FIAO and was found altered in the four eyes with ERMs or visible ILM. The same four eyes presented alteration of photopic 30 Hz flicker that was reduced in amplitude indicating cone inner retinal layer dysfunction. CONCLUSION: FIAO imaging can identify specific patterns associated with ERMs and ILMs. Correlating FIAO imaging of the vitreomacular interface with the structural alterations seen in FIAO at the level of the outer retinal structures can help understand the cause of significant macular dysfunction associated with ERM.
Assuntos
Membrana Epirretiniana , Imagem Multimodal , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Membrana Epirretiniana/diagnóstico , Projetos Piloto , Oftalmoscopia/métodos , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagem , Uveíte/diagnóstico , Adulto , Acuidade Visual , Idoso , Estudos Transversais , Membrana BasalRESUMO
PURPOSE: Extracellular Adenosine triphosphate (ATP) released by dying cells may cause a secondary cell death in neighboring cells in retinal degeneration. We investigated intraocular ATP kinetics to gain mechanical insights into the pathology in rhegmatogenous retinal detachment (RRD). STUDY DESIGN: Retrospective clinical study. METHODS: Vitreous or subretinal fluids (SRF) were obtained from patients with RRD (n=75), macular hole (MH; n=20), and epiretinal membrane (ERM; n=35) during vitrectomy. ATP levels in those samples were measured by luciferase assay. RESULTS: Mean ATP levels in the vitreous from RRD patients were significantly higher compared to those from MH and ERM patients (2.3 and 0.3 nM, respectively. P<0.01). Mean ATP levels in the SRF from RRD (11.7 nM) were higher than those in the vitreous from RRD (P<0.01). Mean ATP levels in the vitreous with short durations (1-8 days) of RRD were higher compared to those with long durations (>8 days) (3.2 and 1.4 nM, respectively. P<0.05). Similarly, ATP in SRF with short durations were higher than those with long durations (23.8 and 3.6 nM, respectively. P<0.05). Furthermore, the concentrations of ectonucleoside triphosphate diphosphohydrolase-1 (ENTPD1), a major ATP degradative enzyme, in the vitreous from RRD were higher than those from MH/ERM (1.2 and 0.2 ng/ml, respectively. P<0.01). ENTPD1 expression was localized in the cytoplasm of CD11b-positive infiltrating cells in the vitreous and retinal cells. CONCLUSION: ATP increased in the vitreous and SRF in RRD and decreased over time with an upregulation of ENTPD1. The kinetics indicate the pathological mechanism of the excessive extracellular ATP after RRD.
Assuntos
Trifosfato de Adenosina , Descolamento Retiniano , Vitrectomia , Corpo Vítreo , Humanos , Trifosfato de Adenosina/metabolismo , Descolamento Retiniano/metabolismo , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Células Fotorreceptoras de Vertebrados/metabolismo , Células Fotorreceptoras de Vertebrados/patologia , Líquido Sub-Retiniano/metabolismo , CinéticaRESUMO
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.
Assuntos
Transtornos da Visão , Vitrectomia , Corpo Vítreo , Descolamento do Vítreo , Humanos , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/patologia , Transtornos da Visão/cirurgia , Vitrectomia/métodos , Corpo Vítreo/cirurgia , Corpo Vítreo/patologia , Descolamento do Vítreo/diagnóstico , Descolamento do Vítreo/patologia , Descolamento do Vítreo/terapiaRESUMO
PURPOSE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE). METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded. RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss. CONCLUSION: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.
Assuntos
Endoftalmite , Infecções Oculares Bacterianas , Acuidade Visual , Humanos , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Endoftalmite/epidemiologia , Endoftalmite/terapia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Adulto , Idoso de 80 Anos ou mais , Adolescente , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/terapia , Adulto Jovem , Doença Aguda , Criança , Pré-Escolar , Lactente , Antibacterianos/uso terapêutico , Corpo Vítreo/microbiologia , Corpo Vítreo/patologia , Vitrectomia/métodosRESUMO
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.
Assuntos
Macula Lutea , Fibras Nervosas , Tomografia de Coerência Óptica , Descolamento do Vítreo , Humanos , Tomografia de Coerência Óptica/métodos , Descolamento do Vítreo/diagnóstico , Descolamento do Vítreo/diagnóstico por imagem , Estudos Retrospectivos , Pessoa de Meia-Idade , Feminino , Masculino , Idoso , Adulto , Fibras Nervosas/patologia , Macula Lutea/patologia , Macula Lutea/diagnóstico por imagem , Idoso de 80 Anos ou mais , Adolescente , Células Ganglionares da Retina/patologia , Adulto Jovem , Criança , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagemRESUMO
Objective: This case report aimed to describe the unusual clinical presentation and histopathological features of post-injection endophthalmitis. Methods: A 56-year-old male phakic patient with diabetic retinopathy received an intravitreal injection (Bevacizumab as per the patient) for neovascular glaucoma elsewhere and presented to our center one day after the dose with hypopyon. The eye was relatively white without pain or lid oedema. The patient was treated as a case of post-injection endophthalmitis with two doses of intravitreal antibiotics 48 hours apart. During the follow-up, he developed a Covid infection. After one week, when the media cleared, white exudates were seen in the vitreous cavity with a relatively healthy retina. He was taken up for pars plana vitrectomy and vitreous biopsy for histopathological study. Results: The microscopic examination of vitreous aspirate revealed crystalline deposits without any microorganisms. Two control slides, one with a mixture of intravitreal antibiotics, which were previously injected, and the other with fresh Triamcinolone were also examined. Although the findings of the drug mixture did not match the vitreous aspirate, they matched with triamcinolone, which established it as a case of pseudo endophthalmitis due to triamcinolone injected elsewhere. Discussion: Initially, it seemed like a straightforward case of post-injection endophthalmitis, but a further examination of the vitreous aspirate showed that it was pseudoendophthalmitis due to an intravitreal triamcinolone injection. Despite the patient being phakic, neovascularization or elevated intraocular pressure may have led to the disruption of the blood-ocular barrier and the migration of Triamcinolone into the anterior chamber. Conclusion: The case's uniqueness lies in being the first reported case of pseudo endophthalmitis in a phakic patient with an intact lens iris diaphragm. The case also highlighted the judicious use of available resources and out-of-the-box thinking to reach a diagnosis that may not always be obvious. Abbreviations: TA = Triamcinolone acetonide, AC = Anterior chamber, IVB = Intravitreal Bevacizumab, PL = Perception of light.
Assuntos
Inibidores da Angiogênese , Bevacizumab , Endoftalmite , Glaucoma Neovascular , Injeções Intravítreas , Humanos , Masculino , Pessoa de Meia-Idade , Glaucoma Neovascular/diagnóstico , Glaucoma Neovascular/etiologia , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Inibidores da Angiogênese/administração & dosagem , Inibidores da Angiogênese/uso terapêutico , Bevacizumab/administração & dosagem , Corpo Vítreo/patologia , Corpo Vítreo/microbiologia , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/microbiologia , COVID-19/complicações , COVID-19/diagnóstico , Vitrectomia/métodos , Glucocorticoides/uso terapêutico , Glucocorticoides/administração & dosagem , SARS-CoV-2 , Retinopatia Diabética/diagnósticoRESUMO
Vitreous, one of the largest components of the human eye, mostly contains water. Despite decades of studying the vitreous structure, numerous unanswered questions still remain, fueling ongoing active research. We attempt to provide a comprehensive overview of the current understanding of the development, morphology, biochemical composition, and function of the vitreous. We emphasize the impact of the vitreous structure and composition on the distribution of drugs. Fast-developing imaging technologies, such as modern optical coherence tomography, unlocked multiple new approaches, offering the potential for in vivo study of the vitreous structure. They allowed to analyze in vivo a range of vitreous structures, such as posterior precortical vitreous pockets, Cloquet canal, channels that interconnect them, perivascular vitreous fissures, and cisterns. We provide an overview of such imaging techniques and their principles and of some challenges in visualizing vitreous structures. Finally, we explores the potential of combining the latest technologies and machine learning to enhance our understanding of vitreous structures.
Assuntos
Tomografia de Coerência Óptica , Corpo Vítreo , Corpo Vítreo/diagnóstico por imagem , Corpo Vítreo/patologia , Humanos , Tomografia de Coerência Óptica/métodosRESUMO
BACKGROUND: Vitreoretinal lymphoma (VRL) is a rare malignant lymphoproliferative tumor. Our study aimed to investigate the mutational profile of VRL distinguishing from uveitis using next-generation sequencing (NGS) analysis on small amounts of vitreous fluid. METHODS: Vitreous samples from twenty-six eyes of twenty VRL patients and six eyes of five uveitis patients were enrolled. All vitreous samples underwent cytology, immunocytochemistry for B-cell markers, cytokines analysis of IL-10 and IL-6, and flow cytometry. NGS was performed in vitreous specimens from the 25 patients using 82 DLBCL-targeted mutation panels. Vitreous fluids from 8 cases were performed paired NGS-based mutation analysis on both cell-free DNA (cfDNA) and genomic DNA. RESULTS: The sensitivity and accuracy rates for vitreous cytology were 70 % and 76 %, and for cytokine analysis (IL-10/IL-6 > 1) were 65 % and 72 %, respectively. Overall, the common mutations in VRL were PIM1 (88.5 %), IGLL5 (88.5 %), KMT2C (73 %), MYD88 (77 %), CD79B (50 %) and TBL1XR1 (46.2 %). In addition, the genetic mutation in cfDNA was consistent with that in genomic DNA in eight VRL cases. CONCLUSIONS: The mutation analysis of 82 DLBCL-targeted spectrum mutation panels by NGS on the vitreous samples is a sensitive and specific tool for distinguishing VRL from uveitis. Utilizing cfDNA for NGS analysis may serve as a liquid biopsy to aid in the diagnosis of VRL, particularly when using small-volume aspirate.
Assuntos
População do Leste Asiático , Sequenciamento de Nucleotídeos em Larga Escala , Mutação , Neoplasias da Retina , Corpo Vítreo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , China , População do Leste Asiático/genética , Linfoma/genética , Linfoma/diagnóstico , Neoplasias da Retina/genética , Neoplasias da Retina/diagnóstico , Corpo Vítreo/patologia , Corpo Vítreo/metabolismoRESUMO
Purpose: Regression of retinoblastoma vitreous seeds (VS) during intravitreal chemotherapy can be delayed, resulting in supernumerary injections. Similarly, VS relapse may not be clinically evident at first. A predictive biomarker of tumor regression and relapse could help guide real-time clinical decision making. Retinoblastoma is an oxygen-sensitive tumor; paradoxically, VS survive in the hypoxic vitreous. We hypothesized that VS elaborate pro-angiogenic cytokines. The purpose was to determine if pro-angiogenic cytokine signatures from aqueous humor could serve as a biomarker of VS response to treatment. Methods: Multiplex ELISA was performed on aqueous from rabbit eyes with human retinoblastoma VS xenografts to identify expressed proangiogenic cytokines and changes in aqueous cytokine levels during intravitreal treatment were determined. Confirmatory RNAscope in situ hybridization for VEGF-A was performed on human retinoblastoma tumor sections and VS xenografts from rabbits. For human eyes undergoing intravitreal chemotherapy, serial aqueous VEGF-A levels measured via VEGF-A-specific ELISA were compared to clinical response. Results: VEGF-A was highly expressed in human retinoblastoma VS in the xenograft model, and was the only proangiogenic cytokine that correlated with VS disease burden. In rabbits, aqueous VEGF-A levels decreased in response to therapy, consistent with quantitative VS reduction. In patients, aqueous VEGF-A levels associated with clinical changes in disease burden (regression, stability, or relapse), with changes in VEGF-A levels correlating with clinical response. Conclusions: Aqueous VEGF-A levels correlate with extent of retinoblastoma VS, suggesting that aqueous VEGF-A may serve as a predictive molecular biomarker of treatment response.
Assuntos
Humor Aquoso , Biomarcadores Tumorais , Ensaio de Imunoadsorção Enzimática , Injeções Intravítreas , Neoplasias da Retina , Retinoblastoma , Fator A de Crescimento do Endotélio Vascular , Corpo Vítreo , Retinoblastoma/metabolismo , Retinoblastoma/tratamento farmacológico , Retinoblastoma/patologia , Animais , Neoplasias da Retina/metabolismo , Neoplasias da Retina/tratamento farmacológico , Neoplasias da Retina/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Humor Aquoso/metabolismo , Humanos , Corpo Vítreo/metabolismo , Corpo Vítreo/patologia , Coelhos , Biomarcadores Tumorais/metabolismo , Biópsia Líquida/métodos , Inoculação de Neoplasia , Feminino , Inibidores da Angiogênese/uso terapêutico , Citocinas/metabolismoRESUMO
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.
Assuntos
Perfurações Retinianas , Humanos , Perfurações Retinianas/fisiopatologia , Perfurações Retinianas/terapia , Perfurações Retinianas/patologia , Corpo Vítreo/patologia , Corpo Vítreo/fisiopatologia , Descolamento do Vítreo/fisiopatologia , Descolamento do Vítreo/terapia , Descolamento do Vítreo/diagnósticoRESUMO
BACKGROUND: Vitreoretinal lymphoma (VRL) is a rare intraocular malignancy that poses a diagnostic challenge due to the non-specific clinical presentation that resembles uveitis. The use of spectral domain optical coherence tomography (SD-OCT) has emerged as a valuable imaging tool to characterize VRL. Therefore, we sought to determine the specific OCT features in VRL compared to the uveitides. METHODS: Retrospective chart review of patients who were seen at Mayo Clinic from January 1, 2010 through December 31, 2022. The medical records and SD-OCT images at time of initial presentation were reviewed in patients with biopsy-proven VRL, intermediate uveitis, or biopsy-confirmed sarcoid posterior uveitis. Patients with VRL or similar uveitides including intermediate uveitis or sarcoid posterior uveitis were included. RESULTS: There were 95 eyes of 56 patients in the VRL group and 86 eyes of 45 patients in the uveitis group, of whom 15 (33.3%) were diagnosed with intermediate uveitis and 30 (66.7%) with sarcoid chorioretinitis. The SD-OCT features more commonly seen at initial presentation in VRL patients (vs. uveitis) included preretinal deposits (31.6% vs. 9.3%, p = 0.002), intraretinal infiltrates (34% vs. 3.5%, p < 0.001), inner retinal hyperreflective spots (15.8% vs. 0%, p < 0.001), outer retinal atrophy (22.1% vs. 2.3%, p < 0.001), subretinal focal deposits (21.1% vs. 4.7%, p = 0.001), retinal pigmented epithelium (RPE) changes (49.5% vs. 3.5%, p < 0.001), and sub-RPE deposits (34.7% vs. 0%, p < 0.001). Features more frequently seen in uveitis included epiretinal membrane (ERM) (82.6% vs. 44.2%, p < 0.001), central macular thickening (95.3% vs. 51.6%, p < 0.001), cystoid macular edema (36% vs. 11.7%, p < 0.001), subretinal fluid (16.3% vs 6.4%, p = 0.04), and subfoveal fluid (16.3% vs. 3.2%, p = 0.003). Multivariate regression analysis controlling for age and sex showed absence of ERM (OR 0.14 [0.04,0.41], p < 0.001) and absence of central macular thickening (OR 0.03 [0,0.15], p = 0.02) were associated with VRL as opposed to uveitis. CONCLUSION: OCT features most predictive of VRL (vs. uveitis) included absence of ERM and central macular thickening.