Comparative study of incomplete posterior vitreous detachment as a risk factor for proliferative vitreoretinopathy

· Background: Abnormal vitreoretinal relationships have recently been implicated in many vitreoretinal disorders. Sites of abnormal vitreoretinal adherences are likely to exist in eyes predisposed to rhegmatogenous retinal detachment (RD), causing either retinal tears or incomplete posterior vitreous detachment (PVD). The present study was designed in two parts to identify the risk for preoperative and postoperative proliferative vitreoretinopathy (PVR) due to incomplete PVD. · Methods: We prospectively evaluated the vitreoretinal relationships using high-resolution kinetic echography in 102 consecutive eyes of 100 patients with rhegmatogenous RD. In the first part, a case-control study was conducted to compare the vitreous status in patients with preoperative PVR (cases) with that in patients with non-PVR-complicated RD (controls). During the second part, patients with noncomplicated RD (65 eyes) who were operated on by a simple retinal attachment procedure were followed up for a mean period of 6.6 months to compare the recurrence of RD due to postoperative PVR according to their vitreous status. · Results: Patients with PVR on study entry had a higher prevalence of partial PVD (28 of 32 eyes, 87%) than did controls (25 of 70 eyes, 35%). The statistical significance of this difference was independent of all other variables studied. After a mean follow-up period of 6.6 months, the incidence of recurrence of RD associated with postoperative PVR was 33% in the eyes with incomplete PVD, compared with 4.9% in the eyes without incomplete PVD. · Conclusions: Our results support the notion that the occurrence of incomplete PVD in RD is a significant risk factor for preoperative and postoperative PVR. Received: 18 June 1997 Revised version received: 9 October 1997 Accepted: 15 October 1997     

The Immunological Studies on Proliferative Intraocular Disorders：Investigation of Activated Lymphocytes,Macrophages and HLA—DR

Purpose: To investigate whether activated B lymphocytes ( CD23 ) , activated T lymphocytes (CD25) ,macrophages(CD68) and human leucocyte antigen class II antigen (HLA- DR) were existed in epiretinal membranes (ERMs) and subretinal membranes (SRMs) of prolif-erative intraocular disorders (PID).Methods : Twenty specimens of ERMs from rhegmatogenous retinal detachment with prolifera-tive vitreoretinopathy( PVR), traumatic PVR and secondary traction retinal detachment, and two specimens of SRMs from rhegmatogenous retinal detachment with PVR and traumatic PRV were studied using immunohistochemical staining.Results: CD68 and HLA - DR were found in all specimens, CD23 and CD25 in 4 cases of ERMs and in 1 case of SRMs, respectively.Conclusions : 1. The ERMs and SRMs of different etiology shared a common basis of inflammation and immunopathology. 2. There would be secondary cellular and humoral immunity in the ERMs and the SRMs of PID. Eye Science 1998; 14:35 - 40.     

增生性玻璃体视网膜病变中组织型转谷氨酰胺酶的表达

目的:检测增生性玻璃体视网膜病变(PVR)视网膜前膜和视网膜色素上皮(RPE)细胞中组织型转谷氨酰胺酶(tTG)的表达情况,探讨tTG是否参与PVR的发病过程.方法:PVR患者21例,收集视网膜前膜,C级8例,D级13例,行tTG免疫组织化学染色.另对培养3-5代的人RPE细胞分别用含有1 00mL/L PVR玻璃体液、正常玻璃体液和PBS的DMEM培养液进行孵育24h后行tTG免疫细胞化学染色.光镜下观察,比较C级和D级膜的表达阳性率,显微图像分析测量3组RPE细胞染色的平均灰度值.结果:在PVR视网膜前膜中tTG呈阳性表达(81%),C级和D级膜表达阳性率无差异 (C级88%,D级77%,P＞0.05).培养的人RPE细胞表达tTG,在PVR患者的玻璃体液作用下,tTG表达的平均灰度值为137.0±2.6,与正常玻璃体液组(143.5±2.9)及PBS对照组(143.6±3.0)相比,表达水平升高(P＜0.05).结论:PVR视网膜前膜和培养的人RPE细胞tTG表达阳性,在PVR患者的玻璃体液作用下,RPE细胞的tTG表达水平升高,这表明tTG参与了PVR的发病过程,在PVR视网膜前膜的形成过程中可能有重要作用.     

Local dry vitrectomy combined with segmental scleral buckling and viscoelastic tamponade for rhegmatogenous retinal detachment with vitreous traction

AIM: To demonstrate combined local dry vitrectomy and segmental scleral buckling for the treatment of partial rhegmatogenous retinal detachment (RRD) with local vitreous traction in patients at high-risk for proliferative vitreoretinopathy (PVR). METHODS: Seven eyes of 7 patients were retrospectively studied, including 3 retinal dialysis and 4 retinal detachment (RD) (3 eyes with peripheral retinal hole and 1 eye with giant tear). All patients exhibited partial RD and local vitreous traction. Combined local dry vitrectomy without conventional infusion and segmental scleral buckling was performed. Viscoelastic fluid was injected into the vitreous cavity if needed. Demographic information, preoperative and post-operative complications, and outcomes were recorded. RESULTS: The mean age of the patients at presentation was 22.43±14.28y. All seven patients obtained retinal reattachment after a single surgical intervention. Post-operative visual acuities were improved in all patients. None of them developed complications, except for temporary mildly increased intraocular pressure in 2 cases. CONCLUSION: Combined local dry vitrectomy and segmental scleral buckling and viscoelastic tamponade if needed are effective for patients of RRD with local vitreous traction. The technique avoids many complications associated with regular surgery and was minimally invasive to both the external and internal eye.     

Soluble cellular adhesion molecules in proliferative vitreoretinopathy and proliferative diabetic retinopathy.

PURPOSE. To measure vitreous levels of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cellular adhesion molecule-1 (sVCAM-1) in the eyes of patients with retinal detachment (RD) due to proliferative diabetic retinopathy (PDR) or proliferative vitreoretinopathy (PVR) and to determine whether the levels of these mediators correlated with clinical parameters of disease. METHODS. Undiluted vitreous specimens were collected from 50 eyes of 48 patients undergoing vitrectomy for traction RD due to PDR (21 specimens) and recurrent RD due to PVR (19 specimens). Control vitreous specimens were obtained from patients undergoing macular hole repair (10 specimens). The levels of sICAM-1 and sVCAM-1 were measured in each sample by specific enzyme-linked immunoadsorbent assays. RESULTS. Vitreous levels of sICAM-1 were significantly increased in vitreous specimens from both PVR (median +/- SD; 12.0 +/- 76.3 ng/ml; P < 0.01) and PDR (8.4 +/- 24.0 ng/ml; P < 0.01) when compared to vitreous from eyes with macular holes (0. 3 +/- 4.2 ng/ml). Vitreous levels of sVCAM-1 were significantly increased in both PVR (36.5 +/- 255.2 ng/ml; P < 0.001) and PDR (26. 2 +/- 93.5 ng/ml; P < 0.01) when compared to control vitreous (17.7 +/- 7.8 ng/ml). The vitreous levels of sICAM-1 were higher in cases of PDR which developed recurrent proliferative disease (P < 0.01) and recurrent RD (P = 0.01), whereas the levels of sICAM-1 in PVR and sVCAM-1 in PDR and PVR did not significantly correlate with these clinical parameters. CONCLUSIONS. Soluble forms of ICAM-1 and VCAM-1 are increased in the vitreous cavity of patients with RD due to PDR or PVR, reflecting the inflammatory nature of these conditions and suggesting a possible role for these mediators in the pathogenesis of proliferative retinal disease. The vitreous levels of these sCAMs at the time of surgery may serve as a marker of inflammation, but their specific levels do not predict the likelihood of recurrent proliferation or surgical anatomic success in most cases of PVR and PDR.     

Anterior proliferative vitreoretinopathy. Clinicopathologic, light microscopic, and ultrastructural findings

Proliferative vitreoretinopathy (PVR) involving the posterior and equatorial retina is an established clinicopathologic entity. Clinically, a similar process, anterior PVR (APVR), results in anterior dragging of the peripheral retina by membranes which connect to the ciliary body or iris and cause circumferentially and radially fixed retinal folds. The pathology of APVR, however, has not been reported. The authors describe pathologic findings in 28 cases of APVR and ultrastructural pathologic findings in 6 surgical APVR specimens. Anterior PVR was frequently associated with retinal detachment (RD) repair (96%) and trauma (38%). Residual vitreous at the vitreous base virtually always provided a scaffold for membranes containing proliferating cells and deposited extracellular matrix. Major components of APVR membranes were fibrovascular tissue (71%), pigment epithelial cells (43%), fibrous and corneal stromal ingrowth (32%), and glial proliferation (18%). Because of its anterior location, APVR membranes also incorporated ciliary epithelium and corneal endothelium. Contraction of APVR membranes caused anterior retinal displacement and detachment in anatomic configurations corresponding to narrow and wide peripheral troughs. The authors' findings indicate that APVR is a distinctive clinicopathologic entity which may complicate rhegmatogenous RD and its repair.     

PVR B 级的裂孔性视网膜脱离术后复发与玻璃体病变关系临床分析

目的回顾分析近10年PVR B级的裂孔性视网膜脱离术后复发与玻璃体病变的关系.方法对429例(435只眼)PVR B级的裂孔性视网膜脱离施行巩膜扣带术治疗,其中41只眼术后复发(9.43%),分析术后复发与玻璃体病变的关系.结果术前玻璃体正常组与浓缩组的复发率(3.19%与12.33%)之间差异有显著性(P＜0.05);正常组与条索牵引组间的复发率(3.19%与14.29%)之间差异有极显著性(P＜0.01);正常组与总体组的复发率(3.19%与9.43%)之间差异有显著性(P＜0.05);术前无玻璃体后脱离组与玻璃体后脱离组间的复发率(5.56%与12.90%)之间差异有显著性(P＜0.05).视网膜脱离术前各种玻璃体的情况在视网膜脱离复发时均有不同程度地加重.结论PVR B级的裂孔性视网膜脱离术前玻璃体病变和玻璃体后脱离对术后复发影响明显.重视玻璃体-视网膜界面动态变化,可进一步提高手术治愈率.     

Expression of vitreous cytokines in proliferative vitreoretinopathy: a prospective study

PURPOSE: Proliferative vitreoretinopathy (PVR) is a major cause of failure of retinal detachment surgery. It is believed to be a wound-healing process in the retina. Many of the cellular functions are influenced by cytokines and growth factors such as interleukins (ILs). The present study was conducted to investigate the presence of transforming growth factor-beta 2 (TGF-beta2), basic fibroblast growth factor (bFGF), IL-1beta, IL-6, and protein in the vitreous of patients with retinal detachment and to determine the value of these mediators in predicting the future development of PVR. METHODS: A prospective study was conducted in 140 consecutive patients with rhegmatogenous retinal detachment in whom vitrectomy was considered necessary. Vitreous samples were analyzed for the presence of TGF-beta2, bFGF, IL-1beta, IL-6, and protein. Patients were then followed up for 3 months for the development of postoperative PVR. RESULTS: The mean levels of TGF-beta2, bFGF, IL-1beta, and protein in the vitreous were significantly higher (P < 0.05) in patients with preoperative PVR compared with those without. The mean levels of TGF-beta2, bFGF, IL-6, and protein in the vitreous were significantly higher (P < 0.05) in patients who had postoperative PVR compared with those who did not. Multivariate logistic regression analysis showed IL-6 and protein to be significant (P < 0.05), independent, predictive risk factors for the development of PVR. CONCLUSIONS: The various cytokines may play a role in the pathobiology of PVR. High vitreous levels of IL-6 and protein were identified as significant risk factors for PVR. A model was developed to predict the probability of development of postoperative PVR in these patients, and it may be used to indicate intravitreal pharmacologic treatment for those at risk.     

Mononuclear phagocytes in proliferative vitreoretinopathy (PVR). A specific role of microglial cells in non-traumatic disease?

Mononuclear phagocytes have been a focus of attention in the cellular biology of proliferative vitreoretinopathy (PVR) for more than ten years. The pattern of phagocyte participation in periretinal traction membrane formation in PVR depends on the etiology, i.e. trauma, rhegmatogenous retinal detachment, previous therapy, i.e. multiple surgical interventions, and the clinical stage of the disease. We have recently identified microglial cells as a distinct cellular population, in membranes from patients with non-traumatic PVR. Current evidence of mononuclear phagocyte function in PVR suggests a role for resident phagocytes of the vitreous and retina in PVR subsequent to rhegmatogenous detachment, and a role for blood-derived monocytes in post-traumatic PVR. The cellular biology of PVR may be much more heterogeneous than previously assumed.     

原发性视网膜脱离对侧眼的观察

目的探讨增生性玻璃体视网膜病变(PVR)C-2级及以下的原发性(孔源性)视网膜脱离对侧眼是否存在相同疾病的危险性,威胁其视力的病理学改变,及预防性治疗的意义。方法对236例(236眼)原发性视网膜脱离进行了回顾性分析,记录年龄、性别、视力、对侧眼威胁视力的病理学改变、预防性治疗效果及随访时间。结果236例平均观察6.6年,其中121例(51.27%)对侧眼存在威胁视力的病理学改变,包括81例(66.94%)有视网膜裂孔,39例(16.53%)发生了视网膜脱离。71例预防性治疗的对侧眼中67例(94.37%)未发生视网膜脱离。结论原发性视网膜脱离的对侧眼发生威胁视力的病理学改变,特别是发生视网膜裂孔的危险性增加,对对侧眼进行预防性治疗是一种有效的方法。     

Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery

PURPOSE: To determine the prevalence of and risk factors for proliferatative vitreoretinopathy (PVR) in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. DESIGN: Observational case series. METHODS: Prospective study. SETTING: A private vitreoretinal clinic in Caracas, Venezuela. STUDY POPULATION: 119 eyes of 119 patients who presented with rhegmatogenous retinal detachment but no previous vitreoretinal surgery between 1995 and 1998. OBSERVATION PROCEDURES: Data from detailed preoperative and postoperative examinations of each eye were recorded prospectively and entered into an electronic database. MAIN OUTCOME MEASURES: Prevalence of PVR of any type and severe PVR, preoperative risk factors for PVR of any type and severe PVR, effect of PVR and retinal detachment duration on initial and final visual acuity, and surgical complexity. RESULTS: The prevalence of PVR of any type was 52.9% and of severe PVR was 26.9%. The mean retinal detachment duration (+/-SD) was 58.4 (+/-129.1) days, and the mean time from initial examination to surgical treatment (+/-SD) was 24.3 (81.2) days. By univariable analysis, long retinal detachment duration, poor initial visual acuity, and large retinal detachment extent were significantly associated with PVR prevalence and severity. The presence of vitreous hemorrhage was significantly associated with PVR prevalence, and cataract was significantly associated with PVR severity. By multivariable analysis, long retinal detachment duration and large retinal detachment extent were simultaneous risk factors for PVR prevalence, while long retinal detachment, large retinal detachment extent, and poor initial visual acuity were simultaneous risk factors for PVR severity. Eyes with longer retinal detachment duration, PVR of any type, and severe PVR had worse initial and final visual acuities than eyes with shorter retinal detachment duration or those without PVR, respectively. Eyes with PVR had more complex surgery than those without PVR. CONCLUSIONS: PVR occurred very frequently in this population and was associated with more complex surgery and worse visual outcomes than among eyes without PVR. We have identified preventable risk factors associated with PVR that suggest a specific and significant need for better access to ophthalmologic care and patient education in this group of patients.     

Cytokine gene polymorphisms in retinal detachment patients with and without proliferative vitreoretinopathy: a preliminary study

PURPOSE: Cytokines and other growth factors such as interleukins play an important role in the pathogenesis of proliferative vitreoretinopathy (PVR). Interindividual variations in cytokine production seem to correlate with some cytokine gene polymorphisms. The purpose of this study was to analyse the distribution of these cytokine gene variants in patients with rhegmatogenous retinal detachment (RD) with and without PVR. METHODS: Single nucleotide polymorphisms were analysed for five cytokines: tumour necrosis factor-alpha (TNF-alpha), transforming growth factor-beta1 (TGF-beta1), interferon-gamma (IFN-gamma), interleukin-6 (IL-6) and interleukin-10 (IL-10). Patients were divided into two surgically treated groups of RD patients: group RD had 27 patients with RD, and group PVR had 31 patients with RD complicated by PVR. A control group was composed of 46 ethnically matched healthy individuals. RESULTS: The genotype distribution of the TGF-beta1 codon 10 polymorphism differed between PVR and RD patients (p = 0.018) and between PVR patients and controls in codon 25 (p = 0.011). There was a higher frequency of TGF-beta1 codon 10 allele T in PVR patients compared with RD patients (p = 0.023). No statistically significant differences between groups were observed for the other polymorphisms examined. CONCLUSION: An association between the TGF-beta1 genetic profile and the development of PVR was detected in this study. Further studies are necessary to confirm this finding and to establish its clinical relevance.     

正视眼视网膜脱离的手术预后与玻璃体病变关系的分析

目的 研究正视眼视网膜脱离（ｒｅｔｉｎａｌ ｄｅｔａｃｈｍｅｎｔ,ＲＤ）患者的手术预后及其与玻璃体改变的关系。方法 回顾１９９６年月至１９９７年７月在我院行手术治疗的孔源性视网膜脱离患者１２６２例（１２４９只眼）,其中近视有ＲＤ组１０３１只眼,正视眼ＲＤ组２４３只眼,并研究增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅ ｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）的分级及玻璃体后脱离（ｐｏｓｔ     

Soluble TNF receptors in vitreoretinal proliferative disease

PURPOSE: To measure vitreous levels of soluble TNF-receptors (sTNF-Rs) types I and II in eyes with rhegmatogenous retinal detachment (RRD), uncomplicated or complicated with proliferative vitreoretinopathy (PVR), and in eyes with proliferative diabetic retinopathy (PDR). To examine whether there is any relationship between vitreous levels of sTNF-Rs and clinical features of these conditions and between vitreous sTNF-Rs and TNFalpha levels and serum levels of sTNF-RS: METHODS: Vitreous levels of sTNF-Rs and TNFalpha were measured by enzyme-linked immunosorbent assay in 30 eyes with PVR, 30 eyes with uncomplicated RRD, and 29 eyes with PDR. Vitreous from eyes of 10 deceased donors and 9 eyes with macular holes served as control specimens. Serum levels of sTNF-Rs were measured in 17 patients with PDR and 21 patients with PVR. RESULTS: Vitreous levels of sTNF-Rs I and II were increased in eyes with PVR, RRD, and PDR when compared with control eyes (P < 0.002). However, vitreous levels of sTNF-Rs I and II were higher in eyes with PVR than in eyes with RRD (P < 0.01) or PDR (P < 0.03). This contrasted with the findings that serum sTNF-Rs were higher in PDR than in PVR (P < 0.016) and that vitreous levels of TNFalpha were higher in eyes with PDR than in eyes with PVR (P < 0.0005). In PVR, vitreous sTNF-Rs levels were associated with the duration of retinal detachment, number of previous external operations, and grade of severity, whereas in PDR these levels were not related to the type or duration of diabetes or its complication with traction retinal detachment. CONCLUSIONS: These observations suggest the existence of TNF inhibitory mechanisms within the eye during retinal processes of inflammation and angiogenesis. That high vitreous levels of sTNF-Rs relate to severity of retinopathy suggests that these molecules may constitute reactive products of inflammation. Effective control of TNFalpha activity by sTNF-Rs within the retinal microenvironment may determine the outcome and severity of retinal proliferative conditions.     

Comparative study of clinical factors that predispose patients to proliferative vitreoretinopathy in aphakia

To clarify the risk factors of proliferative vitreoretinopathy (PVR) in aphakia, the clinical features of 25 aphakic eyes with PVR were statistically analyzed and compared with a control group of 157 aphakic eyes with non-PVR rhegmatogenous retinal detachment. The statistically significant (P less than 0.05) factors that predisposed patients to PVR in aphakia were as follows: a history of vitreous loss on cataract surgery, retinal detachment developing within 3 months after cataract extraction, duration of retinal detachment longer than 3 months, break larger than three disc diameters, and choroidal detachment. Vitreous loss is believed to play the most important role in the development of PVR in aphakia.     

增生性玻璃体视网膜病变玻璃体中的Ⅲ型前胶原

目的:检测增生性玻璃体视网膜病变(PVR)患者血清及玻璃体中Ⅲ型前胶原(Procollagen Ⅲ,PC Ⅲ)的含量,探讨其在PVR发病中的作用。方法:用放射免疫测定法测定5例正常人玻璃体,20例正常人血清及29例孔源性视网膜脱离合并PVR患者玻璃体及血清中的PC Ⅲ。用Logistic回归模型分析PVR患者发病时间、手术史、增生膜及PVR分级与PC Ⅲ含量的相关性。结果:PVR患者血清和对照组血清PC Ⅲ含量分别为83.76±18.52和85.02±17.50μg/L(P>0.05)。正常对照玻璃体PC Ⅲ含量低于最小可测值(40 μg/L)。PVR患者组中有12例未检测到,其余17例玻璃体中PC Ⅲ含量明显升高,平均268.69±176.07μg/L(P<0.05)。玻璃体PC Ⅲ水平与病史长短和PVR级别相关,发病时间延长,其玻璃体PC Ⅲ含量大于40μg/L的概率是小于40 μg/L的5.2655倍;PVR级别增加,其玻璃体PC Ⅲ含量大于40 μg/L的概率是小于40 μg/L的2.7978倍。结论:多数PVR患者玻璃体内可测得PC Ⅲ含量增加,并与PVR分级及发病时间长短相关。PC Ⅲ合成活跃属眼内的局部反应。提示PC Ⅲ及Ⅲ型胶原在PVR发展中起一定的作用。眼科学报1998;14:76—79。     

Tenascin-C levels in the vitreous of patients with proliferative vitreoretinopathy

PURPOSE: To determine whether tenascin-C levels are elevated in the vitreous of patients with proliferative vitreoretinopathy (PVR). METHODS: We assayed tenascin-C levels in vitreous samples of 110 consecutive patients with PVR (30 eyes), rhegmatogenous retinal detachment (RRD; 32 eyes), and macular hole or idiopathic epiretinal membrane (controls, 48 eyes) using an enzyme-linked immunosorbent assay. RESULTS: Vitreous levels of tenascin-C (median [range]) were significantly greater in PVR (845.0 ng/ml [411.0-1,050.0]) than in RRD (21.9 ng/ml [13.2-127.0]) and in the controls (18.0 ng/ml [9.9-199.0]) (p < 0.0001). CONCLUSION: The results indicate the possibility that tenascin-C is involved in the pathogenesis of PVR.     

Risk factors for proliferative vitreoretinopathy after primary vitrectomy: a prospective study

AIM: To assess clinical variables and vitreous protein as risk factors for the development of postoperative proliferative vitreoretinopathy (PVR). METHODS: A prospective study was conducted on 140 patients with a rhegmatogenous retinal detachment in whom a primary vitrectomy was performed. 12 clinical variables were recorded and vitreous samples obtained for measurement of protein concentration. Univariate and multivariate logistic regression analysis was used to determine the risk factors for PVR. RESULTS: Complete data were available for 136 of 140 patients. 40 of the 136 patients (29.4%) developed postoperative PVR. Univariate regression revealed that significant (p<0.05) risk factors included aphakia, presence of preoperative PVR, size of detachment, the use of silicone oil, and high vitreous protein level. Multivariate regression analysis revealed only aphakia (odds ratio 2.72), the presence of preoperative PVR (odds ratio 3.01), and high vitreous protein concentration (odds ratio 1.11) to be significant (p<0.05) independent, predictive risk factors for the development of PVR. CONCLUSIONS: This study has shown that the significant risk factors for PVR are preoperative PVR, aphakia, and high vitreous protein levels. Two models (clinical factors only and clinical factors and vitreous protein) were constructed to predict the probability of developing postoperative PVR and may be used to identify those at risk for possible intravitreal pharmacological treatment.     

Late recurrences more than 1 year after primary successful surgery for rhegmatogenous retinal detachment

BACKGROUND: Recurrent retinal detachment following initial successful surgery usually occurs in the early postoperative course. Redetachment after 1 or more years of complete retinal reattachment is a rare event. The present study investigates the frequency and causes of late recurrences. PATIENTS/MATERIAL AND METHODS: A consecutive series of 2,232 eyes that presented with rhegmatogenous retinal detachment (RD) were treated between January 1994 and December 2006. Among them were 30 cases (30 eyes) presenting with late recurrent RD (1.34 %). We compared the clinical characteristics of initial and late recurrent RD. RESULTS: Over the 13-year period, 54.5 % of rhegmatogenous RD cases were treated with scleral buckling, 42.5 % using vitrectomy techniques and 2.55 % with pneumatic retinopexy. Late recurrent RD occurred 1.1 - 10.4 years (average 3.8, SD 2.56) after initially successful surgery. Previous surgery included scleral buckling in 24 eyes (80 %), vitrectomy in 5 eyes (16.7 %) and pneumatic retinopexy in another eye (3.3 %). At the time of initial treatment, primary reattachment rate was 93.3 % and final 100 %. At the time of late redetachment, the anatomic situation appeared more complex. Accordingly, most eyes were treated by vitrectomy (73.3 %), and only 23.3 % using buckling techniques. Furthermore, the numbers of reoperations to achieve reattachment increased from 6.6 % to 23.3 %. Major causes for late failures were vitreous base traction leading to new or reopened breaks and PVR. Three eyes showed these complications immediately after complicated anterior segment surgery. Comparing visual outcomes after initial (preop logMAR 0.57 +/- 0.7 and postop 0.38 +/- 0.43) and late (preop logMAR 0.87 +/- 0.71 and postop 0.66 +/- 0.5) RD, functional prognosis is worse when redetachment occurs. Nonetheless, in 50 % of eyes useful vision (>or= 20 / 50) was retained by repeat surgery. CONCLUSIONS: Recurrent retinal detachment that presents after more than 1 year of complete reattachment occurs in 1.34 % of cases according to the present study. We found a higher rate after scleral buckling compared to vitrectomy. The most important reasons for late failures are vitreous base traction and periretinal proliferations that clinically appear as new or reopened tears or as PVR. Recurrences show a more difficult retinal situation and require more extensive surgical interventions. Based on the anatomic and functional success rates, repeat surgical procedures are worth considering.     

Vitreous M2 Macrophage-Derived Microparticles Promote RPE Cell Proliferation and Migration in Traumatic Proliferative Vitreoretinopathy

PurposeTo characterize vitreous microparticles (MPs) in patients with traumatic proliferative vitreoretinopathy (PVR) and investigate their role in PVR pathogenesis.MethodsVitreous MPs were characterized in patients with traumatic PVR, patients with rhegmatogenous retinal detachment (RRD) complicated with PVR, and control subjects by flow cytometry. The presence of M2 macrophages in epiretinal membranes was measured by immunostaining. Vitreous cytokines were quantified by ELISA assay. For in vitro studies, MPs isolated from THP-1 cell differentiated M1 and M2 macrophages, termed M1-MPs and M2-MPs, were used. The effects and mechanisms of M1-MPs and M2-MPs on RPE cell proliferation, migration, and epithelial to mesenchymal transition were analyzed.ResultsVitreous MPs derived from photoreceptors, microglia, and macrophages were significantly increased in patients with traumatic PVR in comparison with control and patients with RRD (PVR), whereas no significance was identified between the two control groups. M2 macrophages were present in epiretinal membranes, and their signature cytokines were markedly elevated in the vitreous of patients with traumatic PVR. Moreover, MPs from M2 macrophages were increased in the vitreous of patients with traumatic PVR. In vitro analyses showed that M2-MPs promoted the proliferation and migration of RPE cells via activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway. However, M2-MPs did not induce the expression of fibrotic proteins, including fibronectin, α-smooth muscle actin, and N-cadherin in RPE cells.ConclusionsThis study demonstrated increased MP shedding in the vitreous of patients with traumatic PVR; specifically, MPs derived from M2 polarized macrophages may contribute to PVR progression by stimulating RPE cell proliferation and migration.