Angiogenesis-related cytokines in serum of proliferative diabetic retinopathy patients before and after vitrectomy

AIM: To evaluate serum concentrations of angiogenesis-related cytokines in proliferative diabetic retinopathy (PDR) before and after vitrectomy. METHODS: Serum samples were collected from 30 PDR patients with varying severity before and after vitrectomy. Serum concentrations of vascular endothelial growth factor (VEGF), pigment epithelium-derived factor (PEDF), interleukin-8 (IL-8) and interferon-inducible protein-10 (IP-10) were determined by enzyme-linked immunosorbent assays (ELISA). RESULTS: Serum concentrations of VEGF, PEDF, IL-8 and IP-10 were significantly higher in PDR patients than that in controls, respectively (P<0.05). VEGF concentration decreased significantly in postoperative samples than that in preoperative samples (P<0.05). The concentrations of PEDF, IL-8 and IP-10 did not exhibit significant changes after vitrectomy. CONCLUSION: Elevated cytokines levels in serum may be diagnostically useful in PDR. Angiogenesis-related cytokines play important roles in the development of PDR, and would instruct the risk assessment of pathogenetic condition in PDR patients.     

Full-thickness macular holes treated with vitrectomy and tissue glue

In the surgical treatment of full-thickness macular holes good results have been published with the combination of vitrectomy, gas and application of Transforming Growth Factor 2. Other authors report a 73% success rate in closing a full-thickness macular hole after vitrectomy and gas tamponade alone. We used, in addition to vitrectomy and gas tamponade, a tissue glue to stimulate adhesion of the elevated cuff of neurosensory retina surrounding a full-thickness macular hole and to close to hole itself. A total of 15 eyes of 13 patients (3 men, 10 women), with stage 3 and 4 macular holes were operated. All of the 13 uncomplicated cases showed complete closure of the macular hole. In one case (8%) the visual acuity decreased one line in spite of a funduscopically closed hole, and in two cases (16%) visual acuity remained the same despite closure. Increased visual acuity was seen in ten cases (76%), eight of which improved more than two lines.     

玻璃体切除术中与巩膜切口相关视网膜裂孔的临床研究

目的：分析玻璃体手术过程中由巩膜切口引起的周边部视网膜裂孔的发生率、可能原因及预防方法。方法：回顾分析300例314眼连续玻璃体手术病例，通过表格的形式，记录眼别、诊断、术前周边部视网膜情况、手术名称、术中操作、术中并发症。重点记录术中在巩膜切口附近是否发生锯齿缘解离或周边部视网膜裂孔，并记录裂孔的位置、大小以及处理。剔除术前已经存在上方视网膜锯齿缘解离或较大的周边视网膜裂孔的病例。分析术中巩膜切口附近视网膜裂孔的发生率及可能的原因。结果：入选的294例玻璃体手术眼中，巩膜切口附近发生视网膜锯齿缘解离或周边部视网膜裂孔共19例。其中，球内异物5例(5／19)，增殖性玻璃体视网膜病变4例(4／60)。糖尿病4例(4／87)，视网膜静脉阻塞并发玻璃体积血1例(1／16)，角、巩膜穿通伤4例(4／52)，静脉周围炎并发玻璃体积血1例(1／9)。其中，球内异物眼的发生率最高，为26％。黄斑前膜或黄斑裂孔的发生率最低，34例手术病例中，无1例发生巩膜切口附近的视网膜裂孔。结论：巩膜切口附近视网膜锯齿缘解离或视网膜裂孔的发生与术眼的病变程度、手术的复杂程度有关。术中积极预防是减少这一并发症的关键。     

Intraoperative choroidal detachment during small-gauge vitrectomy: analysis of causes,anatomic, and visual outcomes

IntroductionTo investigate the incidence and causes of intraoperative choroidal detachment (CD) during small-gauge vitrectomy, as well as the anatomic and visual outcomes.MethodsWe retrospectively reviewed the medical records of 1026 consecutive patients who underwent small-gauge vitrectomy from June 2017 to December 2018 at Zhongshan Ophthalmic Centre, Guangzhou, China. Data on the presence, location, and extent of intraoperative CD and its relationship to the infusion cannula were collected. Patient demographic characteristics and postoperative anatomic and visual outcomes were also assessed.ResultsA total of six cases were found to have intraoperative CD, including two with serous CD, three with limited haemorrhagic CD, and one with CD caused by inadvertent perfusion of gas during air/fluid exchange. Retraction of the infusion cannula and acute ocular hypotony were found to be the main causes of intraoperative CD in five out of the six cases. The best-corrected visual acuity of all cases significantly improved after the surgery.ConclusionThe incidence of intraoperative CD during small-gauge vitrectomy is low; the predominant causes are retraction of the infusion cannula and acute ocular hypotony. Immediate awareness and timely closure of the incision may contribute to a better surgical prognosis.Subject terms: Uveal diseases, Diseases     

The adjunctive use of perfluoroperhydrophenanthrene (Vitreon) in diabetic vitrectomy

Objective: To evaluate the utility and efficacy of perfluoroperhydrophenanthrene in the management of retinal detachments secondary to severe proliferative diabetic retinopathy. Patients and Methods: Forty consecutive patients with proliferative diabetic retinopathy and retinal detachments were entered into the study at nine participating clinical centers. Perfluoroperhydrophenanthrene (Vitreon) was used as an adjunct to pars plana vitrectomy and membranectomy. Results: Preoperative diagnoses included combined traction and rhegmatogenous retinal detachments in 23 eyes (57.5%), traction retinal detachments in 13 eyes (32.5%), and recurrent rhegmatogenous retinal detachments in 4 eyes (10%). Vitreous hemorrhage was present in 17 eyes (42.5%). Preoperative visual acuity ranged from light perception or hand motion in 28 eyes (70%) to 5/200 or greater in 12 eyes (30%). Vitreon was primarily used to flatten the retina following relaxing retinotomy in 12 eyes (30%), to displace subretinal fluid in a posterior-to-anterior direction without performing a drainage retinotomy in 15 eyes (37.5%), and to manage intraoperative complications such as iatrogenic tears in 8 (20%) and retinal dialysis in 5 eyes (12.5%). The retina flattened intraoperatively in all cases, facilitating administration of laser photocoagulation. Patients were followed for a minimum of six months (mean 13.2 months). At last follow up, the macula remained attached in 37 eyes (92.5%), including 31 (77.5%) in which the retina was totally attached. The retina remained detached in 3 eyes (7.5%). Visual acuity improved postoperatively in 20 patients (50%), was unchanged in 13 patients (32.5%), and worsened in 7 patients (17.5%). Conclusions: Perfluoroperhydrophenanthrene is a useful and effective intraoperative tool for the management of complex retinal detachments secondary to severe proliferative diabetic retinopathy. This revised version was published online in July 2006 with corrections to the Cover Date.     

Comparison of fibrin glue and sutures for conjunctival closure in pars plana vitrectomy

PURPOSE: Evaluating whether fibrin glue causes less postoperative pain, discomfort, and sick leave in conjunctival closure following 20-gauge pars plana vitrectomy than sutures. DESIGN: Retrospective study. METHODS: A questionnaire was sent in 2006 to 506 patients who underwent 20-gauge pars plana vitrectomy in 2004 at University Hospital, Leuven, Belgium. Postoperative pain, eye discomfort, and sick leave duration were determined. RESULTS: The patients in the glue group had a shorter duration of eye redness (P = .0471), eye discomfort (P = .0376), and ointment use (P = .0105). The patients in the glue group used less ointment (P = .0038), had shorter sick leave with independent workers (P = .0292), and experienced less pain on the first postoperative day after vitrectomy without cerclage (P = .0340). CONCLUSIONS: Fibrin glue causes less postoperative pain, discomfort, and sick leave for closure of conjunctival wounds in 20-gauge pars plana vitrectomy than sutures, and therefore, appears in our hands to be a better alternative to sutures.     

Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy

Background

To compare the incidence of intraoperative iatrogenic peripheral retinal breaks (IPRBs) during 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various indications.

Methods

This was a single-center, comparative, retrospective, interventional case series of 973 23-gauge TSVs and 402 conventional 20-gauge vitrectomies done by two surgeons between January 2004 and December 2009. The incidence rate of intraoperative IPRBs and risk factors were analyzed in association with various clinical and surgical factors.

Results

IPRBs occurred significantly less often during 23-gauge TSV (16 of 973 cases, 1.6 %) than during conventional vitrectomy (25 of 402 cases, 6.2 %, P?<?0.001). Univariate analysis revealed that conventional vitrectomy and operation time were risk factors for the complication. Multivariate logistic regression analysis also revealed that conventional vitrectomy (P?=?0.03, OR?=?2.91), operation time (P?<?0.01, OR?=?1.01), and intraoperative induction of posterior vitreous detachment (PVD, P?=?0.04, OR?=?1.97) were risk factors for IPRBs.

Conclusions

The 23-gauge TSV procedure with the trocar system has a lower incidence of intraoperative IPRBs than conventional 20-gauge vitrectomy. Longer operation time and induction of PVD are also independent risk factors of the complication.     

Retinal detachment after small-incision, sutureless pars plana vitrectomy: possible causative agents

Background and purpose  

To identify possible agents causing retinal detachment following small-incision, sutureless vitrectomy.     

23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变(PDR)的疗效分析

目的 对比分析23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普对增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)疗效及手术相关并发症的影响.方法 回顾性分析南昌大学第二附属医院2015年1月至2016年2月收治的PDR患者42例(42眼)的资料,其中22例在行23G玻璃体切割术前1周于玻璃体内注射康柏西普0.05 mL(A组);另外20例在行23G玻璃体切割术完毕时于玻璃体内注射康柏西普0.05 mL(B组).观察两组患眼手术时间,术后玻璃体内出血情况,术中、术后其他指标及最佳矫正视力等的差异.结果 A组手术完成时间、电凝止血率、医源性裂孔发生率及术中出血率均低于B组.两组术后6个月视力比较差异无统计学意义(P＞0.05),但两组术前、术后视力相比差异均有统计学意义(均为P ＜0.05).术后早期玻璃体出血(≤1个月);A组有4眼(18.2％),B组有3眼(15.0％),两组相比差异无统计学意义(P＞0.05).术后晚期玻璃体出血(＞1个月);A组6眼(27.3％),B组未发现玻璃体内出血,两组相比差异有统计学意义(P＜0.05).随访期间A组有3眼因术后玻璃体再出血,需再次手术,再次手术率13.6％;B组有2眼术后发生牵拉性视网膜脱离,需再次手术治疗,再次手术率10.0％.视网膜激光光凝补充治疗:A组需(2.3±1.0)次,B组需(1.4±0.6)次,两组比较差异有统计学意义(P＜0.05).结论 23G玻璃体切割术中联合康柏西普治疗PDR可有效预防术后早晚期出血,为术后激光补充治疗提供有利条件,减少激光补充治疗次数;而术前联合康柏西普治疗PDR可缩短手术时间,减少术中并发症发生,降低术后早期出血率.     

Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). DESIGN: Retrospective interventional case series. METHODS: Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. RESULTS: Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). CONCLUSIONS: There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.     

A correlation of pregnancy term, disease activity, serum female hormones, and cytokines in uveitis

BACKGROUND/AIMS: Pregnancy and the postpartum period are associated with the activity of autoimmune diseases including uveitis. Although the exact mechanism is unknown, hormones are reported to alter inflammatory cytokines and influence disease activity. The authors studied ocular inflammation, female hormones, and serum cytokine levels during and after pregnancy. METHODS: A prospective, observational case study was conducted. Four pregnant women in their first trimester with chronic non-infectious uveitis were followed monthly until 6 months after delivery. Serum female hormones (oestrogen, progesterone, prolactin) and various cytokines (IL-2, IL-4, IL-5, IL-6, IL-10, IFN-gamma, and TGF-beta) were measured by ELISA. RESULTS: The four patients had five full term pregnancies. Uveitis activity decreased after the first trimester but flared in the early postpartum period. Serum female hormones, highly elevated during pregnancy, drastically dropped post partum. Cytokine levels except TGF-beta were mostly undetectable. CONCLUSION: Female hormones and TGF-beta may contribute to the activity of uveitis during pregnancy and the postpartum period.