Showing papers on "Vitreous Detachment published in 2018"

Evaluation of hyaloid-retinal relationship during triamcinolone-assisted vitrectomy for primary rhegmatogenous retinal detachment.

Abstract: AIMS To determine hyaloid-retinal relationship in primary rhegmatogenous retinal detachment during vitreous surgery. METHODS This is a prospective, interventional study of patients (n = 72) undergoing triamcinolone-assisted 25G vitreous surgery for primary rhegmatogenous retinal detachment. Hyaloid-retinal relationship was noted intraoperatively to identify regions and patterns of firm attachment and was classified into subgroups. Analysis was done to determine association between hyaloid-retinal relationship patterns and preoperative findings: posterior vitreous detachment, proliferative vitreoretinopathy, type of retinal tear, the presence of peripheral degenerations, and postoperative outcomes. RESULTS Three patterns of hyaloid-retinal relationship were identified: type1 (complete absence of posterior vitreous detachment (21%)), type 2 (incomplete posterior vitreous detachment (47%)) and type 3 (complete posterior vitreous detachment (32%)). Posterior vitreous detachment in some form was present in 84% of the cases with retinal tears as the causative break but none of the cases with retinal holes (p < 0.001). None of the cases with vitreoretinal degeneration had complete posterior vitreous detachment (p = 0.001). 69% of proliferative vitreoretinopathy-C cases had type 1 hyaloid-retinal relationship as compared to 11% cases with no proliferative vitreoretinopathy (p < 0.001). Proliferative vitreoretinopathy-related anatomical failure was seen in 7.5%, and 80% of these eyes with recurrent RD had type 1 hyaloid-retinal relationship (p<0.001). Nearly half the patients diagnosed as complete posterior vitreous detachment preoperatively were found to have incomplete posterior vitreous detachment intraoperatively. CONCLUSIONS Majority of the cases with rhegmatogenous retinal detachment have some form of strong vitreoretinal adhesion. Hyaloid-retinal relationship varies with types of retinal breaks, retinal degeneration, and proliferative vitreoretinopathy. Intraoperative hyaloid-retinal relationship is frequently different from that assessed before surgery and the proposed classification may improve surgical decision making and prognostication.

Vitreous changes after intravitreal bevacizumab monotherapy for retinopathy of prematurity: a case series.

Abstract: Reporting a special clinical finding after intravitreal bevacizumab monotherapy for retinopathy of prematurity. In a retrospective case series, the clinical courses of five premature infants with similar vitreous changes after a single dose of intravitreal bevacizumab (IVB) injection without additional laser therapy were reported. The mean post-conceptional age at IVB injection was 39.8 ± 2.2 (range 37–43) weeks. Localized vitreous syneresis and linear fibrotic vitreous condensation occurred 8.2 ± 2.3 weeks after IVB monotherapy in our patients (15.5% of injections). The mean last post injection visit was 61.6 ± 5.3 weeks (post-conceptional age). Further regression and complete retinal vascularization occurred in all patients. Thread-like vitreous condensation with localized vitreous liquefaction may be related to involutional ROP disease itself, combined to anti VEGF therapy and may be a predictor factor for further regression and retinal vascularization. The case series describes a successful response to anti-VEGF monotherapy with no further complications.

A mechanics based analytical model of vitreous motion and vitreous detachment in the human eye when subjected to saccadic movement

Abstract: OF THE DISSERTATION A Mechanics Based Analytical Model of Vitreous Motion and Vitreous Detachment in the Human Eye When Subjected to Saccadic Movement by MICHAEL J. PAVLOU Dissertation Director: Prof. William J. Bottega In the human eye, the detachment behavior of the vitreous cortex from the sensory retina is clinically significant as this pathology is highly correlated with rhegmatogenous retinal detachment, a serious eye condition that can result in vision loss. A mechanics based mathematical model for vitreo-retinal detachment in the human eye when subjected to saccadic eye motion is presented in this dissertation. The problem is formulated as a two-dimensional propagating boundary value viscoelasticity problem in the calculus of variations. This formulation yields the governing equations of the vitreous body, boundary conditions, matching conditions and a transversality condition which, in turn, yields the detachment criterion during a saccade. The first part of the dissertation studies a constrained two-dimensional model where only the dominant motion of the vitreous is considered. Closed form analytical solutions of the coupled set of partial differential equations are obtained via modal analysis of a vibrating two-dimensional continuum with non-periodic loading. Results of numerical simulations are presented, ultimately revealing the evolution of the detachment of the vitreo-retinal interface.

Bedside Ultrasound for the Diagnosis of Retinal Detachment

Abstract: Author(s): San Gabriel, Rami; Alvarado, Maili; Han, Vy | Abstract: ABSTRACT: History of present illness: A 19-year-old male with no significant past medical history presented to the Emergency Department with progressively worsening vision loss in his right eye after blunt trauma to the right orbit The patient endorsed floaters and described his vision as being “cloudy,” but denied any photophobia, foreign body sensation, pain or ocular discharge He did not use corrective lenses and his visual acuity was 20/100 OD and 20/30 OS On exam, the patient had non-injected conjunctiva and normal intraocular pressures Bedside ultrasound was performed and showed evidence of a right-sided retinal detachment and vitreous hemorrhage Ophthalmology was emergently consulted and took the patient to the operating room for cryopexy Significant findings: The ocular point of care ultrasound (POCUS) utilizing a high frequency linear probe shows a retinal detachment (RD) with a thick, hyperechoic undulating membrane in the vitreous humor that is anchored at the ora serrata anteriorly and the optic disc posteriorly Note that the retina is detached all the way to the optic disc making it "mac off" The macula, and more specifically the fovea, is located in the central retina and contains a high concentration of cone photoreceptors responsible for central, high resolution, color vision In a "mac on" RD, the retina detaches in the periphery but remains intact centrally This is an ophthalmologic emergency and timely diagnosis and intervention can be vision saving This patient also has evidence of a posterior vitreous hemorrhage which has a characteristic swirling appearance with kinetic exam on real-time imaging The detached vitreous body is not as well defined and is not anchored posteriorly to the optic discDiscussion: There are many causes of sudden unilateral vision loss: acute angle closure glaucoma, vitreous hemorrhage, retinal detachment, vitreous detachment, retinal artery occlusion, retinal vein occlusion, optic neuritis, and ischemic optic neuropathy1 Many of these cases require emergent intervention if the patient’s vision is to be preserved In this case, the patient’s history of “floaters” is highly suggestive of a retinal etiology Classically, patients with RD can also present with the perception of a “dark curtain” coming over their field of vision2 In a review of 78 articles, ocular ultrasound had a sensitivity and specificity that ranged from 97% to 100% and 83% to 100%, respectively, in the diagnosis of RD,3 demonstrating its strength as a rapid diagnostic tool in accurately diagnosing RD Topics: Ultrasound, ophthalmology, retina

Incidence of Acute Symptomatic Posterior Vitreous Detachment, its Complications and Impact on Emergency Eye Care Set Up

Abstract: Purpose. To determines the incidence of complications of acute symptomatic posterior vitreous detachment (PVD) and its impact on ophthalmic emergency setup. Design. A retrospective study of 172 patients presented in one years’ time, with acute symptomatic posterior vitreous detachment. Methods. A retrospective record of 172 patients (n=172) was reviewed who were seen in one years’ time period at local hospital’s eye departments as emergency referrals. Referrals were made by primary care physicians and optometrists. Only patients with acute symptomatic PVD were taken into account. Their symptomatology, visual acuity, fundus examination findings, follow up appointments and outcomes were checked. Results. Mean age at presentation was 62.76 years. Acute Symptomatic Posterior vitreous detachment was detected without complications in 126 (73.25%). Retinal breaks were found on initial presentation in 33 patients (19.18%). Out of these, 18 had rhegmatogenous retinal detachment on initial presentation (10.46%), while one patient who also had vitreous haemorrhage developed it later. PVD was seen with vitreous haemorrhage in 4 patients (2.32%). Seven patients presented with PVD and associated retinal haemorrhages (4.06%). Demographically 96 patients were females (55.81%) as compared to 76 males (44.186%). The highest incidence was between 51 to 75 years of age (84.29%). Posterior vitreous detachments accounted for 7.50% of total eye emergencies in one year. Conclusions. Patients with flashes and floaters should be seen urgently. Priority should be given to patients with cells in vitreous (shafer’s sign) as well as retinal or vitreous haemorrhages. These patients should be seen by experienced ophthalmologist to rule out any break with 360 degree indirect ophthalmoscopic examinations. Junior doctors should have extensive training with indirect ophthalmoscopy with scleral indentation and should not miss shafer’s sign in all patients with acute symptomatic PVD.

Bilateral Posterior Vitreous Detachment in a Young Patient with Systemic Lupus Erythematosus.

Abstract: Vitreous detachment is a rarely reported manifestation of systemic lupus erythematosus (SLE). We present here the case of a 20-year-old woman with a history of SLE who presented with a decrease in vision in both eyes, massive hepatosplenomegaly, and multiple joint pain. B-scan ultrasonography revealed bilateral vitreous detachment. Ocular involvement in SLE is associated with high disease activity and morbidity. Therefore, ophthalmological screening for ocular involvement is important for SLE patients at any age.

Commentary: Interfere with the interface?

Abstract: It was observed that fewer patients with wet or dry age related macular degeneration (AMD) have complete posterior vitreous detachment (PVD) as compared with controls.[2,3] There are four important principles one needs to keep in mind when understanding the role of VMI in the disease pathogenesis.[1] First, the presence of vitreo‐macular traction (VMT) promotes a low‐grade inflammation that potentiates the disease activity. In addition, VMT can also damage the retinal pigment epithelium (RPE) cells thus increasing the RPE VEGF. Second, when there is an absence of PVD, it is hypothesized that there is decreased oxygenation at the retinal surface, which can lead to higher VEGF levels. Third, the presence of PVD allows cytokines sequestered close to the retina to easily diffuse away, thus decreasing the concentration of VEGF for disease activity. Last, based on a similar logic, the injected anti‐VEGF drugs are able to diffuse better when there is a presence of PVD, thus achieving higher therapeutic levels at the location of disease activity.