Journal of Clinical Medicine

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15 pages, 2250 KiB

Open AccessArticle

Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit—Report 2

by Carolina Bernal-Morales, Manuel Javier Navarro-Angulo, Mariano Rodriguez-Maqueda, Daniel Velazquez-Villoria, Juan Manuel Cubero-Parra, Joaquín Marticorena, Adrián Hernández-Martínez, Miguel Ruiz-Miguel, Alfredo Adan, Diego Ruiz-Casas and Javier Zarranz-Ventura

J. Clin. Med. 2023, 12(2), 436; https://doi.org/10.3390/jcm12020436 - 5 Jan 2023

Cited by 1 | Viewed by 1445

Abstract

The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type [...] Read more.

The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38–4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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16 pages, 527 KiB

Open AccessArticle

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

by Cristina Irigoyen, Ainhoa Goikoetxea-Zubeldia, Jorge Sanchez-Molina, Asier Amenabar Alonso, Miguel Ruiz-Miguel and Maria Teresa Iglesias-Gaspar

J. Clin. Med. 2022, 11(15), 4551; https://doi.org/10.3390/jcm11154551 - 4 Aug 2022

Cited by 3 | Viewed by 2562

Abstract

(1) Objective: To determine the incidence, visual outcomes and risk factors associated with the recurrence of primary retinal detachment (RD) in a tertiary hospital. (2) Methods: A retrospective observational study was conducted, and data were collected on all eyes diagnosed with primary RD [...] Read more.

(1) Objective: To determine the incidence, visual outcomes and risk factors associated with the recurrence of primary retinal detachment (RD) in a tertiary hospital. (2) Methods: A retrospective observational study was conducted, and data were collected on all eyes diagnosed with primary RD between January 2017 and December 2020. A detailed database was generated with data on anatomic and visual outcomes, and surgical technique information, for all the cases. (3) Results: 570 eyes with primary RD were included. Mean annual incidence of primary RD was 21.8 cases per 100,000 inhabitants. Mean follow-up time was 465 (±410.5) days. Mean time to redetachment was 114.4 (±215.8) days, with the median being 35 days. Statistically significant variables related to a higher risk of recurrence were: male sex (p = 0.04), type of tamponade (p = 0.01), surgeon (p = 0.035), inferonasal (p = 0.002) and inferotemporal (p = 0.032) involvement, complex RD (p < 0.001) and ocular comorbidity (p < 0.001). More satisfactory final visual acuity (VA) in patients not suffering redetachment was associated with shorter duration of central vision loss. (4) Conclusions: Sex, type of tamponade, inferior detachment, RD complexity, surgeon and ocular comorbidity were identified as prognostic factors for recurrence. Worse final postoperative VA was found in patients referring central vision loss for more than 4 days before surgery. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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12 pages, 1098 KiB

Open AccessArticle

Outcomes and Prognostic Factors Following Pars Plana Vitrectomy for Intraocular Foreign Bodies—11-Year Retrospective Analysis in a Tertiary Care Center

by Mădălina Claudia Hapca, George Adrian Muntean, Iulia Andrada Nemeș Drăgan, Ștefan Cristian Vesa and Simona Delia Nicoară

J. Clin. Med. 2022, 11(15), 4482; https://doi.org/10.3390/jcm11154482 - 1 Aug 2022

Cited by 6 | Viewed by 1658

Abstract

Aim: To evaluate the visual outcome of penetrating ocular injuries with a retained intraocular foreign body (IOFB) managed by pars plana vitrectomy (PPV) and to describe the risk factors associated with poor visual acuity and retinal detachment (RD) development. Methods: Medical records of [...] Read more.

Aim: To evaluate the visual outcome of penetrating ocular injuries with a retained intraocular foreign body (IOFB) managed by pars plana vitrectomy (PPV) and to describe the risk factors associated with poor visual acuity and retinal detachment (RD) development. Methods: Medical records of 56 patients with IOFB that were removed by PPV over a period of 11 years (1 January 2010–31 December 2020) were reviewed. We extracted the demographic data, initial and final best corrected visual acuity (BCVA) using standard Snellen chart, IOFB characteristics, complications and surgical details. Outcome was evaluated according to the final BCVA: poor <0.1, good 0.1–<0.5 or excellent ≥0.5. Results: The mean age was 36.1 ± 14.1 (range, 16–71) years and the majority of patients were males (55 out of 56, 98.2%). IOFB was retinal in 27 (48.2%) cases and intravitreal in 29 cases (51.8%). IOFB size was ≤3mm in 26 (46.4%) cases and >3mm in 30 (53.6%) cases. Preoperative RD was identified in 12 (21.4%) cases and endophthalmitis in 17 cases (30.4%). IOFBs larger than 3 mm and retinal location were associated with RD development. Poor visual outcome was associated with initial BCVA, retinal location, RD and endophthalmitis. Conclusion: Initial BCVA, retinal foreign body, RD and endophthalmitis were risk factors for poor visual outcome. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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9 pages, 1473 KiB

Open AccessArticle

Comparison of Postoperative Stability of Intraocular Lenses after Phacovitrectomy for Rhegmatogenous Retinal Detachment

by Ayaka Akiyama, Harumasa Yokota, Hiroshi Aso, Hirotsugu Hanazaki, Masanori Iwasaki, Satoru Yamagami and Taiji Nagaoka

J. Clin. Med. 2022, 11(12), 3438; https://doi.org/10.3390/jcm11123438 - 15 Jun 2022

Viewed by 1547

Abstract

We retrospectively compared the stability of intraocular lenses (IOLs) routinely used at our institution by measuring IOL position after phacovitrectomy for rhegmatogenous retinal detachment (RRD). Patients with RRD who underwent phacovitrectomy with gas tamponade received one of three IOLs: 6-mm, single-piece NS-60YG (NIDEK, [...] Read more.

We retrospectively compared the stability of intraocular lenses (IOLs) routinely used at our institution by measuring IOL position after phacovitrectomy for rhegmatogenous retinal detachment (RRD). Patients with RRD who underwent phacovitrectomy with gas tamponade received one of three IOLs: 6-mm, single-piece NS-60YG (NIDEK, 15 eyes); 6-mm, single-piece XY1 (HOYA, 11 eyes); or 7-mm, three-piece X-70 (Santen, 11 eyes). Various parameters associated with the anterior chamber, lens, and IOL were measured by swept-source anterior segment optical coherence tomography (CASIA2; Tomey Corp) before and 1 week and 1 month after surgery. IOL position was determined as follows: IOL position = (postoperative aqueous depth [AQD] − preoperative AQD)/lens thickness. We found no significant difference in axial length between the IOLs (p = 0.97). At 1 week, IOL position was as follows: NS-60YG, 0.32; XY1, 0.24; and X-70, 0.26 (p < 0.05). The respective IOL positions at 1 month were 0.35, 0.27, and 0.28 (p < 0.01). These results indicated the smallest anterior shift with NS-60YG. To replicate the anterior shift of IOL position ex vivo, biomechanical measurement was performed. NS-60YG resisted more displacement force than the other IOLs. Thus, in eyes undergoing phacovitrectomy for RRD, NS-60YG was the most stable of the three IOLs studied. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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7 pages, 221 KiB

Open AccessArticle

Vitrectomy Combined with Cataract Surgery for Retinal Detachment Using a Three-Dimensional Viewing System

by Katarzyna Nowomiejska, Mario Damiano Toro, Vincenza Bonfiglio, Aleksandra Czarnek-Chudzik, Agnieszka Brzozowska, Kamil Torres and Robert Rejdak

J. Clin. Med. 2022, 11(7), 1788; https://doi.org/10.3390/jcm11071788 - 24 Mar 2022

Cited by 4 | Viewed by 2028

Abstract

Purpose: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). Methods: Medical reports of 82 patients were retrospectively reviewed: 26 patients [...] Read more.

Purpose: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). Methods: Medical reports of 82 patients were retrospectively reviewed: 26 patients were operated on with 3D and 56 patients were operated on with CM. The main outcome measures were visual acuity, duration of the surgery, and the rate of postoperative complications. Results: No statistically significant differences in pre- and postoperative visual acuity were found between both groups. There was significant improvement in the visual acuity in both groups. The best postoperative visual acuity was achieved with SF6 gas tamponade, followed by C3F8 gas and silicone oil in both groups. The duration of the surgery (60 min vs. 55 min) and the rate of postoperative complications (15% vs. 14%) were similar in both groups. Conclusions: The similar postoperative visual acuity and rate of complications detected using 3D and CM indicate that the 3D viewing system may be advantageous in the treatment of rhematogenous RD with PPV combined with cataract surgery, i.e., a complex procedure involving both anterior and posterior segment manipulations. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

13 pages, 9925 KiB

Open AccessArticle

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

by Isabel Relimpio-López, Antonio Manuel Garrido-Hermosilla, Francisco Espejo, María Gessa-Sorroche, Lourdes Coca, Belen Domínguez, María Jesús Díaz-Granda, Beatriz Ponte, María José Cano, Enrique Rodríguez de la Rúa, Francisco Carrasco-Peña, Carlos Míguez, Jonathan Saavedra, Antonio Ontanilla, Carlos Caparrós-Escudero, Juan José Ríos and José Antonio Terrón

J. Clin. Med. 2022, 11(6), 1616; https://doi.org/10.3390/jcm11061616 - 15 Mar 2022

Cited by 3 | Viewed by 2324

Abstract

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach [...] Read more.

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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Review

Jump to: Research

18 pages, 2935 KiB

Open AccessReview

Subretinal Injection Techniques for Retinal Disease: A Review

by Cristina Irigoyen, Asier Amenabar Alonso, Jorge Sanchez-Molina, María Rodríguez-Hidalgo, Araceli Lara-López and Javier Ruiz-Ederra

J. Clin. Med. 2022, 11(16), 4717; https://doi.org/10.3390/jcm11164717 - 12 Aug 2022

Cited by 29 | Viewed by 7727

Abstract

Inherited retinal dystrophies (IRDs) affect an estimated 1 in every 2000 people, this corresponding to nearly 2 million cases worldwide. Currently, 270 genes have been associated with IRDs, most of them altering the function of photoreceptors and retinal pigment epithelium. Gene therapy has [...] Read more.

Inherited retinal dystrophies (IRDs) affect an estimated 1 in every 2000 people, this corresponding to nearly 2 million cases worldwide. Currently, 270 genes have been associated with IRDs, most of them altering the function of photoreceptors and retinal pigment epithelium. Gene therapy has been proposed as a potential tool for improving visual function in these patients. Clinical trials in animal models and humans have been successful in various types of IRDs. Recently, voretigene neparvovec (Luxturna^®) has been approved by the US Food and Drug Administration for the treatment of biallelic mutations in the RPE65 gene. The current state of the art in gene therapy involves the delivery of various types of viral vectors into the subretinal space to effectively transduce diseased photoreceptors and retinal pigment epithelium. For this, subretinal injection is becoming increasingly popular among researchers and clinicians. To date, several approaches for subretinal injection have been described in the scientific literature, all of them effective in accessing the subretinal space. The growth and development of gene therapy give rise to the need for a standardized procedure for subretinal injection that ensures the efficacy and safety of this new approach to drug delivery. The goal of this review is to offer an insight into the current subretinal injection techniques and understand the key factors in the success of this procedure. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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11 pages, 1136 KiB

Open AccessReview

Face-Down Posture versus Non-Face-Down Posture following Large Idiopathic Macular Hole Surgery: A Systemic Review and Meta-Analysis

by Hou-Ren Tsai, Tai-Li Chen, Chun-Yu Chang, Huei-Kai Huang and Yuan-Chieh Lee

J. Clin. Med. 2021, 10(21), 4895; https://doi.org/10.3390/jcm10214895 - 24 Oct 2021

Cited by 5 | Viewed by 2490

Abstract

Evidence regarding the effect of a face-down posture (FDP) for large idiopathic macular hole (IMH) is inconsistent. We conducted a systematic review and meta-analysis to determine whether a postoperative FDP is required for the treatment of large IMH. Eligible randomized controlled trials published [...] Read more.

Evidence regarding the effect of a face-down posture (FDP) for large idiopathic macular hole (IMH) is inconsistent. We conducted a systematic review and meta-analysis to determine whether a postoperative FDP is required for the treatment of large IMH. Eligible randomized controlled trials published before September 2021 were retrieved from the Medline, Embase, and Cochrane Library databases. The efficacy outcome was the IMH closure rate and the visual acuity improvement rate. A meta-analysis was performed using a random effects model. The “Grading of Recommendations Assessment, Development, and Evaluation” approach was implemented, and the numbers needed-to-treat (NNTs) were calculated. Seven studies comprising 640 patients were included. We performed a predefined subgroup analysis of IMH size using a cut-off point of 400 µm. Compared with non-FDP, a significant effect of FDP was found in the IMH > 400 µm group (OR = 3.34; 95% CI = 1.57–7.14; trial sequential analysis-adjusted CI = 1.20–11.58; NNTs = 7.9). After stratifying by the posturing periods, the beneficial effect of FDP lasting at least five days, but not three days was observed for large IMH. Maintaining a FDP for at least five days postoperatively is an effective strategy (certainty of evidence: “moderate”) for treating large IMH. Full article

(This article belongs to the Special Issue Surgical Management of Vitreoretinal Diseases)

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