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Current Challenges in the Management of Vitreoretinal Conditions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 16426

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Dr. Georgios Panos

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Department of Ophthalmology, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
Interests: ophthalmology; retina; vitreoretinal surgery; medical retina; molecular biology in ophthalmology; ocular pharmacology; ophthalmic surgery; biomarkers
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The field of medical and surgical retina has grown rapidly during the last few decades. Several new and promising treatments, technological developments, and advanced surgical techniques have become available for eye conditions, including age-related macular degeneration, retinal vein occlusions, diabetic retinopathy and macular oedema, retinal detachment, macular holes and membranes, genetic disorders, uveitis, and inflammations.

This Special Issue aims to summarize modern therapeutic and surgical approaches on retinal and vitreoretinal diseases, adding a valuable contribution to our existing knowledge, to describe the current state of the art, as well as to provide directions for future research.

High-quality original research studies of both clinical and experimental interest and comprehensive review articles will be considered for publication. Moreover, COVID-19-related articles will also be considered.

Potential topics include but are not limited to medical and surgical management of:

Age-related macular degeneration;
Anti-VEGF and new implants;
Retinal vein occlusions;
Retinal detachments;
Diabetic retinopathy and maculopathy;
Epiretinal membranes and macular holes;
Uveitis and inflammations;
Impact of the COVID-19 pandemic on the management of vitreoretinal conditions.

Dr. Georgios D. Panos
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

retina
anti-VEGF
implants
macular degeneration
diabetic retinopathy
vein occlusions
retinal detachments
vitreoretinal surgery
COVID-19 impact

Related Special Issue

Current Challenges in the Management of Vitreoretinal Conditions: 2nd Edition in Journal of Clinical Medicine

Published Papers (11 papers)

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Editorial

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4 pages, 172 KiB

Open AccessEditorial

Current Challenges in the Management of Vitreoretinal Conditions

by Georgios D. Panos

J. Clin. Med. 2024, 13(4), 1171; https://doi.org/10.3390/jcm13041171 - 19 Feb 2024

Viewed by 544

Abstract

In the dynamic realm of ophthalmology, the management of vitreoretinal conditions stands as a testament to both significant progress and ongoing challenges [...] Full article

(This article belongs to the Special Issue Current Challenges in the Management of Vitreoretinal Conditions)

Research

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10 pages, 1963 KiB

Open AccessArticle

Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope

by Rodolfo Mastropasqua, Matteo Gironi, Rossella D’Aloisio, Valentina Pastore, Giacomo Boscia, Luca Vecchiarino, Fabiana Perna, Katia Clemente, Ilaria Palladinetti, Michela Calandra, Marina Piepoli, Annamaria Porreca, Marta Di Nicola and Francesco Boscia

J. Clin. Med. 2024, 13(1), 76; https://doi.org/10.3390/jcm13010076 - 22 Dec 2023

Viewed by 683

Abstract

Background: In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. Methods: In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. Results: At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by −0.30 logMAR (−0.55; −0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (−5.75; −0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. Conclusions: The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy. Full article

(This article belongs to the Special Issue Current Challenges in the Management of Vitreoretinal Conditions)

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9 pages, 668 KiB

Open AccessArticle

Immune Mediators Profiles in the Aqueous Humor of Patients with Simple Diabetic Retinopathy

by Naoyuki Yamakawa, Hiroyuki Komatsu, Yoshihiko Usui, Kinya Tsubota, Yoshihiro Wakabayashi and Hiroshi Goto

J. Clin. Med. 2023, 12(21), 6931; https://doi.org/10.3390/jcm12216931 - 5 Nov 2023

Cited by 4 | Viewed by 1412

Abstract

Various immune mediators identified to date are associated with the development of advanced forms of diabetic retinopathy (DR), such as proliferative DR and diabetic macular edema, although the exact pathophysiological mechanisms of early stages of DR such as simple DR remain unclear. We determined the immune mediator profile in the aqueous humor of eyes with simple DR. Fifteen eyes of fifteen patients with simple DR were studied. Twenty-two eyes of twenty-two patients with cataracts and no DR served as controls. Undiluted aqueous humor samples were collected, and a cytometric bead array was used to determine the aqueous humor concentrations of 32 immune mediators comprising 13 interleukins (IL), interferon-γ, interferon-γ-inducible protein-10 (IP-10), monocyte chemoattractant protein-1, macrophage inflammatory protein (MIP)-1α, MIP-1β, regulated on activation, normal T cell expressed and secreted (RANTES), monokine induced by interferon-γ, basic fibroblast growth factor (bFGF), Fas ligand, granzyme A, granzyme B, interferon-inducible T-cell alpha chemoattractant (ITAC), fractalkine, granulocyte macrophage colony-stimulating factor, granulocyte colony-stimulating factor (G-CSF), vascular endothelial growth factor (VEGF), angiogenin, tumor necrosis factor-α, and CD40 ligand. Among the 32 immune mediators, 10 immune mediators, including bFGF, CD40 ligand, fractalkine, G-CSF, IL-6, IL-8, MIP-α, MIP-1β, and VEGF, showed significantly higher aqueous humor concentrations and the Fas ligand had significantly lower concentration (p < 0.05) in eyes with simple DR compared with control eyes. Of these 10 cytokines with significant concentration alteration, protein–protein interaction analysis revealed that 8 established an intricate interaction network. Various immune mediators may contribute to the pathogenesis of simple DR. Attention should be given to the concentrations of immune mediators in ocular fluids even in simple DR. Large-scale studies are warranted to assess whether altered aqueous humor concentrations of these 10 immune mediators are associated with an increased risk of progression to advanced stages of DR. Full article

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11 pages, 769 KiB

Open AccessArticle

Effect of Changes in Surgical Strategies for the Treatment of Primary Rhegmatogenous Retinal Detachment on Functional and Anatomical Outcomes: A Retrospective Analysis of 812 Cases from the Years 2004 to 2012

by Aleksandra Sedova, Christoph Scholda, Thomas Huebl, Irene Steiner, Stefan Sacu, Michael Georgopoulos, Ursula Schmidt-Erfurth and Andreas Pollreisz

J. Clin. Med. 2023, 12(6), 2278; https://doi.org/10.3390/jcm12062278 - 15 Mar 2023

Cited by 1 | Viewed by 1034

Abstract

Background: At the Department of Ophthalmology and Optometry at the MUV surgical method (scleral buckling, vitrectomy, combined vitrectomy/scleral buckling) and timing (daytime, nighttime) for the treatment of primary rhegmatogenous retinal detachment (RRD) changed continuously in the years 2004 to 2012. This study aims to evaluate changes in surgical strategies over time including their impact on functional and anatomical outcomes. Methods: Retrospective evaluation of patients operated on primary RRD between the years 2004 and 2012. Baseline demographic data, month 3 best-corrected visual acuity (BCVA), surgical method, single success surgery, surgical timing, and intraoperative complications were analyzed. Results: Overall, 812 eyes of 812 patients with a mean (±SD) age of 58.1 ± 13.3 years were included. A total of 413 (51%) patients presented with macula-on and 359 (44%) with macula-off RRD. Month 3 BCVA increased over time, both in macula-on or macula-off groups (p < 0.001). The rate of complete retinal reattachment 3 months postoperatively increased significantly from 65% in 2004 to 83% in 2012 in both groups. Scleral buckling surgeries decreased continuously from 95% to 16% with an appropriate increase in vitrectomies as well as a decrease in surgeries during nighttime (68% in 2004, 6% in 2012) with equal or better visual and functional outcomes. Conclusion: Our data showed that improving functional and single-success surgery outcomes in patients operated on for primary RRD. In the years 2004 to 2012, surgical techniques shifted from scleral buckling to primary vitrectomy and were increasingly scheduled during the daytime. Full article

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12 pages, 1823 KiB

Open AccessArticle

Cystoid Macular Edema after Rhegmatogenous Retinal Detachment Repair with Pars Plana Vitrectomy: Rate, Risk Factors, and Outcomes

by Malik Merad, Fabien Vérité, Florian Baudin, Inès Ben Ghezala, Cyril Meillon, Alain Marie Bron, Louis Arnould, Pétra Eid, Catherine Creuzot-Garcher and Pierre-Henry Gabrielle

J. Clin. Med. 2022, 11(16), 4914; https://doi.org/10.3390/jcm11164914 - 21 Aug 2022

Cited by 7 | Viewed by 2007

Abstract

(1) Background: The aim was to describe the rate and outcomes of cystoid macular edema (CME) after pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) and to identify risk factors and imaging characteristics. (2) Methods: A retrospective consecutive case study was conducted over a 5-year period among adult patients who underwent PPV for primary RRD repair. The main outcome measure was the rate of CME at 12 months following PPV. (3) Results: Overall, 493 eyes were included. The CME rate was 28% (93 patients) at 12 months. In multivariate analysis, eyes with worse presenting visual acuity (VA) (odds ratio [OR], 1.55; 95% CI, 1.07–2.25; p = 0.02) and grade C proliferative vitreoretinopathy (PVR) (OR, 2.88; 95% CI, 1.04–8.16; p = 0.04) were more at risk of developing CME 1 year after PPV. Endolaser retinopexy was associated with a greater risk of CME than cryotherapy retinopexy (OR, 3.06; 95% CI, 1.33–7.84; p = 0.01). Eyes undergoing cataract surgery within 6 months of the initial RRD repair were more likely to develop CME at 12 months (OR, 1.96; 95% CI, 1.06–3.63; p = 0.03). (4) Conclusions: CME is a common complication after PPV for primary RRD repair. Eyes with worse presenting VA, severe PVR at initial presentation, endolaser retinopexy, and cataract surgery within 6 months of initial RRD repair were risk factors for postoperative CME at 12 months. Full article

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9 pages, 1492 KiB

Open AccessArticle

Peripheral Circumferential Retinal Detachment after Pars Plana Vitrectomy: Complications and Management

by Cherng-Ru Hsu and Chung-May Yang

J. Clin. Med. 2022, 11(16), 4856; https://doi.org/10.3390/jcm11164856 - 18 Aug 2022

Viewed by 1356

Abstract

Purpose: This study aimed to evaluate treatment outcomes and complications of peripheral circumferential retinal detachment (PCD) after successful vitrectomy. Methods: Eyes diagnosed with PCD after pars plana vitrectomy (PPV) were retrospectively reviewed. The patient demographic data, complications, management, and treatment outcomes were collected and analyzed. Results: The mean follow-up duration was 18.0 ± 11.9 months. BCVA ranged from light perception to 0.1 (median: counting fingers at 40 cm). Major complications included rubeosis iridis (seven eyes), vitreous hemorrhage (five eyes), hyphema (five eyes), corneal decompensation (three eyes), hypotony (two eyes), and neovascular glaucoma (two eyes). All eyes underwent peripheral retinectomy to remove the detached retina and release traction. Complete retinal reattachment was achieved in all eyes. The final BCVA ranged from hand motion to 0.1 (median: counting fingers at 30 cm). Conclusion: PCD may be associated with delayed-onset complications, causing severe loss of vision. Proper management, including peripheral retinectomy, may preserve visual function. Full article

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7 pages, 1095 KiB

Open AccessArticle

Encircling Scleral Buckling Surgery for Severe Hypotony with Ciliary Body Detachment on Anterior Segment Swept-Source Optical Coherence Tomography: A Case Series

by Sławomir Cisiecki, Karolina Bonińska and Maciej Bednarski

J. Clin. Med. 2022, 11(16), 4647; https://doi.org/10.3390/jcm11164647 - 9 Aug 2022

Cited by 2 | Viewed by 1496

Abstract

This study aimed to evaluate the usefulness of an encircling scleral buckling procedure to manage severe hypotony secondary to proliferative vitreoretinopathy (PVR)-induced retinal detachment. This retrospective study included six eyes of six patients (five women and one man) with hypotony (intraocular pressure [IOP] ≤ 6 mmHg) after multiple reattachment surgeries for PVR-induced retinal detachment. In patients with failure of hypotony resolution after conservative treatment (dexamethasone drops five times daily), 360° scleral buckling was performed under periocular anesthesia. The light perception was evaluated immediately postoperatively. The anatomic parameters were evaluated pre- and postoperatively observed on anterior segment swept-source optical coherence tomography. Ciliary body detachment (CBD) secondary to advanced cyclitic membranes associated with PVR grades C and D was detected in all eyes with hypotony. The mean IOP increased in all eyes (4.83 mmHg preoperatively vs. 10.17 mmHg postoperatively, p = 0.006), with subsequent improvement in best-corrected visual acuity (1.91 logMAR preoperatively vs. 1.50 logMAR postoperatively, p = 0.034). However, no eye showed any significant changes in CBD postoperatively. Scleral buckling surgery might be useful to increase IOP in eyes with persistent severe hypotonia secondary to PVR-induced CBD. Further studies are needed to improve outcomes in eyes with severe PVR-induced retinal detachment. Full article

(This article belongs to the Special Issue Current Challenges in the Management of Vitreoretinal Conditions)

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7 pages, 755 KiB

Open AccessArticle

The Impact of the COVID-19 Pandemic and Lockdown on Macular Hole Surgery Provision and Surgical Outcomes: A Single-Centre Experience

by Georgios D. Panos, Olyvia Poyser, Humera Sarwar, Dharmalingam Kumudhan, Gavin Orr, Anwar Zaman and Craig Wilde

J. Clin. Med. 2022, 11(13), 3678; https://doi.org/10.3390/jcm11133678 - 26 Jun 2022

Cited by 1 | Viewed by 1231

Abstract

Purpose: We aimed to report the impact of the COVID-19 pandemic and related health policies and restrictions on the provision and efficacy of macular hole (MH) surgery. Methods: We carried out a retrospective cohort study. Two MH patient cohorts, those treated during the COVID-19 pandemic (12 months) and the pre-COVID-19 period (12 months before the lockdown) were reviewed and compared. Patient characteristics, time to consultation and surgery, MH size, baseline and postoperative visual acuity (VA) and failure rate were recorded and analysed. Results: A reduction of 43% in MH surgery occurred during the COVID-19 period (93 eyes vs. 53 eyes). Mean time to consultation and time to surgery increased significantly (52.7 days vs. 86.3 days, p < 0.01 and 51.3 days vs. 83.6 days, p = 0.01, respectively), while mean baseline and postoperative vision was significantly lower in the COVID-19 group (0.75 LogMAR vs. 0.63 LogMAR, p < 0.01 and 0.61 LogMAR vs. 0.44 LogMAR, p < 0.01, respectively). The median MH size was significantly larger in the COVID-19 group (296 μm vs. 365 μm, p = 0.016), and the failure rate increased from 7.6% to 15.4% (odds ratio 2.2 (95% CI: 0.72–6.8)). Conclusions: Our findings suggest the COVID-19 pandemic caused a significant reduction in MH surgery, increased waiting times and led to poorer surgical outcomes. For future pandemics, better strategies are required that allow semi-elective and elective surgery to continue in a timely fashion. Health providers should preserve the delivery of ophthalmological care, with enhanced encouragement to seek medical help for acute symptoms. Full article

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Review

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12 pages, 1622 KiB

Open AccessReview

Trans-Scleral Plugs Fixated FIL SSF IOL: A Review of the Literature and Comparison with Other Secondary IOL Implants

by Raffaele Raimondi, Tania Sorrentino, Raphael Kilian, Yash Verma, Francesco Paolo De Rosa, Giuseppe Cancian, Panos Tsoutsanis, Giovanni Fossati, Davide Allegrini and Mario R. Romano

J. Clin. Med. 2023, 12(5), 1994; https://doi.org/10.3390/jcm12051994 - 2 Mar 2023

Cited by 1 | Viewed by 1890

Abstract

Purpose. To revise the current literature on FIL SSF (Carlevale) intraocular lens, previously known as Carlevale lens, and to compare their outcomes with those from other secondary IOL implants. Methods. We performed a peer review of the literature regarding FIL SSF IOLs until April 2021 and analyzed the results only of articles with a minimum of 25 cases and a follow-up of at least 6 months. The searches yielded 36 citations, 11 of which were abstracts of meeting presentations that were not included in the analysis because of their limited data. The authors reviewed 25 abstracts and selected six articles of possible clinical relevance to review in full text. Of these, four were considered to be sufficiently clinically relevant. Particularly, we extrapolated data regarding the pre- and postoperative best corrected visual acuities (BCVA) and the complications related to the procedure. The complication rates were then compared with those from a recently published Ophthalmic Technology Assessment by the American Academy of Ophthalmology (AAO) on secondary IOL implants. Results. Four studies with a total of 333 cases were included for results analysis. The BCVA improved in all cases after surgery, as expected. Cystoid macular edema (CME) and increased intraocular pressure were the most common complications, with an incidence of up to 7.4% and 16.5%, respectively. Other IOL types from the AAO report included anterior chamber IOLs, iris fixation IOLs, sutured iris fixation IOLs, sutured scleral fixation IOLs, and sutureless scleral fixation IOLs. There was no statistically significant difference in the rates of postoperative CME (p = 0.20), and vitreous hemorrhage (p = 0.89) between other secondary implants and the FIL SSF IOL, whereas the rate of retinal detachment was significantly less with FIL SSF IOLs (p = 0.04). Conclusion. The results of our study suggest the implantation of FIL SSF IOLs is an effective and safe surgical strategy in cases where there is a lack of capsular support. In fact, their outcomes seem to be comparable to those obtained with the other available secondary IOL implants. According to published literature, the FIL SSF (Carlevale) IOL provides favorable functional results with a low rate of postoperative complications. Full article

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Other

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59 pages, 959 KiB

Open AccessSystematic Review

Outcomes in the Treatment of Subretinal Macular Hemorrhage Secondary to Age-Related Macular Degeneration: A Systematic Review

by Filippo Confalonieri, Vanessa Ferraro, Gianmaria Barone, Alessandra Di Maria, Beáta Éva Petrovski, Josè Luis Vallejo Garcia, Alessandro Randazzo, Paolo Vinciguerra, Xhevat Lumi and Goran Petrovski

J. Clin. Med. 2024, 13(2), 367; https://doi.org/10.3390/jcm13020367 - 9 Jan 2024

Viewed by 1399

Abstract

Background: Subretinal macular hemorrhage (SRMH) secondary to age-related macular degeneration (AMD) is a relatively rare condition in ophthalmology characterized by blood collection between the neurosensory retina and the retinal pigment epithelium (RPE). Without prompt treatment, visual prognosis is poor. A plethora of treatment approaches have been tried over the past years ranging from intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy to direct subretinal surgery, with no conclusive superiority of one over the other. Materials and Methods: We conducted a systematic review of the outcomes and treatment modalities of SRMH from inception to 14 June 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The level of evidence was assessed for all included articles according to the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: A total of 2745 articles were initially extracted, out of which 1654 articles were obtained after duplicates were removed and their abstracts screened. A total of 155 articles were included for full-text review. Finally, 81 articles remained that fulfilled the inclusion criteria. Conclusions: Even though there are solid results supporting a variety of treatments for SRMH, the best treatment modality has still not been conclusively demonstrated and further research is needed. Full article

(This article belongs to the Special Issue Current Challenges in the Management of Vitreoretinal Conditions)

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19 pages, 2015 KiB

Open AccessSystematic Review

Sympathetic Ophthalmia after Vitreoretinal Surgery without Antecedent History of Trauma: A Systematic Review and Meta-Analysis

by Matteo Ripa, Georgios D. Panos, Robert Rejdak, Theodoros Empeslidis, Mario Damiano Toro, Ciro Costagliola, Andrea Ferrara, Stratos Gotzaridis, Rino Frisina and Lorenzo Motta

J. Clin. Med. 2023, 12(6), 2316; https://doi.org/10.3390/jcm12062316 - 16 Mar 2023

Cited by 1 | Viewed by 1617

Abstract

Background: To evaluate the morbidity frequency measures in terms of the cumulative incidence of sympathetic ophthalmia (SO) triggered by single or multiple vitreoretinal (VR) surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction, and to further investigate the relationship between VR surgery and SO. Methods: A literature search was conducted using PubMed, Embase, and Scopus from inception until 11 November 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist for the case series and the Newcastle–Ottawa Scale were used to assess the risk of bias. The research was registered with the PROSPERO database (identifier, CRD42023397792). Meta-analyses were conducted using the measurement of risk and a 95% confidence interval (CI) for each study. Results: A random-effect meta-analysis demonstrated that the pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who developed SO regardless of the main trigger, was equal to 0.14 with a CI between 0.08 and 0.21 (I² = 78.25, z: 7.24, p < 0.01). The pooled cumulative incidence of SO triggered by single or multiple VR surgery procedures in eyes without an antecedent history of trauma and previous ocular surgery, except for previous or concomitant uneventful lens extraction among patients who underwent VR surgery, was equal to 0.03 for every 100 people, with a confidence interval (CI) between 0.02% and 0.004% (I² = 27.77, z: 9.11, p = 0.25). Conclusions: Despite postsurgical SO being a rare entity, it is a sight-threatening disease. VR surgery should be viewed as a possible inciting event for SO and considered when counseling patients undergoing VR surgery. Full article

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