SciCombinator

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Concept: Posterior vitreous detachment

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Abstract Purpose: To investigate the efficacy of intravitreal bevacizumab injection in patients with acute central serous chorioretinopathy (CSCR). Methods: Between 6 weeks and 3 months, 13 eyes of 22 patients with acute CSCR received an intravitreal bevacizumab injection (2 mg/0.08 mL), 9 eyes had no medical treatment as a control. At baseline and follow-up visits patients had best corrected visual acuity (BCVA), intraocular pressure assessment, dilated fundus examination, and spectral optical coherence tomography imaging. Outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and symptoms. Results: All patients showed prompt improvements of visual acuity and symptoms until the 3rd month and recovered from neurosensory detachment gradually following treatment in the study group. The vision of control subjects recovered later and the regression of serous retinal detachments were fairly slow. The mean BCVA improved from 0.39±0.16 at first visit (at baseline) to 0.73±0.17 at the 6th month in the study group; and, from 0.25±0.17 at first visit (at baseline) to 0.67±0.13 at the 6th month in the control group that was statistically significant (P=0.0001; P=0.0001, respectively). Mean retinal thickness for the study group was decreased from 414.38±102.79 at first visit (at baseline) to 256.46±84.77 at the 3rd month and 198.30±29.81 at the 6th month (P=0.0001, P=0.0001); and that for the control group was decreased from 510.33±80.59 at first visit (at baseline) to 336.33±127.83 at the 3rd month and 205.66±19.65 at the 6th month (P=0.004, P=0.0001, respectively). One of the patients in the control group revealed recurrence at the 6th month and the patient was given intravitreal injection of bevacizumab. Conclusion: Intravitreal bevacizumab injection for acute CSCR can lead to remarkable improvements of visual acuity within 3 months follow-up compared with controls. These results demonstrated that intravitreal bevacizumab injection may be a promising option for selected patients in the treatment of acute CSCR.

Concepts: Improve, Better, Posterior vitreous detachment, Dilated fundus examination, Statistics, Central serous retinopathy, Retina, Ophthalmology

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Background/Aims: To evaluate the effectiveness of intravitreal ranibizumab injection (IVRI) for acute central serous chorioretinopathy (CSC). Methods: Patients with symptomatic CSC of less than 3 months were prospectively recruited. Patients (n = 20/group) were randomly assigned to IVRI (0.5 mg/0.05 ml) or observation and followed for 6 months. logMAR best-corrected visual acuity (BCVA), fluorescein angiography, indocyanine angiography, and central foveal thickness (CFT) were assessed at baseline and at regular follow-ups. Results: All patients had increased BCVA, decreased CFT, and resolution of the neurosensory detachment. Complete resolution of neurosensory retinal detachment required more time in the observation group (13.0 ± 3.1 vs. 4.2 ± 0.9 weeks; p < 0.001). Mean BCVA and mean CFT improved significantly in both groups, but the changes were not significantly different between groups at 6 months. Conclusions: IVRI for acute CSC might hasten resolution of neurosensory detachment compared to observation alone. At 6 months, BCVA and CFT did not differ between IVRI and observation groups. Further studies are required to determine the long-term benefits of IVRI.

Concepts: Retina, Visual acuity, Posterior vitreous detachment, Central serous retinopathy, Ophthalmology

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PurposeTo evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT).MethodsAPE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated.ResultsThirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51±0.37 LogMAR at baseline, improving to 0.23±0.14 LogMAR at 6 months (P=0.002). Foveal thickness was 464±180 μm at baseline, reducing to 246±59 μm at 6 months (P<0.001). Hyaloid was intraoperatively judged 'partially detached' in seven cases and 'totally detached' in one case. Hyaloid peeling was evaluated 'easy' in six eyes and 'very easy' in two eyes.ConclusionsIn the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients.Eye advance online publication, 14 December 2012; doi:10.1038/eye.2012.248.

Concepts: Posterior vitreous detachment, Epiretinal membrane, Retinal detachment, Vitrectomy, Vitreous humour, Visual acuity, Eye, Ophthalmology

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Conventional treatment of idiopathic central serous chorioretinopathy (ICSC) consists of argon laser, photodynamic therapy, or observation. However, in cases of atypical bullous ICSC with exudative detachment preventing any laser therapy, a surgical approach with external drainage of fluid has been performed. We present a case of ICSC with persistent macula involving exudative retinal detachment without evidence of uveitis that responded favorably to internal drainage by vitrectomy along with a scleral buckle placement. Our case, treated with internal drainage, also demonstrated successful long-term reattachment of the serous retinal detachment without any additional complications from the surgery.

Concepts: Laser, Posterior vitreous detachment, Retina, Scleral buckle, Central serous retinopathy, Medicine, Retinal detachment, Ophthalmology

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Three patients had unilateral vitreomacular traction (VMT) syndrome and the diagnosis was confirmed by spectral domain-type optical coherence tomography (OCT). All patients were female aged 51, 55 and 62 years. All denied surgical intervention. In one patient, rapid spontaneous resolution of the vitreomacular traction with a complete posterior vitreous detachment (PVD) and a normal foveal contour was achieved within 15 days. In the remaining two cases a complete PVD could be detected as late as seven months after the initial presentation. In one, though the vitreomacular adhesion released spontaneously, there was a minimal residual epiretinal membrane. In all three eyes, visual acuity was considerably improved. Spontaneous, uneventful resolution has been rarely reported in the natural course of VMT but several recent studies with the aid of OCT have shown that spontaneous resolution might be more common than previously known. In light of our cases, we believe that there is still room to search for OCT clues in eyes with VMT to predict eyes with higher likelihood of spontaneous resolution, thereby avoiding unnecessary pharmacologic and/or surgical intervention.

Concepts: Visual acuity, Retina, Optics, Posterior vitreous detachment, Vitreous humour, Eye, Epiretinal membrane, Ophthalmology

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It is widely accepted that the origin of subretinal fluid in rhegmatogenous retinal detachment (RRD) is liquid vitreous and that posterior vitreous detachment (PVD) and associated retinal tears are caused by vitreoretinal traction from intra-ocular currents, contraction of collagen fibers, and gravity. These explanations, however, are incomplete. We present a new synthesis of experimental and clinical evidence, updating understanding of fundamental pathophysiological processes in RRD. Misdirected aqueous flow is shown to more convincingly explain the origin of subretinal fluid in clinical RRD, to be the most likely cause of acute PVD and retinal tear formation, and also to contribute to initial detachment of the retina at retinal tears. Misdirected aqueous flow in RRD is a pathophysiological process, rather than the “aqueous misdirection syndrome”, and occurs without visible anterior chamber shallowing or acute glaucoma.

Concepts: Glaucoma, Myopia, Lattice degeneration, Vitreous humour, Posterior vitreous detachment, Retina, Ophthalmology, Retinal detachment

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There is significant overlap between the symptoms of patients presenting with retinal detachment (RD) and posterior vitreous detachment (PVD). Urgency to obtain consultation and treatment are dependent on the ability to accurately distinguish these two conditions. The objective of this study was to determine the ability of emergency physicians to differentiate RDs from PVDs using point-of-care (POC) ocular ultrasound.

Concepts: Posterior vitreous detachment

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Hydrogels may be the ideal vitreous substitutes due to their wonderful physical features and biocompatibility. However, their drawbacks, short residence time, and biodegradation in vivo, have led to the fact that none of them have been approved for clinical use. In this study, we developed a novel approach of using a foldable capsular vitreous body (FCVB) injected with polyvinylalcohol (PVA) hydrogel as a vitreous substitute for long-term tamponade. The 3% PVA hydrogel that was cross-linked by gamma irradiation showed good rheological and physical properties and had no toxicity in vitro. After 180 days retention, the 3% PVA hydrogel inside FCVB remained transparent and showed good viscoelasticity without biodegradation and showed good biocompatibility and retina support. This new approach may develop into a valuable tool to improve the stability performance of PVA hydrogel as a vitreous substitute and to extend the application function of FCVB for long-term implantation in vitreous cavity.

Concepts: Substitute good, Physical property, Eye, Posterior vitreous detachment, In vivo, In vitro, Retina, Vitreous humour

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We describe a case of acute bilateral posterior vitreous detachment (PVD) in a 71-year-old female, which developed during a course of electroconvulsive therapy (ECT) for treatment-resistant depression. The risks and benefits of continuing ECT were assessed and the patient completed the full course of 16 ECT treatments without further ophthalmic complications.

Concepts: Patient, Posterior vitreous detachment, Vitreous humour, Ophthalmology, Electroconvulsive therapy

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This study aims to quantify the concentration of apolipoprotein A1 (APOA1) and retinol binding protein (RBP4) expressed in the vitreous humors of patients with rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD), rhegmatogenous retinal detachment (RRD), and idiopathic epimacular membrane (IEM). This study also aims to investigate the potential role of APOA1 and RBP4 as biomarkers of RRDCD.

Concepts: Proteins, Posterior vitreous detachment, Retina, Retinol binding protein, Apolipoprotein, Retinol, Retinal detachment, Apolipoprotein A1