Intravitreal Chemotherapy in the Management of Vitreous Disease in Retinoblastoma

2017 ◽  
Vol 27 (4) ◽  
pp. 423-427 ◽  
Author(s):  
Hayyam Kiratli ◽  
İrem Koç ◽  
Ali Varan ◽  
Canan Akyüz
Keyword(s):  
Side Effects ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Vitreous Hemorrhage ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Vitreous Seeds ◽  
Number Of Injections ◽  
Vitreous Seeding

Purpose To evaluate the therapeutic outcome of intravitreal melphalan injection in the management of vitreous disease in patients with retinoblastoma. We particularly aimed to assess whether higher melphalan dose with lower number of injections was more effective and associated with fewer side effects. Methods This retrospective, interventional, noncomparative, and nonrandomized study included 39 eyes of 37 patients. Vitreous seeds were classified as dust, sphere, and cloud types. Intravitreal injections were performed through pars plana free of any visible tumor using 30-G needle. Response of the seeds (disappearance, conversion into inactive debris, or progression) and enucleation rate were determined as outcome measures. Results All patients previously received systemic or intra-arterial chemotherapy. Vitreous seeding was primary in 54% of eyes and secondary in 46% of eyes. Vitreous seeds were classified as dust in 9 (23.1%) eyes, sphere in 24 (61.5%) eyes, and cloud in 6 (15.4%) eyes. Melphalan dose varied between 20 and 40 µg and 20 (51.3%) eyes received >30 µg. The total number of injections was 70 (range 1-5, mean 1.8 per eye). Various types of regression were obtained in 27 (69.2%) eyes. Sphere-type seeds were the most responsive to melphalan. Nonresponse and disease progression were noted in 12 (30.8%) eyes. After a mean follow-up of 11.8 months, 17 (44%) eyes were enucleated. Vitreous hemorrhage (18%) and retinal pigment epithelial alterations (8%) were the most common side effects. Conclusions Intravitreal melphalan at 30-40 µg in 1 or 2 injections proved effective in 69.2% of eyes with vitreous disease.

scholarly journals Precision Intravitreal Chemotherapy for Localized Vitreous Seeding of Retinoblastoma

2018 ◽  
Vol 5 (4) ◽  
pp. 284-289 ◽  
Author(s):  
Michael D. Yu ◽  
Lauren A. Dalvin ◽  
R. Joel Welch ◽  
Carol L. Shields
Keyword(s):  
Retinal Pigment ◽  
Tumor Control ◽  
Injection Technique ◽  
Complete Control ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Direct Delivery ◽  
Vitreous Seeds ◽  
Vitreous Seeding

Purpose: To describe and evaluate the effectivity of a novel precision intravitreal injection technique for select cases of localized vitreous seeding in retinoblastoma. Methods: Patients with localized vitreous seeds from retinoblastoma received intravitreal chemotherapy via a precision injection technique (P-IVitC) intended to optimize local delivery of melphalan to target seeds. The needle was inserted trans-pars plana and chemotherapy deposited within 3 mm of the target seed(s) under indirect ophthalmoscopic guidance. Without subsequent globe manipulation, the head was then positioned to promote gravity-dependent settling of chemotherapy. Results: There were 8 eyes of 8 patients treated with P-IVitC for active vitreous seeds following adequate solid tumor control with intravenous chemotherapy (n = 3, 38%) or intra-arterial chemotherapy (n = 5, 63%). Viable vitreous seeds were primarily solitary spheres (n = 6, 75%) and measured an average of 2.7 mm in diameter. Vitreous seed resolution (n = 8, 100%) was noted after a mean of 2.6 injections (median 2; range 1–3) of 20 μg melphalan. There was no recurrence at a mean follow-up of 10.0 months. Only 1 eye had an associated complication (focal retinal pigment epithelial mottling, n = 1, 13%). Conclusions: With direct delivery of chemotherapy to within 3–4 mm of vitreous seed activity, P-IVitC provided complete control of localized vitreous seeds with minimal toxicity.

Acquired retinoschisis and vitreous hemorrhage as unusual findings in choroideremia: Case report

2020 ◽  
pp. 112067212094657
Author(s):  
Dario Pasquale Mucciolo ◽  
Vittoria Murro ◽  
Dario Giorgio ◽  
Andrea Sodi ◽  
Ilaria Passerini ◽  
...  
Keyword(s):  
Case Report ◽  
Retinal Pigment Epithelium ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Vitreous Hemorrhage ◽  
Advanced Stage ◽  
Vascular Abnormalities ◽  
Diagnostic Difficulties ◽  
The Right

Purpose: To report a case of choroideremia characterized by peripheral retinoschisis with vascular abnormalities and vitreous hemorrhage. Observations: A 58-year-old man affected by advanced-stage choroideremia was diagnosed with peripheral retinoschisis in both eyes. Vitreous hemorrhage was present in the right eye with a peculiar clot-like lesion at the periphery. At the 1-year follow-up, the vitreous hemorrhage had reabsorbed and the vascular clot-like lesion in the periphery had almost completely disappeared. Conclusion and importance: We have reported fundoscopic and OCT features of peripheral-acquired retinoschisis with vascular abnormalities in a patient with choroideremia. OCT examination is extremely useful in clinical evaluation of the peripheral retinal alterations in these cases, where the absence of the retinal pigment epithelium and the choriocapillaris pose many diagnostic difficulties.

scholarly journals Effectiveness of intravitreal chemotherapy-assisted endoresection in monocular patients with group D retinoblastoma

2020 ◽  
Author(s):  
Xiling Yu ◽  
Xueke Li ◽  
Yue Xing ◽  
Siduo Lu ◽  
Silvia Tanumiharjo ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Repeated Treatment ◽  
Retrospective Case ◽  
Promising Alternative ◽  
Tumour Control ◽  
Intravitreal Chemotherapy ◽  
Pars Plana ◽  
Group D

Abstract Background: This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients.Methods: In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients.Results: Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up.Conclusion: Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.

Macular Edema and Visual Loss after Macular Pucker Surgery with ICG-Assisted Internal Limiting Membrane Peeling

2005 ◽  
Vol 15 (2) ◽  
pp. 289-291 ◽  
Author(s):  
D. Tognetto ◽  
C. Haritoglou ◽  
A. Kampik ◽  
G. Ravalico
Keyword(s):  
Macular Edema ◽  
Visual Loss ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Cataract Extraction ◽  
Internal Limiting Membrane ◽  
Macular Pucker ◽  
Epiretinal Membranes ◽  
Pars Plana

Purpose To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. Methods/Results A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. Discussion This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.

scholarly journals A Case of Giant Macular Hole Progression after Rupture of a Giant Retinal Pigment Epithelial Detachment

2019 ◽  
Vol 10 (2) ◽  
pp. 195-199
Author(s):  
Kosuke Nagaoka ◽  
Satoru Inoda ◽  
Hidenori Takahashi ◽  
Yusuke Arai ◽  
Yuji Inoue ◽  
...  
Keyword(s):  
Macular Hole ◽  
Retinal Pigment Epithelial ◽  
Retinal Pigment ◽  
Posterior Vitreous Detachment ◽  
Pigment Epithelial Detachment ◽  
Retinal Pigment Epithelial Detachment ◽  
Vitreous Detachment ◽  
Pigment Epithelial

We report a case of giant macular hole progression after rupture of giant retinal pigment epithelial detachment (PED). The patient was a 91-year-old man who had a giant PED in the left eye. He had bilateral hypermetropia (+2.00 dpt), and he had developed posterior vitreous detachment. The PED was 5,800 μm in diameter and 800 μm in height and ruptured during follow-up. A macular hole was formed, with a diameter of 400 μm, and the height of the PED had reduced to 360 μm. After 5 months, the macular hole expanded up to a diameter of 600 μm. Therefore, some cases of giant PED may lead to macular hole.

Tube Shunt Related Complications of the Retina and Vitreous

2013 ◽  
Author(s):  
Judianne Kellaway ◽  
Garvin H. Davis
Keyword(s):  
Retinal Detachment ◽  
Vitreous Hemorrhage ◽  
Shunt Implantation ◽  
Suprachoroidal Hemorrhage ◽  
Pars Plana ◽  
One Year ◽  
Tube Shunt ◽  
Choroidal Effusion ◽  
Retinal Complications

Tube shunt complications of the retina and vitreous can threaten vision. It is important to understand how to recognize, prevent, and manage these complications. While many retrospective studies regarding retinal complications of tube shunts are in the literature, there are now 2 major prospective studies that can be looked to for the incidence of retinal complications. In the Tube Versus Trabeculectomy (TVT) Study, at 3 years of follow-up, 4 eyes out of 107 total eyes (4%) with tube shunts had required pars plana vitrectomies due to a retinal complication (e.g., vitreous occlusion of the tube, retinal detachment, choroidal detachment). Drainage of a choroidal effusion was performed in 2 patients. Early postoperative retinal complications (onset at 1 month or less after tube shunt implantation) included choroidal effusion (15 eyes; 14%), suprachoroidal hemorrhage (2 eyes; 2%), and vitreous hemorrhage (1 eye; 1%). Late postoperative retinal complications (onset more than 1 month after tube shunt implantation) included choroidal effusion (2 eyes; 2%) and retinal detachment (1 eye; 1%). In the Ahmed Baerveldt Comparison (ABC) Study, at one year of follow-up, one eye of 276 total eyes (0.4%) required a pars plana vitrectomy to clear a postoperative hemorrhage and one eye (0.4%) required reoperation for drainage of a suprachoroidal hemorrhage. Early postoperative retinal complications (3 months of less after implantation of the tube shunt) reported included choroidal effusion (34 eyes; 12%), suprachoroidal hemorrhage (2 eyes; 1%), endophthalmitis (1 eye; 0.4%), and vitreous hemorrhage (5 eyes; 2%). Late retinal postoperative complications (more than 3 months after tube shunt implantation) included choroidal effusion (3 eyes; 1%), endophthalmitis (2 eyes; 1%), vitreous hemorrhage (3 eyes; 1%), and retinal detachment (2 eyes; 1%). Both of these studies indicate a similar incidence of retinal complications after tube shunt implantation. Tube shunt surgery is performed in cases of uncontrolled glaucoma where medications are inadequate. A pars plana tube is most often indicated for anatomic reasons, such as a small eye, or an eye that already has coexisting corneal disease.

Cytoprotective effect of crocin and trans-resveratrol on photodamaged primary human retinal pigment epithelial cells

2019 ◽  
pp. 112067211989596
Author(s):  
Stefan Kassumeh ◽  
Christian M Wertheimer ◽  
Andreas Ohlmann ◽  
Siegfried G Priglinger ◽  
Armin Wolf
Keyword(s):  
Epithelial Cells ◽  
Pars Plana Vitrectomy ◽  
Retinal Pigment Epithelial ◽  
Light Exposure ◽  
Retinal Pigment ◽  
Retinal Pigment Epithelial Cells ◽  
Enzyme Linked Immunosorbent Assay ◽  
Pigment Epithelial ◽  
Pars Plana ◽  
Pigment Epithelial Cells

Purpose: Light-induced damage to retinal pigment epithelium during pars plana vitrectomy remains a hot topic in ophthalmology. Improvements in technology led to a change of light sources, selective filters, and shorter light exposure time. Currently, there is no satisfying solution to the problem. The aim of the study was to investigate the cytoprotective effects of crocin and resveratrol on light-induced damage to primary human retinal pigment epithelial cells in vitro. Methods: Primary human retinal pigment epithelial cells were exposed to light analogous to the illumination during pars plana vitrectomy. To evaluate the cytoprotective effects and potential toxicity of resveratrol and crocin, human retinal pigment epithelial cells were incubated with varying concentrations of both before 3-[4,5-dimethylthiazol-2-yl] tetrazolium bromide (MTT) viability assay. Furthermore, glutathione levels were measured to investigate synergistic antioxidant potential. Apoptosis of human retinal pigment epithelial cells was determined by a nucleosome detection enzyme-linked immunosorbent assay. Results: Crocin and resveratrol improved cell viability in photodamaged human retinal pigment epithelial cells significantly from 40.65 ± 21.99% in illuminated human retinal pigment epithelial cells and reached a peak viability of 85.64 ± 11.37% in crocin and resveratrol pretreated cells (for all: p < 0.001). In line, the combination of the supplements increased glutathione levels significantly from 39.35 ± 21.96% to 80.74 ± 10.32% ( p = 0.017). No toxic effects were detected ( p > 0.99). However, no change in apoptosis rates could be observed following pretreatment with crocin and resveratrol ( p > 0.99). Conclusion: Crocin and trans-resveratrol revealed cytoprotective effects on human retinal pigment epithelial cells supporting both supplement’s development as potential perioperative treatments in light-induced retinal pigment epithelial damage.

scholarly journals Outcome and Complications of Combined Phacoemulsification and 23-Gauge Pars Plana Vitrectomy

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Selcuk Sizmaz ◽  
Ebru Esen ◽  
Puren Isik ◽  
Burcu Cam ◽  
Nihal Demircan
Keyword(s):  
Intraocular Pressure ◽  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Intraoperative Complications ◽  
Vitreous Hemorrhage ◽  
Patient Demographics ◽  
Posterior Synechia ◽  
Pars Plana ◽  
23 Gauge

Background. With the advances in surgical tools, simultaneous removal of cataract associated with vitreoretinal disorders is gaining popularity. This combined surgery offers several advantages besides limitations. The aim of this study is to assess the outcome and complications of phacoemulsification combined with pars plana vitrectomy (PPV). Patients and Methods. In this retrospective review, medical charts of patients undergoing phacovitrectomy for coexisting cataract and various vitreoretinal disorders were analyzed. Patient demographics, retinal diagnosis, visual acuities (VA) in logMAR, intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Clear corneal phacoemulsification and 23-gauge transconjunctival PPV were administered in all cases. Results. Eighty-four eyes of 64 (76.2%) males and 20 (23.8%) females were enrolled. The average age of patients was 59.5 ± 13.8 (18–81). The average period of follow-up was 7.2 ± 7.5 months (1–36). The vitreoretinal diagnoses were as follows: 28 (33.3%) rhegmatogenous retinal detachment, 23 (27.4%) vitreous hemorrhage, 12 (14.3%) intraocular foreign body, 12 (14.3%) epiretinal membrane, 4 (4.8%) macular hole, 4 (4.8%) tractional retinal detachment, and 1 (1.2%) vitreomacular traction. The most common intraoperative complications were miosis and rupture of the posterior capsule (92.9% and 8.3%, respectively). In 8 (9.5%) cases, there was fibrin in the anterior chamber. Posterior synechia developed in 7 (8.3%) of cases. No severe increase in intraocular pressure was evident. Conclusion. Phacoemulsification combined with PPV is a safe and efficient way of management in cases where cataract coexists with vitreoretinal pathologies.

scholarly journals PARS PLANA VITRECTOMY FOR VITREOUS HEMORRHAGE IN CIPTOMANGUNKUSUMO HOSPITAL

2021 ◽  
Vol 4 (2) ◽  
pp. 99
Author(s):  
Marsha Alyssa Razief Fitri ◽  
Anggun Rama Yudantha
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Diagnostic Procedure ◽  
Vitreous Hemorrhage ◽  
Descriptive Study ◽  
Posterior Segment ◽  
Early Vitrectomy ◽  
Systemic Control ◽  
Pars Plana

Introduction: Vitreous hemorrhage is the presence of blood in the vitreous cavity. This condition could impair the visual function and hindered the clinician’s ability to examine the posterior segment of the eye.  Pars plana vitrectomy (PPV) not only act as a surgical treatment of choice but also diagnostic procedure. Immediate PPV has the advantage to optimalize visual acuity Methods: Retrospective descriptive study of vitreous hemorrhage patients underwent pars plana vitrectomy in Ciptomangunkusumo Hospital, Indonesia from January to December 2018 Result: There were 160 cases of vitreous hemorrhage cases undergoes pars plana vitrectomy in 2018. Most frequent etiology was proliferative diabetic retinopathy (49.4%). Rebleeding was found only in 8 cases within the period of three months follow up. Final visual acuity was improved in majority of the cases and found to be related to timing of the surgery. Conclusion: Early vitrectomy along with systemic control of underlying factors lead to improvement of visual acuity in vitreous hemorrhage.  

scholarly journals Clinical Study of Scleral Fixated Intraocular Lens Implantation in Blunt Ocular Trauma

2021 ◽  
pp. 86-91
Author(s):  
Girish Gadre ◽  
Neha Maheshwari ◽  
V. H. Karambelkar
Keyword(s):  
Intraocular Pressure ◽  
Postoperative Complications ◽  
Vitreous Hemorrhage ◽  
Corneal Edema ◽  
Visual Outcome ◽  
P Value ◽  
Cataractous Lens ◽  
Pars Plana ◽  
The Mean

Aim: to assess visual outcome and complications associated with SFIOL implantation in traumatic lens subluxation/ dislocation cases. Methods: This is a retrospective study of 45 patients who were managed for traumatic dislocation/subluxation of clear or cataractous lenses from June 2019 to July 2020 in a Krishna hospital, Karad, Satara. All cases underwent anterior vitrectomy/3 port pars plana vitrectomy + removal of lens and ab externo 2 point scleral fixation with rigid or foldable sfiol. In posteriorly dislocated/subluxated lens, vitrectomy was done and the lens was removed using pick forceps and retrieved by hand shake technique. In anteriorly dislocated cataractous lens, the lens was removed through the tunnel incision. Results: Majority of the patients were between 55-65 years of age with male pre-ponderance (73.3%).Out of 45 cases, 21 cases (46.6%) were traumatic dislocated lens and 24 cases (53.3%) were traumatic subluxated lens. The mean preoperative BCVA was 0.13 ± 0.24 logMAR, which improved 0.39 ± 0.366 logMAR postoperatively (P <0.0001 ).Preoperatively BCVA in logMAR in 39 cases (86.6%) was 0.3 or better, 6 cases (13.3%) was 0.3 to 1.0 . Postoperatively BCVA in logMAR in 21 cases (46.67%) was 0.3 or better, 24 cases (53.3%) was 0.3 to 1. P-value is 0.00057 which is significant. Early postoperative complications noted were raised intraocular pressure in 12 cases (26.6%), corneal edema in 9 cases (20%), vitreous hemorrhage in 8 cases (17.7%)  and hypotony in 3 cases (6.67%).Late postoperative complications were persistent elevation of intraocular pressure in 10 cases (22.2%), cystoid macular edema in 3 cases (6.67%), epiretinal membrane in 3 cases (6.67%). Conclusion: In every horrendous case, long haul follow-up is needed to distinguish confusions and start treatment at the most punctual.

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