Purpose To analyze total thickness, morphology and individual vascular layers of the choroid in eyes with Stargardt disease using spectral-domain optical coherence tomography (SD OCT). Design ...Cross-sectional retrospective review. Methods Twenty-eight patients with Stargardt disease (53 eyes) with a mean age of 46 (15–79) years and 30 healthy subjects (30 eyes) with a mean age of 49 (22–79) years who underwent 1-line raster scanning with SD OCT were identified. Diagnosis of Stargardt disease was based on ophthalmic history and complete ophthalmic evaluation. The healthy subjects had best-corrected visual acuity of 20/20 or better with no chorioretinal pathology. Two independent raters assessed the total thickness, morphology, and the individual vascular layers of the choroid. Results The choroid was irregularly shaped in 26 of 41 eyes (64%) with Stargardt disease when compared to 0 of 30 healthy eyes (0%). Mean subfoveal total choroidal thickness and mean subfoveal large choroidal vessel layer thickness were significantly reduced in eyes with Stargardt disease when compared to healthy eyes (272.8 ± 32.8 μm vs 225.4 ± 69.9 μm; P = .03 and 219.5 ± 30.6 vs169.2 ± 70.1; P = .04, respectively). The maximal choroidal thickness was subfoveal in 9 of 41 eyes (22%), focal choroidal thinning was observed in 21 of 41 eyes (51%), and attenuation of large choroidal vessel layer was observed in 8 of 41 eyes (20%) with Stargardt disease. There was no association of the best-corrected visual acuity with any choroidal morphologic feature, except that it was better by a mean of 0.61 ± 0.21 in eyes that had preservation of large choroidal vessel layer (33 of 41, 80%) when compared to those that had attenuation of large choroidal vessel layer ( P = .007). Conclusion This study shows alterations in the total thickness, morphology, and the individual vascular layers of the choroid in eyes with Stargardt disease on SD OCT. These findings may potentially contribute to the clinical staging and monitoring of Stargardt disease.
Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal ...detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center.
A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution.
A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P < 0.0001). Anatomical success was strongly correlated with visual acuity outcome (P < 0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P < 0.05). The rates of obtaining a final best-corrected visual acuity > 20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P < 0.01) or traumatic RD (28%, P < 0.05).
Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.
To evaluate angiographic findings in neonates up to 150 weeks postmenstrual age who received intravitreal ranibizumab for primary treatment of Type 1 retinopathy of prematurity.
Retrospective ...evaluation of fluorescein angiogram findings was completed for 30 eyes of 16 neonates who received intravitreal ranibizumab as primary treatment for Type 1 retinopathy of prematurity between April 2013 and January 2015. Outcome measures included maturity to Zone III, vascular blunting, vascular loops, vascular dilatation, capillary dropout, and vascular fluorescein leakage.
Mean gestational age was 24 weeks and mean postmenstrual age at time of intravitreal ranibizumab treatment was 35 weeks. Fluorescein angiograms performed at 44 weeks to 150 weeks postmenstrual age showed only 50% of eyes reached vascularization to Zone III; 40% had persistent vascular leakage; and ≥90% exhibited vascular blunting, vascular dilatation, and/or capillary dropout.
Although intravitreal ranibizumab is effective in initial cessation of Type 1 retinopathy of prematurity, vascularization to Zone III was only achieved in 50% of eyes in our series and most eyes had fluorescein angiography evidence of vascular anomalies. If future studies are performed comparing treatment with laser photocoagulation to anti-vascular endothelial growth factor, fluorescein angiographic studies should be considered to assess the status of the peripheral retinal vasculature to determine treatment effect.
Peptide for ocular delivery (POD) is a novel cationic cell-penetrating peptide (CPP) which, when conjugated with polyethylene glycol (PEG-POD), can deliver plasmid DNA to the retinal pigment ...epithelium (RPE) of adult murine retina. PEG-POD nanoparticles containing an expression cassette for glial cell line–derived neurotrophic factor (PEG–POD~GDNF) were investigated for their ability to inhibit light-induced photoreceptor apoptosis. PEG-POD~GDNF, control nanoparticles, or buffer were injected into the subretinal space of adult murine retina and retinal degeneration induced by blue light. Animals injected with PEG-POD~GDNF showed a significant reduction (3.9–7.7 fold) in apoptosis relative to control-injected animals. The thickness of the outer nuclear layer (ONL) of the superior retina of PEG-POD~GDNF-injected eyes was significantly greater (23.6–39.3%) than control-injected retina 14 days post-light treatment. PEG-POD~GDNF-injected eyes showed a 27–39% greater functional response relative to controls, as measured by electroretinogram (ERG) 7 days post-light treatment. This is one of only two studies demonstrating histological and functional rescue of a mouse model of retinal degeneration following nonviral administration of a transgene into adult retina. Although rescue is short lived for clinical application, this study represents an important step in the development of nonviral gene therapy for retinal diseases.
PURPOSE OF REVIEWVisualization remains a critical factor in successful ocular surgery.Here we review new technology that has the potential to allow for safer and more efficient retinal surgery.
...RECENT FINDINGSVitreoretinal surgery poses unique visualization challenges such as the need for specialized optical systems and the delicate and microscopic features of retinal structures. Better retinal visualization allows for new approaches to increasingly complex retinal cases. Wide-angle viewing has allowed stereopic visualization of the peripheral retina. Improved lighting systems have shown better safety profiles and can facilitate bimanual techniques. The potential to improve surgical decision making has been shown with intraoperative imaging such as optical coherence tomography.
SUMMARYAlthough some of the benefits of these developments have yet to be proven, improved technology for visualization during retinal surgery will hopefully allow for safer and more efficient surgeries.
Background Open globe injury is a common cause of monocular blindness in children. Current formulas to predict outcomes of open globe injury often rely heavily on visual acuity and presence of an ...afferent pupillary defect, examination elements that are difficult to assess in young children. We aimed to analyze the features of open globe injuries in children aged 0-6 years to facilitate development of a novel algorithm for predicting visual outcomes in this age group. Methods The medical records of patients 0-6 years of age presenting at a single institution with open globe injury from 2000 to 2013 were retrospectively reviewed. Epidemiology, physical examination, and intervention data were used to develop a prognostic algorithm. Results A total of 28 patients were included. Mean age at presentation was 4.2 years (range, 1.9-6.7). Glass was the most common mechanism of injury. Associated findings included uveal prolapse (93%), choroidal detachment (39%), hyphema (32%), and retinal detachment (11%). In addition to primary repair, 43% patients required a lensectomy, and 7% underwent surgery to repair retinal detachment. Complicating cataract ( P < 0.005) and a wound >6 mm ( P < 0.05) were associated with a final visual acuity worse than 20/40. A novel algorithm for predicting visual outcome was devised with a sensitivity of 81% and a specificity of 92%. Conclusions Patients 0-6 years of age with open globe injuries present unique risk factors for poor outcome. The trauma score generated by our algorithm is not reliant on presenting visual acuity and may be useful in predicting prognosis in very young children.
To report on the feasibility of 27-gauge (G) vitrectomy for pediatric patients.
This study is an international, multicenter, retrospective, interventional case series. Participants were patients 17 ...years or younger who underwent 27-G vitrectomy for various indications.
The records of 56 eyes from 47 patients were reviewed. Mean age was 5.7 ± 5.2 years. Diagnoses included retinopathy of prematurity (Stages 3 with vitreous hemorrhage, 4A, 4B, and 5), Terson's syndrome, traumatic macular hole, posterior capsular opacification, endophthalmitis, and others. Instruments used were the 27-G infusion, 27-G vitreous cutter, 27-G light pipe, and 27-G internal limiting membrane forceps. Instrument bending was noted in one (1.8%) case. There were no cases with intraoperative complications, infusion issues, or postoperative endophthalmitis. There were 67/145 (46%) sclerotomies that required suturing, of which most (51/145) were sutured out of precaution. There were four cases (7.1%) that required conversion to a larger gauge and three cases (5.3%) that developed postoperative hypotony. Mean visual acuity improved from logarithm of the minimum angle of resolution 1.32 (20/420) to 0.72 (20/105), after a mean follow-up of 125.1 days (P = 0.01). Anatomic success was achieved in 96.4% of eyes after a single surgery.
Twenty-seven-gauge vitrectomy was safe and feasible in selected pediatric vitreoretinopathies. Further studies are warranted to examine indications and outcomes.
A 77-year-old woman with exudative macular degeneration underwent bilateral intravitreal injections of "stem cells" at a clinic in Georgia. One month and 3 months after injection, she developed ...retinal detachments in the left and right eyes, respectively. Increased awareness within the medical community of such poor outcomes is critical so that clinics offering untested practices that have been shown to be potentially harmful to patients can be identified and brought under U.S. Food and Drug Administration oversight. Ophthalmic Surg Lasers Imaging Retina. 2017;48:772-775..
We present 2 cases of sutureless 25-gauge pars plana vitrectomy and fluid-gas exchange, in which incorrect gas concentrations likely led to elevated intraocular pressures and retrobulbar gas. ...Combined removal of orbital gas with anterior orbitotomy and pars plana vitrectomy was performed in the first case to address expanding intraocular and retrobulbar gas resulting from a suspected error in gas dilution. Vitreous and orbital gas removal by needling was effective in the second case. In patients with elevated intraocular pressure and orbital gas accumulation after vitrectomy, combined intraocular and orbital decompressions were effective in optimizing clinical outcomes. There is no consensus regarding the best management of orbital gas after vitrectomy. We propose that a multidisciplinary technique should be considered, when available.
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