Temporal Approach, Digitally Assisted Phacovitrectomy in a Patient with Severe Kyphosis due to Axial Spondyloarthritis

Purpose. To describe a temporal approach, digitally assisted phacovitrectomy in a patient with severe kyphosis due to axial spondyloarthritis. Case Report. A 70-year-old male patient with proliferative diabetic retinopathy with vitreous hemorrhage and cataract and ankylosing spondylitis with severe kyphosis. A temporal approach, digitally assisted 25 G phacovitrectomy was performed with a Constellation platform and the NGENUITY visualization system. The Trendelenburg position was utilized. Conclusion. A temporal approach, digitally assisted phacovitrectomy may be used in select cases of severe kyphosis with positive outcomes.

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Identification of Diagnostic and Prognostic microRNAs for Recurrent Vitreous Hemorrhage in Patients with Proliferative Diabetic Retinopathy

Journal of Clinical Medicine ◽

10.3390/jcm8122217 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2217 ◽

Cited By ~ 2

Author(s):

Parviz Mammadzada ◽

Juliette Bayle ◽

Johann Gudmundsson ◽

Anders Kvanta ◽

Helder André

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Control Group ◽

Ocular Tissues ◽

Recurrent Hemorrhage ◽

Pars Plana ◽

And Control ◽

Insight Into ◽

Recurrent Vitreous Hemorrhage

MicroRNAs (miRNAs) can provide insight into the pathophysiological states of ocular tissues such as proliferative diabetic retinopathy (PDR). In this study, differences in miRNA expression in vitreous from PDR patients with and without incidence of recurrent vitreous hemorrhage (RVH) after the initial pars-plana vitrectomy (PPV) were analyzed, with the aim of identifying biomarkers for RVH. Fifty-four consented vitreous samples were analyzed from patients undergoing PPV for PDR, of which eighteen samples underwent a second surgery due to RVH. Ten of the sixty-six expressed miRNAs (miRNAs-19a, -20a, -22, -27a, -29a, -93, -126, -128, -130a, and -150) displayed divergences between the PDR vitreous groups and to the control. A significant increase in the miRNA-19a and -27a expression was determined in PDR patients undergoing PPV as compared to the controls. miRNA-20a and -93 were significantly upregulated in primary PPV vitreous samples of patients afflicted with RVH. Moreover, this observed upregulation was not significant between the non-RVH and control group, thus emphasizing the association with RVH incidence. miRNA-19a and -27a were detected as putative vitreous biomarkers for PDR, and elevated levels of miRNA-20a and -93 in vitreous with RVH suggest their biomarker potential for major PDR complications such as recurrent hemorrhage incidence.

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Reasons for and Management of Postvitrectomy Vitreous Hemorrhage in Proliferative Diabetic Retinopathy

Current Eye Research ◽

10.3109/02713680903572491 ◽

2010 ◽

Vol 35 (4) ◽

pp. 308-313 ◽

Cited By ~ 8

Author(s):

Hua Yan ◽

Jing Cui ◽

Yingjuan Lu ◽

Jinguo Yu ◽

Song Chen ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage

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Cost Analysis of Intravitreal Aflibercept vs Vitrectomy With Panretinal Photocoagulation for Vitreous Hemorrhage From Proliferative Diabetic Retinopathy

JAMA Ophthalmology ◽

10.1001/jamaophthalmol.2021.1565 ◽

2021 ◽

Author(s):

Benjamin K. Young ◽

Mark W. Johnson ◽

Thomas J. Wubben

Keyword(s):

Diabetic Retinopathy ◽

Cost Analysis ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Panretinal Photocoagulation ◽

Intravitreal Aflibercept

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Endolaserless Vitrectomy With Intravitreal Aflibercept Injection for Proliferative Diabetic Retinopathy-Related Vitreous Hemorrhage (LASER LESS TRIAL)

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418764972 ◽

2018 ◽

Vol 2 (3) ◽

pp. 127-137

Author(s):

Dennis M. Marcus ◽

Harinderjit Singh ◽

Davis C. Starnes ◽

Harveen Walia ◽

Amina Farooq ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Panretinal Photocoagulation ◽

Short Term ◽

Safety And Efficacy ◽

Intravitreal Aflibercept ◽

Central Subfield Thickness ◽

Endothelial Growth Factor

Purpose: For proliferative diabetic retinopathy (PDR) eyes not requiring vitrectomy, Diabetic Retinopathy Clinical Research Protocol S and the CLARITY trial demonstrated better visual function and anatomical outcomes with less proliferative and diabetic macular edema consequences in the antivascular endothelial growth factor groups compared to the panretinal photocoagulation groups. Intravitreal aflibercept injection (IAI) may represent a useful therapy with vitrectomy for PDR-related vitreous hemorrhage (VH) as a viable alternative to intraoperative endolaser during vitrectomy. We will determine the safety and efficacy when aflibercept is used for PDR-related VH with endolaserless vitrectomy. Methods: Evaluation of endolaserless vitrectomy and 2 mg IAI for PDR-related VH. Eyes receive 1 preoperative and intraoperative IAI followed by randomization to a q8week group receiving 4 postoperative q4week IAI followed by q8week IAI or q16week group receiving 2 postoperative q4week IAI followed by q16week IAI. Main Outcome Measures: Herein, we present pooled safety and efficacy outcomes through 4 months. Results: Twenty-one of 24 eyes were randomized. Preoperative average visual acuity (VA) was 36 letters (20/200). At 4-month follow-up, 18 of 21 randomized eyes showed an average VA of 72 letters (20/40) with an average visual gain of 38 (range, 0-84 gain) letters. Average optical coherence tomography (OCT) central subfield thickness (CST) at 1-month postoperative follow-up was 311 µm. Average OCT CST at 4-month follow-up was 272 µm (average thinning of 38 µm). No significant short-term ocular or systemic adverse events were observed through 4 months. Conclusions: Endolaserless vitrectomy with IAI for PDR-related VH demonstrates short-term safety with significant VA improvement.

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Análise da Revisão Cochrane: Anti-fator de Crescimento Vascular Endotelial na Prevenção da Hemorragia Vítrea Pós-Operatória após Vitrectomia por Retinopatia Diabética Proliferativa. Cochrane Database Syst Rev. 2015;8:CD008214.

Acta Médica Portuguesa ◽

10.20344/amp.9437 ◽

2017 ◽

Vol 30 (7-8) ◽

pp. 513 ◽

Cited By ~ 1

Author(s):

David Cordeiro Sousa ◽

Inês Leal ◽

João Costa ◽

António Vaz-Carneiro

Keyword(s):

Systematic Review ◽

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Vascular Endothelial ◽

Cochrane Systematic Review ◽

Endothelial Growth Factor ◽

Postoperative Vitreous Hemorrhage

Postoperative vitreous hemorrhage is a complication following vitrectomy for proliferative diabetic retinopathy, delaying visual recovery and making fundus examination and disease follow-up more difficult. Anti-vascular endothelial growth factor drugs such as bevacizumab, when injected in the vitreous cavity, reduce vascular proliferation and their use has been proposed to reduce the incidence of postoperative vitreous hemorrhage. The authors of this Cochrane systematic review evaluated all randomized controlled trials on the pre- or intraoperative use of anti-vascular endothelial growth factor to reduce postoperative vitreous hemorrhage occurrence after vitrectomy in patients with proliferative diabetic retinopathy. The results suggested that the use of intravitreal bevacizumab was effective in reducing early postoperative vitreous hemorrhage (i.e. at four weeks) occurrence, with a good safety profile. This work aims to summarize and discuss the findings and clinical implications of this Cochrane systematic review.

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Risk Factors of Neovascular Glaucoma After 25-gauge Vitrectomy for Proliferative Diabetic Retinopathy with Vitreous Hemorrhage: A Retrospective Multicenter Study

Scientific Reports ◽

10.1038/s41598-019-51411-6 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Kei Takayama ◽

Hideaki Someya ◽

Hiroshi Yokoyama ◽

Yoshihiro Takamura ◽

Masakazu Morioka ◽

...

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Multicenter Study ◽

Vitreous Hemorrhage ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Uncontrolled Diabetes ◽

Surgical Options ◽

25 Gauge Vitrectomy

Abstract Neovascular glaucoma (NVG) is a terminal severe complication in eyes with proliferative diabetic retinopathy (PDR), and PDR eyes with vitreous hemorrhage (VH) which undergo vitrectomy may have higher risk of postoperative NVG. The incidence and the prognostic factor of postoperative NVG after 25-gauge vitrectomy with advanced surgical options remain unclear. We retrospectively reviewed medical records of 268 eyes of 268 consecutive PDR patients with VH who underwent 25-gauge vitrectomy and 12 months follow-up at seven centers. Preoperative ocular factors (visual acuity, tractional retinal detachment, panretinal photocoagulation [PRP]), demographics and clinical factors (sex, age, diabetic duration, HbA1c, hypertension, anticoagulant medication, and kidney function), surgical procedures, and postoperative complications were compared between patients who developed postoperative NVG (9.3%) and those who did not. NVG eyes was significantly younger (P = 0.026), had shorter diabetic duration (P = 0.022), higher HbA1c (P = 0.028), absence of PRP (P = 0.039) and higher frequency of postoperative VH (P = 0.0075) than non-NVG eyes. Logistic regression analysis identified postoperative VH (P = 0.014), shorter diabetic duration (P = 0.029), and no PRP (P = 0.028) as prognostic factors for postoperative NVG. This multicenter study indicates that younger age, uncontrolled diabetes, no PRP, and postoperative VH are risk factors of post-vitrectomy NVG.

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Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy

Journal of Clinical Medicine ◽

10.3390/jcm8111960 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1960

Author(s):

Andrea Russo ◽

Antonio Longo ◽

Teresio Avitabile ◽

Vincenza Bonfiglio ◽

Matteo Fallico ◽

...

Keyword(s):

Risk Factors ◽

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Vascular Endothelial ◽

Macular Detachment ◽

Anti Vegf ◽

Endothelial Growth Factor

The study’s purpose was to determine the incidence, risk factors, and outcomes of tractional macular detachment after anti-vascular endothelial growth factor (VEGF) pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. Patients who underwent primary vitrectomy for complicated proliferative diabetic retinopathy, from January 2012 to 31 December 2018, were enrolled. Ophthalmic and pre-operative data were extracted from electronic record systems. All eyes with a valuable Optical Coherence Tomography (OCT)performed within 5 days before injection of anti-VEGF and on the day of vitrectomy were included. Multivariable logistic regression showed that significant risk factors for developing tractional macular detachment included days between anti-VEGF and vitrectomy (OR, 0.71 [95% CI 0.65–0.76]; p < 0.001), vitreous hemorrhage (OR, 0.23 [95% CI 0.11–0.49]; p < 0.001), and age (OR, 1.05 [95% CI 1.02–1.08]; p < 0.001). Decision-tree analysis showed that the stronger predictors of tractional macular detachment were the time between anti-VEGF injection and vitrectomy (p < 0.001). Secondary predictors were the presence of vitreous hemorrhage (p = 0.012) in eyes that underwent vitrectomy between 6 and 10 days after anti-VEGF injection and younger age (p = 0.031) in eyes that underwent vitrectomy 10 days after anti-VEGF injection. Tractional macular detachment occurs in 10% of eyes after anti-VEGF injection, the main risk factors being days between anti-VEGF injection and vitrectomy, vitreous hemorrhage, and age.

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