Elimination of vitreomacular traction syndrome in eyes, that were previously surgically treated due to retinal detachment

Aims. Evaluate the efficiency of ILM peeling in the treatment of VMTS on eyes previously treated for retinal detachment. Materials and methods. 4 participants diagnosed with VMTS were enrolled in this study. There were 2 male and 2 female patients aged 30-64 y.o. who were previously surgically treated for their retinal detachment. 3 patients had rhegmatogenous and 1 patient had traumatic tractional retinal detachment with the mean duration of 5.75 years. 3 eyes undergone scleral buckling following subretinal fluid drainage, 1 eye underwent cataract phacoemulsification with an implantation of IOL + closed vitrectomy + pneumatic retinopexy + endolaser retinal photocoagulation + silicone oil, insertion following silicone oil removal from the vitreous cavity. All patients had some degree of myopia as well as peripheral retinal degenerations. 2 patients were diagnosed with epiretinal fibrosis and 2 other with stage 2 small full-thickness macular hole. Mean BCVA before surgery was 0.078, mean central retinal thickness was 390,25 um, small full-thickness macular hole diameter was about 320 um. Before the surgery, all patients undergone cycloscopy, where there were no indications for the additional laser photocoagulation. 3 patients underwent posterior vitrectomy 25G and 1 patient had 25G ports placed on his eye with the peeling of ILM and usage of pneumatic retinopexy, 2 eyes underwent cataract phacoemulsification with IOL implantation. Results and discussion. All surgical interventions were done without any complications. Since there were conjunctival scars left after the previous surgeries, conjunctiva did not show any displacement during the sclerotomy procedures, which led to the formation of post-sclerotomy holes. This fact forced us to make knot sutures, which resulted in foreign body sensations in our patients during the post-op period. Intraoperatively, all patients had their ILM removed, which was proved by OCT in the post-op period. Mean BCVA after operations was 0.3. Mean Central retinal thickness was 314 um based on OCT data in the post-op period. Patients were recommended to undergo cycloscopy 1 month after the surgery and then twice every year. There were no retinal detachment relapse observed in the post-op period. Conclusion: 1. Removal of ILM in patients, that were previously operated due to retinal detachment, is considered as an effective method in the treatment of VMTS. It is clinically manifested as visual acuity improvement, retinal thickness reduction, lamellar hole closure and the absence of full thickness macular hole formation risk in the early and late post-op periods. No retinal detachment relapses were observed. 2. Presence of conjunctival scars following previous retinal detachment surgical interventions leads to the hole formation following sclerotomy procedures, which causes foreign body sensations in patients during the post-op period. 3. Endovitreal surgical intervention for the retinal detachment should include ILM peeling to prevent formation of VMTS in the post-op period. Key words: vitreomacular traction syndrome (VMTS), Internal limiting membrane (ILM), rhegmatogenous retinal detachment ( RRD), optic coherence tomography (OCT).

Submicroscopic characteristics of the lacrimal fluid in vitreomacular traction syndrome, diabetic retinopathy compared with the norm

Study of the lacrimal fluid (LF) as a constant microenvironment of the anterior part of the eye which is the only atraumatically accessible substrate for the diagnosis and research of ophthalmic diseases, such as vitreomacular traction syndrome (VMTS), diabetic retinopathy (DR), makes it possible to study it using electronic microscopy methods. All studied LF samples contain cells and cell fragments; exosomes which are vesicles (40–100 nm) localized in multivesicular bodies, transmitting signals between cells and carrying markers of many diseases. Analysis of the samples revealed changes in the occurrence of these structures in VMTS and DR in comparison with healthy subjects. In this work, the components of the LF were visualized and their changes were established in DR and VMTS, which proves the value of the LF as a diagnostic substrate and determines the need for further research in order to formulate clear criteria for the diagnosis of these diseases in the early stages. Key words: lacrimal fluid; electronic microscopy; vitreomacular traction syndrome; diabetic retinopathy.

Ocular abnormalities in a large Western China patient cohort with Retinitis Pigmentosa

Background: To report the prevalence of ocular abnormalities and investigate visual acuity in a large Western China cohort of retinitis pigmentosa (RP) patients.Methods: A retrospective study was performed, reviewing the medical records and ophthalmic examination reports of 2,127 eyes from 1,065 RP patients in one eye hospital. The authors investigated the prevalence of ocular abnormalities and the relationship between best corrected visual acuity (BCVA) and macular abnormalities.Results: Nyctalopia (58.2%) and blurred vision (27.1%) were the leading consultation causes. BCVA measurements in the better eyes at first clinical presentation showed that 304 patients (28.5%) were categorised as blind and 220 patients (20.7%) as low vision. The most common ocular abnormalities were cataracts (43.1%) and macular abnormalities (59.7%), including epiretinal membranes (51.1%), cystoid macular oedema (18.4%), vitreomacular traction syndrome (2.4%), macular holes (2.3%) and choroidal neovascular membranes (0.05%). Glaucoma was found in 35 eyes (1.6%). The proportions of epiretinal membranes (P = 0.001) and macular holes (P = 0.008) increased significantly with age. The proportions of vitreomacular traction syndrome (P = 0.003) and epiretinal membranes (P < 0.001) in pseudophakia and aphakia eyes were significantly higher than in eyes that had not received operations (including cataracts and clear lens). Cystoid macular oedema was significantly associated with poorer visual acuity in RP patients with clear lens (P = 0.002).Conclusion: Cataracts and macular abnormalities are common in RP patients. In the macular abnormalities, cystoid macular oedema may have a negative effect on BCVA in RP patients with clear lens.

Optical Coherence Tomography with Angiography in the Analysis of Vitrectomy Effectiveness in Patients with Vitreomacular Traction Syndrome

Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.