The purpose of this study was to quantify the effects of phacoemulsification and posterior segment chamber lens placement on vitreous inflammatory and neovascular growth factors. More specifically, the effect of immediately preceding cataract surgery was compared to a history of cataract surgery. This study involved a retrospective review and analysis of vitreous samples from a total of twenty seven patients separated into three groups. Group 1, seven patients who underwent a pars plana vitrectomy with macular surgery, group 2, fourteen patients who underwent a combined cataracts and pars plana vitrectomy procedure and group 3, six patients with a history of cataract surgery who underwent a pars plana vitrectomy. The twenty seven patients were picked from a pool of 100 patients who all received pars plana vitrectomy at Beth Israel Deaconess Medical Center with surgeon Dr. Jorge Arroyo. Exclusion factors included active ocular pathologies such as vitreous hemorrhage and retinal detachment. Undiluted vitreous samples from each group were taken before beginning the pars plana vitrectomy. The vitreous samples were analyzed for concentrations of fourteen specific vitreous cytokines and neovascular growth factors including but not limited to TNF Alpha; and SCD40L. These fourteen cytokines and growth factors were chosen through a literature review on the post-surgery ocular inflammatory response. Statistical analysis was done on the average means of the cytokine levels for each group using SPSS 20 for windows. A comparison of means analysis found no significant difference in the means of the fourteen cytokines for group 1 and group 2. A second comparison of means with a pooled control group of both group 1 and group 2 patients versus group 3 was also run. In this analysis, only SCD40L or soluble CD40 ligand was shown to have a significant difference between groups. SCD40L levels were significantly higher (significance level of .038) in group 3, the history of cataract group with a mean of (9.50±4.76) than in the control group with a mean of (5.50±3.35). The findings of this study indicate that the protein SCD40L may play an important role in mediating the inflammatory response seen post cataract surgery and may be useful as a target for novel therapies against the inflammatory response.

PURPOSE: To study the long-term anatomic and visual outcomes after pars plana vitrectomy (PPV) with and without internal limiting membrane (ILM) peeling in patients with symptomatic vitreomacular traction (VMT). This study assesses the frequency of complications, changes in visual acuity, and changes in anatomical central macular thickness after macular surgery. METHODS: This retrospective, single-site, single-surgeon study reviewed 40 medical records (45 eyes) of patients at the Beth Israel Deaconess Medical Center requiring PPV with ILM peeling (n=27) or without ILM peeling (n=18) for VMT between the years of 2003 and 2016. Successful surgery was defined as the relief of anatomical traction, and the absence of a second surgery, or any post-operative complications (n=42). Visual acuity was documented for each eye prior to surgery and post surgery. RESULTS: All 27 (100%) eyes that had ILM peeling had successfully resolved macular traction following a single surgery, and 15 of the 18 (83.3%) eyes without ILM peel were successful. None of 27 (0%) eyes that had ILM peeling required a second surgery, nor did they have complications. 3 of the 18 (16.7%) eyes without ILM peeling required a second surgery. Best corrected visual acuity (BCVA, logMAR) improved significantly in both groups: BCVA improved from 0.59 ± 0.29 preoperatively to 0.37 ± 0.25 postoperatively in eyes receiving ILM peeling and from 0.77 ± 0.37 to 0.53 ± 0.37 in eyes with PPV only. Mean change in CMT pre-operatively to post-operatively was found to be greater in eyes with PPV alone, but this difference was not statistically significant. CONCLUSIONS: Our case series shows that PPV with ILM peeling for VMT relieved macular traction better than PPV alone, although there was no significant difference in visual acuity outcomes or central macular thickness between the two groups. Further research is required to validate these findings. / 2019-07-11T00:00:00Z

Idiopathic Epiretinal membrane is a proliferation of contractile cells on the surface of the retina that typically occurs after posterior vitreous detachment. Though many questions have been raised on the causes of this condition, a greater debate has been on the treatment of this pathology. The literature suggest the potential benefit in peeling ILM, due to its inherent proliferative characteristics, along with the ERM, during the surgery, however sufficient data has yet to been found. Due to the lack of consensus in treatment of iERM, this study set forth to provide some insight on the surgical outcomes of patients that undergo combined peeling as well attempting to contribute to a potential surgical protocol in treating iERM. This was a retrospective case series study looking at 140 eyes from 126 iERM patients that underwent ERM surgical treatment at Beth Israel Deaconess Medical Center between 1998 and 2015. Pre- and post- operative visual acuities, lens status (phakic, aphakic, pseudophakic), type (kenalog with or without ICG) and duration (0.5min, 1 min, 1.5 min) of the stains used in the procedure, and any prior or successive surgeries were recorded and analyzed. Overall, ERM surgeries demonstrated a significant (p<0.0001) improvement in visual acuity. Furthermore, the combined peel patients demonstrated a significantly (p<0.0467) greater mean change in logMAR score when compared to ERM-only peel procedures. In addition, the combined peel group showed a smaller rate of recurrence. Lastly, simultaneous cataract surgery and the use of ILM stains did not have an impact on the outcome of ERM surgery. The study found that combined (ERM and ILM) peeling along with simultaneous cataract surgery, if a cataract was present, along with the utilization of ILM stains is cost-effective, safe, and effective approach in treating iERM and decreasing its recurrence.

PURPOSE: This study examined the surgical outcomes after pars plana vitrectomy in patients with proliferative diabetic retinopathy at various stages of posterior vitreous detachment. The investigation assessed the changes in visual acuity and the frequency of complications associated with each stage of detachment. METHODS: This retrospective, single-site, single-surgeon study reviewed 328 medical records of patients at Beth Israel Deaconess Medical Center (Boston, MA) requiring pars plana vitrectomy (PPV) for complications of proliferative diabetic retinopathy between 2000 and 2017. The 328 patients were separated into 4 groups based on their vitreous status (Stages 0 and 1, Stage 2, Stage 3, and Stage 4). Preoperative characteristics were collected, including best-corrected visual acuity (BCVA) and diabetes duration. Complications, visual acuity, and reoperation data were collected postoperatively. RESULTS: Sixty-one percent of the patients in the combined group (Stages 0 and 1), 56% in Stage 2, 67% in Stage 3, and 77% in Stage 4 did not require a revision PPV. Thirteen percent of the patients in the combined group, 13% in Stage 2, 5% in Stage 3, and 0% in Stage 4 required a revision PPV for retinal detachment. This represented a statistically significant difference between the groups (p = 0.0254). The combined group had a postoperative change in BCVA of 0.31 compared with 0.29 for Stage 2, 0.67 for Stage 3, and 0.90 for Stage 4. These BCVA changes represented a statistically significant difference (p = 0.0001) between the groups. CONCLUSIONS: This study shows that having a preoperative posterior vitreous detachment leads to improved visual acuity postoperatively and decreased chance of developing a postoperative retinal detachment. The study also indicates that increased vitreoretinal traction results in less change in visual acuity and an increase in complications. Further research is needed to validate these findings.

Univerzita Karlova 1. lékařská fakulta Studijní program: Zobrazovací metody v lékařství (P5150) Studijní obor: Zobrazovací metody v lékařství (5103V000) MUDr. Adam Kopecký Změny na předním segmentu po 25G+ PPV Changes in the Anterior Segment after 25G+ PPV Abstract Vedoucí závěrečné práce/Školitel: doc. MUDr. Jiří Pašta, CSc., FEBO Praha, 2019 Abstract: Pars plana vitrectomy is a dominant surgical method in posterior segment surgery of the eye. The principle of this method is the surgical approach via the pars plana anatomical region. With this approach, surgeon performs the posterior segment surgery without directly affecting the anterior segment of the eye. Short-term effect of pars plana vitrectomy on the anterior segment of the eye has been repeatedly proven. That might be an important factor both in assessing the complications of this method and planning the surgery in complicated patients. Generally, it is presumed that we do not observe long-term effects on anterior segment after pars plana vitrectomy. The aim of our work is to evaluate the long-term changes in the anterior segment after the uncomplicated 25G + PPV with gas tamponde. The group of 20 patients was selected according to strict indication criteria. Using a series of examinations, we examined specific parameters such as: intraocular...

The purpose of this study was to investigate the ultrastructure of the membrana limitans interna (internal limiting membrane, ILM) and to evaluate alterations to the retinal cell layers after membrane peeling with vital dyes. Twenty-five patients (25 eyes) who underwent macular hole surgery were included, whereby 12 indocyanine green (ICG)- and 13 brilliant blue G (BBG)-stained ILM were analyzed using light, transmission electron and scanning electron microscopy. Retinal cell fragments on the ILM were identified in both groups using immunohistochemistry. Comparing ICG- and BBG-stained membranes, larger cellular fragments were observed at a higher frequency in the BBG group. Thereby, the findings indicate that ICG permits an enhanced separation of the ILM from the underlying retina with less mechanical destruction. A possible explanation might be seen in the known photosensitivity of ICG, which induces a stiffening and shrinkage of the ILM but also generates retinal toxic metabolites