BACKGROUND AND AIMS: Currently around 67 million people in Europe are affected by some form of age-related macular degeneration (AMD). As most known types of vitreoretinal (VR) interface disorders can coexist with AMD and as we can favourably affect the former with vitreoretinal surgery, our goal was to evaluate the results of vitreoretinal interface disorder surgery with macular peeling in relation to coincident intermediate stage AMD. METHODOLOGY: This was a retrospective evaluation of eyes operated with 25-gauge pars plana vitrectomy (PPV). The monitored parameters were anatomical and functional findings and, safety of the procedure. The surface of the macula was stained with trypan blue and treated (peeling) with a disposable microforceps. 10% perfluoropropane, or the air tamponade was used. Distance visual acuity was examined on the ETDRS chart, the macular finding was monitored by OCT and photodocumented. The post-operative face-down position was 3-5 days. The follow-up period was 6 months. RESULTS: 17 eyes (14 patients, woman 86%) mean age 74 years. The primary indications for the procedure were: idiopathic macular hole (IMD) 59%, epiretinal membrane 29% and vitreomacular traction syndrome 12%. Ophthalmoscopic and OCT findings of intermediate dry form of AMD (100%), in 24% was drusoid ablation of the pigment leaf. In all cases of IMD, primary closure occurred. Input visual acuity 0.1-0.6 improved to 0.2-0.9 at the end of the follow-up period (P<0.05). No complications during surgery or progression of AMD in the follow-up period were observed. CONCLUSION: PPV for vitreoretinal interface disorders have similar anatomical results, whether the outer part of the retina is disrupted by intermediate AMD or not. Functional results are affected by possible disruption of the RPE or the outer layers of the neuroretina by AMD. The PPV procedure has a standard security profile. It is safe and does not affect the progression of AMD in the short term.
- MeSH
- epiretinální membrána * chirurgie MeSH
- lidé MeSH
- makulární degenerace * komplikace chirurgie MeSH
- nemoci retiny * MeSH
- oční nemoci * chirurgie MeSH
- optická koherenční tomografie MeSH
- perforace sítnice * chirurgie MeSH
- retrospektivní studie MeSH
- staří MeSH
- vitrektomie metody MeSH
- Check Tag
- lidé MeSH
- staří MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
AIM: To present the results of a 2-year therapy with aflibercept in real-life practice in a mixed regimen in patients with a neovascular form of age-related macular degeneration (nAMD) and to evaluate the treatment response of various types of choroidal neovascular membranes (CNV) - occult (Type 1), classic (Type 2) and minimally classic (Type 4). METHODS: This was a multicentric, prospective, observational study of a series of cases. Patients diagnosed with the wet form of AMD were treated in a fixed regimen (3 injections at intervals of 1 month and then injections at 8-week intervals) in the first year, and in a pro re nata regimen (PRN) in the second year. The period of investigation was 24 months. The development of the best corrected visual acuity (BCVA) was evaluated by means of ETDRS optotypes (Early Treatment Diabetic Retinopathy Study) and the central retinal thickness (CRT). Measurements were performed prior to the commencement of therapy and then after 4, 8, 12, 16, 20 and 24 months. RESULTS: The therapeutically naïve group consisted of 135 eyes of 135 patients. Sixty-one eyes suffered from CNV of the 1st type, 50 eyes from CNV of the 2nd type and 24 eyes from CNV of the 4th type. The average baseline of BCVA ± SD in Type 1 CNV was 56.1 ± 10.8 letters of ETDRS, and then, respectively, 62.2 ± 12.9 letters, 62.8 ± 15.1 letters and 59.4 ± 13.2 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD for Type 1 CNV was 442.4 ± 194.9 µm, and then 302.5 ± 144.4 µm, 277.7 ± 106.5 µm and 327.6 ± 138.6 µm at months 4, 12 and 24. The average baseline value of BCVA ± SD in Type 2 CNV was 55.6 ± 9.9 letters of ETDRS, and then 62.5 ± 11.1 letters, 62.5 ± 14.2 letters and 60.6 ± 15.1 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 2 CNV was 446.8 ± 159.1 µm, and then 327.4 ± 127.0 µm, 316.7 ± 139.1 µm and 352.5 ± 132.4 µm at 4, 12 and 24 months. In Type 4 CNV, the average baseline value of BCVA ± SD was 56.7 ± 9.0 letters of ETDRS, and then 59.1 ± 10.6 letters, 59.2 ± 12.6 letters and 58 ± 8.8 letters after 4, 12 and 24 months. The average baseline value of CRT ± SD in Type 4 CNV was 492.1 ± 187.0 µm, and then 333.3 ± 137.5 µm, 326.7 ± 122.4 µm and 328.4 ± 132 µm at months 4, 12 and 24. All these changes were statistically significant (p < 0.05). CONCLUSION: Therapy with aflibercept in a mixed regimen in patients with the wet form of AMD during the investigation resulted in a statistically significant improvement in BCVA and decrease in CRT in both the occult and classic type of CNV. Both the functional and anatomical response to therapy was worse in the minimally classic type (Type 4) of CNV. SUMMARY DECLARATION: Patients suffering from the neovascular form of age-related macular degeneration were treated with aflibercept in a mixed regimen (fixed in the first year and PRN in the second year). After 24 months of examination, a significant improvement of both morphological and functional results was observed in three types of choroidal neovascular membrane.
- MeSH
- inhibitory angiogeneze terapeutické užití MeSH
- injekce intravitreální MeSH
- lidé MeSH
- prospektivní studie MeSH
- ranibizumab terapeutické užití MeSH
- receptory vaskulárního endoteliálního růstového faktoru terapeutické užití MeSH
- rekombinantní fúzní proteiny terapeutické užití MeSH
- vlhká makulární degenerace * diagnóza farmakoterapie MeSH
- výsledek terapie MeSH
- zraková ostrost MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Česká republika MeSH
Cíl: Poukázat na využití optické koherenční angiografie (Optical Coherence Tomography Angiography – OCTA) u chorob vitreoretinálního rozhraní. Na vlastním souboru prezentovat výsledky hodnocení makulární kapilární sítě před a po operaci idiopatické makulární díry (IMD) a OCTA nálezy u pacientů s epiretinální membránou (ERM). Metodika a soubor: Prospektivní hodnocení funkčních výsledků, anatomických a OCTA nálezů před a po operaci IMD. Soubor tvořilo 8 očí osmi pacientů. Předoperačně a 1, 3 a 6 měsíců po operaci byla vyšetřována nejlépe korigovaná zraková ostrost (NKZO), provedeno foto fundu, vyšetření makuly spectral-domain optickou koherenční tomografií (SD OCT), stanovení stadia IMD dle Gasse a OCTA. Při vyšetření OCTA byla hodnocena plocha foveální avaskulární zóny (FAZ) a vaskulární denzita (VD). Operace byla ve všech případech provedena transkonjunktivální bezstehovou 25G vitrektomií, jedním chirurgem, vždy byl proveden peeling vnitřní limitující membrány. K endotamponádě sklivcové dutiny byl použit expanzivní plyn, 7x 20 % SF6, 1x 15 % C3F8. Výsledky: Ve všech 8 případech došlo po operaci k primárnímu uzavření IMD. Průměrná NKZO se statisticky významně zlepšila z 0,74 do 0,48 logMAR (p = 0,0023). Průměrná plocha FAZ se po operaci zmenšila z 0,345 mm² do 0,25 mm² (p = 0,0458). Průměrná VD se zvýšila z 7,93 mm-1 do 8,38 mm-1 (p = 0,2959). Závěr: Posuzování makulární kapilární sítě u pacientů s chorobami vitreoretinálního rozhraní nabízí nové poznatky a důležité detaily, které mohou vést k prognostickým informacím a k lepšímu pochopení patogenese onemocnění. V našem souboru jsme prokázaly statisticky významné zmenšení FAZ u očí po úspěšné operaci IMD a nepřímou závislost mezi zlepšením NKZO a změnou plochy FAZ.
Aims: Present the use of Optical Coherence Tomography Angiography (OCTA) in vitreoretinal interface diseases and results of macular capillary network evaluation before and after idiopathic macular hole surgery (IMD). Methodology: Prospective evaluation of functional results, anatomical and OCTA findings before and after IMD surgery. The group consists of 8 eyes of eight patients. Preoperatively and 1, 3 and 6 months after surgery, the best corrected visual acuity (BCVA) was examined, fundus photography was performed, examination of the macula by spectral-domain optical coherence tomography (SD OCT), determination of the stage of IMD according to Gases and also OCTA examination. The area of the foveal avascular zone (FAZ) and vascular density (VD) were evaluated by using of the OCTA. The operation was performed in all cases by transconjunctival suture 25G vitrectomy by one surgeon, always peeling the inner limiting membrane. An expansive gas, 7x 20% SF6, 1x 15% C3F8, was used for vitreous tamponade. Results: In all 8 cases, the primary closure of the IMD occurred after the operation. The mean BCVA improved statistically significantly from 0.74 to 0.48 logMAR (p = 0.0023). The average FAZ area decreased from 0.345 mm² to 0.25 mm² after surgery (p = 0.0458). The mean VD increased from 7.93 mm-1 to 8.38 mm-1 (p = 0.2959). Conclusions: Assessment of the macular capillary network in patients with diseases of the vitreoretinal interface offers new findings and important details that can lead to prognostic information and a better understanding of the pathogenesis of the disease. We demonstrated a statistically significant reduction in FAZ in the eyes after successful IMD surgery and an indirect relationship between the improvement of BCVA and the change in FAZ area in our cohort.
- Klíčová slova
- OCT angiografie, pars plana vitrektomie, vitreoretinální rozhraní,
- MeSH
- epiretinální membrána MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoci retiny * diagnostické zobrazování patologie MeSH
- neovaskularizace sítnice diagnostické zobrazování MeSH
- optická koherentní tomografie * metody MeSH
- perforace sítnice chirurgie patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- sklivec patologie MeSH
- vitrektomie MeSH
- výsledek terapie MeSH
- zraková ostrost MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cieľ: Retrospektívne zhodnotiť použitie cyklokryokoagulácie (CCK) u sekundárnych neovaskulárnych glaukómov vykonaných na Očnej klinike Fakultnej nemocnice Hradec Králové v rokoch 2016–2019. Materiál a metodika: V retrospektívnej práci bolo hodnotených 30 zákrokov 26 očí 24 pacientov. Vstupné hlavné kritériá boli prítomnosť sekundárneho neovaskulárneho glaukómu pri diabete alebo na podklade oklúzie retinálnej arterie alebo žily a následnej dispenzarizácie pacienta 1. a 6. mesiac od operácie. Hodnotené parametre boli: najlepšie korigovaná zraková ostrosť (NKZO), hodnota vnútroočného tlaku (VOT), údaje o bolestivosti a zmena počtu účinných látok antiglaukómovej terapie. Výsledky: Priemerný vek pacientov v dobe prevedenia zákroku bol 61 rokov (v rozmedzí 22–85 rokov). Priemerný počet zákrokov na 1 oku bol 1,15 z celkového počtu 30 zákrokov 26 očí 24 pacientov. Najčastejšia indikácia k vykonaniu CCK pri sekundárnom glaukóme – cievne komplikácie pri diabete boli u 21 očí a po oklúzií sietnicovej žily alebo artérie v 9 prípadoch. Dvaja pacienti mali v priebehu jedného roka operované obe oči. Traja pacienti podstúpili dva zákroky na tom istom oku v priebehu skúmaného obdobia. Jeden z nich mal dva zákroky na oboch očiach. Priemerná hodnota počtu účinných látok antiglaukomatík klesla z hodnoty 3,10 na 2,87 po 1.mesiaci (p = 0,318) a po 6.mesiacoch bola 2,6 (p < 0,05). Priemerná hodnota VOT klesla z hodnoty 34,67 mmHg na 18,43 mmHg po 1.mesiaci (p < 0,05) a po 6.mesiacoch na 17,90 mmHg (p < 0,05). Priemerná hodnota NKZO stúpla z hodnoty 0,135 na 0,138 po 1. mesiaci (p = 0,444) a po 6 mesiacoch klesla na 0,096 (p = 0,170). Po 1 mesiaci od zákroku zostala priemerná hodnota bolesti rovnaká ako priemerná hodnota bolesti pred zákrokom. Po 6. mesiacoch od zákroku ani jeden pacient neudával bolesť. Záver: Naše výsledky korešpondujú s výsledkami ostatných autorov vo svetovej literatúre. Štatisticky významný rozdiel sme dokázali v znížení počtu účinných látok antiglaukomatík a znížení vnútroočného tlaku po 6 mesiacoch od zákroku. Všetci pacienti po zákroku prestali udávať bolesť.
Purpose: To retrospectively evaluate the use of cyclocryocoagulation (CCK) in secondary neovascular glaucomas performed at the Department of Ophthalmology, Faculty of Medicine, Charles University and University Hospital Hradec Králové in the years 2016–2019. Material and methods: In a retrospective study, 30 procedures of 26 eyes of 24 patients were evaluated. All patients underwent CCK surgery. The main entry criteria were the presence of secondary neovascular glaucoma in diabetes or on the basis of occlusion of the retinal artery or vein and subsequent dispensarization of the patient in the 1st and 6th month after the operation. The parameters evaluated were: the best-corrected visual acuity (BCVA), intraocular pressure value (IOP), data of pain and change in the number of active substances of antiglaucoma therapy. Results: The mean age of patients at the time of the procedure was 62 years (range 22–85 years). The average number of procedures per eye was 1.15 out of a total of 30 procedures, 26 eyes were performed on 24 patients. The most common indication for CCK in secondary glaucoma-vascular complications in diabetes were in 21 procedures, vascular complications – after occlusion of the retinal vein or artery were in 9 cases. Two patients had both eyes operated on within one year. Three patients underwent two procedures on the same eye during the study period. One of them had two procedures on both eyes. The average value of the number of active substances of antiglaucoma drugs decreased from 3.10 to 2.87 after the 1st month (p = 0.318) and after 6 months it was 2.6 (p < 0.05). The average IOP value decreased from 34.67 mmHg to 18.43 mmHg after the 1st month (p < 0.05) and after 6 months to 17.90 mmHg (p < 0.05). The mean value of BCVA increased from 0.135 to 0.138 after the 1st month (p = 0.444) and after 6 months it decreased to 0.096 (p = 0.170). One month from the procedure, the average value of pain remained the same as the pre-surgery average value of the pain. No patients reported pain 6 months after the procedure. Conclusion: Our results correspond to the results of large clinical studies. We showed a statistically significant difference in the reduction of the number of active substances of antiglaucoma drugs and the reduction of intraocular pressure after 6 months after the procedure. All patients stopped reporting pain after the procedure.
