Angelina Meireles

Outcome of Vitrectomy and Chorioretinectomy in Perforating Eye Injuries

Purpose: To evaluate the anatomical and functional results of patients who underwent pars plana vitrectomy for perforating eye injuries as well as to analyze the benefit of the chorioretinectomy procedure. Methods: Retrospective and descriptive study of 24 eyes of 22 patients with perforating eye injuries operated on at the Centro Hospitalar do Porto between January 2006 and December 2012. Results: An early vitrectomy was accomplished in 67% of the eyes and a delayed vitrectomy in 33% of the eyes. A concomitant chorioretinectomy was carried out in 78%. Final proliferative vitreoretinopathy (PVR) was found in 11%. The anatomical success was 83%. At the final follow-up, 78% had best-corrected visual acuity equal to or superior to 5/200. Of the eyes that underwent early vitrectomy, 58% regained a visual acuity of 40/200 or better, versus 17% of the cases that underwent delayed vitrectomy. Conclusion: Early vitrectomy with prophylactic chorioretinectomy seems to be an effective approach to prevent PVR and improve the visual outcome and globe survival in perforating injuries.

Fluocinolone Acetonide Intravitreal Implant 190 μg (ILUVIEN®) in Vitrectomized versus Nonvitrectomized Eyes for the Treatment of Chronic Diabetic Macular Edema

Purpose: To compare the functional and anatomical outcomes after a 0.2 µg/day fluocinolone acetonide (FAc) implant between vitrectomized and nonvitrectomized eyes with chronic diabetic macular edema (DME). Methods: This is a retrospective, comparative analysis of 43 eyes with chronic DME. All eyes were treated with a single 0.2 µg/day FAc implant and followed up for a mean period of 8.5 months (median, 6.0 months; range, 1-21 months). The patients with a 0.2 µg/day FAc implant were divided into 2 groups: 24 eyes which had undergone pars plana vitrectomy prior to 0.2 µg/day FAc (group 1) and 19 eyes which had not been vitrectomized (group 2). Outcome measures included mean changes in best corrected visual acuity (BCVA) in Early Treatment Diabetic Retinopathy Study letters, central subfield foveal thickness (CSFT), and intraocular pressure (IOP), and were measured prior to administration of the 0.2 µg FAc implant, in the first week, at month 1, and quarterly thereafter. Results: Following the 0.2 μg/day FAc implant, the mean change in BCVA at the last observation point, from baseline, was +16.9 ± 3.39 (mean ± SE) letters (p ≤ 0.001) in group 1 and +8.2 ± 4.62 letters (p = 0.092) in group 2. From baseline, a gain of ≥15 letters was achieved in 37.5 and 36.8% of the eyes in group 1 and group 2, respectively. Additionally, an improvement in vision ≥20/40 in 29.2% of group 1 and 15.8% of group 2 was observed. The mean change in CSFT was -217.7 ± 40.8 µm and -155.6 ± 43.4 µm in group 1 and group 2, respectively. The mean change in IOP was +1.6 ± 0.7 mm Hg in group 1 and +0.8 ± 1.3 mm Hg in group 2, relative to baseline. At the last observation point, there were no significant differences between groups 1 and 2 (p > 0.05) in terms of their changes in BCVA, CSFT, and IOP. Conclusion: The results from the real-life practice study demonstrate that the 0.2 μg/day FAc implant is effective and well tolerated in vitrectomized and nonvitrectomized eyes of patients with chronic DME. Our results support the use of a 0.2 μg/day FAc implant to obtain long-term functional and anatomical improvements (mean, 8.5 months; median, 6.0 months) in vitrectomized and nonvitrectomized eyes.

The Portuguese Experience with Ocriplasmin in Clinical Practice

Aim: Evaluate the real-life experience with ocriplasmin on vitreomacular traction (VMT) release and full-thickness macular hole (FTMH) closure in Portugal. Methods: Multicentric, retrospective study of 83 eyes of 78 patients who were treated with intravitreal ocriplasmin for VMT with and without FTMH. Primary outcomes were VMT release and FTMH closure. Secondary outcomes included visual acuity changes and structural features on spectral-domain ocular coherence tomography. Results: VMT resolved in 47 of the 83 eyes (56.6%) and 6 of the 12 FTMH were closed (50.0%). Mean best-corrected visual acuity (BCVA) improved from 65.1 at baseline to 70.8 ETDRS letters at the end of follow-up (p < 0.0001) with a mean follow-up of 138.8 days. Improvement in BCVA was significantly better in eyes with VMT release (p = 0.021). Approximately 73% of patients had normal ellipsoid zone integrity at the end of follow-up, 87% had no neurosensorial detachment and 40% had no intra- or subretinal fluid. Conclusion: VMT release and FTMH closure were achieved in more than half of the treated eyes and were correlated with significant BCVA improvements and favorable baseline characteristics. In fact, if a careful patient selection is carried out, VMT resolution with ocriplasmin can be optimized, tailoring the best approach to each patient.

Prophylactic Chorioretinectomy in Open Ocular Trauma: A Series of 36 Eyes

Purpose: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe. Methods: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy. Results: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%. Conclusion: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates.

Acknowledgements to the Referees

www.karger.com/ore Abcouwer, Steven Ajtony, Csilla Aragona, Pasquale Arévalo, J. Fernando Arias, Lluis Augustin, Albert J. Aveleira, Célia A. Balaskas, Konstantinos Barsam, Allon Bi, Hongsheng Bowl, Wadim Bringmann, Andreas Chatziralli, Irini Chowers, Itay Christoforidis, John Costa, Esmeralda Cruchaga, Carlos Davis, Benjamin De Groef, Lies Digiuni, Maurizio Donate-Lopez, Juan Duran, Juan Fernandes, Rosa Fonollosa, Alex Georgiou, Anne Harrison, Ian He, Mingguang Heeren, Tjebo Hjortdal, Jesper Hussain, Ali Jaksic, Vesna Kalogeropoulos, Christos Kanonidou, Evgenia Kondo, Hiroyuki Kroupis, Christos Kühlewein, Laura Kusaka, Shunji Lai, Chi-Chun Lengyel, Imre Martin, Gottfried Martins, João Mathew, Raeba Medeiros, Marco D. Mesquida, Marina Murta, Joaquim Nakahara, Tsutomu Ni Dhubhghaill, Sorcha Noda, Kousuke Panos, Georgios Paques, Michel Parisi, Vincenzo Picaud, Serge A. Pinazo-Duran, Maria Dolores Porciatti, Vittorio Quadrado, Maria João Radach, Ralph Rezende, Flavio Rotenstreich, Ygal Rozema, Jos J. Santiago, Ana Raquel Sappington, Rebecca M. Saxena, Sandeep Schlottmann, Patricio Schmetterer, Leopold Sheha, Hosam Shieh, Chi-Chang Silva, Rufino Stahl, Andreas Stalmans, Peter Stieger, Knut Strong, Stacey Suzuma, Kiyoshi Terasaki, Hiroko Tian, Kailin Toth, Marta Tsubota, Kazuo Vujosevic, Stela Watson, Peter Xu, Heping Yanagi, Yasuo Yang, Sung Jae Zarogiannis, Sotirios