Javier Elizalde

Current concepts in vitreomacular traction syndrome.

Purpose of review As Reese first described the vitreomacular traction (VMT) syndrome in 1970, the knowledge base about the disease has been changing over time due to the advent of the high-definition optical coherence tomography (HD-OCT). The aim of this article was to present the current information on the pathophysiology, anatomic macular abnormality associations, treatments, and new concepts in VMT syndrome. Recent findings HD-OCT has provided unprecedented visualization of the vitreomacular interface, which has led to better comprehension of the VMT syndrome. The technologic advances also emphasized the need to review the basis of the VMT syndrome and define as yet unsettled and often confusing concepts. Summary The recognition of the role of VMT in a variety of macular conditions is imperative for proper diagnosis and appropriate management of these diseases.

Tyrosine phosphorylation of vitreous inflammatory and angiogenic peptides and proteins in diabetic retinopathy.

PURPOSE To evaluate the degree of phosphorylation of vitreous proteins in patients with type 2 diabetes mellitus and diabetic retinopathy compared with a group of control subjects without diabetes and of similar age and sex. METHODS In samples obtained after vitrectomy for diabetic retinopathy in patients and for macular hole in control subjects, immunoblot techniques were applied to a mini-array system for quantification of a wide range of chemokines and vasoactive peptides and proteins. Antiphosphotyrosine antibody was used for tyrosine phosphorylation evaluation and results were expressed as the percentage of variation compared with that in control subjects. RESULTS Samples from eight patients with type 2 diabetes and from eight control subjects were analyzed. The total quantity of proteins analyzed was similar in both patients and control subjects. Tyrosine phosphorylation was very significantly decreased (<20%, P < 0.05) in diabetic patients with respect to the control group in growth-related oncogene, human cytokine I-309, interleukin-13, monocyte colony-stimulating factor, macrophage-derived chemokine, stem cell factor, transforming growth factor-beta1, angiogenin, and oncostatin M. A significant decrease in phosphorylation (between 20% and 40%, P < 0.05) was observed in epithelial neutrophil-activating peptide 78; granulocyte colony-stimulating factor; granulocyte-monocyte-stimulating colony factor; IL-5, -6, -7, -8, -10, and -12p40p70; monokine induced by interferon-gamma; macrophage inflammatory protein 1-gamma; and normal T expressed and secreted cytokine (RANTES) in comparison with that in the control subjects. The greatest decrease in phosphorylation status was found in IL-1-alpha and -1beta. CONCLUSIONS Diabetic retinopathy is associated with a decrease in tyrosine phosphorylation of many vitreous proteins which may indicate an alteration in protein functionality or action even before significant quantitative variations.

Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1α, IL-1β, and IL-7

Objective: To simultaneously evaluate tyrosine nitrosylation and phosphorylation levels of vitreous interleukins of patients with diabetic retinopathy, in which abnormal tyrosine phosphorylation has been previously described. Research Design and Methods: Specific immunoprecipitation of interleukins IL-1α, IL-1β, IL-2 and IL-7 was carried out in samples obtained during vitrectomy performed for proliferative diabetic retinopathy in patients (n = 12) and for macular hole in controls (n = 12). Tyrosine nitrosylation and phosphorylation levels of the immunoprecipitated interleukins were analysed by Western blot with the respective specific antibodies and correlated. The results were also correlated with the total amount of immunoprecipitated interleukin protein. The mean phosphorylation/nitrosylation ratios of these proteins in vitreous humour of both the control group and diabetic patients were determined. Results: Diabetes was associated with decreased tyrosine nitrosylation of IL-1α, IL-1β and IL-7 and an increased tyrosine phosphorylation/nitrosylation ratio with respect to controls in IL-1α (1.58 ± 0.22 vs. 2.74 ± 0.39, respectively; p < 0.05) and IL-7 (2.15 ± 0.01 vs. 3.26 ± 0.57, respectively; p < 0.05). No significant changes were observed in nitrotyrosine or in the tyrosine phosphorylation/nitrosylation ratio of IL-2. Conclusions:Proliferative diabetic retinopathy is associated with concomitant and simultaneous changes in both tyrosine phosphorylation and tyrosine nitrosylation status of specific pro-inflammatory interleukins present in the vitreous fluid such as IL-1α, IL-1β and IL-7. These changes could be related to the increase in pro-inflammatory activity detected in diabetes-induced retinopathy.

Vitreomacular traction syndrome: postoperative functional and anatomic outcomes.

BACKGROUND AND OBJECTIVE To analyze a variety of vitreomacular traction (VMT) morphologies to establish a major classification that better reflects the preoperative predictive factors of postoperative visual and anatomic outcomes. PATIENTS AND METHODS Thirty-six eyes submitted to vitrectomy surgery were categorized with a VMT pattern (V- or J-shaped) and diameter (focal < 1,500 µm or broad > 1,500 µm) based on optical coherence tomography. RESULTS The researchers compared different classifications of VMT. Despite similar postoperative best corrected visual acuity (BCVA) values (P = .393), cases with focal VMT had greater visual improvement (P = .027) because the preoperative BCVA was significantly lower in the focal group (P = .007). However, the BCVA improvements did not differ between the groups regarding the classic VMT morphologic patterns (P = .235). CONCLUSION Postoperative outcomes and macular disorders are closely related to VMT size. The adhesion diameter (focal or broad VMT) and not the classic VMT morphologic pattern (V- or J-shaped) may better predict the postoperative anatomic and functional outcomes.

Vascular Tumors of the Retina

These congenital, non-progressive lesions are benign, and often solitary and unilateral. Patients are usually asymptomatic, although some may experience decreased vision and neurologic symptoms, such as seizures and cranial nerve palsies [15, 87]. Cutaneous or cerebral hemangiomas may also be found, especially in cases of inherited lesions [2, 4, 15, 22, 23, 58]. Pedigree analysis suggests that this neurooculocutaneous syndrome may be inherited in an autosomal dominant pattern, with incomplete penetrance or variable expressivity [23, 58].

Clinical and OCT Findings in a Case of a Presumed Perfluorooctane Retinal Acute Toxicity

Retinal acute toxicity may be produced by several etiologies. Iatrogenic toxicity is one of the most-feared complications related to vitreoretinal surgery. The authors report a case of retinal acute toxicity due to the use of perfluorooctane during an uneventful retinal detachment surgery done elsewhere. The aim of this report is to describe the clinical and optical coherence tomography features of this complication, which unfortunately occurred in more than 100 cases in Spain. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:460-462.].

Surgical Management of CME Associated with Vitreoretinal Interface

Cystoid macular edema (CME) after ocular surgery was first described in 1953 by Irvine and is related to the release of inflammatory mediators such as prostaglandins, leukotrienes, histamine, bradykinins, platelet-activating factor (PAF), and interleukin (IL)-1 [1–4]. The original report described cystoid changes after vitreous incarceration at the corneal wound after intracapsular cataract surgery. However, nowadays, this terminology is used for any macular edema after surgical procedures. A classic feature of this disease is the cystoid macular abnormalities related to swelling of the outer plexiform layer following release of cytokines at the vitreous cavity, which results in the classic hallmark petaloid pattern seen by fluorescein angiogram (FA) (Fig. 1); additionally, new insights have been added by spectral-domain optical coherence tomography (OCT) technology (Fig. 1b). The management of this entity is described in another chapter. The differential diagnosis should include epiretinal membrane, macular hole, age-related macular degeneration, central serous chorioretinopathy, and, most importantly, vitreomacular traction (VMT) syndrome [1–4].

Heavy silicone oil (densiron) and supine position in the management of massive suprachoroidal hemorrhage: use of heavy silicone for suprachoroidal hemorrhage.

PURPOSE To describe a case of massive suprachoroidal hemorrhage after a phacoemulsification managed with pars plana vitrectomy, heavy silicone oil (Densiron), and supine position. METHODS Report of a 69-year-old woman with systemic hypertension and under antiplatelet treatment who developed a massive suprachoroidal hemorrhage. RESULTS The patient underwent a pars plana vitrectomy and heavy oil endotamponade combined with 3 radial sclerotomies to drain the suprachoroidal blood. Two months after this surgery, the retina remains attached and visual acuity is 3/60 with aphakia and half of the vitreous cavity filled with Densiron. CONCLUSION Pars plana vitrectomy and Densiron endotamponade with supine position can represent a good surgical option in such a dramatic case as a suprachoroidal hemorrhage. Long-term heavy silicone oil endotamponade cannot be advised in these cases.

Contents Vol. 46, 2011

Anatomy, Pathology and Cell Biology A. Prescott, Dundee Biochemistry, Molecular Biology and Molecular Genetics J. Graw, Neuherberg Clinical and Epidemiological Research M. Kojima, Kahoku Cornea and Ocular Surface C. Marfurt, Gary, Ind. Glaucoma H. Th ieme, Mainz Immunology and Microbiology U. Pleyer, Berlin Lens and Cataract S. Varma, Baltimore, Md. Miscellaneous U. Pleyer, Berlin Neuro-Ophthalmology and Vision Sciences P. Aydin, Ankara Ocular Oncology M. Jager, Leiden Physiology, Pharmacology and Toxicology A. Wegener, Bonn Retina and Retinal Cell Biology P. Pereira, Coimbra Editorial Board