Maziar Lalezary

Long-term trends in intraocular pressure after pars plana vitrectomy.

Purpose: To evaluate the effect of vitrectomy on intraocular pressure (IOP). Methods: Retrospective cohort study. Medical records of 101 eyes of 101 patients undergoing nonemergent vitrectomy were reviewed for rates of open-angle glaucoma, increased IOP of >4 mmHg from baseline, change in IOP from baseline, and cataract formation. Preoperative and last measured IOPs were recorded. Baseline risk characteristics including lens status and diabetes were analyzed. Main outcome measures were 1) incidence of open-angle glaucoma; 2) increase in IOP of >4 mmHg; and 3) change in IOP. Results: Mean follow-up was 49 months (range, 12-105 months). Mean baseline IOP was 15.3 mmHg, and mean final IOP was 15.8 mmHg (P = 0.3). At the most recent examination, 35 study eyes had a decrease in IOP from baseline, while 14 eyes had no change and 52 eyes had an increase in IOP. Four study eyes were newly diagnosed with ocular hypertension. No study eye developed open-angle glaucoma or required medical, laser, or surgical treatment for glaucoma. Incidence of increased IOP of >4 was 7% at 4 years and 34% at 8 years. Subgroup analysis of 66 patients comparing study eyes with nonvitrectomized fellow eyes demonstrated no significant difference in rates of increased IOP of >4 (P = 0.85). Neither diabetes nor pseudophakia was associated with significantly increased IOP. Conclusion: In this series, vitrectomy does not appear to increase IOP even after removal of the crystalline lens.

Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) Study: Twelve-Month Findings

PURPOSE To report 1-year outcomes of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation study. DESIGN Prospective, controlled, observational study. PARTICIPANTS Eighty eyes of 40 participants undergoing pars plana vitrectomy for epiretinal membrane (ERM), macular hole (MH), or vitreous opacities. METHODS Enrolled participants underwent baseline evaluation of the study (surgical) and fellow (control) eyes by a masked fellowship-trained glaucoma specialist; evaluation included intraocular pressure (IOP; Goldmann applanation and Tono-Pen), central corneal thickness, gonioscopy, and cup-to-disc ratio measurement. Baseline testing included bilateral color fundus and optic disc photography, fundus autofluorescence, automated perimetry, and optical coherence tomography (OCT) of the macula and optic nerve. Evaluations were repeated at 3 months and 1 year after surgery. MAIN OUTCOME MEASURES The primary outcome measure was changes in peripapillary retinal nerve fiber layer (pRNFL) thickness. Secondary outcomes included changes in macular thickness and IOP. RESULTS Thirty-eight of 40 patients completed 1 year of follow-up. Mean visual acuity (VA) improved in study eyes from baseline (P = 0.003) but remained worse than fellow eyes (P<0.001). Study eyes had thinner inferior pRNFL thickness (114±16.8 μm) compared with fellow eyes (123±14.7 μm; P = 0.004). Mean IOP difference between study eyes and fellow eyes increased from baseline to 1 year. At 1 year, MH study eyes had higher mean IOP (16.0±3.7 mmHg) compared with fellow eyes (14.8±3.4 mmHg; P = 0.08). Mean IOP for pseudophakic study eyes increased from 14.5±3.2 mmHg at baseline to 16.0±2.8 mmHg at 1 year (P = 0.04). Central subfield thickness (CST) and cube volume decreased in study eyes at 1 year but remained greater than that of fellow eyes (P<0.05). Reduction in CST from baseline correlated with degree of VA improvement (P<0.05). Mean deviation (MD) improved in ERM study eyes at 1 year when compared with baseline (-2.2 vs. -4.0; P = 0.02) but remained worse than fellow eyes (-1.2; P = 0.002). CONCLUSIONS One year after vitrectomy, VA, CST, and MD improved in study eyes but not to the level of fellow eyes. Inferior pRNFL thickness decreased in study eyes. Reduction in CST from baseline correlated with degree of VA improvement. Pseudophakic study eyes demonstrated increased IOP when compared with baseline.

Treatment of Congenital Cytomegalovirus Retinitis With Intravitreous Ganciclovir

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Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study: findings at 3 months

Background The purpose of this paper is to report the 3-month findings of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study. Methods Eighty eyes of 40 participants undergoing vitrectomy were enrolled. Participants underwent baseline evaluation of the study (surgical) and fellow (control) eye that included: intraocular pressure, central corneal thickness, gonioscopy, cup-to-disc ratio measurement, color fundus and optic disc photography, automated perimetry, and optical coherence tomography of the macula and optic nerve. Evaluation was repeated at 3 months. Main outcome measures were changes in macula and retinal nerve fiber layer (RNFL) thickness and intraocular pressure. Results All participants completed follow-up. Mean cup-to-disc ratio of study and fellow eyes at baseline was 0.43 ± 0.2 and 0.46 ± 0.2, respectively, and 13% of participants had undiagnosed narrow angles. There was no significant change in intraocular pressure, cup-to-disc ratio, or pattern standard deviation in study eyes compared with baseline or fellow eyes at 3 months. Vision improved in all study eyes at 3 months compared with baseline (P = 0.013), but remained significantly worse than fellow eyes (P < 0.001). Central subfield and temporal peripapillary RNFL thickness were significantly greater in eyes with epiretinal membrane (P < 0.05), and resolution after surgery correlated with visual improvement (P < 0.05). Conclusion The 3-month results do not indicate any increased risk for open-angle glaucoma but suggest that a relatively high percentage of eyes may be at risk of angle closure glaucoma. Temporal RNFL thickness and central subfield were increased in eyes with epiretinal membrane, and resolution correlated with degree of visual recovery.

Influence of previous vitrectomy on incidence of macular oedema after cataract surgery in diabetic eyes

Purpose To evaluate the effect of previous vitrectomy on the incidence of macular oedema (MO) after cataract surgery in diabetic eyes. Methods Ninety phakic eyes of 70 patients with diabetes undergoing non-emergent vitrectomy surgery were reviewed for rates of postvitrectomy MO, cataract formation and postcataract surgery MO. Preoperative and final best-corrected visual acuity were recorded. Baseline risk characteristics were analysed. Results Postvitrectomy MO increases initially but then levels off at 28% by 4 years. Cumulative proportion of eyes requiring cataract surgery after vitrectomy climbs steadily, reaching 40% at 4 years and 60% at 8 years. Of those eyes which underwent vitrectomy and then subsequent cataract surgery, the incidence of postvitrectomy MO was 6% at 6 months, and that of postcataract surgery MO was 30% at 6 months (p<0.02). Previous clinically significant macular oedema (CSMO) predicted development of postcataract surgery MO (p<0.04). Conclusions Previous vitrectomy does not appear to lessen rates of postcataract surgery MO. Cataract formation is common after vitrectomy in diabetic eyes, and risk of postcataract surgery MO is substantial and more likely in eyes with prior CSMO. Cataract formation and risk of postcataract surgery MO should be considered when assessing the long-term benefits of vitrectomy surgery in patients with diabetes.

Acute macular neuroretinopathy: an atypical case.

PURPOSE The purpose of this report is to describe extensive acute macular neuroretinopathy lesions with atypical features. METHODS Retrospective case report. RESULTS A patient developed acute macular neuroretinopathy in the setting of multiple previously described associations including a flu-like illness, sympathomimetic exposure, overdose of norepinephrine reuptake inhibitors, anemia, thrombocytopenia, and hypotensive shock. The fundus lesions superficially resembled retinal hemorrhages in color and fluorescein angiography pattern. The lesions could be detected on autofluorescence and infrared imaging. Optical coherence tomography revealed outer plexiform layer opacification and photoreceptor abnormalities. CONCLUSION This case suggests a compounding effect of factors associated with acute macular neuroretinopathy, possible exacerbating insults and outer plexiform layer abnormalities that may correlate with the temporal course of this condition.

VANISHING RETINAL DETACHMENT.

A case of rhegmatogenous retinal detachment in the setting of chronic kidney disease that exhibited complete reattachment of the retina after routine serial hemodialysis.