@article {2037, title = {Intraoperative Complications With Vitreous Biopsy for Molecular Proteomics.}, journal = {Ophthalmic Surg Lasers Imaging Retina}, volume = {54}, year = {2023}, month = {2023 Jan}, pages = {32-36}, abstract = {

OBJECTIVE: To study the incidence of intraoperative complications while collecting a vitreous sample for proteomic biomarker analyses during small-gauge pars plana vitrectomy (PPV).

METHODS: A retrospective case series was assembled from the surgical logs and charts of patients who underwent 23-, 25-, and 27-gauge PPV along with an undiluted vitreous biopsy. Primary surgical indication and detailed operative reports were reviewed. Complications specific to vitreous biopsy were assessed while complications related to vitrectomy in general without biopsy were not tabulated.

RESULTS: In 1190 eyes that underwent vitreous biopsy, the most common indications for PPV were rhegmatogenous retinal detachment (24.2\%), epiretinal membrane (ERM) (21.7\%), vitreous hemorrhage (11.0\%), uveitis (8.3\%), and macular hole (7.5\%). An adequate sample of 0.5 cc to 1.0 cc was obtained in all cases. There was one sclerotomy break associated with biopsy, but no instances of lens touch, retinal contusion, retinal detachment, or intraocular hemorrhage.

CONCLUSIONS: Undiluted vitreous biopsy obtained at the time of small-gauge vitrectomy is a generally safe procedure and may be considered for collection of samples for proteomic analysis. .

}, keywords = {Biopsy, Humans, Intraoperative Complications, Postoperative Complications, Proteomics, Retinal Detachment, Retrospective Studies, Vitrectomy}, issn = {2325-8179}, doi = {10.3928/23258160-20221214-02}, author = {Mishra, Kapil and Velez, Gabriel and Chemudupati, Teja and Tang, Peter H and Mruthyunjaya, Prithvi and Sanislo, Steven R and Mahajan, Vinit B} } @article {745, title = {Aflibercept therapy for exudative age-related macular degeneration resistant to bevacizumab and ranibizumab.}, journal = {Am J Ophthalmol}, volume = {156}, year = {2013}, month = {2013 Jul}, pages = {15-22.e1}, abstract = {

PURPOSE: To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab.

DESIGN: Retrospective observational case series.

METHODS: A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3~monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed.

RESULTS: The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3~monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0\%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7\%) and worsened in 3 eyes (8.3\%). A significant average decrease was observed for the central macular thickness after 3 injections of 65~μm (P~= 2.9~{\texttimes} 10(-6)), with no significant change in visual acuity.

CONCLUSIONS: Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.

}, keywords = {Aged, Aged, 80 and over, Angiogenesis Inhibitors, Antibodies, Monoclonal, Humanized, Bevacizumab, Drug Resistance, Drug Substitution, Exudates and Transudates, Female, Humans, Intravitreal Injections, Male, Middle Aged, Postoperative Complications, Ranibizumab, Receptors, Vascular Endothelial Growth Factor, Recombinant Fusion Proteins, Retina, Retreatment, Retrospective Studies, Subretinal Fluid, Tomography, Optical Coherence, Treatment Outcome, Vascular Endothelial Growth Factor A, Visual Acuity, Wet Macular Degeneration}, issn = {1879-1891}, doi = {10.1016/j.ajo.2013.02.017}, author = {Bakall, Benjamin and Folk, James C and Boldt, H Culver and Sohn, Elliott H and Stone, Edwin M and Russell, Stephen R and Mahajan, Vinit B} } @article {767, title = {Intraoperative sclerotomy-related retinal breaks during 23-gauge pars plana vitrectomy.}, journal = {Retina}, volume = {33}, year = {2013}, month = {2013 Jan}, pages = {136-42}, abstract = {

PURPOSE: To study the incidence and characteristics of intraoperative sclerotomy-related retinal breaks encountered during 23-gauge pars plana vitrectomy.

METHODS: A retrospective consecutive case series was assembled from the surgical logs and charts of patients who underwent 23-gauge pars plana vitrectomy. Demographic data and preoperative, intraoperative, and postoperative records were examined.

RESULTS: A total 548 eyes met the inclusion criteria. Of them, 145 eyes underwent pars plana vitrectomy for repair of a rhegmatogenous retinal detachment (RRD) and 403 eyes for other indications. Sclerotomy-related retinal breaks were found in 8 of 548 (1.45\%) eyes. No breaks were found in the 145 RRD eyes. In non-RRD cases, 8 of 403 (1.98\%) eyes had sclerotomy-related breaks. All breaks were adjacent to the superior sclerotomies. The incidence of postoperative retinal detachment was 0\% (0 of 403) in the non-RRD group. In eyes with breaks, the primary surgical indication was vitreomacular traction in six of eight eyes and epiretinal membrane in two of eight eyes. Posterior vitreous detachment was absent in six of eight eyes, and six of eight eyes were phakic. Eyes with vitreomacular traction had a significantly higher incidence of breaks (P < 0.0001). Eyes with a surgical indication other than RRD had a higher incidence of breaks, but this was not statistically significant when compared with eyes with RRD (P = 0.087).

CONCLUSION: Pars plana vitrectomy (23-gauge) is associated with a low incidence of sclerotomy-related retinal breaks and postoperative retinal detachments. Eyes with breaks are more likely to be phakic and without a preoperative posterior vitreous detachment. The presence of vitreomacular traction may be a risk factor for the development of intraoperative sclerotomy-related breaks.

}, keywords = {Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Incidence, Intraoperative Complications, Male, Microsurgery, Middle Aged, Postoperative Complications, Retinal Detachment, Retinal Perforations, Retrospective Studies, Sclerostomy, Tomography, Optical Coherence, Visual Acuity, Vitrectomy}, issn = {1539-2864}, doi = {10.1097/IAE.0b013e31825e1d62}, author = {Tarantola, Ryan M and Tsui, Janet Y and Graff, Jordan M and Russell, Stephen R and Boldt, H Culver and Folk, James C and Mahajan, Vinit B} }