transforming-growth-factor-beta and Retinal-Perforations

Idiopathic full-thickness macular holes (FTMH) are an important cause of loss of central vision in the elderly. Improved understanding of the natural history and pathophysiology of FTMH has led to recent advances in the surgical management of patients with this hitherto untreatable condition.. The current concepts of the natural history and surgical treatment are reviewed. Pilot studies of vitrectomy undertaken to relieve the tangential traction at the vitreomacular interface and the role of growth factors as promoters of a limited healing response are reviewed and illustrated by the results of surgical treatment of macular holes obtained by the author and others.. Whereas early pilot studies of vitrectomy of impending (stage I) macular hole suggested beneficial results (80-95% of operated eyes did not progress to FTMH), no such benefit could be demonstrated by a subsequent randomised treatment trial. In a study of early vitrectomy and partial fluid-gas exchange hole closure was achieved in 88% of patients with stage II FTMH with visual improvement in 67%. In other studies of FTMH (stages II-IV) the addition of adjunctive substances such as growth factors, autologous serum, plasma or platelet concentrate has resulted in closure in 77-100% of cases. However, similar results have also been reported with vitrectomy and gas tamponade alone. Histologically the closure of the FTMH is associated with glial proliferation.. Vitrectomy and intraocular tamponade appear to be beneficial in patients with FTMH. The role of adjunctive substances, such as growth factors and other promoters of the healing response, requires clarification by randomised treatment trials.

Topics: Blood Component Transfusion; Blood Transfusion, Autologous; Humans; Retinal Perforations; Transforming Growth Factor beta; Vitrectomy

Idiopathic full-thickness macular holes (FTMH) are a common cause of usually uniocular reduced visual acuity. The accepted pathogenesis has macular hole formation proceeding in stages from an impending hole to a FTMH, with visual acuity deteriorating to less than 6/60 in 85% of cases. Recent surgical advances in the treatment of FTMH, with excellent anatomic and visual results, have changed the surgical indications for both impending and established full-thickness macular holes.

Topics: Aged; Diagnosis, Differential; Female; Fluorescein Angiography; Fluorocarbons; Fundus Oculi; Growth Substances; Humans; Male; Retina; Retinal Perforations; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

Idiopathic macular hole and its early stages raises one of the most fascinating subjects in retinal disease. In this review, we aim to summarize the current knowledge of pathogenesis, the recent classification and the strategies for therapy. Recent evidence strongly suggests tangential traction induced by a thin epiretinal membrane to be the main cause for idiopathic senile macular holes. A thickening of the epicortical vitreous membrane or the internal limiting membrane of the retina could be demonstrated in these cases. When such a precursor situation (stage I) is present, in many cases there will be a progression to a full thickness macular hole (stage II). Further traction usually causes an enlarging of the defect in these eyes and the classic appearance of macular holes (stage III-IV) can then be observed. The clinical appearance, the diagnosis and the strategies of treatment are discussed for all stages of idiopathic senile macular holes. Based on the deeper insight into macular hole development, prophylactic vitrectomy and removal of the epiretinal membrane in cases of stage I macular holes, has been considered in order to prevent a further progression of the disease. There is also evidence that in stages II-IV macular holes, a closure of the hole and a visual improvement can be gained by vitrectomy, removal of the epiretinal membrane and fluid-gas exchange. The additional application of biological modifiers (transforming growth factor-beta, human autologous serum or tissue glue) may enhance the adhesion of the detached retina and therefore lead to better anatomical and functional success rates. The results of the pilot studies are reviewed and the surgical techniques as well as the possible complications are discussed.

Topics: Blood Proteins; Combined Modality Therapy; Fibrin Tissue Adhesive; Fluorescein Angiography; Humans; Laser Coagulation; Retinal Perforations; Transforming Growth Factor beta; Ultrasonography; Vitrectomy

A full-thickness macular hole is a retinal opening involving the fovea causing severe central vision loss among the elderly.. This paper examines the pathogenesis and mechanistic constructs for the development and formation of idiopathic macular hole, reviews the stages of evolution, and provides guidelines for management by the primary care clinician. An update of the current methods of diagnosis and the criteria for surgical intervention, including vitrectomy and epiretinal membrane removal are presented. A perspective on the emerging trends in the treatment of macular hole using transforming growth factor beta-2 application is also introduced.. Clinical practice guidelines for the management of patients with macular holes can be established based on an improved understanding of the pathogenesis of macular hole formation, a knowledge of the various stages of evolution, and the primary care clinician's familiarity with improved diagnostic techniques. An enhanced understanding of the pathogenesis of macular hole will help to predict the risk for the fellow eye, will promote more effective patient education and counseling, and will result in more timely surgical intervention.. More promising results in the surgical closure of macula holes can prevent or minimize significant central vision loss.

Topics: Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Retina; Retinal Perforations; Transforming Growth Factor beta; Vitrectomy

This study aimed to compare the visual and anatomic results of macular hole surgery in eyes treated with recombinant transforming growth factor-beta-2 (TGF-beta2) or placebo.. The design was a prospective, multicenter, randomized, double-masked, placebo-controlled clinical study.. One hundred thirty eyes with idiopathic macular holes of 1 year or less and a refracted Early Treatment Diabetic Retinopathy Study visual acuity of 20/80 or worse were treated with 1.1 microg recombinant TGF-beta2 or placebo to the macular hole after fluid-gas exchange.. The effect of recombinant TGF-beta2 as an adjunctive agent for macular hole surgery was evaluated.. Closure of the macular hole and change in visual acuity at 3 months were measured.. The 3-month visits were completed for 120 eyes. The macular hole was closed at 3 months in 35 (61.4%) of 57 eyes treated with placebo and 49 (77.8%) of 63 eyes treated with recombinant TGF-beta2 (P = 0.08). The mean visual acuity gain was +6.4 letters in eyes receiving placebo and +8.9 letters in eyes treated with recombinant TGF-beta2 (P = 0.27). Visual acuity improved 2 or more lines in 23 (40.4%) of 57 eyes treated with placebo and 30 (47.6%) of 63 eyes treated with recombinant TGF-beta2 (P = 0.42). Intraocular pressure elevation greater than 30 mmHg was more common 2 weeks after surgery in eyes treated with recombinant TGF-beta2 (P < 0.001).. Recombinant TGF-beta2 resulted in a similar proportion of successful closure of macular holes as placebo. There was no statistically significant visual acuity benefit with the use of recombinant TGF-beta2 for the treatment of macular holes.

Topics: Aged; Chemotherapy, Adjuvant; Double-Blind Method; Female; Humans; Intraocular Pressure; Male; Postoperative Complications; Prospective Studies; Recombinant Proteins; Retinal Perforations; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

Vitrectomy and gas tamponade has become a recognised technique for the treatment of macular holes. In an attempt to improve the anatomic and visual success of the procedure, various adjunctive therapies--cytokines, serum, and platelets--have been employed. A consecutive series of 85 eyes which underwent macular hole surgery using gas tamponade alone, or gas tamponade with either the cytokine transforming growth factor beta 2 (TGF-beta 2) or autologous platelet concentrate is reported.. Twenty eyes had vitrectomy and 20% SF6 gas tamponade; 15 had vitrectomy, 20% SF6 gas, and TGF-beta 2; 50 had vitrectomy, 16% C3F8 gas tamponade, and 0.1 ml of autologous platelet concentrate prepared during the procedure.. Anatomic success occurred in 86% of eyes, with 96% of the platelet treated group achieving closure of the macular hole. Visual acuity improved by two lines or more in 65% of the SF6 only group, 33% of those treated with TGF-beta 2 and in 74% of the platelet treated group. In the platelet treated group 40% achieved 6/12 or better and 62% achieved 6/18 or better. The best visual results were obtained in stage 2 holes.. Vitrectomy for macular holes is often of benefit and patients may recover good visual acuity, especially early in the disease process. The procedure has a number of serious complications, and the postoperative posturing requirement is difficult. Patients need to be informed of such concerns before surgery.

Topics: Adult; Aged; Aged, 80 and over; Blood Transfusion, Autologous; Combined Modality Therapy; Female; Gases; Humans; Male; Middle Aged; Platelet Transfusion; Postoperative Period; Prospective Studies; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

To determine the incidence and timing of increased intraocular pressure in eyes with an idiopathic macular hole treated with bovine transforming growth factor-beta 2 (TGF-beta 2) with different intraocular gas concentrations, recombinant TGF-beta 2, or placebo.. Intraocular pressure was measured preoperatively and two days, two weeks, six weeks, and three months postoperatively in two prospective studies of the treatment of idiopathic macular hole with vitrectomy. Group 1 consisted of 95 eyes treated with bovine TGF-beta 2. Eyes in this group were treated with different concentrations of air and perfluoropropane (C3F8) intraocular gas bubbles. Fifteen eyes were treated with air, 15 eyes with 5% perfluoropropane, 15 eyes with 10% perfluoropropane, and 50 eyes with 16% perfluoropropane. Group 2 consisted of 29 eyes treated with recombinant TGF-beta 2. Twenty-six eyes were treated with placebo in a double-masked, randomized, placebo-controlled study evaluating recombinant TGF-beta 2 with a 16% perfluoropropane intraocular gas bubble.. At the two-week examination, the intraocular pressure in Group 1 eyes was > 30 mm Hg in four (26.7%) of 15 eyes treated with air, two (13.3%) of 15 eyes treated with 5% perfluoropropane, one (8.3%) of 12 eyes treated with 10% perfluoropropane, and nine (19.1%) of 47 eyes treated with 16% perfluoropropane. There was no statistically significant difference in the risk of increased intraocular pressure in eyes treated with short-, intermediate-, or long-duration gas tamponade using bovine TGF-beta 2. The intraocular pressure in Group 2 was > 30 mm Hg at the two-week examination in 11 (39.3%) of 28 eyes receiving recombinant TGF-beta 2 compared with one (4.3%) of 23 eyes receiving a placebo (P = .006).. Some eyes develop increased intraocular pressure after vitreous surgery for macular hole, and the increase occurs most frequently between two days and two weeks postoperatively. The risk of increased intraocular pressure is somewhat increased in eyes treated with bovine TGF-beta 2 but is markedly increased in eyes in which recombinant TGF-beta 2 is used as an adjunctive agent for macular hole surgery. Intraocular injection of growth factors produced by similar recombinant DNA techniques may result in potentially dangerous increased intraocular pressure several weeks after surgery. Impurities in the recombinant TGF-beta 2 may explain the relatively high risk of increased intraocular pressure.

Topics: Chemotherapy, Adjuvant; Double-Blind Method; Fluorocarbons; Humans; Incidence; Intraocular Pressure; Ocular Hypertension; Postoperative Complications; Prospective Studies; Recombinant Proteins; Retinal Perforations; Risk Factors; Time Factors; Transforming Growth Factor beta; Vitrectomy

To evaluate the efficacy of human recombinant transforming growth factor-beta 2 (TGF-beta 2) in the closure of persistent macular holes.. Retina service at a university-affiliated hospital in Vancouver.. Seventeen patients with macular holes who had previously undergone vitrectomy, posterior cortical vitreous removal and prolonged gas tamponade, with failure to close the hole.. Treatment with TGF-beta 2 followed by gas tamponade.. Closure of macular hole (defined as complete absence of the surrounding neurosensory detachment).. Of the 17 holes 16 (94%) were closed. The average improvement in Snellen acuity was 1.76 lines; nine patients (53%) had at least two lines of improvement. The patients who gained two or more lines of acuity following surgery with TGF-beta 2 had lost significantly more lines of acuity with the primary procedure (p = 0.008) and had worse Snellen acuity following the primary procedure (p = 0.0004) than the patients who gained one line or less of acuity following surgery with TGF-beta 2. Among the patients with a final visual acuity of 20/80 or better the average duration of the hole from the onset of symptoms to the second procedure was 22.2 months.. Treatment with TGF-beta 2 is a potentially useful adjuvant in the closure of persistent macular holes following failed primary surgery.

Topics: Aged; Humans; Postoperative Period; Recombinant Proteins; Reoperation; Retinal Perforations; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity

Previous studies of treatment of full-thickness macular holes have effected resolution of the surrounding subretinal fluid cuff in 58%-71% of cases. An initial report has found 330 ng and 1,330 ng transforming growth factor-beta 2 to be successful in effecting resolution of the surrounding subretinal fluid cuff in 100% of cases. A randomized, masked, controlled, prospective, multicenter study of 90 patients with full-thickness macular holes was performed to assess the efficacy of the local application of TGF-beta 2 at the time of vitrectomy surgery. Eligibility criteria included: (1) best corrected visual acuity of 20/80 or worse; (2) duration of macular hole for less than 1 year; and (3) absence of other ocular disorders that might interfere with vision. Patients were evenly randomized to receive placebo, 660 ng transforming growth factor-beta 2, or 1,330 ng transforming growth factor-beta 2. The treatment assignment was unmasked at the examination 3 months after treatment only if the macular hole failed to close. If the initial treatment had been placebo, patients were offered crossover to 1,330 ng transforming growth factor-beta 2 during a reoperation. It can be deduced that resolution of the subretinal fluid cuff occurred in 16 of 30 placebo-treated eyes, 53 of 58 eyes treated with transforming growth factor-beta 2, and in 9 of 13 cases (69%) initially treated with placebo that subsequently underwent repeat surgery under the crossover option.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Aged, 80 and over; Exudates and Transudates; Female; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Retina; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy; Wound Healing

Full-thickness macular holes generally cause a significant reduction in visual acuity, due in part to a rim of surrounding neurosensory retinal detachment and retinal thickening. Recent studies have suggested that flattening of this narrow rim of neurosensory detachment can result in improved visual acuity. However, the ability to flatten the neurosensory detachment is limited using current surgical techniques.. Transforming growth factor-beta 2 (TGF-beta 2) is a recently discovered potent stimulator of wound healing. The authors, therefore, performed a prospective randomized study of 60 patients to determine if the local application of TGF-beta 2 to the edge of the macular hole can reproducibly induce flattening of the surrounding neurosensory detachment. The results of a study designed to determine the effect of a pars plana vitrectomy, fluid-gas exchange, and intravitreal instillation of TGF-beta 2 in eyes with a full-thickness macular hole and reduced visual acuity are reported.. After treatment, visual acuity improved 2 lines or more in 5 of 11 eyes treated with 70 ng, in 4 of 12 eyes treated with 330 ng, and in 10 of 11 eyes treated with 1330 ng of TGF-beta 2. In some eyes, hyaluronic acid was added. In these cases, visual acuity improved 2 lines or more in 0 of 9 eyes treated with 70 ng TGF-beta 2, in 2 of 8 eyes treated with 330 ng, and in 4 of 9 eyes treated with 1330 ng.. Logistic regression analysis demonstrated a statistically significant beneficial effect of TGF-beta 2 on visual improvement (P = 0.003).

Topics: Adolescent; Adult; Aged; Child; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Prospective Studies; Retinal Detachment; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy; Wound Healing

Rhegmatogenous retinal detachment (RRD) is caused by one or more full-thickness retinal breaks. The current RRD treatments have several drawbacks. Chitosan is one of the most commonly used natural polymers for wound healing and has been demonstrated to be biodegradable, biocompatible, non-toxic, bioadhesive, and bioactive. This study aimed to determine the reliability and effectiveness of chitosan for sealing retinal breaks in rabbits.. Eighteen blue purple rabbits were randomly divided into three groups: chitosan (n = 6), RRD (n = 6), and control (n = 6). The RRD model was established using vitrectomy, making retinal holes, and subretinal fluid injection in the RRD and chitosan groups. One week after the establishment of the model, chitosan was applied within the range of the holes in the chitosan group, and the vitreous body was filled with perfusion fluid. Except the chitosan treatment, the RRD group underwent the same procedure. Intraocular pressure (IOP) measurement, fundus photography, B-mode ultrasound, optical coherence tomography (OCT), histology, and enzyme linked immunosorbent assay (ELISA) were performed.. Retinas of all eyes in the RRD group were detached, whereas those of all eyes in the chitosan group remained attached. The concentrations of epidermal growth factor (EGF), fibroblast growth factor (FGF)-2, transforming growth factor β (TGF-β), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), and IL-8 in the vitreous fluid of the RRD group were significantly higher than those of the control group (. Chitosan may be a reliable method for sealing retinal breaks. Moreover, chitosan can maintain high levels of growth factors and reduce inflammatory factors in the vitreous, which may reduce and delay the death of retinal cells and help restore visual function after retinal repositioning.

Topics: Animals; Chitosan; Epidermal Growth Factor; Interleukin-6; Interleukin-8; Rabbits; Reproducibility of Results; Retinal Detachment; Retinal Perforations; Retrospective Studies; Transforming Growth Factor beta; Vascular Endothelial Growth Factor A

Imbalance between extracellular matrix protein synthesis and degradation is a key feature of diabetic retinopathy. Fibronectin, a predominant constituent of the extracellular matrix, has been shown to undergo alternative splicing to produce embryonic isoforms in various pathologic conditions, such as fibrotic diseases and tumorigenesis. Two such isoforms, oncofetal fibronectin variants that are characterized by the inclusion of the oncofetal domains A and B, were the focus of the present study.. The expression of oncofetal fibronectin variants was determined in human vitreous samples obtained from patients undergoing vitrectomy for proliferative diabetic retinopathy and nondiabetes-associated ocular conditions such as macular hole. In addition, an animal model of chronic diabetes and cultured endothelial cells was used to elucidate the mechanistic basis for this aberrant expression of oncofetal fibronectin.. Expression of fibronectin containing the oncofetal domain B was upregulated in the vitreous of patients with diabetic retinopathy.. Use of a well-established animal model of chronic diabetic complications and cultured endothelial cells showed that diabetes-induced upregulation of oncofetal fibronectin is, in part, dependent on hyperglycemia-induced transforming growth factor-beta1 and endothelin-1. Furthermore, the data suggest that oncofetal fibronectin is involved in endothelial cell proliferation.

Topics: Aged; Animals; Blotting, Western; Bosentan; Cell Division; Cells, Cultured; Diabetes Mellitus, Experimental; Diabetic Retinopathy; Endothelin-1; Endothelium, Vascular; Female; Fibronectins; Gene Silencing; Humans; Male; Middle Aged; Rats; Rats, Sprague-Dawley; Retinal Perforations; Reverse Transcriptase Polymerase Chain Reaction; Sulfonamides; Transforming Growth Factor beta; Transforming Growth Factor beta1; Up-Regulation; Vitrectomy; Vitreous Body

To study the involvement of apoptosis using different apoptosis markers in PVR pathogenesis.. The presence of mRNA coding for Fas, Fas ligand (FasL), and TNF-related apoptosis inducing ligand (TRAIL) was investigated in vitreous samples from 46 consecutive patients-25 with PVR, 11 with retinal detachment (RD) not complicated by PVR, and 10 with macular hole (MH)-using RT-PCR. From previously examined vitreous samples, 21 PVR, 9 RD, and 10 MH were examined for their levels of TGF-beta2 protein with sandwich ELISA kits. Five epiretinal membranes excised from five patients with PVR were also examined for apoptotic cell death using the terminal deoxytransferase (TdT) mediated dUTP-biotin nick end labeling (TUNEL) technique.. FAS mRNA was detected in 72% of patients with PVR, 55% of patients with RD and 20% of patients with MH. TRAIL mRNA was detected in 67% of patients with PVR, 89% of patients with RD, and 20% of patients with MH. FasL mRNA was detected in 20% of patients with PVR, 9% of patients with RD, and 10% of patients with MH. The median levels of Fas and TRAIL mRNA were significantly higher (P < 0.05) in patients with PVR than in those with MH hole but between patients with PVR and those with RD the difference was not significant (P > 0.05). A significant difference was detected between RD and MH for TRAIL mRNA levels (P = 0.008). For FasL, no significant difference between groups was found. TGF-beta2 was detected in all investigated vitreous samples. A significant difference was found between the PVR and MH groups (P = 0.001) and between the RD and MH groups (P = 0.004), but not between the PVR and RD groups (P < 0.05). The level of TGF-beta2 was significantly correlated to the level of TRAIL mRNA (r = 0.86), but no correlation was found between TGF-beta2 and Fas mRNA levels (r = 0.21). Four of five examined PVR epiretinal membranes showed positive staining for apoptotic cells using the TUNEL technique.. Apoptosis is one of the mechanisms that is involved in PVR pathogenesis. Different apoptosis markers suggest different pathways occur in PVR, including Fas/FasL, TRAIL, and TGF-beta2 mediated processes.

Topics: Adult; Aged; Aged, 80 and over; Apoptosis; Apoptosis Regulatory Proteins; Biomarkers; Enzyme-Linked Immunosorbent Assay; Epiretinal Membrane; Fas Ligand Protein; fas Receptor; Female; Humans; In Situ Nick-End Labeling; Male; Membrane Glycoproteins; Middle Aged; Retinal Detachment; Retinal Perforations; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; TNF-Related Apoptosis-Inducing Ligand; Transforming Growth Factor beta; Transforming Growth Factor beta2; Tumor Necrosis Factor-alpha; Up-Regulation; Vitreoretinopathy, Proliferative; Vitreous Body

To determine whether silicone oil concentrates protein and growth factors in the retro-oil fluid.. A laboratory analysis of intraocular fluid and vitreous specimens obtained from patients undergoing removal of silicone oil, revision vitrectomy, or primary vitrectomy for macular hole, proliferative vitreoretinopathy (PVR), or retinal detachment. Patients were prospectively recruited from routine vitreoretinal operating lists. Vitreous cavity fluid and vitreous samples were analysed for the presence of transforming growth factor beta (TGF-beta2), basic fibroblast growth factor (bFGF), interleukin 6 (IL-6), and total protein using either commercially available enzyme linked immunosorbent assays (ELISA) or protein assay kits.. The median levels of bFGF, IL-6, and protein in the retro-oil fluid were raised (p<0.05) compared to all the other vitreous and vitreous cavity fluid samples. bFGF, IL-6, and protein levels were raised in PVR vitreous compared to non-PVR vitreous. TGF-beta2 levels were not significantly raised in retro-oil fluid or in PVR vitreous.. The concentration of fibrogenic (bFGF) and inflammatory (IL-6) growth factors and protein is raised in retro-silicone oil fluid. This may contribute to the process of retro-oil perisilicone proliferation and subsequent fibrocellular membrane formation.

Topics: Enzyme-Linked Immunosorbent Assay; Eye Proteins; Fibroblast Growth Factor 2; Growth Substances; Humans; Immunosuppressive Agents; Interleukin-6; Prospective Studies; Retinal Detachment; Retinal Diseases; Retinal Perforations; Silicone Oils; Transforming Growth Factor beta; Transforming Growth Factor beta2; Vitrectomy; Vitreoretinopathy, Proliferative; Vitreous Body

To evaluate the results of a third macular hole surgery in eyes with recurrent macular holes and two prior macular hole surgeries.. Retrospective consecutive noncomparative case series.. Sixteen eyes of sixteen patients with two prior macular hole surgeries with recurrent macular hole.. A third vitreous surgery was performed in each eye using a long-acting gas bubble.. Closure of the macular hole and change in visual acuity.. The macular hole was closed in 12 of 16 eyes (75%) at 3 months after the third surgery. Visual acuity improved 2 or more Snellen lines in 9 of 16 eyes (56%), and 5 of 16 eyes (31%) achieved 20/40 or better vision. Six eyes (37.5%) had cataract surgery after the third macular hole surgery, and visual acuity results were similar in eyes with or without cataract surgery. Successful closure of the macular hole improved the visual acuity from 20/80 -1 to 20/50 +1 (P < 0.001). Eyes in which one of the previous surgeries had been temporarily successful in closing the macular hole improved from a mean of 20/80 to 20/40 (P = 0.003). Eyes in which both prior macular hole surgeries had been primary failures had minimal benefit with a preoperative visual acuity of 20/100 +1 and a postoperative visual acuity of 20/100 +2 (P = 0.67).. Repeat macular hole surgery should be considered in eyes with recurrent macular holes and two prior surgeries when the macular hole was temporarily closed by at least one of the two previous surgeries. Successful closure of a macular hole in such cases usually results in significant visual acuity improvement.

Topics: Adult; Aged; Chemotherapy, Adjuvant; Epiretinal Membrane; Female; Humans; Intraoperative Complications; Male; Middle Aged; Platelet-Derived Growth Factor; Recombinant Proteins; Recurrence; Reoperation; Retinal Perforations; Retrospective Studies; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

To evaluate the outcomes of macular hole surgery in highly myopic eyes and to compare these outcomes with a control group of eyes that were not severely myopic.. The study design was a matched, case-control, retrospective chart review. The participants included 26 eyes of 24 patients who had vitreous surgery for macular holes. The eyes were divided into two groups: 13 consecutive eyes with severe myopia (defined as -6.00 diopters of refractive error or greater) and 13 control eyes without severe myopia that were operated on immediately before or after each study eye, with the most recently operated eye chosen. The main outcome parameters were preoperative and final follow-up visual acuity, macular hole closure rates, reoperation rates, duration of preoperative symptoms, and follow-up time.. Using the Snellen equivalent of logarithm of minimal angle of resolution (logMAR) units, visual acuity improved after macular hole surgery in severely myopic eyes from 20/152 to 20/89 (P =.041) and in control eyes from 20/152 to 20/47 (P <.001). At final follow-up, visual acuities were lower in severely myopic eyes compared with control eyes (P =.048). Macular hole closure rates, reoperation rates, duration of pre-operative symptoms, and follow-up intervals were not significantly different statistically between groups.. Macular hole surgery results in anatomical and visual improvements in severely myopic eyes but generally yields poorer visual acuity outcomes compared with eyes that are not severely myopic.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myopia; Reoperation; Retinal Perforations; Retrospective Studies; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity

To evaluate the frequency and prognosis of reopening of a macular hole after initially successful repair in a defined patient cohort.. Retrospective consecutive noncomparative case series.. Seventeen cases of reopened macular holes among 390 cases of idiopathic macular holes that previously had undergone macular hole surgery were studied.. Assessment of demographics, visual acuity, preoperatively, postoperatively, after reopening of macular hole and after reoperation, if applicable, and precipitating factors.. There were 17 (4.8%) of 353 cases in which the macular hole reopened after initial successful surgical closure. The mean visual acuity before reopening was 20/48 and was 20/133 after reopening. Twelve eyes underwent reoperation with improvement to a mean visual acuity of 20/54. The five eyes that were not reoperated on maintained a mean visual acuity of 20/200. Ten of the eyes had undergone cataract surgery between macular hole surgeries, but in only one did the reopening appear to occur in association with this procedure.. Reopening of a previously successfully operated macular hole is uncommon and seems to be a spontaneous event. Reoperation generally yields results similar to those present before the reopening. Reopening of a macular hole associated with cataract surgery is rare.

Topics: Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Female; Humans; Male; Middle Aged; Prognosis; Recurrence; Reoperation; Retinal Perforations; Retrospective Studies; Risk Factors; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

To evaluate the effect of vitrectomy and autoserum for treatment of retinal detachment caused by macular hole.. 19 eyes with retinal detachment caused by macular hole were treated with gas tamponade (C(3)F(8)). The follow-up periods ranged from 6 to 24 months. In the case whose macular hole failed to heal, removal of the remains of prefoveal membrane and/or scratching at the retinal pigment epithelium (RPE) and placing autoserum for 7 minutes in the macular hole were performed.. Closure of macular hole was obtained in 15 eyes (80%). The postoperative visual acuity was 0.05 - 0.4. Macular hole failed to heal in 4 eyes. In one eye the remains of prefoveal membrane were removed; in another 3 eyes, in the macular hole scratching at the retinal pigment epithelium (RPE) and placing autoserum were performed and C(3)F(8) tamponade was used. Anatomical cure was obtained in all the 4 eyes. The final visual acuity was 0.1 or better.. The findings show that removal of prefoveal membrane is imperative. Scratch at RPE with placement of autoserum in the macular hole is effective for the macular hole which has failed to respond to conventional vitrectomy with air tamponade.

Topics: Aged; Female; Humans; Male; Middle Aged; Postoperative Complications; Retinal Detachment; Retinal Perforations; Transforming Growth Factor beta; Transforming Growth Factor beta2; Visual Acuity; Vitrectomy

The purpose of the study is to determine the long-term visual outcomes in patients undergoing successful macular hole surgery.. A consecutive series of eyes with an anatomically successful macular hole surgical result and at least 1 year postoperative follow-up information was identified and studied. Preoperative and postoperative visual acuities were measured in accordance with the Early Treatment Diabetic Retinopathy Study protocol.. Visual acuity, improvement of visual acuity, and rate of final visual greater than or equal to 20/40 were measured.. The median visual acuity increased from 20/125 before surgery to 20/50 1 year after surgery (93 eyes) and to 20/30 at 36 months after surgery (68 eyes). The trend for improvement in visual acuity after 1 year after surgery was statistically significant. The postoperative visual acuity was greater than or equal to 20/40 in 15 (17%) eyes at 3 months and 53 (78%) at 36 months. Before surgery, 12 (13%) eyes were pseudophakic, and 77 (83%) were pseudophakic at 36 months. Median visual acuity in the fellow eye was 20/32 at baseline and 20/32 at 36 months. The visual acuity in the study eye was better than in the fellow eye in 36 (39%) patients at 36 months after surgery.. Visual acuity in patients after anatomically successful macular hole surgery continues to improve even beyond 1 year after surgery. Although substantial improvement occurs soon after cataract extraction, further improvement in visual acuity continues for 2 years thereafter.

Topics: Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retinal Perforations; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

To evaluate the visual and anatomic results of macular hole surgery in eyes that have had symptoms of a macular hole for 2 years or longer.. Fifty-one eyes with chronic macular holes (> or = 2 years' duration) were treated in a retrospective analysis of the results of vitrectomy, 16% perfluoropropane gas tamponade, and one of three adjunctive agents (bovine transforming growth factor beta-2, recombinant transforming growth factor beta-2, or autologous platelet extract). Of 51 eyes, 45 (88.2%) were examined 3 months after surgery. Visual acuity of these 45 eyes was measured preoperatively and 3 months postoperatively using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. Twenty-eight eyes (62.2%) had no prior vitrectomy and 17 eyes (37.8%) had a prior vitrectomy for the macular hole that failed.. The macular holes had a mean duration of 3.7 years and were successfully closed in 32 of 51 total eyes (62.7%) and 32 of 45 eyes (71.1%) that were examined 3 months after surgery. The mean preoperative visual acuity was 20/100 -2 and the mean visual acuity at 3 months was 20/80 for a mean gain of 6.6 ETDRS letters (+ 1.3 lines). Of 45 eyes, 17 (37.8%) were 20/63 or better 3 months after surgery; 21 (46.7%) gained 2 or more ETDRS lines. There was no statistically significant difference in macular hole closure (P = 0.311) or visual acuity change (P = 0.095) in eyes with or without prior vitreous surgery. Eyes with macular holes between 2-2.99 years experienced a somewhat better anatomic and functional result overall than eyes with macular hole from 3-14 years, duration, but the visual acuity change was not statistically significant (P = 0.187). There was substantial variability in visual improvement among eyes with successful closure of the chronic macular hole.. Macular holes of > or = 2 years' duration may be more difficult to close successfully than are more recent macular holes, and the visual improvement appears to be less favorable. Many eyes with chronic macular holes in our study gained substantial visual acuity, so vitreous surgery can be considered in selected eyes with chronic macular holes based on visual needs.

Topics: Adult; Aged; Blood Platelets; Chronic Disease; Female; Fluorescein Angiography; Fluorocarbons; Follow-Up Studies; Fundus Oculi; Humans; Male; Middle Aged; Recombinant Proteins; Retinal Perforations; Retrospective Studies; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

To study the clinicopathologic features of an untreated macular hole in the right eye and a macular hole in the left eye treated by vitrectomy, application of transforming growth factor-beta 2, and gas tamponade.. The patient, a 73-year-old man with bilateral macular holes, was studied clinically before and after surgical treatment of the macular hole in his left eye. The patient's eyes were obtained postmortem and serially step-sectioned through the macula and optic nerve head for electron microscopy.. Examination of 1-micron thick plastic-embedded sections through the macula of the right eye disclosed a 0.6-mm macular hole with rounded gliotic margins, a thin epiretinal membrane, and parafoveal cystic changes. Examination of 1-micron thick plastic-embedded sections through the macula of the left eye disclosed a 0.25-mm defect in the fovea, which was bridged by glial cells. The glial cells were continuous with a thin hypocellular epiretinal membrane without contraction features on both sides of the defect. The ultrastructural features of the glial cells were consistent with Mueller cells.. Treatment of a macular hole with vitrectomy, transforming growth factor-beta 2, and gas tamponade was followed by complete closure of the macular hole by Mueller cell proliferation.

Topics: Aged; Cell Division; Eye Enucleation; Fluorescein Angiography; Fluorocarbons; Fovea Centralis; Fundus Oculi; Humans; Male; Neuroglia; Ophthalmic Solutions; Retina; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

Topics: Cataract; Disease Progression; Humans; Lens Nucleus, Crystalline; Prognosis; Retinal Perforations; Sclerosis; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

We studied the progression of cataracts and visual acuity up to 36 months after vitrectomy and instillation of transforming growth factor beta-2 for treatment of full-thickness macular holes.. Sixty-four eyes with idiopathic and two with traumatic macular holes in this prospective consecutive series were divided into the following two groups: 56 phakic eyes were treated with 70, 330, or 1,330 ng of transforming growth factor beta-2 to study the progression of cataracts, and 31 phakic or pseudophakic eyes were treated with 1,330 ng of transforming growth factor beta-2 to study the long-term visual acuity after macular hole surgery.. Eyes in the cataract progression study had a mean preoperative nuclear sclerosis grade of 0.4, which increased to 2.4 on final lens examination at a mean of 12.4 months postoperatively. The amount of nuclear sclerosis increased progressively with duration of follow-up, and 16 (76%) of 21 eyes followed up for 24 months or more required cataract extraction. The mean preoperative posterior subcapsular cataract grade was 0.0 and increased only slightly to 0.25 on final lens examination. All eyes had initial successful closure of the macular hole, but the macular hole reopened in two eyes (between six and 12 months and at 19 months) for an overall success rate of 29 (93.5%) of 31 eyes at a mean of 19.5 months. The visual acuity increased two or more Snellen lines in 29 (93.5%) of 31 eyes. The final visual acuity was 20/40 or better in 23 (74%) of 31 eyes and the visual improvement was stable in eyes followed up for three years.. Nuclear sclerotic cataracts progress substantially after macular hole surgery with a long-acting intraocular gas tamponade. The visual acuity often decreases 12 or more months after vitrectomy because of cataract progression, but the visual results of vitrectomy and transforming growth factor beta-2 for macular holes are excellent when the cataracts are removed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cataract; Child; Disease Progression; Female; Follow-Up Studies; Humans; Lens Nucleus, Crystalline; Longitudinal Studies; Male; Middle Aged; Prognosis; Prospective Studies; Retinal Perforations; Sclerosis; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

Tangential macular traction by the posterior vitreous cortex has been widely accepted as the major causative factor in the development of idiopathic macular holes. Separation of the posterior cortical vitreous should relieve this vitreoretinal traction.. The authors report five patients with idiopathic full-thickness macular hole formation that occurred in the presence of a well-documented pre-existing complete posterior vitreous detachment.. Of five eyes, three underwent pars plana vitrectomy and instillation of transforming growth factor-beta. No residual prefoveal cortical vitreous was present at the retinal surface at the time of surgery. Additionally, clinically identifiable epiretinal membranes were present in three of five eyes, but these epiretinal membranes were extremely thin, transparent, induced minimal traction, and did not warrant surgical peeling.. It is likely that, in these five patients, some mechanism other than tangential traction by prefoveal vitreous cortex is responsible for idiopathic full-thickness macular hole formation.

Topics: Aged; Aged, 80 and over; Eye Diseases; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Humans; Male; Retinal Perforations; Retrospective Studies; Transforming Growth Factor beta; Visual Acuity; Vitrectomy; Vitreous Body

To evaluate whether vitreous surgery is successful in closing full-thickness traumatic macular holes and whether there is subsequent improvement in visual acuity.. Twelve eyes from 12 consecutive patients with traumatic macular holes underwent vitrectomy, fluid-gas exchange and instillation of bovine or recombinant transforming growth factor (TGF)-beta-2. Three of four eyes underwent repeat vitrectomy with TGF-beta-2 after the initial procedure failed to close the macular hole.. Eleven (92%) of 12 eyes had closure of the macular hole. Follow-up ranged from 3 to 33 months. Visual acuity improved by 2 or more lines in 8 (67%) of 12 eyes. Six (50%) of 12 eyes improved to 20/40 or better. All 3 eyes that underwent reoperation had successful closure of the macular hole and achieved 2 or more lines of visual improvement.. Treatment of full-thickness traumatic macular holes with vitrectomy, fluid-gas exchange, and TGF-beta-2 may result in successful anatomic closure and visual improvement.

Topics: Adolescent; Adult; Air; Child; Eye Injuries; Female; Fluorescein Angiography; Fluorocarbons; Follow-Up Studies; Humans; Male; Ophthalmic Solutions; Recombinant Proteins; Reoperation; Retina; Retinal Perforations; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy; Wounds, Nonpenetrating

Topics: Aged; Combined Modality Therapy; Humans; Retinal Perforations; Transforming Growth Factor beta; Vision, Binocular; Visual Acuity; Vitrectomy

Topics: Aged; Combined Modality Therapy; Humans; Middle Aged; Prospective Studies; Retinal Perforations; Transforming Growth Factor beta; Vitrectomy

To compare the effect of a long-acting (16% perfluoropropane [C3F8]) versus a short-acting (air) intraocular gas tamponade on visual outcome and macular hole closure rate after vitrectomy and intravitreal instillation of transforming growth factor-beta 2 (TGF-beta 2) on the macula.. Vitrectomy with removal of the posterior hyaloid fluid-gas exchange with instillation of TGF-beta 2 was performed in 15 eyes treated with air and 37 eyes treated with 16% C3F8 using identical surgical techniques (mean follow-up, 5.6 months).. The macular hole was closed successfully in 36 (97%) of 37 eyes treated with 16% C3F8 and in 8 (53.3%) of 15 eyes treated with air (P = 0.00007). The visual acuity improved by a mean of 3.1 lines on the Early Treatment of Diabetic Retinopathy Study chart for eyes treated with 16% C3F8 and 1.3 lines for eyes treated with air (P = 0.003).. A longer duration intraocular gas tamponade from 16% C3F8 gives a much higher rate of successful closure of macular holes and improved visual acuity using vitrectomy and TGF-beta 2 than does air.

Topics: Aged; Air; Combined Modality Therapy; Female; Fluorocarbons; Humans; Male; Middle Aged; Prospective Studies; Retinal Perforations; Time Factors; Transforming Growth Factor beta; Treatment Outcome; Visual Acuity; Vitrectomy

We evaluated the fluorescein angiographic features of full-thickness macular holes before and after vitrectomy, fluid-gas exchange, and instillation of transforming growth factor beta-2 in 43 eyes in a masked fashion to evaluate the angiographic characteristics of macular holes preoperatively and the changes that occur with successful and unsuccessful closure of the macular hole. Hyperfluorescence was present in the base of the macular hole preoperatively in 34 of 43 eyes (79.1%), was questionable in eight of 43 eyes (18.6%), and was definitely absent in only one of 43 eyes (2.3%). The hyperfluorescence in the base of the macular hole disappeared in 19 of 20 eyes (95%) with successful closure of the macular hole (P < .00001) and appeared to be caused by blocked fluorescence at the site of the macular hole. The photographic features of eyes with unsuccessful closure of the macular hole changed little, except that the size of the cuff of neurosensory detachment around the hole increased and was associated with decreased postoperative visual acuity. These angiographic changes support the presence of a glial tissue plug bridging a small defect in the fovea of eyes with successful closure of a macular hole.

Topics: Combined Modality Therapy; Evaluation Studies as Topic; Fluorescein Angiography; Fundus Oculi; Humans; Ophthalmic Solutions; Photography; Pilot Projects; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

Vitrectomy with fluid-gas exchange has been shown to close more than one half of full-thickness macular holes, with improvement in visual acuity. By adding the appropriate dose of transforming growth factor-beta 2, a higher success rate has been reported. However, there still remain cases of macular holes that fail to close after vitreous surgery. The current pilot study is designed to determine whether reoperation may have a role in the management of cases that fail after vitreous surgery.. Twelve eyes with persistent full-thickness macular holes that failed to close after an initial vitrectomy underwent reoperation using 1330 ng transforming growth factor-beta 2.. After the second operation, closure occurred in 12 (100%) of 12 eyes. Follow-up ranged from 8 to 16 months. Visual acuity also improved by two or more lines in 5 (42%) of 12 patients. Increased nuclear sclerosis occurred in nine (90%) of the ten phakic eyes. Of the five eyes showing visual improvement, four required cataract extraction and intraocular lens implantation.. Retreatment of persistent full-thickness macular holes with transforming growth factor-beta 2 appears to have a beneficial effect on both neurosensory retinal flattening and visual outcome.

Topics: Adult; Aged; Fluorocarbons; Follow-Up Studies; Humans; Middle Aged; Pilot Projects; Reoperation; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy

Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-beta 2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results.. A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11-81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-beta 2 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole.. Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling.. The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-beta 2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cell Membrane; Child; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Ophthalmic Solutions; Retina; Retinal Perforations; Transforming Growth Factor beta; Visual Acuity; Vitrectomy; Wound Healing