J C Schmidt1, S Mennel, S Hörle, C H Meyer. 1. Department of Ophthalmology, Philipps-University Marburg, Robert-Koch-Strasse 4, 35037 Marburg, Germany.
Abstract
BACKGROUND: The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT. AIMS: To determine intraoperatively the status of the posterior vitreous interface. DESIGN: Interventional case series. METHODS: Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1-4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous. RESULTS: Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10). CONCLUSION: We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.
BACKGROUND: The causes of recurrent choroidal neovascularisation (CNV) after photodynamic therapy (PDT) remain controversial. Subretinal surgery was carried out after unsuccessful PDT. AIMS: To determine intraoperatively the status of the posterior vitreous interface. DESIGN: Interventional case series. METHODS: Conventional three-port vitrectomy was carried out in 10 eyes with CNV that had undergone 1-4 PDT sessions. The vitreous cutter was held close to the edge of the optic nerve to evaluate the status of the posterior vitreous. RESULTS: Lesion size showed an increase from 1.5 (standard deviation (SD) 0.53) to 2.3 (SD 0.83) macular photocoagulation study disc diameters, between the first and the last PDT. Intraoperative findings during vitrectomy showed little liquefaction of the vitreous gel and an incomplete posterior-vitreous detachment, with remarkably firm attachments at the macula in all cases (10/10). CONCLUSION: We determined an abnormally high incidence of vitreous attachments in eyes with recurrent CNV. Vitreomacular attachments may trigger the progression or recurrence of CNV.
Authors: Thomas Bertelmann; Marta Spychalska; Laura Kohlberger; Stefan Strodthoff; Michael Witteborn; Nadia Kicova; Ulrich Sachs; Sebastian Irle; Stefan Mennel Journal: Graefes Arch Clin Exp Ophthalmol Date: 2013-05-12 Impact factor: 3.117