Postoperative aqueous humour flare as a surrogate marker for proliferative vitreoretinopathy development

Mulder, Verena C.; Dijk, Elon H. C. van; Meurs, Ida A. van; Heij, Ellen C. La; Meurs, Jan C. van

doi:10.1111/aos.13560

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…Total protein concentration in the vitreous was investigated in eyes with retinal detachment and higher vitreous protein levels were found in eyes with PVR [29] . Our result is accordance with those reported by Mudler et al [30] showing a significant association between the higher flare values at both 2 and 6wk postoperatively and the development of postoperative PVR in eyes undergoing PPV for RRD. Recently, Narala et al [19] reported a significant association between the preoperative flare of grade ≥2+ and postoperative failure in eyes undergoing vitrectomy for PVR.…”

Section: Resultssupporting

confidence: 94%

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

Sönmez¹

2022

Int J Ophthalmol

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AIM: To evaluate outcomes and determine factors influencing the outcomes of vitrectomy with silicone oil (SO) endotamponade for the management of rhegmatogenous retinal detachment (RRD) complicated by advanced proliferative vitreoretinopathy (PVR). METHODS: This is a retrospective, interventional case series of eyes with PVR grade C associated RRD with or without prior surgery that underwent vitreoretinal surgery and SO tamponade. Eyes with a minimum follow-up of 6mo after SO extraction were included. Eyes were classified into three PVR subgroups according to severity and extension of proliferation. The influence of several preoperative, intraoperative and postoperative factors upon the functional and anatomical outcomes was assessed using multivariate logistic regression analysis. RESULTS: A hundred and one eyes of 101 patients that met the inclusion criteria were studied. Seventy-five of 101 eyes (74.3%) had successful retinal reattachment after one operation. Increased aqueous cell and flare at the first week exam had a statistically significant association with redetachment, recurrent membrane proliferation and keratopathy. Visual acuity improvement was significantly associated with faint postoperative aqueous inflammation values, primary vitrectomy and PVR outside of the posterior pole. CONCLUSION: Although encouraging anatomical and functional outcomes are achieved after vitrectomy and SO tamponade in eyes with RRD complicated by PVR, an increase in aqueous flare or cells at the first week follow-up is most likely to result in postoperative late complications. Primary vitrectomy, PVR associated with minimal posterior pole extension and absent to mild postoperative aqueous inflammation are associated with improved post-operative final visual acuity.

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Section: Resultssupporting

confidence: 94%

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

Sönmez¹

2022

Int J Ophthalmol

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“…Since there seem to be numerous factors influencing LFP, a comprehensive scientific analysis of possible associations is desirable. Few studies have investigated LFP in eyes with RRD [3,4,[10][11][12], and to date no data has been published describing the potential associations between laser flare values, anatomical details, and symptom duration in RRD. We investigated these characteristics to enhance existing knowledge and as experience has shown that they are often associated with each other in everyday clinical practice in the care of patients with retinal detachment.…”

Section: Discussionmentioning

confidence: 99%

“…Yet LFP values seem to have a predictive value regarding the postoperative PVR risk. As a consequence, the value of preoperative laser flare values as a predictor for PVR remains unclear [ 10 , 11 ]. The complex problem of PVR development and the associated rate of retinal re-detachment after primary surgical success is currently the subject of intensive research efforts with the aim to find preventive and therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

Association between laser flare photometry and symptom duration in primary rhegmatogenous retinal detachment

et al. 2022

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Purpose The purpose of this study was to investigate preoperative blood-ocular barrier disruption via laser flare photometry (LFP) in patients diagnosed with rhegmatogenous retinal detachment (RRD), and to analyse possible associations with symptom duration and anatomical parameters. Methods We retrospectively analysed consecutive patients presenting with RRD at a single centre between January 2016 and March 2020. LFP was performed in both eyes after pupillary dilatation prior to RRD surgery. Symptom duration, extent of retinal detachment, and lens status were assessed. For statistical analysis, we carried out the unequal variances t test and Welch’s analysis of variance (ANOVA). Results We included 373 eyes of 373 patients (mean age 63.96 years ± 10.29; female:male ratio 1:1.8). LFP values quantified in photon count per millisecond (pc/ms) increased with longer symptom duration when comparing patients with a symptom duration of 0–3 days (n = 158; 9.25 ± 6.21 pc/ms) and ≥ 4 days (n = 215; 11.97 ± 11.58 pc/ms; p = 0.004). LFP values also rose with the number of retinal quadrants affected by RRD (1 quadrant, 6.82 ± 4.08 pc/ms; 2 quadrants, 10.08 ± 7.28 pc/ms; 3 quadrants, 12.79 ± 7.9 pc/ms; 4 quadrants, 31.57 ± 21.27 pc/ms; p < 0.001), macula off status (macula on, 8.89 ± 6.75 pc/ms; macula off, 12.65 ± 11.66 pc/ms; p < 0.001), and pseudophakic lens status (pseudophakia, 12.86 ± 9.52 pc/ms; phakia: 9.31 ± 9.67 pc/ms; p < 0.001). Conclusion In RRD patients, blood-ocular barrier disruption quantified by LFP is associated with the duration of symptoms and the disease’s anatomical extent. These results warrant further investigation of the potential clinical use of LFP in RRD.

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“… 30 Furthermore, a connection between aqueous flare levels and the development of postoperative proliferative vitreoretinopathy has been identified. 31 Interestingly, the preoperative aqueous flare values ranged considerably between the cataract surgery patients. Relative changes in aqueous flare compared to the absolute aqueous flare values seemed to better reflect the BAB breakdown induced macular changes postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery

Aaronson

Taipale

Achiron

et al. 2021

Trans. Vis. Sci. Tech.

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Purpose To assess whether aqueous flare is related to an increased risk of pseudophakic cystoid macular edema (PCME) following uneventful cataract surgery in nondiabetic and diabetic patients. Methods A post hoc analysis of five consecutive randomized clinical trials in the Department of Ophthalmology, Kymenlaakso Central Hospital, Finland. Aqueous flare levels were recorded in 448 eyes of 448 patients before surgery, and after the course of topical anti-inflammatory treatment 28 days and three months after cataract surgery. Results Aqueous flare increase of <50%, ≥50%, ≥100%, and ≥200% associated in central subfield macular thickness (CSMT) increase across the groups at 28 days and three months after surgery. Increase of aqueous flare ≥100% compared to those with <100% was associated with increased CSMT ( P = 0.022 at 28 days, and P = 0.027 at three months). At three months, macular thickening (at least 10% CSMT increase) was observed in 12.7% compared to 4.6% of eyes when using a cutoff value of 100% increase in aqueous flare ( P = 0.033). Although diabetic patients presented higher aqueous flare levels at baseline compared to nondiabetic patients (12.9 ± 11.8 vs. 9.8 ± 8.2 photon units/ms P < 0.001), the postoperative levels illustrated a similar profile in aqueous flare increase between the two groups. Conclusions At 28 days, aqueous flare increase was associated with macular thickening. A 100% cutoff value could potentially be used when studying anti-inflammatory efficacy of different treatment protocols. Flare values exceeding this cutoff value could be considered as an indication for extending anti-inflammatory therapy. Translational Relevance A 100% increase in aqueous flare at 28 days after cataract surgery from baseline predicted macular thickening up to three months postoperatively. Identifying a correlation between increased aqueous flare levels and pseudophakic cystoid macular edema may allow recognition of the most vulnerable patients, development of prophylactic treatment strategies and reduction of the number and severity of postoperative complications.

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Postoperative aqueous humour flare as a surrogate marker for proliferative vitreoretinopathy development

Cited by 10 publications

References 16 publications

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

Outcomes and predictors of vitrectomy and silicone oil tamponade in retinal detachments complicated by proliferative vitreoretinopathy

Association between laser flare photometry and symptom duration in primary rhegmatogenous retinal detachment

Relationship Between Prolonged Intraocular Inflammation and Macular Edema After Cataract Surgery

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