ripandelli the author has no potential
DESCRIPTION
http://www.tvrs.gr/TRANSCRIPT
![Page 1: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/1.jpg)
1
The author has no potential
conflict of interest to disclose
![Page 2: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/2.jpg)
2
Modificazioni Vitreo-Retiniche negli Stafilomi nel Miope Elevato ed Eventuali
Indicazioni Chirurgiche.
Guido Ripandelli
Tommaso Rossi*
Fabio Scarinci
Mario StirpeIRCCS – Fondazione Bietti, Roma*Ospedale Oftalmico, Roma
![Page 3: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/3.jpg)
3
Macular Vitreo-Retinal InterfaceAbnormalities in Highly Myopic Eyes with
Posterior Staphyloma:5-Years Follow-Up.
Guido Ripandelli, Tommaso Rossi, * Fabio Scarinci, Cecilia Scassa, Vincenzo Parisi, Mario Stirpe.
Retina 2012;32:1531-8.
![Page 4: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/4.jpg)
4
• Purpose: to review prevalence, long-term progression and prognosis of VR interface modifications in highly myopic eyes with posterior staphyloma
When surgery is necessary?
Which is the best timing for surgery?
• Study design: retrospective, single Institution series
![Page 5: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/5.jpg)
5
Patients’ characteristics
• December 1999 - December 2004
• 408 phakic eyes / 204 subjects
• 108 Males / 96 Females
• Age 22-58 years
• Myopia 18-30 D and PS (Axial lenght 30-34 mm)
![Page 6: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/6.jpg)
6
Inclusion Criteria
• AL > 30 mm
• Presence of posterior staphyloma
• Availability of OCT, MP1 at baseline, at latest examination, (before and after surgery)
![Page 7: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/7.jpg)
7
Exclusion Criteria
Patients with incomplete charts, lost at follow-up, with significant media opacities, with previous ocular surgery
![Page 8: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/8.jpg)
8
Characteristics of patients with VR changes
• Prevalence of posterior VR changes: 236/408 (57.8%) eyes
• Minimum follow-up: 5 years
• Lost to follow-up: 22/236 eyes (9.3%)
• Included in the study: 214 eyes (116 subjects)
– Bilateral VR changes 98/116 (84.4%)
– 54 males /62 females
– Age 24-59 years
– Myopia 19-30 D (29.5-34 mm)
– 209 eyes: visual acuity 20/50-20/20
– 5 eyes: C F – 20/100
![Page 9: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/9.jpg)
9
Testing
• Visual acuity (VA)
• Biomicroscopy
• Optical Coherence Tomography (OCT)
• MP1 Microperimetry
• A, B-scan ultrasound
![Page 10: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/10.jpg)
10
Group 1 Epiretinal membrane without retinal changes (EM) : 98 eyes
Group 2 Macular schisis with/without epiretinal membrane (MSEM): 54 eyes
Asymptomatic macular schisis with EM (AMSEM, 33 eyes)
Symptomatic macular schisis with EM (SMSEM, 14 eyes)
Posterior stretch schisis (PSS, 7 eyes)
Group 3 Partial thickness macular hole (PTMH): 24 eyes
PTHM with retinal schisis (15 eyes)
PTHM without retinal schisis (9 eyes)
Group 4 Full thickness macular hole (FTMH): 18 eyes
Asymptomatic full thickness macular hole (AFTMH, 9 eyes)
Symptomatic full thickness macular hole (SFTMH, 9 eyes)
Group 5 Posterior retinal detachment (PRD): 20 eyes
PRD with macula on (PRD M-on, 11 eyes)
PRD with macula off (PRD M-off, 4 eyes)
PRD with macular hole (PRDMH, 5 eyes)
![Page 11: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/11.jpg)
11
Gr. 1 Epiretinal membrane without retinal changes (EM)
98 eyes (45.7%)
![Page 12: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/12.jpg)
12
Gr. 2 Macular schisis with/without epiretinal membrane (MSEM, 54 eyes)
Asymptomatic macular schisis with epiretinal membrane (AMSEM)
33 eyes (15.4%)
![Page 13: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/13.jpg)
13
Symptomatic macular schisis with epiretinal membrane (SMSEM)
14 eyes (6.5%)
Gr. 2 Macular schisis with/without epiretinal membrane (MSEM, 54 eyes)
![Page 14: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/14.jpg)
14
Posterior stretch schisis (PSS)
7 eyes (3.3%)
Gr. 2 Macular schisis with/without epiretinal membrane
(MSEM, 54 eyes)
![Page 15: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/15.jpg)
15
Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)
PTMH with macular schisis
15 eyes (7%)
![Page 16: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/16.jpg)
16
Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)
PTMH without macular schisis
9 eyes (4.2%)
![Page 17: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/17.jpg)
17
Asymptomatic full thickness macular hole (AFTMH)
9 eyes (4.2%)
Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)
![Page 18: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/18.jpg)
18
Symptomatic full thickness macular hole (SFTMH)
9 eyes (4.2%)
Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)
![Page 19: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/19.jpg)
19
PRD in the staphyloma area with macula on (PRD M-on)
11 eyes (5.1%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
![Page 20: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/20.jpg)
20
PRD in the staphyloma area with macula off (PRD M-off)
4 eyes (1.8%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
![Page 21: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/21.jpg)
21
PRD with macular hole (PRDMH)
5 eyes (2.3%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
![Page 22: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/22.jpg)
22
Evolution to pathologies requiring surgery: 24/205 (11.7%)(9 PRD eyes underwent surgery upon presentation)
Gr. 1 Epiretinal membrane without retinal changes (EM) : 2/98 (2V)
Gr. 2 Asymptomatic macular schisis (AMSEM): 6/33 (3V, 3V+PB)
Symptomatic macular schisis (SMSEM): 7/14 (4V, 3V+PB)
Posterior stretch schisis (PSS): 0/7 -
Gr. 3 PTHM with macular schisis (PTMH-MS): 5/15 (3V, 2V+PB)
PTMH without macular schisis (PTMH-w/o MS): 0/9 -
Gr. 4 Asymptomatic macular hole (AFTMH): 2/9 (2V)
Symptomatic macular hole (SFTMH): 1/9 (1V)
Gr. 5 PRD in staphyloma area / macula ON (PRD M-on): 1/11 (1V)
PRD in staphyloma area/ macula off (PRD M-off): 4/4 (2V, 2V+PB)
PRD with macular hole (PRD-MH): 5/5 (2V, 3V+PB)
V= vitrectomy, PB= posterior buckle
![Page 23: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/23.jpg)
23
Observations
High myopia with posterior staphyloma can be associated with a broad spectrum of vitreoretinal alterations and represents an elusive nosological entity, whose natural history, progression, therapeutic options and surgical timing remain uncertain.
![Page 24: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/24.jpg)
24
Observations
• High myopic eyes with posterior staphyloma show high frequency of vitreoretinal alterations (57.8%)
• Bilateral vitreoretinal changes on 84.5% patients
• Anatomical changes and visual acuity remain in most cases unchanged over time
• In evolutive cases the evolution is quite slow
• OCT and MP1 fundamental exams for diagnosing and follow-up
![Page 25: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/25.jpg)
25
Observations
• Microperimetry provides important data for a timely surgical decision
• Foveal sensitivity decrease and worsening of fixation stability are significantly associated to the need for surgery.
![Page 26: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/26.jpg)
26
Observations• The decrease of sensitivity explored by MP1 is
a sign that may precede the objective worsening of visual acuity
VA 20/25 VA 20/25
![Page 27: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/27.jpg)
27
•Surgical removal of ER tissue represents the first attempt to resolve the pathology
Observations
![Page 28: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/28.jpg)
28
• The reduction of posterior staphyloma by means of posterior buckle is a method to use to repair the unsuccessfull cases
Observations
![Page 29: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/29.jpg)
29
Observations
Vitreoretinal interface alterations in highly myopic eyes have not been univocally classified yet and the concept itself of disease progression and surgical indication are largely debatable and deserve standardization.
![Page 30: Ripandelli the author has no potential](https://reader033.vdocument.in/reader033/viewer/2022060120/5592523c1a28ab17498b45a5/html5/thumbnails/30.jpg)
30
Observations
Foveal sensitivity and fixation patterns are associated to a variable risk of progression and visual prognosis differssignificantly among groups. We believe this variability represents underlying separate pathologies that warrant diversified treatment.