Primary Retinal Detachment

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152 heparin was published in eyes undergoing retinal reattachment and thought to be at high risk for the development of PVR rather than having already established PVR. In this study, 200 µg/ml of 5-FU and 5 IU/ml of low-molecular-weight heparin were added to the intravitreal infusate in a randomized fashion, with the remainder of the patients receiving a placebo injection into the infusate during vitrectomy. The incidence of post-operative PVR was judged to be lower at 6 months in the treatment group (12.6%) than the placebo group (26.4%), with those in the placebo group also requiring a higher re-operation rate than those in the 5-FU group. However, no differences were seen in the final complication rates [42]. Results of a similar protocol for the treatment of established PVR are still pending at the time of writing of this chapter. Daunomycin 7 Pharmacological Approaches to Improve Surgical Outcomes Another anti-proliferative agent, daunomycin, has been tested in preclinical and clinical studies. The drug is an anthracycline antibiotic with efficacy in an animal model. Daunomycins appear to have a somewhat lower therapeutic index than 5-FU, principally due to its greater toxicity; but it has been tolerated in animals and in humans as a continuous intravitreal infusion of 7.5 µg/ml for 10 min. In pilot studies of patients undergoing vitrectomy, daunomycin was felt to be effective [26, 43].A variety of other agents have been employed for the treatment of experimental PVR, with no significant published data yet in human trials. These include retinoids, which play an important role in the differentiation and proliferation of various cell types, including RPE. The treatment of RPE cells with vitamin A (all-trans-retinol) significantly inhibits cellular proliferation migration in vitro as well as having effects on morphology [44]. Immunotoxins composed of a monoclonal antibody linked to a biological toxin have been employed in experimental models, including an antibody against the human transferrin receptors to the A chain of ricin [45].
Drugs Acting on the ECM 153 Another chemotherapeutic agent useful in cancer and also in the treatment of coronary restenosis, Taxol, has been tested for efficacy in experimental models in the eye. It appears to act as a promoter rather than an inhibitor of microtubular assembly and inhibits cell-mediated contraction of a collagen gel as well as experimental retinal detachment in various animal models [46]. A related cytoskeletal agent, Colchicine, also inhibits RPE astrocyte and fibroblast proliferation in addition to migration and was shown in one animal model to have some beneficial effects on PVR, although it has not yet been proven to be beneficial in any human studies [47]. Drugs Acting on the ECM Drugs which act on the interface between cells and the ECM have the potential to inhibit intraretinal scarring at a relatively earlier step than simple proliferation. Heparin and related peptides have a multitude of effects on cells and their interaction with the ECM. Heparin is a glycosaminoglycan derived from heparin sulfate,which binds to several ECM proteins, including fibronectin, laminin, and vitronectin [48]. In addition to its antithrombotic properties, for which it was first discovered and processed, heparin clearly has important effects on a variety of growth factors. It actively binds fibroblast growth factor, platelet-derived growth factor, and endothelial-cell growth factor. Soluble heparin causes an increase in cell spreading and produces changes in the cytoskeleton of smooth muscles. It also inhibits the polymerization of type-1 collagen and reduces cell-mediated contraction of collagen gels when cultured fibroblasts or RPE cells are interspersed within a collagen matrix. This may be a process analogous to hypocellular gel contraction,an important attack point in the prevention of PVR [15, 48]. Because heparins have significant anticoagulant affects, they may result in hemorrhagic complications, and this stimulated the
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Ingrid Kreissig (Ed.) Primary Retin
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Professor Dr. med. Ingrid Kreissig
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Contents 1 The History of Retinal D
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List of Contributors Gary W. Abrams
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List of Contributors XI Hermann D.
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2 Helmholz in 1850 made an accurate
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4 (vitreous, gelatin) into the ante
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6 with scleral resection that set t
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8 ditis [72-74].Temperatures up to
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10 1 The History of Retinal Detachm
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16 ion [147]. Perfluorocarbon liqui
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26 2 Prophylaxis in Fellow Eye of P
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32 found that eyes with pre-existin
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36 3 Encircling Operation with Drai
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Chapter 4 Pneumatic Retinopexy for
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Technique 57 Case Selection Proper
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Technique 59 Table 4.1. Gas charact
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Technique 61 solution; however,thes
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Technique 63 gas reflux. Following
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Complications: Prevention and Manag
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New Possibilities 67 ing on type an
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Results 69 Table 4.7 (continued) Au
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Discussion 71 surgical failures. Fa
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Discussion 73 Disadvantages of PR A
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References 75 situations, then to p
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References 77 24. Tornambe PE, Hilt
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References 79 51. Pournaras CJ, Don
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Chapter 5 Vitrectomy for the Primar
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Indications 83 Table 5.1. Indicatio
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Indications 85 Fig. 5.2. The vitreo
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Surgical Technique 87 vitrectomy an
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Outcomes 89 will be visible under a
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Outcomes 91 almost no persistent su
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References 93 7. Heimann H, Bornfel
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96 6 Minimal Segmental Buckling Wit
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98 6 Minimal Segmental Buckling Wit
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100 the operating table with the re
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Page 136 and 137: Table 6.3. Final attachment after m
Page 138 and 139: 130 Choroidals In 4 of the 1,462 de
Page 140 and 141: Table 6.4. Visual acuity at 2 years
Page 148 and 149: 140 Probably, the future question n
Page 154 and 155: 146 7 Pharmacological Approaches to
Page 162 and 163: 154 search for compounds with hepar
Page 168 and 169: Chapter 8 Systematic Review of Effi
Page 170 and 171: Materials and Methods 163 Table 8.2
Page 172 and 173: Discussion 165 30% 25% 20% 15% 10%
Page 174 and 175: Discussion 167 Fig. 8.2. The small
Page 176 and 177: Conclusion 169 vitrectomy and searc
Page 178 and 179: References 171 8. Brazitikos PD, D
Page 180 and 181: References 173 34. Gunduz K, Gunalp
Page 182 and 183: References 175 63. Schepens CL (195
Page 184 and 185: 178 9 Repair of Primary Retinal Det
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Page 192 and 193: 186 a b 9 Repair of Primary Retinal
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Page 198 and 199: Chapter 10 Retinal Detachment Repai
Page 200 and 201: Retinal Detachment Repair: Outlook
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Retinal Detachment Repair: Outlook
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References 207 It is impossible to
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210 C Campbell 7 case selection 57,
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212 M Machemer 13 macular - complic
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214 retinal - detachment - - bilate
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