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An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective.

ABSTRACT: The purpose of this case report is to present a new surgical technique for the treatment of large Subretinal Hemorrhage (SRH) secondary to Age-related Macular Degeneration (AMD). Considering the biomechanics of foam evolution theory, bubble coarsening effect, and gas-liquid biphasic absorption, an SRH due to an AMD case was treated with vitrectomy. The treatment was implemented by subretinal injection of air bubbles combined with rtPA followed by air fluid exchange. The air bubbles helped mess up and remove the blood from the macula area, and no complications occurred. Two weeks postoperatively, there was no sign of hemorrhage and the Central Macular Thickness (CMT) was sharply decreased from 443 μm to 317 μm. At the five-month follow-up, the CMT remained at 267 μm and the patient's visual acuity improved from light perception to 20/70 according to the Snellen chart. The combination of injecting multiple air bubbles and submacular rtPA, followed by air fluid exchange, was able to displace more than (90%) of the subretinal blood just two weeks postoperatively. Our technique is a promising alternative surgical approach for the displacement of SMH due to AMD, with a clear visual and anatomical benefit seen in the early follow-up period.

SUBMITTER: Pappas G

PROVIDER: S-EPMC8163192 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective.

Pappas George G Vidakis Nectarios N Petousis Markos M Kounali Vasiliki V Korlos Apostolos A

Vision (Basel, Switzerland) 20210518 2

The purpose of this case report is to present a new surgical technique for the treatment of large Subretinal Hemorrhage (SRH) secondary to Age-related Macular Degeneration (AMD). Considering the biomechanics of foam evolution theory, bubble coarsening effect, and gas-liquid biphasic absorption, an SRH due to an AMD case was treated with vitrectomy. The treatment was implemented by subretinal injection of air bubbles combined with rtPA followed by air fluid exchange. The air bubbles helped mess u ...[more]

PMID: 34069949

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Project description:PurposeWe report a case of old submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV). Subretinal endoscopic surgery (SES) was performed, which improved visual function. In addition, we show the intraoperative findings of subretinal aberrant PCV vessels as seen under endoscopic observation, which cannot be observed by microscopic surgery.ObservationsA 71-year-old Japanese man presented with an old dehemoglobinized SMH due to PCV in his left eye. At the time of presentation, three weeks had already passed after the onset of the patient's symptoms, and the best-corrected visual acuity (BCVA) was 20/200. SES was performed to remove the SMH and treat the subretinal PCV lesions. After creating retinal detachment using a 38-gauge cannula, three subretinal 25-gauge trocars were inserted from the sclera to the subretinal space. Then, SES was performed under ophthalmic endoscopic observation with continued subretinal irrigation for maintaining the retinal detachment. After removal of the SMH, subretinal polyp-shaped nodular vascular lesions (polyps) and a branching vascular network, which is located inside the retinal pigmented epithelium, were identified. The sites that presumably originated from the aberrant vessels of the PCV and the associated polyps were coagulated using endodiathermy. After the subretinal procedure, the retina was flattened with fluid/air exchange, and silicone oil (SO) was injected into the vitreous cavity. The SMH completely disappeared after surgery. Although at one-month follow-up BCVA (20/250) was slightly worse than that before surgery, there was an improvement in postoperative retinal sensitivity in the macula compared to that before surgery. At the three-month follow-up, the SO was removed. The BCVA was 20/200 one month after SO removal. No postoperative complications occurred. Additional treatment was not required, including anti-vascular endothelial growth factor therapy, for PCV progression or SMH recurrence in the left eye till the final visit two years after surgery.Conclusion and importanceSES could effectively remove the old SMH, and the activity of PCV was suppressed by intraoperative subretinal coagulation. The retinal sensitivity of the macula improved after the SES. In addition, we observed subretinal polyps and a branching vascular network located internal to the retinal pigmented epithelium under intraoperative subretinal endoscopic observation. SES is a good surgical option for the removal of old SMH or treatment of subretinal lesions.

Project description:Preservation of fertility without compromising oncological outcomes is a major objective in young patients at the time of cancer treatment (Azaïs et al., 2018, Bizzarri et al., 2022). Radio(chemo)therapy is often required in pelvic malignancies (anus, rectum, sarcoma). Direct irradiation results in a damage to ovarian (Bizzarri et al., 2023) and endometrial function (Lohynska et al., 2021), compromising the fertility of female patients of reproductive age. While ovarian transposition is an established method to move the ovaries away from the radiation field (Morice et al., 2022, Pavone et al., 2023), corresponding surgical procedures displacing the uterus are investigational (Pavone et al., 2023, Querleu et al., 2010, Ribeiro et al., 2017, Ribeiro et al., 2024). In a human female cadaver model, the reported laparoscopic techniques of uterine displacement were carried out to demonstrate their feasibility and the step-by-step surgical techniques. The surgeries were performed in a hybrid operating room which enables to perform CT-scan and evaluate the uterine positions according to anatomical landmarks. The following procedures were performed in the same cadaveric model and were described in the video: 1. Uterine suspension of the round ligaments to the abdominal wall 2. Uterine ventrofixation of the fundus at the level of the umbilical line 3. Uterine transposition according to the technique reported by Ribeiro et al. All procedures were completed without technical complications. All of these uterine displacement procedures are technically feasible. Uterine transposition is the most technically complex procedure, and its effectiveness in protecting the endometrium should be evaluated in comparison to the simpler techniques (Table 1). Future studies incorporating radiotherapy simulations are needed to define which technique represents the best compromise between surgical complexity and positioning the uterus at a level that receives the lowest possible radiation dose.

Project description:PurposeTo investigate the clinical features, treatment options, and visual outcomes of submacular hemorrhage (SMH) secondary to neovascular age-related macular degeneration (nAMD).DesignA retrospective, observational case series.MethodsSetting: Multicenter institutional setting. Patient Population: A total of 127 patients (127 eyes; 88 men, 39 women; (mean age, 74.2 years)) diagnosed with AMD-associated SMHs exceeding 2 disc diameters involving the fovea. Observation: The AMD types, previous treatments, treatment options, anatomic findings, and best-corrected visual acuity (BCVA) were assessed. Main Outcome Measures: Clinical features, treatment options, and visual outcomes of SMHs secondary to nAMD.ResultsThirty-two eyes had typical AMD, 94 eyes polypoidal choroidal vasculopathy (PCV), and one eye retinal angiomatous proliferation. Eighty-five eyes were treatment-naïve; 42 eyes were treated previously: anti-vascular endothelial growth factor (VEGF) therapy (n = 26), photodynamic therapy (n = 3), and combined therapy (n = 13). Treatment of SMHs included vitrectomy (36 eyes), pneumatic displacement (49 eyes), and anti-VEGF monotherapy (42 eyes). The final BCVA improved significantly in treatment-naïve cases from 0.86 to 0.62 logarithm of the minimal angle of resolution (logMAR) unit (Snellen equivalent from 20/145 to 20/83) and from 0.80 to 0.56 (Snellen equivalent from 20/126 to 20/73) in PCV cases. Meanwhile, the BCVA logMAR values improved from 1.15 to 0.75 (Snellen equivalent from 20/283 to 20/112) and from 0.87 to 0.63 (Snellen equivalent from 20/148 to 20/85) in eyes that underwent vitrectomy or pneumatic displacement, respectively. In eyes with BCVAs between 20/133 to 20/40 at SMH onset, the final VA in the pneumatic displacement group was better than in the anti-VEGF monotherapy group. One eye had a retinal detachment and 1 eye had a macular hole in the vitrectomy group, and 5 eyes had a vitreous hemorrhage in the pneumatic displacement group.ConclusionsThe recommended treatment for SMHs secondary to nAMD exceeding 2 disc area and with BCVA below 20/40 is vitrectomy or pneumatic displacement for visual improvement.

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An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective.

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An Innovatory Surgical Technique for Submacular Hemorrhage Displacement by Means of a Bioengineering Perspective.

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