Differential distribution of fibrovascular proliferative membranes in 25-gauge vitrectomy for proliferative diabetic retinopathy

AIM:To analyze the distribution of fibrovascular proliferative membranes(FVPMs)in proliferative diabetic retinopathy(PDR)patients that treated with pars plana vitrectomy(PPV),and to evaluate the outcomes separately.METHODS:This was a retrospective and cross-sectional study.Consecutive 25-gauge(25-G)PPV cases operated for PDR from May 2018 to April 2020.According to the FVPMs images outlined after operations,subjects were assigned into three groups:arcade type group,juxtapapillary type group,and central type group.All patients were followed up for over one year.General characteristics,operation-related variables,postoperative parameters and complications were recorded.RESULTS:Among 103 eyes recruited,the FVPMs distribution of nasotemporal and inferiosuperioral was significantly different(both P<0.01),with 95(92.23%)FVPMs located in the nasal quadrants,and 74(71.84%)in the inferior.The eyes with a central FVPM required the longest operation time,with silicon oil used in most patients,generally combined with tractional retinal detachment(RD)and rhegmatogenous RD,the worst postoperative bestcorrected visual acuity(BCVA)and the highest rates of recurrent RD(all P<0.05).FVPM type,age of onset diabetes mellitus,preoperative BCVA,and combined with tractional RD and rhegmatogenous RD were significantly associated with BCVA improvement(all P<0.05).Compared with the central type group,the arcade type group had higher rates of BCVA improvement.CONCLUSION:FVPMs are more commonly found in the nasal and inferior mid-peripheral retina in addition to the area of arcade vessels.Performing 25-G PPV for treating PDR eyes with central FVPM have relatively worse prognosis.

Hybrid laparo-endoscopic access:New approach to surgical treatment for giant fibrovascular polyp of esophagus:A case report and review of literature

BACKGROUND Fibrovascular polyps are rare type of esophageal submucosal neoplasms.They are highly vascularized and can cause difficulty swallowing and even fatal complications such as uncontrolled bleeding and death caused by asphyxiation in case of tumor migration to oropharynx.In the article we describe a novel hybrid technique to surgical treatment–an endoscopic submucosal dissection with laparoscopic removal of the tumor.CASE SUMMARY The patient with a giant fibrovascular esophageal polyp presented with cough,discomfort in the throat,difficulty swallowing,and an episode of tumor migration into oropharynx.The patient was investigated with several imaging studies and was diagnosed with a giant highly vascularized esophageal fibrovascular polyp.The follow-up period of eight months accompanied with no complications.CONCLUSION This method has been shown to have comparable rates of recurrence and a low risk of complications.

喉咽纤维血管性息肉1例

喉咽纤维血管性息肉为罕见的,发生于管腔内的良性黏膜下肿瘤,多发生于中老年男性。现将我科收治的1例喉咽巨大纤维血管性息肉病例,分析报道如下。1临床资料患者,男,63岁,因进行性吞咽困难16余年,加重5个月余入院。该患者既往曾行4次喉咽纤维血管性息肉切除术。初次为16年前,经口行肿块切除术,切除肿块米粒大小,术后症状未缓解。第2次为8年前,因吞咽困难进行性加重,并于打嗝、咳嗽时咽部出现异物就诊于外院,

Recurrent giant fibrovascular polyp of the esophagus

Giant fibrovascular polyps of the esophagus and hypopharynx are rare benign esophageal tumors. They arise most commonly in the upper esophagus and may, rarely, originate in the hypopharynx. They can vary significantly in size. Even though they are benign, they may be lethal due to either bleeding or, rarely, asphyxiation if a large polyp is regurgitated. Patients commonly present with dysphagia or hematemesis. The polyps may not be well visualized on endoscopy and imaging plays a vital role in aiding diagnosis as well as providing important information for preoperative planning, such as the location of the pedicle, the vascularity of the polyp and the tissue elements of the mass. They can also be recurrent in rare cases, especially if the resection margins of the base are involved. We review the recent literature and report a case of a 61-year-old man with a recurrent giant esophageal fibrovascular polyp with illustrative contrast barium swallow, CT and intra-operative images, who required several surgeries via a combination of endoscopic, trans-oral, trans-cervical, trans-thoracic and trans-abdominal approaches.

The role of heredity in pterygium development

Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.The aim of this review is to describe the connection between heredity,UV,and inflammation in pterygium development.Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage.Heredity may be a factor.Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop,and that sunlight is only a trigger,and that chronic inflammation promotes pterygium enlargement.We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or(sunlight)most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals.It also just triggers inflammation and collagenolysis,which may be promoters of the enlargement of the fibrovascular mass.Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.

Difficult polypectomy-giant hypopharyngeal polyp: Case report and literature review

Giant esophageal and hypopharyngeal polyps are benign tumors rarely encountered in clinical practice.In most cases,they are completely asymptomatic;however,despite the rarity of these tumors,interest in giant esophageal polyps derives from their degree of growth(characterized by slow growth into the esophageal lumen)and their mobility.In fact,if regurgitation occurs,they can ascend into the oral cavity and be aspirated into the airways,with potentially lethal consequences.The removal of these giant polyps is recommended.An adequate preoperative evaluation to identify the correct origin of the stalk is mandatory for a successful endoscopic or surgical treatment.A 60-year-old man was admitted to our hospital for anemia.The patient underwent gastroscopy,contrast computed tomography and endoscopic ultrasound.At the conclusion of the procedure,during the extraction of the echoendoscope,the patient began retching and regurgitated the polyp,without experiencing respiratory distress.The patient underwent a left cervicotomy and polyp dissection via a pharyngotomy.

Newly diagnosed diabetes mellitus patients presenting with proliferative diabetic retinopathy as an initial sign

AIM: To investigate the clinical features of newly diagnosed diabetes mellitus(NDM) patients showing proliferative diabetic retinopathy(PDR) as an initial sign. ·METHODS: As a retrospective case series,the medical records of a total of four hundred and thirty-two patients who underwent a vitrectomy due to PDR were reviewed to find the subjects. Of 432 patients,six cases of NDM patients showing PDR as an initial sign were included and analyzed with their systemic and ocular features. Main outcome measures: the systemic features and ocular features [preoperative and postoperative best corrected visual acuity(BCVA),intraoperative findings]. ·RESULTS: The mean onset age of visual symptoms was 36.3 years old. The mean serum insulin and C-peptide titer was below the normal range. The mean fasting plasma glucose was 178mg/dL and the mean postprandial 2h plasma glucose was 306mg/dL. The mean HbA1c at diagnosis was 11.02%. In all cases,an acute progressive fibrovascular proliferation was observed. Intraoperative retinal tears were found in three cases of six. The mean preoperative BCVA was +0.67 ± 0.58 logMAR and the mean BCVA at postoperative 6 months was +0.20±0.30 logMAR. ·CONCLUSION: All patients were considered to have latent autoimmune diabetes in adults(LADA). A rapid deterioration of kidney function as well as poor diabetic control status at diagnosis was observed in all six cases. The ocular features of the patients showed acute progressive fibrovascular proliferation and relatively favorable postoperative visual acuity.

Update on indications for diabetic vitrectomy and management of complications

Despite appropriate management of the systemic disease,patients with diabetes may develop severe forms of diabetic retinopathy that require surgery.Non-clearing vitreous haemorrhage(VH),traction retinal detachment involving the macula,combined traction and rhegmatogenous retinal detachment,progressive fibrovascular proliferation(PFP)and rubeosis with acute VH represent the main indications for surgery.Vitrectomy techniques and surgical tools have developed dramatically in the last decade in order to help the surgeon succeed in these challenging cases.

Effect of intravitreal ranibizumab on fibrovascular membranes in patients with proliferative diabetic retinopathy

AIM: To assess the effects of intravitreal ranibizumab(IVR) on angiogenesis and glial activity of the fibrovascular membrane(FVM) in patients with proliferative diabetic retinopathy(PDR). METHODS: Forty-two eyes from 42 patients with PDR requiring vitrectomy were included and divided into two groups: control group(n=16) did not receive IVR, while IVR group(n=26) underwent IVR 5 d before vitrectomy. FVM specimens were collected by the same surgeon during the interventions. Histopathological morphology was examined by hematoxylin-eosin(H-E) staining and cell densities in the FVM was assessed. Microvessels were outlined by immunohistochemical staining of CD31 and microvessel density(MVD) assessed as an index of FVM angiogenesis. Dual-color immunofluorescence staining, and confocal microscopy was used to detect co-localization and relative expression levels of glial fibrillary acidic protein(GFAP) and α-smooth muscle actin(α-SMA) as markers of glialmesenchymal transition(GMT). The GMT index(GI;ratio of relative GFAP/α-SMA expression) was used to semi-quantify the degree of GMT or glial activity of FVMs. RESULTS: H-E staining showed similar vascularization in both groups, with microvessels and scattered stromal cells in the matrix. Infiltrated cell densities did not differ significantly between the two groups(P>0.05). The MVD of the IVR group(130.62±15.46/mm~2) was significantly lower than that of the controls(142.25±19.16/mm~2, P<0.05). In both groups, all sections were strongly immunostained for GFAP and α-SMA. The Pearson’s correlation coefficients(PCC) of intensity of automated pixel count of two markers indicated GFAP and α-SMA co-stained well and GMT participated in the remolding of FVMs in PDR. The mean relative GFAP expression in the IVR group was significantly lower, whereas that of α-SMA was significantly higher than in controls(P<0.05). GI in the IVR group(1.10±0.10) was significantly lower than in the controls(1.21±0.12, P<0.05). CONCLUSION: IVR can reduce angiogenesis, glial activity of FVM and promote glial-fibrotic transformation by reducing MVD and promoting GMT but does not decrease the cell density in patients with PDR.

Vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis

·AIM:To describe a case in which vitrectomy was required for vitreous hemorrhage and fibrovascular proliferation after laser-induced chorioretinal venous anastomosis (LCVA) for non-ischemic central retinal vein occlusion (CRVO).·METHODS:Observational case report.·RESULTS:A 72-year-old man complained of central scotoma in the left eye,and was diagnosed as suffering from non-ischemic CRVO.LCVA was performed in another hospital.Although favorable visual function was briefly maintained postoperatively,severe vitreous hemorrhage developed in his left eye,necessitating vitrectomy.·CONCLUSION:Considering that LCVA carries a risk of serious complications,we must apply this treatment with caution,especially in ethnic groups,such as the Japanese,in whom pigmentation reacts to photocoagulation excessively.·

Fibrovascular proliferation of retinopathy of prematurity in zone Ⅱ after initial ranibizumab treatment

This study was designed to explore the prevalence of fibrovascular proliferation not regressed in zone Ⅱ stage 3 retinopathy of prematurity(ROP)after initial intravitreal ranibizumab(IVR)injections and to explore the possible influence factors.Fifty-seven patients(108 eyes)with ROP who underwent intravitreal injection of ranibizumab between January 2013 and July 2014 participated in the retrospective study.Based on regress of fibrovascular tissue or not after initial injections of ranibizumab,eligible eyes were divided into two groups.Data was collected and analyzed with SPSS 16.0.In the study,108 eyes of 57 patients(18 females,39 males)underwent initial intravitreal injection.The mean birth weight was 1,440.0±357.7 g and the mean gestational age was 30.5±2.0 weeks.Eight of 57(14.0%)patients showed unfavorable fibrovascular proliferation after initial ranibizumab treatment within 2 weeks.Among them,11 eyes were controlled by further laser treatment and 3 eyes underwent vitrectomy.The difference of occurrence rate in hemorrhage between the two groups was significant(P<0.030),and the unfavorable group required more laser treatment(P<0.001).The incidence of unfavorable fibrovascular proliferation was relatively high,and intraocular hemorrhage was possibly associated with the progress in zone Ⅱ stage 3 ROP after initial IVR injection.

A tarsus construct of a novel branched polyethylene with good elasticity for eyelid reconstruction in vivo

Branched polyethylene(B-PE)elastomer was investigated for its potential medical application as a tarsus construct.The in vitro results showed that the B-PE and processed B-PE films or scaffolds did not exhibit noticeable cytotoxicity to the NIH3T3 fibroblasts and human vascular endothelial cells(ECs).The B-PE scaffolds with a pore size of 280–480 mm were prepared by using a gelatin porogen-leaching method.The porous scaffolds implanted subcutaneously in rats exhibited mild inflammatory response,collagen deposition and fast fibrovascularization,suggesting their good biocompatibility.Quantitative real-time PCR analysis showed low expression of pro-inflammatory genes and up-regulated expressions of collagen deposition and vascularization-related genes,validating the results of historical evaluation in a molecular level.The B-PE scaffolds and Medpor controls were transplanted in rabbits with eyelid defects.The B-PE scaffolds exhibited a similar elastic modulus and provided desirable repair effects with mild fibrous capsulation,less eyelid deformities,and were well integrated with the fibrovascular tissue compared with the Medpor controls.

Fibrovascular polyp of the hypopharynx and esophagus

Fibrovascular polyp of the hypopharynx and esophagus, a rare, benign, intraluminal and submucosal tumor, is most commonly originated from the proximal esophagus. We discussed four cases with regurgitation, respiratory symptom or the feeling of a mass in the throat. All the patients were examined with laryngoscope under general anesthesia. A transverse cervical incision was performed in one patient and the polyps were excised under laryngoscope with CO2 laser in the other three patients. All the lesions were removed successfully. Diagnostic and therapeutic principles involved in these cases are presented and discussed. The recognition of fibrovascular polyp of the hypopharynx and esophagus as a potential cause of regurgitation is paramount. Surgical excision is recommended because of the satisfactory outcome.