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Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial

  • Retinal Disorders
  • Published:
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Abstract

Background

Cellophane membranes are an early stage of proliferative vitreoretinopathy (PVR) complicating retinal detachment surgery. Our aim was to assess whether a prolonged administration of systemic corticosteroids would attenuate early stages of PVR such as cellophane membranes.

Design

Prospective randomized placebo-controlled double-blind clinical trial.

Patients and methods

A total of 220 consecutive eyes (220 patients) were operated for primary rhegmatogenous retinal detachment (RD), mainly by scleral buckling procedures. Patients were randomized into two groups: 110 patients (steroid group) received prednisone for 15 days starting with 100 mg at the day of surgery and being tapered to 12.5 mg. The control group of 110 patients received placebo in a comparable manner. Follow-up examinations were performed at 1, 3 and 6 months postoperatively, and included visual acuity and assessment of retinal findings.

Results

Cellophane membranes occurred in 41.8%, 46.9%, and 39.1% in the placebo group and 26.7%, 23.6%, and 19.8% in the steroid group at 1, 3 and 6 months postoperatively (p < 0.05, = 0.0005, and <0.005 respectively). The application of five or more cryocoagulation spots was associated with more cases developing cellophane membranes in the placebo than the steroid group (p < 0.05). A complete reattachment of the retina was achieved in 95% steroid and 89% placebo group eyes, and a reattachment of the macula in 98% of both groups. There was no significant difference of the final visual outcome in both groups.

Conclusion

Early stages of PVR such as cellophane membranes after retinal detachment surgery can be reduced with corticosteroids in oral doses.

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References

  1. Kirchhof B (2004) Strategies to influence PVR development. Graefes Arch Clin Exp Ophthalmol 242:699–703

    Article  PubMed  CAS  Google Scholar 

  2. Koerner F (1989) Clinical diagnosis of proliferative vitreoretinopathy. Klin Monatsbl Augenheilk 194(5):383–388

    Article  CAS  Google Scholar 

  3. McCarty DJ, Mukesh BN, Chikani V, Wang JJ, Mitchell P, Taylor HR, McCarty CA (2005) Prevalence and associations of epiretinal membranes in the visual impairment project. Am J Ophthalmol 140(2):288–294

    Article  PubMed  Google Scholar 

  4. Snead DR, James S, Snead MO (2008) Pathological changes in the vitreoretinal junction 1: Epiretinal membrane formation. Eye 22:1310–1317

    Article  PubMed  CAS  Google Scholar 

  5. Hagler WS, Aturaliya U (1971) Macular pucker after retinal detachment surgery. Br J Ophthalmol 55:451–457

    Article  PubMed  CAS  Google Scholar 

  6. Lobes LD Jr, Burton TC (1978) The incidence of macular pucker after retinal detachment surgery. Am J Ophthalmol 85:72–77

    PubMed  Google Scholar 

  7. Margherio RR, Margherio AR (1995) Macular holes and epiretinal macular membranes. Duane’s Clin Ophthalmol 6(61):1–18

    Google Scholar 

  8. Iandiev I, Bringmann A, Wiedemann P (2010) Proliferative vitreoretinopathy — pathogenesis and therapy. Klin Monatsbl Augenheilk 227:168–174

    Article  CAS  Google Scholar 

  9. Tano Y, Chandler D, Machemer R (1980) Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol 90(6):810–816

    PubMed  CAS  Google Scholar 

  10. Chandler DB, Hida T, Sheta S, Proia AD, Machemer R (1987) Improvement in efficacy of corticosteroids therapy in an animal model of proliferative vitreoretinopathy by pretreatment. Graefes Arch Clin Exp Ophthalmol 225(4):259–265

    Article  PubMed  CAS  Google Scholar 

  11. Hui YN, Liang HC, Cai YS, Kirchhpf B, Heimann K (1993) Corticosteroids and daunomycin in the prevention of experimental proliferative vitreoretinopathy induced by macrophages. Graefes Arch Clin Exp Ophthalmol 231(2):109–114

    Article  PubMed  CAS  Google Scholar 

  12. Dehghan MH, Ahmadieh H, Soheilian M, Azarmina M, Moradian S, Ramezani AR, Tavallal A, Naghibozakerin J (2010) Effect of oral prednisolone on visual outcomes and complications after scleral buckling. Eur J Ophthalmol 20:419–423

    PubMed  Google Scholar 

  13. Bali E, Feron EJ, Peperkamp E, Veckeneer M, Mulder PG, van Meurs JC (2010) The effect of preoperative subconjunctival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial. Graefes Arch Clin Exp Ophthalmol 248:957–962

    Article  PubMed  CAS  Google Scholar 

  14. Pastor JC, Rodriguez E, Marcos MA, Lopez MI (2000) Combined pharmacologic therapy in a rabbit model of proliferative vitreoretinopathy (PVR). Ophthalmic Res 32(1):25–29

    Article  PubMed  CAS  Google Scholar 

  15. Sharma T, Gopal L, Reddy RK, Kasinathan N, Shah NA, Sulochana KN, Miriam KC, Arvind K, Ramakrishna S, Sukumar B (2005) Primary vitrectomy for combined rhegmatogenous retinal detachment and choroidal detachment with or without oral corticosteroids: a pilot study. Retina 25:152–157

    Article  PubMed  Google Scholar 

  16. Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM (1991) An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol 112:159–165

    PubMed  CAS  Google Scholar 

  17. Gilbert C, Hiscott P, Unger W, Grierson I, McLeod D (1988) Inflammation and the formation of epiretinal membranes. Eye 2(Suppl):140–156

    Article  Google Scholar 

  18. Bringmann A, Pannicke T, Grosche J, Francke M, Wiedemann P, Skatchkov SN, Osborne NN, Reichenbach A (2006) Müller cells in the healthy and diseased retina. Prog Retin Eye Res 25:397–424

    Article  PubMed  CAS  Google Scholar 

  19. Rasier R, Gormus U, Artunay O, Yuzbasioglu E, Oncel M, Bahcecioglu H (2010) Vitreous levels of VEGF, IL-8, and TNF- in retinal detachment. Curr Eye Res 35(6):505–509

    Article  PubMed  CAS  Google Scholar 

  20. Goczalik IM, Raap M, Weick M, Milenkovic I, Heidmann J, Enzmann V, Wiedemann P, Reichenbach A, Francke M (2005) The activation of IL-8 receptors in cultured guinea pig Müller glial cells is modified by signals from retinal pigment epithelium. J Neuroimmunol 161:49–60

    Article  Google Scholar 

  21. Goczalik IM, Ulbricht E, Hollborn M, Raap M, Uhlmann S, Weick M, Pannicke T, Wiedemann P, Bringmann A, Reichenbach A, Francke M (2008) Expression of CXCL8, CXCL1, and CXCL2 in neurons and glial cells of the human and rabbit retina. Invest Ophthalmol Vis Sci 49:4578–4589

    Article  PubMed  Google Scholar 

  22. Ricker LJAG, Kijlstra A, Kessels AGH, de Jager W, Liem ATA, Hendrikse F, La Heij EC (2011) Interleukin and growth factor levels in subretinal fluid in rhegmatogenous retinal detachment: A case-control study. PlLoS One 6(4):e19141

    Article  CAS  Google Scholar 

  23. Remy C (1982) Retinal detachment and retraction. Effect of steroidal and nonsteroidal anti-inflammatory agents on the autoimmune reaction against the retina in idiopathic retinal detachment with signs of retraction. J Fr Ophtalmol 5(10):621–632

    PubMed  CAS  Google Scholar 

  24. Baudouin C, Fredj-Reygrobellet D, Baudouin F, Lapalus P, Gastaud P (1989) Immunohistologic study of proliferatived vitreoretinopathy. Am J Ophthalmol 108:387–394

    PubMed  CAS  Google Scholar 

  25. Park AH (2011) The effect of preoperative subconjunctival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 249:151–152

    Article  PubMed  Google Scholar 

  26. Koerner F, Merz A, Gloor B, Wagner E (1982) Postoperative retinal fibrosis — a controlled clinical study of systemic steroid therapy. Graefes Arch Clin Exp Ophthalmol 219:268–271

    Article  PubMed  CAS  Google Scholar 

  27. Weijtens O, Schoemaker RC, Lentjes EG, Romijn FP, Cohen AF, Van Meurs JC (2000) Dexamethasone concentration in the subretinal fluid after subconjunctival injection, a peribulbar injection, or an oral dose. Ophthalmology 107(10):1932–1938

    Article  PubMed  CAS  Google Scholar 

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Acknowledgement

The authors would like to express their gratitude to the late Professor Robert Machemer, M.D., and Ulrich Steinhorst, M.D., Department of Ophthalmology, Durham NC, for their substantial support in planning, discussing and designing this study during the years 1993 through 1999.

No funding was received to support this study.

Author information

Authors and Affiliations

  1. Klinik Siloah, CH-3073, Guemligen, Bern, Switzerland

    Fritz Koerner & Ursula Koerner-Stiefbold

  2. Berner Augenklinik am Lindenhofspital, CH-3012, Bern, Switzerland

    Justus G. Garweg

Authors
  1. Fritz Koerner
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  2. Ursula Koerner-Stiefbold
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  3. Justus G. Garweg
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Corresponding author

Correspondence to Fritz Koerner.

Additional information

Data for this study were collected from patients at the Department of Ophthalmology, University of Bern, Switzerland; former Director F. Koerner.

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments, Good Clinical Practice, and applicable regulatory requirements. The study was approved by the local institutional ethics committee, and all participants gave written informed consent prior to entry into the study.

No proprietary interest of any author.

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Koerner, F., Koerner-Stiefbold, U. & Garweg, J.G. Systemic corticosteroids reduce the risk of cellophane membranes after retinal detachment surgery: a prospective randomized placebo-controlled double-blind clinical trial. Graefes Arch Clin Exp Ophthalmol 250, 981–987 (2012). https://doi.org/10.1007/s00417-011-1919-y

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  • DOI: https://doi.org/10.1007/s00417-011-1919-y

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