Jorge G. Arroyo, MD, MPH
Associate Professor of Ophthalmology, Harvard Medical School
Yousef Aldairy, MD
Mohamed Elmasry, MD
Efren Gonzalez, MD
Mark Kuperwaser, MD
Michael Lewen, MD
Alex Pisig, MD
Steven Reinecke, MD
Peng Sun, MD
Our research focuses on the efficacy and outcomes of novel ophthalmologic surgical techniques, treatment options and imaging for vitreomacular traction, development of an ophthalmic tissue repository, and predictive measures for visual and anatomical success following treatment for retinal diseases.
Endoscopic visualization of the peripheral retina and ciliary body is a valuable tool in vitreoretinal surgery. We are currently conducting two retrospective case series to evaluate the use of endoscopy in (1) ciliary body membrane peeling for patients with ocular hypotony and (2) pars plana vitrectomy with retinectomy for complex retinal detachments complicated by severe proliferative vitreoretinopathy. Our data suggest that while use of the endoscope increases surgical duration, endoscopic vitreoretinal visualization aids in therapeutic and preventative maneuvers, and limits the use of additional intraoperative supplies.
Hypotony is a relatively common postoperative complication for which treatment, either by pharmacologic or surgical means, remains challenging. Our preliminary data suggest that endoscopy-assisted ciliary body membrane peeling has favorable effects in increasing intraocular pressure and stabilizing visual acuity in eyes with chronic hypotony after surgical retinal detachment repair. We have also identified several factors that are correlated with favorable visual and anatomical prognosis following ciliary body membrane peeling.
Vitreomacular Traction: Treatment and Imaging Analysis
Vitreomacular traction (VMT) results when abnormally strong vitreomacular adhesions (VMA) between the vitreous and retina cause tugging of the retina as the vitreous contracts, resulting in distortion of the neurosensory retina, which can lead to vision loss. We conducted a retrospective case series to compare all available treatment options for patients diagnosed with VMT. We also performed a meta-analysis of published literature to assess the rate of VMT resolution among patients who received one of three options: a control injection of saline, intravitreal ocriplasmin (IVO), or pneumatic vitreolysis (PV, the intravitreal injection of an expansile gas with intermittent face down positioning). Our case series confirmed that pars plana vitrectomy has the highest efficacy in treating VMT, as compared with the other nonsurgical options. Both our case series and meta-analysis showed that PV had a higher rate of VMT resolution compared with IVO at Day 28 post-treatment.
We also published a case report describing a patient with resistant VMT successfully treated with an intravitreal injection of a lower dose of ocriplasmin and a residual intravitreal gas bubble from pneumatic vitreolysis. Our report showed the efficacy of combining the mechanical forces of PV with the enzymatic fibrinolytic activity available in a lower dose of ocriplasmin to treat resistant VMT cases, non-invasively.
We have also conducted a study to investigate the value of imaging via spectral-domain optical coherence tomography (SD-OCT) in predicting changes in acuity following successful treatment for VMT. Our results show that recovery of the cone outer segment tips (COST) line and inner segment/outer segment (IS/OS) line defects as observed by SD-OCT is positively correlated with visual acuity improvement after successful VMT treatment.
In May 2017, our research team attended the annual meeting for the Association for Research in Vision and Ophthalmology (ARVO) in Baltimore. We presented our work on endoscopy-assisted retinectomy for complex retinal detachments as well as our findings regarding the capacity of SD-OCT to predict visual outcomes following surgery for VMT. In 2017, I also presented our findings on macular hole formation following pneumatic vitreolysis for vitreomacular traction at the Retina Society and the Macula Society.
Consistent with our interest in studying novel treatments for vitreomacular traction (VMT), we are currently investigating the efficacy of pneumatic vitreolysis (PV) for symptomatic VMT in eyes with and without macular holes. In our current case series, we have found that PV successfully released VMT in all eyes with early or full thickness macular holes (FTMH). However, MH closure was not achieved in any eyes with full thickness MH following PV alone. Our preliminary analysis suggests that foveal thinning is a risk factor for the development of FTMH and that PV alone may be ineffective in treating cases of VMT associated with FTMH.
We have continued to utilize our database of nearly 20 years of clinical and surgical data from the BIDMC retina service to compare treatments and study outcomes and predictive factors for various retinal conditions. We are currently conducting a retrospective comparison of outcomes following different types of retinal detachment repair, including pars plana vitrectomy, scleral buckle with and without vitrectomy, and pneumatic retinopexy. We are also examining long-term visual and anatomical outcomes of choroidal detachment repair in a small case series. In addition, we are investigating the association between the condition of the posterior vitreous, classified as one of five stages, and postoperative measures following vitrectomy for ocular complications associated with diabetes.
Teaching, Training, and Education
I have continued to train rotating residents, fellows, and medical school students from around the world in clinical, surgical, and research settings. We have welcomed several new members to our Retina Service and clinical research team, including ocular oncology specialist Dr. Efren Gonzalez, BIDMC-Lahey Hospital surgical fellows Dr. Steven Reinecke and Dr. Michael Lewen, and BIDMC-Joslin Diabetes Center medical retina fellows Dr. Yousef Aldairy, Dr. Mohamed Elmasry, and Dr. Alex Pisig. Dr. Peng Sun of the First Hospital of China Medical University in Shenyang is completing a 2-year International Retina Research Fellowship with our department. We are working with four Boston University Master’s students conducting their clinical research theses with our group. Rachel Tandias is our current clinical research assistant.
Abstracts, Posters, and Exhibits
Tandias R, Sun P, Arroyo JG. Outcomes of Relaxing Retinotomy for Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy. Poster presented at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), Baltimore, MD,2017.
Sun P, Tandias R, Yu G, Arroyo JG. Correlation between macular features in spectral-domain optical coherence tomography images and visual outcome after vitreomacular traction surgery. Poster presented at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), Baltimore, MD, 2017.
Yu G, Sun P, Van Zyl T, Tandias R, Arroyo JG. Bilateral Central Retinal Vein Occlusions in a Young Patient with a History of Eosinophilic Pneumonia and Thalamic Stroke. Retin Cases Brief Rep 2016;Dec 29:Epub ahead of print.
Arroyo JG, Yu G, Tandias R, Wagley S. Pneumo-Enzymatic Vitreolysis for Resistant Vitreomacular Traction. Ann Clin Case Rep 2016;1(1104):1-2.
Yu G, Duguay J, Marra KV, Gautam S, Le Guern G, Begum S, Sharifzadeh A, Arroyo JG. Efficacy and safety of treatment options for vitreomacular traction: A Case Series and Meta-Analysis. Retina 2016 Jul;36(7):1260-70.
Chang JS, Marra K, Flynn HW Jr, Berrocal AM, Arroyo JG. Scleral Buckling in the Treatment of Retinal Detachment Due to Retinal Dialysis. Ophthalmic Surg Lasers Imaging Retina 2016 Apr 1;47(4):336-40.
Marra KV, Wagley S, Kuperwaser MC, Campo R, Arroyo JG. Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration. J Am Geriatr Soc 2016 Feb;64(2):369-77.