Small gauge vitrectomy for vitreous amyloidosis and subsequent management of secondary glaucoma in patients with hereditary transthyretin amyloidosis

Abstract

AbstractWe conducted a retrospective observational study including 31 eyes of 20 patients in order to investigate the efficacy of 25-gauge vitrectomy for vitreous opacity with minimal conjunctival invasion and subsequent management of intraocular pressure (IOP) secondary to hereditary transthyretin amyloidosis. We followed up these patients for an average of 44.7 ± 32.6 months. The primary outcome was best corrected visual acuity (BCVA) at 1 month after surgery and at the final follow-up visit, with management of subsequent IOP elevation. Secondary outcomes included the post-vitrectomy IOP survival rate, to determine the frequency of IOP elevation requiring glaucoma surgery. Mean age at vitrectomy was 55.4 ± 9.1 years. Logarithm of the Minimum Angle of Resolution (LogMAR) BCVA showed immediate improvement from 0.73 ± 0.62 to 0.00 ± 0.22 at 1 month (p = 4.1 × 10−7), an improvement that was maintained up to the final follow-up visit, when IOP was maintained at 13.1 ± 5.2 mmHg. The survival rate of post-vitrectomy IOP control was 0.51, 0.38, and 0.23 at 12, 24, and 60 months, respectively. A poor post-vitrectomy IOP survival rate suggests that removing vitreous amyloid via 25-gauge vitrectomy is not sufficient to guarantee good visual function; subsequent careful follow-up and proper glaucoma management is also required in order to achieve this goal.