RE-INTERVENTION IN DE NOVO VITREOUS OPACITIES AFTER PARS PLANA VITRECTOMY IN FAMILIAL AMYLOIDOTIC POLYNEUROPATHY TTR VAL30METPORTUGUESE PATIENTS.
OBJECTIVE
To report management of de novo vitreous amyloid opacities after previous pars plana vitrectomy in familial amyloidotic polyneuropathy transthyretin Val30Met.


METHODS
This work is a retrospective observational consecutive case series of five eyes of four patients. Demographic data, transthyretin mutation involved, age at the beginning of disease, duration of disease, treatment (liver transplant or tafamidis), time between vitrectomy and re-intervention, and ophthalmologic changes were evaluated. Surgical re-intervention included phacoemulsification with intraocular lens implantation in phakic eyes, re-vitrectomy as complete as possible with posterior capsulectomy, and internal limiting membrane peeling if wrinkling of internal retinal surface was present.


RESULTS
All patients had transthyretin Val30Met mutation, and three were women. Mean age of onset of the disease was 52 ± 11.0 years, and average evolution time of the disease was 8 years. Three patients had been submitted to liver transplant 4, 9, and 15 years before. Time between first vitrectomy and surgical re-intervention was longer than 2 years in all cases. Two eyes had amyloid deposits on anterior lens surface and pupillary border with scalloped pupil. Two eyes were phakic. Glaucoma was present in two eyes; one of them had previous trabeculectomy. All cases had vitreous opacities behind posterior lens capsule and at vitreous base area. After re-intervention, no further recurrence was observed (average follow-up of 10 months).


CONCLUSIONS
De novo vitreous amyloid opacities may occur several years after pars plana vitrectomy. Amyloid deposition in vitreous cavity was observed only in strong vitreous adherence locations (behind posterior lens capsule and at vitreous base area). The authors expect that this procedure, an extensive re-vitrectomy associated with posterior capsulectomy, will prevent de novo vitreous amyloid opacities.
Department of Ophthalmology, Hospital Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Natália Novais
NN
Ferreira
Department of Ophthalmology, Hospital Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
David Afonso
DA
Cunha Dias
Department of Ophthalmology, Hospital Pedro Hispano, Matosinhos, Portugal.
Rui Pedro
RP
Afonso Carvalho
Unidade Corino de Andrade and Department of Neurophysiology, Hospital Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Maria Teresa
MT
Pardal Monteiro Coelho
D000368:Aged; D028227:Amyloid Neuropathies, Familial / Q000150:complications*; D005128:Eye Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058225:Plaque, Amyloid / Q000601:surgery*; D011228:Prealbumin / Q000235:genetics; D012086:Reoperation; D012189:Retrospective Studies; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000473:pathology*
D011228:Prealbumin