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De novo vitreous opacities after pars plana vitrectomy in familial amyloidotic polyneuropathy TTR Val30Met: what to do?

Session Details

Session Title: Vitreoretinal Surgery I

Session Date/Time: Thursday 17/09/2015 | 08:30-10:30

Paper Time: 08:54

Venue: Apollon.

First Author: : N.Ferreira PORTUGAL

Co Author(s): :    J. Coelho   C. Teresa           

Abstract Details

PURPOSE:To report management of de novo vitreous amyloid opacities after previous pars plana vitrectomy in familial amyloidotic polyneuropathy TTR Val30Met.


Centro Hospitalar do Porto Unidade Corino de Andrade Porto Portugal


Retrospective observational consecutive case series of 5 eyes of 4 patients. Demographic data, TTR mutation involved, age at the beginning of disease, duration of disease, treatment (liver transplant or tafamidis), time between vitrectomy and re-intervention and ophthalmological changes were evaluated. Surgical re-intervention included phacoemulsification with intra-ocular lens implantation in phakic eye, re-vitrectomy as complete as possible with posterior capsulotomy and ILM peeling if wrinkling of internal retinal surface was present.


All patients had TTR Val30Met mutation and three were female. Mean onset of disease age was 52 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, pupillary border and scalloped pupil. Two eyes were phakic. Glaucoma was present in two cases, one of them had previous trabeculectomy. All eyes had vitreous opacities behind posterior lens capsule and at vitreous base area. After re-intervention, no futher recurrence was observed until last follow-up (average 10 months).


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). Posterior capsulotomy associated to an extensive re-vitrectomy seemed to be an effective procedure to prevent de novo vitreous amyloid opacities.

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