Results of office-based fluid-air exchange for postvitrectomy hemorrhage in diabetic retinopathy

ABSTRACT Purpose: This study aimed to evaluate the efficacy and clinical outcomes of a one-way fluid-air exchange procedure for the treatment of postvitrectomy diabetic vitreous hemorrhage in patients with proliferative diabetic retinopathy. Methods: This retrospective study included 233 patients with proliferative diabetic retinopathy, who underwent vitrectomy. A one-way fluid-air exchange procedure was performed in 24 eyes of 24 (10.30%) patients with persistent vitreous cavity rebleeding after the operation. Preprocedural and postprocedural best-corrected visual acuity values were achieved. Complications occurring during and after the procedure were analyzed. Results: Significant visual improvement was observed 1 month after the one-way fluid-air exchange procedure (2.62 ± 0.60 LogMAR at baseline vs. 0.85 ± 0.94 LogMAR at postprocedure, p<0.0001). Moreover, 19 (79.17%) eyes needed the procedure once, and 5 (20.83%) eyed had the procedure more than twice. In 3 (12.50%) eyes, reoperation was eventually required because of persistent rebleeding despite several fluid-air exchanges. No complication was observed during the follow-up. Conclusions: The one-way fluid-air exchange procedure can be an excellent alternative to re-vitrectomy for patients with proliferative diabetic retinopathy suffering from postvitrectomy diabetic vitreous hemorrhage by removing the hemorrhagic contents directly and achieving fast recovery of visual function without apparent complications.

Long-term evaluation of the efficacy and safety of Nd:YAG laser vitreolysis for symptomatic vitreous foaters / Avaliação de longo prazo da eficácia e segurança da vitreólise com Nd:YAG laser para moscas volantes sintomáticas

ABSTRACT Purpose: This study aimed to evaluate the long-term safety and efficacy of neodymium-doped yttrium aluminum garnet (Nd:YAG) vitreolysis for symptomatic vitreous floaters as it remains a controversial procedure due to insufficient robust evidence in the literature for the maintenance of the results and absence of adverse effects. Methods: This is an observational extension to the previously presented prospective, randomized, double-blind clinical trial. Eight of thirteen subjects who underwent vitreolysis with YAG laser returned for a late reevaluation, 18 months after the procedure, to evaluate the efficacy and safety of the procedure. Results: All patients maintained the improvement in symptomatology noted after the procedure, with 25% showing complete improvement and a similar proportion (37.5%) reporting significant or partial improvement. Objective improvement in opacity was similar to that found at 6 months follow-up. The NEI-VFQ 25 quality of life questionnaire showed no statistically significant difference in responses between the 6th and 18th month. No adverse effects were noted on clinical examination or reported by patients. Conclusion: Vitreolysis efficacy observed at 6 months of follow-up was maintained until the eighteenth month, with all patients reporting improvement from the pre-procedure state. No late adverse effects were noted. A larger randomized clinical trial is needed to confirm the safety of the procedure.

RESUMO Objetivos: Avaliar a segurança e eficácia a longo prazo da vitreólise com Nd:YAG laser para moscas volantes sintomáticas, uma vez que permanece como um procedimento controverso devido a falta de evidência científica robusta sobre a manutenção dos resultados e ocorrência de efeitos adversos. Métodos: Este estudo é uma extensão observacional de um ensaio clínico prospectivo, randomizado, duplo cego, previamente publicado. Oito de treze pacientes que foram submetidos a vitreólise com YAG laser foram acompanhados para uma reavaliação tardia, dezoito meses após o procedimento, para avaliar a eficácia e segurança do procedimento. Resultados: Todos os pacientes mantiveram a melhora na sintomatologia notada ao final do procedimento original, com 25% dos casos apresentando melhora completa, e uma proporção semelhante (37,5%) demonstrando melhora significativa ou parcial. A melhora objetiva na opacidade foi similar ao achado no seguimento original de 6 meses. O questionário de qualidade de vida NEI-VFQ 25 não demonstrou diferença estatisticamente significativa nas respostas entre o sexto e o décimo oitavo mês de acompanhamento. Nenhum efeito adverso foi notado no exame clínico ou reportado pelos pacientes. Conclusão: A eficácia da vitreólise observada ao sexto mês do acompanhamento foi mantida até o décimo oitavo mês, com todos os pacientes notando algum grau de melhora quando comparado ao estado pré procedimento. Nenhum efeito adverso tardio foi notado. Um ensaio clínico randomizado maior é necessário para confirmar a segurança do procedimento.

Vitreous metastasis from cutaneous melanoma: diagnosis and management / Metástase vítrea de melanoma cutâneo: diagnóstico e tratamento

ABSTRACT Purpose: To report the clinical findings, treatments, and outcomes in a series of patients with vitreous metastasis from cutaneous melanoma. Methods: This single-center, retrospective, interventional case series included patients with biopsy-confirmed vitreous metastasis from cutaneous melanoma diagnosed between 1997 and 2020. Standard 23- or 25-gauge pars plana vitrectomy was performed for diagnostic sampling. Sclerotomies were treated with double or triple freeze-thaw cryotherapy. Perioperative intravitreal injections of melphalan (32 µg/0.075 mL) were administered, when indicated. Visual acuity, intraocular pressure, and systemic and ocular treatment responses were reported. Results: Five eyes of five patients with unilateral vitreous metastasis from cutaneous melanoma were identified. The median age at diagnosis was 84 (range, 37-88) years. The median follow-up after ophthalmic diagnosis was 28 (8.5-36) months; one patient did not have a follow-up. The initial visual acuity ranged from 20/30 to hand motions. Baseline clinical findings included pigmented or non-pigmented cellular infiltration of the vitreous (5/5), anterior segment (4/5), and retina (3/5). Four patients had secondary glaucoma. Systemic therapy included checkpoint inhibitor immunotherapy (n=3, all with partial/complete response), systemic chemotherapy (n=2), surgical resection (n=3), and radiation (n=2). The median time from primary diagnosis to vitreous metastasis was 2 (2-15) years. One patient had an active systemic disease at the time of vitreous metastasis. The final visual acuity ranged from 20/40 to no light perception. Ophthalmic treatment included vitrectomy in all five patients, intravitreal administration of melphalan in three, and intravitreal administration of methotrexate in one. One patient required enucleation, and histopathology revealed extensive invasion by melanoma cells. Conclusions: Vitreous metastasis from cutaneous melanoma can present as a diffuse infiltration of pigmented or non-pigmented cells into the vitreous and may be misdiagnosed as uveitis. Diagnostic pars plana vitrectomy and periodic intravitreal chemotherapy may be indicated.

RESUMO Objetivo: Descrever os achados clínicos, tratamentos, e desfechos em uma série de pacientes com me tástases vítreas de melanoma cutâneo. Métodos: Série retrospectiva de casos de único centro com intervenção. Pacientes incluídos tiveram seu diagnóstico de MVMC confirmado por biópsia entre 1997 e 2020. Vitrectomia via pars plana com 23 ou 25 gauge foram realizadas para obter espécimens. Esclerotomias foram tratadas com crioterapia em duplo ou triplo congelamento. Injeção intravítrea perioperatória de melfalano (32 ug/0,075 mL) foi administrada quando necessário. Foram relatados acuidade visual, pressão intraocular, resposta terapêutica sistêmica e ocular. Resultados: Cinco olhos de 5 pacientes com metástases vítreas de melanoma cutâneo unilateral foram identificados. Idade média de diagnóstico foi 84 anos (variando de 37-88). Seguimento médio após diagnóstico oftalmológico foi 28 (8,5-36) meses; 1 paciente não teve acompanhamento. Acuidade visual inicial variou de 20/30 a movimentos de mão. Achados clínicos iniciais incluíram infiltração de células pigmentadas e não-pigmentadas no vítreo (5/5), segmento anterior (4/5), e retina (3/5). Quatro pacientes tiveram glaucoma secundário. Tratamento sistêmico incluiu imunoterapia com inibidores da via de sinalização (3 - todos com resposta parcial/completa), quimioterapia sistêmica (2), ressecção cirúrgica (3), e irradiação (2). Intervalo médio entre diagnóstico primário e metástases vítreas foi 2 (2-15) anos. Um paciente teve doença sistêmica ativa simultânea as metástases vítreas. Acuidade visual final variou entre 20/40 e SPL. Tratamento oftalmológico incluiu vitrectomia nos 5 pacientes, melfalano intravítreo em 3 e metotrexato intravítreo em 1. Um paciente precisou de enucleação. A histopatologia revelou invasão celular extensa de melanoma. Conclusões: Metástases vítreas de melanoma cutâneo pode se manifestar como uma infiltração difusa de células pigmentadas e não-pigmentadas no vítreo e erroneamente diagnosticada como uveites. Vitrectomia diagnóstica e quimioterapia intravítrea periódica podem estar indicadas.

Relationship between regression of the hyaloid vessels and development of retinal vessels in mice / 中华实验眼科杂志

Objective:To explore the process of regression of the hyaloid vessels and development of retinal vessels in C57BL/6J mice and the relationship between them.Methods:Seventy-five healthy SPF C57BL/6J mice on postnatal day 1 (P1) were selected and divided into control group (65 mice) and oxygen-induced retinopathy (OIR) model group (10 mice) by the random number table method.No treatment was given to control group.Mice in OIR model group were continuously fed in (75±3)% oxygen for 5 days from P7 and in normoxic condition for 5 days from P12.In control group, 5 mice were randomly selected and killed from P1 to P12 and P17, and the eyeballs were collected.In OIR model group, 5 mice were randomly selected and killed on P12 and P17, and the eyeballs were collected.The number of hyaloid arteries (HA), vasa hyaloidea propria (VHP), and tunica vasculosa lentis (TVL) of mice at different time was observed with a microscope.Another 5 adult mice aged 15 months old were selected to detect the vitreous vasculature using optical coherence tomography.The relationship between retinal astrocytes and retinal vascular development, VHP was observed by immunofluorescence staining.This study was approved by the Ethics Committee of Nankai Hospital (No.NKYY-DWLL-2021-070). The use and care of experimental animals followed the Regulations for the Administration of Affairs Concerning Experimental Animals and the ARVO statement.Results:In control group, HA did not degenerate rapidly during eyeball development, which still presented even 15 months after birth.The number of VHP reduced rapidly from P4 to P8, and tended to be stable at 2.33±1.32 on P10 and 1.80±0.92 on P17.The number of TVL reduced rapidly from P5 to P9, reduced to 2.30±1.42 on P10, with most of the TVL blood vessels being transparent without blood supply, and decreased to 0.30±0.48 on P17.Under the guidance of astrocytes, the retinal vessels of mice grew from the optic disc to the peripheral retina from P1 to P8, forming the primary retinal vascular layer.During the development of retinal superficial vessels, VHP showed synchronous regression and the decreased density and thinner diameter in the area covered by retinal vessels.VHP detached from the retina when retinal vessels developed to the peripheral retina, and there was no structural overlap between astrocytes and VHP.In OIR model group, the number of VHP increased from 2.14±0.90 on P12 to 4.60±1.35 on P17 and the number of TVL increased from 2.90±1.55 on P12 to 5.80±1.75 on P17, showing statistically significant differences ( t=4.188, P<0.001; t=4.668, P<0.001). There was no significant difference in the number of VHP and TVL between the two groups on P12 ( t=0.429, P=0.232; t=1.116, P=0.134). The number of VHP and TVL were significantly larger in OIR model group than in control group on P17 ( t=5.422, 9.574; both at P<0.001). Conclusions:In the vitreous vascular system of mice, the regression of VHP and TVL tends to be stable 10 days after birth, and the regression of HA was not obvious.The normal regression of vitreous vessels in mice depends on the normal development of retinal vessels and astrocytes.Retinal hypoxia delays vitreous vascular regression.

Research progress and considerations on non-clinical studies of the drugs administered through the ocular vitreous body / 药学学报

In recent years, with the development of ophthalmic therapeutic drugs, the vitreous body, as a channel for the treatment of ophthalmic diseases, especially fundus diseases, has opened up a new therapeutic approach for various choroidal neovascular diseases, macular edema, uveitis and other diseases associated with fundus diseases, which is represented by wet age-related macular degeneration (wAMD). The drugs administered through the vitreous body mainly include ocular anti-vascular endothelial growth factor (VEGF) injections, microplasmin and hormones. For this kind of ophthalmic products, there are no clear technical guidelines and norms for non-clinical research at home and abroad. This article combines review practices and cases of marketed products to sort out the research progress and considerations on non-clinical studies of ophthalmic drugs dosing through the ocular vitreous body, in order to provide references for the research and evaluation of such drugs.

Efficacy of foldable capsular vitreous body implantation in ocular trauma and silicone oil-dependent eyes / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the clinical effect of foldable capsular vitreous body(FCVB)implantation on ocular trauma and silicone oil-dependent eyes.METHODS: A prospective case study was performed on 17 cases(17 eyes)with ocular trauma and silicone oil-dependent in the First Hospital of Changsha from October 2017 to April 2022. All patients underwent FCVB or silicone oil removal combined with FCVB implantation. The follow-up time was 6mo, and the visual acuity, intraocular pressure, ocular axes, normal external appearances and FVCB were observed at 1wk and 6mo after operation.RESULTS: Only 6 cases had visual acuity before operation, and there were no statistical differences in the visual acuity before and at 1wk and 6mo after operation(P&#x003E;0.05). The intraocular pressure was low before operation, but it was elevated at 1wk and 6mo after operation. The axial length was unchanged at 1wk and 6mo after operation, and the appearance and structure of eyeball were well maintained, and FCVB was stable with no atrophy during the follow-up period.CONCLUSIONS: FCVB implantation can preserve the appearance of eyeball, and avoid atrophy of eyeball and repeated operation, which has favorable clinical application value in the treatment of ocular trauma and silicone oil-dependent eyes.

Effect of intravitreal injection of anti-vascular endothelial growth factor agents on systemic concentration of vascular endothelial growth factor / 国际眼科杂志(Guoji Yanke Zazhi)

Chorioretinal disease has become a significant problem affecting human vision. Abnormal expression of vascular endothelial growth factor(VEGF)leads to increased fundus permeability and neovascularization. Vitreous injection of anti-VEGF agents can rapidly inhibit the level of VEGF in the eye and effectively control the development of the disease. At present, anti-VEGF agents are widely administered in ophthalmology. However, studies have shown that intravitreal anti-VEGF agents can reduce plasma VEGF concentration after entering the circulatory system, and the pointless off-target effects of drugs may lead to systemic adverse reactions. For elderly patients, patients with serious comorbidities, lactating women, premature infants and other special populations, attention should be paid to systemic VEGF inhibition after multiple injections. In this paper, in order to provide reference for clinical anti-VEGF therapy, the pharmacokinetics therapy, systemic adverse reactions, contralateral eye effects, and effects of anti-VEGF on breast milk and preterm infants were discussed, and the systemic effects of vitreous injection of anti-VEGF agents were reviewed.

Research progress of inflammatory cytokines in intraocular fluid of diabetic macular edema / 中华实验眼科杂志

Diabetic macular edema is a common complication of diabetic retinopathy, and is the main cause of vision decline.Antivascular endothelial growth factor (VEGF) agents are the first-line therapy for DME, but some patients still have refractory or recurrent macular edema after anti-VEGF treatment.This suggests that the pathogenesis of DME may involve inflammation-related cytokines other than VEGF.With the development of high-throughput detection technology, the analysis of inflammatory cytokines in the intraocular fluid of patients such as aqueous humor and vitreous humor has attracted more and more attention.At the same time, recognizing the impact of current treatments on inflammatory cytokines will help to formulate more efficient treatment plans.This article reviewed the changes of inflammatory cytokines, such as interleukin-1β (IL-1β), IL-6, IL-8, monocyte chemoattractant protein-1 and intercellular adhesion factor-1 in the course of DME, analyzed the possible mechanisms involved, and discussed the effects of anti-VEGF agents and glucocorticoids on these inflammatory cytokines.

Correlación entre sodio, cloro y potasio del cuerpo vítreo y el intervalo postmortem sobre los 2. 850 msnm / Correlation between sodium, chlorine and potassium of the vitreous body and the postmortem interval above 2. 850 msnm

RESUMEN: El intervalo Postmortem (IPM) es un importante desafío por resolver en la patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiabilidad de algunos métodos por la gran influencia de factores externos y propios del cadáver, la bioquímica forense ha recibido considerable atención por sus niveles de seguridad. La ciudad de Quito se ubica en la cordillera de Los Andes a 2850 msnm, sin embargo, en la literatura no existen reportes de medición de estos parámetros a una altura como ésta. El objetivo fue establecer una correlación entre sodio (Na+), cloro (Cl-) y potasio (K+) del humor vítreo del cuerpo vítreo y el IPM a la altura de la ciudad de Quito. Para el estudio se utilizaron 128 muestras de cuerpo vítreo provenientes de 16 autopsias practicadas en la Unidad de Medicina Legal Zona 9, en IPM de 6, 12, 24, 48, 72, 96, 120 y 144 horas. Para la obtención del humor vítreo se siguió el método convencional, se dividió para las 8 alícuotas y se llevó a congelación -20 °C hasta el momento de su análisis. La cuantificación de la concentración de electrolitos Na+, Cl- y Potasio+ se realizó mediante analizador ISE de Roche Cobas (Roche Diagnostics) C501, calibrado para uroanálisis, y no fue necesaria la dilución. Durante la calibración y cada tres muestras, se midió un estándar interno para corregir los efectos de la desviación sistemática en la calibración. El enfoque estadístico se basó en un análisis de correlación lineal, utilizando el coeficiente de correlación de Spearman. La correlación entre las horas postmortem y las concentraciones de los diferentes electrolitos, fueron estadísticamente significativas. Se pudo corroborar una correlación lineal significativa entre el IPM y el aumento del K+ en el HV.

SUMMARY: The postmortem interval (PMI) is an important challenge to be solved in forensic pathology, and it consists of being able to determine the time elapsed from death to the moment of autopsy. Given the unreliability of some methods due to the great influence of external factors and those specific to the corpse, forensic biochemistry has received considerable attention for its levels of safety. The city of Quito is located in the Andes mountain range at 2850 meters above sea level, however, in the literature there are no reports of measurement of these parameters at a height like this. The objective was to establish a correlation between sodium (Na+), chlorine (Cl-) and potassium (K+) of the vitreous humor and the MPI at a height of 2,850 masl. For the study, 128 samples of vitreous humor were used from 16 autopsies performed in the Zone 9 Legal Medicine Unit, in IPM of 6, 12, 24, 48, 72, 96, 120 and 144 hours. To obtain the vitreous humor, the conventional method was followed, it was divided for the 8 aliquots and it was frozen at -20 ° C until the moment of its analysis. The quantification of the concentration of electrolytes Na+, Cl- and K+ was carried out using an ISE analyzer from Roche Cobas (Roche Diagnostics) C501, calibrated for urinalysis, and no dilution was necessary. During calibration and every third sample, an internal standard was measured to correct for the effects of systematic deviation on the calibration. The statistical approach was based on a linear correlation analysis, using the Spearman correlation coefficient. The correlation between the postmortem hours and the concentrations of the different electrolytes were statistically significant. A significant linear correlation between the PMI and the increase in K+ in vitreous humor could be corroborated.

Preliminary analysis of the relationship between foldable capsular vitreous body implantation and ciliary body function in traumatic eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical efficacy and safety of the foldable capsular vitreous body(FCVB)implantation in the treatment of severe ocular trauma and also explore the effect of ciliary body function on the FCVB implantation. <p>METHODS: This study retrospectively analyzed 10 cases(10 eyes)with severe ocular trauma which had accepted FCVB implantation performed in Affiliated Xiaolan People's Hospital, Southern Medical University from January 2018 to July 2020. Ciliary body function was judged by score which was made by preoperative examination results. The case which scored 5 or less was studied as ciliary failure: 8 eyes scored more than 5, 2 eyes scored 5 or less. Followed up for 1-31mo, the postoperative best corrected visual acuity(BCVA)and intraocular pressure, anterior chamber, retinal reattachment, FCVB condition and adverse reactions were observed. <p>RESULTS: The operations of 9 eyes with aphakia eyes were successful. Iridodialysis occurred during the operation of 1 eye with lens. Retinal reattachment was found in all 10 eyes, and the position of FCVB in all patients was proper. There was no severe adverse reactions. Comparing the preoperative and postoperative BCVA and intraocular pressure, the difference was not statistically significant(<i>P</i>>0.05). In the group(8 eyes)that ciliary body function scored more than 5, 2 eyes had a supplementary operation individually, 1 eye underwent 2 supplementary operations. In the group(2 eyes)which scored 5 or less, supplementary operations were performed 5 times in 1 eye, only 1 time in the other one case. <p>CONCLUSION: Implantation of FCVB is a safe option to treat severe ocular trauma. But the postoperative visual acuity cannot be improved. The ciliary body function associates with persistent intraocular hypotension and shallow anterior chamber after FCVB implantation.

Application of foldable capsular vitreous body in severe ocular trauma and silicone oil dependent eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy and safety of foldable capsular vitreous body(FCVB)in the treatment of severe ocular trauma and silicone oil dependent eyes.<p>METHODS:A retrospective study. Totally 20 patients who were underwent FCVB implantation due to severe ocular trauma and silicone oil reliance conducted in our hospital from May 2018 to October 2019 were select as observation group, 10 previous severe eye trauma patients without FCVB implantation as control group. The visual acuity(VA), intraocular pressure(IOP), exophthalmos, eye axis length, retinal reattachment, and complications of preoperative and postoperative in observation group and control group were recorded. A 1a follow-up was carried out to compare the changes in the observation indicators of each group so as to evaluate the effectiveness and safety of the FCVB.<p>RESULTS: Before and 1a after operation, there were no statistically significant differences in VA, eyeball protrusion, and axial length of the observation group, but IOP was significantly increased. The preoperative eyeball protrusion and axial length of the control group were larger than those of the observation group, but they were smaller than those of the observation group during the 1a follow-up. The eyeball protrusion and axial length of the control group were also significantly reduced 1a after the operation compared with the preoperative baseline. Retinas were well attached, silicone oil emulsification, secondary glaucoma, endophthalmitis and any other severe adverse event were not even occurred in the observation group.<p>CONCLUSION:FCVB could effectively and safely prevent eyeball atrophy in the treatment of severe eye trauma and silicone oil dependent eyes.

Application of foldable capsular vitreous body in severe ocular trauma and silicone oil dependent eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy and safety of foldable capsular vitreous body(FCVB)in the treatment of severe ocular trauma and silicone oil dependent eyes.<p>METHODS:A retrospective study. Totally 20 patients who were underwent FCVB implantation due to severe ocular trauma and silicone oil reliance conducted in our hospital from May 2018 to October 2019 were select as observation group, 10 previous severe eye trauma patients without FCVB implantation as control group. The visual acuity(VA), intraocular pressure(IOP), exophthalmos, eye axis length, retinal reattachment, and complications of preoperative and postoperative in observation group and control group were recorded. A 1a follow-up was carried out to compare the changes in the observation indicators of each group so as to evaluate the effectiveness and safety of the FCVB.<p>RESULTS: Before and 1a after operation, there were no statistically significant differences in VA, eyeball protrusion, and axial length of the observation group, but IOP was significantly increased. The preoperative eyeball protrusion and axial length of the control group were larger than those of the observation group, but they were smaller than those of the observation group during the 1a follow-up. The eyeball protrusion and axial length of the control group were also significantly reduced 1a after the operation compared with the preoperative baseline. Retinas were well attached, silicone oil emulsification, secondary glaucoma, endophthalmitis and any other severe adverse event were not even occurred in the observation group.<p>CONCLUSION:FCVB could effectively and safely prevent eyeball atrophy in the treatment of severe eye trauma and silicone oil dependent eyes.

Application of foldable capsular vitreous body in severe ocular trauma and silicone oil dependent eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the efficacy and safety of foldable capsular vitreous body(FCVB)in the treatment of severe ocular trauma and silicone oil dependent eyes.<p>METHODS:A retrospective study. Totally 20 patients who were underwent FCVB implantation due to severe ocular trauma and silicone oil reliance conducted in our hospital from May 2018 to October 2019 were select as observation group, 10 previous severe eye trauma patients without FCVB implantation as control group. The visual acuity(VA), intraocular pressure(IOP), exophthalmos, eye axis length, retinal reattachment, and complications of preoperative and postoperative in observation group and control group were recorded. A 1a follow-up was carried out to compare the changes in the observation indicators of each group so as to evaluate the effectiveness and safety of the FCVB.<p>RESULTS: Before and 1a after operation, there were no statistically significant differences in VA, eyeball protrusion, and axial length of the observation group, but IOP was significantly increased. The preoperative eyeball protrusion and axial length of the control group were larger than those of the observation group, but they were smaller than those of the observation group during the 1a follow-up. The eyeball protrusion and axial length of the control group were also significantly reduced 1a after the operation compared with the preoperative baseline. Retinas were well attached, silicone oil emulsification, secondary glaucoma, endophthalmitis and any other severe adverse event were not even occurred in the observation group.<p>CONCLUSION:FCVB could effectively and safely prevent eyeball atrophy in the treatment of severe eye trauma and silicone oil dependent eyes.

Level and clinical significance of vitreous microparticles in proliferative diabetic retinopathy / 中华眼底病杂志

Objective:To observe the level of microparticles in the vitreous of patients with proliferative diabetic retinopathy (PDR), and preliminarily explore the role of microparticles in the pathogenesis of PDR.Methods:A case control study. From January to December 2018, 54 cases of 54 eyes of PDR patients (PDR group) and 20 cases of non-diabetic retinopathy patients (control group), who were diagnosed and treated with vitrectomy (PPV) in the Department of Ophthalmology, Tianjin Medical University General Hospital vitreous samples were included in the study. Among 54 eyes in the PDR group, there were 42, 21, and 17 eyes with vitreous hemorrhage (VH), traction retinal detachment (TRD), and previous intravitreal injection of drugs, respectively. Among the 20 eyes of the control group, idiopathic macular hole, idiopathic anterior macular membrane, vitreous macular traction syndrome, and complete lens dislocation were 6, 6, 2, and 6 eyes, respectively. The PDR group was divided into uncombined TRD group and combined TRD group according to PDR stage and whether TRD occurred, with 33 and 21 eyes, respectively. According to the presence or absence of VH, they were divided into groups with VH and without VH, with 42 eyes and 12 eyes, respectively. According to whether anti-vascular endothelial growth factor (VEGF) drugs were injected into the intravitreal cavity 3 days before PPV, they were divided into anti-VEGF drug group and no anti-VEGF drug group, with 17 eyes and 37 eyes respectively. The levels of retinal photoreceptor cells (RMP), platelets (PMP), endothelial cells (EMP) and phosphatidylserine (PS-MP) expressing on the membrane surface in the sample were detected by flow cytometry. The comparison between the two groups of samples was performed by t test, and the comparison between multiple groups of samples was performed by one-way analysis of variance or Mann-Whitney test. Results:Compared with the control group, the vitreous RMP level of the PDR group was significantly decreased, and the EMP and PMP levels were significantly increased. The differences were statistically significant ( t=-2.361, 5.064, 3.531; P=0.018, <0.001, 0.001). There was no statistically significant difference in PS-MP levels between the two groups ( t=-1.617, P=0.110). Compared with the TRD group, the levels of RMP and PMP in the vitreous of the TRD group were significantly increased, and the difference was statistically significant ( t=-2.221, -2.098; P=0.031, 0.041). The level of EMP in the vitreous body of the anti-VEGF drug group was significantly lower than that of the non-anti-VEGF drug group, however, it was still higher than the control group. The difference was statistically significant ( Z=-2.430, -2.499; P=0.015, 0.012). The level of PMP in the vitreous body of the eye without VH was significantly higher than that in the group with VH, and the difference was statistically significant ( t=-3.097, P=0.003). Conclusions:The elevated levels of EMP and PMP in the vitreous of PDR patients may be related to the damage of retinal capillaries; intravitreal injection of anti-VEGF drugs before surgery can reduce the level of EMP. VH may be related to the procoagulant effect of PMP.

Difference of clinical characteristics in ocular toxocariasis between adults and children and characteristics of anti-toxocaria antibody in intraocular fluids / 中华眼底病杂志

Objective:To compare the clinical manifestations of ocular toxoplasmosis (OT) in adult and children, and to preliminarily explore the role of intraocular fluid detection in the early diagnosis of OT.Methods:A retrospective study. From January 2018 to October 2019, 60 cases of OT patients with 60 eyes diagnosed in the Department of Ophthalmology of Beijing Chaoyang Hospital Affiliated of Capital Medical University were included in the study. The medical history information of patients was collected in parallel with slit-lamp microscopy, indirect ophthalmoscope examination, and canine toxoplasma antibody detection in aqueous or vitreous fluid. Fifty-eight cases underwent visual inspection; 2 cases did not underwent visual inspection, who were children. The visual acuity examination was carried out using the new version of the standard logarithmic visual acuity chart, which was converted into the logarithmic minimum angle of resolution(logMAR) visual acuity during statistics. According to age, the patients were divided into adult group and child group, with 12 eyes in 12 cases and 48 eyes in 48 cases, respectively. The clinical characteristics and main points of diagnosis and treatment of the two groups of patients were compared and observed. The comparison among the measurement data groups conforming and the normal distribution was performed by the independent t test. The comparison between the measurement data groups of the skewed distribution was performed by the Kruskal- Wallis test. The qualitative data were compared with χ 2 test. Results:Among the adult group and the child group, 7 (58.3%, 7/12) and 34 (70.8%, 34/48) patients with a clear history of contact with dogs and cats were in the adult group and the child group, respectively. The adult group was significantly lower than the child group, however, there was no different statistical significance ( χ 2=0.236, P=0.627). At the first visit, the self-reported blurred vision of the adult group and the child group was 10 (83.3%, 10/12) and 22 (45.8%, 22/48) cases, respectively. In the adult group and the child group, 3 (25.0%, 3/12) and 20 (43.5%, 20/46) eyes with logMAR visual acuity greater than 1.85, 8 (66.7%, 8/12) and 22 (45.8%, 22/46) eyes with logMAR visual acuity less than 0.3. The visual acuity of the adult group was better than that of the child group, and the difference was statistically significant ( Z=2.162, P=0.031). There was no statistically significant difference in the composition ratio of different clinical types of the two groups of eyes ( χ 2=1.908, P=0.385). The incidence of inflammation in the anterior segment of the eye in the adult group and the child group were 25.0% (3/12) and 56.3% (27/48), respectively; there was no statistically significant difference between the two groups ( χ 2=3.750, P=0.053). The concentration of antibodies in the vitreous humor of the affected eye in the adult group and the child group was greater than that of aqueous humor. The antibody concentrations of vitreous humor and aqueous humor were 36.51 (22.58) and 19.94 (21.78) U/ml in the children group; 45.95 (56.44) and 32.20 (38.64) U/ml in the adult group. Comparison of antibody concentrations in the vitreous humor and aqueous humor of the affected eyes in the child group showed statistically significant differences ( Z=-1.984, P=0.047). Conclusions:Compared with children with OT, adult patients with OT have better vision and mild inflammation or hyperplasia of the vitreous cavity. The detection of antibodies related to toxoplasma in the intraocular fluid is helpful for early diagnosis.

Clinical observation and perception of foldable capsular vitreous body implantation in 73 cases / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To discuss the surgical method of foldable capsular vitreous body(FCVB)implantation and evaluate its therapeutic effect.<p>METHODS: We retrospectively analysis of 73 cases with severe ocular rupture injury after FCVB implanted and silicone oil dependence after vitrectomy in our Hospital from April 2018 to March 2020. The visual acuity, corneal, anterior chamber depth, intraocular pressure, retina, FCVB status, their satisfaction with appearance is observed after treated from 1-20mo.<p>RESULTS: All the 73 patients in this group were successfully operated. The amount of silicone oil injected into the FCVB during the operation was 2.4-4.2mL, with an average of 3.5±0.36mL. There were 22 eyes with light perception, 46 eyes with manual perception and 5 cases with immediate index; 19 eyes during postoperative follow-up. Corneal clarity or basic clarity was observed in 19 eyes, corneal local opacity in 31 eyes, and corneal grayish white opacity in 23 eyes. There were 32 eyes with normal anterior chamber, 23 eyes with shallow anterior chamber, and 18 eyes with completely disappeared anterior chamber. The intraocular pressure(IOP)could not be tested in 22 eyes due to cornea, 17 eyes with IOP less than 8mmHg, and 34 eyes with IOP between 8 and 21mmHg. Slit-lamp microscope examination showed no obvious deviation of the position of FCVB. The postoperative appearances were satisfactory and basically satisfactory in 52 eyes(71%). No balloon rejection, sympathetic ophthalmitis or other obvious surgical complications were observed in all cases.<p>CONCLUSION: For the patients with severe eyeball rupture and silicone-oil-dependent eyes, the FCVB implantation can prevent from eyeball extraction. The operation is safe and effective, and the eyeball shape and intraocular pressure can be well maintained.

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report / Alterações ultraestruturais detectadas pela tomografia de coerência óptica de fonte de varredura em tração vitreopapilar grave: relato de caso

ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

RESUMO A tração vitreopapilar é uma condição incomum caracterizada por forte adesão e tração da hialoide posterior no disco óptico e retina peripapilar, levando à elevação do disco óptico e à perda visual. Um homem de 85 anos apresentou uma história de 6 meses de perda visual lenta e progressiva no olho esquerdo, juntamente com edema do disco óptico. A tomografia de coerência óptica por fonte de varredura revelou tração persistente ântero-posterior peripapilar com traves vítreas densas sobre o disco óptico. Exame de campo visual demonstrou perda de sensibilidade difusa, generalizada, leve e aumento do ponto cego. Uma vitrectomia posterior de calibre 25 foi realizada com separação hialóide posterior do disco óptico, resultando em melhora anatômica e visual significativa. Em conclusão, a tomografia de coerência óptica por fonte de varredura auxilia na compreensão do mecanismo subjacente à perda visual na síndrome de tração vitreopapilar. Além disso, a vitrectomia posterior pode efetivamente promover melhorias visuais e anatômicas nesses casos.

Surgical management of retinal fold after 23-Gauge pars plana vitrectomy retinopexy / Manejamento cirúrgico de dobra de retina após retinopexia com vitrectomia via pars plana de 23-Gauge

Abstract The authors report a case of retinal fold after retinal detachment repair performed using 23-gauge pars plana vitrectomy technic (PPV). The fundus photography and optical coherence tomography (OCT) showed a posterior retinal fold with the retina periphery attached. The patient's best corrected visual acuity (BCVA) was 20/200 with severe metamorphopsia. A 25-gauge PPV, subretinal balanced saline solution (BSS) injection using a 25-39-gauge cannula, and gas-fluid exchange were performed. The patient's BCVA improved significantly after treatment. The retinal fold observed is not a frequent complication and can be managed with PPV, subretinal BSS injection and fluid-air exchange.

Resumo Os autores relatam um caso de dobra retiniana após a cirurgia de reparação de descolamento de retina realizada com vitrectomia via pars plana de 23 gauge (VVPP). A retinografia e a tomografia de coerência óptica (OCT) mostraram uma dobra posterior da retina com a periferia da retina colada. A melhor acuidade visual corrigida do paciente foi de 20/200 e severa metamorfopsia. Foi realizada uma VVPP de 25G, injeção subretiniana de solução salina balanceada (BSS) utilizando uma cânula de calibre 25-39 e troca de fluido-gasosa. A melhor acuidade visual corrigida do paciente melhorou significativamente após o tratamento. A dobra retiniana não é uma complicação freqüente e pode ser tratada com VVPP, realização de injeção subretiniana de BSS e troca fluido-gasosa.

Application of Mixed-effect Model in PMI Estimation by Vitreous Humor / 法医学杂志

Objective To test the changes of the potassium(K+)and magnesium(Mg2+)concentrations in vitreous humor of rabbits along with postmortem interval(PMI)under different temperatures, and explore the feasibility of PMI estimation using mixed-effect model. Methods After sacrifice, rabbit carcasses were preserved at 5℃, 15℃, 25℃ and 35℃, and 80-100μL of vitreous humor was collected by the double-eye alternating micro-sampling method at every 12 h. The concentrations of K+and Mg2+in vitreous humor were measured by a biochemical-immune analyser. The mixed-effect model was used to perform analy-sis and fitting, and established the equations for PMI estimation. The data detected from the samples that were stoned at 10℃, 20℃ and 30℃ with 20, 40 and 65 h were used to validate the equations of PMI estimation. Results The concentrations of K+and Mg2+[f(x,y)] in vitreous humor of rabbits under different temperature increased along with PMI(x). The relative equations of K+and Mg2+concentration with PMI and temperature under 5℃~35℃ were fK+(x,y)=3.413 0+0.309 2 x+0.337 6 y+0.010 83 xy-0.002 47 x2 (P<0.000 1), and fMg2+(x,y)=0.745 6+0.006 432 x+0.033 8 y(P<0.000 1), respectively. It was proved that the time of deviation for PMI estimation by K+and Mg2+was in 10 h when PMI was between 0 to 40 h, and the time of deviation was in 21 h when PMI was between 40 to 65 h. Conclusion In the ambient temperature range of 5℃-35℃, the mixed-effect model based on temperature and vitreous humor sub-stance concentrations can provide a new method for the practical application of vitreous humor chemi-cals for PMI estimation.

Posterior Vitreous Structures Evaluated by Swept-source Optical Coherence Tomography with En Face Imaging

PURPOSE: To evaluate posterior vitreous structures using swept-source (SS) optical coherence tomography (OCT) with en face imaging. METHODS: We retrospectively reviewed OCT images of healthy individuals who did not have intra-ocular disease. We obtained high-definition horizontal and vertical line scans crossing the fovea and 3D scans using SS-OCT, with the 3D scan centered between the fovea and the optic-nerve head. An enhanced vitreous visualization function was used to highlight vitreous structures. En face mode was used to measure the area of Martegiani (AM) and bursa premacularis (BP). We performed all measurements using a built-in function of the viewing software. RESULTS: We enrolled 24 eyes from 12 healthy individuals. The mean patient age was 28.7 ± 4.6 years (range, 24 to 39 years). The mean AM and BP areas were 5.73 ± 0.88 and 18.76 ± 6.95 mm2, respectively. In en face imaging, AM shape was most frequently a vertical oval (18 / 22, 81.8%), while the predominant BP shape was round (16 / 20, 80.0%). AM was in contact with the optic disc, either at the temporal-disc margin (13 eyes, 59.1%) or the nasal optic-disc margin (9 eyes, 40.9%). CONCLUSIONS: Posterior vitreous structures, such as AM and BP, were readily visualized using en face imaging with SS-OCT. Investigating normal vitreous configuration might help in understanding changes in vitreous structures associated with retinal pathology.