Comparison of complications of intrascleral fixation according to the extent of vitrectomy.

BACKGROUND: Intraocular lens (IOL) fixation is performed after intraoperative anterior or total vitrectomy. This study aimed to compare the intraoperative and postoperative complications of these two techniques. METHODS: This retrospective study included 235 eyes that underwent intrascleral fixation surgery at our hospital between July 2014 and January 2021. The eyes were classified into the anterior vitrectomy group (A-vit group; 134 eyes) and the pars plana vitrectomy group (PPV group; 101 eyes). The age, preoperative and postoperative best-corrected visual acuity, observation period, preoperative and postoperative intraocular pressure, and the incidence of intraoperative and postoperative complications were assessed. RESULTS: Intrascleral fixation was performed more frequently in the PPV group, and a significant difference was observed between the eyes with a history of vitrectomy and eyes with scleral buckles (p = 0.00041). In terms of the incidence of postoperative complications following intrascleral fixation, the incidence of low intraocular pressure postoperative was higher in the PPV group than that in the A-vit group, and a significant difference was observed between the two groups (p = 0.01). CONCLUSIONS: The visual outcome and complications following intrascleral fixation did not differ according to the extent of vitreous excision.

Prevalence and significance of sleep disordered breathing in adolescent athletes.

Sleep disordered breathing (SDB) was more prevalent in adolescent athletes than expected, and several potential warning signs related to autonomic nerve activity appeared in SDB athletes. SDB screening may prevent associated downstream risks in the future. http://ow.ly/GQqK30nGm8r.

Modified capsule expander implantation to reposition and fixate the capsular bag in eyes with subluxated cataractous lenses and phacodonesis: intermediate-term results.

PURPOSE: To report the intermediate-term results of capsule stabilization for scleral fixation with implantation of the Yaguchi hook, a modified capsule expander stabilization hook. SETTING: Department of Ophthalmology, School of Medicine, University of Showa, Fujigaoka Rehabilitation Hospital, Yokohama, Japan. DESIGN: Retrospective case series. METHODS: Patients with zonular dialysis and phacodonesis were followed postoperatively for at least 2 years. All eyes had phacoemulsification and aspiration using an ordinary capsule expander and in-the-bag implantation of an intraocular lens (IOL). Capsule expanders were removed after the residual cortex was removed, and the capsular bag was fixated to the scleral wall via the ciliary sulcus using the modified capsule expander stabilization hook. Preoperative findings, intraoperative complications, and postoperative courses were examined. RESULTS: The mean age of the 11 patients (11 eyes) was 72.2 years ± 10.5 (SD); 5 patients were men. The mean postoperative follow-up was 48.6 ± 13.6 months. The zonular dialysis range was 90 to 180 degrees in 1 eye, 180 degrees in 4 eyes, and 180 to 270 degrees in 1 eye. In 5 eyes, severe phacodonesis was observed without obvious zonular dialysis. In all eyes, the capsular bag and IOL were well centered without severe intraoperative or postoperative complications. CONCLUSION: The modified capsule expander stabilization hook provided good centration and stabilization of the capsule-IOL complex in eyes with severely weak zonular fibers. FINANCIAL DISCLOSURE: Dr. Yaguchi, who is the inventor of the modified capsule expander, has received financial support from Handaya, Tokyo, Japan. No other author has a financial or proprietary interest in any material or method mentioned.

Rap1 GTPase activation and barrier enhancement in rpe inhibits choroidal neovascularization in vivo.

Loss of barrier integrity precedes the development of pathologies such as metastasis, inflammatory disorders, and blood-retinal barrier breakdown present in neovascular age-related macular degeneration. Rap1 GTPase is involved in regulating both endothelial and epithelial cell junctions; the specific role of Rap1A vs. Rap1B isoforms is less clear. Compromise of retinal pigment epithelium barrier function is a contributing factor to the development of AMD. We utilized shRNA of Rap1 isoforms in cultured human retinal pigment epithelial cells, along with knockout mouse models to test the role of Rap1 on promoting RPE barrier properties, with emphasis on the dynamic junctional regulation that is triggered when the adhesion between cells is challenged. In vitro, Rap1A shRNA reduced steady-state barrier integrity, whereas Rap1B shRNA affected dynamic junctional responses. In a laser-induced choroidal neovascularization (CNV) model of macular degeneration, Rap1b(-/-) mice exhibited larger CNV volumes compared to wild-type or Rap1a(-/-) . In vivo, intravitreal injection of a cAMP analog (8CPT-2'-O-Me-cAMP) that is a known Rap1 activator significantly reduced laser-induced CNV volume, which correlated with the inhibition of CEC transmigration across 8CPT-2'O-Me-cAMP-treated RPE monolayers in vitro. Rap1 activation by 8CPT-2'-O-Me-cAMP treatment increased recruitment of junctional proteins and F-actin to cell-cell contacts, increasing both the linearity of junctions in vitro and in cells surrounding laser-induced lesions in vivo. We conclude that in vitro, Rap1A may be important for steady state barrier integrity, while Rap1B is involved more in dynamic junctional responses such as resistance to junctional disassembly induced by EGTA and reassembly of cell junctions following disruption. Furthermore, activation of Rap1 in vivo inhibited development of choroidal neovascular lesions in a laser-injury model. Our data suggest that targeting Rap1 isoforms in vivo with 8CPT-2'-O-Me-cAMP may be a viable pharmacological means to strengthen the RPE barrier against the pathological choroidal endothelial cell invasion that occurs in macular degeneration.

Myopic refractive shift represents dense nuclear sclerosis and thin lens in lenticular myopia.

BACKGROUND: It is not rare to meet unilateral nuclear sclerotic cataracts with myopic refractive changes (lenticular myopia) compared with the fellow eye in the ophthalmic examination of patients with decreased visual acuity. To determine the relationship between the myopic refractive changes and interocular differences of parameters, we investigated the interocular differences of ocular parameters between a lenticular myopic eye and the fellow eye. METHOD: This retrospective study included 68 eyes of 34 patients, who showed unilateral lenticular myopia. We compared the dimensions of ocular component, such as anterior chamber depth, anterior chamber volume, lens thickness, vitreous chamber depth, lens position, lens density of nuclear sclerosis, anterior lens curvature and myopic refractive changes (spherical equivalent refraction) between the lenticular myopic eye and the myopic refractive change were examined. RESULTS: Statistically significant differences were found between the lenticular myopic eye and the fellow eye for anterior chamber depth (p = 0.015) anterior chamber volume (p = 0.031), lens thickness (p < 0.001), lens density of the nuclear sclerosis (p < 0.001) and the spherical equivalent myopic refractive changes (p < 0.001). Based on univariate analysis, the interocular difference in spherical equivalent refraction was significantly correlated with interocular differences of the density of the nuclear sclerosis (r = 0.79, p < 0.001), lens thickness (r = -0.70, p < 0.001) and vitreous chamber depth (r = 0.43, p = 0.012). Based on multiple regression analysis, the interocular difference in spherical equivalent refraction was significantly correlated with interocular differences of density of nuclear sclerosis (p < 0.001) and lens thickness (p = 0.007). CONCLUSION: The difference in myopic spherical change reflects the differences in the severity of nuclear sclerosis and lens thickness between the lenticular myopic eye and the fellow eye.

Periostin, discovered by nano-flow liquid chromatography and mass spectrometry, is a novel marker of diabetic retinopathy.

Diabetes can lead to serious microvascular complications including proliferative diabetic retinopathy (PDR), the leading cause of blindness in adults. Recent studies using gene array technology have attempted to apply a hypothesis-generating approach to elucidate the pathogenesis of PDR, but these studies rely on mRNA differences, which may or may not be related to significant biological processes. To better understand the basic mechanisms of PDR and to identify potential new biomarkers, we performed shotgun liquid chromatography (LC)/tandem mass spectrometry (MS/MS) analysis on pooled protein extracts from neovascular membranes obtained from PDR specimens and compared the results with those from non-vascular epiretinal membrane (ERM) specimens. We detected 226 distinct proteins in neovascular membranes and 154 in ERM. Among these proteins, 102 were specific to neovascular membranes and 30 were specific to ERM. We identified a candidate marker, periostin, as well as several known PDR markers such as pigment epithelium-derived factor (PEDF). We then performed RT-PCR using these markers. The expression of periostin was significantly up-regulated in proliferative membrane specimens. Periostin induces cell attachment and spreading and plays a role in cell adhesion. Proteomic analysis by LC/MS/MS, which permits accurate quantitative comparison, was useful in identifying new candidates such as periostin potentially involved in the pathogenesis of PDR.

[Evaluation of post intraocular lens implantation detrition of clear corneal incisions using an injector system in porcine eyes].

PURPOSE: To evaluate the detrition of clear corneal incisions (CCIs) after intraocular lens (IOL) implantation using an injector system in porcine eyes. METHODS: Group A: after CCIs were performed with 1.8, 2.0, 2.2, 2.4, and 2.65 mm wide slit knives, a Y-60 H (HOYA) IOL was implanted in the anterior chamber using an injector system. Group B: after CCIs were performed with 2.4, 2.65, 2.8, 3.0, and 3.2 mm wide slit knives, a PY-60 R (HOYA) IOL was implanted in the anterior chamber using an injector system. Group C: after CCIs were performed with 2.8, 3.0, 3.2, 3.4 mm wide slit knives, a SN 60 AT (Alcon) IOL was implanted in the anterior chamber using an injector system. CONTROL: CCIs were performed with 3.0 mm wide slit knives. Each group used five porcine eyes for each slit knife (Group A 25 eyes; Group B 25 eyes; Group C 20 eyes; CONTROL 5 eyes). The detrition of the CCIs was evaluated on three different aspects using a scanning electron microscope: a) external expansion at both edges of CCIs; b) rupture of the collagen fibers; c) expansion between the collagen fibers. Aspects a, b and c were given a score of 0, 1, and 2, respectively, and the total points were compared statistically between test and control groups. RESULTS: The degree of CCIs detrition was significantly reduced in CCIs with a width of more than 2.4 mm of CCIs width in Group A, more than 3.0 mm in Group B, and more than 3.2 mm in Group C. CONCLUSIONS: Minimizing the detrition of corneal incisions after IOL implantation needs a larger than the recommended width of corneal incision.

Capsular stabilization device to preserve lens capsule integrity during phacoemulsification with a weak zonule.

We describe a new capsular stabilization device for suspending a lens with weak zonular support. It is flexible, 10.0 mm in length, and fashioned from 5-0 nylon. The contact portion is bent at 1.25 mm with an end bifurcating to form a T-shape to minimize stress on the capsular equator. After a continuous curvilinear capsulorhexis is created, the capsular stabilization devices to hook the capsulotomy margin are inserted. The T-shaped end is passed around the anterior capsular flap to fit the curvature of the equator. Phacoemulsification and aspiration using this device was performed in 12 eyes of 9 patients, and the usefulness and complications were analyzed. The capsular stabilization devices suspended the capsule and facilitated safe phacoemulsification in all eyes. Posterior capsule rupture occurred in 2 eyes. None of the cases had notable postoperative complications. This device ensures a stable capsule-iris complex and reduces surgical risks.

Lens epithelial cell migration between posterior capsule and intraocular lens with variously finished posterior optic edge and two haptic angulations.

PURPOSE: To compare lens epithelial cell migration between intraocular lens (IOL) optics and the posterior capsule of IOLs with various edges and haptic angulations. METHODS: Experimental acrylic IOLs with 3 types of finishing (none, polishing, tumbling and polishing) and 2 types of haptic angulation (10 and 15 degrees ) as well as 3 (AcrySof MA30BA, Sensar AR40, CeeOn 911) clinically implanted IOLs were inserted in rabbit eyes. Scanning electron-microscopic examination of IOLs was carried out before surgery and histological examination of lens capsules 3 weeks after surgery. The grading of lens epithelial cell migration under the IOL was made by scoring. RESULTS: Scanning electron-microscopic examination showed that the optic edge sharpness decreased according to the finishing in experimental IOLs. The AcrySof and CeeOn lenses had sharp edges and the Sensar had a rounded edge. The migration score was highest in the IOL with a rounded edge whereas it was lowest in IOLs with a sharp edge and large haptic angulation. There was no significant difference between the scores of clinically implanted IOLs. CONCLUSION: Sharpness of the optic edge may be a critical factor for the prevention of posterior capsule opacification and more important than haptic angulation in acrylic IOLs.