Decreased levels of interleukin-6 level in tears and clinical changes in subjects with moderate-to-severe infection corneal ulcers treated with platelet-rich fibrin lysate eye drops.

PURPOSE: To assess the change of interleukin-6 (IL-6) levels in tears and ocular clinical parameters in corneal ulcer patients with moderate-to-severe infection after adjunctive therapy with platelet-rich fibrin (PRF) lysate-eyedrops compared with autologous serum eyedrops. MATERIALS AND METHODS: This study was a randomized double-blind controlled trial, which compared two groups of patients at Dr. Sardjito Hospital, Yogyakarta. A total of 42 patients (42 eyes) were divided into the control group (21 patients) and the intervention group (21 patients). All patients received antibacterial/antifungal therapy based on the etiology, and an adjunctive eyedrop therapy: autologous serum eyedrops for the control group and PRF lysate eyedrops for the intervention group. The IL-6 levels and clinical changes in patients, such as the area of corneal defects, pericorneal injection, and the level of blepharospasm were measured at the baseline, day 6, and day 13 after starting the treatment. RESULTS: Compared to baseline, the mean IL-6 level in day 13 decreased by 426.6 ± 665.4 pg/ml (P = 0.005) and 1283.7 ± 1569.1 pg/ml (P = 0.079) in the intervention and control groups, respectively. However, the difference between the two groups was not statistically significant (P = 0.164). In term of corneal defect area, there was a significant decrease at day 6 and day 13 in both groups but there was no statistically significant difference between the two groups in all time points. Similarly, the proportion of blepharospasm and pericorneal injection severity appeared to improve especially on day 13 in both groups but were not statistically different between the two. CONCLUSION: There was a statistically significant decrease in IL-6 levels in the tears in patient using PRF lysate, but there was no significant difference when compared to those using autologous serum. The difference in defect area, degree of blepharospasm, and pericorneal injection was not statistically significant between the two treatment options.

Lag time, high-risk histopathological features, metastasis, and survival interrelation in retinoblastoma: a perspective from lower-middle income country.

AIM: To investigate the impact of lag time to metastasis and survival rates among patients with retinoblastoma. METHODS: This retrospective study was conducted with 52 patients from the Department of Ophthalmology and the Department of Pediatrics of Dr. Sardjito General Hospital, between 1st January 2014 and 31st December 2020. Lag time was defined as the time delay between the first sign of retinoblastoma to the diagnosis of retinoblastoma. The subjects with lag time > one year were included in the case group, while the subjects with lag time < one year were included in the control group. RESULTS: The lag time was significantly correlated with American Joint Committee on Cancer and Intraocular Classification of Retinoblastoma staging of retinoblastoma (P=0.005 and P=0.006, respectively). The lag time was also significantly correlated with both metastasis event [odds ratio (OR): 5.06, 95%Cl: 1.56-16.44, P=0.006] and mortality (OR: 4.54, 95%Cl: 1.37-15.07, P=0.011). The follow-up was continued for 32 subjects for 3y after initial diagnoses. Survival analysis revealed a significant difference among these two groups (P=0.021). Furthermore, lag time was significantly correlated with survival of retinoblastoma (r=-0.53, P=0.046). CONCLUSION: The study highlights the importance of lag time between the onset of first symptoms and the time of retinoblastoma diagnosis which significantly contribute to metastasis and mortality of patients with retinoblastoma. Examinations for the early detection of retinoblastoma should be performed for individuals at-risk to minimize lag time and improve the outcomes.

Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values.

AIM: To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy (transPRK) in myopia and myopic astigmatism. METHODS: This retrospective cohort study included myopic eyes (-0.50 to -8.75 D) with or without astigmatism (up to 3.50 D) enrolled at Dr. Yap Eye Hospital Yogyakarta. TransPRK was performed using Technolaz 217z100 excimer laser. Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities (UDVA) 3mo post-operatively. Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following transPRK. RESULTS: A total of 140 eyes of 87 consecutive subjects were studied. Prevalence of ametropia following transPRK was 20 (14.29%) eyes. Subjects in ametropia group were significantly older than the emmetropia group (31.80±14.23 vs 18.88±2.41, respectively; P<0.001). Bivariate Logistic regression analysis showed that older age (OR=1.23), higher preoperative spherical equivalent (>-6 D; OR=12.78), steeper anterior keratometric readings (Kmax>45 D and mean K>44 D; OR=4.28 and 4.35, respectively) increased the risk of ametropia following transPRK. Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following transPRK. Complications of transPRK were overcorrection, suspected posterior keratoectasia and accommodation insuffiency. CONCLUSION: Older age can be the strongest factor for increasing ametropia risk following transPRK. Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following transPRK.

Neurofibromatosis type 2 gene mutation and progesterone receptor messenger RNA expression in the pathogenesis of sporadic orbitocranial meningioma.

AIM: To investigate neurofibromatosis type 2 (NF2) gene mutation at mRNA levels in sporadic orbitocranial meningioma and its association with progesterone receptor (PR) mRNA expression. METHODS: This was a case-control study. Thirty-four sporadic meningioma patients with no familial NF2-related meningioma history were recruited. They were interviewed for their obstetric, gynecologic, and contraception history. PR investigation was performed with real-time polymerase chain reaction (PCR). NF2 mutation was investigated using Qbiomarker Somatic Mutation PCR Assay at NF2 mRNA level after its cDNA extraction (four mRNA mutation cytoband coordinates for nucleotide change: c.634C>T/p.Q212, c.655G>A/p.V219M, c.784C>T/p.R262 and c.1228C>T/p. Q410). RESULTS: After mutation analysis at mRNA level, NF2 gene mutation was found in 35.29% patients. Non-mutation group was strongly associated with exogenous hormonal exposure (non-mutation vs mutation: 95.5% vs 83.3%, P<0.001). PR mRNA was found significantly lower in non-mutation group (P=0.033) which presumed as long term exogenous progesterone exposure. However, mutation group was associated with higher rate of progression to grade II (mutation vs non-mutation, 18.2% vs 5%, P<0.001) and was associated more in fibrous and anaplastic tumor tissue. CONCLUSION: NF2 mutation-meningioma is associated with higher grade of meningioma. Non NF2 mutation-meningioma is strongly associated with exogenous progesterone exposure and lower PR expression.

Changes in interleukin-6 tear concentration and clinical outcome in moderate-to-severe bacterial corneal ulcers after corneal collagen cross-linking.

We aimed to evaluate interleukin-6 (IL-6) tear concentration and clinical outcome in patients with moderate-to-severe bacterial corneal ulcers post corneal collagen cross-linking (CXL) therapy. This pre-post designed study involving 21 moderate-to-severe corneal ulcer patients who underwent CXL therapy. Patients with infectious corneal ulcer were given CXL therapy as adjunctive treatment after 5d of broadspectrum antibiotic treatment. Patients with moderate to severe infectious bacterial corneal ulcers were included in this study. Tear sampling was performed before CXL therapy, using sterile Schimer paper from conjunctival inferior fornix. CXL therapy was performed in accordance with the CXL Dresden protocol. Data recording and tear sampling were then performed at day 1 and day 7 after CXL therapy. Data recording included, presence of conjunctival hyperemia, visual analogue scale (VAS), size of corneal defects, and decemetocele. There was a decrease in IL-6 tear concentration by day 7 after CXL therapy (P=0.001). IL-6 concentration at 1h after therapy (2274.67±2120.46 pg/mL) tended to be lower than before therapy (4330.09±3169.70 pg/mL), but the difference was not statistically significant (P=0.821). The size of corneal defects decreased significantly post CXL (P=0.007). The logMAR visual acuity before and after CXL therapy was not found to be significantly different (P=0.277). There was a significant decrease in VAS values (P=0.018) and blepharospasm (P=0.011) pre and post CXL. There was no significant decrease in conjunctival hyperemia pre and post CXL (P=0.293). There was significant reduction in IL-6 tear concentration and clinical improvement in moderate-to-severe bacterial corneal ulcers which underwent CXL therapy.

Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females.

Background: The pathogenesis of meningioma in females and its association with exogenous progesterone is remained unclear. This study was aimed to examine expression of Progesterone receptor (PR) and Neurofibromatosis-2 (NF2) and assess their relationships to history of exogenous progesterone use and risk of meningioma. Methods: Our study was a case-control study that involves 115 females, 40 cases who diagnosed with orbito-cranial meningioma and 75 controls of healthy, that has been presented in previous study. The demographic characteristics, reproductive factors, and history of progesterone use were obtained in-depth face-to-face interviews. PR and NF2 mRNA were assessed by real-time quantitative polymerase chain reaction (RT-qPCR) on serum specimens. Results: The mean age of participants in cases vs. controls were 46.6 ± 6.2 vs. 46.5 ± 7.45 (P = 0.969). The expression of PR and NF2 in cases was significantly lower than in controls. The longer duration of progesterone exposure was significantly associated with lower expression of PR and NF2. Significant association between lower expression of PR (OR 11.7; 95% CI 4.17-32.9; P < 0.001 comparing the lowest quartile vs. 3 highest quartile of PR) and NF2 (OR 4.23; 95% CI 1.85-9.67; P = 0.001 comparing the 2 lowest quartiles vs. 2 highest quartiles) with increased risk of meningioma were also reported. Conclusion: In this study we showed that the longer the exposure to exogenous progesterone, the lower the expression of PR and NF2 mRNA in the serum. Low expression of PR and NF2 were associated with higher risk of meningioma, suggesting that low PR expression and inactivation of NF2 might play a key role in progesterone-associated meningioma tumorigenesis and may be potential clinical marker for females at higher risk of meningioma.

Density and morphology of corneal endothelial cell after phacoemulsification using Ringer lactate versus balanced salt solution as irrigating solutions / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the difference in corneal endothelial cell density and morphology after phacoemulsification using Ringer lactate ( RL ) and balanced salt solution ( BSS) irrigating solutions.?METHODS: The prospective randomized controlled trial study was conducted between February 2017 and April 2017 in Dr. YAP Eye Hospital, Yogyakarta, Indonesia. There were a total of 52 subjects ( 52 eyes ) who were senile cataract patients further grouped into two, 26 patients undergoing the phacoemulsification procedure using RL irrigating solution and the other 26 patients with BSS irrigating solution, both conducted by one operator. On the 1, 7, and 28d post operative, an evaluation was done to measure the density and corneal endothelial cell morphology, as well as the variable of inflammation in the two groups.? RESULTS: Fifty - two eyes had undergone phacoemulsification with posterior intraocular lens implantation. Both groups were evaluated for the endothelial cell reduction and corneal endothelial cell morphology change, along with post - operative inflammation. On the 28d post-operative, endothelial cell reduction in the BSS group ( 173. 96 cell/mm2 , 8. 12％) was lower than the RL group (253.20 cell/mm2, 10.25％), percentage of corneal endothelial cell variation coefficient increase in the BSS group ( 2. 92％, 8. 36％) was lower compared to the RL group (3. 42％, 9. 96％), decrease of hexagonal cells of corneal endothelium cells presentation percentage in the BSS group (4. 30％, 8. 17％) was lower compared to the RL group (4. 84％, 8. 97％), and the percentage increase of central corneal thickness in the BSS group (4. 69 μm, 0. 89％) was almost equal to the RL group (4. 53 μm, 0. 90％). All of the results regarding difference in density and corneal cell endothelium morphology between the two groups did not reveal any statistically significant difference (P>0. 05). Inflammatory variable in the two groups were even.? CONCLUSION: BSS and RL were equal in their capability of maintaining endothelial cell loss and endothelial cell morphologic change in senile cataract patients after phacoemulsification.