The effect of the intercellular adhesion molecule-1 and glycated haemoglobin on the management of diabetic neovascular glaucoma.

Introduction: The study hypothesizes that some patients with diabetic neovascular glaucoma (NVG) do not fully respond to transscleral (TSC) cyclophotocoagulation (CPC) due to significant inflammation and insufficient glucose control. Objective: The study aimed to determine the effect of baseline blood levels of intercellular adhesion molecule-1 (ICAM-1) and glycated haemoglobin (HbA1c) on the management of patients with diabetic NVG by TSC CPC. Methods: This open prospective study included 70 diabetic patients (75 eyes; aged Ме 63.0 years) with painful NVG and 20 healthy individuals (aged Ме 61.5 years) as an immunological control. All patients underwent TSC СPC with a diode laser. Baseline HbA1c levels and ICAM-1 expression in blood samples were determined. Follow-up was 12 months. Results: One month after TSC CPC, IOP decreased by 28% compared to baseline. The effectiveness of laser treatment after 12 months of follow-up was 63% with IOP decrease by 46%. In patients with NVG, the initial level of ICAM-1 was 2.5 times higher than in the control group. Patients who did not fully respond to the first TSC CPC (30 eyes) and required additional laser procedure, had high initial HbA1c (9.5%) and high expression values of the ICAM-1 (609.0 cells/µL). Conclusions: Repeated procedures of TSC CPC at high IOP in diabetic patients with NVG are associated with high initial values of expression of ICAM-1 in peripheral blood and high HbA1c. The strategy of management of patients with diabetic NVG should be aimed at intensive glucose control and local anti-inflammatory treatment. Abbreviations: PDR = proliferative diabetic retinopathy, DR = diabetic retinopathy, NVG = neovascular glaucoma, TSC CPC = transscleral cyclophotocoagulation, ICAM-1 = intercellular adhesion molecule-1, HbA1c = glycated haemoglobin, IOP = intraocular pressure.

Vitreoretinal Surgery with Temperature Management: A Preliminary Study in Rabbits.

The present study aimed to evaluate the structure of the rabbit retina after vitreoretinal surgery using prolonged irrigation with solutions of different temperatures. Thirty-six rabbits (72 eyes) were included in this study and randomly divided into 3 equal groups according to the temperature of the intraocular irrigating fluid they received during vitrectomy. Vitreoretinal surgery was performed with a 5°C irrigation solution in group 1 (12 rabbits, 24 eyes), a 22°C irrigation solution in group 2 (12 rabbits, 24 eyes), and a 36°C irrigation solution in group 3 (12 rabbits, 24 eyes). In each group of animals, the mean irrigation/aspiration time was 30 minutes for left eyes and 60 minutes for right eyes. Histological examination of the retina was performed 1, 7, and 30 days after surgery. During surgery, the temperature in the vitreous cavity of the eyes of rabbits of groups 1, 2, and 3 dropped by 26.0°C, 11.2°C (deep hypothermia), and 1.0°C (mild hypothermia), respectively. The highest rewarming rate was detected in group 1 (0.9°C/min) compared with group 2 (0.7°C/min) and group 3 (0.2°C/min). After 60 minutes of irrigation, retinal structural changes were detected in the animals of groups 1 and 2 (in contrast to the animals of group 3). After surgery with irrigation lasting 30 minutes, no retinal structural changes were observed. This study showed that temperature management, avoidance of intraoperative deep hypothermia, and prevention of rapid uncontrolled rewarming may protect the retinal morphology and increase the safety of prolonged vitreoretinal surgery.

Device Development for Ocular Surface Temperature and Heat Flux Density Measurement.

PURPOSE: Currently, much attention is paid to measuring the temperature of the ocular surface in various ophthalmic diseases. However, for a comprehensive assessment of heat transfer of the eye, it is advisable to measure both the ocular surface temperature and the heat flux (HF) density. This will expand our knowledge of the physiology of the eye and create new possibilities for diagnosing ocular pathology. The present study aimed to develop a thermoelectric device to study rabbits' ocular surface temperature and HF density. METHODS: The multichannel thermoelectric device was developed to measure the ocular surface temperature and HF density. This study included ten rabbits (20 eyes). In all animals, the temperature and the HF density were measured on the surface of the central cornea of both eyes. The measurement was repeated after pupils' dilation. RESULTS: The corneal surface temperature of rabbits was 33.1 ± 0.8 °C, and the HF density of the surface of the cornea was 8.3 ± 0.6 mW/cm2. Our results revealed a high degree of interocular symmetry in the surface HF density in healthy rabbits. After pupil dilation, an increase in the HF density on the surface of the rabbit cornea compared with the initial data and control eye was noted. CONCLUSIONS: The application of the developed device showed that it is safe and allows for the measurement of the ocular surface temperature and the HF density. We believe that further studies on the ocular surface HF density measurement in various eye diseases will allow us to evaluate the possibilities of this device and technique for diagnostic purposes.

Photodynamic Therapy with Chlorin e6 Derivative for Chronic Central Serous Chorioretinopathy (Pilot Study).

Purpose: To evaluate the use of photodynamic therapy (PDT) with chlorin e6 (Ce6) derivative in patients with chronic central serous chorioretinopathy (CSC). Methods: Participants in this interventional, single-center clinical pilot study included 39 patients (39 eyes) with chronic CSC. Primary objectives were to assess safety and change in decimal best-corrected visual acuity (BCVA) during the 12-month follow-up. Secondary objectives were to evaluate change in central retinal thickness (CRT) in fovea area, maximal height of subretinal fluid (SRF), subfoveal choroidal thickness (SFCT) on spectral-domain optical coherence tomography, and number of treatments. Results: There were no systemic adverse events and ocular side effects. Mean decimal BCVA showed a significant increase from 0.49 ± 0.25 to 0.63 ± 0.28 (P = 0.001), mean CRT and maximal height of SRF decreased significantly from 335 ± 95 to 219 ± 69 µm and from 149 ± 84 to 32 ± 86 µm respectively (P = 0.001), comparing baseline and month 12. There was no significant difference between mean SFCT before PDT and at month 12. During all follow-up periods mean number of PDT treatments was 1.3 ± 0.7. Complete SRF resolution was observed in 82% (32 eyes) during observation period. Conclusion: Results of this pilot study demonstrate that PDT with Ce6 derivative is a safe method to treat eyes with chronic CSC. PDT with Ce6 derivative is the treatment option for chronic CSC. Further randomized controlled studies with a larger sample size and longer periods of follow-up are needed to assess the effectivity and safety of PDT with Ce6 derivative in chronic CSC.

Intraocular tumours imaging with transpalpebral near-infrared LED transillumination: Pilot study.

Purpose: To determine the possible use of near-infrared(NIR) light-emitting-diode (LED) radiation for imaging intraocular tumours by transpalpebral transillumination. Methods: This study was a pilot, open-label, prospective and non-interventional. Thirty patients (30 eyes; age 30-72 years) with uveal melanomas located in the iris, ciliary body, or choroid were under our observation. A biomicroscopy, ophthalmoscopy, transpalpebral NIR transillumination, and ultrasound examination were performed in all cases. Results: In all cases, NIR transillumination with transpalpebral approach enables visualization of the ciliary body and accurately estimates the projection of the pars plicata and ora serrata onto the sclera. In all patients, transpalpebral NIR transillumination made it possible to image the shadow of intraocular melanoma, estimate its dimensions and location concerning the ciliary body structures. Conclusions: We recommend the non-invasive transpalpebral NIR transillumination technique, together with traditional ultrasound imaging, to improve the accuracy of assessing the size and location of intraocular tumours.

Prospects of Temperature Management in Vitreoretinal Surgery.

Currently, there are no clear recommendations about the safety of certain temperature conditions for intraocular structures during vitreoretinal surgery; instructions on the safe rate of rewarming of the vitreous cavity; and the advisability of monitoring ocular temperature in the postoperative period. The purpose was to study the dynamics of epibulbar and intraocular temperature during vitreoretinal surgery. This study included 20 patients with rhegmatogenous retinal detachment (10 eyes) and retinal detachment associated with proliferative diabetic retinopathy (10 eyes). All patients underwent vitreoretinal surgery. In all cases, the ambient temperature, the patient's body temperature, the temperature of the irrigating solution, and temperature in the anterior, mid-, and posterior vitreous were recorded during surgery. Pre- and postoperative thermometry was also performed on the outer ocular surface. During vitreoretinal surgery with room temperature irrigation solution, a decrease in temperature (p < 0.001) versus the initial one was found in all segments of the vitreous cavity. In the absence of continuous irrigation, a rapid rewarming of the vitreous cavity was noted (an average of 0.18°C/min). Our study also demonstrated the presence of regional hyperthermia of the operated eye in a number of patients (25%) in the postoperative period. Current research shows that vitreoretinal surgery is performed under conditions of uncontrolled local ocular hypothermia and is characterized by a rapid uncontrolled rewarming of the vitreous cavity after cessation of cooling, and in the postoperative period local hyperthermia of the operated eye is observed in a number of patients.

[Imaging of Intraocular Foreign Bodies Located in the Projection of the Ciliary Body by Infrared Transillumination (Pilot Study)]. / Visualisierung von intraokularen Fremdkörpern im Ziliarkörperbereich mittels infraroter Transillumination (Pilotstudie).

BACKGROUND: Despite the improvement in diagnostic technologies, imaging of intraocular foreign bodies (IOFB) located in the projection of the ciliary body remains one of the current problems of ocular traumatology. PURPOSE: To study the possibilities of imaging intraocular foreign bodies in the projection of the ciliary body by infrared transpalpebral transillumination (IRTT). MATERIALS AND METHODS: 10 patients (10 eyes) with a penetrating eye wound and the presence of an IOFB were enrolled in the study. X-ray diagnostic testing, ultrasound examination of the eye and IRTT were performed in all patients. RESULTS: In all patients, the IRTT revealed the shadows of the Pars plana and Pars plicata of the ciliary body on the sclera as well as the shadow of an IOFB. CONCLUSION: The technique of IRTT in patients with penetrating eye injury allows non-invasive imaging of IOFB in the projection of the ciliary body and identification of their localisation.

Comparison of Efficacy of Intravitreal Ranibizumab and Aflibercept in Eyes with Myopic Choroidal Neovascularization: 24-Month Follow-Up.

Purpose: To compare the 24-month efficacy of intravitreal ranibizumab and aflibercept in treatment-naive patients with myopic choroidal neovascularization (CNV). Methods: Ninety-six naive patients (97 eyes) with myopic CNV were included in this single-center study. Patients received intravitreal ranibizumab (IVR) or aflibercept (IVA) following a pro re nata regimen (PRN). Results: Fifty patients (50 eyes) received 0.5 mg IVR, 46 patients (47 eyes) received 2.0 mg of IVA. There was no significant between-group difference in mean decimal best-corrected visual acuity (BCVA) (P = 0.6) or mean central retinal thickness (CRT) (P = 0.9) at 24 months. The mean ± standard deviation (SD) BCVA at baseline in the IVR group was 0.21 ± 0.14 and 0.20 ± 0.14 in the IVA group. At month 24, BCVA was 0.43 ± 0.24 (P < 0.001) in the IVR group and 0.41 ± 0.2 (P < 0.001) in the IVA group. Baseline mean ± SD CRT was 318 ± 84 microns in the IVR group and 303 ± 65 microns in the IVA group. At month 24, CRT was 226 ± 31 microns in the IVR group (P < 0.001) and 224 ± 35 microns in the IVA group (P < 0.001). There were no significant differences in the mean number of injections between the IVR group and the IVA group (2.9 ± 1.2 vs. 2.8 ± 1.1), (P = 0.7). Conclusions: Our study demonstrates that ranibizumab and aflibercept in a PRN regimen lead to a significant increase of BCVA and decrease in central foveal thickness in treatment-naive patients with myopic CNV after 24 months.

Intravitreal aflibercept for the treatment of choroidal neovascularization associated with pathologic myopia: a pilot study.

PURPOSE: To determine the efficacy of intravitreal aflibercept injections for the treatment of patients with choroidal neovascularization (CNV) associated with pathologic myopia. METHODS: In this uncontrolled, prospective cohort study, 31 eyes of 30 consecutive patients affected by CNV associated with pathologic myopia were treated with intravitreal aflibercept (2 mg) as needed following two initial monthly doses and observed over a 12-month follow-up period. The primary endpoint was change in best-corrected visual acuity (BCVA) at month 12, while central retinal thickness (CRT) on optical coherence tomography (OCT), neovascularization activity on fluorescein angiography, the number of aflibercept injections administered, and safety were examined as secondary endpoints. RESULTS: Patients received a mean of 2.6 intravitreal aflibercept injections over the 12-month study period. Compared with baseline, BCVA improved significantly at all time points (P<0.05). Mean (standard deviation [SD]) decimal BCVA was 0.2 (0.1) at baseline and 0.35 (0.16) at month 12. The greatest improvement in BCVA was seen within the first 2 months (P=0.01). Mean (SD) CRT on OCT decreased from 285 (62) µm at baseline to 227 (42) µm (P=0.01) at month 12. There was a continuous decrease in mean CRT on OCT over time. No cases of endophthalmitis, uveitis, stroke, or retinal detachment were noted. No patient demonstrated an intraocular pressure >20 mmHg during any study visit. CONCLUSION: The 12-month results of intravitreal aflibercept for myopic CNV using an as-needed regimen were positive, showing benefits in visual and anatomic outcomes and an acceptable tolerability profile.

Ciliary body imaging with transpalpebral near-infrared transillumination ­ a pilot study.

Background: Near-infrared light is known to pass through human tissues better than visible light. With invisible infrared light, the eye can be illuminated not only through the cornea or the sclera, but also through the eyelid, which can be beneficial in some cases. Purpose: To determine possible use of near-infrared radiation in visualizing ciliary body structures by transpalpebral transillumination. Material and methods: The study cohort included 15 people (30 eyes) with no visible lesions of the anterior segment of the eye; 20 patients (20 eyes) with absolute glaucoma before the laser transscleral cyclodestruction; and 15 patients (15 eyes) with intra­ocular tumours of the ciliary body. In all cases, a color photo of the anterior eye segment, infrared transillumination and ultrasound scan were performed. Results: In healthy individuals and in patients with absolute glaucoma prior to laser cyclodestruction, a ciliary body and its structures were imaged. In patients with intraocular tumours, near-infrared transillumination made it possible to visualize the tumour and to estimate its localization relative to the ciliary body structures. Conclusion: Transpalpebral near-infrared transillumination accurately estimates the projection of ciliary body structures to the sclera. Near-infrared transillumination can be used for ciliary body visualisation in patients with absolute glaucoma prior to laser cyclodestruction. Near-infrared transillumination helps visualize intraocular tumours and determine their projection to the sclera, which can be used for diagnostic purposes and during destruction of the tumour.

Intravitreal ranibizumab for the treatment of choroidal neovascularizations associated with pathologic myopia: a prospective study.

PURPOSE: It was the aim of this study to determine the efficacy of intravitreal ranibizumab as treatment of choroidal neovascularizations associated with pathologic myopia. MATERIALS AND METHODS: In an uncontrolled, prospective time series cohort study, 65 eyes of 64 consecutive patients with choroidal neovascularization associated with pathologic myopia were treated with intravitreal ranibizumab and observed over 12 months. The change in best-corrected visual acuity (BCVA) at 6 and 12 months served as primary end point. Safety, central retinal thickness, neovascularization activity on fluorescein angiography and the number of ranibizumab injections were secondary end points. RESULTS: BCVA improved significantly throughout the follow-up (p = 0.001). The mean BCVA was 0.2 at baseline (SD 0.13) and 0.4 at 12 months (SD 0.21). Improvement was strongest within the first 3 months (p = 0.0001). The mean central retinal thickness showed a reduction from 313 µm (SD 82) to 243.5 µm (SD 31; p = 0.0001). CONCLUSION: Intravitreal ranibizumab offers a safe and effective treatment for choroidal neovascularizations in pathologic myopia.

Serous pigment epithelium detachment associated with age-related macular degeneration: a possible treatment approach.

To evaluate the effects of intravitreal triamcinolone acetonide (TA) as a monotherapy of serous Pigment Epithelial Detachment (PED) associated with AMD (Age-Related Macular Degeneration), this study has been performed. Seventeen patients (19 eyes) with serous PED associated with AMD were observed. All patients received 0.1ml (4mg) of intravitreal TA. The mean follow-up period was 18 months. Re-attachment of serous PED was observed in 37% of cases to the end of follow-up. In other cases, the height and length of serous PED significantly decreased. Visual acuity remained stable in all cases. No evidence of RPE tear or CNV development were noted. Before TA administration, intraocular pressure (IOP) was 20.18 ± 2.58 mmHg however, after intravitreal TA, IOP increased gradually and reached its maximum of all period of observation (23.25±1.85mmHg) six months after injection (P=0.031). In 7 (37%) of the cases, progression to cataract was observed after treatment. After surgery, the visual acuity in all cases increased by 0.2 to 0.5. As a conclusion, intravitreal TA decreases of both the height and length of serous PED associated with AMD after 18 months follow-up in most cases. The presented data provides support for the hypothesis regarding the possibility of monotherapy of serous PED with intravitreal TA.

Digital imaging of the fundus with long-wave illumination.

PURPOSE: To increase the quality, diagnostic value and use of non-invasive fundus examination with transscleral or transpalpebral long-wave (red and near infrared) illumination. MATERIAL AND METHODS: For fundus visualization we used red light diode sources at 660 nm and near infrared light diode sources at 810, 940 nm. Light radiation from diode sources penetrates into the globe through eyelid skin and sclera. Fundus examination was performed without dye injection and local anesthesia. The technique was called "long-wave fundusgraphy" (LFG). RESULTS: Comparing with fluorescein angiography additional topographical information was received concerning CNV associated with hemorrhage or subretinal fluid, which masked the true borders of the neovascular component. If CNV is completely invisible under a layer of blood or pigment, on fluorescein angiography only a hypofluorescent area is registered. In such cases fluorescein angiography is insufficient for correct diagnosis. Examination of such patients with 940 nm excluded maximum masking property of blood or pigment deposits and permitted visualization of CNV. CONCLUSIONS: Non-invasive, consecutive long-wave imaging may be useful for CNV detecting and may obtain additional information about fundus structures in patients with dye intolerance, retinal hyperpigmentation, haemorrhage or fluid masking subretinal structures, miosis or in the presence of opaque media.