Association of Cognitive Function with Amyloid-ß and Tau Proteins in the Vitreous Humor.

BACKGROUND: The eye may serve as source for diagnostic testing for early detection of Alzheimer's disease (AD). Examination of amyloid-ß (Aß) and tau protein content in human vitreous and its correlation to neuro-cognition may improve ocular-based AD detection methods. OBJECTIVE: To evaluate levels of Aß and tau protein in human vitreous humor and investigate the clinical predictive role of these proteins as early diagnostic markers of AD. METHODS: A prospective, single-center, multi-surgeon cohort study. Vitreous humor samples from 80 eyes were measured quantitatively for Aß40-42, pTau, and tTau. Linear regression was used to test associations between AD biomarker levels, Mini-Mental State Exam (MMSE), and serum apolipoprotein E (APOE) allele status, with adjustment for age, sex, and education level of patients. RESULTS: Lower MMSE scores were significantly associated with lower levels of vitreous Aß40 (p = 0.015), Aß42 (p = 0.0066), and tTau (p = 0.0085), and these biomarkers were not associated with any pre-existing eye conditions. Presence of the ɛ4 allele and the ɛ2 allele approached significance with reduced Aß40 level (p = 0.053) and increased p-Tau level (p = 0.056), respectively. CONCLUSION: Patients with poor cognitive function have significantly lower vitreous humor levels of AD-related biomarkers Aß40, Aß42, and tTau. These biomarkers do not correlate with underlying eye conditions, suggesting their specificity in association with cognitive change. This is the first study to our knowledge to correlate cognition with AD-related proteins in the vitreous humor. Results suggest ocular proteins may have a role for early dementia detection in individuals at risk for AD.

FLUORESCEIN ANGIOGRAPHIC EVALUATION OF PERIPHERAL RETINAL VASCULATURE AFTER PRIMARY INTRAVITREAL RANIBIZUMAB FOR RETINOPATHY OF PREMATURITY.

PURPOSE: To evaluate angiographic findings in neonates up to 150 weeks postmenstrual age who received intravitreal ranibizumab for primary treatment of Type 1 retinopathy of prematurity. METHODS: Retrospective evaluation of fluorescein angiogram findings was completed for 30 eyes of 16 neonates who received intravitreal ranibizumab as primary treatment for Type 1 retinopathy of prematurity between April 2013 and January 2015. Outcome measures included maturity to Zone III, vascular blunting, vascular loops, vascular dilatation, capillary dropout, and vascular fluorescein leakage. RESULTS: Mean gestational age was 24 weeks and mean postmenstrual age at time of intravitreal ranibizumab treatment was 35 weeks. Fluorescein angiograms performed at 44 weeks to 150 weeks postmenstrual age showed only 50% of eyes reached vascularization to Zone III; 40% had persistent vascular leakage; and ≥90% exhibited vascular blunting, vascular dilatation, and/or capillary dropout. CONCLUSION: Although intravitreal ranibizumab is effective in initial cessation of Type 1 retinopathy of prematurity, vascularization to Zone III was only achieved in 50% of eyes in our series and most eyes had fluorescein angiography evidence of vascular anomalies. If future studies are performed comparing treatment with laser photocoagulation to anti-vascular endothelial growth factor, fluorescein angiographic studies should be considered to assess the status of the peripheral retinal vasculature to determine treatment effect.

Management of Infantile and Childhood Retinopathies: Optimized Pediatric Pars Plana Vitrectomy Sclerotomy Nomogram.

PURPOSE: To develop a nomogram based on age and disease type for sclerotomy placement in pars plana vitrectomy for infants and children with congenital and acquired vitreoretinopathies. DESIGN: A retrospective, single-center, single-surgeon comparative case series. PARTICIPANTS: A total of 171 eyes of 93 patients ranging in age from a postmenstrual age (PMA) of 34 weeks to a chronological age of 23 years with congenital and acquired vitreoretinopathies. METHODS: The corneal white-to-white diameter and the distance between the ora serrata and surgical limbus (ora-limbus distance) in the nasal, temporal, inferior, and superior quadrants were measured externally in vivo under general anesthesia prior to planned pars plana vitrectomy or laser procedure. The average ora-limbus distance of the quadrants was calculated for each eye (mean ora-limbus distance); and mean ora-limbus distance was evaluated as a function of age and compared among age-matched subjects from control and disease groups. Results were used to create a nomogram for safe sclerotomy placement based on age and disease type. MAIN OUTCOME MEASURES: The main outcome measure was distance (millimeters) from the ora serrata to the surgical limbus; a secondary measurement was corneal white-to-white distance (millimeters). RESULTS: Among all subjects, the ora-limbus distance was greatest in the superior quadrant, followed by the temporal, inferior, and nasal quadrants. A positive logarithmic relationship between ora-limbus distance and age was demonstrated in all groups. Whereas age-adjusted mean ora-limbus distances were similar among the familial exudative vitreoretinopathy and control groups, growth trends differed in patients with coloboma, persistent fetal vasculature, Stickler syndrome and/or myopia, and retinopathy of prematurity (ROP). In ROP, when subjects <12 months of age were considered separately, a negative correlation was found between the ora-limbus distance and PMA, with infants of lesser gestational age exhibiting greater restriction in ora-limbus distance. CONCLUSIONS: Placement of sclerotomies for pars plana vitrectomy in children requires consideration of ocular development in congenital and acquired vitreoretinopathies; we present an age-based nomogram for sclerotomy placement in infants and children based on analyses of ora-limbus distance in several pediatric ocular conditions.

Intestinal obstruction secondary to left paraduodenal hernia.

An internal hernia-congenital or acquired-is a protrusion of bowel through an opening in the peritoneum or mesentery. Internal hernias are the etiology of <2% of intestinal obstructions, with paraduodenal hernias being the most common type of congenital internal hernia. We report a case of a left paraduodenal hernia (LPDH) combined with partial small bowel obstruction in a 69-year-old male with recurrent abdominal pain of 2 years duration and no previous abdominal surgeries. An abdominal computed tomography scan showed an agglomeration of small bowel loops in the left upper quadrant but failed to yield a clear diagnosis. Surgical intervention provided definitive diagnosis and treatment of the LPDH. We additionally review the literature regarding anatomy, pathogenesis, diagnosis and treatment of this uncommon hernia. Intestinal obstruction secondary to an internal hernia is a rare entity; however, delayed diagnosis and surgical intervention may result in significant morbidity and mortality.

True superior gluteal artery aneurysm.

Gluteal artery aneurysms (GAAs), classified as true or false, account for <1% of all aneurysms. Of the 175 GAAs reported in the English literature, 20 are true aneurysms, making this case the twenty-first reported true aneurysm and sixth of atherosclerotic origin. We report a true GAA in a 72-year-old woman. Pelvic computed tomography suggested GAA (7.2 × 4.9 cm); subsequently, an endovascular approach allowed definitive diagnosis and treatment-coil embolization. In accordance with the literature and the surgical and clinical success of our case, endovascular embolization of GAAs has emerged as an effective and safe treatment.