Correlation between Interleukin-6 and Thrombin-Antithrombin III Complex Levels in Retinal Diseases.

PURPOSE: This study aims to evaluate and correlate the levels of interleukin-6 (IL-6) and thrombin-antithrombin III complex (TAT) in the vitreous of patients with different vitreoretinal pathologies. METHODS: Vitreous samples were collected from 78 patients scheduled for pars plana vitrectomy at a tertiary medical center. Patients were divided by the underlying vitreoretinal pathophysiology, as follows: macular hole (MH)/epiretinal membrane (ERM) (n = 26); rhegmatogenous retinal detachment (RRD) (n = 32); and proliferative diabetic retinopathy (PDR) (n = 20). Levels of IL-6 and TAT were measured by enzyme-linked immunosorbent assay and compared among the groups. RESULTS: A significant difference was found in the vitreal IL-6 and TAT levels between the MH/ERM group and both the PDR and RRD groups (P < 0.001 for all). Diabetes was associated with higher IL-6 levels in the RRD group. Different relationships between the IL-6 and TAT levels were revealed in patients with different ocular pathologies. CONCLUSION: Our results imply that variations in vitreal TAT level may be attributable not only to an inflammatory reaction or blood-retinal barrier breakdown, but also to intraocular tissue-dependent regulation of thrombin.

First 100: learning curve for Descemet stripping automated endothelial keratoplasty.

PURPOSE: Endothelial keratoplasty is largely replacing penetrating keratoplasty for the routine treatment of corneal endothelial failure. The aim of the study was to describe the performance, complications, and outcome of the first 100 Descemet stripping automated endothelial keratoplasty (DSAEK) procedures performed at a major medical center, with an emphasis on the learning curve. 
 METHODS: A retrospective, comparative case series study was conducted by a single surgeon at a tertiary, university-affiliated medical center. Data were collected on 100 consecutive DSAEK procedures performed between September 2008, when the technique was introduced in the ophthalmology department, and January 2011. Main outcome measures include best-corrected visual acuity, graft dislocation rate, primary failure rate, and endothelial cell loss. Findings were compared between the first (early group) and last (late group) 50 cases.
 RESULTS: Mean (SD) logMAR best-corrected visual acuity at 1 year improved from 1.02 ± 0.36 to 0.38 ± 0.35 in the early group (p<0.05) and from 0.93 ± 0.48 to 0.25 ± 0.21 in the late group (p<0.05) (n = 86). Although the late group included more complex cases (presence of anterior chamber intraocular lens, need for combination cataract surgery or secondary scleral intraocular lens fixation), graft dislocation was more common in the early group (20% versus 10%, p = 0.26). Primary and late graft failures occurred only in the early group (12% vs 0, p = 0.03). 
 CONCLUSIONS: Rates of primary failure and disc dislocation for DSAEK decrease as surgeons gain experience with the procedure, and the number of functional grafts increases accordingly. Visual outcome improves regardless of surgical experience.

Corneal graft failure following Nd:YAG laser membranotomy for inadvertent retained descemet's membrane after penetrating keratoplasty.

Retained Descemet's membrane (DM) following penetrating keratoplasty (PKP) is a rare finding that may reduce visual acuity following opacification or endanger the graft endothelium. The association between Nd:YAG laser membranotomy and corneal graft failure is reported. Five of 1,350 patients (0.37%) undergoing PKP for pseudophakic bullous keratopathy or graft failure between 1986 and 2008 presented with inadvertent retained DM located close to the graft endothelium. The membrane opacified within 3 to 4 months, reducing the patients' vision. Nd:YAG laser membranotomy was performed using low energy and few pulses. Patients' visual acuity improved from 6/40 to 6/90 before treatment to 6/15(-) to 6/20 at 2 weeks following membranotomy. However, the corneal graft decompensated within 6 to 8 weeks following this procedure, necessitating repeat PKP, with removal of the retained DM. Nd:YAG laser membranotomy may lead to corneal graft failure due to shockwave damage created by the laser pulses, focused near the endothelial surface.

Intravitreal bevacizumab treatment for macular edema due to branch retinal vein occlusion in a clinical setting.

PURPOSE: To report the functional and anatomical outcome of intravitreal bevacizumab (IVB) treatment for macular edema due to branch retinal vein occlusion (BRVO) in a clinical setting. METHODS: The files of 45 patients treated with IVB for BRVO-induced macular edema at a tertiary medical center in 2007-2010 were reviewed. All received three loading doses (1.25 mg) and were followed every 6 weeks. Treatment was repeated for persistent or recurrent edema. If the edema did not resolve after 4-6 injections, grid laser photocoagulation was performed. RESULTS: Mean patient age was 70.7 years (SD 8.5); mean follow-up time, 18.8 months (SD 8.3); mean number of injections, 8.8 (SD 3.8). Fourteen patients (33%) received grid laser treatment before bevacizumab and 23 (51%) after. Mean logMAR visual acuity (VA) was 0.63 (SD 0.43) before treatment (Snellen, 20/140) and 0.4 (SD 0.43) (Snellen, 20/70) after (p < 0.0005). Corresponding central macular thickness (CMT) values were 382.2 microns (SD 155.6) and 320.5 microns (SD 172.8) (p= 0.028). Positive correlations were found between initial VA and initial and final CMT (p = 0.004) and between gain in VA and reduction in CMT (p = 0.03). There was no statistically significant difference in mean initial or final VA and CMT between patients who received grid laser treatment before or during the study and those who did not. CONCLUSIONS: IVB treatment improves visual function and reduces CMT in patients with BRVO-induced macular edema.

Gastric cancer: biology and clinical manifestations in Israel.

BACKGROUND: Gastric cancer (GC) in Israel remains incompletely characterized. The aim of this study was to define the clinical and pathological characteristics of GC in Israel and to compare them to the general Western population. PATIENTS AND METHODS: This is a retrospective analysis of 461 consecutive GC patients treated at a single institution between 1995 and 2007. Epidemiological and clinical-pathological data were retrieved from the patients' medical files and the institutional electronic database and analyzed using standard statistical methods. RESULTS: Epidemiology, clinical manifestations, histopathological findings, clinical course, and prognostic factors for disease outcome were all similar to those reported in the Western literature. Findings unique to the Israeli population included: (1) rarity of GC-associated risk factors; (2) increased GC incidence in Ashkenazi Jews; (3) high incidence of second primary malignancy and family history of cancer; and (4) no dominancy of proximal GCs. CONCLUSION: There do not appear to be any major differences in the biology or clinical manifestations of GC in Israel. Western recommendations for diagnosis and treatment of GC may therefore be applied to the Israeli patient population.