Effect of photodynamic therapy on the morphological changes of periapical inflammation: An experimental study in rats.

AIM: We aimed to explore the morphological changes with photodynamic therapy (PDT) in experimentally produced periapical lesions in rats, and to investigate if PDT used as an adjunct to conventional root canal debridement helps to enhance healing the inflammatory response around root apex of rats. MATERIALS AND METHODS: Sixty adult Sprague-Dawley male rats (70-90 days/140-160 g) were experimented. Pulp was removed from the mesial root of the first maxillary molar and left open to oral environment to allow the formation of periapical lesion. The rats were numbered and randomly divided into two groups: (i) PDT group (n = 30) received a single session of PDT with conventional debridement and, (ii) Control group (n = 30) received conventional debridement but with no PDT. PDT application involved the use of methylene blue photosensitizer for 5 min inside the root canals and irradiated with diode laser of 805 nm and 20 W power output for 90 s and sealed. After 4 weeks, the experimental rats were sacrificed by cervical dislocation. The maxillary first molar was then collected along with the surrounding tissue for further processing. Hematoxylin and eosin and immunohistochemical staining were used to observe the morphological effects. Proliferating Cell Nuclear Antigen (PCNA), STRO-1 and CD-44 were used as the primary antibodies for the immunohistochemical study. RESULTS: A reduction in inflammatory cells, which were mainly composed of lymphocytes, was observed in the periapical lesions after PDT. The number of PCNA-positive cells increased to approximately twice in the PDT as compared to the control group. These PCNA-positive cells included STRO-1 and CD-44 positive cells, indicating enhancement of wound healing and reduction in inflammatory cells. CONCLUSION: The findings of the present experimental study indicate that PDT application induced proliferation of PCNA-positive cells, which included STRO-1 and CD44-positive cells. This suggests that PDT may help to enhance healing periapical lesion, indicating the potential of PDT in the treatment of periapical periodontitis.

Immunohistochemical study of dental pulp cells with 3D collagen type I gel in demineralized dentin tubules in vivo.

Dental pulp cells (DPCs) represent good candidates for the regeneration of dental tissue. This study aimed to evaluate the growth and differentiation potential of DPCs cultured inside demineralized dentin tubules in vivo. Six green fluorescent protein-transgenic rats (body weight 100 g each) and thirty-two Sprague-Dawley (SD) male rats (body weight 250 g each) were used for DPC collection and dentin tubules preparation and transplantation, respectively. Third-passage DPCs with or without collagen gels were loaded into demineralized dentin tubules. Both types of grafts were transplanted into the rectus abdominis muscles of SD rats and were harvested after 21 days. The expression of alkaline phosphatase (ALP), bone sialoprotein (BSP), osteopontin (OPN), nestin, and dentin sialoprotein (DSP) was analyzed by immunohistochemistry. Histological analysis showed that DPCs in the collagen gel formed an osteodentin-like hard tissue matrix after 21 days. Increased positive immunoreactivity for ALP, BSP, OPN, nestin, and DSP was observed in experimental groups compared with control. Our results demonstrate that DPCs in collagen gel inside demineralized dentin tubules show increased growth and differentiation.

Intravitreal Bevacizumab: Indications And Complications.

BACKGROUND: Bevacizmab is still an unlicensed drug for intraocular use in spite of the fact that it has shown comparable efficacy to other anti-vascular endothelial growth factors (anti-VEGF) medications in some large sample randomized control trails. Although repackaged bevacizumab has got safety concerns but its use is growing because of easy availability and low cost. Our study focuses on the diverse and growing indications of intravitreal bevacizumab (IVB) and its ocular complications in our geographical setting. METHODS: This interventional case series was carried out at my private practice in Said Anwar Medical Complex, Dabgari, Peshawar, from January 2008 to July 2015. Total of 6107 injections were given to 4352 eyes. Intravitreal bevacizumab was injected in proper operating room setting. Bevacizumab injections were prepared from same vial by multiple withdrawals taking care of aseptic precautions. Follow up was done at 1 week and 20 days and adverse effects were noted. RESULTS: Diabetic macular oedema (36%), central retinal vein occlusion (17.6%) and branched retinal vein occlusion (11%) were the top three indications of IVB. Other common indications were proliferative diabetic retinopathy (9.6%), neo-vascular glaucoma (5.9%), proliferative diabetic retinopathy with vitreous bleed (4.4%), proliferative diabetic retinopathy with tractional retinal detachment (3.7%), neo-vascular age related macular degeneration (2.9%), central serous retinopathy (1.48%) and Eale's disease (1.48%). Endohthalmitis occurred in 3 eyes (0.069%) while retinal detachment was found in only 2 eyes (0.046%). CONCLUSIONS: Common indications of bevacizumab are diabetic macular oedema, central retinal vein occlusion and branched retinal vein occlusion. Complications like endophthalmitis and retinal detachment are rare.

Retinal Detachment Due to Retinal Dialysis: Surgical Outcome After Scleral Buckling.

PURPOSE: The aim of this study was to determine the efficacy and safety of scleral buckling surgery in retinal detachment due to retinal dialysis. DESIGN: This study was a prospective, interventional case series. METHODS: A total of 48 eyes of 48 consecutive patients were included after obtaining informed written consent. Besides taking a thorough history, all eyes were examined by a retinal surgeon. The macula status, site, and extent of retinal dialysis and rhegmatogenous retinal detachment (RRD) were particularly noted. Proliferative vitreoretinopathy grading was done. Buckling was performed by a single surgeon. At every follow-up, visual acuity, intraocular pressure, retina status, and buckle position were noted. Any complication found was recorded. Follow-up was done for at least 6 months. SPSS version 16 was used for data analysis. RESULTS: We included 48 cases of RRD due to retinal dialysis. The mean ± SD age of the patients was 26.85 ± 15.1 years. The macula was detached in 85.4% of the cases, and proliferative vitreoretinopathy grade C was found in 25% of the cases. A surgical reattachment rate of 95.8% was attained after a single primary buckling procedure. Final Snellen best-corrected visual acuity of 6/18 or better was attained in 12.5% of the cases. However, 62.5% of the cases had best-corrected visual acuity in the range of 6/24 to 6/60. Subretinal hemorrhage occurred in 8.3% of cases intraoperatively after subretinal fluid drainage. CONCLUSIONS: We conclude that scleral buckling has a definite role in the management of RRD due to retinal dialysis.

Outcome of scleral buckling procedures for primary rhegmatogenous retinal detachment.

OBJECTIVE: To study the outcome of conventional scleral buckling procedures performed for primary rhegmatogenous retinal detachment. METHODS: This prospective study was conducted at Khyber Institute of Ophthalmic Medical Sciences, Hayatabad Medical Complex, Peshawar, Pakistan from 02-08-2008 to 29-04-2009. The outcome of fifty-six consecutive cases, operated in nine months duration, for primary rhegmatogenous retinal detachment using scleral buckling procedures, were analyzed prospectively. The main outcome measure was anatomically reattached retina at two weeks postoperative follow-up. RESULTS: Overall success rate was 85.71% (48 of 56 cases) at 2-weeks post-operative follow-up. The most common intra-operative complication was sub-retinal haemorrhage (23.21% cases), and the most common complication at first post-operative day was increased intra-ocular pressure (IOP), (21.43% cases). The raised pressure was transient in most cases, and only 2 (3.57%) had elevated IOP at 2-weeks post-op follow-up. Choroidal detachment was the second commonest post-operative complication (10.7%) The un-aided visual acuity was PL or HM in 32 (57.14%) cases and better than 6/60 in 3 (5.36%) cases pre-operatively. This improved to PL/HM in 12 (21.43%) and better than 6/60 in 16 (28.57%) cases post-operatively. Not very significant improvement in vision despite flat retina was found to be due to late presentation of patients, high grade PVR (Grade-C) in 24 (42.86%) cases and pre-operative 'off' macula in 52 (92.86%) cases, at a short-term follow up. CONCLUSION: Scleral buckling procedures are still effective in the treatment of primary rhegmatogenous retinal detachment even in high-grade PVR cases. A fairly good success rate can be achieved by adopting the appropriate procedures.