Preoperative Endovascular Embolization of Orbital Solitary Fibrous Tumor With 500-700 Micron Tris-Acryl Gelatin Microspheres.

The reported experience with preoperative embolization of solid orbital tumors is scarce. Herein, we present a case of a large and hypervascular orbital solitary fibrous tumor (SFT) in which 500-700 µm tris-acryl gelatin microspheres (TAGM) were used for preoperative embolization. A 41-year-old man presented with severe proptosis, palpable mass, restrictive myopathy, exposure keratopathy, and compressive optic neuropathy in the right orbit. Magnetic resonance imaging showed a 65x35x35 mm, diffusely contrast-enhanced tumor in the superior orbit, extending to the apex, and multiple intratumoral vascular flow voids. A diagnosis of SFT was made by incisional biopsy. Endovascular tumor embolization was performed with 500-700 µm TAGM. Two days later, the tumor was entirely removed with minimal bleeding. No embolization- or surgery-related complications and tumor recurrence or metastasis developed during the 42-month postoperative follow-up.

Protective Effect of Allyl Isothiocyanate in an Experimentally Induced Rat Model for Dry Eye Syndrome.

PURPOSE: Growing evidence emphasizes the role of inflammation and oxidative stress in the pathogenesis of Dry Eye Syndrome (DES). Concordantly, the importance of agents targeting the inflammatory cascade and oxidative stress in the treatment is also progressively increasing. Herein, the study has investigated the protective effects and underlying mechanism of allyl isothiocyanate (AITC) on the ocular surface in a benzalkonium chloride (BAC)-induced dry eye rat model. METHODS: A total of twenty-one Wistar albino rats were used to form the following three groups: Control, BAC, BAC + AITC. DES was established by topical application of BAC (four times daily for two weeks) in two groups, of which one group was treated with AITC (10 mg/kg BW daily oral dosage) for four weeks. Rats were monitored by dry eye diagnostic tests during the study period, and eventually, corneal tissues were used to evaluate for histopathologic analyzes and inflammatory and oxidative status. RESULTS: A significant improvement was observed in various histopathologic and ophthalmologic findings, including tear volume, tear film integrity, ocular surface damage, ocular inflammatory signs, corneal thickness, and edema through AITC supplementation. AITC prominently balanced the inflammatory status and oxidative stress by lowering key proinflammatory mediators (NF-κB, TNF-α, IL-1ß, IL-6, and IL-8) and increasing the activities of antioxidant enzymes (SOD, GSH-Px). Also, levels of protective tear proteins, including Muc1, Muc4, and Muc5 were recovered with AITC supplementation. CONCLUSION: AITC alleviates clinical and histopathologic signs related to DES. Antioxidative and anti-inflammatory properties of AITC play a significant role in the mechanism of action.

Comparison of BAK-preserved latanoprost and polyquad-preserved travoprost on ocular surface parameters in patients with glaucoma and ocular hypertension.

BACKGROUND: To compare the effect of two different prostaglandin analogues (Travatan® vs. Xalatan®) on ocular surface parameters. METHODS: This study includes 44 eyes of 44 patients with newly diagnosed primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Patients were randomly divided into two groups and treated with either benzalkonium chloride (BAK)-preserved latanoprost and polyquad-preserved travoprost. Changes in intraocular pressure (IOP) levels and ocular surface parameters including ocular surface disease index (OSDI) questionnaire, tear breakup time (TBUT), ocular surface staining scores, and Schirmer test scores of patients were performed at baseline, 1, 3, 6, and 12 months of treatment and compared. RESULTS: The age, sex ratio, visual acuity, central corneal thickness, and cup/disc ratio were similar between the groups. A decrease in IOP levels (23.3 ± 2.5 to 15.5 ± 2.3), TBUT (5.5 ± 2.3 to 4.1 ± 1.7 s), Schirmer test values (11.3 ± 5.9 to 8.6 ± 4.7 s), and a worsening in OSDI scores (44.6 ± 15.2 to 55.1 ± 13.1) and staining scores (1.7 ± 1.6 to 2.3 ± 1.8) were observed in all patients in the first month of treatment (p < 0.05, for all). No further worsening was detected during the 1-year follow-up. There was no difference between the groups in terms of alterations in IOP levels and ocular surface parameters. CONCLUSION: Travatan® and Xalatan® have a similar effect on IOP levels and ocular surface parameters in patients with POAG and OHT.

Investigation of macular and optic nerve head structural changes using spectral domain optical coherence tomography in internal carotid artery stenosis.

PURPOSE: To demonstrate differences in optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular thickness in patients with internal carotid artery (ICA) stenosis using spectral domain optical coherence tomography (SD-OCT). METHODS: A case-controlled study was conducted in 31 patients with a diagnosis of unilateral ICA stenosis (the percentage of stenosis was between 65 and 85%), and 53 age- and sex-matched healthy subjects (control group) from March 2016 to April 2018. The ONH parameters, RNFL, and macular thicknesses in the nine macular quadrants according to the Early Treatment Diabetic Retinopathy Study (ETDRS) were measured using SD-OCT. RESULTS: The average macular thickness and outer macular quadrants measurements were lower in the ICA stenosis group (P < 0.05). The thickness of the fovea and inner macular quadrants was similar in healthy and patient eyes. Similarly, the ONH and RNFL profiles based on SD-OCT parameters were similar between the groups. There was a negative weak correlation between mean macular and RNFL thicknesses and the duration and percentage of ICA stenosis. CONCLUSION: The average macular thickness and measurements of outer macular quadrants in the ICA stenosis group were lower than in the control group. Macular changes may occur before symptomatic ocular ischemic syndrome (OIS). SD-OCT macular measurements may be beneficial in the early detection of OIS due to ICA stenosis.

A Novel Integrated Active Herbal Formulation Ameliorates Dry Eye Syndrome by Inhibiting Inflammation and Oxidative Stress and Enhancing Glycosylated Phosphoproteins in Rats.

Dry eye syndrome (DES) is a chronic condition of the eye with insufficient production of tears leading to inadequate lubrication of eyes. Symptoms of DES are associated with discomfort and redness of the eye, blurred vision, and tear film instability which leads to the damaged ocular surface. Inflammation and oxidative stress play a significant role in the pathogenesis of the disease. In this study, the protective effect of different doses (100 or 200 mg/kg) of a novel multi-component oral formulation of lutein/zeaxanthin, curcumin, and vitamin D3 (LCD) was evaluated using a rat model with benzalkonium chloride (BAC)-induced dry eye syndrome. The formulation was administered orally to rats for 4 weeks. We observed a significant improvement in tear volume, tear breakup time, tear film integrity, and reduction in overall inflammation in rats fed with the LCD at dose 200 mg/kg performing better than 100 mg/kg. Furthermore, the formulation helped in lowering oxidative stress by increasing antioxidant levels and restored protective tear protein levels including MUC1, MUC4, and MUC5AC with 200 mg of LCD having the most significant effect. The results strongly suggest that the combination of lutein/zeaxanthin, curcumin, and vitamin-D3 is effective in alleviating the symptoms of dry eye condition with a multi-modal mechanism of action.

Effects of Surgical Timing on Surgical Success and Long-term Motor and Sensory Outcomes of Infantile Esotropia.

PURPOSE: To investigate the effect of surgical timing on long-term motor and sensory outcomes in patients with infantile esotropia. METHODS: The medical records of patients who underwent strabismus surgery for infantile esotropia were reviewed retrospectively. The patients were divided into three groups according to age at the time of surgery: early group (6 to 11 months), late group (12 to 17 months), and very late group (18 to 27 months). The main outcome measures were final alignment, surgical success rate (the angle of deviation at final follow-up of ≤ 10 prism diopters [PD] of esotropia, no exotropia and no need for reoperation), stereoacuity, visual acuity, and the number of reoperations required during the follow-up. RESULTS: A total of 79 patients (44 female, 35 male) met the inclusion criteria. The surgical success rate was 25.9%, 23.1%, and 53.8% in the three groups, respectively (P = .035). After a mean follow-up of 96 months, the average number of operations per child was 1.7 ± 0.9, 1.6 ± 0.6, and 1.4 ± 0.6 in the three groups, respectively (P = .020). The measurable stereopsis rate was higher in the early group (37% vs 3.8% and 3.8%, respectively) (P = .001). The amblyopia rate was similar between groups. CONCLUSIONS: The results show that performing surgery later in life in patients with infantile esotropia increases the motor success rate of surgery. In addition, orthophoria is achieved with fewer surgical operations. However, earlier surgery may improve stereopsis. [J Pediatr Ophthalmol Strabismus. 2020;57(5):319-325.].

Lutein and zeaxanthin isomers modulates lipid metabolism and the inflammatory state of retina in obesity-induced high-fat diet rodent model.

BACKGROUND: Several studies associated high-fat intakes with a high incidence of age-related macular degeneration (AMD). Lutein and Zeaxanthin isomers (L/Zi) may counteract reactive oxygen species produced by oxidative stress. The present study was conducted to determine the possible effects of L/Zi administration on lipid profile, protein genes associated with oxidative stress and inflammation pathways in the obesity induced by a high-fat diet (HFD) in rodents. METHODS: Twenty-eight male Wistar rats were allocated into four groups as follows: (i) Control, (ii) Control + L/Zi, (iii) High Fat Diet (HFD), and (iv) HFD+ L/Z. L/Zi was administrated for 8 weeks at a daily dose of 100 mg/kg BW. RESULTS: L/Zi administration significantly reduced insulin and free fatty acid (FFA) levels (P < 0.001) and ameliorated the oxidative damage by reducing malondialdehyde (MDA) concentration and increasing antioxidant enzymes activities of retina induced by HFD. In addition, supplementation decreased the levels of vascular endothelial growth factor (VEGF), inducible nitric oxide synthase (iNOS), nuclear factor-kappa B (NF-κB) and intercellular adhesion molecule-1 (ICAM) (P < 0.001, respectively) and improved nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) gene proteins in retinal tissues (P < 0.001). CONCLUSION: Rats fed with HFD exhibited increased oxidative stress and upregulation of inflammatory indicators. However, L/Zi supplementation modulates genes involved oxidative stress and inflammation including NF-κB and Nrf2 signaling pathways in the retina which may contribute to ameliorating retinal damage induced by HFD.