Chemokine CXCL-1: activity in the vitreous during proliferative vitreoretinopathy.

The aim of this study was to investigate CXCL-1 chemokine levels in the vitreous during rhegmatogenous retinal detachment (RRD) with and without proliferative vitreoretinopathy (PVR) and identify possible correlations with clinical parameters (extent and duration or RRD and PVR grade). Vitreous samples from patients with primary RRD with or without PVR were collected and assayed using a double antibody enzyme-linked immunosorbent assay (ELISA). Eleven vitreous samples from organ donors were employed as a control group. CXCL-1 levels were measured in 35 vitreous samples from 35 RRD patients. Mean CXCL-1 levels (64·82 ± 6·47 pg/ml) were significantly higher (P = 0·048) compared to controls. There was a significant positive correlation between CXCL-1 levels and the extent of the detachment (r = 0·794, P = 0·006). Peak CXCL-1 levels coincided with 3+ quadrant RRD, an interim of 29-60 days' duration and PVR grade B. Increased CXCL-1 levels may be indicative of mild inflammation in the detached retina and the adjacent vitreous. The results of the present study may provide novel insight into the complex interactions taking place during the early and late stages of RRD complicated by PVR.

Intravitreal anti-VEGF treatment in eyes with combined choroidal neovascularisation and vitreomacular traction syndrome.

PURPOSE: To report the effect of intravitreal anti-vascular endothelial growth factor injections (IVI) on visual acuity in eyes with choroidal neovascularisation (CNVM) and co-existent vitreomacular traction (VMT) or when VMT has developed during the course of treatment. METHODS: Retrospective interventional case series of seven eyes in seven patients. VMT was monitored with serial optical coherence tomography scans. RESULTS: The mean age at presentation was 74 years (range 64-95 years). All patients presented with blurring of central vision, rather than distortion. The aetiology of CNVM was wet age-related macular degeneration in five eyes (72%), angioid streaks in one eye (14%) and pathological myopia in one eye (14%). Ranibizumab was used in four eyes (57%) and bevacizumab in three (43%) for the active CNVM component. The mean follow-up was 11 months (range 2-28 months). None of the eyes in this series required surgery for the VMT component, nor were there any cases of spontaneous resolution of VMT. Visual acuity was stabilised or improved in five of the seven eyes (71%) with IVI. Visual acuity results across the whole group were gain of three or more lines of Snellen visual acuity in two eyes (28%), gain of up to three lines in three eyes (42%), no change in visual acuity in one eye (14%) and loss of up to three lines in one eye (14%). There were no eyes losing more than three lines of Snellen visual acuity. In four eyes with pre-existing VMT, visual acuity improved in three with IVI. In three eyes that developed VMT after IVI, visual acuity improved in two with IVI. Delay from diagnosis of CNVM to treatment with IVI contributed to a poor response. CONCLUSIONS: Most eyes improved visual acuity with IVI for combined CNVM and VMT. Despite the often dramatic features of VMT on optical coherence tomography, treatment of co-existing CNVM should be prompt. Vitreoretinal surgery was not required in this series, but is held in reserve if there is still potential for gain in vision following CNVM resolution.

A comparison of manifest refractions, cycloplegic refractions and retinoscopy on the RMA-3000 autorefractometer in children aged 3 to 15 years.

PURPOSE: The study was conducted to compare the accuracy of readings of the RMA-3000 autorefractometer (Topcon, Tokyo, Japan) with traditional retinoscopy as a means of determining the approximate subjective refraction in children after cycloplegia. METHODS: 142 children aged 3 to 15 years were included. All children had their refractive status measured with the RMA-3000 autorefractometer (noncycloplegic autorefraction [AR]). Subsequently all children underwent cycloplegia and the refractive status was estimated again with the autorefractometer (cycloplegic autorefraction [ARC]) and traditional retinoscopy (RC) by examiners who were unaware of the results from the other techniques. RESULTS: From 69 right eyes with negative sphere we observed that the sphere power was significantly higher (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). From the 73 normal and hyperopic right eyes we observed that the sphere power was significantly lower (more than 0.5 diopters) in AR than in ARC (P = 0.0001) and RC (P = 0.0001). CONCLUSIONS: The use of the autorefractometer in children (in whom accommodation is more active than older patients) without cycloplegia may underestimate the actual hyperopia and overestimate the actual myopia. Manual retinoscopy is still the most accurate technique to estimate refractive status in children.