Safety of 5914 intravitreal ziv-aflibercept injections.

PURPOSE: To analyse the pooled safety data of intravitreal ziv-aflibercept (IVZ) therapy for various retinal conditions. METHODS: This was a retrospective, observational study which included patients from 14 participating centres who received IVZ. The medical records of patients who received IVZ from March 2015 through October 2017 were evaluated. Patient demographics and ocular details were compiled. Ocular and systemic adverse events that occurred within 1 month of IVZ injections were recorded and defined as either procedure-related or drug-related. RESULTS: A total of 1704 eyes of 1562 patients received 5914 IVZ injections (mean±SD: 3.73±3.94) during a period of 2.5 years. The age of patients was 60.6±12.8 years (mean±SD) and included diverse chorioretinal pathologies. Both ocular (one case of endophthalmitis, three cases of intraocular inflammation, and one case each of conjunctival thinning/necrosis and scleral nodule) and systemic adverse events (two cases of myocardial infarction, one case of stroke and two deaths) were infrequent. CONCLUSION: This constitutes the largest pooled safety report on IVZ use and includes patients from 14 centres distributed across the globe. It shows that IVZ has an acceptable ocular and systemic safety profile with incidences of adverse events similar to those of other vascular endothelial growth factor inhibitory drugs. The analysis supports the continued use of IVZ in various retinal disorders.

Biochemical characterization and thermal inactivation of polyphenol oxidase from elephant foot yam (Amorphophallus paeoniifolius).

Polyphenol oxidase from Amorphophallus corm was purified (5.54 fold) by acetone precipitation and ion exchange chromatography. Electrophoretic-blot analysis revealed that the molecular weight of enzyme is 40 kDa. Enzyme preferred catechol as substrate and showed optimum activity at pH 6 and 35 °C with Km of 17.56 mM and Vmax 0.023 U/ml/min. Thermal inactivation kinetics study showed that 5.68% inactivation was achieved at 75 °C within 40 min. The half-life time of PPO is between 126.00 and 32.54 min. The activation energy (Ea) and Z values are 64.22 kJ/mol and 34.01 °C, respectively. The inhibitory action of L-ascorbic acid, sodium azide, NaCl, CaCl2, ZnSO4 and EDTA were studied. Thermodynamic studies indicated a non-spontaneous (ΔG > 0) and endothermic reaction process. Other thermodynamic activation parameters, such as Ea, ΔH#, ΔG# and ΔS#, were also studied. Amorphophallus paeoniifolius polyphenol oxidase can find application in baking industry.

Purification of Protease from Pseudomonas thermaerum GW1 Isolated from Poultry Waste Site.

An extracellular protease was purified from Pseudomonas thermaerum GW1 a new strain identified by morphological, biochemical and 16S rDNA sequencing. It was isolated from soil of Poultry waste site at Ghazipur near Ghaziabad, Delhi. The strain produces extra cellular protease in the culture media that was maintained at 37°C, 140 rpm. The media was harvested for protease after 48 hrs of incubation at 37°C in basal media supplemented with 1% casein. We report 6.08 fold purification of enzyme following ammonium sulphate precipitation and DEAE-cellulose chromatography. The molecular weight of the enzyme was estimated to be approximately 43,000 daltons as shown by casein zymography studies. The optimum pH for the proteolytic activity was pH 8.0 and enzyme remained stable between pH 5 -11 at 60°C. Interestingly Mn(2+) (5mM) activated enzyme activity by 5 fold, while Cu(2+), Mg(2+)and Ca(2+) moderately activated enzyme activity, where as Zn(2+), Fe(2+) and Hg(2+) inhibited enzyme activity. The protease produced was stable in presence of 50 % (v/v) ethylacetate and acetone. Isopropanol, methanol and benzene increased protease activity by 2.7, 1.3 and 1.1 fold respectively but was inhibited in presence of glycerol and DMSO. This organic solvent-stable protease could be used as a biocatalyst for enzymatic peptide synthesis.

Prospective evaluation of intravitreal triamcinolone acetonide in serpiginous choroiditis.

OBJECTIVE: To evaluate intravitreal triamcinolone acetonide (IVTA) in unilateral serpiginous choroiditis with macular involvement with special reference to effectiveness of treatment and its side effects. METHODS: In this prospective nonrandomized, consecutive, interventional case series, IVTA was given in 8 eyes of 8 patients of unilateral active serpiginous choroiditis. Treatment was evaluated on both subjective and objective parameters: any improvement or stabilization of visual acuity, fundus and fluorescein angiography (FA) and central macular thickness on optical coherence tomography (OCT). RESULT: The treatment induced rapid remission clinically and vision improved or stabilized. Mean visual acuity improved from 0.93 +/- 0.21 LogMAR units at baseline to 0.36 +/- 0.24 (p = 0.00) LogMAR units at 6 months. A 33.73% reduction in mean central macular thickness was observed at the 6-month follow-up from 294.63 +/- 17.84 to 195.25 +/- 5.49 mum (p = 0.00). Lesions healed rapidly with FA and OCT proving the clinical observation. CONCLUSION: Intravitreal triamcinolone may prove to be a promising therapeutic approach as a rescue therapy in this recurrent sight-threatening disorder by inducing rapid remission without the systemic side effects seen with systemic immunosuppression.

Rhegmatogenous retinal detachments in children in India: clinical characteristics, risk factors, and surgical outcomes.

PURPOSE: To describe the spectrum of clinical features and surgical outcomes in children with rhegmatogenous retinal detachments in a tertiary-care hospital in northern India. METHODS: In this retrospective interventional case series, 230 eyes of 216 children 18 years of age or younger undergoing surgery for rhegmatogenous retinal detachment were included. Detailed history and complete ophthalmic and systemic examination was performed when essential. Risk factors for retinal detachment were noted. Surgical intervention consisted of scleral buckling alone or standard 3-port pars plana vitrectomy with silicone oil tamponade. Rate of anatomical attachment and status of postoperative visual acuity were noted. RESULTS: Mean age was 11.12 +/- 3.56 years. Most patients (81.9%) were boys. Thirty-five (16.2%) patients had bilateral retinal detachment at presentation. Detachments tended to be complex, with 54.3% (125/230 eyes) having some form of proliferative vitreoretinopathy. Mean follow-up was 12.3 months. Complete retinal reattachment was achieved in 88.7% of eyes; however, visual recovery was modest. CONCLUSIONS: The most common conditions predisposing to rhegmatogenous retinal detachment were peripheral retinal degeneration and trauma. Rhegmatogenous retinal detachments secondary to iridofundal coloboma may be more common than previously reported. A combination of buckling and vitreoretinal techniques helped achieve retinal reattachment in most cases. The presence of anterior proliferative vitreoretinopathy is a poor prognostic factor in terms of both anatomic success as well as visual improvement.

Bilateral vitreous hemorrhage in a child due to isolated platelet factor 3 availability defect.

Vitreous hemorrhage is an uncommon cause of decreased vision in children. We report a 3-year-old child with bilateral vitreous hemorrhage secondary to an isolated platelet factor 3 (PF-3) availability defect. Prophylactic infusion of platelet-rich plasma followed by pars plana vitrectomy in both eyes resulted in an excellent surgical and visual outcome. This report emphasizes the importance of exhaustive hematological and platelet function studies in a child presenting with bilateral vitreous hemorrhage and its implications on the management of present and future bleeding episodes.

Unilateral hypopyon in a child as a first and sole presentation in relapsing acute lymphoblastic leukemia.

Ocular manifestations form a part of the spectrum of varied clinical presentations in leukemias. Most of the ophthalmic manifestations are related to central nervous system leukemia and bone marrow relapse. We report a case of acute unilateral hypopyon uveitis as an initial presenting feature of relapsing acute lymphoblastic leukemia (ALL) in a pediatric patient. Anterior chamber paracentesis was performed in a four-year-old male child presenting with unilateral treatment-resistant hypopyon after remission of ALL. Examination of aqueous humor aspirate revealed presence of malignant cells. Atypical hypopyon, even unilateral can be an indication of relapsing ALL in a child.