Macular hole surgery follow-up with spectral domain-optical coherence tomography-guided facedown posturing.

PURPOSE: The main treatment for macular hole (MH) is pars plana vitrectomy, with or without internal limiting membrane (ILM) peeling, followed by gas tamponade and face-down positioning (FDP). This study aims to present the anatomical and visual outcomes following MH repair with optical coherence tomography (OCT)-guided FDP. METHODS: Thirty-two patients who underwent surgery for idiopathic MH were enrolled. The requirement for the prone position was lifted for those with MH closure observed under gas on postoperative day one OCT. Patients with unclosed MHs were instructed to maintain FDP until the 3rd day. Best-corrected visual acuity at preoperative, postoperative 1st month, and the last visit, closure time post-surgery, duration of prone position, and surgical success rate were recorded. RESULTS: Among the patients, 21 underwent phacovitrectomy + ILM peeling + gas tamponade, while 11 had vitrectomy + ILM peeling + gas tamponade. On postoperative day one, 28 out of 32 MHs closed, with 3 closures on day 3 and one on day 5. There were 18 stage two (56.3%), 13 stage three (40.6%) and 1 stage four (3.1%) MHs. The mean minimum MH diameter was 381.75 ± 68.07 (min 260-max 517) microns. All patients with MH closure time over postoperative day one had non-combined vitrectomy instead of phacovitrectomy. No late complications were observed. CONCLUSIONS: OCT-guided FDP approach yields excellent closure rates with no late complications and ensures good patient comfort.

Choroidal vascularity index changes in different treatments for vitreomacular traction.

INTRODUCTION: The aim of this study was to examine if choroidal vascularity index (CVI) is different in eyes with unilateral vitreomacular traction (VMT) from their healthy fellow eyes; and whether different treatments affect the CVI. METHODS: The baseline and 8-week post treatment CVIs of 56 unilateral VMT patients that underwent spontaneous resolution (n = 30), vitreoretinal surgery (n = 16) or pneumatic vitreolysis (n = 10) were compared with fellow eyes using paired samples t-test. Partial correlation analyses correcting age and gender was used for calculations between treatment groups. P values < 0.05 were considered statistically significant. RESULTS: The mean baseline CVI for VMT and control eyes had no statistically significant difference (p = 0.81, r= -0.38). The post traction release follow-up CVI of VMT eyes and contralateral eyes had no significant difference (p = 0.12, r = 0.49). In spontaneous resolution group, vitreoretinal surgery group and pneumatic vitreolysis group the baseline and follow up CVIs of VMT eyes were statistically similar (p = 0.72, p = 0.32 and p = 0.79 respectively).Spontaneous detachment patients' CVIs showed a 0.57±5.81% increase, vitreoretinal surgery group had a reduction of 1.098±4.76%, and the pneumatic vitreolysis patients showed a CVI reduction of 0.307±4.24%. However, none of these changes was found to be statistically significant when compared between the groups (p = 0.21, r = 0.02). DISCUSSION: Previous studies have argued that vitreomacular traction might have a role on the choroidal changes seen in the vitreoretinal interface disorders. This study has shown that VMT alone does not cause any significant changes in choroidal vascular index pre or post traction release.

Macular Imaging Characteristics in Children with Myelinated Retinal Nerve Fiber and High Myopia Syndrome.

Objectives: To investigate the macular imaging features in patients with unilateral myelinated retinal nerve fiber (MRNF) and high myopia syndrome. Materials and Methods: Six patients with unilateral MRNF and high myopia syndrome and 13 myopic controls were enrolled in this study. Spectral domain (SD) optical coherence tomography (OCT), SD enhanced depth imaging OCT, and OCT angiography (OCTA) imaging results of MRNF-affected eyes were compared with the fellow eyes and myopic controls. Results: All patients had abnormal foveal reflex and/or ectopia. No significant difference in retinal thickness parameters were noted between the groups. In OCT scans, posterior vitreous detachment (PVD) was observed in 4 out of the 6 MRNF-affected eyes. Regarding OCTA parameters, only a significant increase in acircularity index was noted in myelinated eyes (p=0.01). Conclusion: All patients demonstrated normal foveal contours, macular structure, and OCTA features except for a higher acircularity index. The incidence of PVD was notably increased in the myelinated eyes.

A variation of foveal morphology in a group of children with hypermetropia.

PURPOSE: During routine eye examinations, we noticed widened and flattened foveal pits with loss of normal V-shaped foveal profile and a pseudohole-like appearance in some otherwise healthy hypermetropic children. Our purpose was to describe clinical significance and multimodal imaging features of this incidental finding. METHODS: Prospectively, 25 eyes of 13 hypermetropic children with these foveal changes and 36 eyes of 19 hypermetropic children with normal foveal appearance were enrolled. The macular thickness measurements and foveal parameters including pit diameter, depth, base, and area obtained by optical coherence tomography (OCT) (Heidelberg Spectralis, Heidelberg Engineering, Heidelberg, Germany), macular superficial and deep vessel density (VD) and foveal avascular zone values obtained by optical coherence tomography angiography (Avanti RTVue­XR; Optovue, Fremont, CA, USA) were noted. The correlations of these parameters with visual function were evaluated. RESULTS: In the study group, significantly widened and flattened pit contours with decreased central foveal thickness (p = 0.01), and increased distance between foveal edges (p < 0.001) were observed. While the whole image superficial macular VD was similar between the groups (p = 0.74), a significant decrease in deep macular VD was observed in the study group (p = 0.01). None of these changes were correlated with visual acuity. CONCLUSION: Wider and flattened foveal pits described here represent a newly defined variation in healthy hypermetropic children. Although a correlation with visual acuity was not evident, these changes in foveal profile are shown to be related with macular microvascular changes in deep capillary plexus. Awareness of these morphologic changes will help clinicians in the differential diagnosis of macular pseudohole.

Choroidal Vascularity Index and Choroidal Thickness Changes Following Renal Transplantation.

Objectives: This study aimed to evaluate changes in subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), estimated glomerular filtration rate (GFR), mean arterial pressure (MAP), and intraocular pressure (IOP) after renal transplantation. Materials and Methods: A total of 49 renal transplantation patients were included in this prospective study. CVI and SFCT on enhanced-depth imaging optic coherence tomography (EDI-OCT), MAP at the cubital fossa, GFR, and IOP were measured preoperatively and at postoperative 1 week and 1 month. In the analysis of EDI-OCT images, luminal area (LA) and stromal area of the choroid were determined using the image binarization method. CVI was defined as the ratio of LA to total choroid area. The effects of GFR, IOP, and MAP on CVI and SFCT were investigated. Results: The study included 23 women (47%) and 26 men (53%) with a mean age of 26.28±8.25 years (range: 18-52). Changes between preoperative, postoperative 1-week, and postoperative 1-month GFR values, CVI, and SFCT measurements were evaluated. There were significant differences between preoperative and postoperative GFR and SFCT measurements (p<0.001), but no significant differences between preoperative and postoperative CVI (p=0.09), MAP (p=0.14), or IOP (p=0.84) measurements. Conclusion: The present study demonstrated that SFCT increased significantly with GFR, while there was no change in CVI values.

Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders.

Purpose: Vitreomacular interface disorders have long been argued to change choroidal structure. The aim of this study was to determine the choroidal vascularity index (CVI) changes following internal limiting membrane peeling for epiretinal membrane (ERM) and full thickness macular hole (FTMH). Methods: Fifty-nine patients with unilateral ERM and 56 with unilateral FTMH were included in the study. Axial length, pre- and post-surgery intraocular pressure, baseline and post-phacovitrectomy CVI were calculated and compared with the normal fellow eyes. To compare the baseline and the final measurements, Wilcoxon test was used. Mann-Whitney U test was used for independent data comparisons. Median and standard deviations were compared. Results: Axial length, pre- and post-surgery intraocular pressure differences were insignificant between study and fellow eyes within all groups. CVI were significantly lower in post-vitrectomy study eyes of all groups compared with pre-surgery (P < 0.001). There were no significant changes before and after the surgeries in fellow eyes. Baseline CVI of ERM study eyes (median 65.90%) and FTHM study eyes (median 65.59%) did not differ significantly between groups (U = 1336, P = 0.07, r = 0.16). Conclusion: There are conflicting results of vitreoretinal interface disorders CVI in the literature. In this study, both FTMH and ERM eyes showed reduced CVI postoperatively compared with the baseline. Preoperatively, there were no difference between study eyes and the fellow eyes.

The correlation of atrophy, traction and neovascularization in myopic choroidal neovascularization according to a novel myopic maculopathy classification system (atrophy (A), traction (T), neovascularization (N): ATN).

PURPOSE: To grade myopic choroidal neovascularization (CNV) patients according to the new myopic maculopathy classification (A: atrophy, T: traction, N: neovascularization-ATN) and analyze the correlation in between atrophy, traction and neovascularization. METHODS: Fifty-one eyes of 41 patients with the diagnosis of pathologic myopia and myopic CNV were included in this clinical practice study. Patients were graded according to the recently described ATN classification. Color fundus photographs were used to grade the atrophy and spectral domain optical coherence tomography scans were used to grade traction and neovascularization. Active myopic CNVs were treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Chi-square test was used to test the categorical variants and univariate logistic regression analysis was used to predict the independent risk factors of myopic CNV scar formation. RESULTS: Active myopic CNV was observed most frequently in the group with patchy chorioretinal atrophy. Grade of the atrophy and female gender were significantly associated with myopic CNV scar in the univariate logistic regression tests. Multivariate logistic regression showed that atrophy grading is the independent predictor of myopic CNV scar. CONCLUSION: ATN classification is a practical and comprehensive system to grade myopic CNV. Atrophy is an independent predictor for myopic CNV scar and patchy chorioretinal atrophy requires a more careful examination and close follow-up for the risk of CNV development.

Peripapillary Vascular Density Measurement in Pediatric Renal and Liver Transplant.

OBJECTIVES: Noninvasive monitorization of retinal structures of the eye could be a predictor for systemic microvasculature dysfunction in transplant recipients. In this study, our purpose was to determine the optic disc and peripapillary microvascular changes in pediatric patients who had undergone liver or renal transplant surgery. MATERIALS AND METHODS: The study was performed at Baskent University. The medical records were reviewed, and patients who had liver or renal transplant in the last 10 years and were between 4 and 18 years old were included in the study. The optic disc and peripapillary vascular density parameters were obtained by optical coherence tomography angiography (Avanti RTVue XR). The results were compared with the results from age-matched, sex-matched, and spherical equivalent-matched healthy subjects. RESULTS: Our study included 32 eyes of 16 liver transplant patients, 20 eyes of 10 renal transplant patients, and 64 eyes of 32 healthy participants (control). Whole image peripapillary, inside disc, peripapillary, superior and inferior hemisphere, and superior, inferior, temporal, and nasal quadrant peripapillary vascular densities were evaluated. No statistically significant differences in any parameter were noted between the healthy control group and the patient groups (P > .05 for all parameters). CONCLUSIONS: Peripapillary vascular density measurements were not affected in pediatric renal and liver transplant patients.

Clinical characteristics and outcomes of ocular injuries in pediatric patients.

BACKGROUND: Childhood eye injuries are one of the most common causes of acquired unilateral blindness. In this study, our purpose was to investigate the demographics, etiology, and outcome of pediatric patients with ocular injury. METHODS: The charts of children with ocular trauma who presented to Baskent University Hospitals, between January 1, 2017 and December 31, 2019 were retrospectively reviewed. All patients who were under 16 years of age were included. Data were collected on age, sex, time of trauma, injury type, associated injuries, treatments, visual impairment, intraocular pressure (IOP), and ophthalmic sequelae. Ocular traumas were classified according to the Birmingham Eye Trauma Terminology (BETT) system. RESULTS: A total of 21 patients were identified. Male-female ratio was 13/8. The mean age of the patients was 8.5±3.4 years. Mean post-treatment follow-up was 8.2±4.3 months. Injury was unilateral in all cases (10 right eye, 11 left eye). Fifteen patients (71.4%) had open globe, and 6 (28.5%) had closed globe injury. Type of injury was rupture in 7 cases, perforation in 5, penetration in 4, and intraocular foreign body in 4. A total of 5 cases were documented to have retinal detachment during the follow-up. Sharp injuries were documented in 11 (64.7%) cases, and blunt in 6 (35.2%). The most frequent finding was hyphema in blunt injury, and corneal laceration in perforating injury. Five patients had choroidal hemorrhage, 3 had commotio retinae, 2 had intravitreal hemorrhage, 1 had subhyaloidal hemorrhage, 1 had macular hole, and 1 had optic nerve avulsion. Lens aspiration was performed in 12 (57.1%) cases, and 2 of them had intraocular lens implantation. In children whose initial vision was able to be taken, 4 had no light perception, 7 had light perception-counting fingers, and 5 had best-corrected visual acuity of 0.05-0.3. At final visit, 61.9% of patients had a VA of 0.05-0.8. Corneal scar or leucoma was observed in 14 (66.6%) cases at last visit. One eye was enucleated due to post-traumatic endophthalmitis that did not respond to treatment. At final visit, IOP <6 mmHg was identified in 2 cases and >21 mmHg in 4. CONCLUSION: Anterior segment damage is the main cause of visual morbidity in pediatric ocular trauma. Injuries with sharp objects occur twice as often as blunt trauma and reduce vision with residual corneal scarring in about two-thirds of patients. Under-standing the pattern of eye injuries is useful in determining the strategies required to protect children's eye health.

Clinical Features of Untreated Type 2 Macular Telangiectasia and Efficacy of Anti-Vascular Endothelial Growth Factor Therapy in Macular Neovascularization

Objectives: To compare best corrected visual acuity (BCVA), central macular thickness (CMT), and central choroidal thickness (CCT) in patients with type 2 macular telangiectasia (MacTel 2) and a control group and to evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment in MacTel 2 patients with macular neovascularization (MNV). Materials and Methods: We conducted a retrospective chart review of consecutive MacTel 2 patients who underwent a full ophthalmologic examination including BCVA and dilated fundus examination with slit-lamp biomicroscopy, fluorescein angiography, and optical coherence tomography imaging at baseline and follow-up visits. BCVA, CMT, and CCT were compared between all identified patients (n=26) and a control group (n=30). A subgroup analysis was performed among eyes with MNV (n=7) before and after treatment. Results: CMT and CCT were significantly lower in the MacTel 2 group compared to the control group. Forty-one treatment-naive eyes without MNV proliferation showed no significant change in BCVA, CMT, or CCT during follow-up. Eight eyes of 7 MacTel 2 patients developed MNV during follow-up. All of the patients were treated with intravitreal anti-VEGF. Conclusion: It is important to closely follow MacTel 2 patients for MNV development. To avoid adverse effects, we prefer to monitor patients who have not yet developed MNV. Patients with proliferative MacTel 2 with decreasing visual function may benefit from intravitreal anti-VEGF treatment.

Antiproliferative and Mitochondrial Protective Effects of Apigenin in an Oxygen-Induced Retinopathy In Vivo Mouse Model.

Purpose: To investigate the effects of a common dietary flavonoid apigenin on retinal endothelial cell proliferation, retinal morphological structure, and apoptotic cell death in an oxygen-induced retinopathy (OIR) mouse model to evaluate the possibility of the use of apigenin in the treatment of ocular neovascular diseases (ONDs). Methods: Ninety-six newborn C57BL/6J mice were included. Eight groups were randomized, each including 12 mice. Two negative control groups were kept in room air: the first without any injection and the second received intravitreal (IV) dimethyl sulfoxide (DMSO), which is the solvent we used. The OIR groups were exposed to 75% ± 2% oxygen from postnatal days (PD) 7 to 12. On PD 12, the mice were randomly assigned to 6 groups: 2 OIR control groups (1 received no injection, 1 received IV-DMSO), 2 IV-apigenin groups (10 and 20 µg/mL), and 2 intraperitoneal (IP)-apigenin groups (10 and 20 mg/kg). We quantified retinal endothelial cell proliferation by counting neovascular tufts in cross-sections and examined histological and ultrastructural changes through light and electron microscopy. We evaluated apoptosis by terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL). Results: We detected a significant increase in endothelial cell proliferation in the OIR groups. Groups receiving apigenin, both IP and IV, had significant decreases in endothelial cells, atypical mitochondrion count, and apoptotic cells compared with the groups receiving no injections. None of the apigenin-injected groups revealed cystic degeneration or cell loss. Conclusions: Apigenin suppresses neovascularization, has antiapoptotic and antioxidative effects in an OIR mouse model, and can be considered a promising agent for treating OND. Clinical trial (Project number: DA15/19).

Comparison of the effects of anti-vascular endothelial growth factor treatments on pigment epithelial detachment in age-related macular degeneration.

PURPOSE: The aim of this study is to compare structural and visual outcomes of naive neovascular age-related macular degeneration patients with significant pigment epithelial detachment (PED), treated with ranibizumab and aflibercept. METHODS: This was a retrospective case series that included 33 naive patients treated with ranibizumab and 25 with aflibercept. The patients were followed with pro re nata (PRN) after first three intravitreal injections. LogMAR visual acuity, PED height and radius on spectral domain optical coherence tomography findings were compared. RESULTS: Baseline mean PED height was 270.39 ± 114.14 µm and 315.24 ± 115.8 µm (p = 0.14); baseline mean PED radius was 2063.64 ± 942.75 µm and 1958.88 ± 452.22 µm (p = 0.61); and baseline BCVA was 1.16 ± 0.73 and 1.09 ± 0.69 (p = 0.73), for ranibizumab, and aflibercept group, respectively. In aflibercept group, there was statistically significant decrease in PED height at first, third and 12th months. In PED radius, decrease was greater in aflibercept group, however not significant. In addition, in aflibercept group visual acuity was better at all three months; however, none of them were significant. CONCLUSION: Although the maximum improvement was seen at third month, final visual acuity and parameters of PED were better in aflibercept group. The efficacy of the both drug to choroidal neovascularization was known; however, in cases with significant PED, aflibercept can be consider for the first-level treatment.

Relation of anatomy with function following the surgical treatment of idiopathic epiretinal membrane: a multicenter retrospective study.

PURPOSE: To investigate the prognostic factors associated with functional and anatomical outcomes and to assess the longitudinal course of visual acuity and retinal morphology after vitreoretinal surgery for idiopathic epiretinal membrane (ERM). METHODS: This multicenter, retrospective study included a total of 634 eyes who underwent surgery for idiopathic ERM in 22 academic centers nationwide in Turkey. Data on best-corrected visual acuity (BCVA) and optical coherence tomography features (central foveal thickness (CFT), ERM and foveal contour morphology, ellipsoid zone (EZ) integrity) were collected and compared at baseline, 6-month, 12-month, and 24-month follow-ups. Prognostic factors for functional (having ≥ 20/25 Snellen BCVA) and anatomical (having normal/shallow foveal contour) recoveries after surgery were investigated by means of multivariate regression analyses. A cutoff value of preoperative BCVA optimizing functional recovery was calculated using receiver operating characteristic curve analysis. RESULTS: At a median follow-up of 24 months, 37.4% of the eyes achieved ≥ 20/25 BCVA and 54% regained normal or shallow foveal contour. Functional recovery was more likely in eyes with better baseline BCVA and intact EZ (R2 = 0.356, p < 0.001). The cutoff baseline BCVA value for good visual prognosis was 0.35 logarithm of the minimum angle of resolution (Snellen 20/44) (sensitivity 60%, specificity 85%, p < 0.001). Anatomical recovery was negatively associated with advanced age, higher baseline CFT, foveal herniation-type ERM morphology, and internal limiting membrane (ILM) peeling (R2 = 0.225, p < 0.001). The negative effect of ILM peeling on anatomical recovery was not significant after the first postoperative year (p = 0.05). Mean BCVA values and foveal morphology progressively improved at each visit. Cases with convex baseline foveal contour continued to change towards normal foveal depression over 24 months of follow-up, which took longer than the eyes with shallow/flat contoured cases. One-third of eyes with severe baseline EZ defects showed recovery at follow-up and achieved significantly greater visual acuity gains than the remaining eyes with persistent defects (p < 0.001). CONCLUSIONS: Functional and anatomical restoration of the eyes appears to be a slow process after ERM surgery. This process may take much longer in eyes with worse foveal morphology at baseline. Although photoreceptor disruption may be reversible in some eyes, full functional recovery is unlikely when it persists.

Choroidal Thickness After Dexamethasone Implant or Aflibercept in Patients with Diabetic Macular Edema Persistent to Ranibizumab.

Purpose: This study aims to compare subfoveal choroidal thicknesses (SFCTs) after intravitreal dexamethasone (IVD) or intravitreal aflibercept (IVA) treatment in patients with persistent diabetic macular edema (DME) unresponsive to intravitreal ranibizumab (IVR). Methods: The study consisted of patients with DME unresponsive to IVR treatment in which 37 were administered 1 dose IVD (group A) and 34 patients who were administered 3 doses of IVA (group B), as well as 35 healthy individuals (group C). Detailed ophthalmological examination and optical coherence tomography parameters of group A and group B, including central retinal thickness and SFCT, were retrospectively evaluated before and after treatment. Results from preinjection, and 1, 2, and 3 months after injection were analyzed. Results of group A and group B were compared within themselves and also compared with group C. Results: SFCT measurements were compared within group A and group B (1 = preinjection; 2 = 1 month postinjection; 3 = 2 months postinjection; 4 = 3 months postinjection). There was significant thinning in SFCT between 1-2, 1-3, 1-4, 2-3, 2-4, and 3-4 time intervals within both group A and group B (both P < 0.001). Comparison of SFCT measurements showed preinjection, 1-, and 2-month values of group A were significantly thicker than those of group C (P < 0.001), whereas there was no significant difference between 3-month values (P = 0.09). Preinjection, 1-, and 2-month values of group B were significantly thicker than those of group C (P < 0.001), whereas there was no significant difference between 3-month values (P = 0.06). Conclusions: Three month follow-up showed thinning in SFCT measurements in patients with persistent DME unresponsive to IVR who were applied IVD or IVA treatment.

Structural Analysis of the Retina and Choroid before and after Carotid Artery Surgery.

Purpose: To evaluate retinal and choroidal changes in patients with internal carotid artery stenosis who had undergone carotid artery stenting or endarterectomy.Methods: The study included 43 patients with internal carotid artery (ICA) stenosis that required stenting or endarterectomy and 40 healthy controls. Patients were divided into two groups according to the degree of stenosis evaluated by magnetic resonance angiography. Group 1 consisted of patients having ICA stenosis of 50 to 70%, and Group 2 has more than 70%. Enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure the retinal thickness (RT) and choroidal thickness (CT) in all subjects before surgery and at 1, 3, and 6 months after surgery.Results: Subfoveal and parafoveal CT were significantly lower in patients with ICA stenosis than the control group (p < .05, respectively). Patients with 50-70% stenosis had a significant increase in the CT at 1, 3, and 6 months after ICA stenting or endarterectomy (p < .05). Patients with >%70 stenosis did not have a significant increase in the CT at any time after ICA stenting or endarterectomy. Retinal thickness was not statistically different between the patients with ICA stenosis and the control subjects, and RT showed no significant change in patients with ICA stenosis before and after the surgery.Conclusion: Choroidal thickness was significantly thinner in patients with internal carotid artery stenosis. ICA stenting provided a recovery in the choroidal thickness in patients with moderate to advanced stenosis.

Impact of Platelet Count in Retinopathy of Prematurity.

Objectives: The aim of the study was to investigate the risk factors for retinopathy of prematurity (ROP), including platelet count. Materials and Methods: This retrospective study analyzed 137 infants in 3 subgroups: no ROP; mild ROP, and severe ROP requiring laser treatment (type 1 ROP). A retrospective review of records was performed and statistical analysis of possible risk factors for ROP including platelet count was evaluated by using logistic regression. Results: Birth weight (BW), gestational age (GA), and low platelet count in the first week after birth were significant risk factors for developing ROP (p=0.038, 0.02, and 0.004, respectively). BW, GA, ventilation, and lower platelet count were associated with progression to type 1 ROP (p=0.004; 0.027, and 0.021, respectively). Conclusion: Lower platelet count in the first week after birth is a risk factor for ROP development in addition to the previously established factors of ventilation need, low BW, and low GA.

Effect of intravitreal and intraperitoneal cyanidin-3-glucoside injection in oxygen-induced retinopathy mouse model.

Purpose: To evaluate the effect of cyanidin-3-glucoside (C3G) in oxygen-induced retinopathy (OIR) mouse model. Methods: In this experimental study, 10 C57BL / 6J type mice exposed to room air comprised two control groups (n = 5 each; a negative control and a group receiving intravitreal sterile dimethyl sulfoxide [IVS DMSO]). Thirty C57BL / 6J type mice exposed to 75% ± 2% oxygen from postnatal day 7 to postnatal day 12 comprised the OIR groups. On postnatal day 12, these mice were randomized into six groups (n = 5 each): two OIR control groups (negative control and IVS DMSO), two intravitreal C3G groups (300 and 600 ng/µL), and two intraperitoneal C3G groups (0.05 and 0.1 mg/kg). We quantified neovascularization by counting endothelial cell proliferation on the vitreal side of the inner limiting membrane of the retina and examined histological and ultrastructural changes via light and electron microscopy and apoptosis by terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling. Results: The intravitreal C3G groups yielded lower endothelial cell counts compared with the intravitreal DMSO group. The intraperitoneal high-dose group had lower cell counts compared with the OIR control groups. Electron microscopy revealed significantly less mitochondrial dysmorphology in intravitreal groups and the high-dose intraperitoneal mice. We noted no difference in apoptotic cell count between the controls, low-dose intravitreal, and both intraperitoneal groups. However, apoptotic cell count was significantly higher in the high-dose intravitreal group. Conclusion: C3G suppresses endothelial cell proliferation in an OIR mouse model, leads to a reduced hyperoxia-induced mitochondrial dysmorphology, but increases apoptotic cell death in high concentrations.

A diagnostic dilemma in a patient with delayed onset endophthalmitis.

We report a case of nonpainful uveitis nine months after an uncomplicated phacoemulsification cataract surgery. Chronic postoperative endophthalmitis was suspected. Diagnostic vitrectomy and partial capsular bag removal was performed, but the specimens cultured in microbiology laboratory showed no pathogens. Systemic workup came positive for skin Tuberculosis test, and presumed intraocular tuberculosis treatment was started accordingly. Inflammation persisted, so a repeat vitrectomy was performed with removal of the lens implant with the capsule, and this time bedside culture inoculation was performed in operating room, revealing Pseudomonas infection. Delayed-onset postoperative endophthalmitis typically progresses slowly and therefore can be confused with uveitis and treated with steroid and immunosuppressant treatment regimes. Our case confirms both the value of immediate bacterial inoculation and the necessity of aggressive surgical treatment in chronic postoperative endophthalmitis cases.