Effect of internal limiting membrane surgical techniques on the idiopathic and refractory management of macular holes: a systematic review and meta-analysis.

Macular holes (MHs), including atraumatic idiopathic and refractory MHs, affect central vision acuity due to full-thickness defects in the retinal tissue. The existing controversy regarding the pathophysiology and management of MHs has significantly improved with the implementation of internal limiting membrane (ILM) surgical techniques and improved MH closure rates. Thus, to determine the effect of ILM techniques on large idiopathic and refractory MH management, the present study systematically reviewed 5910 original research articles extracted from online literature databases, including PubMed, Cochrane, Google Scholar, and Embase, following the PRISMA guidelines. The primary outcome measures were MH closure rate and postoperative visual acuity. A total of 23 randomized controlled trials (RCTs) with adequate patient information and information on the effect of ILM peeling, inverted ILM flaps, autologous retinal transplantation (ART), and ILM insertion techniques on large idiopathic and refractory MH patients were retrieved and analyzed using RevMan software (version 5.3) provided by the Cochrane Collaboration. Statistical risk of bias analysis was also conducted on the selected sources using RoB2, which showed a low risk of bias in the included studies. A meta-analysis indicated that the inverted ILM flap technique had a significantly greater MH closure rate for primary MH than the other treatment methods (OR = 3. 22, 95% CI 1.34-7.43; p = 0.01). Furthermore, the findings showed that the inverted ILM flap group had significantly better postoperative visual acuity than did the other treatment options for patients with idiopathic MH (WMD = - 0.13; 95% CI = 0.22-0.09; p = 0.0002). The ILM peeling technique had the second highest statistical significance for MH closure rates in patients with idiopathic MH (OR = 2. 72, 95% CI: 1.26-6.32; p = 0.016). In refractory MHs, autologous retinal transplant (ART) and multilayer ILM plug (MIP) techniques improve the closure rate and visual function; human amniotic membrane grafting (hAMG) provides a high degree of anatomical outcomes but disappointing visual results. This study demonstrated the reliability and effectiveness of ILM techniques in improving the functional and anatomical outcomes of large idiopathic and refractory MH surgery. These findings will help clinicians choose the appropriate treatment technique for patients with idiopathic and refractory MH.

Kaposi Sarcoma Mimicking a Lingual Lesion in an HIV-Negative Patient: A Case Report.

Tonsillar Kaposi sarcoma is rare, reported in patients with human immunodeficiency virus (HIV) infection. This case report of a tonsillar Kaposi sarcoma (KS) in an HIV-negative male patient, initially misinterpreted as a lingual lesion diagnosed with KS following tonsillectomy, highlights the value of a differential diagnosis in atypical presentations. The case report discusses the etiologic agent of KS, its detection and treatment, and a few case reports about tonsillar KS with no association with AIDS. The case underscores the diagnostic challenge of oropharyngeal lesions, particularly in patients with risk factors but negative HIV status.

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review.

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events. RESULTS: A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%). CONCLUSION: PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Novel surgical approaches for treating myopic traction maculopathy: a meta-analysis.

BACKGROUND: Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM. METHODS: To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1. RESULTS: Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group. CONCLUSION: Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary. TRIAL REGISTRATION: Retrospectively registered.

Bioinspired Whisker Sensor for 3D Mapping of Underground Mining Environments.

Traversing through challenging, unstructured environments, particularly in mining scenarios characterized by dust concentration, darkness, and lack of communication presents formidable obstacles for traditional sensing technologies. Drawing inspiration from naked mole rats, characterized as being skilled subterranean navigators that depend heavily on touch to navigate their environment, this study introduces a new whisker-sensing disk designed for 3D mapping in unstructured environments. The disk comprises a circular array of 32 whisker sensors, each featuring a slender flexible plastic rod attached to a compliant base housing a 3D Hall-effect sensor. The whisker sensor is modeled using both analytical and data-driven approaches to predict rotation angles based on magnetic field measurements. The validation and comparison of both models are performed by evaluating data from other whisker sensors. Additionally, a series of experiments demonstrates the whisker disk's capability in performing 3D-mapping tasks, along with successful implementation on diverse robotic platforms, highlighting its future potential for effective 3D mapping in complex and unstructured subterranean environments.

Design and Kinematic Modeling of a Soft Continuum Telescopic Arm for the Self-Assembly Mechanism of a Modular Robot.

In recent years, the development of mining robots has grown significantly, offering improved efficiency and safety in hazardous environments. However, there is still room for improvement in adaptability, scalability, and overall performance. The ROBOMINERS project, funded by the European Union's Horizon 2020 Research and Innovation Program, aims to facilitate Europe's access to mineral resources applying disruptive robotic concepts. One such concept is resilience, which can be achieved providing modular mining robots with the ability to reconfigure during operation. To address this challenge, this article presents the development and kinematic modeling of a soft, telescopic, continuum arm integrated into a modular robot. The arm serves as a mechanical interface for coupling different robotic modules or tools following the principle of the car crane. With a fully 3D-printed design, the arm features two sections of variable length that are driven by an innovative actuation method based on soft racks. It provides a 6 degrees of freedom (DoF) motion. The arm kinematic models are obtained by backbone parameterization assuming constant curvature and independent bending between sections for forward kinematics and applying a machine learning-based approach for inverse kinematics. The models are validated through the evaluation of two trajectories, measuring the deviation in each DoF and rack extension. Furthermore, a demonstration of the arm's coupling procedure between two robotic modules and one possible configuration of the robotic system showcases its functionality.

Choroidal Perfusion Changes After Vitrectomy for Myopic Traction Maculopathy.

BACKGROUND: The choroidal vasculature supplies the outer retina and is altered in many retinal diseases, including myopic traction maculopathy (MTM). Choroid health is typically assessed by measuring the choroidal thickness; however, this method has substantial limitations. The choroidal vascularity index (CVI) was recently introduced to provide quantitative information on the vascular flow in the choroid. This index has been evaluated in a wide range of diseases but has not been extensively used to characterize MTM. AIM: This study aimed to investigate the CVI across different stages of MTM and the influence of macular surgery on choroidal perfusion markers in different surgically resolved MTM stages. METHODS: Eighteen healthy myopic eyes in the control group and forty-six MTM eyes in the surgical group were evaluated using enhanced optical coherence tomography (OCT) imaging. Binarized OCT images were processed to obtain the luminal choroidal area (LCA) and stromal choroidal area (SCA), which were used to calculate CVI in the form of a percentage ratio. CVI data were collected at baseline, one and four months postoperatively, and at the final clinical visit. MTM eyes were divided into four stages based on disease severity. The choriocapillaris flow area (CFA) and central subfield thickness (CSFT) were measured along side the CVI. RESULTS: No significant differences were observed between the two groups at baseline, except for visual acuity (p < 0.0001). Surgery significantly improved vision at all postoperative time points (p < 0.0001). At baseline, there were no significant differences in CVI, CFA, or CSFT scores between the control and surgical groups. However, all three measurements were lower at the final visit in the surgical group (p ≤0.0001). No significant differences were found in any of the parameters among the four stages of MTM (p > 0.05). Ultimately, correlation and multivariate linear regression analyses did not reveal any significant association between CVI and visual acuity. CONCLUSIONS: This study did not find significant preoperative differences in CVI between healthy myopic eyes and eyes with MTM. However, the postoperative CVI and CFA values were significantly lower than those of the control eyes. Thus, CVI may not be a good biomarker for surgical outcomes, as the correlation between CVI and visual acuity was not statistically significant.The CVI and CFA decreased after surgery, providing evidence of choroidal changes after surgical management.

Surgical management, use and efficacy of adjuvant dyes in idiopathic epiretinal membranes: a systemic review with network meta-analysis.

BACKGROUND: The epiretinal membrane (ERM) is a nonvascular fibrocellular tissue formed by cellular metaplasia and proliferation at the vitreoretinal surface and is generally treated by pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling. This network meta-analysis aimed to compare the efficacy of all available ERM removal interventions and assessed the use and efficacy of surgical dyes in managing idiopathic ERMs. METHODS: MEDLINE, EMBASE, Cochrane CENTRAL, and the US National Library of Medicine were searched (June 28, 2023). Clinical studies that included patients with ERMs were included. Randomized controlled trials (RCTs) were also appraised using Cochrane risk of bias (ROB). RESULTS: Ten RCTs and ten non-RCTs were included in this study. A pairwise meta-analysis between ERM removal and combined ERM and ILM removal showed no significant difference in visual outcome (change in BCVA) 1 year postintervention (MD = - 0.0034, SE = 0.16, p = 0.832). Similarly, there was no significant difference in the central macular thickness postoperatively between the two groups (MD = - 4.95, SE = 11.11, p = 0.656) (Q = 4.85, df = 3, p = 0.182, I2 = 41.21%). The difference in ERM recurrence between the groups was also not statistically significant (OR = 4.64, p = 0.062, I2 = 0). In a network meta-analysis, there was no significant difference in visual outcomes between ERM removal only and other treatment modalities: combined ILM and ERM removal (MD = 0.039, p = 0.837) or watchful waiting (MD = 0.020, p = 0.550). In a network meta-analysis, there was no significant difference in the visual outcomes between ERM removal alone and dye-stained combined ERM and ILM peeling (MD = 0.122, p = 0.742 for brilliant blue G; BBG and MD = 0.00, p = 1.00 for membrane blue-dual; MBD). The probability of being a better surgical dye for better visual outcomes was 0.539 for the MBD group and 0.396 for the BBG group. The recurrence of ERM was not significantly different when the ILM was stained with any of the dyes. No study was judged on ROB assessment as having low ROB in all seven domains. CONCLUSION: The two types of surgical modalities provided comparable efficacy, with no significant differences between the outcomes. Among the dye-assisted ILM peeling methods, the membrane blue-dual dye was the most effective in providing better structural and functional outcomes.

Postoperative Choroidal Vascular Biomarkers in Eyes with Rhegmatogenous Retinal Detachment-Related Giant Retinal Tears.

PURPOSE: Choroidal vascularity index (CVI) and choriocapillaris flow area (CFA) are perfusion biomarkers relevant to retinal disease management. There is limited knowledge regarding these biomarkers in eyes that have been successfully treated for rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs). This study aimed to analyze the relationship between choroidal perfusion biomarkers and functional outcomes in surgically treated eyes with GRT-associated RRD and their fellow eyes. METHODS: A total of 33 GRT eyes and 29 fellow eyes were included in this study. All RRD-GRT eyes were treated with vitrectomy and categorized into two groups based on whether additional scleral buckles (SB) were placed. Visual and choroidal features were compared between the groups. RESULTS: The subjects had an average age of 55.18 years, a mean time of 2.36 weeks before surgery, and a mean follow-up time of 25.9 months. Best-corrected visual acuity (BCVA) was substantially worse in GRT eyes (1.9 logMAR) than in fellow control eyes (0.23 logMAR) but substantially improved after surgery (0.59 logMAR). There were no differences in the presurgical characteristics and BCVA between the eyes that did and did not undergo SB. Long-term CVI and CFA were lower in eyes with GRT than in their fellow eyes. Among eyes with GRT, those with SB had significantly lower CVI and CFA. Correlation analysis revealed that the CVI and CFA were positively correlated with visual outcomes (negative correlation with logMAR). CONCLUSION: Despite successful surgical repair, long-term functional and choroidal evaluations showed permanent changes in eyes with GRT. Positive correlations between perfusion biomarkers and visual function suggest that better choroidal vasculature is associated with better visual outcomes. The results of this study highlight the benefits of analyzing choroidal vasculature biomarkers and the relationship between the choroidal anatomy and vision.

Determining the Superiority of Vitrectomy vs Aflibercept for Treating Dense Diabetic Vitreous Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10-0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: -0.04-0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71-9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09-4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.

Pneumatic vitreolysis versus vitrectomy for the treatment of vitreomacular traction syndrome and macular holes: complication analysis and systematic review with meta-analysis of functional outcomes.

BACKGROUND: We conducted a systematic review to compare  the effects of pneumatic vitreolysis (PV), enzymatic vitreolysis (EVL) with ocriplasmin, and pars plana vitrectomy (PPV) on vitreomacular traction (VMT) syndrome and macular holes (MHs) to assess their efficacy as treatment options. METHODS: Databases, including PubMed, ClinicalTrials.gov ( www. CLINICALTRIALS: gov ), the Cochrane Central Register of Controlled Trials (CENTRAL)-including the Cochrane Eyes and Vision Group Trials Register (The Cochrane Library 2013, Issue 2)-, Ovid MEDLINE, and EMBASE (January 2000-October 2022), were searched to identify studies comparing the outcomes of PV versus PPV, PPV versus ocriplasmin and ocriplasmin versus PV. RevMan 5.1 was used for the meta-analysis of the studies. RESULTS: Among the 89 studies, 79 were considered eligible for qualitative analysis, and 10 quantitative studies were subjected to meta-analysis. PPV resulted in better postoperative visual acuity improvement than ocriplasmin (standardized mean deviation (SMD) = 0.38, 95% CI 0.03-0.73, p = 0.0003). PV resulted in no significant difference in visual improvement compared  with  PPV (SMD = - 0.15, 95% CI - 0.47 to 0.16, p = 0.35). PPV was significantly more effective in terms of the VMT release rate (risk ratio = 0.48, 95% CI 0.38-0.62, p = 0.00001) and MH closure rate (risk ratio = 0.49, 95% CI 0.30-0.81, p = 0.006) than ocriplasmin. PV was more effective than ocriplasmin in terms of the VMT release rate (risk ratio = 0.49, 95% CI 0.35-0.70, p = 0.0001). Qualitative analysis showed MH closure rates of 46%, 47.8%, and 95% and VMT releases rates of 46%, 68% and 100% after ocriplasmin, PV, and PPV treatments, respectively.  Adverse events and postoperative complications occurring after treatment have also been documented in these studies. CONCLUSION: PPV appears to be the most promising option for MH closure and VMT release, with fewer serious complications than EVL  or PV. However, given the limited number of studies comparing these treatments, further research is needed to establish the superiority of PPV over the other options.

Cambios retinianos periféricos detectados mediante fotografía no midriática de campo ultra amplio en sujetos asintomáticos / Peripheral retinal changes detected by ultra-widefield non-mydriatic photography in asymptomatic subjects

Resumen Objetivo: La fotografía de campo ultra amplio no requiere midriasis, evalúa 200° de la retina y es adecuada para detectar cambios desapercibidos, con riesgo de desprendimiento de retina en individuos asintomáticos; se identificó la frecuencia de cambios periféricos retinianos y cambios con riesgo de desprendimiento de retina, en una muestra de sujetos fáquicos asintomáticos. Materiales y Métodos: Estudio no experimental, analítico, prospectivo, transversal en sujetos con edades de 40-70 años, de cualquier sexo, sin cirugía intraocular previa o síntomas de desgarros retinianos (fotopsias, eritropsia, escotoma periférico). Se obtuvieron imágenes de campo ultra amplio de retina (sin midriasis) con el equipo Optos y se identificó la proporción e intervalos de confianza (I.C.) del 95% de la muestra que tuvo cambios en la retina periférica y cambios con riesgo de desprendimiento de retina (agujeros retinianos, desprendimiento de retina subclínico). Se comparó esta proporción entre sexos y grupos de edad (χ2). Resultados: 1204 ojos de 602 sujetos (promedio de edad 52,92 desviación estándar D.E. ± 7,83 años), 74,41% de los sujetos fueron del sexo femenino. El 16,61% de la muestra presentó cambios periféricos retinianos (I.C. 95% 13,64- 19,58), el 1% de la muestra tuvo cambios con riesgo de desprendimiento de retina. Los cambios periféricos fueron más frecuentes en el grupo de edad de 50-59 años y en mujeres. La miopia superior a -6,00 dioptrías fue infrecuente en ojos con riesgo de desprendimiento de retina. Conclusiones: La fotografía de campo ultra amplio ayuda a demostrar, sin necesidad de dilatar la pupila, que existe una prevalencia baja de cambios retinianos periféricos y cambios con riesgo de desprendimiento de retina en sujetos fáquicos asintomáticos.

Abstract Objective: Ultra wide field photography requires no mydriasis, evaluates 200° of the retina and is adequate to detect overlooked retinal changes, with a risk of retinal detachment in asymptomatic subjects; we identified the frequency of peripheral retinal changes and changes with risk of retinal detachment, in a sample of asymptomatic phakic subjects. Materials and methods: Non-experimental, analytical, prospective, cross- sectional study in subjects aged 40-70 years, of any gender, without previous intraocular surgery or symptoms of retinal tears (photopsia, eritrhopsia, peripheral scotoma). We obtained ultra wide field retinal photographs (without mydriasis) with the Optos device and identified the proportion and 95% confidence intervals (C.I.) of the sample that had peripheral retinal changes and changes with risk of retinal detachment (retinal holes, subclinical retinal detachments). This proportion was compared between genders and age groups (χ2). Results: 1204 eyes of 602 subjects (mean age 59,92 standard deviation ± 7,83 years), 74,41% of the subjects were female. 16,61% of the sample had peripheral retinal changes (95% C.I. 13,64-19,58), 1% of the sample has changes with risk of retinal detachment. Peripheral retinal changes were more frequent in the 50-59 years age group and in women. Myopia over -6.00 diopters was infrequent in eyes with risk of retinal detachment. Conclusions: Ultra wide field photography helped to prove, without the need of mydriasis, that there is a low prevalence of peripheral retinal changes and changes with risk of retinal detachment, in phakic asymptomatic subjects.

Postoperative choroidal vascularity index after the management of macula-off rhegmatogenous retinal detachment.

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that can be treated with various surgical approaches. The role of scleral buckling remains controversial because of its potential long-term deleterious effects on choroidal vascular perfusion and the limited knowledge of this entity. METHODS: A total of 135 eyes were retrospectively selected, including 115 with surgically resolved RRD and 20 healthy control eyes. Of the surgically treated eyes, 64 underwent vitrectomy alone, while 51 underwent scleral buckling combined with vitrectomy. Best-corrected visual acuity (BCVA) was evaluated along with the choroidal vascularity index (CVI) as a metric for the state of the choroidal vasculature. BCVA was compared before and after surgery, and the postoperative BCVA was analyzed with the CVI using correlation and multivariate regression analyses. RESULTS: The preoperative BCVA of the RRD eyes was significantly worse than that of the control eyes, and significantly improved after surgery. However, the long-term postsurgical BCVA was still inferior to that of the control eyes. No significant differences in visual function were found between the two surgical groups. The average CVI was 57.35% in the control eyes, 63.76% in the eyes that underwent vitrectomy, and 53.37% in buckled eyes. The differences in CVI were significant among the three groups. Among the surgical patients, negative Pearson's correlations were found between CVI and postoperative BCVA (expressed in logMAR). A multivariate linear regression model containing four parameters revealed that CVI was the only variable with a significant influence on postoperative BCVA, while the length of time with a detached macula did not have an effect. CONCLUSIONS: RRD surgery drastically restored vision, but the effect of RRD lingered, as postsurgical visual acuity remained inferior to that of the control eyes. The CVI varied between the treatment groups, likely due to both disease pathology and the impact of the surgery. The correlation between CVI and BCVA indicates the important role that the choroidal vasculature plays in visual function.

Ketorolac and (-)-Epicatechin change retinal GFAP and NRF2 expression on hyperglycemic CD1 mice.

Our objective was to determine whether (-)-Epicatechin administered alone or simultaneously with topical Ketorolac decreased the relative expression of GFAP and modulated the response of Nrf2 in a mouse model with induced hyperglycemia. We found that GFAP and Nrf2 decreased in the groups that received treatments alone or simultaneous during 8 weeks; even when the effect on the Nrf2 was not pronounced, it showed a higher concentration when GFAP decreased. Our results suggest a protective effect of Ketorolac and (-) - Epicatechin, which seem to limit the preclinical retinal damage caused by inflammation in hyperglycemia.

Etiology, risk factors, treatments and current status of Alzheimer's disease in Mexico.

Alzheimer's disease is a neurodegenerative disorder whose etiology continues to be discussed, to the point that there are different hypotheses that seek to clarify it, in addition to the fact that, given its multifactorial nature, there are different risk factors associated with its development. As regards diagnosis, advances in molecule detection techniques at femtomolar scales have allowed to distinguish between healthy and diseased subjects at relatively early stages, although there is still much to be done. Aducanumab is a monoclonal antibody targeted against Aß, whose marketing approval by the Food and Drug Administration has been questioned by the international medical community, given the controversial results in clinical trials. Approval of this antibody as a disease-modifying treatment for Alzheimer's disease opens the door to continue using this type of treatments, but with different therapeutic targets, such as, for example, tau protein. Finally, given the population tendency towards longevity, conditions such as Alzheimer's disease are gaining epidemiological importance, which is why it is imperative to analyze and link what is being done in the social, familiar, clinical and research fields and, most importantly, to find those areas of opportunity for the benefit of the patient.

La enfermedad de Alzheimer es un desorden neurodegenerativo cuya etiología aún se discute, al punto de que existen diferentes hipótesis que pretenden esclarecerla; además, dada su naturaleza multifactorial, existen diferentes factores de riesgo asociados a su desarrollo. Respecto al diagnóstico, los avances en las técnicas de detección de moléculas a escalas femtomolares han permitido discernir entre sujetos sanos y enfermos en estadios relativamente tempranos, aunque todavía hay mucho por hacer. Aducanumab es un anticuerpo monoclonal dirigido contra Aß, cuya aprobación por parte de la Food and Drug Administration para comercializarse ha sido cuestionada por la comunidad médica internacional, dados los resultados controversiales en los ensayos clínicos. La aprobación de este anticuerpo como tratamiento modificador de la enfermedad de Alzheimer abre la puerta para seguir utilizando este tipo de tratamientos, pero con blancos terapéuticos diferentes, como, por ejemplo, la proteína tau. Finalmente, dada la tendencia de la población hacia la longevidad, padecimientos como la enfermedad de Alzheimer están tomando importancia epidemiológica, por lo que resulta imperativo analizar y vincular lo que se está haciendo en los ámbitos social, familiar, clínico y de investigación y, sobre todo, encontrar esas áreas de oportunidad en beneficio del paciente.

Incidence and onset time of epiretinal membranes after two retinopexy techniques.

OBJECTIVE: To compare the incidence and onset time of epiretinal membranes after two surgical techniques to treat retinal detachment (retinopexy). METHOD: Non-experimental, retrospective, longitudinal and comparative study in patients treated of primary rhegmatogenous retinal detachment either with cryotherapy and scleral buckle (group 1) or vitrectomy techniques (group 2), without an epiretinal membrane at the moment of surgery. We compared the incidence of postoperative epiretinal membrane between groups, the median onset time (Mann-Whitney's U) and the proportions of eyes without an epiretinal membrane along time with a survival analysis (log-rank). RESULTS: 112 eyes in group 1, 48 in group 2; the incidence of epiretinal membrane was 23.2% in group 1 and 20.8% in group 2 (p = 0.8). The median time of onset was 12 weeks in group 1 (interquartile rank 8.75-16) and 18 in group 2 (12.5-22, p = 0.02). The log-rank test showed no differences of incidence along the follow-up between groups (p = 0.6). CONCLUSIONS: Epiretinal membranes appear early after retinopexy, before in eyes treated with crio-retinopexy. Although their incidence does not differ between groups, detecting them could start two months after a scleral buckle and three after a vitrectomy procedure.

OBJETIVO: Comparar la incidencia y el tiempo en que aparecen las membranas epirretinianas después de dos técnicas quirúrgicas para tratar el desprendimiento de retina (retinopexia). MÉTODO: Estudio observacional, retrospectivo, longitudinal y comparativo en pacientes operados por desprendimiento regmatógeno primario de retina sin una membrana epirretiniana al momento de la cirugía, divididos en grupos: operados mediante criorretinopexia/cerclaje escleral (grupo 1) o vitrectomía (grupo 2). Se compararon entre grupos la incidencia de membrana epirretiniana, la mediana del tiempo de aparición (U de Mann-Whitney) y las proporciones de ojos sin membrana epirretiniana temporalmente mediante un análisis de sobrevida (log-rank). RESULTADOS: En 112 ojos en el grupo 1 y 48 ojos en el grupo 2, la incidencia de membrana epirretiniana fue del 23.2% en el grupo 1 y del 20.8% en el grupo 2 (p = 0.8). La mediana del tiempo de aparición fue de 12 semanas en el grupo 1 (rango intercuartílico [RIC]: 8.75-16) y de 18 semanas en el grupo 2 (RIC: 12.5-22; p = 0.02). La prueba de log-rank no mostró diferencias en la incidencia durante el seguimiento (p = 0.6). CONCLUSIONES: Las membranas epirretinianas se presentan tempranamente después de una retinopexia, antes en ojos operados mediante criorretinopexia. De acuerdo con la incidencia observada, su búsqueda podría empezar 2 meses después de un cerclaje y 3 meses después de una vitrectomía.

Etiología, factores de riesgo, tratamientos y situación actual de la enfermedad de Alzheimer en México / Etiology, risk factors, treatments and current status of Alzheimer's disease in Mexico

Resumen La enfermedad de Alzheimer es un desorden neurodegenerativo cuya etiología aún se discute, al punto de que existen diferentes hipótesis que pretenden esclarecerla; además, dada su naturaleza multifactorial, existen diferentes factores de riesgo asociados a su desarrollo. Respecto al diagnóstico, los avances en las técnicas de detección de moléculas a escalas femtomolares han permitido discernir entre sujetos sanos y enfermos en estadios relativamente tempranos, aunque todavía hay mucho por hacer. Aducanumab es un anticuerpo monoclonal dirigido contra Aβ, cuya aprobación por parte de la Food and Drug Administration para comercializarse ha sido cuestionada por la comunidad médica internacional, dados los resultados controversiales en los ensayos clínicos. La aprobación de este anticuerpo como tratamiento modificador de la enfermedad de Alzheimer abre la puerta para seguir utilizando este tipo de tratamientos, pero con blancos terapéuticos diferentes, como, por ejemplo, la proteína tau. Finalmente, dada la tendencia de la población hacia la longevidad, padecimientos como la enfermedad de Alzheimer están tomando importancia epidemiológica, por lo que resulta imperativo analizar y vincular lo que se está haciendo en los ámbitos social, familiar, clínico y de investigación y, sobre todo, encontrar esas áreas de oportunidad en beneficio del paciente.

Abstract Alzheimer's disease is a neurodegenerative disorder whose etiology continues to be discussed, to the point that there are different hypotheses that seek to clarify it, in addition to the fact that, given its multifactorial nature, there are different risk factors associated with its development. As regards diagnosis, advances in molecule detection techniques at femtomolar scales have allowed to distinguish between healthy and diseased subjects at relatively early stages, although there is still much to be done. Aducanumab is a monoclonal antibody targeted against Aβ, whose marketing approval by the Food and Drug Administration has been questioned by the international medical community, given the controversial results in clinical trials. Approval of this antibody as a disease-modifying treatment for Alzheimer's disease opens the door to continue using this type of treatments, but with different therapeutic targets, such as, for example, tau protein. Finally, given the population tendency towards longevity, conditions such as Alzheimer's disease are gaining epidemiological importance, which is why it is imperative to analyze and link what is being done in the social, familiar, clinical and research fields and, most importantly, to find those areas of opportunity for the benefit of the patient.