Optical-Quality Assessment of a Miniaturized Intraocular Telescope.

Age-related macular degeneration (AMD) causes severe vision impairments, including blindness. An option to improve vision in AMD patients is through intraocular lenses and optics. Among others, implantable miniaturized telescopes, which direct light to healthy lateral regions of the retina, can be highly effective in improving vision in AMD patients. Yet, the quality of the restored vision might be sensitive to the optical transmission and aberrations of the telescope. To shed light on these points, we studied the in vitro optical performance of an implantable miniaturized telescope, namely, the SING IMT™ (Samsara Vision Ltd., Far Hills, NJ, USA) designed to improve vision in patients affected by late-stage AMD. Specifically, we measured the optical transmission in the spectral range 350-750 nm of the implantable telescope with a fiber-optic spectrometer. Wavefront aberrations were studied by measuring the wavefront of a laser beam after passing through the telescope and expanding the measured wavefront into a Zernike polynomial basis. Wavefront concavity indicated that the SING IMT™ behaves as a diverging lens with a focal length of -111 mm. The device exhibited even optical transmission in the whole visible spectrum and effective curvature suitable for retinal images magnification with negligible geometrical aberrations. Optical spectrometry and in vitro wavefront analysis provide evidence supporting the feasibility of miniaturized telescopes as high-quality optical elements and a favorable option for AMD visual impairment treatments.

On the Advent of Super-Resolution Microscopy in the Realm of Polycomb Proteins.

The genomes of metazoans are organized at multiple spatial scales, ranging from the double helix of DNA to whole chromosomes. The intermediate genomic scale of kilobases to megabases, which corresponds to the 50-300 nm spatial scale, is particularly interesting, as the 3D arrangement of chromatin is implicated in multiple regulatory mechanisms. In this context, polycomb group (PcG) proteins stand as major epigenetic modulators of chromatin function, acting prevalently as repressors of gene transcription by combining chemical modifications of target histones with physical crosslinking of distal genomic regions and phase separation. The recent development of super-resolution microscopy (SRM) has strongly contributed to improving our comprehension of several aspects of nano-/mesoscale (10-200 nm) chromatin domains. Here, we review the current state-of-the-art SRM applied to PcG proteins, showing that the application of SRM to PcG activity and organization is still quite limited and mainly focused on the 3D assembly of PcG-controlled genomic loci. In this context, SRM approaches have mostly been applied to multilabel fluorescence in situ hybridization (FISH). However, SRM data have complemented the maps obtained from chromosome capture experiments and have opened a new window to observe how 3D chromatin topology is modulated by PcGs.

Dynamic Pressure Measurements During Vitrectomy in a Model of the Eye.

Purpose: To accurately evaluate pressure changes during vitrectomy in a rigid model of the vitreous chamber and to test the efficiency of the EVA phacovitrectomy system (Dutch Ophthalmic Research Center) in terms of compensation of intraocular pressure variations. Methods: We tested 23-, 25-, and 27-gauge double-blade vitreous cutters in both vented global pressure control and automatic infusion compensation (AIC) modes in a vitreous chamber model, mimicking the real surgical procedure. Balanced salt solution and artificial vitreous, similar to the real vitreous body, were used. We tested both standard-flow (SF) and high-flow (HF) infusion systems, varying the infusion pressure between 20 and 40 mm Hg. In each experiment, flow rate was also measured. Results: Pressure drop was rapidly and efficiently compensated when 23- and 25-gauge cutters were used in AIC mode, with infusion pressures ranging between 30 and 55 mm Hg. The 27-gauge cutter was less efficient in compensating pressure variations. Pressure fluctuations related to the high-frequency motion of the cutter blade were small compared to the overall pressure variations. The use of the HF infusion system resulted in larger flow rates and lower pressure changes compared to the SF infusion system. Conclusions: Despite the rigid material of the model, the present pressure measurements are in line with previous studies performed on porcine eye. The use of AIC mode compensates intraoperative pressure drops efficiently, with both 23- and 25-gauge cutters. The HF infusion system is more efficient than the SF infusion system. Translational Relevance: The AIC infusion mode efficiently compensates intraoperative pressure drops, in both 23- and 25-gauge experimental vitrectomy. The HF infusion system resulted in larger flow rate and lower pressure changes.

Biocompatibility of intraocular liquid tamponade agents: an update.

Intraocular liquids tamponade agents, such as perfluorocarbon liquids (PFCLs), semifluorinated alkanes (SFAs), silicone oils (SOs) and heavy silicone oils (HSOs), are a crucial intraoperative and/or postoperative tool in vitreoretinal surgery, in particular for the management of complex vitreoretinal diseases. However, their use is not without complications, which are potentially severe. Consequently, a growing interest has been devoted to the biocompatibility of these compounds and the adequacy of current regulations that should guarantee their safety. Obviously, an updated knowledge on research findings and potential risks associated to the use of intraocular liquid compounds is essential, not only for vitreoretinal surgeons, but also for any ophthalmologist involved in the management of patients receiving intraocular liquid tamponades. In light of this, the review provides a comprehensive characterisation of intraocular liquid tamponades, in terms of physical and chemical properties, current clinical use and possible complications. Moreover, this review focuses on the safety profile of these compounds, summarising the existing regulation and the available evidence on their biocompatibility.

Experimental assessment of the performance of vitreous cutters with fluids with different rheological properties.

PURPOSE: To assess the influence of rheological properties of an artificial vitreous (AV) on the performance of double-blade (DB) and single-blade (SB) guillotine vitreous cutters, with 23-, 25-, and 27-gauge (G) probes. METHODS: We evaluate the aspiration flow rate, using an optical method, based on image processing. Experiments are conducted using ten viscoelastic vitreous phantoms, with different properties that are measured with rheological tests. RESULTS: Aspiration rate strongly varies with fluid properties. Regardless of cutter geometry and operational conditions, the flow rate significantly decreases as vitreous viscosity and elasticity increase. CONCLUSIONS: All tested vitreous probes are very sensitive to changes in fluid rheology. SB cutters produce smaller flow rates compared with DB ones of the same caliber; however, they are less sensitive to fluid properties at low aspiration pressures. The use of vitreous substitutes for test performance guarantees comparability between flow rate results achieved with different vitrectomy systems operating in different media. This outcome is further confirmed by the low values of estimated flow rate relative errors.

The Role of Endogenous Proteins on the Emulsification of Silicone Oils Used in Vitreoretinal Surgery.

The present work is aimed at investigating the chemicophysical properties of the interface between silicone oils (SOs) used in vitreoretinal surgery and aqueous solutions, in the presence of surfactant biomolecules. Such molecules are thought to play an important role in the formation of SO emulsions in vitrectomised eyes, in which the natural vitreous body has been replaced with a SO. In particular, we have measured the interfacial tension (IT) and the interfacial dilational viscoelasticity (DV) of the interface between SO (Siluron 1000) and serum proteins (albumin and γ-globulins) at various concentrations in a Dulbecco alkaline buffer. The equilibrium IT value is relevant for the onset of emulsification, and the DV influences the stability of an emulsion, once formed. The study is complemented by preliminary emulsification tests. The experimental results show that, when proteins are dissolved in the aqueous solution, the rheological properties of the interface change. The IT decreases significantly for physiological protein concentrations, and the DV modulus achieves high values, even for small protein concentrations. The emulsification tests confirm that, in the presence of proteins, emulsions are stable on the time scale of months. We conclude that the measured values of IT in the presence of serum proteins are compatible with the promotion of droplet formation, which, in addition, are expected to be stable against coalescence. Adsorption of biomolecules at the interface with the SO is, therefore, likely to play an important role in the generation of an emulsion in eyes subjected to vitrectomy. These findings are relevant to identify strategies to avoid or control the formation of emulsions in eyes.

Fluid Dynamic Assessment of Hypersonic and Guillotine Vitrectomy Probes in Viscoelastic Vitreous Substitutes.

Purpose: To assess the fluidics of 23-gauge (G) large-port (L) and tear drop-port (TD) hypersonic vitrectomy probes (HVPs) compared with guillotine vitrectomy probes (GVPs) of various calibers (23G, 25G, and 27G) and geometries (single and double blades). Also, to identify the working parameters that provide the best balance between acceleration and flow rate, and, for HVPs, to measure temperature variations in the fluid. Methods: We used particle image velocimetry to measure flow fields in balanced salt solution and viscoelastic artificial vitreous. We analyzed acceleration, kinetic energy, and volumetric flux. The parameters considered were vacuum pressure, ultrasound stroke, and cut rate. Temperature measurements were taken using an infrared thermal camera. Results: The flow rate was significantly higher for HVPs than GVPs. With both probes, flow rate and acceleration increased with vacuum pressure. Flow rate depended weakly on the ultrasound stroke or cut rate. In HVPs, the acceleration peaked at a stroke of 30 µm, whereas in GVPs it peaked at a cutting rate of 4000 to 5000 cuts per minute (cpm). The HPV/TD combination generated higher flow rates and lower accelerations than did HPV/L. The increase in temperature was small. Conclusions: Under the present experimental setup and medium, HVPs offered better fluidics compared with GVPs in terms of flow and acceleration; however, the flow structure for HVPs is more complicated and unsteady. The HPV/TD combination produced larger flows than did the HPV/L combination and slightly smaller accelerations. HPVs generated a small temperature increase. Translational Relevance: In the tested artificial vitreous, HVPs were found to be more efficient in terms of generating lower acceleration for a given flow rate. The slight increase in temperature observed with HVPs is unlikely to be clinically significant.