Efficiency of Closed Mastication of Gummy Evaluated with Gnatho-hexagraph.

The aim of this study was to determine whether chewing with closed lips improved masticatory efficiency compared with open lips. A total of 21 adults comprising 10 men and 11 women with a mean age of 26.2±3.5 years and normal masticatory function were included in the study. The study participants were instructed to chew a fresh gummy under two conditions for 30 seconds each, one after the other: the first with closed lips, and the second with open lips. The average size of the fragmented gummies was calculated and graded from 1 to 4 according to a specific scale. Masticatory efficiency was evaluated using this "gummy mastication value" and the Gnatho-hexagraph II to observe and analyse jaw movement during chewing. Differences in chewing time and mouth-opening distance were also compared. The gummy mastication value for open and closed lips mastication was 2.51±0.56 and 3.25±0.50, respectively (p<0.01). Masticatory efficiency was significantly greater during closed-lip mastication. The number of chewing strokes over 20 seconds decreased while chewing time and mouth-opening distance increased in cycle 1 with open-lip mastication. In conclusion, the present results revealed that chewing efficiency improved with closed-lip mastication, indicating that instruction to seal the lips while eating is appropriate and necessary.

Intraocular pressure elevation is a delayed-onset complication after successful vitrectomy for stages 4 and 5 retinopathy of prematurity.

PURPOSE: To determine the incidence and risk factors for delayed-onset intraocular pressure (IOP) elevations after vitrectomy for Stages 4 and 5 retinopathy of prematurity and, in addition, to determine the results of treating the IOP elevations. METHODS: Fifty-five consecutive eyes with successful retinal reattachment and at least 24 months of follow-up after vitrectomy were studied. The ophthalmic examinations included slit-lamp biomicroscopy, wide-field digital retinal imaging, and IOP measurements. Eyes were classified into 2 groups: eyes with a postoperative IOP elevation to ≥ 21 mmHg and eyes whose IOP was always <21 mmHg. RESULTS: Eight eyes (14.5%) developed an IOP elevation to ≥ 21 mmHg from 2 months to 4 months (median: 2.5 months) after the vitrectomy. In two of these eyes, the IOP was controlled with antiglaucoma medications. In the other six eyes, trabeculotomy for eyes with open angles and trabeculectomy or goniosynechialysis for eyes with closed angles were performed. The IOPs were successfully controlled after an average of 1.5 glaucoma surgeries. Multivariate logistic regression analyses identified that a young gestational age (odds ratio = 1.147, 95% confidence interval: 1.024-1.346) and lensectomy (odds ratio = 8.795, 95% confidence interval: 1.262-183.3) were significantly associated with the IOP elevation. CONCLUSION: Delayed-onset IOP elevation after vitrectomy for retinopathy of prematurity occurs in 14.5% of the eyes, and it is significantly associated with a young gestational age and presence of lensectomy.

[Long-term prognosis of 5 cases with stage 3A Coats disease after vitrectomy].

PURPOSE: The effectiveness of laser photocoagulation and/or cryopexy to the abnormal retinal vessels for the treatment of eyes with Coats disease is reported. However, in Coats cases with serous detachment laser photocoagulation and/or cryopexy is sometimes not enough to coagulate and consecutively scar the abnormal vessels, leading to persistent subretinal fluid and multiple courses of treatment. Therefore, we investigated the long-term prognosis of Stage 3A Coats cases with macular detachment which underwent vitrectomy. METHODS: Five eyes of 5 cases (all men) with Stage 3A Coats disease, which underwent primary vitrectomy between 1999 and 2009, were investigated retrospectively. The average age at vitrectomy was 13.8 years (range; 6-21 years) and the average preoperative visual acuity in decimal equivalent was 0.1 (range; 0.04-0.5). The average follow-up period after vitrectomy was 83 months (range; 13-137 months). In the vitrectomy, posterior vitreous detachment either occurred or was confirmed. An intentional retinal hole was made and the subretinal fluid was drained through the hole. The abnormal vessels were coagulated by endo-diathermy and/or laser photocoagulation. The vitreous fluid was replaced with long-lasting gas or air. The visual acuity and the findings from the ocular fundus both before and after the vitrectomy were investigated. RESULTS: The average best-corrected visual acuities in decimal equivalent before, 3 and 12 months after the vitrectomy, and at the final visit were 0.1, 0.2, 0.2, 0.4, respectively. There was a statistically significant (p = 0.007) difference between the 4 time points, and the visual acuities at 12 months after vitrectomy and the final visit were significantly (p < 0.05) better than before the vitrectomy. The macular part of the retina in all 5 cases was attached once the gas in the vitreous cavity had disappeared. The foveal exudation which was observed before the vitrectomy in all 5 cases was completely absorbed after the vitrectomy. The average period from the vitrectomy to the complete absorption of the exudation was 20 months. Subfoveal fibrosis was observed in 4 of the 5 eyes and chorioretinal atrophy occurred in 3. CONCLUSIONS: Vitrectomy for eyes with Stage 3A Coats disease may be effective for visual prognosis compared to conventional therapy, i.e., laser photocoagulation and cryopexy, by enabling retinal attachment in the early postoperative period and by causing the foveal exudation to disappear.

Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment.

PURPOSE: To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy (PDR). DESIGN: Retrospective, comparative, consecutive, interventional case series. PARTICIPANTS: Seventy-one eyes of 59 consecutive patients who underwent primary vitrectomy for diabetic TRD and were followed up for more than 6 months after surgery. METHODS: Eyes that received IVB (1 mg) as a preoperative adjunct followed by MIVS (IVB/MIVS group) from November 2005 through December 2007 were compared with eyes that underwent conventional 20-gauge pars plana vitrectomy (20-g PPV group) from September 2003 through October 2005. MAIN OUTCOME MEASURES: Primary and ultimate anatomic success, intraoperative and postoperative complications, and final visual success with at least 6 months of follow-up. RESULTS: This series included 38 eyes (33 patients) in the IVB/MIVS group and 33 eyes (26 patients) in the 20-g PPV group. The primary and ultimate anatomic success rates (95% vs. 91% and 100% in both groups, respectively) and the mean visual acuity changes did not differ significantly between groups; the surgical time and intraoperative bleeding in the IVB/MIVS group decreased significantly compared with the 20-g PPV group (P<0.001). The rate of visual improvement of 3 lines or more at the 6-month follow-up was 68% in the IVB/MIVS group and 49% in the 20-g PPV group, respectively. Progression of the preexisting TRD after IVB occurred in 7 eyes (18%). Absence of previous laser photocoagulation (P = 0.025) and the presence of a ring-shaped fibrovascular membrane (P = 0.013) were relevant findings in eyes with these IVB-induced complications. CONCLUSIONS: Intravitreal bevacizumab plus MIVS offers comparable anatomic success compared with conventional 20-gauge PPV in patients with TRD resulting from severe PDR. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

One-year results of combined photodynamic therapy and intravitreal bevacizumab injection for retinal pigment epithelial detachment secondary to age-related macular degeneration.

BACKGROUND: To evaluate the efficacy of combined photodynamic therapy (PDT) and intravitreal bevacizumab injection in eyes with a serous pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD). METHODS: Twenty-two eyes with a serous PED exceeding two disc areas associated with AMD with choroidal vascular abnormalities [choroidal neovascularization (n = 10), polypoidal choroidal vasculopathy (n = 9), and retinal angiomatous proliferation (n = 3)] received combined PDT and intravitreal bevacizumab, and were followed about every 6 weeks for more than 1 year. Additional treatments were given for residual or recurrent lesions. The main outcome measures were changes in the PED height measured by optical coherence tomography, and the best-corrected visual acuity. RESULTS: After one treatment, the PED resolved in 12 eyes (55%) and the PED decreased in ten eyes (45%). There was no recurrence in eight (36%) eyes; however, PED recurred in 14 eyes. At 1 year, the average PED height decreased to 413 microns from the baseline 751 microns (p < 0.001). Twenty eyes (91%) had improved or stabilized vision; two eyes had decreased vision due to a retinal pigment epithelial tear and subretinal hemorrhage. CONCLUSIONS: Combined PDT and intravitreal bevacizumab may decrease the PED height and stabilize visual acuity at 1 year.

Chandelier illumination to complete Descemet stripping through severe hazy cornea during Descemet-stripping automated endothelial keratoplasty.

We describe a technique that uses chandelier illumination during Descemet-stripping automated endothelial keratoplasty (DSAEK) in severe bullous keratopathy. A 25-gauge or 27-gauge chandelier illumination fiber inserted through the corneal side port serves as sclera-scattering illumination from the sclerocorneal margin and endoillumination from the anterior chamber and provides excellent visibility for Descemet stripping and intraocular manipulation without obstruction by a hazy cornea. In cases complicated by dense cataract, the chandelier fiber can be inserted transconjunctivally into the pars plana, providing sufficient retroillumination to perform phacoemulsification with intraocular lens implantation combined with Descemet stripping for a DSAEK triple procedure. Because of the powerful illumination and hands-free nature of the chandelier fiber, Descemet membrane can be visualized clearly and stripped as 1 sheet without inadvertent complications. This new technique is safe and might encourage surgeons to perform DSAEK in challenging cases.

Chandelier retroillumination-assisted torsional oscillation for cataract surgery in patients with severe corneal opacity.

We describe a technique that uses 25-gauge transconjunctival chandelier endoillumination in combination with a torsional oscillation system for cataract surgery in cases with severe bullous keratopathy. Because of the hands-free and self-retaining nature of the chandelier fiber, continuous curvilinear capsulorhexis and subsequent bimanual intraocular manipulation can be performed easily. Torsional oscillation efficiently emulsifies lens particles along with the fluidics, preventing posterior capsule rupture and endothelial cell damage. After the chandelier fiber is removed at the end of surgery, the 25-gauge incision self-seals. This technique is safe and provides excellent visualization during cataract surgery in patients with severe corneal opacities.

Anatomic and functional outcomes of 25-gauge vitrectomy for repair of eyes with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy.

BACKGROUND: The purpose of this study was to evaluate the outcome of 25-gauge vitrectomy for repair of rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR). METHODS: Twenty-seven eyes of 27 patients who had undergone 25-gauge vitrectomy for grade C PVR were investigated retrospectively. The surgical procedures, anatomic success, and best-corrected visual acuity were assessed. RESULTS: The mean number of operations was 1.4 (range 1-4). During the 25-gauge vitrectomy, 20-gauge instruments were needed in eleven eyes (40.7%) to remove resilient fibrous preretinal membranes, to extract subretinal proliferations, or to remove or infuse silicone oil. The retina was reattached in 21 eyes (77.8%) after the initial vitrectomy and in 25 eyes (92.6%) at the final examination. The mean best-corrected visual acuity in logarithm of the minimal angle of resolution units was 1.36 ± 0.81 before vitrectomy and 0.79 ± 0.71 at one month, 0.73 ± 0.72 at 3 months, 0.73 ± 0.75 at 6 months, and 0.75 ± 0.78 at 12 months after vitrectomy. The best-corrected visual acuities were significantly improved compared with the preoperative ones at all postoperative assessments (P<0.001). CONCLUSION: Twenty-five gauge vitrectomy is a relatively safe and efficacious method of treating RRD with PVR, although combined use of 20-gauge instruments may be needed for certain surgical procedures.

Acute retinal necrosis: factors associated with anatomic and visual outcomes.

PURPOSE: To examine the factors associated with anatomic and visual outcomes in Japanese patients with acute retinal necrosis (ARN). METHODS: One hundred four patients with ARN who were followed for more than 1 year at nine referral centers were reviewed. Retinal involvement at initial presentation was classified into four groups: zone 1 (posterior pole, n = 22), zone 2 (midperiphery, n = 54), zone 3 (periphery, n = 25), and unknown (n = 3). Forty-eight eyes underwent prophylactic vitrectomy before development of retinal detachment (vitrectomy group); 56 eyes were treated conventionally without prophylactic vitrectomy (observation group). RESULTS: The retina was attached in 28 of 48 eyes (58.3 %) in the vitrectomy group and 42 of 56 eyes (75.0 %) in the observation group at the final visit (P = 0.071). At 1 year, 56 eyes (53.8 %) had a best-corrected visual acuity (BCVA) of 20/200 or worse. Multivariate logistic regression analyses identified zone 1 disease (odds ratio = 4.983) and optic nerve involvement (odds ratio = 5.084) as significantly associated with BCVA of 20/200 or worse. Among the zone 3 eyes, significantly (P = 0.012) more eyes in the observation group than in the vitrectomy group had an attached retina. CONCLUSIONS: Prophylactic vitrectomy did not improve the final BCVA in any eyes. Zone 3 eyes had better outcomes without prophylactic vitrectomy.

25-gauge vitrectomy versus intravitreal bevacizumab for macular edema secondary to branch retinal vein occlusion: 1 year follow-up.

INTRODUCTION: This study aims to compare the long-term efficacy of 25-gauge vitrectomy to that of intravitreal bevacizumab (IVB) for the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). MATERIALS AND METHODS: The medical records of 46 eyes of 46 consecutive patients were reviewed. Twenty-seven eyes underwent 25-gauge vitrectomy (VIT Group) and 19 eyes received 1.25 mg of IVB (IVB Group). The best-corrected visual acuities (BCVAs) in logarithm of minimum angle resolution units and central macular thicknesses (CMTs) were evaluated before and 3, 6, and 12 months after the initial treatment. RESULTS: There was no significant difference in the pre-treatment BCVA and CMT between the 2 groups. In the VIT Group, the preoperative BCVA was 0.59 and the CMT was 587.3 µm and the BCVA was 0.35 and the CMT was 286.6 µm, 12 months after the vitrectomy. Both values were significantly (P <0.05) better at 12 months than the preoperative values. In the IVB Group, the average number of IVB was 2.4 during the 1-year period. The BCVA was 0.69 and the CMT was 590.9 µm before the IVB, and the BCVA was 0.36 and the CMT was 360.1 µm, 12 months after the initial IVB. The improvements of these 2 parameters were significant (P <0.05) at 12 months after the initial IVB. The differences in the BCVA and CMT at 12 months between the 2 groups were not significant. CONCLUSION: These results suggest that the 25-gauge vitrectomy and IVB have similar effects in improving the BCVA and CMT in eyes with ME secondary to BRVO. However, IVB often required several injections to preserve the improvement.

Serum concentrations of bevacizumab (avastin) and vascular endothelial growth factor in infants with retinopathy of prematurity.

PURPOSE: To determine the serum concentrations of bevacizumab and vascular endothelial growth factor (VEGF) in infants with retinopathy of prematurity (ROP) who received intravitreal bevacizumab; and to determine whether the changes in the serum concentration of bevacizumab were significantly correlated with the serum concentration of VEGF after intravitreal bevacizumab. DESIGN: Case series. METHODS: Eleven infants (4 girls and 7 boys) with ROP were studied. They received 0.25 mg or 0.5 mg of intravitreal bevacizumab to either 1 eye (unilateral cases) or both eyes (bilateral cases) with vascularly active ROP. Serum samples were collected before and 1 day, 1 week, and 2 weeks after the intravitreal bevacizumab. The serum concentrations of bevacizumab and VEGF were measured by enzyme-linked immunosorbent assay, and the correlation in the serum levels between the 2 was determined. RESULTS: The serum concentration of bevacizumab before and 1 day, 1week, and 2 weeks after a total of 0.5 mg of intravitreal bevacizumab was 0 ng/mL, 195 ± 324 ng/mL, 946 ± 680 ng/mL, and 1214 ± 351 ng/mL, respectively. The serum bevacizumab level before and 1 day and 1 week after a total 1.0 mg of intravitreal bevacizumab was 0 ng/mL, 248 ± 174 ng/mL, and 548 ± 89 ng/mL, respectively. The serum concentration of VEGF before and 1 day, 1 week, and 2 weeks after a total of 0.5 mg intravitreal bevacizumab was 1628 ± 929 pg/mL, 427 ± 140 pg/mL, 246 ± 110 pg/mL, and 269 ± 157 pg/mL, respectively. There was a significant negative correlation (r = -0.575, P = .0125) between the serum concentration of bevacizumab and VEGF when a total of 0.25 mg or 0.5 mg of bevacizumab was injected. CONCLUSIONS: These results indicate that bevacizumab can escape from the eye into the systemic circulation and reduce the serum level of VEGF in infants with ROP. Continued extensive evaluations of infants are warranted for possible effects after intravitreal bevacizumab in ROP patients.

Vitreous levels of angiopoietin-1 and angiopoietin-2 in eyes with retinopathy of prematurity.

PURPOSE: To determine the vitreous levels of angiopoietin (Ang)-1 and Ang-2 in eyes with retinopathy of prematurity (ROP), and to determine the correlation between the 2 levels. DESIGN: Retrospective case-control study. METHODS: Forty-eight eyes with stage 4 ROP were studied. Six eyes with congenital cataract were used as controls. The ROP eyes were classified by the vascular activity into highly (n = 22), moderately (n = 15), and mildly (n = 11) vascular-active ROP. Eyes with highly vascular-active ROP initially received 0.5 mg of intravitreal bevacizumab (IVB) and underwent vitrectomy within 1 week. The others underwent vitrectomy without IVB. Vitreous samples were collected at the beginning of vitrectomy, and the vitreous levels of Angs were measured by enzyme-linked immunosorbent assay. RESULTS: The mean concentrations of Ang-1 and Ang-2 were 201.9 and 7832.1 pg/mL in highly vascular-active ROP eyes, 216.1 and 7731.2 pg/mL in moderately vascular-active ROP eyes, 533.8 and 1685.9 pg/mL in mildly vascular-active ROP eyes, and 0 and 41.5 pg/mL in control eyes. The vitreous Ang-1 level was significantly higher (P < .05) in highly, moderately, and mildly vascular-active ROP eyes than in control eyes. The vitreous Ang-2 level was significantly higher (P < .05) in highly and moderately vascular-active ROP eyes than in control eyes. There was a significant negative correlation (r = -0.406; P = .040) between the Ang-1 and Ang-2 levels in moderately and mildly vascular-active ROP eyes. CONCLUSIONS: The balance of Ang-1 and Ang-2 in the vitreous may be important in the pathogenesis of ROP.

Complications in patients after intravitreal injection of bevacizumab.

PURPOSE: To report complications in patients after intravitreal injection of bevacizumab to treat ocular diseases associated with vascular endothelial growth factor. METHODS: We retrospectively reviewed the systemic and ocular complications that developed within 2 months of each intravitreal injection of bevacizumab in 707 patients (1300 injections) with intraocular neovascularization or macular oedema. RESULTS: Nine ocular (1.27%) and eight systemic (1.13%) complications occurred in 707 patients. The ocular complications included corneal abrasion (n = 2), chemosis (n = 2), lens injury (n = 1), ocular inflammation (n = 2), retinal pigment epithelial tear (n = 1) and acute vision loss (n = 1). The systemic complications included cerebral infarction (n = 1), elevation of systolic blood pressure (n = 2), facial skin redness (n = 1), itchy diffuse rash (n = 1) and menstrual irregularities (n = 3). CONCLUSION: Intravitreal injection of bevacizumab may cause systemic or ocular complications. Caution is advised when considering intravitreal injection of this drug.