Minimal surgery achieved good visual acuity in selected patients with magnetic intravitreal foreign body and traumatic cataract.

BACKGROUND: To explore minimal surgery in selected patients with intravitreal foreign body (IVFD) and traumatic cataract. METHODS: Twelve eyes of 12 patients with small ferrous IVFD and traumatic cataract without endophthalmitis, retinal injury and secondary glaucoma, between September 2015 and March 2017 were retrospectively analyzed. Primary removal of IVFD was performed by external magnetic extraction through the pars plana incision. Secondary removal of traumatic cataract by phacoemulsification and intraocular lens (IOL) implantation with or without anterior vitrectomy were performed. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months and 12 months after surgery. RESULTS: All patients were male with a mean age of 32 years old. All IVFDs were successfully removed without retinal injury. Two to 6 months later, the traumatic cataract was successfully removed by phacoemulsification combined with IOL implantation in the capsule bag in 10 patients. Anterior vitrectomy was implied in 2 patients with large posterior capsule rupture, and the IOLs were placed in the ciliary sulcus. Best-corrected visual acuity ranged from hand movement to 20/100 before surgery and improved ranging from 20/32 to 20/20 at the final follow-up. The IOLs were well centered. Complications such as secondary glaucoma, endophthalmitis and retinal detachment were not found. CONCLUSIONS: Primary removal of small ferrous IVFD by external magnetic extraction followed by secondary cataract removal and IOL implantation is an appropriate choice. Minimal surgery may obtain good visual outcome without complications in selected patients.

SURGICAL REMOVAL OF DENSE POSTERIOR CAPSULE OPACIFICATION AND VITREOUS FLOATERS IN ADULTS BY POSTERIOR CONTINUOUS CURVILINEAR CAPSULORHEXIS THROUGH THE PARS PLANA AND 23-GAUGE VITRECTOMY.

PURPOSE: To evaluate the safety and efficacy of posterior continuous curvilinear capsulorhexis through the pars plana and 23-gauge vitrectomy in surgical management of dense posterior capsule opacification and vitreous floaters. METHODS: Fifteen pseudophakic eyes of 15 patients with dense posterior capsule opacification and vitreous floaters between September 2012 and June 2014 were included; after vitrectomy, posterior continuous curvilinear capsulorhexis through the pars plana was performed. Data were collected, including baseline preoperative characteristics, postoperative outcomes, complications, and a modified quality-of-life survey that patients completed. RESULTS: No intraoperative or postoperative complications were encountered in any of the 15 cases. Mean Snellen best-corrected visual acuity was 20/250 preoperatively and improved to 20/32 postoperatively (P < 0.001). All patients showed normal intraocular pressure 7 days after the procedure. The mean overall corneal endothelial cell loss at postoperative Month 3 was 1.2%. Approximately 80% of the patients had no complaint of vitreous floaters after the procedure. Except for 1 patient (7%) diagnosed with age-related macular degeneration, the rest of the patients (93%) were satisfied with the procedure and would recommend it to friends with dense posterior capsule opacification and vitreous floaters. CONCLUSION: Posterior continuous curvilinear capsulorhexis through the pars plana combined with 23-gauge vitrectomy may be used to remove dense posterior capsule opacification and vitreous floaters in pseudophakic eyes.

Case Report: Hereditary transthyretin (ATTRv) amyloidosis: The p.G103R mutation of the transthyretin gene in a Han Chinese family is associated with vitreous hemorrhage.

Hereditary transthyretin (ATTRv) amyloidosis is a rare disease caused by transthyretin gene (TTR) mutation. We identified that the p.G103R mutation of the TTR gene in a Han Chinese family was associated with vitreous hemorrhage. The proband was a 48-year-old woman who had progressive visual impairment in both eyes for 12 years. A Glass wool-like posterior vitreous cortex attached to the posterior retinal surface of both eyes was found using ocular coherence tomography. Visual acuity improved after the first vitrectomy. Two years later, the patient underwent two more vitrectomies because of vitreous opacity recrudescence. Four years later, she presented with vitreous hemorrhage in the right eye. The vitreous fluids acquired during the vitrectomy showed increased vascular endothelial growth factor, basic fibroblast growth factor, interleukin-6, interleukin-10, vascular cell adhesion molecule, and interleukin-8. Mutation sequencing revealed a heterozygous mutation in nucleotide c.307G > C (p.G103R) in exon 3 of the TTR gene in the proband (IV-13), her daughter (IV-9), and her fourth sister (III-11). To our knowledge, this is the first case of ATTRv amyloidosis caused by a p.G103R mutation of the TTR gene associated with vitreous hemorrhage in China.

Guideline for the treatment of no light perception eyes induced by mechanical ocular trauma.

Severe mechanical ocular trauma with no light perception (NLP) predicts a poor prognosis of visual acuity and enucleation of the eyeball. Since the innovative treatment concept of exploratory vitreoretinal surgery has developed and treatment technology has advanced, the outcomes of severe ocular trauma treatment in NLP patients have greatly improved. However, there remains a lack of unified standards for the determination, surgical indication, and timing of vitrectomy in NLP eye treatment. To address these problems, we aimed to create evidence-based medical guidelines for the diagnosis, treatment, and prognosis of mechanical ocular trauma with NLP. Sixteen relevant recommendations for mechanical ocular trauma with NLP were obtained, and a consensus was reached. Each recommendation was explained in detail to guide the treatment of mechanical ocular trauma associated with NLP.

Optical Coherence Tomography Angiography-Based Quantitative Assessment of Morphologic Changes in Active Myopic Choroidal Neovascularization During Anti-vascular Endothelial Growth Factor Therapy.

Purpose: To establish quantitative profile of the morphologic changes among patients with active myopic choroidal neovascularization (mCNV) before and after anti-vascular endothelial growth factor (VEGF) therapy using optical coherence tomography angiography (OCTA) to assess the therapeutic response. Methods: Patients with active mCNV who received anti-VEGF injections between February 2017 to October 2020 and fit the study criteria were retrospectively reviewed. Quantitative analysis of their OCTA images were carried out to evaluate the morphologic features and vascular changes of mCNV lesions in response to anti-VEGF therapy. For further quantitative profiling, mCNV area, fractal dimension, vessel area, vessel density, vessel diameter, vessel length, vessel junction, junction density, and vessel tortuosity were obtained by means of advanced skeletonization postprocessing analyses. Results: Thirty-one eyes of 29 consecutive patients with OCTA-positive mCNV lesions (mean spherical equivalent: -12.55 ± 3.24 diopters) were included. The 31 cases were divided into two phenotypes at baseline: organized interlacing pattern (83.87%) and disorganized vascular loops pattern (16.13%). The values of mCNV area, fractal dimension, vessel area, vessel length, vessel junction, and junction density decreased remarkably 1 month after the initial anti-VEGF injection (p < 0.001). Although, vessel density, vessel diameter, and vessel tortuosity increased meanwhile, only vessel diameter displayed statistical significance (p = 0.027). Of note, relative ratio analysis showed that vessel junction was the most sensitive biomarker in response to anti-VEGF therapy, reflecting a mean decrease of 50.36%. Sensitivity lowered successively in biomarkers of vessel length, vessel area, junction density, mCNV area, and fractal dimension. In addition, percent change of mCNV area (r = 0.552, p = 0.002), fractal dimension (r = 0.446, p = 0.017), vessel area (r = 0.518, p = 0.005), and vessel length (r = 0.440, p = 0.019) were moderately associated with that of central retinal thickness. Conclusions: The study showed morphological as well as quantitative changes on OCTA responding to anti-VEGF treatment in mCNV patients, among which vessel junctions might be the most predictive biomarker. OCTA-based analysis, providing intuitive images and a large spectrum of quantitative data at the same time, could promote new insights into the therapeutic response assessment in mCNV patients.

Characterization and Management of Late Postoperative Capsular Block Syndrome Following Phacoemulsification or Phacovitrectomy.

PURPOSE: To compare the clinical characteristics of eyes affected by late postoperative capsular block syndrome (CBS) after routine phacoemulsification or phacovitrectomy, and to demonstrate the outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy and posterior continuous curvilinear capsulorrhexis (PCCC) in the treatment of CBS. DESIGN: Retrospective interventional case series study. METHODS: Twenty-eight patients with late postoperative CBS, comprising 13 eyes after phacoemulsification (Group A) and 15 eyes after phacovitrectomy (Group B), were analyzed. Seventeen patients with minimal (degree I), mild (II), and moderate (III) posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy (Group A, 10 eyes and Group B, 7 eyes), while 11 patients with severe (degree IV) PCO underwent PCCC (Group A, 3 eyes and Group B, 8 eyes). RESULTS: A statistically significant postoperative improvement in best-corrected visual acuity (Group A, P = .0002 and Group B, P = .0070) and a significant postoperative decrease in aqueous flare value (Group A, P = .0077 and Group B, P = .0127) were observed. No significant differences were observed in intraocular pressure, aqueous depth, and diopters (P > .05). No surgical complications were experienced by either group. CONCLUSIONS: Late postoperative CBS had similar characteristics whether it developed after phacoemulsification or after phacovitrectomy. Nd:YAG capsulotomy and the PCCC technique are efficient approaches to mild and moderate PCO and severe PCO with CBS, respectively. PCCC may be a viable alternative for treating dense PCO with CBS in pseudophakic eyes.

[Evaluation of photodynamic therapy in idiopathic choroidal neovascularization].

OBJECTIVE: To evaluate the effectiveness of photodynamic therapy (PDT) in the treatment of idiopathic choroidal neovascularization (CNV). METHODS: Sixty-one cases (61 eyes) of CNV were treated with PDT and the fundus appearance, visual acuity, retina thickness as well as the fundus angiographic imaging were observed before and after the therapy. PDT was performed 1.2 times in average and the follow-up period was 6 - 36 months (mean 19 months). RESULTS: At the last follow up, the visual acuity was improved in 41 eyes (67.2%), unchanged in 15 eyes (24.6%) and slightly decreased in 5 eyes (8.2%). Macular hemorrhage and exudation reduced in all cases after PDT. Fundus angiography showed complete closure of CNV in 38 eyes (62.3%), partial closure in 4 eyes (6.6%), incomplete closure in 14 eyes (23.0%) and recurrence in 5 eyes (8.2%). In 6 eyes CNV was complete closed after single PDT with diminish of macular edema and neuronal retinal epithelial detachment. No recurrent CNV was observed during three years' follow-up and the visual acuity remained stable. Our results also demonstrated that the therapeutic effect decreased with patient's age (t = 0.476, P = 0.016). The decrease of visual acuity averaged 0.008 per year. CONCLUSION: Photodynamic therapy is a potential treatment for idiopathic CNV and better outcomes are achieved in younger patients.

[Incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis].

OBJECTIVE: To determine the incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis. METHODS: Vitreoretinal pathologic conditions of 1981 consecutive eyes (995 patients) having undergone laser-assisted in situ keratomileusis for the correction of myopia were studied. Preoperative and postoperative basic examinations included visual acuity, manifest and cycloplegic refraction, slit-lamp microscope examination, applanation tonometry and a fundus examination after pupil dilatation by indirect ophthalmoscopy and biomicroscopy with spherical lens of + 90 diopters. Before laser in situ keratomileusis, preventive treatment was carried out for predisposing lesion of retinal detachment in 8 eyes: 6 eyes for lattice degeneration and 2 eyes for atrophic holes. Postoperative examinations were conducted at 1, 3 and 12 months and once a year thereafter. All eyes were followed up for >/= 12 months. RESULTS: Eyes were followed for a mean of (18.40 +/- 4.50) months (range 12 - 28) after the surgery. Sixteen eyes of 13 patients (0.81%) developed vitreoretinopathy after LASIK, including 6 eyes with lattice degeneration (0.30%) in which one of them had previous laser treatment, 2 with posterior vitreous detachment (0.10%), 2 with macular hemorrhage (0.10%), 4 with rhegmatogenous retinal detachment (0.20%), and 2 with retinal tear without retinal detachment (0.10%) in which one of them had previous laser treatment for lattice degeneration. Five patients were males (5 eyes involved). Others were females. Mean age of the group with vitreoretinal pathologic conditions was 31.80 +/- 5.85 years (range 22 to 43). The interval between refractive surgery and development of vitreoretinal complication was (10.38 +/- 6.20) months (range 1 to 24). The eyes that developed vitreoretinopathy had myopia -4.75 to -15.00 diopters (mean -9.45 +/- 2.61 D) before LASIK. The comparison of incidences of vitreoretinopathy after LASIK between the group of >/= -6.00 D and < -6.00 D before surgery showed significant difference (P < 0.01, chi(2) = 60.78). The comparison of incidences of vitreoretinopathy after LASIK had also significant difference (P < 0.01, chi(2) = 138.64) between the eyes with pre-LASIK lattice degeneration and dry hole and eyes without such lesions. The cases of lattice degeneration and retinal tear were treated with laser retinopexy. All cases of rhegmatogenous retinal detachment were managed with cryoretinopexy and scleral buckling. Retinal reattachment was attained in all eyes and good visual acuities were recovered. CONCLUSION: No direct cause-effect relationship between LASIK and vitreoretinopathy can be proven from this study. Although the incidence of vitreoretinal pathologic conditions in myopic eyes after laser in situ keratomileusis is low, it is necessary to strictly filter candidates. Preoperatively and postoperatively, pay attention to the lattice degeneration and other retina lesions, and long-term follow-up is important.

Association between dietary carbohydrate intake and dietary glycemic index and risk of age-related cataract: a meta-analysis.

PURPOSE: To assess the association of dietary carbohydrate intake and dietary glycemic index (GI), and risk of age-related cataract (ARC), and quantitatively estimate their dose-response relationships. METHODS: We searched Medline, the Cochrane Library, Excerpta Medica database (EMBASE), Institute for Scientific Information (ISI) Science Citation Index, ISI Web of Knowledge, and China National Knowledge Infrastructure (CNKI) databases before October 2013. Two authors independently extracted data and assessed study quality. The random-effect model was used to calculate the pooled odds ratios (ORs). Dose-response analyses, subgroup analyses based on ARC subtypes, heterogeneity, and publication bias assessment were also carried out. RESULTS: Seven studies were included in our meta-analysis. The pooled ORs of ARC for the highest versus the lowest category of carbohydrate intake and GI were 1.18 (95% confidence interval [CI]: 1.01-1.38) and 1.15 (95% CI: 1.00-1.32), respectively. Further subgroup analyses based on ARC subtypes suggested a marginally significant association between higher carbohydrate intake and cortical cataract risk (OR: 1.37, 95% CI: 0.99-1.90), and a statistically significant association between higher GI and nuclear cataract risk (OR: 1.23, 95% CI: 1.03-1.46). In addition, a significant dose-response relationship was observed between carbohydrate intake and the risk of cortical cataract. CONCLUSIONS: Our results indicate that higher dietary carbohydrate quantity and GI may be associated with the risk of cortical and nuclear cataract, respectively. The results should be interpreted cautiously and more studies are warranted to clarify this issue.

Co-existent choroidal neovascular membrane and macular hole in pathologic myopia: a long follow-up clinical outcome and literature review.

Choroidal neovascularization (CNV) is an uncommon complication associated with a macular hole. In this case report of a rare condition, we present a pathologic myopia patient with a co-existent macular hole and choroidal neovascular membrane. The patient was treated with photodynamic therapy for CNV, and then vitreous surgery for the retinal detachment and macular hole. At the end of 4 years follow-up, her visual acuity was improved to 0.1 while the macular hole remained open. Optical coherence tomography is a useful inspection method of the diagnosis of CNV and macular hole.