Bioelectric impact of pathological angiogenesis on vascular function.

Pathological angiogenesis, as seen in many inflammatory, immune, malignant, and ischemic disorders, remains an immense health burden despite new molecular therapies. It is likely that further therapeutic progress requires a better understanding of neovascular pathophysiology. Surprisingly, even though transmembrane voltage is well known to regulate vascular function, no previous bioelectric analysis of pathological angiogenesis has been reported. Using the perforated-patch technique to measure vascular voltages in human retinal neovascular specimens and rodent models of retinal neovascularization, we discovered that pathological neovessels generate extraordinarily high voltage. Electrophysiological experiments demonstrated that voltage from aberrantly located preretinal neovascular complexes is transmitted into the intraretinal vascular network. With extensive neovascularization, this voltage input is substantial and boosts the membrane potential of intraretinal blood vessels to a suprahyperpolarized level. Coincident with this suprahyperpolarization, the vasomotor response to hypoxia is fundamentally altered. Instead of the compensatory dilation observed in the normal retina, arterioles constrict in response to an oxygen deficiency. This anomalous vasoconstriction, which would potentiate hypoxia, raises the possibility that the bioelectric impact of neovascularization on vascular function is a previously unappreciated pathophysiological mechanism to sustain hypoxia-driven angiogenesis.

Effects of Regorafenib, a Multi-Kinase Inhibitor, on Conjunctival Scarring in a Canine Filtration Surgery Model in Comparison with Mitomycin-C.

Regorafenib eye drops were developed for treating age-related macular degeneration. This study aimed to investigate the effects of this multi-kinase inhibitor on intraocular pressure (IOP), bleb formation, and conjunctival changes in a canine filtration surgery model. Glaucoma filtration surgery models were created in 24 eyes of 24 beagles. In experiment 1 (Ex 1), regorafenib eye drops (regorafenib group: n = 6) or a vehicle (control group, n = 6) were instilled twice daily for 4 weeks postoperatively. In experiment 2 (Ex 2), regorafenib eye drops were instilled as in Ex 1 (regorafenib group: n = 6) for 12 weeks while conventional intraoperative mitomycin-C (MMC) was utilized (MMC group: n = 6), In Ex 1, only the regorafenib group showed significant IOP reduction with a significantly higher bleb score. Subconjunctival area, collagen density, vessels, and cells showing proliferation and differentiation were lower in subconjunctival tissue in the regorafenib group. In Ex 2, no significant difference was found in IOP reduction and bleb formation between the regorafenib and MMC groups; bleb walls were significantly thicker and collagen density and vessels were higher in the regorafenib group; and no differences were observed in the above-mentioned cells. Thus, regorafenib might be a better alternative to MMC for creating thicker and less ischemic blebs in glaucoma filtration surgery.

Optical coherence tomography findings of falciform retinal detachment complicated with persistent fetal vasculature.

BACKGROUND: Falciform retinal detachment (FRD) usually causes pronounced retinal wrinkles, and the prognosis of visual function is poor. In this present study, we report a rare case of FRD in which optical coherence tomography (OCT) findings revealed a relatively good visual function. CASE PRESENTATION: This study involved a 22-year-old female who had previously been diagnosed with FRD at 2 years of age, and who presented with microphthalmus in both eyes with pronounced retinal folds from the optic disc to the inferior-temporal side. Based on the clinical findings, we diagnosed it as persistent fetal vasculature (PFV). We found the visual function in her left eye to be relatively poor, yet from 6 to 22 years of age, the corrected visual acuity in that eye remained at 0.08. Although a nystagmus was present, Goldman perimetry showed a relatively wider visual field than expected. Optical coherence tomography (OCT) findings revealed that the retinal layer structure near the FRD was relatively well maintained, except for the temporal peripheral region. CONCLUSIONS: Our findings reveal that OCT examination can be considered useful for predicting the visual function in cases of FRD.

A case of proliferative diabetic retinopathy in which scintillating particles appeared in the intravitreal cavity after laser photocoagulation.

BACKGROUND: To report a case of proliferative diabetic retinopathy (PDR) exhibiting the appearance of scintillating particles presumed to be crystallin inside the intravitreal cavity after laser photocoagulation. CASE PRESENTATION: A 56-year-old male patient presented at our outpatient clinic after becoming aware of decreased vision in his right eye. Ocular examination performed at the patient's initial visit revealed a massive preretinal macular hemorrhage due to PDR in his right eye. Fundus fluorescein angiography revealed extensive retinal non-perfusion areas and neovascularization in both eyes. However, no opacity was observed in the intravitreal cavity of his left eye. Vitreous surgery was performed on the patient's right eye after ultrasonic phacoemulsification aspiration and intraocular lens implantation. Post surgery, the corrected VA in that eye improved from 0.1 to 1.0. In correlation with the treatment performed on the patient's right eye, we began panretinal photocoagulation on his left eye. Examination performed prior to the patient's third session of panretinal photocoagulation revealed a large number of scintillating particles in the posterior vitreous gel in front of the retina. Examination via slit-lamp microscopy revealed that the particles were of varied hues, and closely resembled a 'Christmas tree' cataract. No posterior vitreous detachment was observed, and since these particles were situated as if captured in the posterior vitreous gel, no eye-movement-associated mobility of the particles was observed. Since the cloudiness was not severe enough to interfere with photocoagulation, additional photocoagulation was performed, and the patient is currently under observation. Six months have now passed since the fourth photocoagulation procedure was performed, and there has been no change in the state of the particles. Optical coherence tomography imaging revealed no change before and after the panretinal photocoagulation. The corrected VA in his left eye has remained at 1.0 during the postoperative follow-up period. CONCLUSIONS: We speculate that the production of crystallin in the retina in this case was triggered by the photocoagulation procedure performed for diabetic retinopathy.

A case of pseudoxanthoma elasticum with proliferative diabetic retinopathy.

BACKGROUND: To report the case of a patient with pseudoxanthoma elasticum (PXE) and proliferative diabetic retinopathy (PDR), and discuss the relationship between PXE and diabetic retinopathy (DR). CASE PRESENTATION: A 47-year-old man with PXE presented with angioid streaks and DR in both eyes, and bilateral panretinal photocoagulation was performed for treatment. Vitrectomy had previously been performed in his right eye for vitreous hemorrhage due to PDR. Systemic findings included multiple, discrete, symmetrical, small yellow papules bilaterally in the axilla and inguinal region. Examination on presentation showed vitreous hemorrhage in his left eye, and vitrectomy was performed for treatment. Intraoperative findings showed fibrovascular membrane around the optic disc and vascular arcade. A mottled fundus (peau d'orange appearance) associated with angioid streaks was also present, yet there was no evident choroidal neovascularization (CNV). The postoperative course was satisfactory, and corrected visual acuity improved from 0.02 to 0.7 diopters. CONCLUSION: Despite the peau d'orange appearance in both eyes of this case, no CNV was evident. The vitreous hemorrhage was thus attributed to PDR. Moreover, we reviewed the published literature and discuss the relationship between PXE and DR.

Effects of Gelatin Hydrogel Containing Anti-Transforming Growth Factor-ß Antibody in a Canine Filtration Surgery Model.

In this present study, we investigated the effect of a controlled release of anti-transforming growth factor ß (TGF-ß) antibody on intraocular pressure (IOP), bleb formation, and conjunctival scarring in a canine glaucoma filtration surgery model using gelatin hydrogel (GH). Glaucoma surgery models were made in 14 eyes of 14 beagles and divided into the following two groups: (1) subconjunctival implantation of anti-TGF-ß antibody-loaded GH (GH-TGF-ß group, n = 7), and (2) subconjunctival implantation of GH alone (GH group, n = 7). IOP and bleb features were then assessed in each eye at 2- and 4-weeks postoperative, followed by histological evaluation. We found that IOP was significantly reduced at 4-weeks postoperative in the two groups (p < 0.05) and that IOP in the GH-TGF-ß-group eyes was significantly lower than that in the GH-group eyes (p = 0.006). In addition, the bleb score at 4-weeks postoperative was significantly higher in the GH-TGF-ß group than in the GH group (p < 0.05), and the densities of fibroblasts, proliferative-cell nuclear antigen (PCNA)-positive cells, mast cells, and TGF-ß-positive cells were significantly lower in the GH-TGF-ß group than in the GH group. The findings of this study suggest that, compared with the GH-group eyes, implantation of anti-TGF-ß antibody-loaded GH maintains IOP reduction and bleb formation by suppressing conjunctival scarring due to the proliferation of fibroblasts for a longer time period via a sustained release of anti-TGF-ß antibody from GH.

Comparison of histopathological findings between idiopathic and secondary epiretinal membranes.

To evaluate the histopathological findings of idiopathic and secondary epithelial membranes (ERMs). This study involved 19 ERM cases that underwent pars plana vitrectomy (PPV). ERM specimens were obtained from each patient during PPV and immediately fixed in 10 % formalin. Paraffin sections were stained with hematoxylin eosin (HE) and immunohistochemical analysis was performed with glial fibrillary acidic protein (GFAP), Ki-67, CD34, and nestin antibodies. The 19 ERM cases included 11 idiopathic ERM cases and 8 secondary ERM cases i.e., 2 eyes that underwent PPV for retinal detachment and 6 eyes that underwent PPV for proliferative diabetic retinopathy. HE staining showed that some of the idiopathic ERM specimens consisted of internal limiting membrane. In contrast, numerous invasive cells were observed in the secondary ERM specimens compared to the idiopathic ERM specimens. Immunohistochemical analysis revealed GFAP-positive cells in 4 of the 11 idiopathic ERMs cases, yet no nestin-, Ki-67-, or CD34-positive cells in those cases. In contrast, there were 4 GFAP-positive cases, 2 Ki67-positive cases, 3 CD34-positive cases, and 7 cases including nestin-positive cells. The findings of this study indicate that there are different histological characteristics between idiopathic and secondary ERM and that mature nestin-positive cells in the retina might be related to secondary ERM formation.

Three-Year Outcomes of Pars Plana Ahmed and Baerveldt Glaucoma Implantations for Neovascular Glaucoma in Japanese Eyes.

PRCIS: Tube shunt implantation through the pars plana was effective for neovascular glaucoma (NVG) for at least 3 years, with few serious postoperative complications observed. PURPOSE: The aim was to report 3-year outcomes of pars plana Ahmed and Baerveldt glaucoma implantation for NVG in Japanese eyes. PATIENTS AND METHODS: This study examined 41 eyes of 39 patients who underwent tube shunt implantation through the pars plana with the Baerveldt glaucoma implant (BGI group, 26 eyes) or Ahmed glaucoma valve (AGV group, 15 eyes) for NVG and who were followed up for over 3 years at Osaka Medical College between January 2009 and April 2016. Outcome measures were intraocular pressure (IOP, mm Hg) at presurgery and at 6 months and 1, 2, and 3 years postoperative. Postoperative failure was defined as an IOP of >21 mm Hg or <5 mm Hg, further glaucoma surgery, or no light perception. RESULTS: Mean IOPs at presurgery and at 3 years postoperative were 34.8±9.1 and 15.6±4.6 in the AGV group, and 36.9±9.2 and 12.8±5.5 in the BGI group. Mean antiglaucoma medication scores at 3 years postoperative were 1.3±1.4 in the AGV group and 0.4±0.8 in the BGI group (P=0.05). The number of eyes with a probability of failure at 6 months and at 2 and 3 years postoperative was 2, 3, and 4, respectively, in the BGI group, and 0, 1, and 2, respectively, in the AGV group. CONCLUSION: Findings for NVG cases showed tube shunt implantation through the pars plana was effective. Equivalent good IOP reductions were noted in both groups, with the BGI group requiring fewer postoperative antiglaucoma medications compared with the AGV group. Furthermore, both groups exhibited few serious postoperative complications.

Concurrent vitrectomy for persistent pupillary membrane complicated by severe myopia and vitreomacular traction syndrome: A case report.

INTRODUCTION: In cases of persistent pupillary membrane (PPM), the eye is usually slightly microphthalmic and emmetropia or hyperopia is often present, yet severe myopia is reportedly rare. Here we presented a case of PPM complicated by vitreomacular traction syndrome and posterior staphyloma due to severe myopia. PATIENT CONCERNS: This study involved a 63-year-old female patient who had been diagnosed with bilateral PPM at a local eye clinic and who was subsequently referred to our department for a more detailed examination due to a recent decrease of visual acuity. DIAGNOSES: Slit-lamp microscopy examination revealed bilateral PPM. The ocular fundus revealed peripapillary conus and myopic change in both eyes. Optical coherence tomography examination revealed no particular abnormalities in the right eye, yet did show findings indicative of vitreomacular traction syndrome in the left eye. INTERVENTIONS: In both eyes, we performed surgical removal of the PPM, phacoemulsification aspiration, and intraocular lens implantation, yet in the patient's left eye, vitrectomy was also performed. OUTCOMES: After surgery, the patient's visual acuity improved in both eyes. CONCLUSION: The findings in this case show that when required, vitrectomy should be considered based upon the preoperative Optical coherence tomography findings for PPM.

A Case of Fungal Endophthalmitis Caused by Paecilomyces lilacinus that Might Have Spread from the Sclera into the Intraocular Space.

The aim of this report was to describe a case of fungal endophthalmitis possibly caused by Paecilomyces lilacinus(PL) penetrating the sclera from a conjunctival abscess. This case study involved an 83-year-old male patient with a past history of scleral buckling, subtenon steroid injection, and cataract surgery. The vitreous opacity and a conjunctival abscess appeared in the inferonasal quadrant of his right eye at 5 months after cataract surgery. PL was isolated from a cultured conjunctival discharge specimen obtained from the patient's right eye. Although the treatment with antifungal agents relieved the conjunctival abscess, the vitreous opacity became worse. Thus, vitrectomy was subsequently performed. Intraoperative findings revealed severe vitreous opacity in the inferonasal quadrant, adjacent to the sclera at the site of the conjunctival abscess. Our findings indicate that fungal endophthalmitis appeared to have been caused by PL in the conjunctival abscess that may have penetrated the sclera and spread into the intraocular space.

Type III uveal effusion syndrome suspected to be related to pachychoroid spectrum disease: A case report.

INTRODUCTION: We report a case of type III uveal effusion syndrome (UES) suspected to be related to pachychoroid spectrum disease. PATIENT CONCERNS: A 42-year-old man became aware of visual field constriction and deterioration of visual acuity in his right eye. DIAGNOSIS: Upon examination, a bullous non-rhegmatogenous retinal detachment was observed in the inferior 2 quadrants of the right eye fundus, and the subretinal fluid moved with postural changes. The axial length in that eye was 22.36 mm, thus indicating no nanophthalmia. Preoperative indocyanine green angiography revealed dilated choroidal vessels in the posterior pole of the right eye and mild leakage in the late phase. Optical coherence tomography examination revealed choroidal thickening in both eyes. INTERVENTIONS: For treatment, we first performed sclerotomy, and the intraoperative findings showed no thickening of the sclera. Following surgery, reattachment of the retina was not achieved. OUTCOMES: Thus, we next performed vitrectomy, which led to successful reattachment of the retina. LESSONS: In this case, we theorize that pachychoroid spectrum disease might have been involved in the pathogenesis of type III UES.

Ciliary body suturing using intraocular irrigation for traumatic cyclodialysis: two case reports.

BACKGROUND: We report two cases (two eyes) of traumatic cyclodialysis with prolonged decrease of intraocular pressure that were successfully treated with surgery by ciliary body suturing using intraocular irrigation. CASE PRESENTATION: This study involved a 17-year-old Japanese boy (patient 1) and a 31-year-old Japanese man (patient 2) in whom cyclodialysis was sustained in one eye after blunt-force ocular trauma from a thrown ball. Because the hypotony maculopathy in both patients did not resolve after conservative treatment, ciliary body suturing was performed. Briefly, a 25-gauge trocar intraocular irrigation needle for vitrectomy was inserted into the vitreous cavity of the injured eye. A lamellar scleral flap was then made, and an incision was created on the sclera while maintaining intraocular pressure. Next, the detached ciliary body was sutured to the sclera under direct vision. The intraocular fluid at the site of cyclodialysis was then rapidly drained from the scleral wound because of elevated intraocular pressure in the vitreous cavity, and the ciliary body was visually recognized through the scleral wound under direct vision, thus allowing a stable suture fixation of the ciliary body to the sclera. Postoperatively, the treated eye in both cases showed improvement of intraocular pressure and visual function. CONCLUSIONS: The surgical method described in this report was found to be effective for draining intraocular fluid at the site of cyclodialysis and for performing a stable suture fixation of the ciliary body to the sclera through the scleral wound under direct vision, and it should be considered advantageous for avoiding intraoperative bleeding and suturing in a blinded manner.

Correlation between laser speckle flowgraphy and optical coherence tomography angiography measurements in normal and glaucomatous eyes.

PURPOSE: To investigate the relationship between laser speckle flowgraphy (LSFG) and optical coherence tomography angiography (OCTA) measurements of the peripapillary retina and optic nerve head (ONH) in normal eyes and eyes with primary open-angle glaucoma (POAG). PATIENTS AND METHODS: One eye from each of 46 normal subjects and mild and moderate/advanced POAG patients were included. ONH blood flow acquired by LSFG, circumpapillary vessel density (cpVD, a 250 µm-wide elliptical annulus around the optic disc), and intra-papillary vessel density (ipVD, a 1.5×1.5 mm scan field) acquired by OCTA were measured. Their values were compared among normal controls and patients at each stage of glaucoma using one-way ANOVA, and the correlation between measurements obtained by the two methods was examined by univariate regression analysis. RESULTS: ONH tissue blood flow, tissue mean blur rate (MBR-T), and cpVD in the outer layer of the retina significantly decreased with the progression of glaucoma stage, although the latter showed no significant difference between normal subjects and mild-stage glaucoma patients. MBR-T was significantly correlated with cpVD, but not with ipVD, in the retinal outer layer. CONCLUSION: A correlation was found only between MBR-T and cpVD in the retinal outer layer. A difference in MBR-T, but not in cpVD, was detected between normal controls and mild glaucoma patients.

Rhegmatogenous retinal detachment with a giant tear located in the intermediate periphery: Two case reports.

RATIONALE: We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases. PATIENT CONCERNS AND DIAGNOSES: Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history. INTERVENTIONS: In both cases, reattachment was achieved by performing vitrectomies. OUTCOMES: These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.

Familial exudative vitreoretinopathy complicated with full thickness macular hole: A case report.

RATIONALE: To report a case of familial exudative vitreoretinopathy (FEVR) complicated with full-thickness macular hole (FTMH). PATIENT CONCERNS: A 39-year-old male presented after becoming aware of metamorphopsia in his left eye. DIAGNOSES: Fundus examination showed a retinal avascular area, retinal vascular abnormality, and yellow exudation at the peripheral retina in both eyes. Optical coherence tomography findings revealed impending MH (IMH) due to posterior vitreous detachment (PVD) in his left eye. Despite of the occurrence of spontaneous complete PVD, an FTMH developed at 4 months after the onset of IMH. INTERVENTIONS: To treat the FTMH, vitreous surgery was performed. Intraoperative findings revealed that the thick posterior vitreous membrane (PVM) had no adhesions with the edge of the FTMH. However, a thin epiretinal membrane (ERM) was observed around the MH. OUTCOMES: Postoperatively, the FTMH was closed, and the patient's corrected visual acuity improved from (0.4) to (0.8). LESSONS: In this present case, an IMH developed via traction by a thick PVM, characteristic of FEVR, with FTMH then developing via traction by a thin ERM. Our findings reveal that it is vital to fully understand these anatomical features before performing vitreous surgery for FTMH complicated with FEVR.

Idiopathic macular hole with asteroid hyalosis: Two case reports.

INTRODUCTION: Asteroid hyalosis (AH) is characterized by mild vitreous-body liquefaction and a reduced likelihood of posterior vitreous detachment (PVD). Here, we report the clinical features of 2 cases of macular hole (MH) in eyes with AH. The extent of retinal vitreous adhesion at the time of vitreous surgery, the presence or absence of iatrogenic retinal breaks, and the postoperative course was examined in regard to the association with AH. CASE PRESENTATION: Case 1 involved a 67-year-old female with decreased visual acuity in her left eye. Although preoperative optical coherence tomography examination revealed complete PVD with operculum around the fovea central region, vitreoretinal adhesion was quite strong starting at the midperiphery of the fundus, and an iatrogenic retinal break was formed at the inferior site during vitreous surgery. Endophotocoagulation was performed, and no onset of retinal detachment (RD) postsurgery was observed. Case 2 involved a 74-year-old male with metamorphopsia in his right eye. Preoperative perifoveal PVD was observed, yet vitreoretinal adhesion was strong starting at the midperiphery of the fundus and multiple iatrogenic retinal breaks had formed on the inferior, superior, and temporal sites. Moreover, RD occurred during surgery. Endophotocoagulation and gas tamponade was performed; however, postoperative RD requiring multiple reoperations occurred. CONCLUSION: As with normal MH, MH with AH is thought to be caused by perifoveal PVD, yet as the vitreoretinal adhesion was found to be quite strong starting at the midperiphery of the fundus, we decided to keep the artificial PVD within a range where adhesion was loose.

Case Report of a Family Affected by Stickler Syndrome in Which Rhegmatogenous Retinal Detachment Occurred in Five Eyes of Three Siblings.

PURPOSE: Stickler syndrome is an autosomal dominant inherited disorder that is well known to be highly associated with the development of rhegmatogenous retinal detachment. In this study, we report the case of a family affected by Stickler syndrome in which rhegmatogenous retinal detachment developed in 5 eyes of 3 siblings. CASE SERIES: For treatment, we performed vitreous surgery on 1 eye of the eldest son, and bilateral scleral buckling surgery on the 2 younger children. A good postoperative outcome was obtained on the 4 eyes that underwent scleral buckling surgery, yet the prognosis was poor on the 1 eye that underwent vitrectomy due to redetachment of the retina and corneal complication. Since vitreous surgery was quite difficult due to strong vitreoretinal adhesion, we created an artificial posterior vitreous detachment via the bimanual technique combined with encircling. For the scleral buckling surgery, broad scleral extrusion was needed to seal multiple retinal breaks. CONCLUSIONS: The findings of this study showed a high prevalence of rhegmatogenous retinal detachment in a single family with Stickler syndrome. In these cases, scleral buckling surgery was effective for treating the detached retina, and some prophylactic treatment, such as laser photocoagulation to prevent the occurrence of rhegmatogenous retinal detachment, should be considered for such cases in the future.

A Case of Retinal Detachment with Unique Optical Coherence Tomography Findings after Gamma Knife® Radiosurgery Treatment for Choroidal Melanoma.

PURPOSE: To report a case of retinal detachment with unique optical coherence tomography (OCT) findings after Gamma Knife® (GK; Elekta Instrument AB, Stockholm, Sweden) treatment for choroidal melanoma (CM). CASE REPORT: A 48-year-old woman underwent GK therapy for CM in her right eye from the macula to the temporal side. While the tumor subsequently shrank, the patient developed radiation retinopathy, which was treated with laser photocoagulation. The tumor lesions later subsided; however, her visual acuity (VA) decreased 8 years after the initial treatment. Although the tumor lesions in the right eye had become scarred, a bullous retinal detachment with fixed folds occurred in the superior-nasal quadrants. OCT examination revealed a preretinal membrane, vitreoretinal traction, and an inner retinal break; however, no outer retinal break was clearly detectable. MRI scans showed no increase in tumorous lesions, and 123I-IMP SPECT imaging showed no photon accumulation. Thus, it was determined that there was no tumor activity. The corrected VA in her right eye was light perception, and it was determined that there was no indication for vitreous surgery. CONCLUSION: In this case, an inner retinal break was formed by the vitreoretinal traction around the scarred tumor and radiation retinopathy, thus suggesting the possibility of the development of a rhegmatogenous retinal detachment presumably complicated with an outer retinal break.

Two Cases of Rhegmatogenous Retinal Detachment Associated with Asteroid Hyalosis.

BACKGROUND: To report two cases of rhegmatogenous retinal detachment (RRD) associated with asteroid hyalosis (AH). CASE PRESENTATION: Two patients presented with RRD originating from a flap tear. Case 1 involved a 62-year-old male who was found to have bullous RRD in his left eye originating from a flap tear. During vitreous surgery, a thick vitreous cortex was found to have strongly adhered to the entire retinal surface, from the center to the periphery. A bimanual method was then used in conjunction with the vitrectomy to create an artificial posterior vitreous detachment. After surgery, the retina was successfully reattached, and his corrected visual acuity (VA) improved. Case 2 involved a 70-year-old male who was found to have localized RRD in his left eye originating from a flap tear. During vitreous surgery, a thick vitreous cortex was found to have strongly adhered to the entire retinal surface. After surgery, the retina was successfully reattached, and his corrected VA improved. CONCLUSIONS: RRD associated with AH presents with stronger vitreoretinal adhesion compared to typical RRD, thus requiring a more complicated surgical technique to properly treat the patient.

A Case of a Ruptured Eyeball Caused by High-Pressure Water Jets.

To report the case of a ruptured eyeball caused by high-pressure water jets. In this study, the right eye of a 49-year-old male was injured by high-pressure water jets while he was engaged in demolition work. Upon examination, remarkable hyphema and vitreous hemorrhage were observed in the injured eye. After treating the patient's right eye with vitrectomy, in addition to lens subluxation and iridodialysis, retinal detachment was observed at the nasal inferior. The edge of the retinal break was found to be incarcerated into the nasal sclera rupture wounds. The findings of this study indicate that direct exposure to high-pressure water jets can cause a rupture of the eyeball. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:451-455.].