Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oil-filled eyes.

AIM: To evaluate scleral buckling (SB) surgery using a non-contact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil (SO)-filled eyes. METHODS: Totally 9 patients (9 eyes) with retinal detachment in SO-filled eyes were retrospectively analyzed. All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination. SO was removed at an appropriate time based on recovery. The patients were followed up for at least 3mo after SO removal. Retinal reattachment, complications, visual acuity and intraocular pressure (IOP) before and after surgery were observed. RESULTS: Patients were followed up for a mean of 8.22mo (3-22mo) after SO removal. All patients had retinal reattachment. At the final follow-up, visual acuity showed improvement for 8 patients, and no change for 1 patient. The IOP was high in 3 patients before surgery, but it stabilized after treatment; it was not affected in the other patients. None of the patients had infections, hemorrhage, anterior ischemia, or any other complication. CONCLUSION: This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

Myopic choroidal neovascularization with neovascular signal around perforating scleral vessel prone to recur after anti-VEGF therapy.

BACKGROUND: To compare the recurrence of myopic choroidal neovascularization (mCNV) based on the neovascular signal of mCNV around the perforating scleral vessel (PSV). METHODS: A consecutive series of naïve patients with mCNV accepted anti-VEGF therapy with a minimum 12-month follow-up period. The neovascular signal relationship between PSV and mCNV were classified into the presence of neovascular signal of CNV around PSV or not. The recurrence of mCNV, best-corrected visual acuity (BCVA), hyperreflective foci height, CNV area and CNV flow area were analyzed between two groups. RESULTS: Neovascular signal of CNV around PSV was detected in 20 eyes (39.2%). The one-year recurrence rate in the group with neovascular signal of CNV around PSV was significantly higher than that in the group without neovascular signal of CNV around PSV (P = 0.045). The recurrence time in the group with neovascular signal around PSV was shorter than that in the group without neovascular signal around PSV (P = 0.030). Cox proportional hazard model showed that the presence of neovascular signal of CNV around PSV [hazard ratio (HR): 2.904] and subfoveal choroidal thickness ≤ 50 µm (HR: 0.368) were risk factors for recurrence of mCNV. In the group with neovascular signal around PSV, the BCVA was worse (P = 0.024) and the CNV flow area was more unstable (P = 0.027) after therapy. CONCLUSIONS: PSV was commonly detected in patients with mCNV. The presence of neovascular signal of CNV around PSV was prone to recur with a shorter time in mCNV patients.

Epsilon-poly-l-lysine conjugated erythromycin for enhanced antibiotic therapy.

Antibiotic resistance is a big threat to public health. How to improve the therapeutic efficacy of conventional antibiotics is an effective way to address this issue. In order to enhance the antibacterial activity of conventional antibiotic erythromycin (EM), EM is conjugated to positively charged ε-poly-l-lysine (EPL) to obtain EPL modified EM (EPL-EM). The grafting ratio of EM can be calculated from the 1H NMR spectrum. EPL-EM is stable in physiological environment, while EM can be readily released from EPL-EM upon incubating with esterase which can be secreted by most bacteria. Because of the presence of cationic EPL, EPL-EM showed much stronger antibacterial activity than free EM, with much lower minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Moreover, compared to free EM, the development of drug resistance can be slowed down if EPL-EM is used, which can be ascribed to the reduction of EM dosage. Meanwhile, EPL-EM cannot induce hemolysis and cytotoxicity, which indicates that EPL-EM exhibits excellent biocompatibility. The design of EPL-EM with enhanced antibacterial activity and excellent biocompatibility provides an innovative way to combat antibiotic resistance.

Perforating scleral vessels adjacent to myopic choroidal neovascularization achieved a poor outcome after intravitreal anti-VEGF therapy.

Background: This study aimed to summarize the features of perforating scleral vessels (PSVs) in patients with myopic choroidal neovascularization (CNV) (mCNV) using optical coherence tomography angiography (OCTA) and to identify the associations with the response after intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: A consecutive series of naïve patients who had mCNV and received intravitreal anti-VEGF therapy with a follow-up duration of 12 months or more were enrolled. The prevalence, location, and branches of PSVs were analyzed. Projection-resolved OCTA (PR-OCTA) was used to analyze the neovascular signals between CNV and PSVs. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured. The proportion of CMT change relative to baseline was used to assess therapeutic response. Results: A total of 44 eyes from 42 patients with mCNV were enrolled. PSVs were identified in 41 out of 44 eyes. Branches were identified in the PSVs of 24 eyes (57.14%), and 20 eyes did not have PSV branches (47.62%). In eight eyes (18.18%), PSVs were adjacent to mCNV, and in 36 eyes (81.82%), PSVs were not adjacent to mCNV. After anti-VEGF therapy for mCNV, BCVA increased (F = 6.119, p < 0.001) and CMT decreased (F = 7.664, p < 0.001). In the eyes where PSVs were adjacent to mCNV, BCVA improvements (F = 7.649, p = 0.009) were poor, and changes in CMT were small. Conclusion: The eyes with PSVs adjacent to mCNV showed poor therapeutic responses after intravitreal anti-VEGF therapy.

Association between inflammatory cytokines in the aqueous humor and hyperreflective foci on optical coherence tomography in patients with neovascular age-related macular degeneration and polypoidal choroidal vasculopathy.

Purpose: To investigate the associations between cytokine levels in the aqueous humor (AH) and hyperreflective foci (HF) on spectral-domain optical coherence tomography (SD-OCT) in neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). Methods: The prospective study included 63 eyes with nAMD, 44 with PCV, and 43 with cataracts (Controls). AH samples were obtained before anti-vascular endothelial growth factor (VEGF) therapy or cataract surgery. Cytokines interleukin 6 (IL-6), IL-8, IL-10, interferon-inducible protein 10 (IP-10), monocyte chemotactic protein 1 (MCP-1), and VEGF were measured by multiplex bead assay. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and the number of HF were evaluated at baseline and 1 month after anti-VEGF treatment. Results: No significances difference in IL-6 and IL-8 levels were noted among the three groups (P = 0.370 and P = 0.067). VEGF, IP-10, and IL-10 levels were significantly higher in nAMD and PCV groups than in Controls (all P < 0.05). In nAMD, HF was positively correlated with VEGF (r s = 0.300, P = 0.025) and in eyes with HF group, VEGF and IL-10 were significantly higher than those without HF (P = 0.008 and P = 0.022). In PCV, no correlation was observed between HF and cytokines (all P > 0.05). After anti-VEGF treatment, patients with HF in nAMD and PCV were predisposed to worse visual outcomes (P = 0.022 and P = 0.015) and a significantly greater reduction in CMT (P = 0.001 and P = 0.057). And nAMD patients with HF were more sensitive to anti-VEGF treatment than those without HF (P = 0.029). Conclusions: In the nAMD group, HF was positively correlated with VEGF. Patients in nAMD with HF had elevated levels of VEGF and IL-10 and responded favorably to anti-VEGF. HF might serve as an inflammatory biomarker and a predictive factor for therapeutic efficacy in patients with nAMD.

Microtentacle Formation in Ovarian Carcinoma.

BACKGROUND: The development of chemoresistance to paclitaxel and carboplatin represents a major therapeutic challenge in ovarian cancer, a disease frequently characterized by malignant ascites and extrapelvic metastasis. Microtentacles (McTNs) are tubulin-based projections observed in detached breast cancer cells. In this study, we investigated whether ovarian cancers exhibit McTNs and characterized McTN biology. METHODS: We used an established lipid-tethering mechanism to suspend and image individual cancer cells. We queried a panel of immortalized serous (OSC) and clear cell (OCCC) cell lines as well as freshly procured ascites and human ovarian surface epithelium (HOSE). We assessed by Western blot ß-tubulin isotype, α-tubulin post-translational modifications and actin regulatory proteins in attached/detached states. We studied clustering in suspended conditions. Effects of treatment with microtubule depolymerizing and stabilizing drugs were described. RESULTS: Among cell lines, up to 30% of cells expressed McTNs. Four McTN morphologies (absent, symmetric-short, symmetric-long, tufted) were observed in immortalized cultures as well as ascites. McTN number/length varied with histology according to metastatic potential. Most OCCC overexpressed class III ß-tubulin. OCCC/OSC cell lines exhibited a trend towards more microtubule-stabilizing post-translational modifications of α-tubulin relative to HOSE. Microtubule depolymerizing drugs decreased the number/length of McTNs, confirming that McTNs are composed of tubulin. Cells that failed to form McTNs demonstrated differential expression of α-tubulin- and actin-regulating proteins relative to cells that form McTNs. Cluster formation is more susceptible to microtubule targeting agents in cells that form McTNs, suggesting a role for McTNs in aggregation. CONCLUSIONS: McTNs likely participate in key aspects of ovarian cancer metastasis. McTNs represent a new therapeutic target for this disease that could refine therapies, including intraperitoneal drug delivery.

Retinal microvasculature observations of fellow eyes after intra-arterial chemotherapy for unilateral retinoblastoma using optical coherence tomography angiography.

Purpose: To investigate the characteristics of the retinal microvasculature of the fellow eyes in patients with unilateral retinoblastoma (RB) after intra-arterial chemotherapy (IAC) through optical coherence tomography angiography. Methods: This retrospective study enrolled 11 fellow eyes of patients with unilateral RB receiving IAC (group I), nine fellow eyes of patients with unilateral RB receiving IAC and intravenous chemotherapy (IVC) (group II), and 14 age-matched normal eyes (control group). Optical coherence tomography angiography was performed on all individuals. Vascular density of superficial capillary plexus and deep capillary plexus (DCP), foveal avascular zone related parameters, and retinal thickness were measured and compared among the three groups. Results: There was no statistical difference in age and logMAR visual acuity among the three groups. Compared with the control group, the vascular density of the DCP was lower in group I and II. Decreased vascular density of FD-300 and thinner thickness of outer plexus layer to Bruch's membrane were detected in group II compared with the control group. The vascular density and retinal thickness showed no differences between group I and II. Conclusion: The decreased vascular density in the DCP without measurable visual impairment was observed in fellow eyes after IAC or IAC + IVC for unilateral RB. Further studies with a larger sample would be necessary to determine the clinical significance of these findings.

Macular Retinal Sensitivity and Microvasculature Changes before and after Vitrectomy in Idiopathic Macular Epiretinal Membrane with Classification.

PURPOSE: To observe retinal sensitivity (RS) and microvasculature changes in preoperative and postoperative idiopathic macular epiretinal membrane (iERM) with optical coherence tomography (OCT) classification by microperimetry (MP) and optical coherence tomography angiography (OCTA). METHODS: In this retrospective study, 53 eyes of 53 patients affected with iERM were enrolled and 35 iERM eyes underwent pars plana vitrectomy associated with internal limiting membrane peeling. All iERM eyes were evaluated and graded by OCT. According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into 3 grades. MP was used to measure RS of macular within 20° centered on the fovea and fixation stability (FS). OCTA was used to measure the superficial and deep capillary plexus (DCP) layers using 6 mm × 6 mm scans. Measurements were taken at the baseline visit and 3-month postoperation. Evaluated factors included: best corrected visual acuity, RS, FS, vessel density. RESULTS: Eyes with iERM had worse RS than control eyes (p < 0.0001), especially in higher grade iERM eyes. And higher grade iERM eyes had a marked increase foveal vessel density (FVD) (p < 0.0001) in superficial capillary plexus (SCP) and DCP, and a significant decrease parafoveal vessel density (Para VD) in DCP. After surgery, there was no difference in RS and FS than preoperation (p > 0.05), whether in grade 1 or 2 iERM eyes. However, in OCTA analyses, grade 1 iERM eyes had less whole vessel density (WVD) and perifoveal vessel density (Peri VD) in SCP, than preoperation (p < 0.05). And grade 1 iERM eyes had higher Para VD and Peri VD in DCP (p < 0.05), than preoperative OCTA results. Grade 2 iERM eyes had less WVD, FVD, and Peri VD in SCP, than preoperation (p < 0.05). After surgery, in grade 2 iERM eyes, there was a positive correlation between whole retinal sensitivity and WVD (p < 0.05) in SCP. And there were positive correlations between Para RS and Para VD (p < 0.05), Peri RS and Peri VD (p < 0.05) in SCP. CONCLUSIONS: Classification helps to reveal different changes in iERM eyes. Higher grade iERM eyes had worse RS and microvasculature changes. MP and OCTA play an important role in assessing iERM and help surgical decisions for patients with iERM.

Macular density alterations in myopic choroidal neovascularization and the effect of anti-VEGF on it.

AIM: To analyse macular microvascular alterations in myopic choroidal neovascularization (mCNV) and the efficiency of anti-vascular endothelial growth factor (anti-VEGF) therapy for mCNV by optical coherence tomography angiography (OCTA). METHODS: A total of 123 patients were included in this retrospective study, divided into mCNV group, high myopia (HM) group, and normal group at the Affiliated Eye Hospital of Wenzhou Medical University from January 2017 to January 2019. Superficial vessel density, deep capillary density, foveal avascular zone (FAZ) area, A-circularity index (AI) and vessel density around the 300 µm width of the FAZ region density (FD) and the area of choroidal neovascularization (CNV) lesion (only for mCNV group) were measured on 3×3 mm2 OCTA images. FAZ area was corrected for axial length. Central macular thickness (CMT) was measured on OCT in mCNV group. Compared the parameters on OCTA of 3 groups and pre-anti-VEGF and post-anti-VEGF at 1, 2, 3, and 6mo follow-up in mCNV group. RESULTS: There were significant differences among 3 groups in superficial vessel density, deep capillary density and FD (P<0.05). FAZ area in HM group was smaller than normal group (P<0.05), but there was no significant difference between mCNV group and the other two group. AI increased in mCNV group (P<0.05). The mean CMT, area and flow area of CNV lesion decreased after treatment (P<0.05), while vessel density and FAZ didn't change. The mean CMT, area and flow area of CNV lesion statistically decreased after anti-VEGF treatment in mCNV group (P<0.05), while superficial vessel density, deep capillary density and FAZ area, AI and FD didn't change. The mean reduction ratio of lesions was 50.32% (7.07% to 100%). Lesion regression 100% was observed in 2 cases (4.88%). There was a negative correlation between the CNV lesion area and reduction ratio (r=-0.380, P=0.042) and the flow lesion area and reduction ratio (r=-0.402, P=0.030). CONCLUSION: Macular vessel density decreases, FAZ turns smaller and more irregular in mCNV eyes. Anti-VEGF therapy is efficient for mCNV without affecting vessel density and FAZ, but it is unable to completely eliminate CNV lesions in most cases. The bigger mCNV lesions have lower reduction ratio.

Assessment of macular microvasculature features before and after vitrectomy in the idiopathic macular epiretinal membrane using a grading system: An optical coherence tomography angiography study.

PURPOSE: To evaluate pre- and postoperative microvasculature features in eyes with different idiopathic macular epiretinal membrane (iERM) classifications using optical coherence tomography angiography (OCTA). METHODS: In this retrospective study, 100 eyes with iERM were enrolled; 62 eyes underwent pars plana vitrectomy (PPV). All iERM eyes were evaluated and graded using optical coherence tomography (OCT). According to the thickness of the fovea relative to the surrounding macula from OCT radial line scans, we classified iERM into three grades. Optical coherence tomography angiography (OCTA) was used to measure the foveal avascular zone (FAZ)-related parameters and the superficial and deep capillary plexus layers using 3 × 3 mm scans. Measurements were taken at baseline and 3 months postoperatively. Best corrected visual acuity (BCVA), vessel density (VD), FAZ area, FAZ perimeter (PERIM), acircularity index (AI), and foveal vessel density (FD) were evaluated. RESULTS: Idiopathic macular epiretinal membrane (iERM) eyes with a higher grade had a lower FAZ area and perimeter (p < 0.0001), higher foveal vessel density (FVD) both in the superficial capillary plexus (SCP) (p < 0.0001) and in the deep capillary plexus (DCP) (p < 0.05), and a lower parafoveal vessel density (PRVD) in the DCP (p < 0.0001). The macular vessel density ratio (MVR = FVD/PRVD) increased with an increase in grade both in the SCP and in the DCP (p < 0.0001). For grade 1 iERM eyes, only PRVD in the DCP significantly changed before versus after the operation (p < 0.05). For grade 2 iERM eyes, the FAZ area and perimeter became larger after the operation (p < 0.05). The MVR of grade 2 iERM eyes decreased postoperatively both in the SCP (p < 0.05) and in the DCP (p < 0.001). For grade 1 and grade 2 iERM eyes, preoperative LogMAR BCVA was negatively correlated with the FAZ area (p < 0.01) and perimeter (p < 0.01), and was positively correlated with the MVR in the SCP (p < 0.05). Postoperative LogMAR BCVA was positively correlated with the FVD in the DCP (p < 0.05). CONCLUSIONS: Idiopathic macular epiretinal membrane (iERM) eyes of different grades have significant differences in microvasculature features. According to OCTA, eyes with higher grades have more serious microvascular changes. Grading plays a part in predicting postoperative microvascular characteristics, and grade 1 iERM eyes have a better visual outcome compared with grade 2 iERM eyes.

The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis.

Purpose: To investigate the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique for macular hole retinal detachment (MHRD) in high myopia. Methods: This was a retrospective interventional study on 45 highly myopic eyes with MHRD after ILM peeling (n = 24, peeling group) or the inverted ILM flap technique (n = 21, inverted group). The inverted group was consisted of autologous blood (AB) subgroup (n = 10) and perfluorocarbon liquid (PFCL) subgroup (n = 11). MH closure, best-corrected visual acuity (BCVA), foveal microstructures, and excessive gliosis were analyzed during a follow-up of over 12 months. Results: The inverted group achieved a higher MH closure rate (95.24%) than the peeling group (41.67%; p < 0.001). No significant difference was found in postoperative BCVA between the two groups (p = 0.98) or between the closed MH with or without excessive gliosis (p = 0.60). Excessive gliosis was identified in 9 eyes in the inverted group, and there was no difference in the incidence of excessive gliosis between the AB subgroup (4 in 10 eyes, 40%) and the PFCL subgroup (5 in 11 eyes, 45.45%) (p > 0.999). Conclusion: The inverted ILM flap technique was effective in MH closure but had no advantage in postoperative BCVA and microstructural restoration. Excessive gliosis was only detected in the inverted group but did not affect the postoperative BCVA. Additionally, the incidence of excessive gliosis was not affected by adjuvants.

Measurement and Analysis of Central Corneal Thickness at Different Postnatal Stages in Chinese Premature Infants.

PURPOSE: The objective of this study was to evaluate central corneal thickness (CCT) in Chinese premature infants at different postnatal stages to study the peak point and analyze influential factors on CCT development. METHODS: This was a cross-sectional study of premature infants. Initial CCT measurement was taken at 34 weeks of gestational age (GA) and at intervals until 88 weeks of postmenstrual age (PMA) was reached. The comparison and correlation analysis were carried out to access the association of CCT with gender, birth weight (BW), GA, and retinopathy of prematurity (ROP) for each PMA. The premature infants were divided into the thick CCT group and the thin CCT group according to the average CCT at 40 w. And the difference in CCT between the two groups at subsequent 52 w and 64 w was compared. RESULTS: A total of 1726 premature infants (3463 measurements) with an average of 2.21 ± 1.57 measurements were included in this study. The CCT decreased from 34 w GA to 52 w PMA (R = 92.36, P < 0.0001) and then reached a plateau (R = 2.541, P=0.3567). Male (P < 0.05), low BW (P < 0.05), and low GA (P < 0.05) were associated with thicker CCT at the early stage of PMA. The premature infants who had thick CCT at 40 w would have thick CCT at 52 w and 64 w accordingly. CONCLUSIONS: The CCT values of premature infants decreased over time and plateaued at 52 w PMA. Gender, BW, and GA were considered as the influential factors of CCT at the early stage of PMA. Moreover, CCT at 40 w could forecast its development trend at 52 w or 64 w after birth.

Prediction of Visual Acuity After Cataract Surgery Using Optical Coherence Tomography Findings in Eyes With Retinitis Pigmentosa.

BACKGROUND AND OBJECTIVE: To investigate the predictive factors of visual acuity (VA) after cataract surgery in patients with retinitis pigmentosa (RP). PATIENTS AND METHODS: Retrospective, observational study. The authors reviewed a consecutive series of 70 patients (109 eyes) with RP who underwent cataract surgery. The changes in best-corrected visual acuity (BCVA) before and 3 months after surgery were measured. The relationship between preoperative ellipsoid zone (EZ) conditions, external limiting membrane (ELM) conditions, central macular thickness (CMT), and postoperative BCVA were investigated. RESULTS: The mean BCVA was significantly improved after cataract surgery from 0.80 to 0.45 (P < .001). However, final BCVA did not improve in 57 eyes (52.3%). The mean postoperative BCVA was significantly better in eyes with an intact ELM than those without (P < .001), in eyes with an intact EZ than those without (P < .001), and in eyes with relatively normal CMT (≥ 200 µm) than those with decreased CMT (< 200 µm) (P < .001). In multiple linear regression analysis, preoperative logMAR VA (P < .001), ELM integrity (P < .001), and CMT (P = .017) remained the only three variables that were associated significiantly with postoperative BCVA (R2 = 0.753; P < .001). CONCLUSIONS: Postoperative BCVA in approximately half of the eyes was improved after cataract surgery in patients with RP. The preoperative BCVA and the status of ELM and CMT are important parameters to predict postoperative VA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:587-594.].

[Computerized barcode operational system for package of surgical instruments in operating room].

About 8,000 people die every year in Taiwan as a result of nosocomial infection. Clinically, there is a high possibility for patients to contract nosocomial infection if medical equipment is not completely sterilized. In order to provide care and safety to patients in the operating room, increase management effectiveness and efficiency, and to reduce equipment operating costs, a project was developed to improve operating room management through data collection and analysis. A computerized barcode operational system for packages of surgical instruments was developed and executed throughout an entire operating room. The results showed that average time spent searching for surgical instruments decreased by 2,872 minutes (47.8hrs/month), 150% of the target figure; computerized monitoring of equipment expiration dates reduced total cost by 29.2% abnormal recognition of equipment tags was reduced to 0%. This project is the first one of its kind in the world.