Changes in Retinal Thickness after Vitrectomy for Epiretinal Membrane with and without Internal Limiting Membrane Peeling.

PURPOSE: To investigate anatomic changes in retinal thickness (RT) and functional changes after vitrectomy for idiopathic epiretinal membranes (ERMs) with and without internal limiting membrane (ILM) peeling. METHODS: The medical records of 100 eyes of 96 patients with ERM who underwent vitrectomy and ERM removal were reviewed retrospectively. The RT was measured by optical coherence tomography, and the area was divided into 9 sections. The best-corrected visual acuity (BCVA), 9 RT areas, and incidence rates of recurrent ERM were compared between the groups with and without ILM peeling before the operation and 12 months postoperatively. RESULTS: Thirty-nine eyes that underwent vitrectomy with ILM peeling and 61 eyes that underwent vitrectomy without ILM peeling met the inclusion criteria. There were no significant differences between the groups in the BCVA and any of the RTs before the operation and 12 months postoperatively. The ERMs recurred in 8 (20.5%) of 39 eyes and 26 (42.6%) of 61 eyes in the groups with and without ILM peeling, respectively, with a difference that reached significance (p = 0.02) 12 months postoperatively. CONCLUSIONS: Vitrectomy for ERM affects the BCVA or the RTs 12 months postoperatively. Additional ILM peeling does not affect them, but it might reduce the ERM recurrence rate.

The effectiveness of vitrectomy for diffuse diabetic macular edema may depend on its preoperative optical coherence tomography pattern.

BACKGROUND: To investigate the effectiveness of vitrectomy for diffuse diabetic macular edema (DDME) and its dependence on optical coherence tomography (OCT) findings. METHODS: The records of 65 patients and 81 eyes who received vitrectomy for DDME and followed up for at least 6 months were retrospectively reviewed. All eyes were classified according to their morphological characteristics on OCT including sponge-like diffuse retinal thickening (SDRT: n = 13), cystoid macular edema (CME: n = 42), serous retinal detachment (SRD: n = 13), and the combination of all morphological characteristics (FULL: n = 13). The best-corrected visual acuity (BCVA) and spectral domain OCT were investigated preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: At six months after surgery, BCVA in logMAR units was significantly improved in all groups except the SDRT group. The improvement was -0.04 ± 0.20 in the SDRT group (P = 0.504), -0.16 ± 0.24 in the CME group (P < 0.01), -0.32 ± 0.32 in the SRD group (P < 0.01), and -0.26 ± 0.19 in the FULL group (P < 0.01), and significantly better in eyes with subretinal fluid (SRF; the SRD and FULL groups) than in eyes without SRF (the SDRT and CME groups, P = 0.003). CONCLUSIONS: Vitrectomy can be a useful treatment option for DDME, particularly for eyes with SRF.

PHOTORECEPTOR OUTER SEGMENT LENGTH AND OUTER FOVEAL THICKNESS AS FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER VITRECTOMY FOR VITREOMACULAR TRACTION SYNDROME.

PURPOSE: To investigate the predictive factors for postoperative best-corrected visual acuity (BCVA) in patients with vitreomacular traction syndrome treated with vitrectomy. METHODS: The records of 21 patients with 21 eyes that underwent vitrectomy for vitreomacular traction syndrome and followed for at least 12 months were retrospectively reviewed. The BCVA and spectral domain optical coherence tomography findings were investigated preoperatively and at 1, 3, 6, and 12 months postoperatively. Axial length was measured preoperatively. The correlations between 12-month postoperative BCVA and preoperative parameters, including BCVA, age, axial length, central foveal thickness, outer foveal thickness, and photoreceptor outer segment length, were evaluated. RESULTS: Twelve-month postoperative BCVA was significantly negatively correlated with preoperative outer foveal thickness and photoreceptor outer segment length (outer foveal thickness: P = 0.029, r = -0.501; photoreceptor outer segment length: P = 0.022, r = -0.523, respectively) but not correlated with age, axial length, preoperative BCVA, and preoperative central foveal thickness (age: P = 0.346, r = 0.216; axial length: P = 0.333, r = 0.242; BCVA: P = 0.202, r = 0.290; central foveal thickness: P = 0.065, r = -0.410, respectively). CONCLUSION: Preoperative outer foveal thickness and photoreceptor outer segment length could be good predictive factors of postoperative BCVA in patients with vitreomacular traction syndrome.

Contrast Sensitivity after Pars Plana Vitrectomy: Comparison between Macula-On and Macula-Off Rhegmatogenous Retinal Detachment.

PURPOSE: To evaluate the contrast sensitivity (CS) of eyes successfully repaired by vitrectomy for rhegmatogenous retinal detachment (RRD) with or without preoperative macular involvement. METHODS: In this retrospective, consecutive, interventional case series, 109 eyes received primary vitrectomy for RRD, of which 36 with at least 12 months of follow-up and a best-corrected visual acuity (BCVA) ≥1 at 12 months postoperatively were investigated. The main outcome measurements were BCVA and CS at 12 months postoperatively. Patients with macula-on RRD preoperatively were included in the macula-on group, and patients with macula-off RRD preoperatively were included in the macula-off group. The between-group difference in CS under evening vision conditions was measured with a Takagi glare tester CGT-2000 at 6 visual angles and 13 contrast levels with and without glare. RESULTS: CS was significantly lower in the macula-off group for targets with visual angles of 1.6, 1.0, and 0.64° with glare (p < 0.05) and for the target with a visual angle of 0.64° without glare (p < 0.05). CONCLUSIONS: CS in the higher spatial frequency range (especially with glare) is reduced in macula-off RRD patients with good postoperative BCVA compared to macula-on RRD patients with good postoperative BCVA.

Successful Repair of a Traumatic Medial Rectus Laceration with the Aid of Computed Tomography.

A 79-year-old woman suffered ocular trauma from an umbrella. Exotropia of the left eye was observed, and the left eye could not adduct to the midline. Both edges of the lacerated medial rectus were sutured together with the aid of preoperative computed tomography (CT), which showed posterior muscle belly widening due to posterior slippage toward the equator. The alignment and ocular movement were improved postoperatively. Repairing a lacerated medial rectus is difficult because its edge slips into the muscle cone posteriorly. Preoperative CT was useful in identifying the posterior portion of the lacerated muscle, enabling successful repair.

Long-term intraocular pressure changes after vitrectomy for epiretinal membrane and macular hole.

BACKGROUND: To investigate long-term intraocular pressure (IOP) changes after vitrectomy for epiretinal membrane (ERM) or macular hole (MH). METHODS: We retrospectively reviewed the medical records of 57 eyes with ERM and 61 eyes with MH that underwent vitrectomy. IOP levels and changes at 1, 3, 6, 12 months, and the final visit from baseline were evaluated in vitrectomized eyes and non-vitrectomized fellow eyes. RESULTS: In the ERM group, the mean follow-up period was 29.3 months; the mean preoperative IOP in the operated eyes was 12.9 ± 2.5 mmHg and the final IOP was 13.2 ± 2.9 mmHg. In the MH group, the mean follow-up period was 25.6 months; the mean preoperative IOP in the operated eyes was 13.3 ± 2.5 mmHg and the final IOP was 14.0 ± 3.2 mmHg. The mean final IOP of the fellow unoperated eyes was 13.0 ± 2.5 mmHg in the ERM group and it was 12.9 ± 3.2 mmHg in the MH group. A significant difference was found between the operated eyes and fellow eyes at the final visit in the MH group (P < 0.01) but not in the ERM group (P = 0.40). MH group was significantly at high risk of IOP increase after vitrectomy (P < 0.01). CONCLUSIONS: IOP increase after vitrectomy was found in some eyes with MH during long-term follow-up but it was unlikely in eyes with ERM.

Scleral imbrication combined with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia.

PURPOSE: To evaluate scleral imbrication with vitrectomy and gas tamponade for refractory macular hole retinal detachment associated with high myopia. METHODS: We retrospectively reviewed the medical records of eight eyes with macular hole retinal detachment and high myopia treated with temporal scleral imbrication, pars plana vitrectomy, and gas tamponade for refractory macular hole retinal detachment with history of pars plana vitrectomy. Retinal reattachment and macular hole closure were assessed. Postoperative changes in axial length and surgically induced astigmatism were evaluated. RESULTS: The retinas were reattached in all eyes and the macular holes closed in 6 (75%) eyes. The mean baseline logarithm of the minimum angle of resolution best-corrected visual acuity of 1.43 ± 0.48 significantly (P < 0.01) improved to 0.87 ± 0.34 at the final visit (889 ± 173 postoperative days). The mean baseline axial length of 29.5 ± 1.3 mm decreased significantly (P < 0.01) to 27.1 ± 1.9 mm 1 month after scleral imbrication and 28.1 ± 1.7 mm at the final visit (P < 0.05 vs. baseline, P = 0.13 vs. 1 month). The mean 1-month surgically induced astigmatism of 3.6 ± 1.4 diopters (D) after scleral imbrication significantly (P < 0.05) decreased to 2.4 ± 1.5 D at the final visit. CONCLUSION: Scleral imbrication with vitrectomy and gas tamponade resulted in high reattachment and macular hole closure rates for treating refractory macular hole retinal detachment.

[One year outcomes of pars plana vitrectomy in proliferative diabetic retinopathy].

PURPOSE: To evaluate the 1-year results of pars plana vitrectomy for proliferative diabetic retinopathy. PATIENTS AND METHODS: Two hundred thirty six patients with proliferative diabetic retinopathy received primary vitreous surgery at Shiga University of Medical Science Hospital and had at least 1 year follow-up period. The indications for pars plana vitrectomy included vitreous hemorrhage in 140 eyes, extramacular tractional retinal detachment in 60 eyes, macular tractional retinal detachment in 24 eyes and combined tractional retinal detachment in 12 eyes. The visual acuity and changes in visual acuity at 1-year postoperatively were evaluated. Preoperative bevacizumab injection and postoperative visual outcomes were compared between patients treated with 20 gauge (20 G) surgery and with micro incision vitrectomy surgery (MIVS). RESULTS: The visual acuity improved by 3 lines or more in 166 eyes (70%) and remained unchanged in 56 eyes (24%); it decreased by 3 lines or more in 14 eyes (6%). Tractional retinal detachment in MIVS received more bevacizumab injections. MIVS systems achieved better visual results in the combined tractional retinal detachment group than 20 G system. CONCLUSION: Successful visual improvement at 1-year postoperatively was observed in eyes with proliferative diabetic retinopathy after pars plana vitrectomy. Results of this study may suggest the superior performance of MIVS for pars plana vitrectomy in proliferative diabetic retinopathy.

Comparison of pneumatic displacement for submacular hemorrhages with gas alone and gas plus tissue plasminogen activator.

PURPOSE: To retrospectively evaluate efficacy, safety, and visual outcomes of pneumatic displacement for submacular hemorrhages (SMHs) with or without tissue plasminogen activator (tPA). METHODS: Sixty-eight eyes with fresh SMHs underwent pneumatic displacement. Thirty eyes received intravitreal injection of pure C3F8 gas alone and 38 eyes received gas with tPA (25 µg). The visual analog scale was used to evaluate displacement. The main outcome measures were the visual analog scale score and best-corrected visual acuity 1 month after treatment. The efficacy and safety of tPA were evaluated. RESULTS: The visual analog scale score was 4.9 ± 2.5 in the gas group and 5.9 ± 2.9 in the gas plus tPA group. Sixteen eyes (53.3%) in the gas group and 15 eyes (39.5%) in the gas plus tPA group had best-corrected visual acuity improvements. In the gas group, complications included retinal detachment (n = 1, 3.3%), vitreous opacity (n = 7, 23.3%), and rebleeding (n = 1, 3.3%). In the gas plus tPA group, vitreous opacity (n = 6, 15.8%) was the only complication. Overall, both groups had similar displacement of SMH, visual improvement, and complication rates at 1 month. CONCLUSION: Intravitreal injection of pure C3F8 gas displaced SMHs and improved best-corrected visual acuity in eyes with SMHs. No adjuvant effect or adverse reactions of tPA were found.

A two-step homogeneous assay for apolipoprotein E-containing high-density lipoprotein-cholesterol.

BACKGROUND: Apolipoprotein E-containing high-density lipoprotein shows antiatherogenic properties in vitro. There is a need for a homogeneous assay to determine the concentration of apolipoprotein E-containing high-density lipoprotein for in vivo studies. METHODS: In the proposed homogeneous assay, lipoproteins other than apolipoprotein E-containing high-density lipoprotein were eliminated in the first step. Apolipoprotein E-containing high-density lipoprotein-cholesterol was measured in the second step. The control study used a 13% polyethylene glycol precipitation assay (control assay). RESULTS: The homogeneous assay showed good performance in validation studies. In subjects with normal liver function ( n = 78), a significant correlation was found between the control assay and the homogeneous assay ( r = 0.824). Serum apolipoprotein E-containing high-density lipoprotein cholesterol concentrations, determined by the control assay and the homogeneous assay, respectively, were 0.05 (0.04-0.10) (median [25th-75th percentile]) mmol/L and 0.10 (0.06-0.13) mmol/L for healthy individuals ( n = 12), and 0.03 (0.01-0.13) mmol/L and 0.02 (0.01-0.02) mmol/L for patients with cholestasis ( n = 6). The results indicate that the homogeneous assay recovers cholesterol contained in physiological apolipoprotein E-containing high-density lipoprotein, but not in pathological apolipoprotein E-containing high-density lipoprotein from cholestatic patients. CONCLUSIONS: The proposed two-step homogeneous assay enables selective measurement of physiological apolipoprotein E-containing high-density lipoprotein cholesterol in common autoanalysers. This assay might uncover a role for apolipoprotein E-containing high-density lipoprotein in physiological conditions.

Evaluation of clinical validity of the Rabin cone contrast test in normal phakic or pseudophakic eyes and severely dichromatic eyes.

PURPOSE: To evaluate the clinical validity of the Rabin cone contrast test (RCCT; Innova Systems, Inc.) in patients with normal phakic/pseudophakic eyes and severe dichromatic colour vision deficiency (CVD). METHODS: We evaluated age-related changes in the RCCT scores in 166 phakic eyes and 34 pseudophakic eyes and the RCCT sensitivity and specificity in 28 men with severe dichromatic CVD (10 with protanopia, 18 with deutanopia) and nine age-matched controls. All participants had 20/20 or better Snellen best-corrected visual acuity (BCVA). The RCCT was used to measure the L, M and S-CCT scores (range, 0-100). RESULTS: In normal phakic eyes, the mean L, M and S-CCT scores decreased gradually with ageing, with normal levels in patients in the second to seventh decades of life and some below normal in the eighth and ninth decades of life. In normal pseudophakic eyes, the mean L, M and S-CCT scores were normal in patients in the seventh to ninth decades of life. In eyes with severe CVD, the mean L, M and S-CCT scores were, respectively, 31.5 ± 18.3, 86.0 ± 12.6 and 98.0 ± 6.3 in patients with protanopia; 92.8 ± 10.5, 50.8 ± 19.6 and 97.8 ± 5.2 in patients with deutanopia; and 99.4 ± 1.7, 98.3 ± 5.0 and 99.4 ± 1.7 in controls. The RCCT sensitivity and specificity were 100% for diagnosing the CVD type. CONCLUSION: The RCCT can be used in non-visually impaired patients up to the seventh decade of life and after cataract surgery in elderly patients. The RCCT is available for CVD screening and typing and the score has a wide distribution range even in patients with severe CVD.

Comparison between ranibizumab and aflibercept for macular edema associated with central retinal vein occlusion.

PURPOSE: We compared the efficacy of bimonthly intravitreal injections of ranibizumab (IVR) with that of bimonthly intravitreal injections of aflibercept (IVA) in two prospective, consecutive groups of patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Eyes with ME after CRVO received either bimonthly IVR (ranibizumab group; n = 13) or IVA (aflibercept group; n = 13) injections and were followed monthly for 6 months. Three patients in the ranibizumab group and two in the aflibercept group were lost to follow-up and excluded from the study. The best-corrected visual acuity (BCVA), central foveal thickness (CFT) on optical coherence tomography, and aqueous vascular endothelial growth factor (VEGF) concentrations were evaluated before and after treatment. RESULTS: From baseline to month 6, significant improvements occurred in mean logMAR BCVA (ranibizumab group: 0.78-0.47; p < 0.05; aflibercept group: 0.74-0.54; p < 0.05) and mean CFT (ranibizumab group: 685-311 µm; p < 0.05; aflibercept group: 695-230 µm; p < 0.05). Fluctuations in CFT were seen at months 2, 4, and 6 in the ranibizumab group. Mean aqueous VEGF concentration decreased from baseline to month 2 in the ranibizumab group (509.9-348.2 pg/ml) and aflibercept group (412.1 pg/ml to undetectable limits in eight of 11 eyes and to 13.6, 15.6, and 24.1 pg/ml in the other three eyes, respectively). CONCLUSIONS: There was no significant improvement of visual acuity in one group compared with another; VEGF may not be completely neutralized by bimonthly injections of ranibizumab.

Development of homogeneous assay for simultaneous measurement of apoE-deficient, apoE-containing, and total HDL-cholesterol.

BACKGROUND: Pathophysiological role for high-density lipoprotein (HDL) subclasses remains to be elucidated. Homogeneous assay for simultaneous measurements of apoE-deficient HDL-cholesterol (HDL-C), apoE-containing HDL-C, and total HDL-C is desired, because apoE plays important roles in lipid metabolism. METHODS: The proposed assay consists of a primary reaction to remove non-HDL-C, a secondary reaction to measure apoE-deficient HDL-C, and a tertiary reaction to measure apoE-containing HDL-C. The assay is completed within 10 min. For control study, 13% polyethylene glycol precipitation assay and phosphotungstate-dextran sulfate-magnesium precipitation assay were carried out. RESULTS: Good correlations between the control assays and the proposed assay was obtained in serum samples from patients without liver disease (n=33): r=0.987, 0.957, and 0.991 for apoE-deficient, apoE-containing, and total HDL-C, respectively. ApoE-containing HDL-C by the proposed method in healthy individuals (n=12) and patients with hyper-HDL-cholesterolemia (n=5) were 0.11±0.03 and 0.26±0.05 mmol/l (4.1±1.3 and 10.1±2.0 mg/dl), respectively. ApoE-containing HDL-C increased rapidly at >2.59 mmol/l (100 mg/dl) of total HDL-C, suggesting a unique regulating mechanism of apoE-containing HDL-C. CONCLUSIONS: The established homogeneous assay might be useful for clinical and epidemiological studies on apoE-deficient and apoE-containing HDL subclasses.

Correlation between vascular endothelial growth factor and nonperfused areas in macular edema secondary to branch retinal vein occlusion.

PURPOSE: To determine the role of vascular endothelial growth factor (VEGF) in macular edema secondary to branch retinal vein occlusion (BRVO). PATIENTS AND METHODS: Aqueous humor samples were collected from 52 eyes with macular edema secondary to BRVO before intravitreal drug injections and from 62 control eyes with cataract. VEGF was measured using an enzyme-linked immunosorbent assay. Fluorescein angiography showed capillary nonperfused areas (NPAs). Macular edema was evaluated by optical coherence tomography as the central retinal thickness. RESULTS: The mean aqueous VEGF levels in eyes with BRVO and control eyes with cataract were, respectively, 290.5 pg/mL ± 294.9 pg/mL (range 81.9 pg/mL-1567.3 pg/mL) and 118.0 pg/mL ± 50.1 pg/mL (range 24.6 pg/mL-241.1 pg/mL), which differed significantly (P < 0.0001). The mean VEGF level in eyes with BRVO without apparent NPA was 171.4 pg/mL ± 52.5 pg/mL (range 90.9 pg/mL-299.9 pg/mL), which was significantly higher than controls (P = 0.001). VEGF levels were correlated positively with the size of NPA (P = 0.0002) but not with the central retinal thickness. CONCLUSION: The aqueous VEGF concentration in patients with macular edema secondary to BRVO increased significantly and was correlated significantly with the size of NPA. Aqueous VEGF increased even in eyes without apparent NPA.

Quantification of urinary 18-hydroxycortisol using LC-MS/MS.

BACKGROUND: Urinary 18-hydroxycortisol has been investigated as a marker of aldosterone-producing adenoma (APA). The aim of this study was to develop and validate a method for the measurement of 18-hydroxycortisol using liquid chromatography-tandem mass spectrometry (LC-MS/MS). METHODS: Urine was collected over a 24-hour period in patients with APA (n = 11), idiopathic hyperaldosteronism (IHA, n = 9), and essential hypertension (EH, n = 6). 18-Hydroxycortisol was extracted in solid-phase, and measured by LC-MS/MS based on selected reaction monitoring. RESULTS: The method allowed quantification of 18-hydroxycortisol with a lower quantification limit of 0.26 nmol/L, intra- and inter-assay coefficients of variation of <3.4% and a range of analytical recovery of 98.0-103.7%. Urinary 18-hydroxycortisol excretion for APA, IHA and EH were determined as 725 (SD 451), 102 (SD 68) and 88 (SD 76) nmol/day, respectively. CONCLUSIONS: The proposed method met the basic analytical requirements and was considered to be useful in the screening and differential diagnosis of APA.

Immunological detection of large oxidized lipoproteins in hypertriglyceridemic serum.

BACKGROUND: Triglyceride-rich, low-density lipoproteins (TG-rich LDL) have been reported as an oxidized lipoprotein species in patients with severe liver disease. Using TG-rich LDL as an immunogen, we obtained a monoclonal antibody (G11-6) that reacted with TG-rich LDL from patients with liver disease and with metal-oxidized LDL only in the early process of the oxidation reaction. This study determined the G11-6-reactive lipoproteins in hypertriglyceridemic serum. METHODS: Serum samples from healthy volunteers (n = 12) and hypertriglyceridemic patients (n = 9) were fractionated by gel filtration and subjected to a sandwich enzyme-linked immunosorbent assay (ELISA) using G11-6 and polyclonal anti-apolipoprotein B antibodies. RESULTS: Small LDL and larger lipoproteins reacted with G11-6. G11-6-reactive small LDL was identified in both the healthy subjects and hypertriglyceridemic patients, whereas G11-6-reactive larger lipoproteins were found only in the hypertriglyceridemic patients. CONCLUSIONS: G11-6 is a useful tool for detecting increased large oxidized lipoproteins in hypertriglyceridemic patients.

Measurement of single low-density lipoprotein particles by atomic force microscopy.

BACKGROUND: The size of lipoprotein particles is relevant to the risk of coronary artery disease (CAD). METHODS: We investigated the feasibility of atomic force microscopy (AFM) for evaluating the size of large low-density lipoprotein (LDL) and small dense LDL (sd-LDL) separated by ultracentrifugation. The measurements by AFM in tapping mode were compared to those by electron microscopy (EM). RESULTS: There was a significant difference in particle sizes determined by AFM between large LDL (20.6 ± 1.9 nm, mean ± SD) and sd-LDL (16.2 ± 1.4 nm) obtained from six healthy volunteers (P < 0.05). The particle sizes determined by EM for the same samples were 23.2 ± 1.4 nm for large LDL and 20.4 ± 1.4 nm for sd-LDL. The difference between large LDL and sd-LDL detected by EM was also statistically significant (P < 0.05). In addition, the particle sizes of each lipoprotein fraction were significantly different between AFM and EM: P < 0.05 for large LDL and P < 0.05 for sd-LDL. CONCLUSIONS: AFM can differentiate between sd-LDL and large LDL particles by their size, and might be useful for evaluating risk for CAD.

Novel monoclonal antibody recognizing triglyceride-rich oxidized LDLs associated with severe liver disease and small oxidized LDLs in normal subjects.

BACKGROUND: Triglyceride-rich low-density lipoproteins (TG-rich LDLs) in the plasma of patients with severe liver disease are reported to change macrophages into foam cells in vitro. METHODS: Male BALB/c mice were immunized with TG-rich LDLs isolated from the plasma of a patient with severe liver disease. The resulting monoclonal antibody (G11-6) was used in a sandwich enzyme-linked immunosorbent assay (ELISA) in combination with polyclonal anti-apolipoprotein B antibodies. The time course of copper-mediated LDL oxidation was monitored using this ELISA. The results were compared with those of the two commercial ELISAs for oxidized LDLs using DLH or ML25, thiobarbituric acid reactive substances and the optical absorbance for the conjugated dienes generated in lipid peroxides. Furthermore, the lipoprotein fractions separated by gel filtration were tested with this ELISA in healthy volunteers (n = 11) and patients (n = 3) with liver disease. RESULTS: G11-6 reacted with oxidized LDLs during only the early phase of copper oxidation, being distinct from the other monoclonal antibodies and methods. G11-6 was confirmed to react with TG-rich LDLs in patients, while it reacted with small LDL particles in normal controls. CONCLUSIONS: The monoclonal antibody G11-6 is useful for detecting oxidized small LDLs in normal controls and oxidized TG-rich LDLs in patients with severe liver disease.