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PURPOSE: To investigate the clinical features, management, and prognosis of full-thickness macular holes (FTMHs) inadvertently created during vitrectomy for eyes with proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP). METHODS: Eyes with PDR and FVP that had intraoperatively created FTMHs were retrospectively collected as the study group, and age- and sex-matched subjects with PDR and FVP who did not have intraoperative FTMHs were selected as the control group. Fundus abnormalities, optical coherence tomography (OCT) features, and anatomical and functional outcomes were compared between the two groups. RESULTS: Eleven eyes of 11 patients (5 male and 6 female) were identified as the study group. Follow-up duration was 36.8 ± 47.2 months. FTMHs were managed by ILM peeling or the inverted ILM flap technique. Anatomical success and MH closure were achieved in 100% of eyes in the study group. In comparison to the control group, the study group had a higher proportion of condensed prefoveal tissue (63.6% vs. 22.7%, p = 0.028), and a higher ratio of silicone oil tamponade (63.6% vs. 18.2%, p = 0.014), whereas there were no differences in preoperative and final BCVA, and the severity, activity, and locations of FVP between the two groups. CONCLUSION: Condensed prefoveal tissue was a risk factor of FTMHs created during operation for eyes with PDR and FVP. The ILM peeling or the inverted ILM flap technique may be beneficial for the treatment with favorable anatomical and functional outcomes.
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Diabetes Mellitus , Retinopatía Diabética , Membrana Epirretinal , Perforaciones de la Retina , Humanos , Masculino , Femenino , Vitrectomía/métodos , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/cirugía , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/cirugía , Membrana Epirretinal/cirugía , Estudios Retrospectivos , Agudeza Visual , Tomografía de Coherencia Óptica , Fondo de Ojo , Membrana Basal/cirugíaRESUMEN
OBJECTIVES: To investigate the therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation (HFOV-VG) versus conventional mechanical ventilation (CMV) in the treatment of preterm infants with respiratory failure. METHODS: A prospective study was conducted on 112 preterm infants with respiratory failure (a gestational age of 28-34 weeks) who were admitted to the Department of Neonatology, Jiangyin Hospital Affiliated to Medical School of Southeast University, from October 2018 to December 2022. The infants were randomly divided into an HFOV-VG group (44 infants) and a CMV group (68 infants) using the coin tossing method based on the mode of mechanical ventilation. The therapeutic efficacy was compared between the two groups. RESULTS: After 24 hours of treatment, both the HFOV-VG and CMV groups showed significant improvements in arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, and partial pressure of oxygen/fractional concentration of inspired oxygen ratio (P<0.05), and the HFOV-VG group had better improvements than the CMV group (P<0.05). There were no significant differences between the two groups in the incidence rate of complications, 28-day mortality rate, and length of hospital stay (P>0.05), but the HFOV-VG group had a significantly shorter duration of invasive mechanical ventilation than the CMV group (P<0.05). The follow-up at the corrected age of 6 months showed that there were no significant differences between the two groups in the scores of developmental quotient, gross motor function, fine motor function, adaptive ability, language, and social behavior in the Pediatric Neuropsychological Development Scale (P>0.05). CONCLUSIONS: Compared with CMV mode, HFOV-VG mode improves partial pressure of oxygen and promotes carbon dioxide elimination, thereby enhancing oxygenation and shortening the duration of mechanical ventilation in preterm infants with respiratory failure, while it has no significant impact on short-term neurobehavioral development in these infants.
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Infecciones por Citomegalovirus , Ventilación de Alta Frecuencia , Síndrome de Dificultad Respiratoria del Recién Nacido , Insuficiencia Respiratoria , Lactante , Niño , Recién Nacido , Humanos , Recien Nacido Prematuro , Estudios Prospectivos , Edad Gestacional , Dióxido de Carbono , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Ventilación de Alta Frecuencia/métodos , Respiración Artificial , Insuficiencia Respiratoria/terapia , OxígenoRESUMEN
Purpose: The aim of the study is to present the clinical characteristics and surgical treatment of secondary full-thickness macular hole (MH) after diabetic vitrectomy (DV) in patients with proliferative diabetic retinopathy (PDR). Methods: In this retrospective, observational, and longitudinal study, we enrolled consecutive patients with PDR who developed MH after DV. The macular structure was evaluated using optical coherence tomography. The clinical characteristics, surgical techniques, and outcomes were also recorded. Results: Three patients developed MH within 6 weeks, which was associated with foveal thinning, residual fibrovascular proliferation, or anterior proliferative vitreoretinopathy. Six patients developed MH originating from the epiretinal membrane (ERM) with lamellar MH (LMH) after a median interval of 16.5 months. Three of them were complicated with retinal detachment (RD). Various surgical procedures were performed according to the clinical scenarios, including internal limiting membrane (ILM) peeling, inverted ILM flap insertion, temporal inverted ILM flap, lens posterior capsular flap insertion, and neurosensory retinal free flap insertion. All patients achieved MH closure after surgery, and 5 patients exhibited improved visual acuity. Conclusions: MH may develop after successful DV, with a high rate of associated RD. Rapid MH formation was attributed to unreleased tractional force and weakened foveal structure. The development of ERM and LMH also led to MH. Various surgical techniques could be used for MH closure.
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Background: Late-life depression (LLD), characterized by cognitive deficits, is considered heterogeneous across individuals. Previous studies have identified subtypes with diverse symptom profiles, but their cognitive patterns are unknown. This study aimed to investigate the subtypes of LLD and the cognitive profile of each group. Methods: In total, 109 depressed older adults were enrolled. We performed latent class analysis using Geriatric Depression Scale items as indicators to generate latent classes. We compared the sociodemographic and clinical characteristics with cognitive functions between groups and conducted regression analysis to investigate the association between class membership and variables with significant differences. Results: Two classes were identified: the "pessimistic" group was characterized by pessimistic thoughts and the "worried" group with a relatively high prevalence of worry symptoms. The two groups did not differ in sociodemographic characteristics. The "pessimistic" group showed a higher rate of past history of depression and lower age of onset. The "worried" group had more physical comorbidities and a higher rate of past history of anxiety. The "pessimistic" group was more impaired in general cognitive function, executive function, information processing speed, and attention. Lower general and executive functions were associated with the membership in the "pessimistic" group. Conclusions: Subjects with pessimistic symptoms and subjects with a propensity to worry may form two distinct subtypes of late-life depression with different cognitive profiles. Further, the cognitive evaluation of subjects with pessimistic symptoms is of utmost importance.
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Twenty-one consecutive patients (21 eyes) having proliferative diabetic retinopathy (PDR) and fibrovascular proliferation (FVP) with optical coherence tomography (OCT) available before and after full-thickness macular hole (FTMH) formation were retrospectively reviewed. Four types of FTMH formation pathways in PDR were identified and were quite different from those in idiopathic conditions. The activity, severity and locations of FVP varied in PDR eyes destined to develop FTMHs. Type 1 was characterized by epiretinal membrane (ERM) and/or vitreomacular traction (VMT) inducing foveoschisis, intraretinal cysts or foveal detachment, followed by formation of a FTMH or macular hole retinal detachment (MHRD). In type 2, ERM and/or FVP induced lamellar macular hole (LMH) with foveoschisis, followed by the formation of FTMH or MHRD. Type 3 was characterized by the initial tractional retinal detachment (TRD) with foveal cysts and/or foveoschisis and the subsequent formation of MHRD. Type 4 was characterized by TRD associated with foveal thinning, ensued by the formation of MHRD. The severity of FVP was grade 2 in 66.7% of eyes in both types 1 and 4, and grade 3 in 75% of eyes in type 3 while the severity of FVP was more evenly distributed in type 2.
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Retinopatía Diabética/patología , Membrana Epirretinal/diagnóstico por imagen , Desprendimiento de Retina/diagnóstico por imagen , Perforaciones de la Retina/diagnóstico por imagen , Adulto , Anciano , Retinopatía Diabética/complicaciones , Membrana Epirretinal/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desprendimiento de Retina/etiología , Perforaciones de la Retina/etiología , Tomografía de Coherencia ÓpticaRESUMEN
Purpose: To investigate the mechanisms of anti-inflammatory and anti-oxidative effects of fenofibrate, a peroxisome proliferator-activated receptors-α agonist, in preventing diabetic retinopathy (DR) progression via a diabetic rat model. Methods: Diabetes was induced by intraperitoneal injection of streptozotocin in 6-week-old female Wistar rats. Diabetic rats were divided into diabetes without treatment (n = 10), diabetes treated with low dose fenofibrate (30 mg/kg/day) (n = 10) and high dose fenofibrate (100 mg/kg/day) (n = 10). Serum aqueous humor (AqH) and ocular tissues were gathered after 3-month treatment. Expressions of NF-κB and inflammatory chemokines (monocyte chemoattractant protein-1, fractalkine, and intercellular adhesion molecule-1) were detected by reverse transcription-polymerase chain reaction, Western blot, enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC), and electrophoretic mobility shift assay. The levels of oxidative biomarkers, including acrolein, nitrotyrosine, and 8-hydroxy-2'-deoxyguanosin (8-OHdG), were determined by IHC and ELISA. The reactive oxygen species (ROS) levels in serum and AqH were measured by chemiluminescence methods. Results: After 3 months of treatment, the expressions of mRNA and protein of monocyte chemoattractant protein-1, fractalkine, and intercellular adhesion molecule-1 in the retina of diabetic rats were significantly inhibited by fenofibrate in a dose-dependent manner. These effects were mediated by inhibition of NF-κB by fenofibrate. The levels of oxidative markers, including acrolein, nitrotyrosine, and 8-OHdG, decreased in the retina of diabetic rats after fenofibrate treatment. The ROS levels in the AqH of diabetic rats also suppressed by fenofibrate. Conclusions: Fenofibrate significantly inhibited the expressions of NF-κB and inflammatory chemokines and reduced oxidative products within diabetic retina. Treatment of fenofibrate might be beneficial to preventing DR progression.
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Diabetes Mellitus Experimental/prevención & control , Retinopatía Diabética/prevención & control , Modelos Animales de Enfermedad , Fenofibrato/farmacología , Hipolipemiantes/farmacología , Mediadores de Inflamación/metabolismo , 8-Hidroxi-2'-Desoxicoguanosina/metabolismo , Acroleína/metabolismo , Animales , Humor Acuoso/metabolismo , Glucemia/metabolismo , Western Blotting , Quimiocinas/genética , Quimiocinas/metabolismo , Diabetes Mellitus Experimental/metabolismo , Retinopatía Diabética/metabolismo , Retinopatía Diabética/fisiopatología , Relación Dosis-Respuesta a Droga , Ensayo de Inmunoadsorción Enzimática , Femenino , Inmunohistoquímica , Etiquetado Corte-Fin in Situ , FN-kappa B/genética , FN-kappa B/metabolismo , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/sangre , Reacción en Cadena en Tiempo Real de la Polimerasa , Retina/fisiopatología , Tirosina/análogos & derivados , Tirosina/metabolismoRESUMEN
PURPOSE: To investigate the anti-oxidative and anti-inflammatory effects of cilostazol in the ocular tissues of streptozotocin (STZ)-induced diabetic rats. MATERIALS AND METHODS: Diabetes was induced in 6-week-old Wistar rats via peritoneal injections of STZ. The treatment group received cilostazol 18 mg/kg/day for 8 weeks (n = 10), and the diabetic group received phosphate buffer solution (n = 20). The expression of oxidative stress and inflammatory mediators in the ocular tissues was then assessed by reverse-transcription polymerase chain reactions, immunohistochemical (IHC) staining, Western blot analysis, and enzyme-linked immunosorbent assay (ELISA). RESULTS: Reverse-transcription polymerase chain reactions, IHC staining, Western blot analysis, and ELISA showed that cilostazol inhibited mRNA and protein expressions of intercellular adhesion molecule-1, monocyte chemoattractant protein-1 and fractalkine in the retina and aqueous humor (AqH). Consistent with these findings, cilostazol attenuated the activation of nuclear factor-κB (NF-κB) in the diabetic rats. The levels of oxidatively modified DNA (8-OHdG), nitrotyrosine and oxidative lipids (acrolein) were also diminished in the cilostazol-treated group. Chemiluminescence analysis showed that reactive oxygen species (ROS) levels in the AqH was significantly higher in the diabetic rats than in the non-diabetic rats. Treatment with cilostazol significantly reduced the ROS levels in the AqH compared to the diabetic rats. CONCLUSIONS: Our results indicated that cilostazol reduced inflammatory reactions and oxidative stress in diabetic eyes. The anti-inflammatory effects of cilostazol may be indirectly via reducing oxidative stress, inhibiting NF-κB activity, and subsequently decreasing inflammatory mediators. Cilostazol may be beneficial to prevent the progression of diabetic retinopathy.
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Cilostazol/uso terapéutico , Diabetes Mellitus Experimental/tratamiento farmacológico , Retinopatía Diabética/prevención & control , Inflamación/tratamiento farmacológico , Estrés Oxidativo/efectos de los fármacos , Inhibidores de Fosfodiesterasa 3/uso terapéutico , Animales , Humor Acuoso/metabolismo , Glucemia/metabolismo , Western Blotting , Quimiocina CCL2/genética , Quimiocina CCL2/metabolismo , Quimiocina CX3CL1/genética , Quimiocina CX3CL1/metabolismo , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/metabolismo , Ensayo de Inmunoadsorción Enzimática , Femenino , Regulación de la Expresión Génica/fisiología , Inmunohistoquímica , Molécula 1 de Adhesión Intercelular/genética , Molécula 1 de Adhesión Intercelular/metabolismo , FN-kappa B/metabolismo , Ratas , Ratas Wistar , Especies Reactivas de Oxígeno/metabolismo , Retina/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , EstreptozocinaRESUMEN
PURPOSE: To describe a case of optic neuritis secondary to Angiostrongylus cantonensis infection. METHOD: Case report of a patient with eosinophilic meningitis secondary to A. cantonensis infection. The patient developed a sudden decrease in visual acuity with a visual field defect and color vision loss in his left eye. Both visual evoked potential and clinical manifestations suggested the diagnosis of optic neuritis (os). RESULT: After two weeks of larvicidal drugs and steroid treatment, the patient's visual acuity and color vision had dramatically improved. CONCLUSION: Optic neuritis may occur in patients with A. cantonensis meningitis. Treatment with a combination of steroid and larvicidal agents may be beneficial to these patients.
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Angiostrongylus cantonensis/aislamiento & purificación , Eosinofilia/complicaciones , Meningitis/complicaciones , Neuritis Óptica/etiología , Infecciones por Strongylida/complicaciones , Adulto , Animales , Anticuerpos Antihelmínticos/análisis , Diagnóstico Diferencial , Eosinofilia/parasitología , Estudios de Seguimiento , Humanos , Masculino , Meningitis/parasitología , Neuritis Óptica/diagnóstico , Neuritis Óptica/parasitología , Infecciones por Strongylida/parasitologíaRESUMEN
BACKGROUND: Retained preretinal bubbles were found over the posterior retina after silicone oil removal in patients who had received complicated vitreoretinal surgery. CASE: We report on two patients who underwent vitreoretinal surgery with silicone oil infusion for giant retinal tears; perfluorocarbon liquid was used during the surgery. Posteriorly located preretinal oil was noted after silicone oil removal in both patients. OBSERVATIONS: In both cases, oil bubbles formed, which were transparent and located in unusual places for a long period of time. No alteration of refractive status or harmful effect seemed to be associated with these retained oil bubbles. CONCLUSIONS: This strange phenomenon of fixed preretinal oil bubbles may occur after vitreoretinal surgery. It did not seem to be harmful to the retina during the follow-up periods.
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Cuerpos Extraños en el Ojo/inducido químicamente , Retina/patología , Aceites de Silicona/efectos adversos , Vitrectomía/efectos adversos , Adulto , Cuerpos Extraños en el Ojo/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias , Remisión Espontánea , Desprendimiento de Retina/patología , Desprendimiento de Retina/cirugía , Vitrectomía/métodosRESUMEN
PURPOSE: To investigate clinical findings and ocular characteristics of sterile endophthalmitis following intravitreal injection (IVI) of triamcinolone for the treatment of macular edema. METHODS: IVI is an institutional practice at our hospital. From March 2002 to January 2003, a total of 21 IVIs of triamcinolone acetonide were performed on 19 patients with macular edema secondary to various retinal disorders. Cases diagnosed as sterile endophthalmitis after IVI of triamcinolone were selected for the study. Fisher's discriminant linear analysis was used to determine whether a significant correlation existed between specific ocular features and the occurrence of post-injection sterile endophthalmitis. RESULTS: Five of 21 eyes (23.8%) had sterile endophthalmitis with hypopyon formation after the injection. Of the five sterile endophthalmitis patients, three were pseudophakic with impaired posterior capsule and four had a diagnosis of Irvine-Gass syndrome. The rate of sterile endophthalmitis was significantly higher in pseudophakic patients with impaired posterior capsule (p = 0.0075) and in patients with Irvine-Gass syndrome (p = 0.0008). The best-corrected visual acuity (BCVA) in these patients remained unchanged or even improved when the inflammation subsided. CONCLUSION: Pseudophakia with impaired posterior capsule and the diagnosis of cystoid macular edema due to Irvine-Gass syndrome are two risk factors of sterile endophthalmitis following IVI triamcinolone. No loss of BCVA was noted in the patients with post-injection sterile endophthalmitis.
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Endoftalmitis/inducido químicamente , Glucocorticoides/efectos adversos , Triamcinolona Acetonida/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inyecciones , Cápsula del Cristalino/lesiones , Cápsula del Cristalino/patología , Edema Macular/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Seudofaquia/complicaciones , Factores de Riesgo , Triamcinolona Acetonida/uso terapéutico , Agudeza Visual , Cuerpo VítreoRESUMEN
Adiponectin has been associated with increased risks of microvascular complications in diabetes; however, its role in the development of diabetic retinopathy (DR) is unknown. Fenofibrate is a lipid-lowering agent that has been shown to be capable of preventing DR progression. We investigated the expression of adiponectin and its receptors in DR and evaluated the effects of fenofibrate on their expression. The mRNA and protein levels of adiponectin and its receptors were elevated in retinas of streptozotocin-induced diabetic rats and were suppressed following fenofibrate treatment. Immunofluorescence staining demonstrated that adiponectin and adipoR1 were expressed in cells located within blood vessels, the retinal ganglion, and the inner nuclear layer. AdipoR1 was strongly expressed whereas adipoR2 was only weekly expressed in vascular endothelial cells. The in vitro experiments showed that adiponectin expression was induced by high glucose concentrations in RGC-5 and RAW264.7 cells and was suppressed following fenofibrate treatment. AdipoR1 and adipoR2 levels in RGC-5 cells were elevated in high glucose concentrations and suppressed by fenofibrate. Our results demonstrated that adiponectin may be a proinflammatory mediator in diabetic retinas and fenofibrate appears to modulate the expression of adiponectin and its receptors in diabetic retinas, effectively reducing DR progression.
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Adiponectina/metabolismo , Antiinflamatorios/farmacología , Diabetes Mellitus Experimental/tratamiento farmacológico , Retinopatía Diabética/prevención & control , Fenofibrato/farmacología , Mediadores de Inflamación/metabolismo , Retina/efectos de los fármacos , Estreptozocina , Adiponectina/sangre , Adiponectina/genética , Animales , Humor Acuoso/metabolismo , Glucemia/metabolismo , Línea Celular , Diabetes Mellitus Experimental/sangre , Diabetes Mellitus Experimental/inducido químicamente , Diabetes Mellitus Experimental/genética , Retinopatía Diabética/sangre , Retinopatía Diabética/etiología , Retinopatía Diabética/genética , Femenino , Ratones , ARN Mensajero/metabolismo , Ratas Sprague-Dawley , Receptores de Adiponectina/efectos de los fármacos , Receptores de Adiponectina/genética , Receptores de Adiponectina/metabolismo , Retina/metabolismoRESUMEN
PURPOSE: This study aimed to evaluate the clinical features and visual outcomes of non-traumatic suprachoroidal haemorrhage (SH) in Taiwan. METHODS: We report a retrospective, non-comparative, interventional case series study carried out in an institutional setting. Thirty-nine eyes with non-traumatic SH were studied using a new system for grading the severity of SH. The aetiologies of SH were analysed. The correlations between grades and prognoses of SH were studied. Multiple logistic regression was used to assess factors associated with final visual outcome. RESULTS: Conditions causing SH in the eyes considered in this study included cataract surgery (43.59%), age-related macular degeneration (AMD) (17.95%), filtering operation and vitrectomy (both 10.26%), scleral buckling (5.13%) and others. Twelve eyes (12/39, 30.77%) had a final visual outcome of no light perception. Only 12 eyes (12/39, 30.77%) had final visual acuity (VA) > 4/200. Grade of SH correlated significantly with need for surgical drainage and with final visual outcome (Spearman rank correlations 0.313 and - 0.408, p = 0.010 and p = 0.00317, respectively). 'Good' and 'poor' final VA was significantly associated with VA at the time of SH (multiple logistic regression coefficients 2.132 and - 2.809, p = 0.015 and p = 0.008, respectively), as well as initial retinal detachment (multiple logistic regression coefficients - 2.267 and 2.223, p = 0.036 and p = 0.006, respectively). Higher grades of SH and increased age were associated with poor final visual outcome (multiple logistic regression coefficients - 1.332 and - 0.122, p = 0.013 and p = 0.022, respectively). CONCLUSIONS: Suprachoroidal haemorrhage is a devastating ocular problem. Complications of intraoperative surgery and AMD are common causes. The new SH grading system provides a simple method for evaluating the need for drainage and for predicting visual prognosis. Visual acuity and retinal detachment at the time of SH are major factors associated with good and poor final VA, respectively.