Endophthalmitis in silicone oil-filled eye: A case report.

BACKGROUND: Endophthalmitis occurring in silicone oil-filled eyes is a very rare occurrence, with reported incidence rates ranging between 0.07% and 0.039%. Traditional methods of management of infectious endophthalmitis include the removal of silicone oil, washout of the vitreous cavity, administration of intravitreal antibiotics, and re-injection of silicone oil. CASE SUMMARY: Herein, we report the case of a 39-year-old man with unilateral endophthalmitis after pars plana vitrectomy and silicone oil tamponade. Intravitreal injections of full-dose antibiotics and anterior chamber washout were used to treat the patient. No signs of retinal toxicity were observed during the follow-up period. CONCLUSION: Intravitreal full-dose antibiotic injections and anterior chamber washout are promising alternatives to traditional therapies for endophthalmitis in silicone oil-filled eyes.

Acute Macular Neuroretinopathy after SARS-CoV-2 Infection: An Analysis of Clinical and Multimodal Imaging Characteristics.

BACKGROUND: This study aimed to analyze clinical and multimodal imaging characteristics of acute macular neuroretinopathy (AMN) post-recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Retrospective observational study. Medical records and multimodal imaging of 12 AMN eyes of eight patients (six female and two male) with recent SARS-CoV-2 infection were retrospectively analyzed. RESULTS: Four patients (50%) presented with bilateral AMN. Fundus ophthalmoscopy revealed a reddish-brown lesion around the macula, and two eyes had cotton-wool spots at the posterior pole. Three eyes showed mild hypo-autofluorescence. All FFA images (7 eyes) showed no abnormal signs. On OCT scans, all eyes showed outer nuclear layer (ONL) thinning, 8 eyes (66.7%) showed ONL hyperreflectivity, 5 eyes (41.7%) showed outer plexiform layer (OPL) hyperreflectivity, 8 eyes (66.7%) showed interdigitation zone (IZ) disruption, 11 eyes (91.6%) showed ellipsoid zone (EZ) disruption, 2 eyes (16.7%) showed cotton-wool spots and inner plexiform layer (IPL) hyperreflectivity, 1 eye (8.3%) had intraretinal cyst and 1 eye (8.3%) had inner nuclear layer (INL) thinning. Persistent scotoma, ONL hyperreflectivity and IZ/EZ disruption as well as recovery of OPL hyperreflectivity were reported after follow-up in three cases. CONCLUSIONS: AMN post-SARS-CoV-2 mostly affected young females and could present unilaterally or bilaterally. Dark lesions on IR reflectance and outer retinal hyperreflectivity on OCT are useful in diagnosing AMN. OPL/ONL hyperreflectivity on OCT could disappear after follow-up, but ONL thinning and IZ/EZ could persist.

[Preparation of Iron-improved Blue Algae Biochar and Its Co-adsorption Mechanism for Phosphorus in Surface Water].

To alleviate the problems of eutrophication and blue algae accumulation in water, biochar was prepared from blue algae dehydrated using polymerized ferrous sulfate(PFS) to absorb phosphate in water, and the biochar was activated using steam to adjust the pore structure. The preparation conditions of blue algae biochar were optimized using the response surface method. The optimal results were as follows:the dosage of PFS was 458 mg·L-1, the carbonization temperature was 433℃, and the mass ratio of biochar precursor to steam was 1:11. Biochar without PFS(F0H11-433) and biochar with PFS(F458H11-433) were characterized using X-ray diffraction(XRD), Fourier-transform infrared spectroscopy(FTIR), zeta potential, and Raman spectra(Raman) were used to study whether blue algae biochar and PFS had a synergic effect on phosphate removal. The results showed that:compared with F0H11-433, iron oxide appeared on the surface, the zero point of charge(pHpzc) increased from 4.41 to 6.19, and the disorder and defect degree of biochar was increased in F458H11-433. The pseudo-second-order model and Langmuir model were suitable for describing the adsorption process of F458H11-433, and the saturated adsorption capacity was 31.97 mg·g-1. F458H11-433 had excellent phosphorus removal efficiency in actual lake water, and the residual phosphate content of effluent was less than 0.025 mg·L-1. In the presence of several common anions, it still showed excellent selective adsorption. After five cycles, the phosphate removal of F458H11-433 still reached 75.78%, indicating that F458H11-433 had the characteristic of being renewable. Combined with the material characterization results before and after adsorption, the phosphorus removal mechanism of F458H11-433 mainly involved electrostatic attraction and ligand exchange.

Efficacy and Safety of Aqueous Interleukin-8-Guided Treatment in Cytomegalovirus Retinitis after Bone Marrow Hematopoietic Stem Cell Transplantation.

PURPOSE: To explore the optimal treatment for cytomegalovirus retinitis (CMVR) in patients status-post Allogeneic bone marrow hematopoietic stem cell transplantation (Allo-HSCT), based on aqueous humor indicators. METHODS: A randomized controlled study with 35 eyes. Eyes were randomized with a 1:1 ratio to standard treatment group (Group 1, with treatment endpoint as aqueous CMV-DNA load＜103 copy/ml), and interleukin (IL)-8 group (Group 2, with treatment endpoint as aqueous IL-8 level ＜30 pg/ml or CMV-DNA load＜103 copy/ml) to receive antiviral intravitreal injections. Number of injections, CMVR recurrence rate, complication rate, and vision changes were analyzed and compared. RESULTS: The mean number of injections in group 2 was less than in group 1 (6 vs 8 respectively, p<0.05). There were no significant differences in CMVR recurrence, complication and vision recovery rate. CONCLUSION: Incorporating aqueous humor IL-8 level into the criteria of CMVR treatment decision can safely and effectively reduce the number of intravitreal injections needed and can be used as important indicators to assess treatment endpoint.

Vitrectomy With Silicone Oil Tamponade and Without Internal Limiting Membrane Peeling for the Treatment of Myopic Foveoschisis With High Risk of Macular Hole Development.

Purpose: To explore the efficiency and safety of the surgical procedure of pars plana vitrectomy (PPV) with silicone oil (SO) tamponade and without internal limiting membrane (ILM) peeling for myopic foveoschisis (MF) eyes with high risk of macular hole formation. Methods: Three eyes (three patients) with MF and foveal detachment were enrolled into the study. Comprehensive preoperative ophthalmological assessments, including best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) were performed on the eyes. Central foveal thickness (CFT) and thickness of continuous neurosensory retina at foveola were measured. All patients underwent PPV followed by SO tamponade and without ILM peeling. SO was removed when MF and retinal detachment were resolved. Patients were followed up postoperative at month 1, 3, 6, and 12. Results: All the three eyes achieved complete resolution of MF and foveal reattachment with an average SO tamponade period of 11.67 ± 0.58 months. The average CFT at 6 months was 91 ± 27.5 µm, hence reduced significantly from baseline at 365.3 ± 137.85 µm (P = 0.037). There was no postoperative macular hole formation despite the average preoperative sensory retina thickness of 58 ± 20.07 µm. Mean BCVA was improved from logMAR 1.43 ± 0.75 to logMAR 0.8 ± 0.75 on the last follow-up. Manageable SO-related complications were reported, including SO emulsification, ocular hypertension, and cataract. Conclusion: Vitrectomy with SO tamponade and without ILM peeling as an optional surgical protocol to treat MF is effective and safe, especially for MF eyes vulnerable to macular hole formation.

NEOVASCULAR COMPLICATIONS FROM CYTOMEGALOVIRUS NECROTIZING RETINOPATHY IN PATIENTS AFTER HAPLOIDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION.

PURPOSE: To report the incidence and clinical features of neovascular complications from cytomegalovirus (CMV) necrotizing retinopathy in patients after haploidentical hematopoietic stem cell transplantation. METHODS: Thirty-nine patients (58 eyes) of CMV necrotizing retinopathy after haploidentical hematopoietic stem cell transplantation in our institute between January 2018 and June 2020 were retrospectively reviewed, and cases that developed neovascular complications during follow-up were identified and described. RESULTS: Two (2 eyes) cases that developed neovascular glaucoma from CMV necrotizing retinopathy were identified. Both of them manifested as granular peripheral retinitis, panretinal occlusive vasculitis, and some degree of intraocular inflammation, which were consistent with chronic retinal necrosis. Insidious progression of isolated immune-mediated occlusive vasculitis that could only be observed on fundus fluorescein angiography without active retinitis or intraocular inflammation was recognized to be the cause in one of two cases. CONCLUSION: Neovascular glaucoma developed in 5.1%/cases and 3.4%/eyes complicated by CMV chronic retinal necrosis and vasculitis in patients after haploidentical hematopoietic stem cell transplantation, which warrants the needs for long-term follow-up. Immune-mediated CMV vasculitis could be an isolated manifestation in patients with a minimal immune deviation and may only be found on fundus fluorescein angiography, which emphasizes the importance of fundus fluorescein angiography on a regular basis during follow-up.

Continuous High-Dose (6 mg) vs. Low-Dose (3 mg) Intravitreal Ganciclovir for Cytomegalovirus Retinitis After Haploidentical Hematopoietic Stem Cell Transplantation: A Randomized Controlled Study.

Purpose: To evaluate the safety and efficacy of continuous high-dose (6 mg) intravitreal ganciclovir injections (IVG) for cytomegalovirus (CMV) retinitis (CMVR) after haploidentical hematopoietic stem cell transplantation (Haplo-HSCT), and to explore factors that may influence the treatment procedure. Design: Prospective, randomized, single-blinded, positive-controlled, interventional, comparative study. Methods: A total of 22 patients with CMVR (32 eyes) were randomized to either high-dose group (IVG 6 mg weekly) or low-dose group (IVG 3 mg given twice weekly for 2 weeks as induction phase and weekly thereafter as maintenance phase). Patients who were recorded any positive CMV DNAemia or other active CMV diseases and needed systemic anti-CMV treatment during the study period were excluded. The vision outcome, variables of the treatment procedure, and incidence of complication and CMVR recurrence were analyzed and compared. Logistic regression was applied to determine the factors that may have an impact on the treatment process at baseline. Results: Compared to the low-dose group, the high-dose group resulted in a median of two less intravitreal injections (4 vs. 6 times, respectively, P = 0.016), while the rate of vision stability or improvement (81.2 vs. 87.5%), the incidence of complication (6.2 vs. 18.8%), and CMVR recurrence (12.5% vs. 6.2%) were similar (all P > 0.05). No drug-related toxicity was observed. Initial aqueous CMV-DNA load (OR: 6.872, 95% CI: 1.335-35.377, P = 0.021) and extension of lesion (OR: 0.942, 95% CI: 0.897 to .991, P = 0.020), but not dosing regimen (P = 0.162), were predictors of the treatment duration. Conclusions: Continuous high-dose regimen was well tolerated and resulted in less intravitreal injections, with similar vision outcomes and safety profiles. The clinical course of CMVR after Haplo-HSCT was determined by its own nature at baseline and could not be modified by treatment protocols under consistent immune background.

Tamoxifen retinopathy: a case report.

PURPOSE: To present a case of tamoxifen retinopathy on a 57-year-old woman. DESIGN: An observational case. METHODS: A review of history, clinical examination, and findings on Spectral-domain Optical Coherence Tomography (SD-OCT), fluorescein angiogram (FA) and electro-oculogram (EOG) was conducted. RESULTS: A 57-year old female patient, who had been treated with oral tamoxifen after mastectomy due to breast cancer, had profound visual impairment in both eyes. Disruption of the ellipsoid zone and interdigitation zone which represent photoreceptor damage as well as macular thinning was revealed on SD-OCT in both eyes. Bilateral retinal pigmented epithelium (RPE) function compromised was indicated by reduced Arden ratio in EOG. CONCLUSION: Tamoxifen-induced retinopathy could be detected by SD-OCT and EOG. As it is irreversible, patients who are given tamoxifen need regular ophthalmic consultation, including SD-OCT and EOG before and during the treatment in order to early detect and avoid further retinal damage.

Heme oxygenase-1 enhances autophagy in podocytes as a protective mechanism against high glucose-induced apoptosis.

Injury and loss of podocytes play vital roles in diabetic nephropathy progression. Emerging evidence suggests autophagy, which is induced by multiple stressors including hyperglycemia, plays a protective role. Meanwhile, heme oxygenase-1 (HO-1) possesses powerful anti-apoptotic properties. Therefore, we investigated the impact of autophagy on podocyte apoptosis under diabetic conditions and its association with HO-1. Mouse podocytes were cultured in vitro; apoptosis was detected by flow cytometry. Transmission electron microscopy and biochemical autophagic flux assays were used to measure the autophagy markers microtubule-associated protein 1 light chain 3-II (LC3-II) and beclin-1. LC3-II and beclin-1 expression peaked 12-24h after exposing podocytes to high glucose. Inhibition of autophagy with 3-methyladenine or Beclin-1 siRNAs or Atg 5 siRNAs sensitized cells to apoptosis, suggesting autophagy is a survival mechanism. HO-1 inactivation inhibited autophagy, which aggravated podocyte injury in vitro. Hemin-induced autophagy also protected podocytes from hyperglycemia in vitro and was abrogated by HO-1 siRNA. Adenosine monophosphate-activated protein kinase phosphorylation was higher in hemin-treated and lower in HO-1 siRNA-treated podocytes. Suppression of AMPK activity reversed HO-1-mediated Beclin-1 upregulation and autophagy, indicating HO-1-mediated autophagy is AMPK dependent. These findings suggest HO-1 induction and regulation of autophagy are potential therapeutic targets for diabetic nephropathy.

Expression of cytokines on the iris of patients with neovascular glaucoma.

PURPOSE: To determine the expression levels of cytokines, including growth factors, inflammatory cytokines, and cell migration associated factors on the iris from subjects with neovascular glaucoma (NVG). METHODS: After receiving formal consent from 12 subjects with NVG secondary to proliferative diabetic retinopathy and 12 subjects with primary open angle glaucoma (POAG), trabeculectomy was performed and iris specimens were collected during the surgery. Each subject with NVG received intravitreal injection of bevacizumab 1 week prior to the surgery. The mRNA level of vascular endothelial growth factor, basic fibroblastic growth factor, placental-induced growth factor, interleukin-2, interleukin 6, tumour necrosis factor α, intercellular adhesion molecule 1 (ICAM-1) and integrin subunit αV were determined by real-time polymerase chain reaction. The mRNA levels were compared between the two groups. RESULTS: The mRNA levels of all inflammatory cytokines and integrin subunit αV were significantly increased in the NVG group compared with POAG controls. However, the mRNA level of growth factors and ICAM-1 did not show any difference between the two groups. CONCLUSIONS: Inflammatory process maybe an important cause of iris neovascularization in subjects with NVG in addition to growth factors alone. Further studies should focus on the effect of growth factors in different phases in the pathogenesis of NVG.

TOMM40 rs2075650 polymorphism shows no association with neovascular age-related macular degeneration or polypoidal choroidal vasculopathy in a Chinese population.

PURPOSE: Age-related macular degeneration (AMD) and Alzheimer disease (AD) are age-related neurodegenerative diseases that share similar environmental risk factors, cellular pathologies, and genetic backgrounds. Recently, the rs2075650 single nucleotide polymorphism in the translocase of outer mitochondrial membrane 40 homolog (TOMM40) gene was identified as a risk factor for AMD and Alzheimer disease. We aimed to examine the associations between the TOMM40 rs2075650 polymorphism and neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV) in a Chinese population. METHODS: The study consisted of 900 subjects, including 300 controls, 300 cases with nAMD, and 300 cases with PCV. Genomic DNA was extracted from venous blood leukocytes. The allelic variant of rs2075650 was determined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Differences in the observed genotypic distributions between the case and control groups were tested using chi-square tests, with age and gender adjusted using logistic regression analysis. RESULTS: The TOMM40 rs2075650 polymorphism was not statistically significantly associated with the nAMD or PCV phenotype (p>0.05). The difference remained insignificant after correction for age and gender differences based on the logistic regression models (p>0.05). CONCLUSIONS: Our data provide no evidence to support an association of rs2075650 in TOMM40 with nAMD or PCV, suggesting that this gene is unlikely to be a major AMD and PCV susceptibility gene locus in the Chinese population.

[Long-term outcome after bilateral cataract surgery in infants with congenital cataract].

OBJECTIVE: To evaluate the long-term visual outcome and complications after bilateral congenital cataract surgery performed prior to 12 months of age. METHODS: A prospective case study. 31 cases (62 eyes) of bilateral congenital cataract were included.All patients received bilateral cataract extraction combined with primary capsulotomy and anterior vitrectomy simultaneously.After the operation, all patients wore aphakic glasses during the follow-up period.The unilateral and bilateral visual acuities (VA) at the last visit were determined and post-operative complications were evaluated, and the relationship between bilateral VA and the length of the follow-up period was also analyzed. RESULTS: The median age at surgery was 3.0 M (0.5 to 11 M) , the median follow-up period was 4.0 years (3.0 to 8.5 years). 37 out of 62 eyes (59.68%) achieved unilateral best corrected visual acuity equal or better than 0.3. 27 among 31 cases (87.1%) achieved binocular best corrected visual acuity equal or better than 0.3.Binocular best corrected visual acuity improved with the increase in the follow-up period and the patients' age (R(2) = 0.135,P = 0.0024) .Post-operative complications included strabismus (7 cases, 22.58%), nystagmus (13 cases, 41.94%), optical opacity (3 cases, 9.68%), ocular hypertension (1 cases, 3.23%). CONCLUSIONS: Surgery for congenital cataracts performed prior to 12 months of age is safe, and most of the subjects can achieve functional vision acuity. As these children age, the bilateral best corrected visual acuity can still keep improving.

Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation.

BACKGROUND: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Although much effort has been put into dealing with CMV retinitis secondary to acquired immunodeficiency syndrome (AIDS), the few reports which have been published have mainly focused on treatment of CMVR after HSCT. METHODS: This clinical interventional retrospective study included 14 patients (eight men; mean age 23.89 ± 12.09; 23 eyes) who suffered from CMV retinitis after stem-cell transplantation, in order to evaluate the efficacy and safety of multiple intravitreal injections of ganciclovir (IVG) for patients with CMV retinitis. All patients received 4 injections of IVG of 1 mg at 1 week intervals, and were followed up weekly for at least 2 months with measurement of best-corrected visual acuity (BCVA) and CMV levels in anterior aqueous humor with real-time polymerase chain reaction. Anterior aqueous humor was obtained before each injection. RESULTS: The levels of CMV in anterior aqueous humor showed significant decrease from (6.34 ± 15.78) × 10(5) copies/ml at baseline to (5.22 ± 12.15) × 10(3) copies/ml at 1 month (P < 0.001, Mann-Whitney U test). CMV couldn't be detected in 11 eyes (47.8 %) after two injections, and this rose to 18 eyes (78.3 %) at 1 month. The mean logMAR BCVA was 0.659 ± 0.572 at baseline and 0.680 ± 0.527 at 2 months, which suggested no significant improvement (P = 0.736, Mann-Whitney U test) during the procedure. All patients experienced improved vitreous opacity and diminished area of the lesion under funduscopy after 4 injections of IVG. No severe complications developed. CONCLUSIONS: Multiple IVG seemed to be beneficial for patients with CMV retinitis after stem-cell transplantation, in reducing CMV levels in aqueous humor. Further study to optimize the dose of ganciclovir is needed in order to achieve better treatment outcomes.

Inflammatory cytokines in aqueous humor of patients with choroidal neovascularization.

OBJECTIVE: To investigate the correlations between aqueous concentrations of interleukin 1ß, 6, 8, 10, 12p (IL-1ß, IL-6, IL-8, IL-10, IL-12p), and tumor necrosis factor α (TNF-α) and the parameters of macular edema acquired by optical coherence tomography (OCT) in patients with choroidal neovascularization. METHODS: IL-1ß, IL-6, IL-8, IL-10, IL-12p, and TNF-α in the aqueous humor samples of 17 patients with exudative age-related macular degeneration (AMD), ten patients with pathological myopia (PM), seven patients with idiopathic choroidal neovascularization (CNV), and 14 patients with cataract and idiopathic epiretinal membrane or macular hole in the control group were measured with cytometric bead array. The maximum macular thickness and macular volume within 1 mm, 3 mm, and 6 mm were measured with OCT. RESULTS: In the CNV groups, the aqueous levels of IL-6 and IL-8 were significantly associated with macular volume within 6 mm (p=0.011, p=0.008, respectively), while IL-1ß, IL-10, IL-12p, and TNF-α showed no significant correlation with either the maximum macular thickness or the macular volume. By further selecting patients with CNV who had accepted their last intravitreal injection of bevacizumab within 3 months, the level of IL-6 still significantly correlated with the maximum macular thickness (p=0.019) and macular volume within 1 mm (p=0.018), 3 mm (p=0.018), and 6 mm (p=0.022). In patients with exudative AMD, the level of IL-6 was significantly associated with the maximum macular thickness (p=0.025) and macular volume within 1 mm (p=0.025), 3 mm (p=0.006), and 6 mm (p=0.002). The aqueous level of all cytokines did not vary significantly between the CNV patients who had accepted their last intravitreal injection of bevacizumab within 3 months and the other patients, nor was a difference found among patients with exudative AMD, PM, and idiopathic CNV, and the control group. CONCLUSIONS: Intraocular concentrations of IL-6 and IL-8 (particularly IL-6) are significantly associated with the volume of macular edema in patients with CNV. However, intravitreal injection of antivascular endothelial growth factor drugs did not change the intraocular level of these inflammation cytokines.

Resveratrol attenuates renal hypertrophy in early-stage diabetes by activating AMPK.

BACKGROUND: Recent studies suggest the involvement of the adenosine monophosphate-activated serine/threonine protein kinase (AMPK) pathway in the pathogenesis of diabetic nephropathy (DN). Resveratrol, an agent that activates AMPK, may have the potential to protect against the development of DN. This study was designed to investigate the therapeutic effects of resveratrol on renal hypertrophy in early-stage diabetes and the underlying mechanisms. METHOD: Molecular and structural changes involved in the pathogenesis of DN were tested in a rat model of early-stage diabetes. Renal mesangial cells (RMCs) were cultured in media containing different concentrations of glucose with or without resveratrol. Cellular DNA synthesis was assayed by measuring (3)H-thymidine incorporation. The phosphorylation status of AMPK, eukaryotic translation initiation factor 4E binding protein 1 (4E-BP1), and phospho- ribosomal protein S6 (S6) was analyzed by Western blot. RESULTS: Resveratrol reduced plasma creatinine and urinary albumin excretion and attenuated renal hypertrophy without affecting blood glucose levels. Moreover, resveratrol activated AMPK and inhibited phosphorylation of 4E-BP1 and S6 in diabetic rat kidneys. In vitro, resveratrol blocked high glucose-induced dephosphorylation of AMPK and phosphorylation of 4E-BP1 and S6 and strongly inhibited both the DNA synthesis and proliferation of RMCs. CONCLUSION: These findings suggest the possibility that resveratrol exerts antiproliferative, antihypertrophic effects by activating AMPK and reducing 4E-BP1 and S6 phosphorylation, thus suppressing the development and progression of DN.