Sleep duration and food intake in people with type 2 diabetes mellitus and factors affecting confectionery intake.

AIMS/INTRODUCTION: We carried out a cross-sectional study of people with type 2 diabetes mellitus to elucidate the association between sleep duration and food intake. MATERIALS AND METHODS: Overall, 2,887 participants with type 2 diabetes mellitus (mean age 63.0 years; 61.1% men; mean glycated hemoglobin level 7.5%) were included in this study. The participants' self-reported dietary habits and sleep duration were evaluated using a brief self-administered dietary history questionnaire and Pittsburgh Sleep Quality Index, respectively. The participants were categorized into the following four groups based on sleep duration: <6, 6-6.9, 7-7.9 (reference) and ≥8 h. RESULTS: No significant differences were observed between the groups regarding energy intake (kcal/day), absolute intake (g/day) or relative intake (% energy) of carbohydrates, total fat, proteins and fibers. However, confectionery intake was higher in the <6 h group and lower in the ≥8 h group than in the reference group after adjustment for confounding factors. In multivariate analysis, sleep durations <6 h and ≥8 h significantly correlated with increased (95% confidence interval 0.55 to 3.6; P = 0.0078) and decreased (95% confidence interval -4.0 to -0.32; P = 0.021) confectionery intake, respectively. Confectionery intake was positively correlated with female sex, glycated hemoglobin level and dyslipidemia, whereas it was negatively correlated with alcohol consumption and current smoking status. CONCLUSIONS: Short sleep duration is associated with high confectionery intake in people with type 2 diabetes mellitus; this might disturb their glycemic control. Therefore, short sleepers with type 2 diabetes mellitus could improve their glycemic control by avoiding confectionery intake and maintaining adequate sleep duration.

Association between ANGPTL3, 4, and 8 and lipid and glucose metabolism markers in patients with diabetes.

Lipid management, especially with respect to triglyceride (TG) metabolism, in patients with diabetes is not sufficient with current therapeutic agents, and new approaches for improvement are needed. Members of the angiopoietin-like protein (ANGPTL) family, specifically ANGPTL3, 4, and 8, have been reported as factors that inhibit lipoprotein lipase (LPL) activity and affect TGs. The present study investigated the association between lipid and glucose metabolism markers and the mechanism by which these proteins affect lipid metabolism. A total of 84 patients hospitalized for diabetes treatment were evaluated. Lipid and glucose metabolism markers in blood samples collected before breakfast, on the day after hospitalization, were analyzed. ANGPTL8 showed a significant positive correlation with TG values. HDL-C values displayed a significant positive correlation with ANGPTL3 but a negative correlation with ANGPTL4 and ANGPTL8. The results did not indicate a significant correlation among ANGPTL3, 4, and 8 levels. Thus, it is possible that the distribution of these proteins differs among patients. When patients were divided into groups according to the levels of ANGPTL3 and ANGPTL8, those with high levels of both ANGPTL3 and ANGPTL8 also had high levels of TG and small dense LDL-C/LDL-C (%). Multiple regression analysis indicated that low LPL, high ApoC2, high ApoC3, high ApoE, and high ANGPTL8 levels were the determinants of fasting hypertriglyceridemia. By contrast, no clear association was observed between any of the ANGPTLs and glucose metabolism markers, but ANGPTL8 levels were positively correlated with the levels of HOMA2-IR and BMI. Patients with high levels of both ANGPTL3 and ANGPTL8 had the worst lipid profiles. Among ANGPTL3, 4, and 8, ANGPTL8 is more important as a factor determining plasma TG levels. We anticipate that the results of this research will facilitate potential treatments targeting ANGPTL8 in patients with diabetes.

Relationship between basal sodium intake and the effects of dapagliflozin in albuminuric diabetic kidney disease.

We investigated the impact of basal dietary sodium intake on the dapagliflozin-induced changes in albuminuria and blood pressure (BP) measured at home in patients with diabetic kidney disease (DKD).This was a secondary analysis of the Y-AIDA Study, in which DKD patients with estimated glomerular filtration rate (eGFR) ≥ 45 ml/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g creatinine were administered dapagliflozin for 24 weeks, and dapagliflozin significantly improved albuminuria levels and home BP profiles. The effects on UACR, home-measured BP, and eGFR were compared between high- and low-sodium intake groups (HS and LS groups), which were created using baseline urinary sodium-to-creatinine ratio of 84 participants with available basal sodium-to-creatinine ratios. At baseline, clinic-/home-measured BPs, UACR, and eGFR, were comparable in the two groups. After 24 weeks, the reductions from baseline in ln-UACR were comparable in the two groups. In contrast, the reductions in evening home systolic BP and eGFR from baseline were larger in HS than in LS (BP: - 13 ± 2.08 vs. - 6 ± 1.88, P = 0.020; eGFR: - 3.33 ± 1.32 vs. 0.37 ± 1.29, P = 0.049). The home BP-lowering effects of dapagliflozin are larger in HS than LS, concomitant with a larger reduction in eGFR, suggesting a dapagliflozin-induced improvement in glomerular relative hyperfiltration in HS.

AUTOLOGOUS RETINAL TRANSPLANTATION AS A PRIMARY TREATMENT FOR LARGE CHRONIC MACULAR HOLES.

PURPOSE: To report the outcomes of autologous neurosensory retinal transplant as a primary treatment for patients with large chronic macular holes and evaluate the safety and feasibility of the procedure. DESIGN: Retrospective study, consecutive case series. METHODS: We reviewed seven patients with a primary chronic large macular hole, who underwent autologous neurosensory retinal transplant. Mean preoperative minimum and maximum hole diameters were 643 µm and 1214 µm, respectively. Changes in visual acuity were measured postsurgery, and optical coherence tomography, fluorescein angiography, and microperimetry-3 were analyzed after the procedure. RESULTS: Closure of the macular hole was achieved in all seven eyes in the study. At 1 year post-surgery, there was significant improvement in mean visual acuity (LogMAR 1.10 vs. 0.68, P = 0.001). Optical coherence tomography showed that all grafts had formed attachments to the retinal epithelial cells of the recipient retina. Mean preoperative ellipsoid zone defect was 1,089 ± 403.8 µm (range, 918-1,329 µm) which further decreased to 921 ± 129.1 µm (range, 670-1,201 µm) at final follow up (P = 0.09). Microperimetry-3 testing indicated retinal sensitivity in the graft in five eyes. CONCLUSION: Autologous retinal transplantation may help rebuild the macular structure resulting in functional improvement for eyes with primary chronic large macular hole.

Improved home BP profile with dapagliflozin is associated with amelioration of albuminuria in Japanese patients with diabetic nephropathy: the Yokohama add-on inhibitory efficacy of dapagliflozin on albuminuria in Japanese patients with type 2 diabetes study (Y-AIDA study).

BACKGROUND: The Y-AIDA study was designed to investigate the renal- and home blood pressure (BP)-modulating effects of add-on dapagliflozin treatment in Japanese individuals with type 2 diabetes mellitus (T2DM) and albuminuria. METHODS: We conducted a prospective, multicenter, single-arm study. Eighty-six patients with T2DM, HbA1c 7.0-10.0%, estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73 m2, and urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g creatinine (gCr) were enrolled, and 85 of these patients were administered add-on dapagliflozin for 24 weeks. The primary and key secondary endpoints were change from baseline in the natural logarithm of UACR over 24 weeks and change in home BP profile at week 24. RESULTS: Baseline median UACR was 181.5 mg/gCr (interquartile range 47.85, 638.0). Baseline morning, evening, and nocturnal home systolic/diastolic BP was 137.6/82.7 mmHg, 136.1/79.3 mmHg, and 125.4/74.1 mmHg, respectively. After 24 weeks, the logarithm of UACR decreased by 0.37 ± 0.73 (P < 0.001). In addition, changes in morning, evening, and nocturnal home BP from baseline were as follows: morning systolic/diastolic BP - 8.32 ± 11.42/- 4.18 ± 5.91 mmHg (both P < 0.001), evening systolic/diastolic BP - 9.57 ± 12.08/- 4.48 ± 6.45 mmHg (both P < 0.001), and nocturnal systolic/diastolic BP - 2.38 ± 7.82/- 1.17 ± 5.39 mmHg (P = 0.0079 for systolic BP, P = 0.0415 for diastolic BP). Furthermore, the reduction in UACR after 24 weeks significantly correlated with an improvement in home BP profile, but not with changes in other variables, including office BP. Multivariate linear regression analysis also revealed that the change in morning home systolic BP was a significant contributor to the change in log-UACR. CONCLUSIONS: In Japanese patients with T2DM and diabetic nephropathy, dapagliflozin significantly improved albuminuria levels and the home BP profile. Improved morning home systolic BP was associated with albuminuria reduction. Trial registration The study is registered at the UMIN Clinical Trials Registry (UMIN000018930; http://www.umin.ac.jp/ctr/index-j.htm ). The study was conducted from July 1, 2015 to August 1, 2018.

Intra-retinal Arterial Cannulation using a Microneedle for Central Retinal Artery Occlusion.

Central retinal artery occlusion (CRAO) is a severe disease, often causing blindness. We evaluated the efficacy and safety of a surgical procedure for the treatment of acute CRAO in which retinal arterial cannulation with tissue plasminogen activator (tPA) is performed. The surgical procedure consisted of vitrectomy followed by cannulation of the central retinal artery and injection of tPA (200 µg) using a 47-gauge microneedle. Thirteen CRAO patients were treated within 48 hours of the onset of symptoms. The central retinal artery of all 13 eyes was successfully cannulated. The mean interval between the onset of symptoms and surgery was 38.7 hours. The results for all 13 eyes treated showed a statistically significant improvement in mean visual acuity between before and one month after treatment (-1.60 vs. -0.82 logarithmic values for minimum angle resolution (LogMAR), p = 0.0021). Fluorescein angiography showed complete reperfusion and incomplete reperfusion in 10 eyes and 3 eyes, respectively. Recently developed surgical instruments have made retinal-arterial cannulation feasible. Intra-retinal-arterial cannulation has potential as a method of improving visual function and microcirculation in eyes affected by CRAO.

Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA).

OBJECTIVES: Excessively short and long sleep durations are associated with type 2 diabetes, but there is limited information about the association between sleep quality and diabetes. Accordingly, the present study was performed to investigate this relationship. MATERIALS AND METHODS: The subjects were 3249 patients with type 2 diabetes aged 20 years or older. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates worse sleep quality, and a global PSQI score >5 differentiates poor sleepers from good sleepers. RESULTS: The mean global PSQI score was 5.94 ± 3.33, and 47.6% of the patients had a score of 6 or higher. Regarding the components of the PSQI, the score was highest for sleep duration, followed by subjective sleep quality and then sleep latency in decreasing order. When the patients were assigned to HbA1c quartiles (≤ 6.5%, 6.6-7.0%, 7.1-7.8%, and ≥ 7.9%), the top quartile had a significantly higher global PSQI score than the other quartiles. The top HbA1c quartile had a sleep duration of only 6.23 ± 1.42 hours, which was significantly shorter than in the other quartiles. Also, sleep latency was 25.3 ± 31.8 minutes in the top quartile, which was significantly longer (by approximately 20 minutes) than in the other quartiles. When analysis was performed with adjustment for age, gender, BMI, smoking, and other confounders, the global PSQI score was still significantly higher and sleep duration was shorter in the top HbA1c quartile (HbA1c ≥ 7.9%). CONCLUSIONS: Japanese patients with type 2 diabetes were found to have poor subjective sleep quality independently of potential confounders, especially those with inadequate glycemic control. Impairment of sleep quality was associated with both increased sleep latency and a shorter duration of sleep.

Incretin Kinetics Before and After Miglitol in Japanese Patients With Late Dumping Syndrome.

BACKGROUND: In patients with late dumping syndrome following gastrectomy, it has been reported that hypoglycemia occurs due to inhibition of glucagon secretion as a result of excessive insulin production facilitated by an increase in glucagon-like peptide-1 (GLP-1). METHODS: To determine the kinetics of incretins in Japanese patients with late dumping syndrome, an oral glucose tolerance test was carried out before and after miglitol administration, and the kinetics of insulin and incretins were analyzed. RESULTS: After miglitol administration, there was improvement of hypoglycemia and early phase insulin secretion, with persistent excessive insulin secretion being minimized. These findings revealed that miglitol inhibited rapid excessive influx of carbohydrates into the blood and persistent elevation of GLP-1, resulting in improvement of early phase insulin secretion and minimizing persistent excessive insulin secretion. CONCLUSIONS: Eating frequent small meals is generally effective for late dumping syndrome, but patients often find it difficult to continue such a regimen. Based on the present analysis of incretin kinetics, miglitol may be a useful treatment option for late dumping syndrome.

Potential utility of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism: a case report.

We report a Japanese pedigree with familial primary hyperparathyroidism due to a CDC73 mutation. To our knowledge, this is the first report of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism. The proband had severe psychomotor retardation and received laryngotracheal separation surgery. At 19 yr of age, he developed acute pancreatitis. Hypercalcemia (12.2-13.8 mg/dL), elevated levels of intact PTH (86-160 pg/mL), and a tumor detected upon neck ultrasonography led to the diagnosis of primary hyperparathyroidism. Family history and biochemical examinations revealed that three family members (the proband's mother, elder brother, and maternal grandfather) had primary hyperparathyroidism. We identified a novel heterozygous mutation, c.240delT, p.Glu81Lysfs*28, in the CDC73 gene in three affected family members, excluding the proband's elder brother who refused genetic testing. Parathyroidectomy for the proband was considered as high-risk, because the tumor was located close to the tracheostomy orifice. After receiving approval from the institutional review board and obtaining the consent, we initiated cinacalcet treatment. At 22 yr of age, treatment with 100 mg of cinacalcet maintained serum calcium levels below 11.0 mg/dL with no apparent side effects. Our report presents the potential efficacy of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism, in particularly inoperative cases.

Effects of exenatide and liraglutide on 24-hour glucose fluctuations in type 2 diabetes.

We evaluated the influence of short-term treatment with exenatide twice daily or liraglutide once daily on daily blood glucose fluctuations in 40 patients with type 2 diabetes inadequately controlled by sulfonylureas. The patients in a multicenter, open-label trial were randomly assigned to receive add-on exenatide (10 µg/day, n = 21) or add-on liraglutide (0.3-0.9 mg/day, n = 19), and underwent 24-hour continuous subcutaneous glucose monitoring. There was no significant between-group difference in glucose fluctuations during the day, as assessed by calculating mean amplitude of glycemic excursion (MAGE) and standard deviation (SD). However, the mean blood glucose levels at 3 hours after breakfast and dinner were significantly lower in the exenatide group than the liraglutide group (breakfast: 127.3 ± 24.1 vs. 153.4 ± 28.7 mg/dL; p = 0.006, dinner: 108.7 ± 17.3 vs. 141.9 ± 24.2 mg/dL; p < 0.001). In contrast, mean blood glucose levels and their SD were significantly lower between 0000 h and 0600 h in the liraglutide group than the exenatide group (average glucose: 126.9 ± 27.1 vs. 107.1 ± 24.0 mg/dL; p = 0.029, SD: 15.2 ± 10.5 vs. 8.7 ± 3.8; p = 0.020). Both groups had similar glucose fluctuations despite differences in 24-hour blood glucose profiles. Therefore, each of these agents may have advantages or disadvantages and should be selected according to the blood glucose profile of the patient.

Safety and tolerability of diazoxide in Japanese patients with hyperinsulinemic hypoglycemia.

Diazoxide is a non-diuretic benzothiadiazine derivative, one of a group of substances introduced into clinical practice in the 1950s for the treatment of hypertension. Fajans reported the use of diazoxide for the treatment of insulinoma in 1979. Although patients with hyperinsulinemic hypoglycemia worldwide have been treated with diazoxide for more than 30 years, there are no recent reports about the adverse effects of this drug in Asian patients, including Japanese patients. Herein, we report the results of our retrospective clinical record review of 6 Japanese patients (3 females and 3 males, ranging in age from 58 to 91 years) with hyperinsulinemic hypoglycemia and inoperable insulinoma treated with diazoxide. Diazoxide improved control of hypoglycemic symptoms and maintained normoglycemia in 5 of the 6 patients, and was ineffective in one patient. Surprisingly, although all 6 patients received diazoxide according to the treatment strategy recommended in Western patients, 5 of the 6 patients developed edema and two developed congestive heart failure. Thus, when starting treatment with diazoxide in Japanese patients, the symptoms and signs of fluid retention should be evaluated carefully. Also, appropriate protocols for treatment with diazoxide should be evaluated by means of clinical trials in Japanese patients with hyperinsulinemic hypoglycemia.

Displacement of submacular hemorrhages in age-related macular degeneration with subretinal tissue plasminogen activator and air.

OBJECTIVE: To study the anatomic and visual outcomes of a surgical procedure in which tissue plasminogen activator and air are injected subretinally to displace massive submacular hemorrhages secondary to age-related macular degeneration. DESIGN: Prospective, consecutive, interventional case series. PARTICIPANTS: Thirteen consecutive patients (13 eyes) with massive submacular hemorrhages secondary to age-related macular degeneration. INTERVENTION: The surgical procedure consisted of a 25-gauge vitrectomy and submacular injection of tissue plasminogen activator (25 µg) and 0.4 ml air with a microneedle having an outer diameter of 50 µm. The procedure was followed by having the patient remain in the prone position overnight. MAIN OUTCOME MEASURES: Mean visual acuity change from baseline, mean central lesion thickness change from baseline, fluorescein angiography findings, and surgical complications. RESULTS: Total subfoveal blood displacement was achieved in all 13 eyes (100%). Central lesion thickness decreased from a mean baseline value of 867 µm to a mean value of 379 µm at 1 month after surgery. There was visual improvement in 11 eyes, no visual improvement in 1 eye, and poorer vision in 1 eye. The mean change in Early Treatment Diabetic Retinopathy Study letter score from baseline was 19.4 letters at 1 month (P = 0.006) and 23.3 letters at 3 months (P = 0.001). There was intraoperative macular hole formation. CONCLUSIONS: Submacular air injection with a microneedle facilitates displacement of clots dissolved with tissue plasminogen activator with few complications and results in earlier visual improvement.

Endovascular cannulation with a microneedle for central retinal vein occlusion.

We developed a new surgical treatment in which a microneedle is used for retinal endovascular cannulation to treat eyes with central retinal vein occlusion by flushing thrombus out of the central retinal vein as it passes through the lamina cribrosa. The eyes of 12 consecutive patients (12 eyes) with central retinal vein occlusion were successfully treated using this novel treatment. At 24 weeks after surgery, 9 of 12 eyes had gained more than 15 letters in best-corrected visual acuity, and the mean decrease in central foveal thickness was 271.1 µm. Few complications were observed. The microneedle is stiff and sharp enough to facilitate retinal endovascular cannulation in eyes with central retinal vein occlusion. This new technique is a promising treatment of macular edema due to central retinal vein occlusion.

Internal limiting membrane contrast after staining with indocyanine green and brilliant blue G during macular surgery.

PURPOSE: To evaluate the difference in color contrast by performing a color contrast ratio (CR) analysis and resulting visibility of the internal limiting membrane (ILM) when stained with indocyanine green and brilliant blue G (BBG) during macular surgery by performing a color CR analysis. METHODS: The authors analyzed 40 consecutive cases in which vitrectomy with ILM removal was performed to treat a macular hole or an epiretinal membrane. The surgical procedure was performed in 21 patients (21 eyes) after staining with indocyanine green and in 19 patients (19 eyes) after staining with BBG. The color CRs were estimated based on digital analysis of the red, green, and blue data of the digital images captured, and the CRs obtained with the two dyes were compared. RESULTS: Color contrast analysis was performed in all 40 eyes, in which the ILM was removed after staining with indocyanine green or BBG, and the CRs were estimated in every eye. The CR (mean ± SD) obtained with indocyanine green and BBG was 4.3 ± 0.3 and 2.4 ± 0.1, respectively. Indocyanine green provided a significantly higher CR than BBG (P = 0.015). CONCLUSION: Digital color contrast analysis can be used to evaluate the visibility of digital images, and it may be useful when choosing the dye to use for staining the ILM better.

Double-blind randomized clinical trial of the effects of ezetimibe on postprandial hyperlipidaemia and hyperglycaemia.

AIM: Ezetimibe selectively blocks intestinal cholesterol absorption by inhibiting Niemann-Pick C1-like 1 (NPC1L1) and reducing LDL cholesterol (LDL-C). In animals, ezetimibe reversed diet-induced obesity, liver steatosis, and insulin resistance. In humans, its potential effects on liver steatosis and insulin resistance have been suggested. We investigated the effects of ezetimibe on postprandial hyperlipidaemia and hyperglycaemia in obese subjects with dyslipidaemia in a double-blind randomized crossover trial. METHODS: Twenty obese men with hypertriglyceridaemia were assigned randomly to an ezetimibe- or a placebo-precedence-treated group. Subjects in the ezetimibe group were treated with ezetimibe (10 mg/day) for the first 4 weeks, followed by a 4-week interval and then treated with placebo for another 4 weeks. The placebo group received these treatments in reverse order. Subjects were requested to fast for at least 12 hours and then received a standard meal. Blood samples were collected at 0, 30, 60, 120, 240, 360 and 480 minutes after the meal on Days 0, 28, 56 and 84 and were used to measure the lipid and glucose metabolism markers. RESULTS: Ezetimibe significantly decreased the postprandial serum triglyceride excursion (p=0.01) and fasting serum LDL-C, remnant-like particles(RLP) and ApoB48 levels (p<0.05). Postprandial glucose excursion, serum insulin levels, serum glucose-dependent insulinotropic polypeptide (GIP) and active glucagon-like peptide-1 (GLP-1) were not significantly affected by ezetimibe treatment. CONCLUSION: Ezetimibe restored the postprandial dysregulation of lipid but did not affect glucose metabolism in a double-blind randomized crossover trial.

Effect of dehydroepiandrosterone on atherosclerosis in apolipoprotein E-deficient mice.

AIM: Several clinical trials have indicated that dehydroepiandrosterone (DHEA) reduces coronary events associated with atherosclerosis. The aim of this study was to examine the inhibitory effect of DHEA on atherosclerosis and the mechanisms involved. METHODS: Apolipoprotein E-knockout (apoE-KO) mice were fed an atherogenic high-cholesterol diet with or without 0.4% (w/w) DHEA for 12 weeks. RESULTS: Although the plasma cholesterol and triglyceride levels were not decreased by DHEA, atherosclerotic lesions in the aortic sinus showed a 45% reduction in area with DHEA treatment versus untreated mice (0.19 +/- 0.01 vs. 0.10 +/- 0.02 microm(2); p<0.05). Accumulation of macrophages in aortic lesions was also markedly reduced in the DHEA group, and the macrophage-positive area decreased to 0.33 +/- 0.06 microm(2) from 0.67 +/- 0.07 microm(2) (p<0.01). Furthermore, DHEA suppressed the expression of monocyte chemoattractant protein-1 in the vessel wall. Thus, inhibition of macrophage infiltration by DHEA reduced the formation of atherosclerotic lesions in apoE-KO mice. CONCLUSIONS: DHEA might be an effective agent for clinical management of atherosclerosis, but a larger controlled trial is necessary for confirmation.

Surgically-induced inflammation with 20-, 23-, and 25-gauge vitrectomy systems: an experimental study.

PURPOSE: To evaluate postoperative intraocular inflammation induced in rabbit eyes subjected to surgery using different vitrectomy systems. METHODS: The 20-, 23-, and 25-gauge vitrectomy were performed on a total of 12 rabbit eyes, divided into 3 respective groups, and 4 rabbit eyes were used as a normal control group. The surgery consisted of posterior vitreous detachment induction and core vitrectomy. The main outcome measures were operative time, volume of balanced saline solution consumed and the intravitreal total protein concentration, determined by bicinchoninic acid protein assays, obtained by vitreous tap on postoperative days 1, 3, and 7. RESULTS: The intravitreal protein averages in the 20-, 23-, and 25-gauge vitrectomy groups were, respectively, 31 +/- 4.1, 21 +/- 2.3, and 7 +/- 3.4 mg/mL on postoperative Day 1 (0.13 +/- 0.02 mg/mL in the control eye). The intravitreal protein concentration level was significantly lower with the 25-gauge than with 20- or 23-gauge vitrectomy (P < 0.001), and there were no significant differences in intravitreal protein between the 20- and 23-gauge system on postoperative days 1 and 3. At 7 days postoperatively, there were no significant differences in the intravitreal protein levels among the three groups. Significantly less balanced saline solution was consumed in the 25-gauge vitrectomy group (P < 0.001). CONCLUSION: Postoperative intraocular inflammation can vary among vitrectomy systems. A smaller gauge can minimize the inflammation associated with vitrectomy.

Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy.

PURPOSE: To compare the efficacy and safety of 25-gauge vitrectomy with 20-gauge vitrectomy for macular pucker. DESIGN: Randomized clinical study. METHODS: Sixty-seven eyes (67 patients) with macular pucker were prospectively and randomly assigned to undergo 20-gauge vitrectomy or 25-gauge vitrectomy as a control group. Main outcome measurements consisted of best-corrected visual acuity (BCVA), mean induced astigmatism, total operation time, and postoperative complications. RESULTS: The mean BCVA at baseline and at one month and six months after surgery was 20/78, 20/62, and 20/42, respectively, in the 20-gauge group, and 20/85, 20/45, and 20/40 in the 25-gauge group. A significant difference in change in the logarithm of the minimal angle of resolution of BCVA between 20-gauge and 25-gauge was found at one month (-0.10 vs -0.269, P < .001), but not at six months (-0.327 vs -0.276, P > .01). CONCLUSIONS: If faster visual improvement is desired, 25-gauge vitrectomy may be preferable to 20-gauge vitrectomy for macular pucker.

Multicoated contact lens for bimanual vitreous surgery without endoillumination.

We developed a new multicoated contact lens for use with the bimanual vitrectomy technique. The new lens is made of quartz, and its multicoated surface has properties that decrease light reflection and increase light absorption. The lens is placed on the cornea, and the coaxial light from the operating microscope alone enables surgeons to obtain a clear image of the retinal surface. This new vitrectomy contact lens is very useful for the treatment of eyes with proliferative membranes and allows surgeons to perform vitrectomy by using both hands.

Absorption of short wavelengths of endoillumination in indocyanine green solution: implications for internal limiting membrane removal.

PURPOSE: To measure the absorption coefficients of short wavelengths, irradiated by a light source used for vitreous surgery, in indocyanine green (ICG) solution and balanced salt solution (BSS), and to determine the implications of these absorption coefficients on retinal phototoxicity caused by ICG-assisted internal limiting membrane removal. METHODS: The absorption coefficients of short wavelengths irradiated by a commercially available light source used for vitreous surgery were measured in ICG solution and BSS using a dual-beam spectroradiometer. RESULTS: The absorption coefficient of wavelengths irradiated by the endoillumination light source in ICG solution was almost the same as that obtained in BSS. The absorbance coefficients of the ICG solutions were 0.18 cm(-1) at 400 nm and 0.03 cm(-1) at 450 nm. In BSS, the absorption coefficients were 0.17 cm(-1) at 400 nm and 0.015 cm(-1) at 450 nm. No significant difference in absorbance was seen between 400 nm and 450 nm ( P>0.05). CONCLUSIONS: The absorption of wavelengths is not greater in ICG solution than in BSS. ICG solution during intravitreal use probably does not enhance retinal photochemical injury during ICG-assisted internal limiting membrane removal.