Inhibition of hypoxia-inducible factors suppresses subretinal fibrosis.

Age-related macular degeneration (AMD) is a common cause of vision loss. The aggressive form of AMD is associated with ocular neovascularization and subretinal fibrosis, representing a responsive outcome against neovascularization mediated by epithelial-mesenchymal transition of retinal pigment epithelium (RPE) cells. A failure of the current treatment (anti-vascular endothelial growth factor therapy) has also been attributed to the progression of subretinal fibrosis. Hypoxia-inducible factors (HIFs) increase gene expressions to promote fibrosis and neovascularization. HIFs act as a central pathway in the pathogenesis of AMD. HIF inhibitors may suppress ocular neovascularization. Nonetheless, further investigation is required to unravel the aspects of subretinal fibrosis. In this study, we used RPE-specific HIFs or von Hippel-Lindau (VHL, a regulator of HIFs) conditional knockout (cKO) mice, along with pharmacological HIF inhibitors, to demonstrate the suppression of subretinal fibrosis. Fibrosis was suppressed by treatments of HIF inhibitors, and similar suppressive effects were detected in RPE-specific Hif1a/Hif2a- and Hif1a-cKO mice. Promotive effects were observed in RPE-specific Vhl-cKO mice, where fibrosis-mediated pathologic processes were evident. Marine products' extracts and their component taurine suppressed fibrosis as HIF inhibitors. Our study shows critical roles of HIFs in the progression of fibrosis, linking them to the potential development of therapeutics for AMD.

A COMPARATIVE STUDY OF MEDIUM-SIZED MACULAR HOLE SURGERY WITH INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS CONVENTIONAL PEELING.

PURPOSE: To investigate surgical results for medium-sized (251-400 µ m) macular holes (MHs). METHODS: This retrospective observational study involved 266 eyes of 262 consecutive patients who underwent internal limiting membrane (ILM) peeling (147 eyes in the ILM peeling group) or inverted ILM flap cover technique (119 eyes in the inverted flap group) for primary medium-sized full-thickness MHs. Macular hole associated with retinal detachment, recurrent MH, and traumatic MH were excluded. RESULTS: The primary closure rate for overall medium-sized MHs was 100% (119 of 119 eyes) in the inverted flap group, which was significantly higher than that (94.6% [139/147 eyes]; P = 0.010) in the ILM peeling group. Notably, even after adjusting for the minimum MH diameter, presence of high myopia, or preexisting posterior vitreous detachment, the primary closure rate was significantly better in the inverted flap group than in the ILM peeling group (Cochran-Mantel-Haenszel test, overall adjusted P = 0.006, 0.009, 0.005, respectively). The preoperative and postoperative restoration of the outer retinal layers and visual acuity were comparable between the inverted ILM flap and ILM peeling techniques. CONCLUSION: Primary closure for medium-sized MHs was significantly superior in the inverted flap group than in the ILM peeling group.

Low-concentration povidone-iodine for the prevention of intraocular infections in ophthalmic surgery.

PURPOSE OF REVIEW: Endophthamitis following intraocular surgery is rare using current antiseptic techniques, such as single application of 5% povidone-iodine to the ocular surface and adjuvant topical or intracameral antibiotics. Challenges remain, however, including increased multidrug-resistant bacterial endophthalmitis, increased fungal endophthalmitis, and the low but nonzero endophthalmitis rate attributable to the typical bacteria that colonize the ocular surface. RECENT FINDINGS: Povidone-iodine has a wide spectrum of activity, including activity against novel pathogens, such as SARS-CoV-2. Povidone-iodine alternatives, such as hypochlorous acid can have significantly less efficacy in vitro against endophthalmitis isolates. Repetitive application of dilute povidone-iodine has an excellent safety profile and strong evidence base for efficacy. SUMMARY: Povidone-iodine is widely available, inexpensive, and commonly used by ophthalmologists. The repetitive application of dilute povidone-iodine is a well studied, well tolerated, and efficacious way to transiently sterilize the ocular surface during intraocular surgery. Additional benefits include activity against multidrug-resistant bacteria, fungi, and lack of inducible resistance.

Bilateral Pachychoroid disease with type 3 Uveal effusion syndrome in one eye and central serous Chorioretinopathy in contralateral eye: a case report.

BACKGROUND: We report a case of bilateral pachychoroid disease with type 3 uveal effusion syndrome (UES) in one eye and central serous chorioretinopathy (CSC) in the contralateral eye. CASE PRESENTATION: A 65-year-old man presented to our department because of decreased vision. Visual acuity was 16/20 in the right eye and 2/20 in the left eye, with normal axial lengths. The left eye was diagnosed with CSC and underwent photocoagulation 8 years ago. The right eye showed inferior non-rhegmatogenous retinal detachment and peripheral choroidal detachment. Macular optical coherence tomography showed submacular fluid in the right eye, pachychoroid in both eyes, and choroidal thickness of 565 µm in the right and 545 µm in the left eye. In both eyes, fluorescence angiography showed window defects and mild fluorescence leakage, and indocyanine green angiography showed dilated choroidal vessels, mild choroidal hyperpermeability, and mild dye leakage. The left eye was diagnosed with chronic CSC. Initially, chronic CSC was also suspected in the right eye. However, photodynamic therapy failed, with worsened retinal detachment and visual acuity. Pachychoroid in the peripheral fundus (choroidal thickness 820 µm) was observed only in the right eye. Based on these findings, UES was diagnosed in the right eye. Sclerectomies were performed. The absence of scleral thickening and glycosaminoglycan deposition led to a final diagnosis of type 3 UES. The procedure was not effective, due to connective tissue regeneration at the sclerectomy sites. In the revision surgery, mitomycin-C was used with sclerectomies. One month after surgery, retinal and choroidal detachment disappeared, visual acuity recovered to 8/20, pachychoroid in the macula and peripheral fundus decreased, and choroidal thickness decreased to 352 µm in the macula and 554 µm in inferior peripheral fundus. CONCLUSIONS: Pachychoroid in the posterior pole was the common finding in type 3 UES and CSC, although extensive pachychoroid in the peripheral fundus may have caused retinal and choroidal detachment in the eye with type 3 UES. Full-thickness sclerectomies with mitomycin-C improved pachychoroid in the peripheral fundus and resolved retinal and choroidal detachment, clearly indicating that the sclera was the main cause of type 3 UES.

A case of bilateral pachychoroid disease: polypoidal choroidal vasculopathy in one eye and peripheral exudative hemorrhagic chorioretinopathy in contralateral eye.

BACKGROUND: We report a case of bilateral pachychoroid disease manifesting polypoidal choroidal vasculopathy (PCV) with punctate hyperfluorescent spot (PHS) in one eye, and peripheral exudative hemorrhagic choroidal retinopathy (PEHCR) with central serous chorioretinopathy (CSC) and PHS in the contralateral eye. CASE PRESENTATION: A 51-year-old healthy woman presented with complaint of blurred vision in her right eye. Corrected visual acuity was 20/20 in the right and 24/20 in the left eye. Fundus examination was normal in the left eye. In the right eye, fundus finding of an orange-red nodular lesion and optical coherence tomography (OCT) finding of polypoidal lesions led to a diagnosis of PCV. Four aflibercept intravitreal injections were performed in her right eye. After treatment, indocyanine green angiography (ICGA) confirmed residual polypoidal lesions with branching vascular networks and PHS with choroidal vascular hyperpermeability. OCT showed PHS associated with small sharp-peaked retinal pigment epithelium (RPE) elevation in peripheral fundus and small RPE elevation in posterior fundus. Based on the above findings, PCV with PHS was finally diagnosed in the right eye. Posttreatment corrected visual acuity in the right eye was 20/20. She presented again 32 months later, with complaint of vision loss in her left eye. Left corrected visual acuity was 20/20, and fundus examination showed mild vitreous hemorrhage. Vitrectomy was performed. In temporal midperipheral fundus, fluorescein angiography revealed CSC, and OCT showed pachychoroid. ICGA depicted abnormal choroidal networks and PHS in peripheral fundus. Furthermore, polypoidal lesions were confirmed by OCT. Based on the above findings, PEHCR and CSC with PHS was finally diagnosed in the left eye. Postoperative corrected visual acuity in the left eye was 20/20, and aflibercept intravitreal injection was performed for prevention of recurrence of vitreous hemorrhage. CONCLUSIONS: This is the first case report of PCV with PHS in one eye, and PEHCR with CSC and PHS in the contralateral eye. This case suggests that PCV, PEHCR, and CSC may be linked pathologies of pachychoroid spectrum disease.

Microincision vitrectomy surgery: experimental visualization and quantification of vitreous contamination.

BACKGROUND: To visualize and quantify vitreous contamination following microincision vitrectomy surgery (MIVS) using an experimental vitreous contamination model (EVCM). METHODS: Enucleated porcine eyes with fluoresbrite carboxylate microspheres applied to the conjunctival surface were used as a type 1 EVCM. Twenty-five- or 27-gauge (G) trocar cannulas were inserted through the conjunctiva and sclera, followed by the placing and opening of an infusion cannula. These procedures were monitored by an intraocular fiber catheter. Secondly, condensed microspheres were applied to an excised sheet of porcine sclera to serve as type 2 EVCM. Twenty-five- or 27-G trocar cannulas were inserted perpendicularly through the top of the sclera where the condensed microspheres were applied, an infusion cannula was inserted, 0.1 mL of saline solution injected through the infusion cannula, and samples collected. The fluorescence strength of samples was then measured using fluorophotometry. RESULTS: We visually detected fluorescent microspheres in 10/10 eyes with 25-G and 10/10 with 27-G MIVS. In the experimental quantification study, each MIVS gauge value was significantly higher than the control (P < 0.01). However, there was no significant difference between 25-G and 27-G MIVS. CONCLUSIONS: MIVS carries the risk of introducing contamination directly into the eyes when the trocar cannula is inserted and infusion cannula is opened, even when a 27-G MIVS is used. Our study has shown it is essential that the surgeon be aware of the possibility of introducing contamination from the conjunctiva at all times during MIVS.

Endogenous Endophthalmitis successfully treated with Intravitreal Povidone-iodine injection: a case report.

BACKGROUND: The usefulness of povidone-iodine as an alternative to antimicrobial agents, for endophthalmitis, has recently been documented. We report a case of endogenous endophthalmitis successfully treated with intravitreal injection of povidone-iodine. CASE PRESENTATION: An 88-year-old woman underwent small bowel bypass surgery for postoperative ileus following rectal cancer resection. She developed a fever during total parenteral nutrition and was diagnosed with gram-positive cocci bacteremia of central venous catheter origin. The patient was referred to our department with chief complaints of ocular pain, hyperemia and decreased vision in the right eye, which had manifested during the febrile period. The initial examination revealed the visual acuity in her right eye to be finger counting and that in her left eye 0.2. The right eye showed a severe inflammatory reaction in the anterior chamber, fibrin deposition, and hypopyon. The fundus was difficult to visualize. Endogenous endophthalmitis due to bacteria was diagnosed. Surgical treatment was judged to be difficult based on the patient's poor general condition and mental status, and intravitreal injection of 0.1 ml of 1.25% povidone-iodine was performed on the same day. The inflammation rapidly diminished, and the hypopyon had disappeared 4 days after treatment. The fundus became visible 7 days after treatment and there was no recurrence of endophthalmitis findings. The visual acuity in her right eye recovered to that in the left eye (0.2). CONCLUSION: Intravitreal injection of povidone-iodine is potentially useful and effective as an alternative treatment of antibiotics for endogenous endophthalmitis patients, especially in whom surgical therapy is difficult.

Bilateral multiple serous retinal detachments after treatment with nivolumab: a case report.

BACKGROUND: Immune checkpoint inhibitors have recently been widely used for advanced cancers and are known to cause ocular complications. We herein report a case developing bilateral serous retinal detachments, without ocular inflammation, after starting nivolumab treatment. CASE PRESENTATION: A 73-year-old man was referred to our hospital, having become aware of metamorphopsia 2 months after starting nivolumab (anti-programmed cell death protein 1 monoclonal antibody) for malignant melanoma of the nasal cavity. The initial corrected visual acuity of the right eye was 20/20, and that of the left eye was 20/16. There were no inflammatory findings in the anterior segment or the vitreous. Vitelliform lesions were found in the macular area of both ocular fundi, consistent with serous retinal detachment and subretinal deposits. Swept source optical coherence tomography showed diffuse thickening of the outer photoreceptor segment and thickening of the choroid. Two months after the initial diagnosis, multiple vitelliform lesions were noted, and the fundus findings had worsened. Indocyanine green fluorescein angiography showed delayed inflow in the peripapillary and posterior pole regions in the early phase of imaging. Fundus autofluorescence showed hyperautofluorescence consistent with most of the vitelliform lesions on color fundus photography. CONCLUSIONS: Nivolumab may have impaired the pumping and phagocytosis functions of retinal pigment epithelial cells, resulting in bilateral serous retinal detachments and thickening of the photoreceptor outer segment. This is the first case report, to our knowledge, describing multiple bilateral serous retinal detachments and outer segment thickening without inflammation in a patient treated with nivolumab.

FOVEAL AVASCULAR ZONE AREA ANALYSIS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BEFORE AND AFTER IDIOPATHIC EPIRETINAL MEMBRANE SURGERY.

PURPOSE: To determine the size of the foveal avascular zone (FAZ) by optical coherence tomography angiography before and after idiopathic epiretinal membrane surgery. METHODS: Thirteen consecutive patients (13 eyes) with unilateral epiretinal membrane were studied retrospectively. Optical coherence tomography angiography was used to measure the FAZ area within 3 mm × 3 mm scans of the superficial (superficial FAZ) and deep plexus layers (deep FAZ) before and 6 months after vitrectomy. The unaffected fellow eyes were used as controls. RESULTS: The mean superficial and deep FAZ areas at 6 months after vitrectomy (0.080 ± 0.038 and 0.113 ± 0.045 mm, respectively) were significantly (P < 0.0001, P = 0.0035) larger than the corresponding mean preoperative FAZ areas (0.056 ± 0.030 and 0.082 ± 0.035 mm). However, the areas of FAZ expansion were small (0.024 ± 0.013 and 0.031 ± 0.031 mm). The mean postoperative superficial and deep FAZ areas were significantly (P < 0.0001, P < 0.0001) smaller than those of fellow eyes (0.295 ± 0.108 and 0.410 ± 0.142 mm). Multiple regression analysis showed that preoperative FAZ area had the highest correlation with postoperative FAZ area (P < 0.05). CONCLUSION: This study showed horizontal contraction of the FAZ area in eyes with epiretinal membrane. Because preoperative FAZ area correlates with postoperative FAZ area, FAZ area may be a useful parameter for determining timing of surgery for epiretinal membrane.

Prospective study of vitrectomy for epiretinal membranes in patients with good best-corrected visual acuity.

BACKGROUND: To evaluate the efficacy of epiretinal membrane removal in patients with good best-corrected visual acuity (BCVA) for improving visual function and quality of life (QOL). METHODS: This prospective case study compared 37 subjects with preoperative BCVA ≦ 0.046 logMAR (Good group) to 35 patients with 0.10-0.52 logMAR (Moderate group) at 3 and 6 months. Linear mixed-effect models were used for statistical analysis. The primary outcome was the horizontal metamorphopsia score (MH) at 6 months postoperatively (post-6 M), while secondary outcomes were postoperative BCVA, vertical metamorphopsia score (MV), aniseikonia, stereopsis and central foveal thickness. In the Good group, QOL was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) at 6 and 12 months. RESULTS: MH was significantly improved at post-3 M and post-6 M in the both groups but there were no significant differences between the two groups. MV showed no improvement at the final observation in either group. LogMAR BCVA was significantly improved at post-6 M in the Good group, which had significantly better vision than the Moderate group. Preoperative vertical and horizontal aniseikonia scores remained unchanged in the Good group at post-6 M but worsened in the Moderate group. The NEI VFQ-25 score improved in the Good group, reflecting improved general health, general vision, and mental health. CONCLUSIONS: Early epiretinal surgery for patients with BCVA ≦ 0.046 logMAR was effective for improvement of HM, BCVA, and QOL and prevented worsening of aniseikonia. TRIAL REGISTRATION: UMIN000021220 . Registered 10 September 2015. UMIN Clinical Trials Registry.

Proteolytic Degradation and Inflammation Play Critical Roles in Polypoidal Choroidal Vasculopathy.

Polypoidal choroidal vasculopathy (PCV) is a common subtype of wet age-related macular degeneration in Asian populations, whereas choroidal neovascularization is the typical subtype in Western populations. The cause of PCV is unknown. By comparing the phenotype of a PCV mouse model expressing protease high temperature requirement factor A1 (HTRA1) in retinal pigment epithelium with transgenic mice expressing the inactive HTRA1S328A, we showed that HTRA1-mediated degradation of elastin in choroidal vessels is critical for the development of PCV, which exhibited destructive extracellular matrix remodeling and vascular smooth muscle cell loss. Compared with weak PCV, severe PCV exhibited prominent immune complex deposition, complement activation, and infiltration of inflammatory cells, suggesting inflammation plays a key role in PCV progression. More important, we validated these findings in human PCV specimens. Intravitreal delivery of an HTRA1 inhibitor (DPMFKLboroV) was effective (36% lesion reduction; P = 0.009) in preventing PCV initiation but ineffective in treating existing lesions. Anti-inflammatory glucocorticoid was effective in preventing PCV progression but ineffective in preventing PCV initiation. These results suggest that PCV pathogenesis occurs through two stages. The initiation stage is mediated by proteolytic degradation of extracellular matrix proteins attributable to increased HTRA1 activity, whereas the progression stage is driven by inflammatory cascades. This study provides a basis for understanding the differences between PCV and choroidal neovascularization, and helps guide the design of effective therapies for PCV.

Postoperative roll cake-like macular fold after retinal detachment surgery.

PURPOSE: To report a case developing a severe retinal fold (RF), resembling a roll cake on optical coherence tomography (OCT), after retinal detachment (RD) surgery. CASE REPORT: A 61-year-old man underwent vitrectomy for a limited macula-on-superior rhegmatogenous RD and gas tamponade at another hospital. Despite remaining prone for 4 days, RF was noted after gas disappearance and he was referred to us. OCT showed a roll cake-like RF, which resolved after vitrectomy with internal limiting membrane (ILM) peeling, creation of a new detachment, perfluorocarbon liquid injection, air-fluid exchange, silicone oil tamponade and prone positioning. CONCLUSION: ILM peeling including the area of the retinal fold, followed by new detachment creation and finally perfluorocarbon liquid injection, effectively flattened the severe RF. To our knowledge, this is the most severe case of RF to be documented by OCT and illustrates that broad ILM peeling, including the RF, is effective for treating RF.

Capsular bag irrigation using 0.025% povidone-iodine in balanced salt solution PLUS for the treatment of postoperative endophthalmitis.

We examined the effectiveness and adverse events of using balanced salt solution (BSS) PLUS containing 0.025% povidone-iodine, a non-oculotoxic concentration, for capsular bag irrigation in a case of endophthalmitis mainly involving the anterior chamber. A 57-year-old female underwent cataract surgery and developed hypopyon on day 3 after surgery, with mainly anterior chamber inflammation. The capsular bag was irrigated with BSS PLUS containing 0.025% povidone-iodine. Gram-negative rods were detected from the anterior chamber fluid. Post-procedural visual acuity was 24/20. In a case, endophthalmitis was resolved and there were no adverse events. With the recent increase in multidrug-resistant bacteria, use of 0.025% povidone-iodine in BSS PLUS for anterior chamber irrigation is expected to be useful.

EXPERIMENTAL VISUALIZATION AND QUANTIFICATION OF VITREOUS CONTAMINATION FOLLOWING INTRAVITREAL INJECTIONS.

PURPOSE: To detect and quantify vitreous contamination after intravitreal injection using an experimental vitreous contamination model. METHODS: Enucleated porcine eyes served as a Type 1 experimental vitreous contamination model with fluoresbrite carboxylate microspheres applied to the conjunctival surface. Saline solution (0.05 mL) was injected using a 27-, 30-, or 32-gauge (G) needle. Injection procedures were monitored using an intraocular fiber catheter. Condensed microspheres were applied to an excised sheet of porcine sclera (Type 2 experimental vitreous contamination model). Saline solution (0.05 mL) was injected from the top of an applied condensed microsphere through the sclera using a needle of one of the aforementioned gauges, and samples were then collected. The fluorescence strength of samples was measured using fluorophotometry. RESULTS: We visually detected fluorescent microspheres in 10/10, 9/10, and 9/10 eyes injected with 27-G, 30-G, and 32-G needles, respectively. In the experimental quantification study, values at all needle gauges were significantly higher than those of controls (P < 0.01). Fluorescence strength was significantly higher in the 27-G group than in the 30- (P < 0.01) and 32-G (P < 0.01) groups. CONCLUSION: Intravitreal injection carries the risk of introducing contamination directly into the eyes even when a 32-G needle is used. Furthermore, the 27-G needle carries the highest contamination risk.

Characteristics of Hyperautofluorescent Choroidal Vessels Using Fundus Camera Type Short-Wavelength Autofluorescence.

PURPOSE: To clarify differences between eyes showing hyperautofluorescent choroidal vessels in both nasal and temporal, or only the nasal, portions of the fundus using fundus autofluorescence. METHODS: Nineteen eyes with hyperautofluorescent vessels in both nasal and temporal portions (group 1) and 17 only the nasal portion (group 2) of the fundus were studied. Choroidal and retinal thicknesses (foveal, and nasal and temporal 3,000 µm from the fovea), axial length, and refraction were compared between the two groups. RESULTS: In group 1, the average foveal, nasal, and temporal choroidal thicknesses (mean ± SD) were 69.0 ± 30.9, 57.1 ± 18.7, and 88.3 ± 30.4 µm, retinal thicknesses 170.1 ± 48.5, 221.9 ± 46.5, and 209.5 ± 37.9 µm, axial length 28.2 ± 2.2 mm, and refraction -9.9 ± 5.9 dpt. In group 2, the respective values were 174.8 ± 43.0, 80.5 ± 20.9, and 173.5 ± 46.1 µm, 213.4 ± 29.8, 278.3 ± 20.2, and 252.8 ± 19.6 µm, 24.2 ± 1.4 mm, and -1.8 ± 3.8 dpt. There were significant between-group differences for all items (p < 0.05). CONCLUSIONS: Fundus autofluorescence tends to be associated with the detection of hyperautofluorescent choroidal vessels in eyes with strong myopia or greater axial length.

Characteristics of Hyperautofluorescent Choroidal Vessels within the Macular Atrophic Area Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: The aim of this study was to clarify the characteristic findings in patients with geographic atrophy with or without hyperautofluorescent choroidal vessels within macular atrophic areas on short-wavelength fundus autofluorescence imaging. PROCEDURES: Sixty-seven eyes of 43 consecutive patients with macular atrophic areas were divided into groups with (group 1) and without (group 2) hyperautofluorescent choroidal vessels on fundus autofluorescence imaging and then retrospectively studied using spectral-domain optical coherence tomography. RESULTS: In group 1 (n = 21), the average subfoveal choroidal thickness was 61.5 ± 20.1 µm, and the average foveal retinal thickness was 93.0 ± 51.3 µm. On the other hand, in group 2 (n = 46), the average subfoveal choroidal thickness was 200.7 ± 83.1 µm, and the average foveal retinal thickness was 109.2 ± 58.5 µm. Although retinal thickness did not differ significantly between the two groups (p = 0.28), the difference in choroidal thickness was statistically significant (p < 0.001). CONCLUSIONS: Choroidal thinning might contribute to the hyperautofluorescence of choroidal vessels.

RANDOMIZED CONTROLLED STUDY OF INTRAVITREAL BEVACIZUMAB 0.16 MG INJECTED ONE DAY BEFORE SURGERY FOR PROLIFERATIVE DIABETIC RETINOPATHY.

PURPOSE: To investigate the usefulness of 0.16 mg/0.05 mL intravitreal bevacizumab (IVB) injection 1 day before vitrectomy for proliferative diabetic retinopathy. METHODS: Sixty-two patients with proliferative diabetic retinopathy (66 eyes) with an indication for primary vitrectomy were randomized to IVB group (34 eyes) or sham control group (32 eyes). Intravitreal bevacizumab group received intravitreal injection of 0.16 mg/0.05 mL bevacizumab, and sham control group received sham injection 1 day before vitrectomy. Vitreous fluid was sampled before vitrectomy was started. RESULTS: Frequency of reoperation due to recurrent vitreous hemorrhage within 4 weeks after surgery was significantly lower (P = 0.033) in IVB group (3.1%, 1/32) than in sham control group (20.6%, 7/34). The number of intraoperative endodiathermy spots (0.63 ± 1.0 vs. 1.3 ± 1.4, P = 0.025) and frequency of postoperative recurrent vitreous hemorrhage (3.1%, 1/32 vs. 23.5%, 8/34, P = 0.017) were significantly lower in IVB group than in sham control group. Vitreous vascular endothelial growth factor concentrations were 1315.3 ± 1153.4 pg/mL in sham control group and 25.0 ± 13.6 pg/mL in IVB group (P < 0.0001). CONCLUSION: Intravitreal injection of 0.16 mg/0.05 mL bevacizumab 1 day before vitrectomy blocked vascular endothelial growth factor production in vitreous and significantly reduced the incidence of reoperation due to early postoperative recurrent vitreous hemorrhage.

Vitrectomy using 0.025% povidone-iodine in balanced salt solution plus for the treatment of postoperative endophthalmitis.

PURPOSE: To investigate the bactericidal effect of 0.025% povidone-iodine in Balanced Salt Solution PLUS (0.025% PI-BSS PLUS) and its use in vitrectomy for postoperative endophthalmitis. METHODS: First, an experimental laboratory model using Staphylococcus aureus was used to evaluate the bactericidal effect of PI-BSS PLUS. Next, in a case series of 4 eyes with postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS as irrigation solution was conducted, followed by postoperative intravitreal and intravenous antibiotics. RESULTS: In in vitro study, PI at concentrations of 0.01% and above in BSS PLUS exhibited marked bactericidal effect after 15 seconds of exposure. Bactericidal effect of 0.025% PI-BSS PLUS was maintained at room temperature storage for 15 minutes but was attenuated after 30 minutes. Among 4 eyes that underwent vitrectomy using 0.025% PI-BSS PLUS, coagulase-negative Staphylococcus sp. was isolated in 1 eye at the beginning but not at completion of surgery. In all four eyes, endophthalmitis was resolved with no adverse events. Ocular toxicity was not observed. CONCLUSION: The 0.025% PI-BSS PLUS is bactericidal and nontoxic when used as irrigation solution in vitrectomy. In 4 cases of postoperative endophthalmitis, vitrectomy using 0.025% PI-BSS PLUS followed by postoperative antibiotics resolved endophthalmitis.

[Incidence of Postoperative Retinal Detachment after 25-gauge Vitrectomy for Macular Diseases].

PURPOSE: To examine the rate of postoperative retinal detachment following 25-gauge vitrectomy with extensive peripheral vitreous shaving in eyes with macular diseases. METHODS: A retrospective non-randomized study of 925 macular surgery cases was undertaken. All surgery was performed using 25-gauge vitrectomy and peripheral vitrectomy was done with scleral indentation. Epiretinal membrane (ERM) surgery (n = 523) and idiopathic macular hole (MH) surgery (n = 402) were performed between June 2005 and January 2014 by one surgeon (H. N.) and all cases were followed up for more than six months. We studied the rate of preexisting posterior vitreous detachment (PVD), endolaser treatment performed for retinal hole/tear and postoperative retinal detachment. RESULTS: Preexisting PVD was observed in 61.8% of eyes with ERM and in 10.7% of eyes with MH. The rate of endolaser treatment was 41.5% in ERM and 18.0% in MH cases, a statistically significant difference. Postoperative retinal detachment was seen in four of 925 eyes (0.43%) overall. CONCLUSION: Extensive peripheral vitrectomy using scleral indentation reduced the incidence of postoperative detachment occurring after 25-gauge macular surgery.

Prophylaxis for acute scleral buckle infection using 0.25 % povidone-iodine ocular surface irrigation during surgery.

To investigate whether repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling surgery minimizes ocular surface bacterial contamination at completion of the procedure. A total of 489 consecutive eyes that underwent scleral buckling at a single institution were categorized into two groups according to the intraoperative ocular surface washing method used during two separate time periods--a group using physiological saline (saline group, 222 consecutive eyes) and a group using 0.25 % povidone-iodine (PI group 267, consecutive eyes). In 37 eyes of each group, ocular surface fluids were sampled at the beginning of surgery and at completion of buckling, and subjected to bacteriological culture. Acute scleral buckle infection occurred in one patient, and was caused by Pseudomonas aeruginosa. The incidence of acute scleral buckle infection was 0.45 % (1/222 eyes) in the saline group, and 0 % in the PI group, with no significant difference (P = 0.4540). The bacterial detection rates in ocular surface fluid at the beginning of surgery were 5.4 % (2/37 eyes) using saline and 8.1 % (3/37 eyes) using povidone-iodine, with no significant difference (P = 0.6433). The rates at completion of buckling were 18.9 % (7/37 eyes) using saline and 0 % (0 eye) using povidone-iodine, with a significant difference (P = 0.0114). Repeated washing of the ocular surface with 0.25 % povidone-iodine during scleral buckling procedure reduced the ocular surface bacterial contamination rate to an extremely low level at completion of buckling, suggesting that this method is useful for the prevention of acute scleral buckle infection.