CHOROIDAL THICKNESS IN RELATION TO ETHNICITY MEASURED USING ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY.

PURPOSE: To investigate the posterior choroidal thickness in healthy subjects of three different ethnicities. METHODS: In this prospective cross-sectional study, the choroidal thickness of 88 individuals (176 eyes) was measured using enhanced depth imaging-spectral domain optical coherence tomography. Subfoveal choroidal thickness was measured between the retinal pigment epithelium-Bruch membrane complex and chorioscleral interface. Nasal, temporal, superior, and inferior choroidal thicknesses at 0.5, 1.5, and 3.0 mm locations from the fovea were evaluated as well. RESULTS: Males and females were perfectly matched by number in all groups. The mean age of the entire study population was 27.43 ± 1 years. Mean subfoveal choroidal thicknesses of whites, Africans, Asians, and entire study population were 403.62 ± 37.4 µm, 372.47 ± 31.4 µm, 383.64 ± 40 µm, 386.64 ± 10.5 µm, respectively. Mean spherical error of the entire study population was -1.2685 diopter. Whites had the longest eyes on average 24.17 mm > 24.08 mm (Africans) > 23.86 mm (Asians), with the statistical mean of 24.04 mm for the entire study population. Subfoveal choroidal thickness was not significantly correlated with ethnicity in either ethnic group (P > 0.05). Subfoveal choroid thinned by 2.51 µm per 1 year increase in age (P = 0.282). Subfoveal choroidal thickness and sex were not significantly correlated to (P = 0.402). Subfoveal choroidal thickness was in strong negative correlation only with refractive error (P = 0.01) and axial length (P = 0.008). The intereye difference in subfoveal choroidal thickness was not statistically significant (P = 0.845). CONCLUSION: Enhanced depth imaging-spectral domain optical coherence tomography is a productive imaging method to study the choroidal thickness. Subfoveal choroidal thickness is not significantly correlated with ethnicity. The study reproduced previously found relations between thinner choroids and longer axial lengths, and increasing myopic refraction and showed no significant associations between subfoveal choroidal thickness and age and sex. Either the right or left eye can be used in future studies.

Detection of underdiagnosed concurrent branch retinal artery occlusion in a patient with central retinal vein occlusion using spectral domain optical coherence tomography.

BACKGROUND: Combined branch retinal artery and central retinal vein occlusion is a rare condition that has been infrequently reported. This case report, aside from reporting the above-mentioned condition, highlights the importance of performing spectral domain optical coherence tomography in establishing a complete diagnosis, especially in uncertain and complicated cases. We also present spectral domain optical coherence tomography findings of a case of combined unilateral simultaneous central retinal vein and branch retinal artery occlusion. CASE PRESENTATION: We present a single case of an initially missed, unilateral branch retinal artery occlusion combined with central retinal vein occlusion in a 51-year-old female Chinese patient without a significant past medical history, who experienced sudden, painless vision diminution in her right eye eleven days prior to presentation. She eventually recovered visual acuity to 0.60, despite having presented with poor vision. CONCLUSION: Combined unilateral central retinal vein and branch retinal artery occlusion may occur in patients with no medical history of arterial hypertension and diabetes mellitus and can achieve a relatively good visual outcome. This case reaffirms the significance of performing a spectral domain optical coherence tomography examination in patients suffering from central retinal vein occlusion with suspicion of unilateral simultaneous branch retinal artery occlusion to identify the affected pathological areas.

Characteristics of neural growth and cryopreservation of the dorsal root ganglion using three-dimensional collagen hydrogel culture versus conventional culture.

In vertebrates, most somatosensory pathways begin with the activation of dorsal root ganglion (DRG) neurons. The development of an appropriate DRG culture method is a prerequisite for establishing in vitro peripheral nerve disease models and for screening therapeutic drugs. In this study, we compared the changes in morphology, molecular biology, and transcriptomics of chicken embryo DRG cultured on tissue culture plates (T-DRG) versus three-dimensional collagen hydrogels (C-DRG). Our results showed that after 7 days of culture, the transcriptomics of T-DRG and C-DRG were quite different. The upregulated genes in C-DRG were mainly related to neurogenesis, axon guidance, and synaptic plasticity, whereas the downregulated genes in C-DRG were mainly related to cell proliferation and cell division. In addition, the genes related to cycles/pathways such as the synaptic vesicle cycle, cyclic adenosine monophosphate signaling pathway, and calcium signaling pathway were activated, while those related to cell-cycle pathways were downregulated. Furthermore, neurogenesis- and myelination-related genes were highly expressed in C-DRG, while epithelial-mesenchymal transition-, apoptosis-, and cell division-related genes were suppressed. Morphological results indicated that the numbers of branches, junctions, and end-point voxels per C-DRG were significantly greater than those per T-DRG. Furthermore, cells were scattered in T-DRG and more concentrated in C-DRG, with a higher ratio of 5-ethynyl-2'-deoxyuridine (EdU)-positive cells in T-DRG compared with C-DRG. C-DRG also had higher S100 calcium-binding protein B (S100B) and lower α-smooth muscle actin (α-SMA) expression than T-DRG, and contained fewer terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells after 48 hours of serum starvation. After cryopreservation, C-DRG maintained more intact morphological characteristics, and had higher viability and less TUNEL-positive cells than T-DRG. Furthermore, newly formed nerve bundles were able to grow along the existing Schwann cells in C-DRG. These results suggest that C-DRG may be a promising in vitro culture model, with better nerve growth and anti-apoptotic ability, quiescent Schwann cells, and higher viability. Results from this study provide a reference for the construction, storage, and transportation of tissue-engineered nerves. The study was approved by the Ethics Committee of Aier School of Ophthalmology, Central South University, China (approval No. 2020-IRB16), on March 15, 2020.

[Protective effect of minocycline on glutamate-induced retinal ganglion cell injury and molecular mechanism].

OBJECTIVE: To investigate the protective effect and molecular mechanism of minocycline on toxicity of retinal ganglion cells induced by L-glutamate. METHODS: Primary mouse retinal ganglion cells (RGC) were isolated from mouse retinal in vitro. RGC were divided into control group, L-glutamate group, and L-glutamate + minocycline group, the cell survival rate and nerve axon growth length were observed. In vivo study, B6 mice was intravitreal injected with 2 µl L-glutamate (2 mmol/L) to construct a toxic damage to retinal ganglion cells animal model. One day before the beginning of the experiment, mice were daily intraperitoneal injected with minocycline (60 mg/kg, saline injected in the control group) till day 7, ß3 tubulin positive cells and retinal GFAP protein expression were evaluated by tissue i mmol/L unofluorescence assay. Real-time PCR and Western blot assay were used to detect IFN-γ, IL-1, TNF-α and GFAP and vimentin mRNA and protein expression level in retinal tissues. RESULTS: Compared with control group, RGC survival rate in L-glutamate group was significantly reduced with a dose-and time-dependent. In addition, axon growth was inhibited with the treatment of glutamic acid, while these effects were abolished in the minocycline group (F = 18.87, P < 0.01). Animal study showed that the number of RGC dramatically decreased, however, expression of GFAP in retinal tissue significantly increased in L-glutamate treated mice, compared to control (F = 7.6, P < 0.01). Minocycline treatment significantly improved L-glutamate-induced ganglion cell damage and significantly reduced their GFAP expression. Both mRNA and protein expression levels of IFN-γ, IL-1, TNF-α and GFAP and Vimentin in retinal tissue of L-glutamic acid group significantly upregulated compared to control, while the minocycline significantly reduced the expression of these factors. CONCLUSIONS: L-glutamic acid can induce retinal ganglion cells damage, inhibit axon growth and increase inflammatory and glial-cell related genes and proteins expression. Minocycline could significantly protect retinal ganglion cells from the injury caused by L-glutamate.

[A new change in studies of ophthalmology: translational medicine-from basic to clinic].

Translational medicine is a new concept in the field of international medicine that aims to reduce barriers and build relationships between clinical and basic research, and to translate scientific knowledge and research production into practical applications. Recently, the developments in the study of translational medicine in many fields have been reported abroad. However, the development of translational medicine is in the initial stage in China. A turning point will be brought to ophthalmic research by improving the development of translational research. This review introduces the concept and development of translational medicine as well as the recent advances in the studies of translational medicine in ophthalmology.

[Thickness of the retinal nerve fiber layer in unilateral amblyopic patients with high myopia in children].

OBJECTIVE: To investigate the retina nerve fiber layer (RNFL) thickness in unilateral amblyopic patients with high myopia. METHODS: Twenty-three cases (23 eyes) with unilateral high myopia amblyopia were tested by GD(X) ECC with laser polarized light scans in the posterior pole of retina, to measure the relative RNFL thickness according to papilla optical as a center, 3.2 mm as the diameter of outer ring, 2.4 mm as the diameter of inner ring. The relative RNFL thickness of high myopia amblyopia was compared with fellow eyes, normal eyes and high myopia respectively and statistics analysis. RESULTS: TSNIT average, superior average and inferior average of RNFL in high myopia amblyopia became thinning (56.39 +/- 5.69, 68.30 +/- 10.16, 67.34 +/- 5.83), it showed statistically differences when compared with fellow eyes (t = 2.090, 2.243, 4.236) and normal eyes (t = 3.087, 1.025, 3.481) (P < 0.05). RNFL parameters were no statistically significant differences between high myopia amblyopia and simple high myopia (t = 0.872, 0.297, 0.658; P > 0.05). TSNIT average decreases with axial length in high myopia amblyopia and high myopia, there was inverse linear correlation between RNFL thickness and axial length (r = -0.462, -0.395; P < 0.05). CONCLUSIONS: The RNFL thickness of unilateral high myopia amblyopia of children was thinner than normal, but there wasn't obvious compared with simple high myopia. The reasons for decreased best corrected vision of unilateral high myopia amblyopia in children still need further research.

[Methylation status of RASSF1A and DAPK promoter in retinoblastoma].

OBJECTIVE: To investigate the methylation status of RASSF1A or DAPK promoter in retinoblastoma tissue or peripheral blood from retinoblastoma patients. METHODS: It was an experimental study on the paraffin-embedded retinoblastoma tissue sections, and a case-control study on retinoblastoma cases and normal control people. Methylation status of RASSF1A and DAPK promoter in 28 RB tissues and 9 available peripheral blood samples of RB patients were detected by methylation specific polymerase chain reaction (MSP). Normal retinal tissues from five donor cadaver eyes and normal-peripheral blood samples from five healthy volunteers matched on age and sex were used as controls. The differences of methylation rate among different groups were analyzed statistically by Fisher's exact probability test. RESULTS: The percentage of RASSF1A hypermethylation in RB tissues (60.7%) was statistically higher than in normal retinal tissue 0% (0/5) and adjacent non-neoplastic retinal tissue 17.9% (5/28) (P < 0.01), the hypermethylation percentage in unilateral RB group was higher than bilateral RB group either. Meanwhile, RASSF1A hypermethylation in peripheral blood was detected in 2 of 9 RB cases, showing no statistics difference compared with that of normal person. However, no DAPK promoter hypermethylation was found in all RB tissues and peripheral blood from retinoblastoma patients. CONCLUSION: RASSF1A promoter hypermethylation was frequently present in retinoblastoma, which may play an important role during the pathogenesis of retinoblastoma.

LncRNA-MALAT1 promotes neovascularization in diabetic retinopathy through regulating miR-125b/VE-cadherin axis.

Background: Diabetic retinopathy (DR) is currently the leading cause of blindness and visual disability in adults with diabetes mellitus (DM). Neovascularization has been identified as an important clinical property in DR, however, the exact mechanisms in DR neovascularization are still unclear and need further elucidation.Methods: Quantitative real-time PCR (qRT-PCR) was conducted to detect the expression level of long non-coding RNA (lncRNA)-metastasis associated lung adenocarcinoma transcript 1 (MALAT1), miR-125b and vascular endothelial-cadherin (VE-cadherin) in human retina microvascular endothelial cells (hRMECs) treated with high glucose (HG). Luciferase assay was used to detect interaction of MALAT1 with miR-125b and miR-125b with VE-cadherin. MTT assay, transwell assay, tube formation assay and vascular permeability assay were conducted to detect the cell viability, migration tube formation ability and permeability of hRMECs, respectively. ELISA was used to examine the release of VE-cadherin and vascular endothelial growth factor (VEGF). Western blotting was used to access the protein expression of VE-cadherin, VEGF, ß-catenin, matrix metalloproteinase (MMP) 2 (MMP2) and MMP9.Results: MALAT1 and VE-cadherin were up-regulated while miR-125b was down-regulated in hRMECs treated with HG. MALAT1 could competitively bind to miR-125b against VE-cadherin at the site of 3'-untranslated region (3'-UTR), leading to the up-regulation of VE-cadherin. Knockdown of MALAT1 inhibited the proliferation, migration, tube formation and vascular permeability of hRMECs induced by HG through up-regulating miR-125b. Furthermore, we found the deletion of MALAT1 suppressed the VE-cadherin/ß-catenin complex and neovascularization related proteins expression, which was up-regulated by HG.Conclusion: Knockdown of MALAT1 inhibited cell proliferation, migration and angiogenesis of hRMECs via suppressing the VE-cadherin/ß-catenin complex through targeting miR-125b. Inhibition of MALAT1 may serve as a potential target for anti-angiogenic therapy for DR.

[Arsenic trioxide induced apoptosis in retinoblastoma cells in vitro and its possible mechanism].

OBJECTIVE: To explore the effect of arsenic trioxide on the apoptosis of retinoblastoma cell line HXO-RB(44) and the possible mechanism. METHODS: The effect of arsenic trioxide on the proliferation of retinoblastoma cell line HXO-RB(44) was observed by MTT colorimetric assay; the apoptosis of the HXO-RB(44) was examined by AO/EB staining and flow cytometry analysis (Annexin V+ PI staining); caspase-3 activity and bcl-2/bax expression in the HXO-RB(44) were detected by cpp32 colorimetric assay kit and Western blot. RESULTS: Arsenic trioxide inhibited the proliferation of HXO-RB(44) cell in dose and duration-dependent manner in vitro; arsenic trioxide significantly increased the apoptosis in HXO-RB(44) cells. The activation of caspase-3 was increased, and the rate of bcl-2/bax was down-regulated in the HXO-RB(44) cells processed with arsenic trioxide. CONCLUSION: Arsenic trioxide can inhibit the proliferation of retinoblastoma cell HXO-RB(44) in vitro by apoptosis induction. The apoptosis induction is possibly related to the caspase-3 activation and bcl-2/bax down-regulation.

[Treatment of patients with rhegmatogenous retina detachment combined with non-secondary glaucoma].

OBJECTIVE: To discuss the cause of disease, treatment and therapeutic effect in patients with rhegmatogenous retina detachment (RRD) combined with non-secondary glaucoma. METHODS: Clinical data of 28 patients with RRD combined with primary or congenital glaucoma were retrospectively analyzed. RESULTS: Twenty-five out of the 28 patients succeeded with one operation (89.3%). The intraocular pressure of post-operation:on the 1st day was 10 approximately 46 (28.1+/-6.5) mmHg, on the 7th day was (18.9+/-7.2) mmHg, and on the last re-examination day was (17.6+/-6.2) mmHg. Anti-glaucoma operation was performed in 10 patients after the retinal operation. Chroidal hemorrhage was found in 2 patients and 2 chroidal exudations were found after the retinal operation. CONCLUSION: The proportion of primary open angle glaucoma is higher than that of primary angle closure glaucoma, and trauma or surgery before the retinal operation is an important cause in glaucoma patients with RRD. There is no obvious difference in the ratio of surgical success between non-secondary glaucoma with RRD and those RRD patients without glaucoma. Vitreotomy+ silicon oil injection or drainage of subretinal fluid+air injection+cryocoagulation+explants is recommended. Chroid is easily involved. It is important to control the intraocular pressure during and after the surgery. The final visual acuity is rather poor, which may be related to the glaucoma and intraocular pressure.

[The effects of caspase-3 in apoptosis of cultured retinal microvascular pericytes induced by advanced glycation end products].

OBJECTIVE: One of the earliest changes observed in the development of diabetic retinopathy (DR) is the selective loss of pericytes and acellular capillaries. We tested the hypothesis that advanced glycation end products (AGE) might be involved in the disappearance of retinal pericytes by apoptosis and further investigated the activity and effect of caspase-3 at the same time. METHODS: Cultured bovine retinal microvascular pericytes (BRPs) were exposed to various concentrations of advanced glycation end products-bovine serum albumin (AGE, 0.47, 1.88, 7.50 micromol/L) for 4 days. We assayed the degree of pericytes apoptosis by fluorescence activated cell sorting, and further measured the caspase-3 activity and the effect of selective caspase-3 inhibitor Z-DEVD-fmk on apoptosis and the of ratio Bcl-2/Bax expression. RESULTS: The results showed that AGE could induce significantly the apoptosis of BRPs in a dose-dependent manner compared with controls (r = 0.867, P < 0.01), associated with an increase in intracellular caspase-3 activity. Selective caspase-3 inhibitor Z-DEVD-fmk inhibited pericyte apoptosis induced by AGE. CONCLUSION: These data suggest that the pericyte loss in DR involves an apoptotic process, and that activation of caspase-3 are associated with apoptotic process, which can provide new therapeutic perspectives in diabetic retinopathy.

Applications of CRISPR/Cas9 in retinal degenerative diseases.

Gene therapy is a potentially effective treatment for retinal degenerative diseases. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) system has been developed as a new genome-editing tool in ophthalmic studies. Recent advances in researches showed that CRISPR/Cas9 has been applied in generating animal models as well as gene therapy in vivo of retinitis pigmentosa (RP) and leber congenital amaurosis (LCA). It has also been shown as a potential attempt for clinic by combining with other technologies such as adeno-associated virus (AAV) and induced pluripotent stem cells (iPSCs). In this review, we highlight the main points of further prospect of using CRISPR/Cas9 in targeting retinal degeneration. We also emphasize the potential applications of this technique in treating retinal degenerative diseases.

Diverse roles of macrophages in intraocular neovascular diseases: a review.

Macrophages are involved in angiogenesis, and might also contribute to the pathogenesis of intraocular neovascular diseases. Recent studies indicated that macrophages exert different functions in the process of intraocular neovascularization, and the polarization of M1 and M2 phenotypes plays extremely essential roles in the diverse functions of macrophages. Moreover, a large number of cytokines released by macrophages not only participate in macrophage polarization, but also associate with retinal and choroidal neovascular diseases. Therefore, macrophage might be considered as a novel therapeutic target to the treatment of pathological neovascularization in the eye. This review mainly summarizes diverse roles of macrophages and discusses the possible mechanisms in retinal and choroidal neovascularization.

Advanced glycation end-products induce apoptosis involving the signaling pathways of oxidative stress in bovine retinal pericytes.

One of the histopathologic hallmarks of early diabetic retinopathy is the selective loss of pericytes. Evidences suggest that the pericyte loss in vivo is mediated by apoptosis. However, the underlying cause of pericyte apoptosis is not fully understood. This study investigated the effect of advanced glycation end products (AGEs) on apoptotic cell death in bovine retinal pericytes (BRPs). After incubation of BRPs with 0.47, 1.88, 7.5, 30 microM of AGE-bovine serum albumin (BSA) for 4 days, we assayed the pericytes apoptosis by FACS (fluorescence activated cell sorting), and further measured the signaling pathway involved. The results showed that AGE-BSA could induce significantly the apoptosis of BRPs in a dose-dependent manner compared with controls, associated with an increase in intracellular malondialdehyde level and caspase-3 activity; a decrease in intracellular catalase, SOD activities and Bcl-2/Bax ratio. SOD and selective caspase-3 inhibitor Z-DEVD-fmk can inhibit pericyte apoptosis induced by AGE-BSA. These data suggest that the pericyte loss in diabetic retinopathy involves an apoptotic process, and that elevated AGE observed in diabetes may cause apoptosis in BRPs through an oxidative stress mechanism. The decreased Bcl-2/Bax ratio and activation of caspase-3 are associated with apoptotic process.

[Advanced glycation end products induce apoptosis and expression of apoptotic genes in cultured bovine retinal capillary pericytes].

OBJECTIVE: The purpose of the present study was to examine whether advanced glycation end products (AGE) contribute to the development of apoptosis and expression of apoptotic genes in cultured bovine retinal capillary pericytes (BRPs), in order to investigate retinal microvascular pathologic process during early stage of diabetic retinopathy. METHODS: After a 4 day incubation with various concentrations of AGE (8, 32, 125, 500, 2,000 mg/L) which were prepared in vitro by incubating bovine serum albumin (BSA) with glucose, we studied the degree of apoptosis and the expressions of apoptotic genes (Bax and bcl-2) in BRPs by staining with the Annexin V-FITC and propidium iodide (PI), terminal deoxynucleotidyl transferase mediated dUTP nick end labeling (TUNEL) and immunohistochemistry. RESULTS: (1) After a 4 day incubation with various concentrations of AGE, BRPs showed typical changes of apoptosis, i.e. shrunken cell size, nuclear condensation associated with DNA fragmentation, a relatively intact cell membrane, and loss of cell viability eventually. (2) AGE could induce significant apoptosis of BRPs in a dose-dependent manner as compared with normal cultures or the albumin group not treated by glucose (r = 0.878, P < 0.01). (3) After a 4 day incubation, the level of pro-apoptotic gene Bax was upregulated (r = 0.855, P < 0.01), whereas the level of pro-survival gene bcl-2 was downregulated by AGE in a dose-dependent manner (r = -0.850, P < 0.01). (4) There was a positive correlation between apoptotic rate and Bax-bcl-2 ratio of BRPs induced by AGE (r = 0.808,P < 0.01). CONCLUSIONS: AGE can induce a significant apoptosis of BRPs in a dose-dependent manner and the rate of apoptosis was determined by the Bax/bcl-2 ratio. These results suggest that the selective loss of pericytes in diabetic retinopathy involves an apoptotic process.

[Corneal combined amniotic membrane transplantation for early severe alkali chemical injury of the eye].

OBJECTIVE: To investigate the effect of lamella corneal transplantation combined amniotic membrane transplantation for the early severe alkali burns of eyes. METHODS: Twenty-three eyes with an over second-degree acute corneal alkali injury in 2 weeks were treated by lamella corneal transplantation combined amniotic membrane transplantation. After the operation the patients were treated with an intense and prolonged regimen of topical steroids and topical and systemic vitamin C. All patients were followed up for 6-12 months. RESULTS: Seven eyes were cornea transparent, 10 semi-transparent, and 6 opaque in the 23 eyes, respectively. The visual acuity of 3 eyes was better than 0.3, that of 5 eyes was between 0.25 to 0.1, and that of the other 15 eyes was below 0.1. No eye was enucleated due to the corneoscleral melting. CONCLUSION: Lamella corneal transplantation combined amniotic membrane transplantation may clear away the necrotic tissues and cells of corneal or conjunctiva, prevent and reduce the complication, and improve the prognosis of the patients.

Rhegmatogenous retinal detachment associated with massive spontaneous suprachoroidal hemorrhage and prognosis of pars plana vitrectomy.

AIM: To describe the clinical characters of rhegmatogenous retinal detachment (RRD) associated with massive spontaneous suprachoroidal hemorrhage (SSCH). To evaluate optimal timing and prognosis of pars plana vitrectomy. METHODS: A retrospective review of 6 cases (6 eyes) of RRD and massive SSCH among 3772 cases of RRD was conducted. All of 6 patients were treated with twenty-gauge vitrectomy, suprachoroidal blood drainage, phacoemulsification (PHACO) or lensectomy and silicon oil tamponade. The clinical characters, intraoperative findings and treatment outcomes were reported. RESULTS: In the 6 affected eyes of 6 patients (3 men and 3 women; mean age, 53.83y; range 34-61y), preoperative visual acuity ranged from faint light perception (LP) to counting finger (CF). The average interventional duration from visual decreased to surgery was 12.8 d (range 9-15d). All eyes were associated with high myopia and the mean ocular length was 30.32 mm (range 28.14-32.32 mm). Choroidal hemorrhage were successfully drained in the operation of all 6 eyes. Intraoperative findings showed there were multiple retinal breaks in all 6 eyes and in 4 eyes breaks were along supratemporal and/or infratemporal retinal vascular arcade, especially in the edge of chorioretinal atrophy areas. These patients were followed up from 6 to 34mo (Mean, 23.5mo). The best-corrected visual acuity after surgery varied from CF to 20/100, with improvement in 5 eyes (83.33%) and no change in 1 eye (16.67%). Ocular hypertension ocurred in 1 eye (16.67%), which was successfully treated by silicon oil removal combined with trabeculectomy. In 4 eyes, tractional retinal detachment caused by proliferative vitreoretinopathy (PVR) appeared and a secondary surgery of pre-retinal membrane peeling and silicon oil retained were performed. In 4 eyes, silicon oil cannot be removed. The initial and final reattachment rates were 33.33% and 66.67%, respectively. CONCLUSION: RRD associated with massive SSCH is an extremely rare event. The most common risk factor is long axial length. Vitrectomy and choroidal blood drainage can effectively remove suprachoroidal hemorrhage and promote retinal reattachment in these eyes. However, silicon oil could not be removed in most eyes and final visual acuities are generally poor.

Episcleral macular buckling for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole.

AIM: To evaluate anatomical and visual outcomes of episcleral macular buckling (EMB) for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole. METHODS: Five cases of EMB for initial failure of retinal reattachment after internal limiting membrane (ILM) peeling and silicone oil tamponade caused by myopic macular hole were retrospectively reviewed. A silicone sponge sutured directly across the macular region was performed on the silicone oil filled eyes. Silicone oil was removed no sooner than 1 month post-EMB. The duration of follow-up time after removal of silicone oil was more than 3 months. RESULTS: Retinas of five eyes were all reattached at the last follow-up. The postoperative vision ranged from counting fingers to 0.08. CONCLUSION: Anatomical results improved after EBM for posterior retinal detachment in silicone oil filled eyes associated with myopic macular hole, which was not evident for visual outcome.

Vitreous amyloidosis in two large mainland Chinese kindreds resulting from transthyretin variant Lys35Thr and Leu55Arg.

OBJECTIVE: To describe the clinical and pathological findings of two large mainland Chinese kindreds with vitreous amyloidosis and associated transthyretin mutation. METHODS: Twenty individuals from two kindreds with vitreous amyloidosis were ascertained. The transtheretin (TTR) gene of each individual was analyzed, and a clinical examination was obtained on the index patient. RESULTS: Vitreous amyloidosis and radiculopathy were the significant findings in affected individuals. Vitrectomy was performed on the severely affected individuals, with resulting postoperative visual acuity of 20/80 to 20/25. Congo red staining demonstrated amyloid in the vitreous specimen. In Case A, DNA sequencing of exon 2 in the TTR gene revealed a base-pair substitution at codon 35, AAG > ACG (Lys35Thr). In Case B, a missense mutation of leucine-to-arginine substitution was identified at amino acid position 55 in exon 3, CTG > CGG (Leu55Arg). CONCLUSIONS: TTR Lys35Thr and Leu55Arg mutations are associated with vitreous amyloidosis. The phenotype is variable, with vitreous opacities occurring earlier, and sometimes as the sole signs of amyloidotic polyneuropathies (FAPs). Vitrectomy improves vision in some patients with vitreous amyloidosis.

Efficacy and necessity of prophylactic vitrectomy for acute retinal necrosis syndrome.

AIM: To compare the efficacy of prophylactic vitrectomy for acute retinal necrosis syndrome(ARN) with routine treatment in Chinese patients, thereby investigate the necessity of prophylactic vitrectomy for ARN. METHODS: Thirty patients (37 eyes) were retrospectively included in this study. The eyes were divided into 2 groups by treatment, including routine treatment, which consisted of antiviral medication and vitrectomy after retinal detachment (RD) (n=21), and prophylactic vitrectomy, which consisted of antiviral medication and vitrectomy for the prevention of RD performed during the active inflammatory phase (n=16). The extent of necrosis was determined by fundus photographs at the time of presentation (for eyes with mild vitreous opacity) or the drawings in the operation records. Necrosis of the 37 eyes was divided into 3 grades, including peripheral, middle-peripheral and extensive. The follow-up period ranged from 8 to 57 months. Differences in visual acuity and necrosis between groups were identified using independent samples t-test. RESULTS: Necrosis was more extensive in the routine treatment group than in the prophylactic vitrectomy group (P<0.05). In the routine treatment group, conservative treatment improved necrosis and prevented RD in 6 eyes (29%). Seven eyes (33%) obtained anatomical success, but retinal redetachment occurred in 8 eyes (57%). There were also 5 eyes (24%) developed ocular hypotony or atrophy. Ten eyes (48%) achieved equal or increased visual acuity. In the prophylactic vitrectomy group, RD occurred in 2 eyes (13%). Twelve eyes (75%) were completely anatomically successful, and 10 eyes underwent silicone oil removal. Only one eye (6%) became ocular hypotony. Fourteen eyes (88%) achieved equal or increased visual acuity. The prophylactic vitrectomy group achieved better vision trends than the routine treatment group (P<0.05). Eyes with peripheral necrosis had better visual outcomes than those with mid-peripheral (P<0.05) or extensive (P<0.05) necrosis. However, there was no significant difference between eyes with mid-peripheral and extensive necrosis (P=0.3008) CONCLUSION: Prophylactic vitrectomy can prevent RD and improve the prognosis of ARN, making it an option for cases with rapidly progressing necrosis despite antiviral treatment and cases with moderate to extensive necrosis and severe vitreous opacity.