Oxytocin induced epithelium-mesenchimal transition through Rho-ROCK pathway in ARPE-19 cells, a human retinal pigmental cell line.

Previous reports suggest that oxytocin receptors (OXTRs) are expressed in the retinal pigment epithelium in primates. Oxytocinergic signaling activates the Rho-ROCK pathway, which reorganizes the actin cytoskeleton and alters other cellular biophysical characteristics. Such changes could be involved in the epithelial-mesenchymal transition and development of proliferative vitreous retinopathy. Here, we investigated whether oxytocin (OXT) binding to OXTRs in the retinal pigment epithelium can induce Rho-ROCK-mediated cellular activity. We performed four different assays of Rho-ROCK signaling in a human retinal pigment epithelium cell line (ARPE-19) such as induction of actin fibers, wound healing, cell growth, and collagen gel contraction. The assays were performed with or without OXT (100 nM) exposure, as well as with exposure to ripasudil, a specific ROCK inhibitor. The actin stress fiber formation, a phenotype mediated by activated Rho GTPase, was induced by OXT. OXT also accelerated wound closure 19 h after administration, increased cell growth 24 h afterwards, and induced stronger collagen gel contractions. All four cellular responses were inhibited with the addition of 50 µM ripasudil. Taken together, OXT-mediated activation of Rho-ROCK signal transduction could play a role in regulating epithelial-mesenchymal transition in the retinal pigment epithelium, and increase the possibility of subsequent proliferative vitreous retinopathy after vitrectomy.

Rate of hypotony and intraocular pressure fluctuation immediately after intravitreal dexamethasone implantation in vitrectomized eyes.

PURPOSE: To observe the rate of hypotony and intraocular pressure (IOP) fluctuations immediately following intravitreal dexamethasone implantation in vitrectomized eyes. METHODS: The study included previously vitrectomized eyes scheduled to receive intravitreal dexamethasone implants. IOP measurements were performed at minute 1, minute 10, hour 1, hour 2, hour 3 and day 1. The primary outcome measure of the study was the rate of hypotony at the various time points, while the secondary outcome measure was the IOP profile over time. RESULTS: A total of 26 eyes were enrolled in the study. Immediately following the injection, 11 (42.3%) of the eyes exhibited an IOP<6mm Hg. Hypotony was observed in one eye (3.8%) at hour 3 and day 1. After the immediate IOP reduction, IOP recovered rapidly and showed a peak at hour 1, with 5 eyes (19.2%) exhibiting IOP levels ≥25mmHg and 1 eye (3.8%) ≥30mm Hg. Aside from the eye with persistent hypotony resulting in a choroidal effusion, no other complication was observed. CONCLUSIONS: Injection of dexamethasone implants in vitrectomized eyes resulted in immediate IOP reduction. Hypotony showed a short, self-limited course in the majority of eyes. In the presence of additional risk factors for wound incompetency, regular follow-up in the early post-injection period appears to be needed.

[Anatomical and functional results of macular hole surgery using a temporal inverted internal limiting membrane flap. Experience with 24 cases]. / Résultats anatomiques et fonctionnels de la chirurgie du trou maculaire avec positionnement d'un volet de membrane limitante interne. Retour d'expérience sur 24 cas.

PURPOSE: To evaluate the anatomical and functional outcomes of macular hole (MH) surgery with a temporal inverted internal limiting membrane (ILM) flap technique. METHODS: Monocentric retrospective study of 24 patients who were operated on for macular hole between March 2014 and April 2017 at Nancy University Hospital. All patients underwent pars plana vitrectomy with the inverted ILM flap technique. ILM peeling was restricted to the temporal side of the fovea, and the macular hole was then covered with the ILM flap, followed by SF6 tamponnade and first day face-down positioning. The main outcome measures included macular hole closure rate and visual acuity at 1 month postoperatively. RESULTS: Eight men and 16 women of mean age 67.0±5.4 years were included. The mean axial length was 23.5±1.2mm. The mean diameter of the MH was 362±123µm. Closure of the MH was achieved in 23 of 24 eyes (95.8%) after one surgery. The mean BVCA improved significantly from 0.71±0.20 logMar to 0.29±0.22 logMar (P<0.001) at 1 month postoperatively, for a gain of 0.42±0.24 logMar. CONCLUSION: Macular hole surgery with the inverted ILM flap technique results in good anatomical and functional outcomes, comparable to those obtained with the classic technique with complete ILM peeling.

Short Pulse Duration High-Power Laser Photocoagulation during Vitrectomy for Diabetic Retinopathy Reduces Postoperative Inflammation.

The aim of this preliminary study was to determine the effectiveness of short pulse duration, high-power laser photocoagulation (PC) during vitrectomy for diabetic retinopathy (DR).The effects of short pulse duration PC with power of 340-360 mW and duration of 0.02 second were compared to conventional PC with power of 120-150 mW and duration of 0.2 second. The degree of inflammation was quantified by laser flare cell photometry before and at 1 day, 1 week, 4 week, and 12 weeks postoperatively. Twenty-two eyes of 22 consecutive patients were studied. Ten eyes were treated with short pulse duration PC and 12 eyes with conventional PC. The total energy was significantly lower in the short pulse duration PC group than in the conventional PC group (P = 0.007). The flare cell values were not significantly different between the two groups after 1 day, but at 1 week, the flare cell value was significantly lower in the short pulse duration PC group than in the conventional PC group (P = 0.04). This difference was also present at 4 and 12 weeks (P<0.05). The significant lower inflammation after short pulse duration PC than conventional PC indicates that the short pulse duration PC protocol should be considered to treat DR.

[Long-term use of silicone oil: indications and tolerance]. / Tamponnement prolongé par huile de silicone: indications et tolérance.

PURPOSE: The aim of this study was to analyze the indications and the effect of permanently maintaining silicone oil in the treatment of certain cases of vitreoretinal pathology. PATIENTS AND METHODS: Twenty-seven cases seen from January 2002 to December 2008 were retrospectively studied. Silicone oil was kept in the eyes for more than 2years. The surgical file was analyzed in all cases. The evaluation criteria were ocular pressure, emulsification, cataract, corneal dystrophy, and the functional response of the retina and optic nerve. Ultrasound echography (12 MHz), magnetic resonance imaging, and electrophysiological explorations (visual evoked potential and electroretinography) were performed. RESULTS: Twenty-seven eyes of 27 patients were included in this study. The main reasons for maintaining long-term silicone oil are recurrent vitreous hemorrhage, retinal detachment with severe proliferative vitreoretinopathy, and penetrating injury. The patients were distributed into two groups: group 1 included patients with both functional and anatomic failure, group 2 patients had achieved ambulatory vision. Follow-up ranged from 27 to 72months. Cataract incidence was approximately 91% in group 2. Emulsification was noted without high pressure in 50% of the cases in group 1. High pressure averaged 31.8% in group 2. Keratopathy was observed in 9% of the cases in group 2. Intraorbital migration of silicone oil was found in one case. The visual field was improved in 77% of the cases in group 2. CONCLUSION: This study provided interesting insights into certain clinical situations in which silicone oil has to be maintained permanently. The complications stem not only from the presence of silicone oil, but also from the preoperative status of the eye and the vitreoretinal surgery.

Sex steroid and tropic hormone levels may be associated with postoperative prognosis of vitrectomy in Korean postmenopausal women: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the postoperative prognostic value of sex hormones and related biochemical markers for vitrectomy in postmenopausal Korean women. METHODS: Twenty-three postmenopausal women undergoing vitrectomy who had not received hormone therapy were recruited. Before vitrectomy, hormonal profile such as follicle-stimulating hormone, estradiol, testosterone, tumor markers, and biochemical markers including homocysteine, glycosylated hemoglobin, protein, albumin, and lipid panel was measured. These parameters were correlated with ophthalmologic outcomes such as intraocular pressure, preoperative and postoperative visual acuity, and the visual improvement after surgery. RESULTS: Follicle-stimulating hormone showed a positive correlation with the logarithm of the minimal angle of resolution value of postoperative visual acuity (Pearson's correlation, 0.583; P = 0.009). This significance was maintained after age or preoperative visual acuity was adjusted (P = 0.006 and P = 0.013, respectively). Testosterone also showed a positive correlation with intraocular pressure before and after adjustment for age (P = 0.027 and P = 0.033, respectively). CONCLUSIONS: Sex steroid and tropic hormones may be associated with postoperative ophthalmologic outcomes in the postmenopausal women undergoing vitrectomy. Further larger scale studies will be necessary to confirm these preliminary results.

[Vitrectomy: in search of the ideal vitreous replacement]. / Vitrectomie: op zoek naar de ideale glasvochtvervanging.

Pars plana vitrectomy is a form of surgery to remove the vitreous body. It is performed with various eye diseases. Replacement of the vitreous body is necessitated by its removal. After more than 50 years the search for the ideal vitreous replacement has not yet ended. Different materials are used to replace the vitreous body. The advantages, disadvantages and applications of those materials are discussed. The lack of a material to successfully replace the vitreous body is a significant restriction in the treatment vitreoretinal pathologies.

Vision-related quality of life and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole.

AIM: To evaluate the relationship between vision-related quality of life (VR-QOL) and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole (MH). METHODS: The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 32 patients with MH (age 66.2 (SD 5.4) years) preoperatively and at 3 months postoperatively. Clinical data were collected, including logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), severity of metamorphopsia and letter contrast sensitivity. The severity of metamorphopsia was evaluated by the M-Charts. MH index was measured using optical coherence tomography. The presence and severity of cataract were graded using the Lens Opacities Classification System III reference standards. Multiple regression analysis was performed to investigate the relationship between various explanatory variables and VFQ-25 questionnaire scores. Explanatory variables tested were the severity of metamorphopsia, visual acuity, letter contrast sensitivity, MH index and grade of cataract. RESULTS: Vitrectomy for MH significantly improved VFQ-25 composite score as well as subscale scores, including general vision, near activities, distance activities, social functioning, mental health and dependency (p<0.05, Wilcoxon signed-rank test). Multiple regression analysis revealed that, both preoperatively and postoperatively, the severity of metamorphopsia had a significant correlation with VFQ-25 composite score (p<0.05), whereas other explanatory variables did not. In addition, changes in the severity of metamorphopsia was the single variable that was significantly related to changes in VFQ-25 composite score (p<0.01). CONCLUSION: Vitrectomy for MH significantly improved VR-QOL. The severity of metamorphopsia was significantly associated with both preoperative and postoperative VR-QOL.

Coping with extended facedown positioning after macular hole surgery: a qualitative diary analysis.

BACKGROUND: Patients undergoing facedown positioning have to overcome physical and psychological challenges; however, their perspective and experience are rarely documented in the research literature. OBJECTIVES: The objective of this study was to examine the content of a self-motivated diary written by a person who underwent 77 days of facedown positioning after macular hole surgery. Her narrative about the obstacles during this postsurgical requirement resulted in an insightful description of several core topics relevant to patient care. METHODS: The diary content was summarized using qualitative description procedures. This document was selected due to its unique rich nature. Thematic analysis was used to summarize and describe main topics of importance within the diary. Additional data sources (i.e., medical file, research literature, patient follow-up, and Web sites) were consulted to provide a more comprehensive understanding of the diary content. RESULTS: On the basis of proximity of coded quotes and richness of content, seven areas of interest emerged, including the patient's emotional state, quality of sleep, nutritional considerations, visual functioning, physical status, social support, and entertainment needs. DISCUSSION: Potential patients and their caregivers can learn from the experiences of an individual who has coped successfully with this treatment. This analysis builds the groundwork for the refinement of guidelines for overcoming prevalent physical and psychological barriers.

A new strategy to replace the natural vitreous by a novel capsular artificial vitreous body with pressure-control valve.

PURPOSE: The current vitreous substitutes such as silicone oil, heavy silicone oil, and polymeric gels that are directly injected into vitreous cavity frequently cause severe intraocular complications. There is a very urgent need to find a more suitable artificial vitreous substitute for pars plana vitrectomy (PPV) surgery. METHODS: We have devised a novel capsular artificial vitreous using tailor-made silicone rubber elastomer. The novel device was implanted into the vitreous cavity of rabbit after PPV and the eye was examined by ophthalmoscopy, fundus photography, and tonometry during an 8-week treatment period. B-scan ultrasonography, electroretinogram (ERG), and histological studies by light microscopy were also performed at the end of 8 weeks. RESULTS: The novel artificial vitreous body consists of a thin vitreous-like capsule with a silicone tube-valve system. The capsule can be folded and implanted into vitreous cavity through 1.5 mm incision on sclera. Physiological balanced solution (PBS) was then injected into the capsule and inflated to support retina and control intraocular pressure (IOP) through the tube-valve system subsequently fixed under the conjunctiva. Experiments using rabbits showed that the novel vitreous body could effectively support the retina and apparently induced no significant pathological changes in the eye over 8 weeks. CONCLUSION: This approach may provide a new research strategy in the vitreous replacement technology. The novel artificial vitreous body device can effectively support retina, control IOP, and has good biocompatibility. It may be a good alternative to injecting artificial vitreous although its tamponade properties and usefulness still have to be proven in complex vitreoretinal diseases.

Vitrectomía en hialosis asteroide / Vitrectomy in asteroid hyalosis

Con el objetivo de determinar las modificaciones que la vitrectomía ejerce sobre la capacidad visual (CV) en los pacientes portadores de hialosis asteroide (HA) como única patología intraocular, del total de ojos captados con HA la mitad se asignó aleatoriamente a un grupo experimental el cual fue sometido a vitrectomía pars plana y la otra mitad a un grupo control que no recibió tratamiento alguno, comparando la CV pre y postoperatoria del primero contra el segundo. Se incluyeron un total de 16 ojos de 12 pacientes; 6 de sexo femenino (50 por ciento) y seis del masculino (50 por ciento), la CV preoperatoria del grupo experimental varió de 0.6 a 0.2, X = 0.45, obteniéndose desde los cuatro meses del postoperatorio una CV de 1.0 a 0.3, X = 0.73 (*p < 0.5), en contraste con el grupo control, el cual no presentó cambios estadísticamente significativos en el mismo intervalo de tiempo.

Vitrectomia no tratamento do edema cistóide de mácula pós-pseudofacia / Vitrectomy in pseudophakic cystoid macular edema

Introduçäo: o edema cistóide de mácula (ECM) é uma das principais patologias que determinam baixa acuidade visual em pacientes após cirurgia de catarata. O objetivo desse estudo retrospectivo é determinado a eficácia da vitrectomia no tratamento do edema cistóide de mácula pós-pseudofacia em pacientes com falta de integridade da cápsula posterior. Material e métodos: foram analisados retrospectivamente prontuários de 11 pacientes pseduofácicos com rotura ou falta de cápsula posterior, com diagnóstico de Edema Cistóide de Mácula, que foram submetidos à vitrectomia para tratamento do Edema Cistóide de Mácula. Resultados: Houve significante melhora da acuidade visual após a vitrectomia. Näo houve diferença entre os subgrupos com lente intra-ocular de câmara anterior e posterior ..

Retinopatia da prematuridade grau V: tratamento cirúrgico / Stage V retinopathy of prematurity: surgical treatment

Estudamos os resultados anatômico e funcional de 10 crianças (13 olhos) com retinopatia da prematuridade grau V (ROP V) submetidas a tratamento cirúrgico. Dez olhos foram submetidos à vitrectomia fechada e 3 à vitrectomia a céu aberto no primeiro ano de vida. Onze olhos evoluiram com a retina colada ou parcialmente colada e em 2 olhos a retina permaneceu colada apesar da cirurgia. A acuidade visual piorou em 1 olho, se manteve em 7 olhos e melhorou 6 olhos. Apesar do prognóstico funcional relativamente reservado, a visäo pode melhorar em alguns casos que apresentem a retina colada e a cirurgia deve ser considerada uma importante opçäo de tratamento para estas crianças

Tratamento de luxaçäo de lente intra-ocular de câmara posterior / Repositioning and fixating of dislocated posterior chamber intraocular lens

Objetivos: a luxaçäo de LIO para a cavidade usualmente é acompanhada de baixa da acuidade visual significativa. Os autores apresentam uma técnica de vitrectomia via pars plana e reposicionamento da própria LIO, no sulco ciliar, por meio de suturas esclerais. Métodos: foram tratados 15 casos de luxaçäo de LIO de câmara posterior para a cavidade vítrea. A técnica apresentada consistiu basicamente de vitrectomia via pars plana, apreensäo e exteriorizaçäo das alças da LIO por meio de esclerotomias, realizadas sob retalho escleral sobrejacente ao sulco ciliar, sutura das alças com prolene 9.0 e interiorizaçäo destas. Resultados: Todos os pacientes apresentaram melhora da acuidade visual. Onze pacientes (73.3 p/cento) recuperaram acuidade visual de 20/40 ou melhor. Apenas um paciente

Vitrectomia na síndrome de Terson / Vitrectromy in Terson`s

Avaliou-se, retrospectivamente, os resultados da vitrectomia via pars plana realizada em 14 olhos (nove pacientes) com hemorragia vítrea devida a Síndrome de Terson. Traumatismo crâneo-encefálico e ruptura espontânea de aneurisma cerebral foram as causas da hemorragia intra-craniana em 55,5 por cento e 44,5 por cento dos casos, respectivamente e a vitrectomia ocorreu, em média, 5 meses após a hemorragia vítrea. Em quatro olhos observou-se, durante a cirurgia, descolamento parcial do vítreo posterior em forma de concha na área macular. Catarata sub-capsular posterior desenvolveu-se, no pós-operatório, em 28 por cento dos casos. Um olho desenvolveu descolamento de retina. Houve melhora da acuidade visual em 92 por cento dos casos e 64 por cento dos olhos alcançaram visäo final de 2040 ou melhor. Nos casos em que säo observados sinais precoces de resoluçäo de hemorragia vítrea, a vitrectomia pode ser considerada como um procedimento efetivo e seguro, com pronta reabilitaçäo visual na Síndrome de Terson

Vitrectomia para o tratamento de cisticerco intra-retiniano / Intraretinal cysticercosis treated by vitrectomy

A cisticercose é uma infestaçäo pela forma larvar da Taenia solium. O envolvimento ocular ocorre de 13 a 46 por cento dos pacientes afetados. Os autores descrevem um caso de cisticerco intraocular fortemente aderido à macula, fazendo protusäo para a cavidade vítrea. O parasita foi removido através de vitrectomia pars plana com aspiraçäo de seu envoltório e conteúdo. Parte deste envoltório entretanto, por ser cirurgicamente inseparável da retina subjacente foi deixado em contato com a mácula. No pós-operatório utilizou-se corticoterapia local e sistêmica durante trinta dias. Os autores chamam atençäo para o fato de, mesmo sem a remoçäo de toda a cápsula do cisticerco, a evoluçäo ter sido favorável, com vítreo transparente, sem reaçäo inflamatória ou descolamento da retina no pós-operatório tardio

Síndrome de Terson: casos clínicos / Terson's syndrome: clinical cases

Se presentan 9 pacientes con un total de 15 ojos comprometidos con síndrome de Terson. Se observó franco predominio de mujeres, en general jóvenes y como causa etiológica predominó la rotura de aneurisma intracraneal. Seis de las 9 pacientes fueron bilaterales. Se practicó vitrectomía por pars plana en 11 ojos y las agudezas visuales finales obtenidas en estos pacientes fueron: mayor de 0.1, 11 ojos y mayor de 0.5 en 5 ojos. Cuatro ojos no fueron operados y la agudeza visual final obtenida fue mayor de 0.1 en 4 ojos y mayor de 0.5 en 3 ojos. No hubo complicaciones en el preoperatorio ni en el postoperatorio, sólo hubo una catarata en 1 ojo a los 6 meses del postoperatorio. Entre los hallazgos anatómicos encontrados en los pacientes vitrectomizados encontramos: membrana epirretinal en 5 ojos y 1 ojo con una banda fibrosa a subretinal

Vitrectomia no tratamento do pucker macular / Vitrectomy for macular pucker

Vitrectomia com "peeling" de membrana foi realizada para o tratamento de 34 casos consecutivos de pucker macular com acuidade visual pior ou igual 20/80. O pucker macular era idiopático (11 olhos); ou estava associado a descolamento de retina ou ruptura de retina tratados (15 olhos), uveíte (5 olhos), trauma penetrante (2 olhos) e retinopatia por células falciformes (1 olho). A acuidade visual melhorou em 28 olhos (82,4 por cento), permaneceu a mesma em 5 olhos (14,7 por cento) e piorou em um olho (2,9 por cento). Näo houve diferença estatisticamente significativa no resultado da cirurgia com relaçäo à etiologia da membrana. Dois olhos (5,9 por cento) apresentaram descolamento de retina no pós-operatório imediato e foram tratados com sucesso. De 20 olhos fácicos, 6 (30 por cento) apresentaram opacificaçäo cristaliniana após 1 ano de cirurgia. Dois olhos (5,9 por cento) apresentaram recidiva da membrana epirretiniana