Enhancing Inverted Internal Limiting Membrane Flap Stability in Macular Hole Retinal Detachment by the "Viscoelastic Agent Pool" Technique.

PURPOSE: To evaluate the surgical, anatomical, and functional results of "viscoelastic agent pool" technique-assisted stability of inverted internal limiting membrane flap in macular hole retinal detachment. METHODS: The innovative surgical technique was performed on 10 patients with macular hole retinal detachment. The primary outcomes included best-corrected visual acuity after surgery, rate of closure of macular hole, retinal reattachment, and occurrence of complications. RESULTS: The mean age of the individuals was 67.70 ± 8.75 (range, 55-84) years; mean axial length, 29.34 ± 1.53 (range, 27.10-30.93) mm; mean corrected MH diameter, 685.30± 345.65 (range, 172-1,325) µ m; and average follow-up period, 6.01 ± 1.71 (range, 3.10-8.4) months. In 6 eyes (60%), the postoperative best-corrected visual acuity showed improvement. All patients had macular hole closure, and the retinal reattachment rate was 100%. No postoperative complications were noted. CONCLUSION: The "viscoelastic agent pool" technique, an innovative surgical approach designed to enhance the stability of the internal limiting membrane flap, serves as an effective adjunctive procedure for the inverted internal limiting membrane flap technique. It presents a viable option for patients with macular hole retinal detachment.

Changes of optical coherence tomographic hyperreflective foci in rhegmatogenous retinal detachment patients after successful surgery.

PURPOSE: To assess the changes of hyperreflective foci (HRF) in rhegmatogenous retinal detachment (RRD) patients after successful reattachment surgery. METHODS: Twenty-nine macula-off RRD eyes with successful reattachment surgery were retrospectively analyzed. Optical coherence tomography (OCT) was used to image macular regions and measure HRF in outer retina and inner retina at 0.5, 1, 3, 6, 12 months after surgery. The relationships between HRF and photoreceptor layer status, visual outcomes were evaluated. RESULTS: After retinal reattachment, HRF mainly distributed at the location where external limiting membrane (ELM) or inner and outer segment (IS/OS) line was disrupted. The HRF numbers in outer and inner retina were greater in eyes with discontinuous IS/OS line than eyes with continuous IS/OS line (all p<0.05). In the outer retina,  HRF increased in the initial three months after retinal reattachment, and then decreased gradually after 3 months (p<0.05). The HRF number in the outer retina at postoperative 0.5 months was associated with favorable visual outcomes at 6 and 12 months (r=-0.487,  p =0.025; r=-0.626,  p=0.005, respectively), nevertheless, the HRF number at 3 months was correlated with poor visual results at 6 and 12 months (r=0.441,  p =0.017; r=0.477,  p=0.019, respectively). CONCLUSION: HRF mainly occurred near the site where ELM or IS/OS line was injured after retinal reattachment. In the outer retina, the number of HRF gradually increased in the first 3 months and then gradually decreased. The early appearance of HRF in the outer retina was associated with a good visual prognosis, while the late appearance may suggest a less favorable visual outcome.

Analysis of retinal sensitivity between acute and recurrent central serous chorioretinopathy by microperimetry.

PURPOSE: To evaluate the retinal sensitivity of macular region in acute and recurrent central serous chorioretinopathy (CSCR) using microperimetry. METHODS: This was a retrospective observational study. Twenty-five eyes of 25 subjects diagnosed with either acute or recurrent CSCR without any previous treatment were included in this study. All subjects underwent complete ophthalmological examinations, including central retinal thickness (CRT) using spectral domain OCT and the retinal sensitivity assessments of macular region using microperimeter MP-3. The mean global macular sensitivity (GMS) of 64 loci in the 20° central macular area and the local macular sensitivity (LMS) of the test locations in affected region of serous retinal detachment (SRD) were analyzed. RESULTS: Twelve eyes of 12 subjects with acute CSCR (Group A) and 13 eyes of 13 subjects with recurrent CSCR (Group R) were enrolled. Clinical parameters, including age, duration, mean LogMAR best-corrected visual acuity and CRT, were not statistically significant (p = 0.688, 0.080, 0.222, 0.394, respectively) between Group A and Group R. There were significant differences in the GMS and LMS between the two groups. Compared to group A (24.9 ± 1.6 dB), the mean GMS of group R was significantly (p = 0.018) lower (23.0 ± 2.0 dB). Furthermore, the mean LMS of group R (20.8 ± 3.4 dB) was also significantly lower (p = 0.026) than that of group A (22.3 ± 3.1 dB). CONCLUSIONS: Recurrent CSCR often show worse retinal function in focal areas of the affected macular areas than in acute CSCR. Microperimetry may be a promising method for distinguish between the acute and recurrent CSCR.

PATHOLOGIC STUDY OF UNTREATED INTRARETINAL GLIOSIS SURGICALLY EXCISED VIA PARS PLANA VITRECTOMY.

PURPOSE: To evaluate the pathologic process of intraretinal glioses by investigating mass tissues resected from untreated eyes with intraretinal glioses. METHODS: Five patients with intraretinal gliosis without previous conservative treatment were included. All patients underwent pars plana vitrectomy. The mass tissues were excised and processed for the pathologic study. RESULTS: During surgery, it was observed that the intraretinal gliosis mainly affected the neuroretina and the retinal pigment epithelium was not affected. Pathologic examination revealed that all intraretinal glioses consisted of different proportions of hyaline vessels and hyperplastic spindle-shaped glial cells. In one case, the intraretinal gliosis was mainly composed of hyaline vascular components. In another case, the intraretinal gliosis showed a predominance of glial cells. The intraretinal glioses in the other three cases had vascular and glial components. The proliferated vessels showed different amounts of collagen deposits against different backgrounds. Vascularized epiretinal membrane was found in some intraretinal glioses. CONCLUSION: Intraretinal glioses affected the inner retinal layer. Hyaline vessels were the most characteristic pathologic changes; the proportion of proliferative glial cells varied in different intraretinal glioses. The natural course of intraretinal gliosis may involve the proliferation of abnormal vessels in the early stage, which then gradually become scarred and are replaced by glial cells.

Association between Aqueous Humor Cytokines and Structural Characteristics Based on Optical Coherence Tomography in Patients with Diabetic Macular Edema.

Purpose: To investigate the relationship between aqueous humor cytokines and structural characteristics based on optical coherence tomography (OCT) in patients with diabetic macular edema (DME). Methods: Forty eyes of 28 patients with DME diagnosed in the Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou were included. All patients collected aqueous humor during anti-VEGF treatment, and the IL-6, IL-8, IL-10, VEGF, VCAM-1, ICAM-1, TGF-ß1, FGF, and MCP-1 concentrations were detected. OCT examination was performed before anti-VEGF treatment and 1 month after anti-VEGF operation. Central macular thickness (CMT), macular volume (MV), choroidal thickness (CT), and the number of hyperreflective foci (HRF) were obtained for analysis. Each eye was determined whether there is subretinal effusion (SRD), cystoid macular edema (CME), and diffuse retinal thickening (DRT). Results: The levels of IL-6 and FGF in DME patients with SRD were significantly higher than those without SRD (all P < 0.05). The level of VEGF in DME patients with CME was significantly higher than that in DME patients without CME (P = 0.005); IL-6, TGF-ß1, and MCP-1 were significantly higher in DME patients with DRT than that without DRT (all P < 0.05). There was no significant correlation between aqueous humor cytokines and retinal thickness and retinal volume. However, the thinner the CT, the higher the level of aqueous humor cytokines IL-6 (r = -0.313, P = 0.049) and FGF (r = -0.361, P = 0.022). A multivariate linear regression analysis showed that IL-6 was significantly correlated with CT (P = 0.002) and SRD (P = 0.017), FGF was also significantly correlated with CT (P = 0.002) and SRD (P = 0.005), and TGF-ß1 was correlated with triglycerides (P = 0.030) and HRF (P = 0.021). Conclusion: DME patients with significant macular cystoid edema changes may be related to high VEGF concentrations and thin CT; meanwhile, the presence of SRD or a high number of HRF on OCT macular scans in DME patients may indicate high levels of intraocular inflammatory factors. Thus, OCT morphology characteristics to some extent reflect intraocular inflammatory factors and VEGF levels and may guide treatment alternatives.

Spectral-domain optical coherence tomography characteristics of cystic retinal tuft.

OBJECTIVE: To investigate the characteristics of cystic retinal tufts (CRTs) with 55° widefield spectral-domain optical coherence tomography. METHODS: This was a retrospective study. All subjects underwent a complete ocular examination, ultra-widefield (UWF) pseudocolor fundus photography and Spectral domain optical coherence tomography (SD-OCT) with a 55° widefield lens. The SD-OCT characteristics were analyzed in subjects with CRT. RESULTS: Twenty-six eyes of 25 subjects were scanned and 29 CRTs were analyzed for SD-OCT characteristics. On SD-OCT images, the CRTs exhibited hyperreflective irregular elevated lesions with internal hyporeflective cystoid cavities. Normal layers of the neuroepithelium could not be distinguished. The mean diameter of CRTs was 1022 microns (range, 117-3711 microns; standard deviation, 815 microns). There was vitreoretinal traction at the apex of CRTs. Among them, retinal tears in 24.14% (7/29), suspected retinal tears in 27.59% (8/29), and shallow neuroepithelium detachment in 31.03% (9/29). CONCLUSIONS: The widefield SD-OCT imaging can provide detailed cross-sectional anatomic information of CRT and may guide clinical treatment.

Prediction of Visual Acuity After Cataract Surgery Using Optical Coherence Tomography Findings in Eyes With Retinitis Pigmentosa.

BACKGROUND AND OBJECTIVE: To investigate the predictive factors of visual acuity (VA) after cataract surgery in patients with retinitis pigmentosa (RP). PATIENTS AND METHODS: Retrospective, observational study. The authors reviewed a consecutive series of 70 patients (109 eyes) with RP who underwent cataract surgery. The changes in best-corrected visual acuity (BCVA) before and 3 months after surgery were measured. The relationship between preoperative ellipsoid zone (EZ) conditions, external limiting membrane (ELM) conditions, central macular thickness (CMT), and postoperative BCVA were investigated. RESULTS: The mean BCVA was significantly improved after cataract surgery from 0.80 to 0.45 (P < .001). However, final BCVA did not improve in 57 eyes (52.3%). The mean postoperative BCVA was significantly better in eyes with an intact ELM than those without (P < .001), in eyes with an intact EZ than those without (P < .001), and in eyes with relatively normal CMT (≥ 200 µm) than those with decreased CMT (< 200 µm) (P < .001). In multiple linear regression analysis, preoperative logMAR VA (P < .001), ELM integrity (P < .001), and CMT (P = .017) remained the only three variables that were associated significiantly with postoperative BCVA (R2 = 0.753; P < .001). CONCLUSIONS: Postoperative BCVA in approximately half of the eyes was improved after cataract surgery in patients with RP. The preoperative BCVA and the status of ELM and CMT are important parameters to predict postoperative VA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:587-594.].

Optical coherence tomography with or without enhanced depth imaging for peripapillary retinal nerve fiber layer and choroidal thickness.

AIM: To assess peripapillary retinal nerve fiber layer (RNFL) and choroidal thickness obtained with enhanced depth imaging (EDI) mode compared with those obtained without EDI mode using Heidelberg Spectralis optical coherence tomography (OCT). METHODS: Fifty eyes of 25 normal healthy subjects and 32 eyes of 20 patients with different eye diseases were included in the study. All subjects underwent 3.4 mm diameter peripapillary circular OCT scan centered on the optic disc using both the conventional and the EDI OCT protocols. The visualization of RNFL and choroidoscleral junction was assessed using an ordinal scoring scale. The paired t-test, intraclass correlation coefficient (ICC), 95% limits of agreement (LoA), and Bland and Altman plots were used to test the agreement of measurements. RESULTS: The visibility score of RNFL obtained with and without EDI was of no significant difference (P=0.532), the visualization of choroidoscleral junction was better using EDI protocol than conventional protocol (P<0.001). Peripapillary RNFL thickness obtained with EDI was slightly thicker than that obtained without EDI (103.25±9.42 µm vs 101.87±8.78 µm, P=0.010). The ICC of the two protocols was excellent with the value of 0.867 to 0.924, the 95% LoA of global RNFL thickness was between -10.0 to 7.4 µm. Peripapillary choroidal thickness obtained with EDI was slightly thinner than that obtained without EDI (147.23±51.04 µm vs 150.90±51.84 µm, P<0.001). The ICC was also excellent with the value of 0.960 to 0.987, the 95% LoA of global choroidal thickness was between -12.5 to 19.8 µm. CONCLUSION: Peripapillary circular OCT scan with or without EDI mode shows comparable results in the measurement of peripapillary RNFL and choroidal thickness.

Pretreatment with proteasome inhibitors protects against oxidative injuries via PPARα-dependent and -independent pathways in ARPE-19 cells.

PURPOSES: Oxidative processes may play important roles in age-related macular degeneration. Previous studies have suggested that enhancing proteasome activity by pretreatment with low doses of proteasome inhibitors reduces injury from oxidative damage in neuronal cultures. The objective of the current study was to determine whether proteasome inhibitors could ameliorate the toxicity from oxidative stresses in ARPE-19 cells and to dissect the pathways that may mediate these protective effects. METHODS: The toxicity of oxidative stressors menadione (VK3) and 4-hydroxynonenal (4-HNE) and the protective effects of proteasome inhibitors, including MG-132 and clasto-lactacystin-ß-lactone (LA), were studied in ARPE-19 cells. Binding and activation of the peroxisome proliferator-activated receptors (PPARs) family of transcription factors were studied using electrophoretic mobility shift assay (EMSA) and a peroxisome proliferator-activated response element (PPRE)-driven dual-luciferase reporter gene. RESULTS: An 18-hour pretreatment with 30 to 300 nM MG-132 or 300 to 1000 nM LA reduced the toxicity of menadione or 4-HNE in ARPE-19 cells. The protective effects of MG-132 pretreatment were partially reversed by the PPARα antagonist GW6471 but not by the PPARγ antagonist GW9662; in contrast, neither agent reduced the protective effects of LA. MG-132 but not LA induced increased expression of a PPRE-driven luciferase reporter gene in a dose-dependent manner. Nuclear proteins isolated from ARPE-19 cells treated by MG-132 had increased binding to PPRE sequences as measured by EMSA. CONCLUSIONS: Our data suggest that pretreatment with proteasome inhibitors reduces oxidative injury in ARPE-19 cells and that the underlying mechanisms are different for different proteasome inhibitors, with PPARα-dependent effects for MG-132 and PPAR-independent effects for LA.