Incomplete homonymous hemianopsia progressing to junctional scotoma due to a large internal carotid artery aneurysm: A case report.

Visual field disorders caused by cerebral aneurysms are diverse, nonspecific, and vary in their degree of compression. They should be distinguished from those caused by other common diseases, such as glaucoma.

Investigating the Combined Effects of Mechanical Stress and Nutrition on Muscle Hypertrophic Signals Using Contractile 3D-Engineered Muscle (3D-EM).

Since 3D-EM closely resembles in vivo muscles, the aim of this study was to investigate the effects of exercise (electrical pulse stimulation (EPS)) and nutrition (maca), which contains triterpenes, on muscle hypertrophy by using 3D-EM for the first time. The 3D-EM was composed of C2C12 cells and type 1 collagen gel, was differentiated for 14 days, and was divided into four groups: control, maca, EPS, and maca + EPS. The medium was replaced every two days before each EPS intervention, and the concentration of maca in the culture solution was 1 mg/mL. The intervention conditions of the EPS were 30 V, 1 Hz, and 2 ms (24 h on, 24 h off, for one week). The expression levels of proteins were examined by Western blotting. The intervention of maca and EPS upregulated the expression of MHC-fast/slow (both p < 0.05) compared with the control group, and the addition of maca had no effect on the phosphorylation of mTOR (p = 0.287) but increased the AMPK phosphorylation (p = 0.001). These findings suggest that intervention with maca and EPS has a positive effect on muscle hypertrophy, which has a positive impact on sarcopenia. However, the underlying mechanisms remain to be further explored.

SUBRETINAL ENDOSCOPIC SURGERY FOR METASTATIC CHOROIDAL TUMOR.

PURPOSE: To report a case of a metastatic choroidal tumor treated with subretinal endoscopic surgery. METHODS: A single case report. RESULTS: A 68-year-old woman presented with a metastatic choroidal tumor in the right eye and an intraocular pressure of 54 mmHg. Chemotherapy and radiotherapy were ineffective in eliminating her eye pain. Subretinal endoscopic surgery was performed to remove the metastatic choroidal tumor with the complex retinal detachment attached to the posterior surface of the lens. The day after subretinal endoscopic surgery, the patient's intraocular pressure decreased to 7 mmHg and her pain subsided. The chemotherapeutic strategy was modified according to the pathological findings. Survival prognosis improved from 3 to 18 months. Twenty-one months after the surgery, the retinal detachment was reattached under silicone oil with a best-corrected visual acuity of 20/1,000 and an intraocular pressure of 15 mmHg. CONCLUSION: In this case, subretinal endoscopic surgery preserved visual function, eliminating the need for enucleation.

A case of functional visual loss diagnosed through bilateral randomized visual field testing with a trick method.

Purpose: To report a case of functional visual loss (FVL) diagnosed through bilateral randomized visual field testing using Imo vifa with a trick method. Observations: A 27-year-old man complained of visual field abnormality in his left eye after falling from a height of 4 m. The left eye had a best-corrected visual acuity (BCVA) of 20/16 and a critical flicker frequency (CFF) of 44.5 Hz at the first visit. Commotio retinae was observed in the inferior retina of the left eye, and the pupillary light reflex was normal. Computed tomography and magnetic resonance imaging of the head revealed no abnormalities. However, the Goldmann perimeter (GP) showed constriction of visual field in the left eye. Since traumatic optic neuropathy was suspected initially; therefore, two courses of methylprednisolone pulse therapy were administered. However, the BCVA and CFF gradually worsened to 20/200 and 14 Hz, respectively. Nevertheless, his pupillary light reflex was still normal, and GP showed a spiral visual field. Thus, we suspected that this was a case of FVL and performed bilateral randomized visual field testing using Imo vifa in three steps as a trick method. In the first step, we performed the normal method for bilateral randomized visual field testing. In the second and third steps, we explained to the patient that only the right or left eye would be examined on purpose; bilateral randomized visual field testing was then performed. The results of examinations revealed left homonymous hemianopsias and normal and concentric contraction of the visual field in both eyes. These results could not be explained by organic disease, and the patient was diagnosed with FVL. Conclusions and Importance: Bilateral randomized visual field testing using Imo vifa with a trick method was useful for diagnosing FVL.

Investigation of Brain Function-Related Myokine Secretion by Using Contractile 3D-Engineered Muscle.

Brain function-related myokines, such as lactate, irisin, and cathepsin B (CTSB), are upstream factors that control brain-derived neurotrophic factor (BDNF) expression and are secreted from skeletal muscle by exercise. However, whether irisin and CTSB are secreted by muscle contraction remains controversial. Three-dimensional (3D)-engineered muscle (3D-EM) may help determine whether skeletal muscle contraction leads to the secretion of irisin and CTSB, which has never been identified with the addition of drugs in conventional 2D muscle cell cultures. We aimed to investigate the effects of electrical pulse stimulation (EPS)-evoked muscle contraction on irisin and CTSB secretion in 3D-EM. The 3D-EM, which consisted of C2C12 myoblasts and type-1 collagen gel, was allowed to differentiate for 2 weeks and divided into the control and EPS groups. EPS was applied at 13 V, 66 Hz, and 2 msec for 3 h (on: 5 s/off: 5 s). Irisin and CTSB secretion into the culture medium was measured by Western blotting. Irisin secretion was significantly increased following EPS (p < 0.05). However, there was no significant difference in CTSB secretion between the two groups. The present study suggests that irisin may be a contractile muscle-derived myokine, but CTSB is not secreted by EPS-evoked muscle contractile stimulation in 3D-EM.

Treatment of old submacular hemorrhage by subretinal endoscopic surgery and intraoperative subretinal endoscopic findings.

PURPOSE: We report a case of old submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV). Subretinal endoscopic surgery (SES) was performed, which improved visual function. In addition, we show the intraoperative findings of subretinal aberrant PCV vessels as seen under endoscopic observation, which cannot be observed by microscopic surgery. OBSERVATIONS: A 71-year-old Japanese man presented with an old dehemoglobinized SMH due to PCV in his left eye. At the time of presentation, three weeks had already passed after the onset of the patient's symptoms, and the best-corrected visual acuity (BCVA) was 20/200. SES was performed to remove the SMH and treat the subretinal PCV lesions. After creating retinal detachment using a 38-gauge cannula, three subretinal 25-gauge trocars were inserted from the sclera to the subretinal space. Then, SES was performed under ophthalmic endoscopic observation with continued subretinal irrigation for maintaining the retinal detachment. After removal of the SMH, subretinal polyp-shaped nodular vascular lesions (polyps) and a branching vascular network, which is located inside the retinal pigmented epithelium, were identified. The sites that presumably originated from the aberrant vessels of the PCV and the associated polyps were coagulated using endodiathermy. After the subretinal procedure, the retina was flattened with fluid/air exchange, and silicone oil (SO) was injected into the vitreous cavity. The SMH completely disappeared after surgery. Although at one-month follow-up BCVA (20/250) was slightly worse than that before surgery, there was an improvement in postoperative retinal sensitivity in the macula compared to that before surgery. At the three-month follow-up, the SO was removed. The BCVA was 20/200 one month after SO removal. No postoperative complications occurred. Additional treatment was not required, including anti-vascular endothelial growth factor therapy, for PCV progression or SMH recurrence in the left eye till the final visit two years after surgery. CONCLUSION AND IMPORTANCE: SES could effectively remove the old SMH, and the activity of PCV was suppressed by intraoperative subretinal coagulation. The retinal sensitivity of the macula improved after the SES. In addition, we observed subretinal polyps and a branching vascular network located internal to the retinal pigmented epithelium under intraoperative subretinal endoscopic observation. SES is a good surgical option for the removal of old SMH or treatment of subretinal lesions.

Melatonin enhances cisplatin-induced cell death through inhibition of DERL1 in mesenchymal-like CD44high OSCC cells.

BACKGROUND: Melatonin is a hormone that is primarily produced in the pineal gland and is involved in wide range of biological functions. However, the impact of melatonin on chemotherapy-induced cell death remains to be elucidated in oral squamous cell carcinoma (OSCC) cells. The objective of this study was to clarify the role of melatonin in cisplatin-induced cytotoxicity in CD44high OSCC cells. METHODS: CD44high OSCC cells were cultured on fibronectin-coated hydrogel. A lactate dehydrogenase cytotoxicity assay was performed to evaluate cisplatin-induced cell death. The effect of melatonin on cisplatin-induced cell death and Derlin-1 (DERL1) endoplasmic reticulum membrane protein expression was investigated. RESULTS: CD44high OSCC cells exhibited mesenchymal-like features when cultured on fibronectin-coated hydrogel. Mesenchymal-like CD44high OSCC cells demonstrated strong resistance to cisplatin-induced cell death compared with epithelial-like CD44high OSCC cells. DERL1 mRNA and DERL1 protein expression levels were significantly higher in mesenchymal-like CD44high cells compared with epithelial-like CD44high cells. Cisplatin-induced cell death was significantly enhanced after DERL1 siRNA knockdown, suggesting that DERL1 is involved in resistance to cisplatin-induced cell death. Melatonin significantly inhibited DERL1 expression and enhanced cisplatin-induced cell death in mesenchymal-like CD44high cells. miR-181c-5p expression was significantly upregulated in the presence of melatonin. Furthermore, melatonin-inhibited DERL1 expression was significantly recovered by miR-181c-5p inhibitor. In addition, melatoninenhanced cisplatin-induced cell death was attenuated by miR-181c-5p inhibitor. These results suggest that melatonin-induced miR-181c-5p enhances cisplatin-induced cell death through inhibition of DERL1 in mesenchymal-like CD44high cells. CONCLUSIONS: Melatonin plays a vital role in promoting cisplatin-induced cytotoxicity in mesenchymal-like CD44high OSCC cells.

Age-related changes of color visual acuity in normal eyes.

PURPOSE: To evaluate the age-related change in color visual acuity (CVA) in normal eyes. METHODS: In total, 162 normal eyes (162 subjects, women: 52, men: 110, age range: 15-68 years) with best-corrected visual acuity (BCVA) ≥20/13 were enrolled. Fifteen colors from the New Color Test (chroma 6) were applied to Landolt "C" rings, white point D65 was applied as background, and a luminance of 30 cd/m2 was set for both the rings and the background. These rings were used to measure the chromatic spatial discrimination acuity as the CVA value, while changing the stimulus size. Correlations of the CVA value of each color and age were evaluated. Mean CVA values of all 15 colors (logarithm of the minimum angle of resolution) were compared between age groups in 10-year increments. RESULTS: Nine CVA values (red, yellow-red, red-yellow, green, blue-green, green-blue, purple, red-purple, and purple-red) were negatively correlated with age (all p<0.05); the remaining six (yellow, green-yellow, yellow-green, blue, purple-blue, and blue-purple), as well as BCVA were not. The age groups with the best to worst mean CVA values of 15 colors were as follows: 20-29 (mean ± standard deviation, 0.303 ± 0.113), 30-39 (0.324 ± 0.096), 10-19 (0.333 ± 0.022), 50-59 (0.335 ± 0.078), 40-49 (0.339 ± 0.096), and 60-69 (0.379 ± 0.125) years. There were statistically significant differences between mean CVA values of the following groups: 20-29 and 40-49 years; 20-29 and 60-69 years; 30-39 and 60-69 years (all p<0.01). CONCLUSIONS: The CVA values related to the medium/long-wavelength-sensitive cones were more susceptible to aging than those related to the short-wavelength-sensitive cones. This differed from previous reports, and may be related to the difference in the range of foveal cone function evaluated with each examination.

Effects of miR-224-5p-enhanced downregulation of pannexin-1 on docetaxel-induced apoptosis in amoeboid-like CD44high oral cancer cells.

We previously found that microRNAs play major roles in the maintenance of amoeboid-like oral squamous cell carcinoma (OSCC) cells with high expression of CD44 (CD44high ). However, the roles of microRNAs in chemotherapeutic resistance exhibited by CD44high amoeboid-like OSCC cells are unclear. Here, docetaxel-induced apoptosis was examined in CD44high OSCC cells (CD44high OM-1 cells) cultured on laminin-coated silicone gel. Amoeboid-like CD44high OSCC cells exhibited robust resistance to docetaxel-induced apoptosis and significant upregulation of miR-224-5p expression compared with epithelial-like CD44high OSCC cells and mesenchymal-like CD44high OSCC cells. The expression of pannexin-1 (PANX1), a channel-forming protein that regulates the release of ATP, was significantly upregulated following transfection of amoeboid-like CD44high OSCC cells with an miR-224-5p inhibitor. These results suggest that miR-224-5p inhibits PANX1 expression. Furthermore, miR-224-5p inhibitor-transfected amoeboid-like CD44high OSCC cells exhibited significant enhancement of the proportion of apoptotic cells; however, this effect was significantly inhibited by knockdown of PANX1 with PANX1 small interfering RNA. Additionally, the miR-224-5p inhibitor-enhanced extracellular ATP levels were significantly reduced by PANX1 knockdown. These findings imply that miR-224-5p plays a vital role in the resistance to docetaxel-induced apoptosis by attenuating PANX1-induced ATP discharge. Moreover, amoeboid-like CD44high OSCC cells may be involved in chemotherapeutic resistance of OSCC.

Clinical Outcomes of Endoscope-Assisted Vitreous Surgery for Giant Retinal Tear Detachment.

INTRODUCTION: With the advent of perfluorocarbon liquid (PFCL), the success rate of refractory giant retinal tear (GRT) detachment has dramatically improved. PFCL is a very effective tool when used properly, but in GRT detachment, it may move under the retina through the tear, so it is necessary to devise ways to prevent PFCL from migrating under the retina. Ophthalmic endoscope-assisted vitrectomy may reduce the risk of subretinal migration of PFCL, facilitate safer use of PFCL, and increase the success rate of GRT detachment. The present study aimed to describe the clinical outcomes of endoscope-assisted vitreous surgery for giant retinal detachment. METHODS: Twenty consecutive eyes from 19 patients who had undergone endoscope-assisted vitreous surgery for treatment of a GRT detachment were enrolled. Subretinal fluid drainage, extension of the rolled GRT, and endophotocoagulation under air were performed with the aid of an endoscope, without the use of PFCL. Where necessary, extension of a fixed retinal fold and internal limiting membrane peeling was performed with PFCL. RESULTS: The initial and final retinal reattachment rates were 90 and 95%, respectively. In 3 eyes, a small amount of PFCL was used, and there were no PFCL remnants. The mean follow-up duration was 18 months (range, 3-69 months). After surgery, the mean best-correlated visual acuity significantly improved from 20/514 to 20/41 (p = 0.0008). DISCUSSION/CONCLUSION: Endoscope-assisted vitreous surgery for giant retinal detachment has favourable clinical outcomes for visual acuity and retinal detachment.

[Clinical Outcomes of Endoscope-Assisted 30-Gauge Single-Needle Technique for Intrascleral Intraocular Lens Fixation].

INTRODUCTION: We have developed an endoscope-assisted single-needle technique, which is an improvement of Yamane's double-needle technique of the intrascleral intraocular lens (IOL) fixation techniques. In this surgical procedure, the IOL is manipulated in the vitreous cavity, and the IOL haptic is externalized from the eye one by one with the aid of an ophthalmic endoscope. The purpose of this study was to report the postoperative visual function and safety of this new technique. METHODS: Overall, 19 consecutive eyes (16 patients; mean age, 75.1 ± 9.6 years; mean follow-up period, 5.7 months) that underwent intrascleral IOL fixation surgery with our new technique were included in the study. Manifest refraction, uncorrected/corrected visual acuity, and corneal endothelial cell density were measured before and after surgery. Tilt and decentration of IOL were analyzed using anterior segment optical coherence tomography. RESULTS: The mean absolute prediction error (spherical equivalent) was 0.82 ± 0.52. The mean postoperative best-corrected visual acuity had significantly improved at the final visits (p = 0.02). No significant differences in the mean corneal endothelial cell density were observed between the first (2,232 ± 751 cells/mm2) and final (2,099 ± 649 cells/mm2) visits (p = 0.35). The mean IOL tilt was 8.1 ± 3.2°. There were no vision-threatening complications, such as retinal detachment, endophthalmitis, or IOL dislocation, during or after surgery. CONCLUSIONS: The endoscope-assisted single-needle technique is a safe and effective method of intrascleral IOL fixation surgery.

The Change in Color Vision with Normal Aging Evaluated on Standard Pseudoisochromatic Plates Part-3.

Purpose: To evaluate the influence of aging on color vision in a large normal population using Standard Pseudoisochromatic Plates part-3 (SPP-3), which is a pseudoisochromatic plate test used to detect congenital or acquired color vision deficiency (CVD).Materials and methods: We retrospectively reviewed SPP-3 test results of 23,565 normal eyes of 23,565 subjects (women: 12,035; men: 11,530), who were examined between July 1993 and December 2010. The subjects had a mean age of 46.9 ± 18.5 years, ranging from 5 to 89 years, and they were evaluated following categorization into age groups with five-year increments. Subjects whose best-corrected visual acuity (BCVA) was 20/20 or better, with no history of ocular diseases, were included. Subjects with congenital CVD were excluded.Results: We found a negative correlation between age and the total number of correct answers in SPP-3 (Spearman's correlation coefficient, r = -0.5743; p < .0001). The total number of correct answers was the highest in subjects aged 10-14, 15-19, and 20-24 years (17.2 ± 0.9 [mean ±SD]). The total number of correct answers of these groups had significant differences from those in the 5-9 years age group and those aged >30 years (Dunn's post-hoc test: p < .0001). Among the 19 detection numerals in SPP-3, we found that the correct answer rates of six numerals decreased with aging, and the colors of the numerals and their backgrounds all located parallel to the tritanopic confusion line.Conclusions: Using SPP-3, we confirmed that aging influenced color vision, even in normal eyes with a good BCVA (20/20 or better). The total number of correct answers of SPP-3 was the highest in subjects aged 10-24 years and had already begun to decline in those in their 30s.

TGF-ß1 induces amoeboid-to-mesenchymal transition of CD44high oral squamous cell carcinoma cells via miR-422a downregulation through ERK activation and Cofilin-1 phosphorylation.

BACKGROUND: The objective of this study was to clarify the molecular mechanism of amoeboid-to-mesenchymal transition (AMT) of CD44high oral squamous cell carcinoma (OSCC) cells. METHODS: Morphology and expression of mesenchymal genes were investigated in CD44high OSCC cells (CD44high OM-1 cells) cultured on laminin-coated soft silicone gel. Additionally, microarray analysis was performed to investigate microRNA (miRNA) expression inhibited by transforming growth factor-ß1 (TGF-ß1) in CD44high OM-1 cells. RESULTS: When CD44high OM-1 cells were cultured on 2.0-kPa laminin-coated silicone gel, the cells exhibited an amoeboid-like round morphology. Cofilin-1 expression was found in the nucleus and cytoplasm of amoeboid-like CD44high OM-1 cells. The invasive capacity was significantly reduced after Cofilin-1 knockdown. Additionally, Cofilin-1 knockdown cells had an irregularly extended shape. Phosphorylated Cofilin-1 was significantly upregulated by TGF-ß1. Additionally, TGF-ß1 enhanced N-cadherin and Snail mRNA expression and induced a spindle-shaped morphology. ERK1/2 phosphorylation was induced by TGF-ß1. Microarray analysis revealed that miR-422a exhibited the greatest downregulation (fold change: 0.22) in the presence of TGF-ß1. Importantly, TGF-ß1-inhibited miR-422a expression was recovered by the ERK inhibitor or ERK1/2 knockdown. Additionally, miR-422a inhibitor-transfected CD44high OM-1 cells exhibited high N-cadherin and Snail mRNA expression. Furthermore, Cofilin-1 knockdown and miR-422a inhibition induced a spindle cell morphology. CONCLUSION: Cofilin-1 is involved in the invasive ability of CD44high OSCC cells. TGF-ß1 contributes to AMT by downregulation of miR-422a via ERK activation and Cofilin-1 phosphorylation. Our findings suggest that miR-422a and Cofilin-1 play major roles in the maintenance of amoeboid-like CD44high cells.

Melatonin­induced miR­181c­5p enhances osteogenic differentiation and mineralization of human jawbone­derived osteoblastic cells.

Our previous study revealed that treatment with a combination of fibroblast growth factor­2 and melatonin (MEL) synergistically augmented osteogenic activity and mineralization of MC3T3­E1 mouse preosteoblast cells. Thus, the objective of the present study was to assess the effect of MEL on osteogenetic characteristics in human osteoblastic cells. Human jawbone­derived osteoblastic (hOB) cells were isolated from mandibular bone fragments. RUNX family transcription factor 2 (Runx2) expression, alkaline phosphatase (ALP) enzyme activity and the mineralization ability of hOB cells in the presence of MEL were evaluated. Microarray analysis was also performed to assess the expression of MEL­induced microRNAs (miRNAs/miRs) in hOB cells. Treatment with MEL significantly enhanced Runx2 expression, ALP activity and mineralization staining. However, this effect was significantly reduced following transforming growth factor­ß1 treatment. In total, 124 miRNAs were differentially expressed in MEL­treated hOB cells, compared with untreated cells. Of the upregulated miRNAs, miR­181c­5p exhibited the largest fold change. Runx2 mRNA expression and mineralization staining in the presence of MEL were significantly reduced following transfection with a miR­181c­5p inhibitor. In addition, transfection with miR-181c-5p mimics significantly increased Runx2 expression and mineralization staining. These results suggested that MEL­induced miR­181c­5p was involved in osteogenic differentiation and mineralization of hOB cells. Using TargetScan, a putative miR­181c­5p binding site was identified in the Notch2 gene. Moreover, Notch2 mRNA and protein expression levels in hOB cells were significantly reduced following transfection with miR­181c­5p mimics, confirming Notch2 as a target gene for miR­181c­5p. Notch2 siRNA knockdown significantly increased Runx2 expression and mineralization staining, which suggested that Notch2 may negatively regulate osteogenic differentiation of hOB cells by downregulating Runx2. In conclusion, MEL­induced expression of miR­181c­5p enhanced osteogenic differentiation and calcification of hOB cells.

A case of severe choroidal detachment in both eyes due to systemic lupus erythematosus.

PURPOSE: We report a case of severe choroidal detachments (CDs) in both eyes caused by systemic lupus erythematosus (SLE). OBSERVATIONS: The patient was a 50-year-old woman who presented with conjunctival edema in both eyes, visual dysfunction, and generalized fatigue. At the first visit, the best corrected visual acuity (BCVA) was 20/70 OD and 20/70 OS, and the intraocular pressure (IOP) was 22 mmHg OD and 27 mmHg OS. She had serous retinal detachments (SRDs), CDs, ciliary dissections, and a shallow anterior chamber with partial angle closure in both eyes. Systemic findings included hypoalbuminemia, pleural fluid, generalized fatigue, and brown papules on the back and both legs. First, we suspected Vogt-Koyanagi-Harada disease and administered two courses of methylprednisolone pulse therapy, but the CDs in both eyes gradually deteriorated and worsened to the extent that the optic nerve in both eyes could not be observed, and the BCVA deteriorated to 20/200 OD and 6/200 OS. Further multidisciplinary evaluations for diagnosing collagen diseases revealed vasculitis in the skin histopathology examination, positive results for anti-double stranded DNA antibody and anti-SS-A antibody, and hypocomplementemia in the blood examination, and she was diagnosed with severe SLE in the dermatology department. After administration of high dose intravenous γ-globulin therapy, albumin infusion, and intravenous cyclophosphamide pulse therapy, the SRDs and severe CDs improved along with improvement in hypoalbuminemia, pleural fluid, and generalized fatigue. Moreover, the shallow anterior chamber and high IOP improved to normal in both eyes. The CDs and SRDs completely disappeared, and the BCVA improved to 20/13 OU 6 months after the SLE therapy. CONCLUSION AND IMPORTANCE: In patients with observed SRDs and CDs accompanying hypoalbuminemia, it is necessary to consider collagen diseases such as SLE.

Translational Retinal Imaging.

The diagnosis and treatment of medical retinal disease is now inseparable from retinal imaging in all its multimodal incarnations. The purpose of this article is to present a selection of very different retinal imaging techniques that are truly translational, in the sense that they are not only new, but can guide us to new understandings of disease processes or interventions that are not accessible by present methods. Quantitative autofluorescence imaging, now available for clinical investigation, has already fundamentally changed our understanding of the role of lipofuscin in age-related macular degeneration. Hyperspectral autofluorescence imaging is bench science poised not only to unravel the molecular basis of retinal pigment epithelium fluorescence, but also to be translated into a clinical camera for earliest detection of age-related macular degeneration. The ophthalmic endoscope for vitreous surgery is a radically new retinal imaging system that enables surgical approaches heretofore impossible while it captures subretinal images of living tissue. Remote retinal imaging coupled with deep learning artificial intelligence will transform the very fabric of future medical care.

SUBRETINAL ENDOSCOPIC SURGERY TO TREAT LARGE SUBRETINAL HEMORRHAGES SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate the potential of subretinal endoscopic surgery as a novel treatment for large subretinal hemorrhage secondary to age-related macular degeneration. METHODS: Five patients with large subretinal hemorrhage secondary to age-related macular degeneration underwent subretinal endoscopic surgery, with a minimum follow-up of 12 months. RESULTS: The large subretinal hemorrhage was completely removed by subretinal endoscopic surgery without a large retinotomy in all cases. The fibrovascular pigment epithelial detachment including choroidal neovascularization was completely removed in four cases. In three of these cases, the bleeding was confirmed to be originating from one point of rupture in the Bruch membrane, which was treated by coagulation using intraocular diathermy. Although visual acuity improved in three cases, it deteriorated and remained stable in one case each. Fibrovascular pigment epithelial detachment persisted in one patient after surgery; he needed anti-vascular endothelial growth factor therapy, whereas the other four did not because their fibrovascular pigment epithelial detachment was removed. At the final follow-up, no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy, were noted. CONCLUSION: Subretinal endoscopic surgery can completely remove subretinal hemorrhage and fibrovascular pigment epithelial detachment including choroidal neovascularization without a large retinotomy. It also aids in the direct and detailed confirmation of subretinal lesions by ophthalmic endoscope.

NOVEL ENDOSCOPE-ASSISTED VITREOUS SURGERY COMBINED WITH ATMOSPHERIC ENDOSCOPIC TECHNIQUE AND/OR SUBRETINAL ENDOSCOPIC TECHNIQUE FOR RHEGMATOGENOUS RETINAL DETACHMENT WITH GRADE C PROLIFERATIVE VITREORETINOPATHY.

PURPOSE: The purpose of this study was to investigate the clinical outcomes of novel endoscope-assisted vitreous surgery techniques in patients with rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy. METHODS: Eight consecutive patients who had undergone endoscope-assisted vitreous surgery for rhegmatogenous retinal detachment complicated by Grade C proliferative vitreoretinopathy were investigated. The peripheral vitreous was cut under air with the aid of endoscopic view (atmospheric endoscopic technique), and the subretinal proliferation was removed under subretinal endoscopic observation (subretinal endoscopic technique). RESULTS: Retinal reattachment was achieved after the primary surgery without a large retinotomy and scleral buckling in each case. The mean follow-up was 16.8 months (range, 8-28 months). Atmospheric endoscopic technique was performed in all cases, and subretinal endoscopic technique was performed in three cases. After surgery, the mean best-corrected visual acuity significantly improved from 20/778 to 20/111 (P = 0.014). Although microretinal breaks occurred during the removal of vitreous using atmospheric endoscopic technique in all cases, there were no severe postoperative complications, such as retinal detachment or proliferative vitreoretinopathy. CONCLUSION: Endoscope-assisted vitreous surgery with atmospheric endoscopic technique and/or subretinal endoscopic technique is safe and effective in the treatment of rhegmatogenous retinal detachment with Grade C proliferative vitreoretinopathy.