New suture probe canaloplasty combined with suprachoroidal collagen implantation.

PURPOSE: To present the modified surgery technique of new suture probe canaloplasty with a specially prepared monofilament 4.0 polypropylene suture combined with suprachoroidal drainage (ScD) and collagen sheet implantation for non-penetrating glaucoma surgery. METHODS: Prospective study with a twelve months follow-up. A standard 4/0 polypropylene suture (ProleneTM by Ethicon; thickness: approximately 250 m) is cut and shaped with an ophthalmic knife (MANI® Crescent Knife, Mani Inc 8-3 Kiyohara Industrial Park, Utsunomiya, Tochigi 321-3231, Japan) to create a blunt end without sharp or compressed edges. This improves suture probe canaloplasty by providing a more stable and smoother probing device. Schlemm's canal is prepared using the standard technique of canaloplasty with suprachoroidal drainage. Then, instead of using the canaloplasty microcatheter or the previously published 6/0 double-helix suture, Schlemm's canal is probed with the blunt ending of the 4/0 Prolene suture. After successful 360-degree probing, a doubled 10/0 polypropylene tension suture is threaded through the tip of the 4/0 suture. The 4/0 suture is then pulled back and the 10/0 tension sutures are tied at both ends to tension Schlemm's canal. A special collagen sheet (Ologen®) is placed in suprachoroidal space, and the scleral flap is firmly sewed. RESULTS: 115 eyes were included in this prospective study. In 113 cases the Schlemm's canal could completely be probed with the suture probe and canaloplasty with ScD and collagen sheet implantation succeeded. In two cases the intervention was transformed to 360-degree suture trabeculotomy due to an intraoperative cheese-wiring. Twelve months after successful new suture probe canaloplasty with ScD and Collagen Implantation the IOP had decreased by 37.1% (from 21.6 ± 6.0 mmHg with 3.3 different IOP lowering eye drops to 13.5 ± 3.5 mmHg with 1.0 eye drops). 16 Patients did not achieve sufficient IOP levels and underwent 360-degree suture trabeculotomy during the follow-up. One patient had to be treated with further glaucoma surgery to achieve a sufficient IOP level. Complications were hyphema, postoperative IOP elevation and transient hypotony. No serious or sight-threatening complications occurred. CONCLUSION: New suture probe canaloplasty with ScD and collagen sheet implantation yields the opportunity to conduct a cost-effective canaloplasty easier and less complicated than with the previously described method with the twisted 6/0 suture. The safety profile and IOP lowering effect is comparable. In cases where complete probing fails, there is still the opportunity to switch to suture trabeculotomy over the majorly probed part of Schlemm's canal. The pressure lowering effect of the deep sclerectomy with ScD and suprachoroidal collagen sheet implant seems to have an additional impact on the sufficient pressure lowering procedure.

Laser-Induced Chorioretinal Anastomosis in Neurofibromatosis Type 1.

This case report describes a laser-induced chorioretinal anastomosis in a 38-year-old woman with neurofibromatosis type 1.

Suprachoroidal injection of polyzwitterion hydrogel for treating glaucoma.

Glaucoma is the primary cause of irreversible blindness worldwide. The current treatments are primarily based on drug usage or surgical operation to reduce intraocular pressure (IOP). However, it is expensive and requires patients to insist on taking the medicine for a long time. The suprachoroidal space (SCS) is the space between the choroid and the sclera, which forms part of the uveovortex pathway in the circulation of aqueous humor. So far, it is still challenging to realize the injection of hydrogels into the SCS with long-term duration. In this work, an in situ-forming polyzwitterionic polycarboxybetaine hydrogel is designed and injected to expand SCS to increase the drainage of aqueous humor from the eye via the uveovortex pathway, thus reducing IOP for at least 6 weeks, while commercial hyaluronic acid hydrogel can only last for about 4 weeks. The clinical ophthalmological safety assessment examination shows that the treatment of polyzwitterion hydrogel is well-tolerated that leads to minimal inflammatory reaction, and histopathology assessment demonstrates that the SCS is expanded after injection of the hydrogel. Further analysis of ultrasound biomicroscopy reveals that there is a strong correlation between IOP reduction and SCS expansion. In short, the polyzwitterion hydrogel developed in this work can prolong the period of IOP reduction by expanding SCS, thus treating ocular hypertension and glaucoma without resorting to drugs or regular surgery.

Countering choroid prolapse in corneo scleral repair.

Background: The video shows the meticulous repair of the corneoscleral tear along with management of the choroidal prolapse. Purpose: The video demonstrates the steps to establish the anatomical integrity of the globe and tips to avoid suture bites through the choroid in a corneo-scleral tear repair. Synopsis: Identification of important landmarks helps in the establishment of anatomical integrity. Therefore, the limbal area of tear is first sutured with 10-O nylon. The extent of wound onto the sclera is checked on the other end of the tear. Second limbal suture at the opposite end of the tear is taken, followed by dividing the corneal extent of tear by rule of half and segmental suturing with 10-O nylon. Then conjunctival peritomy is done to explore the scleral extent and the uveal tissue prolapse. Blunt and atraumatic back tip of Weckel sponge is used perpendicular to the plane of the sclera to push the choroid back aiding the scleral bite. Sclera is sutured with 9-O nylon suture taking care not to include the choroidal tissue. Air injection is done to check for any wound leak. Side port is hydrated, and corneal sutures are buried. The conjunctiva is secured with fibrin glue. Anterior chamber is formed with air bubble. Povidone iodine is instilled and BCL placed. Highlights: 1. Suturing the landmark areas first; 2. Exploring the extent of wound; 3. Segmental suturing of the cornea; 4. Pushing the choroid back to avoid bites through it while suturing sclera; 5. Air injection to check for wound leaks; 6. Anterior chamber formation with air at the end. Video link: https://youtu.be/e5lEyLsQR3U.

Changes in entropy on polarized-sensitive optical coherence tomography images after therapeutic subthreshold micropulse laser for diabetic macular edema: A pilot study.

PURPOSE: To investigate the dynamics of the healing process after therapeutic subthreshold micropulse laser (SMPL) for diabetic macular edema (DME) using polarization-sensitive optical coherence tomography (PS-OCT). METHODS: Patients with treatment-native or previously-treated DME were prospectively imaged using PS-OCT at baseline, 1, 2, 3, and 6 months. The following outcomes were evaluated: changes in the entropy value per unit area (pixel2) in the retinal pigment epithelium (RPE) on the B-scan image; changes in the entropy value in each stratified layer (retina, RPE, choroid) based on the ETDRS grid circle overlaid with en face entropy mapping, not only the whole ETDRS grid area but also a sector irradiated by the SMPL; and the relationship between edema reduction and entropy changes. RESULTS: A total of 11 eyes of 11 consecutive DME patients were enrolled. No visible signs of SMPL treatment were detected on PS-OCT images. The entropy value per unit area (pixel2) in the RPE tended to decrease at 3 and 6 months from baseline (35.8 ± 17.0 vs 26.1 ± 9.8, P = 0.14; vs 28.2 ± 18.3, P = 0.14). Based on the en face entropy mapping, the overall entropy value did not change in each layer in the whole ETDRS grid; however, decrease of entropy in the RPE was observed at 2, 3, and 6 months post-treatment within the SMPL-irradiated sectors (P < 0.01, each). There was a positive correlation between the change rate of retinal thickness and that of entropy in the RPE within the SMPL-irradiated sector at 6 months (r2 = 0.19, P = 0.039). CONCLUSION: Entropy measured using PS-OCT may be a new parameter that facilitates objective monitoring of SMPL-induced functional changes in the RPE that could not previously be assessed directly. This may contribute to a more promising therapeutic evaluation of DME. CLINICAL TRIAL: This clinical study was registered in UMIN-CTR (ID: UMIN000042420).

Surgical Management of Choroidal Diseases. / Chirurgisches Management bei Erkrankungen der Aderhaut.

Accumulation of serous fluid in the suprachoroidal space, known as uveal effusion, and choroidal or suprachoroidal haemorrhage (SCH) following rupture of ciliary blood vessels are considered rare, but serious, events with extremely poor functional prognosis. As a result, uveal effusion, and expulsive suprachoroidal haemorrhage in particular, continue to be considered as more or less fatal complications. However, clinical experience demonstrates that both clinical entities can be managed by conservative as well as surgical strategies, depending on their severity and localisation, with sometimes surprisingly favourable visual outcome. In addition to prognostic factors, timely recognition and prompt, if possible preventive, acute care, as well as carefully considered timing of adequate surgical measures taking advantage of the specific characteristics of the choroidal tissue, are crucial to treatment success. Along with technical advances in the field of vitreoretinal surgery, numerous variants of therapeutic approaches to the treatment of choroidal effusion and suprachoroidal haemorrhage have been proposed to date. This review presents some of the most important surgical techniques and strategies in the field.

Microsurgical Dissection and Tissue Clearing for High Resolution Intact Whole Retina and Vitreous Imaging.

Neuronal and vascular structures of the retina in physiologic and pathologic conditions can be better visualized and characterized by using intact whole retina imaging techniques compared to conventional retinal flat mount preparations and sections. However, immunofluorescent imaging of intact whole retina is hindered by the opaque coatings of the eyeball, i.e., sclera, choroid, and retinal pigment epithelium (RPE) and the light scattering properties of retinal layers that prevent full thickness high resolution optical imaging. Chemical bleaching of the pigmented layers and tissue clearing protocols have been described to address these obstacles; however, currently described methods are not suitable for imaging endogenous fluorescent molecules such as green fluorescent protein (GFP) in intact whole retina. Other approaches bypassed this limitation by surgical removal of pigmented layers and the anterior segment of the eyeball allowing intact eye imaging, though the peripheral retina and hyaloid structures were disrupted. Presented here is an intact whole retina and vitreous immunofluorescent imaging protocol that combines surgical dissection of the sclera/choroid/retina pigment epithelium (RPE) layers with a modified tissue clearing method and light sheet fluorescent microscopy (LSFM). The new approach offers an unprecedented view of unperturbed vascular and neuronal elements of the retina as well as the vitreous and hyaloid vascular system in pathologic conditions.

Effect of keratorefractive surgery on choroidal thickness in anisometropic amblyopia.

PURPOSE: To evaluate postoperative change in choroidal thickness (CT) in patients with anisometropic amblyopia undergoing keratorefractive surgery. METHODS: Anisometropic amblyopic patients and nonamblyopic patients who underwent keratorefractive surgery were included in the study. The eyes were divided into three groups. Group 1 consisted of eyes with anisometropic amblyopia, group 2 were the nonamblyopic fellow eyes, and group 3 (control group) were nonamblyopic eyes which had undergone keratorefractive surgery. At the third postoperative month, the CT of these eyes were measured by Enhanced Depth Imaging OCT (EDI-OCT). The choroidal thickness (CT) was measured in the subfoveal area and at 500 micron intervals nasally and temporally. RESULTS: Twenty-three anisometropic amblyopia patients with amblyopic and fellow eyes and 23 control eyes were enrolled. The mean subfoveal choroidal thickness (CT) was 387.3±168.8µm in group 1, 412.2±88.8µm in group 2 and 337.3±99µm in group 3 (P: 0.019). Group 1 and group 2 showed higher choroidal thickness (CT) in the nasal and temporal quadrants than group 3 (P: 0.03, P: 0.04). At the third postoperative month, central foveal choroidal thickness was 356.6±115.5µm in group 1, 375.1±112.5µm in group 2 and 284.4±98.9µm in group 3 (P: 0.071). Choroidal thickness (CT) in the nasal and temporal quadrants at the third postoperative month was also similar (P: 0.210, P: 0.103). CONCLUSIONS: The macular choroid is thicker in amblyopic eyes and non-amblyopic fellow eyes than in the nonamblyopic controls. Improved fixation after refractive surgery may normalize CT.

Long-term clinical outcomes of submacular blood removal with isolated autologous retinal pigment epithelium-choroid patch graft transplantation in long-standing large-sized submacular hematomas: An Indian experience.

Purpose: To study the outcomes of submacular blood removal with isolated autologous full-thickness retinal pigment epithelial (RPE)-choroid patch graft transplantation in long-standing large-sized submacular hematomas in Indian population. Methods: A retrospective study was done on eight consecutive patients of long-standing large-sized submacular hematoma from east India. In all cases, 23G vitrectomy was performed with the induction of retinal detachment (performed with or without 38G or 41G subretinal cannula) and a temporal 180° retinectomy was done. Submacular blood along with choroidal neovascular tissue was removed. A full-thickness RPE-choroid autologous patch graft was taken from a relatively healthy quadrant at the mid periphery and then the graft transferred under perfluorocarbon liquid (PFCL) to place it in the subfoveal area. Then, retina was re-attached using PFCL and laser completed. Silicone oil (5000 cst) was used as a tamponade. Post-operatively, wide-field fundus photographs (Optos), serial optical coherence tomography (OCT), indocyanine green angiography (ICGA), and multifocal electroretinography (ERG) were done. Results: The mean age of the patients at presentation was 67.88 ± 10.03 years. Mean pre-operative best corrected visual acquity (BCVA) was 2.64 ± 0.3 log MAR and mean postoperative BCVA was 1.095 ± 0.27 log MAR (P < 0.05). The mean follow-up was 20 ± 16.57 months. ICG showed re-vascularization of translocated graft in all at 2 months. Multifocal ERG (after 6 months) showed some waveform in all. None of the cases developed re-bleed. Conclusion: Removal of submacular blood and neovascular membrane with autologous RPE-choroid graft is a viable option in cases with long-standing large submacular hematomas.

Intraocular Pressure Peaks After Suprachoroidal Stent Implantation.

PRéCIS:: Retrospective analysis of 38 suprachoroidal glaucoma stent implantations showed sudden intraocular pressure (IOP) elevations to >30 mm Hg in 37% of eyes, 39% needing additional glaucoma surgery, and a success rate at 12 months of 24%. PURPOSE: To study the efficacy and safety of suprachoroidal stent in everyday clinical practice at a tertiary glaucoma center. MATERIALS AND METHODS: This retrospective single-center consecutive case series involved patients treated at Helsinki University Hospital with the CyPass Micro-Stent. Preoperative IOP was ≥18 mm Hg. Success was IOP between 6 and 18 mm Hg and lowering of IOP at least 20% from baseline without an increase in glaucoma medications over baseline or use of oral acetazolamide, and no subsequent glaucoma surgery. RESULTS: Of the total 38 eyes of 33 patients, 17 had primary open-angle glaucoma, 16 had exfoliative glaucoma, 2 each had uveitic glaucoma or steroid-induced glaucoma, and 1 had pigmentary glaucoma. Median preoperative IOP was 25.8 [interquartile range (IQR), 9.7] mm Hg with a median of 3 (IQR, 2) glaucoma medications. Kaplan-Meier estimate of median survival time was 79 days (95% confidence interval, 37-121 d). Success rate at 12-month follow-up was 24%. Sudden IOP elevation to over 30 mm Hg occurred in 14 eyes (37%). Highest IOP was 68 mm Hg. IOP peaks occurred between 1 week and 8 months after the surgery. In total, 43% of those with IOP elevation to >30 mm Hg had no symptoms. After the CyPass implantation, 15 eyes (39%) needed additional glaucoma surgery within a median of 167 (IQR, 109) days. CONCLUSIONS: Suprachoroidal stenting in a heterogenous clinical population resulted in a high incidence of sudden IOP peaks with a low success rate.

Coats retinopathy with pachychoroid and central serous chorioretinopathy in the fellow eye.

A 37-year-old man presented with blurring of vision and scotoma in the left eye since last 2 weeks and has a history of poor vision in his right eye since childhood. On examination, his best corrected visual acuity in the right eye was counting finger 1 m and 20/20, N/12 in the left eye. Fundus examination revealed features of Coats disease in the right eye and central serous chorioretinopathy (CSCR) in the left eye. He was given intravitreal triamcinolone acetonide injection in the right eye for reducing subretinal exudation. Simultaneously, focal laser photocoagulation was done to the CSCR leaks in the left eye to prevent the possible worsening of CSCR due to steroid injection in the fellow eye. He underwent cryotherapy to the retinal telangiectatic vessels 3 weeks after steroid injection in the right eye. Optical coherence tomography (OCT) of both eyes showed pachy vessels with a compression of overlying choriocapillaries. After 1 month, the condition of the right eye was unchanged and the CSCR in the left eye was completely resolved with the recovery of near visual acuity.

Efficacy of Combined Suprachoroidal Stent and Cataract Surgery in Patients With Glaucoma.

PURPOSE: The purpose of this study was to evaluate the efficacy of intraocular pressure (IOP) control after combined CyPass Micro-Stent implantation and cataract surgery (combined surgery). METHODS: All cases of combined surgery performed from February 2017 to July 2018 at Stein and Doheny Eye Institutes were reviewed. The primary outcome was a qualified success with stratified IOP targets based on criteria: final IOP (A) ≤18 mm Hg and reduction of 20%, (B) ≤15 mm Hg and reduction of 25%, (C) ≤12 mm Hg and reduction of 30%. Secondary outcome measures included postoperative IOP and number of medications, complications, additional glaucoma surgery, and postoperative refractive error. Predictive factors for failure were investigated. IOP spike was defined as a postoperative IOP ≥30 or >10 mm Hg increase from preoperative IOP. RESULTS: One hundred forty-one eyes (107 patients) were included. Mean (±SD) preoperative IOP was 15.4±3.4 mm Hg on an average of 2.2±1.1 medications. A statistically significant reduction in IOP and number of medications was seen at 12 months (13.8±4.2 mm Hg, 1.3±1.3 medications, P<0.001). Fifteen eyes (10.6%) had a postoperative IOP spike. Thirteen eyes (9.2%) experienced 17 complications (12.1%). Additional glaucoma surgery was performed in 3 eyes (2 patients). Cumulative success rates at 1 year based on criteria A, B, and C were 42%, 33%, and 28%, respectively. Lower preoperative IOP, greater preoperative medication number, the occurrence of postoperative IOP spike, and non-Caucasian ethnicity were associated with failure. CONCLUSION: Combined CyPass Micro-Stent implantation and cataract surgery may reduce glaucoma medication burden with a success rate of 28% to 42% at 1 year.

Changes in choriocapillaris and retinal morphology after laser photocoagulation by OCT angiography: A case report.

RATIONALE: Earlier studies have shown that laser photocoagulation treatments are associated with good long-term visual acuity in most patients with severe nonproliferative diabetic retinopathy (S-NPDR). Histopathologic studies of autopsied eyes have demonstrated defects in the choriocapillaris beneath the retinal laser lesions secondary to photocoagulation for S-NPDR. These lesions have been observed to expand centrifugally over time especially in the posterior pole, and the atrophy of the retinal pigment epithelium (RPE) can be significantly enlarged. There are, however, limited studies detailing the in vivo changes that occur in the RPE and choriocapillaris following laser photocoagulation. PATIENT CONCERNS: A 46-year-old woman presented with visual disturbances in both eyes. DIAGNOSES: Fundus examinations showed many retinal hemorrhages and soft exudates in the four quadrants due to S-NPDR. INTERVENTIONS: Laser photocoagulations with a 532-nm wavelength argon laser with power of 170 to 230 mW and spot size of 200 µm were performed to treat the S-NPDR. The changes in the choriocapillaris and retinal vasculature were followed by optical coherence tomography (OCT) angiography. OUTCOMES: The choriocapillaris beneath the laser spots was disrupted from 1 hour following the photocoagulation but it was restored at week 2. The choriocapillaris appeared almost normal at some laser spots, but they were still some spots that were altered at 1 year. The outer retina and RPE were disrupted beneath the laser spots at 1 year. On the contrary, there were no visible retinal vascular changes in the superficial and deep plexuses of retinal vasculature determined by OCT angiography with manual and automated segmentation. LESSONS: The choriocapillaris in human eyes can recover after laser photocoagulation although the outer retina and RPE remain disrupted and do not recover.

Two-Year Efficacy of Ranibizumab Plus Laser-Induced Chorioretinal Anastomosis vs Ranibizumab Monotherapy for Central Retinal Vein Occlusion: A Randomized Clinical Trial.

Importance: Adding a laser-induced chorioretinal anastomosis (L-CRA) to current treatments for central retinal vein occlusion (CRVO) may improve outcomes and lessen therapy burdens. Objective: To determine the 2-year efficacy of intravitreal ranibizumab with an L-CRA vs ranibizumab alone for patients with macular edema caused by CRVO. Design, Setting, and Participants: In this randomized clinical trial conducted at a single university clinic from March 2012 to June 2015, 58 participants with macular edema caused by CRVO were randomized 1:1 to either an L-CRA or sham procedure at baseline. All participants received monthly intravitreal injections of ranibizumab, 0.5 mg. Data were analyzed from April 2017 to September 2017. Interventions: Random assignment to L-CRA plus monthly injections of intravitreal ranibizumab, 0.5 mg, (combination group; n = 29) or to a sham L-CRA procedure plus monthly injections of intravitreal ranibizumab, 0.5 mg, (ranibizumab alone group; n = 29) for 6 months. From month 7 to month 24, participants were evaluated monthly and received an injection of ranibizumab if a loss of 5 or more letters of best-corrected visual acuity (BCVA) on ETDRS chart from previous highest score occurred or if there was evidence of residual macular edema on optical coherence tomography. Main Outcomes and Measures: Mean number of injections from month 7 to month 24, change in BCVA, and change in central subfield thickness (CST). Results: Of the 58 included participants, 38 (66%) were men, and the mean (SD) age was 68.6 (11.8) years; participants had a mean (SD) BCVA of 57.09 (11.87) ETDRS letters (Snellen equivalent, 20/73) and a mean (SD) CST of 738.36 (175.54) µm. A successful L-CRA was created in 24 of 29 participants (83%) in the combination group. The mean number of injections from month 7 to month 24 was 3.2 (95% CI, 2.5-3.8) in the combination group and 7.1 (95% CI, 6.0-8.0) in the ranibizumab alone group. The ratio of the number of injections in the combination group compared with the ranibizumab alone group was 0.46 (95% CI, 0.36-0.61; P < .001). Mixed-effects regression modeling showed a difference in mean BCVA at 2 years between the combination and ranibizumab alone groups (combination, 70.3 letters [Snellen equivalent, 20/40]; ranibizumab alone, 61.6 letters [Snellen equivalent, 20/60]; difference, 8.8 letters; 95% CI, 0.2-17.3; P = .05). There was also a difference in CST at 2 years between the combination and ranibizumab alone groups (mean CST: combination, 303.6 µm; ranibizumab alone, 394.5 µm; difference, 90.9 µm; 95% CI, 24.3-157.5; P = .01). Four participants (14%) in the combination group required a vitrectomy for early macular traction or vitreous hemorrhage. Conclusions and Relevance: For macular edema caused by CRVO, an L-CRA significantly reduced the number of ranibizumab injections required. Trial Registration: anzctr.org.au Identifier: ACTRN12612000004864.

Choroidal vascularity index changes after vitreomacular surgery.

PURPOSE: To study the structural changes in the choroid using swept-source (SS) optical coherence tomography (OCT), a tool for the choroidal vascularity index (CVI) following epiretinal membrane removal. METHODS: Fifty-two eyes of 26 patients were evaluated in this prospective, single-centre, observational study. Twenty-six eyes underwent vitrectomy for epiretinal membrane removal (VT-group), and the control group consisted of 26 corresponding fellow eyes (F-group). All patients were evaluated at baseline, 30 and 90 days postsurgery. Using a modified image binarization algorithm for SS-OCT scans, the subfoveal choroidal area was segmented into the luminal and stromal areas, and the CVI was measured by calculating the proportion of the luminal area (LA) to the cross-sectional choroid area. RESULTS: The mean CVI in the VT-group was 63.86 ± 4.04% at the baseline, 62.45 ± 4.21% at 30 days postsurgery and 61.06 ± 3.79% at 90 days (p < 0.001). The F-group had a mean CVI of 61.12 ± 2.29% at the baseline, 60.91 ± 2.25% at 30 days postsurgery and 61.05 ± 2.28% at 90 days (p = 0.29). CONCLUSION: The CVI decreases following epiretinal membrane removal when compared to the fellow eyes, which suggests structural changes in the vascular layers of the choroid. The implication of these results may be that secondary inflammation resulting from mechanical traction induces choroidal thickness by way of increased vascularization of the choroid.

Vitreous levels of apolipoprotein A1 and retinol binding protein 4 in human rhegmatogenous retinal detachment associated with choroidal detachment.

Purpose: This study aims to quantify the concentration of apolipoprotein A1 (APOA1) and retinol binding protein (RBP4) expressed in the vitreous humors of patients with rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD), rhegmatogenous retinal detachment (RRD), and idiopathic epimacular membrane (IEM). This study also aims to investigate the potential role of APOA1 and RBP4 as biomarkers of RRDCD. Methods: Enzyme-linked immunosorbent assay (ELISA) kits were used to obtain levels of APOA1 and RBP4 from the vitreous humor samples of 76 primary patients. These patients included 23 patients with RRDCD, 28 patients with RRD, and 24 patients with IEM. All patients were undergoing planned pars plana vitrectomy. The differences between the concentrations of the molecular biomarkers among different patient groups were analyzed using the Mann-Whitney U-test for nonparametric values and independent samples t-test or one-way ANOVA analysis for parametric data. The relationship between the molecular biomarkers, grades of proliferative vitreoretinopathy (PVR), and quadrants of retinal detachment were analyzed using nonparametric Spearman's rank correlation analysis. Results: The vitreous concentrations of APOA1 and RBP4 were statistically significantly higher in the RRDCD group compared to the RRD and IEM groups. Patients with severe PVR demonstrated a higher concentration of APOA1 and RBP4 compared to those with mild PVR, but this finding was not statistically significant. There was a statistically significant positive correlation between APOA1 and RBP4 in the RRDCD and RRD groups. Nonparametric Spearman's rank correlation analysis revealed that levels of APOA1 and RBP4 increased statistically significantly with an increasing number of detached retinal quadrants in the RRDCD and RRD groups. Conclusions: The findings of this study allude to the potential of APOA1 and RBP4 as specific biomarkers of RRDCD. The findings of this study may contribute to increased understanding regarding the role of APOA1 and RBP4 in RRDCD.

Safety Studies for a 44-Channel Suprachoroidal Retinal Prosthesis: A Chronic Passive Study.

Purpose: Following successful clinical outcomes of the prototype suprachoroidal retinal prosthesis, Bionic Vision Australia has developed an upgraded 44-channel suprachoroidal retinal prosthesis to provide a wider field of view and more phosphenes. The aim was to evaluate the preclinical passive safety characteristics of the upgraded electrode array. Methods: Ten normal-sighted felines were unilaterally implanted with an array containing platinum electrodes (44 stimulating and 2 returns) on a silicone carrier near the area centralis. Clinical assessments (color fundus photos, optical coherence tomography, full-field electroretinography, intraocular pressure) were performed under anesthesia prior to surgery, and longitudinally for up to 20 weeks. Histopathology grading of fibrosis and inflammation was performed in two animals at 13 to 15 weeks. Results: Eight animals showed safe electrode array insertion (good retinal health) and good conformability of the array to the retinal curvature. Eight animals demonstrated good mechanical stability of the array with only minor (<2 disc diameters) lateral movement. Four cases of surgical or stability complications occurred due to (1) bulged choroid during surgery, (2) hemorrhage from a systemic bleeding disorder, (3) infection, and (4) partial erosion of thin posterior sclera. There was no change in retinal structure or function (other than that seen at surgery) at endpoint. Histopathology showed a mild foreign body response. Electrodes were intact on electrode array removal. Conclusions: The 44-channel suprachoroidal electrode array has an acceptable passive safety profile to proceed to clinical trial. The safety profile is expected to improve in human studies, as the complications seen are specific to limitations (anatomic differences) with the feline model.

Prophylactic Chorioretinectomy in Open Ocular Trauma: A Series of 36 Eyes.

PURPOSE: The aim of this paper was to report the outcomes of prophylactic chorioretinectomy in open-globe injuries where a foreign body penetrated the choroid or perforated the globe. METHODS: We conducted a retrospective, consecutive, noncomparative, and descriptive study of patients registered in the ocular trauma database between January 2006 and December 2014, who underwent vitrectomy with chorioretinectomy. RESULTS: Thirty-six patients (33 male, 3 female) with a mean age of 40 years and a median of follow-up of 13 months were included. Twenty-one cases had penetrating globe injuries with an intraocular foreign body and 15 cases had perforating globe injuries. A concomitant chorioretinectomy was performed in all eyes, although it was only partial in 8 eyes. At the end of follow-up, proliferative vitreoretinopathy (PVR) rates were 6.5%, anatomical success was 80.6%, and the globe survival rate was 96.8%. CONCLUSION: Prophylactic chorioretinectomy is a surgical procedure that may decrease posttraumatic PVR, thus improving final visual acuity and increasing globe survival rates.