Adjunctive dexamethasone implant in patients with atopic dermatitis and retinal detachment undergoing vitrectomy and silicone oil tamponade: an interventional case series.

BACKGROUND: To report the clinical course and outcomes of adjunctive dexamethasone implants in patients with atopic dermatitis (AD) and retinal detachment (RD) undergoing vitrectomy and silicone oil tamponade. METHODS: This retrospective, interventional case series included AD patients with RD and various degrees of proliferative vitreoretinopathy (PVR) who were scheduled to undergo vitrectomy. Following total vitrectomy and retinopexy, silicone oil tamponade was performed. Finally, an intraocular dexamethasone implant was injected intravitreally. Anatomical and functional outcomes were assessed at 12 months, and extended follow-up data were also collected. RESULTS: Seven eyes from six patients (five male, one female) were included. The median age was 29 (range, 20-38) years. Preoperatively, six eyes were pseudophakic, two eyes had a history of previous vitreoretinal surgery, and one had uveitis. Postoperatively, best-corrected visual acuity improved in two eyes, worsened in one, and remained similar in four. Retinal attachment was maintained in all eyes at 12 months. The major complication was an increase in postoperative intraocular pressure in six eyes, requiring either medical or surgical treatment. During the extended follow-up period (15-37 months), retinas remained attached in all eyes and stable visual acuity was maintained in five. CONCLUSIONS: Injection of an intraoperative dexamethasone implant to silicone oil-filled eyes appears tolerable and may be beneficial in the surgical management of AD patients with RD and PVR.

PREDICTORS OF REFRACTORY MACULAR EDEMA AFTER BRANCH RETINAL VEIN OCCLUSION FOLLOWING INTRAVITREAL BEVACIZUMAB.

PURPOSE: To evaluate the predictors of refractory macular edema (ME) that develops despite multiple bevacizumab injections in patients with branch retinal vein occlusion (BRVO). METHODS: A total of 107 patients who followed at least 2 years were assigned to 2 groups: a refractory group (n = 56) and a responsive group (n = 51). Baseline characteristics, treatment response at 3 months, and fluorescein angiographic findings at 6 months were compared. Then we tried to identify factors associated with refractory ME development. RESULTS: Compared to the responsive group, the refractory group had older age, longer pre-treatment duration, and shorter occlusion distance from disk. At 3 months, the refractory group exhibited lower visual acuity, thicker central retinal thickness (CRT), and larger proportion of external limiting membrane (ELM) and outer plexiform layer disruption. After 6 months, proportion of unresolved vein occlusion, macular ischemia, number of microaneurysms, and non-perfusion areas were higher in the refractory group. Refractory ME was associated with pre-treatment duration ≥3 months, short occlusion distance from disk, thick CRT and ELM disruption at 3 months, and unresolved vein occlusion at 6 months. CONCLUSION: If BRVO-ME patients exhibit the above-mentioned characteristics, they may have refractory ME, which should inform treatment decisions.

Highly suspected primary intraocular lymphoma in a patient with rheumatoid arthritis treated with etanercept: a case report.

BACKGROUND: To describe a case of highly suspected primary intraocular lymphoma (PIOL) in a patient using etanercept for the treatment of rheumatoid arthritis. CASE PRESENTATION: A 50-year-old female patient presented with decreased vision in her left eye that lasted for a week. She had a 15-year history of seropositive rheumatoid arthritis (RA), and had been taking weekly etanercept for the preceding 8 months. Funduscopic examination and SD-OCT showed a swollen ellipsoid zone (EZ) and a retinal pigment epithelium (RPE) irregularity of the right eye. We also noted EZ disruption and a RPE irregularity in the left eye. As subretinal infiltration was aggravated in the right eye after the initial treatment, we completed a vitrectomy. Vitreous cytology revealed PIOL with positive CD20 immunostaining. She was treated with serial intravitreal methotrexate injections and systemic chemotherapy. After the treatment, subretinal infiltration and subRPE deposits were decreased in the right eye with no evidence of recurrence in either eye. CONCLUSIONS: This case suggests a potential relationship between immunosuppression with anti-TNFα medication, and increased risk for lymphoma, especially in patients with underlying rheumatologic disorders and especially in patients with suspected chronic refractory uveitis.

Uveoretinal Adverse Effects Presented during Systemic Anticancer Chemotherapy: a 10-Year Single Center Experience.

BACKGROUND: The present study describes our 10-year experience with uveoretinal adverse events that manifest because of chemotherapy. METHODS: A retrospective chart review was performed for all patients who presented to the ophthalmologic department while undergoing systemic chemotherapy between July 2005 and June 2015. RESULTS: A total of 55 patients (mean age, 51.2 years, 38 women [69.1%]) suspected of having uveoretinal disease owing to the use of chemotherapeutic agents alone were enrolled. Breast cancer was the predominant disease (36.4%); noninfectious anterior uveitis (21.8%) was the most common condition. Bilateral involvement was observed in 16 patients (29.1%). Although cisplatin (21.8%) was the most commonly used drug, daunorubicin, cytarabine, tamoxifen, toremifene, and imatinib were also frequently used. The median duration until ophthalmologic diagnosis was 208.5 days (range, 19-5,945 days). The proportion of patients with final visual acuity (VA) < 20/40 Snellen VA (0.5 decimal VA) was 32.7%. However, no relationship was observed between final VA < 20/40 and age, sex, therapeutic agents, and metastasis. CONCLUSION: Uveoretinal complications were mostly mild to moderate and exhibited a favorable response to conservative therapy. A considerable number of patients exhibited significant irreversible loss of vision after cessation of the causative chemotherapeutic agent. Ophthalmological monitoring is required during chemotherapy.

Improved Visual Outcome and Low Recurrence with Early Treatment with Intravitreal Anti-Vascular Endothelial Growth Factor in Myopic Choroidal Neovascularization.

PURPOSE: The aim of this study was to determine the correlation between the duration of myopic choroidal neovascularization (CNV) and treatment outcome after anti-vascular endothelial growth factor (VEGF) injections. METHODS: We performed a retrospective review of treatment-naïve myopic CNV patients who were treated with anti-VEGF and followed for at least 24 months to identify factors predicting final outcome and recurrence. RESULTS: Among 106 eyes, a shorter duration of CNV was a significant predictor of a better final best-corrected visual acuity, even after controlling for other factors (p = 0.042). When divided into 3 groups according to CNV duration before treatment (<2, 2-8, and 8-24 weeks), the recurrence rate (19, 25, and 52%, respectively; p = 0.006) and number of injections (3.5, 4.0, and 5.5, respectively; p = 0.021) were significantly lower in eyes with a shorter duration of CNV. CONCLUSIONS: Early anti-VEGF treatment of myopic CNV decreased the recurrence rate and number of injections and improved visual outcome.

Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response.

PURPOSE: To investigate the structural integrity of the superficial capillary plexuses (SCPs) and deep capillary plexuses (DCPs) using optical coherence tomography (OCT) angiography (OCTA) in patients with diabetic macular edema (DME) and its association with the response to anti-vascular endothelial growth factor (VEGF) treatment. DESIGN: Retrospective, case-control study. PARTICIPANTS: We included 51 DME eyes with a poor response to anti-VEGF agents and 32 age-matched DME eyes with a good response to anti-VEGF treatment, along with 20 fellow eyes without DME from the cases and controls. METHODS: The medical records, including OCTA and spectral-domain OCT (SD OCT), were reviewed and compared between the groups. En face OCTA images of the SCP and DCP were obtained for each eye. An anti-VEGF responder was defined by a reduction of more than 50 µm in central retinal thickness after 3 consecutive anti-VEGF treatments. A poor responder was defined by a reduction of less than 50 µm or an increase in central retinal thickness after 3 monthly injections. MAIN OUTCOME MEASURES: We measured the vascular density and foveal avascular zone (FAZ) area and counted the number of microaneurysms in each layer. The SD OCT images were compared with OCTA findings. RESULTS: Compared with non-DME eyes, DME eyes had a lower vascular density (P < 0.001) and larger FAZ area (P < 0.001) in the DCP and more microaneurysms (P < 0.001) in both layers. Although there was no significant difference in the SCP between anti-VEGF responders and poor responders, poor responders tended to show greater damage and more microaneurysms in the DCP (P < 0.001) and a larger FAZ area (P < 0.001). The topographic location of the disrupted synaptic portion of the outer plexiform layer (OPL) in SD OCT exactly corresponded to the nonflow area of the DCP in OCTA. CONCLUSIONS: Compared with DME eyes that responded to anti-VEGF treatment, poor responders show significant damage to the integrity of the DCP, but not the SCP. The degree of OPL disruption in SD OCT corresponds well with the extent of DCP loss in DME eyes. The extent of DCP loss and the corresponding OPL disruption could be useful predictors of responsiveness to anti-VEGF treatment.

Electromagnetic biaxial vector scanner using radial magnetic field.

We present an electromagnetic biaxial vector-graphic scanning micromirror. In contrast to conventional electromagnetic actuators using linear magnetic field, proposed device utilizes a radial magnetic field and uniquely designed current paths to enable the 2 degree-of-freedom scanning motion. As the radial field is generated by concentrically assembled magnets placed under the scanner die, large driving torque can be generated without the aid of hermetic packaging and relatively small device volume can be achieved. Mechanical half scan angle of 6.43° and 4.20° have been achieved at DC current of 250mA and 350mA for horizontal and vertical scans, respectively. Forced actuation along both scan axes has been realized by feedback control.

Electromagnetic biaxial microscanner with mechanical amplification at resonance.

We present the design, fabrication, and measurement results of an electromagnetic biaxial microscanner with mechanical amplification mechanism. A gimbaled scanner with two distinct single-crystal silicon layer thicknesses and integrated copper coils has been fabricated with combination of surface and bulk micromachining processes. A magnet assembly consisting of an array of permanent magnets and a pole piece has been placed under the substrate to provide high strength lateral magnetic field oriented 45° to two perpendicular scanning axes. Micromirror has been supported by additional gimbal to implement a mechanical amplification. A 1.2mm-diameter mirror with aluminum reflective surface has been actuated at 60Hz for vertical scan and at 21kHz for horizontal scan. Maximum scan angle of 36.12° at 21.19kHz and 17.62° at 60Hz have been obtained for horizontal and vertical scans, respectively.

Acceleration of Bone Regeneration by BMP-2-Loaded Collagenated Biphasic Calcium Phosphate in Rabbit Sinus.

PURPOSE: The objective of this study was to determine the effectiveness of collagenated biphasic calcium phosphate (CBCP) as a carrier for bone morphogenetic protein-2 (BMP-2) at the early stage of healing in rabbit sinus. MATERIAL AND METHODS: In 16 rabbits, BMP-2-loaded CBCP was grafted into one sinus (the BMP group) and saline-soaked CBCP was grafted into another sinus (the CTL group). The groups were assigned randomly. After 2 weeks (n = 8) or 4 weeks (n = 8), radiographic and histological analysis was performed. RESULTS: Total augmented volume was significantly larger in the BMP group at both healing periods. Furthermore, new bone volume was significantly greater in the BMP group at 4 weeks. Marked bone formation near the schneiderian membrane was found in the BMP groups at the early healing period. At 4 weeks, evenly distributed new bone was observed in the BMP group, whereas the new bone was sparsely distributed in the central portion in the CTL group. CONCLUSION: It can be concluded that the addition of BMP-2 to CBCP resulted in a greater initial augmented volume as a result of postoperative swelling, which is replaced by early bone formation, and it was prominent near the Schneiderian membrane.

Anti-inflammatory effect of (-)-epigallocatechin-3-gallate on Porphyromonas gingivalis lipopolysaccharide-stimulated fibroblasts and stem cells derived from human periodontal ligament.

PURPOSE: (-)-epigallocatechin-3-gallate (EGCG) has been reported to exert anti-inflammatory and antibacterial effects in periodontitis. However, its exact mechanism of action has yet to be determined. The present in vitro study evaluated the anti-inflammatory effects of EGCG on human periodontal ligament fibroblasts (hPDLFs) and human periodontal ligament stem cells (hPDLSCs) affected by bacterial lipopolysaccharide (LPS) extracted from Porphyromonas gingivalis. METHODS: hPDLFs and hPDLSCs were extracted from healthy young adults and were treated with EGCG and/or P. gingivalis LPS. After 1, 3, 5, and 7 days from treatment, cytotoxic and proliferative effects were evaluated using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and bromodeoxyuridine assay, respectively. And then, the gene expressions of hPDLFs and hPDLSCs were observed for interleukin (IL)-1ß, IL-6, tumor necrosis factor (TNF)-α, osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL), and RANKL/OPG using real-time polymerase chain reaction (PCR) at 0, 6, 24, and 48 hours after treatment. The experiments were performed with the following groups for hPDLFs and hPDLSCs; 1) No treat, 2) EGCG alone, 3) P. gingivalis LPS alone, 4) EGCG+P. gingivalis LPS. RESULTS: The 20 µM of EGCG and 20 µg/mL of P. gingivalis LPS had the lowest cytotoxic effects, so those concentrations were used for further experiments. The proliferations of hPDLFs and hPDLSCs increased in all groups, though the 'EGCG alone' showed less increase. In real-time PCR, the hPDLFs and hPDLSCs of 'EGCG alone' showed similar gene expressions to those cells of 'no treat'. The gene expressions of 'P. gingivalis LPS alone' in both hPDLFs and hPDLSCs were highly increased at 6 hours for IL-1ß, IL-6, TNF-α, RANKL, and RANKL/OPG, except the RANKL/OPG in hPDLSCs. However, those increased gene expressions were down-regulated in 'EGCG+P. gingivalis LPS' by the additional treatment of EGCG. CONCLUSIONS: Our results demonstrate that EGCG could exert an anti-inflammatory effect in hPDLFs and hPDLSCs against a major pathogen of periodontitis, P. gingivalis LPS.

Effect of (-)-epigallocatechin-3-gallate on maintaining the periodontal ligament cell viability of avulsed teeth: a preliminary study.

PURPOSE: Avulsed tooth can be completely recovered, if sound periodontal ligament (PDL) of tooth is maintained. Although a lot of storage solutions have been explored for the better storage of avulsed tooth, there is a shortcoming that the preservation time is much short. On the other hand, there has been studies that (-)-epigallocatechin-3-gallate (EGCG), the most abundant polyphenol in green tea, which is related to the anti inflammatory, antioxygenic, and antibacterial effects, allows the successful preservations of tissues and cells. This study evaluated the effect of EGCG on avulsed-teeth preservation of Beagle dogs for a period of time. METHODS: The atraumatically extracted teeth of Beagle dogs were washed and preserved with 0/10/100 µM of EGCG at the time of immediate, period 1 (4 days in EGCG-contained media and additional 1 day in EGCG-free media), period 2 (8 days in EGCG-contained media and additional 2 days in EGCG-free media) and period 3 (12 days in EGCG-contained media and additional 2 days in EGCG-free media). Then, the cell viabilities of preserved teeth was calculated by dividing optical density (OD) of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay with OD of eosin assay to eliminate the measurement errors caused by the different tissue volumes. RESULTS: From the results, the immediately analyzed group presented the highest cell viability, and the rate of living cells on teeth surface decreased dependent on the preservation period. However, the 100 µM of EGCG-treated group showed statistically significant positive cell activity than EGCG-free groups throughout preservation periods. CONCLUSIONS: Our findings showed that 100 µM EGCG could maintain PDL cell viability of extracted tooth. These results suggest that although EGCG could not be a perfect additive for tooth preservation, it is able to postpone the period of tooth storage. However, further in-depth studies are required for more plausible use of EGCG.