Secondary in-the-bag Intraocular Lens Implantation in Aphakic Eyes After Vitrectomy and Silicone Oil Tamponade for Rhegmatogenous Retinal Detachment.

PURPOSE: To describe a novel technique for capsular bag reopening and secondary in-the-bag intraocular lens (IOL) implantation in aphakic eyes after vitreoretinal surgery and intraocular tamponade. METHODS: We enrolled 14 eyes of 14 patients who underwent primary vitreoretinal surgery with silicone oil tamponade for rhegmatogenous retinal detachment between September 2018 and September 2019. The novel technique was used for capsular bag reopening and foldable single-piece IOL implantation. Patients were followed up at least 24 weeks with routine ophthalmic examinations, corneal endothelial cell density, and IOL tilt and decentration measurement. RESULTS: The procedure was successfully completed in 13 cases; in one case, because of posterior capsular tear, the IOL was implanted with ciliary sulcus fixation. After a mean follow-up of 48.8 ± 14.8 (range, 24.9-65.9) weeks, the best-corrected visual acuity (before 20/76 Snellen, 0.63 ± 0.23 logarithm of the minimum angle of resolution equivalent and after 20/35 Snellen, 0.32 ± 0.32 logarithm of the minimum angle of resolution equivalent; P = 0.001) and spherical equivalent (before +8.22 ± 4.08, after -2.39 ± 1.77 D; P < 0.001) improved, intraocular pressure (before 15.93 ± 4.40, after 16.25 ± 4.25 mmHg; P = 0.743) remained unchanged. The IOL was well centered with a mean horizontal and vertical tilt of 0.5070 ± 0.3319° and 0.4652 ± 0.3465°, respectively, and decentration of 0.1705 ± 0.1334 mm and 0.1712 ± 0.1576 mm, respectively. CONCLUSION: With this technique, capsular bag reopening and secondary in-the-bag IOL implantation could be achieved in most cases with satisfactory visual outcome and IOL position.

Scleral Suture Intraocular Lens Fixation Under Microscope-Intraoperative Optical Coherence Tomography.

PURPOSE: The aim of this study was to evaluate the accessibility and potential value of intraoperative optical coherence tomography (iOCT) during scleral suture intraocular lens (IOL) fixation. METHODS: This was a prospective cohort study in the Department of Ophthalmology, Eye and ENT Hospital, Fudan University, China. Seven eyes with insufficient capsular support and undergoing two-point scleral suture IOL fixation were included. The potential value of iOCT was evaluated, as well as the safety and efficacy of the surgery. RESULTS: Seven eyes were included. With a tailor-made iOCT, the structure of the anterior segment could be clearly visualized during the surgery. Intraoperatively, iOCT helped locate the proper place for fixation and access the position of the IOL. After an average 4.43-month follow-up, the spherical equivalent changed significantly ( P < 0.001), but the intraocular pressure, best-corrected visual acuity, and endothelial cell density remained unchanged ( P > 0.05). The IOL was well-centered with a horizontal and a vertical tilt of 0.74 ± 0.60° and 1.13 ± 0.65°, and decentration of 0.28 ± 0.12 mm and 0.30 ± 0.13 mm. The estimated IOL-induced astigmatism was -0.11 diopters (D) ± 0.46 D. CONCLUSION: Real-time high-resolution images of the anterior segment acquired by the iOCT helped the surgeon to achieve satisfactory results in scleral suture IOL fixation.

Change in axial length after vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

BACKGROUND: We aimed to explore the changes in the axial length and related factors after vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS: This study retrospectively evaluated patients who underwent vitrectomy with silicone oil (SO) tamponade for RRD and subsequent silicone oil removal at our clinic. Using a Zeiss IOLMaster 700, axial length was measured before vitrectomy for RRD and SO removal. The change in axial length (ΔAL) was calculated, and multivariate binary logistic regression analysis was performed to investigate the potential correlation between ΔAL and clinical factors, such as preoperative hypotony, extreme myopia, age, macular involvement, choroidal detachment, operation duration, and operation history. RESULTS: In total, 213 eyes from 213 patients were included. The mean axial length changed significantly pre- and post-vitrectomy (25.98 ± 2.87 mm and 26.25 ± 3.07 mm, respectively, P < 0.001); the mean ΔAL was 0.37 ± 0.62 mm. Multivariate binary logistic regression analysis showed that preoperative hypotony and extreme myopia were significantly correlated with the ΔAL (P = 0.001 and P = 0.001, respectively). A higher proportion of hypotonic eyes had ΔAL ≥ 0.3 mm (33/76 in hypotony eyes and 32/137 in others; P = 0.003). A higher proportion of extremely myopic eyes also had a ΔAL ≥ 0.3 mm (23/46 in extremely myopic eyes and 42/167 in others; P = 0.002). CONCLUSION: For patients with RRD and cataracts, as axial length changed significantly after vitrectomy in those with hypotony or extreme myopia, secondary lOL implantation should be considered.

Alterations in the Retinal Vascular Network and Structure in MOG Antibody-Associated Disease: An Optical Coherence Tomography Angiography Study.

BACKGROUND: To determine retinal vessel density in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS: Twenty-five patients with MOGAD and 20 healthy participants were enrolled. Patients with MOGAD were divided into myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-positive eyes with a history of optic neuritis (ON; MOG-Ab-ON+ group) or without a history of ON (MOG-Ab-ON- group). Visual function, retinal vessel densities, and thickness were measured. RESULTS: The retinal nerve fiber layer, parafoveal ganglion cell and inner plexiform layers, and vessel densities in the peripapillary and parafoveal areas were significantly decreased in the MOG-Ab-ON+ eyes compared with healthy eyes and MOG-Ab-ON- eyes (all P < 0.05). An increasing number of ON episodes was associated with greater decreases in these variables (all P < 0.05). Visual field mean deviation was not significantly decreased in patients with a history of 1 or 2 episodes of ON, although the relative decreases in retinal nerve fiber layer thickness, parafoveal ganglion cell and inner plexiform layer thickness, peripapillary vessel density, and parafoveal vessel density reached 33.1%, 23.2%, 17.0%, and 11.5% (all P < 0.05), respectively, in eyes with 2 episodes of ON. The mean deviation was significantly correlated with peripapillary vessel density (P < 0.05) after adjustment for other variables. Best-corrected visual acuity was not significantly correlated with optical coherence tomography variables (all P > 0.05). CONCLUSIONS: MOG-Ab-associated ON was associated with significant decreases in retinal structure and vessel density, without significant deteriorations in visual function. The peripapillary vessel density might predict the visual outcomes in patients with MOG-Ab-associated ON.

Modified Intrascleral Fixation for Repositioning the Dislocated Single-Piece, Rigid PMMA Intraocular Lens.

PURPOSE: To describe a modified intrascleral fixation technique for repositioning single-piece rigid polymethyl methacrylate intraocular lenses (IOLs). METHODS: Four patients with dislocated IOLs were enrolled. Surgical modifications included using ≤1-mm scleral incision for haptic externalization, placing the IOL haptic placement in scleral tunnels, and using 8-0 absorbable sutures. Patients were followed up for 6 months with routine ophthalmic examinations, corneal endothelial cell counts, and ultrasound biomicroscopy (UBM). RESULTS: The mean follow-up time was 13.5 ± 5.45 months. The IOL was well centered and the spherical refraction improved (+10.25 ± 2.21 vs. -0.81 ± 1.59 D, P < 0.05), whereas the best-corrected visual acuity (pre 20/43 Snellen, 0.42 ± 0.33 logarithm of the minimum angle of resolution equivalent and post 20/36 Snellen, 0.31 ± 0.22 logarithm of the minimum angle of resolution equivalent; P = 0.235), intraocular pressure (pre 13.8 ± 3.21, post 13.55 ± 5.14 mmHg), corneal endothelium density (pre 2,423.8 ± 279.6/mm, post 2,280.25 ± 350.7/mm), and total astigmatism (pre -1.94 ± 0.43, post -1.69 ± 0.59 D) remained unchanged. The average horizontal and vertical IOL tilt was 0.33 ± 0.22° and 0.81 ± 0.38°, respectively. Intraocular lens decentration was 0.10 ± 0.03 mm horizontally and 0.13 ± 0.06 mm vertically. CONCLUSION: The modified intrascleral fixation technique shows encouraging midterm results in patients with dislocated single-piece, rigid polymethyl methacrylate IOLs. Larger samples and longer follow-up are required to confirm the outcomes of this technique.

Quantitative signs on ultrasound biomicroscopy images associated with the status of silicone oil emulsification within the eye.

OBJECTIVES: Silicone oil (SO) is a commonly used intraocular tamponade in the treatment of rhegmatogenous retinal detachment (RRD). SO emulsification is a common complication after SO injection. This study aimed to investigate correlations between SO emulsification signs on ultrasound biomicroscopy (UBM) and the real number/size of SO droplets. METHODS: An observational, cross-sectional study. Thirty-five RRD patients (19 males; 35 eyes) who underwent pars plana vitrectomy and SO injection were enrolled in the study. SO emulsification signs on UBM (endothelial deposits, floating droplets, ghost images, hyperoleon, anterior chamber angle impregnation, anterior iris surface impregnation, posterior iris surface impregnation and ciliary body impregnation) were acquired and quantified two days before SO removal, while real number/size of the SO droplets with a diameter in 0.4-20 µm in the first 2 mL washout fluid collected intraoperatively during SO removal were assessed by Coulter counter. Then the correlations between these values were explored. RESULTS: The grade of tissue impregnation and hyperoleon area in the anterior chamber demonstrated significant correlations with the number of large (5-20 µm) SO droplets (r = 0.336; P = 0.048 and r = 0.350; P = 0.039, respectively); however, no significant correlations were observed with the total number of droplets (0.4-20 µm)or the number of small (0.4-5 µm) droplets (both P ＞ 0.05). CONCLUSION: The UBM quantitative grade of tissue impregnation and hyperoleon area in the anterior chamber could provide a noninvasive overview of the actual degree of SO emulsification before SO removal surgery.

Effects of 12-week gait retraining on plantar flexion torque, architecture, and behavior of the medial gastrocnemius in vivo.

Objective: This study aims to explore the effects of 12-week gait retraining (GR) on plantar flexion torque, architecture, and behavior of the medial gastrocnemius (MG) during maximal voluntary isometric contraction (MVIC). Methods: Thirty healthy male rearfoot strikers were randomly assigned to the GR group (n = 15) and the control (CON) group (n = 15). The GR group was instructed to wear minimalist shoes and run with a forefoot strike pattern for the 12-week GR (3 times per week), whereas the CON group wore their own running shoes and ran with their original foot strike pattern. Participants were required to share screenshots of running tracks each time to ensure training supervision. The architecture and behavior of MG, as well as ankle torque data, were collected before and after the intervention. The architecture of MG, including fascicle length (FL), pennation angle, and muscle thickness, was obtained by measuring muscle morphology at rest using an ultrasound device. Ankle torque data during plantar flexion MVIC were obtained using a dynamometer, from which peak torque and early rate of torque development (RTD50) were calculated. The fascicle behavior of MG was simultaneously captured using an ultrasound device to calculate fascicle shortening, fascicle rotation, and maximal fascicle shortening velocity (Vmax). Results: After 12-week GR, 1) the RTD50 increased significantly in the GR group (p = 0.038), 2) normalized FL increased significantly in the GR group (p = 0.003), and 3) Vmax increased significantly in the GR group (p = 0.018). Conclusion: Compared to running training, GR significantly enhanced the rapid strength development capacity and contraction velocity of the MG. This indicates the potential of GR as a strategy to improve muscle function and mechanical efficiency, particularly in enhancing the ability of MG to generate and transmit force as well as the rapid contraction capability. Further research is necessary to explore the effects of GR on MG behavior during running in vivo.

Effects of different habitual foot strike patterns on in vivo kinematics of the first metatarsophalangeal joint during shod running-a statistical parametric mapping study.

Existing studies on the biomechanical characteristics of the first metatarsophalangeal joint (1st MTPJ) during shod running are limited to sagittal plane assessment and rely on skin marker motion capture, which can be affected by shoes wrapping around the 1st MTPJ and may lead to inaccurate results. This study aims to investigate the in vivo effects of different habitual foot strike patterns (FSP) on the six degrees of freedom (6DOF) values of the 1st MTPJ under shod condition by utilizing a dual-fluoroscopic imaging system (DFIS). Long-distance male runners with habitual forefoot strike (FFS group, n = 15) and rearfoot strike (RFS group, n = 15) patterns were recruited. All participants underwent foot computed tomography (CT) scan to generate 3D models of their foot. The 6DOF kinematics of the 1st MTPJ were collected using a DFIS at 100 Hz when participants performed their habitual FSP under shod conditions. Independent t-tests and one-dimensional statistical parametric mapping (1-d SPM) were employed to analyze the differences between the FFS and RFS groups' 1st MTPJ 6DOF kinematic values during the stance phase. FFS exhibited greater superior translation (3.5-4.9 mm, p = 0.07) during 51%-82% of the stance and higher extension angle (8.4°-10.1°, p = 0.031) during 65%-75% of the stance in the 1st MTPJ than RFS. Meanwhile, FFS exhibited greater maximum superior translation (+3.2 mm, p = 0.022), maximum valgus angle (+6.1°, p = 0.048) and varus-valgus range of motion (ROM) (+6.5°, p = 0.005) in the 1st MTPJ during stance. The greater extension angle of the 1st MTPJ in the late stance suggested that running with FFS may enhance the propulsive effect. However, the higher maximum valgus angle and the ROM of varus-valgus in FFS may potentially lead to the development of hallux valgus.

Effects of Barefoot and Shod Conditions on the Kinematics and Kinetics of the Lower Extremities in Alternating Jump Rope Skipping-A One-Dimensional Statistical Parameter Mapping Study.

PURPOSE: To explore the difference in the biomechanics of the lower extremity during alternating jump rope skipping (AJRS) under barefoot and shod conditions. METHODS: Fourteen experienced AJRS participants were randomly assigned to wear jump rope shoes or be barefoot (BF) during the AJRS at a self-selected speed. The Qualisys motion capture system and Kistler force platform were used to synchronously collect the ground reaction forces and trajectory data of the hip, knee, ankle, and metatarsophalangeal (MTP) joints. One-dimensional statistical parameter mapping was used to analyze the kinematics and kinetics of the lower extremity under both conditions using paired t-tests. RESULTS: Wearing shoes resulted in a significant decrease in the ROM (p < 0.001) and peak angular velocity (p < 0.001) of the MTP joint during the landing phase. In addition, the MTP joint power (p < 0.001) was significantly larger under shod condition at 92-100% of the landing phase. Moreover, wearing shoes reduced the peak loading rate (p = 0.002). CONCLUSION: The findings suggest that wearing shoes during AJRS could provide better propulsion during push-off by increasing the MTP plantarflexion joint power. In addition, our results emphasize the significance of the ankle and MTP joint by controlling the ankle and MTP joint angle.

Alpha 7-nicotinic cholinoceptor regulation of pericyte-containing retinal capillaries.

BACKGROUND AND PURPOSE: Local blood flow regulation relies on the coordination between neurons and pericyte-containing capillaries. Pericyte relaxation and contraction are influenced by vasoactive substances and regulated by neurotransmitters. α7 nicotinic acetylcholine receptors (α7-nAChRs), involved in the regulation of vascular function and inhibitory γ-aminobutyric acid (GABA) systems, have neuroprotective effects against CNS diseases. Although α7-nAChRs are found throughout the retina, their contribution to the retinal capillary tone remains unknown. Here, we investigated the neurovascular coupling mechanism underlying α7-nAChR-mediated retinal capillary tone regulation. EXPERIMENTAL APPROACH: Changes in capillary diameter and pericyte transverse diameter during drug perfusion were observed using differential interference contrast (DIC) microscopy, to help elucidate signalling pathways underlying α7-nAChR-mediated regulation of capillary blood flow at the whole retinal level. Patch clamp technique was used to investigate α7-nAChR-mediated regulation of the GABA synaptic circuit. Immunofluorescence was used to explore the expression of α7-nAChRs and GABA receptors. KEY RESULTS: Activating α7-nAChRs on the endothelial cell membrane caused perinuclear accumulation of endothelial nitric oxide synthase (eNOS), resulting in dilated retinal capillaries and pericytes via the nitric oxide synthase (NOS)/nitric oxide (NO)/guanosine 3',5'- monophosphate (cGMP) signalling pathway. Neuronal α7-nAChR activation directly relaxed retinal capillaries and pericytes via a neurovascular coupling mechanism. α7-nAChR also increased the vesicular release of GABA, possibly promoting the release of NO by binding to GABAA receptors in retinal ganglion cells (RGCs) and relaxing blood vessels via eNOS-NO, with GABA binding to GABAB receptors on retinal capillary endothelial cells. CONCLUSION AND IMPLICATIONS: α7-nAChR activation causes vasorelaxation of retinal capillaries.

The Effects of Habitual Foot Strike Patterns on the Morphology and Mechanical Function of the Medial Gastrocnemius-Achilles Tendon Unit.

As a crucial and vulnerable component of the lower extremities, the medial gastrocnemius-Achilles tendon unit (gMTU) plays a significant role in sport performance and injury prevention during long-distance running. However, how habitual foot strike patterns influence the morphology of the gMTU remains unclear. Therefore, this study aimed to explore the effects of two main foot strike patterns on the morphological and mechanical characteristics of the gMTU. Long-distance male runners with habitual forefoot (FFS group, n = 10) and rearfoot strike patterns (RFS group, n = 10) and male non-runners (NR group, n = 10) were recruited. A Terason uSmart 3300 ultrasonography system was used to image the medial gastrocnemius (MG) and Achilles tendon, Image J software to analyze the morphology, and a dynamometer to determine plantar flexion torque during maximal voluntary isometric contractions. The participants first performed a 5-minute warm up; then, the morphological measurements of MG and AT were recorded in a static condition; finally, the MVICs test was conducted to investigate the mechanical function of the gMTU. One-way ANOVA and nonparametric tests were used for data analysis. The significance level was set at a p value of <0.05. The muscle fascicle length (FL) (FFS: 67.3 ± 12.7, RFS: 62.5 ± 7.6, NRs: 55.9 ± 2.0, η2 = 0.187), normalized FL (FFS: 0.36 ± 0.48, RFS: 0.18 ± 0.03, NRs: 0.16 ± 0.01, η2 = 0.237), and pennation angle (PA) (FFS: 16.2 ± 1.9, RFS: 18.9 ± 2.8, NRs: 19.3 ± 2.4, η2 = 0.280) significantly differed between the groups. Specifically, the FL and normalized FL were longer in the FFS group than in the NR group (p < 0.05), while the PA was smaller in the FFS group than in the NR group (p < 0.05). Conclusion: Long-term running with a forefoot strike pattern could significantly affect the FL and PA of the MG. A forefoot strike pattern could lead to a longer FL and a smaller PA, indicating an FFS pattern could protect the MG from strain under repetitive high loads.

Outcomes of Secondary Intracapsular Intraocular Lens Implantation in Patients following Rhegmatogenous Retinal Detachment.

This study reports the outcomes of a secondary IOL implantation technique in patients that suffered from rhegmatogenous retinal detachment combined with a cataract, which included reopening the capsular bag, enabling secondary intracapsular intraocular lens (IOL) implantation. We included consecutive cases with rhegmatogenous retinal detachment (RRD) treated with vitrectomy and silicone oil tamponade, and subsequent secondary IOL implantation during silicone oil removal between September 2019 and June 2022. Demographics, pre- and postoperative clinical data, and complications were collected. Visual and refractive outcomes and IOL position were evaluated. Thirty eyes were included and followed up for a mean of 24.2 ± 5.06 months. Compared with the preoperative values, no significant changes were observed in the intraocular pressure (p = 0.170) and endothelial cell density (p = 0.336); however, the best-corrected visual acuity (Snellen: 20/83 vs. 20/38; logMAR: 0.66 ± 0.23 vs. 0.37 ± 0.32; p < 0.001) and spherical equivalent (p < 0.001) improved significantly. The mean prediction error (ME) was -0.45 ± 0.68 D (-1.9-0.54 D), and the mean absolute prediction error (MAE) was 0.62 ± 0.52 D (0.01-1.9 D). The macula-on subgroup demonstrated significantly better refractive outcomes than the macula-off subgroup (ME, p = 0.046; MAE, p = 0.008). The IOL was well positioned, with a mean horizontal and vertical tilt and decentration of 0.53 ± 0.49° and 0.21 ± 0.16 mm, and 0.54 ± 0.45° and 0.22 ± 0.16 mm, respectively. Secondary intracapsular IOL implantation provided a good and stable IOL position and satisfactory refractive outcomes, and is a feasible treatment option for patients with RRD.

Assessment of Silicone Oil Emulsification: A Comparison of Currently Applied Methods.

Purpose: To compare ultrasound biomicroscopy (UBM), Coulter counter, and B-scan ultrasonography in the evaluation of silicone oil (SO) emulsification. Methods: Patients who underwent primary pars plana vitrectomy with SO tamponade for rhegmatogenous retinal detachment and SO removal were included. UBM images were acquired before the SO removal, and B-scan images were taken after removal. The number of droplets in the first and last 2 mL of washout fluid was analyzed using a Coulter counter. The correlations between these measurements were analyzed. Results: Thirty-four eyes received both UBM and Coulter counter analysis for the first 2 mL of washout fluid, and 34 underwent B-scan and Coulter counter analysis of the last 2 mL washout fluid. The mean UBM grading was 26.41 ± 9.71 (range: 1-36); the mean SO index obtained with B-scan was 5.25 ± 5.00% (range: 0.10-16.49%), and the mean number of SO droplets was 1.26 ± 2.45 × 107/mL and 3.34 ± 4.22 × 106/mL in the first and last 2 mL of washout fluid, respectively. There were significant correlations between UBM grading and SO droplets in the first 2 mL and between B-scan grading and SO droplets in the last 2 mL (all P < 0.05). Conclusions: UBM, Coulter counter, and B-scan ultrasonography could all be used in the evaluation of SO emulsification, and their findings were comparable.

R-(+)-WIN55212-2 protects pericytes from ischemic damage and restores retinal microcirculatory patency after ischemia/reperfusion injury.

BACKGROUND AND PURPOSE: Cannabinoids are vasoactive substances that act as key regulators of arterial tone in the blood vessels supplying peripheral tissues and the central nervous system. This study aimed to investigate the potential of R-(+)-WIN55212-2 (WIN), a cannabinoid receptor 1 agonist (CB1), as a treatment for retinal ischemia/reperfusion (I/R) injury. EXPERIMENTAL APPROACH: Male Wistar rats were subjected to retinal I/R injury by increasing intraocular pressure in the anterior chamber. The rats were randomly divided into four groups: normal control, I/R, vehicle (pre-treated with dimethyl sulfoxide [DMSO] via intraperitoneal injection), and experimental (pre-treated with WIN at a dose of 1 ml/kg via intraperitoneal injection). The rats were sacrificed at different time points of reperfusion (1 hour, 3 hours, 6 hours, and 1 day) after inducing retinal I/R injury, and their retinas were collected for analysis. Oxygen-glucose deprived/reperfusion (OGD/R) was performed by initially perfusing the retinas with oxygenated artificial cerebrospinal fluid (ACSF), then switching to an OGD solution to simulate ischemia, followed by another perfusion with ACSF. Pericyte contraction and the "no-reflow" phenomenon were observed using infrared differential interference contrast (IR-DIC) microscopy and immunohistochemistry. Western blot, enzyme-linked immunosorbent assay (ELISA), and nitric oxide (NO) detection were used to explore the potential mechanism. KEY RESULTS: In both the OGD/R and I/R models, retinal pericytes exhibited persistent contraction even after reperfusion. The ability of WIN to regulate the tone of retinal pericytes and capillaries was specifically blocked by the BKCa inhibitor iberiotoxin (100 nM). WIN demonstrated a protective effect against retinal I/R injury by preserving blood flow in vessels containing pericytes. Pretreatment with WIN alleviated the persistent contraction and apoptosis of retinal pericytes in I/R-induced rats, accompanied by a reduction in intracellular calcium ion (Ca2+) concentration. The expression of CB1 decreased in a time-dependent manner in the I/R group. After I/R injury, endothelium-derived nitric oxide (eNOS) levels were reduced at all time points, which was successfully reversed by WIN therapy except for the 1 day group. Additionally, the downregulation of cyclic guanosine monophosphate (cGMP) and BKCa expression at 3 hours, 6 hours, and 1 day after I/R injury was restored by pretreatment of WIN. CONCLUSIONS & IMPLICATIONS: WIN exerted its protective effects on retinal I/R injury by inhibiting the contraction and apoptosis of pericytes through the CB1-eNOS-cGMP-BKCa signaling pathway, thus ameliorated the occlusion of retinal capillaries.

Silicone oil residual after vitrectomy for rhegmatogenous retinal detachment.

OBJECTIVE: To explore the presence of residual emulsified silicone oil (SO) droplets in patients with rhegmatogenous retinal detachment (RRD) and their possible risk factors. METHODS: Patients who underwent primary pars plana vitrectomy with SO injection for RRD and SO removal at the same eye centre were included. Approximately 10 weeks after SO removal, B-scan ultrasonography was performed, and using ImageJ, the silicone oil index (SOI) was measured, and its possible correlations with other clinical factors were explored. RESULTS: A total of 101 eyes were included. Residual SO particles were found in all the patients (100%), and the mean SOI was 4.04% ± 5.16% (range 0.06%-19.88%). Multiple linear regression revealed that, among all the clinical factors, axial length (AL) and ocular hypertension (intraocular pressure (IOP) > 21 mmHg or the use of antiglaucoma medications) before SO removal were positively and significantly associated with the SOI (all P < 0.05). Patients with ocular hypertension after SO removal had a higher SOI, a longer SO duration, a higher IOP before SO removal and a longer AL than those without (all P < 0.05). CONCLUSIONS: Patients with a larger AL and higher IOP before SO removal were more prone to have more residual SO droplets, which might in turn lead to an elevated IOP. In these eyes, thorough irrigation or repeated fluid-air exchange might be necessary.

Activation of the GABA-alpha receptor by berberine rescues retinal ganglion cells to attenuate experimental diabetic retinopathy.

Purpose: The aim of this study was to investigate the role and mechanism of berberine (BBR) in the protection of injured retinal ganglion cells (RGCs) in diabetic retinopathy (DR). Methods: Experimental diabetic retinopathy rat model was successfully induced by a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg) in male SD rats with sufficient food and water for 8 weeks. Animals were randomly divided into four groups: (1) non-diabetic, (2) diabetic, (3) diabetic + BBR + PBS, and (4) diabetic + BBR + SR95531. BBR (100 mg/kg) was given daily by gavage to rats in the group (3) and group (4) for 8 weeks, and weekly intravitreal injections were conducted to rats in the group (3) with 5 µL of 1×PBS and rats in the group (4) with 5 µL of GABA-alpha receptor antagonist SR95531 to investigate the underlying mechanisms. The survival and apoptosis of RGCs were observed by fluorescence gold labeling technology and TUNEL staining. Visual function was evaluated by visual electrophysiological examination. Western blotting and immunofluorescence staining were used to analyze the expression of GABA-alpha receptors in RGCs. Results: In an animal model, BBR can increase the survival of RGCs, reduce RGCs apoptosis, and significantly improve the visual function. The reduction of GABA, PKC-α, and Bcl-2 protein expression caused by DR can be considerably increased by BBR. SR95531 inhibits BBR's protective effect on RGC and visual function, as well as its upregulation of PKC-α and Bcl-2. Conclusion: BBR is a promising preventive or adjuvant treatment for DR complications, and its key protective effect may involve the regulation of RGC apoptosis through the GABA-alpha receptor/protein kinase C-alpha (GABAAR/PKC-α) pathway.

Alterations in the Retinal Vascular Network and Structure in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis: A Longitudinal OCTA Study.

PURPOSE: To investigate the longitudinal microstructural and microvascular changes in patients with myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) without new attacks. METHODS: We included 20 eyes of 12 MOG-ON patients without new attacks during the follow-up and 24 eyes of 12 age- and sex-matched healthy controls. RESULTS: The BCVA, retinal vessels and structure were significantly lower in MOG-ON eyes than in healthy eyes(all P < .05). In MOG-ON eyes, the BCVA (p = .408) and mean deviation (p = .854) were not significantly decreased at the follow-up visit. However, there were small, significant decreases in parafoveal vessel density (p = .026), peripapillary vessel density (p = .008), and RNFL thickness (p = .03), but not GCIPL thickness (p = .107). CONCLUSIONS: Ongoing deterioration was observed in RNFL thickness and parafoveal and peripapillary vessel density, but not GCIPL thinning, in MOG-ON eyes without a new attack of ON.

Internal Limiting Membrane Peeling and Flap Inverting under Air in Large Idiopathic Macular Hole Surgery.

PURPOSE: To evaluate the efficacy of internal limiting membrane (ILM) peeling combined with modified flap inverting under air in the treatment of large idiopathic macular hole (MH). METHODS: Eyes with a large idiopathic MH (minimum diameter >550 µm) were included in this study. The surgical procedure included standard 23-gauge pars plana vitrectomy (PPV), ILM peeling, complete fluid-gas exchange, and ILM flap inversion under air. The patients underwent follow-up exam including optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) measurement. RESULTS: Sixteen eyes from 16 patients were included. Mean MH diameter was 681.43 ± 112.12 µm. After a mean follow-up time of 6.25 ± 2.65 months, in all cases, the MH was closed, and the ILM flap could be seen at the inner surface of the fovea. U-shaped and V-shaped MH closure was achieved in 11 and 5 cases, respectively. The BCVA improved significantly from 1.49 ± 0.35 logMAR to 0.89 ± 0.35 logMAR (p < 0.05), and visual acuity of 20/100 or better was achieved in 8 eyes. CONCLUSION: ILM flap inverting under air was helpful in improving the functional and anatomic outcomes of vitrectomy for large idiopathic MH.

A Novel Screening Technique for Ulnar-Sided Carpometacarpal Dislocations.

Diagnosing ulnar-sided carpometacarpal joint dislocation is difficult, and more than half of injuries are missed on initial examination. The authors hypothesized that measuring the angle between the capitate and the metacarpals (capitate-metacarpal angle) on a plain radiograph would provide a simple, reliable tool to aid in the diagnosis of ulnar-sided carpometacarpal dislocation. This study retrospectively reviewed patients who underwent surgery for ulnar-sided carpometacarpal dislocation (study group). Two authors identified the contour of the capitate and the second, fourth, and fifth metacarpals on plain radiographs. The control group consisted of patients who had radiographs and no bony carpal or metacarpal pathology. Information on the contour of each bone was entered into MATLAB, version 8.5, software (MathWorks, Natick, Massachusetts), which calculated the 2-dimensional angles. A 3-dimensional model based on computed tomography scan data was used to obtain a "true lateral" image to account for variable rotation on plain radiographs. With the use of conventional lateral hand radiographs, the average capitate-metacarpal angle in the control group was 10° compared with 19° in the study group. Using a screening value of 15° on plain radiographs, the sensitivity of the capitate-metacarpal angle was 0.85 and the specificity was 0.79. Both 2-dimensional and 3-dimensional measurements showed that the angle between the capitate and the lesser metacarpals is a reliable screening tool for carpometacarpal dislocation. During evaluation of patients with posttraumatic hand pain, an increased capitate-metacarpal angle may indicate the need for advanced imaging studies to further evaluate the carpometacarpal joints. [Orthopedics. 2017; 40(2):e352-e356.].