Diabetic retinopathy remains the leading vascular-associated cause of blindness throughout the world. Its treatment requires a multidisciplinary interventional approach at both systemic and local levels. Current management includes laser photocoagulation, intravitreal steroids, and anti-vascular endothelial growth factor (VEGF) treatment along with systemic blood sugar control. Anti-VEGF therapies, which are less destructive and safer than laser treatments, are being explored as primary therapy for the management of vision-threatening complications of diabetic retinopathy such as diabetic macular edema (DME). This review provides comprehensive information related to VEGF and describes its role in the pathogenesis of diabetic retinopathy, and in addition, examines the mechanisms of action for different antiangiogenic agents in relation to the management of this disease. Medline (Pubmed) searches were carried out with keywords “VEGF”, “diabetic retinopathy”, and “diabetes” without any year limitation to review relevant manuscripts used for this article.
Diabetic retinopathy; VEGF; DME; diabetes; central retinal vein occlusion; PGF.
Posterior vitrectomy facilities are lacking in Sub Sahara Africa due to paucity of trained personnel in vitreo retinal subspecialty. More cases are seen needing vitrectomy, especially cases with vitreous opacities and complications of cataract surgery as more residents are being trained. The review will aim to determine whether vitrectomy facility should be a priority as part of ophthalmic facility in the region.
A 3 year review was carried out. All cases of posterior vitrectomy performed at the retinal unit of the University College Hospital, Ibadan, Africa between 2008 and 20011 were retrieved. Indications, and visual outcome were documented. Proportions and percentages were used to analyse the data.
Sixty six posterior vitrectomies were performed during the period. The most common indication for vitrectomy was vitreous hemorrhage n=30 [45.5%].Complication of cataract surgery such as dropped intraocular lens 7 [10.7%], sclera fixated intra ocular lens 6 [9.2%], and dropped nucleus 5 [7.5%] were emerging indications. Other indications noted include complicated retinal detachments 4 (6.1%), membranectomy for posterior capsule opacity from pediatric cataract surgery 3 (4.5%) and congenital lens subluxation 2 (3.0%). Improved visual outcome was noted after surgery. Forty nine [75%] eyes were blind [visual acuity of < 3/60] before vitrectomy. This proportion dropped to 24 [37%] after vitrectomy with an additional 24% regaining navigational vision [visual acuity of 3/60 to Counting fingers at 1meter] .
Vitrectomy should be an integral part of eye care and its availability should be made a priority in ophthalmic facilities of Sub Sahara Africa, especially those involved in ophthalmology training.
Cataract surgery complications; posterior vitrectomy; retinal; sub Sahara Africa; vitreous opacities.
To correlate inflammatory and proangiogenic key cytokines from undiluted vitreous of treatment-naïve central retinal vein occlusion (CRVO) patients with SD-OCT parameters.
Thirty-five patients (age 71.1 years, 24 phakic, 30 nonischemic) underwent intravitreal combination therapy, including a single-site 23-gauge core vitrectomy. Twenty-eight samples from patients with idiopathic, non-uveitis floaterectomy served as controls. Interleukin 6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF-A) levels were correlated with the visual acuity (logMar), category of CRVO (ischemic or nonischemic) and morphologic parameters, such as central macular thickness-CMT, thickness of neurosensory retina-TNeuro, extent of serous retinal detachment-SRT and disintegrity of the IS/OS and others.
The mean IL-6 was 64.7pg/ml (SD ± 115.8), MCP-1 1015.7 ( ± 970.1), and VEGF-A 278.4 ( ± 512.8), which was significantly higher than the control IL-6 6.2 ± 3.4pg/ml (P=0.06), MCP-1 253.2 ± 73.5 (P<0.0000001) and VEGF-A 7.0 ± 4.9 (P<0.0006). All cytokines correlated highly with one another (correlation coefficient r=0.82 for IL-6 and MCP-1; r=0.68 for Il-6 and VEGF-A; r=0.64 for MCP-1 and VEGF-A). IL-6 correlated significantly with CMT, TRT, SRT, dIS/OS, and dELM. MCP-1 correlated significantly with SRT, dIS/OS, and dELM. VEGF-A correlated not with changes in SD-OCT, while it had a trend to be higher in the ischemic versus the nonischemic CRVO group (P=0.09).
The inflammatory cytokines were more often correlated with morphologic changes assessed by SD-OCT, whereas VEGF-A did not correlate with CRVO-associated changes in SD-OCT. VEGF inhibition alone may not be sufficient in decreasing the inflammatory response in CRVO therapy.
Vitreous samples; CRVO; VEGF; MCP-1; IL-6; CBA; SD-OCT.
Choroidal Naevi are generally thought to be trivial. However, sometimes they cause visual loss, visual filed defect and rarely transform into malignant melanoma. We report the first case of unilateral numerous choroidal naevi in a healthy female associated with transient cystoid macular oedema and postulate about its pathogenesis.
Choroidal naevus; macular oedema; cystoid macular oedema.
To analize changing trends in indications and surgical techniques of corneal transplantation at an ophthalmological tertiary referral center in Colombia over a 7 year period.
A retrospective analysis was performed of medical records from patients who underwent corneal transplantation surgeries at Fundación Oftalmológica de Santander (FOSCAL) in Bucaramanga, Colombia, between August 2004 and August 2011.
During this period from a total of 450 corneal transplants performed, we had access to 402 medical records (89.4%). The patients’ mean age was 55. Leading indications were: pseudophakic/aphakic bullous kerathopathy (PBK/ABK) (34.6%), corneal scar (15.7%), active infectious keratitis (14.4%) and keratoconus (12.7%). During the first period (2004-2007) PBK/ABK was the leading indication, followed by stromal opacities and keratoconus. During the second period (2008-2011) PBK/ABK remained the leading indication. Infectious keratitis, however, became the second most common indication. Stromal opacities and keratoconus, moved to third and fourth, respectively. All transplants performed in the first period (2004-2007) were penetrating keratoplasties. In the second period (2008-2011) 18.7% of the procedures were performed using the Descemet’s stripping automated endothelial keratoplasty technique (DSAEK).
Similar to other international results, PBK/ABK was the leading indication for corneal transplantation at our institution. Keratoconus is becoming a less common indication for keratoplasty in our institution. Infectious keratitis remains a frequent indication for corneal transplantation in this geographical area. In our institution we started performing DSAEK in 2009, and it is emerging as the procedure of choice in corneal diseases that involve only the endothelial layers.
Corneal transplantation; penetrating keratoplasty; endothelial keratoplasty; lamellar keratoplasty; DSAEK
The prevalence of HIV/AIDS and HBsAg sero-positivity is very high in sub-Saharan African. There is a risk of horizontal transmission of these diseases amongst ophthalmic patients.
To determine the proportion patients for eye surgery who are HIV/AIDS and HBsAg sero-positive at the National Eye Centre, Kaduna, Nigeria.
Patients selected for eye surgery during a surgical camp at the National Eye Centre, Kaduna were counseled for Voluntary Counseling and Testing (VCT) and HBsAg to determine their viral status.
A total of 650 patients who were selected were screened. The distributions of the indications for selection were as follows: cataract 483 (74.3%); glaucoma 44 (6.8%) and pterygium 123 (18.9%). Two patients (0.2%) were found to be HIV seropositive while 11 (1.5%) were HbsAg positive.
Pre-operative screening of all patients going for ophthalmic surgery for HIV and HbsAg may be desirable in our environment.
HIV; HBsAg; ocular surgery; seroprevalence; Nigeria.
To evaluate the position stability of a phakic intraocular lens (Cachet pIOL; Alcon, Laboratories, Inc., Fort Worth, TX) in the anterior chamber (AC) during a 6-months follow-up.
Thirty eyes of 16 subjects underwent a Cachet pIOL implantation for the correction of high myopia from -6.50 to -16.00 D with plano targeted refraction. The position stability of the Cachet pIOL was evaluated using an Anterior Segment-OCT (AS-OCT, Carl Zeiss AG, Oberkochen, Germany) at 1- and 6-months postoperatively. Three measurements have been taken into account: 1) the minimum distance between the anterior surface of the Cachet pIOL optic disk and the central corneal endothelium; 2) the minimum distance between the optic disk’s edges of the pIOL and the endothelium; 3) the minimum distance between the posterior surface of the pIOL optic disk and the anterior surface of the crystalline lens. The endothelial cell density (ECD) was also recorded.
No statistically significant changes of the Cachet pIOL position in the AC were found during follow-up. The average changes were ≤0.1 mm between 1- and 6-months postoperatively (P>0.05). At the end of follow-up, The mean ECD loss was 0.7 % (from 2794 ± 337 cell/mm2 to 2776 ± 388 cell/mm2; P>0.05).
A high position stability of the Cachet pIOL in the anterior chamber was shown during a 6-months follow-up.
Phakic IOL; high myopia; cachet; anterior segment oct.
To determine the incidence of blindness secondary to idiopathic intracranial hypertension (IIH) in the United Kingdom.
New cases of blindness occurring secondary to IIH were identified prospectively through the British Ophthalmological Surveillance Unit (BOSU) from October 2005 to November 2006. Only idiopathic cases of intracranial hypertension and those meeting the World Health Organisation`s definition of blindness were included. Cases that were already blind or had already been blind registered before the study period were excluded.
There were 24 new cases of registerable blindness secondary to IIH reported during the 12 month period. Questionnaires were completed for 19 cases. Of these 19 cases, 3 were not truly idiopathic and 3 cases did not fulfil the strict criteria for blindness. One case was a duplicate report. There were 12 definite cases of blindness secondary to IIH giving a UK incidence of blindness secondary to IIH of 0.6-2% (assuming a UK population of 63.2 million and an incidence of IIH of 1-3/100,000). If the 5 cases reported as blind but without a completed questionnaire are assumed to be true cases then the incidence of blindness would be 1-3%.
The results of this study suggest that approximately 1-2% of new cases of IIH are likely to become blind in a given year. This contrasts with rates of between 4-10% reported previously in hospital-based studies, but may be a more accurate figure for the population as a whole. Under-ascertainment and improving standards of care may also have contributed to the lower figure than previously reported.
Blindness; intracranial hypertension; pseudotumour cerebri.
To evaluate the morphology of optic discs in eyes suffering from retinal vein occlusion (RVO) alone or in combination with primary open-angle glaucoma (POAG).
Prospective, observational study. 48 consecutive patients were enrolled, 30 with unilateral RVO diagnosis, 18 with unilateral retinal vein occlusion (RVO) associated with POAG. We divided RVOs on the basis of occlusion site: arterio-venous crossing (AV-RVO), optic cup (OC-RVO), optic nerve (ON-RVO) with head nerve swelling (ONHS-RVO) or without it (NONHS-RVO). A control group of 25 patients who were sex and age matched was selected.
Comparing the fellow eyes of the patients with RVO and control healthy eyes, no differences emerged in cup/disc ratio but they came out for the HRT values in Rim Area, cup shape measure and height variation contour (p<0.05).
The most frequent occlusion site was at the level of an arteriovenous crossing in patients not suffering from POAG (36.7%) and at the level of the optic cup in patients with RVO and POAG (50%). In the RVO group without POAG, the OC-RVO subgroup has shown an higher cup area (0.366±0.094) and cup/disc area ratio (0.184±0.063), a lower rim volume (0.374±0.021) and a different cup shape measure (-0.221±0.066) (p<0.05) compared with the AV and NONHS sites. Compared with NONHS group differences emerged also for the fibres parameters and in the height variation contour (0.346±0.081). Also in the RVO group with POAG significant differences (p<0.05) have been surveyed between OC-RVO and other occlusion sites in cup area (0.119±0.029), cup/disc area ratio (0.532±0.09), rim volume (0.374±0.07), cup/shape measure (-0.079±0.013).
Classification of the analyzed parameters on the basis of the occlusion site provides a basis for which clinical decisions and research on causal factors in future studies can be based on.
Optic disc; retinal vein occlusion (RVO); glaucoma; HRT.
The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy.
Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests.
Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50).
Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.
Transconjunctival sutureless vitrectomy; 23-gauge vitrectomy; post-operative hypotony; post-operative IOP.
HRA (Heiderberg Retina Angiograph) 2 uses a confocal scanning laser system which can provide high quality digital images but its imaging field is only 30°at most. HRA2 with a wide-field contact lens system allows an imaging field of up to 150°.
We examined the advantages and disadvantages of HRA2, with a wide-field contact lens, for the evaluating diabetic retinopathy (DR).
HRA2 was beneficial for obtaining images of the entire retina simultaneously, without missing peripheral retinal non-perfusion and neovascularization. On the other hand, clear images connot be acquired in cases with media opacities such as corneal dystrophy, cataract and asteroid hyalosis, or in those with yellow tinted IOL.
HRA2 with a wide-field contact lens is useful for visualizing peripheral retinal lesions in DR cases.
Heidelberg retina angiograph 2; wide-field contact lens; diabetic retinopathy.
To report one year outcomes of focal Navigated Retina Laser Therapy (NAVILAS) for diabetic macular edema (DME).
Retrospective cohort series of 7 diabetic patients treated with NAVILAS focal laser. Statistical analysis included descriptive and continuous variables (Best-corrected logMAR Visual Acuity and time-domain optical coherence tomography (OCT) parameters) which were compared using a non-parametric procedure, the Friedman tests for repeated measures. A p-value of less than 0.05 was considered to denote statistical significance.
diabetic patients (4 male; 3 female) with an average age of 60.8 years (range 48-85 years) were included. All treated eyes were phakic; patients had an average hemoglobin A1C of 9.1 (range 7.8-11.7) at baseline and 8.0 (range 7.4-8.4) at 12 months. Six of the 7 patients had intravitreal bevacizumab injections prior to focal laser treatment with 1 patient having had more than 1 prior injection (total 3). At 12 months, median logMAR improved from 0.695 (± interquartile range 0.574) to 0.477 (± 0.573, p <0.001). OCT median central foveal thickness decreased from 248 (± 112) to 220 µm (± 41, p <0.001); total macular volume decreased from 7.84 (± 0.8) to 7.44 mm3 (± 0.7, p = 0.117); and largest macular subfield thickness decreased from 354 (± 116) to 289 µm (± 42, p <0.001). All patients were treated without complications.
Focal NAVILAS showed to be safe and effective in treating DME with improvement in visual acuity and macular edema on OCT over 12 months in this case series. In clinical practice, combined treatment with focal laser including NAVILAS and anti-vascular endothelial growth factor may provide long-term improvement in DME.
Anti-VEGF; bevacizumab; diabetes; focal laser photocoagulation; macular edema; NAVILAS.
To evaluate the effect of a single intravitreal ranibizumab injection in eyes with acute nonarteritic ischemic optic neuropathy (NAION).
Subjects and Methods:
In this retrospective clinical data analysis, 17 eyes of sixteen patients who experienced a visual loss with duration of 15 days or less comprised the study group. In addition to standard ophthalmic examination, retinal nerve fiber layer thickness (RNFLT) analysis with spectral domain OCT was also performed prior to 0.5 mg Ranibizumab injection, one week, one, three, six months and one year after the injection.
The mean time between visual loss and intravitreal injection was 7.5 days (Range, 2-15 days). Mean age of patients was 59 years (Range, 41-90 years). Male to female ratio was 6:10. After a single dose of ranibizumab injection, visual gain was noted in 14 of 17 study eyes. In two eyes, visual acuity was minimally reduced and no change was noted in the remaining eye with an initial visual acuity of hand motions. While pre-injection mean best-corrected visual acuity (BCVA) was 1.45 ±0.88 log Mar unit, post-injection mean BCVA was 1.00±0.68, 0.86 ±0.70, 0.80 ±0.71, 0.77 ±0.70, 0.77 ±0.70 log Mar unit respectively at the first week, first month, third month, sixth month and first year. In all patients, the mean RNFLT dramatically decreased after the injection during the follow- up. While pre-injection mean RNFLT was 210 ±38 µm, post-injection mean RNFLT was 162.11±40.2, 94±27, 71.23±22.5, 63 ±19 and 57 ±18 µm respectively at the first week, first month, third month, sixth month and first year. No injection related complication was noted during the follow-up period.
Intravitreal ranibizumab injection can be a treatment modality in eyes with acute NAION.
Intravitreal injection; nonarteritic anterior ischemic optic neuropathy; optic coherence tomography; optic nerve; ranibizumab.
Massive intraocular hemorrhage developed in a child with advanced unilateral retinoblastoma after intrarterial treatment with Melphalan and Topotecan. The child tested positive for sickle cell trait. Sickle cell trait may predispose such children to slower vascular transit time, hypoxia, sickling and vascular occlusion caused by catheter induced decreased flow. Enucleation confirmed the ultrasound and selective angiogram findings in addition to a completely calcified tumor. Clinicians should be on the lookout for the association of sickle-cell disease/trait and intraocular hemorrhages after intraarterial chemotherapy to fully understand its clinical significance.
Retinoblastoma; sickle cell; intra-arterial chemotherapy; enucleation.
Many of the common systemic diseases present characteristic changes in the fundus of the eye, but fundoscopy is often performed by an ophthalmologist. Our purpose was to assess the value of fundoscopy for the general practitioners (GPs) regarding the diagnosis and management of the cases which they face in daily practice.
689 patients were referred by GPs to the outpatient ophthalmology department for fundoscopy during the year 2010. The causes of this referral, the results of ophthalmoscopy and its significance in the final diagnosis were recorded and analyzed.
In 22 patients (3.1%), fundoscopy revealed optic disc edema. In 7 patients with head trauma (9.7%), fundoscopy revealed intravitreous haemorrhage and Berlin edema. From the patients with photopsias or floaters, 5 (10.2%) had retinal detachment. Finally, in cases with diabetes mellitus or hypertension, ophthalmoscopy was very important to detect the existence and grade the degree of diabetic or hypertensive retinopathy, if they appeared, and as a result to evaluate the prognosis of the disease.
Fundoscopy is fundamental for the GP, as it may help to confirm or exclude the diagnosis of many common diseases. Nevertheless, there are clinical entities where ophthalmoscopy should be performed by an ophthalmologist, in order to be more specific and accurate, and GP should be able to recognise these cases.
Fundoscopy; general practice; ophthalmoscopy.
To compare the performance of scanning laser topography (SLT) and scanning laser polarimetry (SLP) on the rim of the optic nerve head and its surrounding area and thereby to evaluate whether these imaging technologies are influenced by other factors beyond the thickness of the retinal nerve fiber layer (RNFL).
Materials and Methodology:
A total of 154 eyes from 5 different groups were examined: young healthy subjects (YNorm), old healthy subjects (ONorm), patients with normal tension glaucoma (NTG), patients with open-angle glaucoma and early glaucomatous damage (OAGE) and patients with open-angle glaucoma and advanced glaucomatous damage (OAGA). SLT and SLP measurements were taken. Four concentric circles were superimposed on each of the images: the first one measuring at the rim of the optic nerve head (1.0 ONHD), the next measuring at 1.25 optic nerve head diameters (ONHD), at 1.5 ONHD and at 1.75 ONHD. The aligned images were analyzed using GDx/NFA software.
Both methods showed peaks of RNFL thickness in the superior and inferior segments of the ONH. The maximum thickness, registered by the SLT device was at the ONH rim where the SLP device tended to measure the lowest values. SLT measurements at the ONH were influenced by other tissues besides the RNFL like blood vessels and glial tissues. SLT and SLP were most strongly correlated at distances of 1.25 and 1.5 ONHD.
While both imaging technologies are valuable tools in detecting glaucoma, measurements at the ONH rim should be interpreted critically since both methods might provide misleading results. For the assessment of the retinal nerve fiber layer we would like to recommend for both imaging technologies, SLT and SLP, measurements in 1.25 and 1.5 ONHD distance of the rim of the optic nerve head.
Glaucoma; normal tension glaucoma; retinal nerve fiber layer; scanning laser topography; scanning laser polarimetry; same OD diameter distances.
Both choroidal neovascularization during pregnancy, and choroidal neovascularization following implantation of phakic intraocular lenses have been reported in the literature. To our knowledge, this is the first case reported of a gravid woman developing choroidal neovascularization in an eye with a phakic intraocular lens. A 31-year-old woman became aware of her pregnancy three weeks after placement of the Verisyse™ iris-supported phakic intraocular lens. She was at 15 weeks gestation when she developed a Fuch’s spot consistent with choroidal neovascularization. By eight months gestation, her symptoms nearly resolved. While the development of choroidal neovascularization in this patient may appear incidental, women of childbearing age considering phakic intraocular lenses warrant additional discussion on the possible increased likelihood of choroidal neovascularization.
Choroidal neovascularization; pregnancy; phakic intraocular lens; antiphospholipid syndrome.
Posterior lamellar grafting of the cornea has become the preferred technique for treatment of corneal endothelial dysfunction. Posterior lamellar grafts are usually cut by a micro-keratome or a femto-second laser after the epithelial side of the donor cornea has been applanated. This approach often results in variable central graft thickness in different grafts and an increase in graft thickness towards the periphery in every graft. The purpose of this study was to evaluate if posterior lamellar grafts can be prepared from the endothelial side by a femto-second laser, resulting in reproducible, thin grafts of even thickness.
A CZM 500 kHz Visumax femto-second laser was used. Organ cultured donor grafts were mounted in an artifical anterior chamber with the endothelial side up and out. Posterior grafts of 7.8 mm diameter and 130 micron thickness were prepared by femto-second laser cutting. A standard DSAEK procedure was performed in 10 patients with Fuchs endothelial dystrophy. Patients were followed-up regularly and evaluated by measurement of complications, visual acuity, corneal thickness (Pentacam HR), and endothelial cell density.
Femto-laser cutting of grafts and surgery was uncomplicated. Rebubbling was necessary in 5 of 10 cases (normally only in 1 of 20 cases). All grafts were attached and cleared up during the first few weeks. After six months, the average visual acuity was 0.30 (range: 0.16 to 0.50), corneal thickness was 0.58 mm (range 0.51 to 0.63), and endothelial cell density was 1.570 per sq. mm (range: 1.400 to 2.000 cells per sq. mm). The grafts were of uniform thickness, but substantial interface haze was present in most grafts.
Posterior lamellar corneal grafts can be prepared from the endothelial side using a femto-second laser. All grafts were clear after 6 months with satisfying endothelial cell counts. Poor visual acuity caused by interface scatter was observed in most patients. Femto-second laser cutting parameters needs to be optimised to enable smooth cutting in the posterior stroma.
Corneal grafts; Femto-laser; cornea; DSAEK.
Our work describes the management of young patients who presents with vitreous haemorrhage. It is important to note that the causes differ significantly from adults with vitreous haemorrhage.
A 16-year old patient presented with vitreous haemorrhage. B-scan ultrasonography showed hypodense elements in the retina. A vascularized gelatinous mass was revealed after vitrectomy. Later the patient developed white cysts in the anterior chamber and histological findings were indicative of a retinoblastoma. The patient was enucleated and the diagnosis of retinoblastoma was confirmed. Intraocular surgery in young people with unknown retinoblastoma enhances the risk of metastasis development, orbital recurrence and death. Unexplained vitreous haemorrhage can obscure the view of a tumour but ultrasonic findings of a retinal mass calls for further imaging e.g. through MRI. The case illustrates the importance of excluding intraocular malignancy and advises a limited use of surgery in the initial examination of vitreous haemorrhage in young people.
Late onset retinoblastoma; vitreous haemorrhage; vitrectomy; retinal tumour.
For five consecutive eyes from five patients with liquefied aftercataract, Nd:YAG laser treatment significantly reduced high-order aberrations. Two eyes showing a reduction in positive spherical-like aberrations after treatment showed a postoperative myopic shift, while three eyes showing no change in spherical-like aberrations demonstrated hyperopic or only a slight myopic shift.
Cataract surgery; aftercataract; Nd:YAG laser posterior capsulotomy; high-order aberration.
The aim of the study was to investigate changes in cell adhesion molecule expression in human lens epithelial cells (HLEC) subjected to glucocorticoids.
Human lens epithelial cells were exposed to different concentrations of dexamethasone for 24 hours. Cell adhesion molecule expression was studied by western blot and immunohistochemistry of vimentin, N-cadherin, E-cadherin, α-catenin, β-catenin and γ-catenin. Expression of the glucocorticoid receptor (GR) was also studied. Cell morphology was examined by transmission electron microscopy (TEM).
Expression of N-cadherin, α-catenin, β-catenin and GR was significantly decreased in dexamethasone exposed cells as compared to unexposed cells. No significant change in γ-catenin was present. Visualization of adhesion molecules, N-cadherin and α-catenin, by immunohistochemistry showed decreased antigen reactivity in dexamethasone exposed as compared to the unexposed cells. However, no change was seen for β-catenin and γ-catenin. E-cadherin was not detectable using western blot or immunohistochemistry.
TEM showed multilayering of cells, vacuole formation and appearance of electron-dense multivesicular bodies in HLEC exposed to 0, 0.1, 1, 10 and 100 αM dexamethasone.
Glucocorticoids affect several adhesion molecules in lens epithelial cells, something that may contribute to the pathogenesis of posterior subcapsular opacification.
Human lens epithelial cells; glucocorticoids; opacification; TEM; posterior subcapsular cataract; E-cadherin.
Electrogenic Na+-HCO3- cotransporter NBCe1 is expressed in several tissues such as kidney, eye, and brain, where it may mediate distinct biological processes. In particular, NBCe1 in renal proximal tubules is essential for the regulation of systemic acid/base balance. On the other hand, NBCe1 in eye may be indispensable for the maintenance of tissue homeostasis. Consistent with this view, homozygous mutations in NBCe1 cause severe proximal renal tubular acidosis associated with ocular abnormalities such as band keratopathy, glaucoma, and cataract. The widespread expression of NBCe1 in eye suggests that the inactivation of NBCe1 per se may be responsible for the occurrence of these ocular abnormalities. In this review, we discuss about physiological and pathological roles of NBCe1 in eye.
NBCe1; proximal renal tubular acidosis; band keratopathy; glaucoma; cataract.
To describe ocular findings in 3 cases of solar retinopathy using high definition, spectral domain optical coherence tomography (SD-OCT) and review the literature for optical coherence tomography (OCT) characteristics associated with worse vision.
Case series and retrospective review of clinical features and Spectralis SD-OCT (Heidelberg Engineering, Vista, California, United States of America). A literature review of OCT findings in cases of solar retinopathy reported on MEDLINE was also performed and analyzed.
Six eyes of 3 patients with solar retinopathy revealed significant foveal pathology. Visual acuity ranged from Snellen 20/30 to 20/50. High definition SD-OCT demonstrated defects at the level of the inner and outer segment junction of the photoreceptors as well as in the inner high reflective layer. There was a significant correlation between chronic disruption of the inner photoreceptor junction with worse vision based on the current case series and literature review.
Screening patients with exposure to central foveal damage from solar retinopathy with high definition SD-OCT improves diagnosis and assessment of photoreceptor damage and vision loss.
Solar retinopathy; fovea; spectral domain optical coherence tomography; Spectralis SD-OCT.
Bevacizumab (Avastin®) has been used by ophthalmologists in many countries as an off-label drug for the treatment of wet age-related macular degeneration (AMD). Due to its short half-life necessitating frequent intravitreal injection, a method for sustained delivery is in need. We demonstrated that bevacizumab could be released in a sustained fashion over 90 days from nano- and microspheres fabricated from poly(DL-lactide-co-glycolide) and poly(ethylene glycol)-b-poly(D,L-lactic acid), respectively. The drug release rate could be adjusted by alteration of the drug/polymer ratio. The use of such nano- and microspheres as bevacizumab delivery vehicles may improve the treatment of wet AMD.
Bevacizumab; age-related macular degeneration; nanospheres; microspheres; and controlled release.
To report the tumor, patient, and treatment characteristics of long-term metastatic uveal melanoma survivors.
A non-comparative, retrospective case series of patients from a single institution surviving >24 months with metastatic uveal melanoma (UM).
Nine patients met the study criteria and their charts were reviewed. The mean age at diagnosis of UM was 44.1 years (SD +/- 14.4 years). Initial treatment modalities included enucleation (67%), brachytherapy (22%), and proton beam radiation (11%). The average time from primary tumor diagnosis to detection of metastasis was 125.9 months (SD +/- 95 months). The most common location for initial metastasis was the liver. All patients underwent treatment for metastatic disease including systemic therapy, surgical resection, and isolated hepatic perfusion. The majority of patients received treatment with a tyrosine kinase inhibitor (sorafenib, sunitinib, and/or imatinib). The median survival with metastasis was 51 months (range 27-123 months). Patients had a long disease-free interval before presentation of metastatic disease.
A small subset of patients with metastatic UM has prolonged survival. Identification of these patients may be helpful for future clinical trial design.
Tumor; uveal melanoma; metastasis; alanine transaminase; transpupillary thermal therapy and chemotherapy.