Macular changes detected by Fourier‐domain optical coherence tomography in patients with hypotony without clinical maculopathy

Purpose: To investigate macular changes in eyes with postoperative hypotony without clinical maculopathy using high‐resolution Fourier‐domain optical coherence tomography (FD‐OCT). Methods: Fourteen eyes of 12 patients with postoperative intraocular pressure (IOP) ≤ 6 mmHg for at least 4 weeks but with no detectable clinical features associated with hypotony maculopathy were imaged by FD‐OCT prospectively. Images were analysed by two retina specialists masked to clinical findings. Results: Most patients were female (83%) and myopic (75%) with a mean age of 65 ± 17 [standard deviation (SD)] years (range 2–86 years). Mean central corneal thickness was 519 ± 34 μm [95% confidence interval (CI) 502–537] and mean IOP before surgery was 20 ± 8 mmHg (95% CI 15–24). During the period of hypotony (mean 15 ± 6 weeks), the average mean IOP was 4 ± 1 mmHg (95% CI 3–5). Abnormal FD‐OCT findings (retinal folds and/or intraretinal fluid) were present in eight eyes. These patients had a higher rate of visual symptoms (75% versus 17%), visual acuity loss (≥ 2 lines; 63% versus 17%) and increased mean foveal thickness (250 ± 26 versus 210 ± 12 μm; p < 0.01, Mann–Whitney U‐test) compared with those with normal FD‐OCT. Conclusion: FD‐OCT identified subclinical macular abnormalities in over half of the eyes with postoperative hypotony. These findings were accompanied by visual disturbances and central macular thickening. FD‐OCT can be an important diagnostic tool for this disorder when clinical features are absent.     

大鼠泪液缺乏型干眼症眼表组织中IL- 6和TNF-α的表达

目的：探讨白介素6（interleukin- 6,IL- 6）和肿瘤坏死因子（tumor necrosis factor α ,TNF-α）在泪液缺乏型干眼症发病机制中的作用.方法：SD大鼠48只随机分成实验组和对照组两组,实验组通过摘除泪腺的方法制作干眼模型,对照组不做处理,分别于实验前1d及实验后1,2,4wk检测泪液的分泌、泪膜破裂时间及观察角膜荧光素染色,术后4wk将动物脊髓离断致死,用免疫组织化学方法检测结膜及角膜组织中IL- 6和TNF-α的表达.结果：实验组大鼠SchirmerⅠ滤纸湿长较正常组缩短（P〈0.01）,泪膜破裂时间较正常组缩短（P〈0.01）;IL- 6和TNF-α在两组均有表达,在实验组表达较强,对照组表达较弱,两者差异有统计学意义（P〈0.05）.结论：IL- 6和TNF-α在泪液缺乏型干眼的发病机制中起着重要的作用,泪液缺乏型干眼的发病机制与炎症有关.     

Comparison of 23‐gauge sutureless sclerotomy architecture and clinical outcomes in macular and non‐macular surgery using spectral‐domain optical coherence tomography

Purpose: To compare the 23‐gauge (23‐G) sutureless vitrectomy incision architecture in macular and non‐macular surgery, using anterior segment spectral‐domain optical coherence tomography (SD‐OCT), and to evaluated its influence on clinical outcomes. Methods: A prospective, observational case series of 43 patients who underwent primary transconjunctival 23‐G pars plana vitrectomy (PPV) for macular and non‐macular diseases. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD‐OCT (OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany). Sclerotomy architecture, including good wound apposition, presence of gaping and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative and postoperative medical record data were also prospectively collected. Results: Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p < 0.05) and was more frequent in the non‐macular group than in the macular group (p < 0.05). The incidence of incision gaping increased significantly as the incision angle increased. In the macular group, the mean postoperative intraocular pressure (IOP) did not change from the preoperative value, whereas in the non‐macular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p < 0.005). The mean IOP did not differ significantly between the two groups of surgery at 1 week, and at 1 month postoperatively. Conclusions: In 23‐G PPV, non‐macular surgery is associated with a significant postoperative IOP decrease in comparison with macular surgery, which could be explained by the most remodelled wound architecture.     

Reproducibility of retinal thickness measurements in patients with age‐related macular degeneration using 3D Fourier‐domain optical coherence tomography (OCT) (Topcon 3D‐OCT 1000)

Purpose: Conventional time‐domain optical coherence tomography (OCT) has become an important tool for following dry or exudative age‐related macular degeneration (AMD). Fourier‐domain three‐dimensional (3D) OCT was recently introduced. This study tested the reproducibility of 3D‐OCT retinal thickness measurements in patients with dry and exudative AMD. Methods: Ten eyes with dry AMD and 12 eyes with exudative AMD were included in the study. Sets of three OCT 6 × 6‐mm raster scans were taken by one operator. Mean retinal thickness was calculated for 36 areas. Coefficients of variation (CoV) were calculated for each patient and area. For analysis, two separate areas (central and peripheral) were defined. Generalized estimating equations (GEEs) were applied to all 36 subfields in order to analyse possible differences in CoV and mean retinal thickness between dry and exudative AMD. Results: Mean retinal thickness values were significantly larger in the central area in exudative AMD (p < 0.001). Mean CoV for exudative AMD was 3.7% (standard deviation [SD] 1.4%). Mean CoV for dry AMD was 1.8 (SD 0.6%). The reproducibility of retinal thickness measurements was significantly less in exudative AMD (p = 0.009). Conclusions: Reproducibility of 3D‐OCT retinal thickness measurements was good in both groups. However, reproducibility was significantly better in dry AMD than in exudative AMD.     

Effect of intravitreal bevacizumab (Avastin®) in neovascular age‐related macular degeneration using a treatment regimen based on optical coherence tomography: 6‐ and 12‐month results

Purpose: To study the effect of intravitreal bevacizumab therapy on visual and anatomical outcomes in patients with neovascular age‐related macular degeneration (AMD) within a follow‐up period of 6 and 12 months. Methods: A retrospective analysis of 102 eyes of 102 consecutive patients with neovascular AMD evaluated repeated intravitreal bevacizumab (1 or 2.5 mg) injections. Retreatment was performed following an optical coherence tomography (OCT)‐based regimen. Ophthalmic examination included best‐corrected visual acuity (BCVA), dilated fundus examination and OCT imaging. Data were analysed at baseline, 6 months (24 weeks) and 12 months (48 weeks) after treatment initiation. Results: BCVA remained stable at 6 months (mean: 0.00 ± 0.41 logMAR; p = 0.95) and 12 months (mean: +0.02 ± 0.43 logMAR; loss of ～ 1 letter; p = 0.70) after the first treatment. OCT retinal thickness decreased by a mean of ?37.8 ± 101.6 μm (p < 0.05) compared to baseline at month 6 and ?38.6 ± 93.3 μm (p < 0.05) at month 12. A mean of 2.6 ± 1.2 injections were needed to obtain absence of fluid by OCT, and the time to recurrence was 23 ± 11 weeks thereafter. There was no difference in BCVA and OCT outcomes between treatment‐naive eyes and eyes that had undergone prior treatment. Conclusion: The 6‐ and 12‐month follow‐up of repeated intravitreal bevacizumab therapy in eyes with neovascular AMD demonstrated stabilization of vision and no safety concerns. An OCT‐based retreatment strategy appears appropriate in the management of patients treated with intravitreal bevacizumab.     

Sub‐Tenon injection of 2% lidocaine prevents intra‐operative floppy iris syndrome (IFIS) in male patients taking oral α‐adrenergic antagonists

Purpose: To compare 2% sub‐Tenon and 1% intra‐cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study. Methods: From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α‐adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub‐Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra‐cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra‐operative pupillary constriction and iris prolapse. Results: Intra‐operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub‐Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra‐cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra‐cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub‐Tenon lidocaine group and 4.02 ± 1.06 mm in the intra‐cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub‐Tenon lidocaine group and in 10 cases in the intra‐cameral lidocaine group (p = 0.00). Twenty‐five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra‐cameral lidocaine group and 16.6% (2 of 12 patients) in the sub‐Tenon lidocaine group (p = 0.00). Conclusion: Sub‐Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α‐adrenergic inhibitors as compared with intra‐cameral lidocaine.     

A multicentre,double‐masked,randomized, controlled trial assessing the effect of oral supplementation of omega‐3 and omega‐6 fatty acids on a conjunctival inflammatory marker in dry eye patients

Purpose: To determine whether oral supplementation with omega‐3 and omega‐6 fatty acids can reduce conjunctival epithelium expression of the inflammatory marker human leucocyte antigen‐DR (HLA‐DR) in patients with dry eye syndrome (DES). Methods: This 3‐month, double‐masked, parallel‐group, controlled study was conducted in nine centres, in France and Italy. Eligible adult patients with mild to moderate DES were randomized to receive a placebo containing medium‐chain triglycerides or treatment supplement containing omega‐3 and omega‐6 fatty acids, vitamins and zinc. Treatment regimen was three capsules daily. Impression cytology (IC) was performed at baseline and at month 3 to assess the percentage of cells expressing HLA‐DR and to evaluate fluorescence intensity, an alternate measure of HLA‐DR. Dry eye symptoms and objective signs were also evaluated. Analyses were performed on the full analysis set (FAS) and per‐protocol set (PPS). Results: In total, 138 patients were randomized; 121 patients with available IC were included in the FAS, and of these, 106 patients had no major protocol deviations (PPS). In the PPS, there was a significant reduction in the percentage of HLA‐DR‐positive cells in the fatty acids group (p = 0.021). Expression of HLA‐DR as measured by fluorescence intensity quantification was also significantly reduced in the fatty acids group [FAS (p = 0.041); PPS (p = 0.017)]. No significant difference was found for the signs and symptoms, but there was a tendency for improvement in patients receiving the fatty acids treatment. Conclusion: This study demonstrates that supplementation with omega‐3 and omega‐6 fatty acids can reduce expression of HLA‐DR conjunctival inflammatory marker and may help improve DES symptoms.