Lipid accumulation and protein modifications of Bruch’s membrane in age-related macular degeneration

Age-related macular degeneration (AMD) is a progressive retinal disease, which is the leading cause of blindness in western countries. There is an urgency to establish new therapeutic strategies that could prevent or delay the progression of AMD more efficiently. Until now, the pathogenesis of AMD has remained unclear, limiting the development of the novel therapy. Bruch’s membrane (BM) goes through remarkable changes in AMD, playing a significant role during the disease course. The main aim of this review is to present the crucial processes that occur at the level of BM, with special consideration of the lipid accumulation and protein modifications. Besides, some therapies targeted at these molecules and the construction of BM in tissue engineering of retinal pigment epithelium (RPE) cells transplantation were listed. Hopefully, this review may provide a reference for researchers engaged in pathogenesis or management on AMD.     

Glaucoma secondary to trabecular meshwork precipitates: a case report of Grant’s syndrome

AIM: To describe a via pars plana anterior iris enclavation IOL fixation technique. METHODS: A total of 35 consecutive aphakic vitrectomised patients (average age 71±7.14y) underwent pars plana vitrectomy (PPV) and via pars plana anterior iris enclavation IOL fixation. RESULTS: The mean preoperative best corrected visual acuity (BCVA) was 0.11±0.14 logMAR, the mean post-operative BCVA was 0.07±0.11 logMAR. The preoperative mean spherical equivalent was 7.22±4.21. The final mean spherical equivalent was -0.25±0.15. No eyes had hypotony, retinal or choroidal detachment or endophthalmitis. CONCLUSION: This technique may be a safe and useful in the case of aphakia, and a prospective study would be useful to confirm this findings.     

Vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes

AIM: To report the success of vitrectomy in eliminating cystoid macular oedema and improving vision in three eyes of two patients with diabetic cystoid macular oedema. In all of the eyes there was no ophthalmoscopic evidence of traction from a posterior hyaloid membrane or from proliferative tissue. METHODS: Pars plana vitrectomy was performed on three eyes of two patients with diabetic cystoid macular oedema who did not show traction upon examination with a slit lamp biomicroscope and a scanning laser ophthalmoscope. RESULTS: Cystoid changes disappeared 1, 3, and 5 days, postoperatively, and diffuse macular oedema resolved within 2 weeks. The visual acuity was improved and maintained. CONCLUSION: Vitrectomy can be effective in some patients with diabetic cystoid macular oedema even in patients who lack evidence of traction by ophthalmoscopy.     

玻璃体切割术联合曲安奈德治疗严重PDR患者的糖尿病性黄斑水肿

【摘要】 目的 探讨玻璃体切割术联合曲安奈德（TA）治疗严重增殖性糖尿病视网膜病变（PDR）患者糖尿病性黄斑水肿的疗效。设计 回顾性比较性病例系列。研究对象 2009年7月至2010年4月中南大学湘雅二医院连续实施玻璃体切割术的严重PDR患者25例（28眼）。方法 12例14眼在玻璃体切除术毕玻璃体内注射曲安奈德（IVTA）2 mg,为IVTA组;13例14眼仅做玻璃体切割,未注射TA,为对照组。用OCT等检查随访观察患者6个月。两组患者术前PDR复杂性评分无差异。主要指标 LogMAR最佳矫正视力、OCT黄斑中央厚度。结果 术后6个月,IVTA组LogMAR最佳矫正视力（0.76±0.45）显著优于对照组（1.20±0.50）（t=2.473,P=0.020）;IVTA组OCT黄斑中央厚度（266.92±50.23 μm）显著低于对照组（285.37±46.81 μm）（t=16.470,P=0.000）。结论 玻璃体切割术联合玻璃体内注射曲安奈德有利于控制严重PDR患者的糖尿病性黄斑水肿和提高视力。（眼科,2012,21：248-252）     

玻璃体切割治疗弥漫性糖尿病黄斑水肿疗效观察

目的:研究玻璃体切割治疗弥漫性糖尿病黄斑水肿的临床效果。方法:收集2004-03/2006-07在我院因弥漫性糖尿病黄斑水肿性行玻璃体切割方法治疗的患者23例(23眼),所有患者均严格控制血糖、血压,术前均详细检查视力、眼压、裂隙灯、检眼镜眼底、荧光血管造影(fluorescein fundus angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT),分别记录术前术后1,3,6,12mo视力及黄斑厚度,进行对比,并观察手术后并发症,平均随访14.5±1.2mo。结果:所有患者均顺利进行玻璃体手术治疗,其中有8例患者在曲安奈德(triamcinolone acetonide,TA)辅助下完成玻璃体手术,术前患者平均视力0.24±0.15,术后1,3,6,12mo平均视力0.19±0.14,0.25±0.16,0.28±0.15,0.32±0.19,术后12mo与术前矫正视力对比有显著性差异,术前黄斑厚度平均OCT值438±169μm,术后1,3,6,12mo平均OCT值为317±123,263±87μm,237±6,228±41μm,与术前分别对比均有显著性差异。术中2例出现医源性网膜裂孔,激光封口,无患者术后出现玻璃体出血,虹膜新生血管,视网膜前膜,无患者行白内障手术。结论:玻璃体切割手术治疗弥漫性黄斑水肿可在短期内明显减轻黄斑水肿,并逐步改善患者视功能,其远期效果需进一步观察。     

Macular abnormalities in patients with retinitis pigmentosa: prevalence on OCT examination and outcomes of vitreoretinal surgery

Purpose: To determine the prevalence of macular abnormalities detected by optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP), and to report the results of pars plana vitrectomy (PPV) in five patients with RP. Methods: OCT images of the macula of 622 eyes of 323 patients with RP were evaluated. All patients had a complete clinical examination, and PPV was performed on two RP patients with a macular hole (MH), two patients with vitreomacular traction (VMT) syndrome, and one patient with cystoid macular oedema (CME). Results: A macular lesion was detected by OCT in 46 eyes (7.4%) of 37 patients (11.5%). CME was detected in 34 eyes (5.5%) of 26 patients, an epiretinal membrane in four eyes of four patients, VMT in five eyes of four patients, and full‐thickness MH in three eyes of three patients. PPV was performed on five of these eyes. The MH was closed with vision improvement after a single surgery in one eye, and was closed after repeated PPVs with a decrease of vision in another eye. In both patients with VMT, the visual acuity decreased after the surgery. The macular morphology and visual acuity did not improve postoperatively on the one patient with CME who underwent PPV. Conclusion: When OCT is used, macular abnormalities are present in 7.4% of patients with RP, which is lower than the prevalence reported earlier. Although vitrectomy can improve the macular morphology in some patients with RP, improvement of visual function may be limited most likely because of the long‐standing retinal dysfunction.     

玻璃体切除手术后对人工晶状体度数计算的影响

目的:评估玻璃体切除手术对人工晶状体计算的影响。方法:通过测量玻璃体切除手术术前、术后角膜曲率、眼轴长等指标测算预装晶状体残留屈光度,并与术后3mo验光实测等值球镜屈光度的偏差比较验证。结果:患者玻璃体切除手术术前后角膜曲率、眼轴长无明显差异。玻璃体切除手术术前、术后预测残留屈光度和术后3mo验光实测残留屈光度分别为-0.21±0.09D,-0.36±0.08D和-0.42±0.14D,P>0.05,差异不显著。结论:玻璃体切除手术不影响对人工晶状体精确测定。     

Anterior Vitrectomy for Chronic Aphakic Cystoid Macular Edema

This report describes a series of 13 patients who underwent anterior vitrectomies for chronic aphakic cystoid macular edema (CME). All eyes had formed vitreous adherent to the intracapsular wound, vision of 20/50 or worse, and fluorescein angiographically documented CME for six months or more. Following the presentation of the results (success rate of 69%) and a discussion of this form of treatment, the beginning of a national, randomized, prospective study designed to evaluate the effectiveness of this treatment is described.     

Results of Visual Acuity and Foveal Thickness in Diabetic Macular Edema after Vitrectomy

Purpose

To report results of an investigation of visual acuity (VA) and foveal thickness in diabetic macular edema (DME) patients after vitrectomy.

Methods

A retrospective study was performed of the records of 47 patients (61 eyes) who received pars plana vitrectomy (PPV) for DME. All eyes were followed up for over 6 months (mean, 24.8 months; range, 6–60 months). VA and foveal thickness evaluated by optical coherence tomography were reviewed preoperatively and postoperatively.

Results

Twenty-four-month follow-up data were available for 46 of the 61 eyes (75%). VA at the final examination had improved by 0.2 log units or more in 34 of the 61 eyes (56%), remained unchanged in 21 eyes (34%), and worsened in six eyes (10%). Mean foveal thickness decreased by more than 20% of the preoperative value in 50 of the 61 eyes (82%), remained unchanged in ten eyes (16%), and increased by more than 20% in one eye (2%) at the final examination. Postoperative best-corrected visual acuity (BCVA) at both 12 and 24 months was significantly better than preoperative BCVA (P < 0.0001). Foveal thickness at 3 months or later significantly decreased from the preoperative value (P < 0.0001), but remained unchanged in comparison with postoperative 12 months and 24 months values (P = 0.19). Preoperative VA and presence of cystoid macular edema (CME) were independently associated with final visual acuity (P = 0.001).

Conclusions

PPV for DME effectively improved VA and reduced foveal thickness for a longer postoperative period. Better preoperative VA was associated with better final postoperative VA. The eyes without CME tended to have better final postoperative VA.?Jpn J Ophthalmol 2007;51:204–209 © Japanese Ophthalmological Society 2007

     

Keratometric alterations following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy

Purpose: To assess the alterations in keratometric astigmatism following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Methods: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25‐gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. Results: In the 25‐gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post‐operative follow‐up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). Conclusion: Both 25‐gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post‐operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post‐operatively     

黄斑裂孔手术和白内障手术同时进行或序贯进行的研究

目的：研究黄斑裂孔手术和白内障手术同时进行或序贯进行。
　　方法：在大不里士发起了一项对黄斑裂孔和白内障患者的临床试验,研究了黄斑裂孔手术和白内障手术同时进行或序贯进行对这些患者的影响。研究中22例患者( A组)首先进行超声乳化术及人工晶状体植入手术,1 mo后同时进行23 G微创玻璃体切除术和视网膜内界膜剥除术。21例患者(B组)进行白内障超声乳化人工晶状体植入手术联合23 G微创玻璃体切除术以及视网膜内界膜剥除术。
　　结果：A组包括7例男性,15例女性;B组包括9例男性,12例女性( P=0.545)。 A组和B组患者的平均年龄分别为66.63±4.75岁和67.71±4.99岁(P=0.472)。术后3mo,A组中2例患者,B组中5例患者黄斑裂孔未愈合(P=0.240);A组1例患者,B组4例患者并发葡萄膜炎(P=0.185);B组2例患者眼内压升高(P=0.233);A组2例患者,B组4例并发后囊混浊(P=0.412)。
　　结论：两组相比,同时进行手术组产生并发症患者较多,但经统计学分析,术后疗效及并发症之间无统计学差异。     

Surgical Therapy for Chronic Aphakic Cystoid Macular Edema

Aphakic cystoid macular edema (ACME) is a common condition seen after intracapsular cataract extractions. In an overwhelming majority of these cases, the condition improves spontaneously. Those cases that persist for months or years, however, are often associated with vitreous strands adherent to the surgical wound and distortion of the pupil. This article reviews the surgical and photocoagulation therapies for this condition that have been reported over the past two decades. All studies report encouraging results, but all have been nonrandomized, uncontrolled trials. This paper describes two randomized, controlled clinical studies that are attempting to evaluate objectively the role of vitrectomy for chronic cases of aphakic cystoid macular edema.     

玻璃体切割术联合或不联合内界膜剥除治疗严重PDR伴黄斑皱褶移位

目的:观察性研究25G微创玻璃体切割联合内界膜剥除治疗严重增殖性糖尿病视网膜病变(PDR)伴黄斑皱褶移位的临床疗效。方法:收集2016-01/2017-12在江苏省人民医院眼科病房接受玻璃体切割手术的严重PDR伴黄斑皱褶移位的患者36例36眼的临床资料,其中2016-01/12入院的患者18例18眼纳入对照组,行25G微创玻璃体切割术,2017-01/12入院的患者18例18眼纳入联合组,行25G微创玻璃体切割联合内界膜剥除术。观察术前,术后7d,1、3、6mo最佳矫正视力(BCVA)、黄斑中心区厚度(CMT)、眼压及并发症。结果:术后6mo,两组患者BCVA较术前显著提高(均P<0.05);联合组CMT小于对照组(P<0.001)。术后6mo内,联合组中2眼(11%)高眼压、1眼(6%)黄斑水肿;对照组1眼(6%)高眼压,1眼(6%)黄斑前膜,1眼(6%)玻璃体积血,两组并发症发生率无差异(均P=1.000)。结论:采用25G微创玻璃体切割联合内界膜剥除术治疗严重PDR伴黄斑皱褶移位能安全有效地提高患者视力及降低黄斑中心区厚度。     

无菌空气填充治疗大孔径特发性黄斑裂孔的疗效观察

目的:探讨无菌空气填充治疗大孔径特发性黄斑裂孔的安全性和有效性。方法:回顾性研究。共纳入2017-06/2018-05我院收治的特发性黄斑裂孔患者8例9眼,平均黄斑裂孔最小直径>700μm,平均黄斑裂孔基底部直径>1300μm,所有患者均行白内障超声乳化摘除及25G玻璃体切割联合内界膜填塞、无菌空气填充术。平均随访12mo,比较术前和术后最佳矫正视力(BCVA)及黄斑裂孔闭合情况。结果:末次随访时,所有患者黄斑裂孔均闭合,SD-OCT显示术后黄斑裂孔的闭合率为100%(9/9)。术后BCVA(LogMAR)较术前显着改善(0.83±0.26 vs 1.27±0.28),差异有统计学意义(P=0.007)。所有患者术中及术后均未发生并发症。结论:无菌空气填充治疗大孔径特发性黄斑裂孔安全、有效。     

改良四通路玻璃体切割在人工晶状体后脱位治疗中的应用

目的:报道改良四通路玻璃体切割术治疗1例后房型人工晶状体后脱位.方法:一位青年性白内障患者,双眼白内障术后均发生人工晶状体后脱位,其1眼应用改良四通路玻璃体切割技术将人工晶状体复位,另1眼应患者的要求而未行手术治疗.结果:术中和术后未发生任何并发症,患者术眼视力迅速回复,术后14 mo最佳矫正视力为0.5;而未行手术治疗的另1眼发生全视网膜脱离,仅残余手动视力.结论:改良四通路玻璃体切割术是治疗人工晶状体后脱位的一个好选择.     

Combined Phacoemulsification,Primary Intraocular Lens Implantation,and Pars Plana Vitrectomy in Children with Uveitis

Abstract

Purpose: To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.

Methods: Data regarding visual acuity (VA), inflammatory status, medical therapy, and complications was collected from the medical charts of 17 children (21 eyes) with chronic uveitis who underwent combined cataract surgery and PPV at the Eye Clinic, Sahlgrenska/Mölndal, between 2002 and 2011.

Results: Seventy-six percent of the children had juvenile idiopathic arthritis. Median preoperative VA was 1.70 logMAR and median VA after 12 months was 0.17 logMAR. Postoperatively, glaucoma developed in 7 eyes, cystoid macular edema in 3 eyes, and visual axis opacification requiring treatment in 5 eyes.

Conclusions: Although combined phacoemulsification, primary IOL implantation, and PPV in children with uveitis resulted in favorable visual outcome and stable inflammation in a majority of children, the technique should so far be reserved for uveitic cases with vitreous pathology.     

Pars plana vitrectomy versus three intravitreal injections of bevacizumab for nontractional diabetic macular edema. A prospective,randomized comparative study

Background:

The aim of this study was to compare the effectiveness of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) with three, monthly, intravitreal bevacizumab (IVB) injections for refractory diabetic macular edema.

Materials and Methods:

This was a prospective, randomized, comparative, interventional study. Forty-four patients were enrolled and randomized in two groups. Twenty-two eyes enrolled in Group I received three IVB injections at monthly interval. Twenty-two eyes were enrolled in Group II which underwent PPV with ILM removal. The primary outcomes measured were: (1) Best corrected logMAR visual acuity (BCVA) using Snellen''s visual acuity chart. (2) Central macular thickness (CMT) on optical coherence tomography. The secondary outcome measures were: Complication rates like (1) progression of lens opacities, (2) high intraocular pressure needing further treatment/procedure, (3) development of vitreous hemorrhage related to the procedure employed, (4) retinal detachment and (5) severe inflammation/endophthalmitis.

Results:

In Group I (IVB): 3 (13.6%) eyes showed no change in BCVA; 3 (13.6%) eyes reported decrease in BCVA and 16 (72.8%) eyes showed improvement in BCVA; (P = 0.0181). In Group II (PPV): 4 (18.2%) eyes showed no change in BCVA; 5 (22.7%) eyes showed decrease and 13 (59.1%) eyes showed improvement in BCVA (P = 0.0281). Mean decrease in CMT in IVB group was 108.45 μ, whereas mean decrease in CMT in PPV group was 161.36 μ. No major complications were seen in either group.

Conclusion:

Posttreatment decrease in CMT was more in PPV group and vision improvement more in IVB group. However, no statistically significant difference between the two methods was found.