Hyaline Research Articles

An instrument for inducing continuous passive motion after fracture of the tibial plateau in rabbits

Objective To design and develop intelligent rehabilitation equipment for administering continuous passive motion (CPM) of a rabbit′s knee joint after tibial plateau fracture. Methods The equipment constructed had three main parts: the core machinery, electronic control and a control program designed based on bionics principles. Twenty six-month-old New Zealand White male rabbits were randomly divided into sedentary (SED) and CPM groups after their knees had been fractured. The rabbits in the CPM group were given 30 min of early joint rehabilitation once a day for 4 weeks using the CPM equipment, while those in the SED group were kept in their cages and allowed free activity without any special exercise program. The body weight, range of motion and swelling of the affected knee joint were measured before the fracture and on the 3rd, 7th, 14th, 21st and 28th days after the fracture. On the 28th day after the fracture the pathological structure of the articular cartilage on the operative side was observed under a light microscope. Results The equipment ran safely and reliably, and drove the rabbits to move synchronously. It could accurately and conveniently adjust the knee flexion angle, movement speed and movement time. The intelligence of the equipment met the experimental requirements. On the 3rd day after the operation the average range of motion in the joints of both groups had changed significantly compared to that before the fracture. On the 28th day after the fracture the average degree of swelling and range of motion in the CPM group were significantly different from those of the SED group. On the 28th day, deformity and the smoothness of the fracture line in the CPM group were superior to those in the SED group. Moreover, the dominant tissues in the defect area of the CPM group were mainly hyaline cartilage while those in the SED group were mainly repair fibrocartilage. The defect area and its adjacent articular cartilages, chondrocyte regeneration and arrangement, layers of cells and subchondral tidal line recovery of the CPM group were better than in the SED group on average. Conclusion The equipment for knee joint manipulation is convenient to use, reliable and effective for the early rehabilitation of tibial plateau fracture, at least in rabbits. It promotes remodeling of the fracture and cartilage repair after tibial plateau fracture, and also improves range of motion in the knee and reduces swelling. Key words: Passive motion; Tibial plateau fracture; Rehabilitation equipment

Panretinal photocoagulation versus intravitreal injection of bevacizumab as a preoperative adjuvant before vitrectomy in the management of proliferative diabetic retinopathy

Background Proliferative diabetic retinopathy (PDR) characterized by neovascularization of the optic disk, retina, and/or iris may be an aberrant attempt to alleviate hypoxia in eyes with severe capillary closure or other retinal ischemia. The new vessels grow perpendicular to the plane of the retina into the scaffolding provided by the vitreous cortex, typically from venules at the junction of the perfused and nonperfused retina. Objective This work aims to study the effect of panretinal photocoagulation (PRP) versus intravitreal injection of bevacizumab (Avastin) before vitrectomy in the management of PDR. Patients and methods Our clinical study was conducted on 60 eyes in 40 patients with PDR with indications of vitrectomy (vitreous hemorrhage, tractional retinal detachment involving or threatening the macula, combined tractional/rhegmatogenous retinal detachment and fibrovascular membranes covering and distorting the macula, persistent macular edema with viteromacular traction) managed by parsplana vitrectomy after preoperative preparation by intravitreal injection of bevacizumab (Avastin) or PRP used as an adjunct was grouped into two groups: group A and group B; FFA was done previtrectomy for all cases. Results Intraoperative using of endodiathermy is reported as once in eight cases, twice in 15 cases, three times in seven cases in group A, while once in 14 cases, twice in six cases, and not used in 10 cases in group B. Intraoperative use of endolaser is reported as less than 1500 shoots in seven cases, and more than 1500 shoots in 23 cases in group A, while less than 1500 shoots in 29 cases, and more than 1500 shoots in one case in group B. Therefore, bevacizumab or PRP induces regression of active fibrovascular proliferation decreasing the extent of bleeding during tissue segmentation and delamination. The lesser intraoperative bleeding makes visualization of the surgical plane better, which in turn facilitates a precise separation of the proliferative tissue from the retina and helps avoid accidental retinal vascular damage and iatrogenic retinal breaks and make the surgery and the results better than conventional surgery (without using any adjuvants). Conclusion Use of both adjuvants before vitrectomy enhances the outcome of vitrectomy when best indicated rather than without using. The shorter time of surgery and less use of endodiathermy or endolaser is with the PRP group, although postoperative best-corrected visual acuity gaining is not significant. So, accurate clinical differences between two adjuvants need more researches.

OPTICAL COHERENCE TOMOGRAPHY OF THE VITREOLENTICULAR INTERFACE AFTER PHACOEMULSIFICATION WITH PRIMARY POSTERIOR CAPSULORHEXIS

The discussion about the safety and efficiency of the posterior capsulorhexis is still ongoing. Optical coherence tomography (OCT) can help us to study the process of capsule barrier recovering and condition of the anterior hyaloid membrane after primary posterior capsulorhexis. Aim of the study was to investigate the features of the vitreolenticular interface (VLI) after lens surgery with the primary posterior capsulorhexis. Material and methods. VLI OCT (RTVue, «Optovue», USA) was performed in 101 patients (123 eyes) after phacoemulsification with primary posterior capsulorexis. The postoperative period ranged from 1 day to 9 years. Results. We revealed a large variability of the VLI. This was due to the degree of the involutional changes in the involved structures. In the early postoperative period we observed the different variants of the relationships between the posterior capsule and the intraocular lens (IOL): from almost contact to subtotal inadhesion with a movable margin of the capsulorhexis. However, in all cases we noted the contact between posterior capsule and IOL along the optical edge of the latter. In the following days the adhesion between the lens optics and the posterior capsule progressed from the periphery to the center. The term needed for complete adhesion was 1-8 days. Three main types of VLI have been identified in the late postoperative period. Conclusion . The involutional changes of structures determine the features of the VLI in the early and late postoperative period. The contact between posterior capsule and IOL along the lens optics edge was detected from the first day, full adhesion was noted 1–8 days after surgery.

Method of preventing late hemorrhagic complications after surgical treatment of secondary neovascular glaucoma

To study the effectiveness of a new method of preventing late hemorrhagic complications of surgical treatment of secondary NVG after central retinal vein occlusion (CRVO). The study included 148 patients (150 eyes) with secondary NVG after CRVO. The patients were divided into two groups: 98 patients (100 eyes) of the 1st group underwent sinustrabeculectomy with cyclovitrectomy and traditional surgery preparation and post-op treatment; the second group consisted of 50 patients (50 eyes) who received surgical treatment in combination with interferon therapy. All patients were observed for 1.5 years with necessary ophthalmic examination methods. At the end of the follow-up, the second group showed statistically significant (p<0.01) reduction in the rates of hemorrhagic complications by 80%, progression of neovascularization of the iris and structures of the angle of anterior chamber of the eye by 50%, progression of neovascularization of the retina accompanied by the development of fibrosis of posterior hyaloid membrane by 37%. Reduction of the rate of complications positively affected the functional and tonometric results leading to improved visual acuity and preservation or even widening of the field of vision by 118%, as well as 60% improvement of tonometric results. The newly developed method of preventing post-surgical complications allowed significant reduction of the risks of hemorrhagic complications and improvement of functional and tonometric results of surgical treatment of patients with secondary NVG after CRVO.

CHANGES IN THE POSTERIOR VITREOUS AFTER CATARACT SURGERY ASSESSED BY SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY.

To assess changes in the posterior vitreous caused directly by phacoemulsification with implantation of an intraocular lens, using the enhanced vitreous swept-source optical coherence tomography system (Topcon, Tokyo, Japan). Consecutive patients with cataract without posterior vitreous detachment were enrolled. Swept-source optical coherence tomography examinations were performed 1 day before and several days after surgery, using enhanced vitreous visualization. We compared preoperative and postoperative posterior vitreous status and measured the distance between the internal limiting membrane and the posterior vitreous membrane at 26 locations at the posterior pole. Images of 33 eyes (21 patients) could be analyzed. The perifoveal posterior vitreous detachment was not extended in any eyes, and the internal limiting membrane to posterior vitreous membrane distance before and after surgery did not differ at any location measured (P = 0.071-1.000). The posterior precortical vitreous pocket was dilated in three eyes. Age, gender, axial length, preoperative visual activity, nuclear sclerosis, duration of surgery, and duration between surgery and swept-source optical coherence tomography did not differ between the dilated vitreous pocket group (n = 3) and the unchanged group (n = 30). The height of the posterior vitreous membrane remained unchanged after surgery, although the posterior precortical vitreous pocket was dilated in three patients. Cataract surgery procedures seem to have little influence on the posterior vitreous membrane.

Surgical approach to pediatric traumatic cataract

Purpose: The aim of this study was o evaluate our surgical approach in children who were operated due to traumatic cataract in our clinic.Material and Methods: By using anterior vitrector, lensectomy was performed in pediatric patients who have traumatic cataract. The patients who have capsular support, the intraocular lens (IOL) was implanted in the capsular bag or in the sulcus and who do not have capsule support the IOL was implanted with sutureless intrascleral fixation method.Results: 21 eyes of 21 patients were included in the study. The mean age of the cases was 8.7 ±3.5 years. All of the cases had penetran injuries, and performed corneal suturation before due to the corneal perforation. Lensectomy was performed by using anterior vitrectomy probe in all patients. ln two patients, monoblock foldable IOL were implanted in the capsular bag, in 12 patients three-piece foldable IOL were implanted in the sulcus and in 4 patients three-piece foldable lens were implanted with intrascleral fixation. The combination of pars plana vitrectomy-lensectomy and three-piece foldable IOL implantation with intrascleral fixation were done in three patients because of retinal problem. Scleral tunnel was preferred to corneal tunnel for implantation of IOL.Conclusion: Lens capsule integrity was usually impaired in traumatic cataract cases. It may be not possible to do capsulorrhexis in these cases. Vitreous and fibrotic membrane are usually found in anterior chamber in these cases. It is considered that it is more appropriate to do lensectomy by using anterior vitrectomy probe instead of standard cataract surgery.

The analysis of infusion air misdirection in microincisional vitrectomy

Objective To analyze the pathogenic mechanisms and management methods of infusion air misdirection in microincisional vitrectomy. Methods The data of 440 eyes of 440 cases received vitrectomy from Jan.2016 to Jan.2017 were retrospectively analyzed. There were 412 cases of 23 G vitrectomy and 28 cases of 20 G vitrectomy. Results Infusion air misdirection occurred in 23 G vitrectomy in 15 eyes of 15 cases when performing air-fluid exchange. No case happened in 20 G vitrectomy. Infusion air misdirection was mainly caused by inability of trocar tip to penetrate the vitreous cortex and other factors. The management was released anterior chamber gas and readjusted infusion cannula. Conclusion Infusion air misdirection happens more frequently in 23 G vitrectomy than 20 G vitrectomy(χ2=4.141, P=0.042). This complication can be avoided or treated appropriately if recognized. Key words: Vitrectomy, microincisional; Infusion air misdirection; Air-fluid exchange; Mechanisms; Management

Influence of irrigation dynamic pressure-assisted hydrodissection on intraocular pressure and the posterior chamber-anterior hyaloid membrane barrier during cataract surgery.

To evaluate the effects of irrigation dynamic pressure-assisted hydrodissection (irrigation-hydro: iH) on intraocular pressure (IOP) and the posterior chamber-anterior hyaloid membrane (PC-AHM) barrier in porcine eyes. Experimental. In Experiment 1, IOP was recorded while irrigating the anterior chamber (AC), during iH, and during phacoemulsification and aspiration in 20 porcine eyes using bottle heights of 50, 70, and 90cm. Under the same conditions, IOP was recorded during conventional manual cortical cleaving hydrodissection (manual hydro: mH) in 20 porcine eyes. In Experiment 2, after iH, ACs were perfused for 5 seconds with balanced salt solution containing 1.0-μm fluorescein beads in 20 porcine eyes using bottle heights of 70, 118, and 169cm. PC-AHM barrier staining grade was evaluated by the Miyake-Apple view. iH proved successful in all cases. In Experiment 1, IOP during iH was relatively stable and peak IOP was below the baseline bottle height-dependent pressure. No eyes showed a peak IOP > 75mmHg during iH, but 8 eyes showed a peak IOP > 75mmHg during mH. In Experiment 2, neither AHT nor ruptured capsules were observed at any bottle height. Unlike mH, IOP during iH was relatively stable without any high peak IOP. Thus, iH offers a simple technique for reducing peak IOP and avoiding disturbance of the PC-AHM barrier.

Vitrectomy for Diabetic Macular Edema: Optical Coherence Tomography Criteria and Pathology of the Vitreomacular Interface

To correlate spectral-domain optical coherence tomography (SDOCT) criteria and clinical data with pathology of the vitreomacular interface (VMI) in eyes with diabetic macular edema (DME). Retrospective cross-sectional study and laboratory investigation. We included specimens of 27 eyes of 26 patients with center-involved DME that underwent vitrectomy with peeling of the internal limiting membrane (ILM). Selection of specimens was consecutive and in retrospect using our register of the Vitreoretinal Pathology Unit. Clinical data and SDOCT examinations were correlated to immunocytochemistry and transmission electron microscopy. Classification of DME comprised sponge-like diffuse retinal thickening, cystoid macular edema, and serous retinal detachment. VMI was evaluated for presence of epiretinal membrane (ERM) and thickened vitreous cortex (tVC). ERMs and tVC were found in all DME types. Diffuse DME showed tVC more often than cystoid DME. Hyalocytes, contractile myofibroblasts, glial cells, matrix metalloproteinases-2 and -9, and collagen type I, II, and III were positive tested irrespective of DME type. There were no significant cell fragments at the retinal side of the ILM. Visual acuity improved in the majority of cases and macular thickness decreased significantly during mean follow-up of 17 ± 10months. All eyes presented pathologic VMI changes irrespective of the OCT classification of DME type or presence of ERM. Composition of fibrocellular membranes at the VMI indicated remodeling of vitreous cortex and transdifferentiation of hyalocytes into myofibroblasts. Our findings might argue for an early surgical intervention in eyes with DME irrespective of the presence of traction formation imaged by SDOCT.

Adiponectin: A potential candidate for treating fibrosis in posterior segment of the eye

Fibrosis in ocular tissues causes severe visual deterioration and blindness in patients with glaucoma, cataract, age related macular degeneration (AMD) and diabetic retinopathy (DR). Currently available anti-fibrotic agents exhibit undesirous cytotoxic effects and thus prove ineffective to treat post-surgical fibrosis. Accordingly, there is a need to develop efficient and novel anti-fibrotic agents. Adiponectin (APN), an adipokine from adipocytes is increased in the aqueous and vitreous humor of the patients with micro-angiopathy and chronic inflammation. Furthermore, it is reported to be elevated in the subretinal fluid, vitreous and epiretinal membrane of patients with AMD, proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR) respectively.Since APN has anti-angiogenic activity and reduces VEGF levels, we hypothesize that APN might regulate the angio-fibrotic switch and drive the formation of fibrovascular membrane at advanced stages of AMD, PVR and PDR. Intriguingly, APN is shown to inhibit liver, cardiac and pulmonary fibrosis, yet it accelerates renal fibrosis. Therefore, the factors such as tissue and cell type, disease specific pathological milieu and the choice of APN receptor interaction could determine the pro- or anti-fibrotic nature of APN. We speculate that APN could play a profibrotic role in the posterior segment of the eye.

Симптом «патологической подвижности» задней капсулы

Purpose . To study the anatomical topographic and clinical features and preconditions for the redundant mobility of the posterior capsule in cataract phacoemulsification. Material and methods . The main group I and the comparative group II were formed. The group I included phacoemulsification results with the intraocular lens (IOL) implantation in 12 patients with brown nuclear cataract, the absence of the posterior layer of cortical masses, the increase in fiber length of the ciliary zonule by more than 0.7mm with its local breaks and the presence of the pseudoexfoliation syndrome of different degrees. The group II included 13 patients with brown nuclear cataract, the absence of the posterior cortical layer and the increase in fiber length of the ciliary zonula less than 0.7mm. Patients had no pseudoexfoliation syndrome or its 1st st age. The magnitude of the posterior capsule excursion in absence of posterior epi-nucleus and emulsification of the last fragment of the nucleus was determined intraoperatively in all patients visually and according to the analysis of video r ecording. Results . In the group I the greatest mobility of the posterior capsule was observed in patients with the absence of the posterior fiber portion in the ciliary zonula and their damages in the anterior and medial portions. In 4 cases a pronounced mobility of posterior capsule led to its rupture in a round shape without hyaloid membrane damage. The damage was transferred into a 4mm posterior capsulorhexis and IOL was implanted into the capsular bag. The postoperative visual acuity was 0.68±0.07. In the group II any pathological mobility of the posterior capsule and its ruptures was not detected. The postoperative visual acuity was 0.61±0.07. Conclusion . The symptom of the posterior capsule pathological mobility is formulated and the conditions for its occurrence are determined. The criteria for the ciliary zonule system alteration are studied according to the UBM data in the presence of which the symptom of the posterior capsule pathological mobility occurs.

BENEFIT OF INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY FOR VITREOMACULAR SURGERY IN HIGHLY MYOPIC EYES.

To report the feasibility and information provided by intraoperative optical coherence tomography (iOCT) during vitreomacular surgery in highly myopic eyes. Retrospective observational case series on consecutive highly myopic eyes that underwent vitreomacular surgery with iOCT for epiretinal membrane (ERM), macular hole, and myopic foveoschisis. The main outcome was the qualitative and quantitative assessment of retinal changes: detection of persistent epiretinal structures, new openings, central macular thickness, and macular hole diameters after each step of the surgical procedure. Quantitative measurements (in pixels) were manually obtained on iOCT video screen captures. Twenty-two eyes were included: six ERMs, 10 macular holes, and 6 with myopic foveoschisis. An unsuspected postpeeling macular opening was detected by iOCT in 2/22 eyes. Intraoperative optical coherence tomography also allowed for detecting the presence of residual fragments of the vitreous cortex in 6/12 eyes after surgically induced posterior vitreous detachment. Intraoperative optical coherence tomography detected residual fragments of the internal limiting membrane in 5/21 eyes after internal limiting membrane peeling, and residual fragments of ERM in 3/15 eyes with ERM. Quantitative analysis did not find any significant change in central macular thickness and macular hole diameters before and after ERM and internal limiting membrane peeling. In highly myopic eyes, iOCT could help assess undetected macular openings and otherwise posterior vitreous status and epiretinal structure peeling.

Penicillifer diparietisporus: a New Record from Field Soil in Korea

A fungus was isolated from field soil collected from Daegu, Korea. The colony of the isolated fungus showed short, branched, and light to dark yellow pigments with hyaline, yellowish red to orange brown aerial mycelia. In addition, the fungus produced solitary to aggregated perithecia, ovoid to pyriform, short neck, and asci as well as biseriately arranged ascospores. Phylogenetic analysis using the internal transcribed spacer region and translation elongation factor 1-α sequences and morphological characteristics identified the isolated fungus as Penicillifer diparietisporus , which belongs to the family Nectriaceae. To our knowledge, this is the first report of Penicillifer diparietisporus in Korea.

Influence of the vitreolenticular interface in pediatric cataract surgery

To report the status of Berger space in pediatric cataract cases and the influence of anterior vitreolenticular interface dysgenesis during primary posterior continuous curvilinear capsulorhexis (PCCC). Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. Prospective case series. The study comprised consecutive pediatric cataract cases planned for bag-in-the-lens intraocular lens (BIL IOL) implantation. A video-based analysis of the surgical interventions included the type of crystalline lens opacification, presence of a posterior capsule plaque (PCP), presence of anterior vitreolenticular interface dysgenesis, complications during primary PCCC, integrity of the anterior hyaloid membrane, need for anterior vitrectomy, and feasibility of BIL IOL implantation. Abnormalities in Berger space were observed in 35 of the 64 pediatric cataract cases. Anterior vitreolenticular interface dysgenesis was most often found in cases with persistent fetal vasculature (PFV) and those with posterior cataract. Anterior vitreolenticular interface dysgenesis was diagnosed significantly more often in eyes with unilateral cataract and those with PCP. In pediatric cataract cases presenting with PCP and anterior vitreolenticular interface dysgenesis, the primary PCCC procedure was surgically more demanding, often resulting in detectable breaks in the anterior hyaloid membrane (58.6%) and sometimes necessitating an unplanned anterior vitrectomy (13.8%). Bag-in-the-lens IOL implantation was feasible in all except 1 eye with PFV, which was left aphakic. Primary vitreolenticular interface abnormalities are often encountered during pediatric cataract surgeries, especially when confronted with PCP in a unilateral cataract. The presence of anterior vitreolenticular interface dysgenesis may complicate a primary PCCC procedure, resulting in an unplanned anterior vitrectomy in some cases.

Spectral-domain optical coherence tomography of peripheral lattice degeneration of myopic eyes before and after laser photocoagulation

To investigate the microstructural characteristics of lattice degenerations before and after laser photocoagulation in myopic eyes by spectral-domain optical coherence tomography (SD-OCT). Twenty-five eyes of 25 consecutive patients at the High Myopia Clinic of the National Taiwan University Hospital were retrospectively reviewed. Myopic eyes with peripheral lattice degeneration were enrolled in the study. Best-corrected visual acuity (BCVA), axial length measurement, color fundus photography was performed. SD-OCT analyses on the lattice degeneration were performed before and after prophylactic laser photocoagulation. All patients were followed for at least 6 months. In total, 25 myopic eyes with peripheral lattice degenerations were studied. The mean refractive error was -9.92±4.77 Diopters (D) with 21 (84%) of the eye being highly myopic (Over -6.0 D). The average axial length was 27.7±1.86mm. In these myopic eyes, retinal thinning was the most common finding (92%), followed by vitreoretinal traction (72%), retinoschisis (44%), vitreous membrane with deposits (36%), and retinal break with subretinal fluid (4%). A blunting effect of the vitreoretinal tractions was found after laser photocoagulation. To our knowledge we firstly investigated the pre- and post-laser photocoagulation microstructural changes using SD-OCT. It demonstrated a beneficial effect of retinoplasty, which released vitreoretinal tractions after laser photocoagulation. Combined with the findings of subtle microstructural retinal breaks and subretinal fluid, early prophylactic laser treatment warrants sincere consideration in these myopic eyes.

Multislice spiral CT findings and its diagnostic value of mixed glandular glass nodular adenocarcinoma

Objective To analyze the characteristics of mixed ground glass nodular adenocarcinoma in multi-slice spiral CT(MSCT) and its diagnostic value. Methods This study was prospective study, 120 patients with mixed glass nodules lung adenocarcinoma were classified as lung adenocarcinoma in the People's Hospital of Xinzhou from January 2014 to December 2016.178 cases of mixed glass nodular pneumonitis were classified as pneumonia.The MSCT signs were compared between the two groups.The imaging features of medullographic nodules with different pathologic types of lung adenocarcinoma by grouping of patients with lung adenocarcinoma were compared. Results In the lung adenocarcinoma group, the dizzy uneven thickness rate(61.67%), leaf rate(60.00%), clear boundary rate(80.83%), blood vessels, gather tax rate(64.17%), pleural indentation rate(61.67%) were significantly higher than those in the pneumonia group(35.96%, 35.39%, 41.01%, 44.94%, 41.57%, χ2=8.69, 12.47, 33.64, 7.62, 7.97, all P<0.01). The mixed grinding glass nodules of IAC, MIA and MIS in size, number, shape, position and density were significantly different(all P<0.05). The IAC type mixed grinding glass nodules was irregular single nodules(volume generally≥5 mm), common deviation centricity growth, and with blood vessels.The AIS type mixed grinding glass nodule was single nodule(volume generally≥5 mm), formed a polygon or dotted, common growth of centricity, vascular density was close to the same level.The volume of the MIA type mixed grinding hyaline nodules was most <5 mm, common to multiple, with oval or round most, common to deviate from the centricity growth, lower density than plane tree blood vessels. Conclusion MSCT is helpful in the differential diagnosis of mixed ground glass nodules of lung adenocarcinoma and mixed ground glass nodular inflammatory lesions, and pathological types have leaded to the identification of mixed ground glass nodules of lung adenocarcinoma MSCT, which has higher application value. Key words: Lung neoplasms; Adenocarcinoma; Tomography, spiral computed; Diagnosis

Modern Possibilities for the Vireoretinal Interface Contrasting (Experimental Study)

The contrast agents in vitreoretinal surgery are necessary to ensure the visualization of translucent and ultra-thin membranes and vitreoretinal interface (VRI) structures, but the ideal staining agent has not been found yet.Purpose. To investigate and compare staining properties of two vital dyes for vitreous body (VB) and vitreoretinal interface visualization: “Kenalog-40” and “Vitreocontrast”.Patients and methods. The study was performed on 20 cadaveric eyes. After eyeball dissection with the original technology, we carried out posterior vitreous cortex separation and comparative staining of retinal fragments on the side of VB and corresponding section of the VB by “Kenalog-40” and “Vitreokontrast”. Vitreo-retinal interface samples underwent morphological analysis.Results. In contrast to «Kenalog-40», «Vitreocontrast» enables the visualization of thin layer of VB on retina surface after splitting of cortical layers during posterior vitreous detachment induction. Upon that, the adherent particles of the “Vitreocontrast” suspension remained on the corresponding splitted fragment of the VB. After staining with “Kenalog-40”, the VB surface remained smooth, shiny, with no visible changes. The results of histological examination of the obtained retinal and VB samples confirmed the presence of VB layer on the retina surface at the site of vitreoshisis formation during the induction of posterior vitreous detachment.Conclutions. Received data confirm the possibility of vitreoshisis formation during posterior vitreous body detachment, and demonstrate the advantages of the staining properties of the “Vitreokontrast” suspension for visualization of fine structures of vitreoretinal interface.

Traumatic Macular Hole

The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH differs from that of the idiopathic macular hole (IMH). A sudden compression and expansion of the globe leads to vitreous traction, which can result in a TMH. The final visual acuity depends on the severity of the disruption of the photoreceptors and the retinal pigment epithelial cells. The posttraumatic approach is discussed controversially. A spontaneous closure and, therefore, a conservative approach should be considered in young patients with minor defects and good visual acuity without detachment of the posterior vitreous body. In these cases, it is advisable to wait for months. In the absence of adhesion at the edges of the hole and concomitant pathologies of the pigment epithelium, the spontaneous closure is improbable. In this case, a pars plana vitrectomy with removal of the vitreous and epiretinal membranes can lead to anatomical reconstruction and improvement of the visual acuity. The success of an operative intervention is complex and is associated with the experience of the surgeon as well as the characteristics of the trauma.

Lamellar Macular Holes; Pathophysiology, Classification, Clinic, Diagnosis, and Treatment

Lamellar macular hole (LMH), first described as a macular lesion developing after the opening of the central cyst in an eye with cystoid macular edema, has been used to define an aborted stage in full-thickness macular hole (MH) development. Abnormal posterior vitreous detachment associated with contraction of vitreous cortex plays a role in its pathophysiology. As a result of foveal traction of the attached and contracted macular vitreous cortex, splitting of the inner and outer retinal layers is observed. Contraction of the frequently accompanying epiretinal membrane also has an effect on the development of LMHs. Classified as tractional, degenerative, and mixed types, LMHs are seen as reddish, round, oval or lobulated lamellar defects at the fovea with the fundoscopic examination. In the differential diagnosis, it can be mistaken with MHs, and pseudoholes. Its diagnosis is best made with optic coherence tomography (OCT) examination. The diagnostic criteria with OCT are, defects in inner retinal layers with irregular foveal contour, thinning of the base of the fovea, partial-thickness MH with preservation of photoreceptors, and intraretinal splitting. Epiretinal proliferation is seen in most of the eyes. A thick, homogenous layer consisting of unusual material on the epiretinal surface has been defined as LMH-associated epiretinal proliferation by OCT. Persistent vitreopapillary adhesion is demonstrated in one-third of eyes. Patients with LMHs stay stable with minimal complaints about a long time, and surgery is not needed in most of them. When the patients have serious visual complaints, or a decrease in visual acuity (VA) is noted, surgery is indicated. The anatomical and functional success rate is high with pars plana vitrectomy, peeling of ERM, and ILM, air/gas endotamponade. Patient selection is important. Low preoperative VA, disruption at the junction of inner-outer photoreceptor layers, and foveal thinning are poor prognostic indicators. Further studies are warranted to determine which patients will benefit from surgery.

Macular Hole: Etiology, Physiopathology, Diagnosis, Differential Diagnosis, and Treatment

Retinal defects evolving whole neural layers in the macular area especially in the fovea are being called macular hole (idiopathic macular hole; IMH). It causes painless central visual loss and deterioration of vision that is called metamorphopsia. Antero-posterior dynamic forces (vitreomacular traction; VMT) caused by tangential tractional vectors of the prefoveal vitreous cortex and progression to full-thickness macular hole due to weakening of the inner retinal layers are attributed for the etiology of macular hole. IMH is seen frequently unilaterally in females and patients &gt; 65 years of age. An approach for IMH treatment, aiming to release the traction and closure of the macular hole by pharmacological vitreolysis is the use of ocriplasmin, which is a plasmin derivative. To release the synechia on the vitreomacular interface and to normalize the abnormalities of the retinal surface are the aims of IMH surgery. Besides, vitreoretinal surgery constitutes suitable conditions for the closure of the hole. Separation and detachment of the posterior hyaloid, core vitrectomy, removal of the peripheral vitreous, and Internal Limiting Membran (ILM) peeling are the standard stages of the classic IMH surgery. Condition of the other eye, presence of Epiretinal Membran (ERM), hole width, patient's age, and quality of life are important factors when evaluating the patients. Ocriplasmin alternative must be kept in mind in holes smaller than 400 μ especially if VMT is existent. IMH is such a pathology that can be treated successfully by vitrectomy and ILM peeling at the present situation.