Hyaline Research Articles

New Surgical Technique for Management of Recurrent Macular Hole.

Recurrence of macular hole (MH) following the standard approach of pars plana vitrectomy, posterior hyaloids removal, internal limiting membrane peeling, gas tamponade, and postoperative positioning is a common postoperative complication following MH surgery. We present a new surgical technique which involves induction of serous macular detachment around the MH, parafoveal retinal massage to bring its edges closer, gas tamponade, and face down positioning. The recurrent MHs had closed in all four consecutive patients with a parallel gain in visual acuity following this technique. All patients had Type 1 closure of the MH indicating its closure without any defect of the neurosensory retina. The MHs remained closed during the follow-up without any late reopening.

INFORMATIVITY OF SPECTRAL OPTICAL COHERENT TOMOGRAPHY IN AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY

The purpose: to evaluate the informativity of optical coherence tomography in patients with aggressive posterior retinopathy of prematurity. Patients and methods. spectral optical coherence tomography using portable device iVue-100 with a removable camera (Optovue, USA) was held in 32 children (64 eyes) with aggressive posterior retinopathy of prematurity with a gestational period 26–31 week. Results. Children with aggressive posterior retinopathy of prematurity at the stage of early clinical manifestations, in addition to the indication that the immaturity of the retina, according to the spectral optical coherence tomography revealed only a few areas of epiretinal proliferation, which are not visualized with a digital retinoscopy and binocular indirect ophthalmoscopy. When the process is more pronounced in children with retinopathy of prematurity aggressive rear stage manifestation already determined multiple zones epiretinal proliferation as a mushroom and flake conglomerates with rear zone hyaloid membrane had an uneven seal. Coarser structural disorders of the retina and the vitreoretinal interface have been identified in patients with advancedstage aggressive posterior retinopathy of prematurity. We determined the shaft extraretinal proliferation as a comb, as well as portions of epiretinal proliferation on the border of vascularized and avascular retina, which tended to merge, and the formation of massive hyperreflection complexes, lifted back hyaloid membrane, which was not only uneven sealed, but in some places is stratified. Conclusion. Despite the complexity of the procedure and the complexity of its implementation, the data obtained are particularly valuable and informative because they allow to complement the clinical picture and objectify it. It helps to choose the optimal tactics and improvement of a differentiated approach to the treatment of aggressive posterior retinopathy of prematurity.

Результаты хирургического лечения дислокации интраокулярных линз

Purpose . The analysis of clinical results in the replacement of dislocated posterior chamber IOL with capsular bag (CB) to the iridovitreal IOL RSP-3 (Russia) via a scleral-corneal tunnel incision. Material and methods . The study included 26 patients (26 pseudophakic eyes) with a dislocation of the IOL capsular bag (CB) complex after the previously performed phacoemulsification (PE), who underwent a removal of IOL with CB through a scleral-corneal tunnel incision with the following implantation of irido-vitreal IOL RSP-3. Besides the standard examination, the patients underwent a corneal endothelium count test before operation, at discharge, 1, 6 and 12 months later. Results. The dislocated IOL occupied from 20 to 50% of the pupil area causing complaints on a low visual acuity (VA), ineffectiveness of spectacle correction and binocular or monocular diplopia. All operations passed uneventfully. The early postoperative period was non-reactive in the majority of cases. It was possible intraoperatively to preserve a stable depth of anterior chamber using viscoelastic Discovisc (Alcon), thus, avoiding a rupture of anterior hyaloid membrane of vitreous body and damage of corneal endothelium. The best corrected VA (BCVA) increased from 0.32±0.05 to 0.81±0.1 in the dynamics of postoperative period, induced astigmatism indexes decreased in the absence of negative dynamics of endothelium cell density (the loss of corneal endothelium cells averaged 4.7% from the initial level). Conclusion. The used surgical method of replacement of the dislocated IOL-CB complex after the PE of senile cataract to the iridovitreal IOL RSP-3 via the scleral-corneal tunnel minimizes the risks of intra- and post-operative complications. The advantages of this technology are the safety, low indexes of induced corneal astigmatism, and high and stable visual effect.

Rhegmatogenous Retinal Detachment Associated with Choroidal Detachment

Review describes the theme of rhegmatogenous retinal dеtаchment associated with choroidal separation. It is rare, but quite severe eye pathology. In most cases it has a very poor prognosis. Most authors consider the retinal detachment as a primary pathogenetic part, which decompensates the production of aqueous humor by increasing the absorptive surface of the retinal pigment epithelium. Dilatation of choroidal arterioles occurs in hypotension, it leads to extravasation of protein-rich fluid in the choroidal and the suprachoroidal space. This helps to further swelling and separation of the ciliary body and the choroid with reduced production of aqueous humor and progressive hypotension. There is a high risk of developing “retino-choroidal” separation in patients with macular rupture due to localization of retinal separation and rupture rear hyaloid membrane. The protein level in aqueous humor can be increased to 70 times. It may be a result of reflux of suprachoroidal proteins through uveoscleral route and / or venous proteins through the trabecular network. In addition, the diffusion of proteins from the posterior camera and vitreous cavity is possible. This creates favorable conditions for cell proliferation that can lead to postoperative proliferative vitreoretinopathy. Typically patients have a pronounced signs of inflammation, pain, and “red eye”, which is accompanied with vision decrement. Rhegmatogenous retinal reparationcan be associated with such clinical symptoms as severe panuveit, deepening of the anterior camera and the inflammatory response in the moisture, concentric wrinkles and sagging back of the iris, posterior synechia, iridofakodenez, blurred vitreous detachment of the ciliary body, hypotension, and choroidal and retinal detachment in addition. Debatableness of etiopathogenesis and a clinical picture, which is similar to other eye diseases create significant difficulties in early diagnosis and proper treatment of this pathology. Correct early diagnosis of “retino-choroidal dеtаchment” is complicated by several factors: sluggish pupil dilation, exacerbated by the presence of posterior synechiaes, clouding environments with the presence of cellular elements, choroidal dеtаchment, masking the retinal tears. Rhegmatogenous retino–choridal dеtаchment should be differentiated from a number of pathologies. The most obvious sign of “retinyl choroidal” dеtаchment is severe generalized inflammation leading to an erroneous diagnosis of uveitis. A particular problem is the differentiation with syndrome of uveal effusion, choroidal melanoma. Retino-choroidal dеtаchment is a rare pathology that requires timely and correct diagnosis of pathogenically based treatment.

Enzymatic Vitreolysis for Vitreomacular Traction in Diabetic Retinopathy.

Vitreomacular traction (VMT) is one of many possible factors involved in the etiology of diabetic macular edema (DME). Pharmacologic vitreoretinal separation is a potential alternative to vitrectomy for VMT in diabetic retinopathy. Small case series have been published on the use of enzymatic vitreolysis in tractional DME, and demonstrate that the enzymatic release of the posterior vitreous cortex is more likely following the injection of plasmin enzyme. Further prospective and randomized clinical trials are necessary to evaluate the clinical relevance of ocriplasmin for vitreomacular traction in diabetic retinopathy, and additional studies are needed to determine more accurately which patients might benefit most from this treatment and how often and at what concentration ocriplasmin should be administered.

Plan de cuidados de enfermería en prematuro con enfermedad de membrana hialina

La enfermedad de membrana hialina es una causa del síndrome de dificultad respiratoria muy frecuente en el recién nacido pretérmino. Se ha realizado el plan de cuidados mediante las intervenciones de enfermería a un prematuro de 31 semanas que ingresó a la unidad de cuidados intensivos neonatales por presentar enfermedad de membrana hialina. Se aplicó la valoración según dominios de NANDA hallándose los siguientes diagnósticos significativos “00032 Patrón respiratorio ineficaz”, “00030 Deterioro del intercambio gaseoso”, “00107 Patrón de alimentación ineficaz del lactante”, “00132 Dolor agudo” y “00126 Conocimientos deficientes”. Por lo cual se aplicaron las intervenciones de enfermería según la taxonomía II de los diagnósticos, intervenciones y resultados de enfermería. La oxigenoterapia fue una de las principales intervenciones de enfermería que se aplicaron con la técnica de presión positiva continua en la vía aérea nasal. Un modo no invasivo de poder cubrir la necesidad de ventilación en el prematuro. Como resultado se obtuvo la disminución del FiO2 de 30% a 25% mejorando su patrón respiratorio. El aspecto de la buena comunicación entre enfermera y la madre del paciente fue fundamental para poder tranquilizar su estado tenso y aumentar su nivel de conocimiento, encontrando así un apoyo emocional dentro del ambiente hospitalario.

FIRST REPORT OF SWEET POTATO LEAF SPOT CAUSED BY NEOPESTALOTIOPSIS ELLIPSOSPORA IN GUIZHOU PROVINCE, CHINA

During May to September 2015, sweet potato [Ipomoea batatas (L.) Lam.] plants with leaf spot symptoms were observed in Guizhou Province, China, at 25°12'06.8"N 107°57'25.3"E with about 15% incidence. The disease first appeared as small, round, yellow specks on leaves. Successively, the affected areas became necrotic and gradually enlarged to 3-9 mm in diameter. The fungal species present on the sample was isolated onto PDA using a single spore culture technique as described in Chomnunti et al. (2014). Colonies on PDA attained 30–40 mm in diameter after 7 days at 25°C, producing a dense aerial mycelium on the surface. Conidia were ellipsoid, 4-septate, 20.0–26.0 × 5.0–7.5 μm. Apical and basal cells were hyaline, whereas the three median cells were versicolored. Each apical cell had 3 tubular apical appendages, 7–24 μm long. The conidial dimensions of these isolates correspond to Pestalotiopsis ellipsospora Maharachchikumbura & K.D. Hyde (Maharachchikumbura et al., 2012). Sequence data for the rDNA internal transcribed spacer (ITS), Beta tubulin (TUB) and partial translation elongation factor 1-alpha (TEF) of three N. ellipsospora isolates were deposited in GenBank under the accession Nos. KU500017 to KU500019 (ITS), KU500010 to KU500012 (TUB) and KU500013 to KU500015 (TEF). A BLAST search showed 100% similarity with N. ellipsospora isolate (CBS 115113) sequences deposited in GenBank. The disease was reproduced on sweet potato healthy leaves inoculated using either 3-day-old mycelial discs or inoculum (1× 106 conidia/ml) prepared by scraping conidia from 10-day-old cultures on PDA plates. To our knowledge this is the first report of Neopestalotiopsis causing leaf spot on sweet potatoes in the world.

FIRST REPORT OF POWDERY MILDEW, CAUSED BY ARTHROCLADIELLA MOUGEOTII, ON GOJI BERRY IN TURKEY

Lycium barbarum, known as Goji berry or wolfberry, is a Chinese medicine plant in the family Solanaceae, and has been recently cultivated in Bolu, Turkey. During autumn 2015, severe powdery mildew symptoms were observed on Goji berry plantation area. White to grayish white fungal mycelia were shown on leaves and stems. Also, brownish discolorations and defoliation were exhibited. Microscope examination showed that conidia were formed in chains, hyaline, short-cylindrical and their length and width ranged from 19 to 31 (mean=26.2) μm and from 10 to 14.5 (mean=13.2) μm, respectively. Apothecial structures were not observed. The fungus was identified as Arthrocladiella mougeotii on the basis of morphological characteristics and the host specialization (Braun, 1987). To verify the identification, DNA isolation was performed by using the conidia collected by scraping from surface of infected leaves. The rDNA internal transcribed spacer (ITS) region including 5.8S rDNA was amplified using primers ITS5 (White et al., 1990) and p3 (Kusaba and Tsuge, 1995) and sequenced. The amplified 640 bp product (GenBank accession No. KX017568) revealed 99% genetic similarity with the sequences of an A. mougeotii isolate previously reported (AB022380). Pathogenicity was performed by gently pressing diseased leaves onto young leaves of one-year-old healthy plants. Non-inoculated Goji berry plants were used as control. All plants were transferred to a greenhouse. A month later, the fungus having identical morphological features was observed only on infected plants. To the best of our knowledge, this is the first report of A. mougeotii on Goji berry in Turkey.

FIRST REPORT OF COLLETOTRICHUM KAHAWAE subsp. CIGGARO ON MANDARIN IN ITALY

In May 2015, symptoms of light brown necrotic lesions were observed on mandarin (Citrus reticulata) leaves in Calabria region in southern Italy. The fruiting bodies (acervuli) of the fungus appeared on the necrotic tissues. Isolation was made on potato dextrose agar (PDA) from small sections (3-5 mm2) of lesions margins after surface disinfection in 1% NaOCl. The isolated fungus developed cottony, grey with aerial mycelium with stromatic acervuli producing orange masses of conidia. Conidia were hyaline, cylindrical tapering slightly from only one side measuring 16 - 20 × 3.5 - 5.5 μm. These morphological criteria matched those of Colletotrichum kahawae clade (Weir et al., 2012). Fungal identity at species level was further confirmed by amplification and sequencing of the beta-tubulin (TUB), partial histone 3 (HIS3) and internal transcribed spacer (ITS) region of ribosomal DNA (rDNA) gene regions as described by Damm et al. (2012). The TUB sequence (GenBank accession No. KU605630) shared 100% homology with the TUB sequence of C. kahawae subsp. ciggaro (KC297082). The sequences of HIS3 (KU605631) and ITS (KU605632) were 100% homologous with KC297048 and GU174550, respectively. The isolated fungus was tested for pathogenicity on detached mandarin leaves. A 5-mm2 mycelial plugs were applied on the wounded leaves and kept for 7 days at 25°C under high relative humidity (RH). Symptoms developed were similar to those observed on the trees. Re- isolation revealed the same morphology of the original isolate. To our knowledge this is the first report of C. kahawae subsp. ciggaro on mandarin in Italy.

FIRST REPORT OF ASPERGILLUS MINISCLEROTIGENES AS A POSTHARVEST PATHOGEN OF SOYBEAN SEEDS FROM PAKISTAN

In August 2014, seeds of Glycine max in storage rooms at Lahore, Pakistan, were found to be colonized by an unknown fungus. For pathogen isolation, seeds were incubated on moist blotters, developing a green mass of fungal spores. Spores were transferred to Czapek Dox agar medium and incubated at 25±2°C. After 7 days of incubation colonies were velvety, green and floccose, consisting of white vegetative mycelium and acquired the diameter of 3-4 cm. Globose dark brown sclerotia were produced, smaller than A. flavus. Radiate conidial heads were observed that were mostly biseriate however uniseriate heads were also present. Conidiophores were hyaline, coarsely roughened and 0.9-1.2 mm in length. Vesicles were subglobose to globose, 25-40 μm in diameter, while metulae were 8-12 μm and phialides 5-8 μm long. Conidia were pale or olive green, 3.5-5 μm in diameter. Pathogen was identified as Aspergillus minisclerotigenes (FCBP1353) (Pildain et al., 2008) and differentiated from A. flavus and A. parvisclerotigenus by studying aflatoxin profiles (B1, B2, G1, and G2) using thin-layer chromatography. Amplification of DNA fragment of 650 bp was done using the universal primers ITS1/ITS4 (Batista et al., 2008) and total genomic DNA as a template (White et al., 1990). BLAST analysis of this strain (GenBank accession No. KJ564033) showed 99% similarity to different strains (JX292091, JF412776, KF841549, JF412775). Phylogenetic analysis of identified pathogen and closely related species of A. flavus group by the Maximum Likelihood Hood tree method and profiling of DNA bands examined in the members of Aspergillus section Flavi amplified by three different Inter Simple Sequence Repeat (ISSR) primers clearly confirmed the pathogen identity. Surface sterilized healthy seeds were soaked in spore suspension (104 spores ml-1) from a one week old pathogen culture for 30 s, dried and transferred onto moist blotting paper in Petri plates. Control seeds were treated with sterilized distilled water. After 7 days incubation at 25°C, 90% of seeds were colonized and re-isolation of the same pathogen confirmed the Koch's postulates. To our knowledge, this is the first report of A. minisclerotigenes seed rot from Pakistan.

Early Postnatal Hyperoxia in Mice Leads to Severe Persistent Vitreoretinopathy.

To describe a mouse model of hyperoxia-induced vitreoretinopathy that replicated some of the clinical and pathologic features encountered in infants with severe retinopathy of prematurity and congenital ocular conditions such as persistent hyperplastic primary vitreous. Experimental mice (C57BL/6J) were exposed to 65% oxygen between postnatal days (P)0 to P7 and studied at P10, P14, and 3, 5, 8, 20, and 40 weeks. Controls were exposed to normoxic conditions. Fundus imaging and fluorescein angiography were performed at all time points, and spectral-domain optical coherence tomography (SD-OCT) and electroretinography were performed at 8- and 20-week time points. Eyes were processed for resin histology, frozen sections, and retinal whole mounts. Immunostaining was performed to visualize vasculature isolectin B4 (Ib4), collagen type IV, glial fibrillary acidic protein, and α-smooth muscle actin. Early exposure to hyperoxia resulted in bilateral vitreous hemorrhages at 3 weeks. From 5 weeks onward there were extensive zones of retinal degeneration, scarring or gliosis, retinal folding, and detachments caused by traction of α-smooth muscle actin-positive vitreous membranes. Tortuous retinal vessels, together with hyperplastic and persistence of hyaloid vessels are evident into adulthood. In the early stages (P10-3 weeks), branches from the tunica vasculosa lentis (TVL) supplied the marginal retina until retinal vessels were established. The peripheral retina remained poorly vascularized into adulthood. Electroretinography revealed 50% to 60% diminution in retinal function in adult mice that strongly correlated with vitreal changes identified using SD-OCT. This animal model displays a mixture of vitreoretinal pathologic changes that persist into adulthood. The model may prove valuable in experimental investigations of therapeutic approaches to blinding conditions caused by vitreous and retinal abnormalities.

The Efficacy and Safety Profile of Ocriplasmin in Vitreomacular Interface Disorders

ABSTRACTVitreomacular adhesion (VMA) describes the adhesion of the posterior hyaloid face to the inner retina in any part of the macula. This can arise after incomplete separation of the posterior vitreous cortex from the macula during vitreous liquefaction. While the VMA may resolve spontaneously, a strong and persistent adhesion can lead to a variety of anatomical changes, including vitreomacular traction (VMT) and macular hole (MH). Both conditions can present with metamorphopsia and decreased vision. In cases of symptomatic VMT and full-thickness macular hole, pars plana vitrectomy has long been the standard of care. However, due to the possible surgical complications and need for postoperative care, many have searched for non-surgical options via pharmacologic vitreolysis. Ocriplasmin (Jetrea, Thrombogenics USA, Alcon/Novartis EU) is a recombinant protease approved in October 2012 for the treatment of symptomatic vitreomacular adhesion (VMA). There have been conflicting views on the safety of Ocriplasmin with changes in the ellipsoid zone seen on OCT and changes seen on ERG indicating photoreceptor damage. This publication reviews the efficacy and safety of ocriplasmin injection for VMA based on previously published data.

Analysis of the incidence and relevant factors of retinopathy of prematurity among 109 pairs of twin premature infants

Objective To explore the incidence and related factors of retinopathy of prematurity (ROP) in twins. Methods The incidence and related factors of 109 pairs of twin premature infants were analyzed retrospectively in 218 cases of premature retinopathy screening in the Maternal and Child Health Hospital of Jiaxing during January 2012 to February 2014 Sex, birth weight, nasal oxygen breath, continuous positive airway pressure (CPAP), mechanical ventilation, blood transfusion, and others concominant disease such as asphyxia, sepsis, respiratory distress, congenital heart disease, and hypoglycemia were recorded. Two-sample t test and Logistic regression analysis were used to investigate the risk factors of ROP. Results The incidence of ROP in twin premature infants was 10.56%. There was no significant difference (P>0.05) of the incidence of ROP between lighter and heavier groups. When compared ROP group to normal fundus of premature babies in gestational age, birth weight, and Apgar score, postnatal pulmonary surfactant application, nasal oxygen breath, CPAP, mechanical ventilation, blood transfusion, anemia, asphyxia, respiratory distress, hypoalbuminemia, septicemia hypoglycemia, pulmonary hyaline membrane disease, congenital heart defects, there were statistical differences (P<0.05). Logistic regression analysis indicated that low gestational age, asphyxia, septicemia and hypoglycaemia were the possible risk factors of ROP. Conclusions The weight of twin premature infants is not a major risk factor for ROP. Gestational age, asphyxia, septicemia, and hypoglycaemia are the most important risk factors in the development of ROP. Key words: Twins; Retinopathy of prematurity; Incidence

A case of cutaneous Arthrinium phaeospermum infection after lower limb amputation

A 59-year-old female patient, who received bilateral lower limb amputation 39 years ago, presented with eczematoid changes in both lower limbs for over 20 years, and with chronic granuloma-like lesions complicated by verrucous hyperplasia for more than 10 years. There were large areas of infiltrative and proliferative lesions with exudation and peripheral erythema at the amputation sites in both knee joints. The lesions were hard with tenderness on palpation. Microscopic examination of lesional scales with 10% KOH showed negative results for fungi. However, three times of culture on the Sabouraud dextrose agar (SDA) medium all grew the same kind of fungus, and the front side and reverse side of its filamentous colony were white and orange yellow respectively. Microculture showed that linear hyaline conidiophores came out from lageniform mother cells with conidia ascending alongside. The conidia looked like dark brown eye lens, with an equatorial germ slit. Based on these findings, this fungus was identified as Arthrinium phaeospermum. Periodic acid-Schiff (PAS) staining showed scattered hyphae in the stratum corneum. The internal transcribe spacer (ITS) sequence of the isolated fungus showed 99% consistency with that of Arthrinium phaeospermum. The patient was diagnosed with cutaneous Arthrinium phaeospermum infection, and treated with oral itraconazole capsules 200 mg/d for 16 days. One month later, follow-up showed satisfactory outcomes. Key words: Dermatomycoses; Amputation stumps; Infection; Itraconazole; Arthrinium phaeospermum

Retrospective analysis of 65 Castleman diseases

Objective To explore and clarify the clinical features and management of patients with Castleman disease. Methods The clinicopathological features and therapeutic method of 65 patients with Castleman disease admitted to our hospital continuously from 2005 to 2012 were analyzed retrospectively. The mean follow-up time for the entire series was 40(15-71) months. Results In contrast to Localized Castleman disease(LCD), Multi-centric Castleman disease (MCD) patients were relatively older and exhibit various symptoms and abnormal laboratory tests. We found 44 tumor in LCD group. LCD ones, most of which were hyaline vascular(33/42, 78.6%), were more likely originated in retroperitoneum, enterocoelia(10/44, 22.7%) or mediastinum(10/44, 22.7%). The initial treatment for LCD patients was complete surgical resection and all patients are current alive with no evidence of recurrence. MCD ones always accompanied by fever(9/23, 39.1%), anemia(9/23, 39.1%) and splenomegaly, and most of MCD patients were plasmacytic variants(14/23, 60.9%) or mixed cellular variants(5/23, 21.7%). We found 66 tumor in MCD group and they were more likely originated in neck(16/66, 24.2%) and groin area(12/66, 18.2%). Surgery combined with CHOP-like chemotherapy or CHOP-like chemotherapy alone was the mainstream treatment for MCD ones. 21 patients achieved complete remission or partial remission, and only 2 patients died of lung infection. Whether patients could tolerate long-term chemotherapy or not was an important prognostic factor. Conclusions LCD patients had no typical clinical symptoms and could be cured by surgery. Most of MCD patients always had a good prognosis after receiving CHOP-like chemotherapy. Key words: Castleman disease; Clinical feature; Treatment outcome; Prognosis

An after after-cataract: A curious case of visual axis re-opacification

Posterior capsular opacification (PCO) is common after cataract surgery. Recurrence is very rare after a successful Yttrium aluminium-garnet (YAG) capsulotomy in adults. We report a case of visual axis re-opacification after a successful YAG capsulotomy for PCO in an adult. A 60-year male underwent phacoemulsification with +20.0 D acrylic hydrophobic intraocular lens implantation and silicon oil removal (SOR) five months after a successful retinal detachment repair. He underwent a capsulotomy after two months of surgery; however, the visual axis re-opacified after three more months. A YAG anterior hyaloidotomy resulted into improved vision which was maintained over further follow-up.In a post-vitrectomy pseudophakic eye, compression by silicon oil on the posterior capsule is lost after SOR, causing easier and faster migration of lens epithelial cells from the equator to the centre forming an early PCO. Recurrence is possible due to the proliferation of lens epithelial cells along anterior hyaloid also.This case highlights the infrequent scenario of visual axis re-opacification and therefore has teaching value for residents and trainee doctors, who should be made aware of this occurrence. Patients should be explained about this possibility when undergoing YAG capsulotomy in complicated cases such as this one.

SCLERAL IMBRICATION COMBINED WITH PARS PLANA VITRECTOMY WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR MYOPIC SCHISIS.

We investigated whether scleral imbrication combined with pars plana vitrectomy without internal limiting membrane peeling would be effective in treating eyes with myopic macular schisis. In this retrospective, interventional case series, 8 eyes of 8 patients with myopic retinoschisis without a macular hole were studied. Scleral imbrication was done with 6-mm-wide mattress sutures placed at the temporal quadrants. Pars plana vitrectomy and removal of the vitreous cortex were performed, but the internal limiting membrane was not removed. The best-corrected visual acuity was measured, and the retinal morphology was determined by spectral-domain optical coherence tomography before and at 6 and 12 months postoperatively. The mean age of the subjects was 67.1 years. The best-corrected visual acuity improved from 0.71 ± 0.25 to 0.36 ± 0.19 logarithm of the minimum angle of resolution units (Snellen equivalent: from 20/100 to 20/50) at 12 months (P = 0.028). The axial length was shortened from 29.5 ± 1.7 to 28.5 ± 2.5 at 12 months (P = 0.012). The central foveal thickness decreased from 540 ± 171 μm to 170 ± 85 μm at 12 months (P = 0.012). In the 6 macular-detached eyes, 5 eyes (83%) had a complete resolution. The curvature of posterior eye wall was flatter at 12 months (P = 0.049). No retinal complications were observed. Scleral imbrication combined with pars plana vitrectomy can be an effective method of treating myopic schisis.

Applying internal limiting membrane peeling for vitreoretinal disorders to improve the surgical outcomes

The internal limiting membrane (ILM), composed of collagen fibers, glycosaminoglycans, laminin and fibronectin, is the basement membrane of the retinal Muller glia cells and serves as an interface between the vitreous and retina. The ILM is the structural interface between the vitreous and retina. ILM removal ensures separation of the posterior hyaloid from the macular surface, which can relieve macular traction and prevent postoperative epiretinal membrane formation. Thus, vitrectomy with ILM peeling has become an increasingly utilized and vital component in surgical intervention for various vitreoretinal disorders. However, many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers.There were some surgical strategy (fovea-sparing ILM peeling or inverted internal limiting membrane flap technique, or Abrasion Technique). But some controversies exist, such as when ILM peeling is necessary, which adjuvant to use to perform the procedure, and what is the best technique to peel the ILM. A full assessment ILM structure and function and related factors of surgery is helpful to predict the anatomical and functional prognosis. Key words: Retinal diseases/surgery; Vitreoretinal surgery; Editorial

The application of inverted internal limiting membrane flap technique in macular hole

Vitrectomy combined with internal limiting membrane (ILM) peeling and vitreous tamponade is a conventional method for treating macular hole (MH), but the visual acuity and MH closure rate remains to be further improved. After removal of posterior vitreous cortex, the ILM is grasped with an ILM forceps and peeled off in a circular fashion for approximately 1 disc diameters around the MH. During the circumferential peeling, the ILM is not removed completely from the retina but is left attached to the edges of the MH. The ILM was then massaged gently over the MH from all sides until the ILM became inverted and then peel all other ILM within vascular arcades. Inverted ILM flap technique is one of the important improvement methods in MH vitrectomy, especially for MH with large diameter and unhealed MH after ILM peeling. Compared with conventional vitrectomy combined with ILM peeling, inverted ILM flap technique can enhance MH closure and improve visual acuity. Due to lack of large sample observation in clinical trials of inverted ILM flap technique, we still need more cases and longer follow-up of this technology to more accurately evaluate the effectiveness and safety of this technique. Key words: Retinal perforations/surgery; Vitreoretinal surgery; Review

Laser for vitreous floaters

SummaryBackgroundThe presence of a space between the posterior capsule and the anterior vitreous was first proposed in 1887 but difficulties inherent in examining this structure had made it impossible to visualize this area in vivo until now. Estimation of the size of this space was considered as impossible.Materials and methodsWe utilize an optical coherence tomography system attached to the Zeiss Opmi Lumera 700/Rescan microscope (Zeiss Ltd, Germany) to provide real‐time images of the Berger space, the anterior hyaloid and the ligament of Wieger.ResultsThe results of three patients show beautiful real‐time OCT images of the Berger space and of the ligament of Wieger. In one high myopic eye there was even evidence of anterior vitreous detachment (AVD).ConclusionPreviously unseen transparent structures of the eye can now be imaged intraoperatively using real‐time OCT. This technique provides information on the status of the posterior capsule but more interestingly from the anterior hyaloid and its posterior capsule attachment by the ligament of Wieger. These previously unseen changes in the anterior hyaloid may contribute to the better understanding of the posterior segment complications after cataract surgery.