Hyaline Research Articles

FIRST REPORT OF JUJUBE DIEBACK CAUSED BY FUSARIUM SOLANI

In spring 2010, a severe branch dieback was observed in jujube (Ziziphus jujuba) orchards of the Sarbishah region of southern Khorasan (Iran). Symptoms included twig dieback, blackish discoloration of wood and foliage, and wilting followed by leaf shedding. Samples of symptomatic tissues, including discoloured wood and cambium from twigs and branches, were excised, surface-sterilised, plated onto Petri dishes with potato dextrose agar (PDA), and incubated in the dark at 25°C for 10 days. On PDA, the colonies presented a cream-coloured mycelium with yellow pigmentation and a creamy reverse. On carnation leaf agar, macroconidia were abundant, thick walled, 4 to 6 celled, hyaline, fusoid, and measured 5-7×20-37.5 μm. Microconidia, which were formed in false heads developing on long monophialides, were oval, reniform and fusiform, had 0 to 2 septa and measured 2.5-5×7-15 μm. Chlamydospores were single, double or several in chain, and measured 5-7.5×5-9 μm. Based on these morphobiometric and cultural characteristics, the fungus was identified as Fusarium solani (Demicri and Maden, 2006; Leslie and Summerell, 2006). For pathogenicity tests, normal and wounded shoots of three 6-year-old jujube trees were inoculated with 5 mm diameter mycelium disks from two 10day-old single-spore isolates. Inoculation sites were covered with moistened cotton wool and parafilm. Control inoculations were made with sterile PDA. Disease symptoms, including tissue discoloration, were first observed 14 days after inoculation of the shoots, from which the fungus was reisolated. Controls did not develop symptoms. F. solani is frequently found associated with damage or stress events caused by other biotic or abiotic agents (Booth, 1971). This represents the first evidence of F. solani pathogenicity to Z. jujuba.

Prevalence of early and late stages of physiologic PVD in emmetropic elderly population

To investigate the early and late stages of posterior vitreous detachment (PVD) in the foveal area in correlation with age and gender. Three hundred and thirty-five emmetropic eyes of 271 Caucasian patients (216 women/119 men) were examined by optical coherence tomography (OCT) and ultrasound (US). Eyes were classified into groups according to the patients age (up to 69.9; 70-74.9; 75-79.9; over 80 years) and to the clinical findings [Vitreous state: Detached in US; Detached in OCT; Foveal adhesion (FA); Attached vitreous]. The mean age was 76 ± 8 ranging from 44 to 89 years in female and 72 ± 10 ranging from 46 to 87 years in male subjects. The vitreous was attached in 32% of all eyes, 18.5% had FA, 18.5% were detached in OCT and 68% were detached in US. While prevalence of FA decreases with increasing age, OCT-diagnosed detachments did not change significantly with age. Between the ages of 70 and 75, an increase in PVD rates occurred. The prevalence of PVD was similar in both genders. Women were significantly older than men in the late-stage PVD in the eyes. The use of OCT and US enabled us to detect a partial or total PVD in 80% of the eyes. A sudden increase in late-stage PVD between the ages of 70 and 75 was observed, correlating with the reported age prevalence of various macular diseases. In contrast to myopics, both genders of elderly emmetropics have a similar prevalence of PVD.

Misleading axial length measurements with the IOLMaster due to a dense posterior vitreous surface membrane and a macular edema in a diabetic patient

Misleading axial length measurements with the IOLMaster due to a dense posterior vitreous surface membrane and a macular edema in a diabetic patient

Outcomes of 25-Gauge Pars Plana Vitrectomy in the Surgical Management of Proliferative Diabetic Retinopathy

To report outcomes and complications of 25-gauge pars plana vitrectomy (PPV) for patients with complications of proliferative diabetic retinopathy (PDR). Retrospective, interventional, consecutive case series of 174 eyes undergoing primary 25-gauge PPV for PDR from 2006 to 2009. Primary outcomes were visual acuity changes and rates of postoperative complications. Visual acuity improved from 20/187 before to 20/69 after surgery (P < .0001). Postoperative vitreous hemorrhage occurred in 38.7% of eyes and 10.4% of all eyes required another PPV for non-clearing vitreous hemorrhage. Complications included limited choroidal effusion (5.2%), rhegmatogenous retinal detachment (4.6%), hypotony, rubeosis, and ocular hypertension (4.1%), neovascular glaucoma (2.3%), hyphema (1.2%), and phthisis bulbi (0.6%). The authors found 25-gauge PPV to be effective for vitreous removal and membrane dissection. The spectrum and frequency of complications were similar to those reported for 20-gauge PPV for PDR. In the surgical management of PDR, 25-gauge PPV is an alternative.

Contrast‐enhanced ultrasonography in the differentiation of retinal detachment and vitreous membrane in dogs and cats

To evaluate contrast-enhanced ultrasonography (CEU) and colour Doppler imaging (CDI) for detection of persistent vascularisation in retinal detachment. In 22 eyes, retinal detachment (n=13) and vitreous membranes (n=9) were confirmed by ophthalmological examination, during cataract surgery, by histopathology or after vitreoretinal surgery. Tentative diagnosis of retinal detachment or vitreous membrane was made using grey-scale B-mode ultrasonography. Assessment of retinal detachment was based on the presence or absence of vascularisation in the membranous structure using CDI and CEU. Sensitivity, specificity, positive-predictive value and negative-predictive value of grey-scale ultrasonography in differentiating retinal detachment from vitreous membrane were 92·3%, 66·6%, 80% and 85·7%. In 91% of eyes, colour Doppler assessment was unsuccessful due to the movement of the eye. Persistent vascularisation was demonstrated in all cases of retinal detachments with CEU. CEU was 100% accurate for detection and differentiation between retinal detachment and vitreous membrane. CEU is a useful clinical tool for the diagnosis of retinal detachment and vitreous membrane in dogs and cats.

Influence of in vivo or vitro microenvironment on the mechanical properties and histological structure of tissue engineered cartilage

To investigate the influence of in vivo or vitro microenvironment on the mechanical properties and histological structure of tissue engineered cartilage, and to provide the appropriate parameters for cartilage construct in vitro. Human fetal articular chondrocytes were cultured and expanded in vitro, the passage 2 chondrocytes were seeded at the density of 6 x 10(7) cells/cm3 to cylindric dimensional scaffolds made by polyglycolic acid (PGA) and polylactic acid (PLA). These constructs were cultured in vitro for 4 weeks. After 4 weeks, part of samples were implanted subcutaneously into nude mice for 6 and 12 weeks, the others continued to be cultured in vitro. All specimens were harvested after 6 and 12 weeks, and evaluated by gross observation, histology, histochemistry, ultrastructure and mechanical test. All specimens in vivo and vitro eventually formed good shape hyaline cartilage. The constructs in vivo group was white color with smooth surface, and had better mechanical properties than those in vitro, by TEM we can observe the thick and striated collagen fibers in regularly arranged collagen fibril which was similar to adult articular cartilage. The constructs in vitro group was yellow color with coarse surface, the appearance and ultrastructure was similar to fetal articular cartilage. Specimens implanted for 12 weeks in vivo had better compressive modulus(38.28 +/- 3.95) MPa and collagen diameter (41.58 +/- 2.78) nm than those cultured in vitro at the same time (4.12 +/- 0.63) MPa, (15.83 +/- 1.70) nm (P < 0. 01). The structure and function of human tissue engineered cartilage became mature gradually from vitro to vivo, thick and striated collagen fibrils net similar to adult articular cartilage can be formed in constructs of vivo group,increased collagen cross-linking might be the reason that their mechanical properties been greatly improved.

Lamellar macular hole formation in chronic cystoid macular edema associated with retinal vein occlusion

To report the formation of a lamellar macular hole (LMH) in four eyes with chronic cystoid macular edema (CME) associated with retinal vein occlusion (RVO). We reviewed retrospectively the medical records of four patients with chronic CME associated with RVO, in whom LMH formation was observed by a series of examinations with optical coherence tomography. All eyes showed a large chronic cystoid space in the fovea. Three eyes showed an epiretinal membrane, and one eye showed traction of a posterior hyaloid membrane to the fovea. The chronic cystoid space changed into an LMH by rupture of its inner wall due to traction. After formation of the LMH, the mean total foveal thickness decreased from 590±131 to 95±22μm, equal to the thickness of the foveal photoreceptor layer before the formation of the LMH (mean 100±23μm). Visual acuity did not change substantially from before to after the formation of the LMH. Chronic CME associated with RVO can transform into an LMH through the rupture of the inner wall of the foveal cystoid space. While this transformation is accompanied by a substantial reduction in macular thickness, it does not lead to changes in visual function.

Anterior chamber migration of dexametasone intravitreal implant (Ozurdex®)

Dear Editor, Ozurdex® (Allergan Inc., Irvine, CA, USA) is an intravitreal implant containing the dexamethasone. It uses NOVADUR® drug delivery technology, in which a biodegradable material is combined with the active drug dexamethasone to form a small rod-shaped implant of 0.46 mm in diameter and 6 mm in length. Inside the eye, the implant is progressively dissolved in the vitreous gel, as it slowly releases dexamethasone (0.7 mg). This biodegradable device is indicated for the treatment of macular edema following branch or central retinal vein occlusions. In large clinical trials, Ozurdex® has also proved effective in the treatment of posterior non-infectious uveitis, and diabetic and macular edema to and pseudophakic macular edema [1, 2]. Herein we report the case of a 68-year-old male diagnosed with macular edema following branch retinal vein occlusion in his left eye. Visual acuity was 0.6 logMAR. The patient had undergone cataract surgery years before, with intraoperative violation of the lens posterior capsula, anterior vitrectomy assisted with triamcinolone and iris-claw intraocular lens implantation. An intravitreous injection of Ozurdex® (Allergan Inc., Irvine, CA, USA) was performed without remarkable complications. Three weeks later, the patient attended our emergency department complaining of blurred vision in his left eye. Slit-lamp examination revealed the presence of diffuse corneal edema, and anterior migration of the implant (Fig. 1). The intraocular pressure measured 18 mmHg. The implant was surgically removed from the anterior chamber 48 hours later. However, corneal edema did not resolve, and the patient finally underwent corneal transplantation. The anterior chamber transit has been previously described for triamcinolone acetonide, resulting in pseudohypopion [3, 4]. Probably due to a similar mechanism, the dexamethasone implant may also migrate into the anterior chamber, with secondary corneal descompensation due to the contact of the implant with the endothelium. This may be more frequent in pseudophakic cases with Nd-YAG capsulotomy, or posterior capsule violation during phacoemulsification. Nevertheless, pseudohypopion after intravitreal triamcinolone injection has been described in both phakic or pseudophakic patients with posterior capsule integrity, it being presupposed then that the zonula is not complete or that the crystals are capable of crossing through it [3, 4]. In this particular case, the lack of anterior hyaloid may facilitate the penetration of Ozurdex into the anterior chamber too. In our opinion, the state of anterior hyaloid can be assessed by slit-lamp examination only. However, ecography could be useful in cases of uncertain anterior hyaloid status. The authors certify that they have not been published or are being considered for publication elsewhere. The authors also transfer property rights (copyright) of this work to Graefe’s Archive for Clinical and Experimental Opthalmology. D. Pardo-Lopez : E. Frances-Munoz :R. Gallego-Pinazo : M. Diaz-Llopis Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain

Osteopontin expression in vitreous and proliferative retinal membranes of patients with proliferative vitreous retinopathy.

To analyze osteopontin (OPN) expression in vitreous and proliferative retinal membranes of patients with proliferative vitreous retinopathy (PVR). A total of 54 vitreous fluid samples were obtained between 2009 and 2010, which contained 45 with PVR (group A) and 9 without PVR (group B). Enzyme-linked immunosorbent assay was applied to quantify the OPN concentrations in vitreous fluid. Four samples of proliferative retinal membrane were also obtained at the time of vitrectomy, and their contents of OPN were measured by Real-time RT-PCR. The OPN levels in the vitreous fluid were 778.48±62.06ng/mL in group A and 452.99±32.52ng/mL in group B. The vitreous OPN levels in group A were significantly higher than those in group B and to rise by time in the early stages of PVR. The average OPN levels in the proliferative retinal membranes (F=0.14) were also higher than those in the retinal pigment cells (F=0) using Real-time RT-PCR. The high vitreous and proliferative retinal membrane OPN levels in PVR suggest that OPN might promote the development of PVR. The vitreous OPN concentrations are rising by the time in the early phases of PVR.

Epiretinal Membranes and Incomplete Posterior Vitreous Detachment in Diabetic Macular Edema, Detected by Spectral-Domain Optical Coherence Tomography

PURPOSE. To present the vitreoretinal interface in diabetic macular edema (DME) associated with both epiretinal membrane (ERM) and incomplete posterior vitreous detachment (PVD), as detected by spectral-domain optical coherence tomography (SD-OCT). METHODS. In a retrospective study, findings were analyzed in one eye in consecutive patients. Excluded were eyes that had undergone vitreoretinal intervention or that had complete PVD or complete vitreous attachment. RESULTS. Of 44 eyes with DME and ERM, incomplete PVD was apparent in 23 (52.2%) eyes. A hyperreflective unified ERM/posterior vitreous cortex (PViC) membrane, or EVi membrane, was apparent in various sizes in 20 (87.0%) of the 23 eyes. This unified membrane (n = 20) was associated with vitreopapillary adherence in 19 (82.6%) of 23 eyes. Two major OCT presentations (n = 23) were encountered: incomplete vitreopapillary detachment (n = 11; 25% of 44), with attachment to the macular ERM, and posterior vitreous detachment from the macula, associated with vitreopapillary adhesion (n = 10; 22.7%), in four different manifestations. In the remaining two eyes, there was no association between the ERM and the PViC. CONCLUSIONS. In eyes with DME, ERM, and incomplete PVD, the posterior cortical vitreous and ERM appeared as one united EVi membrane in various lengths in most eyes, typically associated with vitreopapillary adhesion. These findings may have clinical importance in the context of epimacular membrane characteristics and its removal in DME.

Increased Expression of Periostin in Vitreous and Fibrovascular Membranes Obtained from Patients with Proliferative Diabetic Retinopathy

Preretinal fibrovascular membranes (FVMs) form as a sequela to proliferative diabetic retinopathy (PDR), and their presence can lead to a severe decrease of vision. The purpose of this study was to determine whether periostin, a matricellular protein that plays a role in cell adhesion and migration, is associated with the formation of FVMs. One hundred six vitreous samples and 15 FVMs were obtained during vitrectomy on patients with PDR. Semiquantitative RT-PCR was performed to determine the periostin level of the mRNA. Immunohistochemical analyses were performed to determine the sites of periostin expression in the FVMs. ELISA was used to measure the concentrations of periostin, bFGF, and VEGF in the vitreous. The periostin level of the mRNA was high in 10 of 10 FVMs tested but was barely detectable in the control retinas. Sequencing of the periostin PCR products revealed three splice variants of the FVMs. Immunohistochemical analysis showed colocalization of periostin and α-SMA in FVM cells. The concentration of periostin in the vitreous was significantly higher in patients with PDR than in the 31 eyes of patients with a macular hole or an epiretinal membrane (P < 0.001). Among the PDR patients, the mean vitreous level of periostin in eyes with FVMs was significantly higher than in those without FVMs (epicenter only; P < 0.001). The correlation between the vitreous concentrations of periostin and of bFGF and VEGF was not significant. These findings indicate that periostin may be involved in the development of FVMs.

Mechanisms and treatment of primary angle closure: a review

Angle closure can recur following peripheral iridotomy in up to 58% of cases, due to plateau iris syndrome, lens disproportion or ciliary block. Ciliary block glaucoma is an important differential diagnosis of shallow anterior chamber, angle closure and high intraocular pressure, which may occur spontaneously or following laser or surgery. Some underlying mechanisms of ciliary block glaucoma remain poorly understood but lens-ciliary body apposition and anterior hyaloid changes with increased hydraulic resistance are major pathogenic factors. An understanding of the pathogenic factors facilitates early recognition of ciliary block glaucoma, and aids a logical sequence of intervention. We review the mechanisms of post-iridotomy angle closure and propose a stepwise treatment strategy for these conditions.

Surgical macular decompression for macular edema in retinal vein occlusion.

Recently, a number of surgical and laser approaches have been used to improve visual outcome in cases of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Intravitreal steroid injection alone appears to offer only temporary improvement at best. Radial optic neurotomy for CRVO and arteriovenous adventitial sheathotomy for BRVO are the most frequently utilized surgical procedures for these conditions, but evidence regarding efficacy is still lacking. We have suggested that macular decompression by internal limiting membrane (ILM) peeling may reduce macular edema and hemorrhage and improve visual acuity by relieving elevated intraretinal tissue pressure and facilitating egress of blood and extracellular fluid out of inner retinal layers into the vitrectomized vitreous cavity. 50 cases of severe visual loss due to macular edema caused by CRVO or BRVO, not eligible for laser photocoagulation, underwent pars plana vitrectomy with removal of preretinal hyaloid, peeling of the ILM stained with indocyanine green dye, air-fluid exchange, and postoperative prone positioning. In all cases, intraretinal blood and retinal thickening diminished within 6 weeks of surgery. Visual acuity improved in 87% of CRVO cases and 68% of BRVO cases. Vision improved and stabilized at 39 days after surgery. Average improvement was 2.6 lines with a 6-line improvement in 1 case. There was no difference in outcome between cases with ischemic or nonischemic features on fluorescein angiography. Macular decompression using vitrectomy and ILM peeling is effective in the treatment of severe visual loss due to macular edema in CRVO and in those BRVO cases that do not qualify for laser photocoagulation.

Application of Curosurf in children with hyaline membrane disease and the nursing measures

Objective To investigate the effect of curosurf in treatment of children with hyaline membrane disease and the nursing. Methods 56 cases of children patients with hyaline membrane disease from June 2008 to June 2010 admitted to neonatal wards were selected. The control group (26 cases)treated with mechanical ventilation alone and corresponding conventional care, on this basis, the treatment group (30 cases) was treated with curosurf and give systemic nursing intervention. Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate, death rate, PaO2 and PaCO2 before and after treatment were observed in two groups. Results Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate in the treatment group was significantly lower than that in the control group; PaO2 and PaCO2 amelioration in the treatment group was better than the control group. Conclusions Children with hyaline membrane disease should be treated with curosurf and given systemic nursing intervention as early as possible, it can rapidly improve the symptoms of hypoxia, reduce complications, decrease mortality, accelerate the recovery of disease. Key words: Curosurf; Hyaline membrane disease; Nursing

AGING CHANGES OF VITREOMACULAR INTERFACE

The posterior precortical vitreous pocket (the pocket) is a premacular liquefied lacuna, the physiologic presence of which was reported in autopsy eyes. We describe the morphologic features of the pocket in normal individuals. We performed spectral-domain optical coherence tomography in 102 eyes of 51 normal subjects of various ages in a sitting position. The pocket was identified as an optically lucent space anterior to the posterior fundus in 85 of 102 eyes (83.3%) in the age-group. The vitreous cortex was extremely thin at the central fovea, and it gradually thickened along with age in the perifoveal area. A shallow perifoveal posterior vitreous detachment developed in 16 of 32 eyes (50%) of subjects aged >51 years. The lamellar structure of the vitreous cortex was seen in 7 of the 32 eyes (22%) of subjects aged >51 years. Spectral-domain optical coherence tomography confirmed the presence of the pocket in all ages. Thickened vitreous cortex and perifoveal posterior vitreous detachment were physiologic findings in older individuals. The lamellar structure of the vitreous cortex may be related to the vitreoschisis.

Influence of Elevated Intraocular Pressure on the Posterior Chamber–Anterior Hyaloid Membrane Barrier During Cataract Operations

To investigate the influence of elevated intraocular pressure on the posterior chamber-anterior hyaloid membrane (PC-AHM) barrier during cataract operations in ex vivo porcine eyes. A pressure transducer was connected to porcine eye anterior chambers (ACs). In experiment 1, ACs were perfused for 20 seconds with balanced salt solution containing 1.0-μm fluorescein beads (10 eyes per bottle height: 45, 85, 145, and 285 cm). In experiment 2, 5 ophthalmic viscosurgical devices with different molecular weights and sodium hyaluronate concentrations were infused into the ACs (20 eyes per ophthalmic viscosurgical device). After continuous curvilinear capsulorrhexis, hydrodissection was performed. After both experiments, PC-AHM barrier staining was evaluated through the Miyake-Apple view. Types of fluorescein staining patterns were classified as AC, zonule of Zinn, AHM, AHM tear, and ruptured capsule. In experiment 1, plateau intraocular pressure and staining type were positively correlated (Spearman rank correlation; r = 0.703, P < .001). In experiment 2, mean peak intraocular pressure was significantly greater in the ruptured capsule-type eyes than in the AC-, zonule of Zinn-, AHM (P < .001), or AHM-tear-(P = .02) type eyes, as well as in the AHM- and AHM-tear-type eyes compared with the AC and zonule of Zinn type eyes (P < .001). Intraocular pressure was significantly higher in eyes infused with ophthalmic viscosurgical devices with a higher molecular weight or sodium hyaluronate concentration (P < .05). Stress on the PC-AHM barrier increases as intraocular pressure increases. Ophthalmic viscosurgical devices with a higher molecular weight or sodium hyaluronate concentration might induce increased IOP during cataract operations. To maintain normal PC-AHM barrier function, excessive intraocular pressure should be avoided during cataract operations.

Clinicopathologic and immunohistochemical study of 23 cases of mesenchymal chondrosarcoma

To study the clinicopathologic and immunohistochemical features of mesenchymal chondrosarcoma. The clinical and histologic features of 23 cases of mesenchymal chondrosarcoma were analyzed. Immunohistochemical study was also performed in 14 of the cases. The age of patients ranged from 12 to 47 years. Fourteen of them occurred in males. Thirteen cases involved the bony skeleton and 5 cases affected the soft tissue. The patients presented with pain and/or swelling. Histologically, the tumor consisted of a mixture of undifferentiated small round cells and hyaline cartilage. Transition between the two components was demonstrated and growth plate-like cartilage was observed. Immunohistochemical study showed that the small round cells were positive for Sox9 (14/14), CD99 (12/14), vimentin (6/14), CD56 (4/14), CD57 (4/14), neuron-specific enolase (3/14) and desmin(1/14). They were negative for Coll-II, S-100 protein, epithelial membrane antigen, pan-cytokeratin, synaptophysin, chromogranin A, CD34 and c-erbB2. Mesenchymal chondrosarcoma is a rare malignant tumor. Thorough histologic examination, when coupled with immunohistochemical findings, is helpful in arriving at a correct diagnosis.

Epithelial Membrane Protein-2 (EMP2) and Experimental Proliferative Vitreoretinopathy (PVR)

Purpose: Proliferative vitreoretinopathy (PVR) is believed to result in part from de-differentiation of retinal pigment epithelium (RPE) with cellular migration in the vitreous cavity, membrane formation, and contraction in an aberrant wound-healing strategy. In an in vitro collagen-gel contraction assay, epithelial membrane protein 2 (EMP2) controls contraction through activation of focal adhesion kinase (FAK) in a RPE cell line (ARPE-19). The purpose of this study was to investigate how blocking or altering the level of EMP2 expression changed clinical PVR in an in vivo model.Methods: Using the ARPE-19 cell line, the levels of EMP2 modulated through stable transfections of an EMP2 overexpressing construct, EMP2 ribozyme, or vector alone. These transfected cell lines were used in a rabbit model of PVR. The severity of PVR was classified by two masked observers. An EMP2 blocking antibody was also used to decrease functional EMP2 in the PVR model. Immunohistochemistry was used to evaluate EMP2 expression in vivo.Results: The transfectants with lower levels of EMP2 had significantly less PVR severity than the degree of PVR induced by wild-type cells (p = 0.05). Also, the transfectants with a low-level of EMP2 expression showed a strong trend of less PVR severity than the high-levels EMP2 transfectants (p = 0.06). Blocking EMP2 with a specific polyclonal antibody significantly decreased the level of PVR severity (p = 0.02). PVR membranes were found to be positive for EMP2 expression.Conclusions: These in vivo studies support a direct correlation between EMP2 expression and severity of PVR. These results validate the potential for controlling RPE biology through a change in EMP2 expression, and provide a potential therapeutic target for this disease.

PORES OF THE INNER LIMITING MEMBRANE IN FLAT-MOUNTED SURGICAL SPECIMENS

To demonstrate the incidence of pores in the inner limiting membrane (ILM) in flat-mounted ILM specimens and to show the immunocytochemical properties of cellular proliferation associated with them. One hundred and twelve ILM specimens from patients with idiopathic macular holes were flat mounted and screened for pores. The ILM was assessed by phase-contrast and interference microscopy. Various antibodies were used against glial cells, hyalocytes, and retinal pigment epithelial cells. In total, only three pores were found. They were characterized by a full-thickness defect of the ILM with irregular borders and cellular proliferation on the ILM. Glial cells were seen in direct association with the ILM pore. Glial cell and hyalocyte markers were the main immunologic features observed. Inner limiting membrane pores are a rare finding. Glial cells are likely to cross the ILM through these pores on their way from the retina to the vitreoretinal border. Given the frequency of cellular proliferation and the rare finding of ILM pores, other pathways have to be considered in playing the leading role in epiretinal proliferation. They might include migration of cells through ILM thinning along retinal vessels and proliferation of vitreous cortex hyalocytes at the vitreoretinal border.

Risk factors of premature behavioral neurological assessment

Objective To analyze the characteristic of twenty-item premature behavioral neurological assessment,and to assess the risk factors of neonatal behavioral neurological assessment(NBNA) in premature infants. Methods Total two hundred and seventy-four premature infants hospitalized in Guangzhou Children's Hospital were assessed with the NBNA after correcting age 40 weeks,premature infants were divided into two groups:normal group (n =221 ) and abnormal group (n =53) according to NBNA. The birth history, mother pregnancy situation, the disease during neonatal period and results in hospital were reviewed,and the risk factors of NBNA in premature infants were assessed. Results There were significant differences in gestational age, birth weight, head circumference, body height, Apgar score, resuscitation time, hospitalization time and total gastrointestinal nutrition time between the two groups( P ＜ 0. 05 ). The incidences of superfoetation,hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease were different between the two groups( P ＜ 0. 05 ). There were no differences in gender, antenatal hormone use, anaemia, hypotension and evoked potential abnormality (P ＞0. 05 ). Multivariate logistic regression analysis showed that the risk factors of NBNA score in premature infants would include low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury, severe infection, hyperbilirubinemia, hypoglycemia and chronic lung disease. Conclusion Although the premature infants corrected age 40 weeks,but the capability and initiative muscular tension are still lower than term infant. Low Apgar score, low birth weight, hyaline membrane disease, hemorrhagic and hypoxic brain injury ,severe infection ,hyperbilirubinemia,hypoglycemia and chronic lung disease are important risk factors related to premature behavioral neurological assessment. Key words: Behavioral neurological assessment; Risk factors; Infant,premature