Hyaline Research Articles

The prophylaxis ofpulmonary surfactant on hyaline membrane disease in preterm infants with differentgestatiooal ages

：Objective To evaluatethe clinical effects and safety of pulmonary surfactant (PS) on-hya line membrane disease(HMD) in preterm infants of different gestational ages, and to discuss the bestopportu-nity for prophylaxis on HMD with PS. Methods Nine hundred and eleven preterminfants with gestational a-ges (GA) ＜35 weeks were analyzedretrospectively,among which 146 babies given PS prophylactically were classified as GroupA,and the other 765 babies without PS as Group B. HMD morbidity and mortality within 7days,as well as the period of mechanical ventilation,oxygen therapy and hospitalizationand major complica-tions were analyzed statistically in both groups. Results Compared toGroup B,HMD morbidity within 7 days was significantly lower by 28. 1% (P＜ 0.05) in Group A. HMD morbidities within 7 days in babies with GA＜ 30 weeks,GA =30 weeks and 31 weeks of Group A werereduced by 43.2% ,58.4% and 50.9% respectively. A significant difference in the 7-daysmortality was observed between Group A (6.2%) and Group B (18.2% ). The mortality ofbabies with GA <30 weeks,GA =30 weeks,GA =31 weeks in Group A reduced by 23.0% ,26.0%and 17.6% respectively with prophylactic administration of PS. There were significantdiffer-ences in the time of ventilation and oxygen therapy (P ＜ 0.05), but no difference was showed in the time of hospitalization between twogroups( P ＞0.05). Compared to Group B,Group A had a lower incidence of lunghemorrhage, ventilator-associated pneumonia and air leak (P＜0.05). ConclusionProphylactic administration of PS results in lower HMD morbidity and mortality,shorteningthe time of ventilation and oxygen therapy, as well as reducing complication incidencesuch as lung hemorrhage,ventilator-associated pneumonia,air leak,par-ticularly in thepreterm infants with GA≤31 weeks. Key words: Infant,newborn,preterm; Hyaline membrane disease; Pulmonarysurfactant; Gestational age

Manifestation and treatment of lipoid proteinosis in larynx

To investigate the manifestation, characteristics and treatment of lipoid proteinosis (LP) in larynx. Sixteen cases of LP with hoarseness as the first sign were reported. The onset was in the newborn period in 10 cases. The upper eyelids were infiltrated in all cases, 13 of them reported an age of onset older than 6 - 8 years. The laryngeal behaviors and its treatment, multisystem manifestations, and characteristics of histopathology were evaluated. One patient had moderate hoarseness, and the others had severe hoarseness. Videolaryngoscopy revealed thickening of the interarytenoid region and irregularities along the rims and the surface of the vocal folds due to yellowish papules. Oral tissues showed yellow-white infiltrates in 13 cases (81.3%). Whitish moniliform papules on the upper eyelids were found in all cases. Pock-like or acneiform scars were particularly evident on the face and the limbs in 14 cases (87.5%). Histologically, it was characterized by deposition of hyaline material in the submucosa and dermis of the eyelid or larynx with periodic acid-Schiff-positive and Congo red stain-negative. Eight patients underwent microlaryngosurgery for the excision of deposits in the vocal folds. The vocal function was significantly improved after surgery. One of the most common features of lipoid proteinosis is hoarseness since infancy with laryngeal involvement. LP patients also display skin or mucosa infiltration of multiple systems. Microlaryngosurgical excision of the deposits in the vocal fold could improve the voice.

The effects of plasmin Kringle domains deficiency mutant on the interface of vitreous and retina in rabbit eyes

Background The vitreoretinal traction plays a critical role in the formation of macular hole and cystoid macular edema.Enzymatic vitreolysis has potential in relieving vitreoretinal traction as a simple and less invasive method in comparison with pars plane vitrectomy.ObjectiveThis study is to investigate the effects of plasmin mutant with kringle domains deficiency(Plm△K)on vitreoretinal interface in new Zealand white rabbits.Methods Plm△K was prepared through activating plasminogen mutant with Kringle domains deficiency (Plg△K) by tissue plasminogen activator (tPA).100μL of Plm△K at the dose of 0.5,1.0 and 1.5μmol/min was injected respectively into the vitreous of 48 New Zealand white rabbits and 16 eyes for each dose.B-scan and optical coherence tomography (OCT) were performed to detect the structure variety at the vitreoretinal interface in 1 day and 7 days after injection.The gross anatomy analysis with triamcinolone acetonide fine particle suspension,as well as histopathological examinations by scanning electron microscopy,was performed in the different time points mentioned above.Results Two peptide chains were determined with the relative molecular weight about 26000 and 5000 by the gel imaging analysis of reduced SDS-PAGE.Separation of the posterior vitreous cortex from retina was found after intravitreous injection under the B-scan and OCT.The ultrastructure change of vitreoretinal interface as well as the examination of fine particle suspension by triamcinolone acetonide demonstrated the same outcome.The degree of remnants of vitreous cortex showed the negative correlation with the dosage of Plm△K (r=-0.9516,P=0.048).No significant correlation was found between the degree of remnants of vitreous cortex and the action time(r=-0.720,P=0.470).There was no obvious morphological difference in outer layer of retina between control eyes and Plm△K-treated eyes.No drug-related adverse event was found after intravitreous injection of Plm△K.Conclusion Intravitreous injection of Plm△K alone can induce complete separation of vitreous from retina.This procedure is safe and effective. Key words: vitreoretinal interface; plasmin; Kringle domain; deficiency mutant

Macular appearance after diabetic vitrectomy for fibrovascular proliferation: an optical coherence tomography study

To investigate morphological variations in the macular area with optical coherence tomography (OCT) after vitrectomy for diabetic fibrovascular proliferation. We reviewed 108 cases using OCT 7-15 months after vitrectomy. Of these, 32 received OCT within 3 months postoperatively. Morphological variations were categorized and correlated with visual outcome. Only 24 cases (21.4%) had no obvious abnormalities. The most frequent findings were epiretinal membrane (52.8%), macular thickening (37.0%) and macular cysts (28.7%). Multivariate regression showed that diffuse macular thickening, loss of foveal depression and diffuse retinal thinning were significantly associated with poor visual acuity. Sequential OCT (< 3 and >or= 7 months) revealed that epiretinal membrane and oedema outside of fovea changed significantly between two examinations. OCT may identify diverse morphological changes in the macular area after diabetic vitrectomy for fibrovascular proliferation. Macular appearance may change over time, and certain types of morphological changes may be associated with poor visual function.

Clinical criteria for definition of idiopathic interstitial pneumonia (IIP)

Clinical criteria for definition of IIP proposed in 1991 by the Project Team for Diffuse Lung Diseases Organized by Japanese Ministry of Health and Welfare are reviewed. After the clinical roentgenological, and pathological researches of 92 IIP patients, we concluded that IIP patients were grouped into two clinical types, acute and chronic, by their clinical courses and characteristic pathological findings. The latter is, moreover, grouped into two types, typical and atypical, by their morphological characteristics. The acute type are represented by alveolitis with marked edema and cell infiltration of alveolar wall, and by hyaline membrane formation. "Typical" of chronic types only have typical pathologic changes of interstitial pneumonia and/or fibrosis represented by honeycombing. "Atypical" have both those interstitial changes and intra-alveolar scar formation and fibrosis due to organized pneumonia and secondarily occurred emphysema such as bulla as well. The continuity in clinical courses between acute and chronic types are still obscure.

Observations by Spectral-Domain Optical Coherence Tomography Combined with Simultaneous Scanning Laser Ophthalmoscopy: Imaging of the Vitreous

To determine the ability to detect normal vitreous structure, evolving posterior vitreous detachment (PVD), and related vitreoretinal changes with combined spectral-domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscopy (SLO). Observational cross-sectional study. Simultaneous SD-OCT and SLO imaging instruments (SD-OCT/SLO) were used to image both eyes of patients with symptoms of PVD. The vitreous cortex, preretinal lacunae, hyaloid, and its relations to the retinal surface were analyzed. In addition, ultrasound was performed in a subset of patients to determine the stage of PVD. Two-hundred two eyes of 113 subjects were scanned. There was a high correlation between diagnosis of complete PVD by clinical examination and OCT (95 vs 93 eyes, respectively; kappa, 0.82). A partial PVD was detected more frequently by SD-OCT/SLO than by biomicroscopy examination (45 vs 7 eyes; P < .0001). Ultrasound was performed in a subset of 30 eyes. A high agreement was found between ultrasound and SD-OCT/SLO results for both complete PVD (kappa, 0.933) and incomplete PVD (kappa, 0.91). Vitreous cortex was detected in 181 eyes, and posterior precortical vitreous pocket was detected in 85 eyes. The effects of PVD, including vitreoretinal traction, paravascular lamellar holes, and fine changes at the fovea, could be visualized reliably in detail only with SD-OCT/SLO. In all these eyes, SD-OCT/SLO allowed improved visualization of the vitreoretinal relationship. SD-OCT/SLO provides unprecedented in vivo information about the physiologic and pathologic vitreous structure; it allows an extremely detailed analysis of the vitreoretinal interface, and it is particularly useful for defining focal changes and PVD.

A prospective randomizedcontrolled trial of synchronized nasal intermittent positive pressure ventilation intreatment of hyaline membrane disease in premature infants

：Objective To assess theefficacy of synchronized nasal intermittent positive pressure ventilation (SNIPPV) asprimary treatment of hyaline membrane disease (HMD) in premature infants. Methods Aprospective randomized controlled trial was conducted. Preterm infants, who were diagnosedas HMD, admitted to the neonatal intensive care unit of Peking University Third Hospitalfrom March 2008 to March 2009 were recruited in the study group. Non-invasive ventilationwere given to the infants who still breath with difficulty after surfactant therapy.Twenty infants were randomized to SNIPPV group and 22 comparable infants to NCPAP group.Vital signs, blood gas analysis and prevalence of non-invasive ventilation failure andcomplications were compared between the two groups, t test and x~2 test were used forstatistical analysis. Results Infants treated initially with SNIPPV had a higher PaQ_2level [(78. 3±17. 6) vs (62. 5±20.5) mm Hg, P<0.05, and (83. 3±17. 7) vs (69. 6±18.8) mm Hg, P<0. 05] and lower PaCQ_2 level [(42.2±12.2) vs (53.7±11.0) mm Hg,P<0.05, and (41.4±11.2) vs (55.3±10.9) mm Hg, P<0.05] than those treated withNCPAP after 3 and 12 hours' ventilation, respectively. SNIPPV group had a decreasedincidence of hypoxemia and hyperbicarbonatemia than NCPAP group after 3 hours' ventilation(5. 0% vs 36.4%, P<0.05,and 20.0% vs 50.0%, P<0.05),and a decreased incidence ofhyperbicarbonatemia after 12 hours' ventilation(20.0% vs 59.1%, x~2=6.654,P=0.010).Infants treated initially with SNIPPV had lower incidence of non-invasive ventilationfailure than infants treated with NCPAP(15. 0% vs 45. 5%, x~2 =4.456, P=0.033). There wasno significant difference on the prevalence of complications between the two groups.Conclusions SNIPPV as a primary measure applied after surfactant therapy is feasible inventilation of premature infants with HMD and is more effective than NCPAP.

Injectable repair offull-thickness cartilage defects with basic fibroblast growth factor-modified bone marrowmesenchymal cells

：Objective To testify thefeasibility of the basic fibroblast growth factor (bFGF)-modified bone marrow mesenchymalstem cells to repair full-thickness cartilage defects by injection.Methods The bone marrowstromal cells (BMSCs) were derived from bone nla.rYow of the rabbits and cultured invitro,and modified by bFGF.The Expression of the type Ⅱ collagen and aggrecan Was detected by immunohistochemistry and RT-PCR.Twenty-oneNew Zealand white rabbits were divided into three groups randomly.The cultured BMSCs mixedwith calcium alginate gel were used to fill the full-thickness hyaline cartilage defectscreated at the femoral condyle,and the de~cts repaired with gel or without treatmentserved as control groups.After 8 weeks,the reconstructed tissue Was evaluatedmacroscopically and microscopically.Histologic analysis and electron microscopic detectionwere also performed to observe the structure of repair tissue.Results The populationdoubling time(PDrr)of BMSCs was about 33.8 h.The exprezsion of the type Ⅱ collagen and aggrecan was detected after bFGF application.Thereconstructed tissue with BMSCs was similar with the microstructure of hyalinecartilage,and contained ulore ceils and thick extracellular matrix than other groups.TypeⅡ collagen wasdetected within the matrix by immunohistochemical staining.Plenty of collagen fibersaround cells could be seen under the transmission electron microscopy.Only partial softconnective tissue filled the bottom of the defects in other two control groups.ConclusionThe compound of bFGF-modified BMSCs with injectable calcium alginate gel is applicable forfull-thickness cartilage defects. Key words: Cartilage; Defect; Basic fibroblast growth factor; Bonemarrow mesenchymal stem cells

Urinary Tract Lesions in Cats And Dogs: Epidemio-Pathological Study

The present study aimed to provide an epidemiological and pathological study on urinary tract diseases in dogs and cats, spontaneous cases, encountered in the Department of Pathology, Forensic Medicine, and Necropsy Diagnosis of FMV Cluj from 1st January 2008 to 1st March 2010. The biological material was represented by 49 cadavers, respectively 15 cats and 34 dogs which presented lesions of the urinary tract. The animals were brought to the Veterinary Pathology Department for the necropsy and histopathological exam. Necropsy was performed according to conventional necropsy technique. This was followed by collection of biological samples, inserted into the fixative agent (10% formalin, pH 7) for 24 hours then processed through the paraffin inclusion technique and examined microscopically for histopathological diagnosis. Histological analysis of samples was performed with an Olympus BX 41 optical microscope and image processing was performed using the software CellB. From the total of 768 animals (635 dogs and 133 cats) which were examined during the mentioned period, only 49 animals (6.38%) presented urinary tract lesions. A total of 11.27% of the investigated cats and 5.35% of the investigated dogs presented urinary tract disorders (table 1).Urinary tract pathology, respectively mainly renal pathology, is more important in cats than in dogs, and most significant lesions were represented by acute tubular necrosis (following ethylene-glycol intoxication), chronic fibrous and proliferative nephritis and lipid dystrophy. In dogs, the lesions that predominated were represented by acute and chronic renal infarcts, chronic nephritis (of fibrous and lympho-hystiocitic type), acute tubular necrosis and dystrophies (such as mineralization and hyalinization).

The challenges of cartilage repair and the potential of stem cell applications.

Articular cartilage injuries pose a treatment challenge. These injuries are a direct cause of pain and loss of function and may precipitate osteoarthritis in the affected joint. Typically affecting a younger, more active population whose expectations of treatment and need for long term joint preservation are high. Articular cartilage poses a treatment challenge in that its capacity for satisfactory healing is limited. The common endpoint of conservative management and traditional surgical interventions is the generation of biomechanically inferior fibrocartilage. Regenerative techniques using human stem cells would appear to represent an exciting modality for the production of true hyaline cartilage with material and biological properties suited for lasting function. This review article summarises the current research regarding the use of human stem cells in the treatment of such injuries.

Cavitation rheology of the vitreous: mechanical properties of biological tissue

We demonstrate the importance of measuring the mechanical properties of biological tissue in vivo by quantifying the mechanical properties of bovine vitreous both in its native state and upon removal from the eye. The mechanical properties are determined by the cavitation rheology technique developed in our labs to determine the linear modulus. This technique involves inducing a cavitation event at the tip of a syringe that is located at an arbitrary location within the vitreous sample. The pressure at which the cavitation event occurs can be directly related to the modulus. We show that the modulus decreases upon removal of the vitreous from the ocular cavity and decreases still further when the vitreous cortex, the thin membrane that surrounds the vitreous, is removed. This study has important implications for both diagnostic science of diseased tissue and developmental biology in studying tissue properties with age.

Central posterior capsule pigmentation in a patient with pigment dispersion and previous ocular trauma: A case report

We report a 55-year-old man with unusually dense, unilateral central posterior capsule pigmentation associated with the characteristic clinical features of pigment dispersion syndrome, including a Krukenberg's spindle and dense trabecular pigmentation in both eyes. A history of an old blunt ocular trauma probably caused separation of the anterior hyaloid from the back of the lens, thereby creating an avenue by which pigment could reach the potential space of Berger's from the posterior chamber.

Seröz Makula Dekolmanına Yol Açan Aktif Oküler Toksoplazmozisteki Optik Koherens Tomografi Bulguları

In this study we present the structural vitreoretinal changes observed during the clinical follow-up of a 35-year-old female patient presenting with serous macular detachment complicated with active ocular toxoplasmosis. The patient applied to the ophthalmology outpatient clinic with the complaint of impaired vision in the left eye; during her clinical follow-up her active toxoplasma chorioretinitis and accompanying serous macular detachment (SMD) in the macula of the same eye were evaluated with optical coherence tomography (OCT). In the OCT sections encompassing the active lesion, there was increased reflectance and thickening in posterior hyaloid membrane and retinal layers as well as local fluid collection in the subretinal space. Secondary to increased retinal reflectance, retinal pigment epithelium-choriocapillaris junction demonstrated focal shadowing. The clinical findings of the patient improved with treatment. During her control OCT examination, it was seen that posterior hyaloid membrane at the site of the lesion was detached, collected fluid underneath the retina was resolved, retinal tissue became thinner with irregular layers and the suppressed reflectance of the retinal pigment epithelium-choriocapillaris junction was partially improved. OCT sections at the level of macula demonstrated total disappearance of SMD.

Residual triamcinolone acetonide at macular hole after vitreous surgery

Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement.

Localisation of opticin in human proliferative retinal disease

This study sought to determine the distribution of opticin, an extracellular matrix small leucine-rich repeat protein secreted by the non-pigmented ciliary body epithelium (CBE), in pathological eye tissues including posterior hyaloid membranes (PHM) and epiretinal membranes (ERM) from subjects with proliferative diabetic retinopathy (PDR), central retinal vein occlusion (CRVO) and proliferative vitreoretinopathy (PVR). Eight enucleated eyes and eleven surgically excised PHMs/ERMs from patients with PDR, CRVO or PVR were analysed by immunohistochemistry for the presence and distribution of opticin, vitreous (delineated by a type II collagen antibody) and blood vessels (using CD31 and CD34 antibodies as endothelial markers). Opticin was present at the basal surface of the non-pigmented CBE and, in a patchy distribution, within CBE cells in all 8 enucleated globes. It also co-localised with the type II collagen of vitreous, where present, in these eyes. Opticin was present in 16 of the 19 PHMs/ERMs, where it was arranged in layers (10 membranes), diffusely (4 membranes) or in foci (2 membranes). Where in a layered pattern, opticin co-localised with vitreous type II collagen incorporated into the membrane, whereas the other two patterns did not co-localise with type II collagen labelling. We concluded that even in advanced proliferative retinal disease, the CBE continues to express and secrete opticin. Opticin was co-distributed with vitreous type II collagen and was also present in the pre-retinal membranes of proliferative retinopathies, where it could play a role in their development.

OCT-guided Nd:YAG laser hyaloidotomy

PURPOSE: To evaluate the effectiveness and safety of OCT-guided Nd:YAG laser hyaloidotomy as a treatment modality for subhyaloid premacular bleedings. DESIGN: Retrospective observational case report. METHODS: A young women with premacular bleeding was evaluated with OCT and Nd:YAG laser hyaloidotomy was subsequently done. RESULTS: OCT scans, especially the ones which were taken above the sedimented blood level, demonstrated that the bleeding was localized under the posterior hyaloid membrane. Rapid resolution of premacular bleeding and substantial visual acuity improvement were registered already three days after the Nd:YAG laser hyaloidotomy. CONCLUSION: Valsalva maculopathy often involves younger, working active patients who often need fast visual acuity recovery. Data from this case report demonstrated that OCT-guided Nd:YAG laser hyaloidotomy is a safe and effective treatment for subhyaloidal premacular bleedings.

Microplasmin Degrades Fibronectin and Laminin at Vitreoretinal Interface and Outer Retina during Enzymatic Vitrectomy

Purpose: To determine whether intravitreal administration of microplasmin (μPlm) will degrade fibronectin (FN) and laminin (LN) in rat retina during μPlm-induced posterior vitreous detachment (PVD).Methods: Increasing doses of μPlm, from 0.01 U to 0.03 U, were injected into the left eyes of 60 Sprague-Dawley rats to induce PVD. The right eyes were injected with the same volume of balanced salt solution (BSS). Histochemistry, scanning electron microscopy (SEM), and phase contrast microscopy were performed after 1 day and 7 days, to assess the remnant vitreous cortex. The FN and LN level located at the vitreoretinal interface and the outer retina were detected by immunohistochemistry.Results: μPlm induced complete PVD in a dose-dependent fashion, without internal limiting membrane (ILM) damage (P = 0.0001, r = −0.479). The FN and LN in the photoreceptor cell layer (PCL) were completely degraded in all μPlm-treated eyes. In eyes with complete PVD, the FN, but not the LN, was completely removed from the ILM by μPlm treatment.Conclusion: Intravitreal injection of microplasmin degraded FN and LN at the vitreoretinal junction as well as at the outer retina.

Surgical treatment and prognosis analysis of localized retroperitoneal Castleman disease: a study of 20 cases

To investigate the clinical characteristics, surgical treatment and prognosis analysis of localized retroperitoneal Castleman disease (CD), and to improve the level of diagnosis and treatment of retroperitoneal Castleman disease with paraneoplastic pemphigus (PNP). The clinical data of retroperitoneal CD with PNP from January 1993 to May 2009 were compared with CD without PNP retrospectively, including clinical features, tumor site, lab examination, surgical treatment, pathologic subtype and results of surgery. (1) Retroperitoneal Castleman disease more likely originated in para-kidney and iliac fossa with middle age of 36 years old, especially in left retroperitoneum. Of the 20 cases, 18 tumors (90%) were hyaline vascular variants and 2 were mixed variants. There was no statistical difference in gender, age, tumor site and pathological subtype between two groups. (2) Retroperitoneal CD with PNP more likely complicated with bronchiolitis obliterans (BO) and high level of serum CEA/CA242. (3) Retroperitoneal Castleman tumors had clear margin, intact envelop and were easily resectable, however the biological behavior of CD with PNP might tend malignant changing, invade adjacent blood vessel or seed locally, and eventually relapse after operation. (4) The 5-year survival rate of retroperitoneal CD with PNP was 42.8%, significantly lower than those without PNP. The average survival time was 30 months. Bronchiolitis obliterans and radical resection were the key effect in prognosis of retroperitoneal CD. Retroperitoneal CD with PNP has distinctive clinical features. Early diagnosis, prompt removal of tumor and termination secretion of causative antibody are critical to the management of this disease.

Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphology

Idiopathic macular hole is characterized by a full thickness anatomic defect in the foveal retina leading to loss of central vision, metamorphopsia and a central scotoma. Classic macular hole surgery consists of vitrectomy, posterior vitreous cortex separation and intraocular gas tamponade, but during the past decade focus has especially been on internal limiting membrane (ILM) peeling as adjuvant therapy for increasing closure rates. With increasing use of ILM peeling and indocyanine green (ICG) staining, which is used for specific visualization of the ILM, concerns about the safety of the procedure have arisen. At present, it is not known whether ICG-assisted ILM peeling potentially reduces the functional outcome after macular hole surgery. The purpose of the present PhD thesis was to examine whether ICG-assisted ILM peeling offers surgical and functional benefit in macular hole surgery. We conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (iii) vitrectomy plus 0.15% trypan blue (TB)-assisted ILM peeling. Morphologic and functional outcomes were assessed 3, 6 and 12 months after surgery. The results show that surgery with ILM peeling, for both stages 2 and 3 macular holes, is associated with a significantly higher closure rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (>or=20/40). Macular hole surgery can be considered a safe procedure with a low incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better mean visual acuity in the non-peeling group (78.2 letters) compared to the ICG-peeling group (70.9 letters), p = 0.06. Performing repeated macular hole surgery was associated with a significant reduction in functional outcome indicating that primary focus should be on closing the macular hole in one procedure. Morphological studies of closed macular holes with contrast-enhanced optical coherence tomography (OCT) found thinning and discontinuity of the central photoreceptor layer matrix that were highly specific for predicting the likelihood of an eye having regained reading vision 12 months after macular hole surgery. Additionally, healing after macular hole surgery appeared to begin with the contraction of the inner aspect of the retina, forming a roof over a subfoveal fluid-filled cavity, and to end with a gradual restoration of the anatomy in the outer layers of the retina at the junction of the photoreceptor inner and outer segments. We found the more intact this structure was on contrast-enhanced OCT 3 months after macular hole surgery, the better the visual acuity after 12 months, whereas late rather than early resolution of subfoveal fluid had no impact on final visual outcome. The use ILM peeling and intraoperative dyes did not have any functionally important effects on postoperative macular structure. Based on the above findings, we conclude that ILM peeling should be performed in all cases of full thickness macular hole surgery. The use of 0.05% intraoperative isotonic ICG with short exposure time appears to be a safe alternative in stage 3 macular hole surgery, whereas a slight reduction in functional potential not can be excluded when performing 0.05% isotonic ICG-assisted ILM peeling in stage 2 macular hole surgery.

Morphology and Accommodative Function of the Vitreous Zonule in Human and Monkey Eyes

To explore the attachments of the posterior zonule and vitreous in relation to accommodation and presbyopia in monkeys and humans. Novel scanning electron microscopy (SEM) and ultrasound biomicroscopy (UBM) techniques were used to visualize the anterior, intermediate, and posterior vitreous zonule and their connections to the ciliary body, vitreous membrane, lens capsule, and ora serrata, and to characterize their age-related changes and correlate them with loss of accommodative forward movement of the ciliary body. alpha-Chymotrypsin was used focally to lyse the vitreous zonule and determine the effect on movement of the accommodative apparatus in monkeys. The vitreous attached to the peripheral lens capsule and the ora serrata directly. The pars plana zonule and the posterior tines of the anterior zonule were separated from the vitreous membrane except for strategically placed attachments, collectively termed the vitreous zonule, that may modulate and smooth the forward and backward movements of the entire system. Age-dependent changes in these relationships correlated significantly with loss of accommodative amplitude. Lysis of the intermediate vitreous zonule partially restored accommodative movement. The vitreous zonule system may help to smoothly translate to the lens the driving forces of accommodation and disaccommodation generated by the ciliary muscle, while maintaining visual focus and protecting the lens capsule and ora serrata from acute tractional forces. Stiffening of the vitreous zonular system may contribute to age-related loss of accommodation and offer a therapeutic target for presbyopia.