Inactive Scars Research Articles

Fellow Eyes Conversion Rates in Patients With Unilateral Exudative Age-Related Macular Degeneration: An Academy IRIS® Registry Analysis.

This study aimed to examine conversion rates from non-exudative to exudative age-related macular degeneration (AMD) in the fellow eye of patients with unilateral exudative AMD using the Academy IRIS® Registry. This study was a retrospective, cohort analysis from 2016 to 2019. Patient and disease characteristics including initial AMD stage were collected. Cox proportional-hazard (PH) and logistic regression modeling were performed. The risk of conversion was lower for men relative to women and for Asians and Blacks relative to Whites. Compared to never-smokers, active smokers were at increased risk of conversion, and compared to initially early non-exudative AMD eyes, intermediate and advanced non-exudative AMD eyes had higher rates of conversion. Compared to active choroidal neovascularization eyes, eyes with inactive choroidal neovascularization and inactive scars had lower rates of fellow eye conversion. In this cohort analysis of unilateral exudative AMD patients, women, Whites, and active smokers had higher rates of non-exudative to exudative AMD conversion in the fellow eye. [Ophthalmic Surg Lasers Imaging Retina 2024;55:220-226.].

Strigid herpesvirus-1 as a differential for chronic keratitis in owls

An adult free-ranging great horned owl was referred for evaluation of chronic ulcerative keratitis in the left eye that had been treated for several months. In vivo confocal microscopy confirmed that the corneal lesion was an inactive scar, and histopathology and molecular testing of a proliferative palpebral conjunctival lesion in the same eye confirmed infection with strigid herpesvirus- 1. Resolution of the conjunctivitis occurred following the biopsy and the owl was released. Four months later the owl re-presented with presumed rodenticide poisoning, and there was no evidence of recurrence of ocular disease.

Reamputation stumps below knee.

Aim To investigate rehabilitation outcomes of patients with malformed tibial stumps. Methods Observations included 421 patients with residual limb diseases and malformations (extensive inactive scars adhered to the bone, excessively long or short stumps, bone filing, osteomyelitis of the stump, muscle attachment to the skin scar, excessive mobility and deviations of the fibula, improper filing). Four hundred and thirty-six (436) reconstructive surgeries were performed. A follow-up period was from 6 months to 15 years. Radiological, ultrasonic, tensometrical, and histological methods were used. Results Due to the frequent combination of several malformations and diseases in the same patient, non-free skin grafting with displaced dermal-subcutaneous flaps, which cover rather large defects, was widely used. The surgeries were performed simultaneously and allowed for reconstruction without shortening the bone lever stump. Complications in the form of marginal necrosis were obtained in three (0.71%) patients. The improved technique of muscle grafting with the fixation of muscles to the bone provided an elastic stump covering the bone filing. The authors have developed original methods of surgery to create a bone block of the tibia, which make it possible to obtain painless, highly functional stumps using partial support and ensure long-term use of modern prosthesis designs in 100% of cases. Conclusion Non-free dermal plasty with cutaneous-subcutaneous flap is the method of choice for closing skin defects on the residual limb. Muscle-bone fixation permits to eliminate some residual limb defects and to form an elastic muscular residual limb with closed bone filaments. Synostosis formation in different ways considerably improves functional quality of the residual limb.

Treatment of idiopathic choroidal neovascular membrane with ranibizumab - our experience.

To evaluate the anatomical and functional outcome of ranibizumab therapy in patients with idiopathic choroidal neovascularization (CNV). File and Methodology: The group consists of 6 patients. Patients were older 18 years but they were under 50 years of age. The monitoring period lasted 12 months. We confirmed active idiopathic CNV in subfoveal position with fluorescein angiography (FAg) and optical coherence tomography (OCT). The activity of idiopathic CNV we demonstrated with leakage of dye by FAg examination. The presence of serous retinal pigment epithelium detachment and / or subretinal fluid and / or intraretinal edema in the form of intraretinal cysts demonstrated activity of CNV on OCT scans. Adecrease of the visual acuity under 85 letters was observed at the ETDRS (Early Treatment Diabetic Retinopathy Study) visual acuity chart. After the initial administration of ranibizumab apro re nata regimen was used. We indicated repeated injection of ranibizumab in patients with signs of activity of idiopathic CNV on OCT scans or by FAg. Also we indicated repeated injection of ranibizumab in patients with new loss of visual acuity on the ETDRS visual acuity chart connected with signs of activity of CNV on OCT scans or by FAg. On average, we observed the gain of +11 letters on the ETDRS visual acuity chart after 12 months of the follow-up period. On average we observed reduction of central macular thickness -233μm. At the 12th month of follow-up we observed in all patients of our group only inactive scar without exudation. No serous retinal pigment eithelium detachment, subretinal fluid or intraretinal cysts were observed. Only 3 injections of ranibizumab were administered on average to each patient during the 12 months of the follow-up period. In our study, we observed the positive effect of ranibizumab on the course of idiopathic CNV. With ranibizumab treatment we achieved regression of CNV with resorption of macular edema in all patients of our group. With the disappearance of the activity of idiopathic CNV ranibizumab gives real hope to improve visual acuity.

Immune Mediators against Toxoplasma Gondii during Reactivation of Toxoplasmic Retinochoroiditis

ABSTRACTPurpose: The purpose of this article is to analyze possible associations between systemic and ocular cytokine levels and specific clinical ophthalmologic signs from patients with a reactivation of toxoplasmic retinochoroiditis (RTR).Methods: A total of 18 patients with an active RTR episode, 8 patients with inactive scars, and 14 control patients were included in the study. Serum samples and aqueous humor (AH) samples were analyzed for IFN (interferon)-γ, interleukin (IL)-10, and IL-6 levels by ELISA. Inflammation grade, location, and size of the retinochoroidal active lesion, sampling time, and time to resolution were recorded.Results: A significantly negative correlation between AH and serum levels of IFN-γ was detected (p < 0.05). Patients with an AH IFN-γ/IL-10 ratio lower than 1 were associated with the longest time to resolution and/or severe complications.Conclusion: Serum IFN-γ levels may be used as a prognostic marker for both time to resolution and the development of possible severe complications during a given RTR episode.

Swept-Source OCT Angiography of Serpiginous Choroiditis

To examine and quantify choriocapillaris lesions in active and quiescent serpiginous choroiditis (SC) using swept-source optical coherence tomography angiography (SS-OCTA) and en-face image analysis. Prospective observational case series. Patients with a clinical diagnosis of SC. A SS-OCTA prototype was used to image active and quiescent serpiginous lesions longitudinally before and after anti-inflammatory treatment. En-face slabs of choriocapillaris flow (CC-slab) or outer nuclear layer structure (ONL-slab) were generated from OCTA and OCT data, respectively. Qualitative and quantitative analyses on lesion boundary and area using a semi-automated MATLAB algorithm. Lesions were also compared to traditional multimodal imaging. Six eyes of three patients were imaged. Choroidal lesions were identified and analyzed in four of six eyes. Lesions with well-defined boundaries were identified in the CC-slab in areas of both active and inactive choroiditis. CC-slab lesion size and shape showed good correlation with lesions identified on indocyanine green angiography. CC-slab lesion area increased with disease activity and decreased with corticosteroid treatment. During active disease, the CC-slab lesion area was larger than both the ONL-slab and fundus autofluorescence lesion areas. Active CC-slab lesions not associated with corresponding abnormal autofluorescence resolved without clinical scarring after treatment. In inactive scars, the areas of retinal and choriocapillaris lesions were similar and did not change over time. En-face analysis of SS-OCTA choriocapillaris flow voids provide a non-invasive method for the detection of lesions in patients with SC. The presence of lesions in the choriocapillaris in the absence of retinal pigment epithelium and outer retinal abnormalities supports the hypothesis that choriocapillaris is the primary site of pathology in SC, and may be a sensitive early sign of disease activity. We propose a simple grading system of SC lesions based on SS-OCTA and fundus autofluorescence findings. SS-OCTA is a promising non-invasive method for monitoring patients with SC.

Ocular inflammatory disease and ocular tuberculosis in a cohort of patients co-infected with HIV and multidrug-resistant tuberculosis in Mumbai, India: a cross-sectional study.

BackgroundThe prevalence and the patterns of ocular inflammatory disease and ocular tuberculosis (TB) are largely undocumented among Multidrug Resistant TB (MDR-TB) patients co-infected with Human Immunodeficiency Virus (HIV) and on antituberculosis and antiretroviral therapy (ART).MethodsLilavati Hospital and Research Center and Médecins Sans Frontières (MSF) organized a cross-sectional ophthalmological evaluation of HIV/MDR-TB co-infected patients followed in an MSF-run HIV-clinic in Mumbai, India, which included measuring visual acuity, and slit lamp and dilated fundus examinations.ResultsBetween February and April 2012, 47 HIV/MDR-TB co-infected patients (including three patients with extensively drug-resistant TB) were evaluated. Sixty-four per cent were male, mean age was 39 years (standard deviation: 8.7) and their median (IQR) CD4 count at the time of evaluation was 264 cells/μL (158–361). Thirteen patients (27%) had detectable levels of HIV viremia (>20 copies/ml). Overall, examination of the anterior segments was normal in 45/47 patients (96%). A dilated fundus examination revealed active ocular inflammatory disease in seven eyes of seven patients (15.5%, 95% Confidence Intervals (CI); 5.1-25.8%). ‘These included five eyes of five patients (10%) with choroidal tubercles, one eye of one patient (2%) with presumed tubercular chorioretinitis and one eye of one patient (2%) with evidence of presumed active CMV retinitis. Presumed ocular tuberculosis was thus seen in a total of six patients (12.7%, 95% CI; 3.2-22.2%). Two patients who had completed anti-TB treatment had active ocular inflammatory disease, in the form of choroidal tubercles (two eyes of two patients). Inactive scars were seen in three eyes of three patients (6%). Patients with extrapulmonary TB and patients <39 years old were at significantly higher risk of having ocular TB [Risk Ratio: 13.65 (95% CI: 2.4-78.5) and 6.38 (95% CI: 1.05-38.8) respectively].ConclusionsOcular inflammatory disease, mainly ocular tuberculosis, was common in a cohort of HIV/MDR-TB co-infected patients in Mumbai, India. Ophthalmological examination should be routinely considered in HIV patients diagnosed with or suspected to have MDR-TB, especially in those with extrapulmonary TB.

Association of liver abnormalities with carcass grading performance and value

The association of liver abnormalities with carcass grading performance, value, and dressed yield was evaluated on data from 76,191 carcasses housed in 2 databases. Liver abnormalities were assigned as follows: normal = edible liver; A- = 1 to 2 small abscesses or inactive scars; A = 1 to 2 large abscesses or multiple small abscesses; A+ = multiple large abscesses; A+AD = liver adhered to gastrointestinal tract or diaphragm or both; A+OP = open liver abscess; cirrhosis; distoma; and telangiectasis. Overall liver abnormality rates among both databases were A- = 5.0%, A = 2.6%, A+ = 2.0%, A+AD = 2.7%, A+OP = 1.4%, cirrhosis = 0.1%, distoma = 5.4%, and telangiectasis = 0.3%, with 80.5% of livers being normal. In database 1 (n = 3,936), BW was 33.3 kg less (P < 0.01) for carcasses with cirrhotic livers compared with carcasses with normal livers. Dressed yields for carcasses with A-, A+, A+AD, A+OP, and cirrhosis liver abnormalities were 0.28 to 0.89 percentage points less (P < 0.05) than carcasses with normal livers. In database 2 (n = 72,255), carcasses with A-, A+, A+AD, A+OP, cirrhosis, distoma, and telangiectasis liver abnormalities had reduced (P < 0.05) HCW and reduced (P < 0.05) LM area as compared with carcasses with a normal liver. Less (P < 0.05) 12th-rib subcutaneous fat was observed for carcasses with A-, A, A+, A+AD, A+OP, cirrhosis, and distoma abnormalities compared with carcasses with normal livers. Estimated KPH was less (P < 0.05) for carcasses with A-, A+, A+AD, A+OP, cirrhosis, and distoma abnormalities. Calculated yield grade was less (P < 0.05) for carcasses with A+AD, A+OP, cirrhosis, and distoma abnormalities compared with carcasses with normal livers. Marbling score of carcasses that had livers with A+AD or A+OP abscess scores or distoma was less (P < 0.05) than that of carcasses with normal livers. In database 2, market price per 45.35 kg did not differ (P = 0.32) among liver classification. Gross carcass value analyses indicated carcasses with A-, A, A+, A+AD, A+OP, cirrhosis, and distoma liver abnormalities were less valuable (P < 0.05) than carcasses with normal livers. These data delineate the association of liver abnormalities present at harvest with subsequent changes in carcass characteristics and ultimately lost carcass value.

Morphological analysis of the connective tissue reaction in linear hypertrophic scars treated with intralesional steroid or silicone-gel sheeting. A light and electron microscopic study

The linear hypertrophic scar has become the most common type of pathologic scarring. Silicone-gel sheeting is the first line therapy while intralesional steroid is the second. A light and electron microscopic analysis was carried out to reveal differences in tissue reaction following the two different treatments. Two groups of 12 patients each were treated for 4 months. For the first group, diluted Triamcinolone acetonide was injected until an inactive state was achieved. The other group of patients was treated with silicone-gel sheeting. The scars were examined every two weeks and their appearance documented. After reaching the expected therapeutic response, inactive scars were removed. The excised scars were evaluated through light microscopic histopathology and electron microscopy. The light and electron microscopic observations revealed marked differences following treatments. The activity of fibroblasts and the numbers of collagen fibers forming bundles decreased and the orientation of the collagen fibers was more variable in the treated scars. The amount of elastic fibers increased after both steroid and silicone-gel sheeting treatment. Vascularization was also slightly changed, with more capillaries and fewer pre-capillary arteries detected in the treated scars. Both treatments resulted in the same decrease in score but steroid treatment was more rapid in onset. We suggest that the two different treatments work through different mechanisms, although the final functional outcome is similar.

Photodynamic Therapy for Choroidal Neovascularization in Patients with Multifocal Choroiditis and Panuveitis

To evaluate the visual benefit of photodynamic therapy (PDT) with verteporfin in patients with choroidal neovascularization (CNV) secondary to multifocal choroiditis and panuveitis over a longer follow-up period. A total of 14 eyes of 12 patients (mean age 34 years) with a classic subfoveal CNV (13/14) or juxtafoveal CNV (1/14) were treated with PDT. Visual outcome was assessed by best-corrected visual acuity (VA). Morphologic characteristics of CNVs such as localization, size, and activity were monitored by fluorescein angiography. Patients were followed for 3 to 45 months (mean 23 months). During this period, one to six PDTs (mean 2.4) were performed. At the time of the first PDT no acute inflammation was seen in the affected eyes. Improved or stabilized visual function (VA loss < or = 2 lines in the Early Treatment Diabetic Retinopathy Study chart) was observed in 71.4% of the eyes. A total of 78% of the eyes showed an inactive scar in the area of CNV after PDT. Treatment failure after PDT occurred due to uninfluenced CNV growth. No further complications were observed. PDT in subfoveal or juxtafoveal classic CNV secondary to multifocal choroiditis and panuveitis stabilized or improved VA in the majority of patients over a longer follow-up period. No risk factor for failed VA rehabilitation could be defined.

Cell-Based Cardiac Repair

Received February 28, 2005; revision received April 25, 2005; accepted April 29, 2005. It has now been more than a decade since the first experiments were performed using cell transplantation for the prevention and treatment of heart failure.1–3 Although the biomedical community was initially somewhat skeptical of this approach, a large body of experimental evidence was amassed showing that injected cells could create new tissue and improve function of the failing heart. This evidence, coupled with the recognized limitations of heart failure treatments and the intuitively appealing concept of “regenerative medicine,” has contributed to a crescendo of activity in cell-based cardiac repair. Given the flurry of clinical trials that are currently under way, we think it is timely to review progress over the past 10 years and provide a critical assessment of where the field stands and where it appears to be headed. Cell-based cardiac repair began with studies of skeletal myoblasts derived from skeletal muscle satellite cells.1–3 Myoblasts were the initial choice because of their availability from autologous or syngeneic sources, their ability to proliferate, and their ability to withstand ischemia better than many cell types. Although it was originally hoped that these cells would transdifferentiate into cardiomyocytes, it is now clear that myoblasts remain stubbornly committed to form mature skeletal muscle in the heart3–5 (with the exception of rare cell fusion events at the graft–host interface6). Skeletal muscle is one of the few cell types in the body that does not normally express gap junction proteins, and hence, structural and physiological studies indicate that skeletal muscle cells do not form electromechanical junctions with cardiomyocytes when engrafted into the heart.7,8 Despite this, numerous studies have shown beneficial effects of skeletal myoblast grafting into the infarcted heart in rodents and large animals.8–13 Cardiomyocytes would …

Combined photodynamic therapy and intravitreal triamcinolone for the treatment of myopic choroidal neovascularization in a 13-year-old girl

Combination photodynamic therapy with verteporfin (PDT) and intravitreal triamcinolone acetonide (IVT) is currently being investigated as a treatment for choroidal neovascularization (CNV) due to age-related macular degeneration. However, PDT with triamcinolone has never previously been described in the treatment of CNV secondary to pathologic myopia, or in a young person. We describe the case of a young girl treated with combination PDT and IVT for a myopic subfoveal CNV membrane. This study was an interventional case report. The medical chart of a 13-year-old child treated with combination PDT with IVT was reviewed for changes in visual acuity on the ETDRS chart, CNV leakage on fluorescein angiography, and adverse events reported. ETDRS visual acuity improved from 20/80-2 to 20/25 in the right eye over 7 months following two treatments of a myopic CNV lesion with combination PDT and IVT. Following treatment, an inactive scar with no further leakage was visible on fluorescein angiography. An increase in intraocular pressure was associated with the second IVT treatment, and successfully treated with topical therapy. Combination PDT with IVT may be considered under appropriate circumstances to treat children with CNV.

Clinical Features and Prognosis in Ocular Toxoplasmosis

To evaluate retrospectively the clinical characteristics, complications, and prognosis in patients with ocular toxoplasmosis. We reviewed the records of 189 patients (243 eyes) with ocular toxoplasmosis who were examined between 1972 and 1999. Color fundus photography and, in some patients, fluorescein angiography and indocyanine green angiography were performed. There were 98 male (52%) and 91 female (48%) patients with a mean age of 22.8 +/- 8.9 years. Of the patients, 140 (74%) had congenital and 49 (26%) had acquired toxoplasmosis. At the initial examination, there were active lesions in 65 eyes and inactive lesions in 178 eyes. Active lesions included retinochoroiditis in 59 (91%), papillitis in 2 (3%), and neuroretinitis in 4 (6%) eyes. There was also an inactive scar in 17 eyes with active retinochoroiditis. Localisation of the active retinochoroiditis was the macula in 44 (74%), the macula and peripheral retina in 3 (5%), the peripheral retina in 9 (15%) and the peripapillary retina in 3 (5%) eyes. Optic atrophy, pigment epithelial detachment, choroidal neovascularization, lamellar macular hole, and retinal neovascularization were seen during the follow-up period. Ocular toxoplasmosis commonly affects the macula and seriously impairs visual acuity. The prevention of acquired and congenital infections is very important in controlling ocular toxoplasmosis. Patients should be followed to avoid late complications.

Therapeutic Lamellar Keratectomy in the Management of Nontuberculous Mycobacterium Keratitis Refractory to Medical Treatments

Nontuberculous Mycobacterium keratitis is characterized by its indolent course and poor response to antibiotic drugs. Between November 1989 and September 1993, 10 eyes diagnosed to have nontuberculous Mycobacterium keratitis underwent therapeutic lamellar keratectomy in conjunction with fortified topical medications. Nine operated eyes (90%) recovered with a shortened course and healed with an inactive scar. Six patients (60%) achieved a visual acuity of 20/40 or better postoperatively. For recalcitrant nontuberculous Mycobacterium keratitis, therapeutic lamellar keratectomy is highly recommendable for patients with intractable paracentral or peripheral ulcer, for uncompliant patients, for patients who cannot tolerate drug-induced ocular toxicity, or when penetrating keratoplasty is to be reserved for late rehabilitation of the eye.

Regression of Cytomegalovirus Retinitis With Zidovudine

A 55-year-old man with the acquired immunodeficiency syndrome had cytomegalovirus (CMV) retinitis develop in his left eye. The patient declined treatment with ganciclovir but elected to be treated with zidovudine. Two months later his CMV retinitis regressed, and it remained inactive for a total of 9 months. The most likely explanation was zidovudine-mediated improvement in the patient's immune function with subsequent suppression of the CMV retinitis in the left eye. The patient ultimately and preterminally had CMV retinitis develop in his right eye. He subsequently died and his eyes were examined at autopsy. Active CMV retinitis lesions were noted in the right eye while inactive scars were noted in the left eye. Immunoperoxidase staining and in situ hybridization studies demonstrated the presence of CMV in the right eye but not in the left eye. While ganciclovir remains the treatment of choice for CMV retinitis, zidovudine treatment may have a beneficial effect on CMV retinitis in some patients.

Cytomegalovirus Retinitis and Acquired Immunodeficiency Syndrome

In a series of 157 patients with acquired immunodeficiency syndrome (AIDS), 46 (29%) developed cytomegalovirus (CMV) retinitis. In five patients, CMV retinitis was the initial AIDS-defining opportunistic infection (11% of patients with CMV retinitis and 3% of patients with AIDS). Retinal detachments developed in seven patients (15%) and in four were present before the institution of ganciclovir therapy. Bilateral CMV retinitis was present in 35% of patients at presentation and subsequently developed in nine (60%) of 15 patients while not being treated with ganciclovir. Conversely, none of 18 patients with unilateral disease developed bilateral disease while receiving ganciclovir. Of patients treated with ganciclovir for their CMV retinitis, 81% had a response to the drug, and 61% achieved a complete response, resulting in a nonprogressive and inactive scar. Patients who achieved a complete response with ganciclovir had a significantly longer survival than those who did not, suggesting greater immune compromise in those patients who failed to respond to ganciclovir.

A Follow-up Study on Serpiginous Choroiditis

Fifteen patients suffering from serpiginous choroiditis were followed up for 1 to 10 years (mean 4.9 years). There were 7 women and 8 men with ages ranging from 20 to 65 years (mean 35 years). In 13 patients both eyes were involved. Ten of the 15 patients had both inactive scars and fresh lesions when first seen. The individual lesions resolved in a few weeks but, due to the gradual extension of the primary lesions centripetally in the shape of halos or pseudopods, signs of activity were observed for 1 to 9 months after the initial examination. After an interval of 3 months to 4 years, new recurrences were found in 8 patients; in some of them progression was noticed on serial fundus photographs only. Central vision was lost in 6 eyes, in 2 of them due to a subretinal neovascular membrane. Progression and recurrences could not be prevented by antituberculous medication or systemic corticosteroids. The cause of serpiginous choroiditis remains unknown but, on the basis of the fluorescein angiography, occlusion of the uveal vessels, possibly due to an immune vasculitis, is suggested. Immunological studies revealed no signs of diffuse vasculitis. Of the histocompatibility antigens, HLA-A2 was found in five and HLA-B7 in 4 of the 6 patients studied.

A follow-up study on serpiginous choroiditis.

Fifteen patients suffering from serpiginous choroiditis were followed up for 1 to 10 years (mean 4.9 years). There were 7 women and 8 men with ages ranging from 20 to 65 years (mean 35 years). In 13 patients both eyes were involved. Ten of the 15 patients had both inactive scars and fresh lesions when first seen. The individual lesions resolved in a few weeks but, due to the gradual extension of the primary lesions centripetally in the shape of halos or pseudopods, signs of activity were observed for 1 to 9 months after the initial examination. After an interval of 3 months to 4 years, new recurrences were found in 8 patients; in some of them progression was noticed on serial fundus photographs only. Central vision was lost in 6 eyes, in 2 of them due to a subretinal neovascular membrane. Progression and recurrences could not be prevented by antituberculous medication or systemic corticosteroids. The cause of serpiginous choroiditis remains unknown but, on the basis of the fluorescein angiography, occlusion of the uveal vessels, possibly due to an immune vasculitis, is suggested. Immunological studies revealed no signs of diffuse vasculitis. Of the histocompatibility antigens, HLA-A2 was found in five and HLA-B7 in 4 of the 6 patients studied.

The role of T-lymphocytes in the reactivation of presumed ocular histoplasmosis scars.

The surprising finding of viable lymphocytes in clinically inactive scars gives more credence to the immunological theory regarding reactivation of histoplasmosis scars. We feel that the T-lymphocyte theory can explain the mechanism by which an inactive scar becomes active upon reintroduction of the antigen. The clinical course of the disease as well as the response to corticosteroid therapy and photocoagulation are also consistent with this hypothesis.