Injection Of Balanced Salt Solution Research Articles

Topical and subconjunctival anesthesia versus topical anesthesia alone in patients with senile cataracts undergoing phacoemulsification: a double-blind randomized controlled trial

BackgroundThis study compared topical anesthesia to a combination of topical anesthesia and subconjunctival anesthesia for phacoemulsification.MethodsThis double-blinded parallel placebo-controlled randomized trial involved senile cataract patients scheduled for phacoemulsification between May and December 2022. Patients were randomly assigned to receive either topical anesthesia with 0.5% tetracaine hydrochloride and subconjunctival balanced salt solution injection (Control group) or topical anesthesia and subconjunctival injection with 2% lidocaine (Lidocaine group). Baseline parameters, cataract grades, and various outcomes were recorded, including pain scores at specific time points, patient cooperation scores, requests for additional anesthesia, and complications. Statistical methods included Fisher’s exact test, the t-test, ordinal logistic regression, and linear regression with robust standard errors.ResultsIn total, 176 patients were included in the study after excluding 33 patients. A significant reduction in immediate postoperative pain was achieved in the Lidocaine group (p < 0.001) and was maintained for 2 h (p = 0.011). Additionally, better cooperation was observed in this group (p = 0.038). However, patients in the Lidocaine group experienced more pain during the subconjunctival injection (p = 0.001) and a significant increase in subconjunctival hemorrhage related to the injection (p < 0.001). Despite this, the rates of surgical complications were comparable between the groups, and all phacoemulsification procedures were successfully completed using the assigned anesthetic technique.ConclusionsThe addition of subconjunctival lidocaine injection to topical anesthesia reduced postoperative pain and improved patient cooperation during phacoemulsification. However, the lidocaine injection was painful, and it carried a higher risk of spontaneous-relief subconjunctival hemorrhage.Trial registrationTrial Registration Number: TCTR20220804003, date of registration August 4, 2022, retrospectively registered.

Safety of intracameral injection of levofloxacin 0.5% eye drops single dose 0.6 ml preservative free on rabbit eye

Background This was an experimental, parallel, and randomized study to evaluate the safety of single intracameral injection of 0.6 ml 0.5% preservative-free levofloxacin eye drops on rabbit eye. Methods In total, 24 eyes of 12 New Zealand white rabbits were divided into three groups. The first group (LFX) was treated with 0.1 ml intracameral injection of levofloxacin 0.5% eye drops of 0.6 ml preservative-free (n = 6), the second group (CRAV) was treated with 0.1 ml intracameral injection of levofloxacin 0.5% eye drops 5 ml commercially available eye drops preservative-free (n = 6), and the third group (BSS) were treated with 0.1 ml intracameral injection of balanced salt solution (n = 12). All groups received a single dose. The clinical evaluation was performed on the 1st, 3rd, 5th, and 7th day after injection. Each eye was enucleated on the 7th day and underwent a histopathology examination. Results The clinical scores among the three groups did not show any significant difference on days 1st, 2nd, 3rd, and 7th (p&gt;0.05). The only ones noted in clinical scores were mild corneal opacity, mild cells, and flares in the anterior chamber. The histopathology score demonstrated no statistically significant difference between the three groups (p&gt;0.05). Vacuolization of corneal endothelial cells was noted in all groups but was not statistically significant. Conclusions A single intracameral injection of 0.6 ml 0.5% preservative-free levofloxacin eye drops was safe for rabbit eye, according to clinical and histopathology scores, similar to levofloxacin 0.5% eye drops in 5 ml bottle preservative free.

Displacement of Submacular Hemorrhage With Vitrectomy Combined With Subretinal Balanced Salt Solution and Air.

To describe a technique of displacement of submacular hemorrhage (SMH) using subretinal injection of balanced salt solution and filtered air. Patients presenting within 2 weeks of massive SMH (>4 disk diameter) were prospectively included. All patients underwent 25-gauge pars plana vitrectomy, posterior vitreous detachment, injection of subretinal balanced salt solution and filtered air followed by partial fluid air exchange, 20% sulfur hexafluoride tamponade, and heads-up positioning postoperatively. Degree of displacement of SMH was assessed at 1 month and change in best-corrected visual acuity was assessed at 3 months. Ten patients with massive SMH who underwent the aforementioned procedure were included. Complete displacement of bleed from the macula was achieved in nine (90%) of 10 eyes at 1 month. There was significant improvement in best-corrected visual acuity from baseline at 1 month ( P = 0.015) and 3 months ( P = 0.043). Pars plana vitrectomy with injection of subretinal balanced salt solution and filtered air was well-tolerated and efficacious in displacing large and thick SMH in patients operated within 2 weeks of onset of symptoms.

Combined Internal Limiting Membrane Peeling and Subretinal Balanced Salt Solution Injection: A Novel Technique to Unfold Congenital Falciform Folds.

To describe a novel surgical technique to unfold congenital falciform folds. A retrospective, interventional case series was performed where a novel technique was applied to treat five cases of congenital falciform folds. Twenty-five-gauge vitrectomy was performed along with the removal of all vitreous adhesions. The internal limiting membrane was peeled from the macula and around the macular fold area. A Tano diamond-dusted membrane scraper was used to stretch the folded retina mechanically. Then, subretinal balanced salt solution was injected using a 38-gauge subretinal needle to create multiple blebs around the folded retina. Finally, 20% sulfur hexafluoride gas was used for tamponade. Follow-up was conducted for a minimum of 6 months. Vision improved from preoperative mean best-corrected visual acuity logMAR 1.44 (20/550) ± 0.32 to postoperative mean best-corrected visual acuity logMAR 0.75 (20/112) ± 0.17 ( P value = 0.0208) after intervention. There was a reduction in the macular fold. Postoperatively, a macular hole with retinal detachment developed in one of five (20%) eyes. The novel technique of vitrectomy with combined internal limiting membrane peeling and subretinal balanced salt solution injection is visually rewarding in treating congenital falciform folds.

Safety of intracameral injection of levofloxacin 0.5% eye drops single dose 0.6 ml preservative free on rabbit eye.

This was an experimental, parallel, and randomized study to evaluate the safety of single intracameral injection of 0.6 ml 0.5% preservative-free levofloxacin eye drops on rabbit eye. In total, 24 eyes of 12 New Zealand white rabbits were divided into three groups. The first group (LFX) was treated with 0.1 ml intracameral injection of levofloxacin 0.5% eye drops of 0.6 ml preservative-free (n = 6), the second group (CRAV) was treated with 0.1 ml intracameral injection of levofloxacin 0.5% eye drops 5 ml commercially available eye drops preservative-free (n = 6), and the third group (BSS) were treated with 0.1 ml intracameral injection of balanced salt solution (n = 12). All groups received a single dose. The clinical evaluation was performed on the 1 st, 3 rd, 5 th, and 7 th day after injection. Each eye was enucleated on the 7 th day and underwent a histopathology examination. The clinical scores among the three groups did not show any significant difference on days 1 st, 2 nd, 3 rd, and 7 th (p>0.05). The only ones noted in clinical scores were mild corneal opacity, mild cells, and flares in the anterior chamber. The histopathology score demonstrated no statistically significant difference between the three groups (p>0.05). Vacuolization of corneal endothelial cells was noted in all groups but was not statistically significant. A single intracameral injection of 0.6 ml 0.5% preservative-free levofloxacin eye drops was safe for rabbit eye, according to clinical and histopathology scores, similar to levofloxacin 0.5% eye drops in 5 ml bottle preservative free.

Macular hole reopening after inverted internal limiting membrane flap

Introduction: Here, we present a case of macular hole (MH) reopening after an initial successful closure with an inverted internal limiting membrane (ILM) flap procedure. Case Report: The patient was a 72-year-old Hispanic male who presented with decreased vision in the right eye who was found to have a 431 μm, full-thickness macular hole. The patient underwent three separate 25-gauge pars plana vitrectomies to correct the macular hole. The first involved an inverted ILM flap technique, the second one removal of the flap and the third one subretinal injection of balanced salt solution (BSS). Conclusion: The failure of the inverted ILM flap, we believe, was primarily due to the inferiorly attached flap being pulled down by surface tension of the rising fluid level.

BEVACIZUMAB EFFECT ON EXPRESSION OF COLLAGEN TYPE I AFTER TRABECULECTOMY

Objective to determine the effect of bevacizumab as an antifibrotic agent on collagen density, collagen thickness and collagen type I after trabeculectomy in rabbit. Materials and methods : Sixteen male New Zealand white rabbits divided by two groups, 8 rabbits in control group and 8 rabbits in treatment group. Control group underwent trabeculectomy and injection of balanced salt solution. Treatment group underwent trabeculectomy and subconjunctival injection of bevacizumab (1.25mg, 25mg/mL). They were terminated on 14 postoperative days. Masson Trichrome were performed to evaluate collagen collagen density, collagen thickness. Immunohistochemistry using a monoclonal antibody to collagen type I was performed to evaluate collagen type I expression. Results This study showed the density of collagen fibers decreased and statistically significant in the treatment group (p = 0.075, p 0.05). Expression of type I collagen obtained a decrease in the treatment group compared to BSS group (p = 0.006, p&lt;0.05). Conclusion Bevacizumab reduces bleb fibrosis by inhibition of angiogenesis and accumulation of extracellular matrix. Postoperative subconjunctival injection of bevacizumab may limiting scar tissue formation at the site of trabeculectomy by blocking collagen synthesis.

Clinical Study of Neurodegenerative Treatment on Glaucoma by Insulin Intravitreal Injection

Purpose: Our trail was to study insulin intravitreal injection’s (IIV) efficacity and safety to treat glaucoma neurodegeneration.&#x0D; Methods: Eleven subjects (11eyes) were recruited;10 patients treated in a double masked randomized sham controlled including 5 patients received one IIV injection 3UI and 5 patients received one injection of balanced salt solution(BSS) 3UI. A follow up during 168days was realized using Optical Coherence Tomography(OCT) and visual field(VF).The eleventh patient received two IIV injection without masking the injection content within one month between each injection and followed up for 877days.All the patients have a correct ocular pressure and no ocular treatment was stopped.&#x0D; Results: The 5 patients who received IIV revealed a swift improvement of decibel (DB), and remains stable during the first month. The average improvement was 6.62DB during 168days.The 5 patients treated with one BSS injection showed no significant improvement regaining 1. 45DB.The last patient who received two injections showed increase from 7.54DB to 17.22DB with a functional amelioration of 9. 68DB.The OCT examination showed a structural improvement during the first month, then returned to the initial value. No complication was observed during and after the treatment.&#x0D; Conclusion: Insulin shows not only efficacity and safety but more than that, the visual field(VF) of the patients became stable and show no deterioration in all the follow up, which confirmed that insulin act to improve the function rather than structure. it means insulin reconnect the stoma and improve the neurite outgrowth This treatment will change the evolution of this pathology and protect the glaucomatous patients against blindness.

Outcomes from the Retrospective Multicenter Cross-Sectional Study on Lamellar Macular Hole Surgery.

PurposeTo analyze the functional and anatomical parameters of lamellar macular hole (LMH) surgery with internal limiting membrane peeling and determine which surgical technique provides the best visual outcome.MethodsThis is a retrospective multicenter cross-sectional study on patients who underwent pars plana vitrectomy (PPV) for LMH with or without combined phaco-vitrectomy, as well as gas-, air- or BSS-tamponade. Pre- and postoperative examination included best corrected visual acuity (BCVA) measurements for functional comparison and optical coherence tomography (OCT) scans to determine the contributing anatomical parameters.ResultsA total of 66 consecutive patients were included (age: 71.79 ± 8.52 years), of which 47 (71.2%) were diagnosed as tractional type LMH, and 19 patients (28.8%) as degenerative type. An epiretinal membrane (ERM) was present in 63 of the patients (95.5%), LMH-associated epiretinal proliferation (LHEP) was present in 19 patients (28.8%), and 16 patients (24.2%) had concomitant ERM and LHEP. In the group of tractional LMH, the mean central foveal thickness (CFT) was 81.1% thicker (P < 0.05) than in the degenerative group. Thirty-one patients (47.0%) underwent a combined phaco-vitrectomy procedure, while the rest underwent 23G, 25G or 27G PPV. Seventeen of the 66 patients received gas-tamponade (25.7%)-either SF6 or C3F8, 26 received air-tamponade (39.4%), while the remaining 23 patients received balanced salt solution (BSS)-tamponade (34.9%) during vitrectomy. The total BCVA showed significant improvement postoperatively (p < 0.001) and accordingly in the following groups: tractional LMH type (p < 0.001), degenerative type (p < 0.001), simple PPV (p < 0.001), phaco-vitrectomy (p < 0.001), BSS injection (p < 0.01), gas-tamponade (p < 0.05). None of the patients included in the study developed a full thickness macular hole postoperatively.ConclusionPPV provided a high success rate and functional improvement for treating LMH for both tractional and degenerative types, as well as combined phaco-vitrectomy treatment when cataract was present.

Unfolding falciform folds and their consequences - To touch or not to touch.

Background:Falciform folds are congenital tractional retinal folds due to strong contractile forces and hyperextensibility of retina resulting in temporal dragging of the macula and often associated with familial exudative vitreoretinopathy and retinal detachment (RD). Retinologists are reluctant to treat these entities in view of their poor visual recovery.Purpose:To describe a novel surgical technique to unfold the falciform folds.Synopsis:This video demonstrates innovative surgical techniques to remove both pre-retinal and sub-retinal adhesions and unfold these folds, managing its consequences and visual recovery. We describe cases of congenital falciform folds with poor visual acuity, where we did vitrectomy, membrane adhesion removal, peeling of the internal limiting membrane (ILM) the macula, mechanical stretching of the folded retina by Tanno scraper or Finesse flex loop, then sub-retinal injection of balanced salt solution (BSS) by 38 gauge sub-retinal needle o create multiple blebs around the folded retina and finally sulphur hexafluoride tamponade. Post-operative macular hole with RD can be a complication. When this falciform fold is complicated by RD, there is risk of intraoperative subretinal migration of infusion cannula and therefore the need for peripheral relaxing retinectomy for redundant retinal fold as well as silicone oil as endotamponade. Vision improved in all our patients after the surgery.Highlights:Both long-standing pre-retinal adhesions as well as sub-retinal adhesions are responsible for he tformation of congenital falciform folds. For pre-retinal adhesions, vitrectomy with removal of all the adhesions along with peeling of the sticky ILM and then mechanical stretching of folded retina by Tanno scraper or Finesse flex loop are necessary. To remove sub-retinal adhesions, sub-retinal injection of BSS is necessary to stretch the folded retina from behind, but it should be done away from the retina to avoid formation of macular hole.Online Video Link: https://youtu.be/9h8IE3abKIM

Non-viscoelastic Repositioning of Dislocated Toric and Non-toric Implantable Collamer Lens After Blunt Trauma

PURPOSE: To describe a new minimally invasive technique for the treatment of uncomplicated Visian Implantable Collamer Lens (ICL) (STAAR Surgical) luxation in the anterior chamber in two cases. METHODS: A single or double 1-mm watertight corneal paracentesis was made with no viscoelastic or irrigation/aspiration. The ICL was then repositioned and pupil contraction was induced with intracameral injection of acetylcholine. Hydration of the corneal paracentesis and injection of intracameral moxifloxacin 0.5% ophthalmic solution (0.5 mg/0.1 mL) were done. RESULTS: Both cases had a normal follow-up with no significant complication. First day postoperative vault evaluated with anterior segment optical coherence tomography was 480 µm for case 1 and 1,010 µm for case 2. At the last follow-up visit, the ICL was centered in both cases with a subjective vault of 2 in case 1 and a vault of 1 in case 2. No cataract formation was described. CONCLUSIONS: This minimally invasive technique can be a fast and effective method to treat ICL decentration. The corneal paracentesis should be watertight and injection of balanced salt solution in the anterior chamber should be done to increase its depth. In addition, the movement should be fast without touching the iris or the crystalline lens, only the ICL. [ Journal of Refractive Surgery Case Reports. 2022;2(1):e18–e21.]

Selective Large-Area Retinal Pigment Epithelial Removal by Microsecond Laser in Preparation for Cell Therapy.

PurposeCell therapy is a promising treatment for retinal pigment epithelium (RPE)-associated eye diseases such as age-related macular degeneration. Herein, selective microsecond laser irradiation targeting RPE cells was used for minimally invasive, large-area RPE removal in preparation for delivery of retinal cell therapeutics.MethodsTen rabbit eyes were exposed to laser pulses 8, 12, 16, and 20 µs in duration (wavelength, 532 nm; top-hat beam profile, 223 × 223 µm²). Post-irradiation retinal changes were assessed with fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). RPE viability was evaluated with an angiographic probit model. Following vitrectomy, a subretinal injection of balanced salt solution was performed over a lasered (maximum 13.6 mm2) and untreated control area. Bleb retinal detachment (bRD) morphology was then evaluated by intraoperative OCT.ResultsWithin 1 hour after irradiation, laser lesions showed FA and ICGA leakage. OCT revealed that large-area laser damage was limited to the RPE. The angiographic median effective dose irradiation thresholds (ED50) were 45 µJ (90 mJ/cm2) at 8 µs, 52 µJ (104 mJ/cm2) at 12 µs, 59 µJ (118 mJ/cm2) at 16 µs, and 71 µJ (142 mJ/cm2) at 20 µs. Subretinal injection over the lasered area resulted in a controlled, shallow bRD rise, whereas control blebs were convex in shape, with less predictable spread.ConclusionsLarge-area, laser-based removal of host RPE without visible photoreceptor damage is possible and facilitates surgical retinal detachment.Translational RelevanceSelective microsecond laser-based, large-area RPE removal prior to retinal cell therapy may reduce iatrogenic trauma.

A Modified Surgical Technique for Submacular Injection.

To describe a modified simple surgical technique for submacular injection. The technique involves pars plana vitrectomy, a viscous fluid control (VFC) system for semi-automatic subretinal injection of tissue plasminogen activator (tPA), bevacizumab, and air and intravitreal gas injection for submacular hemorrhage (SMH), or subretinal balanced salt solution (BSS) for submacular perfluorocarbon (PFC) bubbles or persistent macular holes. This technique was successfully performed for SMH (five patients), a subfoveal PFC bubble (two patients), and persistent full-thickness macular hole (FTMH) (one patient). The single surgical complication was an FTMH in a PFC bubble. Four SMH patients had postoperative displacement of the hemorrhage. The FTMH was partially closed. Semi-automatic subretinal injection of tPA, bevacizumab, and air with the VFC system promoted displacement and clearance of SMH without complications. A subretinal BSS injection is effective for removing subfoveal PFC bubbles and for closing persistent FTMH. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:551-555.].

Microscope-Integrated OCT-Guided Volumetric Measurements of Subretinal Blebs Created by a Suprachoroidal Approach.

PurposeTo investigate the use of imaging modalities in the volumetric measurement of the subretinal space and examine the volume of subretinal blebs created by a subretinal drug delivery device utilizing microscope-integrated optical coherence tomography (MIOCT).MethodsAn MIOCT image-based volume measurement method was developed and assessed for accuracy and reproducibility by imaging ceramic spheres of known size that were surgically implanted into ex vivo porcine eyes. This method was then used to measure subretinal blebs created in 10 porcine eyes by injection of balanced salt solution utilizing a subretinal delivery device via a suprachoroidal cannula. Bleb volumes obtained from MIOCT were compared to the intended injection volume.ResultsValidation of image-based volume measurements of ceramic spheres showed accuracy to ±0.029 µL (5.6%) for objects imaged over the posterior pole and ±0.025 µL (4.8%) over peripheral retina. The mean expected injection volume from extraocular tests of the suprachoroidal cannula was 66.44 µL (σ = 2.4 µL). The mean injection volume as measured by the MIOCT imaging method was 54.8 µL (σ = 12.3 µL), or 82.48% of expected injection volume.ConclusionsMIOCT can measure the volume of subretinal blebs with accuracy and precision. The novel suprachoroidal approach using a subretinal delivery device was able to deliver greater than 80% of expected injection volume into the subretinal space, as assessed by MIOCT.Translational RelevanceMIOCT provides a method for visualization, and analysis of images enables surgeons to quantify and evaluate the success of subretinal drug delivery via a suprachoroidal approach.

Hints for Gentle Submacular Injection in Non-Human Primates Based on Intraoperative OCT Guidance

PurposeDelivery of Advanced Therapy Medicinal Products to the submacular space is increasingly evolving into a therapeutic modality. Cell replacement for age-related macular degeneration (AMD) and gene therapy for RPE65 are recent successful examples. Herein, a nonhuman primate (NHP) model was used to investigate surgical means to detach the macula.MethodsSixteen eyes of 13 healthy macaques underwent a 25-gauge vitrectomy and subretinal injection of balanced salt solution monitored by microscope-integrated intraoperative optical coherence tomography (miOCT). The animals were followed with OCT and histology.ResultsThe miOCT monitoring allowed a more precise definition of surgical trauma ranging from an initial full-thickness foveal tear, or induction of a cystoid macular edema (CME), until no foveal defect was discernible, as the technique improved. However, as the subretinal fluid wave detached the fovea, the aforementioned lesions formed, whereas persistent retinal adhesion reproducibly proved to remain in the distal parafoveal semi-annulus. Measures to reduce foveal trauma during submacular fluid injection included reducing intraocular pressure, injection volume, and velocity, as well as the retinal location for bleb initiation, use of a vitreous tamponade, and a dual-bore subretinal cannula.ConclusionsA stable very low intraocular pressure and careful subretinal injection may avoid tangential macular stretching or mechanical CME formation, while vitreous tamponade may facilitate a more lamellar subretinal flow, all thereby reducing foveal trauma during submacular injection in NHP.Translational RelevanceThese results can be relevant to any submacular surgery procedure used today, as they synergistically reduce the risk of compromising foveal integrity.

Release and extraction of retained subfoveal perfluorocarbon liquid facilitated by subretinal BSS, vibration, and gravity: a case report

BackgroundPerfluorocarbon liquid (PFCL) is an effective surgical adjuvant in performing vitrectomy for severe vitreoretinal pathologies such as proliferative vitreoretinopathy and giant retinal tears. However, subretinal retention of PFCL can occur postoperatively and retained PFCL causes severe visual disorders, particularly when PFCL was retained under the fovea. Although several procedures have been proposed for subfoveal PFCL removal, such as direct aspiration or submacular injection of balanced salt solution (BSS) to dislodge the subfoveal PFCL, the retinal damage associated with these procedures has been a major problem. Here, we report a case of subfoveal retention of PFCL for which we performed a novel surgical technique that attempts to minimize retinal damage.Case presentationA 69-year-old man presented with subfoveal retained PFCL after surgery for retinal detachment. To remove the retained PFCL, the internal limiting membrane overlying the subretinal injection site is first peeled to allow low-pressure (8 psi) transretinal BSS infusion, using a 41-gauge cannula, to slowly detach the macula. A small drainage retinotomy is created with the diathermy tip at the inferior position of the macular bleb, sized to be slightly wider than that of the PFCL droplet. The head of the bed is then raised, and the surgeon gently vibrates the patient’s head to release the PFCL droplet to allow it to migrate inferiorly towards the drainage retinotomy. The bed is returned to the horizontal position, and the PFCL, now on the retinal surface, can be aspirated. The subfoveal PFCL is removed while minimizing iatrogenic foveal and macular damage. One month after PFCL removal, the foveal structure showed partial recovery on optical coherence tomography, and BCVA improved to 20/40.ConclusionCreating a macular bleb with low infusion pressure and using vibrational forces and gravity to migrate the PFCL towards a retinotomy can be considered as a relatively atraumatic technique to remove subfoveal retained PFCL.

Pneumatic retinopexy preceded by drainage of subretinal fluid for the treatment of severe bullous retinal detachment.

To compare the efficacy and safety outcomes of scleral buckling (SB) and drainage-injection-pneumoretinopexy (DIP), a modified pneumatic retinopexy technique, in which, before gas injection, subretinal fluid is drained with a simultaneous injection of balanced salt solution (BSS) in the vitreous chamber, for the treatment of severe superior bullous rhegmatogenous retinal detachment (SBRD). This prospective, randomized, comparative study included 58 eyes with severe SBRD that were randomized 1:1 to undergo SB or DIP. The main outcome measures included success rate, visual acuity, mean change in refractive error and surgery duration. The primary anatomic success rate was 93% for both procedures. Both groups showed significantly improved visual acuity after surgery. The change in refractive error and surgery duration was significantly higher in the SB group. Drainage-injection-pneumoretinopexy (DIP) appeared to be less traumatic, but with a longer persistence of subretinal fluid in a greater number of patients. Our findings suggested that both SB and DIP are safe and effective treatments yielding functional and anatomical recovery in patients with severe SBRD. However, the DIP technique may be easier and less costly, with a success rate similar to that of SB.

Ocular toxicity of intravitreal golimumab in a rabbit model

Background/aimTo investigate the effect of intravitreal golimumab on rabbit retina histopathology.Materials and methodsSixteen albino New Zealand rabbits were divided into three groups. The right eye of each rabbit in groups I, II, and III received a single intravitreal injection of 5 mg/0.05 mL (6 eyes), 10 mg/0.1 mL (6 eyes), or 20 mg/0.2 mL (4 eyes) golimumab, while left eyes served as controls with the same volume of a balanced salt solution injection. All animals were examined using slit-lamp biomicroscopy and indirect ophthalmoscopy before and after intravitreal injection and at days 1 and 7. Animals were euthanized on day 7 and the eyes were enucleated for immunohistochemistry evaluation and electron microscopic examination of the retinas.ResultsFor groups I, II, and III, the number of cells in the outer nuclear layer and the inner nuclear layer was decreased compared to those in the control groups. In group I, the percentage of caspase-3 staining of the outer nuclear layer was significantly higher than that in the control. For groups II and III, TUNEL and caspase-3 staining percentages in the outer and inner nuclear layers were found to be significantly higher than those for the control groups. In the ganglion cell layer, for groups I, II, and III, neither TUNEL nor caspase-3 staining percentages showed any significant difference between two groups. No significant dose-dependent relationship was found for increasing doses of golimumab in all layers. Myelin figures and karyorrhexis in the photoreceptor cells were prominent in electron microscopy of the golimumab-injected eyes.ConclusionGolimumab caused apoptosis in both photoreceptors and bipolar cells of the rabbit retina. Potential retinal toxicity of intravitreal golimumab should be considered if an intravitreal administration is planned.

Removal of foveal hard exudates by subretinal balanced salt solution injection using 38-gauge needle in diabetic patients

To examine the anatomic and visual outcomes after removal of foveal hard exudates through a macular hole created by subretinal balanced salt solution (BSS) injection. This was a retrospective, consecutive, case series. Six patients (7 eyes) underwent vitrectomy with removal of foveal hard exudates. All patients were women and the mean age was 65years (range from 55 to 71). All patients had a history of panretinal photocoagulation. Previous treatments included intravitreal anti-vascular endothelial growth factor injection in one eye and vitrectomy in both eyes of one patient. The geometric mean preoperative decimal visual acuity was 0.11 (range from 0.08 to 0.3). The mean postoperative follow-up period was 12months (range from 6 to 19). The status of lens was two phakic and five pseudophakic. Surgical procedures included simultaneous cataract surgery if phakic, creation of posterior vitreous detachment if not present, internal limiting membrane (ILM) peeling and a gas or air tamponade. Manual subretinal BSS injection using 38-gauge needle was performed at ILM-peeled area. Removal of foveal hard exudates was conducted by the water flow through the macular hole created during subretinal BSS injection. Foveal hard exudates decreased in all cases early after surgery. The geometric mean final decimal visual acuity was 0.31 (range from 0.1 to 0.9). Visual acuity improved more than 0.2 LogMAR units in six eyes and unchanged in one eye. There was no severe complication and recurrence of macular edema. This procedure may be effective for foveal hard exudates in diabetic patients.

Managing Challenges of Phacoemulsification in Vitrectomized Eyes: A New Technique.

AIM:This study aimed to describe a novel approach to manage the challenges of phacoemulsification in vitrectomized eyes.METHODS:Intraoperative titrated intravitreal injection of balanced salt solution (BSS) through pars plana was done using a 30G needle hooked to a 1 cc syringe to build up the vitreous pressure.RESULTS:Five eyes of five patients who had previous vitrectomy were given intraoperative injection. This led to the prevention of lens–iris diaphragm retropulsion and routine completion of phacoemulsification. The preoperative visual acuity was < 6/60 in all patients. The postoperative visual acuity was 6/9 or better in all patients, except in one patient which was 6/60, which is explained by diabetic ischemic maculopathy. Neither injection-related intraoperative nor postoperative complications were noted.CONCLUSION:Challenges of phacoemulsification in vitrectomized eyes can be prevented by a simple titrated intraoperative injection of BSS intravitreally through pars plana.