Subretinal Fluid In Patients Research Articles

Factors Predictive of Persistent Subretinal Fluid in Acute Central Serous Chorioretinopathy

Purpose: To identify the clinical parameters predictive of persistent subretinal fluid in acute central serous chorioretinopathy (CSC). Methods: Clinical data of consecutive eyes diagnosed with first-time, acute, treatment-naïve CSC followed up for at least 6 months from symptom onset were evaluated retrospectively. Acute CSC was defined as CSC in which symptoms were noticed within 3 months of presentation. Subretinal fluid, central retinal thickness (CRT), subfoveal choroidal thickness, and fundus autofluorescence (FAF) were examined. Results: Of the 48 eyes in 48 patients, 38% exhibited subretinal fluid persisting for at least 6 months after the symptom onset. FAF alterations at baseline were observed in 52 and 36% of affected and fellow eyes, respectively. Multivariable analysis showed that persistent fluid was significantly associated with the presence of FAF alterations in fellow eyes (odds ratio = 23.5, P = 0.024), in addition to greater age (odds ratio = 1.16, P = 0.015) and thicker CRT (odds ratio = 1.01, P = 0.022). Conclusion: Fellow eye FAF alterations, in addition to older age and thicker CRT, were significant predictors of persistent subretinal fluid in patients with acute CSC. These findings underscore CSC's bilateral aspects and noninvasive markers' role in predicting persistent subretinal fluid.

Bilateral Choroidal Thicknesses Analysis of Active and Resolved Central Serous Chorioretinopathy

Objectives: This study aimed to examine the choroidal thicknesses (ChT) changes before and after resolution of subretinal fluid in patients with central serous chorioretinopathy (CSR) and in their fellow eyes. Materials and Methods: Patients with acute CSR were studied and followed until subretinal fluid resolved. Sixty-eight eyes from 34 CSR cases (24 men and 10 women, mean age of 37.34±6.2, range 27-50) were examined. Their ChT was measured using enhanced depth imaging optical coherence tomography (EDI-OCT). Imaging repeated after sub-retinal fluid resolution. ChT changes were analyzed before and after the resolution of subretinal fluid in both eyes. Results: Mean ChTs in CSR eyes were 387±97 µm, 414±97 µm, and 384±87 µm in 1 mm temporally away from the center, central sub-fovea, and 1 mm nasally away from the center, respectively; and those in the fellow eyes were 283±55 µm, 303±60 µm, and 282±56 µm in the same order. ChT decreased significantly (P≤0.001) to 305±82 µm, 334±86 µm, and 313±76 µm in CSR eyes and to 242±52 µm, 262±55 µm, and 246±48 µm in contralateral eyes in the temporal, central sub-foveal, and nasal sequences after subretinal fluid resolution, respectively. There was a strong correlation between the ChT in active phase and the ChT in resolved phase in both affected and fellow eyes. There was no detectable correlation between central sub-foveal fluid height and sub-foveal choroidal thickness in the affected and fellow eye (P=0.23). Conclusion: Nasal and temporal comparison of the affected and fellow eyes before and after fluid resolution showed that the nasal choroid was thinner than temporal choroid (as the average population) in active phase. In the resolution phase, however, it was the temporal choroid that was thinner than the nasal choroid, and the resolution pattern was not asymmetric.

Association of Abnormal Renal Profiles with Subretinal Fluid in Diabetic Macular Edema.

To investigate the risk factors for subretinal fluid (SRF) in diabetic macular edema (DME). We reviewed the records of 66 patients with DME. Systemic parameters, including hypertension, glycosylated hemoglobin, serum fasting glucose, total cholesterol, triglycerides, and diabetic kidney disease, were evaluated. Renal parameters for diabetic kidney disease included serum albumin, serum creatinine, albuminuria, and estimated glomerular filtration rate. Ocular factors included visual acuity and diabetic retinopathy, and the following parameters are evaluated through optical coherence tomography examination: disorganization of the retinal inner layers, loss of ellipsoid zone, central subretinal fluid thickness, central macular thickness, and presence of SRF. Higher albuminuria (odds ratio, 3.431; 95% confidence interval, 1.039-11.334; P=0.043) was associated with the presence of SRF in patients with DME. Lower serum albumin levels (beta = -14.028, se = 6.646, P=0.044) were associated with increased SRF thickness. Poor kidney function was associated with the presence of SRF in DME. Screening for SRF in DME in patients with higher albuminuria and lower serum albumin levels should be routinely performed.

Possible role of Spironolactone in a sample of Iraqi patients with acute central serous chorioretinopathy

Background: Central serous chorioretinopathy (CSCR) is an idiopathic condition aggravated by exogenous or endogenous glucocorticoids. Vascular deregulation in the choroid is a new hypothesis regarding central serous chorioretinopathy occurrence. The inhibition of choroidal mineralocorticoid receptors has a great role in shortening the duration of CSCR by inhibiting choroidal vasodilatation and leak. Objective: To assess the effect of oral spironolactone on subretinal fluid, central macular thickness and visual acuity in patients with acute CSCR compared to observation. Subjects and Methods: a hospital based, randomized clinical trial carried out at outpatient clinic in Ibn-Alhaitham Teaching Eye Hospital/ Baghdad, enrolling 60 patients with acute unilateral CSCR, allocated randomly (every other patient) to either receiving spironolactone 25 mg orally, twice daily for 2 months (30 patients) or observation only (30 patients). The follow-up included visual acuity measurement, central macular thickness and subretinal fluid height examinations by ocular coherence tomography (OCT) at one- and two-months post enrollment for all patients. Results: Complete absorption of subretinal fluid was observed in 21(70%) of the eyes in the treatment group and in 6(20%) in the control group at two-months. Visual acuity and mean macular thickness improved significantly in both groups at the one- and two- months, mean changes was larger in treatment group compared to control group at the two-month-follow up endpoint. Conclusion: Oral spironolactone imparted greater improvement in central macular thickness and faster resolution of sub retinal fluid in patients with acute central serous chorioretinopathy versus observation.

Deep Learning for Detecting Subretinal Fluid and Discerning Macular Status by Fundus Images in Central Serous Chorioretinopathy

Subretinal fluid (SRF) can lead to irreversible visual loss in patients with central serous chorioretinopathy (CSC) if not absorbed in time. Early detection and intervention of SRF can help improve visual prognosis and reduce irreversible damage to the retina. As fundus image is the most commonly used and easily obtained examination for patients with CSC, the purpose of our research is to investigate whether and to what extent SRF depicted on fundus images can be assessed using deep learning technology. In this study, we developed a cascaded deep learning system based on fundus image for automated SRF detection and macula-on/off serous retinal detachment discerning. The performance of our system is reliable, and its accuracy of SRF detection is higher than that of experienced retinal specialists. In addition, the system can automatically indicate whether the SRF progression involves the macula to provide guidance of urgency for patients. The implementation of our deep learning system could effectively reduce the extent of vision impairment resulting from SRF in patients with CSC by providing timely identification and referral.

Eplerenone for treatment of chronic central serous chorioretinopathy.

To assess the morphological and functional outcome of oral eplerenone for treatment of patients with chronic central serous chorioretinopathy (CSC) in a real life experience. In this retrospective study, we reviewed the clinical files of 30 patients with chronic CSC. All patients were treated with eplerenone for a period of 6 weeks or 3 months depending on the clinical response. Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and height of the subretinal fluid (SRF). Comparisons between responders and non-responders were performed to identify factors that were predictive of the treatment response. All patients were treated with eplerenone 18 ± 20 weeks after onset of the first symptoms. BCVA (LogMAR) improved from 0.2 ± 0.2 to 0.13 ± 0.18 at 6 weeks (p = 0.01) and to 0.09 ± 0.15 at 3 months (p = 0.01). Mean CMT decreased from 409 ± 136 to 323 ± 87 µm at 6 weeks (p = 0.001) and to 298 ± 98 µm at 3 months (p = 0.01). Mean height of SRF decreased from 153 ± 126 to 73 ± 79 µm at 6 weeks (p = 0.001) and to 49 ± 88 µm at 3 months (p = 0.005). Complete resolution of SRF was achieved in 20 patients after 3 months (67%). Reported stress in the medical history was the only statistical significant predictive factor associated with a positive treatment response. This study showed a statistically significant improvement of the best corrected visual acuity and a significant reduction of macular thickness and subretinal fluid in patients with chronic CSC treated with oral eplerenone, especially in patients under stress.

EFFICACY OF ADJUVANT TOPICAL DORZOLAMIDE-TIMOLOL IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION REFRACTORY TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY.

To evaluate the efficacy of adjuvant topical dorzolamide-timolol in patients with neovascular age-related macular degeneration unresponsive to anti-vascular endothelial growth factor therapy. This retrospective, interventional study included 15 patients with neovascular age-related macular degeneration refractory to anti-vascular endothelial growth factor. Patients used topical dorzolamide-timolol twice daily in the neovascular age-related macular degeneration eye and received anti-vascular endothelial growth factor therapy at each visit, with the same fixed interval and agent as before the addition of dorzolamide-timolol. Central macular thickness, maximal subretinal fluid height, and maximal pigment epithelial detachment height were measured at baseline and every visit. The mean follow-up period was 17.2 ± 5.5 weeks. The mean central macular thickness decreased from 383.5 μm at baseline to 298.3 μm at the final visit (P = 0.041). The mean maximal subretinal fluid height decreased from 105.0 μm at baseline to 58.3 μm at the final visit (P = 0.021). Complete resolution of subretinal fluid was observed in 3 of 11 subretinal fluid-type eyes. There was no significant change in the maximal pigment epithelial detachment height. The mean logarithm of the minimum angle of resolution visual acuity decreased from 0.61 (20/81 Snellen) at baseline to 0.66 (20/91 Snellen) at final visit, which was not significant (P = 0.314). The mean intraocular pressure decreased significantly from 14.9 mmHg at baseline to 12.3 mmHg at the final visit (P = 0.005). The use of adjuvant topical dorzolamide-timolol was effective in decreasing central macular thickness and subretinal fluid in patients with neovascular age-related macular degeneration refractory to continual fixed-interval intravitreal anti-vascular endothelial growth factor therapy, but did not result in functional improvement in this short-term study.

Application of the Balloon Snake in the Volume Measurement of Subretinal Fluid in Central Serous Chorioretinopathy

ABSTRACTPurpose: To apply the Balloon Snake to detect the edge and measure the volume of subretinal fluid (SRF) from spectral domain optical coherence tomography (SD-OCT) images of patients with central serous chorioretinopathy (CSC).Methods: A total of 20 CSC patients whose SD-OCT images collected from their unilateral eyes were enrolled for the study. An image analysis program developed based on the Balloon Snake was used to detect the edge and to measure the volume of SRF.Results: Good agreement was found between the manual segmentation and the Balloon Snake-based method (intraclass correlation coefficient = 0.994). For each volume measurement, the mean time used by the Balloon Snake-based method was 130.5 ± 63.2 (range 54.0 to 227.3) seconds, approximately 30 min faster than the manual segmentation.Conclusion: The Balloon Snake-based method produced accurate and time-efficient volume measurement of SRF in patients with CSC.

Thrombin Generation in Vitreous and Subretinal Fluid of Patients with Retinal Detachment

Purpose: To measure prothrombin fragments (F1+2) and thrombin-antithrombin complex (TAT) in vitreous and subretinal fluid (SRF) of rhegmatogenous retinal detachment (RRD) patients and to validate and further specify our earlier finding of increased thrombin activity in patients with proliferative vitreoretinopathy (PVR). Methods: F1+2 and TAT were measured in 31 vitreous and 16 SRF samples using the Enzygnost® immunoassays. Results: We found significant levels of F1+2 and TAT in the vitreous of all patients with RRD compared to patients with macular hole or macular pucker. However, there was no significant difference between patients who would develop PVR in the future, had established PVR, and patients with uncomplicated RRD both in vitreous concentrations of F1+2 (Kruskal-Wallis p = 0.963) and TAT (p = 0.516). Conclusion: The analysis of F1+2 and TAT confirmed significant thrombin generation in both vitreous and SRF of patients with RRD. An imbalance between the thrombin regulation mechanisms TAT and α2-macroglobulin possibly explains the difference from our previous findings.

CENTRAL SEROUS CHORIORETINOPATHY TREATED WITH MINERALOCORTICOID ANTAGONISTS: A ONE-YEAR PILOT STUDY.

To assess the treatment response to mineralocorticoid antagonists in a pilot study of patients diagnosed with central serous chorioretinopathy using multimodal imaging. This retrospective observational case series included 23 eyes of 14 patients with central serous chorioretinopathy treated by a single physician (L.A.Y.) with either spironolactone, eplerenone, or both consecutively over a 12-month period. Choroidal thickness, central macular thickness, and best-corrected visual acuity were measured and compared with baseline values. Twelve eyes of 11 patients demonstrated subretinal fluid before or during the initiated treatment course. Subretinal fluid was measured and compared with baseline values in this subgroup. In all eyes (n = 23), best-corrected visual acuity improved at 12 months of treatment; however, central macular thickness and choroidal thickness showed no improvement. In the subgroup with subretinal fluid (n = 12), subretinal fluid was significantly decreased at 6 months and 12 months of treatment; however, central macular thickness, choroidal thickness, and best-corrected visual acuity showed no significant change. Mineralocorticoid antagonists may improve best-corrected visual acuity and decrease subretinal fluid in patients with central serous chorioretinopathy, but do not affect the choroidal or macular thickness. This pilot study demonstrates that mineralocorticoid receptor antagonists may be effective in treating central serous chorioretinopathy but warrants consideration for future research within a randomized clinical trial.

MACULAR HOLE CLOSURE OVER RESIDUAL SUBRETINAL FLUID BY AN INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE IN PATIENTS WITH MACULAR HOLE RETINAL DETACHMENT IN HIGH MYOPIA.

To describe the closure of a macular hole over residual subretinal fluid in patients with macular hole retinal detachment in high myopia who had been treated using an inverted internal limiting membrane flap technique. Three patients with macular hole retinal detachment in high myopia underwent pars plana vitrectomy using the inverted internal limiting membrane flap technique. One patient received a silicone oil injection, and the other two patients received a long-acting gas injection at the end of the surgery. After surgery, spectral domain ocular coherence tomography examination was performed. In the patient with the silicone oil injection, spectral domain optical coherence tomography revealed that the macular hole was sealed with an inverted internal limiting membrane flap in the presence of subretinal fluid 1 day after surgery. The inner retinal layers gradually regained a more physiologic configuration over the residual subretinal fluid. In all patients, macular holes were completely closed over the subretinal fluid, which was gradually absorbed. Using the inverted internal limiting membrane flap technique, macular holes were closed over residual subretinal fluid in patients with macular hole retinal detachment. The results indicate that reattachment of the retina may not be necessary for closure of macular holes.

Detection of Mycobacterium tuberculosis Genome in Subretinal Fluid of Patients with Latent Tuberculosis Infection

ABSTRACTPurpose: To test our hypothesis that Mycobacterium tuberculosis (MTB) DNA may be present in retinal pigment epithelium (RPE) cells in individuals with latent tuberculosis (TB) infection.Methods: A total of 100 patients with rhegmatogenous retinal detachment (without any signs of endogenous uveitis in either eye) underwent pars plana vitrectomy (PPV) with internal tamponade. All were subjected to tuberculin skin test. None had manifest systemic TB disease. The subretinal fluid collected during surgery was subjected to multitargeted polymerase chain reaction (PCR) targeting three genes of MTB (IS6110, MPB64 and protein b).Results: In total, 16 patients had latent TB, of which TB PCR was positive in six patients.Conclusions: We demonstrate presence of MTB genome in the subretinal fluid containing RPE cells from individuals with latent TB infection, who did not have any evidence of intraocular TB or manifest systemic TB disease, and suggest that MTB can be sequestrated in the RPE cells in latent TB.

Refractory subretinal fluid in patients with neovascular age-related macular degeneration treated with intravitreal ranibizumab: visual acuity outcome.

To investigate the functional outcome of eyes with neovascular AMD (nAMD) and subretinal fluid (SRF) refractory to treatment with ranibizumab. Retrospective chart review of consecutive treatment-refractory SRF in nAMD despite monthly ranibizumab injections during 12 months or more. Data were evaluated for baseline characteristics, location of the refractory SRF, mean visual acuity (VA) change, number of injections, and timepoint of first complete disappearance of SRF. Forty-five eyes in 44 patients (mean age of 76 years) were included. The mean follow-up was 32.4 months (range 12-73 months). The mean number of injections was 11.6 in the first year and 27.5 over follow-up. The refractory SRF was located subfoveally in 66.7 %. In 12 eyes (26.7 %), complete absorption of SRF was found after a mean of 22.6 months (range, 13-41 months). Mean VA increased by 10.4, 8.2, and 8.6 letters by month 12, 24, and 36, respectively. Neovascular AMD with SRF refractory to monthly retreatment with ranibizumab may still allow good and maintained visual improvement, even if the fluid is located subfoveally. SRF may progressively absorb under continuous monthly treatment. The necessity to treat refractory SRF with monthly injections could be questioned and would need future investigations.

USING PATIENT POSITIONING TO PROMOTE RESORPTION OF SUBRETINAL FLUID IN RHEGMATOGENOUS RETINAL DETACHMENT BEFORE PNEUMATIC RETINOPEXY

The purpose of this study was to determine if the volume of subretinal fluid in patients with acute rhegmatogenous retinal detachment may be reduced through patient positioning before pneumatic retinopexy. This was a prospective, masked nonrandomized cohort study examining the change in subretinal fluid volume in patients with rhegmatogenous retinal detachment before and after a 1-hour period of specific head positioning, as measured using B-scan ultrasonography. A series of B-scans, each 2 mm apart in the sagittal plane, were acquired for each eye both before and after the positioning period with the patient lying in a supine position. Ten patients with acute unilateral rhegmatogenous retinal detachment were enrolled. All patients experienced a reduction in subretinal fluid volume, from a mean prepositioning volume of 0.89 ± 0.63 mL to a mean postpositioning volume of 0.45 ± 0.43 mL. The mean relative reduction in subretinal fluid measured as a percentage of prepositioning subretinal fluid volume was 55.4% ± 20%, ranging from 35.3% to 93.5%. In patients with acute rhegmatogenous retinal detachment that fall within the classic indications for pneumatic retinopexy, significant reduction of subretinal fluid volume may be obtained through a 1-hour period of patient positioning in a retinal break-dependent manner.

Long-term visual acuity in patients with age-related macular degeneration and persistence of subretinal fluid after treatment with ranibizumab

ObjectiveTo analyse the long-term visual acuity (VA) in patients with age-related macular degeneration (ARMD) treated with ranibizumab, and who had persistent subretinal fluid after the induction therapy and/or in the successive controls. Materials and methodsWe reviewed the medical records, optical coherence tomography (OCT) and fluorescein angiograms of 216 patients treated with ranibizumab between January 2008 and April 2010, selecting those who had persistent subretinal fluid or recurrent fluid for at least one year of follow-up. ResultsA total of 36 eyes from 34 patients were included, with 19 eyes (52.7%) having persistent, and 17 (47.2%) recurrent subretinal fluid throughout the follow-up (mean 29.06±9.28 months). The average number of injections was 7.89±3.2. The central macular thickness (CMT) at the start of follow-up was 330±84μm, at 3 months 265.2±62μm, and 294.5±37μm at the end of the follow-up. The initial mean VA was 0.3±0.2, at 3 months 0.43±0.2 (p<0.05) and at the final review, 0.41±0.22 (p<0.05). Hemorrhages in recurrences were associated with a worse final VA (p=0.004). At the end of follow-up, 18 eyes (50%) continued with ranibizumab treatment, 16 eyes (44%) were kept under observation, and 2 patients died. There were no differences between VA and CMT between the groups. ConclusionsThe persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab does not significantly reduce the visual gain obtained after induction therapy, despite discontinuation of treatment during follow-up. Haemorrhages in the recurrences were associated with a worse final VA.

Agudeza visual a largo plazo en pacientes con degeneración macular asociada a la edad tratados con ranibizumab y persistencia de fluido subretiniano

ObjectiveTo analyse the long-term visual acuity (VA) in patients with age-related macular degeneration (ARMD) treated with ranibizumab, and who had persistent subretinal fluid after the induction therapy and/or in the successive controls. Materials and methodsWe reviewed the medical records, optical coherence tomography (OCT) and fluorescein angiograms of 216 patients treated with ranibizumab between January 2008 and April 2010, selecting those who had persistent subretinal fluid or recurrent fluid for at least one year of follow-up. ResultsA total of 36 eyes from 34 patients were included, with 19 eyes (52.7%) having persistent, and 17 (47.2%) recurrent subretinal fluid throughout the follow- up (mean 29.06±9.28 months). The average number of injections was 7.89±3.2. The central macular thickness (CMT) at the start of follow-up was 330±84μm, at 3 months 265.2±62μm, and 294.5±37μm at the end of the follow-up. The initial mean VA was 0.3±0.2, at 3 months 0.43±0.2 (P<.05) and at the final review, 0.41±0.22 (P<.05). Haemorrhages in recurrences were associated with a worse final VA (P=.004). At the end of follow-up, 18 eyes (50%) continued with ranibizumab treatment, 16 eyes (44%) were kept under observation, and 2 patients died. There were no differences between VA and CMT between the groups. ConclusionsThe persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab does not significantly reduce the visual gain obtained after induction therapy, despite discontinuation of treatment during follow-up. Haemorrhages in the recurrences were associated with a worse final VA.

ANTIANGIOGENIC ISOFORMS OF VASCULAR ENDOTHELIAL GROWTH FACTOR PREDOMINATE IN SUBRETINAL FLUID OF PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT AND PROLIFERATIVE VITREORETINOPATHY

In proliferative vitreoretinopathy (PVR), a nonangiogenic eye disease that is characterized by the formation of mainly avascular membranes, vascular endothelial growth factor (VEGF) levels are found to be upregulated. Recently, it was discovered that VEGF is alternatively spliced to form the angiogenic (VEGF xxx) and antiangiogenic (VEGF xxx b) family of isoforms. Previous studies on expression of VEGF in PVR samples have not distinguished between the two families of isoforms. We measured total VEGF and VEGF xxx b levels in subretinal fluid of patients with PVR (n = 10) and in patients with uncomplicated rhegmatogenous retinal detachment (n = 27) using enzyme-linked immunosorbent assay. : We found total VEGF levels to be 2- to 3-fold elevated in the PVR group as compared with the rhegmatogenous retinal detachment group (P = 0.047). Antiangiogenic VEGF xxx b isoforms predominated (>60% of total VEGF) in the majority of rhegmatogenous retinal detachment and PVR samples investigated, although a wide variability of isoform ratios was observed within both groups. The absence of an increased ratio of VEGF xxx to VEGF xxx b in patients with PVR as compared with patients with uncomplicated rhegmatogenous retinal detachment may explain a lack of blood vessels in PVR membranes. Elevated VEGF levels indicate that this cytokine may play a role in the pathogenesis of PVR that is not related to angiogenesis.

Long‐term visual acuity in patients with age‐related macular degeneration treated with ranibizumab and persistence of subretinal fluid

AbstractPurpose To analyze the visual acuity (VA) in the long term in patients with age‐related macular degeneration (ARMD) treated with ranibizumab with persistent subretinal fluid after induction therapy and / or in the follow‐up.Methods A retrospective study of all patients with ARMD treated with ranibizumab between January 2008 and April 2010 with persistent subretinal fluid for at least one year of follow‐up after the induction therapy with ranibizumab. We reviewed the medical records, optical coherence tomography and fluorescein angiography in all patients included in the study.Results 36 eyes of 34 patients were included in the study of a total of 216 patients analyzed. 19 eyes (52.7%) had persistent and 17 (47.2%) recurrent sub‐retinal fluid during the follow‐up (mean 29.06 ± 9.28 months). The initial mean VA was 0.3 ± 0.2, at 3 months 0.43 ± 0.2 and at the end of the follow‐up 0.41 ± 0.22 (p&gt; 0.05). The appearance of bleeding in the relapse was associated with poorer final VA (p = 0.004). There was no significant difference in final VA in the membrane type, lesion size, presence of pigment epithelial detachment or blood before treatment. 18 eyes (50%) remain on treatment with ranibizumab,16 eyes (44%) are observed and 2 patients died. We did not find differences in VA and central macular thickness between both groups.Conclusion The persistence or recurrence of macular subretinal fluid in patients treated with ranibizumab did not significantly lower visual gain obtained after the induction therapy, despite the discontinuation of treatment during the follow‐up.

Glucosamine inhibits epithelial-to-mesenchymal transition and migration of retinal pigment epithelium cells in culture and morphologic changes in a mouse model of proliferative vitreoretinopathy

To explore the effect of glucosamine (GlcN) on transforming growth factor (TGF)-β signalling and several processes involved in proliferative vitreoretinopathy (PVR). We evaluated the surface levels of TGF-β receptor and its binding of TGF-β in ARPE-19 cells. Release of cytokines and collagen, and expression of signalling intermediates were quantified. Migration was qualitatively and quantitatively examined. The morphology of cells undergoing PVR in vitro and in a mouse PVR model was observed. Glucosamine reduced the surface levels of TGF-β receptor and the ability of ARPE-19 cells to bind TGF-β. In ARPE-19 cells, TGF-β1 plus epidermal growth factor (EGF) or TGF-β2 increased the expression of alpha-smooth muscle actin (α-SMA) and decreased the expression of zona occludens protein (ZO-1). Transforming growth factor-(β2) also caused the release of platelet-derived growth factor (PDGF), connective tissue growth factor (CTGF) and type 1 collagen and increased the phosphorylation of SMAD2 and SMAD3. Platelet-derived growth factor and CTGF stimulated cell migration, and TGF-β2 stimulated wound closure, contraction of collagen and changes in cell morphology. Treatment with GlcN counteracted all of these effects, and its administration in the mouse model reduced the morphologic appearance of PVR. Glucosamine could inhibit the TGF-β signalling pathway in retinal pigment epithelium cells and several of the downstream events associated with epithelial-mesenchymal transition and PVR.

Nature of subretinal fluid in patients undergoing vitrectomy for macular hole: a cytopathological and optical coherence tomography study

Outer retinal defects (ORDs) may occur after surgical closure of full thickness macular holes (FTMH) and be associated with delayed visual recovery. This may be due to the nature of the subretinal fluid (SRF) cuff and/or the loss of retinal elements. Vitrectomy with internal limiting membrane (ILM) peel was performed for FTMH. After fluid-air exchange, SRF was either aspirated from the hole (group 1) or left in situ (group 2). The SRF specimens obtained were examined by light microscopy and correlated with optical coherence tomography (OCT). In group 1, cellular material was found in 6 out of 12 cases. Photoreceptors were seen in 3 and macrophages in 3 cases. Nine of 12 holes closed and ORDs were seen in 3 of these. In group 2, 7 out of 8 holes closed, with 4 having ORD. There was no difference in visual acuity (LogMAR) for closed holes at 3 months between groups 1 (0.61, range 0.3-1) and 2 (0.51, range 0.3-0.78) nor between patients with ORD (0.57, range 0.3-1.0) or without ORD (0.57, range 0.3-1.0). SRF from FTMH may contain macrophages and photoreceptors. Such photoreceptor loss may contribute to reduced retinal function. ORDs occur commonly in spite of fluid aspiration, but their presence is still compatible with good vision. Aspiration of SRF did not appear to confer added benefit in this series.