Subretinal Fluids Research Articles

Treatment failure in neovascular age-related macular degeneration is associated with a complex chemokine receptor profile

ObjectiveTo investigate if chemokine expression patterns on leucocyte subsets influence the short-term anatomical treatment response of intravitreal antivascular endothelial growth factor therapy against neovascular age-related macular degeneration (AMD).Methods and analysisThis...

Automatic Characterization of the Serous Retinal Detachment Associated with the Subretinal Fluid Presence in Optical Coherence Tomography Images

An accurate detection of the macular edema (ME) presence constitutes a crucial ophthalmological issue as it provides useful information for the identification, diagnosis and treatment of different relevant ocular and systemic diseases. Serous Retinal Detachment (SRD) is a particular type of ME, which is characterized by the leakage of fluid that has a propensity of being accumulated in the macular region. This paper proposes a new methodology for the automatic identification and characterization of the SRD edema using Optical Coherence Tomography (OCT) images. The subretinal fluids and the External Limiting Membrane (ELM) retinal layers are identified and characterized to measure the disease severity. Four different visualization modules were designed including representative derived parameters to facilitate the doctor’s work in the diagnostic evaluation of ME. The different steps of this method were validated using the manual labelling provided by an expert clinician. The validation of the proposed method offered satisfactory results, constituting a suitable scenario with intuitive visual representations that also include different relevant biomarkers.

MACULAR CHANGES FOLLOWING PARSPLANA VITRECTOMY FOR RETINAL DETACHMENT USING OCT

Background: Retinal detachment is the separation of the neurosensory retina (NSR) from the underlying retinal pigment epithelium (RPE). These two layers are derived from neuroectoderm that lines the optic vesicle during embryogenesis. Objective: We compared spectral-domain optical coherence tomography imaging with postoperative visual acuity to evaluate the relationship between morphological changes in the macula and visual outcome after successful repair of RRD with macula off. Patients and methods: We enrolled 30 patients (30 eyes) 21 eyes were phakic (70%) and 9 eyes were pseudophakic (30%). with successful repair of RRD. the examination had been done 1,2,6-months and one year follow up after surgery in this prospective research. The mean age of the patients was 17 to 73 years with mean age value of 44 ± 13.4 years. The duration of retinal detachment (RD) ranged from 1 to 14 weeks with a mean of 6.8± 4.2 weeks. There was history of trauma in 3 cases (10%). The IS/OS line was evaluated considering its continuity and any disruption in the line was measured by manual caliber. The extent of disruption was evaluated in the 5-lines raster scan. In the scan that showed the largest defect, the extent of the IS/OS disruption was measured along a 1.8 mm-diameter area centered on the fovea. Results: SD-OCT was done to all patients post-operatively according to OCT findings, the 30 eyes were divided into three groups; A, B, and C. Group A included all cases with residual subretinal fluid, Group B included cases with other finding rather residual subretinal fluids. Group C included eyes with no detectable OCT findings. There were 8 (26.7%) eyes with retained subretinal fluids (Group A), 18 eyes (60%) with pathology other than Subretinal fluid (Group B), and 4 eyes (13.33%) with no detectable pathology after the operation (Group C) Conclusion: SD-OCT is an irreplaceable instrument for the postoperative assessment of macula in patients who have undergone surgery for macula-off RRD. It permits detection of the presence of foveal changes that are not visible with ophthalmoscope. Persistent sub-retinal fluid is responsible for the poor prognosis after surgery. Although there was a detectable improvement in vision with decrease of the amount of subretinal fluid, Visual prognosis related to other pathological finding as photoreceptors integrity, and presence or absence of Cystoid macular edema.

The efficacy of half-dose verteporfin photodynamic therapy for chronic central serous chorioretinopathy

Objective To evaluate the efficacy and safety of half-dose verteporfin photodynamic therapy (PDT) for chronic central serous chorioretinopathy (CSC). Methods 35 eyes (35 patients) with chronic (or recurrent) CSC treated with half-dose verteporfin PDT. Best-corrected visual acuity(BCVA), central macular thickness (CMT) were measured before and after treatment (1, 3 and 6 months). The mean BCVA was 0.28±0.22, mean CMT was(384.5±85.0)μm. The situation of subretinal fluids (SRF) absorption was observed. Results In 35 eyes, SRF of 29 eyes (82.9%) completely absorbed and 6 eyes (17.1%) not completely absorbed after one month of treatment. SRF of all eyes (100.0%) completely absorbed after three months of treatment. After 6 months of treatment, SRF of 3 eyes (8.6%) were recurrence, which might be completely absorbed when a half-dose maintenance therapy PDT was used again. The mean BCVA significantly improved to 0.14±0.13 at 1 months, 0.05±0.11 at 3 months and 0.05±0.12 at 6 months after PDT (t=5.410, 7.830, 7.758; P<0.05). The mean CMT decreased to (224.3±61.4) μm at 1 months, (199.6±32.7) μm at 3 months and (205.3±39.6) μm at 6 months after PDT (t=11.856, 11.781, 11.900; P<0.05). The mean CMT of controlled 32 eyes after treatment was (198.5±33.9) μm , much lower than the fellow eyes(232.3±17.5) μm (t=-3.988, P<0.05). Conclusions Half-dose verteporfin PDT was safe and effective in treating chronic CSC, but may cause thinning of CMT. Key words: Central serous chorioretinopathy/therapy; Photochemotherapy; Treatment outcome

Spectral domain optical coherence tomography characteristics of polypoidal choroidal vasculopathy and its correlation with vision outcomes

Objective To evaluate the spectral domain optical coherence tomography (SD-OCT) characteristics of polypoidal choroidal vasculopathy (PCV) and its correlation with the visual acuity after photodynamic therapy (PDT) combined with intravitreal ranibizumab.Methods Twenty-six eyes of 26 patients with PCV diagnosed by indocyanine green angiography (ICGA) were enrolled in this study.All the patients were examined for best corrected visual acuity (BCVA),slit lamp microscope,SD-OCT,fundus fluorescein angiography (FFA) and ICGA before and 1,3 months after treatment.The mean baseline BCVA was (31.46±16.87) letters,mean central retinal thickness (CRT) was (581.19±309.05) μm,and mean subfoveal choroidal thickness (SFCT) was (248.92±95.45) μm.Patients were divided into 2 groups according to the final visual improvement after 6 month of treatment:GR or sensitive Group (17 eyes) and PR or non-sensitive Group (9 eyes).GR group included 12 males and 5 females,with a mean age of (65.24± 7.03) years,a mean CRT of (619.06±335.07) μm and a mean SFCT of (271.24±±106.61) μm.There were 4 eyes with subretinal hemorrhage (SRH),2 eyes with interface retinal fluid (IRF),13 eyes with subretinal fluids (SRF) and 15 eyes with pigment epithelial detachment (PED).PR group included 8 males and 1female,with a mean age of (64.00±7.02) years,a mean CRT of (509.67±255.21) μm and a mean SFCT of (271.24 ± 106.61) μm.There were 6 eyes with subretinal hemorrhage (SRH),5 eyes with interface retinal fluid (IRF),6 eyes with subretinal fluids (SRF) and 8 eyes with pigment epithelial detachment (PED).The difference of sex,age,CRT and SFCT between these two groups was not significant (P＞ 0.05).The relationship of baseline SD-OCT and post-treatment BCVA was analyzed.Results On 1,2,3,6 months after treatment,the BCVA were (38.46±19.81),(40.04±20.80),(42.96±21.63),(43.77±20.91) letters respectively.On 6 months after treatment,the mean CRT in GR and PR group were (360.71±276.54),(341.44±193.68) μmrespectively (P＞0.05).64.71％ (11/17) eyes in GR group and 22.22％ (2/9) eyes in PR group had a SFCT thicker than 263μm.The difference was statistical significant between two groups [odds ratio (OR):0.052,95 ％ confidence interval (CI):0.005-0.533; P=0.013].Logistic regression analysis showed that existence of IRF (OR=9.375,95％ CI:1.299-67.645 ; P=0.026) or SRH (OR=6.500,95％CI:1.094-38.633 ; P=0.040) at baseline was negative prognostic factor to treatment.Conclusion Thick SFCT is a protective factor,however,existence of IRF or SRH at baseline is negative prognostic factor of final visual improvement. Key words: Diagnostic imaging; Tomography, optical coherence; Choroid diseases/therapy; Photochemotherapy; Antibodies, monoclonal

Influence of image compression on the interpretation of spectral-domain optical coherence tomography in exudative age-related macular degeneration

To evaluate the effect of image compression of spectral-domain optical coherence tomography (OCT) images in the examination of eyes with exudative age-related macular degeneration (AMD). Thirty eyes from 30 patients who were diagnosed with exudative AMD were included in this retrospective observational case series. The horizontal OCT scans centered at the center of the fovea were conducted using spectral-domain OCT. The images were exported to Tag Image File Format (TIFF) and 100, 75, 50, 25 and 10% quality of Joint Photographic Experts Group (JPEG) format. OCT images were taken before and after intravitreal ranibizumab injections, and after relapse. The prevalence of subretinal and intraretinal fluids was determined. Differences in choroidal thickness between the TIFF and JPEG images were compared with the intra-observer variability. The prevalence of subretinal and intraretinal fluids was comparable regardless of the degree of compression. However, the chorio-scleral interface was not clearly identified in many images with a high degree of compression. In images with 25 and 10% quality of JPEG, the difference in choroidal thickness between the TIFF images and the respective JPEG images was significantly greater than the intra-observer variability of the TIFF images (P=0.029 and P=0.024, respectively). In OCT images of eyes with AMD, 50% of the quality of the JPEG format would be an optimal degree of compression for efficient data storage and transfer without sacrificing image quality.

Regression of peripapillary choroidal neovascular membrane in a patient with sarcoidosis after oral steroid therapy

Choroidal neovascular membrane (CNV) may occur in patients with posterior uveitis. Treatment of patients with corticosteroids induces regression of the inflammation in the posterior pole with downregulation of many cytokines including vascular endothelial growth factors. We report herewith, a case of biopsy proven sarcoidosis that developed posterior uveitis and peripapillary CNV membrane and subretinal hemorrhage with fluid. The patient was treated with systemic steroids. She demonstrated progressive regression of the CNV membrane and complete resolution of the subretinal hemorrhage and fluids. In conclusion, control of the posterior segment inflammation is crucial in the resolution of the CNV membrane in uveitis and the intravitreal anti-vascular endothelial growth factor may not be always indicated.

Clinical course of patients with exudative-haemorrhagic age-related macular degeneration treated with ranibizumab. Eye2Eye study

ObjectiveTo assess the mean best-corrected visual acuity (BCVA) change in patients with exudative-hemorrhagic age-related macular degeneration (EH-ARMD) after 12-month period of treatment with ranibizumab. MethodsA retrospective, multicentre and national study of intravitreal administered ranibizumab was conducted on two groups of EH-ARMD patients: only one eye affected (group 1) vs second eye affected (group 2), having the first one affected.Eligible subjects were ≥50 years old with primary or secondary active subfoveal EH-ARMD-related choroidal neovascularisation (CNV). ResultsA total of 184 patients (91 group 1 and 93 group 2) were included. Mean age (SD) was 75.3 (7.5) years, and 53.6% were women. The BCVA showed a VA improvement at 12 months of 9.3 (18.0) number of letters in group 1 and 5.1 (16.8) number of letters in group 2 (p<0.0001 and p=0.0042, respectively). No statistical differences between groups were observed. Lesion characteristics in the total population (baseline vs 12-month) were: drusen (69.1% vs 61.1%), macular hemorrhages (59.0% vs 7.3%), lipid exudates (28.1% vs 8.2%), and retinal pigment epithelium detachment (46.8% vs 19.0%). The optical coherence tomography (OCT) in the total population (baseline vs 12-month) showed a reduction in macular edema (73.6% vs 20.9%), subretinal fluids (71.3% vs 14.7%), and intraretinal cysts (38.5% vs 19.7%), as well as a reduction of the mean foveal thickness 377.4±109.8μm vs 249.1±67.8μm in group 1 and 354.1±123.2μm vs 254.6±67.4μm in group 2, p<0.0001, both groups, with no significant differences between groups. ConclusionsIntravitreal administration of ranibizumab for a minimum of 12-months significantly improved the BCVA, decreased lesion characteristics, and reduced the initial mean foveal thickness in patients with CNV primary or secondary to EH-ARMD, both in patients with only one eye affected and in patients with a second eye affected, having the first one affected.

Scleral buckling versus vitrectomy for macula-off rhegmatogenous retinal detachment as accessed with spectral-domain optical coherence tomography: a retrospective observational case series.

BackgroundScleral buckling surgery and pars plana vitrectomy are competing methods in the treatment of retinal detachment. The recent development of spectral-domain optical coherence tomography (SD-OCT) has dramatically improved the visualization of the photoreceptor layer relative to conventional OCT, and offers new opportunities to investigate the discordances between anatomic and functional outcomes after retinal detachment surgery. Hence, the study aim was to use SD-OCT to compare the postoperative macular recovery between scleral buckling and vitrectomy for macular-off rhegmatogenous retinal detachment.MethodsIn this retrospective observational case series, we observed 32 patients who underwent scleral buckling surgery (group 1) and 26 patients who underwent pars plana vitrectomy (group 2) as the primary surgery for macula-off rhegmatogenous retinal detachment. OCT was used to examine microstructural changes in the macular area.ResultsThe mean visual acuity improvement was 0.4 ± 0.8 logMAR in group 1 and 0.7 ± 0.9 logMAR in group 2. As detected by SD-OCT, subretinal fluid was present in 26 of the group 1 eyes (81.3%) and 5 of the group 2 eyes (19.2%) at 8 weeks postoperatively.This difference was statistically significant (Fisher’s exact test, P < 0.05). Moreover, detection by SD-OCT revealed epiretinal membranes in 5 of the group 1 eyes (15.6%) and 11 of the group 2 eyes (42.3%), a difference that was statistically significant (Fisher’s exact test, P < 0.05).ConclusionsMacular recovery and the mean visual acuity differed between the 2 groups of patients. With the help of SD-OCT, we observed that subretinal fluids could persist for a relatively longer period after scleral buckling. Based on our results, we conclude that primary vitrectomy surgery is a better choice for macular recovery of the macula-off rhegmatogenous retinal detachment.

The seasick choroid: a finding on enhanced depth imaging spectral-domain optical coherence tomography of choroidal lymphoma.

To describe previously unreported imaging features of choroidal lymphoma using enhanced depth imaging optical coherence tomography (OCT). Enhanced depth imaging OCT was performed before and after the therapy. A 32-year-old white man with a 4-month history of blurred vision in the right eye was found to have a macular fold. There was no visible intraocular tumor. There were no signs of anterior segment inflammation, vascular abnormalities, or infiltrative disease. Visual acuity was 20/150 in the right eye and 20/20 in the left eye. Enhanced depth imaging OCT demonstrated a macular retinal fold and marked thickening of the choroid with striking choroidal surface undulation and folds imparting an appearance similar to a "sea storm" (seasick appearance). Deep choroidal structures could not be visualized, and the sclerochoroidal interface could not be identified. Overlying subretinal fluid and intraretinal fluid was noted. Ultrasonography demonstrated diffuse, relatively smooth thickening of the choroid (4.0-mm thickness) with minor extraocular hypoechoic area. Based on these findings, choroidal lymphoid proliferation was suspected, and fine-needle aspiration biopsy confirmed B-cell lymphoma. Results of systemic evaluation were unremarkable. After external beam radiotherapy with dose of 40 Gy, visual acuity returned promptly to 20/40 and the lymphoid infiltration resolved with flattening of the macular fold and resolution of subretinal and intraretinal fluids. The enhanced depth imaging OCT returned to a more normal appearance with the resolution of the retinal fold and reduction of the choroidal mass with retinal pigment epithelial-choroidal surface features to a "calm sea" appearance. Enhanced depth imaging OCT is a useful tool for subclinical monitoring of choroidal infiltration from lymphoma before and after therapy.

Factor Xa and thrombin induce epithelial-mesenchymal transition by retinal pigment epithelial cells via PDGF-Rβ signaling

Proliferative vitreoretinopathy (PVR) is an inflammatory fibrotic disorder of the retina. Retinal pigment epithelial (RPE) cells contribute to PVR development through uncontrolled proliferation and extracellular matrix production as well as cytokine secretion. Insight into factors that stimulate these processes by RPE in PVR is limited, which may explain the lack of satisfying treatment so far. Blood-retinal barrier breakdown and vascular damage are early pathobiological events of PVR. Vascular damage results in activation of the coagulation system and subretinal fluids from retinal detachment patients have been described to contain high pro-coagulant activity. The effect of coagulation proteases on RPE is however hardly studied so far. Of all proteins involved in the coagulation cascade only factor Xa and thrombin are able to induce various cellular responses via their receptors which are expressed at the cell membranes of various cell types. These receptors, the so-called protease activated receptors (PARs) consist of 4 members: PAR1, -2, -3 and -4. Cleavage of PARs results in the activation of signal transduction pathways that control multiple cellular functions like inflammation, fibrosis and tissue repair. Here we examine the effect of factor Xa and thrombin on epithelial-mesenchymal transition (EMT) by RPE. EMT is a biological process that allows epithelial cells to undergo multiple biochemical changes that enable them to assume a mesenchymal phenotype. Similar processes have also been described for RPE cells in PVR membranes. Differentiation from an epithelial phenotype into a mesenchymal phenotype results in the loss of epithelial markers like zona occludens (ZO)-1 and the enrichment of mesenchymal markers like α-smooth muscle actin (α-SMA). Another component of PVR development as a result of EMT consists of excessive production of extracellular matrix (ECM) proteins; mainly collagen subtype-I. In this study we show that factor Xa and thrombin are able to upregulate the expression of pro-fibrotic mediators like PDGF-A, -B, TGF-α and TIMP-1 by RPE cells and induce fibrotic responses known to be involved in the development of PVR. In line with these findings we also show that mainly thrombin but also factor Xa, can induce EMT by RPE via PDGF-B mediated PDGF-Rβ signaling.

Evolución clínica de pacientes con degeneración macular asociada a la edad de tipo exudativo-hemorrágico tratados con ranibizumab. Estudio Eye2Eye

ObjectiveTo assess the mean best-corrected visual acuity (BCVA) change in patients with exudative-haemorrhagic age-related macular degeneration (EH-ARMD) after 12-month period of treatment with ranibizumab. MethodsA retrospective, multicentre and national study of intravitreal administered ranibizumab was conducted on 2 groups of EH-ARMD patients: only one eye affected (group 1) versus second eye affected (group 2), having the first one affected.Eligible subjects were ≥ 50 years old with primary or secondary active subfoveal EH-ARMD-related choroidal neovascularisation (CNV). ResultsA total of 184 patients (91 group 1 and 93 group 2) were included. Mean age (SD) was 75.3 (7.5) years, and 53.6% were women. The BCVA showed a VA improvement at 12 months of 9.3 (18.0) number of letters in group 1 and 5.1 (16.8) number of letters in group 2 (P<.0001 and P=.0042, respectively). No statistical differences between groups were observed. Lesion characteristics in the total population (baseline vs 12-month) were: drusen (69.1% vs 61.1%), macular haemorrhages (59.0% vs 7.3%), lipid exudates (28.1% vs 8.2%), and retinal pigment epithelium detachment (46.8% vs 19.0%). The optical coherence tomography (OCT) in the total population (baseline vs 12-month) showed a reduction in macular oedema (73.6% vs 20.9%), subretinal fluids (71.3% vs 14.7%), and intraretinal cysts (38.5 vs 19.7%), as well as a reduction of the mean foveal thickness 377.4 ± 109.8μm vs 249.1 ± 67.8μm in group 1 and 354.1 ± 123.2μm vs 254.6 ± 67.4μm in group 2, P<.0001, both groups, with no significant differences between groups. ConclusionsIntravitreal administration of ranibizumab for a minimum of 12-months significantly improved the BCVA, decreased lesion characteristics, and reduced the initial mean foveal thickness in patients with CNV primary or secondary to EH-ARMD, both in patients with only one eye affected and in patients with a second eye affected, having the first one affected.

Intraocular and systemic levels of vascular endothelial growth factor in advanced cases of retinopathy of prematurity

To measure vitreous, aqueous, subretinal fluid and plasma levels of vascular endothelial growth factor in late stages of retinopathy of prematurity. Interventional study. We enrolled patients with clinical diagnoses of bilateral stage V retinopathy of prematurity, confirmed by b-scan ultrasound and programmed for vitrectomy. During surgery we took samples from blood, aqueous, vitreous, and subretinal fluids. The vascular endothelial growth factor concentration in each sample was measured by ELISA reaction. A control sample of aqueous, vitreous and blood was taken from patients with congenital cataract programmed for phacoemulsification. For statistical analysis, a Mann-Whitney and a Wilcoxon W test was done with a significant P value of 0.05. We took samples of 16 consecutive patients who met the inclusion criteria. The vascular endothelial growth factor levels in the study group were: aqueous, 76.81 ± 61.89 pg/mL; vitreous, 118.53 ± 65.87 pg/mL; subretinal fluid, 1636.58 ± 356.47 pg/mL; and plasma, 74.64 ± 43.94 pg/mL. There was a statistical difference between the study and the control group (P < 0.001) in the aqueous and vitreous samples. Stage 5 retinopathy of prematurity has elevated intraocular levels of vascular endothelial growth factor, which remains high despite severe retinal lesion. There was no statistical difference in plasma levels of the molecule between the control and study group.

High Subretinal Fluid Procoagulant Activity in Rhegmatogenous Retinal Detachment

An increased mRNA expression of genes related to blood coagulation has been demonstrated in an experimental retinal detachment model but has not yet been confirmed in human clinical specimens. Tissue factor (TF), the initiating factor of blood coagulation, may be a determinant of the extent of tissue injury after rhegmatogenous retinal detachment (RRD). This study was conducted to determine whether subretinal fluid and vitreous fluid collected from patients with RRD have a procoagulant effect. Calibrated thrombin generation (CAT) was used to investigate the thrombogenic properties of 28 subretinal fluids collected during scleral buckling surgery for RRD. Further, the thrombogenic properties of vitreous fluids from RRD (n = 12), macular pucker (n = 5), macular hole (n = 6), and proliferative diabetic retinopathy (n = 5) were compared with the properties of eye bank eyes (n = 11), which served as control specimens. The procoagulant activity of TF was determined with Western blot analysis. The addition of subretinal fluid from all RRD patients (28/28, 100%) induced thrombin generation in normal and severely factor (F)XII-deficient plasma. Contrary to the subretinal fluid, the addition of vitreous fluids from various ocular disorders evoked very little thrombin generation in normal and severely FXII-deficient plasma (4/12, 33% RRD; 1/5, 20% macular pucker; 0/6, 0% macular hole; 0/5, 0% proliferative diabetic retinopathy; and 2/11, 18% eye bank eyes). The procoagulant activity in subretinal fluid was almost completely neutralized by antibodies against human TF. The presence of TF in subretinal fluid was confirmed by Western blot. Subretinal fluid of patients with RRD induces high procoagulant activity, determined by measuring the level of tissue factor.

Clinical findings in unilateral acute idiopathic maculopathy

We report a case of unilateral acute idiopathic maculopathy (UAIM) with new clinical findings. A 34-year-old Japanese man had a neurosensory retinal detachment (approximately 5 disk diameters) with yellowish-white exudates at the macula in the left eye (visual acuity (VA) 0.4). Fluorescein angiography (FA) showed early hypofluorescent spots and late pooling in the subretinal space. Three weeks after onset, indocyanine green angiography (IA) showed numerous hypofluorescent spots at the lesion. Optical coherence tomography (OCT) showed subretinal fluids and an elevated choroidal lesion with low reflectivity, suggesting choroidal edema. The VA and fundus appearance spontaneously resolved without treatment three months after onset. The VA was 1.0 six months after onset. Irregular pigmentation remained at the macular lesion. The main UAIM pathology may be outer retinal layer and retinal pigment epithelial inflammation. FA, IA, and OCT suggested that choroidal inflammation may be involved in the pathogenesis of UAIM.

Balance of Vascular Endothelial Growth Factor and Pigment Epithelial Growth Factor prior to Development of Proliferative Vitreoretinopathy

Background: Pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) are imbalanced in eyes with proliferative diabetic retinopathy or proliferative vitreoretinopathy (PVR). It is not known whether such an imbalance is already present in early PVR stages. We therefore analyzed VEGF and PEDF concentrations in subretinal fluids prior to PVR development. Methods: A large number (n = 137) of subretinal fluid samples were obtained at the time of scleral buckling surgery for rhegmatogenous retinal detachment (RRD). Thirty patients developed PVR within 6 months after surgery. One hundred and seven patients undergoing the same surgery but without complications served as controls. Furthermore, vitreous from 16 patients with macular hole or pucker (MHP) served as reference for baseline intraocular concentrations. PEDF and VEGF concentrations were measured by commercial ELISAs. Results: PEDF levels were substantially higher (9.6 µg/ml) compared to MHP vitreous (0.3 µg/ml, p < 0.001). VEGF levels were also higher (RRD: 0.07 ng/ml; MHP: 0.01 ng/ml, p < 0.05). Subretinal concentrations were not significantly different between PVR and control RRD patients. Conclusions: Although both VEGF and PEDF are increased at first surgery for RRD, they do not predict PVR development later on. The high PEDF concentrations and its known antiangiogenic activity suggest a protective role against neovascularization.

Serous retinal detachment as an early presentation of thrombotic thrombocytopenic purpura

A 23-year-old woman presented with abdominal pain and blurred vision in both eyes. Fundoscopy revealed large bullous detachments of her neurosensory retina with shifting subretinal fluids bilaterally. Laboratory studies showed a hemoglobin of 6.5 mmol/l, thrombocytes 20×10 9/l, and LDH 1098 U/l. A peripheral blood smear revealed red blood cell fragmentation. A diagnosis of thrombotic thrombocytopenic purpura was made. The patient was treated with four sessions of plasmapheresis followed by plasma infusions, which resulted in a complete recovery.

Comparative Studies of Morphological Changes and Interleukin Concentration in Subretinal Fluid of Patients with Retinal Detachment

Morphological evaluation was performed with the light and scanning electron microscope of subretinal fluids (SRF) collected during operations from 36 patients with rhegmatogenous retinal detachment. Duration of the disease was 3 weeks, 5–8 weeks, 10 weeks and 6 months. The immunoenzymatic method was used to establish the presence of interleukins IL-1β, IL-2, IL-4 and IL-6 in SRF. It was revealed that the differentiation of the morphological picture of SRF depended on the duration of detachment. Most cell-rich SRF came from the 3-week detachment. Mononuclear cells were predominant in that period (macrophages, lymphocytes). In the later period (over 8 weeks) a decrease in the number of cells and a change in cellular composition were noted in the fluids examined, while after six months of detachment normal cellular elements were absent. In all time intervals analyzed, no significant increase in IL-1β, IL-2 and IL-4 was noted in SRF. However, a significant quantity of IL-6 was found, particularly in the 5- to 8-week detachment. The authors assume that the presence of a large number of inflow cells in ‘fresh’ detachment can trigger a variety of inflammation-based immunological processes which stimulate the development of vitreoretinal proliferation.

Ocular Fluid Ferning Test and Fractals

The ferning test can be regarded as a crystallization process obtained by simple water subtraction. Such a process is feasible for every kind of ocular fluid (i.e. tears and aqueous, vitreous and subretinal fluids). The ferning test can be described in terms of fractal geometry, as the image characteristics related to this test are consistent with three of the main properties of fractals: self-similarity, fractal dimension and lacunarity.

Biological activities of vitreous gel, retrohyaloid fluid and subretinal fluid from diabetic and non-diabetic eyes.

This study compared the effects of vitreous gel, retrohyaloid fluid and subretinal fluid from diabetic and non-diabetic eyes on the proliferation and migration of retinal microvascular cells in vitro. Intraocular fluids were obtained from eyes undergoing repair of retinal detachment, due either to proliferative diabetic retinopathy or rhegmatogenous retinal detachment associated with a degree of proliferative vitreoretinopathy. The results demonstrated that the intraocular stimulatory activity for the proliferation of retinal microvascular endothelial cells varied between the different ocular compartments. The mitogenic and migrational activity in vitreous gel was greater than that of either the subretinal or retrohyaloid fluids of the same eye, and the activity of subretinal fluid was intermediate between that of the vitreous gel and the retrohyaloid fluid. There was no significant difference between the activities of the samples from diabetic and non-diabetic eyes.