Preservation Of Vision Research Articles

Neuro-ophthalmic manifestations of cancer: a narrative review.

Neuro-ophthalmic manifestations of cancer are vast and early recognition of a serious ocular condition due to either cancer or its therapy is important for both vision preservation as well as providing valuable treatment and prognostic information regarding the underlying malignancy. This review focuses on direct and indirect effects of cancer on the eye and its adnexa, hematologic malignancy, complications of traditional and novel oncologic therapies, and paraneoplastic syndromes as they relate to the eye as these disorders can lead to potentially devastating or irreversible vision loss. PubMed was searched primarily for the following topics: optic nerve infiltration, primary vitreoretinal lymphoma (PVRL), ocular paraneoplastic disorders, and ophthalmic complications of cancer therapeutics. Literature was selected based on historical significance and landmark studies (e.g., Cross et al. series of paraneoplastic optic neuritis patients; Chan's textbook on primary intraocular lymphoma) as well as publications published after 2000. References from select studies were additionally included. Given the sparsity of literature on many subjects, most publications were included during this time frame in our review. There are several ophthalmic entities that the oncologist should be aware of including leukemic optic nerve infiltration, PVRL, paraneoplastic syndromes as they related to the eye, and adverse effects of therapeutics. Unfortunately, given the rarity of some of these entities [e.g., paraneoplastic optic neuropathy (PON), cancer-associated retinopathy (CAR)], diagnosis can be difficult and treatment options are often limited. Oncologists can develop a set of basic ophthalmology examination skills that will help to triage and manage patient eye complaints. In certain instances, oncologists have the potential to avert devastating vision loss with early recognition of neuro-ophthalmic complications.

Vision Preservation in COVID-Related Cerebral Sinovenous Thrombosis With Optic Nerve Sheath Fenestration.

Johnston, Andrew B. MD1; Choudhri, Asim F. MD2,3; Inoa, Violiza A. MD4; Ditta, Lauren C. MD1,5,6Author Information

Toxic photochemistry and signaling repercussions of blue light in cells exposed to retinal

Age‐related visual damage by blue light and its adverse effects on quality of life for many people >55 yrs have been well documented. Eliminating blue wavelengths has been shown to reduce age‐related visual impairment and facilitate vision preservation in the elderly. The blue region of the visible spectrum is abundant in sunlight and common electronic light emitters. Many adults receive increased ultraviolet and blue light exposure upon retirement by moving closer to the tropics and spending more time outdoors. The cornea and lens of the eye are largely opaque to ultraviolet, while blue light readily permeates into the retina. We propose that all‐trans‐retinal (ATR), the light‐sensitive chromophore released from photoexcited photopigments in the retina, could induce age‐related vision impairment. Our data demonstrate that exposing cells incubated with ATR and exposed to blue light or sunlight permanently distorted the chemical properties of the crucial signaling lipid PIP2 and disrupted its subcellular location and signaling. Similar conditions permanently displaced G proteins in the phototransduction cascade and Ras family G proteins from the plasma membrane to the cell interior. Chemical evidence shows the oxidation of their farnesyl lipid anchor during this perturbation. Upon ATR and blue light, the percent positivity for TUNEL stain, indicating DNA damage, is significantly higher in primary cells isolated from mouse retina. We also show α‐Tocopherol, a lipid‐soluble antioxidant, inhibits the above cellular photodamage. Therefore, we now ask the critical question: could resident ATR concentrations in photoreceptor cells cause retina neurodegeneration upon physiologically relevant light exposures?

PREDICTED PROTEIN STRUCTURE VARIATIONS INDICATE THE CLINICAL PRESENTATION OF CYP4V2-RELATED BIETTI CRYSTALLINE DYSTROPHY.

To investigate the relationship between different CYP4V2 disease-causing variants and disease severity in Bietti crystalline dystrophy (BCD). Twenty-one subjects from 19 unrelated families with a clinical diagnosis of BCD were enrolled. A novel severity prediction score for BCD based on the predicted molecular impact of CYP4V2 variants was applied for grouping and subsequent analyses. The more severe variants led to less CYP4V2 protein function preservation and a higher severity prediction score. All subjects harbored two alleles of CYP4V2 disease-causing variants, of which c.802-8_810del17insGC was the most prevalent (14/21, 66.67%) and c.1507G>C was novel. According to the severity score, the subjects were categorized into severe, moderate, and mild groups with different preservation of central vision (mean logMAR visual acuity 0.95 ± 0.82, 0.89 ± 1.22, and 0.56 ± 0.64, respectively). The patients with a lower severity score had slower disease progression. This is the first cohort study of BCD in Taiwan, and we established a novel BCD severity index based on the molecular impact of different CYP4V2 variants. More severe impairment of CYP4V2 protein led to a more severe disease course with earlier progression. Our results could be helpful in identifying a therapeutic window for patients with BCD.

Hypertension of the eye in case of damage to the interstitial brain

Ocular hypertension with a lesion of the hypothalamus differs from true glaucoma in the preservation of vision, the absence of glaucomatous excavation of the optic nerve disc, in some cases poor tolerability or inefficiency of myotics. This symptom in some patients preceded the appearance of other signs of damage to the hypothalamus, while in others it was the only symptom of the disease.

Postvitrectomy endophthalmitis caused by Morganella morganii: a case report and literature review

BackgroundPostvitrectomy endophthalmitis is a rare and serious complication following vitreoretinal surgeries. Morganella morganii, an emerging gram-negative, facultative anaerobic rod, is related to severe nosocomial infections in various organs and thus has gained importance in recent decades. Morganella morganii infection following intraocular surgery is rarely reported.Case presentationWe report an immunocompetent patient with Morganella morganii-related endophthalmitis after vitrectomy for retinal detachment who presented with hand motion visual acuity, hypopyon and a unique retrolental exudative membrane. Initially, the patient was unresponsive to empirical intravitreal ceftazidime and vancomycin but recovered with vision preservation (20/63) after surgical removal of the membrane and silicone oil tamponade.ConclusionsMorganella morganii intraocular infection is often devastating, likely due to its high multidrug-resistance rate via intrinsic ß-lactamase production, multiple acquired traits related to additional genetic mechanisms, and fimbrial adhesion, urease production, and type III secretion system-associated biofilm formation. The above characteristics of M. morganii may lead to an inadequate response to empirical intravitreal antibiotics, and early surgical intervention should be considered.

Managed care opportunities and approaches to select treatment for sight preservation.

Anti-vascular endothelial growth factor therapies have become the mainstay of treatment for both diabetic macular edema and neovascular age-related macular degeneration. This treatment is imperative for vision preservation including visual acuity. However, treatment burdens include high costs, frequent injections, continued visual loss, and loss of ability to perform day-to-day functions. Although clinical trial data have provided insights to treatment options and protocols, real-world patient experiences and adherence to therapies do not often mimic clinical trials as patients cannot fully adhere to their treatment schedule, leading to poor disease outcomes. Payers may consider various strategies such as step therapies, fee schedule management, and driving utilization through specialty pharmacies to contain costs. However, it is important to recognize not all patients will respond to a one-size-fits-all approach to treatment, warranting a more personalized approach.

Is Tissue Still the Issue? The Promise of Liquid Biopsy in Uveal Melanoma.

Uveal melanoma (UM) is the second most frequent type of melanoma. Therapeutic options for UM favor minimally invasive techniques such as irradiation for vision preservation. As a consequence, no tumor material is obtained. Without available tissue, molecular analyses for gene expression, mutation or copy number analysis cannot be performed. Thus, proper patient stratification is impossible and patients’ uncertainty about their prognosis rises. Minimally invasive techniques have been studied for prognostication in UM. Blood-based biomarker analysis has become more common in recent years; however, no clinically standardized protocol exists. This review summarizes insights in biomarker analysis, addressing new insights in circulating tumor cells, circulating tumor DNA, extracellular vesicles, proteomics, and metabolomics. Additionally, medical imaging can play a significant role in staging, surveillance, and prognostication of UM and is addressed in this review. We propose that combining multiple minimally invasive modalities using tumor biomarkers should be the way forward and warrant more attention in the coming years.

Empires of Antiquities: Modernity and the Rediscovery of the Ancient Near East, 1914–1950

Empires of Antiquities: Modernity and the Rediscovery of the Ancient Near East, 1914–1950

Medical therapy for glaucoma: A review.

A number of pharmacological targets are exploited to modify the parameters in the Goldmann equation and reduce the intraocular pressure (IOP). This strategy constitutes the foundation for the medical management of glaucoma, the evolution of which, until only recently, has been in relative stagnation. A burst of innovation has produced new ocular hypotensive drugs and long-acting delivery methods, including intracameral delivery, which are expanding the clinician's medical armamentarium. A number of IOP-independent neuroprotection strategies have shown strong potential in animal models of glaucoma, but translational attempts have been surprisingly limited. However, while pharmacological options are expanding, the traditional role of topical medical therapy is being challenged by selective laser trabeculoplasty, micro-invasive glaucoma surgery, and sustained delivery methods. A scientifically rigorous assessment of new treatments will be critical to empower clinicians with evidence-based information to optimise vision preservation and quality of life outcomes for their patients.

Intra-Arterial Chemotherapy for Retinoblastoma

The management of retinoblastoma is challenging and complex. Preservation of the eyeball as well as vision, with minimum morbidity, is the aim in the initial stages. This has been made possible by the use of chemotherapy that is targeted to the eye in the form of selective intravitreal and intra-arterial chemotherapy which has shown promising results. The efficacy and safety of intra- arterial chemotherapy have been reported by many specialized centers. The aim of this article was to review the role of intraarterial chemotherapy in the management of retinoblastoma and its clinical outcomes. In addition, we will review the possible complications of the procedure. We were able to collect articles relevant to our research objectives by reviewing the title and abstract of each article. Irrelevant articles and those that did not meet the inclusion criteria were excluded. This yielded a total of 19 studies. The results indicated that intraarterial chemotherapy is an effective and new modality of treatment for retinoblastoma to salvage the eyeball and helps in the prevention of enucleation with minimal local and systemic complications that are mostly transient. For future work, we recommend conducting more prospective studies with large samples and the long duration of follow-up. Also, we recommend future studies focusing on assessing visual acuity, as most of the currently available studies did not assess the visual acuity, making the judgment on vision preservation with IAC difficult.

The nuclear factor E2-related factor 2 and age-related macular degeneration.

After the discovery of anti-vascular endothelial growth factor agents as treatment of wet age-related macular degeneration, the number of studies with the objective to understand the molecular mechanisms involved in the age-re lated macular degeneration genesis has increased. The importance of the nuclear factor e2-related factor 2 lies in its activation-derived proteins being involved in the maintenance of the redox balance and consequent prevention of degenerative macular disease. This article aims to present the characteristics of nuclear factor e2-related factor 2 and describe the main nuclear factor e2-related factor 2-activated antioxidant enzymes that contribute to the preservation of vision.

An Epithelial Abrasion Model for Studying Corneal Wound Healing.

The cornea is critical for vision, accounting for about two-thirds of the refractive power of the eye. Crucial to the role of the cornea in vision is its transparency. However, due to its external position, the cornea is highly susceptible to a wide variety of injuries that can lead to the loss of corneal transparency and eventual blindness. Efficient corneal wound healing in response to these injuries is pivotal for maintaining corneal homeostasis and preservation of corneal transparency and refractive capabilities. In events of compromised corneal wound healing, the cornea becomes vulnerable to infections, ulcerations, and scarring. Given the fundamental importance of corneal wound healing to the preservation of corneal transparency and vision, a better understanding of the normal corneal wound healing process is a prerequisite to understanding impaired corneal wound healing associated with infection and disease. Toward this goal, murine models of corneal wounding have proven useful in furthering our understanding of the corneal wound healing mechanisms operating under normal physiological conditions. Here, a protocol for creating a central corneal epithelial abrasion in mouse using a trephine and a blunt golf club spud is described. In this model, a 2 mm diameter circular trephine, centered over the cornea, is used to demarcate the wound area. The golf club spud is used with care to debride the epithelium and create a circular wound without damaging the corneal epithelial basement membrane. The resulting inflammatory response proceeds as a well-characterized cascade of cellular and molecular events that are critical for efficient wound healing. This simple corneal wound healing model is highly reproducible and well-published and is now being used to evaluate compromised corneal wound healing in the context of disease.

ATTITUDE OF FAMILY DOCTORS TO PREVENTION OF EYE DISORDERS IN CHILDREN

The aim of our study was to analyze the results of a survey conducted by family doctors, family pediatricians with clarification of their attitude to the prevention of visual impairment in children.
 Materials and Methods. Results of a sociological survey conducted among family doctors and family pediatricians in Ukraine (504 questionnaires). Methods of sociological research and medical statistics were used.
 Results and Discussion. Almost all family doctors recognize that preventive work should be the main in their practice (92.86±1.15)%, however, the available equipment of the workplace in more than half of family doctors (52.38±2.22)% does not allow preventive examinations of visual functions in children. Only a quarter (25.4±1.94)% of family doctors consider their workplace fully equipped for full primary care. High awareness of family physicians about risk factors (95.63±0.91)%, hygienic norms of visual load in childhood (79.37±1.80)%, is combined with the fact that only 18.25±1.72)% of family doctors in daily practice conduct preventive diagnostic ophthalmological examinations of children, having sufficient knowledge and skills to conduct them. Their preventive work is limited to oral information about the possible risk of diseases and eye injuries (92.06±1.20)%. Most doctors recognize the need for regular vision testing in children and support the introduction of a state prevention program for the preservation of vision from childhood (98.41±0.56)%.
 Conclusions. The results of the study suggest a lack of ability of primary care to solve the problem of preventing the growth of ophthalmic pathology among children. The algorithm of preventive intervention, based on organizational, diagnostic, treatment-and-prophylactic measures, should first of all be focused on cooperation of family doctors, family pediatricians, pediatric ophthalmologists and paramedics of medical and educational institutions in order to timely identify risk factors for effective management formation of visual functions in children of different ages.

The Management of Congenital Microphthalmia With Orbital Cyst: A Case Series.

To describe a series of patients treated for congenital microphthalmia associated with orbital cyst and recommend a management protocol. This retrospective case series comprised 6 patients (7 eyes) who attended an oculoplastic tertiary medical center from 2001 to 2018. Clinical, treatment, and outcome data were collected from the electronic files. Main outcome measures were preservation of vision and cosmetic appearance. Four patients were diagnosed at birth. Six cysts were located inferiorly and one superiorly. Two patients had a visual potential of light perception or better in the affected eye. In 4 eyes, the cyst was initially retained and the eye was fitted with a custom-made conformer. In 1 eye, the fornices were too shallow for a conformer, warranting fornix reconstruction and cyst excision. Early surgery was required in 1 eye for an expanded cyst and large orbit volume, and in another eye the cyst had overgrown the orbit, causing bone erosion and remodeling. Cosmetic results were good in 3 of the eyes in which the cyst was retained in early childhood, stimulating orbital growth. Congenital microphthalmia with orbital cyst is rare. Management should focus on preserving visual potential, especially in unilateral cyst cases when the other eye is also microphthalmic. Otherwise cosmetic symmetry is the main concern; cyst retention combined with ocular conformers may stimulate socket expansion. The authors found that, in most cases, if treated early, enucleation was avoidable during cyst excision. Early assessment, meticulous follow-up, and individually tailored treatment are warranted. [J Pediatr Ophthalmol Strabismus. 2022;59(3):192-199.].

Regression and pseudoprogression of pediatric optic pathway glioma in patients treated with proton beam therapy.

We examined regression patterns in pediatric optic pathway gliomas (OPGs) after proton beam therapy (PBT) and evaluated local control and visual outcomes. A total of 42 brain magnetic resonance imaging (MRI) scans from seven consecutive sporadic OPGs that were initially treated with chemotherapy and received PBT between June 2007 and September 2016 at the National Cancer Center, Korea were analyzed. Patients underwent brain MRI regularly before and after PBT. Total tumor, cystic lesion, and solid enhancing lesion area delineation and volume calculations were performed on gadolinium-enhanced T1-weighted MRI using Eclipse version 13, Varian. The median follow-up period after PBT was 70months (range 47-88). The median age at the time of PBT was 7years (range 4-16) and the median duration of chemotherapy before referral to PBT center was 25months (range 3-70). The median time to the greatest increase in cystic volume was 32months (range 12-43) after PBT. Solid enhancing lesion volume gradually decreased throughout the follow-up period. On an individual basis, total volume change was varied. However, on average, it regressed, although at a slower rate than solid enhancing lesion volume did. The local control rate was 85.7% (5-year progression-free survival rate, 80%; 5-year overall survival rate, 100%) and the rate of vision preservation was 71.4% (five of seven patients). The regression patterns in pediatric OPGs after PBT involve significant cystic change. Therefore, total volume is not appropriate for evaluating response. Care by a multidisciplinary team is necessary to manage clinical symptoms related to radiologic changes.

Long-Term Transplant Effects of iPSC-RPE Monolayer in Immunodeficient RCS Rats.

Retinal pigment epithelium (RPE) replacement therapy is evolving as a feasible approach to treat age-related macular degeneration (AMD). In many preclinical studies, RPE cells are transplanted as a cell suspension into immunosuppressed animal eyes and transplant effects have been monitored only short-term. We investigated the long-term effects of human Induced pluripotent stem-cell-derived RPE (iPSC-RPE) transplants in an immunodeficient Royal College of Surgeons (RCS) rat model, in which RPE dysfunction led to photoreceptor degeneration. iPSC-RPE cultured as a polarized monolayer on a nanoengineered ultrathin parylene C scaffold was transplanted into the subretinal space of 28-day-old immunodeficient RCS rat pups and evaluated after 1, 4, and 11 months. Assessment at early time points showed good iPSC-RPE survival. The transplants remained as a monolayer, expressed RPE-specific markers, performed phagocytic function, and contributed to vision preservation. At 11-months post-implantation, RPE survival was observed in only 50% of the eyes that were concomitant with vision preservation. Loss of RPE monolayer characteristics at the 11-month time point was associated with peri-membrane fibrosis, immune reaction through the activation of macrophages (CD 68 expression), and the transition of cell fate (expression of mesenchymal markers). The overall study outcome supports the therapeutic potential of RPE grafts despite the loss of some transplant benefits during long-term observations.

778 A Systematic Review of Surgery for Optic Pathway Glioma

Abstract Aim Optic pathway gliomas (OPG) are a rare group of primary CNS malignancies usually found in children. The contemporary role of surgery in managing OPG is unclear. This review aimed to systematically assess the contemporary role for surgery in managing OPGs with respect to survival and functional outcomes. Method A systematic review was conducted in accordance with the PRISMA guidelines. A broad search strategy was employed in the literature search of the major medical databases. Articles describing OPG patients (stratified by modified Dodge classification (mDC) location) undergoing tumour-directed surgery were included, whilst articles with <10 patients, published before 2000 and describing individual case reports, opinions or secondary research were excluded. Primary outcomes were overall survival (OS), progression-free survival (PFS), visual outcome and endocrine outcome. Results 1221 articles were originally identified, with 21 included in the qualitative synthesis. There were 13 Level II and 8 Level IV articles. 5-year OS and PFS was 94.6% and 57.8% respectively (n = 2139). Total resection of mDC I OPG was curative, with no other surgical strategy being associated with survival benefit. Surgery was not significantly associated with visual or endocrine outcome, aside from preservation of contralateral vision (p < 0.001) in one series and predicting posterior pituitary dysfunction and GH deficiency (both p = 0.05) in one cohort. Conclusions Patients undergoing surgery for OPG have excellent overall survival, but a significant proportion have disease progression and associated endocrinopathy. Although total resection of mDC I OPG appears curative, more robust evidence is required to ascertain the surgical role in OPG.

External lumbar drainage in progressive pediatric idiopathic intracranial hypertension.

Pediatric idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure despite normal cerebrospinal fluid and neuroimaging findings. Initial management is typically medical; however, nearly 10% of children will eventually require surgery for persistent headache and/or vision loss. External lumbar drainage, which is a considerably safer treatment option, has not been adequately analyzed in children with medically refractory IIH. The authors conducted a single-institution retrospective analysis of children with medically refractory IIH who had undergone external lumbar drain (ELD) placement because of worsening papilledema, reflected as increased retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) testing. The main outcome measures were effects of external lumbar drainage on papilledema resolution, symptoms, and vision. The authors analyzed the medical records of 13 children with IIH (11 girls, mean age 15.0 ± 2.3 years) whose mean CSF opening pressure was 45.5 ± 6.8 cm H2O. In all children, the average global RNFL thickness in both eyes significantly increased at ELD placement (right eye 371.8 ± 150.2 μm, left eye 400.3 ± 96.9 μm) compared with presentation thickness (right eye 301.6 ± 110.40 μm, left eye 350.2 ± 107.7 μm) despite acetazolamide medical therapy (20-30 mg/kg/day), leading to ELD placement after 9.5 ± 6.9 days (range 3-29 days). After ELD insertion, there was headache resolution, gradual and continuous improvement in optic disc thickness, and preservation of good vision. ELD placement in children with medically refractory IIH who demonstrated worsening papilledema with increased RNFL thickening on OCT testing typically results in symptom relief and disc edema resolution with good visual outcome, often preventing the need for additional definitive surgeries that carry greater failure and morbidity risks.

Long-term vision outcomes and breed differences of Ahmed Glaucoma Valve implantation in 132 eyes of 122 dogs.

To evaluate the long-term vision outcomes of Ahmed glaucoma valve (AGV) implantation in dogs. The medical records of dogs that underwent AGV implantation from January 2010 to December 2019 were reviewed to assess the duration of post-surgical vision preservation (PVP). The relationship between PVP and the underlying cause of glaucoma, implant placement, and preoperative intraocular pressure was evaluated. One hundred and thirty-two eyes of 122 dogs (mean age, 8.3±2.6years) were included. The mean±standard error of PVP for all eyes was 57.5±3.9months. PVP in the dogs with primary acute glaucoma and prior history of cataract surgery was 56.4±4.7 and 59.3±5.9months, respectively (p=.712). The PVP of the Shiba Inu, American Cocker Spaniel, and other breeds was 63.1±5.5, 33.7±5.3, and 59.1±6.3months, respectively (p<.05). The PVP in dogs with medial implantation was 61.9±4.7months, and in those with lateral implantation was 45.4±6.4months (p=.034). Among the 132 eyes investigated, 48 (36.4%) lost vision by the last follow-up, and 18 eyes retained vision for more than 5years. Two of the total number of eyes retained their vision for more than 8years. The vision outcomes regarding the use of AGV for the management of canine glaucoma were favorable in dogs.