Vitreous Cavity Research Articles

Neuroglia Cell-Originated Vitreous Cyst in a Retinitis Pigmentosa Patient.

A 47-year-old female presented with a complaint of a dark shadow floating in front of her right eye. She was diagnosed with retinitis pigmentosa in both eyes 15 years ago in Southwest Hospital. On examination, her presenting visual acuity was 20/400 in both eyes. Visual acuity did not improve even with pinhole and best refractive correction. On slitlamp examination, anterior segment of both eyes was normal. Intraocular pressure of both eyes was within reference limit. On posterior segment examination, fundus evaluation of both eyes revealed typical bone-spicule pigment, and a free-floating cyst of about 6 mm in diameter was seen in the vitreous cavity of the right eye (Fig. 1A). The patient expressed a strong desire for surgery to relieve the dark shadow in her right eye.FIGURE 1: A, Funduscopy showed a free-floating cyst in the vitreous cavity and bone-spicule pigment in the retina. The cyst was gray-white and about 6 mm in diameter. B, Hematoxylin-eosin staining and immunohistochemical staining (GFAP, syn, and S100) of the capsule wall. GFAP indicates glial fibrillary acidic protein; S100, calcium binding protein; syn, synuclein.The cyst was removed by 25-G pars plana vitrectomy (Supplementary Digital Content Video, https://links.lww.com/APJO/A195). Immunohistochemical staining of the capsule wall showed glial fibrillary acidic protein (GFAP), S100 (calcium binding protein), and synuclein (syn) positive (Fig. 1B). GFAP and S100 are markers of neuroglia cells, which are expressed in astrocytes and Muller glia cells of the retina. Syn can also be expressed in activated neuroglia cells. While our staining also showed melanocyte markers (HMB45, MelanA), epithelial cell marker (cytokeratin), macrophage marker (CD68), and lymphocyte marker (CD45) were all negative. These suggested the vitreous cyst originated from the neuroglia cell. Vitreous cysts are rare clinical findings, which can be congenital or acquired. Congenital ones have been reported to be associated with the residual hyaloid vascular system. Acquired ones are usually associated with ocular trauma, uveitis, intraocular infection, retinitis pigmentosa, and retinal detachment.1 Most vitreous cysts can be observed without any treatment. Laser disruption or vitrectomy may be performed when the patient has obvious symptoms and a strong desire for therapy. In our case, the cyst occurred in retinitis pigmentosa and originated from the neuroglia cell. The patient no longer complained about the floater after the operation.

Results of Secondary Implantation by Sutureless Scleral Fixation Carlevale Intra Ocular Lens: A Prospective Study of 15 Cases

Implantation of an intraocular lens (IOL) in the capsular bag is considered the gold standard in cataract surgery. However, ophthalmologists often face patients with aphakia or insufficient capsular support following complicated cataract surgery, trauma or various zonulopathies. In such cases, the implantation of an IOL in the capsular bag is risky or impossible. Managing this type of patients remains a real challenge for surgeons, despite the considerable progress made in secondary implantation techniques. Lately, the new Carlevale Sutureless scleral fixation implant has enlarged this therapeutic arsenal, establishing itself as an attractive alternative for secondary implantation, offering good functional results with a low complication rate. We conducted a prospective interventional study including 15 eyes diagnosed with aphakia, subluxation or dislocation of an intraocular implant. All our patients consulted in the ophthalmology department of Jacques Coeur hospital in Bourges between November 2020 and November 2021. Our patients underwent secondary implantation surgery by Sutureless scleral fixation technique (SSF) with a Carlevale-type lens (Soleko, Italy). The post-operative follow-up was adjusted to the evolution of each case, with a minimum of 12 months' follow-up. It included at each visit the assessment of the best corrected visual acuity (BCVA), refraction, Intra-ocular pressure, clinical ophthalmic examination and endothelial cellularity count. The mean age of our patients was 76 ± 13.5 years, with a slight male predominance (53%). The indication for the secondary implantation surgery was the presence of aphakia in 60% of cases. IOL subluxation was noted in 33% of cases, while the remaining 6% concerned intraocular implants dislocated in the vitreous cavity. Mean best corrected visual acuity (BCVA) was 0.7 ± 0.25 log MAR preoperatively and 0.15 ± 0.33 log MAR at one year postoperatively, representing a mean gain of 5 lines on the Snellen scale. ........

Особенности медикаментозной терапии в до- и в послеоперационном периоде у пациентов с глаукомой, перенесших витреоретинальное вмешательство

Cystoid macular edema (CME, Irwine-Gass Syndrome), despite modern methods of postoperative rehabilitation, remains an urgent problem in ophthalmology. It is most common in cataract surgery, but it also occurs with successfully performed vitreoretinal surgery. Purpose. Analysis of the causes of the development of CME and optimization of the tactics of treatment of patients with glaucoma who underwent vitreoretinal intervention. Material and methods. 6 people with CME after vitreoretinal surgery aged 69.2 ± 7.1 years were under observation at the Tri-Z clinic branch in Moscow in 2022. Vitrectomy was performed in 4 patients (66.7 %) for vitreomacular interface pathology, in two patients (33.3 %) for retinal detachment. All patients received locally prostaglandin analogues (PА) for primary open-angle glaucoma. Tactics of management of patients with glaucoma in CME: 1) cancellation of PA and replacement with therapy of similar efficacy (a combination of drugs from other groups in the absence of contraindications to their use); 2) in CME with retinal thickness up to 450 microns, Diprospan ® injection was performed parabulbar and bromfenac 0.09 % was administered locally twice a day for 2 months.; 3) with CME with a retinal thickness of more than 450 microns, dexamethasone 0.7 mg (Ozurdex®) implant was injected into the vitreal cavity and bromfenac 0.09 % was administered locally twice a day for 2 months. Results. In all patients, retinal thickness decreased from 516.2 ± 125.1 microns to 334.6 ± 62.6 microns (p< 0.05, U-criterion). After 1 month after treatment, the MVA improved from 0.41 ± 0.09 to 0.88 ± 0.11 (p< 0.05, t-criterion). Conclusions. The use of PA in patients with glaucoma may provoke CME, which requires their replacement with a combination of drugs without loss of antihypertensive efficacy. The appointment of bromfenac 0.09 % for prolonged use (up to 2 months or more) after vitreoretinal surgery reduces the risk of developing CME. The proposed tactics of management of patients with glaucoma in CME has shown its effectiveness. Keywords: cystoid macular edema, Irwine-Gass Syndrome, vitreoretinal surgery, prostaglandin analogues

Evolution of demarcation line after pneumatic retinopexy—a case report

BackgroundDemarcation line in a rhegmatogenous retinal detachment (RD) is a classic finding noted in chronic cases. In this case report, we describe a case of evolution of post-operative demarcation line after pneumatic retinopexy (PnR) in a subtotal rhegmatogenous RD.Case descriptionA 31-year-old male diagnosed with acute, subtotal, macula-off rhegmatogenous RD in the left eye of 15-day duration underwent PnR on the same day. His presenting visual acuity was 6/48 in the left eye. Transconjunctival cryopexy was performed to the retinal break at the same sitting and 0.5 cc of 100% perfluoroproprane (C3F8) gas was injected in the vitreous cavity and right lateral position was advised to the patient.ResultA pigmentary demarcation line was noted extending the nasal part of the macula along the most dependent part of the detachment on the immediate post-operative day and was more obviously visible on the 2nd and then on the 11th post-operative day. The visual acuity at the last follow-up visit improved to 6/18. Successful reattachment of the retina was noted on the last follow-up visit.ConclusionPost-operative demarcation lines after RD surgery could develop due to subretinal migration of pigments and along the most-dependent part depending upon post-operative positioning of the patient. Careful post-operative positioning, particularly in macula splitting RDs could be important to avoid pigment accumulation along the foveal area.

Long Noncoding RNA MIAT Modulates Chronic Retinal Ischemia-Reperfusion Injury in Mice via the microRNA-203-3p/SNAI2 Axis.

Retinal ischemia-reperfusion injury (RIRI) is a vital pathological process of multiple ocular diseases. This study aimed at investigating the effects of the MIAT/miR-203-3p/SNAI2 axis on RIRI. RIRI was produced by inducing an exceedingly high intraocular pressure (IOP) in mice. Mouse retinal ganglion cells (RGCs) were subjected to oxygen-glucose deprivation/reoxygenation (OGD/R) to mimic in vitro models. Relevant oligonucleotides or plasmids were transfected into OGD/R-induced RGCs in vitro or injected into RIRI mice models in vivo via a vitreous cavity. The findings of our paper indicated that MIAT and SNAI2 were highly expressed and miR-203-3p was lowly expressed in mouse RIRI tissues and OGD/R-induced RGCs. Interfering MIAT promoted the viability of OGD/R-induced RGCs, decreased apoptosis, and reduced oxidative stress in vitro. Silencing MIAT increased retinal neuronal cell numbers and decreased retinal neuronal cell apoptosis in mouse RIRI tissues in vivo. MIAT sponged miR-203-3p, and miR-203-3p targeted and inhibited SNAI2 expression. SNAI2 up-regulation or miR-203-3p down-regulation reversed the protective effects of MIAT down-regulation on RIRI in mice and OGD/R-induced RGCs. MIAT sponges miR-203-3p upregulated the expression of SNAI2, thereby promoting RIRI in mice. In summary, MIAT may be a therapeutic target for the treatment of chronic RIRI.

Exosome-loaded degradable polymeric microcapsules for the treatment of vitreoretinal diseases.

The therapeutic benefits of many cell types involve paracrine mechanisms. Inspired by the paracrine functions of exosomes and the sustained degradation properties of microcapsules, here we report the therapeutic benefits of exosome-loaded degradable poly(lactic-co-glycolic acid) microcapsules with micrometric pores for the treatment of vitreoretinal diseases. On intravitreal injection in a mouse model of retinal ischaemia-reperfusion injury, microcapsules encapsulating mouse mesenchymal-stem-cell-derived exosomes settled in the inferior vitreous cavity, released exosomes for over one month as they underwent degradation and led to the restoration of retinal thickness to nearly that of the healthy retina. In mice and non-human primates with primed mycobacterial uveitis, intravitreally injected microcapsules loaded with exosomes from monkey regulatory T cells resulted in a substantial reduction in the levels of inflammatory cells. The exosome-encapsulating microcapsules, which can be lyophilised, may offer alternative treatment options for vitreoretinal diseases.

Phacophragmatomes and Integrated Phacoemulsification Features in Vitrectomy Devices

Posterior dislocation of lens fragments into the vitreous cavity is a rare complication of cataract surgery. As a result of this complication, vision-threatening sequelae such as permanent intraocular inflammation, secondary glaucoma, corneal edema, cystoid macular edema, and retinal detachment may occur. Therefore, judicious intraoperative and postoperative management should be used to reduce the risk of complications in the removal of dislocated lens fragments. Release of vitreous adhesions from the dislocated nucleus with pars plana vitrectomy (PPV), followed by removal of dislocated lens fragments using a phacophragmatome or vitrectomy probe is the most effective solution. This usually requires the cooperation of anterior and posterior segment surgeons

Forward Light Scattering of First to Third Generation Vitreous Body Replacement Hydrogels after Surgical Application Compared to Conventional Silicone Oils and Vitreous Body.

To treat certain vitreoretinal diseases, the vitreous body, a hydrogel composed of mostly collagen and hyaluronic acid, must be removed. After vitrectomy surgery, the vitreous cavity is filled with an endotamponade. Previously, pre-clinical hydrogel-based vitreous body substitutes either made from uncrosslinked monomers (1st generation), preformed crosslinked polymers (2nd generation), or in situ gelating polymers (3rd generation) have been developed. Forward light scattering is a measure of Stray light induced by optical media, when increased, causing visual disturbance and glare. During pinhole surgery, the hydrogels are injected into the vitreous cavity through a small 23G-cannula. The aim of this study was to assess if and to what extent forward light scattering is induced by vitreous body replacement hydrogels and if Stray light differs between different generations of vitreous body hydrogel replacements due to the different gelation mechanisms and fragmentation during injection. A modified C-Quant setup was used to objectively determine forward light scattering. In this study, we found that the 1st and 3rd generation vitreous body replacements show very low stray light levels even after injection (2.8 +/- 0.4 deg2/sr and 0.2 +/- 0.2 deg2/sr, respectively) as gel fragmentation and generation of interfaces is circumvented. The 2nd generation preformed hydrogels showed a permanent increase in stray light after injection that will most likely lead to symptoms such as glare when used in patients (11.9 +/- 0.9 deg2/sr). Stray light of the 2nd generation hydrogels was 3- and 2-fold increased compared to juvenile and aged vitreous bodies, respectively. In conclusion, this significant downside in the forward light scattering of the 2nd generation hydrogels should be kept in mind when developing vitreous body replacement strategies, as any source of stray light should be minimized in patients with retinal comorbidities.

Экспериментальное лечение эндофтальмита, вызванного синегнойной инфекцией с множественной лекарственной устойчивостью, с помощью конъюгатов на основе наночастиц

Relevance. Pseudomonas aeruginosa (PA) is an extremely dangerous microorganism whose elimination from the host organism is very difficult due to the presence of multidrug resistance (MDR) factors in PA. The outcome of endophthalmitis (EP) mediated by PA in 50% of cases will be evisceration of the eyeball, and more than 95% of patients receive visual acuity – hand movements near the face and below. In this regard, studies of quantum dots (QDs), which have shown high anti-infective activity in laboratory conditions, are of particular relevance. Purpose. Evaluation of the effectiveness of the treatment of EP caused by PA with MDR using QDs-based conjugates in the experiment. Material and methods. The object of the study was laboratory rabbits of the Chinchilla breed (n=27), male, aged from 3 to 3.5 months. As an EP inducer, all laboratory animals underwent intravitreal injection (IVI) of a multidrug-resistant PA strain in a volume of 0.05 ml in the right eye. QDs of the Ag (10%):InP/ZnS MPA type were taken as the basis for the creation of conjugates with antibiotics (AB). After the manifestation of EP, the animals underwent intravitreal injections (IVI) of dosage forms in accordance with the distribution into the following subgroups, 3 rabbits in each. Subgroups No. 1–3 – IVI 2.25 mg/0.1 ml Ceftazidime. Subgroups No. 4–6 – IVI 0.1 ml of QDs solution at concentrations of 10%, 0.1%, 0.01%, respectively. Subgroups No. 7–9 – IVI solution of QDs 0.05 ml (at concentrations of 10%, 0.1%, 0.01%, respectively) in combination with 2.25 mg/0.05 ml of Ceftazidime (conjugates). Efficacy was evaluated based on clinical parameters: the dynamics of hypopyon resorption, the presence of inflammatory cells in the anterior chamber, the dynamics of regression of pathological suspension in the vitreal cavity, the dynamics of pathological neovascularization of the iris, the dynamics of the cornea. Results. Rabbits from subgroups No. 1–3 (1st group) were characterized by the least dynamics in relation to the regression of symptoms during the 7-day observation period. Rabbits from subgroups No. 4–6 (2nd group) were characterized by moderate positive dynamics in relation to the regression of symptoms. Rabbits from subgroups No. 7–9 (3rd group) were characterized by the best positive dynamics in relation to the regression of symptoms. Conclusion. It was possible to prove the effectiveness of the treatment of experimental antibiotic-resistant EP caused by a strain of PA with MDR by means of QDs Ag(10%):InP/ZnS MPA at concentrations of 10%, 0.1% and 0.01%, especially in combination with 2.25 mg/0.05 ml of Ceftazidime in as a conjugate. Based on the results obtained, it can be assumed that active research and the use of QDs as conjugates with modern ABs can solve the overall problem of combating MDR strains. Key words: Pseudomonas Aeruginosa, quantum dots, endophthalmitis, multidrug resistance, antibiotic resistance, conjugates

Современные представления о склеральном пломбировании в лечении регматогенной отслойки сетчатки

Relevance. Rhegmatogenous retinal detachment (RRD) is a serious problem of modern ophthalmology, leading to an irreversible decrease in vision and, in extreme cases, to its loss. The prevalence of RRD according to various sources varies from 8.9 to 24.4 cases per 100,000 population, in most cases these are patients of working age – 84–89%. Purpose. To analyze the role of extrascleral buckling in treatment of rhegmatogenous retinal detachment. Material and methods. In the search for materials, open electronic databases Google and Google Scholar, PubMed, Embase, MEDLINE and Web of Science were used, 58 sources were analyzed up to 2023. Results. At the beginning of the 20th century, retinal detachment irreversibly led to blindness, but starting from the late 1920s, the first surgical techniques appeared that made it possible to successfully restore its anatomical position. Extrascleral buckling (ESP) became an established treatment for retinal detachment with a long-term success rate of 93%. The vast majority of rebleeds ultimately continued to occur due to missed tears, inaccurate buckling, or inadequate retinopexy. Much has changed since the development in 1971 by R. Machemer of a device for vitrectomy through the pars plana, as a result of which the surgical focus shifted towards the vitreal cavity. Conclusion. Scleral buckling still remains an effective surgical intervention in a certain group of patients with retinal detachment, including combined operations, and its undoubted advantage is the unpretentiousness of technical support. Key words: rhegmatogenous retinal detachment, extrascleral buckling, encircling, cryopexy, encircling tape length

Fluid Supplementation Through Weakened Zonules via Side-Port Incision to Maintain Intraocular Pressure in High Myopic Eyes.

During phacoemulsification, the infusion pressure can cause the liquefied vitreous fluid to escape through the ciliary fiber interspace in highly myopic eyes, leading to reduced vitreous cavity pressure similar to vitrectomized eyes. This study assessed the probability of low intraocular pressure (IOP) in high myopic eyes with different axial length (AL) group undergoing cataract surgery, as well as the impact of balanced salt solution (BSS) supplementation and the optimal IOP value for such supplementation. The control group consisted of cataract eyes with normal AL (group 1: 22mm ≤ AL < 24.5mm), while cataract eyes with high axial myopia were categorized into three groups (group 2: 26mm ≤ AL < 28mm, group 3: 28mm ≤ AL < 30mm, group 4: AL ≥ 30mm). IOP was measured using the iCare pro tonometer intraoperatively. BSS supplementation was performed to raise IOP in cases of low IOP, before intraocular lens (IOL) implantation and before the end of surgery. The probability of low IOP was calculated, and the IOP before and after supplementation were compared. Ninety-five eyes were included. The total probability of low IOP in groups 2, 3, and 4 was 56.52, 62.50, and 70.83%, respectively, significantly higher than that in group 1 (16.67%). Similarly, the probability of low IOP before IOL implantation was significantly higher in groups 2, 3, 4 (43.48, 41.67, and 62.50%) compared to group 1 (4.17%, P < 0.05). The IOP before and after the first BSS supplementation in three high myopia groups were statistically significant (P < 0.05), increasing from 12.10mmHg (range, 6.0-24.9mmHg) to 16.60mmHg (range, 10.2-34.4mmHg). After the second BSS supplementation before the end of surgery, the IOP of high myopia groups increased from 12.60mmHg (range, 7.0-25.3mmHg) to 14.60mmHg (range, 9.8-25.3mmHg). The condition of highly myopic eyes seems more likely to develop low IOP during cataract surgery. There is an observed correlation: as AL increases, the total probability of low IOP rises. In patients with IOP < 9.5mmHg intraoperatively, fluid supplementation via a side-port incision can effectively raise IOP to about 16mmHg before IOL implantation and about 14mmHg after incision sealing, facilitating smoother IOL implantation and reducing the risk of postoperative low IOP. NCT, NCT05201677. Registered 23 November 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05201677 .

Факторы, влияющие на эмульгирование силиконового масла в витреальной полости. Обзор литературы

In modern ophthalmic surgery, several types of silicone oils are used, which differ primarily in viscosity and molecular weight. Surgical treatment of severe proliferative vitreoretinopathy, severe forms of retinal detachment leads to the fact that the period of silicone oil in the vitreal cavity is delayed, and sometimes becomes lifelong. The main change that happens to silicone inside the eye is its emulsification, which creates one of the most serious problems in vitreoretinal surgery. Domestic and foreign literature sources were analyzed in this work and the main factors affecting the emulsification of silicone oil in the vitreal cavity were identified. the in vitro experiments conducted by different authors prove that such factors as the biological fluid inside the eye (blood, plasma, intraocular fluid), the severity of the inflammatory process inside the eye, tamponade term, age of patients, physical properties of silicone oil can be triggers in the development of emulsification. Emulsification of silicone oil does not occur in all cases of tamponade, which indicates that there are factors that prevent the development of emulsification, which is the subject of further study and addi Keywords: silicone, silicone oil, emulsification, secondary glaucoma

Novel Technique for 27-Gauge Forceps-Assisted Transscleral Refixation of the Dislocated CZ70BD Intraocular Lens.

To report a novel technique for refixation of the dislocated CZ70BD intraocular lens. Posterior vitrectomy is performed with a 23-gauge or 25-gauge pars plana vitrectomy system with chandelier illumination. One needle of a double-arm 9-0 prolene needle is passed through the sclera 1.5 mm postlimbus. The needle is retrieved through the corneal paracentesis using a 27-G needle, and the suture is then cut. The suture end is passed through the eyelet of the dislocated CZ70BD intraocular lens inside the vitreous cavity. This is aided with a pair of 27-G MaxGrip forceps, which is inserted through a 27-G sclerostomy site at the intended scleral outlet. After passing the suture through the eyelet, the suture is pulled out at the 27-G sclerostomy site and a knot is tied and rotated. Similar procedure is performed for the second haptic if necessary. Seven eyes were successfully operated on using this technique with a mean follow-up of 12.4 months. There was significant improvement in the best-corrected visual acuity after the operation ( P = 0.016). Postoperative intraocular lens centration and alignment were satisfactory. One patient developed macula-on retinal detachment 1 month after the operation, which was successfully repaired without loss in the best-corrected visual acuity. The described novel technique is effective for refixation of dislocated CZ70BD intraocular lens.

Анализ интраоперационных и ранних послеоперационных осложнений при факоэмульсификации катаракты

Relevance. Despite the high level of cataract surgery, in some cases complications arise that lead to a decrease in visual functions, an increase in the duration of inpatient treatment and additional economic costs. Analysis of the results of cataract phacoemulsification helps to increase the effectiveness of predicting complications and their prevention. Aim. Analysis of intraoperative and early postoperative complications in cataract surgery for 2021–2022, conducted on the basis of the 2nd ophthalmological department of the State Budgetary Institution “N.A. Semashko Regional Clinical Hospital” Ryazan, Russia. Material and methods. Retrospective analysis of 66 case histories of patients who had complications in the intra- and postoperative period of cataract surgery. Results. Intraoperative complications included: posterior capsule opening (22 cases), dislocation of lens masses into the vitreal cavity (10 cases), hemorrhagic ciliochoroidal detachment (4 cases), expulsive hemorrhage (2 cases), hyphema (2 cases). In the postoperative period, the following complications were detected: hyphema – 2, hemophthalmos-4, ciliochoroidal detachment – 5, dislocation of intraocular lens (IOL) – 5, retained lenticular material in the anterior chamber – 4, exudative reaction – 12, keratopathy – 6, pupillary block – 1, endophthalmitis – 1. Conclusion. The improvement of the phacoemulsification technique together with the preoperative preparation of patients with cataracts made it possible to achieve a low level of intra- and postoperative complications (1.16% in 2021 and 0.89% in 2022, respectively, of all operated patients with cataracts). However, after analyzing the nature of complications, we identified a number of patterns: among intraoperative complications, the most common is the opening of the posterior capsule of the lens (0,29%), among postoperative – an exudative reaction (0,16%). Keywords: сataract phacoemulsification, complications of cataract phacoemulsification, rupture of the posterior lens capsule, exudative inflammatory eye response, expulsive hemorrhage.

Observation of the Curative Effect of the Dexamethasone Vitreous Cavity Implant for the Treatment of Irvine-Gass Syndrome

ObjectiveTo investigate the clinical efficacy of dexamethasone vitreous cavity implants (Ozurdex) for the treatment of macular edema (Irvine-Gass Syndrome) after cataract surgery. MethodEight patients (eight eyes) with Irvine-Gass syndrome were enrolled for vitreous injections with Ozurdex. The patients included six men (six eyes) and two women (two eyes) with a mean age of 67.12 ± 11.92 years. Changes in the patients best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure were compared before and after treatment. ResultThe mean visual acuity BCVA of the patients was 0.81 ± 0.26 before implantation, which improved to 0.20 ± 0.12, 0.13 ± 0.09, and 0.15 ± 0.13 at 2 weeks, 1 month, and 3 months after implantation, respectively (P < 0.001). The patient’s mean CMT before implantation was 703.00 ± 148.88 μm, and it reduced to 258.87 ± 37.40 μm, 236.25 ± 28.74 μm, and 278.00 ± 76.82 μm at 2 weeks, 1 month, and 3 months after implantation, respectively (P < 0.001). ConclusionThe dexamethasone vitreous cavity implant (Ozurdex) is a safe and effective treatment, which can effectively improve patient’s visual acuity and reduce macular edema associated with cataract surgery.

Поздний синдром капсульного блока с гиперметропическим сдвигом. Клинический случай

Capsular block syndrome (CBS) is one of complications of modern cataract surgery technique, due to restriction of fluid passage from the capsular bag, which in different terms of postoperative period of cataract phacoemulsification may lead to reduction of both anatomical and functional results of surgery. The treatment of choice of the capsular block syndrome, especially during early postoperative period, is YAG laser dissection of the posterior capsule, which in most cases allows restoring transparency and refraction. In cases like lactocrumenasia (a variant of late CBS) it is not always possible to visualize the posterior capsule and evacuate the contents, therefore, the treatment of choice can be surgical dissection and aspiration of the contents. However, according to the literature, there is a possibility of infection of isolated capsule contents which obliges to correctly and carefully determine the surgical tactics in such cases. This article presents a rare case of late postoperative capsular block syndrome with hyperopic shift in a patient with proliferative diabetic retinopathy and silicone tamponade of the vitreous cavity. Key words: capsular block syndrome; hyperopic shift; cataract phacoemulsification.

Отдаленные результаты хирургического лечения сквозных макулярных разрывов без тампонады витреальной полости

Purpose. To evaluate the long-term results of surgical treatment of full-thickness macular holes without vitreous cavity tamponade. Methods. The analysis of surgical treatment of 64 patients (64 eyes) with full-thickness macular holes of large diameter was carried out. Tamponade of the vitreal cavity at the end of the operation was not performed. Results. In all cases surgical treatment provided a positive anatomical, morphological and functional result. Conclusions. The study demonstrated the possibility of surgical treatment of of full-thickness macular holes without vitreous cavity tamponade. Key words: macular hole, platelet-rich plasma.

Combined Use of Anti-VEGF Drugs Before and During Pars Plana Vitrectomy for Severe Proliferative Diabetic Retinopathy.

This study aimed to evaluate the combined administration of anti-vascular endothelial growth factor (anti-VEGF) drugs before and during pars plana vitrectomy (PPV) and to explore its efficacy and safety in the treatment of patients with severe proliferative diabetic retinopathy (PDR). This retrospective case series included consecutive patients who underwent PPV. Patients were categorized into two groups: the preoperative group was injected with anti-VEGF drugs before PPV, and the combination group was injected with anti-VEGF drugs before and during PPV. Preoperative, intraoperative, and postoperative clinical data were collected for analysis. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) and occurrence of postoperative vitreous cavity haemorrhage (POVCH). In total, 63 eyes of 60 patients with severe PDR were analysed. The operative duration and occurrence of intraoperative haemorrhage, iatrogenic retinal breaks, and silicone oil tamponade were similar between the two groups. The benefits on BCVA, and CRT after 1week postoperatively, were more obvious in the combination group (P < 0.01). Combination therapy had the potential to reduce the incidence of POVCH. No ocular or systemic adverse events occurred in either group. The combined use of anti-VEGF drugs before and during PPV in patients with severe PDR not only includes the advantages of preoperative injection, but also has more significant prognostic benefits and favourable safety profiles.

Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports.

Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).

Surgical treatment of idiopathic macular holes with a fovea-sparing technique and 20% SF6 gas tamponade

Purpose: To assess the macular hole (MH) closure rate and final visual acuity after idiopathic MH treatment with a modified fovea-sparing technique and 20% SF6 gas tamponade. Material and Methods: Fifteen patients (16 eyes; 12 women and 3 men; mean age (standard deviation or SD), 65.5 (5.90 years)) with Gass stage 2 to stage 4 MHs were involved in the study. Before surgery, mean best-corrected visual acuity (BCVA) (SD) was 0.15 (0.09), and mean MH diameter (SD), 437.2 (164.7) µm. Patients underwent surgical treatment with the modified fovea-sparing technique and 20% SF6 gas tamponade of two-week duration and were instructed to maintain a face-down position for a week after surgery. Results: At 1 month after the first surgery, MHs were closed in 11/16 eyes (68.75%). In addition, mean BCVA (SD) in eyes with closed MHs improved significantly from 0.15 (0.09) to 0.48 (0.16) (р = 0.000000). Of the five eyes in which the MH had failed to close after primary fovea-sparing surgery, two received a gas fluid exchange gas tamponade with 15% С3F8, and these patients were advised to maintain a face down position for 3 more weeks. In addition, in another two eyes, the vitreous cavity was revised, and the internal limiting membrane (ILM) was removed by a conventional technique with 15% С3F8 gas tamponade. Moreover, one patient rejected repeat intervention. In the four eyes in which the MH had failed to close after primary fovea-sparing surgery, after a repeat intervention, the MH was closed, and mean BCVA (SD) improved to 0.35 (0.04). There was no significant difference between the eyes in which the MH failed to close and the eyes in which the MH did close after primary surgery in terms of mean MH size (SD) (455 (203) µm versus 415 (155) µm, р = 0.66) or MH duration. Conclusion: A long gas tamponade (longer than 1 week) is required to improve the closure rate with the fovea-sparing ILM peeling technique for idiopathic MHs.