Vitreous Opacities Research Articles

Hereditary vitreoretinal amyloidosis with transthyretin Gly83Arg variant, a long-term study.

This study evaluated the clinical data on ophthalmic follow-up and treatment efficacy of hereditary vitreoretinal amyloidosis kindred due to transthyretin Gly83Arg variant over a 15-year follow-up period. The clinical data of patients with hereditary ATTRG83R amyloidosis from 2006 to 2021 were analysed retrospectively. Sanger sequencing of the transthyretin gene, detailed medical history, pedigree charting, and systemic and ophthalmic examinations were carried out in all patients. The changes of best-corrected visual acuity (BCVA) after vitrectomy and the associations of amyloidosis recurrence and post-vitrectomy glaucoma were analysed. Fourteen patients with ATTRG83R were included, all experiencing vision loss due to vitreous opacities. The average age of onset was 40.93 ± 6.96 (29 to 52) years. The preoperative BCVA was 2.20 ± 0.69 logMAR, whereas the postoperative BCVA improved to 0.13 ± 0.35 logMAR (P < 0.05). The recurrence time was 58.83 ± 20.85 months after vitrectomy. At 90 months after vitrectomy, the cumulative recurrence rate was 94.7%. Eight eyes developed glaucoma after vitrectomy. None of the 5 eyes without vitrectomy developed glaucoma. Paired chi-square test showed a significant difference in the incidence rate of glaucoma between eyes with or without vitrectomy (P < 0.05). However, retinal amyloid angiopathy and cataract surgery were not associated with glaucoma (P > 0.05). Poor intraocular pressure control in 7 eyes resulted in severe visual impairment. Hereditary ATTRG83R amyloidosis predominantly manifests as vitreous opacity, and vitrectomy can improve the visual acuity in affected patients. However, the recurrence of amyloidosis and related complications significantly impact long-term visual outcomes. Thus, delaying vitrectomy appropriately and maintaining regular follow-up visits is advisable.

Punctate hyperreflective vitreous opacities: a ubiquitous finding in healthy children beyond infancy.

The vitreous evolves from birth over lifetime. Little is known about the appearance of the healthy vitreous during childhood. We aimed to characterise posterior vitreous features in healthy children using spectral domain optical coherence tomography (SD-OCT). Retrospective cohort study including healthy eyes of 78 children aged 2-12 years and 39 healthy adults. Patients diagnosed with intraocular inflammation or vitreoretinal pathology were excluded. Proportion of eyes with presence of punctate hyperreflective vitreous opacities (PHVO). Percentage of B-scans demonstrating PHVO within an OCT volume scan, correlation between presence of PHVO and patients' age group, retinal measurements, and presence of premacular bursa were analysed. 154 paediatric eyes (median age 9.08 (IQR 5.17-9.75) years) and 76 adult eyes (30.75 (IQR 26.42-38.08) years) were included; 12244 OCT images were reviewed. All eyes (100%) in the paediatric group and 73% in the adult group presented PHVO. The median percentage of OCT images showing PHVO was 77.05% (IQR 51.23-88.52) in children and 8.0% (IQR 0-16.03) in adults (p < 0.001). Separate analysis of right and left eyes confirmed the results (p < 0001). Premacular bursa appeared in 20.5% of paediatric and 31.6% of adult eyes (p = 0.103). Mean central subfield thickness was significantly lower in children (257 ± 21 µm vs. 276 ± 18 µm, p < 0.001), while median total macular volume was similar (8.59 (IQR 8.25-8.86) mm3 vs. 8.62 (IQR 8.39-8.96) mm3, p = 0.145). This study demonstrates that PHVO are ubiquitous physiologic vitreous findings in healthy children beyond infancy. These findings enhance the understanding of the development of the posterior segment of the eye and might improve paediatric OCT interpretation, potentially avoiding misdiagnoses and unnecessary interventions in children.

Application of Artificial Intelligence in the Diagnosis, Follow-Up and Prediction of Treatment of Ophthalmic Diseases.

To describe the application of artificial intelligence (AI) in ophthalmic diseases and its possible future directions. A retrospective review of the literature from PubMed, Web of Science, and Embase databases (2019-2024). AI assists in cataract diagnosis, classification, preoperative lens calculation, surgical risk, postoperative vision prediction, and follow-up. For glaucoma, AI enhances early diagnosis, progression prediction, and surgical risk assessment. It detects diabetic retinopathy early and predicts treatment effects for diabetic macular edema. AI analyzes fundus images for age-related macular degeneration (AMD) diagnosis and risk prediction. Additionally, AI quantifies and grades vitreous opacities in uveitis. For retinopathy of prematurity, AI facilitates disease classification, predicting disease occurrence and severity. Recently, AI also predicts systemic diseases by analyzing fundus vascular changes. AI has been extensively used in diagnosing, following up, and predicting treatment outcomes for common blinding eye diseases. In addition, it also has a unique role in the prediction of systemic diseases.

Exogenous Methicillin-Resistant Staphylococcus aureus Endophthalmitis is Caused by Multidrug-Resistant Lineages that are Associated with Poor Outcomes

ABSTRACT Purpose To investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) endophthalmitis and correlate it with the presenting clinical features and outcomes. Methods Nine patients presenting with MRSA endophthalmitis from 2014 to 2022 were included. Phenotypic and genomic tests were used for strain characterization. Demographics, clinical presentation, treatment and outcomes were reviewed. Results The MRSA population was dominated by multidrug-resistant (MDR) strains within the clonal complex 5 (CC5) carrying an SCCmec type II genetic element (USA100-like strains). These strains carried genes that confer resistance to five antibiotic classes, in addition to mutations in topoisomerase genes (gyrA and parC) that resulted in resistance to all fluoroquinolones tested. Patients were mostly male (56%), with a median age of 82.7 years, and most had no recent history of extensive healthcare exposure. All cases were exogenous following ocular surgery (67%) or intravitreal injection (33%). The main exam findings were visual acuity ≤ hand motion, hypopyon (89%), and vitreous opacity (89%). Five patients (56%) showed improvement in visual acuity at 1 month following presentation, three (33%) at 3 months, and two (22%) at 6 months. Complications included evisceration (n = 1) and phthisis (n = 1). Patients who had pars plana vitrectomy within 48 hours of presentation had better clinical outcomes compared to those who did not. Conclusion Exogenous MRSA endophthalmitis is caused by MDR strains that resemble the hospital-acquired lineage USA100. These strains cause severe endophthalmitis in patients with no recent hospital/healthcare exposure.

Symptomatic Vitreous Opacities: Exploring the Mismatch between Clinical Observation of Vitreous Alterations and Self-Reported Symptoms

Objectives: To assess the mismatch between the clinical observation of vitreous alterations and self-reported symptoms in young patients complaining of symptomatic vitreous opacities (SVO). Methods: The ophthalmic medical records of young patients presenting primarily with SVO were retrospectively evaluated. Symptoms severity was assessed using a questionnaire. The status of the vitreous body was examined with indirect ophthalmoscopy at the slit-lamp and classified according to an ad hoc severity scale. Results: Sixty eyes of thirty otherwise healthy patients (median age: 32.5 (IQR: 29.0–37.0) years old) complaining of SVO (median duration: 38 months; interquartile range: 18–84 months) were enrolled. SVO was rated as severe by 50% of participants, affecting all the activities explored in the questionnaire. Twenty-three patients (76.6%) reported SVO-related depression and/or anxiety, for which eleven patients (36.6%) were or had been using medication. Fifty-eight eyes (96.6%) showed no evidence of (or minimal) vitreous opacity, while two eyes (3.3%) were found to have significant vitreous opacity. No significant inter-gender differences (p &gt; 0.05) and no significant differences (p &gt; 0.05) were found between the severity of vitreous opacity and patients’ reported symptoms nor with their psychological status and medication use. Conclusions: Severe discomfort related to the perception of vitreous floaters exists in young patients whose vitreous gel examination is unremarkable or shows only minor alterations. We believe this discrepancy can be explained by optical anisotropy; significant forward-scattering of light, which results in floater symptoms; and reduced back reflection, which limits the clinical observation.

A chronic myeloid leukemia presenting as panuveitis combined with retinal and choroidal vascular occlusion: a case report

BackgroundChronic myeloid leukemia (CML) can manifest ocular complications stemming from hematologic irregularities or direct infiltration of neoplastic cells. This article details the case of a patient with newly diagnosed CML exhibiting elevated platelet counts (PLT) who developed panuveitis accompanied by retinal vascular occlusion.Case presentationA 52-year-old woman experienced a notable decline in vision in her left eye over a 2-week period. Classical anterior uveitis, vitreous cavity opacity, optic nerve edema, and retinal vascular obstruction were observed. The right eye exhibited papilledema and retinal vein tortuosity. Despite admission, the condition of both eyes deteriorated, accompanied by a continuous increase in PLT. She was diagnosed with CML based on bone marrow biopsy and chromosomal examination. Following platelet apheresis therapy and chemotherapy, the condition of her right eye significantly improved, but the left eye’s condition remained irreversible.ConclusionsThis is a rare case of newly diagnosed CML presenting with diverse ocular manifestations in both eyes. The disparate outcomes in eyes with varying lesion stages underscore the importance of prompt diagnosis.

Differential intestinal microbes and metabolites between Behcet's uveitis and Fuchs syndrome

ObjectiveBehcet's uveitis (BU) is a type of uveitis with a high rate of blindness, characterized by anterior segment inflammation, vitreous opacity, and retinal vasculitis. Its pathogenesis is still unclear. Fuchs syndrome (Fuchs) is another common type of uveitis, which clinically presents with anterior segment inflammation and vitreous opacity, but rarely causes blindness. This study aims to compare the gut microbiota and metabolites of two different types of uveitis to clarify whether the differences in clinical manifestations are relevant to the alterations in gut microbiota. MethodsFaecal samples were collected from new-onset BU (n = 11) patients without systemic treatment and other diseases. 16S rRNA and liquid chromatography-tandem mass spectrometry (LC-MS/MS) were performed to analyze gut microbes and metabolites. Fuchs (n = 15) was used as the disease control, and healthy controls (n = 18) without autoimmune diseases and systemic medication were included. ResultsMicrobial composition and metabolite profiles differed significantly among the three groups. Compared to controls, Fusicatenibacter and eight metabolites were specifically altered in BU patients, and Pantoea and five metabolites in Fuchs. Pathways involving delta-tocopherol, palmitic acid, and serotonin are significantly disrupted in BU patients. Pathways involving linoleic acid are dysregulated considerably in Fuchs. Microbial markers consisting of 4 genera and 7 metabolites can respectively distinguish BU patients from controls. AUC values of metabolite markers were greater than those of microbial markers. Furthermore, serum zonulin levels were significantly elevated in both types of uveitis, with no difference between them. Correlation analysis revealed correlations between zonulin levels and multiple microbes. ConclusionsPatients with BU and Fuchs syndrome showed significant differences in gut microbiota and metabolites. Disruption of the intestinal mucosal barrier was observed in both types of uveitis. However, the mechanism of different intestinal microbiota causing different clinical manifestations needs to be studied in the future.

Sexual transmission of HTLV-1 resulting in uveitis with short-term latency and low proviral load.

Human T-cell Lymphotropic Virus Type 1 (HTLV-1) is traditionally linked to severe conditions such as adult T-cell leukemia/lymphoma, HTLV-1-associated myelopathy, and HTLV-1 uveitis, with vertical transmission, particularly mother to child thorough breastfeeding, considered the primary route. Despite efforts to reduce vertical transmission through antenatal screening in Japan, horizontal transmission has contributed to the rising prevalence of HTLV-1 in metropolitan areas. This case reports the youngest documented instance of HTLV-1 uveitis resulting from horizontal transmission through sexual contact in an 18-year-old woman. The patient presented with blurred vision in her right eye, and a comprehensive ophthalmologic examination identified vitreous opacity and retinal vasculitis. Serological tests confirmed HTLV-1 infection, with a proviral load of 2.66 copies per 100 peripheral blood mononuclear cells, measured by real-time PCR. A differential diagnosis confirmed HTLV-1 uveitis. Further family and partner investigations confirmed horizontal transmission, most likely through sexual contact. Over 6 years of follow-up, the patient experienced multiple recurrences of HTLV-1 uveitis and developed HTLV-1-associated keratopathy. This case highlights the potential for rapid disease progression with relatively low proviral loads and short latency, emphasizing the need for updated public health strategies for sexually active young populations.

The Gly103Arg variant in hereditary transthyretin amyloidosis.

Hereditary transthyretin amyloidosis (ATTRv) is an autosomal dominant inherited systematic disease primarily affecting the peripheral and autonomic nervous system, heart, eyes and kidney. Over 140 variants have been identified worldwide, with the Gly103Arg variant reported exclusively in China. This variant is characterized by early onset eye manifestations, making accurate and timely diagnosis difficult. Therefore, we conducted a case study and literature review to investigate the clinical characteristics of the Gly103Arg variant in hereditary transthyretin amyloidosis. We identified three patients and an asymptomatic carrier in a four-generation family by sequencing the TTR gene. The proband underwent a lumbar puncture, electromyography, abdominal fat biopsy, among other tests. Case reports of Gly103Arg variant were retrieved through a literature search for an analysis of clinical characteristics. The study included clinical data of 44 patients. Our literature review collected data on 41 patients and the present report supplied 3 patients with the Gly103Arg variant. The mean age at onset was 39.1 ± 4.27 years (range 30-47 years) with a female ratio of 52.3%. All cases were reported in China, predominantly in southern regions, especially Yunan and Guizhou Provinces. The initial manifestation was blurred vision, except for one case presenting with numbness in the upper extremities. All of them had vitreous opacity; 17 cases had peripheral neuropathy,6 cases had autonomic neuropathy, and 3 cases had cardiopathy. No disease-related deaths have been reported to date. The Gly103Arg variant is unique to the Chinese population, frequently occurring in southern China. The main clinical manifestations are blurred vision, vitreous opacity, and neuropathy, with cardiopathy being rare. ATTRv should be considered if a patient diagnosed with CIDP does not respond to related therapy. Abdominal fat biopsy is a convenient and accurate diagnostic method.

A Case of Fulminant Serratia marcescens Panophthalmitis After Penetrating Keratoplasty

Purpose: To report the first case of fulminant Serratia marcescens panophthalmitis after penetrating keratoplasty (PK). Methods: This is a report of a patient who developed fulminant panophthalmitis shortly after undergoing PK with anterior chamber intraocular lens placement. Slit-lamp examination, B-scan ultrasound (B scan), and orbital computed tomography of the left eye (OS) were performed to further evaluate the patient. Tissue culture and histopathologic examination of the corneal specimen were completed to confirm the diagnosis. Results: A 78-year-old pseudophakic woman presented with 2 days of increasing pain, swelling, and purulent discharge after uneventful PK and secondary anterior chamber intraocular lens placement OS. Examination was notable for light perception without projection, elevated intraocular pressure of 48 mmHg, and a perforated corneal ulcer. B scan demonstrated diffuse vitreous opacities and membranes. Orbital computed tomography demonstrated proptosis and high-attenuation material within the left globe. Canthotomy, vitreous sampling, and antibiotic injections were performed. Corneal tissue cultures grew S. marcescens. Therapeutic PK was performed, but after rapid decompensation, the eye was eviscerated. Conclusions: This is the only reported case of fulminant S. marcescens panophthalmitis after PK. S. marcescens panophthalmitis is an aggressive and rapidly progressive infection with poor visual outcomes despite appropriate intravitreal and systemic antibiotic therapy.

Pars-plana vitrectomy for the treatment of vitreous amyloid in patients with hereditary transthyretin amyloidosis.

To describe a series of patients with hereditary transthyretin amyloidosis (ATTRv) with vitreous amyloid and to study the efficacy and safety of pars plana vitrectomy (PPV) for its treatment. Retrospective study of 266 patients with ATTRv due to Val30Met mutation submitted to PPV for vitreous amyloid, with a minimum 3-month follow-up. Indications for surgery were disabling myodesopsia or 2 lines loss in visual acuity. Only the first operated eye was considered for analysis. Male patients were operated at younger age (51.0 vs 53.6, p<0.001). Best-corrected visual acuity improved from 0.38 to 0.89 (decimal scale, p<0.001). Preoperative glaucoma was associated with lower gain in visual acuity (p<0.001). During the follow-up, 69%, 22% and 1% developed new onset glaucoma, retinal angiopathy or retinal detachment, respectively, and 36% required cataract surgery. PPV was also required in the fellow eye in 57%. ATTRv-related death occurred in 27%, 9.3 95%CI 8.0-10.7 years after PPV. Vitreous opacities are frequently the first symptomatic manifestation of ocular amyloidosis. Moreover, they may be a marker of mortality. Vitrectomy is a safe and effective treatment, but these patients require long-term follow-up to monitor the development or worsening of glaucoma or retinal angiopathy.

Isolated posterior capsule rupture secondary to blunt ocular trauma: Case presentation and literature review

IntroductionAn isolated posterior capsule rupture (PCR) is a rare complication associated with traumatic cataracts. We report our findings in three cases of traumatic cataracts with isolated PCR caused by blunt ocular trauma. Presentation of casesCase 1: A 1.5-year-old boy was examined after his parents noticed that the center of the pupil of the left eye was white. The mother reported that the boy had fallen and bruised his left forehead 4 months earlier. Case 2: An 18-year-old boy had a traumatic cataract that developed one month after a blow to his eye. Case 3: A 13-year-old boy was treated for hyphema and high intraocular pressure after blunt trauma to his eye. Ten days later, a total cataract developed. Anterior segment optical coherence tomography revealed an isolated PCR with a protruding lens cortex, and ultrasonography showed vitreous opacities. DiscussionAn isolated PCR was observed intraoperatively in the center of the posterior lens capsule. The lens cortex was prolapsed into the PCR or into the vitreous cavity in Case 3. An intraocular lens (IOL) was implanted in the lens capsule or to the ciliary sulcus after vitrectomy in Case 3. Vision improved in all eyes. ConclusionsOur findings indicated that the external force by a trauma to the eye can lead to an isolated PCR with a protruded lens cortex in young patients. These PCRs can be successfully treated with the IOL implanted in or out of the capsular bag.

Secondary silicone-induced glaucoma after vitrectomy for regmatogenic retinal detachment

BACKGROUND: Retinal detachment is a leading cause of impaired vision and blindness, affecting 2–9% of individuals. Research has shown that local immune-inflammatory processes contribute significantly to the development of this condition. Polymethylsiloxane has long been used as a tamponade substance in the treatment of retinal detachment. It is currently utilized in various forms of retinal detachment as well as in the management of complications such as retinal edge folding and vitreous opacity. However, the use of silicone oil in the vitreous cavity can lead to the development of secondary ocular hypertension and glaucoma, with prevalence rates ranging from 2.2% to 64.2% according to studies. AIM: Conduct a comparative analysis of biochemical and morphometric indicators and justify the expediency of conducting immune therapy for patients with secondary silicone-induced glaucoma. METHODS: A prospective study included 22 patients (22 eyes) in the main group and 22 patients in the comparison group (22 eyes). The average age of the patients was 55±5.3 years (46–68 years), with 28 females and 16 males. Patients in the main group received anti-cytokine therapy (aminopropyldithioethylene-diamine sodium and anakinra). The primary endpoint of the study was the assessment of retinal nerve fiber layer thickness and perimetric indices. RESULTS: The results revealed an inverse relationship between cytokine levels and retinal nerve fiber layer thickness in patients who underwent vitrectomy with silicone tamponade. Additionally, a direct relationship was observed between the diameter of emulsified silicone in the anterior chamber and cytokine levels. The impact of mechanical fragmentation of polymethylsiloxane during nystagmus and direct toxic effects on optic nerve fibers requires further investigation. The study also highlighted the need for more accurate methods of selecting anterior chamber fluid for evaluating the effectiveness of immune therapy. Determining the appropriate dosage, duration, and administration method of anti-cytokine drugs also requires further research. Evaluation of ophthalmotonometric indicators, retinal nerve fiber layer thickness, and mean deviation revealed significantly better outcomes in patients receiving anti-cytokine therapy compared to the control group. CONCLUSION: The findings of this study support the use of anti-cytokine therapy to normalize biochemical parameters in the anterior chamber and reduce clinical manifestations of secondary silicone-induced glaucoma.

A novel case of endophthalmitis secondary to Paenibacillus yonginensis after intravitreal injection of aflibercept.

To report a case of endophthalmitis after intravitreal injection due to Paenibacillus yonginensis. This is a retrospective case report. An 87-year-old man with longstanding neovascular age-related macular degeneration (AMD) in his left eye presented with pain and loss of vision three days after intravitreal injection of aflibercept. Examination revealed a hypopyon and vitreous opacities. A diagnostic anterior chamber paracentesis and intravitreal injections of vancomycin and ceftazidime were performed. One month later, vitrectomy was performed for non-clearing vitreous opacities with a good final visual outcome. The causative bacterium, Paenibacillus yonginensis, was identified with polymerase chain reaction (PCR) sequencing from the aqueous specimen. We encountered a rare presentation of endophthalmitis caused by Paenibacillus yonginensis. Paenibacillus species have been implicated in human infection in recent years. DNA sequencing can allow for the identification of uncommon bacteria.

Evaluation of the Ocular Safety of Hollow Mesoporous Organosilica Nanoparticles with Different Tetrasulfur Bond Content.

Drug therapy for eye diseases has been limited by multiple protective mechanisms of the eye, which can be improved using well-designed drug delivery systems. Mesoporous silica nanoparticles (MSNs) had been used in many studies as carriers of therapeutic agents for ocular diseases treatment. However, no studies have focused on ocular biosafety. Considering that MSNs containing tetrasulfur bonds have unique advantages and have drawn increasing attention in drug delivery systems, it is necessary to explore the ocular biosafety of tetrasulfur bonds before their widespread application as ophthalmic drug carriers. In this study, hollow mesoporous silica nanoparticles (HMSNs) with different tetrasulfur bond contents were prepared and characterized. The ocular biosafety of HMSN-E was evaluated in vitro on the three selected ocular cell lines, including corneal epithelial cells, lens epithelial cells and retinal endothelial cells (HREC), and in vivo by using topical eye drops and intravitreal injections. In cellular experiments, HMSNs caused obvious S content-dependent cytotoxic effect. HMSNs with the highest tetrasulfur bond content (HMSN-E), showed the highest cytotoxicity among all the HMSNs, and HREC was the most vulnerable cell to HMSN-E. It was shown that HMSN-E could react with intracellular GSH to generate H2S and decrease intracellular GSH concentration. Treatment of HREC with HMSN-E increased intracellular ROS, decreased mitochondrial membrane potential, and induced cell cycle arrest at the G1/S checkpoint, finally caused apoptosis and necrosis of HREC. Topical eye drops of HMSN-E could cause corneal damage. The intravitreal injection of HMSN-E could induce inflammation in the vitreum and ganglion cell layers, resulting in vitreous opacities and retinal abnormalities. The incorporation of tetrasulfur bonds into HMSN can have toxic effects on ocular tissues. Therefore, when mesoporous silica nanocarriers are designed for ophthalmic pharmaceuticals, the ocular toxicity of the tetrasulfur bonds should be considered.

Surgical Treatment of Cataracts Complicated by Chronic Uveitis. Literature Review

The problem of surgical treatment of cataracts in patients with chronic uveitis is relevant due to a high proportion of intra­ and postoperative complications, despite the development of modern microinvasive technologies. Associated complications of chronic uveitis (adhesions in the anterior eye segment, secondary glaucoma, vitreous opacities, cystoid macular edema, etc.), difficulties in intraocular lens implantation, the need for pharmacological support and subsequent rehabilitation of patients complicate surgery, while many issues remain controversial. Late patients’ recourse for medical aid, severity and duration of the inflammatory process contribute to irreversible changes in the retina, which results in poor functional results of surgery. The development of surgical technologies minimizing the risk of intra­ and postoperative complications is relevant today.

Prospects and limitations of cumate-inducible lentivirus as a tool for investigating VEGF-A-mediated pathology in diabetic retinopathy

Diabetic retinopathy (DR) is a multifactorial disease displaying vascular-associated pathologies, including vascular leakage and neovascularization, ultimately leading to visual impairment. However, animal models accurately reflecting these pathologies are lacking. Vascular endothelial growth factor A (VEGF-A) is an important factor in the development of micro- and macro-vascular pathology in DR. In this study, we evaluated the feasibility of using a cumate-inducible lentivirus (LV) mediated expression of vegf-a to understand DR pathology in vitro and in vivo. Retinal pigment epithelial cells (ARPE-19) were transduced with cumate-inducible LV expressing vegf-a, with subsequent analysis of vegf-a expression and its impact on cell proliferation, viability, motility, and permeability. Cumate tolerability in adult Wistar rat eyes was assessed as an initial step towards a potential DR animal model development, by administering cumate via intravitreal injections (IVT) and evaluating consequent effects by spectral domain optical coherence tomography (SD-OCT), flash electroretinography (fERG), ophthalmic examination (OE), and immunohistochemistry. Transduction of ARPE-19 cells with cumate-inducible LV resulted in ~ 2.5-fold increase in vegf-a mRNA and ~ threefold increase in VEGF-A protein secretion. Transduced cells displayed enhanced cell proliferation, viability, permeability, and migration in tube-like structures. However, IVT cumate injections led to apparent retinal toxicity, manifesting as retinal layer abnormalities, haemorrhage, vitreous opacities, and significant reductions in a- and b-wave amplitudes, along with increased microglial activation and reactive gliosis. In summary, while cumate-inducible LV-mediated vegf-a expression is valuable for in vitro mechanistic studies in cellular drug discovery, its use is not a feasible approach to model DR in in vivo studies due to cumate-induced retinal toxicity.

A Single-Center Case Series of Acute Retinal Necrosis at Teikyo University: Clinical Characteristics and Treatment Outcomes.

Aim To evaluate the clinical characteristics, treatment course, and prognosis of patients with acute retinal necrosis (ARN), which can rapidly progress and cause severe vision loss. Design Single-center retrospective case series. Subjects and methods Six patients and seven eyes diagnosed with ARN at Teikyo University Hospital were included in this study. The clinical presentation and treatment prognosis were investigated based on data obtained from medical records. Results The mean age of the patients at the initial diagnosis was 63.6 years. Although the mean Logarithm of the Minimum Angle of Resolution (LogMAR) visual acuity tended to decrease from 0.77 at the first visit to 1.29 at the last visit, the difference was not statistically significant. Intraocular manifestations observed during the study period included ocular hypertension (14.3%), anterior uveitis (100.0%), retinal hemorrhage (71.4%), vitreous opacity (100.0%), retinal exudative vasculitis (85.7%), optic nerve atrophy (85.7%), retinal vascular occlusion (85.7%), choroidal atrophy (85.7%), macular edema (100.0%), subretinal fluid in the macula (71.4%), and retinal detachment (85.7%). Treatment modalities included oral and intravitreal antivirals (85.7%), antiplatelet medications (85.7%), steroid eye drops (85.7%), subcapsular (57.1%) and vitreous (42.9%) steroid injections, oral steroids (71.4%), and surgical intervention (85.7%). Vitrectomy led to retinal recovery in all five eyes that underwent the procedure. Conclusions The visual prognosis of patients with ARN is poor, particularly in those with preexisting visual impairment. Early detection coupled with antiviral therapy and prompt surgical intervention have been identified as potential factors that influence visual outcomes. Given the severity of ARN, collecting data from multiple centers could aid in devising future diagnostic and therapeutic strategies.

Case of acute retinal necrosis with rapid progression to proliferative vitreoretinopathy: A case report.

Acute retinal necrosis (ARN) was first reported in 1971 by Urayama et al as an acute uveitis accompanied by retinal arteritis and white retinal lesions in the peripheral retina that can progress to a rhegmatogenous retinal detachment (RRD). We have experienced a case of ARN that, unlike the common developmental course to an RRD associated with ARN, progressed to proliferative vitreoretinopathy (PVR) involving the entire retina in 2 days. The purpose of this report is to present our findings in the case of ARN with an atypical rapid time course. The patient was a 56-year-old woman who was treated for uveitis of unknown origin by her primary care physician. She was referred to our hospital because of a worsening of the fundus findings. Fundus examination in our hospital revealed vitreous opacities in the right eye, yellowish-white lesions extending around the retina, and some retinal hemorrhages. Because the retinal changes suggested ARN, we performed a polymerase chain reaction of the anterior atrial fluid and detected varicella-zoster virus. Then, the diagnosis of ARN was confirmed, and treatment was begun. At 1 month and a half after beginning the treatment, focal retinal traction was observed in the right fundus. Two days later, a circumferential PVR and a total retinal detachment were detected. We then performed vitrectomy with an encircling buckle and a silicone oil tamponade. Our examination 6 months postoperatively showed that the retina was attached and the BCVA was 20/200. Our findings of a case of ARN showed that the progression from a local vitreous traction to a full circumferential PVR can develop in 2 days.

Clinical features, management, and outcomes of patients with sterile endophthalmitis associated with intravitreal bevacizumab injection: retrospective case series.

To evaluate clinical features, treatment protocol, outcomes, and complications that developed in this case series of 24 patients who had consecutive sterile endophthalmitis after intravitreal bevacizumab (IVB) injection. In this retrospective case series, IVB was repackaged in individual aliquots from the three batches that were used on the same day. IVB was injected into 26 eyes of 26 patients due to diabetic macular edema, age-related macular degeneration, and branch retinal vein occlusion. All patients had intraocular inflammation. Patients were divided into two groups severe and moderate inflammation according to the intraocular inflammation. The medical records of all patients were reviewed. At each follow-up visit, the complete ophthalmologic examination was performed, including best corrected visual acuity (BCVA), intraocular pressure, biomicroscopy, and posterior fundus examination. Twenty-four of 26 patients were included in the study. Two patients were excluded from this study since they didn't come to follow-up visits. The mean BCVA was 1.00 ± 0.52 Log MAR units before IVB. At the final visit, the BCVA was 1.04 ± 0.47 Log MAR units. These differences were not significant (p = 0.58). Of the 24 eyes, 16 eyes had severe, and 8 eyes had moderate intraocular inflammation. Eleven eyes in the severe inflammation group underwent pars plana vitrectomy due to intense vitreous opacity. Smear, culture results, and polymerase chain reaction results were negative. Sterile endophthalmitis may occur after IVB injection. Differential diagnosis of sterile endophthalmitis from infective endophthalmitis is crucial to adjust the appropriate treatment and prevent long-term complications due to unnecessary treatment.