The role of submacular surgery in the treatment of choroidal neovascular membranes

The growth of choroidal neovascular membranes (CNVM) beneath the macula can cause significant disturbances of central vision. Conditions such as age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS) are the most common etiologies. The Macular Photocoagulation Study group presented data that clearly showed laser photocoagulation to be beneficial in the treatment of CNVM. Poor visual results and a high rate of recurrence have prompted clinicians to seek out alternative treatments. Experiences with CNVM removal utilizing submacular surgical techniques have shown that central visual function may be restored or preserved in POHS, multifocal choroiditis and idiopathic causes. The Submacular Surgery Trials were designed to investigate whether submacular surgery is more effective in retaining central acuity in patients with subfoveal CNVM, than observation alone. The goal of this paper is to review the role of submacular surgery in the treatment of subfoveal choroidal neovascular membranes.     

Foveal Damage Due to Subfoveal Hemorrhage Associated with Branch Retinal Vein Occlusion

To investigate the functional and morphologic prognoses of eyes with subfoveal hemorrhage from acute branch retinal vein occlusion (BRVO), and to examine the effect of intravitreal ranibizumab injection (IVR) on these prognoses, we assessed 81 eyes with acute BRVO, of which 38 did not receive IVR [IVR(-) group], and 43 were treated with IVR [IVR(+) group] for macular edema. The foveal morphologic changes were examined via optical coherence tomography (OCT). At initial examination, 63 eyes exhibited subfoveal hemorrhage. At final examination, the defect lengths in the foveal external limiting membrane (ELM) and ellipsoid lines in these eyes were longer, and final VA was significantly poorer, compared with eyes without subfoveal hemorrhage. In comparisons between the final measurements in eyes with subfoveal hemorrhage in the IVR(-) and IVR(+) groups, while there were no differences in initial ocular conditions, final VA was significantly better in the IVR(+) group. The defects in the ELM and ellipsoid lines in the IVR(+) group were shorter than those of the IVR(-) group (p = 0.002 in both). Final VA was correlated with the defect lengths of foveal ELM and ellipsoid lines in both the IVR(-) and IVR(+) groups (both p < 0.001). In addition, the defect lengths of foveal ELM and ellipsoid lines were closely correlated with the duration of subfoveal hemorrhage (both p < 0.001). BRVO-associated subfoveal hemorrhage caused damage to the foveal photoreceptors, and visual dysfunction. However, IVR improved these prognoses, by accelerating the absorption of the subfoveal hemorrhage.     

Therapeutic benefit of radial optic neurotomy in a rat model of glaucoma

Radial optic neurotomy (RON) has been proposed as a surgical treatment to alleviate the neurovascular compression and to improve the venous outflow in patients with central retinal vein occlusion. Glaucoma is characterized by specific visual field defects due to the loss of retinal ganglion cells and damage to the optic nerve head (ONH). One of the clinical hallmarks of glaucomatous neuropathy is the excavation of the ONH. The aim of this work was to analyze the effect of RON in an experimental model of glaucoma in rats induced by intracameral injections of chondroitin sulfate (CS). For this purpose, Wistar rats were bilaterally injected with vehicle or CS in the eye anterior chamber, once a week, for 10 weeks. At 3 or 6 weeks of a treatment with vehicle or CS, RON was performed by a single incision in the edge of the neuro-retinal ring at the nasal hemisphere of the optic disk in one eye, while the contralateral eye was submitted to a sham procedure. Electroretinograms (ERGs) were registered under scotopic conditions and visual evoked potentials (VEPs) were registered with skull-implanted electrodes. Retinal and optic nerve morphology was examined by optical microscopy. RON did not affect the ocular hypertension induced by CS. In eyes injected with CS, a significant decrease of retinal (ERG a- and b-wave amplitude) and visual pathway (VEP N2-P2 component amplitude) function was observed, whereas RON reduced these functional alterations in hypertensive eyes. Moreover, a significant loss of cells in the ganglion cell layer, and Thy-1-, NeuN- and Brn3a- positive cells was observed in eyes injected with CS, whereas RON significantly preserved these parameters. In addition, RON preserved the optic nerve structure in eyes with chronic ocular hypertension. These results indicate that RON reduces functional and histological alterations induced by experimental chronic ocular hypertension.     

An Instrument for Biofeedback Applied to Vision

One hundred and ten patients (179 eyes) with reduced visual acuity caused by different ocular disorders underwent visual rehabilitation with an instrument for biofeedback: improved biofeedback integrated system (Ibis). One hundred and fourteen eyes had age-related macular degeneration, 39 eyes had myopic macular degeneration, and 26 eyes were affected by different ocular disorders. A placebo training was developed on 34 patients (47 eyes). Thirty-three eyes had age-related macular degeneration and 15 eyes had myopic macular degeneration. Visual acuity was found to be improved in 130/179 eyes (72.62%). Mean visual acuity was 0.24 before training and 0.36 at the last follow-up. A review of the literature and possible mechanisms are discussed.     

Long-term result of autologous cultivated oral mucosal epithelial transplantation for severe ocular surface disease

The present study aimed to investigate the clinical outcomes of autologous cultivated oral mucosal epithelial transplantation (COMET) on human amniotic membrane (AM) for corneal limbal stem cell deficiency (LSCD). In this prospective, noncomparative case series, 20 eyes (18 patients) with bilateral severe ocular surface disease were chosen to undergo COMET on human AM. The primary outcome was clinical success, and the secondary outcomes were the best-corrected visual acuity difference, corneal opacification, symblepharon formation, and complications. The mean patient age was 48.2 ± 15.5 years. The mean follow-up time was 31.9 ± 12.1 months (range 8–50 months). All except one eye exhibited complete epithelialization within the first postoperative week. A successful clinical outcome, defined as a stable ocular surface without epithelial defects, a clear cornea without fibrovascular tissue invasion at the pupillary area, and no or mild ocular surface inflammation, was obtained in 15 of 20 eyes (75 %). The clinical success rate at 1 year was 79.3 %, and that at 4 years (end of follow-up) was 70.5 %. Fourteen of 20 (70 %) eyes exhibited improvement in visual acuity after COMET, and some required subsequent cataract surgery (2 eyes), penetrating keratoplasty (3 eyes), or keratoprosthesis implantation (1 eye). Preoperative symblepharon was eliminated in most eyes (8 of 13, 61.5 %) after COMET combined with eyelid reconstruction when needed. The only complication was corneal perforation (1 eye) induced by a severe eyelid abnormality; treatment with a tectonic corneal graft was successful. COMET can successfully restore ocular surface damage in most eyes with corneal LSCD.     

Photodynamic therapy with Verteporfin in subfoveal choroidal metastasis of breast carcinoma (a controlled case)

A 55-year old woman with growing unilateral subfoveal choroidal metastasis of breast carcinoma was treated by photodynamic therapy (PDT) with verteporfin. Best corrected visual acuity remained stable during the whole follow-up of 6 months. Tumor flattened from 2.2 mm to 0 mm on ultrasound one month after the therapy. PDT with verteporfin appears to be the best tolerated method for palliative treatment of growing subfoveal choroidal metastasis of the breast carcinoma.     

Eye-specific segregation of optic afferents in mammals,fish, and frogs: The role of activity

Eye-specific patches or stripes normally develop in the visual cortex and superior colliculus of many (but not all) mammals and are also formed, after surgically produced binocular innervation, in the optic tectum of fish and frogs. The segregation of ocular dominance patches or columns has been studied using a variety of anatomical pathway-tracing techniques, by electrophysiological recording of postsynaptic units or field potentials, and by the 2-deoxyglucose method following visual stimulation of only one eye. In the tectum of both fish and frogs and in the cortex and colliculus of mammals, eye-specific patches develop from initially diffuse, overlapping projections. Of the various mechanisms that might cause such segregation, the evidence favors an activity-dependent process that stabilizes synapses from the same eye because of their correlated activity. First, several environmental manipulations affect the segregation of afferents in visual cortex: strabismus and alternate monocular exposure apparently enhance segregation, whereas dark rearing slows the segregation process, and monocular deprivation causes the experienced eye to form larger patches at the expense of those of the deprived eye. Second, blocking activity in both eyes is effective in preventing the segregation both in the tectum of fish and frog and in the visual cortex of cat. With the eyes blocked, alternate stimulation of the optic nerves permits the segregation of ocular dominance, at least onto single cells in the cat visual cortex. These findings are discussed in terms of an activity-dependent stabilization of those synapses having correlated activity (those from neighboring ganglion cells within one eye) but not of those lacking correlated activity (those from left and right eyes). We suggest that the eye-specific patches represent a compromise between total segregation of the projections from the two eyes and the formation of a single continuous retinotopic map across the surface of the cortex or tectum.     

复明片联合曲伏前列素滴眼液对原发性开角型青光眼患者眼部血流动力学和房水EPO、sCD44的影响

摘要 目的：探讨复明片联合曲伏前列素滴眼液对原发性开角型青光眼（POAG）患者眼部血流动力学和房水促红细胞生成素（EPO）、可溶性CD44（sCD44）的影响。方法：选择2017年4月~2020年11月在本院接受治疗的112例193眼的POAG患者,根据随机数字表法分为对照组（n=56,96眼）和研究组（n=56,97眼）,对照组患者接受曲伏前列素滴眼液治疗,研究组接受复明片联合曲伏前列素滴眼液治疗,对比两组疗效、眼部血流动力学和房水EPO、sCD44,视力、视野、眼压,观察治疗期间不良反应发生状况。结果：研究组的临床总有效率高于对照组（P<0.05）。治疗12周后,研究组平均光敏感度（MS）、视力高于对照组,24 h眼压平均值小于对照组（P<0.05）。治疗12周后,研究组舒张末期流速（EDV）、收缩期峰值流速（PSV）高于对照组,血流阻力系数（RI）小于对照组（P<0.05）。治疗12周后,研究组房水EPO、sCD44水平低于对照组（P<0.05）。两组不良反应发生率组间对比无统计学差异（P>0.05）。结论：复明片联合曲伏前列素滴眼液治疗POAG患者,可促进患者视力、视野、眼压改善,可能与调节眼部血流动力学和房水EPO、sCD44水平有关。     

Blue flicker modifies the subfoveal choroidal blood flow in the human eye

The objective of the present study was to reveal an interaction between choroidal blood flow (ChBF) and light-induced photoreceptor activity, a physiological coupling that has been already demonstrated for retinal blood flow but rejected for ChBF. Ten healthy adults volunteered for this study. A real-time recording near-infrared laser-Doppler flowmeter was used to quantify the subfoveal ChBF while the luminance of blue flicker between 1 and 64 Hz was first increased and then decreased by 4.0 log units in 1.0-log unit steps between 0.0375 and 375 cd/m2. In separate testing, flash electroretinograms (ERGs) provided electrophysiological indexes of the relative response of short-wave cones (s-cones) and rods to blue light stimulation. Group-averaged, normalized ChBF measurements revealed that it was modulated by approximately 9% by flicker frequency. Increasing the blue flicker luminance from low to high attenuated the subfoveal ChBF, volume, and velocity by approximately 32%, approximately 30%, and approximately 5%, respectively. Decreasing the luminance from high to low over the same range had no effect on the subfoveal choroidal hemodynamics. The markedly different effects of reversed directions of change in blue flicker luminance on the subfoveal ChBF were linked to transitions between rod-dominated and s-cone-dominated retinal responses. Collectively, these findings indicate that the blue light-induced photoreceptor response is associated with a differential distribution of the ChBF across the ocular fundus according to the degree and type of retinal photoreceptor stimulated.     

Changes in visual fields associated with web reduction in the spider family uloboridae

When visual fields of the primitive orb-weaver, Waitkera waitkerensis, are reconstructed using measurements taken from intact lenses and cross and longitudinal sections of the prosoma, they show that this species has complete visual surveillance, but that none of the visual fields of its eight eyes overlap. The more advanced orb-weaver, Uloborus glomosus, also has eight eyes, but each eye has a greater visual angle, giving this species a complex pattern of overlapping visual fields. Uloborids that spin reduced webs are characterized by reduction or loss of the four anterior eyes and other carapace modifications necessary for them to effectively monitor and manipulate their reduced webs. The eyes of these uloborids have greater visual angles than those of orb-weavers, resulting primarily from perimetric expansion of their retinal hemispheres. Additionally, the axes of their visual fields are more ventrally directed due to greater dorsal than ventral retinal expansion and to ventral redirection of the entire eye. Consequently, even though the anterior lateral eyes of the triangle-weaver Hyptiotes cavatus lack retinae, the species' six functional eyes permit complete visual surveillance and exhibit visual overlap. The single-line-weaver, Miagrammopes animotus, has lost its four anterior eyes, and with them much of the anterior vision and all of the visual overlap found in the other species. However, changes similar to those of H. cavatus permit this species to retain most if its dorsal and ventral visual surveillance. Thus, ocular changes act in consort to maintain relatively complete visual surveillance in the face of eye loss and other major carapace modifications necessary for the operation of reduced webs.     

复杂性眼外伤患者玻璃体切割围手术期护理体会

目的:玻璃体切割术是眼科手术中比较复杂精细显手术,主要应用于治疗眼外伤导致的玻璃体出血,玻璃体浑浊,复杂性视网膜脱离以及增殖性玻璃体视网膜病变。本文主要探讨玻璃体切割术治疗复杂性眼外伤患者的围手术期护理的临床效应。方法:总结作者所在科室多年来护理眼外伤患者的临床经验,对2013年3月至2013年7月入院的75例(75只眼)复杂性眼外伤患者进行悉心的术前心理护理,完善的用药指导,充分的术前准备,术后特殊卧位的指导,预防并发症的护理及出院指导。结果:术后视力提高57例(76.0%),视力不变13(17.3%)例,视力下降5例(6.7%),28例眼内异物患者均经手术顺利取出异物。相关手术并发症经医护人员的对症治疗后均得到有效控制。患者术后满意度达98%以上,医生满意度达100%。结论:复杂性眼外伤患者玻璃体切割手术围手术期进行全方位的护理服务,对促进病人康复起到至关重要的作用。     

Circadian organization in Aplysia californica.

Substantial progress has been made in unraveling the organization of the circadian system of Aplysia californica. There are at least three circadian pacemakers in Aplysia. One has been localized in each eye and a third lies outside the eyes. Removal of the eyes disrupts the free-running locomotor activity rhythm; however, an extraocular oscillator can mediate a free-running rhythm in some eyeless animals. Although photoreceptors sufficient for entrainment of the ocular oscillator have been localized in the retina, photoreceptors outside the eyes are capable of "driving" a diurnal rhythm of locomotor activity and may also influence entrainment of ocular pacemakers. Finally, attention has been focused on the optic nerve as a coupling pathway between various parts of the system. The evidence suggests that information transmitted in the optic nerves is involved in entrainment of the ocular pacemaker by light, and in ocular control of the locomotor activity rhythm.     

Clinical features of ocular toxoplasmosis in Korean patients

We report here the records of 10 consecutive Korean patients (10 eyes) with ocular toxoplasmosis which showed the typical clinical manifestations with seropositivity for Toxoplasma gondii specific IgG antibodies by micro-ELISA between 2006 and 2010. Nine patients were males and 1 was female; their age was 50.5 ± 13.8 years. The most common accompanying signs were vitritis (100%), anterior uveitis (70%), and scattered white deposit (80%). Pre-existing retinochoroidal scar was found in 1 (10%) patient. All patients received antiparasitic chemotherapy and systemic corticosteroid treatment, which resolved the presenting attack and recovered the visual acuity better than initial one in 9 patients and worse in 1. Optic atrophy, cataract, and retinal neovascularization were observed during the follow-up period and recurrence was detected in 3 eyes (30%) 6 to 20 months after the initial attack. In Korea, although rarely detected and reported, ocular toxoplasmosis needs more attention in clinical field of retinal diseases.     

Physical and morphological aspects of the eye of the manatee trichechus inunguis natterer 1883: (Sirenia: Mammalia)

The eyes and aspects of vision of the Amazonian manatee Trichechus inunguis NATTERER 1883: (Sirenia: mammalia) have been examined in five animals, in relation to previous findings for sirenians. This paper presents a review of previous findings confirming those upon gross ocular anatomy, retinal histology and ocular refraction. The confirmation of a primarily rod retina, high receptor: ganglion cell ratio and low refractive error under water were of note. A visual pigment based upon vitamin A₁ and a difference spectrum of λ max at 505 nm was in agreement with Dartnalls nomogram. The findings suggest a retina more suited to low light levels and at best, moderate visual acuity, though motion perception appears present and a low degree of binocular vision possible.     

d-Ibuprofen in ocular inflammation induced by paracentesis of the rabbit eye

The anti-inflammatory compound d-ibuprofen has been investigated for anti-inflammatory and cyclooxygenase inhibitory activity in ocular inflammation induced by paracentesis of eyes of living rabbits. d-Ibuprofen is the dextro-rotary isomer of ibuprofen, a potent non-steroidal anti-inflammatory agent. Eyes pretreated topically with d-ibuprofen 0.8% showed a significant inhibition of aqueous protein (73.0%) and prostaglandin E2 (96.4%) increase after paracentesis as compared to paracentesized untreated fellow eyes and control eyes. In aqueous humor no significant correlation between the increase in prostaglandin E2 and protein could be established after paracentesis. These results indicate that d-ibuprofen could be a useful ocular anti-inflammatory agent as cyclooxygenase inhibitor.     

Patient‐specific determination of change in ocular spherical aberration to improve near and intermediate visual acuity of presbyopic eyes

The purpose was to determine the optimum negative spherical aberration induction required to improve near and intermediate visual acuity (VA) of presbyopic eyes. A total of 174 normal and diabetic (no retinopathy) presbyopic eyes (age ≥ 40 years) were measured with visual adaptive optics simulator (Voptica, Spain). First, baseline uncorrected VA and aberrations were measured. VA at 40 cm (near), 80 cm (intermediate) and distance was measured. Then, a negative spherical aberration (SA) was added to baseline ocular SA, and VA at all targets was reassessed after correction of distance refractive error. Clinically, baseline SA and root mean square of higher order aberrations were similar between the normal and diabetic presbyopic eyes. Baseline VA of the diabetic eyes at near and intermediate was better than the same of normal eyes (P = 0.001). After SA change, VA at near and intermediate of both normal and diabetic presbyopic eyes improved. However, fewer diabetic eyes needed higher SA change than normal eyes (P = 0.03). The corresponding trends with change in VA at near and intermediate were also similar between the normal and diabetic eyes. Patient‐specific modulation of ocular SA to improve near and intermediate VA in a large cohort of eyes was successful in improving VA, sometimes even distance VA.      

Cataract surgery and intraocular lens implantation in children with juvenile rheumatoid arthritis associated uveitis

Clinical records of 6 children (7 eyes) with juvenile rheumatoid arthritis (JRA) who underwent cataract surgery with IOL implantation between January 1998 and December 2002 were reviewed. The median age at the time of cataract surgery was 8 years (range 5-14 years). The median follow up was 48 months (range 26 to 60 months). Five of six children (6 eyes) were on systemic immunosuppressive or anti-inflammatory therapy. Glaucoma was present in three eyes before surgery, and all three eyes underwent combined cataract surgery and trabeculectomy with mitomycin C. A final best corrected visual acuity of 0.5 or better was achieved in all eyes Postoperative complications included posterior capsule opacification (n = 5), glaucoma (n = 1), and cystoid macular edema (n = 1). Intraocular lens implantation in children with control of preoperative and postoperative ocular inflammation could lead to favorable visual results.     

Visual fields of orb web and single line web spiders of the family Uloboridae (Arachnida,Araneida)

Summary In the family Uloboridae, web reduction is associated with changes in web monitoring posture and prosomal features. A spider must extend its first pair of legs directly forward to monitor the signal line of a reduced web. This posture is facilitated by shifts in prosomal musculature that cause reduced web uloborids to have a narrower anterior prosoma, a reduced or absent anterior eye row, and prominent posterior lateral eye tubercles. The eye tubercles and larger posterior eyes of these uloborids suggest that web reduction may also be accompanied by ocular changes that compensate for reduction of the anterior eyes by expanding the visual fields of the posterior eyes. A comparison of the visual fields of the eight-eyed, orb web species Octonoba octonaria and a four-eyed, reduced web Miagrammopes species was made to determine if this is true. Physical and optical measurements determined the visual angles of each species' eyes and the pattern of each species' visual surveillance. Despite loss of the anterior four eyes, the Miagrammopes species has a visual coverage similar to that of O. octonaria. This is due to (1) an increase in the visual field of each of the four remaining Miagrammopes eyes, accruing from an extension of the retina and an increase in the lens' rear radius of curvature, and (2) a ventral shift of each visual axis, associated with the development of an eye tubercle and an asymmetrical expansion of the retina. Miagrammopes monitor their simple webs from twigs or moss where they are vulnerable to predation. Therefore, maintenance of visual cover may enable them to detect predators in time to assume or maintain their characteristic, cryptic posture. It may also allow them to observe approaching prey and permit them to adjust web tension or prepare to jerk their webs when prey strikes.     

Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC

Purpose

To report on the influence of ophthalmic artery chemosurgery (OAC) on enucleation rates, ocular and patient survival from metastasis and impact on practice patterns at Memorial Sloan Kettering for children with advanced intraocular unilateral retinoblastoma.

Patients and Methods

Single-center retrospective review of all unilateral retinoblastoma patients with advanced intraocular retinoblastoma treated at MSKCC between our introduction of OAC (May 2006) and December 2014. End points were ocular survival, patient survival from metastases and enucleation rates.

Results

156 eyes of 156 retinoblastoma patients were included. Primary enucleation rates have progressively decreased from a rate of >95% before OAC to 66.7% in the first year of OAC use to the present rate of 7.4%. The percent of patients receiving OAC has progressively increased from 33.3% in 2006 to 92.6% in 2014. Overall, ocular survival was significantly better in eyes treated with OAC in the years 2010–2014 compared to 2006–2009 (p = 0.023, 92.7% vs 68.0% ocular survival at 48 months). There have been no metastatic deaths in the OAC group but two patients treated with primary enucleation have died of metastatic disease.

Conclusion

OAC was introduced in 2006 and its impact on patient management is profound. Enucleation rates have decreased from over 95% to less than 10%. Our ocular survival rate has also significantly and progressively improved since May 2006. Despite treating more advanced eyes rather then enucleating them patient survival has not been compromised (there have been no metastatic deaths in the OAC group). In our institution, enucleation is no longer the most common treatment for advanced unilateral retinoblastoma.     

How can squint change the spacing of ocular dominance columns?

The pattern of ocular dominance columns in primary visual cortex of mammals such as cats and macaque monkeys arises during development by the activity-dependent refinement of thalamocortical connections. Manipulating visual experience in kittens by the induction of squint leads to the emergence of ocular dominance columns with a larger size and larger column-to-column spacing than in normally raised animals. The mechanism underlying this phenomenon is presently unknown. Theory suggests that experience cannot influence the spacing of columns if the development proceeds through purely Hebbian mechanisms. Here we study a developmental model in which Hebbian mechanisms are complemented by activity-dependent regulation of the total strength of afferent synapses converging onto a cortical neurone. We show that this model implies an influence of visual experience on the spacing of ocular dominance columns and provides a conceptually simple explanation for the emergence of larger sized columns in squinting animals. Assuming that during development cortical neurones become active in local groups, which we call co-activated cortical domains (CCDs), ocular dominance segregation is controlled by the size of these groups: (1) Size and spacing of ocular dominance columns are proportional to the size sigma of CCDs. (2) There is a critical size sigma* of CCDs such that ocular dominance columns form if sigmasigma*. This critical size of CCDs is determined by the correlation functions of activity patterns in the two eyes and specifies the influence of experience on ocular dominance segregation. We show that sigma* is larger with squint than with normal visual experience. Since experimental evidence indicates that the size of CCDs decreases during development, ocular dominance columns are predicted to form earlier and with a larger spacing in squinters compared to normal animals.