Advanced glycation end products (AGE) are present in amyloid deposits in beta2-microglobulin amyloidosis, and it has been postulated that glycation of beta2-microglobulin may be involved in fibril formation. The aim of this paper was to ascertain whether AGE occur in amyloid deposits in familial amyloidotic polyneuropathy (FAP).
Department of Medicine, Umeå University Hospital and First Department of Internal Medicine, Kumamoto University School of Medicine.
The presence of AGE was sought immunohistochemically and biochemically in amyloid-rich tissues from patients with FAP.
Biopsy specimens from nine patients and 10 controls were used for the immunohistochemical analysis. For amyloid preparation, vitreous samples from three FAP patients were used.
Immunohistochemical studies using a polyclonal anti-AGE antibody revealed positive immunoreactivity in intestinal materials, but the pattern of reactivity was unevenly distributed; it was often present in the border of amyloid deposits, or surrounding them. Non-amyloid associated immunoreactivity was also observed in a few regions of the specimens, although the AGE-positive structures were situated in areas containing amyloid deposits. Western blotting of purified amyloid from the vitreous body of FAP patients revealed a significant association of AGE with amyloid fibrils.
The immunoreactivity for the AGE antibody suggests that AGE may be involved in fibril formation in FAP.
PURPOSE: To evaluate whether cataract surgery in children should be performed with anterior vitrectomy and to examine the properties of the AcrySof SA30AL intraocular lens (IOL) in the pediatric eye. SETTING: Filatov Institute, Odessa, Ukraine. METHODS: Cataract surgery was performed in 66 children aged 3 to 15 years. They were randomized to surgery with or without anterior vitrectomy. All eyes were implanted with the single-piece AcrySof SA30AL IOL (Alcon). During the study, the patients who needed surgery for after-cataract had a second surgical procedure. Two years after surgery, the surgical method was evaluated using exact logistic regression. Also, the Evaluation of Posterior Capsule Opacification (EPCO) score was compared between the patients who had surgery for after-cataract and the patients who did not need this. The presence of posterior synechias and centration of the IOL were assessed. RESULTS: Children in the younger age group (
The role of face-down posturing after macular hole (MH) surgery remains unclear and controversial. We evaluated the anatomical and visual outcomes of MH repair using a short duration (3 days) of prone positioning.
Prospective series of 50 consecutive eyes in 50 patients with Stage 2 or Stage 3 idiopathic MHs. All eyes underwent vitrectomy MH surgery with internal limiting membrane peeling and 20% sulfur hexafluoride (SF6) gas tamponade. The procedure was combined with phacoemulsification cataract surgery in phakic eyes. Surgical outcomes, MH closure rates, complications, and postoperative visual acuity were investigated.
Anatomical closure of MHs was achieved in 49 (98%) of 50 eyes by 1 surgery. Postoperative logarithm of the minimum angle of resolution visual acuity decreased (i.e., improved) by 0.271 (95% confidence interval, 0.101-0.441 [P = 0.0024]). One complication of intraocular lens pupillary capture and one case of chronic cystoid macular edema were observed. There were no complications attributed to intraocular pressure fluctuations.
Vitrectomy with internal limiting membrane peeling and gas tamponade with SF6 followed by short-duration 3-day face-down positioning is a successful surgical intervention for Stage 2 and Stage 3 idiopathic MHs. This method possessed minimal complications and offered significant improvement in visual acuity.
Separation of the vitreous and posterior hyaloid membrane (PHM) or posterior vitreous detachment (PVD) typically occurs between the ages of 45 and 65 years in the general population, but may occur earlier in myopic or otherwise predisposed individuals. Age-related synergetic changes occurring within the cortical and central gel must be distinguished from the PHM, which envelopes it. This study reports on the correlation between 'true' PVD seen clinically by the physician using dynamic examination, high-power slit-lamp biomicroscopy, and oblique illumination with some of its histological, immunohistochemical, and ultrastructural features post-mortem. The presence of the Weiss ring does not necessarily indicate total clean separation of PHM, nor does its absence confirm that the PHM remains attached, since it may be destroyed during the process of separation. Immediately prior to PVD with the vitreous gel attached, the PHM must, by definition, form part of the inner limiting membrane. The detached PHM frequently exhibits basement membrane (BM) and its indigenous laminocytes stain focally for GFAP and type IV collagen. The PHM is distinct from and much thicker than the BM of Müller cells alone and the factors that initiate or limit separation of the PHM require greater study, particularly the role of laminocyte proliferation and migration.
To evaluate the outcome of combined cataract surgery with primary intraocular lens (IOL) implantation and pars plana vitrectomy (PPV) in children with uveitis.
Data regarding visual acuity (VA), inflammatory status, medical therapy, and complications was collected from the medical charts of 17 children (21 eyes) with chronic uveitis who underwent combined cataract surgery and PPV at the Eye Clinic, Sahlgrenska/Mölndal, between 2002 and 2011.
Seventy-six percent of the children had juvenile idiopathic arthritis. Median preoperative VA was 1.70 logMAR and median VA after 12 months was 0.17 logMAR. Postoperatively, glaucoma developed in 7 eyes, cystoid macular edema in 3 eyes, and visual axis opacification requiring treatment in 5 eyes.
Although combined phacoemulsification, primary IOL implantation, and PPV in children with uveitis resulted in favorable visual outcome and stable inflammation in a majority of children, the technique should so far be reserved for uveitic cases with vitreous pathology.
PURPOSE: To study the type and frequency of complications requiring additional surgery in infants operated on for congenital cataract before 12 months of age. METHODS: The medical records of 57 infants who underwent surgery for unilateral and bilateral congenital cataracts during a five-year-period were reviewed retrospectively. The follow-up period ranged from 9 to 70 months with a mean of 37 months. Cataract extraction was performed on 83 eyes. RESULTS: Thirty-eight operations for after-cataracts were performed on 32 out of 83 eyes. Fourteen vitrectomies were made on 11 eyes because of pupillary block glaucoma. Glaucoma requiring trabeculectomy developed in eight eyes 2 to 14 months after cataract extraction. This type of glaucoma occurred almost exclusively in eyes operated on during the first two months of life. CONCLUSION: Complications requiring additional surgery are very common in infants operated on for congenital cataracts during the first year of life. Glaucoma requiring trabeculectomy developed particularly in infants who had their cataract extraction very early. Glaucoma development was not more common in infants operated on for after-cataract.
Diabetic vitrectomy represents an end-point of diabetic retinopathy progression. This study was designed to estimate long-term incidence of diabetic vitrectomy and associated risk factors.
Retrospective review of prospectively collected data from a large diabetes centre between 1996 and 2010. Surgical history was obtained from The Danish National Patient Register.
The population consisted of 3980 patients with type 1 diabetes. Median follow-up was 10.0 years. In total, 106 patients underwent diabetic vitrectomy in the observation period. Surgery indications were nonclearing vitreous haemorrhage (43%) or tractional retinal detachment (57%). The cumulative incidence rates of diabetic vitrectomy were 1.6% after 5 years and 2.9% after 10 years. When excluding patients with no or mild diabetic retinopathy, the corresponding rates were higher; 3.7% and 6.4%, respectively (p 75 mmol/mol in the observation period (p 0.05 for all variables).
Diabetic vitrectomy is rarely required in a type 1 diabetes population with varying degrees of retinopathy, but the risk increases markedly with poor metabolic control.
The Endophthalmitis Vitrectomy Study (EVS) was a multicentre randomized clinical trial designed to guide the management of postoperative bacterial endophthalmitis. There is speculation that many physicians do not follow its recommendations, despite its intent. We surveyed Canadian vitreoretinal surgeons to determine whether surgeons are adopting the EVS recommendations in their management of bacterial endophthalmitis after cataract surgery.
A survey was sent to 98 vitreoretinal surgeons across Canada who manage postoperative endophthalmitis following cataract surgery. The survey explored the management of patients presenting with a hypopyon or suspected endophthalmitis, or both, early (up to 2 weeks) after cataract surgery. For purposes of comparison with the EVS, the questions were divided into presenting visual acuity categories.
Of the 98 surgeons 30 (30.6%) responded to the survey. The preferred treatment for patients presenting with no light perception visual acuity was pars plana vitrectomy (23 respondents [76.7%]); 7 respondents (23.3%) preferred vitreous tap/biopsy. All but one of the respondents stated that they prefer pars plana vitrectomy for patients presenting with light perception vision; the remaining physician preferred either pars plana vitrectomy or vitreous tap/biopsy. For patients with hand motions visual acuity, 17 respondents (56.7%) would perform pars plana vitrectomy, 11 (36.7%) would perform vitreous tap/biopsy, and 2 (6.7%) would perform either procedure. Most of the respondents (20 [66.7%]) would perform vitreous tap/biopsy for patients with visual acuity of counting fingers, whereas 9 (30.0%) would perform pars plana vitrectomy, and 1 (3.3%) would perform either procedure. All the respondents indicated that they would use intraocular antibiotic therapy for initial treatment, 29 (96.7%) would use topical antibiotic therapy, 17 (56.7%) would inject antibiotics subconjunctivally, and 1 (3.3%) would use intravenous antibiotic therapy. Fourteen respondents (46.7%) would use intraocular steroid therapy.
Most of the Canadian vitreoretinal surgeons who responded to this survey do not follow the recommendations of the EVS.
Comment In: Can J Ophthalmol. 2003 Jun;38(4):264; author reply 264-512870857
PURPOSE: To report four cases of Eales' disease in Inuit from Greenland diagnosed within a 6.5-year period. There are no previous reports on Eales' disease among Greenlanders. METHODS: Four younger Inuit, three males and one female, were diagnosed with Eales' disease based on fundus changes and exclusion of possible differential diagnoses. Several studies point to a possible relation between Eales' disease and tuberculosis (TB); examination of possible exposure to TB was part of the clinical investigation. RESULTS: Retinal changes made panretinal laser photocoagulation necessary in all cases. Four eyes in three patients were vitrectomized. Three patients received oral corticosteroid treatment. The final visual outcome was relatively good, with a visual acuity below 6/60 (3/36) in only one vitrectomized eye. All patients had been exposed to TB. CONCLUSION: Eales' disease seems to be rather common in the small population of Inuit (56,000) in Greenland. Attention is required to ensure diagnosis and appropriate treatment, including laser photocoagulation, leading to a reasonably good prognosis.