Sodium chloride incites reactive oxygen species in green algae Chlorococcum humicola and Chlorella vulgaris: Implication on lipid synthesis, mineral nutrients and antioxidant system

In the present study, microalgae Chlorococcum humicola and Chlorella vulgaris were grown in different concentrations of NaCl (25-1000 mM) to elucidate its impact on morphology, lipid synthesis, minerals status and antioxidative responses. Scanning Electron microscopy showed distorted cell morphology and increased cell size by 33.52% (C. humicola) and 27.79% (C. vulgaris) at 100 mM NaCl. Energy Dispersive Spectroscopy data revealed reduction in mineral contents (C, S, Fe, Mg, Si, Mn and Zn) by 14-54% in both algae. Further, C. humicola was found to have high lipid content than C. vulgaris under NaCl regime. The activities of superoxide dismutase, catalase and glutathione reductase were increased by 2.5-5 folds in both algae as compared to control. The increased level of ascorbate, cysteine and proline in both algae indicated tolerance against salinity. Thus, C. humicola and C. vulgaris may exhibit dual benefits viz., high lipid production and reclamation of sodic soil.

Large Spot Laser for Treatment of Retinopathy of Prematurity

BACKGROUND AND OBJECTIVE

To compare large spot versus standard spot laser for treatment of retinopathy of prematurity (ROP).

PATIENTS AND METHODS

Eighty eyes of 40 infants with bilateral type 1 ROP were randomized for laser photocoagulation using laser indirect ophthalmoscope with either standard spot or large spot size laser. During the procedure, total time taken and Premature Infant Pain Profile (PIPP) scores were noted. Regression of disease and refractive error were noted on follow-up.

RESULTS

The infants were randomized into two groups. All infants in both groups had regression of ROP. Large spot laser significantly reduced total treatment duration in zone I by 32% (P = .005) and zone II by 63.4% (P = .0006). Moderate-to-severe pain occurred in PIPP scores in both groups throughout the procedure (under topical anesthesia) and was comparable between the groups. Mean change in refractive error (myopia) from pre-laser (2.090 diopters [D] ± 1.345 D) to 3 months' post-laser (2.465 D ± 1.399 D) was not statistically significant between the groups.

CONCLUSIONS

Large spot laser significantly reduced total duration of laser treatment in zone I/II ROP. Large spot laser is a useful alternative for treatment of ROP in terms of faster procedure, lesser total duration of pain, and similar regression profile. It does not cause additional myopia and can be performed without additional training. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e233-e239.].

Ocular kinetics and safety of intravitreally injected angiotensin converting enzyme inhibitor lisinopril

Background and objectives

The study investigated the intravitreal safety and vitreous disposition of lisinopril, an angiotensin converting enzyme inhibitor in rabbits for its projected use in retinopathy.

Methods

For the safety study, following the baseline ERG recording and fundus photography, 40 µg/50 µl of lisinopril sterile injection was injected unilaterally in the rabbit eyes (n = 4), where other eye served as a control. The electroretinogram and fundus images were obtained at 24, 48, 72 and 168 h following the intravitreal injection. For pharmacokinetics evaluation of the lisinopril, one eye of each rabbit (n = 4) received an intravitreal injection of lisinopril (40 µg/50 µl). The concentration of lisinopril in the ocular tissues, humours, plasma, lung, kidney and liver were measured through ESI-LC-MS/MS.

Results

Upon the electroretinography studies, no significant difference was observed in the ERG pattern in the lisinopril injected eye when compared to the baseline of the respective animals till the 7th day of the study. In the fundus imaging, no morphological changes were observed in the retina of the animal. The concentration of the lisinopril was found to be above to the IC50 in the retina-choroid till 36 h. The concentration found in the plasma and body tissues were many folds less than the IC50 of the lisinopril.

Conclusions

Intravitreal injection of 40 µg/50 µl of lisinopril found to be safe in the rabbit eye as evidenced by the electroretinography and fundus imaging studies. The average half-life of lisinopril is 12.6 h and the above-mentioned dose able to sustain its IC50 value till the 36 h.

Reducing Waiting-time of Preterm Babies at a Retinopathy of Prematurity Clinic: A Quality Improvement Project

OBJECTIVE

To decrease the waiting time for preterm babies visiting the Retinopathy of prematurity clinic in a tertiary eye hospital.

DESIGN

Interventional study.

SETTING

Tertiary eye care hospital.

PATIENTS

All preterm babies reporting for screening and follow up at Retinopathy of prematurity clinic.

INTERVENTION/PROCEDURE

A quality improvement team comprising of a faculty (team leader), two senior residents, two junior residents, one nursing officer, and a registration staff was constituted. Fish bone analysis was done to understand various reasons for the high waiting time for preterm babies. Baseline data was collected followed by multiple Plan-Do-Study- Act (PDSA) cycles.

MAIN OUTCOME MEASURE

Average waiting-time, maximum waiting-time, and last baby entry-time were measured.

RESULTS

The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range 74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min (90 to 118 min), respectively. At the end of 3rd PDSA cycle, these reduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110 to 135 min), and 60 min (range 45 to 80 min), respectively and were sustained; the decrease from baseline being 14.3%, 31.2%, and 46%, respectively.

CONCLUSION

The time spent in the waiting area at the Retinopathy of Prematurity clinic was significantly reduced by simple changes in the process flow.

Reducing Preoperative Waiting-time in a Pediatric Eye Operation Theater by Optimizing Process Flow: A Pilot Quality Improvement Project

OBJECTIVE

To decrease the preoperative area waiting-time for children posted for eye surgery.

METHODS

A pilot quality improvement project was conducted in a single paediatric eye operation theatre in our tertiary-care hospital. Operation theatre process flow was analyzed, baseline data was collected, and two Plan-Do-Study-Act cycles were performed on consecutive days. Average and maximal waiting-time were recorded across six operation theatre days.

RESULTS

The average and maximal waiting time at baseline were 221 and 390 minutes, respectively. After two rapid Plan-Do-Study-Act cycles, these were reduced to 29 (87% reduction) and 52 minutes (87% reduction) from baseline, respectively, and could subsequently be sustained.

CONCLUSION

Preoperative waiting time in ophthalmic operation theatre was significantly reduced by simple process flow optimization, thereby improving quality of care.

Macular hole-associated retinal detachment in Best vitelliform dystrophy: Series of two cases and literature review

Two eyes of 2 patients with macular hole-associated retinal detachment in clinically diagnosed vitelliruptive stage of Best vitelliform dystrophy were surgically managed by 25-gauge sutureless pars plana vitrectomy, internal limiting membrane (ILM) peeling with inverted ILM flap, and short-acting (SF₆) gas tamponade. The patients were assessed with respect to best-corrected visual acuity, color fundus photographs, shortwave fundus autofluorescence, and swept source optical coherence tomography. Surgical intervention led to Type 1 closure of macular hole, resolution of retinal detachment, and improvement in vision in both patients.

Asymmetric Presentation of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) usually has symmetric presentation and progression between fellow eyes. In this retrospective review of records, asymmetric presentation was noted in 16 (3.9%) out of 410 babies over a period of one year. Management and final outcome differed in 10 and 11 infants respectively. ROP need not always be symmetric and may require variable management.

Bilateral proliferative retinopathy in B-cell acute lymphoblastic leukemia

A 4-year-old child with B-cell acute lymphoblastic leukemia presented with vitreous hemorrhage due to proliferative retinopathy in both eyes. Pars plana vitrectomy was performed in both eyes to clear nonresolving vitreous hemorrhage after systemic stabilization. Visual recovery was limited by the disc drag in the right eye and subfoveal exudation in the left eye. Etiopathogenesis and management of proliferative retinopathy in acute leukemias are discussed.

Anti-vascular endothelial growth factor (VEGF) drugs for treatment of retinopathy of prematurity

BACKGROUND

Vascular endothelial growth factor (VEGF) plays a key role in angiogenesis in foetal life. Researchers have recently attempted to use anti-VEGF agents for the treatment of retinopathy of prematurity (ROP), a vasoproliferative disorder. The safety and efficacy of these agents in preterm infants with ROP is currently uncertain.

OBJECTIVES

To evaluate the efficacy and safety of anti-VEGF drugs when used either as monotherapy, that is without concomitant cryotherapy or laser therapy, or in combination with planned cryo/laser therapy in preterm infants with type 1 ROP (defined as zone I any stage with plus disease, zone I stage 3 with or without plus disease, or zone II stage 2 or 3 with plus disease).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 11), MEDLINE (1966 to 11 December 2016), Embase (1980 to 11 December 2016), CINAHL (1982 to 11 December 2016), and conference proceedings.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials that evaluated the efficacy or safety of administration, or both, of anti-VEGF agents compared with conventional therapy in preterm infants with ROP.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane and Cochrane Neonatal methods for data collection and analysis. We used the GRADE approach to assess the quality of the evidence.

MAIN RESULTS

Six trials involving a total of 383 infants fulfilled the inclusion criteria. Five trials compared intravitreal bevacizumab (n = 4) or ranibizumab (n = 1) with conventional laser therapy (monotherapy), while the sixth study compared intravitreal pegaptanib plus conventional laser therapy with laser/cryotherapy (combination therapy).When used as monotherapy, bevacizumab/ranibizumab did not reduce the risk of complete or partial retinal detachment (3 studies; 272 infants; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.21 to 5.13; risk difference (RD) 0.00, 95% CI -0.04 to 0.04; very low-quality evidence), mortality before discharge (2 studies; 229 infants; RR 1.50, 95% CI 0.26 to 8.75), corneal opacity requiring corneal transplant (1 study; 286 eyes; RR 0.34, 95% CI 0.01 to 8.26), or lens opacity requiring cataract removal (3 studies; 544 eyes; RR 0.15, 95% CI 0.01 to 2.79). The risk of recurrence of ROP requiring retreatment also did not differ between groups (2 studies; 193 infants; RR 0.88, 95% CI 0.47 to 1.63; RD -0.02, 95% CI -0.12 to 0.07; very low-quality evidence). Subgroup analysis showed a significant reduction in the risk of recurrence in infants with zone I ROP (RR 0.15, 95% CI 0.04 to 0.62), but an increased risk of recurrence in infants with zone II ROP (RR 2.53, 95% CI 1.01 to 6.32). Pooled analysis of studies that reported eye-level outcomes also revealed significant increase in the risk of recurrence of ROP in the eyes that received bevacizumab (RR 5.36, 95% CI 1.22 to 23.50; RD 0.10, 95% CI 0.03 to 0.17). Infants who received intravitreal bevacizumab had a significantly lower risk of refractive errors (very high myopia) at 30 months of age (1 study; 211 eyes; RR 0.06, 95% CI 0.02 to 0.20; RD -0.40, 95% CI -0.50 to -0.30; low-quality evidence).When used in combination with laser therapy, intravitreal pegaptanib was found to reduce the risk of retinal detachment when compared to laser/cryotherapy alone (152 eyes; RR 0.26, 95% CI 0.12 to 0.55; RD -0.29, 95% CI -0.42 to -0.16; low-quality evidence). The incidence of recurrence of ROP by 55 weeks' postmenstrual age was also lower in the pegaptanib + laser therapy group (76 infants; RR 0.29, 95% CI 0.12 to 0.7; RD -0.35, 95% CI -0.55 to -0.16; low-quality evidence). There was no difference in the risk of perioperative retinal haemorrhages between the two groups (152 eyes; RR 0.62, 95% CI 0.24 to 1.56; RD -0.05, 95% CI -0.16 to 0.05; very low-quality evidence). However, the risk of delayed systemic adverse effects with any of the three anti-VEGF drugs is not known.

AUTHORS' CONCLUSIONS

Implications for practice: Intravitreal bevacizumab/ranibizumab, when used as monotherapy, reduces the risk of refractive errors during childhood but does not reduce the risk of retinal detachment or recurrence of ROP in infants with type 1 ROP. While the intervention might reduce the risk of recurrence of ROP in infants with zone I ROP, it can potentially result in higher risk of recurrence requiring retreatment in those with zone II ROP. Intravitreal pegaptanib, when used in conjunction with laser therapy, reduces the risk of retinal detachment as well as the recurrence of ROP in infants with type 1 ROP. However, the quality of the evidence was very low to low for most outcomes due to risk of detection bias and other biases. The effects on other critical outcomes and, more importantly, the long-term systemic adverse effects of the drugs are not known. Insufficient data precludes strong conclusions favouring routine use of intravitreal anti-VEGF agents - either as monotherapy or in conjunction with laser therapy - in preterm infants with type 1 ROP.

IMPLICATIONS FOR RESEARCH

Further studies are needed to evaluate the effect of anti-VEGF agents on structural and functional outcomes in childhood and delayed systemic effects including adverse neurodevelopmental outcomes.

Epiretinal membrane development after submacular perfluorocarbon liquid removal

Optical coherence tomography of submacular perfluorocarbon liquid and its safe removal with a small gauge cannula have been presented in the report. This case was complicated by development of an epiretinal membrane, though visual acuity was preserved.

Prospects and applications near ferroelectric quantum phase transitions: a key issues review

The emergence of complex and fascinating states of quantum matter in the neighborhood of zero temperature phase transitions suggests that such quantum phenomena should be studied in a variety of settings. Advanced technologies of the future may be fabricated from materials where the cooperative behavior of charge, spin and current can be manipulated at cryogenic temperatures. The progagating lattice dynamics of displacive ferroelectrics make them appealing for the study of quantum critical phenomena that is characterized by both space- and time-dependent quantities. In this key issues article we aim to provide a self-contained overview of ferroelectrics near quantum phase transitions. Unlike most magnetic cases, the ferroelectric quantum critical point can be tuned experimentally to reside at, above or below its upper critical dimension; this feature allows for detailed interplay between experiment and theory using both scaling and self-consistent field models. Empirically the sensitivity of the ferroelectric T _c's to external and to chemical pressure gives practical access to a broad range of temperature behavior over several hundreds of Kelvin. Additional degrees of freedom like charge and spin can be added and characterized systematically. Satellite memories, electrocaloric cooling and low-loss phased-array radar are among possible applications of low-temperature ferroelectrics. We end with open questions for future research that include textured polarization states and unusual forms of superconductivity that remain to be understood theoretically.

A radio counterpart to a neutron star merger

Gravitational waves have been detected from a binary neutron star merger event, GW170817. The detection of electromagnetic radiation from the same source has shown that the merger occurred in the outskirts of the galaxy NGC 4993, at a distance of 40 megaparsecs from Earth. We report the detection of a counterpart radio source that appears 16 days after the event, allowing us to diagnose the energetics and environment of the merger. The observed radio emission can be explained by either a collimated ultrarelativistic jet, viewed off-axis, or a cocoon of mildly relativistic ejecta. Within 100 days of the merger, the radio light curves will enable observers to distinguish between these models, and the angular velocity and geometry of the debris will be directly measurable by very long baseline interferometry.

Cysticercosis of the eye

Cysticercosis is a preventable and eradicable cause of blindness endemic in the Indian subcontinent, South-East Asia and other developing countries. Ocular and orbital cysticercosis has varied presentations depending upon the site of involvement, number of lesion and the host immune response. In this article we present a review of the various clinical manifestations, diagnosis and management protocol for orbital and ocular cysticercosis. Owing to its varied presentation, cysticercosis may pose a diagnostic challenge to the health professionals. Early diagnosis and management can prevent the vision loss and optimize visual outcomes.