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Tetsumoto A, Imai H, Otsuka K, Matsumiya W, Miki A, Nakamura M. Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment. Jpn J Ophthalmol 2019; 63:317-321. [PMID: 31104165 DOI: 10.1007/s10384-019-00672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the perioperative clinical factors, which contribute to the postsurgical aqueous flare intensity (AFI) following 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD). STUDY DESIGN Retrospective clinical study. METHODS We performed retrospective analyses of the medical records of 47 eyes of 47 patients with primary RRD who had undergone 27GPPV with a wide-angle viewing system. AFI was measured preoperatively and 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery. RESULTS AFI was significantly increased 1 week after the surgery (p<0.01) and then decreased overtime. At 6 months after surgery it was still statistically significantly higher than preoperative AFI (p=0.03). There was no statistical difference between preoperative AFI and that at 12 months following surgery. Multiple regression analyses revealed that the number of retinal photocoagulations and the performance of scleral indentation had significant positive correlation with AFI at 1 week, 1 month, 3 months, and 6 months, and at 1 month and 3 months after the surgery, respectively. CONCLUSION Intraoperative retinal photocoagulation and scleral indentation are probable causes of increased AFI after 27G PPV for RRD.
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Affiliation(s)
- Akira Tetsumoto
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hisanori Imai
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Keiko Otsuka
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Wataru Matsumiya
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akiko Miki
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery-Related, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Sawa M. Laser flare-cell photometer: principle and significance in clinical and basic ophthalmology. Jpn J Ophthalmol 2016; 61:21-42. [PMID: 27888376 DOI: 10.1007/s10384-016-0488-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 12/19/2022]
Abstract
A slit-lamp examination is an indispensable and essential clinical evaluation method in ophthalmology, but, it is qualitative subjective. To complement its weaknesses in making a quantitative evaluation of flare intensity and number of cells in the aqueous humor in the eye, we invented the laser flare-cell photometer in 1988. The instrument enables a non-invasive quantitative evaluation of flare intensity and number of cells in the aqueous with good accuracy and repeatability as well as maneuverability equal to slit-lamp microscopy. The instrument can elucidate the pathophysiology in the blood-aqueous barrier (BAB) function in a variety of ocular disorders. The accuracy of the instrument makes it possible to investigate not only the pathophysiology of intraocular disorders but also the effects of various drugs and surgical procedures in BAB. The instrument does not only lighten the burden on patients in clinical examinations and study but it also helps minimize the sacrifice of experimental animals and improves the reliability of the results by minimizing inter-individual variations through its good repeatability. Here I shall relate how the instrument has been applied to clinical and basic studies in ophthalmology and what novel knowledge its application contributed to pathophysiology in ophthalmology.
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Affiliation(s)
- Mitsuru Sawa
- Public Interest Incorporated Foundation Isshinkai, 3-37-8 Hongo, Bunkyo, Tokyo, 113-0033, Japan. .,Emeritus Professor, Nihon University, Tokyo, Japan.
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Hwang HS, Ahn YJ, Lee HJ, Kim MS, Kim EC. Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery. Acta Ophthalmol 2016; 94:e189-94. [PMID: 25828946 DOI: 10.1111/aos.12716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/11/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare the macular thickness and volume change, and inflammatory cytokine levels after cataract surgery performed using two different sizes of incision (microincision versus small incision). METHODS In this randomized, comparative clinical trial, 84 eyes with nuclear density from Grade 3-4 were randomly divided into two groups (microincision, 2.2 mm; and small incision, 2.75 mm). Forty-two patients underwent phacoemulsification with microincision coaxial cataract surgery and 42 patients underwent phacoemulsification with small incision coaxial cataract surgery. Clinical measurements included preoperative, 1-week, 1-month and 2-month postoperative best corrected visual acuity, central corneal thickness (CCT) and endothelial cell count. ELISA and RT-PCR were performed for IL-1β, IL-6, VEGF and PGE2 preoperatively and at 1 week postoperatively. RESULTS The percentage increase in CCT in the microincision group was significantly higher than that in the small incision group at 1 week after cataract surgery (p = 0.01). The increase in macular thickness in the microincision group was significantly higher than that in small incision group at 1 month after cataract operation (p = 0.04). Also, IL-1β, IL-6, VEGF and PGE2 concentrations and their expression ratio in the microincision group were significantly higher than those in the small incision group at 1 week after cataract surgery compared to the preoperative period (p < 0.05). CONCLUSIONS Phacoemulsification with microincision coaxial cataract surgery may increase the macular thickness compared to phacoemulsification with small incision coaxial cataract surgery. Blood-aqueous barrier breakdown may occur more frequently after microincision cataract surgery than after small incision cataract surgery.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology; Chuncheon Sacred Heart Hospital; College of Medicine; Hallym University; Chuncheon Korea
| | - Ye Jin Ahn
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Hee Jin Lee
- Institute of Clinical Medicine Research; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Man Soo Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
| | - Eun Chul Kim
- Department of Ophthalmology & Visual Science; College of Medicine; Catholic University of Korea; Seoul Korea
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Time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment. Retina 2013; 32:1862-7. [PMID: 22466487 DOI: 10.1097/iae.0b013e3182456f38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the time course of changes in aqueous flare intensity after vitrectomy for rhegmatogenous retinal detachment (RD) and to determine the clinical factors related to an increase in aqueous flare. METHODS The present study included 22 unilateral patients with RD undergoing primary 20-gauge vitrectomy. Aqueous flare intensity was measured preoperatively and at 1 week, 2 weeks, 1 month, and 3, 6, and 12 months postoperatively using the laser flare meter. RESULTS Before vitrectomy, aqueous flare intensity was significantly higher in eyes with RD than in contralateral normal eyes. Vitrectomy increased aqueous flare intensity, and the peak was observed at the first postoperative week. Aqueous flare intensity decreased to a stable level at 3 months postoperatively but remained significantly higher than that of contralateral and preoperative eyes throughout the observation period. Clinical factors that were found to be significantly correlated with an increase in aqueous flare intensity included 1) before the surgical procedure: extent of RD and intraocular pressure, and 2) 3 months postoperatively: size of retinal breaks, number of laser photocoagulation spots, operation time, and performance of combined cataract surgery. Multiple regression analysis revealed that aqueous flare intensity at 3 months postoperatively had significant correlation with the size of retinal breaks (P < 0.005) and the number of laser photocoagulation spots (P < 0.05). CONCLUSION Aqueous flare intensity after vitrectomy for RD decreased to a stable level at 3 months postoperatively but remained significantly higher than the normal level. The size of retinal breaks and the degree of surgical invasion were associated with the increase in aqueous flare.
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Ben Simon GJ, Kenet G, Spierer A. Fibrinoid reaction after lens extraction in rabbit eyes. J Cataract Refract Surg 2012; 38:890-3. [DOI: 10.1016/j.jcrs.2011.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/29/2011] [Accepted: 12/02/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Guy J Ben Simon
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
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Chen MS, Chang CC, Lin CP, Wang PC, Lin LR, Hou PK, Ho TC. Role of vascular endothelial growth factor in the breakdown of the blood-aqueous barrier after retinal laser photocoagulation in pigmented rabbits. J Ocul Pharmacol Ther 2011; 28:83-8. [PMID: 22011077 DOI: 10.1089/jop.2011.0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Retinal laser photocoagulation is used to treat a variety of retinal diseases. Breakdown of the blood-aqueous barrier has been noted after retinal laser photocoagulation. The effect of vascular endothelial growth factor (VEGF) on the function of the blood-aqueous barrier after retinal laser photocoagulation remains undetermined. The current study was designed to evaluate the relationship between intraocular levels of VEGF and breakdown of the blood-aqueous barrier after retinal laser photocoagulation in rabbits. METHODS Pigmented rabbits were treated with retinal laser photocoagulation in one eye; the other served as control. Laser flare photometry was carried out on post-treatment days 1, 3, 7, and 14. Animals were sacrificed at the time period just mentioned postlaser, the eyes were removed, and samples of vitreous and aqueous humor were collected. Intraocular VEGF levels were measured by using an immunoassay. An intravitreal injection of VEGF was administered, and the aqueous flare intensity and VEGF levels in the aqueous and vitreous humor were measured at the time periods just mentioned. RESULTS A significant increase in the aqueous flare intensity after retinal laser photocoagulation was noticed on postoperative day 1, with the values returning to baseline levels on day 14. The VEGF levels in the vitreous of the lasered eyes were significantly increased on day 1 compared with the nonlasered control eyes. The VEGF levels in the aqueous humor of the lasered eyes were also significantly increased on day 1 compared with the control eyes. An intravitreal injection of VEGF induced a significant increase in the aqueous flare intensity and VEGF levels in the aqueous and vitreous humor. CONCLUSIONS The current results suggested that retinal laser photocoagulation can produce a breakdown of the blood-aqueous barrier. VEGF may play a role in the blood-aqueous barrier dysfunction after retinal laser photocoagulation.
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Affiliation(s)
- Muh-Shy Chen
- Department of Ophthalmology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Bali E, Feron EJ, Peperkamp E, Veckeneer M, Mulder PG, van Meurs JC. Response to: The effect of a preoperative subconjunctival injection of dexamethasone on bloodretinal barrier breakdown following scleral buckling retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2011. [PMCID: PMC3026770 DOI: 10.1007/s00417-010-1412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ernesto Bali
- The Rotterdam Eye Hospital and Erasmus Medical Center Rotterdam, 3011 BH Rotterdam, The Netherlands
| | - Eric J. Feron
- The Rotterdam Eye Hospital and Erasmus Medical Center Rotterdam, 3011 BH Rotterdam, The Netherlands
| | - Ed Peperkamp
- The Rotterdam Eye Hospital and Erasmus Medical Center Rotterdam, 3011 BH Rotterdam, The Netherlands
| | - Marc Veckeneer
- The Rotterdam Eye Hospital and Erasmus Medical Center Rotterdam, 3011 BH Rotterdam, The Netherlands
| | - Paul G. Mulder
- Department of Biostatistics, Erasmus University, Rotterdam, The Netherlands
| | - Jan C. van Meurs
- The Rotterdam Eye Hospital and Erasmus Medical Center Rotterdam, 3011 BH Rotterdam, The Netherlands
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The effect of a preoperative subconjunctival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery. Graefes Arch Clin Exp Ophthalmol 2011; 249:151-2; author reply 153. [PMID: 20473514 PMCID: PMC3026770 DOI: 10.1007/s00417-010-1408-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 05/02/2010] [Indexed: 12/14/2022] Open
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Foulds WS, Kaur C, Luu CD, Kek WK. A role for photoreceptors in retinal oedema and angiogenesis: an additional explanation for laser treatment? Eye (Lond) 2009; 24:918-26. [PMID: 19745837 DOI: 10.1038/eye.2009.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To investigate the possible roles of retinal photoreceptors in macular oedema and retinal angiogenesis with particular reference to the mode of action of laser therapy. METHODS (i) Studies in rats made hypoxic for 2 h by administering an oxygen/nitrogen mixture of reduced oxygen content, and growth factors determined by RT-PCR, western blotting, and immunohistochemistry. Assessment of blood-retinal barrier integrity using fluorescent and electron-dense tracers. (ii) Studies in pigs with one retina made hypoxic by selective embolisation of the retinal capillary circulation with fluorescent microspheres. (iii) Assessment of laser therapy in selected cases of retinal neovascularisation indicating a role for photoreceptors. RESULTS In the hypoxic retina, angiogenic and vascular permeability factors such as vascular endothelial growth factor (VEGF), nitric oxide synthases (NOSs), and insulin-like growth factor-1 are upregulated in retinal astrocytes and Müller cells but are also present in large amount in the photoreceptors. Hypoxia-inducible factor-1 (HIF-1) is upregulated in retinal glial cells but not in the photoreceptors, suggesting that growth factors in the photoreceptors may not have been generated there. The tracer dye, rhodium isothiocyanate, leaking from an abnormally permeable inner blood-retinal barrier in the hypoxic retina accumulates in the photoreceptors. CONCLUSIONS The results indicate that laser treatment of macular oedema or retinal neovascularisation may obtain its effect not only by improving oxygen availability in the inner retina, but also by reducing the load of angiogenic/permeability factors that accumulate in the photoreceptors in hypoxic/ischaemic conditions.
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Affiliation(s)
- W S Foulds
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
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Mocan MC, Kadayifcilar S, Eldem B. Elevated intravitreal interleukin-6 levels in patients with proliferative diabetic retinopathy. Can J Ophthalmol 2007; 41:747-52. [PMID: 17224958 DOI: 10.3129/i06-070] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND We conducted this study to elucidate the possible role of interleukin-6 (IL-6) in the pathogenesis of proliferative diabetic retinopathy (PDR). METHODS Together with pertinent clinical and laboratory data, intravitreal and serum concentrations of IL-6 were determined in 8 patients with PDR by means of enzyme-linked immunosorbent assay (ELISA). The results were compared with data from 8 nondiabetic control subjects undergoing vitrectomy. RESULTS Significantly higher intravitreal IL-6 concentrations were found in patients with PDR (mean [SD], 755 [177] pg/mL) compared with control subjects (93 [151] pg/mL) (p = 0.001). The serum IL-6 levels in the PDR group were lower than the measurable threshold of the ELISA kit (<0.16 pg/mL). Diabetic patients with macular edema had a higher mean (SD) level of intravitreal IL-6 (896 [73] pg/mL) compared with patients without macular edema (613 [119] pg/mL) (Mann-Whitney U test, p = 0.03). Correlation analysis did not reveal any significant association between intravitreal IL-6 levels and patient age, duration of either diabetes mellitus or vitreous hemorrhage, panretinal photocoagulation, type of current medical therapy, hyperglycemia, or the biochemical indicators of renal function. INTERPRETATION IL-6, a proinflammatory cytokine, may have a role in PDR. Intraocular production of IL-6 appears to be responsible for the elevated intravitreal levels observed.
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Affiliation(s)
- Mehmet C Mocan
- Department of Opthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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Eter N, Spitznas M, Sbeity Z, Vogel A. Evaluation of the blood–aqueous barrier by laser flare cell photometry following retinal cryocoagulation. Graefes Arch Clin Exp Ophthalmol 2003; 242:120-124. [PMID: 14658072 DOI: 10.1007/s00417-003-0806-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Revised: 10/09/2003] [Accepted: 10/24/2003] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the influence of peripheral 360 degrees retinal cryocoagulation on the blood-aqueous barrier of patients with retinal vascular disorders. METHODS The aqueous of 50 eyes of 50 patients with diabetic retinopathy or central vein occlusion was measured by laser flare photometry (FC-2000, Kowa) before peripheral 360 degrees retinal cryocoagulation and 1 day, 1 week, and 1 month thereafter. RESULTS Mean aqueous flare values before treatment were 15.7 (+/-8.2) photon counts/ms; mean cell count was 9.8 (+/-14.8) cells/0.5 mm(3). One day after retinal cryocoagulation flare values had increased statistically significantly to a mean of 39.2 (+/-85.8) photon counts/ms, while the increase in mean cell number to 15.0 (+/-37.2) cells/0.5 mm(3) did not reach statistical significance. One week following treatment, mean flare values had dropped to 30.9 (+/-49.6) photon counts/ms and were no longer significantly elevated compared with baseline, while the mean cell count of 11.1 (+/-27.0) cells/0.5 mm(3) was now statistically significantly elevated compared with baseline. One month after treatment the flare values had decreased to a mean of 19.7 (+/-12.0) photon counts/ms, and mean cell count had decreased to 8.1 (+/-10.4) cells/0.5 mm(3); at this point neither parameter showed a statistically significant difference from baseline values. CONCLUSION Peripheral 360 degrees retinocryocoagulation does not lead to permanent disturbance of the blood-aqueous barrier.
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Affiliation(s)
- Nicole Eter
- Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 , Bonn, Germany.
| | - Manfred Spitznas
- Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 , Bonn, Germany
| | - Zaher Sbeity
- Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 , Bonn, Germany
| | - Antje Vogel
- Department of Ophthalmology, University of Bonn Medical Center, Sigmund-Freud-Strasse 25, 53105 , Bonn, Germany
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