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Ophthalmology. Retina Jun 2024
Re: Fujimoto et al.: Macular retinoschisis from optic disc without a visible optic pit or advanced glaucomatous cupping (no optic pit retinoschisis [NOPIR]). (Ophthalmol Retina. 2023;7:811-818).
Topics: Humans; Optic Disk; Retinoschisis; Tomography, Optical Coherence; Macula Lutea; Glaucoma
PubMed: 38466256
DOI: 10.1016/j.oret.2024.02.005 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied...
[Analysis of the therapeutic efficacy of pars plana vitrectomy without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis and central foveal detachment].
To investigate the efficacy of pars plana vitrectomy (PPV) without intraocular tamponade in the treatment of high myopic eyes with myopic foveoschisis (MF) accompanied by foveal detachment (FD). A retrospective case series study was conducted. The medical records of patients diagnosed with unilateral MF accompanied by FD at the Eye & ENT Hospital of Fudan University between May 2018 and December 2021 were collected. All patients underwent 23-gauge PPV with posterior vitreous cortex clearance, and no intraocular tamponade was applied. The cases were divided into groups based on whether the internal limiting membrane was peeled during surgery or retained. Follow-up was conducted for at least 12 months. The main outcome measures included postoperative best-corrected visual acuity (BCVA, converted to logarithm of the minimum angle of resolution), central foveal thickness (CFT), MF resolution, and complications. Statistical analyses were performed using -tests, chi-square tests, Fisher's exact tests, and univariate and multivariate linear regression. A total of 40 patients (40 eyes) with MF and FD were included in the study, with 30.0% being male and 70.0% female. The mean age was (56.9±11.7) years, and the axial length of the eyes was (29.1±1.9) mm. At 12 months postoperatively, BCVA improved from baseline 1.15±0.58 to 0.73±0.39 (=6.11, <0.001), and CFT decreased from baseline (610.1±207.2) μm to (155.9±104.1) μm (=13.47, <0.001). Complete resolution of MF with foveal reattachment was observed in 80.0% of eyes, with a median time of 6 (5, 8) months. There was no significant difference in BCVA and CFT between the internal limiting membrane peeled group and retained group [0.68±0.39 0.79±0.40, =0.85, =0.403; (148.3±63.8)(164.3±137.2)um,=0.48, =0.634]. One eye experienced macular hole and another eye developed retinal detachment postoperatively. Correlation analysis showed a positive correlation between BCVA at 12 months postoperatively and baseline BCVA (=0.433, <0.001). Pars plana vitrectomy without intraocular tamponade is effective in treating MF accompanied by FD. The choice between internal limiting membrane peeling and retention does not significantly affect visual prognosis.
Topics: Humans; Male; Female; Middle Aged; Aged; Vitrectomy; Myopia, Degenerative; Retrospective Studies; Retinoschisis; Tomography, Optical Coherence; Basement Membrane; Visual Acuity; Retinal Detachment; Retinal Perforations
PubMed: 38462371
DOI: 10.3760/cma.j.cn112142-20231019-00155 -
[Zhonghua Yan Ke Za Zhi] Chinese... Mar 2024Myopic maculopathy is the primary cause of irreversible visual impairment in patients with pathologic myopia, and myopic traction maculopathy often requires vitrectomy...
Myopic maculopathy is the primary cause of irreversible visual impairment in patients with pathologic myopia, and myopic traction maculopathy often requires vitrectomy for treatment. Myopic traction maculopathy encompasses epiretinal membrane, foveoschisis, macular hole, and macular hole-related retinal detachment. It is recommended to perform vitrectomy combined with inner limiting membrane peeling for Type II epiretinal membrane, foveal-sparing inner limiting membrane peeling for foveoschisis, inverted inner limiting membrane flap technique for macular hole, and vitrectomy combined with macular buckle for refractory macular hole-related retinal detachment. Myopic traction maculopathy is a chronically progressive condition, and surgeons need to accurately determine the timing of surgery and choose appropriate procedures to maximize the benefits for patients.
Topics: Humans; Retinal Detachment; Retinal Perforations; Epiretinal Membrane; Vitrectomy; Traction; Myopia, Degenerative; Visual Acuity; Retinoschisis; Macular Degeneration; Tomography, Optical Coherence; Retrospective Studies
PubMed: 38462367
DOI: 10.3760/cma.j.cn112142-20231221-00299 -
Expert Opinion on Drug Metabolism &... Mar 2024Carbonic anhydrases (CAs, EC 4.2.1.1) have been established drug targets for decades, with their inhibitors and activators possessing relevant pharmacological activity... (Review)
Review
INTRODUCTION
Carbonic anhydrases (CAs, EC 4.2.1.1) have been established drug targets for decades, with their inhibitors and activators possessing relevant pharmacological activity and applications in various fields. At least 11 sulfonamides/sulfamates are clinically used as diuretics, antiglaucoma, antiepileptic, or antiobesity agents and one derivative, SLC-0111, is in clinical trials as antitumor/antimetastatic agent. The activators were less investigated with no clinically used agent.
AREAS COVERED
Drug interactions between CA inhibitors/activators and various other agents are reviewed in publications from the period March 2020 - January 2024.
EXPERT OPINION
Drug interactions involving these agents revealed several interesting findings. Acetazolamide plus loop diuretics is highy effective in acute decompensated heart failure, whereas ocular diseases such as X-linked retinoschisis and macular edema were treated by acetazolamide plus bevacizumab or topical NSAIDs. Potent anti-infective effects of acetazolamide and other CAIs, alone or in combination with other agents were demonstrated for the management of , vancomycin resistant enterococci, , and infections. Topiramate, in combination with phentermine is incresingly used for the management of obesity, whereas zonisamide plus levodopa is highly effective for Parkinson's disease. Acetazolamide, methazolamide, ethoxzolamide, and SLC-0111 showed synergistic antitumor/antimetastatic action in combination with many other antitumor drugs.
Topics: Humans; Carbonic Anhydrase Inhibitors; Acetazolamide; Sulfonamides; Drug Interactions; Antineoplastic Agents; Structure-Activity Relationship; Phenylurea Compounds
PubMed: 38450431
DOI: 10.1080/17425255.2024.2328152 -
BMC Ophthalmology Mar 2024Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myopic traction maculopathy (MTM) is a complication of pathological myopia and encompasses various pathological conditions caused by tractional changes in the eye. These changes include retinoschisis, foveal retinal detachment, and lamellar or full-thickness macular holes (FTMHs). This meta-analysis evaluated the safety and efficacy of novel surgical for treating MTM.
METHODS
To compare the outcomes of different surgical approaches for MTM, multiple databases, including Web of Science, PubMed, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and the Meta-Register of Controlled Trials, were comprehensively searched. The meta-analysis was performed using RevMan 5.1.
RESULTS
Nine comparative studies involving 350 eyes were included in this meta-analysis. There were significant differences between fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane peeling (ILMP). Preoperative best-corrected visual acuity BCVA (standard mean difference (SMD): -0.10, 95% CI: -0.32 to 0.12) and central foveal thickness CFT (SMD: 0.05, 95% CI: -0.22 to 0.33) were not significantly different (p = 0.39 and p = 0.71, respectively). However, the postoperative BCVA improved significantly (SMD = - 0.47, 95% CI: - 0.80, - 0.14, p = 0.006) in the FSIP group compared to the standard ILMP group. Postoperative CFT did not differ significantly between the two groups (p = 0.62). The FSIP group had a greater anatomical success rate than the other groups, although the difference was not statistically significant (p = 0.26). The incidence of postoperative macular hole formation was significantly lower (OR = 0.19, 95% CI = 0.07-0.54; p = 0.05) in the FSIP group than in the standard ILMP group. The unique characteristics of highly myopic eyes, such as increased axial length and structural changes, may have contributed to the greater incidence of FTMH in the ILMP group.
CONCLUSION
Based on the findings of this meta-analysis, FSIP is the initial surgical approach for early-stage MTM and has shown promising outcomes. However, to establish the safest and most efficient surgical technique for treating different MTM stages, further comparative studies, specifically those focusing on ILMP and FSIP, are necessary.
TRIAL REGISTRATION
Retrospectively registered.
Topics: Humans; Fovea Centralis; Macular Degeneration; Myopia, Degenerative; Retinal Detachment; Retinal Perforations
PubMed: 38443856
DOI: 10.1186/s12886-024-03374-0 -
Scientific Reports Mar 2024We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case...
We evaluated the distribution and types of retinal hemorrhages (RHs) and other damages in eyes with abusive head trauma (AHT). This retrospective, consecutive case series of AHT and non-AHT conditions involved 54 children with AHT, 43 children with head bruises, and 49 children with blunt eye trauma, each of non-AHT supported by reliable witness accounts. RHs and other damage were evaluated using ophthalmoscopy and wide-field fundus photography. A variety of RH types and other damage were identified in the AHT group but not in the non-AHT group. RHs in AHT extended from the posterior pole to the far periphery in 77% of eyes and on/near the veins in 86% and arteries in 85%, most of which were in the far periphery. Retinoschisis, white-dot lesions, and retinal folds were seen even in the far periphery. RHs on/near the veins and arteries, retinoschisis, and retinal folds suggest a traumatic mechanism of the tractional force of the vitreous that is attached to the entire retinal surface. Identifying the distribution and arterio and venous origins of RHs is a key factor in determining the association with trauma. Thus, wide-field fundus photography is useful to record and evaluate the origin of the RHs and other retinal damage.
Topics: Child; Humans; Retinal Hemorrhage; Retinoschisis; Retrospective Studies; Craniocerebral Trauma; Retinal Diseases; Eye Injuries; Retina
PubMed: 38438406
DOI: 10.1038/s41598-024-54664-y -
Medical Physics Mar 2024Deep learning based optical coherence tomography (OCT) segmentation methods have achieved excellent results, allowing quantitative analysis of large-scale data. However,...
BACKGROUND
Deep learning based optical coherence tomography (OCT) segmentation methods have achieved excellent results, allowing quantitative analysis of large-scale data. However, OCT images are often acquired by different devices or under different imaging protocols, which leads to serious domain shift problem. This in turn results in performance degradation of segmentation models.
PURPOSE
Aiming at the domain shift problem, we propose a two-stage adversarial learning based network (TSANet) that accomplishes unsupervised cross-domain OCT segmentation.
METHODS
In the first stage, a Fourier transform based approach is adopted to reduce image style differences from the image level. Then, adversarial learning networks, including a segmenter and a discriminator, are designed to achieve inter-domain consistency in the segmentation output. In the second stage, pseudo labels of selected unlabeled target domain training data are used to fine-tune the segmenter, which further improves its generalization capability. The proposed method was tested on cross-domain datasets for choroid or retinoschisis segmentation tasks. For choroid segmentation, the model was trained on 400 images and validated on 100 images from the source domain, and then trained on 1320 unlabeled images and tested on 330 images from target domain I, and also trained on 400 unlabeled images and tested on 200 images from target domain II. For retinoschisis segmentation, the model was trained on 1284 images and validated on 312 images from the source domain, and then trained on 1024 unlabeled images and tested on 200 images from the target domain.
RESULTS
The proposed method achieved significantly improved results over that without domain adaptation, with improvement of 8.34%, 55.82% and 3.53% in intersection over union (IoU) respectively for the three test sets. The performance is better than some state-of-the-art domain adaptation methods.
CONCLUSIONS
The proposed TSANet, with image level adaptation, feature level adaptation and pseudo-label based fine-tuning, achieved excellent cross-domain generalization. This alleviates the burden of obtaining additional manual labels when adapting the deep learning model to new OCT data.
PubMed: 38426594
DOI: 10.1002/mp.17012 -
European Journal of Ophthalmology Feb 2024To report the long-term anatomical and functional results of macular buckle for Myopic Traction Maculopathy (MTM) in stages 3a, 3b, 4a, and 4b according to the MTM...
PURPOSE
To report the long-term anatomical and functional results of macular buckle for Myopic Traction Maculopathy (MTM) in stages 3a, 3b, 4a, and 4b according to the MTM Staging System (MSS).
METHODS
Retrospective observational cohort study involving 55 consecutive patients with MTM in stages 3a, 3b, 4a, and 4b who underwent macular buckle (MB). Postoperative outcomes, including optical coherence tomography (OCT) scans to evaluate the MTM stage and its progression, were evaluated 1-month postoperatively (i.e., "intermediate follow-up") and at last follow-up ranging between 6 and 156 months postoperatively (i.e., "final follow-up").
RESULTS
Fifty-five eyes affected by MTM who underwent MB were enrolled. The mean preoperative and postoperative axial length was 31.13 ± 2.14 and 29.73 ± 2.16 mm, respectively (p < 0.01), with a mean axial shift of 1.32 ± 0.77 mm. The mean sample best corrected visual acuity (BCVA) at baseline, intermediate, and final follow-ups was 0.87 ± 0.36, 0.73 ± 0.31, 0.41 ± 0.32 logMar, respectively (p < 0.01). Foveal and retinal anatomical improvements were achieved in 50 (91%) and 53 (96.4%) eyes at intermediate follow-up, respectively. In the final follow-up, 54 (98.2%) and 55 (100%) eyes showed foveal and retinal anatomical improvements, respectively.
CONCLUSIONS
MB as a single procedure, when applied to MTM in stages 3a, 3b, 4a, and 4b, leads to significant anatomical and functional improvement. The MTM Staging System allows us to evaluate the best surgical technique and the surgical timing tailored to the different stages to increase the surgery's success and lower the complications of each technique.
PubMed: 38419477
DOI: 10.1177/11206721241234958 -
Frontiers in Medicine 2024X-linked retinoschisis (XLRS), due to loss-of-function mutations in the retinoschisin () gene, is characterized by a modest to severe decrease in visual acuity. Clinical...
PURPOSE
X-linked retinoschisis (XLRS), due to loss-of-function mutations in the retinoschisin () gene, is characterized by a modest to severe decrease in visual acuity. Clinical trials for XLRS utilizing intravitreal (IVT) gene therapy showed ocular inflammation. We conducted a subretinal dose-response preclinical study using rAAV2tYF-CB-h utilizing the knockout (-KO) mouse to investigate short- and long-term retinal rescue after subretinal gene delivery.
METHODS
-KO mice were subretinally injected with 2 μL of rAAV2tYF-CB-h vector with 8E9 viral genomes (vg)/eye, 8E8 vg/eye, 8E7 vg/eye, or sham injection, and compared to untreated eyes. Reconstitution of human RS1 protein was detected using western blotting. Analysis of retinal function by electroretinography (ERG) and structural analysis by optical coherence tomography (OCT) were performed at 1, 2, 3, 5, 7, and 12 months post injection (MPI). Immunohistochemistry (IHC) was performed to evaluate cone rescue on the cellular level. Functional vision was evaluated using a visually guided swim assay (VGSA).
RESULTS
Western blotting analysis showed human RS1 protein expression in a dose-dependent manner. Quantification of western blotting showed that the RS1 protein expression in mice treated with the 8E8 vg dose was near the wild-type (WT) expression levels. ERG demonstrated dose-dependent effects: At 1 MPI the 8E8 vg dose treated eyes had higher light-adapted (LA) ERG amplitudes in 3.0 flash and 5 Hz flicker compared to untreated ( < 0.0001) and sham-treated eyes ( < 0.0001) which persisted until the 12 MPI endpoint, consistent with improved cone function. ERG b-wave amplitudes were higher in response to dark-adapted (DA) 0.01 dim flash and 3.0 standard combined response (SCR) compared to sham-treated ( < 0.01) and untreated eyes ( < 0.001) which persisted until 3 MPI, suggesting short-term improvement of the rod photoreceptors. All injections, including sham-treated, resulted in a cyst severity score of 1 (no cavities), with significant reductions compared to untreated eyes up to 3 MPI ( < 0.05). The high and low dose groups showed inconsistent ERG improvements, despite reduced cyst severity, emphasizing the dose-dependent nature of gene augmentation's efficacy and the tenuous connection between cyst reduction and ERG improvement. IHC data showed a significant cone rescue in eyes treated with the 8E8 vg dose compared to sham-treated and untreated eyes. VGSA showed better functional vision in 8E8 vg dose treated mice. Eyes treated with the highest dose showed occasional localized degeneration in the outer nuclear layer.
CONCLUSION
Our data suggest that a dose of 8E8 vg/eye subretinally improves retinal function and structure in the -KO mouse. It improves cone function, rod function, and reduces cyst severity. Sham treatment resolves schisis cysts, but 8E8 vg/eye is needed for optimal retinal electrical function rescue. These findings offer a promising path for clinical translation to human trials.
PubMed: 38414621
DOI: 10.3389/fmed.2024.1304819 -
Graefe's Archive For Clinical and... Feb 2024Lamellar macular holes (LMHs) are a manifestation of myopic tractional maculopathy (MTM). Owing to the complex and multidirectional traction force in the elongated... (Review)
Review
Lamellar macular holes (LMHs) are a manifestation of myopic tractional maculopathy (MTM). Owing to the complex and multidirectional traction force in the elongated eyeball, the clinical features, development, evolution, and treatment algorithms of LMH in highly myopic eyes may differ from those of idiopathic LMH or MTM in general. This review aimed to specifically explore the LMHs in highly myopic eyes. Several developmental processes of LMH and their association with macular retinoschisis have been demonstrated, with the tractional component identified in all processes. Epiretinal proliferation was more prevalent and more extensive in LMHs in highly myopic eyes than in idiopathic LMHs. LMHs in highly myopic eyes may remain stable or progress to foveal detachment and full-thickness macular hole with or without retinal detachment. The predictive factors associated with disease progression were summarized to facilitate monitoring and guide surgical intervention. The treatment of LMHs in highly myopic eyes was based on an algorithm for treating myopic tractional maculopathy, including gas tamponade, pars plana vitrectomy, macular buckling, and a combination of vitrectomy and macular buckling. New internal limiting membrane (ILM) manipulation techniques such as fovea-sparing ILM peeling or fovea-sparing ILM peeling combined with ILM flap insertion could reduce the risk of developing iatrogenic full-thickness macular holes postoperatively. Further research should focus on the treatment of LMH in highly myopic eyes.
PubMed: 38407591
DOI: 10.1007/s00417-024-06419-8