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Amantadine hydrochloride (HCl) is commonly prescribed for treating influenza A virus infection and Parkinson’s disease. Recently, several studies have indicated that the use of amantadine HCl is associated with corneal edema; however, the cytotoxic effect of amantadine HCl has not been investigated. In the present study, the effects of amantadine HCl on cell growth, proliferation, and apoptosis in bovine cornea endothelial cells, and in vitro endothelial permeability were examined. Results showed that lower doses of amantadine HCl do not affect cell growth (≤ 20 μΜ), whereas higher doses of amantadine HCl inhibits cell growth (≥ 50 μΜ), induces apoptosis (2000 μΜ), increases sub-G1 phase growth arrest (2000 μΜ), causes DNA damage (≥ 1000 μΜ), and induces endothelial hyperpermeability (≥ 1000 μΜ) in bovine cornea endothelial cells; additionally, we also found that amantadine HCl attenuates the proliferation (≥ 200 μΜ) and arrests cell cycle at G1 phase (≥ 200 μΜ) in bovine cornea endothelial cells. In the present study, we measured the cytotoxic doses of amantadine HCl on cornea endothelial cells, which might be applied in evaluating the association of corneal edema.

Rationale: Graft detachment and endothelial cell damages are 2 major concerns for cataract surgeries in cases after Descemet stripping automated endothelial keratoplasty (DSAEK). We invented a simple but innovative method to anchor the DSAEK graft with sutures during the surgery to avoid possible graft detachment. Patient concerns: We present a 59-year-old male who had done DSAEK surgery. Due to progressed blurry vision due to cataract, he underwent sequential cataract surgery 1 year after DSAEK surgery. We applied the method to the patient successfully and the result was satisfying. Diagnosis: Cataract post-DSAEK surgery. Interventions: At the beginning of surgery, we made 4 radial fixation sutures with Nylon 10-0 though cornea-DSAEK graft at paracentral point and then through limbus. The sutures were located at 45°, 135°, 225°, and 315°. At the end of surgery, 4 fixation sutures were removed. Outcomes: The DSAEK graft was kept well attached during and after the surgery. Only low-grade corneal edema was found postoperation. Lessons: We provide this special method and applied it to our patient successfully. By using our method, surgeons can reassure graft adhesion during and after surgery, especially for those need cataract surgery after DSAEK surgery.

Rationale: Descemet's membrane detachment (DMD) may occur during or following cataract surgery, causing corneal edema and visual loss1. The incidence of DMD after phacoemulsification surgery is only approximately 0.5%, and mostly surgical-related. Late onset bilateral spontaneous DMD after sequential uneventful cataract surgeries, is even rarer, and may result from not only surgery itself, but also from an underlying anatomic abnormality 2. Patient concerns: We present a 80 year old female developed bilateral descemet's membrane detachment after sequential uncomplicated cataract surgeries. Diagnosis: Bilateral Descemet's membrane detachment. Interventions: One eye (left eye) was treated with intracameral air injection and the fellow eye (right eye) was treated with medical treatment only. Outcomes: The DMDs were reattached in both eyes after treatment. Surgical intervention accelerated the duration of recovery and there were no significant outcome differences between the right and the left eye. Lessons: Even if there is a large area of DMD with visual axis involvement, conservative treatment with close observation might still provide a satisfactory result if Descemet's membrane is separated from the posterior corneal stroma by ≤1 mm.

Purpose. To investigate the morphological and functional outcomes of idiopathic epiretinal membrane (ERM) surgery between three different surgical techniques: ERM peeling only, whole-piece ILM peeling, and maculorrhexis ILM peeling. Patients and Methods. This is a retrospective, consecutive, and comparative study enrolling 60 patients from Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Surgery performed between July 2011 and June 2012 was done with ERM peeling only (group I). ERM peeling and ILM peeling as a whole piece (group II) were performed between July 2012 and July 2013. Surgery performed between August 2013 and December 2014 was done with maculorrhexis ILM peeling (group III). Main outcome measures include visual acuity change (BCVA) and central foveal thickness (CFT). Results. At 12 months postoperation, the mean BCVA in group III was significantly better than in group I and group II. Comparison of CFT reduction between the three groups revealed significantly more reduction in group III than in group II at all postoperative follow-up periods. Eyes with restoration of foveal depression were observed in 52.6% in group I, 52.4% in group III, but only 20% of eyes in group II. None of the eyes in both ILM peeling groups encountered recurrence of macular pucker formation. Conclusion. All three techniques can achieve visual acuity improvement and macular thickness reduction. Maculorrhexis ILM peeling achieves more rapid improvement of visual function, better final visual outcome, and a higher rate of normal foveal contour than whole-piece ILM peeling.

Purpose Myopic foveoschisis occurs in 9–34% of highly myopic eyes with posterior staphyloma. The pathogenesis is still not fully understood. But the relative inflexibility of the inner retina and a tangential traction induced inward traction force in the posterior staphyloma are possible mechanisms. Conventional internal limiting membrane (ILM) peeling generally yields good results. However, a postoperative full-thickness macular hole happens in 13–28% of cases. Therefore, this study describes a modified ILM peeling technique named ‘ILM maculorrhexis’ to minimize the occurrence of postoperative macular hole in patients with foveoschisis. Methods This retrospective case review that included 10 eyes of 10 consecutive patients who underwent vitrectomy with ILM maculorrhexis to treat myopic foveoschisis was studied. After surgery, complete ophthalmic examination and SD-optic coherence tomographic examinations were performed 1, 3, 6, 9 and 12 months postoperatively. Results After surgical intervention, the foveoschisis resolved dramatically in all 10 eyes. The mean central foveal thickness decreased significantly from 840 μ to 273 μ at 12 months postoperatively. Mean LogMAR best-corrected visual acuity improved from 1.04 preoperatively to 0.59 12 months postoperatively. After the follow-up time of at least 12 months, all 10 eyes remained fovea attached, and none of the 10 eyes developed macular hole. Conclusions This technique minimizes traction force over the extremely thinned foveal tissue in highly myopic eyes. In the long-term follow-up of at least 12 months, all 10 cases had good anatomic and visual results. But we still need a larger case number and longer follow-up for further evaluation.