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To determine the long-term anatomic outcomes and surgical complications of pars plana vitrectomy (PPV) and 4-point Gore-Tex-sutured Akreos AO60 intraocular lens (IOL) scleral fixation.Retrospective, multicenter, multisurgeon case series.Ninety-seven patients in tertiary eye care centers.The patients underwent PPV and intraocular fixation of the Akreos AO60 IOL using Gore-Tex CV-8 sutures between January 2015 and April 2020. The inclusion criteria were aphakia, no capsular support, and a minimal 1 year of follow-up.Uncorrected visual acuity (VA), complication rates or types, and refraction.Data from 101 eyes of the 97 patients were analyzed (mean follow-up duration, 33.4 months; range, 12-62 months). The mean ± standard deviation uncorrected logarithm of the minimum angle of resolution VA improved from 1.04 ± 0.73 (20/200 Snellen equivalent) before surgery to 0.66 ± 0.65 (20/80) at 6 months after surgery (P0.001). The most prevalent complications included hypotony (12.9%), ocular hypertension (12.9%), corneal edema (8.9%), cystoid macular edema (6.9%), and vitreous hemorrhage (5.9%). Refraction was measured between 3 and 6 months after surgery, and 61.8% of the patients had spherical equivalent of ± 2.0 diopters. Most complications occurred in the first postoperative month and resolved spontaneously or with medical treatment.The results demonstrated that this surgical technique is well tolerated by the eyes, with a low complication rate in the long term. The rates of IOL opacification were infrequent for up to 62 months of follow-up.

Synthetic hydrogels have been proposed as vitreous substitutes recently. This study aims to evaluate the biocompatibility of polyvinyl alcohol (PVA) crosslinked with trisodium trimetaphosphate (SMTP) hydrogel in rabbit vitrectomized eyes. Seven animals were submitted to pars plana vitrectomy and the vitreous was replaced by PVA/SMTP hydrogel. Optical coherence tomography, fluorescein angiogram, clinical, and electrophysiological (ERG) examinations were analyzed at baseline, on postoperative days 7 and 30. The fellow eye was used as the control group. Hydrogel opacification was observed and ERG recordings were reduced in the hydrogel group in rod response, b-wave cone response and flicker. A histological analysis showed retinal disorganization, presence of multinucleated cells, and intraretinal hydrogel particles. The PVA/SMTP hydrogel showed poor biocompatibility. Novel biomaterials compounds should be analyzed in vivo.

Hydrogels are polymeric materials with numerous medical and biological applications because of their physicochemical properties. In this context, the conditions were defined for obtaining a hydrogel with characteristics similar to the vitreous humor using polyvinyl alcohol (PVA) and trisodium trimetaphosphate (STMP). The concentration of PVA (X1 ), PVA/STMP ratio (X2 ), and initial pH (X3 ) were modified, and their effect was analyzed in terms of the refractive index (Y1 ), density (Y2 ), dynamic viscosity (Y3 ), and final pH (Y4 ). The results demonstrated that X1 interferes with Y1 , Y2 , and Y3 , and X2 interferes with Y2 and Y3 . The best condition for obtaining a hydrogel with characteristics similar to the vitreous humor was 4.2586% PVA (wt/wt), STMP/PVA ratio of 1:6.8213 (wt/wt), and initial pH of 9.424. DSC, ATR-FTIR, swelling degree, and AFM analysis confirmed the PVA reticulation with STMP. Furthermore, STMP increased the glass transition temperature and decreased the water uptake of ∼50% of the hydrogels, which can be explained by the crosslinking of PVA chains. Infrared spectroscopy revealed a decrease of hydroxyl bonds and confirmed the reticulation between PVA and STMP. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1386-1395, 2016.

Hydrogels are made from natural or synthetic polymers and, currently, they have many biomedical applications. In this work, the conditions for obtaining a hydrogel with similar physicochemical characteristics to the vitreous humor were defined using polyvinyl alcohol (PVA) and glutaraldehyde (GLUT) as cross-linker. The concentration of PVA and GLUT were modified, and their effect was analyzed in terms of the refractive index, density, and dynamic viscosity. The hydrogel which was obtained using 3.98% (w/V) of PVA, 3.13 mL (1.57 g) of GLUT in 100 mL, and the initial pH of 7.2 showed similar characteristics to the vitreous humor (density = 1.0174 ± 0.0050 g mL

Objetivo: Analisar as taxas de incidencia de neovascularizacao do segmento anterior (NSA) e de glaucoma neovascular (GNV), em pacientes com edema macular secundario a oclusao de veia central da retina (OVCR), em tratamento com injecoes intravitreas de triamcinolona (IVTA) ou bevacizumab (IVB). Metodos: Neste estudo prospectivo, randomizado, duplo mascarado e sham controlado, 35 pacientes com edema macular secundario a OVCR foram randomizados para IVB, IVTA ou para o grupo controle (sham), durante os 6 primeiros meses do estudo. O desfecho primario foi a taxa de incidencia de NSA no mes 6. Os desfechos secundarios foram alteracoes medias da acuidade visual corrigida (BCVA) e espessura foveal central (EFC) ao exame de tomografia de coerencia optica, ate o mes 12. Resultados: NSA ocorreu em oito (22,86%) olhos, cinco (62,50%) olhos no grupo sham e tres (37,50%) olhos no grupo tratado com injecoes intravitreas de Triamcinolona, Nao houve nenhum caso com NSA no grupo tratado com bevacizumab durante 12 meses de acompanhamento (p=0,009). A BCVA apresentou diferenca estatisticamente significante (p

To evaluate the in vivo and in vitro toxicity of sunitinib malate, a multikinase inhibitor molecule.Experimental, Prospective, Controlled.Human retinal pigment epithelial (ARPE-19) and human umbilical vein endothelialcells (HUVECS) were used in a culture toxicity test and exposed to different concentrations of sunitinib malate for 18 hours. The HUVECs also were cultured to evaluate the angiogenesis inhibitory effect of sunitinib malate. Fundus photography and angiographic, electrophysiologic, and histopathologic evaluations with light and electron microscopy were performed in two groups of five rabbits each that received different intravitreal concentrations of the drug. Each rabbit received 0.1 ml of sunitinib malate in the right eye (one group with 12.5 mg/ml, the other group with 25 mg/ml); all animals received 0.1 ml of physiologic saline solution in the left eye. After sacrifice, the eyes were enucleated and fixed with modified Karnovsky solution.No toxicity related to sunitinib malate was observed using an in vitro model with the 12.5 and 25 mg/ml solutions in HUVEC and ARPE cell cultures. No toxicity was observed in the in vivo model with 12.5 mg/ml, but light microscopy showed that the 25 mg/ml solution damaged the photoreceptors layer. No functional changes in the electroretinogram were observed in any group.Sunitinib malate 12.5 mg/ml caused no toxicity in in vivo and in vitro models, but the 25 mg/ml concentration caused retinal changes suggesting toxicity in the in vivo model. Further research with the drug is needed in models of ocular neovascularization.

Intravitreal injections are the standard technique applied in the treatment of some vitreoretinal diseases. In this paper the technique and complications of intravitreal injections are presented. In summary, the procedure involves various consecutive steps. Initially, days before the treatment topical antibiotics and acetazolamide may be prescribed for reduction of the ocular flora and intraocular pressure. Before the injection, the pupil should be dilated and topical anesthesia should be achieved. Injection shall be performed in the operating room under sterile conditions, the surgeon should wear surgical gloves and mask. The eye is then exposed with sterile blepharostat and sterile-drape thereby providing protection of the needle against the contact with contaminated lashes and lids. Injection is done 3.5 mm from the limbus through the pars plana. The needle should be inserted up to 6 mm into the vitreous cavity. Immediately after injection the patient must be examined by indirect ophthalmoscopy to verify central artery perfusion and complications as vitreous hemorrhage. Visual acuity better than light perception should be detected right after injection. If persistent central retinal artery occlusion is diagnosed, anterior chamber paracentesis should be performed. The patient may be discharged with an occlusive patch. Examination at the first postoperative day should exclude various complications such as endophthalmitis, and topical steroid and antibiotics should be prescribed for 7 days. Some complications encountered after intravitreal injections include retinal detachment, vitreous hemorrhage, cataract, uveitis, ocular hypertension, or endophthalmitis.

Objetivos: Estudos epidemiológicos recentes mostram que o uso de Cannabis sativa (maconha) durante a gravidez é cada vez mais frequente. Estudos experimentais evidenciam que o uso da maconha durante a gestação afeta o desenvolvimento fetal, peso ao nascer e o desenvolvimento infantil. Os receptores canabinoides estão presentes na retina de camundongos desde o nascimento. Os efeitos da exposição de gestantes à droga sobre a saúde fetal, especialmente sobre a retina em desenvolvimento, ainda não são bem compreendidos. Considerando que o período pré-natal é potencialmente sensível no desenvolvimento normal da retina, o objetivo deste estudo foi avaliar se os camundongos nascidos de mães expostas à fumaça da queima da Cannabis inalada durante a gestação apresentaram alterações morfológicas na retina ao longo da vida em comparação aos camundongos cujas mães não foram expostas à fumaça da queima da Cannabis. Métodos: Parâmetros biométricos fetais foram avaliados por ultrassonografia, dopplervelocimetria e testes comportamentais em neonatos e jovens adultos. A exposição das gestantes foi realizada através de um aparato para geração e inalação de fumaça capaz de mimetizar o uso recreacional de Cannabis em humanos. Dez fêmeas grávidas de camundongos BALB/c foram expostas à fumaça da queima de cigarros de Cannabis sativa a partir do 5,5° dia gestacional (DG) (fase pós implantacional) até o 17,5° DG (grupo Cannabis, CAN) e dez fêmeas foram expostas à inalação de ar filtrado (grupo controle, AF). Para avaliar as alterações estruturais in vivo da retina da prole, foram realizadas tomografia de coerência óptica de domínio espectral (Heildelberg Engineering, Alemanha) em 20 animais no 60º dia (camundongo adulto jovem), 120º, 200º e 360º dias pós-natal (DPN) (camundongo idoso) sob sedação. Trinta e sete camundongos de ambos os grupos foram sacrificados nos 20º, 60º ou 360º DPN para estereologia da retina (cálculo do volume fracionário das camadas da retina, volume de cada camada retiniana e volume total da retina) e microscopia de luz. Resultados: Os dados tomográficos mostraram que os animais do grupo CAN apresentaram diminuição de 17% na espessura total da retina no 120º DPN (p=0,005) quando comparados aos animais do grupo AF e essa diferença foi devida à redução de 21% na espessura na retina externa (p < 0,001). Na análise de cada camada da retina, os animais do grupo CAN apresentaram aumento na espessura da camada de segmentos internos e externos dos fotorreceptores em comparação ao grupo AF (p < 0,001). Na análise volumétrica pela estereologia da retina, os animais do grupo CAN apresentaram aumento de 89% do volume da camada de segmentos internos e externos dos fotorreceptores em relação ao grupo AF (p=0,001) e normalização no 360º DPN (p=0,001). Na análise da retina sob microscopia de luz, os animais do grupo CAN apresentaram espessamento de 64% na camada de segmentos internos e externos dos fotorreceptores no 360º DPN em relação ao grupo AF (p=0,041). Conclusão: A exposição materna durante a gestação à fumaça da queima da Cannabis sativa altera o desenvolvimento normal da retina da prole e esse efeito se mantém mesmo na fase adulta dos camundongos. Essas alterações são evidências experimentais de que os indivíduos cujas mães usaram maconha durante a gestação devem ser acompanhados por oftalmologista mais precoce e mais regularmente que os indivíduos cujas mães não usaram maconha Objectives: Recent epidemiologic studies have shown that the use of Cannabis sativa (marijuana) during pregnancy is increasing. Research into the impact of marijuana use during pregnancy has focused primarily on brain development and cognitive outcomes in the offspring. Cannabinoid receptors are present in the retina in mice since birth. Little is known about the impacts of maternal cannabis use on the retinal development and its potential postnatal consequences. Considering that the pre-natal period is potentially sensitive in the normal development of the retina, the aim of this study is to evaluate if the offspring of pregnant mice exposed to the smoke of Cannabis during pregnancy presents morphologic retinal changes from birth on in comparison to the offspring of pregnant mice that were not exposed to the smoke of the Cannabis during pregnancy. Methods: Fetal biometric parameters were evaluated by ultrasonography, dopplervelocimetry and behavioral tests in neonates and young adults. Twenty pregnant BALB/c mice were exposed (nose-only) daily to either marijuana smoke (10 animals, CAN group) or filtered air (10 animals, FA group) from gestational day 5 to 18. Exposure occurred in a smoke-generating and inhalation apparatus capable of mimicking the use of Cannabis in humans according to dose and exposure. In vivo retinal thickness was assessed by spectral domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg Engineering, Germany) on days 60 (adult young mice), 120, 200, and 360 (old mice) under anesthesia. Fifty seven mice of both groups were sacrificed on days 20, 60, and 360 for stereology of the retina (fractionary volume of the retinal layers, volume of each retinal layer, and of the total volume of retina) and light microscopy. Results: SD-OCT findings showed that the animals of CAN group presented 17% decrease in the total thickness of the retina on day 120 (p=0.005) when compared to animals of FA group and it was secondary to the 21% thinning of the external retina (p=0.001). The analysis of each retinal layer showed that mice of the CAN group presented thickening of the internal and external segments of the photoreceptors in comparison to animals from the FA group (p < 0.001). In the volumetric analyses by retinal stereology, the CAN group presented an 89% increase of the internal and external segments of the photoreceptors on day 60 compared to the FA group (p=0.001) and normalization on day 360 (p=0.001). Light microscopy showed that animals of the CAN group presented 64% thickening of the internal and external segments of the photoreceptors on day 360 compared to group FA (p=0,041). Conclusion: Maternal exposure to the smoke of Cannabis sativa during pregnancy causes structural changes in the retina of the offspring that continue even with the aging of the mouse. These are experimental evidences that suggest that children and young adults born from mothers who used to smoke marijuana during pregnancy may require clinical care earlier and more frequent than the non-exposed population