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Implantation of intraocular lens after combined procedure of vitrectomy and cataract surgery is usually required to reduce the postoperative refraction errors. However, because of the severe fibrosis of the anterior capsule and the adhesion between the anterior and posterior capsules, it is difficult to reopen the capsular bag to complete the secondary IOL implantation. We describe here a surgical approach for reopening the severe adhesion between capsules and removing the significant fibro-proliferative membranous material by injecting viscoelastic agent into the periphery of the capsular bag to separate the anterior and posterior capsules. The IOL was implanted into the capsular bag without any zonular rupture or posterior capsule tear. The position of the intraocular lens was stable during postoperative follow-ups up to 3 months. Our procedure to open a severely fibrosis capsule is safe and effective, and may be used as a preferred method.

This new instrument review describes a modified trocar and cannula system with lateral micropores for simplified drainage of suprachoroidal fluid during primary vitrectomy in patients with rhegmatogenous retinal detachment associated with choroidal detachment.

Background To explore the ocular vascular variation involvement in mild cognitive impairment (MCI) and Alzheimer’s disease (AD) cohorts. The measurement of the retinal vessel density was performed by spectral-domain optical coherence tomography angiography (OCTA). Methods This study including 24 eyes of normal cognitively individuals (NC group), 23 eyes of MCI patients (MCI group) and 11 eyes of AD patients (AD group) measured retinal vessel density with OCTA. Mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP) were calculated based on systemic blood pressure and intraocular pressure. We estimated the association between systemic and ocular vascular elements with cognitive assessment test (Mini-Mental Status Examination, MMSE) result by Pearson’s correlation and linear regression model test. Results The retinal microvascular density were significantly lower in AD group compared to NC group while foveal avascular zone(FAZ) area were larger in AD group versus NC group. Both FAZ and vascular density parameters showed significant correlation with MMSE. After multivariate linear regression analysis, only FAZ and outer ring of optic nerve head were significantly associated MMSE. There was significant difference among three groups in MAP value while it was MOPP was found significant correlation with MMSE. Conclusion The OCTA parameters showed statistic difference between AD group and NC group. While only FAZ and outer ring of optic nerve head were significantly associated with estimated MMSE in multivariate linear regression analysis. So FAZ and outer ring of optic nerve head might be regarded as potential indicators for representing early sign of preclinical stage of AD.

Purpose To investigate the effects of indocyanine green (ICG) solution on the viability and cytolysis of human lens epithelial cells ex vivo. Methods A total of 200 pieces of anterior capsules were obtained during cataract surgery, and 110 pieces of the anterior capsules were randomly divided into five groups and treated by immersion in different concentrations of ICG solution. The remaining 90 anterior capsules were also divided into five groups and treated with a combination of drug immersion and washing in balanced salt solution. Electron microscopy and trypan blue and eosin stains were used to analyze the cells. Percentage of dead, shedding, or living lens epithelial cells was estimated and used to demonstrate effects of the ICG on viability and cytolysis. Results Compared with the control group, the percentage of dead and shedding lens epithelial cells increased while the percentage of living lens epithelial cells decreased in all the immersion groups. In the washing groups, the percentage of the living lens epithelial cells was 63.42% ± 2.49%, 54.04% ± 1.84%, 43.51% ± 2.63%, 29.21% ± 2.40%, and 15.73% ± 1.61% for the five groups and reflected a concentration-effect relationship. Electron microscopy showed that the higher the concentration of the ICG solution, the more severe the destruction of the lens epithelial cell structure. Conclusions ICG could reduce the viability of the lens epithelial cells and promote cell cytolysis. Translational Relevance Our study showed that ICG could directly reduce the viability of the lens epithelial cells in a concentration-dependent fashion, which can theoretically reduce the incidence of posterior capsule opacification.

Purpose: To investigate the role of distilled water (DW) in isolated human lens epithelial cells (LECs) viability and lysis ex vivo.Methods: After immersion in DW or balanced salt solution (BSS) for 1-, 2-, and 3-minutes, respectively, the cell viability of LECs was quantitatively evaluated. In addition, the capsule samples soaked in DW or BSS for 1-, 2-, and 3-minutes were combined with rinse for 1 minute to analyze the difference of LECs shedding percentage in each subgroup. The histopathological changes of the samples after treating were observed.Results: The percentage of LECs shed in DW immersion combined with rinse was significantly higher than in DW immersion alone (p all p all Conclusions: Soaking in the DW can cause LECs death, and DW immersion combined with rinse was an effective method to remove LECs. The histopathology changes of treated DW suggested cellular necrosis was one type of LECs death mechanism.

BackgroundSpontaneous subretinal hemorrhage (SSRH) is a rare disease that severely affects the visual function, and is difficult to diagnose. This study aimed to describe the multimodality imaging characteristics of SSRH in a young male patient.Case presentationA 28-year-old male was presented to our hospital with “sudden drop of left eye vision for one week.” Three weeks ago, he was admitted to other hospital due to sudden severe pain and unclear vision in the left eye for 1 h. The intraocular pressure was 69 mmHg, and the blood pressure was 230/120 mmHg. Skull CT and MRI detected abnormal signal shadows in the left eye and no abnormalities in the brain. B-ultrasonography indicated occupying lesions in the left eye. Two weeks later, the patient came to our hospital for treatment as the vision of the left eye had decreased sharply. Admission examination: blood pressure was 200/120 mmHg, best-corrected visual acuity was 20/20 in the right eye and hand motion in the left eye. Fundus details could not be evaluated in the left eye because of hemorrhage in the vitreous cavity. B-ultrasonography of the left eye revealed a dense, diffuse intravitreal hemorrhage. Skull MRI showed an abnormal signal shadow in the left eyeball, suggesting intraocular hemorrhage. Vitrectomy revealed a dome-shaped lesion in the peripheral part of the inferotemporal region during the operation. Postoperative indocyanine green angiography (ICGA) of the lesion showed hypofluorescence and no leakage or altered morphology during the whole imaging process. Follow-up showed gradual reabsorption of SSRH.ConclusionsIn this case, SSRH was considered to be associated with high blood pressure. Multimodal imaging provides accurate data for the diagnosis and follow-up of the disease.

OBJECTIVE To observe the protective effects of drug-contained serum of Lingqi Huangban Granule (LQHBG), a compound traditional Chinese herbal medicine, on oxidative stress-induced injury in rabbit retinal pigment epithelial (RPE) cells in vitro. METHODS The oxidative stress of rabbit RPE cells in vitro was induced with hydrogen peroxide (500μmol/L) and different concentrations of LQHBG were administered to rats to prepare medicated serum. RPE cells were randomized into normal control group (no hydrogen peroxide), model group (hydrogen peroxide), model plus serum group (hydrogen peroxide and 10% control serum), model plus low-dose LQHBG group (hydrogen peroxide and low-dose LQHBG-medicated serum) and model plus high-dose LQHBG group (hydrogen peroxide and high-dose LQHBG-medicated serum). Teminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay and flow cytometry (FCM) were used to measure apoptosis of cultured rabbit RPE cells. Protein expressions of caspase-3 and Bcl-X(L) were observed by Western blot method. RESULTS FCM results showed that the apoptotic rates of the normal control group, model group, control serum group and serum containing low- and high-dose LQHBG groups were (4.85±0.26)%, (20.02±1.37)%, (21.84±0.94)%, (13.56±0.55)%, and (8.58±0.39)%, respectively; compared with the model group, the apoptotic rates of RPE cells in the low- and high-dose LQHBG groups were obviously reduced in a dose-related manner (P

To investigate the effects of Ginkgo biloba extract (EGb 761) on the morphology and function of retinal ganglion cells (RGC) in guinea pigs with optic nerve transection.Seventy-five albino guinea pigs were randomly divided into five groups: normal control group, sham-operated group, untreated group, normal saline group and EGb 761 group. No operation was performed in the normal control group. Optic nerve was merely exposed in the sham-operated group, but transected at 1.0 mm from posterior pole of the eye ball in the untreated, normal saline and EGb 761 groups. Guinea pigs in the EGb 761 group or the normal saline group received daily intraperitoneal injection of EGb 761 (100 mg/kg) or corresponding volume of normal saline from 7 days before experiment to 28 days after experiment. Three guinea pigs in each group were sacrificed for apoptosis assay (TUNEL method) of RGC. Pattern electoretinograms (PERGs) were recorded 14 and 28 days after transection, respectively. At the end of the examination, six guinea pigs were killed for histological examination and RGC count.No TUNEL-positive cells were observed in the normal control, sham-operated and EGb 761 groups, but there were TUNEL-positive cells in the untreated group and the normal saline group. The numbers of RGCs in the untreated and normal saline groups were less than those in the normal control and sham-operated groups at 14 days or 28 days (P0.05). Although the number of RGCs in the EGb 761 group was less than those in the normal control and sham-operated groups (P0.05), it was more than those in the untreated and normal saline groups (P0.05). N(95) amplitude in EGb 761 group was higher than those in the untreated and normal saline groups (P0.05) and close to those in the normal control and sham-operated groups (P0.05) at 14 days or 28 days. The number of RGCs was positive correlated to N(95) amplitude (r=0.859, P=0.001 5).EGb 761 can inhibit the apoptosis of RGCs in guinea pigs after optic nerve transection, thus protect the morphology and function of RGCs.

Erythropoietin (EPO), known for its role in erythroid cell differentiation, has been suggested to have a neuroprotective effect on retinal neurons. The aim of the current study was to investigate the expression pattern of EPO and erythropoietin receptor (EPOR) in the detached retina of a rat model of retinal detachment (RD).Forty-eight albino Sprague-Dawley rats were randomized into normal control group (n = 6) and RD model group (n = 42). The rat RD model was established by slow injection of 1.4% sodium hyaluronate into the upper half of the subretinal space, in which the upper half of the neurosensory retina was detached from the underlying retinal pigment epithelium (RPE). The expression of EPO and EPOR mRNA/protein was determined at 1, 3, 6, 12, 24, 48, and 72 hr after sodium hyaluronate injection by semiquantitative RT-PCR and Western blot analysis, respectively. Meanwhile, the distributions of EPO and EPOR were examined by immunohistochemistry.EPO and EPOR mRNA levels increased gradually after sodium hyaluronate injection and peaked 48 hr later. EPO mRNA level became significantly higher than that in the normal control group at 12 hr after injection, and EPOR mRNA level became significantly higher at 6 hr (p0.05). Moreover, the protein levels of EPO and EPOR presented a similar tendency to the mRNA level and became significantly higher than those in normal control group at 3 hr after injection (p0.05). Immunohistochemical results showed that both EPO and EPOR were strongly expressed all over the neurosensory retina 48 hr after injection, but EPOR was not found in the rod outer segment. Only weak expression of EPO and EPOR was noticed in the retina of normal control group.The levels of EPO and EPOR in detached retina increase with the duration of retinal detachment and reach their peaks at 48 hr; most layers of detached neurosensory retina can express EPO and EPOR. It is indicated that the EPO/EPOR system might play an important role in protection of retinal neurons during RD; supplementation with exogenous EPO might promote the survival of retinal neurons.

Retinal light injury can lead to degeneration of the photoreceptor cell layer. It has been hypothesized that the mechanism for this process is the photochemical damage. Ginkgo balboa extract (Ginkgo biloba extract EGB761) EGB761 is a free radical scavenger. The purpose of this study was to investigate the possible effect of orally administered EGB761 on retinal light damage of mouse photoreceptor cells.Kunming mice were randomly chosen for the following groups containing 20 animals in each: control group, light damage group, saline control group, and drug treatment group. The drug treatment group and saline control group were given daily gavage of EGB761 (150 mg×kg(-1)×d(-1)) one week before light exposure. At 7, 14, and 30 days after light exposure, animals were sacrificed and eyes were examined by light microscopy, electron microscopy, and retinal histopathology using in situ detection of apoptotic cells.In the light damage group after 7 days there was visible edema, and the outer nuclear layer appeared withered with deeply stained dead cells, leaving only a thin nuclear layer of 7 - 8 cells. After 14 days, the photoreceptor cell layer disappeared, leaving only the outer nuclear layer of 1 - 3 cells with an average thickness of (37.988 ± 1.207) µm. The average thickness of the retina was (126.32 ± 2.31) µm. In the drug treatment group, the photoreceptor cell layer and outer nuclear layer damage were significantly lower than the saline group (t = 21.993, P0.001), demonstrating that EGB761, especially at 14 days after light exposure, can reduce retinal light damage in mice.Oral administration of EGB761 can partially inhibit apoptosis of photoreceptor cells, resulting in increased photoreceptor cell survival.

To observe the protective effect of Huangban Granule, a compound of traditional Chinese herbal medicine, on rats with retinal damage induced by light.A total of 24 male Sprague-Dawley (SD) rats were randomly divided into normal control group, untreated group and Huangban Granule group. Retinal light damage was induced by exposure to constant white fluorescent light for 5 hours at an illumination of 2,800 Lux. The Huangban Granule was given 10 days before light exposure until the animals were sacrificed in Huangban Granule group, and an equal volume of distilled water for the rats in untreated group. Electroretinogram (ERG) was recorded in all animals 2 weeks after light exposure and the animals were sacrificed for histopathological examination of retina. The outer nuclear layers (ONLs) on the superior and inferior retina were counted.Fourteen days after light exposure, the ONLs on the superior retina were 3 to 6 in the untreated group and 7 to 9 in treatment group. There were 9 to 11 layers in normal group. The mean number of ONLs in the untreated group (4.68+/-1.64) was less than that in the treatment group (8.23+/-1.35) (P0.01). B-wave amplitudes were (319.38+/-71.96) muV and (135.16+/-42.30) muV in Huangban Granule group and the untreated group respectively (P0.01). A-wave amplitudes were (184.63+/-47.23) muV and (83.35+/-27.75) muV (P0.01), and oscillatory potential amplitudes were (239.38+/-20.19) muV and (125.44+/-26.23) muV (P0.01) respectively in the two group. There was no significant difference in implicit times of a-wave and b-wave among the three groups.Huangban Granule obviously protects both function and morphology of the retina from light-induced retinal damage in rats.

To investigate the effect of edaravone (MCI-186), a free radical scavenger, against ischemia/reperfusion (I/R) injury in the rat retina.Retinal ischemia was induced in male Sprague-Dawley rats by elevating intraocular pressure to 110 mmHg for 60 min. The rats were intraperitoneally injected with edaravone at a dose of 3 mg/kg at 30 min before ischemia, and then treated with edaravone (3 mg/kg, ip) twice daily for 1 or 5 d after I/R. The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in the retinal tissues were determined on d 1 after I/R injury. The apoptosis of retinal neurons was detected on d 1 after I/R injury by terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling staining. The electroretinogram (ERG) was recorded on d 5 after reperfusion.Edaravone lowered MDA levels, raised SOD activity, and attenuated I/R-induced apoptosis of retinal neurons within the inner nuclear, ganglion cell, and outer nuclear layers of the rat retina. Moreover, edaravone suppressed I/R-induced reduction in a- and b-wave amplitudes of ERG.Edaravone can protect the retina from I/R injury in rats through reducing oxidative stress and inhibiting apoptosis of retinal neurons, which suggests that edaravone might be a potential choice for the treatment of I/R-induced eye disorders.

To investigate the effect of Ginkgo biloba extract EGb 761, a free-radical scavenger, on the antioxidation capability of retina after light-induced retinal damage in rats in an attempt to understand the mechanism by which EGb 761 protects the photoreceptors after light-induced retinal damage.Seventy-two female Sprague-Dawley (SD) rats were evenly randomized into normal control group (NC group), light-induced retinal damage model group (M group), model + normal saline group (MN group), and model + EGb 761 group (ME group). Light-induced retinal damage model was induced via exposure to white light at 2740 +/- 120 lux for 6 hr. Rats in MN group and ME group were intraperitoneally injected daily with normal saline and 0.35% EGb 761 (100 mg/kg), respectively, 1 week before and 2 weeks after light exposure. The levels of malondialdehyde (MDA), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in the retinal tissues were determined 24 hrs after light exposure; photoreceptor apoptosis was detected 4 days after light exposure. One and 2 weeks after light exposure, histopathologic examination was carried out, and the outer nuclear layer (ONL) thickness (number of nuclei) in the superior and inferior retina was counted.Twenty-four hours after exposure, the MDA levels in the other three groups were significantly higher than that in the NC group (p0.05); those in the M and MN groups were similar to each other (p0.05); and that of the ME group was significantly lower than those in the M and MN group (p0.05). The activities of T-SOD, GSH-Px, and CAT were similar in the M and MN groups (p0.05); the activities in the M and MN groups were significantly lower than those in the NC and ME groups (p0.05); and the activities in the ME group were significantly higher than those in the M and MN groups (p0.05). Four days after exposure, the apoptotic photoreceptors within the ONL in the ME group were obviously fewer than those in the M and MN groups. One week and 2 weeks after exposure, the ONL thickness (number of nuclei) in the ME group was more than that in the M and MN groups but less than that in the NC group.Intraperitoneal injection of EGb 761 can enhance the antioxidation ability of retina and partially inhibit the apoptosis of photoreceptors, thus exert a protective effect on photoreceptors.

To investigate the prevalence and causes of blindness and low vision among adults agedor = 60 years in the urban population of Nantong.Cluster sampling was used to select 8 from 14 communities in Xinchengqiao Blocks, in which all individuals agedor = 60 years were visited. The visual acuity without correction and the presenting acuity with the participants' habitual distance correction were measured separately for each eye. In individuals with visual acuity less than 0.6, pinhole visual acuity was tested with pinhole spectacle. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using a slit lamp-microscope and direct ophthalmoscopy. The survey was preceded by a pilot study.Of 3352 enumerated subjects, 3040 individuals participated in this survey (90.69% response rate). According to pinhole visual acuity and World Health Organization (WHO) visual impairment criterion (blindness: less than 0.05 in the better eye; low vision: less than 0.3 to 0.05 in the better eye), the prevalence of blindness and low vision was 1.35% and 1.84% respectively. The prevalence of blindness and low vision for females were 1.92% and 2.33%, respectively, which were differenced from that in males (0.66% and 1.24%, respectively). The prevalence of blindness and low vision increased with age. The survey showed that the most important cause leading to blindness and low vision was cataract. According to the presenting visual acuity and visual impairment criterion (blindness: less than 0.1 in both eyes), the prevalence of blindness and visual impairment was 1.58% and 13.59%, respectively, 2.10% and 15.98% in females and 0.95% and 10.66% in males, respectively. The prevalence of blindness and visual impairment was raised with increasing age. Cataract was also the leading cause for blindness.The prevalence of blindness in the Nantong area was lower than that in northern, southern and western China. Females and illiteracy were more likely to have blindness and low vision than that of males and literate. The leading causes of blindness in Nantong are, in descending sequence, cataract, ocular fundus diseases, ametropia and corneal scar/opacity.