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Background/AimsTo assess 24 pro-inflammatory cytokines in the aqueous and serum of normal patients without diabetes.Methods94 consecutive eyes of 94 patients undergoing elective vitrectomy surgery were prospectively enrolled. Blood and aqueous sampling were done in the operating room. A microparticle bead-based multiplex assay was used to measure aqueous and serum levels of: fibroblast growth factor-2, eotaxin, granulocyte colony stimulating factor (G-CSF), FMS-like tyrosine kinase 3 ligand (FLT-3L), growth-regulated alpha protein (GROa), interleukin (IL)-10, monocyte chemotactic protein (MCP)-3, macrophage-derived chemokine (MDC), soluble CD40L (sCD40L), IL-17A, interleukin-1 receptor antagonist (IL-1RA), IL-1β, IL-2, IL-4, IL-6, IL-8, interferon gamma-induced protein 10 (IP-10), MCP-1, macrophage inflammatory protein-1β, tumour necrosis factor-α, vascular endothelial growth factor (VEGF), regulated on activation normal T expressed and secreted (RANTES), platelet-derived growth factor (PDGF)-AA and PDGF-AB/BB.ResultsA significant positive correlation between aqueous and serum levels was observed for FLT-3L (r=0.45; p<0.001) and positive trends were observed for eotaxin (r=0.27; p=0.04), MDC (r=0.34; p<0.01) and RANTES (r=0.33; p=0.007). There were no significant differences observed based on age or gender. In contrast, aqueous cytokine levels for G-CSF, GROa and MCP-1 were significantly higher in pseudophakic eyes compared with phakic eyes: G-CSF (16.52 pg/mL±22.39 vs 2.77 pg/mL±6.80, p<0.0001), GROa (12.45 pg/mL±6.54 vs 8.26 pg/mL±5.48, p=0.001) and MCP-1 (1340.51 pg/mL±565.21 vs 830.44 pg/mL±454.36, p<0.0001), respectively.ConclusionsWe report the first characterisation of 24 different pro-inflammatory cytokines in 94 patients without diabetes. The absence of the crystalline lens was associated with significantly higher aqueous levels of G-CSF, GROa and MCP-1.Trial registration number NCT04505566.

To evaluate the relative efficacy of novel retinoblastoma treatments, eye classification-specific success rates for current standard-of-care intravenous chemotherapy regimens must be known. This meta-analysis included studies if: (1) patients received intravenous chemotherapy for retinoblastoma, (2) globe salvage data was reported, (3) only intravenous chemoreduction (with/without local consolidation) was used. The outcome measure was globe salvage success without need for salvage radiotherapy, subdivided by disease classification and chemotherapy regimen. Data from 27 studies (1483 eyes) were pooled. By Reese–Ellsworth classification, globe salvage rates were 85% (95%CI:73–92%) for Group I, 78% (95%CI:70–85%) for Group II, 68% (95%CI:56–78%) for Group III, 47% (95%CI:34–60%) for Group IV, and 35% (95%CI:26–45%) for Group V (Va: 35% [95%CI:21–54%]; Vb: 42% [95%CI:29–56%]; those without sub-classification: 31% [95%CI:19–47%]). By International Classification, globe salvage rates were 93% (95%CI:80–97%) for Group A, 83% (95%CI:73–89%) for Group B, 73% (95%CI:54–86%) for Group C, 40% (95%CI:31–51%) for Group D, and 19% (95%CI:5–50%) for Group E. Standard carboplatin-etoposide-vincristine out-performed two-drug regimens (odds ratio (OR) = 1.9 (95%CI:1.3–3.0) for Groups I-IV and OR = 2.1 (95%CI:1.3–3.4) for Group V; p = 0.002 for each). For eyes with diffuse vitreous seeds (Vb), an enhanced regimen out-performed standard chemotherapy (OR = 2.4 [95%CI:1.3–4.7]; p = 0.004). In conclusion, two-drug regimens were less effective for all eyes, whereas enhanced regimens were more effective for eyes with vitreous seeds. Novel therapies can now be compared to these baseline globe salvage rates.

PurposeIncreasing rates of antibiotic resistance in endophthalmitis have been reported. This study examines outcomes of triple therapy with intravitreal vancomycin, ceftazidime, and moxifloxacin for endophthalmitis.MethodsRetrospective, consecutive series of all patients treated with abovementioned intravitreal antibiotics from January 2009 to June 2021. Percentages of eyes attaining greater than or equal to 20/200 and 20/50 Snellen visual acuities and adverse events were evaluated.Results112 eyes met inclusion criteria. 63 of 112 eyes (56%) achieved a visual acuity of 20/200 during follow-up, with 39 (35%) returning to at least 20/50. In subgroup analysis, 23 of 24 (96%) eyes with post-cataract endophthalmitis obtained ≥ 20/200 acuity and 21 of 24 (88%) obtained ≥ 20/50 acuity during follow-up. There were no cases of macular infarction.ConclusionsIntravitreal moxifloxacin (160 µg/0.1 mL) was well tolerated as an adjunct to vancomycin and ceftazidime for bacterial endophthalmitis. Use of this novel combination offers several theoretical advantages compared to standard therapy with two antibiotics, including expanded gram-negative coverage and potential synergy, and may be particularly valuable in geographies where the local antibiogram supports empiric use. Further study is merited to verify the safety and efficacy profile.

A woman in her 60s with a functional glaucoma tube shunt presented after vitrectomy for epiretinal membrane peeling with symptomatic choroidal effusions not responsive to medical therapy. She underwent a minimally invasive, transconjunctival choroidal drainage procedure, which was directly visualized under a widefield viewing system to prevent intraocular hemorrhage or retinal penetration of the needle. This allowed for preservation of her conjunctiva, restoration of normal intraocular pressure by temporary blockage of her tube shunt with a viscoelastic, and resolution of her choroidal effusions.

This paper reports 3-year intraocular pressure (IOP) outcomes of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study. The prospective, controlled, observational study included 80 eyes of 40 participants undergoing routine pars plana vitrectomy. Study patients underwent preoperative evaluation and multimodal testing of the study (surgical) and fellow (control) eye. This testing was repeated at 3 months postoperatively and then annually for 3 years. Thirty-two of 40 patients (80%) completed 3-year follow-up. At 3 years postoperatively, there was no difference in IOP measurements in surgical eyes overall from baseline (P = .36). Subgroup analysis of pseudophakic eyes at baseline showed a significant elevation in IOP from 14.3 mm Hg ± 2.9 mm Hg at baseline to 16.8 mm Hg ± 3.2 mm Hg at 3-year follow-up (P < .029). Fellow eyes did not experience a significant change from baseline. The authors' 3-year results show that IOP is consistently and significantly elevated in pseudophakic eyes compared to baseline following routine vitrectomy. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:371-376.].

Background We sought to compare the accuracy of standard and novel echographic methods for computing intraocular tumor largest basal diameter (LBD). Design Multicenter, retrospective cohort study. Subjects All patients presenting with new diagnosis of uveal melanoma (UM). Methods Ultrasounds were obtained for all patients, and axial length (AL) was measured for a subset of patients. LBD was calculated as: (1) a single chord measured on B scan ultrasound (one-chord method [1CM]), or (2) by subdividing the basal diameter into two chords, which were summated (two-chord method [2CM]), or (3) by a mathematically-derived formula (MF) based on geometric relationships. The accuracy of each method was then compared, and sensitivity of each technique to factors such as tumor size and AL were analyzed. Main outcome measures Accuracy, robustness, correctness of predicted plaque size. Results 116 UMs were analyzed; 1CM-calculated LBD underestimated 2CM-calculated LBD by 7.5% and underestimated LBD by MF by 7.8%; 2CM and MF were tightly correlated (average LBD difference = 0.038%). At larger LBDs, 1CM underestimated 2CM and MF by a much greater percentage ( p  < 0.001). By linear regression, 1CM underestimated LBD compared to 2CM by 0.8% and underestimated LBD compared to MF by 1.2% for every 1-mm LBD increase ( p  < 0.001 for each). Increasing the number of ultrasound chords beyond two did not significantly impact LBD calculations. For eyes with AL within two standard deviations of the mean, AL did not impact plaque selection using MF. 1CM would have led to selection of an undersized plaque in 41% of cases compared to 2CM and would have misclassified half of all eyes that actually required enucleation. For tumors with LBD < 12 mm, 1CM does not significantly underestimate LBD. Conclusions Tumor LBD by 1CM is an inaccurate means of determining actual LBD, especially for larger tumors. Using either 2CM or MF is much more accurate, especially for tumors > 12 mm, where a single chord on ultrasound is more likely to lead to incorrect, undersized plaque selection. Our MF can be applied with great accuracy even in cases where the AL of the eye is not measured, using the population average AL (23.7 mm), and the formula LBD = 23.7 sin - 1 ( chord length / 23.7 ) .

Purpose: To quantify the economic burden of vision loss in U.S. children and adolescents aged 0 to 18 years. Methods: This was a cross-sectional economic analysis study using publicly available data sources from the Centers for Disease Control and Prevention (CDC). This study employed a comprehensive data analysis using the American Community Survey, Medical Expenditure Panel Survey, American Time Use Survey, Bureau of Labor Statistics, National and State Health Expenditure Accounts, and the National Health Interview Survey. Total costs attributed to vision loss among children were categorized into medical expenses, nursing home care, supportive services, and productivity losses. Data were stratified by state to investigate regional differences in economic burden within the continental United States. Results: The study found that in 2017, the average economic burden per-child with vision loss in the United States was $15,150 annually, with a total cost of approximately $9.4 billion annually. This compares to a cost of $13,110 per-person affected age 19 to 64 years and $21,560 per-person affected age 65 years or older. The per-affected child cost for males ($15,210) was slightly higher than for females ($15,090) and generally uniform across geographies. Productivity loss due to informal care requirements represented the largest cost driver at 73.2%. Conclusions: Vision loss in children and adolescents imposes a significant economic burden, particularly through productivity losses due to informal caregiving. The findings underscore the need for targeted public health strategies that consider the regional disparities in economic impact and focus on preventive measures to reduce the long-term economic and social consequences of pediatric vision loss.

PurposeThe purpose of this study is to measure optical coherence tomography angiography (OCTA)-defined retinal vascular and choriocapillaris parameters in diabetic patients without clinically evident diabetic retinopathy.MethodsRetrospective case series of eyes in patients with a documented history of either type 1 or type 2 diabetes mellitus without any clinical signs of diabetic retinopathy seen at the Vanderbilt Eye Institute. All eyes underwent dilated funduscopic examination along with OCTA. OCTA analytics were performed to calculate vessel density, flow area, and foveal avascular zone size.ResultsThirty-seven eyes of 20 patients were included in the analysis. The mean glycated hemoglobin A1c of the 20 patients was 7.2%. All patients underwent dilated funduscopic examination by a fellowship-trained retina specialist. No patients had any overt retinopathy on clinical examination. Fifteen eyes had vascular abnormalities (microaneurysms) present on OCTA. Patients with microaneurysms and patients without microaneurysms were compared. Vessel density of the 6 × 6 mm macular cube images was significantly increased in patients with microaneurysms compared with patients without microaneurysms. There were no other significant differences in OCTA characteristics.ConclusionOCTA can detect microvascular changes not otherwise noted on dilated clinical examination. These pre-clinical findings may facilitate earlier intervention for improved glycemic control and prevention of the onset of clinical retinopathy.

Background. Software guided optic nerve assessment can assist in process automation and reduce interobserver disagreement. We tested depth analysis software (DAS) in assessing optic nerve cup-to-disc ratio (VCD) from stereoscopic optic nerve images (SONI) of normal eyes. Methods. In a prospective study, simultaneous SONI from normal subjects were collected during telemedicine screenings using a Kowa 3Wx nonmydriatic simultaneous stereoscopic retinal camera (Tokyo, Japan). VCD was determined from SONI pairs and proprietary pixel DAS (Kowa Inc., Tokyo, Japan) after disc and cup contour line placement. A nonstereoscopic VCD was determined using the right channel of a stereo pair. Mean, standard deviation, t-test, and the intraclass correlation coefficient (ICCC) were calculated. Results. 32 patients had mean age of 40±14 years. Mean VCD on SONI was 0.36±0.09, with DAS 0.38±0.08, and with nonstereoscopic 0.29±0.12. The difference between stereoscopic and DAS assisted was not significant (p=0.45). ICCC showed agreement between stereoscopic and software VCD assessment. Mean VCD difference was significant between nonstereoscopic and stereoscopic (p<0.05) and nonstereoscopic and DAS (p<0.005) recordings. Conclusions. DAS successfully assessed SONI and showed a high degree of correlation to physician-determined stereoscopic VCD.