Age-related macular degeneration (AMD) is the leading cause of visual impairment and blindness in the elderly in developed countries but therapeutic options are limited. Many observational studies have shown that a high dietary intake of antioxidants, fish oil, and carotenoids is associated with a lower risk of prevalent and incident AMD. The Age-Related Eye Disease Study 1 demonstrated that routine supplementation with a certain formulation of vitamins C, E, β-carotene, and zinc with copper reduces the risk of worsening AMD and severe vision loss by 25% over a 6-year period in patients with intermediate or advanced AMD in 1 eye or intermediate AMD in both eyes. The recent Age- Related Eye Disease Study 2 demonstrated that a certain combination of lutein and zeaxanthin is a safe and effective alternative to β-carotene, which is known to be associated with lung cancer in smokers. The aim of this review focuses on the role of supplements in the treatment and prevention of AMD and sums up the recent findings about the micronutrients most frequently used for AMD.
Aged ; Antioxidants ; Blindness ; Carotenoids ; Copper ; Developed Countries ; Eye Diseases ; Fatty Acids, Omega-3 ; Fish Oils ; Humans ; Lung Neoplasms ; Lutein ; Macular Degeneration* ; Micronutrients ; Vision Disorders ; Vitamins ; Zeaxanthins ; Zinc

PURPOSE: To determine whether the knotless technique can be an alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made. METHODS: Five patients underwent the knotless technique for posterior chamber intraocular lens transscleral fixation when a scleral flap could not be made. Partial thickness scleral anchoring sutures were repeated three times near the transscleral penetration site in both ends. The end of the anchoring suture was passed under the exposed part of the partial thickness scleral anchoring suture and pulled to adjust the position of the intraocular lens. Then, anchoring sutures were covered with a conjunctival flap. Complications and change of intraocular lens astigmatism were evaluated. RESULTS: During the 8-month postoperative follow-up period, one case of ciliary body hemorrhage due to intraoperative transscleral penetration and one case of mild intraocular lens tilting owing to the improper tension of the string were observed. Except for one case with a concurrent penetrating keratoplasty, intraocular lens astigmatism showed no significant change during the postoperative follow-up period and no significant difference compared to transscleral fixation with a scleral flap. CONCLUSIONS: Knotless technique for external fixation of posterior chamber intraocular lens transscleral fixation is a safe and easy technique and may be a good alternative for the scleral flap-making technique in posterior chamber intraocular lens transscleral fixation when a scleral flap cannot be made.
Astigmatism ; Ciliary Body ; Follow-Up Studies ; Hemorrhage ; Humans ; Keratoplasty, Penetrating ; Lenses, Intraocular ; Sutures

Systemic hypertension affects not only the heart, kidneys, brain, and large arteries but also the eyes. High blood pressure (BP) causes a series of pathophysiological changes in the retinal vasculature, including focal and diffuse narrowing of the retinal arteriole, opacification of the arteriolar wall, and compression of the venules by arterioles. In severe cases, hemorrhage, nerve fiber layer infraction, and disc swelling can occur. Systemic hypertension results in various retinal vascular diseases, such as hypertensive retinopathy, retinal vein or artery occlusion, retinal arterial macroaneurysm, and nonarteritic ischemic optic neuropathy. High BP also increases the risk of development and progression of diabetic retinopathy. Signs of hypertensive retinopathy are predictive of target-organ damages, including cardiovascular and cerebrovascular diseases. While managing patients with hypertensive retinopathy, physicians should be aware of the management of cardiovascular and cerebrovascular risk factors.
Arteries ; Arterioles ; Brain ; Cardiovascular Diseases ; Cerebrovascular Disorders ; Diabetic Retinopathy ; Heart* ; Hemorrhage ; Humans ; Hypertension* ; Hypertensive Retinopathy ; Kidney ; Nerve Fibers ; Optic Neuropathy, Ischemic ; Retinal Vein ; Retinaldehyde ; Risk Factors ; Vascular Diseases ; Venules

Purpose: To compare the subfoveal choroidal vascularity indices (CVIs) of treatment-naïve patients with central retinal vein occlusion (CRVO) with controls. Methods: Twenty-one eyes of 21 treatment-naïve CRVO patients and 42 age- and sex-matched control eyes (of 42 subjects) lacking any retinal disease were included. The subfoveal CVIs were measured using ImageJ software. Results: The mean subfoveal CVI in eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes (0.6464 ± 0.0326 vs. 0.6209 ± 0.0434 respectively; p = 0.024). In contrast, no significant difference in the mean subfoveal CVI was found between CRVO eyes 6 months after initial diagnosis and control eyes (0.6311 ± 0.0600 vs. 0.6209 ± 0.0434 respectively; p = 0.238). Of the 21 eyes with CRVO, 18 (85.7%) received intravitreal injections (bevacizumab, ranibizumab, aflibercept, or triamcinolone) and four (19.0%) underwent panretinal photocoagulation. Conclusions The subfoveal CVI of eyes with treatment-naïve CRVO at the initial visit was significantly higher than that of control eyes, but decreased by 6 months. Further studies are needed to determine whether CRVO treatments such as intravitreal injection or panretinal photocoagulation affect choroid hemodynamics.

PURPOSE: To investigate clinical manifestations and prognostic factors of autoimmune-related peripheral corneal ulcers. METHODS: Nineteen eyes in 18 patients who were diagnosed with autoimmune-related peripheral corneal ulcer from November 1999 to August 2010 were enrolled in the present study. Clinical manifestations and treatment results were investigated retrospectively. RESULTS: The average age at presentation was 64.6 years with female (66.7%) and unilateral (94.4%) dominance. The main etiologies were Mooren's ulcer (53.6%) and rheumatoid arthritis (26.3%). The ulcer depth was greater than 75% of the corneal thickness in more than half of the cases (57.9%) and the mean extent of the ulcer was 69.5degrees. There were no significant improvements in visual acuity after treatment (p = 0.789) and no significant differences in treatment outcomes among etiologies or treatment modalities. The patients who underwent ulcer recurrence (p = 0.048) or treatment failure (p = 0.005) had poorer final visual acuity than those patients who did not. The ulcer depth correlated with treatment failure (p = 0.037). The final visual acuity showed positive correlations with visual acuity at presentation (p = 0.031) and negative correlations with the number of recurrences (p = 0.042). CONCLUSIONS: The visual acuity at presentation and ulcer depths were significant prognostic factors. These factors appeared to be helpful in the treatment of marginal keratitis depending on the depth of the ulcer.
Arthritis, Rheumatoid ; Connective Tissue Diseases ; Corneal Ulcer ; Eye ; Female ; Humans ; Keratitis ; Recurrence ; Treatment Failure ; Ulcer ; Visual Acuity

PURPOSE: To report a case of bilateral Coats' disease. CASE SUMMARY: A 19-month-old boy presented with esodeviation of his eyes, which started 5 months prior. A fundus exam showed total bullous exudative retinal detachment with retinal vascular telangiectasia in the right eye and localized exudative retinal detachment with vascular telangiectasia at the inferior periphery in the right eye. Fluorescein angiogram of the left eye showed retinal telangiectatic vessels, avascular area and fluorescein leakeage from telangiectatic vessels. The patient received external drainage of subretinal fluid and intravitreal air injection of the right eye and Argon LASER photocoagulation and cryotheraphy of the left eye. A cytologic exam of the subretinal fluid drained from the right eye showed no malignant cells. Forty-four months after the operation, his best corrected visual acuity was no light perception in the right eye and 0.4 in the left eye. Both fundi were flat and stable. No complications, such as glaucoma, recurred retinal detachment, or pain, occurred. CONCLUSIONS: Coats' disease rarely occurs bilaterally and can be involved asymmetrically. The disease presents more severely when bilateral and can progress after long-term observation. Proper treatment and long-term follow-up of both eyes are necessary to prevent visual loss and preserve eyes.
Argon ; Drainage ; Esotropia ; Eye ; Fluorescein ; Follow-Up Studies ; Glaucoma ; Humans ; Infant ; Light ; Light Coagulation ; Retinal Detachment ; Retinaldehyde ; Subretinal Fluid ; Telangiectasis ; Visual Acuity

Purpose: This study evaluated the short-term safety of resident-performed intravitreal injections. Methods: We retrospectively reviewed the medical records of 503 patients (503 eyes) treated for the first time in our hospital from January 2018 to October 2020 via intravitreal bevacizumab, ranibizumab, aflibercept, or triamcinolone acetonide injections by residents or retina specialists. In terms of short-term ophthalmic complications, patients were followed-up 1 day, 1 week, and 1 month after injection. Results: A total of 503 eyes of 503 patients were included. Intravitreal injections were given to 211 and 292 eyes by residents (the resident group) and retina specialists (the retina specialist group), respectively. There were no between-group differences in baseline characteristics except in terms of the indications for injection. Intraocular pressure elevation >5 mmHg occurred in two eyes (0.95%) in the resident group and five (1.71%) in the retina specialist group, but the difference was not statistically significant. Subconjunctival hemorrhage occurred in 29 eyes (13.74%) of the resident group and 32 eyes (10.96%) of the retina specialist group; again, the difference was not statistically significant. No case of noninfectious endophthalmitis occurred in the resident group but two (0.68%) cases occurred in the retina specialist group; again, the difference was not significant. There were two (0.95%) cases of infectious endophthalmitis in the resident group and one (0.34%) case in the retina specialist group; again, the difference was not significant. No corneal erosion, traumatic lens damage, vitreous hemorrhage, or retinal tearing or detachment were noted in either group. Conclusions Resident-performed intravitreal injections appear to be safe.

During chronic inflammatory response, mono- cytes/macrophages produce 92-kDa matrix metalloproteinase-9 (MMP-9), which may contribute to their extravasation, migration and tissue remodeling. Activation of peroxisome proliferator- activated factor receptor-gamma (PPAR-gamma) has been shown to inhibit MMP-9 activity. To evaluate whether ox-LDL, a PPAR-gamma activator, inhibits PMA-induced MMP-9 expression and activity, and if so, whether CD36 and PPAR-gamma are involved in this process, we investigated the effect of ox-LDL on MMP-9 expression and activity in PMA-activated human monocytic cell line U937. PMA-induced MMP-9 expression and activity were suppressed by the treatment with ox-LDL (50 micrigram/ml) or PPAR-gamma activators such as troglitazone (5 micrometer), ciglitazone (5 micrometer), and 15d- PGJ2 (1 micrometer) for 24 h. This ox-LDL or PPAR-gamma activator-mediated inhibition of micrometer P-9 activity was diminished by the pre-treatment of cells with a blocking antibody to CD36, or PGF2a (0.3 micrometer), which is a PPAR-gamma inhibitor, as well as overexpression of a dominant-negative form of CD36. Taken together, these results suggest that ox-LDL suppresses PMA-induced MMP-9 expression and activity through CD36-mediated activation of PPAR-gamma.
Antibodies, Blocking/pharmacology ; Antigens, CD36/immunology/*physiology ; Cells, Cultured ; Chromans/pharmacology ; Gelatinase B/antagonists & inhibitors/genetics/*metabolism ; Humans ; Lipoproteins, LDL/pharmacology/*physiology ; Monocytes/drug effects/*enzymology/metabolism ; NF-kappa B/antagonists & inhibitors ; PPAR gamma/*metabolism ; Prostaglandin D2/*analogs & derivatives/pharmacology ; RNA, Messenger/analysis/metabolism ; Research Support, Non-U.S. Gov't ; Tetradecanoylphorbol Acetate/antagonists & inhibitors/pharmacology ; Thiazolidinediones/pharmacology ; Transcription, Genetic/drug effects

Purpose: To compare the ocular biometry and postoperative refractive outcomes using two devices; the swept-source opticalcoherence tomography biometer (Argos) versus the partial coherence interferometer (IOL Master®500, Carl Zeiss Meditec AG,Jena, Germany). Methods: The axial length (AL), anterior chamber depth (ACD) and keratometry (K) in 221 cataract eyes were measured withArgos and IOL Master®500. One month after surgery, refraction of the respective eyes was conducted and the mean absoluteerror (MAE) calculated for analysis of the refractive outcomes. Results: Measurement was not possible in 13 eyes with the IOL Master®500 but was possible with Argos. Measurement was notpossible in one eye with either biometer. Agreement in measured ocular biometry between the two devices by intraclass correlationcoefficient (ICC) and Bland-Altman plot (ICC AXL = 0.999, ACD = 0.975, K = 0.978) was excellent. The AL and ACD measuredwith Argos were significantly longer than measured with IOL Master®500 (p= 0.005, p= 0.000). The MAE showed no significantdifference between the Argos and IOL Master®500 (p= 0.087). Conclusions The measurement of ocular biometry was better in Argos than in IOL Master®500. The accuracy of the intraocularlens power calculations of Argos was clinically acceptable and compatible with a conventional device.