Zhizhong Ma

Prognostic Indicators for No Light Perception After Open-Globe Injury: Eye Injury Vitrectomy Study

PURPOSEnTo describe ocular characteristics, surgical interventions, and anatomic and visual outcomes of traumatized eyes with no light perception (NLP) following open-globe injury and to investigate prognostic predictors for NLP cases after open-globe injury.nnnDESIGNnInterventional case series study.nnnMETHODSnThirty-three traumatized eyes with NLP were selected from the Eye Injury Vitrectomy Study database, a hospital-based multicenter prospective cohort study. Inclusion criteria were NLP cases following open-globe injury with outcomes of anatomic restoration, phthisis bulbi, or enucleation. Exclusion criteria were cases with missing records, undergoing vitrectomy after injury at nonparticipating hospitals, direct optic head injury, endophthalmitis, and hypotonous or silicone oil-sustained eyes. All cases underwent vitreoretinal surgery or enucleation after exploratory surgery and were followed up for at least 6 months. Two outcomes were assessed: favorable outcome (anatomically restored eye globes with light perception [LP] or better vision) and unfavorable outcome (NLP, phthisis bulbi, or enucleation).nnnRESULTSnThe following 7 risk factors were significant between the 2 groups: rupture (P = .021); open globe III (P = .046); scleral wound ≥10 mm (P = .001); ciliary body damage (P < .001); severe intraocular hemorrhage (P = .005); closed funnel retinal detachment or retinal prolapse (P = .005); and choroidal damage (P = .001).nnnCONCLUSIONSnThese 7 risk factors are possible predictors of poor prognosis. Traumatized eyes with NLP can be anatomically restored with LP or better vision if vitreoretinal surgery is attempted, and a favorable anatomic and visual outcome is increased by having a decreased number of these risk factors.

Risk factors, anatomical, and visual outcomes of injured eyes with proliferative vitreoretinopathy: eye injury vitrectomy study.

Purpose: To investigate potential risk factors for development of proliferative vitreoretinopathy (PVR) post trauma and evaluate the effect of PVR on anatomical and visual outcomes in injured eyes. Methods: Overall, 179 eyes with PVR and 221 eyes without PVR after injury were selected from the database of the Eye Injury Vitrectomy Study, a multicenter cohort study launched in 1997. Multivariate logistic regression was used to ascertain the independent risk factors for development of PVR and to evaluate the influence of PVR on anatomical and visual outcomes. Results: An interval of injury and vitrectomy of more than 28 days (odds ratio, 139.25; confidence interval, 50.09–387.10), severe vitreous hemorrhage (odds ratio, 2.72; confidence interval, 1.13–6.52), and total retinal detachment (odds ratio, 12.67; confidence interval, 3.96–40.52) were important independent risk factors for PVR. One hundred and fifteen eyes (52.0%) and 49 eyes (27.4%) without and with PVR, respectively, were anatomically restored with ambulant visual acuity (≥4/200). Proliferative vitreoretinopathy, poor initial visual acuity, relative afferent pupillary defect, total retinal detachment, and retinal tear or retinal defect were unfavorable prognostic indicators. Conclusion: Proliferative vitreoretinopathy occurs frequently in injured eyes and is associated with poor outcomes. Its onset depends on interval of injury and vitrectomy, wound location, vitreous hemorrhage, and retinal detachment. Early vitrectomy (before 2 weeks) and aggressive therapy should be considered for specific high-risk cases.

Case-control study of risk factors for no light perception after open-globe injury: eye injury vitrectomy study.

Purpose: Investigate possible risk factors of no light perception (NLP) after open-globe injury. Explore whether these risk factors are predictors for an unfavorable visual outcome. Methods: This case–control study matched 72 eyes with NLP according to type and zone of injury to 2 controls per case with light perception or better vision. Cases were selected from the Eye Injury Vitrectomy Study database. All injured eyes in the study underwent surgical intervention. Results: Ciliary body damage (odds ratio = 2.94), closed funnel retinal detachment (odds ratio = 2.43), and choroidal damage (odds ratio = 2.80) were independent risk factors for NLP after open-globe injury. There were 67 traumatized eyes with NLP that had ≥1 of these risk factors. In 43 of the cases (64.2%), the eyes recovered light perception or better after vitreoretinal surgery. The five traumatized NLP cases without these risk factors obtained a favorable visual outcome after vitreoretinal surgery. There was no statistical significance in visual outcome between them (P = 0.162). Conclusion: Ciliary body damage, closed funnel retinal detachment, and choroidal damage are independent risk factors for NLP posttrauma but not prognostic indicators for NLP visual outcome. Traumatized eyes with NLP may recover light perception or better vision if appropriate interventional measures are used for treatment of the injured ciliary body, retina, and choroid.

Autologous Transplantation of Simple Retinal Pigment Epithelium Sheet for Massive Submacular Hemorrhage Associated With Pigment Epithelium Detachment

PURPOSEnTo evaluate the long-term outcome of autologous simple RPE sheet transplantation in patients with simultaneous massive submacular hemorrhage and pigment epithelium detachment (PED).nnnMETHODSnFourteen patients with 10 occult AMD eyes and 4 PCV eyes underwent a surgical procedure including a 180° peripheral temporal retinotomy, choroidal neovascular membrane (CNVM) excision, and transplantation of an autologous simple RPE sheet developed from the PED region outside the CNVM lesion. Best-corrected visual acuity, multifocal ERG, and microperimetry were recorded to evaluate macular function. Optical coherence tomography, fundus fluorescein angiography, and an RPE autofluorescence test were performed to observe the status of the transplanted simple RPE sheet.nnnRESULTSnMean follow-up duration was 24 ± 6 months. Mean ETDRS score increased from 14.0 ± 23.4 preoperatively to 31.9 ± 23.8 at 18 months postoperatively (P < 0.05). Of 14 eyes, 5 (36%) presented with central fixation postoperatively, whereas only 3 (21%) eyes presented with central fixation preoperatively. Ten grafts (71%) showed normal RPE color. Postoperative complications included one (7%) retinal detachment due to proliferative vitreoretinopathy and one (7%) delayed recurrent submacular hemorrhage.nnnCONCLUSIONSnTransplantation of an autologous simple RPE sheet for eyes with massive submacular hemorrhage associated with PED was achieved with a simplified surgical procedure, resulting in increased postoperative visual acuity.

Melatonin delays photoreceptor degeneration in a mouse model of autosomal recessive retinitis pigmentosa

Retinitis pigmentosa (RP) comprises a group of incurable inherited retinal degenerations. Targeting common processes, instead of mutation‐specific treatment, has proven to be an innovative strategy to combat debilitating retinal degeneration. Growing evidence indicates that melatonin possesses a potent activity against neurodegenerative disorders by mitigating cell damage associated with apoptosis and inflammation. Given the pleiotropic role of melatonin in central nervous system, the aim of the present study was to investigate whether melatonin would afford protection against retinal degeneration in autosomal recessive RP (arRP). Rd10, a well‐characterized murine model of human arRP, received daily intraperitoneal injection of melatonin (15 mg/kg) between postnatal day (P) 13 and P30. Retinas treated with melatonin or vehicle were harvested for analysis at P30 and P45, respectively. The findings showed that melatonin could dampen the photoreceptors death and delay consequent retinal degeneration. We also observed that melatonin weakened the expression of glial fibrillary acidic protein (GFAP) in Müller cells. Additionally, melatonin could alleviate retinal inflammatory response visualized by IBA1 staining, which was further corroborated by downregulation of inflammation‐related genes, such as tumor necrosis factor alpha (Tnf‐α), chemokine (C‐C motif) ligand 2 (Ccl2), and chemokine (C‐X‐C motif) ligand 10 (Cxcl10). These data revealed that melatonin could ameliorate retinal degeneration through potentially attenuating apoptosis, reactive gliosis, and microglial activation in rd10 mice. Moreover, these results suggest melatonin as a promising agent improving photoreceptors survival in human RP.

Outcomes of scleral buckling using chandelier endoillumination.

To report the results and complications of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using 25‐gauge chandelier endoillumination.

Clinical features and prognosis of eyeball rupture: eye injury vitrectomy study.

The objective of the study was to delineate clinical characteristics, surgical interventions, anatomic and visual outcomes of ruptured eye balls after trauma, and establish the prognostic indicators, which can assist clinicians in making correct surgical decisions during globe exploration for ruptured eyes.

Clinical features and outcomes of vitrectomy in pediatric ocular injuries-eye injury vitrectomy study

Context: Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently. Aims: To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS). Settings and Design: Retrospective, consecutive, interventional case series. Materials and Methods: Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009. Statistical analysis used: Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.). Results: Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively. Conclusions: Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.

A comparison of autologous transplantation of retinal pigment epithelium (RPE) monolayer sheet graft with RPE-Bruch's membrane complex graft in neovascular age-related macular degeneration.

To compare the outcome after choroidal neovascular (CNV) membrane excision and retinal pigment epithelium (RPE) transplantation and make further evaluation of two types of RPE grafts on the visual function in patients with neovascular age‐related macular degeneration (AMD), complicated by massive subretinal haemorrhage.

Anatomical Outcome of Vitreoretinal Surgery Using Temporary Keratoprosthesis and Replacement of the Trephined Corneal Button for Severe Open Globe Injuries: One-Year Result

In this case series of 74 patients with coexisting vitreoretinal injury and severe corneal opacification, after temporary keratoprosthesis (TKP) assisted pars plana vitrectomy (PPV), an allograft corneal transplant was not performed at the same time; instead, the patients trephined corneal button was sutured back. One year after the surgery, if intraocular pressure of the injured eyes was above 8u2009mmHg, removing silicone oil was attempted, and penetrating keratoplasty could be performed. Finally, 10 eyes (13.5%) were enucleated due to atrophia bulbi; 46 eyes (62.2%) were silicone-oil sustained; 15 eyes (20.3%) were anatomically restored; and 3 eyes (4.0%) experienced recurrent retinal detachment. These figures only demonstrate a small percentage of the injured eyes in our series, which have PKP indications. It is a practical option to suture back the patients trephined cornea following a TKP assisted PPV; keratoplasty was reserved for selected cases.