Single-cell RNA sequencing analysis of the retina under acute high intraocular pressure

High intraocular pressure causes retinal ganglion cell injury in primary and secondary glaucoma diseases,yet the molecular landscape characteristics of retinal cells under high intraocular pressure remain unknown.Rat models of acute hypertension ocular pressure were established by injection of cross-linked hyaluronic acid hydrogel(Healaflow■).Single-cell RNA sequencing was then used to describe the cellular composition and molecular profile of the retina following high intraocular pressure.Our results identified a total of 12 cell types,namely retinal pigment epithelial cells,rod-photoreceptor cells,bipolar cells,Müller cells,microglia,cone-photoreceptor cells,retinal ganglion cells,endothelial cells,retinal progenitor cells,oligodendrocytes,pericytes,and fibroblasts.The single-cell RNA sequencing analysis of the retina under acute high intraocular pressure revealed obvious changes in the proportions of various retinal cells,with ganglion cells decreased by 23%.Hematoxylin and eosin staining and TUNEL staining confirmed the damage to retinal ganglion cells under high intraocular pressure.We extracted data from retinal ganglion cells and analyzed the retinal ganglion cell cluster with the most distinct expression.We found upregulation of the B3gat2 gene,which is associated with neuronal migration and adhesion,and downregulation of the Tsc22d gene,which participates in inhibition of inflammation.This study is the first to reveal molecular changes and intercellular interactions in the retina under high intraocular pressure.These data contribute to understanding of the molecular mechanism of retinal injury induced by high intraocular pressure and will benefit the development of novel therapies.

The role of heredity in pterygium development

Several risk factors,which include heredity,ultra-violet (UV) light and chronic inflammation,contribute to pterygium development.However,there is no report integrating these factors in the pathogenesis of pterygium.The aim of this review is to describe the connection between heredity,UV,and inflammation in pterygium development.Existing reports indicate that sunlight exposure is the main factor in pterygium occurrence by inducing growth factor production or chronic inflammation or DNA damage.Heredity may be a factor.Our studies on factors in pterygium occurrence and recurrence identify that heredity is crucial for pterygium to develop,and that sunlight is only a trigger,and that chronic inflammation promotes pterygium enlargement.We propose that genetic factors may interfere with the control of fibrovascular proliferation while UV light or(sunlight)most likely only triggers pterygium development by inducing growth factors which promote vibrant fibrovascular proliferation in predisposed individuals.It also just triggers inflammation and collagenolysis,which may be promoters of the enlargement of the fibrovascular mass.Pterygium probably occurs in the presence of exuberant collagen production and profuse neovascularisation.

Accuracy of biometric formulae for intraocular lens power calculation in a teaching hospital

AIM: To evaluate the accuracy of three commonly used biometric formulae across different axial lengths(ALs) at one United States Veterans Affairs teaching hospital.METHODS: A retrospective chart review was conducted from November 2013 to May 2018. One eye of each patient who underwent cataract surgery with a monofocal intraocular lens(IOL) was included. The range of postoperative follow-up period was from 3 wk to 4 mo. The Holladay 2, Barrett Universal II, and Hill-Radial Basis Function(Hill-RBF) formulae were used to predict the postoperative refraction for all cataract surgeries. For each formula, we calculated the prediction errors [including mean absolute prediction error(MAE)] and the percentage of eyes within ±0.25 diopter(D) and ±0.5 D of predicted refraction. We performed subgroup analyses for short(AL<22.0 mm), medium(AL 22.0-25.0 mm), and long eyes(AL>25.0 mm).RESULTS: A total of 1131 patients were screened, and 909 met the inclusion criteria. Resident ophthalmologists were the primary surgeons in 710(78.1%) cases. We found no statistically significant difference in predictive accuracy among the three formulae over the entire AL range or in the short, medium, and long eye subgroups. Across the entire AL range, the Hill-RBF formula resulted in the lowest MAE(0.384 D) and the highest percentage of eyes with postoperative refraction within ±0.25 D(42.7%) and ±0.5 D(75.5%) of predicted. All three formulae had the highest MAEs(>0.5 D) and lowest percentage within ±0.5 D of predicted refraction(<55%) in short eyes.CONCLUSION: In cataract surgery patients at our teaching hospital, three commonly used biometric formulae demonstrate similar refractive accuracy across all ALs. Short eyes pose the greatest challenge to predicting postoperative refractive error.

Pediatric Nd:YAG laser capsulotomy in the operating room: review of 87 cases

AIM: To report a large series of children having Nd:YAG laser capsulotomy in the operating room using the lateral decubitus position. METHODS: Medical records of children who underwent Nd:YAG laser capsulotomy in the operating room at Ann & Robert H. Lurie Children's Hospital of Chicago between September 2008 and April 2017 were reviewed. Induction of general anesthesia and intubation was performed in the supine position after which the patient was placed in lateral decubitus position. The Nd:YAG laser capsulotomy was performed using a standard protocol. At the completion of the procedure, the patient was turned back into the supine position and extubated. RESULTS: This study included 87 eyes of 60 patients. Patient's age ranged from 1 to 18 y(mean 6.4±4.1 y). In most cases(84/87, 97%), the procedure was performed under general anesthesia. In all cases, good focus on the membrane was achieved, and the procedure was performed successfully. There were no intraoperative ocular or anesthesia-related complications. CONCLUSION: When performing Nd:YAG laser capsulotomy in the operating room, the lateral decubitus position allowsan easy and safe approach without the risk of potentially devastating complications that have been associated with the previously described sitting and prone positions.

Importance of 3-D image reconstruction of spectraldomain OCT on outcome of grid laser photocoagulation for diffuse diabetic macular edema

AIM:To present the outcome of modified grid laser photocoagulation(GLP)in diffuse diabetic macular edema(DDME)in eyes without extrafoveal and/or vitreofoveal traction.METHODS:Inclusion criteria for the retrospective study were DDME eyes of patients with typeⅡdiabetes mellitus that had≥4 months of follow-up following GLP.Only one eye per patient was analyzed.Using 3-D spectral-domain optical coherence tomography(3-D SDOCT),eyes that had either extrafoveal or vitreofoveal traction,or had been previously treated by an intravitreal medication(s)were excluded.Treated DDME eyes were divided into 4 groups:A)"Classic"DDME that involved the central macula;B)edema did not involve the macular center;C)eyes associated with central epiretinal membrane(ERM);D)DDME that was associated with macular capillary dropout≥2 disc-diameter(DD).RESULTS:GLP outcome in 35 DDME eyes after 4-24(mean,13.1±6.9)months was as follows:Group A)18eyes with"classic"DDME.Following one or 2(mean,1.2)GLP treatments,best-corrected visual acuity(BCVA)improved by 1-2 Snellen lines in 44.4%(8/18)of eyes,and worsened by 1 line in 11.1%(2/18).Central macular thickness(CMT)improved by 7%-49%(mean,26.6%)in77.8%(14/18)of eyes.Causes of CMT worsening(n=4)were commonly explainable,predominantly(n=3)associated with emergence of extrafoveal traction,5-9months post-GLP.Group B)GLP(s)in DDME that did not involve the macular center(n=6)resulted in improved BCVA by 1-2 lines in 2 eyes.However,the central macula became involved in the edema process after the GLP in 3(50%)eyes,associated with an emergence of extrafoveal traction in one of these eyes 4months following the GLP.Group C)GLP failed in all 5eyes associated with central ERM.Group D)GLP was of partial benefit in 2 of 6 treated eyes with macular capillary dropout≥2DD.CONCLUSION:Eyes with DDME that involved the macular center were found to achieve favourable outcomes after GLP(s)during mid-term follow-up,unless complicated pre-GLP or post-GLP by vltreoretinal interface abnormalities,often extrafoveal traction or ERM,or by capillary dropout≥2DD.Prospective studies with larger cohorts are required.

Effect of brimonidine tartrate on basophil activation in glaucoma patients

AIM:To evaluate the mechanism of which brimonidine tartrate 0.15%causes clinical hypersensitivity.METHODS:A prospective case-control study comparing 8 glaucoma patients with clinical hypersensitivity to brimonidine to a control group consisting 13 healthy volunteers.Blood samples were stimulated with brimonidine 0.15%,timolol 0.5%or brimonidine tartrate/timolol maleate 0.2%/0.5%.Premixed antibodies(CD63/FITC and aIgE/PE)were added for direct staining and whole-blood samples were lysed,fixed and analyzed by a flow cytometer.The basophil population was defined by high IgE cell expression.Degranulation was identified by the expression of the activation molecule CD63.RESULTS:Basophil activation was not significant when comparing percent of activated basophils of patients and healthy controls after exposure to brimonidine(2.58%,2.45%,respectively,P=0.72).There was a significant suppression of basophil activation when a combination of brimonidine-timolol(0.87%)was compared to timolol(2.27%;P=0.012)and to brimonidine alone(2.58%;P=0.017).CONCLUSION:The results of our study do not support the hypothesis that brimonidine induces an immediate allergic reaction.Basophil activation was suppressed by the presence ofβ-blockers in patients hypersensitive to brimonidine and in healthy individuals.This finding indicates that timolol suppress brimonidine drug reaction by a different mechanism.

Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM:To evaluate the causes of phakic implantable collamer lens(ICL)exchange/explantation in patients with and without keratoconus(KC)at two tertiary hospitals in Riyadh,Saudi Arabia.METHODS:A retrospective chart review of all patients who underwent ICL(model V4 c with central port)exchange/explantation was performed using the electronic medical record systems.All available preoperative and postoperative data were documented for each patient.RESULTS:Over 7 y,2283 ICL implantation procedures were performed;46 implants(2%)required exchange(21 implants)/explantation(25 implants),of which 14 cases(30.4%)were patients with KC.Indications for ICL exchange/explantation in non-KC group were vault measurement,cataract formation,increased intraocular pressure,inaccurate refraction,and patient dissatisfaction in 22(68.75%),4(12.5%),3(9.37%),2(6.25%),and 1(3.12%)case,respectively.The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients(78.57%),inaccurate refraction in 2 patients(14.28%),and patient dissatisfaction postoperatively in 1(7.14%)case.CONCLUSION:ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature.Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.

Lack of association between lysyl oxidase-like 1 polymorphisms and primary open angle glaucoma: a meta-analysis

AIM:To study the associations between lysyl oxidaselike 1(LOXL1)polymorphisms and primary open angle glaucoma(POAG)remain inconsistent.In this study,we have performed a meta-analysis to investigate the association of LOXL1 polymorphisms with POAG risk.METHODS:Published literature from PubMed and other databases were retrieved.All studies evaluating the association between LOXL1 polymorphisms(rs2165241,rs1048661,rs3825942)and POAG risk were included.Pooled odds ratio(OR)and 95%confidence interval(CI)were calculated using random-or fixed-effects model.RESULTS:Twelve studies were identified as eligible articles,with thirteen(2098 cases and 16 473 controls),thirteen(1795 cases and 2916 controls)and sixteen population cohorts(2456 cases and 2846 controls)for the association of rs2165241,rs1048661 and rs3825942with POAG risk respectively.Overall analyses showed noassociation between each LOXL1 polymorphism and POAG risk,and the negative associations were remained when the subjects were stratified as Caucasian and Asian.The heterozygote of rs2165241 was associated with reduced POAG risk in hospital-based populations(TC vs CC:OR,0.79,95%CI:0.63-0.99),and rs1048661was associated with increased POAG risk in hospitalbased populations in a dominant model(TT vs CC+CT:OR,1.23,95%CI:1.01-1.50);however,these associations were not found in population-based subjects.CONCLUSION:This meta-analysis suggests that LOXL1 polymorphisms are not associated with POAG risk.Given the limited sample size,the associations of LOXL1 polymorphisms with POAG risk in hospital-based populations await further investigation.

EFFECT OF SHORT-TERM SOFT CONTACT LENS WEAR ON HUMAN OCULAR ABERRATIONS

Objective To evaluate the effect of short-term soft contact lens （SCLs） wearing on human ocular aberrations （ HOA ）. Methods This prospective study included 50 eyes of 50 young volunteers wearing SCLs for 1 month. The ocular aberrations were measured by Allegretto Wavefront Analyzer. The root-mean-square （RMS） values of the general （RMSG） , higher-order （RMSH） , first to sixth order （ RMS1 to RMS6） and aberration coefficients were analyzed. Results There were no significant differences in the mean values of RMSG, RMSH, RMS1 to RMS6 （ P 〉 0. 05 ） and changes of absolute values of aberration coefficients between baseline and various visits after SCLs discontinuation. However, at d I after the discontinuation of SCLs, changes in coefficient values of the third-order aberrations （ C6 to C9 ） were slightly higher than others, and C7 was the highest. The increase factors of RMS values were higher at 1 week and lower at the 2 week visit after SCLs discontinuation. The uniformity of dominating type in HOA and the corneal topography form was both about 60% after discontinuation of SCLs. The corneal thickness increased after SCLs wear and gradually decreased to baseline until 1 month discontinuation of SCLs. Conclusion The effect of short-term SCLs wear on human ocular aberrations is slight but profound. A month or more wait should be allowed before the short-term SCLs wearers are scheduled for wavefronted-guided LASIK.

Enhancing diabetic retinopathy screening:Non-mydriatic fundus photography-assisted telemedicine for improved clinical management

The utilization of non-mydriatic fundus photography-assisted telemedicine to screen patients with diabetes mellitus for diabetic retinopathy provides an accurate,efficient,and cost-effective method to improve early detection of disease.It has also been shown to correlate with increased participation of patients in other aspects of diabetes care.In particular,patients who undergo teleretinal imaging are more likely to meet Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set metrics,which are linked to preservation of quality-adjusted life years and additional downstream healthcare savings.

Smart molecules in ophthalmology:Hydrogels as responsive systems for ophthalmic applications

This comprehensive review delves into a unique intersection of hydrogels as smart molecules and their transformative applications in ophthalmology.Beginning with the foundational definition,properties,and classification of hydrogels,the review explores their synthesis and responsive capabilities.Specific applications examined encompass topical drug delivery,contact lenses,intravitreal drug delivery,ocular adhesives,vitreous substitutes,and cell-based therapy.A methodical analysis,including an overview of relevant ocular structures and a comparative evaluation of hydrogel-based solutions against traditional treatments,is conducted.Additionally,potential constraints,translation challenges,knowledge gaps,and research areas are identified.Our methodical approach,guided by an extensive literature review from 2017 to 2023,illuminates the unprecedented opportunities offered by hydrogels,along with pinpointing areas for further inquiry to facilitate their transition into clinical practice.

Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

Endogenous fungal endophthalmitis:risk factors,clinical course,and visual outcome in 13 patients

AIM:To analyze the risk factors,ophthalmological features,treatment modalities and their effect on the visual outcome in patients with endogenous fungal endophthalmitis(EFE).METHODS:Data retrieved from the medical files included age at presentation to the uveitis clinic,gender,ocular symptoms and their duration before presentation,history of fever,eye affected,anatomical diagnosis and laboratory evidence of fungal infection.Medical therapy recorded included systemic antifungal therapy and its duration,use of intravitreal antifungal agents and use of oral/intravitreal steroids.Surgical procedures and the data of ophthalmologic examination at presentation and at last follow-up were also collected.RESULTS:Included were 13 patients(20 eyes,mean age 58 y).Ten patients presented after gastrointestinal or urological interventions and two presented after organ transplantation.In one patient,there was no history of previous intervention.Diagnostic vitrectomy was performed in 16 eyes(80%)and vitreous cultures were positive in 10 of the vitrectomized eyes(62.5%).In only 4 patients(31%),blood cultures were positive.All patients received systemic antifungal therapy.Sixteen eyes(80%)received intravitreal antifungal agent with voriconazole being the most commonly used.Visual acuity(VA)improved from 0.9±0.9 at initial exam to 0.5±0.8 logMAR at last followup(P=0.03).A trend of greater visual improvement was noted in favor of eyes treated with oral steroids(±intravitreal dexamethasone)than eyes that were not treated with steroids.The most common complication was maculopathy.Twelve eyes(60%)showed no ocular complications.CONCLUSION:High index of suspicion in patients with inciting risk factors is essential because of the low yield of blood cultures and the good general condition of patients at presentation.Visual prognosis is improved with the prompt institution of systemic and intravitreal pharmacotherapy and the immediate surgical intervention.Oral±local steroids could be considered in cases of prolonged or marked inflammatory responses in order to hasten control of inflammation and limit ocular complications.

One-year outcomes and predictable factors for microhook ab interno trabeculotomy

AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.

光学相干断层成像术与超声生物显微镜用于窄前房角检测的比较性研究

Objective: To assess the accuracy of classification of narrow anterior chamber (AC) angles using quantitative imaging by optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM). Design: Observational comparative study. Methods: A high-speed (4000 axial scans/s) anterior segment OCT prototype was developed using a 1.3- μ m light source. Seventeen normal subjects (17 eyes) and 7 subjects (14 eyes)-with narrow angle glaucoma were enrolled. All subjects underwentg onioscopy, OCT, and UBM. Quantitative AC angle parameters (angle opening distance, angle recess area, and the trabecular-iris space area [a new parameter we have defined])-were measured from OCT and UBM images using proprietary processing software. Main Outcome Measures: Specificity and sensitivity in identifying narrow angles with image-derived AC angle parameters. Results: Eight of 31 eyes were classified as having narrow angles (Shaffer grade ≤ 1 in all quadrants). The AC angle parameters measured by both OCT and UBM had similar mean values, reproducibility, and sensitivity specificity profiles. Both OCT and UBM showed excellent performance in identifying eyes with narrow angles. Areas under the receiver operating characteristic curves for these parameters were all in the range of 0.96 to 0.98. Conclusions: Optical coherence tomography was similar to UBM in quantitative AC angle measurement and detection of narrow angles. In addition, it was easier to use and did not require contact with the eye. Optical coherence tomography is a promising method for screening individuals at risk for narrow angle glaucoma.

Pediatric uveitis:EYE-Q and metrics beyond visual acuity

Pediatric uveitis is an inflammatory ocular disease that can lead to sight-threatening complications.Pediatric patients have distinct challenges in the diagnosis and management of uveitis,secondary to difficulties in performing ophthalmic examinations in young children,delayed diagnosis due to lack of adherence with recommended screening schedules,medication side-effects,and increased burden of disease into adulthood.Measurement of outcomes in pediatric uveitis has traditionally relied upon the ophthalmic examination and general quality of life(QOL)measures.However,the ophthalmic examination does not take into account the impact of uveitis on a child’s QOL and general QOL measures do not adequately assess the specific effects of vision.Several vision-related quality of life(VR-QOL)instruments have been used to measure outcomes in both adults and children including:the National Eye Institute Visual Function Questionnaire(NEI VFQ-25),Vision-related Quality of Life of Children and Young People(VQoL_CYP),the Children’s Visual Function Questionnaire(CVFQ),and the Effect of Youngsters’Eyesight on Quality of Life(EYE-Q).However,the NEI VFQ-25 is not a valid or applicable measure in children,and the VQoL_CYP and CVFQ are not uveitis specific and may not characterize disease specific burdens.The EYE-Q is the only uveitis-specific pediatric questionnaire that measures visual functioning and VR-QOL in 5-18 years old children and adolescents with uveitis.It has been shown to be a valid and reliable assessment tool in several cohorts of children with uveitis.A comprehensive assessment of the impact of uveitis on a child that includes a vision-specific measure,such as the EYE-Q,allows for better understanding of the true burden of uveitis in children.For this review,we describe traditional outcome measures in uveitis studies,general QOL measures and vision-specific measures in adults and in children.

对3岁儿童进行视觉筛选可行吗?比较Lea Sym-bol表和HVOT(LM)表

Purpose: The aim of this prospective study was to compare visual screening at the age of 3 years with screening at 4 years using two different charts. Methods : A total of 478 3-year-old children were tested at four child health care cen tres (CHCCs). Of these children, 440 were tested again at the age of 4 years. A third group, a control group, consisting of 229 children, was examined only at t he age of 4 years. All children were tested with both the HVOT chart and the Lea Symbol chart. Results: Testability rates for 3-year-olds were almost the same with the Lea Symbol chart and the HVOT chart (82.8%and 84.8%, respectively). The corresponding rates for the same children tested at 4 years of age were 96.5 %and 97.0%, and for the 4-year-olds not previously tested 92.9%and 92.8%. The mean testing time was somewhat shorter for the Lea Symbol chart in all three groups, but the difference was not statistically significant. The difference in the assessment of visual acuity between the two charts was small and less than 1/10th of a line. The positive predictive value was lower at 3 years (58%) than has previously been found at 4 years (74.6%). Conclusion: Three-year-old chi ldren co-operate well in visual acuity testing. However, the examination time i s a little longer and the testability rate is about 10%lower than at 4 years. B oth 3-year-old and 4-year-old children can be tested equally well with the H VOT and the Lea Symbol charts.

Ethambutol induced toxic optic neuropathy in HIV positive patients

AIMTo determine whether HIV and the use of antiretroviral therapy is a risk factor for the development of ethambutol toxic optic neuropathy. To describe the clinical course of ethambutol toxic optic neuropathy in patients with HIV and to identify prognostic factors.

XEN Gel Stent exposure 7mo after primary implantation:a case report

Dear Editor,XEN Gel Stent 45 gm (Allergan Pic, Irvine, CA, USA) is a minimally-invasive procedure in glaucoma surgery perceived to reduce the risk of postoperative hypotony while sufficiently lowering the intraocular pressure (IOP) and requiring less topical antiglaucoma medications postoperatively.

Idiopathic cholesterol crystal embolism with atheroembolic renal disease and blue toes syndrome:A case report

BACKGROUND Cholesterol crystal embolization(CCE)is a multisystemic and fatal disease with multiple clinical manifestations;however,there are few cases of idiopathic CCE.Here we report a patient with idiopathic CCE accompanied by atheroembolic renal disease and blue toes who had a relatively good prognosis in the short-term due to early treatment with corticosteroids and statins.CASE SUMMARY A 76-year-old man complained of coldness,numbness and purple color change in his left foot for 7 d.He had a feeling of fatigue,constipation,foamy urine,poor appetite and sleep.He had a lacunar infarction for 5 years and hypertension for 9 mo.Laboratory results showed elevated eosinophils,cholesterol,uric acid,serum creatinine,urea and 24 h urine analysis revealed proteinuria.A renal biopsy revealed atheroembolic renal disease.Taken together,these findings strongly supported the diagnosis of idiopathic CCE and atheroembolic renal disease.CONCLUSION Atheroembolic renal disease and blue toes syndrome can be caused by idiopathic CCE,and early treatment with corticosteroids is effective but requires further investigation.