Neurodegeneration and choroidal vascular features on OCT in the progression to advanced age-related macular degeneration

AIM:To quantify and compare longitudinal thickness changes of the ganglion cell complex(GCC)and the choroid in patients with different patterns of age-related macular degeneration(AMD)progression.METHODS:Retrospective cohort analysis of anonymized data from participants aged 50y or more and diagnosed with early/intermediate AMD in at least one eye(with no evidence of advanced AMD).A total of 64 participants were included from the Instituto de Retina de Lisboa(IRL)study(IPL/2022/MetAllAMD_ESTeSL)and divided into 4 groups according to the Rotterdam classification for AMD.Spectral domain optical coherence tomography(SD-OCT)was used to assess and quantify GCC and choroid thickness at two time points(first visit vs last visit)with a minimum interval of 3y.RESULTS:In the GCC inner ring,a thinner thickness(P=0.001)was observed in the atrophic AMD group(51.3±21.4μm)compared to the early AMD(84.3±11.5μm),intermediate AMD(77.6±16.1μm)and neovascular AMD(88.9±16.3μm)groups.Choroidal thickness quantification showed a generalized reduction in the central circle(P=0.002)and inner ring(P=0.001).Slight reductions in retinal thickness were more accentuated in the inner ring in the atrophic AMD(-13%;P<0.01).CONCLUSION:The variation of the analyzed structures could be an indicator of risk of progression with neurodegenerative(GCC)or vascular(choroid)pattern in the intermediate and atrophic AMD.The quantification of both structures can provide important information about the risk of disease progression in the early and intermediate stages but also for the evolution pattern into late stages(atrophic or neovascular).

Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography

AIM:To compare the three-dimensional choroidal vascularity index(CVI)and choroidal thickness between fellow eyes of acute primary angle-closure(F-APAC)and chronic primary angle-closure glaucoma(F-CPACG)and the eyes of normal controls.METHODS:This study included 37 patients with unilateral APAC,37 with asymmetric CPACG without prior treatment,and 36 healthy participants.Using swept-source optical coherence tomography(SS-OCT),the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally.Pearson’s correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors.RESULTS:The mean subfoveal CVIs were 0.35±0.10,0.33±0.09,and 0.29±0.04,and the mean subfoveal choroidal thickness were 315.62±52.92,306.22±59.29,and 262.69±45.55μm in the F-APAC,F-CPACG,and normal groups,respectively.All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes(P<0.05),while there were no significant differences between the F-APAC and F-CPACG eyes.In the peripapillary region,the mean overall CVIs were 0.21±0.08,0.20±0.08,and 0.19±0.05,and the mean overall choroidal thickness were 180.45±54.18,174.82±50.67,and 176.18±37.94μm in the F-APAC,F-CPACG,and normal groups,respectively.There were no significant differences between any of the two groups in all peripapillary sectors.Younger age,shorter axial length,and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness(P<0.05).CONCLUSION:The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls.Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG.A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Using choroidal thickness to detect myopic macular degeneration

AIM:To explore the usage of choroidal thickness measured by swept-source optical coherence tomography(SS-OCT)to detect myopic macular degeneration(MMD)in high myopic participants.METHODS:Participants with bilateral high myopia(≤−6 diopters)were recruited from a subset of the Guangzhou Zhongshan Ophthalmic Center-Brien Holden Vision Institute High Myopia Cohort Study.SS-OCT was performed to determine the choroidal thickness,and myopic maculopathy was graded by the International Meta-Analysis for Pathologic Myopia(META-PM)Classification.Presence of MMD was defined as META-PM category 2 or above.RESULTS:A total of 568 right eyes were included for analysis.Eyes with MMD(n=106,18.7%)were found to have older age,longer axial lengths(AL),higher myopic spherical equivalents(SE),and reduced choroidal thickness in each Early Treatment Diabetic Retinopathy Study(ETDRS)grid sector(P<0.001).The area under the receiver operating characteristic(ROC)curves(AUC)for subfoveal choroidal thickness(0.907)was greater than that of the model,including age,AL,and SE at 0.6249,0.8208,and 0.8205,respectively.The choroidal thickness of the inner and outer nasal sectors was the most accurate indicator of MMD(AUC of 0.928 and 0.923,respectively).An outer nasal sector choroidal thickness of less than 74μm demonstrated the highest odds of predicting MMD(OR=33.8).CONCLUSION:Choroidal thickness detects the presence of MMD with high agreement,particularly of the inner and outer nasal sectors of the posterior pole,which appears to be a biometric parameter more precise than age,AL,or SE.

Evaluation of retinal and choroidal thickness changes in overweight and obese adults without ocular symptoms by swept-source optical coherence tomography

AIM:To evaluate the relationship of overweight and obesity with retinal and choroidal thickness in adults without ocular symptoms by swept-source optical coherence tomography(SS-OCT).METHODS:According to the body mass index(BMI)results,the adults enrolled in the cross-sectional study were divided into the normal group(18.50≤BMI<25.00 kg/m^(2)),the overweight group(25.00≤BMI<30.00 kg/m^(2)),and the obesity group(BMI≥30.00 kg/m^(2)).The one-way ANOVA and the Chi-square test were used for comparisons.Pearson’s correlation analysis was used to evaluate the relationships between the measured variables.RESULTS:This research covered the left eyes of 3 groups of 434 age-and sex-matched subjects each:normal,overweight,and obesity.The mean BMI was 22.20±1.67,26.82±1.38,and 32.21±2.35 kg/m^(2) in normal,overweight and obesity groups,respectively.The choroid was significantly thinner in both the overweight and obesity groups compared to the normal group(P<0.05 for all),while the retinal thickness of the three groups did not differ significantly.Pearson’s correlation analysis showed that BMI was significantly negatively correlated with choroidal thickness,but no significant correlation was observed between BMI and retinal thickness.CONCLUSION:Choroidal thickness is decreased in people with overweight or obesity.Research on changes in choroidal thickness contributes to the understanding of the mechanisms of certain ocular disorders in overweight and obese adults.

Automated evaluation of parapapillary choroidal microvasculature in crowded optic discs:a controlled,optical coherence tomography angiography study

AIM:To compare superficial and deep vascular properties of optic discs between crowded discs and controls using optical coherence tomography angiography(OCT-A).METHODS:Thirty patients with crowded discs,and 47 control subjects were enrolled in the study.One eye of each individual was included and OCT-A scans of optic discs were obtained in a 4.5×4.5 mm^(2) rectangular area.Radial peripapillary capillary(RPC)density,peripapillary retinal nerve fiber layer(pRNFL)thickness,cup volume,rim area,disc area,cup-to-disc(c/d)area ratio,and vertical c/d ratio were obtained automatically using device software.Automated parapapillary choroidal microvasculature(PPCMv)density was calculated using MATLAB software.When the vertical c/d ratio of the optic disc was absent or small cup,it was considered as a crowded disc.RESULTS:The mean signal strength index of OCT-A images was similar between the crowded discs and control eyes(P=0.740).There was no difference in pRNFL between the two groups(P=0.102).There were no differences in RPC density in whole image(P=0.826)and peripapillary region(P=0.923),but inside disc RPC density was higher in crowded optic discs(P=0.003).The PPCMv density in the inner-hemisuperior region was also lower in crowded discs(P=0.026).The pRNFL thickness was positively correlated with peripapillary RPC density(r=0.498,P<0.001).The inside disc RPC density was negatively correlated with c/d area ratio(r=-0.341,P=0.002).CONCLUSION:The higher inside disc RPC density and lower inner-hemisuperior PPCMv density are found in eyes with crowded optic discs.

Non-linear relationship between age and subfoveal choroidal thickness in Chinese patients with proliferative diabetic retinopathy

BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR.METHODS This was a cross-sectional retrospective study.The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR.Contralateral eyes that met the criteria were included in the study.All necessary laboratory tests were performed at the time of admission.Central macular thickness(CMT)and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography.CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software.RESULTS The final analysis included a total of 234 individuals with PDR.The average age was 55.60 years old±10.03 years old,and 57.69%of the population was male.Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR[β=-2.44,95%confidence interval(95%CI):-3.46 to-1.42;P<0.0001].In the fully adjusted model,the correlation between SFCT and age remained steady(β=-1.68,95%CI:-2.97 to-0.39;P=0.0117).Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear,with an inflection point at 54 years of age.CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness.The non-linear link between SFCT and age in PDR patients should be taken into account.

Automatic fovea detection and choroid segmentation for choroidal thickness assessment in optical coherence tomography

AIM:To develop an automated model for subfoveal choroidal thickness(SFCT)detection in optical coherence tomography(OCT)images,addressing manual fovea location and choroidal contour challenges.METHODS:Two procedures were proposed:defining the fovea and segmenting the choroid.Fovea localization from B-scan OCT image sequence with three-dimensional reconstruction(LocBscan-3D)predicted fovea location using central foveal depression features,and fovea localization from two-dimensional en-face OCT(LocEN-2D)used a mask region-based convolutional neural network(Mask R-CNN)model for optic disc detection,and determined the fovea location based on optic disc relative position.Choroid segmentation also employed Mask R-CNN.RESULTS:For 53 eyes in 28 healthy subjects,LocBscan-3D’s mean difference between manual and predicted fovea locations was 170.0μm,LocEN-2D yielded 675.9μm.LocEN-2D performed better in non-high myopia group(P=0.02).SFCT measurements from Mask R-CNN aligned with manual values.CONCLUSION:Our models accurately predict SFCT in OCT images.LocBscan-3D excels in precise fovea localization even with high myopia.LocEN-2D shows high detection rates but lower accuracy especially in the high myopia group.Combining both models offers a robust SFCT assessment approach,promising efficiency and accuracy for large-scale studies and clinical use.

Beta-alanine promotes angiogenesis in laser-induced choroidal neovascularization mice models

AIM:To investigate the effect ofβ-alanine(BA)on laserinduced choroidal neovascularization(CNV)mice models.METHODS:Laser-induced CNV mice models were established,and BA was administrated for one week and two weeks in advance,separately.Furthermore,retinal pigment epithelium(RPE)-choroid flat mounts were separated,and immunohistochemical staining was performed.The laser-induced CNV lesion areas were measured and compared.In addition,liver and kidney morphologies were observed to identify potential hepatorenal toxicity.RESULTS:Enlarged CNV lesion areas were observed in the BA treated group.No significant differences were observed in the liver and kidney sections between groups.CONCLUSION:BA treatment increase CNV lesion areas,suggesting the detrimental effects of BA as a nutritional supplement in age-related macular degeneration(AMD)population.

Detecting early changes in choroidal vascularity and thickness using optical coherence tomography in patients with corneal crosslinking for keratoconus

AIM:To investigate changes in choroidal thickness and vascularity in keratoconus patients treated with corneal crosslinking.METHODS:This study evaluated 28 eyes of 22 patients with keratoconus who underwent corneal crosslinking.The choroidal thicknesses were evaluated on enhanced depth imaging optical coherence tomography at the preoperative and postoperative 3d,1,and 3mo.Choroidal thickness in the four cardinal quadrants and the fovea were evaluated.The choroidal vascularity index was also calculated.RESULTS:There was no significant difference in central choroidal thickness between the preoperative and postoperative 3d,1mo(P>0.05).There was a significant increase in the 3mo(P=0.034)and a significant decrease in the horizontal choroidal vascularity index on the postoperative 3d(P=0.014),there was no statistically significant change in vertical axes and other visits in horizontal sections(P>0.05).CONCLUSION:This study sheds light on choroidal changes in postoperative corneal crosslinking for keratoconus.While it suggests the procedure’s relative safety for submacular choroid,more extensive research is necessary to confirm these findings and their clinical significance.

Comment on:Evaluation of retinal and choroidal thickness changes in overweight and obese adults without ocular symptoms by swept-source optical coherence tomography

Dear Editor,We have read with interest the article by Li et al[1].In the response to this article[1]which is a well thought out and written paper,I would like to draw attention to some critical points in this study and add some comments to the results and the conclusion of the study which authors have detected.In the Li et al’s[1]study,it is detected that,choroidal thickness is significantly negatively correlated with body mass index(BMI)and choroidal thickness is decreased in people with overweight or obesity.

Etiology of anterior choroidal artery infarction:a systematic review

Objective:To systematically review the etiology of anterior choroidal artery(AChA)infarction.Methods:A systematic literature search up to May 11,2024,for AChA infarction with its etiology.Epidemiologic and clinical data of patients,anatomic distribution of the lesions,and etiologic classification of AChA infarction were extracted.Results:A total of 1007 individual patient data was included(967 from retrospective clinical studies and 40 from case reports).Among the clinical research,patients’mean age was 64.7.There were 62.24%of male and 37.76%of female patients.Hypertension(66.04%)was the most common risk factor for patients with AChA infarction.Dyslipidemia(32.92%),diabetes mellitus(30.93%),and smoking(26.54%)were also common risk factors.Moreover,the posterior limb of the internal capsule was the most frequently affected structure.Undetermined etiology(n=173,38.02%),according to the trial of org 10172 in acute stroke treatment(TOAST)etiological classification,was the most common etiology,followed by small vessel disease(n=117,25.71%),large artery atherosclerosis(n=84,18.46%),and cardioembolism(n=63,13.85%).Furthermore,eighteen strokes were caused by other determined etiologies(3.96%).Conclusions:Undetermined etiology was the most common etiology of AChA infarction.Hypertension,dyslipidemia,diabetes mellitus,and smoking were common risk factors for patients with AChA infarction.It is necessary to prevent the risk factors.

Impact of multifocal gas-permeable lens designs on short-term choroidal response, axial length, and retinal defocus profile

AIM:To investigate the impact of multifocal gas permeable contact lens(MFGPCL)in various add power and distance/near area allocation on short-term changes of choroidal thickness(ChT),axial length(AL),and retinal defocus profile in young adults.METHODS:Seventeen young adults(2 males and 15 females;age 23.17±4.48y)were randomly assigned to wear two designs binocularly with a one-week washout period in between.Total of four MFGPCL designs were assessed.All designs were distance-center that varied in two add power(+1.50 and 3.00 D)and/or two distance zone(DZ)diameters(1.50 and 3.00 mm;design A:DZ 1.5/add 3.0,B:DZ 1.5/add 1.5,C:DZ 3.0/add 3.0,D:DZ 3.0/add 1.5).ChT,AL,and peripheral refraction data were collected on each subject at baseline,on days 1 and 7 of MFGPCL daily wear.ChT was assessed in four quadrants using a spectraldomain optical coherence tomography.RESULTS:AL was shortened by-26±44μm with lens C,-18±27μm with lens D,-13±29μm with lens A,and-8±30μm with lens B(all P<0.05).A significant overall increase in ChT was observed with all 4 designs(lens A:+6±6μm,B:+3±7μm,C:+8±7μm,and D:+8±7μm).Temporal and superior choroid exhibited more choroidal thickening associated with MFGPCL.All designs induced significant relative peripheral myopia(RPM)beyond the central 20o across the horizontal meridian in both nasal and temporal fields(P<0.05).CONCLUSION:MFGPCLs show a significant influence on ChT and AL,which are associated with significant increase in RPM after short-term wear.The reliability and feasibility of quantifying short-term changes in ChT support its use as a promising marker for the long-term efficacy of myopia-controlling treatments.

Analysis of choroidal morphology and comparison of imaging findings of subtypes of polypoidal choroidal vasculopathy:a new classification system

AIM:To classify polypoidal choroidal vasculopathy(PCV)into 2 subtypes based on the subfoveal choroidal thickness(SFCT)and to further evaluate their multimodal image features.METHODS:A retrospective observational case series study.Sixty-four eyes of 64 patients with PCV were enrolled and classified into 2 groups based on SFCT(thick-choroid group/thin-choroid group).Then further analyze the spectrum domain optical coherence tomography(SD-OCT)and indocyanine green angiography(ICGA)differences of the two subtypes.Imaging analysis included measurement of SFCT,maximum vascular diameter ratio(MVDR),choroidal vascularity index(CVI),central macular thickness(CMT),and the presence of pigment epithelial detachment(PED)on SD-OCT.Polypoidal lesions(polyps)number,branching vascular network(BVN)area,greatest linear dimension(GLD),and the choroidal vascular hyperpermeability(CVH)were analyzed by ICGA.RESULTS:The distribution of SFCT was bimodal with two peaks at 195 and 285μm,and a trough at 225μm.The 225μm was taken as the cutoff point for the following classification of thick/thin choroid groups.The PCV eyes in the thick-choroid group presented with greater MVDR,CVI within 3 and 6 mm of the fovea,but lower CMT,less PED,small PED diameters on SD-OCT scans,and fewer polyps,smaller BVN and GLD,but more frequency of CVH on ICGA.CONCLUSION:The SFCT at 225μm can be used as a readily available indicator for the classification of PCV subtypes.The thick-choroid group presents much apparent enlargement of the choroidal layer and vasculature expansion,which indicates different pathogenesis of the two subtypes.

Celastrol inhibits laser-induced choroidal neovascularization by decreasing VEGF induced proliferation and migration

AIM:To evaluate celastrol's effect on choroidal neovascularization(CNV).METHODS:In this study,neovascular formation in vitro(tube formation and aortic ring culture)and in vivo(laser induced neovascular in mice)was treated with celastrol to evaluate this natural compound's impact on CNV.Western blot was applied to explore the possible mechanism for it.For in vitro assay,triplicate for each group was repeated at least three times.For in vivo assay,each group contains 5 mice.RESULTS:Celastrol supressed tube formation and aortic ring sprout neovascularization.In vitro assay exhibited that celastrol inhibiting vascular endothelial growth factor(VEGF)-induced proliferation and migration of human umbilical vein endothelial cells and human choroidal endothelial cells,and by blocking VEGF signaling.Furthermore,intraperitoneal administration of celastrol significantly reduced the area of laser-induced CNV in an in vivo mouse model.By day 14,the area of CNV had decreased by 49.15%and 80.26%in the 0.1 mg/kg celastrol-treated group(n=5)and in the 0.5 mg/kg celastrol treated group(n=5),respectively,compared to the vehicle-treated group(n=5).CONCLUSION:Celastrol inhibits CNV by inhibiting VEGF-induced proliferation and migration of vascular endothelial cells,indicating that celastrol is a potent,natural therapeutic compound for the prevention of CNV.

Inhibitory effects of safranal on laser-induced choroidal neovascularization and human choroidal microvascular endothelial cells and related pathways analyzed with transcriptome sequencing

AIM:To determine the effects of safranal on choroidal neovascularization(CNV)and oxidative stress damage of human choroidal microvascular endothelial cells(HCVECs)and its possible mechanisms.METHODS:Forty-five rats were used as a laser-induced CNV model for testing the efficacy and safety of safranal(0.5 mg/kg·d,intraperitoneally)on CNV.CNV leakage on fluorescein angiography(FA)and CNV thickness on histology was compared.HCVECs were used for a H_(2)O_(2)-induced oxidative stress model to test the effect of safranal in vitro.MTT essay was carried to test the inhibition rate of safranal on cell viability at different concentrations.Tube formation was used to test protective effect of safranal on angiogenesis at different concentrations.mRNA transcriptome sequencing was performed to find the possible signal pathway.The expressions of different molecules and their phosphorylation level were validated by Western blotting.RESULTS:On FA,the average CNV leakage area was 0.73±0.49 and 0.31±0.11 mm^(2)(P=0.012)in the control and safranal-treated group respectively.The average CNV thickness was 127.4±18.75 and 100.6±17.34μm(P=0.001)in control and safranal-treated group.Under the condition of oxidative stress,cell proliferation was inhibited by safranal and inhibition rates were 7.4%-35.4%at the different concentrations.For tube formation study,the number of new branches was 364 in control group and 35,42,and 17 in 20,40,and 80μg/mL safranal groups respectively(P<0.01).From the KEGG pathway bubble graph,the PI3K-AKT signaling pathway showed a high gene ratio.The protein expression was elevated of insulin receptor substrate(IRS)and the phosphorylation level of PI3K,phosphoinositide-dependent protein kinase 1/2(PDK1/2),AKT and Bcl-2 associated death promoter(BAD)was also elevated under oxidative stress condition but inhibited by safranal.CONCLUSION:Safranal can inhibit CNV both in vivo and in vitro,and the IRS-PI3K-PDK1/2-AKT-BAD signaling pathway is involved in the pathogenesis of CNV.

Improved thickness measurement method for choroidal hyperpermeability in central serous chorioretinopathy

AIM:To observe choroidal thickness changes in the choroidal hyperpermeability area(CHA)in patients with central serous chorioretinopathy(CSC)after photodynamic therapy(PDT)using indocyanine green angiography(ICGA)combined with optical coherence tomography(OCT).METHODS:This was a cohort study of 17 eyes(17 patients)with CSC.In all patients,the range of CHA was determined by ICGA.The patients were divided into two groups based on CHA covered the fovea(group A)or not(group B).All patients received half-dose verteporfin PDT over CHA in ICGA.Choroidal thickness was measured by OCT before,1,and 3 mo after treatment.The choroidal thickness values of the fovea and CHAs were obtained for each measurement.Secondary outcomes were changes in the best-corrected visual acuity(BCVA)and amount of subretinal fluid(SRF).RESULTS:The differences in center choroidal thickness at baseline and at 1 and 3 mo post-PDT were statistically significant in group A and all patients(both P<0.001).There was no significant difference in group B(P=0.059).The differences of thickness of CHA and BCVA at baseline and1 and 3 mo post-PDT were statistically significant in group A,group B,and all patients(all P<0.01).All patients showed complete SRF absorption at 3 mo post-PDT.CONCLUSION:Center choroidal thickness does not accurately reflect changes in CHA of patients whose CHA does not covered the fovea center.Using CHA as the observation target can make up for this limitation,expand the scope of application,and reduce bias.

A modified method for suprachoroidal fluid drainage in kissing choroidal detachment

●AIM:To introduce a new method for suprachoroidal fluid drainage before 23-gauge pars plana vitrectomy.●METHODS:A 15o side-port blade was firstly used to create a sclerotomy into the suprachoroidal space for initial drainage.A 30-guage needle was then applied to inject balanced saline solution through the existing sclerotomy for further drainage.After most of the suprachoroidal fluid was drained,standard 3-port 23-guage pars plana vitrectomy was performed.●RESULTS:We have succeeded in using this technique to treat five patients with retinal detachment and kissing choroidal detachment(KCD).The choroidal detachment was visibly recessed in all cases after drainage with no intraoperative complications.After removal of silicon oil at 3 mo follow-up,all patients obtained a reattached retina.No postoperative complications such as hypotony and endophthalmitis occurred.●CONCLUSION:The new technique is efficient and safe for suprachoroidal fluid drainage for patients with rhegmatogenous retinal detachment.In future,further larger series are needed to attest to its safety and efficacy.

Choroidal metastatic mucinous abscess caused by Pseudomonas aeruginosa:A case report

BACKGROUND Pseudomonas aeruginosa(P.aeruginosa)is considered a common pathogenic bacterium.Choroidal metastatic mucinous abscess caused by P.aeruginosa is rarely reported.CASE SUMMARY We describe the diagnostic and treatment processes of a case involving a complex choroidal space-occupying lesion.Our analyses of early clinical manifestations revealed a high possibility of choroidal melanoma,as indicated by the choroidal space-occupying lesion and uveitis.Further magnetic resonance imaging results revealed no positive evidence for the diagnosis of choroidal melanoma.The exact properties of the space-occupying lesion could not be ascertained prior to surgery.However,the lesion was subsequently confirmed as a metastatic abscess by diagnostic vitrectomy.The occupying lesion was found to occupy 75%of the vitreous cavity in the surgery.The entire white viscous tissue was completely removed,and the necrotic retina was cleaned up.After surgery,microbiological culture revealed mucoid P.aeruginosa,which was sensitive to a variety of antibiotics.The bacterial infection grew and disseminated towards the outside of the eye.After the fifth injection,the left eye was successfully retained.CONCLUSION This is a peculiar case because a huge,local,space-occupying lesion had formed due to the dissemination of low-toxic mucinous P.aeruginosa in the blood from the lungs to the choroid.After surgical removal,the bacteria were able to re-grow;thus,local infection re-spread following surgery.The patient lost vision,but we managed to retain the full structure of the eyeball and eliminated the focus of infection.

In Vitro Model of Human Choroidal Neovascular

Choroidal capillary endothelia cell （CEC） plays a critical role in the development of choroidal neovascularization which is one of the major causes of blindness. An effective method for CEC cultivation was proposed. The isolation of human choroidal CECs using micro dissection followed by the use of superparamagnetic beads （Dynabeads） coated with the CD 31, which selectively binds to the endothelial cell surface. Cells bound to beads were isolated using a magnetic particle concentrator. The CECs were planted into type Ⅳ collagen coated 24 well plates. The results show that the primary cultured CEC is induced to tube formation in collagen Ⅳ coated environment, which can be presented as an in vitro model of choroidal neovascularization.

Sub-Tenon's urokinase injection-assisted vitrectomy in early treatment of suprachoroidal hemorrhage: Four cases report

BACKGROUND Suprachoroidal hemorrhage(SCH) is a rare but potentially catastrophic ocular event. Surgery for SCH is often challenging because of the difficulty in resolving the retinal and choroidal detachment. Here, we describe a novel surgical technique in which urokinase is administered by sub-Tenon's injection to target an organized clot in SCH prior to drainage.CASE SUMMARY A consecutive case series of four eyes with serous and hemorrhagic choroidal detachments secondary to cataract surgery or trauma was documented to evaluate the feasibility of using a sub-Tenon's urokinase injection-assisted 23-gauge and 20-gauge incision to drain choroidal detachments. Urokinase(2000 IU) was given by sub-Tenon's injection one day before surgery for clot liquefaction. A 23-gauge infusion line was placed in the anterior chamber. A 20-gauge incision was created in the suprachoroidal space 3.5 mm from the limbus. After drainage, pars plana vitrectomy was performed because of concomitant pathology that demanded this additional procedure. Visual acuity, ocular findings, the timing of surgical interventions, surgical procedures, and outcomes were retrospectively reviewed in four patients. Postoperative follow-up of the patients ranged from 6 to 24 mo(mean, 13 mo). After the treatment, all patients achieved excellent anatomical recovery. CONCLUSION Sub-Tenon's urokinase injection-assisted vitrectomy makes clot liquefaction happen in the early treatment stage, resulting in marked stability during the procedure.