1: Retina. 2008 Mar;28(3 Suppl):S81-6. 

Heterogeneous tumor vasculature in retinoblastoma: implications for vessel
targeting therapy.

Jockovich ME, Pina Y, Alegret A, Cebulla C, Feuer W, Murray TG.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami
School of Medicine, Miami, Florida, USA.

PURPOSE: The aim of this study is to correlate tumor size of retinoblastoma
tumor samples with blood vessel maturation to assess how these factors may
affect vessel targeting therapy. METHODS: Analysis was performed on
retinoblastoma tumor specimens (n = 5) enucleated as primary treatment from May
2005 to February 2006. Tumor size was measured as the largest cross sectional
area of the tumor, measured during pathologic assessment. Vessel density and
heterogeneity was measured by immunohistochemical analysis. Total microvessel
density was detected by staining endothelial cells using a lectin from Bandeira
simplicifolia; novel vasculature was detected with the endothelial cell marker
endoglin (CD105). Blood vessel basement membrane was detected with an antibody
against type IV collagen. Vessel maturation was assessed by pericyte
recruitment, detected with alpha smooth muscle actin (alpha-sma). RESULTS: A
statistically significant correlation was detected between tumor burden and age
at enucleation (P = 0.008). All retinoblastoma tumor samples harbored a high
degree of blood vessel heterogeneity containing both immature neovessels as well
as pericyte-committed mature vasculature. There was a statistically significant
correlation between type IV collagen and age at enucleation (P = 0.045).
CONCLUSIONS: This study provides a framework for a better understanding of tumor
and vessel development in retinoblastoma. Results of this study provide insight
into the relationship between age and tumor burden in these tumors. Knowledge of
the degree of heterogeneity detected in these tumors will aid in the selection
of novel blood vessel targeting strategies for children with this disease and
other diseases with pathologic neovascularization.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 18317352 [PubMed - indexed for MEDLINE]

2: Retina. 2008 Apr;28(4):667; author reply 667-8. 

Re: Changes of intraocular pressure after intravitreal injection of bevacizumab
(Avastin).

Utman SA, Dhillon B.

Publication Types:
    Comment
    Letter

PMID: 18398378 [PubMed - in process]

3: Retina. 2008 Apr;28(4):667-8. 

Correspondence.

Kozak I, Falkenstein IA, Cheng L, Freeman WR.

From Jacobs Retina Center, University of California at San Diego, La Jolla,
California.

PMID: 18398377 [PubMed - in process]

4: Retina. 2008 Apr;28(4):666; author reply 666-7. 

Re: Phacovitrectomy for primary retinal detachment repair in presbyopes.

Jain R, Newland H.

Publication Types:
    Comment
    Letter

PMID: 18398376 [PubMed - in process]

5: Retina. 2008 Apr;28(4):666-7. 

Correspondence.

Smith M, Raman SV, Pappas G, Simcock P, Ling R, Shaw S.

West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, Devon, United
Kingdom.

PMID: 18398375 [PubMed - in process]

6: Retina. 2008 Apr;28(4):665; author reply 665-6. 

Re: Phacovitrectomy for primary retinal detachment repair in presbyopes.

Zhou P, Zhao MW, Li XX.

Publication Types:
    Comment
    Letter

PMID: 18398374 [PubMed - in process]

7: Retina. 2008 Apr;28(4):665-6. 

Correspondence.

Smith M, Raman SV, Pappas G, Simcock P, Ling R, Shaw S.

West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, Devon, United
Kingdom.

PMID: 18398373 [PubMed - in process]

8: Retina. 2008 Apr;28(4):660-4. 

Diagnostic and therapeutic challenges. Acute retinal necrosis syndrom.

Park SS, Holz HA, Ravage ZB, Merrill PT, Nguyen QD.

PMID: 18398372 [PubMed - in process]

9: Retina. 2008 Apr;28(4):657-9. 

Green light assisted internal limiting membrane peeling in macular hole surgery.

Gomes AM, Saraceno JJ, Bandeira EV, Abujamra S, Takahashi WY.

Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil.
andremv@uol.com.br

PMID: 18398371 [PubMed - in process]

10: Retina. 2008 Apr;28(4):653-6. 

En bloc perfluorodissection in vitreoretinal surgery: a new surgical technique.

Arevalo JF.

Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas,
Venezuela. arevalojf@movistar.net.ve

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18398370 [PubMed - in process]

11: Retina. 2008 Apr;28(4):645-52. 

Inflammatory markers in nondiabetic and diabetic rat retinas exposed to ischemia
followed by reperfusion.

Gustavsson C, Agardh CD, Hagert P, Agardh E.

Unit on Vascular Diabetic Complications, Department of Clinical Sciences, Malmo
University Hospital, Lund University, Malmo, Sweden. carin.gustavsson@med.lu.se

PURPOSE: To examine the retinal inflammatory response to ischemia-reperfusion in
nondiabetic and diabetic rats injected with either an omega-3-polyunsaturated
fatty acid (docosahexaenoic acid [DHA]) or a 3-hydroxy-3-methylglutaryl coenzyme
A reductase inhibitor (pravastatin). METHODS: Diabetes was induced by an
intraperitoneal injection of streptozocin, and retinal ischemia was induced by
ligation of the optic nerve and vessels, followed by reperfusion for 1 hour or
24 hours. Five minutes before surgery, an intravenous injection of DHA,
pravastatin, or vehicle (ethanol) was administered. The mRNA expressions of
tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, caspase-1, IL-1beta,
P-selectin, vascular cellular adhesion molecule (VCAM)-1, and intercellular
adhesion molecule (ICAM)-1 were compared between ischemic and nonischemic
retinas as well as diabetic and nondiabetic nonischemic retinas. RESULTS:
Ischemia induced increased expressions of TNF-alpha (P or=500 microg diclofenac
demonstrated toxicity. In contrast, doses up to 3000 microg ketorolac
demonstrated enhanced b-wave amplitude responses. Delayed drug toxicity was
observed for the highest doses of both NSAIDs. CONCLUSIONS: Intravitreal 3000
microg ketorolac and 300 microg diclofenac were nontoxic in this animal study,
and may offer an effective and safer alternative to intravitreal
corticosteroids.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 18398362 [PubMed - in process]

19: Retina. 2008 Apr;28(4):581-94. 

Central retinal vein occlusion associated with cilioretinal artery occlusion.

Hayreh SS, Fraterrigo L, Jonas J.

Department of Ophthalmology and Visual Sciences, College of Medicine, University
of Iowa, Iowa City, IA 52242-1091, USA. sohan-hayreh@uiowa.edu

PURPOSE: To describe the clinical characteristics and pathogenesis of central
retinal vein occlusion (CRVO) associated with cilioretinal artery occlusion
(CLRAO). METHODS: The study included 38 patients (38 eyes) who had CRVO
associated with CLRAO and were seen in our clinic from 1974 to 1999. At their
first visit to our clinic, all patients provided a detailed ophthalmic and
medical history and underwent comprehensive ophthalmic evaluation, color fundus
photography, and fluorescein fundus angiography. At each follow-up visit, the
same ophthalmic evaluations were performed, except for fluorescein fundus
angiography. RESULTS: Of 38 eyes, 30 had nonischemic CRVO, 5 had ischemic CRVO,
and 3 had nonischemic hemi-CRVO. Patients with nonischemic CRVO were
significantly younger (mean age +/- SD: 45.3 +/- 16.0 years) than those with
ischemic CRVO (72.3 +/- 9.2 years; P = 0.001) and those with nonischemic
hemi-CRVO (64.7 +/- 7.5 years; P = 0.018). At least one third of the patients
gave a definite history of episode(s) of transient visual blurring before the
onset of constant blurred vision. Initially, the ophthalmoscopic and fluorescein
angiographic findings were similar to those seen in CRVO and hemi-CRVO, except
that all these eyes had retinal infarct in the distribution of the cilioretinal
artery; its size and site varied widely. Fluorescein angiography typically
showed only transient hemodynamic block and not the typical CLRAO. During
follow-up, visual acuity improved markedly in nonischemic CRVO (P < 0.001) and
nonischemic hemi-CRVO but deteriorated in ischemic CRVO. Retinopathy resolved
spontaneously in 22 eyes with nonischemic CRVO (mean duration +/- SD: 42.0 +/-
101.0 months), in 2 eyes with ischemic CRVO (15.4 +/- 4.5 months), and in 1 eye
with nonischemic hemi-CRVO. Retinociliary collaterals developed in 30% of eyes
with nonischemic CRVO, in 40% of eyes with ischemic CRVO, and in 66% of eyes
with nonischemic hemi-CRVO. CONCLUSION: CRVO associated with CLRAO constitutes a
distinct clinical entity. The pathogenesis of CLRAO in CRVO is due to transient
hemodynamic blockage of the cilioretinal artery caused by a sudden sharp rise in
intraluminal pressure in the retinal capillary bed (due to CRVO) above the level
of that in the cilioretinal artery.

Publication Types:
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov\'t

PMID: 18398361 [PubMed - in process]

20: Retina. 2008 Apr;28(4):573-80. 

Secondary ocular hypertension after intravitreal injection of 4 mg of
triamcinolone acetonide: incidence and risk factors.

Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB.

Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
dvitor@ufmg.br

PURPOSE: To analyze the incidence of secondary ocular hypertension (SOH) after
intravitreal triamcinolone acetonide (IVTA) injection and its risk predictors.
METHODS: Retrospective review of charts for 219 consecutive patients receiving a
4-mg IVTA injection. RESULTS: One hundred fifty eyes of 150 patients who were
followed for at least 3 months and met inclusion criteria were considered. Main
indications for IVTA injection were neovascular age-related macular degeneration
(79 eyes [52.7%]), choroidal neovascularization due to other etiologies (22 eyes
[14.7%]), diabetic macular edema (14 eyes [9.3%]), central retinal vein
occlusion (12 eyes [8.0%]), and branch retinal vein occlusion (8 eyes [5.3%]).
SOH defined as intraocular pressure (IOP) of >or=21 mmHg was recorded for 32.0%
of injected eyes at some point during a mean follow-up of 7.7 months. There was
no association between SOH and age, sex, arterial hypertension, diabetes
mellitus, indication for IVTA injection, prior cataract surgery, or concurrent
photodynamic therapy. Although previous pars plana vitrectomy did not influence
risk, peak IOP was lower in vitrectomized eyes (P = 0.044). Prior diagnosis of
glaucoma was a significant risk factor for SOH (relative risk = 2.17; P =
0.004). In nonglaucomatous eyes, baseline IOP of >or=16 mmHg was associated with
a higher risk of SOH (relative risk = 2.31; P = 0.003). Baseline IOPs of <12
mmHg, 12-14 mmHg, 15-17 mmHg, 18-20 mmHg, and >20 mmHg were associated with
incidences of SOH of 11.1%, 25.4%, 40.0%, 46.2%, and 50.0% (P = 0.01),
respectively. CONCLUSIONS: A 4-mg IVTA injection was associated with SOH in
32.0% of treated eyes. The risk of SOH was higher in eyes with previous glaucoma
and higher baseline IOP. Peak IOP after IVTA injection was lower in
vitrectomized eyes. Risk factor analysis may permit better individualization of
the risk-benefit ratio for IVTA injection.

PMID: 18398360 [PubMed - in process]

21: Retina. 2008 Apr;28(4):568-72. 

Three-year anatomic and visual outcomes after vitrectomy for stage 4B
retinopathy of prematurity.

El Rayes EN, Vinekar A, Capone A Jr.

Research Institute of Ophthalmology, Cairo, Egypt.

PURPOSE: To assess anatomic and visual outcome following vitrectomy for stage 4B
retinopathy of prematurity (ROP) after 3 years follow-up. METHODS: Retrospective
analysis of 56 eyes (46 infants) with stage 4B ROP-related retinal detachment.
Eyes underwent either lens-sparing vitrectomy (LSV) or combined lensectomy and
vitrectomy (LV). Visual outcome after a minimum follow-up of 36 months was
ascertained by using either Teller or Snellen acuities, or sweep visual evoked
potential. RESULTS: LSV was performed in 42.9% and LV in 57.1% of eyes. Retinal
reattachment was achieved in 73.2% overall (LV 71.8% versus LSV 75%) (P = 0.96).
Ambulatory vision (VA better than 20/1900) and near reading vision (better than
20/800) were attained in 97.4% and 42.8% of eyes respectively. Attached retina,
LSV, and pretreatment with retinal ablation were associated with a higher
incidence of near reading or better vision compared to detached (P < 0.001),
undergoing LV (P < 0.001), and non pretreated eyes (P = 0.011). CONCLUSION:
After 3 years, more than 40% of eyes operated for ROP stage 4B in this series
had a visual acuity compatible for near reading or better. Eyes undergoing LSV
and with prior peripheral retinal ablation had better visual outcomes.

PMID: 18398359 [PubMed - in process]

22: Retina. 2008 Apr;28(4):564-7. 

Incidence of acute onset endophthalmitis following intravitreal bevacizumab
(Avastin) injection.

Mason JO 3rd, White MF, Feist RM, Thomley ML, Albert MA, Persaud TO, Yunker JJ,
Vail RS.

Retina Consultants of Alabama, Callahan Eye Foundation Hospital, Birmingham,
Alabama 35233, USA.

PURPOSE: To report the incidence of acute endophthalmitis as a complication of
intravitreal bevacizumab (Avastin) (IVB) injection in a tertiary vitreoretinal
group practice. METHODS: A retrospective chart review of 5,233 consecutive eyes
that underwent IVB injection at Retina Consultants of Alabama (RCA) from October
1, 2005, to August 31, 2007, was performed to identify cases of acute
endophthalmitis. RESULTS: During the 23-month study interval, the overall
incidence rate of postinjection endophthalmitis was 0.019% (1/5,233). In the
single case of acute endophthalmitis, bacterial cultures revealed
coagulase-negative Staphylococcus (CNS) species. Visual acuity after treatment
for endophthalmitis was improved (baseline 4/400) to 20/400 at two months after
the initial IVB injection. CONCLUSIONS: Acute endophthalmitis is a rare
potential complication of IVB. Prophylaxis with topical povidone-iodine and
adherence to aseptic technique minimizes the risk of postinjection infection.
SUMMARY STATEMENT: A retrospective review of 5,233 consecutive intravitreal
injections of bevacizumab (Avastin) revealed only a single case of acute
endophthalmitis. Adherence to aseptic technique and the use of povidone-iodine
prophylaxis minimizes the risk of postinjection intraocular infection.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18398358 [PubMed - in process]

23: Retina. 2008 Apr;28(4):558-63. 

Retinal function after vitrectomy.

Wallenten KG, Andreasson S, Ghosh F.

Department of Ophthalmology, University Hospital, Lund, Sweden.

PURPOSE: To study retinal function after vitrectomy. METHODS: Core vitrectomy
was performed in 12 rabbits under standardized conditions using a vitreous
cutting rate of either 600 or 1200 cuts/min. Full-field electroretinography
(ERG) and multifocal electroretinography (mfERG) were performed pre- and
postoperatively. Morphologic change was monitored by immunohistochemistry
directed against glial fibrillary acidic protein (GFAP). RESULTS: Three days
postoperatively, the b-wave amplitudes of all cone and rod responses of the ERG
were significantly reduced in all vitrectomized eyes. At 28 days, the rod
response was still reduced, but returned to normal by 58 days. No correlation
was found between vitreous cutting speed and ERG findings. No reduction in the
central cone function was detected in the mfERG. GFAP upregulation was found in
the entire retina of vitrectomized eyes 3 days after surgery. GFAP expression
was present after 28 and 58 days in eyes in which the vitreous cutting rate had
been set to 600 cuts/min, but not in the 1200 cuts/min eyes. CONCLUSION: Pars
plana vitrectomy transiently affects retinal function in rabbit eyes. Vitreous
cutting speed is not related to the reduced function but appears inversely
correlated to Muller cell activation, indicating that high-speed vitreous
cutters are more lenient to the retina.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18398357 [PubMed - in process]

24: Retina. 2008 Apr;28(4):553-7. 

Ocular surface fluid contamination of sutureless 25-gauge vitrectomy incisions.

Singh A, Chen JA, Stewart JM.

Department of Ophthalmology, University of California, San Francisco, CA
94143-0730, USA.

PURPOSE: To determine whether 25-gauge transconjunctival sutureless vitrectomy
incisions are more likely to allow the inflow of ocular surface fluid than
sutured vitrectomy incisions. METHODS: Four groups of cadaver eyes underwent
three-port vitrectomy in a laboratory setup. Groups A and B had 25-gauge
vitrectomy, with and without conjunctival displacement, respectively, and were
left unsutured. Group C had 25-gauge vitrectomy with suturing of the
sclerotomies. Group D had 20-gauge sutured vitrectomy. In all groups, India ink
was applied to the ocular surface after the procedure, and the intraocular
pressure (IOP) was varied to simulate postoperative IOP changes. Histology of
the incisions was performed. RESULTS: Ink particles were identified in the wound
in over two-thirds of eyes that underwent 25-gauge sutureless vitrectomy.
Conjunctival displacement had no effect on ink ingress. Sutured 25- and 20-gauge
incisions did not demonstrate ink particles in the wound. CONCLUSIONS:
Twenty-five-gauge transconjunctival sutureless vitrectomy incisions, with or
without conjunctival displacement, allowed the entry of ocular surface fluid
into the eye in this laboratory model. Based on the limited number of eyes
examined in this study, sutureless vitrectomy techniques may carry an increased
risk of bacterial contamination that could predispose to endophthalmitis.
Suturing may protect against ocular surface fluid ingress.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18398356 [PubMed - in process]

25: Retina. 2008 Apr;28(4):545-52. 

Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight
incisions.

Acar N, Kapran Z, Unver YB, Altan T, Ozdogan S.

Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
nur.nuracar@gmail.com

PURPOSE: To evaluate the rate, duration, and associated complications of
postoperative hypotony after 25-gauge sutureless vitrectomy. METHODS: In a
retrospective, interventional, institutional case series, 25-gauge sutureless
vitrectomy with straight incisions was performed on 111 eyes. Postoperative
intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and
1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications
associated with low IOP were assessed to determine outcome. RESULTS: Mean
follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2
hours and on postoperative day 1 (P < 0.001) and increased to preoperative
levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%,
and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of
postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was
2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas
endotamponade that remained hypotonic for the first postoperative week underwent
reoperation due to unsealed MHs. CONCLUSIONS: Twenty-five-gauge sutureless
vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2
hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not
increase the incidence of postoperative complications.

PMID: 18398355 [PubMed - in process]

26: Retina. 2008 Apr;28(4):538-44. 

Discrepancy between fluorescein angiography and optical coherence tomography in
detection of macular disease.

Kozak I, Morrison VL, Clark TM, Bartsch DU, Lee BR, Falkenstein I, Tammewar AM,
Mojana F, Freeman WR.

Jacobs Retina Center at Shiley Eye Center, University of California at San
Diego, La Jolla, California 92037, USA.

PURPOSE: To compare high-resolution optical coherence tomography (OCT) and
fluorescein angiography (FA) in detection of macular edema (ME) of various
etiologies. METHODS: In a retrospective study over a 12-month period at one
retina center, data for consecutive eyes that had undergone simultaneous
conventional FA (HRA; Heidelberg Engineering, Vista, CA) and StratusOCT (Carl
Zeiss Meditec, Dublin, CA) to rule out ME were reviewed. A subset of patients
underwent additional examination with extremely high-resolution
(6-microm)/ultrahigh-speed spectral OCT/scanning laser ophthalmoscopy (OTI,
Inc., Toronto, Ontario, Canada). RESULTS: Of 1,272 eyes, 1,208 (94.97%) had the
finding of ME or subretinal fluid confirmed by both techniques. There were 49
eyes (3.86%) for which FA showed dye leakage in the macular area and OCT showed
normal foveal contour. Of 10 eyes in this group that underwent imaging with
ultrahigh-speed spectral OCT/scanning laser ophthalmoscopy, 8 had subtle diffuse
lucencies in the retina. For 15 eyes (1.17%), OCT showed intraretinal and
subretinal fluid, which was missed by FA. CONCLUSIONS: Both FA and
high-resolution OCT are highly sensitive techniques and correlate well in
detection of ME. However, there is a small chance that when performed alone they
might miss existing subtle ME.

Publication Types:
    Research Support, Non-U.S. Gov\'t

PMID: 18398354 [PubMed - in process]

27: Retina. 2008 Apr;28(4):535-7. 

Presbyopia-correcting intraocular lenses: what retinal surgeons should know.

Tewari A, Shah GK.

Vitreoretinal Division, Kresge Eye Institute, Department of Ophthalmology, Wayne
State University, Detroit, Michigan, USA.

BACKGROUND: Presbyopia-correcting intraocular lenses (IOLs) are becoming more
popular among patients undergoing cataract surgery. Performing vitrectomy with
these lenses can be challenging. METHODS: A review of the currently available
presbyopia-correcting IOLs is performed. The problems with vitrectomy and
presbyopia-correcting IOLs are identified, and suggestions are given on
minimizing intraoperative complications. RESULTS AND CONCLUSIONS: As these
lenses gain popularity among patients with cataracts, retinal surgeons need to
be aware of the challenges of working through them when performing vitrectomy.
However, with careful preoperative evaluation and planning, complications can be
avoided.

PMID: 18398353 [PubMed - in process]