Impact of dextran in organ culture media for preservation of DMEK (Descemet Membrane Endothelial Keratoplasty) precut tissue

Purpose: To compare the morphological and functional outcomes of Descemet Membrane Endothelial Keratoplasty (DMEK) performed with precut tissue preserved in organ culture medium with dextran to tissue preserved in organ culture medium without dextran. Methods: In this retrospective study, 103 patients underwent DMEK surgery with precut tissue in our Department of Ophthalmology between June 2015 and September 2016. We preserved the precut tissue in an organ culture medium for a maximum period of 48 hours. For group 1 49 tissues were preserved in medium 1 (without dextran), for group 2 54 tissues were preserved in medium 2 (with 6% dextran T-500) after stripping of the doner. The best-corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD), measurements were taken at 2 weeks, 6 weeks and 6 months interval after surgery. Repeat keratoplasty rates were also compared. Results: BCVA was statistically significantly better in group 1 at each time point (p<0.05). Group 1 had a significantly lower CCT compared to group 2 at 2 weeks and 6 months after surgery (p<0.05). There was no significant difference in the ECD between donor grafts before surgery, but it was significantly higher in group 1 after 2 and 6 weeks (p<0.05). Repeat keratoplasty rates (i.e. repeat DMEK or subsequent penetrating keratoplasty PKP) were significantly higher in group 2 (p<0.05) Conclusions: Patients who underwent DMEK performed with precut tissue preserved in organ culture medium without dextran have better visual acuity, thinner corneas and higher endothelial cell density. The rate of repeat keratoplasty was also significantly lower. These findings show that dextran has an undesirable impact on the preservation of DMEK precut tissue.Ziel: Ziel der Studie war es, die morphologischen und funktionellen Ergebnisse bei vorpräparierten DMEK-Transplantaten mit und ohne Dextran-Kultur-Medium zu vergleichen. Patienten und Methoden: In dieser retrospektiven Studie wurden die Daten von 103 Patienten ausgewertet, die in unserer Klinik zwischen Juni 2015 und September 2016 eine DMEK mit vorpräpariertem Gewebe bekamen. Das Gewebe wurde nach der kompletten Spenderpräparation bei allen Patienten in einem Gewebekulturmedium für maximal 48 Stunden konserviert. In Gruppe 1 wurden 49 DMEK-Röllchen in Medium 1 (Gewebekulturmedium ohne Dextran) konserviert, und in Gruppe 2 wurden 54 DMEK-Röllchen in Medium II (Gewebekulturmedium mit 6 % Dextran T500) konserviert. Der bestkorrigierte Visus, die zentrale Hornhautdicke im Vorderabschnitt-OCT (VAA-OCT) sowie die Endothelzelldichte (EZD) wurden nach 2 Wochen, nach 6 Wochen und nach 6 Monaten postoperativ untersucht. Die Zahl der Re-Keratoplastiken wurde ebenso verglichen. Ergebnisse: In den Verlaufskontrollen zeigte sich in Gruppe 1 ein statistisch signifikant besserer Visus im Vergleich zu Gruppe 2 (p<0.05) zu allen Untersuchung-Zeitpunkten. Die mittlere zentrale Hornhaut-Dicke war nach 2 Wochen und nach 6 Monaten postoperativ signifikant niedriger in Gruppe 1 im Vergleich zu Gruppe 2 (p<0.05). Die mittlere EZD der Spender-Transplantaten vor der DMEK war vergleichbar, war aber signifikant höher in Gruppe 1 nach 2 Wochen und nach 6 Wochen. Die Notwendigkeit für eine Re-Keratoplastik (Re- DMEK oder perforierende Re-Keratoplastik) in Gruppe 2 war signifikant höher (p<0.05). Schlussfolgerung: Insgesamt haben die Patienten mit DMEK-Röllchen, die in einem Gewebekulturmedium ohne Dextran konserviert wurden, einen höheren Visus, eine dünnere zentrale Hornhaut und eine höhere Endothelzelldichte. Die Re-Keratoplastik-Rate war auch signifikant niedriger. Damit lässt sich schlussfolgern, dass Dextran einen negativen Einfluss auf die Lagerung der DMEK-Röllchen nach der Präparation hat

Incidence and treatment approach of intraocular pressure elevation after various types of local steroids for retinal diseases

Purpose For the treatment of macular edema, in addition to the use of antivascular endothelial growth factors, steroids are also used intravitreally and sub-Tenon. Side efects include among others cataract formation and elevation of intraocular pressure (IOP). The aim of this retrospective study was to elicit the IOP elevation after administration of various steroidal medication, the time of onset, and the efcacy of the administered IOP-lowering therapies. Methods We included 428 eyes with a postoperative (n=136), diabetic (n=148), uveitic macular edema (n=61), and macular edema after retinal vein occlusion (n=83). These patients were treated with one or more diverse steroidal agents once or multiple times. These drugs included: triamcinolone acetonide (TMC) as intravitreal injection (TMC IVI) or subTenon (TMC ST), as well as dexamethasone (DXM) and fuocinolone acetonide (FA) intravitreally. An increase of IOP of≥25 mmHg was designated as pathological. A steroid response in anamnesis, the time of onset of IOP rise from the frst administration, and the therapy administered were documented. Results Of 428 eyes, 168 eyes (39.3%) had IOP elevation up to a mean of 29.7 (SD ±5.6) mmHg, which occurred at a median of 5.5 months. Steroids most frequently leading to rise of IOP included DXM (39.1% of all eyes receiving that drug), TMC IVI (47.6%), TMC ST combined with DXM (51.5%), DXM with FA (56.8%), and TMC IVI with DXM (57.4%). A Kaplan–Meier analysis and the Log Rank test showed a signifcant diference (p<0.001). IOP rise was treated as follows: 119 conservatively (70.8%), and 21 surgically (12.5%, cyclophotocoagulation 8.3%, fltering surgery 1.8%, in 4 the steroidal drug implant was removed 2.4%), and 28 eyes received no therapy (16.7%). Sufcient IOP regulation was achieved in 82 eyes (68.9%) with topical therapy. In 37 eyes (31.1%) with persistently elevated intraocular pressure, topical therapy had to be continued over the follow-up of 20±7 months. Conclusions IOP increases after any type of steroid application are not rare. Results of our study let us suspect that especially therapy with intravitreal dexamethasone, either as a monotherapy or in combination with another steroid, tends to increase IOP more than other steroids. Regular IOP checks are necessary after each steroid administration, with possible initiation of long-term conservative and/or surgical therapy if necessary

Chronic renal failure as predictive factor for acute elevation of systolic blood pressure after fluorescein angiography in patients with retinal diseases

Purpose: To investigate the influence of fluorescein angiography (FA) on blood pressure (BP) in patients with retinal diseases, and analyze the predictive factors for acute elevation of systolic BP after FA. Design: and Methods: A prospective study was conducted with 636 patients undergoing FA between April 2021 and October 2021. BP and pulse were measured in each patient before and 20 min after FA. The baseline characteristics of patients who developed an acute elevation in systolic BP (>10 mmHg) were compared with those of the remaining patients to detect factors that may predict this acute elevation. Results: Overall, mean systolic BP changed from 142 ± 17 mmHg to 140 ± 20 mmHg after 20 min (p = 0.1). Mean diastolic BP changed from 79 ± 15 mmHg to 78 ± 13 mmHg after 20 min (p = 0.45). Mean pulse rate changed from 73 ± 14 bpm to 70 ± 12 bpm after 20 min (p = 0.001). 103 patients (16 %) had acute elevation of systolic BP (>10 mmHg). Mean systolic BP changed from 143 ± 17 mmHg to 162 ± 19 mmHg after 20 min in this group (p = 0.001). Patients in this group were significantly older compared to the rest (73 ± 12 vs 67 ± 15, p = 0.001). The rate of chronic renal failure was significantly higher in this group compared to the rest of the patients (42/7.8 % vs 15/14.6 %, p = 0.01). Conclusions: This study demonstrated that fluorescein angiography is a relatively safe procedure with regards to blood pressure changes. However, chronic renal failure could be considered as predictive factor for acute elevation of systolic blood pressure after this procedure

Prevalence of Geographic Atrophy in Advanced Age-Related Macular Degeneration (AMD) in Daily Practice

Purpose: To investigate the prevalence of geographic atrophy (GA) in advanced age-related macular degeneration (AMD) and the proportion of eyes that would meet the indication criteria for treatment with the first intravitreal anti-C3 agent (pegcetacoplan). Methods: This retrospective cross-sectional study included all AMD patients who visited the Macular-Retina-Centre Oberkassel in 2021. Eyes were classified according to AMD stages. Eyes with GA were divided into two groups regarding foveal involvement. Baseline factors were compared between eyes with foveal GA (FGA) and eyes with non-foveal GA (NFGA) to identify predictive factors for foveal involvement. Results: A total of 2033 eyes from 1027 patients were included. AMD stage was early in 296 (14.5%) cases, intermediate in 368 (18.1%) cases, and advanced in 1249 (61.4%) cases. A total of 1204 (60%) eyes had GA [932 (77%) FGA and 272 (23%) NFGA], while 125 eyes (27.4% from eyes with advanced dry AMD) met the indication criteria for treatment with intravitreal pegcetacoplan. The proportion of eyes with neovascular AMD was significantly higher in the FGA group compared to the NFGA group [598 (64.2%) vs. 152 (55.8%), p = 0.01]. Conclusions: At least a quarter of eyes with advanced AMD would be suitable for the upcoming intravitreal pegcetacoplan therapy. Foveal involvement of GA in advanced AMD seems to be more likely in neovascular AMD than in dry AMD

Topical NSAIDs and Oral Acetazolamide for Macular Edema after Uncomplicated Phacoemulsification : Outcome and Predictors of Non-Response

Purpose: To investigate the effectiveness of nonsteroidal anti-inflammatory eye drops (NSAIDs) combined with oral acetazolamide for postoperative macular edema (PME) after uncomplicated phacoemulsification (PE) and identify predictors of non-response. Methods: We analyzed data of uncomplicated PE and identified eyes with PME. First-line therapy included topical NSAIDs combined with oral acetazolamide. In the case of non-response, triamcinolone was administered subtenonally. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: 94 eyes out of 9750 uncomplicated PE developed PME, of which 60 eyes were included. Follow-ups occurred 6.4 ± 1.8, 12.5 ± 3.7 and 18.6 ± 6.0 weeks after diagnosis. BCVA and CMT improved significantly in all follow-ups. In total, 40 eyes showed a response to first-line therapy at the first follow-up (G1). The remaining 20 eyes showed no response and required subtenon triamcinolone (G2), of which 11 eyes showed complete regression at the second followup and 4 eyes at third follow-up. A further 5 eyes showed no response and required intravitreal injection. Multivariate linear regression model showed that Diabetes mellitus (DM) and increased cumulative dissipated energy (CDE) are predictors of non-response. Conclusion: Topical NSAIDs with acetazolamide resulted in complete regression of PME in 67% of all cases. DM and increased CDE might be considered as predictors of non-response to this treatment

MHD Stability of a Streaming Resistive Hollow Jet Analytic and Numeric Analysis

The axisymmetric magneto hydrodynamic (MHD) stability of streaming resistive hollow jet under oblique varying magnetic fields has been discussed. The stability criterion is established in its general form, studied analytically and the results are confirmed numerically. The destabilizing effect of the capillary force is found in small domain in the axisymmetric perturbation

Intravitreal aflibercept following treat and extend protocol versus fixed protocol for treatment of neovascular age-related macular degeneration

Background To assess the morphological and functional outcome of intravitreal aflibercept following the treat and extend protocol compared to the fixed protocol for treatment of eyes with neovascular age-related macular degeneration. Methods This retrospective study included 126 eyes of 113 patients with primary onset neovascular age-related macular degeneration who were followed for 12 months. All eyes were treated with 2 mg/0.05 mL aflibercept. All eyes received an upload with three monthly aflibercept injections. We subsequently studied two groups of eyes. For group 1, 54 eyes were treated following the treat and extend protocol. For group 2, 72 eyes were treated following the fixed protocol (fixed 2-monthly interval). Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and number of injections. Results BCVA (logMAR) in group 1 vs group 2 was (0.61 ± 0.3 vs 0.72 ± 0.3, p = 0.09) before treatment and (0.48 ± 0.3 vs 0.51 ± 0.3, p = 0.6) after one year of treatment. CMT in group 1 vs group 2 was (371 ± 101 μm vs 393 ± 116 μm, p = 0.5) before treatment and (284 ± 60 μm vs 290 ± 67 μm, p = 0.1) after one year of treatment. Number of injections/eye in group 1 vs group 2 was (8.5 ± 2.2 vs 7.0 ± 0, p < 0.001). Conclusions Significant differences regarding BCVA and central macular thickness were not found between both treatment protocols during the first year of treatment using aflibercept. However, a significantly higher number of injections was needed for eyes in the treat and extend group during the first year of treatment. This might suggest that aflibercept should better not be extended past an 8 weeks interval during the first year of treatment. Study registration This study was approved by the Ethics Committee of the Medical Association of Saarland, Germany (Nr. 123/20, Date: 16.06.2020). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors

Macular vascularisation changes analysed using OCT angiography after successful rhegmatogenous retinal detachment repair

AIM: To analyse the macular vascularisation changes analysed using optical coherence tomography angiography (OCTA) after successful rhegmatogenous retinal detachment (RRD) repair by comparing gas vs silicone oil and macula-on vs macula-off. METHODS: This retrospective data collection included 77 eyes with RRD that underwent pars plana vitrectomy (PPV) and gas or silicone oil tamponade. We performed an OCTA during the postoperative control between 6 and 24mo after the last surgery and evaluated the main parameters measured by OCTA: foveal avascular zone (FAZ) and parafoveolar vascular density (PVD) in the superficial capillary plexus. The patients were divided into four groups: RRD with macular involvement treated with gas tamponade, RRD without macular involvement treated with gas tamponade, RRD with macular involvement treated with silicone oil tamponade and RRD without macular involvement treated with silicone oil tamponade. A one-way ANOVA test combined with post hoc Bonferroni corrections compared FAZ sizes and PVD in all four groups. RESULTS: The FAZ size was statistically significantly larger in eyes with RRD involving the macula than in those not involving it (P=0.005). There was no statistically significant difference in the FAZ sizes of the eyes treated with silicone oil tamponade compared to those treated with gas tamponade (P=0.54). There was no statistically significant difference in the PVD comparing all four groups. CONCLUSION: Despite the known risks associated with silicone oil, our findings suggest that the type of tamponade used during PPV to treat an RRD has no significant effect on the future integrity of the PVD or the size of the FAZ in the superficial capillary plexus as measured by OCTA

Report on needs and priorities in the field of international cooperation agreements on water management in the target MACs

This report aims to provide a revision of the water related goals within the international agreements joined by the three case study countries,Egypt, Morocco and Tunisia, while emphasizing the critical points that should be developed and reinforced in the near future through an integrated approach for water policies, initiatives and management

Retinal Vascular Occlusion after COVID-19 Vaccination : More Coincidence than Causal Relationship? Data from a Retrospective Multicentre Study

Background: To investigate whether vaccination against SARS-CoV-2 is associated with the onset of retinal vascular occlusive disease (RVOD). Methods: In this multicentre study, data from patients with central and branch retinal vein occlusion (CRVO and BRVO), central and branch retinal artery occlusion (CRAO and BRAO), and anterior ischaemic optic neuropathy (AION) were retrospectively collected during a 2-month index period (1 June–31 July 2021) according to a defined protocol. The relation to any previous vaccination was documented for the consecutive case series. Numbers of RVOD and COVID-19 vaccination were investigated in a case-by-case analysis. A case– control study using age- and sex-matched controls from the general population (study participants from the Gutenberg Health Study) and an adjusted conditional logistic regression analysis was conducted. Results: Four hundred and twenty-one subjects presenting during the index period (61 days) were enrolled: one hundred and twenty-one patients with CRVO, seventy-five with BRVO, fifty-six with CRAO, sixty-five with BRAO, and one hundred and four with AION. Three hundred and thirty-two (78.9%) patients had been vaccinated before the onset of RVOD. The vaccines given were BNT162b2/BioNTech/Pfizer (n = 221), followed by ChadOx1/AstraZeneca (n = 57), mRNA1273/Moderna (n = 21), and Ad26.COV2.S/Johnson & Johnson (n = 11; unknown n = 22). Our case–control analysis integrating population-based data from the GHS yielded no evidence of an increased risk after COVID-19 vaccination (OR = 0.93; 95% CI: 0.60–1.45, p = 0.75) in connection with a vaccination within a 4-week window. Conclusions: To date, there has been no evidence of any association between SARS-CoV-2 vaccination and a higher RVOD risk