Intraocular lens dislocation and tube shunt in the posterior chamber: a case report

BACKGROUND: To describe management of a case of intraocular lens (IOL) and capsular bag (CB) dislocation in an eye with an Ahmed glaucoma valve in the posterior chamber. CASE PRESENTATION: A 75-year-old pseudophakic man with open-angle glaucoma and diabetic retinopathy developed neovascular glaucoma. After two intravitreous injections of bevacizumab and panretinal photocoagulation were administered, the new vessels regressed. However, goniosynechiae were observed over 360° of the angle. An Ahmed glaucoma valve model FP7 was implanted with the tube in the posterior chamber with adequate intraocular pressure control. Nineteen years after cataract surgery, when the IOL-CB complex became dislocated, they were sutured transclerally to the sulcus without Ahmed glaucoma valve modification. After a coughing episode, the vitreous pushed the IOL-CB complex forward and the tube was behind the IOL-CB complex. A 25-gauge posterior vitrectomy was performed, and the tube was returned to in front of the optic of the IOL using a forceps tip through a sclerotomy. CONCLUSION: This case suggested that management of IOL-CB dislocation can modify glaucoma shunt function. A complete pars plana vitrectomy may be required in order to reposition the dislocated IOL-CB complex in the presence of a posterior chamber drainage tube implant

Effect of Lutein and Antioxidant Supplementation on VEGF Expression, MMP-2 Activity, and Ultrastructural Alterations in Apolipoprotein E-Deficient Mouse

Oxidative stress is involved in the pathogenesis of several diseases such as atherosclerosis and age-related macular degeneration (AMD). ApoE-deficient mice (apoE−/−) are a well-established model of genetic hypercholesterolemia and develop retinal alterations similar to those found in humans with AMD. Thus supplementation with lutein or multivitamin plus lutein and glutathione complex (MV) could prevent the onset of these alterations. ApoE−/− mice (n=40, 3 months old) were treated daily for 3 months with lutein (AE-LUT) or MV (two doses): AE-MV15 (15 mg/kg/day) and AE-MV50 (50 mg/kg/day) and were compared to controls with vehicle (AE-C). Wild-type mice (n=10) were also used as control (WT-C). ApoE−/− mice showed higher retinal lipid peroxidation and increased VEGF expression and MMP-2 activity, associated with ultrastructural alterations such as basal laminar deposits, vacuoles, and an increase in Bruch's membrane thickness. While lutein alone partially prevented the alterations observed in apoE−/− mice, MV treatment substantially reduced VEGF levels and MMP-2 activity and ameliorated the retinal morphological alterations. These results suggest that oxidative stress in addition to an increased expression and activity of proangiogenic factors could participate in the onset or development of retinal alterations of apoE−/− mice. Moreover, these changes could be prevented by efficient antioxidant treatments

Real time-Polymerase Chain Reaction (Rt-PCR) results.

<p>Differences between treated and untreated eyes in all study groups (Mean+/−SD; 5 eyes/study group). Top left: IV-Control vs IV-17. Top right: IV-Control vs IV-144. Middle left: IVT-17. Middle right: IVT-144. Bottom left: IVT-17+144. (NS: Not significant; * p<0.05; ** p<0.01).</p

Fluorescein angiography (FA) images of all study groups.

<p>Left-image: Baseline, right-image: 4 weeks post-treatment. A: Intravenous control group (IV-Control). B: Intravenous P17 group (IV-17). C: Intravenous P144 group (IV-144). D: Intravitreal P17 group (IVT-17). E: Intravitreal P144 group (IVT-144). F: Intravitreal P17+P144 group (IVT-17+144).</p

Western blotting for vascular endothelial growth factor (VEGF) expression in RPE in intravenous groups (left) and intravitreal groups (right).

<p>Bars represent mean ± SEM of percentage of arbitrary units (AU) vs. control (Total protein loaded: 8 µg; 5–6 eyes/group). (* p<0.05).</p

VEGF protein expression, pSMAD-2 protein levels and MMP-2 activity in RPE homogenates - Intravenous groups.

<p>Data are shown as mean ± SEM of percentage of arbitrary units (AU) vs control group. (*p<0.05).</p

VEGF protein expression, pSMAD-2 protein levels and MMP-2 activity in RPE homogenates - Intravitreal groups.

<p>Data are shown as mean ± SEM of percentage of arbitrary units (AU) vs control eye. (*p<0.05 and **p<0.01).</p

Western blotting for phosphorylated SMAD-2 (pSMAD-2) expression in RPE in intravenous groups (left) and intravitreal groups (right).

<p>Bars represent mean ± SEM of percentage of arbitrary units (AU) vs control (Total protein loaded: 8 µg; 5–6 eyes/group).(* p<0.05; ** p<0.01).</p