AOP*** Brief Communications Progressive atrophy of retinal pigment epithelium after trypan-blue-assisted ILM peeling for macular hole surgery

We report a case of progressive atrophy of the retinal pigment epithelium (RPE) after trypan-blue-assisted peeling of internal limiting membrane (ILM) for macular hole surgery. A 68-yearold Caucasian female underwent a 20-g pars plana vitrectomy for a chronic stage-3 macular hole. The ILM was stained with 0.06% trypan blue (VisionBlue™, DORC Netherlands) for 2 min after fluid air exchange. Dye was reapplied for another 2 min due to poor staining. The ILM was completely removed around the macular hole with forceps. RPE atrophy was noticed at the edge of the hole 1 month after surgery. It progressively increased in intensity and enlarged over 2 years. Her final visual acuity was counting fingers, significantly worse compared to her presenting visual acuity of 20/200. Progressive atrophy of RPE in our patient was most likely due to the toxicity of trypan blue. Reapplication of the dye may increase the likelihood of toxicity. Key words: Internal limiting membrane, macular hole, retinal pigment epithelial atrophy, trypan blue,vital dyes Vital dyes such as indocyanine green, trypan blue (TB), and brilliant blue green are commonly employed during macular hole surgery to stain the internal limiting membrane (ILM). TB provides a faint staining of the ILM and has been reported to be safe in some clinical studies. [1] However, experimental studies Case Report A 68-year-old phakic Caucasian female presented with decreased central vision in the left eye for the past 18 months secondary to a large macular hole. She denied any prior history of trauma, A ring-shaped area of hypopigmentation corresponding to the edge of the macular hole was noted one month after surgery [ Discussion RPE atrophy, first noted at the edge of the hole 1 month postoperatively, gradually became more intense and enlarged over a 2-year period with progressive decline in visual acuity to counting fingers. The lesion was not typical of facet or phototoxicity lesions observed after macular hole surgery

Modeling and sensitivity analysis of grid-connected hybrid green microgrid system

The demonstrated research work analyses the technoeconomic modelling and sensitivity analysis of the available resources for the rural community in India. The various resources used in this study are solar, wind, hydro, battery and utility grid-connected system. The usefulness of the on-grid system in the rural sector is that excess amount of electricity produced through renewable energy sources (RES) could be sold back to the utility grid. A total of 12 possible configurations of various resources with and without a grid-connected system was analyzed for minimum Levelized Cost of Energy (LCOE) and Total Net Present Cost (TNPC). Further, sensitivity analysis is accomplished for different sensitive variables to understand the nature of the system for wider application in rural communities. The solar-wind-hydro-based utility grid-connected network is observed to be the best optimal configuration with a minimum value of LCOE of 0.056 $/kWh. The simulation results reveal that the effective utilization of RES has been a cost-efficient and reliable system to the power supply in remote communities

Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema

AbstractA 65-year-old male with uncontrolled diabetes, received posterior subtenon triamcinolone (PST) injection in the right eye for diabetic macular edema. Two days following PST, he developed scleral abscess at the injection site. The Gram stain showed Gram positive cocci in clusters. He responded favorably with systemic control of diabetes, topical concentrated cefazolin, concentrated tobramycin, and intravenous antibiotics. Possibility of infective complications should be considered when using periocular steroids, especially in diabetics. Strict control of diabetes and aggressive systemic antibiotics favor rapid healing in such cases

Progressive atrophy of retinal pigment epithelium after trypan-blue-assisted ILM peeling for macular hole surgery

We report a case of progressive atrophy of the retinal pigment epithelium (RPE) after trypan-blue-assisted peeling of internal limiting membrane (ILM) for macular hole surgery. A 68-year-old Caucasian female underwent a 20-g pars plana vitrectomy for a chronic stage-3 macular hole. The ILM was stained with 0.06% trypan blue (VisionBlue™, DORC Netherlands) for 2 min after fluid air exchange. Dye was reapplied for another 2 min due to poor staining. The ILM was completely removed around the macular hole with forceps. RPE atrophy was noticed at the edge of the hole 1 month after surgery. It progressively increased in intensity and enlarged over 2 years. Her final visual acuity was counting fingers, significantly worse compared to her presenting visual acuity of 20/200. Progressive atrophy of RPE in our patient was most likely due to the toxicity of trypan blue. Reapplication of the dye may increase the likelihood of toxicity

Comparison of intravitreal bevacizumab, intravitreal triamcinolone acetonide, and macular grid augmentation in refractory diffuse diabetic macular edema: A prospective, randomized study

Background: In spite of laser being the gold standard treatment for Diabetic Macular edema (DME), some patients do not respond to laser. Various treatment modalities are being tried in the management of refractory diffuse DME (DDME). Purpose: To compare the efficacy of intravitreal bevacizumab (IVB), intravitreal triamcinolone acetonide (IVTA), and macular grid augmentation in the management of refractory DDME. Settings and Design: Prospective randomized study in a tertiary eye care center. Materials and Methods: Sixty patients with refractory DDME were randomly assigned to three groups: Group 1 received IVB (1.25 mg/0.05 ml), Group 2 received IVTA (4 mg/0.1ml), and Group 3 underwent laser augmentation. Primary outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) at the end of 6 months. Statistics: Analysis was performed using SPSS 14.0 Results: Group 1 and 2 showed significant improvement in mean BCVA from 20/160 at baseline to 20/80 and from 20/125 to 20/63, respectively, at 6 months (P < 0.05). These groups also showed a significant reduction in the mean CMT from 457 ± 151 μ at baseline to 316 ± 136 μ and from 394 ± 61 μ to 261 ± 85 μ, respectively, at 6 months (P < 0.05). Group 3 showed only small improvement in mean BCVA from 20/100 to 20/80 (P = 1.0) while mean CMT increased from 358 ± 89 μ at baseline to 395 ± 127 μ at 6 months (P = 0.191). Eight (40%) eyes in Group 2 had intraocular pressure (IOP) rise and 10 (50%) eyes developed cataract. Conclusions: Both IVB and IVTA may be effective in the treatment of refractory DDME compared with macular grid augmentation. IVTA may be associated with side effects such as IOP rise and cataract formation

Ultrawide field fluorescein angiogram in a family with gyrate atrophy and foveoschisis

Gyrate atrophy of choroid and retina is an autosomal recessive condition characterized by peripheral multiple sharp areas of chorioretinal atrophy which become confluent with age. Macula and central vision is typically involved late in the disease. Macular involvements such as cystoid macular edema, epimacular membrane, and choroidal neovascularization have been reported in gyrate atrophy. In this report, we present a family with diminished central vision presenting within 8 years of age. All of three siblings had typical peripheral chorioretinal atrophic lesions of gyrate atrophy and hyperornithinemia. On spectral domain optical coherence tomography, two of elder siblings showed macular edema. Hyporeflective spaces appeared to extend from outer nuclear layer to the inner nuclear layer level separated by multiple linear bridging elements in both eyes. Ultrawide field fluorescein angiogram (UWFI) even in late phase did not show any leak at macula suggesting foveoschisis. Foveoschisis in gyrate atrophy has not been reported before