Kresge Eye Institute

To evaluate the use of povidone-iodine infusion during pars plana vitrectomy and to assess its clinical outcomes in the treatment of severe endophthalmitis. A retrospective case series of 40 patients (41 eyes) with clinically or culture-confirmed endophthalmitis underwent pars plana vitrectomy with 0.025% povidone-iodine in the infusion solution. Outcomes included infection resolution, improvements in visual acuity, the need for additional surgeries, and signs of ocular toxicity. Of the 41 eyes treated, infection resolved in 33 (80.4%) eyes postoperatively. Visual acuity improved postoperatively in 29 eyes (70.7%). Mean uncorrected visual acuity improved from 20/3,337 (2.22 ± 0.70 logMAR) preoperatively to 20/540 (1.43 ± 0.88 logMAR) postoperatively ( P < 0.0001). No ocular toxicity or unexplained vision loss related to povidone-iodine infusion was observed. The addition of 0.025% povidone-iodine infusion during pars plana vitrectomy appears safe and led to favorable post-surgical outcomes in a traditionally high-risk cohort.

To report a case of asymptomatic grade III lipemia retinalis in the setting of pegylated asparaginase chemotherapy with concomitant glucocorticoid treatment which preceded an episode of acute pancreatitis. Case Report. A 31-year-old male with acute lymphoblastic leukemia developed lipemia retinalis (triglycerides 1907 mg/dL) during consolidation therapy with pegylated asparaginase and glucocorticoids. Discontinuation of asparaginase and initiation of fenofibrate led to complete resolution of retinal findings and normalization of triglycerides. A month later, he developed acute pancreatitis (lipase 660 U/L) which resolved with intensive care management. He remains in remission with stable ocular findings. Lipemia retinalis may serve as an early ophthalmic marker of chemotherapy-induced hypertriglyceridemia, particularly in the setting of combined glucocorticoid and asparaginase therapy. Prompt recognition is critical, as it can precede life-threatening complications such as acute pancreatitis and guide timely modifications in treatment.

Metabolomic profiling of aqueous humor from primary open-angle glaucoma (POAG) patients using targeted metabolomics analysis and assessment of the potential anti-neuroinflammatory and neuroprotective roles of key dysregulated metabolites in a mouse model of retinal neuroinflammation. A targeted metabolomics was performed on aqueous humor from POAG patients (n = 19) and healthy subjects (n = 10) via LC-MS/MS. In vitro neuroprotection studies were performed using a mouse cone photoreceptor cell line (661W) exposed to oxidative stress. For in vivo therapeutic studies, a few key dysregulated metabolites were delivered either topically via extracellular vesicle (EV)-mediated delivery or intravitreally into a C57BL/6 mouse model of retinal neuroinflammation. The neuroprotective and anti-neuroinflammatory properties were determined in the presence and absence of metabolites through pattern electroretinography, TUNEL, and quantitative PCR analyses. Among the 135 endogenous metabolites identified, 31 metabolites showed significant dysregulation in POAG. Metabolite set enrichment analysis revealed that these altered metabolites were associated with dysregulation of multiple key cellular pathways, including glycolysis, pentose phosphate pathway, short-/long-chain fatty acid metabolism, mitochondrial β-oxidation, and electron transport chain under glaucomatous conditions. Among these differentially expressed metabolites, a putative neuromodulator (agmatine) and a vitamin (thiamine) significantly decreased in POAG patients. Intravitreal or EV-mediated topical delivery of agmatine and thiamine significantly reduced the inflammatory response and protected retinal ganglion cell function against neuroinflammatory damage in the mouse retina. Agmatine and thiamine treatment also significantly protected photoreceptor cells from oxidative stress-induced cell death and attenuated the inflammatory cytokine response. Our results revealed significant metabolic alterations in POAG that affect key cellular functions. Agmatine and thiamine could be potential immunomodulatory or neuroprotective drugs to treat or prevent neuroinflammatory damage to the retina during glaucoma.

Effective regulation of energy metabolism is critical for survival. Metabolic control involves various nuclei within the hypothalamus, which receive information about the body's energy state and coordinate appropriate responses to maintain homeostasis, such as thermogenesis, pancreatic insulin secretion, and food-seeking behaviors. It has recently been found that the hippocampus, a brain region traditionally associated with memory and spatial navigation, is also involved in metabolic regulation. Specifically, hippocampal sharp wave-ripples (SWRs), which are high-frequency neural oscillations supporting memory consolidation and foraging decisions, have been shown to reduce peripheral glucose levels. However, whether SWRs are enhanced by recent feeding-when the need for glucose metabolism increases, and if so, whether feeding-dependent modulation of SWRs is communicated to other brain regions involved in metabolic regulation-remains unknown. To address these gaps, we recorded SWRs from the dorsal CA1 region of the hippocampus of mice during sleep sessions before and after consumption of meals of varying caloric values. We found that SWRs occurring during sleep are significantly enhanced following food intake, with the magnitude of enhancement being dependent on the caloric content of the meal. This pattern occurred under both food-deprived and ad libitum feeding conditions. Moreover, we demonstrate that GABAergic neurons in the lateral hypothalamus, which are known to regulate food intake, exhibit a robust SWR-triggered increase in activity. These findings identify the satiety state as a factor modulating SWRs and suggest that hippocampal-lateral hypothalamic communication is a potential mechanism by which SWRs could modulate peripheral metabolism and food intake.

Introduction: To report a new method for ethylenediaminetetraacetic acid (EDTA) chelation with the use of an Amoils brush to debride calcium band keratopathy involving a laser-assisted in situ keratomileusis (LASIK) flap. Patient and Clinical Findings: A 77-year-old man with a history of bilateral LASIK presented with visually significant band keratopathy involving the flap. Diagnosis, Intervention, and Outcomes: We report the successful removal of the band keratopathy using EDTA chelation and debridement with an Amoils brush to prevent flap dislodgment. 1 month postoperatively, the patient experienced an improvement in corrected distance visual acuity with resolution of the band keratopathy. Conclusions: Debridement using an Amoils brush, in conjunction with EDTA chelation, is an effective and safe treatment for visually significant band keratopathy involving a LASIK flap.

Linking sensory input and its consequences is a fundamental brain operation. During behavior, the neural activity of neocortical and limbic systems often reflects dynamic combinations of sensory and task-dependent variables, and these "mixed representations" are suggested to be important for perception, learning, and plasticity. However, the extent to which such integrative computations might occur outside of the forebrain is less clear. Here, we conduct cellular-resolution two-photon Ca2+ imaging in the superficial "shell" layers of the inferior colliculus (IC), as head-fixed mice of either sex perform a reward-based psychometric auditory task. We find that the activity of individual shell IC neurons jointly reflects auditory cues, mice's actions, and behavioral trial outcomes, such that trajectories of neural population activity diverge depending on mice's behavioral choice. Consequently, simple classifier models trained on shell IC neuron activity can predict trial-by-trial outcomes, even when training data are restricted to neural activity occurring prior to mice's instrumental actions. Thus, in behaving mice, auditory midbrain neurons transmit a population code that reflects a joint representation of sound, actions, and task-dependent variables.

A scoping review of 45 peer-reviewed manuscripts involving intraocular pressure (IOP) change and concurrent optical coherence tomography angiography (OCTA) assessments was performed to aggregate knowledge, summarize major findings, and identify gaps in literature and methodology relating to the effect of IOP change on OCTA. Articles were identified through PubMed/Medline, Google Scholar, Cochrane, Web of Science, and article reference lists. A total of 838 results were identified, and 45 articles met the inclusion and exclusion criteria for detailed analysis. OCTA metrics including vessel density (VD), perfusion density, and flow density of the superficial capillary plexus and the radial peripapillary capillaries were analyzed in relation to relative temporal IOP changes. Overall, IOP changes were found to affect superficial vascular plexus (VD) measurements on OCTA, especially when IOP elevated above the physiologic normal range (10-21 mmHg). No significant association was found between diurnal IOP variation and OCTA metrics. Cataract surgery improved the whole-image signal strength and VD regardless of changes in IOP. Beta-blockers were associated with paradoxically reduced vessel density in normal tension glaucoma patients in two studies. Although glaucoma surgical intervention studies were inconsistent and limited by scan quality and low sample sizes, patients requiring glaucoma surgery exhibited attenuated postoperative superficial VD recovery despite significant IOP reductions with surgical intervention. In addition to ensuring near-perfect signal strength with minimal media opacities and controlling for high myopia, central corneal thickness, and the presence of retinopathy, clinicians should consider the statistically significant impact of IOP on OCTA metrics when interpreting results.

A 67-year-old woman with history of mild suture hyper-sensitivity presented with localized scleritis after strabismus surgery. After infection was ruled out, the patient was prescribed topical and systemic non-steroidal anti-inflammatory drugs and systemic steroids, which led to full clinical resolution. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e4-e6.].