OCT angiography documented reperfusion of translocated autologous full thickness RPE-choroid graft for complicated neovascular age-related macular degeneration

PurposeThe purpose of this study is to investigate the reperfusion of translocated retinal pigment epithelium (RPE)-choroid graft in the treatment of patients with neovascular age-related macular degeneration (nAMD), using OCT angiography (OCTA), a novel non-invasive, high-resolution imaging modality.Patients and methodsEighteen eyes of 18 consecutive patients suffering from complicated nAMD underwent RPE-choroid patch graft translocation surgery using a peripheral retinotomy and flap-over technique. We analyzed functional and anatomical outcome using visual acuity, Spectral Domain OCT and OCTA.ResultsWith a mean follow-up of 11 months, out of 18 patients, 15 gained vision, 1 remained stable, and 2 lost vision. Overall, the visual acuity improved with a mean of 30 letters. Perfusion of the graft tissue was confirmed in all patients. Two patients developed signs of a recurrent neovascular membrane during follow-up. No cases of proliferative vitreoretinopathy occurred in this series.ConclusionsOCTA images show signs of perfusion in all grafts. Encouraging functional results and low risk of severe complications suggest that RPE-choroid graft translocation is a valid option in patients with complicated nAMD.

Two cases of acute macular neuroretinopathy

PURPOSE

To report chorioretinal vasoconstriction as a potential pathogenic mechanism in acute macular neuroretinopathy (AMNR). To describe a time lag between the onset of functional deficits and that of fundoscopically visible lesions and illustrate the superior value of infrared (IR) compared to red-free or white light imaging in AMNR.

METHODS

Two young female patients (30 and 19 years old) with AMNR are described. Both underwent detailed clinical examination with additional imaging using IR, blue, and red-free light. Functional evaluation with pattern and multifocal electroretinography, Goldmann manual, and automated Humphrey visual fields (VFs) was also performed.

RESULTS

The first patient was diagnosed with AMNR after a caesarian section during and after which she received treatment with vasoconstrictive drugs. She was followed up for 28 months, after which time she still suffered from bilateral U-shaped paracentral scotomata associated with macular lesions. The second patient complained of central scotomata prior to the onset of any visible fundoscopic lesions, following a bout of flu. VFs confirmed a central scotoma and pattern electroretinography was consistent with loss of macular function. Bilateral petaloid lesions became visible after 3 days when function began to improve. In both patients IR imaging was superior to standard red-free and white light in identifying macular lesions.

CONCLUSIONS

Vasoconstriction in the chorioretina may be pathogenic in AMNR. Functional complaints precede fundus lesions in AMNR. And, IR light is superior to red-free or white light imaging in detecting typical fundus lesions in AMNR both early and late in the course of the disease.

Coordinate diurnal regulation of hepatic acyl-coenzyme A: cholesterol acyltransferase and cellular levels of esterified cholesterol

Hepatic ACAT, HMG-CoA reductase and both cellular free and esterified cholesterol were measured at 3 h intervals over a 24 h period in the rat. ACAT exhibited a characteristic low amplitude diurnal rhythm with maximum activity at the mid-light phase that was significantly higher than the minimum activity observed at the mid-dark phase. The cellular esterified cholesterol concentration showed a diurnal rhythm that closely paralleled the rhythm of ACAT activity. The cellular free cholesterol concentration was not significantly altered during the 24 h cycle. In rats fed cholesterol, the diurnal rhythm of ACAT was still maintained despite the increase in ACAT activity during the entire 24 h cycle suggesting that the ACAT rhythm is the result of changes in the level of ACAT protein expression. The results also indicate that the diurnal rhythms of ACAT and HMG-CoA reductase are generated by a process independent of the LDL receptor rhythm. All three rhythms are also independent of changes in the level of free cholesterol in the cell.

The Dubbo study: an Australian prospective community study of the health of elderly

The proportion of Australian population over 60 years has risen progressively over the last 40 years and this growth is projected to continue. Major health problems of the elderly include coronary heart disease, cerebro-vascular disease, osteoporosis and fracture. The risk factors for coronary heart disease and stroke in middle-aged subjects have been extensively documented in prospective studies in Australia and elsewhere, and include lipid disorders, hypertension, cigarette smoking, diabetes and family history. Few prospective studies have been targeted exclusively on the elderly and information available with respect to vascular risk factors is fragmentary and contradictory. This is the background to a new prospective study of the health of elderly Australians now under way in Dubbo, NSW. The goals of the Dubbo Study are to identify predictors of mortality, hospitalisation and placement in long-term care, while specific aims are the study of risk factors for chronic diseases and disability. This report describes the study rationale, reasons for selecting Dubbo as the study site, methods and measures, participation rates and demography. The target population included all non-institutionalised subjects 60 years and over, domiciled in Dubbo, and is comprised of 1693 males and 2167 females. The attendance rate for an extensive medical and sociological baseline assessment over a 13 months' period was 73% for both sexes. The prospective study is now in place and within three to five years will be generating definitive information in the elderly.

Long-term treatment of hypercholesterolaemia with a new palatable formulation of guar gum

Nineteen patients with primary hypercholesterolaemia previously stabilized on diet alone were treated with a new formulation of guar gum (6g t.d.s. with meals) in a placebo-controlled, single-blind study. Seventeen patients completed 3 months treatment without serious side effects, while 2 patients withdrew immediately because of severe diarrhoea. Thirteen patients have completed 12 months treatment with guar gum. There have been no significant changes in safety parameters. Plasma cholesterol was reduced by a significant 15% during the first 3 months of treatment (7.9 +/- 0.8 vs 6.7 +/- 1.0 mmol/l, P less than 0.001) and this effect has been sustained for 12 months. The fall in plasma cholesterol was associated with a significant 20% fall in LDL cholesterol, but with no change in HDL cholesterol. Plasma triglycerides did not change significantly. Percentage cholesterol absorption was reduced by guar gum in 4/5 normal subjects examined.

Treatment of hypercholesterolaemia with oral lecithin

An open clinical trial was performed to evaluate the plasma cholesterol-lowering potential of oral lecithin in large doses (20--30 g/day), with or without supplementary clofibrate. Three healthy subjects and seven patients with hypercholesterolaemia were studied over periods ranging from eight weeks to 11 months. In one-third of healthy subjects and in 3/7 patients, lecithin therapy led to a significant fall in plasma cholesterol concentration (10--18% fall). Combination of lecithin and clofibrate in two of the patients led to still lower plasma cholesterol levels (21 and 22% fall). Most of the change in plasma cholesterol concentration, when it occurred, was due to a reduction in beta lipoproteins. Evidence is presented that oral lecithin may reduce plasma cholesterol levels by acting as a source of linoleic acid.