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""Written by a pioneering leader in the development of vitreoretinal surgical techniques and instruments, Vitreous Microsurgery is a comprehensive how-to guide to all vitreoretinal procedures. This thoroughly updated Fifth Edition describes many new techniques and refinements of established procedures and includes new chapters and new illustrations. More than 170 three-dimensional full-color illustrations--many by the Charles Retina Institute's resident medical artist, Byron Wood--enable surgeons to clearly visualize the techniques. The focus of the text is on the decision making process a surgeon goes through in evaluating the best course of treatment for his/​her patient undergoing vitreous surgery. The book describes in detail clinically proven methods of managing the anterior and posterior segment vitreous surgery patient in a systematic manner. The text is organized in a building block approach with general methodology preceding its application to specific disease states. The book stresses algorithms for intra-operative decision making, relying on knowledge of physical principles and performed in the order of ascending risk. A companion website included with purchase offers the fully searchable text and an online image bank"--Provided by publisher."

"Latar Belakang : Uveitis adalah suatu kelompok penyakit yang ditandai dengan adanya inflamasi intraokular, berkontribusi sebanyak 25% kebutaan di dunia. Kekeruhan vitreus adalah salah satu tanda klinis yang penting untuk evaluasi dan monitor penyakit khususnya pada uveitis intermediet, posterior, dan panuveitis.Tujuan : Memperoleh pengukuran kuantitatif dari kekeruhan vitreus menggunakan optical coherence tomography (OCT) dengan Image J sebagai metode alternatif dari standar baku pengukuran kualitatif, skala Nussenblatt.Metode: Studi ini adalah studi potong lintang, prospektif. Studi ini menyertakan karakteristik klinis dan demografis pasien uveitis dan kontrol. Penilaian OCT makula dan foto fundus dilakukan oleh dua orang yang berbeda.Hasil: Sebanyak 29 partisipan dengan uveitis dan 29 kontrol sehat diikutkan dalam penelitian. Lebih dari setengah pasien memiliki panuveitis (59.6%) dengan toksoplasma sebagai etiologi tersering (27.6%). Median dari Vitreus/Epitel Pigmen Retina intensitas relatif (VRIr) sebagai pengukuran yang didapat dari OCT didapatkan lebih tinggi pada pasien dengan uveitis dibandingkan dengan kontrol sehat (0.265; 0.168-0.605 dan 0.175;0.152-0.199 secara berurutan). Nilai intra-rater dengan kedua metode ini menunjukkan hasil yang sangat baik dengan penilai 1 memperoleh 0. 975 (0.958, 0.985); penilai 2 memperoleh 1.00 (0.999, 1.000) untuk VRIr, dan penilai 1 memperoleh 0.920 (0.829, 0.962) dan penilai 2 memperoleh 0.908 (0.804, 0.957) untuk skala Nussenblatt. VRIr memiliki nilai inter-rater yang lebih tinggi jika dibandingkan dengan skala Nussenblatt (0.998; 0.996 - 0.999 dan 0.717; 0.696 - 0.737, p<0.001). Korelasi positif yang kuat ditemukan diantara VRIr dan skala Nussebblatt (rho= 0.713, p<0.001).Kesimpulan: VRIr memiliki nilai inter-rater dengan kesesuaian yang hampir sempurna dan kesesuaian intra-rater yang sangat baik dengan adanya korelasi positif yang kuat terhadap skala Nussenblatt, menjadikan VRIr sebagai metode kuantitatif dari pengukuran kekeruhan vitreus.

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Background : Uveitis is a group of diseases characterized by intraocular inflammation, causing 25% of blindness world-wide. Vitreous haziness is one of important clinical endpoint for disease evaluation and monitoring in intermediate, posterior uveitis and panuveitis.

Purpose : To obtain quantitative measurement of vitreous haziness using optical coherence tomography (OCT) with Image J as alternative method to gold standard qualitative measurement, Nussenblatt scale.

Methods: Prospective , cross-sectional study was conducted for this purpose. Clinical and demographic characteristic of uveitic and healthy control were recorded in this study. OCT macula and fundus photograph were obtained and graded by two independent graders.

Result: A total of 29 uveitic eyes and 29 healthy controls were included in this study. More than half of recruited patients had panuveitis (59.6%) with toxoplasma as the most common etiology (27.6%). Median of Vitreous/RPE relative intensity (VRI) as the OCT-derived measurement showed higher in uveitic patients compared to healthy controls (0.265; 0.168-0.605 and 0.175;0.152-0.199 respectively). Intra-rater of two methods showed excellent result with grader 1 was 0.975 (0.958, 0.985) ; grader 2 was 1.00 (0.999, 1.000) for VRI, and grader 1 was 0.920 (0.829, 0.962) and grader 2 was 0.908 (0.804, 0.957) for Nussenblatt Scale. VRI had higher inter-rater agreement compared to Nussenblatt scale (0.998; 0.996 - 0.999 and 0.717; 0.696 - 0.737, p<0.001). Strong positive correlation was found between VRI and Nussenblatt scale (rho= 0.713, p<0.001).

Conclusion: VRI had near perfect inter-rater agreement and excellent intra-rater agreement with strong positive correlation with Nussenblatt scale, making VRI a quantitative method of vitreous haziness measurement."

"Tujuan: Membandingkan kadar vascular endothelial growth factor VEGF dan placental growth factor PlGF plasma dan vitreus pada tikus diabetes dengan kontrol gula darah GD buruk, dengan perbaikan kontrol gula darah, dan tikus nondiabetes, dan melihat pengaruh perbaikan kontrol gula darah terhadap kadar VEGF dan PlGF. Metode: Penelitian ini merupakan uji eksperimental pada hewan coba tikus strain Sprague Dawley. Sebanyak 18 ekor tikus disertakan dalam penelitian dan secara acak dibagi ke dalam kelompok perlakuan n=14 dan kontrol n=4 . Kelompok perlakuan diberikan injeksi Streptozotocin untuk menginduksi diabetes. Tikus dengan kadar GD 72 jam pasca induksi lebih dari 300 mg/dL didiagnosis diabetes. Kadar GD diperiksa secara berkala pada seluruh subyek. Setelah 4 mingu, kelompok perlakuan dibagi ke dalam kelompok I untuk terminasi dan kelompok II untuk perbaikan kontrol GD dengan injeksi insulin selama 4 minggu berikutnya, begitu pula dengan kelompok kontrol. Saat terminasi, sampel plasma darah dan vitreus diambil untuk analisis kadar VEGF dan PlGF melalui pemeriksaan enzyme-linked immunosorbent assay ELISA. Hasil: Sebanyak 17 ekor tikus bertahan hidup hingga akhir penelitian dengan 1 ekor tikus mati dari kelompok perlakuan. Kadar GD kelompok perlakuan II menurun drastis dan mencapai normoglikemia. Pemeriksaan ELISA bulan pertama menunjukkan kadar VEGF vitreus kelompok perlakuan I cenderung lebih tinggi dibandingkan kontrol I, yakni 196,36 65,24 pg/dL dan 123,64 44,99 pg/dL p=0,20 . Pemeriksaan ELISA bulan kedua menunjukkan kadar PlGF vitreus kelompok perlakuan II lebih tinggi dibandingkan kontrol II, yakni 59,04 2,48 dan 51,93 3,15 p=0,01. Kadar VEGF vitreus dan plasma kelompok perlakuan I dan II tidak berbeda bermakna, sedangkan kadar PlGF vitreus dan plasma lebih tinggi pada bulan kedua. Kesimpulan: Kadar VEGF dan PlGF vitreus mengalami peningkatan pada kelompok tikus diabetes dibandingkan nondiabetes, dan perbaikan kontrol gula darah selama 1 bulan belum dapat menurunkan kadar VEGF dan PlGF.

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Aim: To compare plasma and vitreous level of vascular endothelial growth factor VEGF and placental growth factor PlGF in diabetic rats with poor blood glucose BG control, reconstitution of good BG control, and nondiabetic rats, and to investigate the effect of reconstitution of good BG control to VEGF and PlGF plasma and vitreous level.

Methods: This is an experimental study using Sprague Dawley rats. Eighteen rats were divided into intervention group n 14 and control group n 4. Intervention group were given Streptozotocin STZ injection to induce diabetes. Rats with BG level more than 300 mg dL at 72 hours after injection were considered diabetes and successful models. BG levels were monitored periodically in all subjects. After 4 weeks, intervention group was randomly divided into group I for termination and group II for reconstitution of good BG control with insulin for following 4 weeks, and so was the control group. Plasma and vitreous samples were taken. VEGF and PlGF levels were detected with enzyme linked immunosorbent assay ELISA.

Results: Seventeen rats survived and one rat died in intervention group. BG level of intervention group II decreased dramatically to normoglycemia. ELISA at month 1 showed that VEGF vitreous level tend to be higher in intervention group I compared to control I, 196.36 65.24 pg dL and 123.64 44.99, respectively p 0.20. ELISA at month 2 showed that PlGF vitreous level of intervention group I were significantly higher compared to control I, 59.04 2.48 and 51.93 3.15, respectively p 0.01. Vitreous and plasma VEGF of intervention group I and II were not different, while vitreous and plasma PlGF were significantly higher in group II.

Conclusions: Vitreous levels of VEGF and PlGF were increased in diabetic rats compared to nondiabetic, and reconstitution of good BG control for 1 month were unable to reduce VEGF and PlGF levels. "

"ABSTRACTBACKGROUND:proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. METHODS:an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels.RESULTS:a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 - 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 - 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak.CONCLUSION:median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR."

"Risiko kegagalan dapat terjadi pada rekonstruksi dengan flap bebas karena mengandalkan vaskularisasi kecil. Pemeriksaan klinis yang merupakan baku emas dalam evaluasi sirkulasi flap masih bersifat subjektif dan sulit untuk mendeteksi gangguan vaskularisasi secara dini. Indocyanine green (ICG) merupakan instrumen pemeriksaan objektif yang dapat digunakan untuk evaluasi sirkulasi flap, tetapi belum ada konsensus mengenai dosis ICG dan kekuatan fluoresensi bersifat dose-dependent. Pada penelitian awal model in vitro dan hewan coba didapatkan konsentrasi 0,5 mg/mL menghasilkan fluoresensi yang setara dengan konsentrasi standar (5 mg/mL). Analisis dosis titrasi ICG dilakukan pada penelitian ini untuk mengevaluasi (sirkulasi) flap bebas menggunakan kamera near-infrared radiation standar serta korelasinya terhadap pemeriksaan suhu flap, TcPCO2, TcPO2, kadar HIF-1α, dan gambaran histopatologi flap untuk menunjang bedah mikro rekonstruksi. Penelitian menggunakan desain eksperimental uji klinis acak tersamar ganda di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM) dan Rumah Sakit Persahabatan (RSP) pada bulan September 2022 hingga Januari 2024. Sebanyak 63 pasien yang sesuai dengan kriteria inklusi dari kuesioner skrining dilakukan randomisasi menjadi 3 kelompok konsentrasi ICG, yaitu 5 mg/mL, 2,5 mg/mL, dan 0,5 mg/mL yang diberikan ICG secara intravena, dengan jumlah masing-masing 21 flap. Data diambil segera pasca-operasi, 24 jam, 72 jam, serta 120 jam pasca-operasi. Ketiga kelompok menunjukkan peningkatan fluoresensi ICG dari waktu ke waktu, dengan intensitas fluoresensi pada konsentrasi 2,5 mg/mL serupa dengan konsentrasi standar (p = 0,792), tetapi intensitas konsentrasi 0,5 mg/mL lebih lemah (p = 0,006 dan p = 0,041). Intensitas fluoresensi tidak berkorelasi dengan pemeriksaan objektif lainnya. Disimpulkan besar dosis ICG memengaruhi intensitas fluoresensi karena fenomena quenching effect dan keseimbangan ikatan ICG dengan protein plasma. Analisis konsentrasi 5 mg/mL dan 2,5 mg/mL menghasilkan intensitas serupa sehingga penggunaan dosis 2,5 mg/mL dapat menggantikan dosis standar pada praktik klinis. Pemeriksaan objektif lainnya belum dapat menggantikan pemeriksaan ICG untuk evaluasi sirkulasi flap bebas.

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The risk of failure in free flap reconstruction may occur due to small vascularization. Clinical examination, which is the gold standard for free flap evaluation, is subjective and difficult to detect early vascularization problems. Indocyanine green (ICG) is an objective instrument to evaluate flap circulation, but there is no ICG consensus and the fluorescence emitted is dose-dependent. In the preliminary studies conducted in vitro followed by in vivo with animal models, we found that 0.5 mg/mL concentration produced equivalent fluorescence to the standard concentration (5 mg/mL). This study aimed to analyze the titration dose of ICG to evaluate free flaps using a standard near-infrared radiation camera and its correlation with the examination of flap temperature, TcPCO2, TcPO2, HIF-1α levels, and histopathological to support reconstructive microsurgery procedure. This was a randomized, double-blind clinical trial at Dr. Cipto Mangunkusumo National Central General Hospital and Persahabatan Hospital from September 2022 to January 2024. A total of 63 patients that met the inclusion criteria through screening questionnaire were randomized into 3 ICG concentration groups: 5 mg/mL, 2.5 mg/mL, and 0.5 mg/mL. The ICG was given intravenously to each group which consist of 21 subjects. The data were obtained immediately postoperative, 24 hours, 72 hours, and 120 hours post-operative. There were 63 flaps divided into three groups with 21 flaps each. All three groups showed an increase in ICG fluorescence over time, with fluorescence intensity emitted by 2.5 mg/mL concentration is equivalent to the standard concentration (p = 0.792), but the fluorescence from 0.5 mg/mL concentration emitted weaker intensity (p = 0.006 and p = 0.041). Fluorescence intensity did not correlate with other objective examinations. It was concluded that the titration dose of ICG influenced the fluorescence intensity due to quenching effect and ICG and plasma protein bond equilibrium. Analysis of 5 mg/mL and 2.5 mg/mL concentration groups produced similar intensities, leading to the feasibility of 2.5 mg/mL concentration to replace the standard dose in clinical practice. Other objective examinations can not replace ICG examination for free flap perfusion evaluation."