Though microaneurysms are the hallmark of diabetic retinopathy (DR), large aneurismal changes termed as ''macroaneurysms'' (MAs) may also occur in the course of chronic diabetic macular edema. MAs are usually accompanied by intraRETINAL hard exudates, fluid accumulation and RETINAL HEMORRHAGES. Detection of MAs is clinically important as it implies that macular edema is usually chronic and therefore can be resistant to intravitreal anti-vascular endothelial growth factor injections. Multimodal imaging consisting of fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) or OCT-angiography (OCTA) can be performed to detect and understand the nature of MA and thereby select proper treatment modality. Herein, we report multimodal imaging features of a 64-year-old woman with insulin-dependent diabetes mellitus presented with treatment naï ve severe macular edema and a macroaneurysm at the right temporal macula. In conclusion, FA, ICGA and OCT seem to be far superior to OCTA to detect these lesions due to probable slow flow inside the MA...

Purpose: 7-ketocholesterol (7kCh), a natural byproduct of oxidation in lipoprotein deposits is implicated in the pathogenesis of diabetic retinopathy and age-related macular degeneration (AMD). This study was performed to investigate whether several clinical drugs can inhibit 7kCh-induced caspase activation and mitigate its apoptotic effects on RETINAL cells in vitro. Method: Two populations of RETINAL cells, human RETINAL pigment epithelial cells (ARPE-19) and rat neuroRETINAL cells (R28) were exposed to 7kCh in the presence of the following inhibitors: Z-VAD-FMK (pan-caspase inhibitor), simvastatin, memantine, epicatechin, and Z-IETD-FMK (caspase-8 inhibitor) or Z-ATAD-FMK (caspase-12 inhibitor). Caspase-3/7,-8, and-12 activity levels were measured by fluorochrome caspase assays to quantify cell death. IncuCyte live-cell microscopic images were obtained to quantify cell counts. Results: Exposure to 7kCh for 24 hours significantly increased caspase activities for both ARPE-19 and R28 cells (P < 0. 05). In ARPE cells, pretreatment with various drugs had significantly lower caspase-3/7,-8, and-12 activities, reported in % change in mean signal intensity (msi): Z-VAD-FMK (48% decrease, P < 0. 01), memantine (decreased 47. 8% at 1 µ M, P = 0. 0039 and 81. 9% at 1 mM, P < 0. 001), simvastatin (decreased 85. 3% at 0. 01 µ M, P < 0. 001 and 84. 8% at 0. 05 µ M, P < 0. 001) or epicatechin (83. 6% decrease, P < 0. 05), Z-IETD-FMK (68. 1% decrease, P < 0. 01), and Z-ATAD-FMK (47. 7% decrease, P = 0. 0017). In contrast, R28 cells exposed to 7kCh continued to have elevated caspase3/7,-8, and-12 activities (between 25. 7% decrease and 17. 5% increase in msi, P > 0. 05) regardless of the pretreatment. Conclusion: Several current drugs protect ARPE-19 cells but not R28 cells from 7kChinduced apoptosis, suggesting that a multiple-drug approach is needed to protect both cells types in various RETINAL diseases.

Introduction: Predicting the outcome is one of the most frequent and important issues when approaching patients with intracranial hemorrhage (ICH). Objective: This study aimed to evaluate the correlation of SUSPEKT score variables plus electrocardiogram (ECG) abnormalities with one-month mortality of patients with ICH presenting to emergency department (ED). Methods: In this cohort study, adult patients presenting to the EDs of three educational hospitals, during one year, were followed and their one-month mortality rate as well as independent predictors of outcome among the variables of SUSPEKT score plus electrocardiography findings were evaluated. Results: One hundred seventy-seven patients with the mean age of 63. 07± 14. 89 years were studied (59. 9%). The most common locations of intra-parenchymal hemorrhage were basal ganglia (53. 7%) and cortex (36. 2%). Ninety-two (52. 0%) of cases had at least one ECG abnormality. The most frequent ECG abnormalities were ST segment depression (20. 3%), T wave inversion (16. 4%), and left ventricular hypertrophy (14. 7%). Thirty (16. 9%) cases died during the 30-day follow-up. Survived and non-survived cases were significantly different regarding the location of intra-parenchymal hemorrhage (p < 0. 0001), presence of intraventricular hemorrhage (IVH) (p = 0. 007), ST segment elevation (p < 0. 0001), bradycardia (p < 0. 0001), tachycardia (p < 0. 0001), arterial fibrillation (p < 0. 0001), blood sugar (p = 0. 044), and serum level of potassium (p = 0. 022). Conclusions: The location of hemorrhage (basal ganglia), higher blood sugar, and presence of ECG abnormalities (ST segment elevation, tachycardia, bradycardia, atrial fibrillation) were among the independent predictors of one-month mortality of ICH patients in this study.

During RETINAL surgeries, the presence of large RETINAL defects or breaks (giant RETINAL tears or retinotomies ≥ 3 clock hours) requires the use of perfluorocarbon liquid (PFCL) to stabilize the posterior retina. Thereafter, direct PFCL‑ oil exchange is preferred to avoid posterior slippage of the retina. However, in an eye filled with PFCL, fluid currents at the surface of the PFCL pose a few problems when laser is attempted. Multiple bubbles are formed due to fluid currents, and the fluid jet from the infusion port may continually dislodge the free end of the retina despite the presence of PFCL. This effect is accentuated when instruments are exchanged or if the active port is unoccluded. On the other hand, if laser is postponed until the eye is filled with oil, fluid accumulation may occur under the macula, as posterior tamponade is absent. We present a modified technique that entails the use of a “ sandwich” of anterior SO and posterior PFCL to comfortably perform laser in a well‑ formed closed vitreous chamber with continuous maintenance of RETINAL attachment.