Objective The intravitreal injection (IVI) of pharmacological agents is the most commonly performed ocular procedure and is associated with a host of complications. The majority of IVI-related complications data is derived from randomized controlled clinical trials, which report a high adverse event rate. The nature of these protocol-driven trials limit their applicability to the diverse circumstances seen in routine clinical practice. The goal of this study is to determine the prevalence of patient reported IVI-related complications, their risk factors, and the manner in which patients presented in a tertiary eye care center. Design A retrospective, IRB-approved review. Subjects, Participants and/or Controls 44,734 injections in 5,318 unique patients at the Cleveland Clinic Cole Eye Institute from 2012-2016. Methods, Intervention, or Testing Intravitreal injection. Main Outcome Measures Complication occurrence within 15 days of injection. Results From 2012-2016, a total of 44,734 injections were performed in 5,318 unique patients. Overall, complication rates were low, representing 1.9% of all injections, with 1031 unique complications in 685 (12.9%) patients. The most common minor complications, or those not requiring intervention, were irritation (n=312) and subconjunctival hemorrhage (n=284). The most common serious complications, or those requiring intervention, were corneal abrasion (n=46) and iritis (n=31). The majority of complications (66%) were adequately managed by a telephone/Epic electronic message encounter only. Importantly, no injection protocol parameter, such as type of anesthesia, preparation, or post-injection medication, increased the risk of a complication. However, patient sex, age, number of previous injections, and provider strongly influenced the risk of patient-reported complications. Conclusions Overall, complication rates seen in routine clinical practice were low compared to clinical trial reporting. Providers should feel confident in the safety and administration of IVI during times when follow-up office visits and resources may be limited. When performing an IVI, factors such as a patient’s sex, age, number of previous injections, and provider must be taken into account to ensure the best possible outcomes.

A patient with bilateral diffuse uveal melanocytic proliferation (BDUMP) associated with endometrial cancer was treated with plasmapheresis, but failed therapy with progressive serous retinal detachment. We collected plasma before and after plasmapheresis therapy. Our goal was to determine if the cultured melanocyte elongation and proliferation (CMEP) factor and hepatocyte growth factor (HGF) was present in the IgG enriched fraction and understand why our patient failed plasmapheresis therapy. Melanocytes were cultured for 3-5 days in the presence of control medium, unfractionated pre-plasmapheresis BDUMP medium, IgG enriched or IgG depleted BDUMP medium, or unfractionated post-plasmapheresis BDUMP medium. Subretinal fluid was collected from patients with BDUMP and control retinal detachments and analyzed by electropheresis with immunoblotting. Medium with unfractionated BDUMP plasma stimulated melanocyte growth 1.4-1.5 fold compared to control medium on days 3-5 (p < 0.001 for all). Both IgG enriched and IgG depleted BDUMP medium mildly increased melanocyte growth 1.3 fold (p < 0.05 for enriched, p < 0.01 for depleted) compared to control. In comparison, unfractionated BDUMP medium caused a 1.7-fold increase in melanocyte growth, which was significantly more than the enriched (p < 0.01) and depleted (p < 0.05) fractions. Pre-plasmapheresis and postplasmapheresis unfractionated BDUMP medium equally stimulated melanocyte growth 1.7-fold (p < 0.05) compared to control. HGF was present in IgG depleted, pre-plasmapheresis, and postplasmapheresis samples, but absent in the IgG enriched fraction. There was no enrichment of IgG in the subretinal fluid from eyes with BDUMP. In conclusion, CMEP factor is not concentrated in the IgG enriched plasma fraction in our patient who failed plasmapheresis therapy. HGF levels

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Preparation of a single cell suspension from solid tissue is vital for a successful flow cytometry experiment. We report a detailed and reproducible method to produce a quality cell suspension from the zebrafish retina. Zebrafish retinas, especially their Müller glia cells, are of particular interest for their inherent regenerative capacity, making them a useful model for regenerative medicine and cell therapy research. Here, we detail a papain‐based dissociation that is gentle enough to keep cells intact, but strong enough to disrupt cell‐cell and cell‐matrix interactions to yield a cell suspension that produces clean and reliable flow cytometric cell sorting results. This procedure consistently results in over 90% viability and three populations of cells based on GFP expression. The dissociation procedure described herein has been optimized for the collection of Müller glia from Tg(apoe:gfp) zebrafish retinas; however, the overall process may be applicable to other cell types in the fish retina, additional flow cytometric techniques, or preparing cell suspensions from similar tissues. © 2019 International Society for Advancement of Cytometry

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Introduction: Indications for patellofemoral arthroplasty (PFA) remain under debate, with many surgeons favoring total knee arthroplasty (TKA) even in patients with limited degeneration in the tibiofemoral compartments. Case Report: A 30-year-old man with a history of bilateral patellar instability treated in youth with multiple surgeries presented with 8+ months of recurrent bilateral knee pain. Evaluation showed bilateral severe patellofemoral arthritis with preserved medial and lateral compartments. Bilateral sequential robotic-assisted PFAs (RA-PFA) were offered as a precise approach to reconstructing patellofemoral biomechanics while minimizing bone resection to avoid compromising potential future TKA. Four months after his latest surgery, he returned to a physically demanding job, and he remains active and pain free at 1 year postoperatively. Conclusion: RA-PFA can provide less invasive, accurate, and individualized treatment for younger patients with severe disease without compromising future conversion to TKA. Keywords: Robotic, patellofemoral arthroplasty, trochlear dysplasia, patellar instability, patellofemoral osteoarthritis.