Unintentional transplantation of autologous retinal pigment epithelium during limited macular translocation.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
E De Juan
Publications and source records attributed to E De Juan.
Vitrectomy surgery for impending macular hole based on optical coherence tomography.
Explore the source record for details and available documents.
Aged↗
Limited inferior macular translocation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration.
PURPOSE: To review a series of patients with age-related macular degeneration undergoing limited macular translocation for the treatment of subfoveal choroidal neovascularization, to determine short-term visual acuity outcomes, to measure amounts of attainable retinal movement, and to identify prognostic factors. METHODS: A retrospective review was conducted on a consecutive series of patients undergoing inferior limited macular translocation with scleral imbrication for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration. The main outcome measures investigated were distance of macular translocation, visual acuity at 3 and 6 months after surgery, change in visual acuity from baseline, and the development of intraoperative and postoperative complications. Univariate and multivariate analyses of a number of potential prognostic factors were undertaken. RESULTS: Macular translocation was achieved in all 102 eyes (101 patients) included in this study. The range of movement varied from 200 to 2,800 microm with a median movement of 1, 200 microm. Nearly 33% of the study group achieved a visual acuity better than 20/100 at 3 months, and 49% achieved this vision at 6 months. At 3 and 6 months, 37% and 48% of the study group, respectively, experienced 2 or more lines of improvement on visual acuity testing, and by 6 months 16% experienced greater than 6 lines of visual improvement. Good baseline vision, achieving the desired amount of macular translocation, a greater amount of macular translocation, and recurrent choroidal neovascularization at baseline were associated with better visual acuities at 3 and 6 months. Poor preoperative vision and the development of complications were associated with worse vision at 3 and 6 months. CONCLUSIONS: Limited macular translocation is a technically feasible procedure that can lead to significant visual improvement and good visual acuity in some patients presenting with subfoveal choroidal neovascularization associated with age-related macular degeneration. A randomized prospective clinical trial of this surgical technique is warranted.
Adult↗
Complications associated with limited macular translocation.
PURPOSE: To report the ocular complications associated with the limited macular translocation procedure. METHODS: Retrospective review of 153 consecutive eyes of 151 patients that had the limited macular translocation procedure for subfoveal choroidal neovascularization between April 1996 and February 1999. The major study variables investigated included the incidence of specific ocular complications and their impact on visual acuity at 3 months after the surgery. In addition, baseline patient characteristics and operative factors were evaluated to determine whether they were significant risk factors for the development of an ocular complication. The existence of a surgical procedure learning process was investigated. RESULTS: One hundred forty-one (92.15%) of 153 eyes achieved at least 3-month follow-up. At least one complication occurred in 53 of 153 eyes (34.6%) and in 51 of these 53 eyes (96. 22%) the complications occurred before 3 months of postoperative follow-up. The intraoperative and postoperative complications included retinal detachment (17.4%), retinal breaks (13.4%), macular holes (7.8%), macular fold (4.6%), and intraocular hemorrhage (vitreous, subretinal, or choroidal; 9.2%). Eyes that developed retinal detachment, subretinal hemorrhage, and macular fold had significantly more loss of visual acuity than eyes without each of these complications (P =.0001, P =.038, and P =.027, respectively). The presence of predominantly classic choroidal neovascularization, the occurrence of an intraoperative retinal break, any intraocular hemorrhage, or macular fold formation were significantly associated with retinal detachment (P =.021, P =.025, P =.013, and P =.014, respectively). The incidence of any complication, retinal detachment, and hemorrhage significantly decreased during the study period, suggesting a learning process (P =.03, P =.006, P =.027, respectively). CONCLUSIONS: A variety of ocular complications can occur during or after limited macular translocation, and some are associated with reduced postoperative visual acuity. Improved surgical techniques and experience may significantly reduce the incidence of these complications.
Aged↗
Retinal detachment in Marfan syndrome.
PURPOSE: To report postsurgical findings in patients with Marfan syndrome and retinal detachment (RD). METHODS: The authors identified and retrospectively reviewed the charts of one cohort of 12 patients (15 eyes) with Marfan syndrome and RD who were operated on at the Wilmer Institute and a second cohort of 16 such patients (24 eyes) who were operated several years earlier and elsewhere. RESULTS: First cohort--Final visual acuity (VA) was 20/80 or better and the retina was flat in all five phakic eyes (100%). The RD occurred after the eye had undergone lens removal in 10 eyes, 6 of which (60%) had a final VA of 20/80 or better, and 9 of which (90%) had a final VA of 5/200 or better (P = 0.20). Second cohort--The final VA was 20/80 or better and the retina was flat in 6 of the 7 phakic eyes (86%). Among 17 aphakic or pseudophakic eyes, only 5 (29%) had a flat retina and VA of 20/80 or better, whereas 12 (71%) had no light perception (P = 0.03). CONCLUSIONS: The results of RD operations done in the past in Marfan patients were worse when the eye was aphakic. In most cases operated more recently, the prognosis for successful RD repair was good regardless of whether the eye was phakic.
Adolescent↗
Bioadhesives for intraocular use.
BACKGROUND/PURPOSE: A safe, effective adhesive could be useful in the management of retinal holes or tears and selected complicated retinal detachments, as well as for attaching a small electronic device (retinal prosthesis) to the retina. In this study, we examined nine commercially available compounds for their suitability as intraocular adhesives. METHODS: The following materials were studied: commercial fibrin sealant, autologous fibrin, Cell-Tak, three photocurable glues, and three different polyethylene glycol hydrogels. An electronic strain gauge measured the adherence forces between different glues and the retina. The stability of hydrogels at body temperature and the impermeability of the hydrogel adhesive to dextran blue were examined. Long-term biocompatibility testing of the most promising glues in terms of adhesive force, consistency, and short-term safety (hydrogels) were done in rabbits. Funduscopy, electroretinogram, and histology of the retina were performed. RESULTS: Hydrogels had 2 to 39 times more adhesive force (measured in mN) than the other glues tested. They liquefied at body temperature after 3 days to a few months. Hydrogels were impermeable to dextran blue. One type of hydrogel proved to be nontoxic to the retina. CONCLUSIONS: Hydrogels proved to be superior for intraocular use in terms of consistency, adhesiveness, stability, impermeability, and safety.
Adhesiveness↗
Age-related retinal pigment epithelium and Bruch's membrane degeneration in senescence-accelerated mouse.
PURPOSE: To investigate age-related changes in the retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillaris in the senescence-accelerated mouse (SAM). METHODS: The external and eyecup features and light and electron microscopic findings were examined in three male and two female mice of a senescence-prone mouse strain (SAM P(8)) monthly for 12 months. These results were compared with those in age-matched mice of similar background but senescence resistant (SAM R(1)). Choroidal vascular casts were prepared at 12 months in seven mice each of the SAM P(8) and SAM R(1) strains. Quantitative analysis of area of choriocapillaris was performed by automated image analysis, and the results were analyzed by paired Student's t-test. RESULTS: We found in the SAM P(8) strain that hair loss, coarseness of hair texture, and ulceration of skin appeared and increased as the age advanced (at approximately 5-9 months). Eyecup examination showed no differences. Light and electron microscopy revealed progressively more prominent abnormalities in the RPE and Bruch's membrane mice older than 10 months. Two of the five SAM P(8) mice older than 11 months showed what appeared to be intra-Bruch's membrane choroidal neovascularization. The RPE and Bruch's membrane appeared normal in the SAM R(1) strain. In the SAM P(8), vascular casts of the choriocapillaris showed a mild but significant decrease in vascular area when compared with the SAM R(1) strain at 12 months (P = 0.011). CONCLUSIONS: Senescence accelerated mice develop progressive age-related changes in the RPE-Bruch's-choriocapillaris complex that have features that may be relevant in the study of age-related macular changes in humans.
Aging↗
Allogenic fetal retinal pigment epithelial cell transplant in a patient with geographic atrophy.
PURPOSE: To test the hypothesis that healthy fetal retinal pigment epithelium (RPE) can rescue the remaining viable RPE and choriocapillaries and thereby the photoreceptors in non-neovascular age-related macular degeneration (ARMD) (geographic atrophy [GA]). METHODS: A 65-year-old legally blind woman with non-neovascular ARMD underwent fetal RPE transplantation. Best-corrected visual acuity testing, detailed fundus examination, fundus photography, fluorescein angiography, scanning laser ophthalmoscope macular perimetry, and humoral and cellular immune response testing were performed. A suspension of RPE was infused into the subretinal space through a retinotomy along the superotemporal arcade at the edge of the area of GA. The patient did not take systemic immunosuppressants. RESULTS: The patient's vision remained unchanged for 5 months after the surgery. Fluorescein angiography after transplantation showed leakage and staining at the level of the outer retina. There was progressive subretinal fibrosis in the area of the transplant. Immune response studies showed a weakly positive mixed lymphocyte response against phosducin and rhodopsin. CONCLUSION: Although it is surgically feasible to transplant fetal RPE to the subretinal space of patients with GA, such an allogenic RPE transplant without immunosuppression leads to leakage on fluorescein angiography and eventual fibrosis. A very weak immune response against proteins associated with photoreceptors is also of concern.
Aged↗
N-acetylcysteine protects against age-related decline of oxidative phosphorylation in liver mitochondria.
Since it has been proposed that oxygen radical inactivation of key enzymes plays a critical role in cell aging, we have investigated the effects of a thiolic free radical scavenger on the oxidative phosphorylation enzymes of liver mitochondria from female OF-1 mice. At 48 weeks of age a control group was fed standard food pellets and another group received pellets containing 0.3% (w/w) of N-acetylcysteine. A 24-week treatment resulted in a significant increase in the specific activities of complex I, IV and V in the hepatic mitochondria of the N-acetylcysteine-treated animals as compared to aged controls.
Acetylcysteine↗
Glucose deprivation increases aspartic acid release from synaptosomes of aged mice.
To investigate the possible existence of age-related changes in excitatory amino acid release in brain, and the influence of glucose deprivation on this process, we have determined the release of endogenous aspartate and glutamate from synaptosomes freshly isolated from the cerebrum of young (12 months old) and aged (24 months old) mice. We found that there are no age-related changes in the synaptosomal release of aspartic and glutamic acids. However, in the absence of glucose in the medium of incubation aspartate and glutamate release was higher in old than in young animals (P < 0.05, and P = 0.09 respectively). Our results suggest that the ability of cerebral synaptosomes to release glutamate and aspartate remains functionally intact in old cerebrum, but there is an age-dependent dysfunction in this process linked to energy metabolism disturbances.
Age Factors↗
Impairment of mitochondrial oxidative phosphorylation in the brain of aged mice.
To elucidate the role of mitochondrial oxidative phosphorylation in neuronal aging, we have studied the activity of the respiratory complexes in the brain of young, adult and old mice. In synaptic mitochondria, we found a significant decrease in complexes IV (29%, P < 0.001) and V (21%, P < 0.01) in old as compared with adult mice. Nonsynaptic mitochondria also showed a senescent decrease in complexes I (15%, P < 0.01), II + III (34%, P < 0.01) and IV (17%, P < 0.01) activities. These findings suggest a dysfunction in mitochondrial oxidative phosphorylation in brain aging.
Aerobiosis↗
Age-related changes in glutathione and lipid peroxide content in mouse synaptic mitochondria: relationship to cytochrome c oxidase decline.
To elucidate the contribution of lipid peroxides and glutathione to brain aging, we have carried out a comparative study of their contents in synaptic mitochondria from young (10-week-old), adult (24-week-old), and senescent (72-week-old) mice. In synaptic mitochondria, there is a significant decline in lipid peroxide content (P < 0.01) and cytochrome c oxidase activity (P < 0.001) in senescent as compared to adult and young mice. By contrast, glutathione concentration showed an increase in senescent (P < 0.05) in comparison to the other age groups. Moreover, there was a significant inverse correlation between age and lipid peroxide content (r = -0.5, P < 0.001) or cytochrome c oxidase-specific activity (r = -0.58, P < 0.001). We suggest that this age-dependent decrease in lipid peroxide content in synaptic mitochondria may be the result of an age-related decline in the activity of the electron transport chain, with concomitant decrease in oxyradical production, in the senescent organelles.
Aging↗
Management of anterior vitreous traction in proliferative vitreoretinopathy.
The major cause of failure in retinal detachment surgery is proliferative vitreoretinopathy. The surgical treatment of proliferative vitreoretinopathy has improved dramatically over the past ten years. Still failure is too common and the need for reoperation remains high. We believe this is often due to anterior vitreous traction. We report our present "conservative" surgical approach to treating such patients using newly developed fiberoptic instrumentation. Using this approach, we have achieved total retinal reattachment in 42 of 48 patients with C3 or greater proliferative vitreoretinopathy with six months or greater follow up.
Eye Diseases↗
Penetrating ocular injuries. Types of injuries and visual results.
The authors studied the hospital records of 453 patients who underwent primary surgical repair of penetrating ocular injuries at the Wilmer Institute from January 1970 through December 1981. The injury was due to blunt force in 22%, a sharp laceration in 37%, and a missile in 41%. The following factors correlated with the final visual outcome: (1) initial visual acuity after the injury, (2) presence of an afferent pupillary defect, (3) type of injury, (4) location and extent of the penetrating wound, (5) type of lens damage, (6) presence and severity of vitreous hemorrhage, and (7) type of intraocular foreign body. This study emphasizes that the prognosis after a penetrating injury is strongly influenced by the nature of the injury and the extent of initial damage.
Adolescent↗
Tissue adhesive therapy for corneal perforations.
The current indications for and method of application of tissue adhesive are described. A method for an expanded utilisation of tissue adhesive is discussed. To study the effect of the introduction of tissue adhesive to The Wilmer Institute in 1974, the records of 104 consecutive non-traumatic corneal perforations or descemetoceles admitted to The Wilmer Institute from 1960 to 1980 were assessed retrospectively with follow-up being obtained from records or from referral physicians for 87 of these perforations. Forty-nine percent of the cases were caused by bacterial corneal ulcers, 13% by exposure, 12% by chemical burns, 6% by fungal keratitis, 5% by herpes simplex keratitis, and 15% were undiagnosed. Since the introduction of tissue adhesive in 1974, there has been an apparent trend towards a lower enucleation rate (6%) in the tissue adhesive treated group compared with 19% in perforations treated by other therapies.
Adolescent↗
Sodium hyaluronate and tissue adhesive in treating corneal perforations.
The injection of sodium hyaluronate through perforation sites prior to tissue adhesive application has extended the current use of this modality to large perforations and perforations in which intraocular tissue is incarcerated. Three clinical cases are described in which the conjoint therapy was used, and four monkey eyes were studied clinically and histopathologically to test for adverse drug interactions.
Animals↗
Optic disc neovascularization associated with ocular involvement in acute lymphocytic leukemia.
A case of vitreous involvement in acute lymphoblastic leukemia associated with neovascularization of the optic nerve head is presented. The diagnosis was made from a vitreous biopsy specimen obtained by pars plana vitrectomy and prepared by a membrane filter and modified Papanicolaou stain technique. Fibrovascular membranes and leukemic cells were seen on microscopic examination of the vitreous biopsy specimen. Retinal neovascularization associated with acute lymphoblastic leukemia is discussed.
Biopsy↗