The cornea in normal condition and in Groenouw's macular dystrophy.
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Biomedical subjects
Publications and source records attributed to V Victoria-Troncoso.
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The mitochondrias of the hyalocytes contain lactic dehydrogenase but no glucose-6-phosphate dehydrogenase, so that only aerobic respiration is possible. Among the lysosomal enzymes, acid phosphatases and beta-glucuronidase are found, the latter facilitating the turnover of the hyaluronic acid. There is no galactosidase, as the hyaluronic acid of the vitreous does not contain galactose.
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Since we use a very strict control of the viability of the endothelium of the graft, we have no more failures in corneal grafting not even in cases with bad prognoses, such as Fuchs' endothelial dystrophy. On the contrary, in corneal grafting without this control, we had failures in 20% of the cases.
Compared with the normal lens, the cataractous lens is characterized by morphological and distribution anomalies of the epithelial cells. At the electron microscope an enlargement of the intercellular spaces and large intercellular, as well as intracellular, vacuoles are seen. An important development of the lysosomal system and of the endoplasmic reticulum is also observed.
Tissue culture of cataractous lens epithelium shows deterioration of cellular tropism, anisomorphism, anisometry, and formation of large intracytoplasmic vacuoles with deterioration of the lysosomal system, the vacuolated cells showing no tendency to form fibers.
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Since we use a very strict control of the viability of the endothelium of the graft, we have no more failures in corneal grafting, even not in cases with bad prognosis, such as Fuch's endothelial dystrophy. On the contrary, in corneal grafting without this control, we had a failure in 20% of the cases.
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The scanning electron microscope shows that the keratocytes of the macular dystrophy of the cornea have an irregular and anfractuous surface and that some cytoplasmic particles are broken off. This explains the isolated elements found in the stroma.
The non-depolymerised mucopolysaccharides of the anterior chamber angle can become hydrated. This biological oedema can obstruct the trabcculae, but the physiological liberation of catabolic enzymes from the lysosomes depolymerises the mucopolysaccharides and prevent this obstruction. This is, on the contrary, facilited by the corticosteroids, which reinforce the lysosomal membranes and impede the liberation of the catabolic enzymes. There are clones of goniocytes which are corticosensitive and other which are not. Depending upon the predominace of the one or the other, the cortisone test will be positive or negative.
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The acridine orange is an excellent vital stain for the "in vivo" study of the lysosomal dynamics in cultured keratocytes. In normal keratocytes the lysosomes are mostly grouped around one or both nucleus poles. In keratocytes from macular dystrophy of the cornea there is a hypertrophy of the lysosomal system, which in vain tends to compensate for the consequences of the enzymatic deficiency.
The vitreous is feebly antigenic and is characterized by the absence of gamma-globulins and immunocompetent cells. Moreover, it is isolated from the aqueous humour by a mucopolysaccharide molecular filter. It represents an incomplete and primitive immunological system, reacting like an embryonic tissue and exhibiting only phagocytosis.
In three patients treated for macular degeneration with argon laser photocoagulation choroidal neovascularization occurred four to six weeks later at the photocoagulation site. Two of the patients were treated for angioid streaks of the macular region, the third patient was treated for disciform macular degeneration. Argon laser photocoagulation also induced neovascularization experimentally in pigmented rabbits.