Effects of prostaglandins E2 and F2a on the carotid arterial blood flow, cerebrospinal fluid pressure and intraocular pressure in dogs.
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The combination of traction on the retina and of intraocular currents in the presence of a retinal hole is the cause of rhegmatogenous retinal detachment. The strong suction forces of the pigment epithelium and choroid counteract such a development. Chorioretinal scars serve as a seal against currents. Eliminating the effects of traction and of intraocular currents and making use of the absorption forces of the pigment epithelium and choroid are the primary aims in successfully treating rhegmatogenous retinal detachment. Direct closure of the retinal hole is not always necessary.
The distribution of the immunoglobulins IgG, IgM, and IgA in turkey serum, bile, egg white, egg yolk, intestinal secretions, and some intraocular tissues has been studied. Just as in the chicken and the pigeon, IgG is the most abundant immunoglobulin in the serum and IgA in egg white, intestinal secretions and bile. In addition, IgM was detected in serum and egg white, and IgG in egg yolk, iris, vitreous body, and aqueous humor. The discussion deals with the importance of using purified immunoglobulin fractions and heavy-chain-specific antisera in disease studies in the turkey, specially in the case of infectious diseases which lead to the occurrence of "rheumatoid factors".
PURPOSE: To evaluate the spatial relationships of the intraocular space, the cerebrospinal fluid space, and the lamina cribrosa in highly myopic eyes. METHODS: The study included 36 human globes with an axial length of more than 26.5 mm that showed marked glaucomatous optic nerve damage (n = 29; highly myopic glaucomatous group) or in which the optic nerve was affected by neither glaucoma nor any other disease (n = 7; highly myopic normal group). Two non-highly myopic control groups included 53 globes enucleated because of malignant choroidal melanoma (n = 42; non-highly myopic normal group) or because of painful absolute secondary angle-closure glaucoma (n = 11; non-highly myopic glaucomatous group). Anterior-posterior histologic sections through the pupil and the optic disc were morphometrically evaluated. RESULTS: In both highly myopic groups compared with both non-highly myopic groups and in the highly myopic glaucomatous group compared with the highly myopic normal group, the lamina cribrosa was significantly (P < 0.001) thinner. Correspondingly, the distance between the intraocular space and the cerebrospinal fluid space was significantly (P < 0.05) shorter in the highly myopic normal group than in the non-highly myopic normal group and in the highly myopic glaucomatous group than in the highly myopic normal group. CONCLUSIONS: In highly myopic eyes, the lamina cribrosa is significantly thinner than in non-highly myopic eyes, which decreases the distance between the intraocular space and the cerebrospinal fluid space and steepens the translaminar pressure gradient at a given intraocular pressure, which may explain the increased susceptibility to glaucoma in highly myopic eyes. As in non-highly myopic eyes, thinning of the lamina cribrosa gets more pronounced in highly myopic eyes if glaucoma is also present.
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A patient with direct trauma to the orbit was found to have an ocular air-fluid level, apparently the first such case to be reported.
PURPOSE: Posterior chamber foldable silicone intraocular lenses (IOLs) are becoming increasingly prevalent in patients undergoing a pars plana vitrectomy with fluid-air exchange. The authors report an important limitation of foldable silicone IOLs during fluid-air exchanges in pars plana vitrectomies. METHODS: The charts of 18 pseudophakic patients with foldable silicone IOLs who underwent vitrectomy with fluid-air exchange by the authors were reviewed. RESULTS: There was a statistically significant difference in the occurrence of condensation during fluid-air exchange between the group of patients with a capsulotomy versus those that did not have a capsulotomy (P = 0.003). Condensation limiting the view of the retina occurred during fluid-air exchange in 11 of 11 of the patients with foldable silicone lenses and a capsulotomy. Attempts to remove the condensation with a soft-tipped aspiration cannula resulted in limited view of the retina for 1 to 2 minutes in 6 of 11 patients. Use of a thin film of silicone oil restored the view in one patient. In the presence of an intact posterior capsule, condensation did not occur on identical foldable silicone IOLs in seven of seven patients. CONCLUSION: Recognition of the presence of a foldable silicone lens is important when an air-fluid exchange is anticipated. If a capsulotomy is present, the surgeon must be aware that condensation may limit the view of the retina severely during and after surgery. Intraoperatively, the view of the retina usually can be restored in short surgeries by wiping the posterior lens surface with a soft-tipped cannula, and in more complex surgeries by applying a thin film of silicone oil on the posterior surface of the lens.
PURPOSE: Condensation occurs rapidly on silicone intraocular lenses (IOLs) after vitrectomy and fluid-air exchange in the presence of a posterior capsulotomy, severely limiting the retinal view. Foldable IOLs made of an acrylic polymer are now available. The authors compare the condensation and subsequent retinal view degradation after vitrectomy and fluid-air exchange in rabbit eyes implanted with polymethylmethacrylate (PMMA), soft acrylic polymer (ACRYSOF), and silicone IOLs. METHODS: Thirty rabbits underwent bilateral lens removal. Twenty PMMA, 20 acrylic polymer, and 20 silicone IOLs were implanted into the capsular bag. After three-port vitrectomy, eyes were randomly assigned to undergo a posterior capsulotomy or to an intact posterior capsule. Fluid-air exchange was performed, and the amount of condensation on the IOL surface and resultant retinal view was graded. Surgical maneuvers then were performed to decrease the condensation. These maneuvers included wiping the IOL surface with a soft-tipped cannula and coating it with viscoelastic. RESULTS: No condensation occurred on IOLs in eyes with an intact posterior capsule. Significantly more condensation occurred on IOLs in eyes with a capsulotomy, regardless of IOL type (P < 0.014). Wiping the condensation resulted in significantly less condensation and improved retinal view on the PMMA and acrylic IOLs when compared with the silicone IOLs (P < 0.024). Condensation was eliminated on all three IOL types after viscoelastic was applied. However, increased distortion of the retinal view was induced by the viscoelastic on the silicone IOL as compared with the other IOLs. CONCLUSIONS: Condensation and subsequent retinal image degradation occurs uniformly after vitrectomy, posterior capsulotomy, and fluid-air exchange in eyes with PMMA, acrylic, and silicone IOLs. Because the condensation can be eliminated most easily on acrylic IOLs compared with silicone IOLs, when foldable IOL techniques are used it is likely that an acrylic polymer IOL would be advantageous for those patients at risk for future vitreous procedures requiring fluid-air exchange.
PURPOSE: The lamina cribrosa, as the main structural element of the optic nerve head, forms a pressure barrier between the intraocular space and the retrobulbar space. The function as a pressure barrier may have importance for the pathogenesis of ocular diseases related to intraocular pressure and/or cerebrospinal fluid (CSF) pressure, such as the glaucomas. The purpose of the present study was to examine the anatomic relationship between the lamina cribrosa, the intraocular pressure space, and the retrobulbar cerebrospinal pressure space in eyes with glaucoma. METHODS: The study included 53 globes enucleated because of malignant choroidal melanoma (n = 42) without involvement of the optic nerve (control group) or because of painful absolute secondary angle-closure glaucoma (n = 11; glaucoma group). Anterior-posterior histologic sections through the pupil and the optic disc were morphometrically evaluated. RESULTS: In the glaucoma group compared with the control group, the lamina cribrosa was significantly (P < 0.001) thinner, the part of the outer lamina cribrosa surface directly exposed to the pia mater and indirectly exposed to the CSF space was significantly (P = 0.001) wider, and the shortest distance between the intraocular space and the CSF space was significantly (P < 0.001) shorter. The posterior lamina cribrosa surface in direct contact with the pia mater was located close to the optic disc border. CONCLUSIONS: The thickness of the lamina cribrosa and the anatomic relationships between the intraocular space and the CSF space differ significantly between normal and glaucomatous eyes. The findings may be of importance for the pathogenesis of glaucomatous optic neuropathy.
Clinical observations indicated a prompt cessation of episcleral capillary bleeding after exposure of those tissues to aqueous humor during intraocular surgery. Based on this observation, both aqueous and vitreous humors were obtained from eyes provided by an eye bank and from human eyes prior to intraocular surgery. Samples of cerebrospinal fluid also were obtained from two patients, one with optic atrophy and another with nutritional amblyopia. A total of 49 specimens were studied. Aqueous humor shortened the average ear lobe puncture bleeding time from 4.74 +/- 0.2 to 1.13 +/- 0.1 minutes. Varying dilutions of aqueous humor, up to a dilution of 1:16, shortened prothrombin and partial thromboplastin times when compared with normal control plasma without aqueous. Vitreous humor shortened partial thromboplastin time but had no effect on prothrombin time. The effect of cerebrospinal fluid on prothrombin and partial thromboplastin times was similar to the aqueous, but to a lesser degree.
Aquaporin (AQP) water channels are expressed in the eye at sites of aqueous fluid production and outflow: AQP1 and AQP4 in nonpigmented ciliary epithelium, and AQP1 in trabecular meshwork endothelium. Novel methods were developed to compare aqueous fluid dynamics in wild-type mice versus mice lacking AQP1 and/or AQP4. Aqueous fluid production was measured by in vivo confocal microscopy after transcorneal iontophoretic introduction of fluorescein. Intraocular pressure (IOP), outflow, and anterior chamber compliance were determined from pressure measurements in response to fluid infusions using micropipettes. Aqueous fluid volume and [Cl(-)] were assayed in samples withdrawn by micropipettes. In wild-type mice (CD1 genetic background, age 4-6 wk), IOP was 16.0 +/- 0.4 mmHg (SE), aqueous fluid volume 7.2 +/- 0.3 microl, fluid production 3.6 +/- 0.2 microl/h, fluid outflow 0.36 +/- 0.06 microl/h/mmHg, and compliance 0.036 +/- 0.006 microl/mmHg. IOP was significantly decreased by up to 1.8 mmHg (P < 0.002) and fluid production by up to 0.9 microl/h in age/litter-matched mice lacking AQP1 and/or AQP4 (outbred CD1 and inbred C57/bl6 genetic backgrounds). However, AQP deletion did not significantly affect outflow, [Cl(-)], volume, or compliance. These results provide evidence for the involvement of AQPs in intraocular pressure regulation by facilitating aqueous fluid secretion across the ciliary epithelium. AQP inhibition may thus provide a novel approach for the treatment of elevated IOP.
PURPOSE: To assess the endothelial cell loss after cataract extraction using a fluid-based system and compare it with conventional ultrasound. METHODS: A total of 46 eyes of 23 patients with up to 3+ bilateral cataract were included. The first eye was randomized to either fluid-based system or conventional ultrasound, and the fellow eye received the alternate system. Visual acuity and ultrasound pachymetry were measured preoperatively and at 1 day, 1 week, and 1 and 3 months postoperatively. Specular microscopy was performed preoperatively and 3 months after the surgery. Data was analyzed using the paired t test and Wilcoxon signed rank test. A P value less than 0.05 was considered statistically significant. RESULTS: Postoperatively, no significant differences were found among the groups. However, there was a significant difference (P < 0.01, analysis of variance with Tukey as posttest) in corneal pachymetry at day 1 after the surgery compared with baseline in both groups. There was a 6.3% and 7.9% loss of endothelial cells in the fluid-based system and ultrasound group, respectively. CONCLUSION: Visual acuity, pachymetry, and endothelial cell loss after cataract extraction and intraocular lens implantation using a fluid-based system is similar to conventional ultrasound.