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PubMed1988

Natural history and management of advanced Coats' disease.

Thirteen children evaluated in the Oncology Service of Wills Eye Hospital from 1976 through 1986 were found to have advanced unilateral Coats' disease, producing a total bullous exudative retinal detachment. All 13 eyes were blind. Six children were given no treatment for their retinopathy, and four of the six eventually developed painful neovascular glaucoma, necessitating enucleation of the affected eye. The other seven children underwent intraocular infusion, drainage of subretinal fluid, and cryotherapy on one or more occasions. None of these seven eyes has developed painful neovascular glaucoma, and the affected eye remains cosmetically acceptable in all seven children.

Child↗

PubMed1997

Sulfonamides and secretion of aqueous humor.

The connection between carbonic anhydrase and the formation of aqueous humor arose in the decade 1950-1960 when a number of experiments of differing types showed that HCO3- ion catalytically formed in the ciliary process from CO2 was a principal element in the production of the aqueous. It was soon shown that inhibitors of the enzyme, given systemically, slowed HCO3- formation and sodium and fluid transport and thereby lowered intraocular flow and pressure in normal vertebrates and in patients with glaucoma. In the past 15 years successful efforts have been made to produce sulfonamide inhibitors that reach the ciliary process after local application to the cornea. The effects of locally acting sulfonamides are largely due to their amphoteric properties. They are soluble in both lipid and non-lipid media and penetrate cornea and sclera to reach ciliary process. Potency against carbonic anhydrase II is of the order of K(I) = 10(-9) M, so that topical application inhibits essentially all enzyme in the processes and is an effective nontoxic treatment for glaucoma.

Aqueous Humor↗

PubMed2005

Blood culture and conventional media for vitreous culture in infectious endophthalmitis.

OBJECTIVE: To study culture of vitreous fluid specimens in patients with infectious endophthalmitis, using blood culture bottles compared with conventional culture media. MATERIAL AND METHOD: Patients with infectious endophthalmitis, occurred within 6 weeks after ocular trauma or intraocular surgery, were prospectively studied. Vitreous fluid specimens were cultured in both blood culture bottles and conventional culture media. The measured outcome is the yield of positive culture and time to positive culture. RESULTS: The vitreous fluid culture was positive in 14 of 27 eyes (51.85%). Blood culture bottle was positive in 14 of 14 eyes (100%), whereas conventional culture media was positive in 7 of 14 eyes (50%). Most specimens in both techniques showed positive culture within 24 hours. CONCLUSION: Vitreous fluid culture with blood culture bottles is superior to conventional media with statistically significant difference. There was no significant difference in time to positive culture.

Adolescent↗

PubMedDate not supplied

Characterization of human IgG subclasses within intraocular compartments.

Multiple factors regulate the distribution of the human immunoglobulin (Ig) G1-4 subclasses within different compartments of the human eye. An experimental protocol was developed for analysis of IgG1-4 using a combination of high pressure liquid chromatography (HPLC) chromatofocusing and an enzyme-linked immunosorbent assay (ELISA). IgG in the human cornea, aqueous humor, and vitreous was extracted and fractionated by chromatofocusing in a pH 9.0-6.0 gradient. A monoclonal antibody based capture-type ELISA was used to determine the IgG1-4 subclass distribution within the fractions. Histograms generated were then used to determine the IgG1-4 subclass profile for each intraocular compartment. Results indicate that the IgG species are similar but unique for each compartment. In contrast to the distribution for normal serum/plasma IgG1-4, the intraocular profiles were extremely heterogeneous and variable. These results indicate that the intraocular compartments are in a state of disequilibrium. There are apparently both common and unique factors that regulate the distribution of individual IgG subclass species for each intraocular compartment. In addition to differences in fluid dynamics, tissue biochemistry, and barrier properties, parameters, unique to the IgG subclass species may also profoundly effect intraocular localization and retention.

Adult↗

PubMed1998

Increased presence of Epstein-Barr virus DNA in ocular fluid samples from HIV negative immunocompromised patients with uveitis.

AIMS: To investigate whether routine testing for Epstein-Barr virus (EBV) is necessary in the examination of a patient with uveitis. METHODS: Intraocular EBV DNA was determined in 183 ocular fluid samples taken from patients with AIDS and uveitis, HIV negative immunocompromised uveitis, acute retinal necrosis, toxoplasma chorioretinitis, intraocular lymphoma, anterior uveitis, and miscellaneous uveitis of unknown cause. In 82 samples from this group of patients paired serum/ocular fluid analysis was performed to detect local antibody production against EBV. Controls (n = 46) included ocular fluid samples taken during surgery for diabetic retinopathy, macular pucker, or cataract. RESULTS: Serum antibody titres to EBV capsid antigen proved to be significantly increased in HIV negative immunocompromised patients with uveitis (p < 0.01) compared with controls. Local antibody production revealed only three positive cases out of 82 patients tested, two results were borderline positive and one patient had uveitis caused by VZV. EBV DNA was detected in three out of 46 control ocular fluid samples. In the different uveitis groups EBV DNA was noted, but was not significantly higher than in the controls, except in six out of 11 HIV negative immunocompromised patients (p = 0.0008). In four out of these six cases another infectious agent (VZV, HSV, CMV, or Toxoplasma gondii) had previously been identified as the cause of the uveitis. CONCLUSIONS: When comparing various groups of uveitis patients, EBV DNA was found more often in HIV negative immunocompromised patients with uveitis. Testing for EBV does not have to be included in the routine management of patients with uveitis, since indications for an important role of this virus were not found in the pathogenesis of intraocular inflammation.

AIDS-Related Opportunistic Infections↗

PubMed1986

Hypotony and retinal detachment.

The present work has been based on the assumption that the decreased intraocular pressure in eyes with retinal detachment is due to an abnormal posterior aqueous outflow, in addition to the normal anterior pathways. Subretinal fluid may leak out either through the peri-optic connective tissue or across the retinal pigment epithelium. In order to test the validity of these alternatives against clinical observations, a fluid dynamic model has been developed to calculate intraocular pressure-drop versus detached area in both cases. In contrast to the choroidal alternative, the numerical results from the peri-optic route exhibit qualitative agreement with clinical observations. It is concluded that both clinical and theoretical findings lend support to the hypothesis that the intraocular pressure-drop in eyes with retinal detachment is due to drainage of subretinal fluid via the peri-optic tissue.

Aqueous Humor↗

PubMed1978

Effects of cervical sympathetic ganglionectomy on cyclic-AMP and prostaglandins in brain and eye tissues and fluids.

Studies were conducted confirming supersensitivity to catecholamines on intraocular pressure and pupil size following bilateral superior cervical ganglionectomy in rabbits. At the termination of these studies we examined changes in cyclic adenylic acid and prostaglandin content in jugular vein effluent and various brain and ocular tissues and fluids of the sympathectomized versus control animals. In the blood effluent we found significant elevation of cyclic adenylic acid and significant lowering of prostaglandin F1alpha in the sympathectomized animals. Although we found elevation of prostaglandin in certain tissues of the sympathectomized animals, there were no significant changes in cyclic adenylic acid levels between sympathectomized and control animals in the tissues examined. The findings of prostaglandin (blood and tissue) and cyclic adenylic acid (blood) changes in sympathectomized animals, associated with known changes in intraocular pressure and pupil size (due to catecholamine supersensitivity) must elicit further interest in the correlation and interpretation of various other central physiological and metabolic events in cervical sympathectomized animals.

Animals↗

PubMed1986

Postural variations of intraocular pressure--preflight experiments for the D1-mission.

Specific alterations in systemic circulation due to fluid shift in microgravity may lead to a rise in intraocular pressure (IOP). This situation can be simulated by head-down tilt. Several series of tonometry were performed using a handheld applanation tonometer: (1) Short time postural changes up to -90 degrees head down and back. (2) A period of 2 h in -10 degrees head down. (3) Repetition of series 2 after dehydration of the subjects. (4) Seven-day bedrest study in -7 degrees head-down tilt. (5) A period of lower body negative pressure (LBNP). (6) Valsalva maneuver. Immediately on tilting, the IOP rises with hydrostatic pressure and returns to normal again after about 1 h. The IOP seems to change parallel to venous pressure. Further experiments are planned for Spacelab missions.

Adult↗

PubMed2000

Continuous assessment of intraocular pressure - telematic transmission, even under flight- or space mission conditions.

Fluid shift after entering into microgravity, but also under equivalent flight conditions leads to enormous increase of intraocular pressure. To assess this precisely position - and gravity independent, handsome, automatic tonometers have been developed (German-Spacelab D1-Mission, German-Spacelab D2-Mission, German-Russian-MIR-Mission) telemetric transmission of measuring results of course would find scientific but also functional interest. The same is true for recently designed automatic intraocular pressure sensors, registering intraocular pressure continuously, day and night. Also recently designed new automatic ophthalmodynamometer, allowing directly to assess the intracranial pressure, but also perfusion pressure within the eye also could benefit from a direct telemetric transmission. New technical solutions allowing for the first time even telematic data transmission, are reported.

Humans↗

PubMed1989

The use of viscoelastic substances in the drainage of postoperative suprachoroidal hemorrhage.

Suprachoroidal hemorrhage is a serious surgical complication occurring in up to 10% of aphakic patients undergoing filtration surgery. Surgical treatment includes drainage of the hemorrhage through sclerotomies and reformation of the anterior chamber with balanced salt solution or air. Two patients are presented whose suprachoroidal hemorrhages were managed with the instillation of 10% sodium hyaluronate. The intraocular administration of a space-occupying fluid produces an even distribution of hydraulic force to facilitate drainage of the hemorrhage and avoids the optical problems associated with the use of intraocular air. While most cases of suprachoroidal hemorrhage can be effectively managed using balanced salt solution or air, we believe that viscoelastic agents may be of special benefit in selected situations.

Aged↗

PubMed1986

[Intraocular pulse fluctuations in pressure in neovascularization glaucoma in comparison to other forms of glaucoma (results of direct manometric measurements)].

With tonometric and tonographic measurements it is possible to detect and record oscillations which are synchronous with the intraocular pulse. These oscillations decrease with increasing IOP. In contrast, with direct manometric measurement, the amplitude of the intraocular pulse increases with increasing intraocular pressure. Therefore, in order to determine the intraocular pulse amplitude in patients, direct manometric measurements were performed on blind or almost blind eyes. Intraocular pressure was experimentally elevated by injecting fluid through a cannula into the anterior chamber, using a special Guyon syringe. The course of the drop in pressure and the amplitudes of the intraocular pulse were recorded with the Neuhaus apparatus and a light-spot pen. The most striking result was that in neovascular glaucomas there are excessive pulse amplitudes. The question whether the poor prognosis of neovascular glaucoma is associated with these intraocular pulsations is discussed.

Anterior Chamber↗

PubMed1989

'In-the-bag' hyphaema--a rare complication of posterior chamber lens implantation.

A 72-year-old woman developed a hyphaema on the first postoperative day after a combined trabeculectomy and extracapsular cataract extraction with posterior chamber intraocular lens implantation. On the second day the blood had redistributed to accumulate 'in the bag' posterior to the intraocular lens and had formed a fluid level. Postural drainage helped to clear the hyphaema from both locations, with no short-term effect on visual function or the filtering bleb.

Aged↗

PubMedDate not supplied

Hemorrhage of major branch retinal artery during vitrectomy.

A 45-year-old man had vitreoretinal surgery for intraocular foreign body. Five weeks postoperatively he developed severe proliferation of fibrous tissue from a chorioretinal scar at the site where the intraocular foreign body had lacerated the inferior temporal retinal artery. During a second vitreous surgical procedure, there was severe hemorrhaging from the previously lacerated inferior temporal retinal artery. Elevation of the intraocular pressure to 80 mm Hg after complete air fluid exchange, followed by repeated application of diathermy, resulted in permanent closure of the inferior temporal retinal artery. Elevation of intraocular pressure above the systolic blood pressure of the retinal artery following air fluid exchange offers a successful method for dealing with this serious complication of vitreoretinal surgery.

Eye Foreign Bodies↗

PubMed1991

Increased intraocular pressure in severely burned patients.

Six eyes of three patients with severe body burns had intraocular pressure ranging from 37.2 to 81.7 mm Hg. Because of extreme orbital congestion, lateral canthotomies were performed, which caused abrupt decrease in intraocular pressure (range, 17.6 to 49.0 mm Hg). None of the patients had a history of glaucoma, narrow angles, or any precondition for a pupillary block mechanism. Two patients survived and neither had optic nerve damage or increased intraocular pressure after hospital discharge. Tonometry should be performed in patients with severe burns and orbital congestion, especially in those patients receiving large amounts of intravenous fluids. Lateral canthotomies may be of benefit to relieve potentially damaging high intraocular pressure.

Adult↗

PubMed1999

[Evaluation of endothelial cells after the usage of gentamycin in irrigation-aspiration fluid during extracapsular cataract extraction].

PURPOSE: Assessment of the density of endothelial cells after usage of gentamicin in irrigation-aspiration fluid. MATERIAL AND METHODS: 60 patients subjected to extracapsular cataract extraction with intraocular lens implantation. In 30 eyes irrigation was performed with Ringer fluid (group I) and in 30 eyes Ringer fluid with gentamicin (group II) 4 mg gentamicin were added to 500 ml of Ringer fluid obtaining the concentration 8 micrograms/ml. Evaluation of endothelial cells density was carried before operation, 1 month and 6 months after. RESULTS: Percentage endothelial cells loss in group I was 7.8% 1 month postoperatively and 14.5% 6 months after operation and in group II 8.5% and 14.87%, respectively. CONCLUSION: Gentamicin added to irrigation-aspiration fluid doesn't cause enhanced endothelial cells loss during extracapsular cataract extraction.

Aged↗

PubMed2002

Intraocular pressure and glaucoma.

Aqueous humor is a transparent fluid that fills the anterior and posterior chambers, and the pupil, of the eye. It is produced in the ciliary processes, and exits the eye through two major pathways--the iridocorneal (conventional) outflow, and the uveoscleral (unconventional) outflow. Equilibrium between production and drainage of aqueous humor enables the body to maintain constant intraocular pressure (IOP). Disruption of aqueous outflow, usually through the conventional pathway, results in elevation of IOP. This elevation in IOP is a major risk factor in the pathogenesis of glaucoma, a group of diseases characterized by decreased retinal function and progressive optic nerve damage that may result in blindness. This article reviews the anatomy and physiology of aqueous dynamics in exotic species, the causes, clinical signs and diagnosis of glaucoma, and therapeutic approaches.

Animals↗

PubMed1992

Interactions between light and vitreous fluid substitutes.

To determine the interactions between light and vitreous fluid substitutes, we studied the absorption and fluorescence properties of the following fluids that are commonly used in vitreoretinal surgery: Ringer's solution, balanced salt citrate-buffered solution, balanced salt bicarbonate-buffered solution, hydroxypropyl methylcellulose ophthalmic solution, hyaluronate sodium, perfluorocarbons, silicone oil, and fluorosilicone oil. The absorption spectra for all the fluids peaked in the UV-C (reference range <280 nm) and UV-B (reference range from 315 to 280 nm) regions of the spectrum, with little or no absorption in the visible region of the spectrum (from 400 to 700 nm). Emission of almost all of the fluids occurred mainly in the 300- to 360-nm region, with fairly low-quantum efficiency. The limited light absorption properties of the fluids calls for caution during transpupillary and intraocular laser photocoagulation to avoid excessive retinal damage, mainly when the laser power is increased during treatment. Transmission of incoherent light (environmental and ophthalmic artificial light) through highly transparent vitreous fluid substitutes may lead in time to dangerous light exposure, particularly in aphakic eyes. The emitted fluorescence in these fluids generates a minimal risk of long-term damage.

Absorption↗

PubMed1994

Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders.

BACKGROUND: Retinal ischemia induces intraocular neovascularization, which often leads to glaucoma, vitreous hemorrhage, and retinal detachment, presumably by stimulating the release of angiogenic molecules. Vascular endothelial growth factor (VEGF) is an endothelial-cell-specific angiogenic factor whose production is increased by hypoxia. METHODS: We measured the concentration of VEGF in 210 specimens of ocular fluid obtained from 164 patients undergoing intraocular surgery, using both radioimmuno-assays and radioreceptor assays. Vitreous proliferative potential was measured with in vitro assays of the growth of retinal endothelial cells and with VEGF-neutralizing antibody. RESULTS: VEGF was detected in 69 of 136 ocular-fluid samples from patients with diabetic retinopathy, 29 of 38 samples from patients with neovascularization of the iris, and 3 of 4 samples from patients with ischemic occlusion of the central retinal vein, as compared with 2 of 31 samples from patients with no neovascular disorders (P < 0.001, P < 0.001, and P = 0.006, respectively). The mean (+/- SD) VEGF concentration in 70 samples of ocular fluid from patients with active proliferative diabetic retinopathy (3.6 +/- 6.3 ng per milliliter) was higher than that in 25 samples from patients with nonproliferative diabetic retinopathy (0.1 +/- 0.1 ng per milliliter, P = 0.008), 41 samples from patients with quiescent proliferative diabetic retinopathy (0.2 +/- 0.6 ng per milliliter, P < 0.001), or 31 samples from nondiabetic patients (0.1 +/- 0.2 ng per milliliter, P = 0.003). Concentrations of VEGF in vitreous fluid (8.8 +/- 9.9 ng per milliliter) were higher than those in aqueous fluid (5.6 +/- 8.6 ng per milliliter, P = 0.033) in all 10 pairs of samples obtained simultaneously from the same patient; VEGF concentrations in vitreous fluid declined after successful laser photocoagulation. VEGF stimulated the growth of retinal endothelial cells in vitro, as did vitreous fluid containing measurable VEGF. Stimulation was inhibited by VEGF-neutralizing antibodies. CONCLUSIONS: Our data suggest that VEGF plays a major part in mediating active intraocular neovascularization in patients with ischemic retinal diseases, such as diabetic retinopathy and retinal-vein occlusion.

Adolescent↗