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Interface fluid associated with diffuse lamellar keratitis and epithelial ingrowth after laser in situ keratomileusis.

We report a case in which diffuse interface keratitis began 1 week after bilateral uneventful laser in situ keratomileusis (LASIK). A layer of fluid in the interface with epithelial ingrowth was noted in the left eye 20 days postoperatively. The same complication occurred in the right eye 5 months after LASIK. Dry-eye syndrome and steroid-induced intraocular pressure elevation occurred in this patient with pre-existing ocular hypertension. A long course of interface inflammation was resistant to topical steroids. Surgical removal of the epithelial ingrowth and drainage of the fluid, combined with medical treatment, resulted in resolution of the inflammation. The cytopathologic examination of the fluid showed epithelial cells without signs of inflammation. The clinical features of this case represent a new complication of LASIK.

Adult↗

Influence of estrogens on intraocular tension in the eyeballs of rabbits.

Iridocorneal angles from the eyes of female rabbits subjected to large doses of estrogens were examined under an electron scanning microscope. A temporary rise in intraocular tension was noted lasting up to 24 h after injection of estrogens, followed by a slow return to normal conditions. Histostructural changes of the iridicorneal angle were observed as widening of the marginal sector, enlarging of the dimple-shaped depressions and also increased number and narrowing of the micropores in the central part of the iridocorneal field. The authors postulate that estrogens affect the histostructure of the iridocorneal field and also stimulate the circulation of the aqueous fluid.

Animals↗

Complex microcirculation patterns detected by confocal indocyanine green angiography predict time to growth of small choroidal melanocytic tumors: MuSIC Report II.

PURPOSE: Multiple independent laboratories have confirmed the histologic observation that some tumor microcirculation patterns (MCPs) in uveal melanomas are associated strongly with death resulting from metastatic disease. Because these patterns are imageable with confocal indocyanine green angiography (ICG), we designed a prospective study to evaluate whether these angiographically detectable MCPs predict time to tumor growth. DESIGN: Observational case series, prospective, non-randomized. PARTICIPANTS: Ninety-eight patients with unilateral, small, choroidal melanocytic tumors. METHODS: The following information and tumor characteristics were recorded for each patient: demographic parameters, best-corrected visual acuity, intraocular pressure, related visual symptoms, location and dimension of tumor, pigmentation, orange pigment, drusen, tumor-associated hemorrhage, subretinal fluid, and confocal ICG angiographically determined microcirculation patterns-silent (avascularity), normal (preexisting normal choroidal vessels within the tumor), straight vessels, parallel without and with cross-linking, arcs without and with branching, loops, and networks. MAIN OUTCOME MEASURES: Time to growth of the tumor, with growth defined as an increase in the maximal apical tumor height of 0.5 mm measured by standardized A-scan ultrasonography, photographic documentation of an increase of the largest basal diameter of at least 1.5 mm, advancement of one tumor border of at least 0.75 mm, or a combination thereof. RESULTS: Twenty-eight of the 98 tumors in this study (29%) met the predetermined criteria for tumor growth. The median time to growth was 127 days (range, 51-625 days). The following tumor characteristics were significantly associated with time to tumor growth: flashes (P = 0.0224), orange pigment (P = 0.012), subretinal fluid (P < 0.001), maximum basal tumor diameter at initial examination (P = 0.015), maximum apical tumor height (P < 0.001), parallel with cross-linking MCP (P < 0.001), arcs with branching MCP (P = 0.006), loops (P < 0.001), and networks (P < 0.001). Of these, the angiographic documentation of any of the complex MCPs (parallel with cross-linking, arcs with branching, loops, networks, or a combination thereof) showed the strongest association with the time to tumor growth in a Cox proportional hazard model. CONCLUSIONS: The characteristics of our patient cohort are comparable by clinical and echographic parameters with cohorts for predicting tumor growth, described previously in the literature. In addition, we detected a novel clinical predictor of tumor growth: the confocal ICG angiographic detection of complex MCPs.

Adult↗

Particulate contamination in eye surgery.

Flushing fluid from microsponges (surgical spears) and solutions for irrigation (balanced salt solution and Ringer solution) as well as other medicaments for intraocular use during surgery (solutions of Zolyse, solutions of Miochol and Healon) have been examined for particulate contamination. The method used to collect and analyse the particles involved scanning electron microscopy (SEM) and energy dispersive analysis of X-ray (EDAX) in order to determine elements within the range of atomic number 9-93 in the periodic system. The investigation disclosed particulate contamination of all solutions examined. Particle number (greater than 5 microns) per ml varied from 15 to 400 and the size from 5 microns-800 microns. Microsponges released particles in numbers from 25-90 in a size range of 5-3000 microns per ml flushing fluid (Total flushing volume 20 ml). More than half of the particles were below 10 microns in all specimens examined. The irrigation solutions and solutions of medicaments contained only few particles above 40 microns. Most of the particles were of organic material which is not detectable with EDAX. This analytical system disclosed a wide range of inorganic elements, being present in the examined solution in the form of particles or as solutes.

Drug Contamination↗

Validity of pulsatile ocular blood flow measurements.

The determination of average net pulsatile ocular blood flow form measurements of the intraocular pressure (IOP) pulse is based upon 1) an accurate measurement of IOP and its time variation; 2) a knowledge of the relation between the volume of the living eye and its IOP; 3) a physical model for the flow of blood through the eye: and 4) a concept of steady venous outflow from the eye. Each of these premises needs to be examined. The present analysis assesses the validity of the pneumatic tonometer for measuring the pressure in a flowing column of gas that is directed toward a thin membrane that is in contact with the surface of the cornea. The pressure of this stream of gas exerts a force against the cornea that depresses the corneal surface against the opposing force of the IOP. The balance of these forces and the resultant effect on the tonometer pressure sensor is described by the theories of elasticity, thermodynamics and fluid mechanics. In this treatment, differential equations are solved for the elastic deflections of the cornea subject to the opposing intraocular and tonometer pressures. This permits the pressure in the chamber of the pneumatic tonometer to be related through first principles to the IOP. The response of the tonometer pressure sensor to a range of IOPs (5-60 mmHg) is obtained, as well as the dynamical response of the tonometer to IOP oscillations. The conclusion is that the pneumatic tonometer provides a high fidelity, noninvasive measure of the IOP and its time variation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗

[Secondary surgical management of massive suprachoroidal hemorrhage].

OBJECTIVE: To evaluate the surgical techniques and the efficacy for massive suprachoroidal hemorrhage (MSH). METHODS: Secondary surgery performed on 11 cases of MSH occurring during or after intraocular surgery was delayed for 11 to 28 days (mean, 15.4 days). All eyes underwent posterior drainage sclerotomies under constantly maintained limbal fluid line pressure, followed by pars plana infusion and vitreoretinal surgery. The perfluorocarbon liquid was used intraoperatively in 6 cases. RESULTS: The drainage of the choroidal hemorrhage was successful in all cases. The blood drained from suprachoroidal space was completely liquified and chocolate in color. Tractional retinal detachment occurred in 2 eyes; 9 eyes had retinas normal in position. The mean follow-up was 7.8 months. Visual acuities were improved, >or=0.1 in 6 eyes. CONCLUSION: Immediate management of MSH includes watertight wound closure and medical treatment for elevated intraocular pressure, and secondary surgery was performed timely, including external drainage by creating sclerotomies and vitreoretinal surgery. The above methods of treatment have certain advantages and are promising for the management of MSH.

Adolescent↗

Lens refilling and endocapsular polymerization of an injectable intraocular lens: in vitro and in vivo study of potential risks and benefits.

Endocapsular cataract removal and injection of a liquid artificial lens has several advantages, including restitution of accommodation, small corneoscleral incision, a more physiological position of the intraocular lens, and a reduced rate of secondary opacification. Our technique consists of bimanual phacofragmentation followed by injection of a fluid monomeric material that can be polymerized inside the capsular bag by short light exposure. Our study assessed the potential risks of the technique (e.g., heat damage to ocular tissue, light damage to the retina) and investigated the technique in vivo. We performed in vitro experiments on porcine cadaver eyes and an in vivo study on 15 rabbits. After a clinical follow-up of at least 12 weeks, the eyes were investigated histopathologically. During the polymerization process, the highest temperature measured at the posterior lens capsule was 45.1 degrees Celsius for a few seconds. The measured irradiance (0.065 watts per cm2) and the risk of photochemical damage to the retina during 20 seconds of polymerization were comparable to that caused by 1.5 minutes of standard coaxial illumination with the operating microscope. In vivo there were no serious inflammatory reactions except in four cases in which there had been intraoperative problems. The rate of secondary opacification appeared less than in conventional intraocular lens implantation in rabbits, especially when the capsule refilled completely. Retinal damage could not be detected histopathologically. In conclusion, refilling techniques may be successful once appropriate refilling materials become available.

Animals↗

Microbiologic analysis of aqueous humor in phacoemulsification.

PURPOSE: This study was designed as a microbiologic survey of the fluids aspirated from the anterior chamber at the end of cataract extraction performed by phacoemulsification, and to correlate the contamination rate of the anterior chamber to the surgical technique used. METHODS: One hundred and one consecutive patients (126 eyes) who underwent cataract extraction by phacoemulsification and posterior chamber intraocular lens implantation were included in the study. Microscopical examination, culture, and determination of the number of colonies were carried out on the bacteria and fungi in the anterior chamber fluids aspirated at the end of surgery, before final suture placement. RESULTS: Anterior chamber fluids yielded positive cultures in nine specimens (8.14%), six of which were identified as coagulase-negative staphylococci. Quantification disclosed colony counts ranging between 2-10 and 10-40 per mL. CONCLUSIONS: Preliminary results in a small population show that the contamination of the aqueous humor is significantly less frequent if the cataract extraction is performed by phacoemulsification.

Adult↗

[Analysis of the local synthesis of Toxoplasma gondii-specific immunoglobulins in the anterior eye chamber fluid. Report of two cases].

We reported two cases strongly suspected of ocular toxoplasmosis, in which a puncture of anterior eye chamber was performed for a final verification of clinical diagnosis. In both patients, fresh focal lesions of retinochoroiditis associated with old pigmented retinal scars were diagnosed. The 62-year-old women had a serological evidence of recently acquired T. gondii infection with an increasing IgG titre of a low avidity and a presence of specific IgM and IgA antibodies. In the 13-year-old girl, an immunological profile of the chronic infection was shown, confirmed by a high IgG avidity value. In the patient with a clinical picture of recurrent congenital toxoplasmosis, intraocular production of T. gondii-specific IgG was found in anterior eye chamber. The analysis of the specific antibodies synthesis in ocular fluid by the Western blot seems to be a valuable immunodiagnostic method for a final diagnosis of ocular toxoplasmosis.

Adolescent↗

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at 18 months.

Sixty-five eyes with giant retinal tears previously reviewed at 6 months after vitrectomy and fluid/silicone-oil exchange were again reviewed 18 months after surgery. The retina remained attached in 54 eyes (83%), and of these 32 (57%) had visual acuities of 6/60 or better. Poor acuities were attributed in most cases to cataract associated with silicone-oil contact or macular damage from preoperative macular detachment. Glaucoma occurred chiefly in those eyes which were aphakic prior to surgery, or were rendered aphakic at surgery, but did not influence the visual outcome at this stage. Encouraging results of surgery after 6 months were confirmed after 18 months, although the level of vision had fallen in some cases due to the development of lens opacities.

Adolescent↗

Uveitis-associated flap edema and lamellar interface fluid collection after LASIK.

PURPOSE: To report two cases of corneal pathology associated with anterior uveitis after laser in situ keratomileusis (LASIK). DESIGN: Observational case report. METHODS: A 47-year-old man and a 50-year-old woman who experienced vision loss and corneal changes associated with acute anterior uveitis after LASIK were examined. RESULTS: The 47-year-old man, who had undergone LASIK for low myopia developed an interlamellar fluid pocket at the level of the flap interface, whereas the 50-year-old woman, who underwent LASIK for hyperopia, developed marked flap edema without interface fluid collection. CONCLUSIONS: These two cases demonstrated acute corneal fluid accumulation associated with episodes of acute anterior uveitis in eyes that had undergone LASIK. Uveitis should be considered a risk factor for vision threatening corneal complications after LASIK.

Acute Disease↗

Transient shallow anterior chamber induced by supraciliary fluid after vitreous surgery.

PURPOSE: To report the mechanism of transient shallow anterior chamber after vitreous surgery for proliferative diabetic retinopathy. METHOD: Using ultrasound biomicroscopy, we examined a patient with transient shallow anterior chamber after vitreous surgery for proliferative diabetic retinopathy. RESULTS: On the day after surgery, slit-lamp examination disclosed a shallow anterior chamber that persisted for 1 week and deepened thereafter. Ultrasound biomicroscopy 5 days postoperatively disclosed a narrow angle in the peripheral anterior chamber and supraciliary fluid. At 14 days postoperatively, suprachoroidal fluid could not be detected, and the angle was wide. CONCLUSION: The shallow anterior chamber in this patient was caused by supraciliary fluid after vitreous surgery.

Aged↗

Detection of connective tissue growth factor in human aqueous humor.

PURPOSE: Connective tissue growth factor (CTGF) has been shown to be substantially involved in various processes of fibrosis. We investigated if CTGF is present in aqueous humor (AH). METHODS: Samples from AH were collected from 10 volunteers during cataract surgery. Specific ELISA analysis was performed with goat IGG against human CTGF. RESULTS: CTGF was above the detection limit of the assay in 80% of the samples. The concentration of CTGF in the anterior chamber fluid was 1.24 +/- (SD) 0.26 ng/ml. CONCLUSION: CTGF is present in a majority of AH samples, possibly representing a constant component in this fluid. The origin and physiological importance of CTGF is yet unclear. The involvement of CTGF in processes of intraocular fibrosis and wound healing is possible.

Aged↗

Drainage of the subretinal fluid and injection of saline solution into the vitreous body.

In a group of 250 cases operated upon for retinal detachment, drainage of the subretinal fluid was carried out in 96%. Since in 54 cases, i.e. 22%, a large quantity of subretinal fluid was evacuated, saline solution was injected into the vitreous. The following complications due to drainage were noted: intraocular haemorrhages (16%), incarceration of the retina (1%) and temporary iridocyclitis (2%). None of these complications prevented reattachment. In 54 cases in which injection of saline solution into the vitreous was carried out, we have noted: temporary occlusion of the central retinal artery (5 cases), temporary cloudiness in the vitreous body (2 cases) and traumatic cataract (1 case). The injection of saline solution into the vitreous was well tolerated. Although the complications due to drainage are rather numerous (intraocular infection and haemorrhages, incarceration of retina, secondary retinal hole, glial proliferation in the vitreous, dehiscence at the place of drainage), these complications rarely occur if the drainage is carried out in a proper manner. Despite the fact that drainage and injection of saline solution into the vitreous do not cause more severe complications, however, we consider that the method of avoiding drainage and internal tamponage, whenever it is possible, represents a fully justified trend.

Drainage↗