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[Precision of lenticular thickness in relation to full stroma corneal thickness. Experimental results with the lamellar microkeratome].

In this study 150 pig corneas and 20 human corneas were dissected with an automatic rotating microkeratome for lamellar grafting. The cornea thickness varied between 0.507 mm and 0.829 with an average 0.66 mm. The aim of this investigation was to show the influence of corneal thickness, the chosen diameter and spacing on the precision of cutting lenticles. We did ten series: the pig corneas were dissected at three different intervals of 0.15, 0.25, 0.35 mm and diameters of 9 and 6mm. The human corneas were cut at intervals of 0.4 mm and 0.25 mm and with diameter of 9 and 7 mm. Although the pig corneas were fresh, the intraocular pressure was too low. It was raised with an injection of physiological salt solution to a predefined level. The rotating speed of the trephine blade, the speed of blade advancement and lubrication fluid were kept constant. Ultrasound pachymetry was performed on the center of the corneas before cutting had on the lenticles afterward. We showed that a thick corneal diameter had a negative influence, i.e., the greater the diameter, the lesser the precision; the same was true for the corneal thickness. On the other hand, the intervals had just the opposite effect: the closer they were, the better the correlation. The human eye results were different in quantity but not in tendency, with less striking effects. The average variation for pig corneas was 22% and for human eyes 8%. The best results were received with a large interval, a small diameter, and a normal corneal thickness in human eyes.

Animals↗

Effect of ascorbic acid on intraocular pressure of normal and buphthalmic rabbits.

Compared with serum the aqueous humor of the eye is high in ascorbic acid. The administation of ascorbic acid appears to have a transient hypotonic effect on intraocular pressure in normal eyes. Its effect on glaucomatous eyes is not as well defined particularly in the case of the rabbit. In this communication we shown the ocular hypotensive effal (+/+) or have hereditary glaucoma (bu/bu). We also show that the transport of ascorbate from the serum to the aqueous is much slower in buphthalamic rabbits than in normal controls. Osmolarity is suggested as a possible hypotensive mechanism and a differential fluid transport rate between the blood and the aqueous for the different genotypes is suggested as a possible mechanism for the difference in duration.

Animals↗

[Experimental studies with timolol: a new ocular hypotensive agent (author's transl)].

The present report reviews the animal pharmacology supporting the clinical use of timolol maleate ophthalmic solution in the therapy of glaucoma and elevated intraocular pressure (IOP). The studies have included the effects of timolol upon normal IOP of rabbits and upon elevated IOP in two models of experimental ocular hypertension. Comparisons are made between the latter actions of timolol and those of the reference adrenergic antiglaucoma agent, epinephrine. The interaction of timolol and the beta-adrenergic stimulant, isoproterenol, was also studied to assess the ability of timolol to block beta-adrenergic receptors in the eye. Additionally, the penetration and distribution of timolol in ocular and extraocular tissues and fluids following local application to the eyes of rabbits is described and a resume of the toxicological studies with timolol are presented.

Animals↗

Beta adrenergic effects on ciliary epithelial permeability, aqueous humor formation and pseudofacility in the normal and sympathectomized rabbit eye.

Relatively selective beta 1- and beta 2-adrenergic agonists (tazolol and terbutaline) and antagonists (metoprolol and butoxamine) were topically applied to albino rabbit eyes and to isolated ciliary epithelium. The beta 2-agonist, terbutaline, was the most effective agent in reducing intraocular pressure although all compounds induced changes in aqueous humor formation rate and pseudofacility. The effects on the isolated ciliary epithelium were determined on tissues derived from both normal and superior cervical ganglionectomized eyes. The beta 1- and beta 2-agonists as well as the beta 1-antagonist induced large permeability increases while the beta 2-antagonist induced a small permeability increase in normal tissues. In ganglionectomized tissues the beta 1-antagonist effect was decreased and the beta 2-antagonist effect enhanced while the agonist effects were almost unchanged. The results show that both beta 1- and beta 2-receptors exist in the ciliary epithelium and that stimulation of either receptor leads to an increase in fluid permeability and alterations in aqueous dynamics.

Adrenergic beta-Agonists↗

Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator.

We injected 25 micrograms of recombinant tissue plasminogen activator into the anterior chamber or the vitreous cavity in seven aphakic patients for pupillary block caused by a complete fibrin pupillary membrane that formed after vitrectomy with fluid-gas exchange. Progressive fibrin deposition resulted in pupillary block by three days after vitrectomy surgery in six patients, and seven days after vitrectomy in one patient. The pupillary block was associated with increased intraocular pressure in six patients. Tissue plasminogen activator was injected via the corneoscleral limbus in five patients and via the pars plana in two patients. In all patients, injection of tissue plasminogen activator resulted in complete fibrinolysis of the fibrin pupillary membrane within four hours, associated with a deepening of the anterior chamber. In the six patients with increased intraocular pressure at the time of tissue plasminogen activator injection, dissolution of the fibrin membrane was associated with a decrease in pressure. In all patients, intraocular pressure had returned to normal by three days after the injection. No complications were associated with the injection.

Adult↗

Utility of microdissection and polymerase chain reaction for the detection of immunoglobulin gene rearrangement and translocation in primary intraocular lymphoma.

OBJECTIVE: Primary intraocular lymphoma, a non-Hodgkin's lymphoma, is a primary central nervous system lymphoma (PCNSL). Diagnosis is usually made by identifying malignant, large B lymphocytes in the vitreous, eye, brain, and cerebral spinal fluid; however, these cells are few, friable, and difficult to recognize. Recently, clonal heavy chain immunoglobulin (IgH) gene rearrangement and bcl-2 gene translocation have been reported in systemic B-cell lymphoma and are used for the detection of malignant cells and in making a diagnosis. The authors investigated the molecular changes in three eyes and a chorioretinal biopsy specimen of four patients with PCNSL. DESIGN: Human tissue study. MATERIALS: Five ocular specimens of PCNSL were collected. INTERVENTION: The first patient had a diagnostic enucleation of the left eye. The second patient underwent diagnostic chorioretinal biopsy. In the third case, a pair of autopsied eyes with reactive lymphoplasmacytic infiltrates of a patient with acquired immune deficiency syndrome (AIDS) were studied. In the fourth case, an enucleated eye of a patient with AIDS-associated lymphoma was sampled. MAIN OUTCOME MEASURES: The bcl-2 and IgH genes of the lymphoma cells from routine, paraffin-embedded, formaldehyde-fixed, or frozen histologic tissue sections were analyzed using microdissection and polymerase chain reaction (PCR) technique. RESULTS: Lymphoma cells obtained from the above four cases showed IgH rearrangement gene in the third framework of the VH region. Bcl-2-associated translocation also was detected in three cases (cases 1, 2, and 4). CONCLUSION: Rearrangement of the IgH gene can serve as a molecular marker for PCNSL. Microdissection allows for procurement and analysis of specific, selected, minute cell populations that are obtained from histologic sections of the complex, heterogeneous tissue. Translocation of IgH and bcl-2, the apoptotic "survival" signal and proto-oncogene, could contribute to the pathogenesis of PCNSL. The combination of microdissection and PCR is a powerful tool for studies of small lesions and cell populations and for understanding disease mechanisms.

Adult↗

Intracranial pressure in microgravity conditions: non-invasive assessment by ophthalmodynamometry.

BACKGROUND: As well known from former manned spaceflight experiments (German D2-Mission/German D1-Mission 1985/German-Russian MIR-Mission 1 992/German-D2-Mission 1993), fluid shift after entry into microgravity leads to a rapid increase in pressure and volume within the upper compartments of the human body. This has been proven by precise measurements with automatic selftonometers for intraocular pressure. HYPOTHESIS: There is little doubt, that a very similar--even more, marked--increase of intracranial pressure happens soon after entry into microgravity. This may be the cause for some of the reported hormonal and even neurological changes in metabolism. There is no non-invasive method to assess these important increases in pressure. METHODS: Ophthalmodynamometry in general allows for rather precise estimation of intracranial BP, but so far the method was too complicated for routine application, specifically in spaceflight conditions. Therefore, using the microprocessor controlled technology of our automatic selftonometer we have designed a very precise automatic instrument which can be applied by the astronaut/kosmonaut. The measurement takes only a few seconds. CONCLUSIONS: This easily applied, non-invasive method would allow for completely new insights into these important changes and explain some of the clinical consequences noted so far.

Astronauts↗

Adjuvant methods in macular hole surgery: intraoperative plasma-thrombin mixture and postoperative fluid-gas exchange.

BACKGROUND AND OBJECTIVE: The optimal method for surgical management of idiopathic macular holes remains unknown. Adjuvant methods including intraoperative cytokines and postoperative fluid-gas exchange with and without laser have been described. We report on the safety and final results of routine intraoperative autologous plasma-thrombin mixture and postoperative fluid-gas exchange when necessary as an adjunct to the surgical therapy of this disease. PATIENTS AND METHODS: A consecutive series of 114 patients (mean age 66.9 years) with primary idiopathic full thickness Stage II, III, and IV macular holes were primarily treated by vitrectomy, fluid/perfluorocarbon gas exchange, and application of autologous plasma-thrombin mixture to the macular hole. Visible epiretinal membranes were peeled but the normal appearing internal limiting membrane was not routinely stripped. Outcome measures included final Snellen visual acuity, rate of macular hole closure, complications, and number of supplemental procedures performed. RESULTS: Closed at one month, were 110 of 121 (91%) macular holes, including two that underwent repeat fluid/gas exchange and laser within the first two weeks after surgery. At the time of final follow-up (mean: 10.9 months), 110 of 121 (91%) macular holes were closed. This included 8 of 9 eyes that had reopening of the macular hole between one and 21 months successfully treated by repeat fluid-gas exchange and 2 eyes that underwent a second successful pars plana vitrectomy, membrane peeling, and repeat fluid-gas exchange. Overall, 98 of 121 eyes overall (81%) were successfully treated by a single surgery; 94 of 121 (78%) achieved two lines or greater of visual improvement; 83 of 121 (69%) achieved 20/70 or better vision; and 47 eyes (39%) achieved 20/40 or better vision. Complications in this series included infectious endophthalmitis (1 eye), intraoperative retinal break (2 eyes), late retinal detachment (5 eyes), transient mild intraocular pressure elevation (46 eyes), inflammatory response (six eyes), epiretinal membrane (6 eyes), intraretinal hemorrhages (1 eye), and cataract (33 of 99 phakic eyes underwent cataract extraction during the follow-up). CONCLUSION: A combination of intravitreal perfluorocarbon gas and autologous plasma-thrombin mixture (tissue glue) was well tolerated in most patients and did not result in any specific long-term complications. The use of supplemental fluid-gas exchange when necessary improved the final success rate. Further well-controlled and randomized studies will be required to determine the efficacy of this as an adjunct or alternative to other methods of treatment for macular holes.

Adult↗

Exudative retinal detachment secondary to orbital and intraocular benign lymphoid hyperplasia.

A 69-year-old white woman presented with glaucoma secondary to benign lymphoid hyperplasia and elevated episcleral venous pressure. Retinal detachment developed subsequent to trabeculectomy and cataract formation. A biopsy of orbital tissue that surrounded the vortex veins revealed mature lymphocytes. Cytology of subretinal fluid also revealed the presence of lymphocytes. Radiation therapy resulted in absorption of subretinal fluid.

Aged↗

Incomplete capsular bag distension syndrome after neodymium:YAG capsulotomy.

We report a 60-year-old man with incomplete capsular bag distension syndrome 2 years after neodymium:YAG (Nd:YAG) laser capsulotomy for capsule opacification, which developed from extracapsular cataract extraction with intraocular lens (IOL) implantation performed 4 years before presentation to our clinic. The patient reported floaters of 15 days duration. Slitlamp examination showed shallowing of the inferior and medial anterior chamber. Dilated pupil examination showed a peripheral capsular bag inferiorly and medially behind the IOL. The bag was distended and filled with turbid fluid. The central and superior capsule was absent as a result of the previous Nd:YAG treatment. The IOL lie over the anterior capsule, and peripheral capsule leaves' edges were adhered. An Nd:YAG laser puncture of the incomplete capsular bag resolved the condition.

Cataract Extraction↗

Retinal detachment and pseudophakia.

Retinal detachments occur in up to 3.6% of pseudophakic patients. The intraocular lens makes it hard to see the peripheral fundus but the small pupil ophthalmoscope is a valuable help. The functional and anatomic success rates after operation are about 5% less than those of patients with aphakic retinal detachments matched for age and sex. I present fifteen cases of pseudophakic detachment. Any manipulation likely to induce contact between lens and cornea such as collapse of the globe after drainage of fluid or gas injections should be avoided. Careful examination of the fundus before and after cataract extraction and careful selection of paients for lens implantation are the only means of reducing the incidence of retinal detachment.

Aged↗

Late postoperative capsular block syndrome: entrapment of liquefied after-cataract by capsular bend.

We report a case of capsular bend-related entrapment of liquefied after-cataract that resulted in late postoperative capsular block syndrome in a 56-year-old man. Slitlamp examination showed a capsular bend formation at the square edge of the optic. Superiorly, leakage in the capsular bend resulted in fluid extending into Soemmering's ring, although communication with the anterior chamber was limited by the capsular bend. Fluid was seen between the lens and posterior capsule.

Humans↗

In vitro analysis of AcrySof intraocular lens glistenings in AcryPak and Wagon Wheel packaging.

PURPOSE: To compare the formation of "glistenings" in acrylic intraocular lenses (IOLs) packaged in Wagon Wheel and AcryPak packaging systems. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Acrylic IOLs in Wagon Wheel (WW) and AcryPak (AP) packaging were analyzed in vitro. The lenses were placed in a test chamber with a controlled temperature and evaluated every 48 hours for 336 hours. The presence of glistenings within the lens optic was assessed using slitlamp evaluation and a quantitative microscopic evaluation with an image analysis system. RESULTS: When maintained at a constant temperature, the WW-packaged IOLs showed no glistening formation and the AP-packaged IOLs, significant glistening formation. Glistenings were noted in the WW-packaged IOLs only under fluctuating temperature conditions. Quantitative image analysis confirmed the presence of glistenings only in AP-packaged IOLs maintained at a constant temperature. CONCLUSION: The glistenings in AcrySof IOLs were temperature dependent and confined to IOLs packaged in AcryPak folders and maintained at constant (body) temperatures. These findings are believed to be consistent with fluid formation within the acrylic optic, somehow related to the AcryPak packaging system.

Acrylates↗

Intraocular HIV-1-specific IgG synthesis in a patient with CMV retinitis.

A sight-threatening cytomegalovirus (CMV) retinitis is often associated with acquired immune deficiency syndrome (AIDS). We report the detection and quantitation of antibodies specific for CMV and human immunodeficiency virus type 1 (HIV-1) in the vitreous fluid and serum of an AIDS patient suffering from bilateral CMV retinitis. The ratio of the concentrations of HIV-1-specific immunoglobulin G (IgG) to total IgG in the vitreous fluid was found to be higher than that of the peripheral blood, indicating a local production of HIV-1-specific IgG synthesis within the ocular compartment. In contrast, CMV-specific IgG levels in serum were found to be higher than that of vitreous fluid, indicating an intact blood-ocular barrier. CMV and HIV were also isolated from the ocular tissues of this patient. These findings are consistent with the hypothesis that CMV retinitis may be associated with HIV-1 infection of the ocular tissues, which evokes an HIV-1-specific humoral immune response locally within the ocular compartment.

Acquired Immunodeficiency Syndrome↗

Suppression of VIP- and terbutaline stimulated aqueous humor flow by increased intraocular pressure in the cynomolgus monkey.

The effect of increased intraocular pressure (IOP) on stimulated aqueous humor flow (AHF) was studied in cynomolgus monkeys. Two experimental series were performed, one with unilateral VIP-treatment (60 micrograms intracamerally) and one with unilateral terbutaline-treatment (10 micrograms.ml-1 perfusion fluid). The AHF was determined with a labelled albumin dilution method, and an artificial increase in IOP was produced by clamping the outlet of the perfusion system, thus causing a net inflow of perfusion fluid. The initial AHF was significantly higher in the VIP-treated eye than in the control eye - 1.568 +/- 0.095 as compared to 1.112 +/- 0.103 microliters.min-1 (P less than or equal to 0.01). The spontaneous IOP was 5.8 +/- 0.4 mmHg (P less than or equal to 0.001) higher in the VIP-treated eye. There was no difference in pseudofacility between the VIP-treated eye (0.063 +/- 0.016 microliter.min-1.mmHg-1) and the control eye (0.065 +/- 0.022 microliter.min-1.mmHg-1), but the total and true outflow facilities were higher in the VIP-treated eye. In the experiments with terbutaline, the initial AHF was 1.729 +/- 0.114 for the experimental eye and 1.262 +/- 0.104 microliters.min-1 for the control eye (P less than or equal to 0.01). The pseudofacility tended to be higher in the terbutaline-treated eye (0.072 +/- 0.026 microliters.min-1.mmHg-1) than in the control eye (0.048 +/- 0.012 microliters.min-1.mmHg-1), but the difference was not statistically significant. There was no difference in total and true outflow facility between the experimental and control eye. The results indicate that the pressure sensitivity of the AHF is independent of the initial level of the AHF. VIP increases true outflow facility, possibly via a direct effect on the trabecular meshwork. VIP also appears to rise the IOP due to an increase in episcleral venous pressure, which could be secondary to vasodilatation in the anterior segment.

Animals↗

[Laser magnetotherapy after cataract extraction with implantation of intraocular lens].

Effects of low-intensive laser and alternating magnetic field on the course of the postoperative period were studied in patients with exudative reaction after extracapsular cataract extraction with implantation of intraocular lens (IOL). The results are analyzed for 148 eyes with early exudative reaction after IOL implantation (136 patients aged 42-75 years). The patients were observed for up to 6 months. The treatment efficiency was evaluated by the clinical picture of inflammatory reaction, visual acuity, and results of biochemical analysis of the lacrimal fluid (the ratio of lipid peroxidation products to antioxidants in cell membrane). The course of the postoperative period was more benign and recovery sooner in patients of the main group in comparison with the control.

Adult↗

Ocular hypertension in mice with a targeted type I collagen mutation.

PURPOSE: To evaluate intraocular pressure (IOP) in transgenic mice with a targeted mutation in the gene for the alpha1 subunit of collagen type I. METHODS: Homozygous B6; 129-Cola1(tm1Jae) mice and corresponding wild-type mice were anesthetized. A fluid-filled glass microneedle connected to a pressure transducer was then inserted through the cornea into the anterior chamber to measure IOP. All measurements were made between 11:30 AM and 1:30 PM. The IOP of seven Col1a1(r/r) and eight corresponding wild-type Col1a1(+/+) male mice was measured at 12, 18, 24, and 36 weeks after birth. The IOP of 5 to 24 additional Col1a1(r/r) mice was measured at 7, 12, 18, 24, and 36 weeks after birth. The structure of the anterior segment and the distribution of collagen I were assessed by immunohistochemistry. RESULTS: Mean IOP measurements of the control Col1a1(+/+) mice (IOP(c)) at 12 and 18 weeks after birth were relatively constant at 18.9 +/- 2.0 and 19.2 +/- 1.9 mm Hg, respectively. Mean IOP then decreased to 15.8 +/- 0.8 and 16.2 +/- 1.2 mm Hg at 24 and 36 weeks, respectively. In contrast, mean IOP measurements in the transgenic (Col1a1(r/r)) mice was 2.7 +/- 3.4 mm Hg higher at 12 weeks and increased to a maximum of 23.6 +/- 2.4 mm Hg at 24 weeks. The difference between mean IOP in these two groups gradually increased to a maximum of 4.8 mm Hg (30%) at 36 weeks and was significantly different from the control mice at both 24 and 36 weeks of age. No anterior segment abnormality was observed in Col1a1(r/r) mice and no difference between the anterior segment appearance of Col1a1(r/r) and Col1a1(+/+) mice was observed throughout the 36-week analysis period. However, collagen I immunoreactivity in sclera and associated structures was greater in Col1a1(r/r) mice than in Col1a1(+/+) mice. When the mean IOP measurements from the additional Col1a1(r/r) mice were included with these measurements, mean IOP at each age was 16.7 +/- 0.8, 21.8 +/- 3.9, 23.2 +/- 2.8, 23.5 +/- 2.4, and 22.1 +/- 3.6 mm Hg, respectively. Mean IOP in the Col1a1(r/r) mice was significantly higher than in the Col1a1(+/+) mice at 18, 24, and 36 weeks by 21%, 44%, and 36%, respectively (P < 0.05). CONCLUSIONS: These results demonstrate ocular hypertension in mice with a targeted type I collagen mutation and suggest there is an association between IOP regulation and fibrillar collagen turnover.

Animals↗