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PubMed1987

Effects of intraocular irrigation with melatonin on the c-wave of the direct current electroretinogram and on the standing potential of the eye in albino rabbits.

The direct current electroretinogram (ERG) and the standing potential (SP) were recorded from both eyes of 14 albino rabbits during intraocular perfusion of one of the eyes, which was vitrectomized, with a recently developed eye irrigation solution (PHS) produced by Pharmacia Ophthalmics. PHS was then replaced by a test solution containing melatonin dissolved in PHS (0.002 microM-200 microM). The fluids were subsequently alternated (PHS - melatonin - PHS). During uniocular irrigation with melatonin the mean c-wave amplitude and SP level of the intact control eye were increased (c-wave +24%, p less than 0.01; SP +0.65 mV, p less than 0.05) compared with the values during the initial perfusion with PHS. In contrast, the c-wave amplitude of the irrigated eye was markedly decreased in many rabbits during perfusion with melatonin compared with the initial PHS, but the mean reduction was small and not statistically significant. The mean SP level was reduced (-1.54 mV, p less than 0.001). This difference between the eyes probably depends on the route by which melatonin reaches the retinal pigment epithelium and thus whether it primarily affects the apical (as in the irrigated eye) or the basal (as in the control eye) pigment epithelial membrane. A peak in the b-wave amplitude was observed in both eyes during uniocular irrigation with melatonin when compared with the amplitude measured during the initial perfusion with PHS (irrigated eye: +27%, p less than 0.001; control eye +18%, p less than 0.002).

Animals↗
PubMed1981

Iatrogenic intraocular injection of depot corticosteroid and its surgical removal using the pars plana approach.

A four-year-old girl, while undergoing a repeat excisional biopsy for a progressive orbital hemangioma, sustained an accidental intraocular injection of methylprednisolone acetate (Depo-Medrol) resulting in a mass of intravitreal and subretinal depot material as well as a retinal tear, retinal detachment, and rapid cataract formation. Pars plana lensectomy, vitrectomy, xenon arc endophotocoagulation and air fluid-gas exchange techniques were used to restore the ocular tissues for visual functions in the affected eye and to save the globe from the devastating toxic effects of the vehicles in the depot corticosteroid preparation.

Biopsy↗
PubMed2004

Active iris mechanics and pupillary block: steady-state analysis and comparison with anatomical risk factors.

Primary angle-closure glaucoma arises when the iris physically obstructs outflow of aqueous humor, increasing the intraocular pressure and damaging the optic nerve. Pupillary block, the predominant mechanism for angle closure, is believed to be driven by mechanical interaction between the aqueous humor and the iris. We performed steady-state simulations of this coupled fluid-solid system, including an active sphincter to control pupil constriction. Model results compared favorably against Mapstone's pupil-blocking force analysis. We also evaluated anatomical risk factors and quantified their contributions to pupillary block and angle closure. The results showed that greater lens curvature and shorter iris-zonule distance contribute significantly to pupillary block and the associated narrowing of the angle. Surprisingly, the model predicted that maximum pupillary block and angle closure occur at the minimum pupil dilation, contradicting the clinical observation that angle closure is most severe in dark conditions. This discrepancy suggests the involvement of one or more phenomena not captured by our current model.

Animals↗
PubMed1997

[Surgical management for giant retinal tear].

OBJECTIVE: To study the effect of surgical management for giant retinal tear (GRT). METHODS: A standard three-point vitrectomy with silicone oil intraocular injection was performed on 41 cases. Of them, scleral buckling was also performed on 35 cases and lensectomy, on 17 cases. The basal vitreous gel and peri-retinal membranes were resected completely in all the cases. Air-fluid exchange, retinal tack or liquid perfluorocarbon were used to unroll and flatten the flap of the GRTs. Cryopexy or endophotocoagulation were applied to close the GRTs. RESULTS: In the follow-up for 3-39 months (mean 11.6 months), total retinal attachment was achieved in 29 cases, macular retinal attachment in 7 cases, and no retinal attachment in 5 cases. The final visual acuities were 0.01-0.05 in 6 cases, 0.06-0.1 in 17 cases, 0.2-0.5 in 11 cases and 0.6-1.0 in 2 cases. CONCLUSIONS: The key factor of successful operation is to unroll and flatten the flap of GRTs completely. Scleral buckling shows advantages and disadvantages, while appropriate scleral buckling is necessary in GRTs with proliferative vitreo-retinopathy. Postoperative further proliferation is the main factor affecting the long term effect of the treatment.

Adolescent↗
PubMed2002

High-density vitreous substitute in the management of advanced Coats' disease.

Advanced Coats' disease is a threat to vision. Management of advanced Coats' disease has long been a challenge to ophthalmologists. Some people have attempted to use pars plana vitrectomy and intraocular diathermy on diseased vessels followed by intraocular gas or silicone oil injection. However, internal drainage is technically difficult. We present a case of advanced Coats' disease for which, after an encircling buckle and pars plana vitrectomy, intravitreal injection of perfluorodecaline was used to displace the subretinal fluid to the peripheral subretinal space, and transscleral external drainage was achieved. Finally panretinal laser photocoagulation, cryotherapy and endodiathermy were performed on diseased vessels. Visual improvement and reattachment of the posterior pole were achieved. So we think a high-density vitreous substitute can be a useful adjunct in the management of advanced Coats' disease. It minimizes the disadvantages of the internal or external approaches, while maintaining most of the advantages of both.

Adolescent↗
PubMed1993

Trabeculectomy with releasable sutures.

We attempted to reduce some of the postoperative complications of trabeculectomy by using releasable scleral flap sutures. This technique allows an initial tight closure of the scleral flap with the option to increase aqueous humor outflow in the early postoperative period. We reviewed our experience with trabeculectomy and releasable sutures in 146 eyes (134 patients) and compared these cases with a prior series of 128 eyes (124 patients) that underwent trabeculectomy with permanent scleral flap sutures. In the control group, 42 eyes (32.8%) had clinically detectable shallowing of the anterior chamber in the postoperative period. In contrast, shallow anterior chamber was noted in 21 eyes (14.4%) in the group with releasable sutures (P = .0003). Flat anterior chamber, defined as iridocorneal touch to the pupil margin, occurred in 11 control eyes (8.6%) but in only 2 eyes (1.4%) with releasable sutures (P = .0078). Surgical intervention to drain suprachoroidal fluid and re-form the anterior chamber was required in eight control eyes (6.2%) but in only one study eye (0.7%) (P = .014). At 1 year of follow-up, the two groups were similar in terms of mean intraocular pressure, the need for ocular hypotensive medications, and failure rate.

Aged↗
PubMed2002

Reduction of intraocular pressure in mouse eyes treated with latanoprost.

PURPOSE: To determine whether topical treatment of mouse eyes with latanoprost alters intraocular pressure (IOP). METHODS: In a masked study design, NIH Swiss mice received a 2-microL topical instillation of 0.00015%, 0.0006%, 0.0025%, or 0.01% latanoprost or vehicle (phosphate-buffered saline [PBS]). After 1, 2, or 3 hours, the animals were anesthetized, and a fluid-filled glass microneedle connected to a pressure transducer was inserted through the cornea into the anterior chamber to measure IOP. The reduction of IOP after latanoprost measurement was calculated by the comparison between treated and nontreated eyes in the same mouse. The effect of latanoprost after a single 0.01% dose was also measured at 6, 12, and 24 hours. As in the previous study, the identity of all eye drop solutions was masked. RESULTS: In mouse eyes receiving topical PBS, the mean IOP was 14.8 +/- 2.2 mm Hg (n = 173 males). There was no significant difference in IOP between male and female eyes and between right and left eyes. At 1 hour after topical treatment with 0.00015% or 0.0025% latanoprost, IOP increased by as much as 11% +/- 7%. At 2 and at 3 hours after application, IOP decreased in a dose-dependent manner. These decreases were significant in eyes receiving 0.0025% or 0.01% latanoprost (P < 0.05, Student-Newman-Keuls test) and the largest decrease (14% +/- 8%) was noted 2 hours after treatment with 0.01% latanoprost. At 6, 12, or 24 hours after treatment, there was no difference in latanoprost- and PBS-treated eyes. CONCLUSIONS: Latanoprost reduces mouse IOP in a dose-dependent manner. The mouse may be a useful model for studying the effect of drugs on IOP.

Administration, Topical↗
PubMed2002

Vitreous hemorrhage as the initial presentation of postoperative endophthalmitis.

PURPOSE: To describe a patient with postoperative endophthalmitis whose only abnormal finding at presentation was a vitreous hemorrhage. DESIGN: Interventional case report. METHODS: A 68-year-old diabetic woman underwent cataract extraction with intraocular lens implantation in the left eye. Three days after surgery, she had painless loss of vision, minimal anterior chamber inflammation, and dense vitreous hemorrhage in the left eye. RESULTS: On the fourth postoperative day, significant anterior chamber inflammation developed with fibrin and a hypopyon. During vitrectomy with intravitreal antibiotic injection, an area of retinitis surrounding an eroded retinal blood vessel was found. Cultures of undiluted vitreous fluid grew coagulase-negative Staphylococcus organisms. The endophthalmitis resolved and 20 months later, her best-corrected visual acuity had improved to 20/40. CONCLUSION: Postoperative endophthalmitis may present as a vitreous hemorrhage, secondary to retinitis and erosion of a retinal blood vessel.

Aged↗
PubMed2005

Roles of the conjunctiva in ocular drug delivery: a review of conjunctival transport mechanisms and their regulation.

Conjunctiva plays many roles including protection of ocular surface, production of tear film, and a conduit for drug clearance (depending on drug properties) into the systemic circulation or for drug transport to the deep tissues of the eye. The conjunctiva, which is a moderately tight epithelium, endowed with various transport processes for the homeostasis of ions, solutes, and water in the conjunctival surface and tear film. Modulation of ion transport in the conjunctiva leads to alterations in transconjunctival fluid flow that may become useful for treatment of dry-eye state in the eye. As a possible drug delivery route to the posterior portion of the eye, conjunctiva is an attractive route due to both larger surface area than that of cornea and expression of several key transport processes. Tear contains D-glucose and many amino acids, in addition to the usual ions in the body fluids. Several ion-coupled solute transport processes for absorption of amino acids, D-glucose, monocarboxylate, nucleosides, and dipeptides are expressed in the conjunctiva. Thanks to the rich endowment of these transport processes, drug transport across the conjunctiva into the intraocular tissues may become quite feasible. Subconjunctival injection of microparticles and matrix materials (which allows sustained release of drugs) is shown to maintain reasonable levels of various drugs in the vitreous, perhaps attesting to the fact that conjunctiva per se may contribute as a part of multiple transport barrier(s) in ocular drug delivery. In addition, several conjunctival approaches have been investigated to optimize treatment of dry-eye syndrome and intraocular diseases, and more can be accomplished in the coming years.

Amino Acids↗
PubMed2006

Scheimpflug imaging in late Capsular Bag Distention syndrome after phacoemulsification.

PURPOSE: To describe two cases of late Capsular Bag Distention syndrome (CBDS) and posterior capsular opacification (PCO) as documented on Pentacam. DESIGN: Case series. METHODS: A 55-year-old male and a 72-year-old female presented three years after phacoemulsification and intraocular lens (IOL) implantation with a complaint of decreased vision. Scheimpflug imaging was done using Pentacam. Patients underwent Nd:YAG capsulotomy for PCO, and postcapsulotomy capsular bag dynamics were imaged on Pentacam. RESULTS: Three years after phacoemulsification, patients presented with blurred vision and posterior bowing of opacified posterior capsule. Anterior capsular opening was apparently sealed by lens optic, and space between IOL and opacified posterior capsule was filled with turbid fluid. Nd:YAG laser capsulotomy was done. All findings, including collapse of distended bag, were precisely documented on Scheimpflug images. CONCLUSIONS: Pentacam Scheimpflug imaging is a useful technique to diagnose and document the presence and progress of CBDS and PCO.

Aged↗
PubMed1998

[Endogenous infectious endophthalmitis].

INTRODUCTION: Endogenous endophthtalmitis is an intraocular infection of hematogenous origin. EXEGESIS: It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection. CONCLUSION: Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.

Aged↗
PubMed2002

High postdialysis urea rebound can predict intradialytic increase in intraocular pressure in dialysis patients with lowered intradialytic hemoconcentration.

BACKGROUND: Intradialytic (ID) decrease in intraocular pressure (IOP) parallel to ultrafiltration-induced hemoconcentration has been recently reported. However, exacerbation of glaucoma in hemodialysis (HD) patients during HD sessions is occasionally observed. Postdialysis urea rebound (PDUR) is induced by the lag in urea removal from the cells to urea removal from the extracellular fluid, which when increased can result in ID drag of water to intracellular compartment. It is our hypothesis that similar lag in urea removal from ocular compartments may also be reflected by PDUR, and may induce drag of water into ocular compartments counteracting the effect of hemoconcentration. Our assumption was, therefore, that PDUR might predict ID increase in IOP. METHODS: IOP, serum urea and hematocrit levels were measured at the start, end and 1 h postdialysis, in 19 chronic HD patients with normal IOP. RESULTS: PDUR was positively correlated with mean (both eyes) ID changes in IOP (MIDIOP) (r = 0.5, p = 0.03) and % MIDIOP (r = 0.55, p = 0.02). ID increase in IOP was observed only in the 7 patients with relatively higher PDUR (> or = 9 mg%), who had also a relatively lower % ID change in Hct (<8%). MIDIOP was negatively correlated with % ID changes in Hct (r = -0.65, p = 0.03) in the 12 patients with PDUR > or = 9 mg, and positively correlated with PDUR (r = 0.57, p = 0.03) in the 14 patients with % ID change in Hct <8%. CONCLUSION: High PDUR may predict susceptibility to ID increase in IOP in patients with lowered ID hemoconcentration.

Aged↗
PubMed1985

Slit-lamp fluid-gas exchange and other office procedures following vitreoretinal surgery.

Many complicated postoperative vitreoretinal cases require reoperations. It is possible to perform some of these procedures outside the operating room. We describe examining room techniques for fluid-gas exchange, fluid and gas aspiration, and adherent vitreous strand removal. We also discuss a slit-lamp technique for using sodium hyaluronate (Healon) following fluid-gas exchange to eliminate optical distortion from endothelial striae.

Anesthesia, Local↗
PubMed2005

[Diagnostic and therapeutic management of Vogt-Koyanagi-Harada syndrome].

PURPOSE: To determine the most efficient diagnostic tools in Vogt-Koyanagi-Harada syndrome, taking into account the international diagnostic criteria, and to evaluate the therapeutic management of these patients. PATIENTS AND METHODS: This study examined patients with a suspicion of VKH syndrome who presented between January 2001 and March 2003, including ocular and extraocular evaluation of the disease at the time of diagnosis. Each patient was classified according to the 1978 international diagnostic criteria and the revised 2001 criteria. In most cases, intravenous steroid pulses were administered. Immunosuppressors were initiated when inflammation was not controlled with steroids. RESULTS: Twenty-two patients were included. The mean age was 33.5 years (range, 15-49 years). Posterior segment involvement, which was observed in 21 patients, depended on the stage of the disease. Anterior segment inflammation was associated in eleven cases. Neurologic symptoms, including meningitis, cerebrospinal fluid lymphocytic pleocytosis, tinnitus, or hearing loss were observed in 12 patients. Fourteen patients had dermatologic signs. Five patients who developed VKH syndrome did not meet the 1978 criteria, and three patients did not meet the 2001 revised criteria. In 19 cases, intraocular inflammation was controlled with corticosteroids. In three cases, corticosteroids could not be discontinued. These patients were treated with immunosuppressive molecules: azathioprine, cyclophosphamide, interferon alpha. At the end of the follow-up period, inflammation was controlled in all patients. DISCUSSION: Revision of the diagnostic criteria provides a more subtle diagnosis of VKH syndrome. However, it is difficult to consider the variability of clinical symptoms during the duration of disease. Corticosteroids must be used at appropriate dosages, followed by slow tapering over 6 months. This attitude seems to reduce the duration of ocular inflammation and decreases the frequency of recurrence. The use of immunomodulating drugs could be reduced by early and appropriate use of systemic steroids. Interferon alpha seems to be a promising alternative in corticoresistant or corticodependent forms of the disease, but further controlled studies are required.

Adolescent↗
PubMed2006

[Macular hole surgery without postoperatory < > down positioning. Pilot study].

PURPOSE: To evaluate the visual and anatomical outcomes of macular hole surgery using phacoemulsification, vitrectomy and intraocular gas tamponade without the use of postoperative face down positioning. METHODS: Phacoemulsification with an intraocular lens implant, followed by vitrectomy with internal limiting membrane peeling and perfluoropropane (C3F8), was performed in patients with stage 3 or 4 macular holes. After surgery, patients had to avoid the supine position for 15 days. Patients with a gas level <50% during the first week had a fluid-gas exchange. Visual acuity and closure of the macular hole were evaluated after 1 year of follow-up. RESULTS: 20 eyes of 20 patients, aged 60 to 75 years (median age 68 years), were included in this study. The best initial visual acuity ranged from 0.05 to 0.13 (ETDRS), with the median being 0.06. The final visual acuity was 0.05 to 0.30 with a median of 0.10. A statistically significant improvement (p=0.001, Wilcoxon) was found. The anatomic postoperative results revealed 90% (n=18) of the macular holes were closed while 10% (n=2) were not. CONCLUSIONS: Macular hole surgery has, in general, good results and patients can achieve improvement in their visual acuity without the need for uncomfortable and unbearable post operative posture positions.

Aged↗
PubMed1993

[Proliferative vitreoretinopathy. On the significance of protein transfer through the blood-retina barrier].

In several studies, unphysiologically high concentrations of different proteins have been measured in the vitreous of patients with proliferative vitreoretinopathy (PVR). It has not yet been determined whether these high values result from the alteration of the blood-retina barrier (BRB) or whether the proteins are produced intraocularly. In the present study we measured the concentrations of IgG and complement factor C4 in vitreous aspirates and plasma samples from patients with PVR (n = 15). We calculated an IgG and C4 index analogous to the IgG index in routine cerebrospinal fluid chemistry, which is used to estimate the rate of intrathecal IgG synthesis. Comparison of the C4 index revealed no significant difference between patients and controls. Although a higher IgG index was demonstrated in pathologic vitreous, no intravitreal cells that are able to synthesize IgG have been found. These findings suggest that high levels of IgG and C4 are related to an elevated transfer at the disrupted BRB.

Blood-Retinal Barrier↗
PubMed2006

A pilot study on slit lamp-adapted optical coherence tomography imaging of trabeculectomy filtering blebs.

BACKGROUND: Our study aims to identify anatomical characteristics of glaucoma filtering blebs by means of slit lamp-adapted optical coherence tomography (SL-OCT) and to identify new parameters for the functional prognosis of the filter in the early post-operative period. METHODS: Patients with primary open-angle glaucoma, aged 18 years and older, scheduled for primary trabeculectomy at the Department of Ophthalmology, Radboud University Nijmegen Medical Centre, were considered for our study. All patients underwent standardized trabeculectomy with intra-operative application of mitomycin C. The filtering blebs were evaluated clinically and with SL-OCT on day 1 and 1, 2, 4 and 12 weeks following surgery. The resulting data were analysed and weighed against surgical success. To better understand the SL-OCT data a small comparative histologic study was performed. RESULTS: The study included 20 eyes of 20 patients. After completion of our study, 15 eyes of 15 patients (mean age+/-SD 67 +/- 16 years) were eligible for data analysis and 5 eyes missed at least one follow-up visit. Filtering surgery was considered successful (intraocular pressure < or = 21 mmHg without antiglaucomatous medication) in 11 of 15 eyes. SL-OCT frequently demonstrated multiple hypo-reflective layers within Tenon's capsule ("striping" phenomenon) in the first post-operative week. Presumably, these layers corresponded with drainage channels in the histological specimen. These channels were present in functional filters but not in the failures. In addition, the visualisation of the sclera below the filtering zone was better defined in failures compared with successful filtering blebs ("shading" phenomenon). We observed no differences in the volume and clinical aspect of the blebs in the successful group compared with the unsuccessful group. CONCLUSIONS: Successful filtering blebs show characteristic optical properties on SL-OCT. These phenomena suggest a diffusely enhanced fluid content and the presence of intra-bleb drainage channels in functional filtering blebs.

Aged↗