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PubMed1990

Intraoperative massive suprachoroidal hemorrhage during pars plana vitrectomy.

Seven eyes (7 patients) developed massive suprachoroidal hemorrhage (MSCH) during pars plana vitrectomy (PPV) for complicated retinal detachments. The MSCH developed late in the procedure following PPV, air fluid exchange, endolaser, cryopexy, and scleral buckling in five of seven eyes. In two eyes, mild hemorrhagic choroidal detachments noted intraoperatively progressed to MSCH within 72 hours postoperatively. Diagnosis of MSCH was confirmed by echography and CT scan. Multiple scleral buckling surgeries, high myopia, aphakia, and intraocular inflammation were the main risk factors. Placement of a broad posterior scleral buckle with intraoperative hypotony and cryopexy were important precipitating factors. Visual results were poor, with six of seven eyes showing no light perception. The mean follow-up time was 12.8 months. Once acute MSCH is recognized intraoperatively, surgical decompression at that time should be avoided as MSCH itself may tamponade the choroidal bleed. Details of prevention and management are discussed.

Adult↗

PubMed2003

Vitreal pathogenic role in optic pit foveolar retinoschisis and central serous retinopathy.

PURPOSE: To expand on current theories concerning the vitreal-induced mechanism underlying the development of foveolar retinoschisis and macular sensory detachments associated with optic nerve head pits. To propose the notion that vitreal traction may contribute to the pathogenesis of serous detachments in central serous chorioretinopathy (CSC). REPORTS: We describe two patients, one with macular retinoschisis and the other with central serous detachment. The first patient, a 45-year-old Hispanic female, presented with a temporally located optic nerve head pit, foveolar retinoschisis and schisis retinal spaces extending to the surrounding macula and to the disc. The second patient, a 43-year-old Haitian male, developed a central serous retinal detachment OS with decreased visual acuity one day following in-office administration of Apraclonidine (0.5 per cent Iopidine, Alcon) and Dorzolamide-Timolol Maleate (Cosopt, Merck) to lower elevated intraocular pressure (IOP). Macular retinal pigment mottling and epiretinal membrane sheen OU had been observed on his initial visit. Visual acuity improved within a three-day period with resolution of the serous detachment. CONCLUSION: We suggest that the persistence of Cloquet's canal may permit fluid leakage into the proximal vitreous in cases of congenital optic nerve head pits. Tangential vitreal traction may promote the opening of a fistula at the optic pit and additionally thrust vitreal fluid into the pit and retinal space inducing the formation of schisis spaces, foveolar-schisis and underlying sensory serous detachment. We question whether a reduction in vitreous volume, induced by initial administration of anti-glaucoma medications, may contribute to the development and/or recurrence of central serous choroidopathy in predisposed individuals.

Adult↗

PubMed1998

Polymerase chain reaction in the diagnosis of bacterial endophthalmitis.

BACKGROUND: Microbiological investigations of vitreous fluid (VF) and aqueous humour (AH) specimens have often failed to detect the infecting agent in infectious endophthalmitis, resulting in a clinical dilemma regarding therapy. In this study, the polymerase chain reaction (PCR) was evaluated in the diagnosis of bacterial and Propionibacterium acnes endophthalmitis. METHODS: 58 intraocular specimens (30 VF and 28 AH) from 55 cases of endophthalmitis and 20 specimens (14 VF and 6 AH) as controls from non-infective disorders were processed for microbiological investigations. Nested PCR directed at the 16S rDNA using universal primers for eubacterial genome was done. PCR for P acnes was performed on specimens microbiologically negative by conventional techniques but eubacterial genome positive. RESULTS: Of the 20 controls from non-infective cases, one (5%) was positive using eubacterial primers and none with P acnes primers. PCR for eubacterial genome showed 100% correlation with 20 (34.5%) bacteriologically positive specimens. Eubacterial genome, was detected in 17 (44.7%) of 38 bacteriologically negative specimens and nine (52.9%) out of the 17 were positive for P acnes genome. Among the 21 eubacterial PCR negative specimens, seven were fungus positive. By inclusion of PCR, microbiologically positive specimens increased from 46.5% to 75.8%. PCR on AH was as sensitive as that on VF for the detection of both eubacterial and the P acnes genome. CONCLUSION: PCR performed on AH and VF is a reliable tool for the diagnosis of bacterial and P acnes endophthalmitis particularly in smear and culture negative specimens.

Aqueous Humor↗

PubMed2006

Intraocular viral and immune pathogenesis of immune recovery uveitis in patients with healed cytomegalovirus retinitis.

PURPOSE: To investigate immune and viral contributions to the pathogenesis of immune recovery uveitis (IRU), which presents as vitritis, macular edema, or formation of epiretinal membranes, and develops in patients with acquired immunodeficiency syndrome (AIDS) who experienced cytomegalovirus (CMV) retinitis before antiretroviral treatment (ART) induced immune reconstitution. METHODS: Aqueous and vitreous fluids from patients with IRU, active CMV retinitis, and control human immunodeficiency virus (HIV)-negative, noninflamed eyes were compared for presence of cytokines IL-6, IL12, interferon gamma using enzyme-linked immunosorbent assay techniques, and CMV DNA (by polymerase chain reaction). RESULTS: IRU eyes (11 patients, 18 samples) had the highest levels of IL-12 (median 48 pg/mL), moderate levels of IL-6 (median 146 pg/mL), and low but significant interferon gamma (median 15 pg/mL), compared to controls (P < 0.01). All uveitis eyes tested (9/9) were CMV DNA negative. In contrast, active CMV retinitis eyes were CMV DNA positive, had higher levels of IL-6 (median 349 pg/mL) (25 patients, 41 samples) than both control (P = 0.0001) and uveitis eyes (P = 0.048), similar levels of interferon gamma (median 27 pg/mL) to uveitis eyes, but less IL-12 (median 0 pg/mL) than uveitis eyes. CONCLUSIONS: Inflammatory IRU can be differentiated from active CMV retinitis by the presence of IL-12, less IL-6, and absence of detectable CMV replication.

AIDS-Related Opportunistic Infections↗

PubMed1997

Influence of intraocular lens haptic material on bacterial isolates from anterior chamber aspirate.

PURPOSE: To determine whether intraocular lens (IOL) type affects the bacterial count in anterior chamber aspirates obtained immediately after cataract surgery. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This in vivo study evaluated two groups of eyes that had uneventful cataract extraction and implantation of one of two types of IOLs: all poly(methyl methacrylate) (PMMA) (n = 73) or polypropylene haptic (n = 83). Anterior chamber fluid aspirates (0.1 mL) were obtained with a 30 gauge cannula at the end of surgery and inoculated onto chocolate agar and in thioglycolate broth. Microbiology evaluation was performed using standard methods. RESULTS: Seven eyes (9.5%) with all-PMMA IOLs and 21 (25.3%) with polypropylene haptic IOLs were positive for bacterial isolates (P = .0322; chi-square test). Mean colony count (+/-SD) was 11.43 +/- 3.78 and 13.16 +/- 4.78 colony-forming units/ milliliter in the PMMA and polypropylene haptic IOL groups, respectively. No eye developed endophthalmitis. CONCLUSION: Polypropylene haptic IOLs were associated with a significant increase in bacteria in the anterior chamber.

Aged↗

PubMed2004

Intraocular properties of urokinase-derived antiangiogenic A6 peptide in rabbits.

To investigate the intraocular properties of an antiangiogenic peptide, A6, a total of 70 New Zealand rabbit eyes were used. For the toxicity study, 0.05 mL of 0.459 M or 0.148 M A6 was injected intravitreally; right eyes received A6, and left eyes received a vehicle. Serial intraocular pressure measurement, slit lamp, and indirect ophthalmoscopy were performed. The rabbit eyes were evaluated by fluorescein angiography, electroretinography, and histology after the scheduled sacrifice. The pharmacokinetics of an intravitreal A6 (0.05 mL of 0.488 M) and a subtenon A6 (0.5 mL of 0.305 M) injection was studied. There was no toxicity observed following the 0.148 M A6 intravitreal injections. In 2 eyes with a 0.459 M A6 intravitreal injection, focal retinal pigmentary change was observed at the injection site, which was contacted by the hyperosmolar drug bolus. Choroidal A6, following the intravitreal injection, remained therapeutic (>or=10 microM) for 72 hours. The vitreous half-life was 19.4 hours. Choroidal concentrations following the subtenon injection were minimal. The low choroidal concentrations observed may relate to the polar nature of A6. More hydrophobic analogs of A6 are likely to cross the retina more efficiently. However, in diseased eyes, in the area of choroidal neovascularization (CNV), the fluid-filled, damaged, edematous retina may permit the drug to enter the choroid in higher concentrations.

Angiogenesis Inhibitors↗

PubMed1995

[Healing of laser-induced sclerostomy channels in the rabbit].

BACKGROUND: Obliteration of sclerostomy canals during the course of healing is of course undesirable, but before interference with the process can hope to be successful, a stepwise ultrastructural delineation of the course of events provoked by surgucal intervention is essential. In the current study, such an analysis is undertaken, and the changes in tissue morphology discerned correlated with observed modulations in IOP. METHODS: Two cw-Nd:YAG laser sclerostomies were created ab interno on one eye in each of ten rabbits; the unoperated fellow-eyes served as controls. IOP was monitored daily over a twelve-day period. Changes incurred within the canals and to collaterally damaged scleral tissue were analyzed at two-day intervals by light and electron microscopy. RESULTS: The development of well-defined filtering blebs demonstrated the success of the procedure. IOP was significantly lowered during the entire course of the observation period, but after the fifth postoperative day, the blebs had disappeared. Within five days of surgical intervention, morphological analysis revealed the canal to be invaded by macrophages originating from both the iris root and episcleral tissue; these were actively engaged in the phagocytosis of intensely damaged collagen abutting on the lumen. A few days later, the lumen had become occluded by fibroblasts and a dense capillary network. The course of regeneration observed within scleral tissue which had undergone moderate thermal insult, suggests that collagen fibrils undergo a process of repolymerization. CONCLUSIONS: Although the time course of repair is more rapid in rabbits than in humans, the data gleaned nonetheless yield valid information respecting the sequence of events involved in the scarification process. The loose nature of the tissue occluding the canal lumen apparently permits the percolation of fluid through it, thus accounting for the clinical discrepancy between a continuing decrease in IOP and the disappearance of a filtering bleb.

Animals↗

PubMed2003

The effect of the aspiration of pericardial effusion on intraocular pressure.

OBJECTIVE: To assess the effect of pericardial effusion on intraocular pressure (IOP). PATIENTS AND METHODS: Twenty-two patients with pericardial effusion were enrolled into the study. The average pericardial effusion was 2245 +/- 257 cc, and the mean IOP was 26.1 +/- 2.1 mm Hg in the initial examination. Pericardial effusion was aspirated via canula under topical anaesthesia at two or three-day intervals. IOP was measured after every aspiration of pericardial fluid. We statistically compared the changes in the mean IOP after every aspiration (one-way ANOVA), and calculated the correlation (regression analysis) between the amount of fluid and the changes in IOP. RESULTS: An average of 400 ml of fluid was aspirated at two or three-day intervals. The mean IOP decreased to 23.3, 21.2, 19.1 and 16.3 mm Hg after aspirations, respectively. These decreases in the mean IOP were statistically significant (p < 0.01). In regression analysis, we observed a meaningful relationship between the changes in IOP and the amount of pericardial effusion (p < 0.001). CONCLUSION: We found that pericardial effusion affected IOP due to increased episcleral venous pressure. Therefore, patients with pericardial effusion should be referred for an ophthalmological examination with IOP measurement. IOP-lowering medication can eventually be started or adjusted by the ophthalmologist.

Adult↗

PubMed2003

Persistent hyperplastic primary vitreous: magnetic resonance imaging and clinical findings.

BACKGROUND: This study presents magnetic resonance imaging (MRI) findings of both the anterior and posterior types of persistent hyperplastic primary vitreous (PHPV) to facilitate the differential diagnosis from other intraocular abnormalities. METHODS: Seventeen patients with PHPV who were evaluated using non-contrast and contrast-enhanced T1- and T2-weighted images were retrospectively reviewed. RESULTS: Among the 17 patients with PHPV (6 males, 11 females), 13 had unilateral PHPV (11 left eyes, 2 right eyes), and 4 had bilateral PHPV. The MRI findings of the anterior type of PHPV included a shallow or collapsed anterior chamber, an anterior segment anomaly, and a retrolental vascular membrane which demonstrated hyperintensity after contrast enhancement. The MRI findings of the posterior type consisted of microphthalmos; a tubular image, representing the hyaloid vessel; a funnel-shaped retinal detachment, with the subretinal fluid hyperintense on both T1- and T2-weighted images; the fluid-fluid level, which was hypointense on both T1- and T2-weighted images and probably corresponded to the presence of hemorrhage in the subretinal space; a retrolental mass; and vitreous hemorrhage. The most common clinical presentations of patients with PHPV in our study were microphthalmos, a shallow or collapsed anterior chamber, and leukocoria. CONCLUSIONS: The presentation of PHPV at different stages was variable; the MRI features of PHPV along with clinical findings were able to facilitate the differential diagnosis from other intraocular abnormalities such as retinoblastoma and Coats' disease.

Adolescent↗

PubMed2000

Pharmacology of the intraocular pressure (IOP) lowering effect of systemic dexanabinol (HU-211), a non-psychotropic cannabinoid.

The purpose of this study was to characterize the intraocular pressure (IOP) lowering activity and possible mechanism of action of the synthetic, non-psychotropic cannabinoid dexanabinol (HU-211) [(+)(3S,4S), 7-hydroxy-delta-6-tetrahydrocannabinol 1,1 dimethylheptyl], following intravenous (i.v.) administration in the rabbit. IOP (pneumatonometry), aqueous humor inflow rate (fluorophotometry), blood pressure, and heart rate (computerized physiograph system connected to central ear artery cannula) were measured in unanesthetized albino rabbits. Intravenous administration of HU-211 resulted in a dose-related reduction in IOP; a maximal IOP reduction of 5.0 +/- 0.2 mmHg was observed 4 hr after a 0.5 mg/kg dose. No significant changes in blood pressure or heart rate were observed during the first hr following this dose of HU-21 1. Pupil diameter did not change significantly during the 5 hr following the 0.5 mg/kg i.v. dose. No significant change in the rate of aqueous humor inflow occurred during the 6 hr after a 0.5 mg/kg dose of HU-211, thereby implicating outflow changes as the major source of IOP reduction. IOP reduction by HU-211 following pre-treatment with the alpha2 adrenergic antagonist, yohimbine (1 mg/kg, i.v.), was only 30% of that of HU-211 alone. IOP reduction following pretreatment with the alpha2 agonist, clonidine (0.5 mg/kg i.v.), was twice as large as that of HU-211 alone. Pretreatment with the beta-adrenergic antagonist, propranolol (0.5 mg/kg i.v.), resulted in a 50% reduction in the IOP-lowering effect of HU-211. In summary, HU-211, administered i.v., is an effective IOP-lowering agent, devoid of any significant side effects (blood pressure, heart rate or pupil diameter, all of which have been reported previously for cannabinoids). Involvement of the adrenergic system is indicated in mediating the IOP-lowering effects of HU-211 that appear to reflect a change in fluid outflow from the eye.

Animals↗

PubMed1996

Fluid vitreous substitutes in vitreo retinal surgery.

Advances in the surgical instrumentation and vitreoretinal techniques have allowed intraoperative reapproximation of retina to a more normal position. The use of intravitreally injected liquid materials (viscoelastic liquids, liquid perfluorocarbons and silicone oil), as adjunctive agents to vitreo-retinal surgery play an important role in facilitating retinal reattachment. These materials are used as intraoperative instruments to re-establish intraocular volume, assist in separating membranes adherent to the retina, manipulate retinal detachments and mechanically flatten detached retina. Over the longer term, silicone oil maintains intraocular tamponade. One should be cognizant of the potential uses, benefits and risks of each of these vitreous substitutes.

Animals↗

PubMed1993

Intraocular and plasma kinetics of tenoxicam in rabbits.

Non-steroidal anti-inflammatory drugs (NSAID) represent potentially useful agents in the treatment of a number of ocular pathologies, but their intraocular penetration and distribution have not yet been reported. With the aim of clarifying this point, we evaluated the concentrations of the well known NSAID, tenoxicam, in the aqueous and vitreous humors of rabbits treated i.m. with the drug (7 mg/kg). The tenoxicam kinetics in these ocular fluids followed that in plasma with the time-to-peak shifted to higher values in the vitreous (1 h) as compared to that in the aqueous and plasma (40 min). AUC was also higher in the vitreous (10.4 micrograms.h/ml) than in the aqueous humor (2.8 micrograms.h/ml).

Animals↗

PubMed1999

Quantification of intraocular retained perfluorodecalin after macroscopic complete removal.

BACKGROUND: A study was performed to determine the amount of intraocular retained perfluorodecalin after macroscopic complete removal. MATERIAL AND METHODS: Freshly enucleated pig eyes had the anterior segment removed, vitrectomy was carried out, and the eye cups were placed in 0.9% buffered saline solution. One millilitre of perfluorodecalin was instilled for 30 min, followed by a fluid-air exchange. Perfluorodecalin was macroscopically removed. The retina was rinsed twice with 0.9% buffered saline solution. In a second group no rinsing was done, while in a third group no fluid-air exchange was performed. Finally all eye cups were filled with 2.0 ml of the perfluoropolyether Hostinert 130 to dissolve retained perfluorodecalin. The quantity of perfluorodecalin in perfluoropolyether was determined by gas chromatography. RESULTS: Retained perfluorodecalin was detected in all experiments. The smallest portion of perfluorodecalin retained (range 0.04-0.08, mean 0.058%, SD +/- 0.015%) was observed without fluid-air exchange. After fluid-air exchange the portion with rinsing was 0.11-0.27% (mean 0.21%, SD +/- 0.059%) and that without rinsing was 0.51-0.69% (mean 0.60%, SD +/- 0.065%). CONCLUSIONS: Even after macroscopic complete removal of perfluorodecalin a thin layer remains on the retina. If intraoperative fluid-gas exchange is necessary, multiple rinsing with 0.9% buffered saline solution should be performed to reduce the amount of perfluorocarbon liquid retained.

Animals↗

PubMed2002

Intraocular lymphoma.

There are two distinct forms of intraocular lymphoma. One originates within the central nervous system (CNS) and is called primary CNS lymphoma. The second form arises outside the CNS and metastasizes to the eye. When primary CNS lymphoma initially involves the retina, it is named primary intraocular lymphoma (PIOL). Although PIOL is a rare malignancy, the incidence has dramatically increased in the past 15 years. Typical clinical manifestations include blurred vision and floaters. Ophthalmic examination reveals vitreitis and subretinal infiltrates. Diagnosis of PIOL can be difficult and requires neuroimaging, examination of the cerebrospinal fluid and/or vitreous. Molecular analysis detecting immunoglobulin gene rearrangements and ocular cytokine levels showing elevated interleukin (IL)-10 with an IL-10 to IL-6 greater than 1.0 are helpful adjuncts for the diagnosis. Treatment includes systemic chemotherapy and radiation with current regimens favoring the use of chemotherapy first. In contrast, metastatic systemic lymphoma, like other metastatic ocular tumors, is usually confined to the uvea, in particular the choroid. Compared with PIOL, metastatic systemic lymphomas have a much lower prevalence, better prognosis, and are less likely to create a diagnostic dilemma.

Eye Neoplasms↗

PubMed2005

Mouse model of sustained elevation in intraocular pressure produced by episcleral vein occlusion.

We have developed an inducible mouse model of glaucoma based on episcleral vein cauterization (EVC). Intraocular pressure (IOP) elevation in adult mice was produced by cauterizing three episcleral veins. Serial IOP measurements were done by induction-impact tonometry. IOP was significantly elevated by 104+/-20% in 20 out of 23 mice (87%) within the first day after EVC, and remained elevated for 4 weeks, with mean IOP 94% higher in EVC-treated vs. contralateral control eyes. Aqueous outflow blockade was verified from the IOP response to pulsed fluid infusions into the anterior chamber. Retinal ganglion cell (RGC) loss, determined by retrograde labelling using Fluoro-Gold applied to the superior colliculous, was approximately 20% at 2 weeks after EVC. We conclude that episcleral vein occlusion in mice produces significant and sustained elevation in IOP associated with increased outflow resistance and RGC loss, and thus may be useful to model glaucoma in genetically modified and drug-treated mice.

Animals↗

PubMed2005

[Cystoid macular edema in uveitis].

Cystoid macular edema (CME) is the most frequent cause of visual deterioration in uveitis patients. Intraocular inflammation disturbs the blood-retina barrier and leads to retinal edema. The basis of successful treatment is the anti-inflammatory and immunosuppressive therapy of uveitis. Restoration of the blood-retina barrier is mediated by corticosteroids and nonsteroidal anti-inflammatory agents. Resorption of extracellular fluid is improved by systemic carboanhydrase inhibitors. Despite aggressive therapy loss of visual acuity is frequent. Therefore, early diagnosis of CME and initiation of treatment, even if visual acuity is not yet impeded, is mandatory.

Acetazolamide↗

PubMed1995

[Ocular toxoplasmosis: value of immunoblotting for the determination of an intra-ocular synthesis of antibodies].

The aim of this study was to demonstrate the intraocular synthesis of specific antibodies in case of Toxoplasma retinochoroiditis on the basis of immunoblot analysis. Vitreous or aqueous and serum were analyzed by immunoblot in four cases of toxoplasmic chorioretinitis. The same assays were performed on samples from 16 control subjects. Immunoblot analysis of serum and ocular fluid from patients with toxoplasmic chorioretinitis showed IgG and IgA specific antibodies. Recognition patterns were different and demonstrated neo-antibodies in ocular fluid. In control samples only IgG were found and the same patterns were observed in the two compartments. Immunoblot is a useful technique to demonstrate the local synthesis of antibodies in ocular toxoplasmosis by comparison of recognition patterns between serum and ocular fluids. Integration of immunoblot patterns allows quantification of antibodies specific for each Toxoplasma antigen in the two compartments.

Adult↗

PubMed2006

[Intraocular pressure measurement during the day and night for glaucoma patients and normal controls using Goldmann and Perkins applanation tonometry].

OBJECTIVE: Our aim was to evaluate intraocular pressure (IOP) levels in primary open angle glaucoma (POAG) patients and healthy controls during both the day and night while measuring in an upright as well as in a supine position. METHODS: In a prospective clinical trial, 30 glaucoma patients on topical treatment and 50 healthy controls received IOP measurements every 4 h for a 24 h period starting at 8 am. Additionally, blood pressure and heart rate were measured and perfusion pressures were calculated. At 12 am IOP was initially measured in a sitting position and then, after 20 min, in a supine position. At midnight this was carried out conversely. At 4 am IOP was measured in a supine position; all other measurements were performed in a sitting position. Measurements in the sitting position were performed by Goldmann and Perkins tonometry and in a supine position by Perkins tonometry. RESULTS: IOP was 1 mmHg lower in Perkins tonometry measurements compared to Goldmann tonometry. There was no difference between the two patient groups. In a supine position, IOP measured by Perkins tonometry was higher than in an upright position. At 12 am the difference was 1.8 mmHg+/-2.7 mmHg (p=0.001) in healthy subjects and 1.3+/-2.7 mmHg (p=0.013) in the POAG patients. At 12 pm the increase of IOP in the supine position was even more pronounced with 2.4+/-3.4 mmHg in healthy subjects and 5.6+/-3.2 mmHg in the POAG patients (p=0.001). The blood pressure and the perfusion pressure were lowest during night measurements. CONCLUSIONS: During diurnal IOP measurements in an upright position there were no statistically significant differences in IOP changes between groups. However, in a supine position IOP was significantly higher than in a sitting position and increased more in the glaucoma patients than in healthy controls. This observation might be due to a faulty regulation of the fluid shift in glaucoma patients and could cause progression of glaucomatous damage.

Aged↗