Ocular findings in Japanese women with nevus of Ota

Background: Nevus of Ota is common in Japanese women, but most patients are not examined ophthalmologically. Methods: We performed ophthalmologic examinations on 16 Japanese women who had had bluish pigmentation in the periorbital region, sclera, and conjunctiva since birth. Results: Fifteen patients had unilateral involvement, and one had bilateral lesions. The visual acuities were good, and the intraocular pressures were within normal range. All patients had a negative family history. Three patients had light pigmentation in the optic disc in the affected eye. Conclusion: We believe that optic disc pigmentation associated with nevus of Ota, as found in these three patients, may be common but have been rarely described.     

Evolution of ocular clinical and electrophysiological findings in pediatric Bardet-Biedl syndrome

Bardet-Biedl syndrome (BBS) is ahereditary autosomal-recessive disorder,characterized by mental retardation, obesity,pigmentary retinopathy,polydactyly and, only in males, hypogenitalism.Even though genetic studies haverevealed five different forms of BBS correlatedto distinct loci on differentchromosomes, a diagnosis of BBS is stillprimarily based on clinical data. Thepresent study discusses the evolutionof clinical ophthalmological andelectrophysiological characteristics ofBBS patients in developmental age.The main results obtained on asample of 13 pediatric patients are thefollowing: progressive loss of visualacuity arised early in the first decade of life ophthalmoscopic signs of pigmentaryretinopathy were present only in 46%of the children studied striking anomalies in theelectroretinogram were also detectedin the cases without pigmentary retinopathy the electroretinographic results, whendetectable, suggested a greater involvement of thephotopic system as against the scotopic system.     

Deamination of 3-hydroxykynurenine in bovine lenses: a possible mechanism of cataract formation in general

Background: 3-Hydroxykynurenine, a metabolite of tryptophan, acts as UV filter in the human lens. In this study, we looked for this substance and its metabolites in young and old bovine lenses, because of their possible role in the formation of cataract. Methods: The substances were detected by HPLC analysis. The fluorescent substance formed from 3-hydroxykynurenine was characterized by thin-layer chromatography followed by reaction with ninhydrin, UV and fluorescence spectrum analysis, and atom bombardment for molecular mass determination. The kynurenine aminotransferase activity was determined by the method of Tobes. Results: 3-Hydroxykynurenine was detected at concentrations of 0.07, 0.19, and 1.14 g/g of tissue in the bovine iris/ciliary body, retina, and transparent bovine lenses respectively. 3-Hydroxykynurenine was deaminated in old bovine eyes but not in calf eyes. In old eyes, kynurenine aminotransferase activity was 2.7, 3.5, and 9.6 mol/g of tissue per h in retina, iris/ciliary body, and lens respectively. Conclusion: The deamination of 3-hydroxykynurenine resulted in the formation of a fluorescent substance which was identified as oxidized xanthurenic acid. This substance, accumulating in the bovine lens and interacting with lens proteins, could induce cataract formation.     

The use of tissue plasminogen activator in post-traumatic total hyphaema

Background: We wanted to evaluate whether intracameral injection of tissue plasminogen activator (tPA) is useful in managing traumatic hyphaema. Methods: Two eyes with total hyphaema after a severe penetrating injury were treated with a single intracameral injection of 25 g of tPA 5 and 14 days after the injury, respectively. Results: Most of the blood coagulum dissolved within 24 h, and in one of the two eyes the intraocular pressure decreased from 45 to 8 mmHg. The other eye was hypotonic. No re-bleeding or complications related to the use of tPA were noticed. Conclusion: The results in these two cases suggest that tPA is a useful adjunct in managing total hyphaema.     

HLA antigens in a Japanese family with Behçet's disease

Background: Familial Behçet's disease is rare. Methods: HLA antigens in a Japanese family with Behçet's disease were examined. Results: The affected patients had HLA B51, and unaffected family members also had the same antigen. Conclusion: It is likely that not only HLA B51 but also other factors may be involved in the pathogenesis of Behçet's disease in Japanese patients.     

Unusual retinal pigment epitheliopathy and choroidopathy in carcinomatosis: A rare case of cancer-associated retinopathy

Background: Cancer-associated retinopathy is a syndrome causing ocular symptoms. It is a rare entity and only a few cases have been reported. Methods: A 67-year-old woman with small-cell endometrial carcinoma suffering from deterioration of visual acuity is presented. Results: The patient presented with extensive mottled changes of the retinal pigment epithelium, accompanied by diffuse subretinal fluid in the posterior pole and exudative retinal detachments inferior in both eyes. Conclusion: This patient suffered from a rare variety of cancer-associated retinopathy.     

The effect of nasolacrimal occlusion on drug-induced mydriasis

Background: Nasolacrimal occlusion has been shown to improve the efficacy of some topically applied ocular drugs. The aim of this study was to investigate the effect of nasolacrimal occlusion on tropicamide-induced mydriasis. Methods: We compared pupillary dilatation by 0.125% tropicamide with and without nasolacrimal occlusion in 40 healthy volunteers. Results: Analysis of variance with repeated measures failed to show any advantage due to nasolacrimal occlusion in drug-induced mydriasis. Conclusion: Nasolacrimal occlusion did not increase the mydriasis obtained with 0.125% tropicamide.     

Ultrasound biomicroscopic analysis of the effect of pilocarpine on the anterior chamber angle

Background: This study was carried out to determine the effects of pilocarpine on the anterior chamber angle in healthy volunteers. Methods: We measured changes in anterior chamber depth (ACD), trabecular-iris angle (TIA), angle opening distance at 250 and 500 m from the scleral spur (AOD250 and AOD500), and iris thickness using ultrasound biomicroscopy in 48 eyes of 48 normal volunteers (ages 18–57 years, mean 34.8 years) before and 1 h after instillation of 2% pilocarpine. Results: Pilocarpine altered the TIA by –18.6° to + 10.5° (mean –4.16°), and change in the TIA increased significantly and linearly in relation with decrease in the pretreatment TIA (r = 0.929). Pilocarpine altered AOD250 change by –136 to +94 m (mean –38 m) and AOD500 by –151 to +157 m (mean –42 m); changes in the AOD250 and AOD500 were significantly correlated to the pretreatment AOD250 and AOD500 values, respectively (r = 0.923 andr = 0.896, respectively). The pilocarpine-induced change in the ACD showed a linear relationship to the pretreatment ACD (r = 0.887). The changes in the TIA, AOD250 and AOD500 showed greater increases in association with lower pretreatment ACD (r = 0.848,r = 0.891,r = 0.842) and smaller change in the ACD (r = 0.834,r = 0.839,r = 0.812). Conclusions: The response of the anterior chamber angle to pilocarpine, narrowing or widening, depended on its pretreatment state. The ability to predict the pilocarpine-induced change in the angle before the instillation of pilocarpine would be helpful in treating patients with glaucoma.     

Pressure sore in a patient who underwent repair of a retinal tear with gas injection

Purpose: To demonstrate a pressure sore following strict head positioning in a patient who underwent encircling band, vitrectomy and gas injection. Methods: A male patient was admitted to the hospital with a large posterior horseshoe tear in the inferior temporal retina with severe vitreous traction and retinal detachment. Encircling band, vitrectomy cryotherapy and gas injection was performed. After surgery the patient was instructed to sit in a facedown position. Results: A pressure sore resulted from prolonged immobility of the right elbow due to face-down positioning following encircling band, vitrectomy and gas injection. Conclusion: A patient injection. Conclusion: A patient may rarely have compulsive personality traits that result in extreme compliance to the physician's recommendations; therefore, general instructions given for head positioning should include permission for a change in position when required, at least for brief periods of time.     

Measurement of basal tear turnover using a standardized protocol

Background: The aim of this study was to compare basal tear turnover values of healthy volunteers in different countries. Methods: Healthy volunteers aged between 20 and 70 years were selected in three European cities. Basal tear turnover values were calculated according to a standardized protocol from the decay of the fluorescein concentration in tears after instillation of 1-l drop of fluorescein in the conjunctival sac. Fluorescein concentration was measured with identical commercial fluorophotometers. A monoexponential decay of fluorescein was assumed to represent basal tear flow. Results: The mean tear turnover values were 13.1%/ min ± 4.6 SD (n=4), 16.0%/ min ± 5.2 SD (n=24) and 17.5%/ min ± 3.4 SD (n = 20) in Clermont-Ferrand (France), Leiden (The Netherlands) and Madrid (Spain), respectively. The differences between the values were not significant (Mann-Whitney test P > 0.09). Conclusions: The tear turnover in the different cities was similar. The methods used were simple and the software easy to use.Concerted Action, supported in part by the European Commission, on Ocular Fluorometry: Standardization and Instrumentation Development of the 4th European Community Medical and Health Research Programme (No. MR 4*/0314/P).     

Actinomyces infection in porous polyethylene orbital implant

Background: A 60-year-old patient developed actinomycotic inflammation within a porous polyethylene orbital implant which she received following enucleation. Methods: She had repeated conjunctival exposures with inflammation the primary implant was removed and replaced with another one. Results: The anterior two-thirds of the porous implant was infiltrated with numerous actinomycotic granules surrounded by polymorphonuclear cells and necrotic debris. The organisms were demonstrated with Gram stains on the histopathologic preparations and with scanning electron microscopy. Within the zones of inflammation, the polyethylene skeleton of the implant was extensively damaged. Conclusion: Actinomycetes have been described as causative organisms in conjunctivitis, blepharitis, canaliculitis, dacryocystitis and keratitis, but to the best of our knowledge actinomycotic involvement has never been reported in an infected porous orbital implant.     

Increased release of tenascin in tear fluid after photorefractive keratectomy

Background: Extracellular matrix protein tenascin (TN) is expressed in the anterior stroma during corneal wound healing. In this study we analysed TN release in tear fluid after photorefractive keratectomy (PRK). Methods: Tear fluid TN concentrations of ten PRK patients were measured with an immunoassay. Tear fluids were collected preoperatively and 1, 2 and 7 days after PRK. The tear fluid collection time and the volume of tears collected were registered. Because tear fluid flow was greatly increased postoperatively, tear fluid flow-corrected release (TN flux) was calculated. Results: The tear fluid flow was 4.50±0.94 l/min (mean±SEM) preoperatively, 55.48±16.70 l/min (P<0.01) on the 1st, 33.91±7.91 l/min (P<0.01) on the 2nd, and 13.79±5.49 l/min (P>0.05) on the 7th postoperative day. The preoperative TN concentration was 0.85±0.20 g/ml. On the 1st postoperative day it decreased to 0.37±0.17 g/ml (P>0.05), most likely due to the dilution effect caused by hypersecretion after PRK. The TN concentration was 0.67±0.12 g/ml (P>0.05) on the 2nd and 0.78±0.15 g/ml (P>0.05) on the 7th postoperative day. The preoperative TN flux was 5.23±1.88 ng/min. On the 1st and 2nd postoperative days the TN flux was 14.40±4.99 ng/min (P<0.05) and 22.66±6.I2 ng/min (P<0.05), respectively. On the 7th postoperative day a tendency towards decreased flux (14.00±6.02 ng/min, P>0.05) was observed. Conclusion: Although there is a minor decrease in TN concentration after PRK due to increased tear fluid flow, a significant increase in TN flux was observed. Complete reepithelialization of the ablated area was observed in all eyes at the follow-up visit on postoperative day 7.     

The effect of preservatives and antiglaucomatous medication on the histopathology of the conjunctiva

Background: Topical medication applied chronically for the treatment of glaucoma changes the cellular profile of the conjunctiva. We wanted to determine the role of preservatives, which are usually combined with the drugs, on this effect Methods: We applied metipranolol 0.3 % and pilocarpine 2 % with and without benzalkonium chloride 0.01 % and cetrimonium chloride 0.004 %, respectively. Twenty-four rabbits, divided into four groups, were treated for 3 months. The complete globes and the adherent bulbar conjunctiva were examined histopathologically and immunohistochemically Results: With special stains for collagen, a slight increase of the thickness of subepithelial collagen of the conjunctiva was present in both groups treated with medication and preservative compared with eyes treated with medication alone. This effect was also true for special antibodies for collagen type IV and -smooth muscle actin in the eyes treated with pilocarpine, but not in the eyes treated with metipranolol Conclusion: The results suggest that preservatives may have an additional adverse effect on the conjunctiva in addition to the effects of the medications alone.This paper was presented in part at the First Annual Meeting of the European Community Ophthalmic Research Association (ECORA), Bonn, Germany, 4 October 1993The authors have no financial or other interest in any of the substances used in this study     

Distribution of calcium and sulphur in the blue-light-exposed rat retina

Background: Blue-light exposure inhibits cytochrome oxidase and may therefore inhibit retinal metabolism. The reduced metabolism decreases the extrusion of calcium from the photoreceptor cell. Overload of calcium is proposed as one of the factors that lead to photoreceptor degeneration after light exposure. The light-induced photoreceptor degeneration can be ameliorated by calcium overload blocker. In the present study the calcium concentration was measured in the inner and outer segment layer of the rat retina. Methods: Six eyes were exposed to blue (404 nm) light at a retinal dose of 380 kJ/m². Five eyes served as the control group. The calcium and sulphur distributions were measured with a nuclear microprobe in the freeze-dried rat retina. The proton beam size was 12 × 12 m and the energy of the protons was 2.55 MeV The calcium concentration was calculated using sulphur as a reference. Results: The level of calcium per milligram sulphur was 21 g (range 17–23 g) in the inner segment of the control retina. It increased to 62 g/mg sulphur (range 52–67 g) and 61 g/mg sulphur (range 58–66 g) 1 h and 12 h after blue-light exposure, respectively. Conclusion: The findings of the present study support the idea that accumulation of calcium in the inner segment layer is one of the factors that cause photoreceptor degeneration.     

Transforming growth factor-β regulates human retinal pigment epithelial cell phagocytosis by influencing a protein kinase C-dependent pathway

Background: Transforming growth factor- (TGF-) plays an important role in the pathogenesis of many ocular diseases, including proliferative vitreoretinopathy. We examined the effect of TGF- on the phagocytosis of rod outer segments by retinal pigment epithelium (RPE), which is a major function of RPE, and investigated the dependence of this effect on the protein kinase C (PKC) pathway. Methods: Phagocytotic uptake of fluoresceinated bovine rod outer segments was determined by flow cytometry. RPE cells were treated with TGF-1 or TGF-2 and their effects on phagocytosis were examined. The effects of various PKC inhibitors (calphostin C, staurosporine, and extended exposure to phorbol 12-myristate 13-acetate, PMA) and a stimulator (brief exposure to PMA) on RPE phagocytosis was evaluated. Results: Both TGF-1 and TGF-2 up-regulated RPE phagocytosis and PMA abolished the upregulating effect of TGF-. In contrast, PKC inhibition by staurosporine and calphostin C resulted in increased phagocytosis. A combination of TGF- and PKC inhibitor treatment did not produced any additive effect on phagocytosis. Conclusion: We concluded that TGF- up-regulates human RPE phagocytosis, but that this effect is counteracted by PKC activation. It is possible that this TGF--induced effect is due, in part, to a negative modulation of the PKC-dependent pathway.     

Ab interno infrared laser trabecular ablation: Preliminary short-term results in patients with open-angle glaucoma

Background: Outflow obstruction of trabecular drainage structures results in elevation of intraocular pressure (IOP) in various forms of chronic open-angle glaucoma. In vitro studies have shown that laser trabecular ablation (LTA) with opening of Schlemm's canal can be reproducibly performed by use of infrared lasers with minimal damage to collateral tissue structures. Methods: In order to investigate the clinical applicability and efficacy of ab interno contact laser photoablation of trabecular meshwork in the surgical treatment of human glaucoma, we conducted a pilot study using an erbium: YAG laser (2.94 m) with a quartz fiber endoprobe (320 m core diameter) applying 10–20 single laser pulses (5–7 mJ) to the trabecular mesh-work. Results: Under goniocopic visualization trabecular tissue was photovaporized in eight patients with primary or secondary chronic open-angle glaucoma. Intraoperalively, moderate reflux bleeding occurred from laser-induced craters. No major intra- or postoperative complications occurred. Preoperative and postoperative gonioscopy of the treated area demonstrated successful removal of trabecular tissue. Mean IOP was reduced from 36.1 mmHg of 21.3 mmHg at a limited follow-up of 3 months. Conclusion: With modifications this technique may have clinical potential in the surgical management of glaucoma. Prospective long-term studies with more patients are warranted to evaluate the outcome of LTA.     

Surgical risk factors for severe postoperative proliferative vitreoretinopathy (PVR) in retinal detachment with grade B PVR

Background: Previous studies have shown that grade B proliferative vitreoretinopathy (PVR) is a considerable risk factor for the development of severe postoperative PVR. We conducted a prospective study to elucidate which surgical procedures used in retinal detachment management may stimulate the PVR process in such eyes. Materials and methods: The study included 156 eyes of 152 consecutive patients with rhegmatogenous retinal detachment complicated by grade B PVR referred before any failed surgery and operated on between 1983 and 1993. The parameters evaluated by multivariate statistical analysis included the cumulative circumferential extent of the retinal tears, the extent of the scleral buckle, gas injection, vitrectomy, the method used for retinopexy, and the time of surgical management during the period of the study. Results: The incidence of severe postoperative PVR was 25.8% in eyes managed with cryotreatment versus 2.2% in eyes managed with argon laser photocoagulation (P=0.001). The rate of severe postoperative PVR was not influenced by the other surgical variables. Conclusion: We conclude that cryotherapy may be a risk factor for the development of severe postoperative PVR in retinal detachments associated with grade B PVR.     

Indocyanine green and fluorescein angiography of surgically excised macular choroidal neovascularizations: correlations with histopathologic and ultrastructural findings

Background: Informations are expected from the histopathological study of surgically excised choroidal neovascular membranes (CNMs), particularly in relation to the angiographic aspects of vascular architecture. Methods: Fluorescein and indocyanine green (ICG) angiograms were studied together with the histopathological features of 12 surgically excised subfoveal CNMs in eyes affected by age-related macular degeneration (ARMD). Results: Instead of the early and delayed diffuse hyperfluorescence secondary to CNMs observed on fluorescein angiography (seven were well defined, five scar evolved), ICG revealed (a) very early hypofluorescence of the membrane bulk over the fluorescence of the outer choroidal vascular bed and (b) late hyperfluorescence gradually increasing and partially defining the border of membranes. CNMs with well-defined hyperfluorescent aspects were characterized by fibrovascular bulk lined on one side by retinal pigment epithelium. Fibrosis reaction predominated over the vascular components in scar-evolved membranes. Conclusions: Fluorescein and ICG angiographic differences in the appearance of CNMs could depend on (a) the morphological structure and size of the CNM (b) its location within the chorioretinal layers and (c) different molecular characteristics of the dyes used.     

Blood-retina barrier in acute retinal branch vein occlusion

Background: Extensive clinical studies on retinal branch vein occlusion have not yet been able to clarify its pathogenesis. A study designed to look at the associated blood-retina barrier changes may contribute to a better understanding of the different forms of evolution of this pathology. Methods: A prospective study was done in seven patients with recent large temporal branch vein occlusion. Vitreous fluorophotometry, fluorescein angiography and retinal colour photography were performed within the 1st week after the onset of symptoms, 1 week later, and at 12 and 24 weeks. Results: A more marked blood-retina barrier breakdown was found at 1, 2, 12 and 24 weeks in the eyes that later developed extensive capillary non-perfusion. Conclusions: Our results suggest that the breakdown of the blood-retina barrier may play an important role in the subsequent development of retinal nonperfusion in eyes with large branch vein occlusion. We postulate that the eyes that will present later extensive capillary nonperfusion develop, from the initial stages of the disease, a progressive ischaemic capillaropathy characterized by blood-retina barrier breakdown. Retinal pigment epithelium degeneration and arterial lumen narrowing, secondary to the vein obstruction, may help to increase and perpetuate the blood-retina barrier breakdown during the first 6 months after the occlusion.     

Hemodynamic parameter estimation from ocular fluorescein angiograms

Background: A method is proposed for parameterizing choroidal blood flow from fluorescein angiograms. Methods: After digitizing and aligning the angiographic sequence, the intensity build-up curves of fluorescence are analysed per pixel (approx. 10 m in fundo). Two models are compared. A one-compartment model predicts an exponential build-up curve, from which the following parameters are estimated: maximum fluorescence, dye appearance time and local perfusion rate (reciprocal of the time constant of the exponential). To account for the contribution of the systemic circulation to the shape of the build-up curve, a two-compartment model is used which predicts a bi-exponential curve. Results: Introduction of the second (systemic) compartment resulted in a significant improvement of fit in 37 of 48 patients studied. The rate constants of the systemic compartment found were mainly in the range of 0.30–1.00 s^–1. Conclusion: For the individual patient, the local perfusion rates may vary strongly, with lower perfusion rates possibly being of prognostic value for ocular diseases such as glaucoma or diabetic retinopathy.