High-resolution ultrasonography in central serous chorioretinopathy

PURPOSE: To investigate the use of high-resolution ultrasonography for detecting choroidal layer abnormalities in eyes with central serous chorioretinopathy (CSC). DESIGN: Prospective observational case series. METHOD: Optical coherence tomography (OCT) and high-resolution ultrasonography with a 20-MHz immersion probe were performed bilaterally in 10 patients, of whom 5 were affected by unilateral active CSC and 5 by unilateral cystoid macular edema (CME). Ten age-matched control subjects were also investigated. RESULTS: Both OCT and high-resolution ultrasonography showed a macular elevation in eyes with CSC and CME. High-resolution ultrasonography has shown evidence of a nonechogenic linear band under the retinal pigment epithelium in patients affected by CSC. This could be found in neither patients with CME or in control subjects. CONCLUSION: High-resolution ultrasonography can detect a nonechogenic space consistent with hyperpermeability of choroidal capillaries in eyes with active CSC. Shadowing by an altered retinal pigment epithelium cannot be ruled out, however.     

大肠杆菌内毒素诱导的大鼠眼内炎表现及细胞因子的表达

Objective To observe the histopathologic features and expression patterns of tumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β) and Escherichia coli lipopolysaccharide (LPS) in the rat vitreous with LPS induced-endophthalmitis. Methods Wistar rats were randomly divided into saline control group (SC, 136 rats),endophthalmitis group (EO, 168 rats)and blank control group (BC, 12 rats). EO group received an intravitreal injection of 5βl LPS; SC group received 5μl sterile saline and no intervention for BC group. Six, 12, 24, 48, and 72 hours, 5 and 7 days after injection, intraocular inflammation were observed and the eyes and vitreous were collected for histopathological examination and measurement of TNF-α, IL-1β and LPS expression. Results Severe inflammatory responses in the eyes were observed in EO group between six and 72 hours after LPS injection, ocular inflammation subsided seven days after LPS injection. In the vitreous, a peak neutrophil count was observed at 24 hours (1224. 64±132.2) cells/eye that rapidly declined at 72 hours (342. 25± 47. 7) cells/eye. The levels of TNF-α and IL-1β in EO group were peaked at 24 hours with (996.18±89.45) and(5556±1440) pg/L, respectively;Persisted at 48 hours and began to decline rapidly thereafter. Seven days after LPS injection, levels of TNF-α and IL-1β returned to baseline with (22.16 ±5.84) and (73.7±18. 7) pg/L, respectively. LPS concentration in EO group decrease rapidly at 72 hours with (11.03±3.41) ng and disappear on days 7 with (0.22±0.08) ng after LPS injection. Conclusions Massive neutrophils infiltration, high levels expression of TNF-α and IL-1β and spontaneous elimination of bacterial elements in vitreous cavity were major pathologic characteristics in this experimental model. The expression patterns of TNF-α, IL-1β were in accord with LPS clearance process.     

大肠杆菌内毒素诱导的大鼠眼内炎表现及细胞因子的表达

Objective To observe the histopathologic features and expression patterns of tumor necrosis factor-α (TNF-α), interleukin-1β(IL-1β) and Escherichia coli lipopolysaccharide (LPS) in the rat vitreous with LPS induced-endophthalmitis. Methods Wistar rats were randomly divided into saline control group (SC, 136 rats),endophthalmitis group (EO, 168 rats)and blank control group (BC, 12 rats). EO group received an intravitreal injection of 5βl LPS; SC group received 5μl sterile saline and no intervention for BC group. Six, 12, 24, 48, and 72 hours, 5 and 7 days after injection, intraocular inflammation were observed and the eyes and vitreous were collected for histopathological examination and measurement of TNF-α, IL-1β and LPS expression. Results Severe inflammatory responses in the eyes were observed in EO group between six and 72 hours after LPS injection, ocular inflammation subsided seven days after LPS injection. In the vitreous, a peak neutrophil count was observed at 24 hours (1224. 64±132.2) cells/eye that rapidly declined at 72 hours (342. 25± 47. 7) cells/eye. The levels of TNF-α and IL-1β in EO group were peaked at 24 hours with (996.18±89.45) and(5556±1440) pg/L, respectively;Persisted at 48 hours and began to decline rapidly thereafter. Seven days after LPS injection, levels of TNF-α and IL-1β returned to baseline with (22.16 ±5.84) and (73.7±18. 7) pg/L, respectively. LPS concentration in EO group decrease rapidly at 72 hours with (11.03±3.41) ng and disappear on days 7 with (0.22±0.08) ng after LPS injection. Conclusions Massive neutrophils infiltration, high levels expression of TNF-α and IL-1β and spontaneous elimination of bacterial elements in vitreous cavity were major pathologic characteristics in this experimental model. The expression patterns of TNF-α, IL-1β were in accord with LPS clearance process.     

大肠杆菌内毒素诱导的大鼠眼内炎表现及细胞因子的表达

目的 观察大肠杆菌内毒素(LPS)诱导的大鼠眼内炎模型组织病理学特征和玻璃体内肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和LPS的表达模式.方法 采用随机数字表法将大鼠随机分为生理盐水对照组(SC组)136只、眼内炎组(EO组)168只、空白对照组(BC组)12只.E0组玻璃体腔注射5 μl LPS溶液诱导眼内炎动物模型;SC组注入等量无菌生理盐水;BC组不作任何干预.注射后6、12、24、48、72 h,5、7 d,观察大鼠眼部炎症表现并分别摘除各组眼球行组织病理学检查,并取其玻璃体检测细胞因子TNF-α、IL-1β和LPS的浓度.结果 EO组注射后6～72 h,眼内可见严重炎症反应,注射后7 d炎症基本消退.注射后24 h,眼内白细胞浸润数量为(1224.64±132.2)个/眼,达到高峰;注射后72 h,浸润细胞数量迅速下降至(342.25±47.7)个/眼.EO组注射后24 h,TNF-α和IL-1β浓度分别为(996.18±89.45)、(5556±1440)pg/ml,均达到高峰并持续至注射后48 h,随后迅速下降;注射后7 d,TNF-α和IL-1β浓度分别为(22.16±5.84)、(73.7±18.7)pg/ml.EO组注射后72 h,玻璃体腔内LPS含量迅速下降为(11.03±3.41)ng,7 d后玻璃体腔内LPS含量为(0.22±0.08)ng.结论 大鼠眼内炎模型的主要病理特征是大量白细胞眼内浸润,TNF-α、IL-1β的高水平表达以及玻璃体腔自发性细菌成分清除;TNF-α、IL-1β表达模式与LPS眼内清除过程一致.     

High-resolution ultrasonic imaging of the posterior segment

PURPOSE: Conventional ophthalmic ultrasonography is performed using 10-megahertz (MHz) transducers. Our aim was to explore the use of higher frequency ultrasound to provide improved resolution of the posterior pole. DESIGN: Prospective case series. PARTICIPANTS: One normal subject and 5 subjects with pathologies affecting the posterior coats, including nevii, small melanomas, and macular hole. METHODS: We modeled the frequency-dependent attenuation of ultrasound across the eye to develop an understanding of the range of frequencies that might be practically applied for imaging of the posterior pole. We compared images of the posterior coats made at 10, 15, and 20 MHz, and 20-MHz ultrasound images of pathologies with 10-MHz ultrasound and optical coherence tomography (OCT). MAIN OUTCOME MEASURES: Ability to resolve normal and pathologic structures affecting posterior coats of the eye. RESULTS: Modeling showed that frequencies of 20 to 25 MHz might be used for posterior pole imaging. Twenty-megahertz images allowed differentiation of the retina, choroid, and sclera. In addition, at 20 MHz the retina showed banding patterns suggesting an internal structure comparable in many respects to that seen in OCT and histology. Images of ocular pathology provided much improved detail relative to 10-MHz images and deeper penetration than OCT. CONCLUSIONS: Twenty-megahertz ultrasound can be practically employed for imaging of the posterior pole of the eye, providing a 2-fold improvement in resolution relative to conventional 10-MHz instruments. Although not providing the resolution of OCT, ultrasound can be used in the presence of optical opacities and allows evaluation of deeper tissue structures.     

全视场光学相干层析技术的角膜高分辨率成像

目的:针对活体共聚焦显微镜(in vivo confocal microscopy,IVCM)和传统光学相干层析技术(optical coherence tomography,OCT)在人眼角膜成像各自存在成像视野小或无法细胞成像的限制,开发具有高分辨率的非接触全视场光学相干层析系统(full-field optica...     

High-resolution photography of the retinal nerve fiber layer

Abnormalities in the appearance of the retinal nerve fiber layer can indicate the presence of optic nerve atrophy, but a major problem has been the difficulty of visualizing the nerve fiber layer in some individuals. By selectively illuminating the white nerve fiber layer in comparison with the red retinal pigment epithelium and choroidal background, red-free light increases the visibility of the nerve fiber layer. Compared with the standard red-free photographic technique, a 560-nm short-pass cut-off filter, used with extended-range, high-resolution, extremely fine-grain film (Kodak No. 2415 Technical Pan film), considerably enhanced the ability to resolve nerve fiber bundles.     

On slit-lamp microscopy

Theoretically the contact lens with a refractive power of -64 dioptres is superior to the concave pre-set lens (Hruby lens) or the convex lens (Bayadi). In practice the results are as follows: With the convex lens the examination of the vitreous is unsatisfactory. The reversed image with the convex lens will become familiar with some experience as one will also get used to the mirror images of the three-mirror contact lens. However, the abnormal curvature of the image is really a nuisance. On the other hand the large field of view is an advantage. The convex lens is only practically useful when it can be firmly attached to the slit-lamp microscope, as otherwise the new adjustment necessary for searching the fundus is too difficult. Attachment to the microscope is also of advantage with the Hruby lens. The concave contact lens of 64 dioptres is best suited for detailed examination of vitreous and fundus and for measurements. When no value is placed on a minute examination and a quick simple orientation suffices, the concave pre-set lens (Hruby lens) has the advantage that the lens does not have to be placed on the eye. If it is centred to the middle axis of the microscope, it facilitates especially quick observation. There will be cases where the pre-set lens will be the only answer, especially shortly after an operation or with very sensitive patients. Furthermore, the Hruby lens is preferable to the Bayadi lens because the vitreous can be better examined. The Hruby lens is also advantageous for examination of the region in the middle, lateral periphery of the fundus, 30 degrees - 60 degrees, and is superior in this area to the simple concave contact lens. The Bayadi lens seems to us only indicated for fundus examination of extremely high myopes. There it definitely offers advantages over and above the concave lens. For the most peripheral fundus, expecially below and above, the three-mirror lens with its modification is so far the best method. Especially for examination of the vitreous good brightness of the slit image is required for stereoscopic examination with as large an angle as possible between microscope and illumination. The lateral parts of the most peripheral fundus cannot be examined with the vertical slit in connection with the three-mirror lens. However, this is possible with the horizontal and tilted position of the slit and intermediate positions with an oblique slit. The slit must form an angle with the microscope in order to examine vitreous and fundus in optical section. With the indentation contact lenses ciliary processes and pars plana are now accessible to slit-lamp microscopy.     

Clinical specular microscopy

Clinical specular microscopy (CSM) has recently been introduced as a means of qualitative and quantitative examination of the human corneal endothelium at high magnification. With the aid of CSM, a decline in endothelial cell density with age has been documented and several endothelial abnormalities from disease or trauma can be detected. Donor material for corneal grafting can be examined by CSM and keratoplasty procedures can be designed to decrease endothelial damage. Cataract surgical procedures can cause endothelial cell loss. According to most studies, intracapsular extraction causes less cell loss than does phacoemulsification, and cataract extraction with intraocular lens (IOL) insertion causes the greatest loss. Cell loss from IOL can be minimized by decreasing lens-corneal contact. Elevated intraocular pressure may lead to endothelial cell loss, as may therapy with epinephrine. Endothelial toxicity of other drugs and solutions can be studied by CSM. While long term studies are necessary to correlate the morphologic changes detected by CSM with future endothelial function, shortterm studies can be helpful in developing medical and surgical techniques that minimize corneal endothelial trauma.