Differentiation of ischemic from non-ischemic central retinal vein occlusion during the early acute phase

We investigated prospectively in 128 patients (140 eyes) the role of six routine clinical tests in the differentiation of ischemic central retinal vein occlusion (CRVO) from non-ischemic CRVO during its early acute phase. There were fourfunctional tests [visual acuity, visual fields, relative afferent pupillary defect (RAPID), electroretinography (ERG)] and twomorphologic tests (ophthalmoscopy and fluorescein fundus angiography). We found that none of the six tests had 100% sensitivity and specificity in such a differentiation during the early, acute phase, so that no one test can be considered a gold standard; however, combined information from all six is almost always reliable. Overall, the four functional tests proved far superior to the two morphologic tests in differentiating ischemic from non-ischemic CRVO: RAPID was most reliable in uniocular CRVO (with a normal fellow eye), followed closely by ERG in all cases; combined information from RAPID and ERG differentiated 97% of cases; perimetry was the next most reliable, followed by visual acuity. The two morphologic tests performed worst; fluorescein angiography provided either no information at all on retinal capillary nonperfusion (in at least one-third of the eyes during the early, acute phase) because of multiple limitations, or sometimes provided misleading information. Ophthalmoscopic appearance is the least reliable, most misleading parameter.A preliminary summary of this was presented at the Macula Society Meeting, Cannes, France (June, 1987) and at the XVIth Meeting of the Club Jules Gonin, Bruges, Belgium, 4–8 September 1988. This investigation was supported by grant EY-1151 from the National Institutes of Health and, in part, by unrestricted grants from Research to Prevent Blindness, Inc., and from Alcon Research Institute     

Correlation of electroretinographic and fluorescein angiographic findings in unilateral central retinal vein obstruction

Background: In central retinal vein obstruction (CRVO), electroretinogram (ERG) abnormalities and extensive retinal capillary dropout (CD) in the fluorescein angiogram (FA) are good indicators of retinal ischemia. We retrospectively studied patients with unilateral CRVO and compared the ERG and FA results Methods: Single white flash ERG, photopic ERG, scotopic ERG and flicker ERG were recordered in 30 cases of unilateral CRVO. We analyzed the correlation between the ERG results and the presence/absence of extensive CD Results: The ERG b/a-wave amplitude ratios, photopic and scotopic b-wave amplitudes, and flicker amplitudes were significantly smaller (P<0.05) in eyes with extensive CD (n=12, 40%), than in eyes without (n=18, 60%). When the photopic or scotopic b-wave amplitudes were normal or supernormal, extensive CD on FA was absent in all eyes. When the b/a-wave ratios were 1.0 or when the b-wave amplitudes with white flash or flicker amplitudes were normal or supernormal, extensive CD was present in less than 32% of eyes Conclusion: These results suggest that the ERG results, especially the b/awave amplitude ratio, are significantly correlated with the presence/absence of CD on FA in CRVO.     

Histochemical survey of the anterior segment of the normal human foetal and adult eye

The distributions of the lysosomal enzymes [acid phosphatase (AP),N-acetyl--d-glucosaminidase (NAG), -glucuronidase (-Gluc), -galactosidase (-Gal), dipeptidylpeptidase II (DPP II)] and of the membrane-bound proteases [aminopeptidase M (APM), aminopeptidase A (APA), -glutamyltransferase (GGT), dipeptidylpeptidase IV (DPP IV)] were investigated in the normal human adult and foetal anterior segment by histochemical methods. The distribution of these hydrolases varied between ocular tissues. The most active enzymes in the adult corneal epithelium and endothelium were AP, -Gluc, NAG, -Gal and GGT; in the keratocytes, APM, APA, -Gluc and GGT predominated. The adult trabecular meshwork cells were stained by AP, -Gluc, NAG, APM, GGT, DPP II and DPP IV. The enzymes AP, -Gluc, APM and APA, however, displayed greater activity in the endothelium of Schlemm's canal. The adult ciliary epithelium stained strongly for all lysosomal hydrolases; GGT was the most active protease here. Differences in enzyme activity were noted in some tissues when foetal and adult anterior segments were compared. There appeared to be a decrease in the activity of some enzymes with age and post-mortem delay greater than 24 h. The function(s) of each enzyme and their possible roles in the respective tissues are discussed.     

Integrins in human anterior chamber angle

Background: Integrins, which are composed of an and subunit, are capable of binding to a number of extracellular matrix proteins and, hence, affect cell adhesion and proliferation.Methods: The distribution of the integrin (₁, ₃-₅) and (_1–6 and _v) subunits in human anterior chamber angle was studied in eyes from subjects aged 9 months to 81 years using the indirect immunofluorescence technique.Results: Immunoreaction for the ₁ subunit was found throughout the trabecular meshwork (TM), in the cribriform layer, and in the endothelial lining of Schlemm's canal (SC). Labelling for the ₃ subunit was found in the TM and the cribriform layer only. In infant eyes the ₅ subunit was present in all three areas with the highest concentration in the cribriform layer, whereas no reaction was observed in adult eyes. The ₆ subunit was localized to the endothelium of SC only. Immunoreaction for the _v subunit was present in the TM and the cribriform layer of infants and young adults.Conclusion: The present results suggest the presence of several integrin heterodimers, acting as potential receptors for laminin, collagen, fibronectin, and vitronectin, in the anterior chamber angle.     

Zum Kammerwasserabfluß des Primatenauges — ein Modell

Zusammenfassung An Hand eines Abflußmodells eines Primatenauges wird das Zeitverhalten des Druckes im Schlemmschen Kanal bei intraocularer Druck- und episkleraler Venendruckänderung untersucht. Die elastische Membran des Trabekelsystems folgt jeder intraocularen Druckschwankung und könnte damit als Pumpmechanismus wirken. Der entstandene Druckanstieg im Schlemmschen Kanal gleicht sich durch verstärkten Abstrom aus.

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Summary In an outflow model of primate eye the relation-time of pressure in Schlemm's channel is investigated by changes of intraocular pressure and episcleral venous pressure. The elastic membran of the trabecal system follows every oscillation of the i.o. pressure and so it effects like a mechanism of pump. The increased pressure in the Schlemm's channel is compensated by increase of the outflow.

     

Employment of bioluminescence for the quantification of adenosine phosphates in the human cornea

Background: Quantification of adenosine phosphates in human corneal extracts has been performed using spectrophotometry. We employed the bioluminescence technique to obtain a more sensitive assay for adenosine phosphates and to reduce the volume of the test sample. Methods: The bioluminescence assay for ATP, already known from sterility control, was modified and expanded. Standard curves were established using a standard solution with equimolar concentrations of ATP, ADP and AMP. To monitor the method, adenosine phosphates were measured in 35 human corneal extracts using both spectrophometry and bioluminescence. Results: Linear standard curves ranging from 1 to 45 pmol were established. The two methods yielded comparable results despite the use of a basic dilution of 1: 100 for the new technique. Conclusion: Bioluminescence provides a highly sensitive quantification of adenosine phosphates in the human cornea and facilitates an extremely detailed evaluation of the metabolic status of the cornea.Dedicated to Prof. Martin Reim on the occasion of his 65th birthday     

Zur Histologie des Netzhauteinrisses

Zusammenfassung An Hand von histologischen Bildern kann gezeigt werden, daß es sich bei den zunächst der Netzhaut aufliegenden (später diese mehr oder weniger ersetzenden) sklerotischen Arealen um Bindegewebszellen (proliferierte Glaskörperrindenzellen und manchmal Zellen aus dem Gefäßbindegewebe) eventuell in Verbindung mit stark pigmentierten (Pigmentepithelien) Zellen mit reichlicher, hyalinisierender bzw. sklerosierender (sklerotisches Areal) Zwischensubstanz handelt. Diese Areale treten bevorzugt im Bereiche des Ansatzes von Glaskörperverdichtungen an der Netzhaut auf. Sowohl ein oberflächlich liegendes größeres sklerotisches Areal als auch — im Bereiche des Netzhautloches — ein Netzhautdeckel (proliferierte Glaskörperrindenzellen in fester Verbindung mit relativ unveränderter Netzhaut) wurden durch den infolge der Schleuderbewegung auftretenden Zug der hier ansetzenden Glaskörperstruktur ausgerissen.

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Summary On the basis of histological aspects it is demonstrated that the sclerotic areas which at first are situated on the retina and later more or less replace the retina, consist of connective tissue cells (proliferated cells of the cortex of the vitreous body and sometimes cells of the connective tissue of the vessels), in connection with highly pigmentated pigment cells with abundant hyalinizing or sclerosing (sclerotic area) intermediate substance. These areas occur mainly in the region of the insertion of densifications of the vitreous body at the retina. A superficially located, larger sclerotic area, as well as — in the region of the retinal hole a cover of the retina (proliferated cells of the cortex of the vitreous body in a stable connection with a relatively unchanges retina) were torn out by the tension (caused by the centrifugal movement) of the structure of the vitreous body inserted here.

     

Die Stereo-Ultrastruktur der Cornealoberfläche bei der Ratte

Zusammenfassung Die dreidimensionale Beschaffenheit der Cornealoberfläche der Ratte wurde mittels des Scanning Electron Microscope und anhand konventioneller elektronenmikroskopischer Schnittpräparate untersucht. Dabei konnte das Vorhandensein von Mikrovilli (0,15 breit, bis 1,0 hoch) und von Mikroplicae (0,1–0,2 breit, 0,3–0,4 hoch, 1–3 lang) nachgewiesen werden. Bei diesen Strukturen dürfte es sich um während der Desquamation entstandene Ausstülpungen der Epithelzellmembran im Bereiche der Desmosomen handeln.

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The stereo ultrastructure of the corneal surface in rat

Summary Combined morphological examination of the corneal surface of rat both with the scanning and the transmission electron microscope reveals two kinds of protrusions covering the polygonal, regularly arranged epithelial cells: Mikrovilli and Mikroplicae; the former being approximatively 0.15 large and up to 1.0 high, the latter being 0.1–0.2 large, 0.3–0.4 high and 1–3 long. These formations are with high probability the remnants of desmosomes having been formed during desquamation.

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Diese Untersuchungen wurden mit Unterstützung des Fonds National suisse de la recherche scientifique (Nr. 5322.3) durchgeführt.     

Biochemical study on some acid hydrolases in the normal rabbit cornea

Summary The activities of acid phosphatase, -glucuronidase, -galactosidase, and N-acetyl--D-glucosaminidase were investigated in the normal rabbit cornea. For all spectrophotometric assays, appropriate p-nitrophenyl derivates were used. Only -glucuronidase was determined employing Phenolphthalein glucuronid as a substrate. Acid phosphatase revealed the highest activity, followed by N-acetyl--D-glucosaminidase and -galactosidase. In the case of -glucuronidase the lowest activity was found. The results on the rabbit cornea are compared with those on some other tissues described in the literature. Correlation of biochemical data and histochemical findings in the same species is briefly discussed.

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Zusammenfassung Bestimmung der Fermentaktivität der sauren Phosphatase, -Glukuronidase, -Galaktosidase und N-acetyl--D-Glukosaminidase in normalen Kaninchenhornhäuten. Für alle spektrometrischen Bestimmungen wurden die entsprechenden Substrate von den p-nitrophenyl-Derivaten angewandt. Nur -Glukoronidase wurde mit Phenolphthaleinglukuronid nachgewiesen. Die saure Phosphatase hatte die höchste Aktivität, die N-acetyl--D-glukosaminidase und -Galaktosidase folgten. Die geringste Fermentaktivität wies die -Glukuronidase auf. Unsere Ergebnisse, die Kaninchenhornhaut betreffend, werden verglichen mit den in der Literatur angegebenen Enzymaktivitäten in anderen Geweben. Kurze Diskussion der Korrelation der biochemischen und histochemischen Befunde in derselben Spezies.

     

Binding Affinity of Bunazosin,Dorzolamide, and Timolol to Synthetic Melanin

Purpose The purpose of this study was to compare the binding affinity of bunazosin and dorzolamide to synthetic melanin relative to that of timolol.Methods Synthetic melanin was prepared from dopa by the action of tyrosinase. Timolol, dorzolamide, and bunazosin were incubated separately at a concentration of 10^–4M in 2ml of 0.066M phosphate buffer containing 5mg of synthetic melanin. After centrifugation, the absorbance of each free drug in the supernatant was measured at its optimum wavelength. The percentage of each drug bound to melanin was calculated directly from the change in absorbance relative to the initial value.Results The increase in the binding rates of all three drugs seemed to reach a plateau after 30min. After incubating for 60min, the binding rate of timolol was 22.2% ± 4.9%, bunazosin 36.3% ± 2.5%, and dorzolamide 8.5% ± 1.9%. There were statistically significant differences between the binding rates of each drug.Conclusions Under our study conditions, the order of binding affinity of these ocular hypotensive agents to synthetic melanin seems to be as follows: bunazosin timolol dorzolamide. Jpn J Ophthalmol 2004;48:34–36 © Japanese Ophthalmological Society 2004     

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.     

The routes for bulk drainage of aqueous humour in rabbits with and without cyclodialysis

Summary The bulk drainage of aqueous humour into the general circulation and into the orbital tissues was studied with ¹³¹I-labelled albumin and red dextran (molecular weight 40,000) in rabbits with and without cyclodilaysis.In animals at a normal intraocular pressure of about 20 mm Hg and without an artificial cleft between the anterior chamber and the suprachoroid the rate of aqueous bulk flow into the general circulation was 3.99 ± 0.55 l/min. There seemed to be some outflow also through other routes ending up in the episcleral tissues in the limbus region but less than 0.11 ± 0.02 l/min was drained in that way.Even in dead eyes maintained at an intraocular pressure of 14 mm Hg only negligible quantities of labelled anterior chamber fluid passed into the tissues with bulk flow.In acute experiments in living animals, after a cleft had been opened between the anterior chamber and the suprachoroid without damaging the sclera, the rate of aqueous production was 5.64 ± 0.65 l/min. On an average 54% of the aqueous humour was drained into the suprachoroid from where great amounts penetrated the sclera in part by way of perivascular spaces in part directly through the scleral substance. Before the cleft was produced the facility of outflow was 0.237 ± 0.038 l/min per mm Hg, afterwards it was on an average 0.505 ± 0.092 l/min per mm Hg higher.

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Zusammenfassung Der bulk Abfluß von Kammerwasser in den Blutstrom und in die Gewebe der Orbita wurde in normalen und cyclodialysierten Kaninchen mit ¹³¹I-Albumin and rotem Dextran (Molekulargewicht 40,000) studiert. In Tieren mit normalem intraocularen Druck (20 mm Hg) war der Abfluß ins Blut 3.99 ± 0.55 l/Min. Es gab wahrscheinlich auch einen Abfluß in die Gewebe, aber dieser Abfluß war geringer als 0.11 ± 0.02 l/Min. Auch in toten, perfundierten, Augen gab es bei einem intraocularen Druck von 14 mm Hg nur einen sehr geringen Abfluß in die Gewebe.Nachdem in akuten Experimenten ein Spalt zwischen der Vorderkammer und dem Suprachoroidalraum geöffnet war, war die Kammerwasserproduktion 5.64 ± 0.65 l/Min. Durchschnittlich 54% davon wurden zum Suprachoroidalraum drainiert, von wo große Mengen die Sklera zum Teil durch perivaskulare Spatien, zum Teil direkt durch die Skleralsubstanz durchsetzten. Bevor der Spalt geöffnet wurde, war die Abflußfazilität 0.237 ± 0.038 l/Min per mm Hg, nachher war sie um 0.505 ± 0.092 l/Min per mm Hg gesteigert.

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Résumé Le bulk drainage d'humeur aqueuse dans la circulation générale et dans les tissues orbitaux était étudié avec d'albumine marquée par ¹³¹I et de dextrane rouge (poids moléculaire 40,000) chez des lapins avec et sans cyclodialyse. Chez des animaux avec une pression intraoculaire normale d'environ 20 mm Hg et sans une communication artificielle entre la chambre antérieure et la suprachoroïde la vitesse du bulk flux aqueux dans la circulation générale était 3.99 ± 0.55 l/min. Il semblait avoir quelque flux aussi par d'autres voies directement dans le tissue épiscléral dans la région limbale; mais moins que 0.11 ± 0.02 l/min. était drainé ainsi.Même dans des yeux morts maintenus sous une pression intraoculaire de 14 mm Hg seulement des quantités insignifiantes d'humeur aqueuse marquée filtraient de la chambre antérieure dans le tissu épiscléral comme bulk flux. Dans des expériences aiguëes avec des animaux vivants, après avoir fait une ouverture entre la chambre antérieure et la suprachoroïde sans blesser la sclérotique, le débit de l'humeur aqueuse était 5.64 ± 0.65 l/min. En moyenne 54% de l'humeur aqueuse étaient drainés dans la suprachoroïde, et de là partiellement par des espaces périvasculaires partiellement par la substance sclérotique. Avant que l'ouverture était créée la facilité du flux était 0.237 ± 0.038 l/min per mm Hg, après elle était en moyenne 0.505 ± 0.092 l/min per mm Hg plus haut.

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Department of Pharmacology, University of Uppsala.     

Cell death and disposal in retinoblastoma: an electron microscopic study

Background: Tumor necrosis and cell death are common features of retinoblastoma. In non-malignant retinal cells after ischemia, as well as in many nonretinal tumors, cell death occurs in at least two ways. We investigated whether similar patterns of cell death could be demonstrated in retinoblastoma cells. Methods: Nine globes with retinoblastoma from eight patients were studied. Paraffin sections stained with HE or the Feulgen method were examined by light microscopy. Several samples from each tumor were selected for electron microscopic study. Results: Ultrastructurally, two main types of cell death were identified. Type I was characterized by progressive lysis of the cytoplasm and karyoplasm. Nuclear chromatin either dissolved or was transformed into compact clumps becoming extracellular dense bodies. Phagocytosis of cell remnants by neighboring tumor cells, or occasional macrophages, was common. Type II was characterized by progressive condensation and shrinkage of the cytoplasm and nucleus. Type II was subdivided in two forms distinguished mainly by characteristic patchy vs crescentic chromatin condensation. Small parts of condensed cytoplasm were engulfed by neighboring tumor cells. Compact cell remnants then underwent either phagocytosis by neighboring retinoblastoma cells or progressive intercellular disaggregation. Conclusion: Retinoblastoma cells may undergo at least two types of cell death. Type I fits the definition of necrosis, while both forms of type II exhibited several features consistent with apoptosis. The types of cell death observed in retinoblastoma exhibited similarities to patterns observed in ischemic retina, as well as in other malignant tumors. Type II cell death (apoptosis) may play a role in limiting tumor growth.Presented in part at the 1993 ARVO Meeting in Sarasota, Fla., USA     

Penetration of five beta-adrenergic antagonists into the rabbit eye after ocular instillation

Aqueous humor and serum levels of five beta-adrenergic blockers were measured using gas Chromatographic techniques following ocular instillation of 1% solutions to rabbits. Octanol/buffer partition ratios were also determined. No apparent relationship was found betweeen the peak levels of the agents in aqueous humor and their octanol/buffer partition ratios. However, peak aqueous humor levels of timolol (461 ng/100 mg) and practolol (919 ng/100 mg), whose partition ratios were less than unity, occurred somewhat later (1 h) than the peaks of propranolol (859 ng/100 mg at 30 min), oxprenolol (1,771 ng/100 mg at 30 min) or alprenolol (1,004 ng/ 100 mg at 10 min) whose partition ratios exceeded unity. Peak levels in serum of timolol (8.0 ng/100 l), propranolol (4.2 ng/100 l), oxprenolol (11.5 ng/100 l), and alprenolol (4.5 ng/100 l) were achieved within 10 min and reduced to less than 15% within 4 h. Peak serum levels of practolol (9.9 ng/100 l) occurred somewhat later (2 h) and remained high (41%) 6 h later.     

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.     

Methods of visual acuity determination with the spatial frequency sweep visual evoked potential

Purpose The spatial frequency sweep visual evoked potential (sVEP) is used to rapidly determine visual acuity in children or non-responsive patients. Two techniques have been used to separate signal from noise: (1) the 95% confidence interval for the signal amplitude (95% CI) or (2) the amplitude of a Fourier frequency adjacent to 2×the signal frequency (DFT). The purpose of this study is to determine if there is a significant difference in acuity estimates with these techniques.Methods Ten normal subjects (approximately 0.00logMAR acuity) and 11 patients with decreased visual acuity took part in this project. Stimulus production and data analysis were done with an Enfant 4010 (Neuroscientific Corp). Standard VEP recording techniques were employed. The stimulus was a horizontal-oriented, sine wave grating that swept up the spatial frequency spectrum (contrast 80%, temporal reversal rate 7.5Hz). Sweeps were repeated until the confidence intervals for the data were no longer decreasing. The Bailey LovielogMAR chart was used to determine visual acuity. A line was fit to the high spatial frequency data using either the 95% CI or the DFT as the noise estimate. By using these linear equations, acuity estimates were obtained at 0, 1, and 2V signal amplitudes.Results The average logMAR acuity for the subjects with normal acuity was –0.06±0.070 (SD). The sVEP acuity estimates were 0.08±0.098, 0.18±0.092, and 0.33±0.195 (0, 1, and 2V extrapolations) with the 95% CI used as noise and 0.07±0.100, 0.18±0.103, and 0.33±0.202 (0, 1, and 2V extrapolations) with the DFT used as noise. By using the average noise from the Fourier frequency as the extrapolation level, the acuity was 0.10±0.098logMAR. The averagelogMAR acuity for the subjects with decreased visual acuity was 0.67±0.306 (SD). The sVEP acuity estimates were 0.53±0.175, 0.66±0.171, and 0.88±0.295 (0, 1, and 2V extrapolations) with the 95% CI used as noise and 0.53±0.179, 0.65±0.176, and 0.86±0.268 (0, 1, and 2V extrapolations) with the DFT used as noise. By using the average noise from the Fourier frequency as the extrapolation level, the acuity was 0.57±0.186logMAR. No significant difference was found between the two acuity estimate techniques for all of the subjects (repeated measures ANOVA, p=0.16, F₂₀=2.131). The sVEP estimates of acuity to the 0V and noise levels were not significantly different from the logMAR acuity (paired t-test, all p values >0.05).Conclusions The results indicate that the sVEP acuity does not depend on the noise estimation technique. In agreement with prior studies, the sVEP acuity underestimates the logMAR acuity in normally sighted individuals by about an octave.     

Effect of Prostaglandin E2 on aqueous humor flow in the rabbit eye

Summary The examinations were carried out in albino rabbits under urethane anaestesia. After intracameral injection of 0.5 g Prostaglandin E₂, dissolved in 10 l 10% ethanol, intraocular pressure increased by 20.5±4.9 mm Hg. Aqueous humor protein concentration in the uninjected control eyes was 0.176±0.03 g%. Thirty minutes after intracameral injection of 10 l 10% ethanol solution the concentration rose to 0.38±0.19 g-%, and after of 0.5 g Prostaglandin E₂ to 1.85 ±0.41 g% These interventions were not followed by significant changes in aqueous humor osmolarity (normal value 313.7±17.9 mOsm, after ethanol 330 5±18. 0, and after prostaglandin E₂ 329.3±6.9).In a special series of experiments the rate of aqueous humor production was determined. In the uninjected control eyes a value of 1.57±0.61 l/min was found, but after intracameral injection of 0.5 g prostaglandin E₂, 5.45±1.99 l/min.The authors draw the conclusion that prostaglandin E₂ increases intraocular tension not by enhancing aqueous humor production but by disrupting the bloodaqueous humor barrier.

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Zusammenfassung Die Untersuchungen wurden an Albinokaninchen in Urethannarkose durchgeführt. Nach Injektion von 0,5 g Prostaglandin E₂ (in 10 l10%iger Äthanollösung) in die Vorderkammer stieg der Augenbinnendruck um 20,5±-4,9 mm Hg an. Der Gesamteiweißgehalt im Kammerwasser der intakten Kontrollaugen betrug 0,176±0,03 g-%. 30 min nach Einspritzung von 10 l 10%iger Äthanollösung in die Vorderkammer erhöhte sich der Gesamteiweißgehalt auf 0,38±0,19 g-%. Diese Einwirkungen hatten keine signifikante Änderung der Kammerwasser-Osmolarität zur Folge (Normalwert 313,7±17,9 mOsm, nach Äthanol 330,5±18,1 und nach Prostaglandin E₂ 329,3±6,9).In einer besonderen Versuchsreihe wurde die Kammerwasserproduktion bestimmt. In den intakten Kontrollaugen ergab sich hierbei ein Wert von 1,57±0,61 (l/m, nach Gabe von 0,5 g Prostaglandin E₂ aber 5,45±1,99 l/min.Die Autoren ziehen den Schluß, daß Prostaglandin E₂ den Augenbinnendruck nicht durch Steigerung der Kammerwasserproduktion, sondern durch Schädigung der Blut-Kammerwasserschranke erhöht.

     

The basement membrane complex of the human corneal epithelium

The present report reviews the fine structure of the basement membrane zone or complex in the normal human cornea and describes its alterations in cases of early and acute keratoconus. In normal human cornea the basement membrane zone is formed by a basal lamina (with a lamina lucida and a lamina densa), special fibrils, collagen fibrils and assemblies of filaments. These components are less evident in the central region of the cornea than in its periphery. In early stages of keratoconus the basement membrane zone is thickened and the lamina densa displays an irregular course. In acute keratoconus, the basement membrane zone is also thickened and includes a large number of special fibrils as well as bundles of microfibrils (oxytalan fibers). The conclusion that the basement membrane complex of the corneal epithelium is equivalent to the epidermal-dermal junction of the skin is discussed.This paper was presented in part at the Eighth Annual Meeting of the European Club for Ophthalmic Fine Structure in West Berlin on 28^th, 29^th March, 1980     

Relaxing incisions with compression sutures for control of astigmatism after penetrating keratoplasty

Background: Ten percent of patients with persisting postoperative astigmatism following penetrating keratoplasty (PK) require surgical re-intervention, despite an otherwise successful transplant. Relaxing incisions (RIs) in combination with compression sutures seem to be the preferable procedure. However, poor predictability and lack of long-term experience complicate the issue. Here we report the 2-year follow-up results of 25 patients with high PK astigmatism treated by means of RIs and compression sutures Methods: Commonly, free-handed RIs were placed at the graft-host interface and 10–0 nylon compression sutures were placed perpendicular to the incisions. PK sutures had been removed no less than 4 months prior to refractive surgery Results: Nineteen eyes regained a functional vision of >- 0.4. The net decrease in astigmatism was 6.1 ± 4.3 D (47 ± 21 %). The mean vector-corrected change in astigmatism was 13.1 ± 5.7 D. Cylinder axis variation was reasonably low, with a correlation of attempted versus achieved axis of r=0.85. Within the first 3 months after operation the induced astigmatism regressed by, on average, 5.5 ± 4.3 D, making intraoperative overcorrection necessary. As an inevitable side effect, refractive procedures resulted in a myopic shift (4.7 ± 6.9 D) in spherical equivalence Conclusion: RIs and compression sutures are very useful in reducing postkeratoplasty astigmatism if correction of extremely high cylinder (> 10 D) is not intended. However, predictability still remains unsatisfactory and more than one operation may be required.     

Topical and intravenous gentamicin in traumatically lacerated eyes

Intravenous or topical gentamicin may be the initial mode of treatment for lacerated or ruptured eyes by emergency room physicians while awaiting ophthalmic consultation and surgical repair. The purpose of this study was to determine the possibility of having retinotoxic intravitreal gentamicin concentrations in experimentally lacerated rabbit eyes treated with either intravenous or topical gentamicin separately or in combination with each other. Nontoxic concentrations of gentamicin were found in the vitreous bodies by all routes of drug administration. After 3 h intravitreal concentrations of gentamicin were: 0.20–0.30 g/ml when treated intravenously, 0–2.9 g/ml when treated topically, and 0.20–0.51 g/ml when treated both intravenously and topically. While the upper range of topically applied gentamicin concentrations (2.9 g/ml) is therapeutic for some pathogens, the wide range of intravitreal concentrations (0–2.9 g/ml) achieved does not indicate that topically applied gentamicin with or without intravenously administered gentamicin can reliably achieve therapeutic concentrations. Offprint requests to: M.O. Yoshizumi

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