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.     

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.     

Angiogenesis in early choroidal neovascularization secondary to age-related macular degeneration

Background: The morphological features of angiogenesis in early choroidal neovascularization secondary to age-related macular degeneration are yet to be fully described. Methods: Six eyes from five patients which on clinical and histological examination showed advanced age-related macular degeneration and early choroidal neovascularization have been studied by transmission electron microscopy. Results: Pre-existing choroidal capillaries and venules showed changes which included endothelial cell budding, pericyte enlargement, endothelial cell sprout formation and the development of intrachoroidal new vessels. In one case, an endothelial cell sprout continuous with an intrachoroidal vessel penetrated Bruch's membrane. Examination of early subretinal pigment epithelial new vessels showed them to spread between the inner layers of Bruch's membrane within the space usually occupied by the basal linear deposit and drusen. New vessel formation took place in blind pouches at the margins of new vessel networks, either in the absence of pericytes or in the presence of mainly myofibroblast-like pericytes. Conclusion: This ultrastructural study describes two phases of new vessel growth associated with the onset of choroidal neovascularization secondary to age-related macular degeneration. The initial intrachoroidal phase appears to be a low-turnover form of neovascularization which may lead to new vessels penetrating Bruch's membrane. Extensive subretinal pigment epithelial neovascularization, on the other hand, results from a high-turnover phase of neovascularization characterized by extensive endothelial cell proliferation and migration. Pericyte phenotypic changes associated with these different phases of neovascularization appear to relate to the dynamics of angiogenesis taking place in each process.     

Immunohistochemical localization of epidermal growth factor receptor and epithelial antigen in tumors of the human conjunctiva,eyelid, lacrimal gland,and orbit

Background: Increased numbers of epidermal growth factor (EGF) receptors are observed in squamous cell carcinomas of human lung, head, neck, and cervix. We studied the presence of EGF receptors and epithelial antigen in some ophthalmic lesions. Methods: Immunohistochemical staining for EGF receptors was assessed in tumors of human conjunctiva, eyelid, lacrimal gland, and orbit with monoclonal antibodies (EGF-R1 and clone 29.1). Reactivity of Ber-EP4, which reocgnizes epithelial antigen, was also examined. Results: Strong staining of EGF-R1 and clone 29.1 and weak to moderate staining of Ber-EP4 were demonstrated in conjunctival squamous cell carcinomas. Cell membranes of conjunctival papilloma were moderately or strongly stained with these antibodies. Ductal components in sebaceous gland adenoma of the eyelid and pleomorphic adenoma of the lacrimal gland were positively stained. The antibodies did not bind to reactive lymphoid hyperplasia of the orbit and Wegener's granulomatosis. Relatively good correlation for immunostaining reaction was observed among EGF-R1, clone 29.1, and Ber-EP4 in each tumor. Conlcusion: Immunostaining using EGFR1, clone 29.1, and Ber-EP4 may be useful in differentiating epithelial tumors from non-epithelial lesions. Strong immunostaining for EGF receptor may be the hallmark of epidermoid malignancy.     

Interpretation of high-pass resolution perimetry with a probability plot

Background: The interpretation of high-pass resolution perimetry (HRP) fields can be difficult. An age-related probability plot was derived from a known data base to determine whether this improved specificity and sensitivity in early glaucoma detection Methods: Forty glaucoma patients with minor field loss and 40 normals of equivalent age and sex underwent HRP. All had previous Humphrey field data available for comparison. The detection of previously confirmed field defects by HRP was examined using different parameters. Results: Using the age-corrected 95% confidence levels gave the best results, with sensitivity of 82.5% (33/40) and specificity of 85% (34/40). Using the contour plot yielded lower sensitivity (67.5%), while subjectively eyeballing the ring printout gave higher sensitivity (90%), but led to poor specificity (72.5%). Conclusion: The use of a probability plot enhances the performance of HRP. A certain proportion of cases may be missed using one criterion alone, but combining the information with other indices can increase the yield.The authors have no proprietary interest in the equipment and technique described herein     

Morphological differentiation of the conjunctival goblet cells in the chick (Gallus domesticus)

Background: These is no consensus in the literature regarding the differentiation of conjunctival goblet cells in vertebrates. Method: The conjunctival epithelium of the chick was studied before and after hatching in order to demonstrate the morphological evolution of the goblet cells. The entire conjunctiva was processed for light microscopy either on semithin sections stained with toluidine blue-pironine or on traditional sections stained with Alcian blue pH 2.5-PAS. Results: It was possible to demonstrate that goblet cells underwent remarkable changes in their secretory activity. At 12 h after hatching, isolated Alcian blue-positive cells were present in the fornix. At 24 h after hatching, cells positive for both Alcian blue and PAS were scattered among epithelial cells. Two days after hatching, cells which reacted positively only to PAS were also present. Conclusion: It is suggested that the differentiation of conjunctival goblet cells occurs first in the fornix, probably due to the particular vascular environment of this region, and then spreads all over the conjunctiva.     

Early conjunctival changes following treatment with metipranolol and preservatives are not reversible with dexamethasone

Background: Topical medication for the treatment of glaucoma alters the cellular and extracellular composition of the superficial and deep conjunctival layers. We sought to determine whether, after short-term use of metipranolol with preservatives, subsequent application of steroids or metipranolol without preservatives affects these conjunctival changes. Methods: Rabbits received topical metipranolol over a period of 6 months. For the following 2 months, one group received metipranolol without preservatives, and another group steroids. For controls, animals were treated with preservatives only or metipranolol with preservatives for 6 months. Superior bulbar conjunctiva was examined by light microscopy, immunohistochemistry, and transmission electron microscopy. Results: On light microscopic and immunohistochemical examination of conjunctival specimens from all groups, there was an increase of subepithelial collagen deposition in all treated groups. Treatment with steroids or preservative-free metipranolol did not alter the initial effects. By electron microscopy, additional extracellular matrix changes were seen as well as degenerative changes of tissue fibroblasts. Conclusion: The animal model used was able reliably to produce conjunctival changes following antiglaucomatous therapy. The changes seen were early changes, because there was no increase of inflammatory cells. Steroids did not significantly affect the changes. The beneficial effect of steroids used prior to glaucoma surgery remains controversial.The authors have no financial or other interest in any of the substances mentioned in this studyPresented in part at the Association for Research in Vision and Ophthalmology (ARVO) meeting in Ft. Lauderdale, Fla., USA, 21–26 April 1996     

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.     

Precision of ultrasonic estimates of choroidal melanoma regression

Background: Important prognostic information may be gained from knowledge of the volume and, over time, the change in volume of intraocular tumours such as choroidal melanomas. Methods: The precision and time consumption of three different ultrasonographic methods were evaluated. Seven choroidal melanomas were analysed after placement of a ruthenium plaque and again after tumour regression had occurred. Perpendicular ultrasound B-scans were printed and analysed by overlay grid counting or outline tracing of tumour structures to calculate the volume. These two methods, using only two perpendicular scans, were compared with a micro-computer-controlled ultrasonographic three-dimensional rotation scanning system, where each tumour was manually outlined in 20 revolving scan planes. Results: The three-dimensional volume scanning method was the most precise, but also the most demanding in hardware and time consumption. Conclusion: Increased precision and less observer-dependent estimation of shrinkage rate after radiotherapy is available at the cost of sophisticated equipment.     

Effects of norfloxacin on the retina in rabbits

Background: Fluoroquinolones have a strong affinity with melanin, and their ocular effects have been reevaluated. Norfloxacin, one of the fluoroquinolones, has broad-spectrum activity against aerobic gram-positive and gram-negative bacteria. We examined the retinal toxicity and intraocular pharmacokinetics of intravitreal norfloxacin in rabbits. Methods: Twenty-three albino and 23 pigmented rabbits were divided into three groups to evaluate retinal toxicity and two groups to investigate the intraocular pharmacokinetics. Each of these five groups was further divided into two subgroups (albino rabbits and pigmented rabbits). Results: With 500 Etg norfloxacin, the oscillatory potential of the electroretinogram was transiently and selectively deteriorated in albino and pigmented rabbits, whereas the electroretinogram remained unchanged with 50 g in pigmented rabbits. No changes were observed in the visual evoked potential or on histology of the retina 7 days after an intravitreal injection of 50 or 500 ltg norfloxacin. The electroretinogram and the retinal histology became abnormal 7 days after four intravitreal injections of 500 g norfloxacin at 7-day intervals. As regards the intraocular pharmacokinetics after an intravitreal injection, the norfloxacin concentration in the chorioretina was as high as that in the vitreous 3 h after injection and was much higher than that in the vitreous 7 days after injection. Similar results were obtained after multiple injections. Conclusion: These results indicate a high concentration of norfloxacin in the melanin-containing ocular tissues.     

Ophthalmological and neuro-ophthalmological involvement in Churg-Strauss syndrome: a case report

Background: It is well known that different types of eye involvement may develop during the course of systemic vasculitides. Methods: We report here a case of Churg-Strauss syndrome (allergic granulomatous angiitis) characterized by the presence of multiple ophthalmological and neuro-ophthalmological lesions, i.e., mononeuritis of the fourth cranial nerve, multifocal choroidal ischaemia, and bilateral ischaemic optic neuropathy. Results: Ischaemic lesions in the posterior ciliary plexus and chorio-retinal circulation, which appeared simultaneously after a phase of disease activity, were documented. Conclusion: The simultaneous occurrence of multiple ocular features in a patient with Churg-Strauss syndrome suggests that regional vasculitis may be the pathological mechanism underlying the multiple ophthalmological lesions in this disorder.     

Course of the optic nerve fibers through the lamina cibrosa in human eyes

Background: This study investigated whether regional variations in the course of the optic nerve fibers through the lamina cribrosa may be one of the reasons why the local susceptibility for glaucomatous optic nerve fiber loss differs among the various regions of the optic disc. Methods: The study included 34 human eyes enucleated because of a malignant melanoma of the peripheral choroid without involvement of the anterior chamber angle or the optic nerve. Anterior-posterior sections through the pupil and the optic disc were histomorphometrically evaluated. In the central region and the peripheral part of the optic disc, we measured the thickness of the lamina cribrosa and the length of the lamina cribrosa channels through which the nerve fibers pass. Results: In the peripheral parts of the disc, compared with its central region, the lamina cribrosa was significantly thicker (P<0.0001, Wilcoxon test), the lamina cribrosa channels with the nerve fibers passing through were significantly longer (P<0.0001), and the ratio of length of the fiber channels to the thickness of the lamina cibrosa was significantly higher (P=0.0001). Conclusion: The lamina cribrosa is thicker and the course of the optic nerve fibers through the lamina cribrosa is more curvilinear in the disc pheriphery than in the disc center. These variations in the anatomy of the lamina cribrosa may be one of several factors influencing the regional susceptibility for glaucomatous optic nerve fiber loss within the optic nerve head.     

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.     

Orbital exenteration: Surgical and reconstructive strategies

Background: Radical exenteration procedures, which include the removal of orbital content and eyelids, result in serious functional limitations, especially with respect to eating and speaking. Therefore we have recently changed our surgical concept. Methods: Seventy-seven patients underwent orbital exenteration during the 20-year period from 1974 to 1995 at the Department of Maxillofacial Surgery, Essen University. The simultaneous removal of periorbital bone was performed in 45 of these cases. Results: The 1-year survival rate was 89%, the 5-year rate was 63% and the 10-year rate was 48%. The surgical approach, the amount of resected orbital tissue and the reconstructive procedure have been adapted to the individual needs, depending on the location and extent of the tumor. Subsequently, the surgical morbidity has decreased. Discussion: Detailed consideration of all clinical and histological findings is essential before surgery, in order to prevent a higher rate of recurrence following these modified operations.     

A comparison of colour Doppler imaging of orbital vessels and other methods of blood flow assessment

Background: Comparison of the haemodynamic measurements obtained by colour Doppler imaging and other methods of ocular blood flow measurements was desired. Methods: The blood velocity findings from colour Doppler imaging of patients with central retinal vein occlusion were compared to the results of fluorescein video-angiography, continuous tonography and ophthalmodynamometry. Results: Patients with low or undetectable blood velocities in the central retinal vein had longer retinal dye transit times on fluorescein video-angiography. Tonography showed a positive correlation with the velocities in the ophthalmic artery, but ophthalmo-dynamometry showed a negative correlation with these velocities. Conclusion: The relationships between the blood velocities in orbital vessels and other blood flow measurements emphasise that there is a complex interaction of the blood flow parameters. Care must therefore be taken when interpreting the results of studies.     

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.     

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.     

Quantitative analysis of immunogold labellings of collagen types I,III, IV and VI in healthy and pathological human corneas

Background: We studied the distribution of collagen types I, III, IV and VI in one healthy human cornea and in seven pathological human corneas, in which the disorders were three cases of pseudophakic bullous keratopathy (two severe, one moderate) and one case each of stage IV keratoconus, chronic ulcer, vascularized cornea and disciform keratitis. Methods: Transmission electron microscopy examinations were performed on post-embedding immunogold-labelled sections. The staining was evaluated by gold particle count in the different tissues. The presence or absence of a given antigen was determined by statistical analysis, using a d-value test. Results: Our results on healthy corneal tissues corroborate the data available from previous studies, except for collagen type VI, which we found to be absent in Bowman's layer. In pathological corneas with a collagenous layer posterior to Descemet's membrane, collagen types I, III and especially IV were detected in this collagenous layer. Collagen types I, III and VI were detected in the anterior healed stroma of other pathological corneas, except for the keratoconus cornea, in which intense collagen III staining was observed. Conclusion: The presence of collagen types I and III in the posterior collagenous layer of our pseudophakic bullous keratopathy corneas suggests that this layer corresponds to scar tissue secreted by stimulated endothelial cells.     

Fundus pulsation measurements in diabetic retinopathy

Background: There is experimental evidence that retinal blood flow is impaired in patients with diabetes mellitus. Much less attention has been paid to choroidal blood flow. Hence it was the aim of the present study to investigate choroidal blood flow in diabetic retinopathy. Methods: A new noninvasive laser interferometric technique was used to measure fundus pulsations in the macula. The fundus pulsation amplitude, which is the maximum distance change between cornea and retina during the cardiac cycle, is a measure of local pulsatile blood flow. The eyes (n = 214) were divided into four groups according to the modified Airlie House classification: (1) no retinopathy (control group), (2) background retinopathy, (3) moderate to severe preproliferative retinopathy, (4) proliferative retinopathy. In 83 eyes of different groups fundus pulsation measurements were repeated after 1–6 weeks. Results: Fundus pulsation amplitudes were significantly smaller in group 4 than in the control group (P < 0.027). The reproducibility of the measurements was high and did not differ among the study groups. Conclusions: Local fundus pulsations in the macula are reduced in proliferative diabetic retinopathy, which is compatible with previous findings of reduced choroidal blood flow in late stages of the disease. Laser interferometric measurement of fundus pulsations is non-contactile, assures optimal comfort for the patient and could be used for the long-term observation of patients with diabetes mellitus.     

Reattachment to a substrate prevents apoptosis of human retinal pigment epithelium

Background: Epithelial cells generally fail to survive in suspension. Harvesting human retinal pigment epithelium (RPE) for transplantation may separate the cells from their extracellular matrix and induce apoptosis. We investigated whether reattachment of RPE to a substrate will prevent apoptosis. Methods: Second-passage human RPE cells were plated onto tissue culture plastic precoated with extracellular matrix, fibronectin or laminin, uncoated tissue culture plastic, untreated plastic and untreated plastic coated with 4% agarose. Reattachment rates were determined for each substrate 24 h after plating. The TUNEL technique was used to determine apoptosis rates in attached cells, unattached cells and the entire cell population. Results: Attachment rates were as follows: ECM-coated tissue culture plastic fibronectin-coated tissue culture plastic laminin-coated tissue culture plastic uncoated tissue culture plastic untreated plastic agarose-coated untreated plastic. Apoptosis rates for the entire cell population increased as the RPE cell attachment rate decreased. The proportion of apoptotic cells in the entire population was inversely related to the percent attached cells (r = -0.95). Conclusion: Reattachment of harvested RPE to a substrate decreased the rate of RPE apoptosisin vitro. RPE cells which are removed from their substrate prior to transplantation must reattach rapidly to a substrate to prevent apoptosis.Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 1996