Neovascular tissue in the intertrabecular spaces in eyes with neovascular glaucoma.

AIMS/BACKGROUND: To investigate histological changes in the trabecular meshwork in eyes with neovascular glaucoma. METHODS: Light and electron microscopic studies were carried out on the trabecular meshwork of three enucleated eyes with neovascular glaucoma. The presence and distribution of factor VIII in the trabecular meshwork was assessed using the ABC method. RESULTS: Peripheral anterior synechiae covering the trabecular meshwork were detected in two eyes, which would explain the rise in intraocular pressure. In the third the angle was not completely closed by peripheral anterior synechiae. The spaces between the trabecular beams were lined by a single layer of vascular endothelium, and were filled with red blood cells in this patient. Factor VIII was positively stained in the endothelial cells, lining both these spaces and Schlemm's canal. A basal lamina and microfibrils were detected just beneath the newly formed vascular endothelial cells. CONCLUSION: The neovascular tissue found in the trabecular spaces might be one of the factors responsible for intraocular pressure elevation in eyes with neovascular glaucoma.     

Decreased Endothelial Permeability in the Iridocorneal Endothelial Syndrome

Five patients with the iridocorneal endothelial (ICE) syndrome were examined by fluorophotometry. All patients had typical abnormal corneal endothelium, peripheral anterior synechiae, and distortion of the iris (pupillary irregularity or anterior stromal traction tears) in one eye only. Fluorescein was deposited in the superior cornea of both eyes by iontophoresis, and the cornea and anterior chamber concentrations and total mass of fluorescein were measured hourly over the ensuing eight hours. In all five patients, the endothelial permeability to fluorescein was within normal limits in the normal eye. In four of the five abnormal eyes, endothelial permeability was markedly decreased. In these four patients, the permeability to fluorescein in the normal eye was approximately six times that in the abnormal eye. In the fifth patient, the endothelial permeability was normal in both eyes. The central corneal thicknesses were normal in both eyes of all five patients. These results indicate that in many eyes with the ICE syndrome, corneal endothelial permeability to solutes is markedly decreased. Decreased endothelial permeability to solutes has not been documented previously in any clinical corneal disorder and may be of importance in the pathophysiologic changes that accompany endothelial disease.     

角巩缘无缝线隧道切口白内障超声乳化人工晶体植入术后房角镜观察

目的：观察角巩膜缘无缝线隧道切口白内障超声乳化及后房型人工晶体植入术后前房角的变化。方法：用Goldmann房角膜观察了107眼通过5mm巩膜缘无缝线隧道切口进行白内障超声乳化及后房型人工晶体植入术后1个月前房角的变化。结果：107眼（100％）可见内切口位于Schwalbe线前的透明角膜上,48眼（44．86％）内切口平整,59眼（55．14％）,内切口后唇轻度卷曲,42眼（39．25％）角膜后弹力层不同程度脱离,9眼（8．41％）发生周边虹膜周边前粘连,但未见有粘连至巩膜突上,3眼（2．8％）虹膜周边粘连致术后瞳孔呈梨形。结论：白内障超声乳化及后房型人工晶体植入术后角巩膜缘无缝线隧道切口是 一种较好的手术方法,但也存在着角膜后弹力层不同程度脱离、虹膜周边前粘连等并发症。     

Pathology of anterior chamber angle in diabetic neovascular glaucoma: extension of corneal endothelium onto iris surface

The purpose of this study is to elucidate the extension of the corneal endothelium onto the iris surface, a condition which has been found in the eyes with rubeosis iridis in various ocular disorders. Histopathology of the anterior chamber angle was studied by electron microscopy in 6 eyes with neovascular glaucoma occurring in the advanced stage of diabetic retinopathy. Histopathological findings embraced extensive peripheral anterior synechiae occluding the filtration angle and fibrovascular tissue on the anterior surface of the iris. In addition, formation of a continuous layer of endothelium was observable on the surface of the iris facing the anterior chamber in the 6 eyes. The newly formed endothelium was continuous with the corneal endothelium at the pseudo-angle formed by the attachment of peripheral anterior synechiae. Two types of corneal endothelial cells were found near the pseudoangle, one type with degenerative changes and the other apparently engaged in normal metabolic activity. It may be assumed from these findings that, while the corneal endothelium undergoes degeneration, new cells of unknown origin proliferate on the posterior corneal surface to replace the disrupted corneal endothelium and extend onto the iris surface.     

Ultrasound biomicroscopy in opaque grafts with post-penetrating keratoplasty glaucoma

PURPOSE: To evaluate the anterior segment in opaque grafts with post-penetrating keratoplasty glaucoma (PPKG) by using ultrasound biomicroscopy (UBM). METHODS: An observational clinical case series of patients with opaque corneal grafts with PPKG who underwent UBM examination of the anterior chamber is reported. Indication for keratoplasty, lens status, intraocular pressure at the time of presentation, and the time of diagnosis of glaucoma were noted. Examination included slit-lamp biomicroscopy, posterior-segment ultrasound evaluation, and UBM evaluation of the anterior segment. RESULTS: Thirty-one eyes of 31 patients with PPKG were recruited into the study. The mean intraocular pressure was 35.5 +/- 5.8 mm Hg (range, 26-52 mm Hg). The mean time of follow-up after penetrating keratoplasty was 6.97 +/- 2.98 months (range, 2-16 months). Of the 31 patients, 11 had undergone penetrating keratoplasty for therapeutic purposes (infectious keratitis), whereas the remaining 20 had undergone keratoplasty for optical reasons. Fourteen (45.1%) patients were pseudophakic, 13 (41.9%) were aphakic, and 4 (12.9%) were phakic. The types of synechiae noted on the UBM included peripheral anterior synechiae in 30/31 (96.7%) eyes, synechiae at the graft-host junction in 13/31 (41.93%) eyes, both peripheral anterior synechiae and graft-host junction synechiae in 12/31 (38.7%) eyes, central iridocorneal synechiae in 6/31 (19.3%) eyes, and intraocular lens iris synechiae in 3/31 (9.6%) eyes. CONCLUSIONS: Secondary angle closure caused by anterior synechiae formation is one of the important causes of PPKG in eyes with opaque grafts. UBM serves as a useful tool for anterior-segment evaluation in such cases and can help in planning the site for glaucoma filtering surgeries and drainage devices.     

Cataract surgery with ciliary sulcus fixation of intraocular lenses in patients with uveitis.

PURPOSE: To describe intentional placement of intraocular lens haptics in the ciliary sulcus of patients with uveitis who are at high risk for postoperative posterior synechiae and lens dislocation. METHODS: We reviewed our experience with 16 eyes of 12 patients with uveitis who underwent cataract surgery with ciliary sulcus fixation of intraocular lenses. Patients were followed for a median of 16.5 months (range, 9 to 44 months) after surgery. We evaluated eyes for surgical technique and the following preoperative and postoperative factors: best-corrected visual acuity, intraocular pressure, anterior chamber cells, and posterior synechiae. The following additional postoperative factors were sought: lens dislocation, lens edge capture, and evidence of pigment dispersion. RESULTS: Posterior synechiae were present in 13 eyes before surgery; postoperative posterior synechiae developed in only three of these eyes. These adhesions resulted in lens edge capture in one eye and limited lens decentration in another. Scant pigment was present on the lens optic or in the anterior chamber, suggesting pigment dispersion, in four eyes. We found no evidence of consistently increased anterior segment inflammation or intraocular pressure after surgery when compared with preoperative levels for this group of patients. Postoperative posterior synechiae were seen more often in eyes that had can-opener anterior capsulotomy than in eyes that had continuous, curvilinear capsulorhexis (P = .036). CONCLUSIONS: Ciliary sulcus fixation allows the intraocular lens to serve as a physical barrier between the iris and the lens capsule remnants. This technique may be useful for reducing the risk of postoperative posterior synechiae in patients with uveitis without increasing the risk of other postoperative problems.     

Complications of rigid anterior chamber implants

Despite accurate lens sizing, 100 eyes with rigid anterior chamber implants showed a high incidence of lens-related trauma postoperatively: pigment dispersion (pseudoguttata), angle recession, peripheral anterior synechiae, iris erosion/atrophy, iris holes from stretching, angle fibrosis, haptic tip erosion into sclera and iris, neovascularization of peripheral iris and angle, lens rotation through iridectomy and into ciliary body, lens tilting with corneal endothelial touch, high refractive cylinder with long intraocular lenses, pigment proliferation onto iris surface, partial slippage of the intraocular lens into vitreous following intracapsular procedure, and pupillary-block glaucoma. Vision results were good. Glaucoma and cystoid macular edema rates were low. Bullous keratopathy and retinal detachment didn't occur. High endothelial cell loss was associated with those lenses that "propellered" and those that tilted and touched endothelium. The adverse findings may be static or may represent a continuing process of tissue damage.     

超声乳化术治疗闭角型青光眼合并白内障患者应用超声生物显微镜的价值

目的:评价白内障超声乳化联合人工晶状体植入术治疗闭角型青光眼合并白内障的临床效果以及超声生物显微镜(ultrasoundbiomicroscope,UBM)的指导作用。方法:闭角型青光眼合并白内障患者56例60眼,均接受超声乳化联合人工晶状体植入术。根据术前UBM检查结果分组。(1)按术前房角关闭粘连范围分组,A1组6眼,房角关闭粘连≤1/2周,B1组24眼,1/2周<房角关闭粘连≤3/4周,C1组30眼,房角关闭粘连≥3/4周;(2)根据术前晶状体厚度分组,A2组36眼,晶状体厚度≥4.80mm,B2组24眼,晶状体厚度<4.80mm。术前及术后1mo常规行眼压、最佳矫正视力以及UBM检查中央前房深度、房角结构变化等,进行统计学分析。结果:术后大部分患者最佳矫正视力均不同程度地提高,前房加深,房角不同程度地重新开放。术后A1组眼压较术前无明显统计学差异;B1和C1组与术前相比均有显著统计学差异,其中B1组1眼,C1组8眼于术后3～21d眼压再次升高,给予降眼压药物治疗或行滤过手术后降至正常范围;A2组术后2眼以及B2组术后7眼在术后眼压>21mmHg,手术成功率分别为94.4%及70.8%,差异有统计学意义。结论:UBM证实房角关闭粘连范围≤3/4周,晶状体明显增厚的闭角型青光眼合并白内障的患者,单纯行超声乳化联合人工晶状体植入有良好效果,房角关闭粘连范围>3/4时术后易出现青光眼复发。UBM检查有助于术前选择手术方式及术后预测远期疗效。     

Filtration angles in pseudophakic eyes]

Examination of the filtration angle comprised 86 eyes with implanted artificial intraocular lenses in the 8th postoperative month. The evaluation detected in both groups the appearance of pigmentary deposits in the trabecular area, of circumferential anterior synechiae and of vascular proliferation of the circumference of the iris. In some patients with anterior chamber lenses were observed abnormalities in the position of the implant.     

无缝线隧道切口可折叠人工晶体植入术后房角镜观察

了解无缝线隧道切口白内障手术内切口及周边虹膜的变化。方法用Ｇｏｌｄｍａｎｎ房角镜，术前、术后观察３．５ｍｍ无缝线巩膜隧道切口超声乳化白内障摘除及可折叠人工晶体植入术５６例（５８只眼）的前房角改变。结果５６只眼可见内切口位于ｓｃｈｗａｌｂｅ线前的透明角膜上，２只眼内切口在Ｓｃｈｗａｌｂｅ线上。４２只眼（７２．４１％）内切口平整，１４只眼（２４．１４％）内切口后唇轻微卷曲，５只眼（８．６２％）角膜后弹力层脱离，２只眼（３．４５％）发生虹膜周边前粘连。结论通过无缝线隧道切口进行可折叠人工晶体植入术，周边虹膜前粘连发生率较低，但容易发生角膜后弹力层脱离。     

The trabecular meshwork in acute and chronic angle closure glaucoma

PURPOSE: To determine the effect of acute and chronic primary angle closure glaucoma (PACG) on the trabecular meshwork. METHODS: Trabecular specimens of 16 consecutive patients with primary angle closure glaucoma (PACG)--6 acute PACG eyes, and 10 chronic PACG eyes without an acute attack--were studied by light and electron microscopy. RESULTS: Acute PACG: The trabecular meshwork revealed a generalised oedema and an accumulation of pigment in the widened trabecular spaces and Schlemm's canal. Attenuated trabecular endothelial cells appeared to be devoid of subcellular components. Chronic PACG: In chronic PACG eyes the trabecular architecture had lost its regular arrangement, with fewer and narrower trabecular spaces and fusion of the trabecular beams in areas. There were numerous electron-dense bodies in the trabecular tissues, both within the trabecular beams and in the extracellular spaces, which had a banded fibrillar structure. An overall loss of endothelial cells was noted; the remaining cells were crowded together and were polymorphic. Melanin pigment was present both within the stroma and in the endothelial cells. CONCLUSIONS: Pigment accumulation in the trabecular spaces and within the cells and a noninflammatory degeneration appeared to be the primary changes in the trabecular meshwork after acute angle closure glaucoma. In chronic PACG eyes, there was evidence of loss of endothelial cells and reactive repair processes. These changes were present in areas away from visible peripheral anterior synechiae. A gonioscopic evaluation of the extent of peripheral anterior synechiae alone may not reflect the extent of trabecular meshwork damage in acute and chronic PACG. Patients experiencing an acute attack of PACG require a long-term follow up, because the intraocular pressure (IOP) may rise later, due to ongoing changes compromising the outflow facility, or due to the effects of aging in the trabecular meshwork.     

Endothelialization of central isolated leukomata adhaerentes

Among 820 eyes enucleated between 1980 and 1984 and examined histologically there were 132 globes with central corneal-perforations. In ten of these there was a leukoma adherens not in contact with the anterior chamber angle. In all cases it was endothelialized with formation of a new basal lamina. The mean interval between trauma and enucleation of these ten eyes was 22.6 +/- 16.7 years (0.5-52 years), the mean age of the patients at the time of enucleation 50.7 +/- 22.4 years (15-78 years). Common to all these eyes and therefore of possible pathogenetic importance were: suitable tissue in contact with the corneal endothelium; traumatization of the endothelium and other intraocular structures; intraocular inflammation. The tissue which was pathologically changed and adherent to the cornea served as a "scaffold" for the endothelialization. Healing of the wound caused cell migration and proliferation and, together with intraocular inflammation, secretion of growth factors.     

Ultrasound biomicroscopy of Chinese eyes with iridocorneal endothelial syndrome

AIM: To document the ultrasound biomicroscopic (UBM) findings in Chinese patients with iridocorneal endothelial (ICE) syndrome. METHODS: 21 patients with ICE syndrome and 15 normal subjects underwent UBM. UBM findings of anterior segment were compared between normal subjects and three clinical types of ICE syndrome: progressive iris atrophy (PIA), Chandler's syndrome (CS), and Cogan-Reese syndrome (CRS). RESULTS: Central anterior chamber depth was significantly less in patients with ICE syndrome (2.25 (SD 0.32) mm) than in normal subjects (2.76 (0.32) mm). Peripheral anterior synechiae were observed in all the ICE patients by UBM. Three out of four CRS subjects showed an "arborised" shape of iridocorneal angle. Two eyes out of 10 with CS presented bridge-shaped synechiae. A membrane-like mound was observed in iridocorneal angle in two patients: one with CRS and one with CS. UBM was found to be more effective in detecting peripheral anterior synechiae (PAS) and iris atrophy than slit lamp microscopy and gonioscopy, mainly because of corneal oedema in patients with CS. Four out of 11 patients with unilateral ICE syndrome had shallow or closed anterior chamber angles in their fellow eyes. Two of them successfully responded to laser peripheral iridotomy. CONCLUSIONS: UBM is an effective method to reveal the anterior segment features and provides a useful tool in the diagnosis of ICE syndrome. Different subtypes of ICE syndrome may have different UBM manifestations. UBM can help to identify angle closure in the fellow eye of unilateral ICE syndromes.     

小切口非乳化人工晶状体植入术房角及眼压观察

目的 探讨非超声乳化隧道切口白内障手术内切口对周边虹膜的影响及眼压的变化。方法 26例27眼老年性白内障进行术后定期随访前房角及眼压。结果 27眼内切口位于Schwalbe线前的透明角膜上。2眼(7．4％)虹膜周边前粘连，12眼角膜后弹力层脱离(44．4％)，14眼(51．8％)因黏弹剂残留引起高眼压。结论 通过非超声乳化隧道切口进行白内障人工晶状体植入术观察，周边虹膜前粘连发生率低，应术后严格注意观察眼压，以便及时处理。     

周边虹膜切除术远期疗效的预测

目的观察和分析周边虹膜切除术对原发性闭角型青光眼的远期疗效，筛选出术后远期疗效的预测方法，以便提高周边虹膜切除术的远期成功率。方法对504只接受周边虹膜切除术治疗1至5年后的原发性急性闭角型青光眼临床前期、缓解期和原发性慢性闭角型青光眼早期的患眼进行回顾性的多因素分析。其内容包括：手术前、后的视力，眼压，中央和周边前房深度，房角形态以及杯盘比值。部分患者还作暗室试验和视野检查。结果504只眼接受周边虹膜切除术的患眼中，74只眼（14．6％）1至5年后前房角出现新的粘连闭合或原粘连闭合继续扩大，并发生青光眼性的视功能损害。这些失败眼都具有前房隐窝浅、虹膜根部附止前、虹膜呈爬行性前粘连和周边虹膜切除术后周边前房没有明显加深，房角没有加宽的临床特点。结论正确评估手术前前房角的形态结构和观测手术后周边前房深度的变化是预测手术后的远期疗效，筛选出日后会失败的高危眼的二个重要指标。     

Follow-up of aphakic patients with anterior vitrectomy in one eye and uneventful cataract extraction in the fellow eye.

Twenty patients had operations for bilateral cataract in 2 separate sessions, with uncomplicated extraction on one side and vitreous loss managed with anterior vitrectomy on the other. The cataracts, the type of surgery, and the postoperative treatment were identical in both eyes. The differences between the 2 eyes were not statistically significant so far as the amount of astigmatism, final visual acuity, and peripheral anterior synechiae were concerned. The main difference was found to be the period of time the vitrectomised eyes remained red and uncomfortable as compared to the eyes with uncomplicated surgery.     

Effect of local abnormalities and systemic disorders on phacotrabeculectomy and the post-operative period

The aim is to present that local abnormalities of eyes chronically treated for glaucoma and cardiovascular, metabolic disorders may influence the course of phacotrabeculectomy and post-operative period. MATERIAL AND METHODS: The research covered 68 patients. In 89 eyes phacoemulsification of cataract connected with Cairns-type trabeculectomy and implantation of lens prosthesis has been performed. The patients were divided into two groups: I group - 37 patients, 45 surgeries. All patients were chronically treated for arterial hypertension and other cardiovascular disorders. 7 patients had non-insulin-dependent type II diabetes mellitus without diabetic retinopathy. II group - 31 patients without cardiovascular and metabolic disorders, 44 surgeries. Stromal atrophy and posterior synechiae were recognized as local abnormalities (12 eyes in I group and 18 eyes in II group). They were released during phacotrabeculectomy. RESULTS: In post-operative period, higher coefficients of complications such as hematoceles or blood in the anterior chamber were shown in both groups, more incidents of fibrinous reaction in I group and exudate in the anterior chamber after release of posterior synechiae in II group. Statistically significant difference at p=0,016 was observed only in comparison of the incidence of complications after release of choroid-lens synechiae in I group, in comparison to II group, where synechiae were not released. Choroidal detachment was observed in 8 eyes of I group and in 1 eye of II group. Anterior chamber reconstructed in 3 eyes of I group and 1 of II group was noted. In one case of booth groups, drainage of the suprachoroid space were performed. The study didn't show statistically significant differences in the frequency of fibrinous reaction or inflammatory exudates in 9 eyes of diabetic patients, in comparison to other patients of I group. CONCLUSIONS: Additional procedures, especially releasing of posterior synechiae are correlated with most often early complications as hematoceles, hyphema in anterior chamber, exudate or fibrinous reaction. Cardiovascular disorders are associated with non stability of choroidal circulation, that with post-operative hypotony may correlated with choroidal detachment. In patient with non-insulin-dependent type II diabetes mellitus without diabetic retinopathy, fibrinous reaction or inflammatory exudate, clinical symptoms of blood-aqueous humor barrier damage were not observed in every case.     

白内障超声乳化吸除与囊外摘除人工晶体植入术后前房角对比观察

目的：对比观察巩膜隧道切口白内障超声乳化吸除折叠式人工晶体植入术和常规白内障囊外摘除人工晶体植入术后前房角对比情况。方法：采用Ｇｏｌｄｍａｎｎ房角镜分别观察３６眼巩膜隧道切口白内障超声乳化吸除折叠式人工晶体植入术和常规白内障囊外摘除人工晶体植入术后切口的变化、周边虹膜改变、晶体袢固定等情况。结果：白内障超声乳化吸除折叠式人工晶体植入术组及常规白内障囊外摘除人工晶体植入术组术后切口后弹力层脱离分别为     

The results of cataract extraction and intraocular lens implantation in patients with Behçet's disease

PURPOSE: To evaluate the results of extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in patients with Beh?et's disease. METHODS: Retrospective study was based on 19 uveitic eyes of 12 patients with Beh?et's disease who underwent classic ECCE with IOL implantation in 5 eyes and phacoemulsification with IOL implantation in 14 eyes between 1993-1999. RESULTS: In eyes with Beh?et's uveitis 0.5 or better postoperative visual acuity was found in 21% at the end of mean 34.2-4.6 (range 5 to 66) months follow-up. The most frequent postoperative complications were posterior capsule opacification in 9 (47%), posterior synechiae in 5 (26%), anterior synechiae in 3 (16%). Anterior and posterior synechiae in the phacoemulsification group were less than those in the ECCE group (respectively p<0.05 and p<0.01). CONCLUSIONS: In eyes with chronic Beh?et's uveitis, cataract extraction and IOL implantation by phacoemulsification had fewer postoperative complication than ECCE, but most of the patients had low visual acuity due to preoperatively existing optic atrophy and/or inflammatory degeneration or edema of macula.     

原发性急性闭角型青光眼双眼眼前段相关结构的对比研究

目的研究原发性急性闭角型青光眼双眼眼前段相关结构特征。方法采用超声生物显微镜（UBM）眼前段活体结构检查技术、UBM眼前段图像处理技术，对10例原发性急性闭角型青光眼患者的双眼（一眼急性发作期，对侧眼临床前期）房角状态、房角相关解剖结构进行了定量观察及对比研究。结果UBM检查发现：双眼前房深浅（轴深）、房角开放距离500、小梁睫状突夹角、睫状体大小均有显著性差异。结论急性闭角型青光眼急性发作眼较临床前期眼前房更浅，房角关闭，睫状体前位和增大使眼前段更拥挤。采用UBM检查能从解剖学上进一步认识急性闭角型青光眼的发病机制。