The IgG4-related systemic disease is a recently described entity of fibro-inflammatory systemic damage. Although initially described in some forms of pancreatitis, the disease can affect all organs. The common histological features include a lymphoplasmacytic infiltration (especially to IgG4), fibrosis and phlebitis. Elevated serum level of IgG4 is also often present. This rare but certainly underdiagnosed disease must be kept in mind of all clinician faced to a non-specific inflammatory lesion. We report a case of ocular inflammation and lung tumors in a patient of 84 years for which the diagnosis was made through immunolabelling with IgG4 in lesions biopsied. PMID:23159548
Vandenbos, F; Benchetrit, M; Tieulié, N; Ambrosetti, D; Chanalet, S; Burel-Vandenbos, F
Most lymphomas that involve the ocular adnexal structure are low grade, B cell, non-Hodgkin’s lymphomas. The treatment depends upon the grade and stage of the disease. High grade lymhoma requires treatment with systemic chemotherapy whereas the localized low grade (extranodal marginal zone lymphoma) can be successfully managed with local radiotherapy. Chlamydia psittaci infection is associated with low grade ocular lymphoma; however there is wide geographic variation in the strength of this association. Blanket antibiotic therapy is not advised unless there is proof of an infective agent. The monoclonal antibody, rituximab, may be successful for CD20 positive lymphoma, although it is likely that rituximab will have better long-term results when used in combination with systemic chemotherapy.
Cohen, Victoria Mary Lendrum
Based on histological and immunohistochemical examination of various organs of patients with autoimmune pancreatitis (AIP), a novel clinicopathological entity of IgG4-related sclerosing disease has been proposed. This is a systemic disease that is characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Clinical manifestations are apparent in the pancreas, bile duct, gallbladder, salivary gland, retroperitoneum, kidney, lung, and prostate, in which tissue fibrosis with obliterative phlebitis is pathologically induced. AIP is not simply pancreatitis but, in fact, is a pancreatic disease indicative of IgG4-related sclerosing diseases. This disease includes AIP, sclerosing cholangitis, cholecystitis, sialadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, interstitial pneumonia, prostatitis, inflammatory pseudotumor and lymphadenopathy, all IgG4-related. Most IgG4-related sclerosing diseases have been found to be associated with AIP, but also those without pancreatic involvement have been reported. In some cases, only one or two organs are clinically involved, while in others, three or four organs are affected. The disease occurs predominantly in older men and responds well to steroid therapy. Serum IgG4 levels and immunostaining with anti-IgG4 antibody are useful in making the diagnosis. Since malignant tumors are frequently suspected on initial presentation, IgG4-related sclerosing disease should be considered in the differential diagnosis to avoid unnecessary surgery.
Kamisawa, Terumi; Okamoto, Atsutake
Aims. To elucidate characteristics of IgG4-related disease involving the peripheral nervous system. Methods. Retrospective review of 106 patients with IgG4-related disease identified 21 peripheral nerve lesions in 7 patients. Clinicopathological and radiological features were examined. Results. Peripheral nerve lesions were commonly identified in orbital or paravertebral area, involving orbital (n = 9), optic (n = 4), spinal (n = 7), and great auricular nerves (n = 1). The predominant radiological feature was a distinct perineural soft tissue mass, ranging 8 to 30?mm in diameter. Histologically, the epineurium was preferentially involved by massive lymphoplasmacytic infiltration rich in IgG4+ plasma cells. All lesions were neurologically asymptomatic and steroid-responsive at the first presentation, but one recurrent lesion around the optic nerve caused failing vision. Conclusion. IgG4-related disease of the peripheral nervous system is characterized by orbital or paravertebral localization, perineural mass formation, and rare neurologic symptoms. The term “IgG4-related perineural disease” seems appropriate to describe this entity.
Inoue, Dai; Zen, Yoh; Sato, Yasuharu; Abo, Hitoshi; Demachi, Hiroshi; Uchiyama, Akio; Gabata, Toshifumi; Matsui, Osamu
The purpose of this study is to determine the relationship of ocular adnexal benign or reactive lymphoid hyperplasia, including orbital pseudotumor, with immunoglobulin G4 (IgG4)-related diseases. Medical charts of 9 consecutive patients with ocular adnexal benign lymphoid lesions, seen in the Department of Ophthalmology, Okayama University Hospital, were reviewed, and pathological sections were restained immunohistochemically for IgG4-, IgG-, and CD138-positive plasma cells. The diagnosis of IgG4-positive lesions was based on 10 or more IgG4-positive plasma cells in a high-power field and greater than 40% ratios of IgG4-positive plasma cells/CD138-positive plasma cells and IgG4-positive plasma cells/IgG-positive plasma cells. IgG4-positive lesions were determined as absent in 5 patients (4 with bilateral lacrimal/orbital lesions and one with a unilateral conjunctival lesion), none of whom showed systemic manifestations. In contrast, IgG4-positive lesions were present in 4 patients (3 with bilateral lacrimal/orbital lesions and one with a unilateral lacrimal/orbital lesion), who showed systemic manifestations : one with Hashimoto thyroiditis, one with IgG4-positive bilateral interstitial lung disease and hepatic inflammatory pseudotumor, one with bilateral interstitial lung disease, and one with systemic lymphadenopathy and antiphospholipid syndrome. In conclusion, IgG4-positive ocular adnexal benign lymphoid lesions might be used as a benchmark for the probable presence of other systemic lymphoid lesions. PMID:21123971
Matsuo, Toshihiko; Ichimura, Kouichi; Sato, Yasuharu; Tanimoto, Yasushi; Kiura, Katsuyuki; Kanazawa, Sou; Okada, Toshiaki; Yoshino, Tadashi
Based on histological and immunohistochemical exami- nation of various organs of patients with autoimmune pancreatitis (AIP), a novel clinicopathological entity of IgG4-related sclerosing disease has been proposed. This is a systemic disease that is characterized by ex- tensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Clinical manifestations are apparent in the pancreas, bile duct, gallbladder, sali- vary gland,
Terumi Kamisawa; Atsutake Okamoto
Ocular adnexal non-Hodgkin’s lymphoma (NHL), the most common form of ophthalmic NHL, has a unique incidence pattern showing a steady and rapid increase in the past few decades, nearly equal rates among both genders, and predominance among Asians/Pacific Islanders. No major cause for ocular adnexal NHL has been identified, although infectious agents, immune disorders and genetic/epigenetic factors have all been implicated in its etiology. Identifying putative risk factors and biologic mechanisms leading to carcinogenesis in ocular adnexal NHL may enable implementation of effective preventive and/or therapeutic approaches for this malignancy. This article summarizes current knowledge on epidemiology of ocular adnexal NHL and the role of various potential risk factors in its etiology.
Moslehi, Roxana; Schymura, Maria J; Nayak, Seema; Coles, F Bruce
Background To determine the prognostic value of cell-cycle associated markers in ocular adnexal lymphoma (OAL). Methods Two hundred sixty-one consecutive cases of ocular adnexal lymphoproliferative lesions were subdivided into reactive lymphoid hyperplasia (RLH), atypical lymphoid hyperplasia (ALH) and OAL. The latter were sub-typed according to the new WHO Lymphoma Classification. All lesions were investigated applying standard immunohistochemical methods with antibodies
Sarah E. Coupland; Martin Hellmich; Claudia Auw-Haedrich; William R. Lee; Harald Stein
Infectious agents play a critical role in MALT lymphoma development. Studies from Italy showed Chlamydia psittaci infection in 87% of ocular adnexal MALT lymphomas and complete or partial regression of the lymphoma after C. psittaci eradication in four of nine cases. However, C. psittaci was not demonstrated in ocular adnexal MALT lymphomas from the USA. This study was thus designed to investigate further the role of C. psittaci, and other infectious agents commonly associated with chronic eye disease, in the development of ocular adnexal MALT lymphoma. The presence of C. psittaci, C. trachomatis, C. pneumoniae, herpes simplex virus 1 and 2 (HSV1, HSV2), and adenovirus 8 and 19 (ADV8, ADV19) was assessed separately by polymerase chain reaction in 142 ocular adnexal MALT lymphomas, 53 non-marginal zone lymphomas, and 51 ocular adnexal biopsies without a lymphoproliferative disorder (LPD), from six geographical regions. C. psittaci was detected at similar low frequencies in non-LPD and non-marginal zone lymphoma groups from different geographical regions (0-14%). Overall, the prevalence of C. psittaci was significantly higher in MALT lymphomas (22%) than in non-LPD (10%, p=0.042) and non-marginal zone lymphoma cases (9%, p=0.033). However, the prevalence of C. psittaci infection in MALT lymphoma showed marked variation among the six geographical regions examined, being most frequent in Germany (47%), followed by the East Coast of the USA (35%) and the Netherlands (29%), but relatively low in Italy (13%), the UK (12%), and Southern China (11%). No significant differences in the detection of C. pneumoniae, C. trachomatis, HSV1, HSV2, ADV8, and ADV19 were found between lymphomas and controls from different geographical regions. In conclusion, our results show that C. psittaci, but not C. pneumoniae, C. trachomatis, HSV1, HSV2, ADV8 or ADV19, is associated with ocular adnexal MALT lymphoma and that this association is variable in different geographical areas. PMID:16583361
Chanudet, E; Zhou, Y; Bacon, C M; Wotherspoon, A C; Müller-Hermelink, H-K; Adam, P; Dong, H Y; de Jong, D; Li, Y; Wei, R; Gong, X; Wu, Q; Ranaldi, R; Goteri, G; Pileri, S A; Ye, H; Hamoudi, R A; Liu, H; Radford, J; Du, M-Q
Given the fact that infectious agents contribute to around 18% of human cancers worldwide, it would seem prudent to explore their role in neoplasms of the ocular adnexa: primary malignancies of the conjunctiva, lacrimal glands, eyelids, and orbit. By elucidating the mechanisms by which infectious agents contribute to oncogenesis, the management, treatment, and prevention of these neoplasms may one day parallel what is already in place for cancers such as cervical cancer, hepatocellular carcinoma, gastric mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma. Antibiotic treatment and vaccines against infectious agents may herald a future with a curtailed role for traditional therapies of surgery, radiation, and chemotherapy. Unlike other malignancies for which large epidemiological studies are available, analyzing ocular adnexal neoplasms is challenging as they are relatively rare. Additionally, putative infectious agents seemingly display an immense geographic variation that has led to much debate regarding the relative importance of one organism versus another. This review discusses the pathogenetic role of several microorganisms in different ocular adnexal malignancies, including human papilloma virus in conjunctival papilloma and squamous cell carcinoma, human immunodeficiency virus in conjunctival squamous carcinoma, Kaposi sarcoma-associated herpes virus or human herpes simplex virus-8 (KSHV/HHV-8) in conjunctival Kaposi sarcoma, Helicobacter pylori (H. pylori,), Chlamydia, and hepatitis C virus in ocular adnexal mucosa-associated lymphoid tissue lymphomas. Unlike cervical cancer where a single infectious agent, human papilloma virus, is found in greater than 99% of lesions, multiple organisms may play a role in the etiology of certain ocular adnexal neoplasms by acting through similar mechanisms of oncogenesis, including chronic antigenic stimulation and the action of infectious oncogenes. However, similar to other human malignancies, ultimately the role of infectious agents in ocular adnexal neoplasms is most likely as a cofactor to genetic and environmental risk factors.
Verma, Varun; Shen, Defen; Sieving, Pamela C.; Chan, Chi-Chao
Nephropathy associated with IgG4-related disease is characterized by tubulointerstitial nephritis. To better identify its pathology, the present study analyzed clinicopathologic features of IgG4-related tubulointerstitial nephritis cases from across Japan. Sixteen cases were identified as IgG4-related nephropathy using the criterion of high serum IgG4 levels (>135 mg/dL) with abnormal kidney computed tomography or elevated serum creatinine levels. Male predominance (75%) and advanced age (average, 62.0 years) were noted. Eight cases displayed no autoimmune pancreatitis. Renal computed tomography abnormalities were found in 12 of 13 cases examined. Renal dysfunction was found in 15 of 16 cases at biopsy. Distinctive features of tubulointerstitial lesions included (1) well-demarcated borders between involved and uninvolved areas; (2) involvement of the cortex and medulla, often extending beyond the renal capsule and with occasional extension to retroperitoneal fibrosis; (3) interstitial inflammatory cells comprising predominantly plasma cells and lymphocytes, with a high prevalence of IgG4-positive cells often admixed with fibrosis; (4) peculiar features of interstitial fibrosis resembling a "bird's-eye" pattern comprising fibrosis among inter-plasma cell spaces; and (5) deposits visible by light and immunofluorescent microscopy in the tubular basement membrane, Bowman capsule, and interstitium that are restricted to the involved portion, sparing normal parts. Ultrastructural analysis revealed the presence of myofibroblasts with intracellular/pericellular collagen accompanied by plasma cell accumulation from an early stage. Histology could not discriminate between IgG4-related tubulointerstitial nephritis with and without autoimmune pancreatitis. In conclusion, the distinctive histologic features of IgG4-related tubulointerstitial nephritis can facilitate the differential diagnosis of tubulointerstitial nephritis, even without autoimmune pancreatitis or an abnormal computed tomography suggesting a renal tumor. PMID:21889187
Yamaguchi, Yutaka; Kanetsuna, Yukiko; Honda, Kazuho; Yamanaka, Nobuaki; Kawano, Mitsuhiro; Nagata, Michio
Objective: To determine the stage at initial examina- tion and the prevalence of systemic involvement in pa- tients with orbital and ocular adnexal lymphoma. Methods: The medical records of all patients with or- bital and ocular adnexal lymphoma treated in a recent 7-year period were reviewed for stage at initial exami- nation, highest stage during the follow-up period, and recurrence-free
Elham Hatef; Dianna Roberts; Peter McLaughlin; Barbara Pro; Bita Esmaeli
IgG4-related sclerosing disease is a recently recognized syndrome characterized by mass-forming lesions in exocrine glands or extranodal tissues due to lymphoplasmacytic infiltrates and sclerosis, a raised serum IgG4 level and increased IgG4+ plasma cells in the involved tissues. We report the morphologic features of the enlarged regional (n=3) and nonregional lymph nodes (n=3) in patients with this syndrome. The patients presented with autoimmune pancreatitis, lymphoplasmacytic sclerosing cholangitis, chronic sclerosing dacryoadenitis, or chronic sclerosing sialadenitis. The histologic features of the lymph nodes could be categorized into 3 patterns: Castleman diseaselike, follicular hyperplasia, and interfollicular expansion by immunoblasts and plasma cells. The percentage of IgG4+/IgG+ plasma cells was markedly elevated (mean 62% vs. 9.9% in 54 control lymph nodes comprising a wide variety of reactive conditions). We also report 6 cases of primary lymphadenopathy characterized by increased IgG4+/IgG+plasma cells (mean 58%). These cases share many clinical and pathologic similarities with IgG4-related sclerosing disease. In fact, 2 of these patients developed lymphoplasmacytic sclerosing cholangitis or lacrimal and submandibular gland involvement during the clinical course. These cases therefore probably represent primary lymph node manifestation of the disease. The importance of recognition of the lymphadenopathic form of IgG4-related sclerosing disease lies in the remarkable response to steroid therapy, and the potential of mistaking the disease for lymphoma either clinically or histologically. PMID:18344866
Cheuk, Wah; Yuen, Hunter K L; Chu, Stephenie Y Y; Chiu, Edmond K W; Lam, L K; Chan, John K C
IgG4-related disease is a syndrome which involves lymphoplasmacytic infiltrates and soft tissue sclerosis, elevated serum IgG4 titer, and increased IgG4-positive plasma cells in a variety of tissues. Scleroderma is also characterized by fibrosis and lymphoplasmacytic infiltrates. To our knowledge, the presence of IgG4-positive cells has not been well characterized in scleroderma. A retrospective review of scleroderma and related disorders (calcinosis, raynaud's syndrome, esophageal dysmotility, sclerodactyly, telangiectasia (CREST) syndrome, progressive systemic sclerosis, morphea) was performed. Thirty-four cases of scleroderma and related disorders were identified; IgG4-positive and IgG-positive plasma cells were counted in 10 HPF and an IgG4:IgG ratio determined. A cutoff ratio of 0.3 was used to define significant elevation. Three of the scleroderma cases had IgG4:IgG greater than 0. Only 1 case had a significant elevation. Of the 3 cases with elevated ratio, IgG4-positive cells ranged from 2 to 64 (median = 14), with an IgG4:IgG ranging from 0.06 to 0.34 (median = 0.22). Similar results were produced with the other sclerosing disorders. These results suggest that scleroderma is not part of the IgG4-related disease spectrum. PMID:23563250
Reddi, Deepti M; Cardona, Diana M; Burchette, James L; Puri, Puja K
BACKGROUND—The histological characteristics of ocular adnexal lymphomas have previously provided only a limited guide to clinical outcome for affected patients. This clinicopathological relation was re-examined using the Revised European American Lymphoma (REAL) system to classify the tumours in a large cohort of patients.?METHODS—The biopsies and clinical follow up data for 192 patients with ocular adnexal lymphoma were reviewed, the biopsies being regraded in accordance with the REAL classification. For each of five histological groups, logistic regression analysis was used to determine the odds ratios (OR) for the presence of systemic disease at the time of orbital diagnosis and Cox regression analysis was used to assess the hazard ratios (HR) for disseminated disease and lymphoma related death. For 108 patients in whom extraorbital spread occurred, the histological category of lymphoma was compared with the sites of dissemination.?RESULTS—At presentation, the frequency of previous or concurrent extraorbital disease increased from marginal zone lymphoma (OR 1.0), diffuse lymphoplasmacytic/lymphoplasmacytoid lymphoma (OR 2.3), follicle centre lymphoma (OR 3.8), diffuse large B cell lymphoma (OR 4.0) to other histological lymphoma variants (OR 26.8). For all histological types, the estimated risk of extraorbital disease and lymphoma related death continued for many years and the proportion of patients with at least one extraorbital recurrence after 5 years was 47% for MZL, 48% for LPL, 64% for FCL, 81% for DLCL, and 95% for other lymphoma variants. The corresponding estimated rates for 5 year lymphoma related mortality were 12%, 19%, 22%, 48%, and 53% respectively.?CONCLUSIONS—Patients with ocular adnexal lymphoma can be classified by REAL into five distinct groups, which show a progressive increase in the risks of extraorbital disease at diagnosis, of disease dissemination with time, and of tumour related death.??
Jenkins, C.; Rose, G.; Bunce, C.; Wright, J.; Cree, I.; Plowman, N.; Lightman, S.; Moseley, I.; Norton, A.
Ocular adnexal lymphomas (OAL) involve the peri-global soft tissues like orbit, eyelid, conjunctiva, lacrimal gland. We describe a rare case of primary bilateral OAL, histomorphologically small lymphocytic lymphoma, B cell phenotype of lacrimal gland origin. Rapid intraoperative diagnosis can be suggested on imprint cytology; subsequent histology and immunohistochemistry are helpful for confirmation and further line of management. Since no preformed lymphoid structures are expected within the orbit or lacrimal gland, any lymphoid mass here should be critically evaluated as a lymphoproliferative lesion.
Bandyopadhyay, Arghya; Majumdar, Kaushik; Gangopadhyay, Mimi; Khan, Kalyan; Chakraborty, Subrata; Ghosh, Asim Kr.
Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis that is characterized by lymphoplasmacytic infiltrate, storiform fibrosis, obliterative phlebitis, and increased IgG4+ plasma cells. Serum IgG4 levels usually are elevated. Patients with AIP frequently have disease affecting other organs or sites; these tissues show similar histologic changes, including increased IgG4+ plasma cell infiltrate and response to corticosteroid therapy. A new clinicopathologic concept of IgG4-related systemic disease (ISD) has been proposed. These diseases often are not limited to the pancreas, and the pancreas may not be involved at all. In this article, we review the literature and our own experience to detail the clinicopathologic features of AIP and extrapancreatic lesions in ISD.
Zhang, Lizhi; Smyrk, Thomas C
IgG4-related disease has gained increased attention worldwide. While the initial focus was on autoimmune pancreatitis which was first described in Asian populations and turned out to be of relevance in Western populations too, the scope has recently broadened towards a notion of a multi-systemic disease with very diverse manifestations such as autoimmune pancreatitis, IgG4-related sclerosing cholangitis (IgG4-SC), retroperitoneal fibrosis and tubulointerstitial nephritis. IgG4-SC (also known as IgG4-associated cholangitis, IAC) represents a rare but clinically challenging differential diagnosis in patients with obstructive jaundice and proximal extra- or intrahepatic biliary strictures which can be mistaken for cholangiocarcinoma (CC). We present the case of a 79-year-old male patient who presented with obstructive jaundice and biliary strictures at the hepatic duct bifurcation without any evidence for autoimmune pancreatitis and without elevation of serum IgG4-concentrations who underwent hemihepatectomy for suspected CC. However, on histological examination of the resection specimen CC could not be confirmed. It was only after several episodes of obstructive jaundice had reoccurred that the diagnosis of IgG4-SC could be established by reexamination of the surgical specimen which showed extensive infiltration with IgG4-positive plasma cells. Appropriate medical treatment with steroids and azathioprine led to complete remission of the disease. Early recognition of IgG4-SC can save patients from potential harmful and unnecessary surgical interventions. Here we describe the clinical features of this rare case of IgG4-SC with extensive liver tissue infiltration with IgG4-positive cells but without elevated serum IgG4 concentration or evidence of autoimmune pancreatitis. We describe diagnostic criteria for IgG4-SC and review recent insights in pathophysiology and treatment options. PMID:22965631
Nguyen-tat, M; Gamstätter, T; Marquardt, J U; Geißinger, E; Schadmand-Fischer, S; Lang, H; Siegel, E; Schuchmann, M; Galle, P R; Wörns, M A
IgG4-related systemic disease is an autoimmune disease that was first recognized in the pancreas but also affects other organs. This disease may manifest as tubulointerstitial nephritis (IgG4-TIN), but its clinicopathologic features in the kidney are not well described. Of the 35 patients with IgG4-TIN whose renal tissue specimens we examined, 27 (77%) had acute or progressive chronic renal failure, 29 (83%) had involvement of other organ systems, and 18 of 23 (78%) had radiographic abnormalities. Elevated total IgG or IgG4 serum levels were present in 79%. All pathologic specimens featured plasma cell–rich TIN, with most showing diffuse, expansile interstitial fibrosis. Immune complexes along the tubular basement membranes were present in 25 of 30 (83%). All specimens had a moderate to marked increase in IgG4+ plasma cells by immunohistochemistry. We used a control group of 175 pathologic specimens with plasma cell–rich interstitial infiltrates that can mimic IgG4-TIN to examine the diagnostic utility of IgG4 immunostaining. Excluding pauci-immune necrotizing and crescentic glomerulonephritis, IgG4 immunohistochemistry had a sensitivity of 100% (95% CI 90–100%) and a specificity of 92% (95% CI 86–95%) for IgG4-TIN. Of the 19 patients with renal failure for whom treatment and follow-up data were available, 17 (89%) responded to prednisone. In summary, because no single test definitively diagnoses IgG4-related systemic disease, we rely on a combination of histologic, immunophenotypic, clinical, radiographic, and laboratory features. When the disease manifests in the kidney, our data support diagnostic criteria that can distinguish IgG4-TIN from other types of TIN.
Raissian, Yassaman; Nasr, Samih H.; Larsen, Christopher P.; Colvin, Robert B.; Smyrk, Thomas C.; Takahashi, Naoki; Bhalodia, Ami; Sohani, Aliyah R.; Zhang, Lizhi; Chari, Suresh; Sethi, Sanjeev; Fidler, Mary E.
In the present study, we evaluated the ophthalmologic outcomes of 24 patients who received chemotherapy and/or radiotherapy for the treatment of non-conjunctival ocular adnexal mucosa-associated lymphoid tissue-type (MALT) lymphoma. Ophthalmologic outcomes were assessed in patients who received chemotherapy and/or radiotherapy from March 2004 until May 2010. Outcomes were determined according to common symptoms following chemotherapy and/or radiotherapy, which consisted of decreased visual acuity, dry eye symptoms, retinopathy, optic neuropathy, increased intraocular pressure, and blepharitis. Nine patients received chemotherapy alone, eight patients received radiotherapy alone, and seven patients received chemotherapy with additional radiotherapy (chemoradiation therapy). Patients treated by chemotherapy alone showed better ophthalmologic outcome scores (mean score, 1.56) than those treated by radiation alone or chemoradiation therapy (mean score, 4.01). In conclusion, the treatment of ocular adnexal lymphoma including radiotherapy showed poor ophthalmologic outcomes due to radiation-induced complications. Recently, many new treatment options have emerged, such as immunotherapy or radioimmunotherapy. In the future study, to select a better treatment modality with fewer complications, well-designed prospective trials with ophthalmologic outcomes are needed. PMID:22543827
Paik, Ji-Sun; Cho, Won-Kyung; Lee, Sung-Eun; Choi, Byung-Ock; Jung, Seung-Eun; Park, Gyeong-Sin; Kim, Sung-Hoon; Yang, Suk-Woo; Cho, Seok-Goo
Hypertrophic pachymeningitis (HP) is an inflammatory condition in which the dura mater of the cranium or spine becomes thickened, leading to symptoms that result from mass effect, nerve compression, or vascular compromise. The differential diagnosis of HP includes immune-mediated conditions such as rheumatoid arthritis and vasculitis, malignancies, and infections. Many times, no diagnosis is reached; in such cases, the disease has been described as idiopathic HP. IgG4-related disease (IgG4-RD) is a recently described inflammatory condition known to cause tumefactive lesions at myriad anatomical locations. Both IgG4-RD and idiopathic HP share similar demographics, histopathology, and natural history. We hypothesized that IgG4-RD is a common cause of idiopathic HP.To investigate this hypothesis, we identified all pathology specimens diagnosed as noninfectious HP during 25 years at our institution. Fourteen cases had stained slides and paraffin blocks to permit review of the original hematoxylin and eosin stained slides as well as immunostaining of cell blocks. Recently published consensus guidelines describing characteristic histopathology and the necessary quantity of IgG4+ plasma cell infiltrate were used to diagnose IgG4-RD.Four cases (66.6%) that had been regarded previously as representing idiopathic HP were diagnosed as IgG4-RD; of all the reviewed cases, IgG4-RD represented 29% of cases. Of the remaining cases, 3 cases were associated with granulomatosis with polyangiitis (GPA), 2 with lymphoma, and 1 each with rheumatoid arthritis, giant cell arteritis, and sarcoidosis. Two of the cases could not be diagnosed more precisely and were classified as undifferentiated HP. Clinical history, serologic tests, cerebrospinal fluid studies, and radiology alone could not identify the cause of HP. Rather, biopsy with histopathology and immunostaining was necessary to reach an accurate diagnosis. Significant IgG4+ plasma cell infiltrates were observed in rheumatoid arthritis, granulomatosis with polyangiitis, and lymphoma, underscoring the importance of histopathology in making the diagnosis of IgG4-RD.This case series demonstrates that IgG4-RD may be the most common etiology of noninfectious HP and highlights the necessity of biopsy for accurate diagnosis. PMID:23793110
Wallace, Zachary S; Carruthers, Mollie N; Khosroshahi, Arezou; Carruthers, Robert; Shinagare, Shweta; Stemmer-Rachamimov, Anat; Deshpande, Vikram; Stone, John H
Summary Twelve biopsied ocular adnexal benign lymphoid hyperplasias (OABLH) satisfying benign histological criteria were investigated for clonal immunoglobulin (Ig) heavy-chain gene rearrangement by means of a two-step polymerase chain reaction (PCR) method using formalin-fixed and paraffin-embedded tissue. Of the 12, 4 (33%) demonstrated clear single bands of the rearranged gene for the Ig heavy-chain, of between 100 and 150 base
Yasuo Takano; Masahiko Okudaira
IgG4-related disease is a newly recognized fibro-inflammatory condition characterized by several features: a tendency to form tumefactive lesions in multiple sites; a characteristic histopathological appearance; and-often but not always-elevated serum IgG4 concentrations. An international symposium on IgG4-related disease was held in Boston, MA, on 4-7 October 2011. The organizing committee comprising 35 IgG4-related disease experts from Japan, Korea, Hong Kong, the United Kingdom, Germany, Italy, Holland, Canada, and the United States, including the clinicians, pathologists, radiologists, and basic scientists. This group represents broad subspecialty expertise in pathology, rheumatology, gastroenterology, allergy, immunology, nephrology, pulmonary medicine, oncology, ophthalmology, and surgery. The histopathology of IgG4-related disease was a specific focus of the international symposium. The primary purpose of this statement is to provide practicing pathologists with a set of guidelines for the diagnosis of IgG4-related disease. The diagnosis of IgG4-related disease rests on the combined presence of the characteristic histopathological appearance and increased numbers of IgG4? plasma cells. The critical histopathological features are a dense lymphoplasmacytic infiltrate, a storiform pattern of fibrosis, and obliterative phlebitis. We propose a terminology scheme for the diagnosis of IgG4-related disease that is based primarily on the morphological appearance on biopsy. Tissue IgG4 counts and IgG4:IgG ratios are secondary in importance. The guidelines proposed in this statement do not supplant careful clinicopathological correlation and sound clinical judgment. As the spectrum of this disease continues to expand, we advocate the use of strict criteria for accepting newly proposed entities or sites as components of the IgG4-related disease spectrum. PMID:22596100
Deshpande, Vikram; Zen, Yoh; Chan, John Kc; Yi, Eunhee E; Sato, Yasuharu; Yoshino, Tadashi; Klöppel, Günter; Heathcote, J Godfrey; Khosroshahi, Arezou; Ferry, Judith A; Aalberse, Rob C; Bloch, Donald B; Brugge, William R; Bateman, Adrian C; Carruthers, Mollie N; Chari, Suresh T; Cheuk, Wah; Cornell, Lynn D; Fernandez-Del Castillo, Carlos; Forcione, David G; Hamilos, Daniel L; Kamisawa, Terumi; Kasashima, Satomi; Kawa, Shigeyuki; Kawano, Mitsuhiro; Lauwers, Gregory Y; Masaki, Yasufumi; Nakanuma, Yasuni; Notohara, Kenji; Okazaki, Kazuichi; Ryu, Ji Kon; Saeki, Takako; Sahani, Dushyant V; Smyrk, Thomas C; Stone, James R; Takahira, Masayuki; Webster, George J; Yamamoto, Motohisa; Zamboni, Giuseppe; Umehara, Hisanori; Stone, John H
Immunoglobulin (IgG) 4-related disease is characterized by elevated serum IgG4 and tissue infiltration by IgG4-positive plasma cells. We report a case of IgG4-related inflammation of the orbit simulating extranodal marginal zone B-cell lymphoma (EMZL). A 72-year-old female complained of bilateral eyelid swelling for three years. A MRI scan demonstrated two kinds of lesions, tumor 1, presenting with a predominantly low density, and tumor 2, of relatively high density. Laboratory tests showed high serum IgG4 concentrations, measuring 991 mg/dl. Partial resection of each tumor was conducted in September 2011. Based on the clinicopathological findings, tumors 1 and 2 were diagnosed as IgG4-related inflammation and EMZL, respectively. The patient initially received oral prednisolone at 30 mg/per day, followed by irradiation with a total dosage of 30 Gy to both eyes. The bilateral tumors consequently diminished, and she is currently well with no recurrence or systemic involvement. In conclusion, EMZL can arise from massive IgG4-related orbital inflammation. Since IgG4-related inflammation can represent multiple nodular lesions, biopsies from multiple sites within the lesion are required to make a correct diagnosis in selected cases. Oral prednisolone combined with radiotherapy is an effective treatment for patients with IgG4-related ophthalmic disease simulating EMZL. PMID:23749941
Kase, Satoru; Noda, Mika; Ishijima, Kan; Yamamoto, Teppei; Hatanaka, Kanako; Ishida, Susumu
We studied the relation between prostaglandin analogue use and ocular adnexal features. We used a prospective, cross-sectional study involving 157 current, 15 past, and 171 never users of prostaglandin analogues. Patients 50 years of age or older and without conditions affecting ocular adnexal anatomy underwent glaucoma medication use history, external digital photography and systematic external adnexal exam. Two masked readers assessed the digital photos for upper lid dermatochalasis and lower lid steatoblepharon using a validated grading scheme. Another masked clinical examiner also assessed upper lid ptosis, levator muscle function, and inferior scleral show. We performed ordinal logistic regression analysis accounting for multiple covariates to assess the relation between prostaglandin analogue use and adnexal features. Multivariable analyses indicated there was a 230-fold increased risk of incremental involution of dermatochalasis (odds ratio (OR) = 2.30; 95% confidence interval (CI) 1.43-3.69; p = 5.44E-04) and a 249-fold increased risk of incremental loss of lower lid steatoblepharon (OR = 2.49; 95% CI, 1.54-4.03; p= 1.98E-04) associated with current prostaglandin analogue use (bimatoprost 0.03%, travoprost 0.005%, or latanoprost 0.004%) versus prostaglandin analogue never or past users. Upper lid ptosis (OR = 4.04; 95% CI, 2.43-6.72; p = 7.37E-08), levator dysfunction (OR = 7.51; 95% CI, 3.39-16.65; p = 6.74E-07) and lower lid retraction (OR = 2.60; 95% CI, 1.58-4.28; p = 1.72E-04) were highly associated with current prostaglandin analogue use versus prostaglandin analogue never or past users. The associations between prostaglandin analogue use and deepening of the upper lid sulci and between prostaglandin analogue use and loss of inferior periorbital fat are confirmed in this multivariable analysis. The associations between prostaglandin analogue use and levator muscle dysfunction and between prostaglandin analogue use and upper lid ptosis represent significant side effects that could impact visual function in glaucoma patients. PMID:23650502
Shah, Mamta; Lee, Grace; Lefebvre, Daniel R; Kronberg, Benjamin; Loomis, Stephanie; Brauner, Stacey C; Turalba, Angela; Rhee, Douglas J; Freitag, Suzanne K; Pasquale, Louis R
Orbital apex and skull base masses often present with neuro-ophthalmic signs and symptoms. Though the localization of these syndromes and visualization of the responsible lesion on imaging is typically straightforward, definitive diagnosis usually relies on biopsy. Immunohistochemistry is important for categorization and treatment planning. IgG4-related disease is emerging as a pathologically defined inflammatory process that can occur in multiple organ systems. We present two patients with extensive inflammatory mass lesions of the central nervous system with immunohistochemistry positive for IgG4 and negative for ALK-1 as examples of meningeal based IgG4-related inflammatory pseudotumors. In both patients, there was treatment response to mycophenolate mofetil. PMID:22546342
Moss, Heather E; Mejico, Luis J; de la Roza, Gustavo; Coyne, Thomas M; Galetta, Steven L; Liu, Grant T
We report a 72-year-old man with respiratory involvement of immunoglobulin G4 (IgG4)-related disease, who developed dry cough and shortness of breath on effort. The chest computed tomography scan image showed massive and diffuse ground-glass opacity, interlobular thickening, and bronchial wall thickening. The infiltration of IgG4-positive plasma cells in the transbronchial lung biopsy and high serum IgG4 concentrations were found. The patient was treated with 0.6 mg/kg oral prednisolone and showed rapid improvement. This is a case of IgG4-related disease in which the only complication was respiratory involvement. PMID:22310965
Umeda, Masataka; Fujikawa, Keita; Origuchi, Tomoki; Tsukada, Toshiaki; Kondo, Akira; Tomari, Shinya; Inoue, Yuichi; Soda, Hisashi; Nakamura, Hideki; Matsui, Shoko; Kawakami, Atsushi
A 77-year-old man with jaundice and a pancreatic head tumor was referred to our hospital in August 2006. The initial laboratory tests, computed tomography (CT) scan, magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography suggested IgG4-related cholangitis and autoimmune pancreatitis. Oral prednisolone (PSL) was then administered. This treatment reduced the size of the pancreatic parenchyma, and the lower common bile duct (CBD) returned to its normal size. Thus, the oral PSL was gradually tapered to a maintenance dose. In February 2010, a CT scan and MRI showed segmental wall thickening and stenosis of the middle CBD, the progression of which led to extrahepatic obstructive jaundice. We suspected the emergence of a cholangiocarcinoma rather than the exacerbation of the IgG4-related sclerosing cholangitis because the stricture of the CBD was short and localized. Then, a percutaneous transhepatic biliary drainage was performed. The biopsy specimens obtained via the percutaneous transhepatic tract indicated an abnormal glandular formation, suggesting the presence of a moderate, well-differencated adenocarcinoma. The gross examination, microscopic examination and immunohistochemical analysis of the pancreaticoduodenectomy specimen suggested that a cholangiocarcinoma developed from the IgG4-related sclerosing cholangitis. PMID:24009815
Douhara, Akitoshi; Mitoro, Akira; Otani, Emi; Furukawa, Masanori; Kaji, Kosuke; Uejima, Masakazu; Sawai, Masayoshi; Yoshida, Motoyuki; Yoshiji, Hitoshi; Yamao, Junichi; Fukui, Hiroshi
IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory condition which often shows a dramatic response to steroid therapy. IgG4-RD can present either as a single lesion or as a systemic multi-organ disorder. Common histological findings include a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and phlebitis. Although diagnostic criteria for IgG4-RD have been proposed in many organs/sites, they are not well established in the central nervous system. Published data on IgG4-RD in meninges is also limited. To our knowledge, only 15 potential cases of meningeal IgG4-RD have been reported. We add a case of probable IgG4-related pachymeningitis in a 42-year-old woman who presented with headache and left transverse sinus obstruction. Follow-up after 2-months of high dose steroids shows dramatic clinical and imaging improvement. The differential diagnosis for IgG4-related pachymeningitis, including lymphoplasmacyte-rich meningioma, idiopathic hypertrophic pachymeningitis, and lymphoproliferative disease is discussed. PMID:23320997
Tanboon, Jantima; Felicella, Michelle Madden; Bilbao, Juan; Mainprize, Todd; Perry, Arie
Immunoglobulin (Ig) G4-related sclerosing disease is a recently described syndrome characterized by lymphoplasmacytic infiltration of exocrine glands or extranodal tissues and elevated serum IgG4. We report three cases of lymphadenopathy secondary to IgG4-related sclerosing disease. Histologic features of involved lymph nodes included interfollicular immunoblasts and plasma cells, similar to Castleman's disease. The percentage of IgG4-/IgG-positive plasma cells in the three patients was markedly elevated (30, 50, and 60%). Administration of prednisolone led to remission in every case. One of three cases was consulted to our hospital due to suspected diagnosis of angioimmunoblastic T cell lymphoma (AITL). The case demonstrates many clinical and pathologic similarities between IgG4-related sclerosing disease and AITL. Pathological similarities between AITL and the lymphoplasmacytic subtype of IgG4-sclerosing disease have recently been reported. It is important to accurately diagnose IgG4-related lymphadenopathy given its ready response to steroid therapy and the potential for misdiagnosing lymphoma on clinical grounds. PMID:21116748
Shimizu, Ikuo; Nasu, Kentaro; Sato, Keijiro; Ueki, Hiromitsu; Akahane, Daigo; Sumi, Masahiko; Ueno, Mayumi; Ichikawa, Naoaki; Asano, Naoko; Kojima, Masaru; Kobayashi, Hikaru
IgG4-related lung disease is commonly associated with autoimmune pancreatitis. Recently, isolated IgG4-related interstitial lung disease (ILD) without other organ involvement has newly been reported in two cases with clinical features of nonspecific interstitial pneumonitis (NSIP).We report the first case of an isolated IgG4-related ILD in a 78-year-old man with dry cough and dyspnea, whose clinical findings proved to be different from NSIP. Serum IgG4 levels were increased. Chest CT scan revealed bilateral consolidations especially in the lower lobes, enlarged mediastinal and hilar lymph nodes and pleural effusions. Video-assisted thoracoscopic (VATS) lung biopsy revealed a pattern similar to usual interstitial pneumonia (UIP) and an abundant IgG4-positive plasma cell infiltration. He was effectively treated by steroid therapy.Increasing recognition of IgG4 related diseases has led to a growing number of new entities. The novel concept of isolated IgG4-related ILD as a pulmonary manifestation of a systemic IgG4-related disorder should be taken into account as a possible differential diagnosis of ILD and mass-forming lesions, even when no other organ manifestation is clinically apparent at the time of diagnosis. Lung specific diagnostic criteria and algorithms are required to enhance diagnostic accuracy in cases of possible IgG4-related ILD. PMID:23509921
Wibmer, Thomas; Kropf-Sanchen, Cornelia; Rüdiger, Stefan; Blanta, Ioanna; Stoiber, Kathrin M; Rottbauer, Wolfgang; Schumann, Christian
We describe a 21-year male with mood disorder on lithium therapy and psoriasis-like skin lesions presenting with rapidly progressive renal failure. The kidney biopsy showed acute tubulointerstitial nephritis with immunoglobulin G4-positive plasma cell infiltration. He was started on oral steroids with a provisional diagnosis of IgG4-related tubulointerstitial nephritis. All dermatological, psychiatric and renal manifestations dramatically improved, and he was taken off lithium. He had a relapse of his psychiatric symptoms on stopping steroids, and they again responded to steroids. PMID:23616060
Ramachandran, Raja; Rajakumar, Venkatesh; Rawat, Amit; Nada, Ritambhra; Kumar, Vivek; Rathi, Manish; Kohli, Harbir S; Sakhuja, Vinay; Jha, Vivekanand
An 85-year-old man was admitted for non-productive cough and bilateral pleural effusion on a chest X-ray film. Although his pleural effusion was exudative and showed an increased number of lymphocytes and a high level of adenosine deaminase, Mycobacterium tuberculosis infection, even with a microbiological culture, PCR and interferon-gamma release assay, was unverifiable. Cytology of his pleural effusion demonstrated plasmacytoid-like large atypical cells. Immunological tests showed high levels of IgG and IgG4 in both his serum and pleural effusion. A fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed uptake of FDG in orbital lesions, salivary glands, gastric wall, biliary system and lymph nodes (cervical, supraclavicular, axillary, hilar, mediastinal, along the lesser gastric curvature). Histological examination of an orbital pseudotumor and gastric mucosal biopsy revealed that numerous numbers of mostly IgG4 positive plasma cells, had accumulated. Based on these findings, systemic IgG4-related disease was diagnosed. Corticosteroid therapy was started and the volume of pleural effusion markedly declined. We report a rare case of IgG4-related disease accompanied by pleural effusion with a high level of ADA. PMID:21485156
Tanaka, Hideyuki; Ichiyasu, Hidenori; Notsute, Daisuke; Yamashita, Akihisa; Hamamoto, Junji; Kohrogi, Hirotsugu
We present a case of a 23-year-old gentleman who presented with dysphagia, weight loss, and recurrent esophageal strictures requiring multiple dilatations. An endoscopic ultrasound with esophagogastroduodenoscopy revealed a mass present in the distal esophagus. Fine needle aspiration suggested that the mass in the lower esophagus resembled a gastrointestinal stromal tumor. After surgical resection, final pathologic analysis revealed that the tumor was comprised of benign-appearing fibroinflammatory cells with an increase and predominance of IgG4-positive plasma cells. The microscopic appearance was consistent with a benign condition as a result of an IgG4-related process. He did not, however, have any other symptoms indicative of systemic autoimmune disease or connective tissue disorders. We present the pre-operative imaging, operative management, pathologic diagnosis, and literature review of this rare condition and the first known report of autoimmune esophagitis as part of the IgG4 spectrum of diseases. PMID:20195914
Lopes, James; Hochwald, Steven N; Lancia, Nicholas; Dixon, Lisa R; Ben-David, Kfir
Patients with autoimmune pancreatitis have a striking polyclonal elevation of total IgG4 in serum. This observation has been confirmed and extended to other fibrotic conditions (that are therefore called IgG4-related disease) but as yet remains unexplained. The affected tissue contains many IgG4-producing plasma cells embedded in a fibrotic matrix originating from activated mesenchymal (stellate) cells. We propose that the process results from an unusual interaction between two regulatory systems: the regulatory arm of the immune system (including Bregs) and the tissue repair regulatory components orchestrated by the activated stellate cell. This interaction results in ongoing mutual activation, generating TGFbeta, IL10, and vitamin D. This environment suppresses most immune reactions but stimulates the development of IgG4-producing plasma cells.
Lighaam, Laura C.; Aalberse, Rob C.; Rispens, Theo
Extranodal marginal zone lymphomas (EMZL) are the most common lymphomas in the ocular adnexa. The etiology and potential role for antigenic stimulation in these lymphomas are still controversial. We have examined IGHV gene usage and mutations in 67 Chlamydophila psittaci-negative ocular adnexal EMZL. Clonal IGHV gene sequences were identified in 43 tumors originating from the orbit (19), conjunctivae (18) and lacrimal gland (6). Forty four potentially functional clonal IGHV gene sequences were detected with overrepresentation of the IGHV4 family and IGHV4-34 gene. All but 3 sequences were mutated with the average percent homology to the germ line of 93.5±6.1. Multinomial model and Focused binomial test demonstrated evidence for positive and/or negative antigen selection in 59% of the potentially functional IGHV genes. Intraclonal variation was detected in 8 of 11 tumor specimens. Overall our findings demonstrate that C. psittaci-negative ocular adnexal EMZL exhibit biased usage of IGHV families and genes with evidence for intraclonal heterogeneity and antigen selection in multiple tumors, implicating B-cell receptor-mediated antigen stimulation in the pathogenesis of these lymphomas.
Zhu, Daxing; Lossos, Chen; Chapman-Fredricks, Jennifer R.; Matthews, Julie M.; Ikpatt, Offiong F.; Ruiz, Phillip; Lossos, Izidore S.
IgG4-related disease (IgG4-RD) is a chronic and relapsing disease. The diagnosis of IgG4-RD is based on a combination of features that include clinical, imaging, serologic, histology, and immunohistochemistry. Nonetheless, histopathology has emerged as the gold standard for the diagnosis of IgG4-RD. Guidelines for the pathologic diagnosis of this condition have been published by an international group of experts: a triumvirate of histologic features allows for a confident diagnosis of IgG4-RD to be made in most cases: (1) a dense lymphoplasmacytic infiltrate, (2) storiform-type fibrosis, and (3) obliterative phlebitis. Elevated numbers of IgG4-positive plasma cells are essential for the diagnosis, but this feature is not sufficient in, and of, itself. IgG4-positive plasma cells are also seen in a variety of inflammatory and neoplastic diseases. An elevated IgG4 to IgG ratio, more than 40%, improves the specificity of this stain. A wide range of inflammatory and neoplastic diseases including antineutrophil cytoplasmic antibody (ANCA)-related vasculitis, chronic infections, mesenchymal neoplasms, carcinoma, and lymphoma should be excluded before arriving at a diagnosis of IgG4-RD. This review aims to provide the histopathologist with a set of practical guidelines for the diagnosis of IgG4-RD, and also addresses the many controversies associated with the diagnostic aspects of this disease. PMID:23068297
Four patients with IgG4-related disease (IgG4-RD) showed increased percentages of RP105-negative B cells in the peripheral blood. Case 1: A 66-year-old man having retroperitoneal fibrosis had 18.8% of RP105-negative B cells. Oral prednisolone improved the affected lesions and the percentage of RP105-negative B cells decreased (3.2%) after the treatment. Case 2: A 53-year-old man with retroperitoneal fibrosis had 27.9% of RP105-negative B cells. Case 3: A 38-year-old man with follicular hyperplasia showed increased percentage of RP105-negative B cells (8.3%). Case 4: A 60-year-old man with interstitial nephritis had 27.5% of RP105-negative B cells. The treatment decreased the numbers of RP105-negative B cells. Increased numbers of RP105-negatvie B cells is possibly associated with disease activity of IgG4-RD. Analysis of expression of RP105 on B cells may be helpful in evaluation of disease activity of IgG4-RD.
Koarada, S; Tashiro, S; Nagao, N; Suematsu, R; Ohta, A; Tada, Y
In this study we investigated the distribution of IgG4+ plasma cells and regulatory T (T(REG)) cells, a major regulator of IgG4 production, in nodal and extranodal Rosai-Dorfman disease (RDD). Twenty-six specimens (15 nodal, 11 extranodal) were examined, with reactive lymph nodes and site-matched extranodal specimens as controls. Overall, 84.6% (22/26) of the specimens showed various degrees of sclerosis (7 mild, 8 moderate, and 7 severe). Nineteen cases (73.1%) exhibited more than 10 IgG4+ cells/0.060 mm(2) (photographed area at ×40), and 8 cases (30.8%) showed more than 40% of IgG+ cells being IgG4+. Only 1 control case exhibited more than 10 IgG4+ cells/0.060 mm(2) (P < .05). The number of T(REG) cells was comparable between nodal RDD and controls, whereas extranodal RDD exhibited significantly higher numbers of T(REG) cells than controls. These findings demonstrate that a subset of RDD shows features of IgG4-related disease and indicate an overlap between certain aspects of the 2 diseases. PMID:23596114
Zhang, Xuefeng; Hyjek, Elizabeth; Vardiman, James
A 54-year-old man had a 5-year history of painless bilateral eyelid swelling, proptosis, and diplopia. MRI showed enlargement of extraocular muscles, lacrimal gland, and divisions of the trigeminal nerve (figure 1). Biopsy from the left infraorbital canal demonstrated lymphoplasmacytic infiltrate and fibrosis. Mean number of immunoglobulin G (IgG)4+ cells was 155 per high-power field and ratio of IgG4+/IgG+ cells was 89% (figure 2). Serum IgG4 concentration was 878 mg/dL (normal range 4-86 mg/dL). Symptoms resolved with steroids. The patient relapsed during tapering and azathioprine was added. IgG4-related disease is characterized by IgG4-positive cells and lymphocyte infiltration into various organs, including orbital tissues. Thickening of branches of the trigeminal nerve is highly suggestive of IgG4-related disease.(1,2.) PMID:24101754
Deschamps, Romain; Deschamps, Lydia; Vignal, Catherine; Putterman, Marc; Galatoire, Olivier; Gout, Olivier
IgG4-related disease was first described in adults with autoimmune pancreatitis but is now known to affect multiple organs. Lung involvement has never been described in children to our knowledge. Here, we report an adolescent presenting with recurrent dry cough and hemoptysis who was found to have venous ectasia in the left upper lobe, and diffuse bronchiectasis. Sustained high levels of IgG4 (1,090 mg/dL) were found, and the endobronchial biopsy revealed a marked infiltration of plasma cells producing IgG4 (ratio of IgG4 plasma cells to IgG plasma cells >50%). This unique case highlights the occurrence of IgG4-related disease in a child and underscores the importance of careful scrutiny of all investigations in complex pediatric respiratory cases. PMID:23918112
Pifferi, Massimo; Di Cicco, Maria; Bush, Andrew; Caramella, Davide; Chilosi, Marco; Boner, Attilio L
IgG4-related disease is an emerging disease entity characterized by elevated serum IgG4 concentration and tumefaction or tissue infiltration by IgG4-positive plasma cells. In IgG4-related disease, tumor-like lesions develop in multiple organs, such as the lacrimal gland, salivary gland, lung, pancreas, kidney, and lymph nodes. We report here three cases of IgG4-related orbital inflammation that presented as unilateral pseudotumors. The patients all were men, with an age range of 65-75 years. The patients had been pointed out unilateral intra-orbital masses, and histopathological examinations revealed marked accumulation of IgG4-positive plasma cells (IgG4/IgG ratio: 51.1-71.6 %) with fibrosis. But storiform fibrosis was seen in only one case, and no obliterative phlebitis was seen. The serum levels of IgG4 were increased to 178-670 mg/dL. The masses had well-defined homogeneous signal intensities, and they were hypo-intense on T1-weighted MR images and iso-intense on T2-weighted MR images. Gadolinium enhanced mass lesions in two cases. All orbital mass lesions responded well to corticosteroid treatment. PMID:23138265
Origuchi, Tomoki; Yano, Hiroki; Nakamura, Hideki; Hirano, Akiyoshi; Kawakami, Atsushi
IgG4-related disease has been recently defined as a distinct clinic-pathologic entity, characterized by dense IgG-4 plasmacytic infiltration of diverse organs, fibrosis, and tumefactive lesions. Salivary and lacrimal glands are a target of this disease and, when affected, may clinically resemble Küttner tumor, Mikulicz disease, or orbital inflammatory pseudotumor. In some patients, the disease is systemic, with metachronous involvement of multiple organs, including the pancreas, aorta, kidneys, and biliary tract. We report a 66-year-old man who presented with salivary gland enlargement and severe salivary hypofunction and was diagnosed with IgG4-related disease on the basis of a labial salivary gland biopsy. Additional features of his illness included a marked peripheral eosinophilia, obstructive pulmonary disease, and lymphoplasmacytic aortitis. He was evaluated in the context of a research registry for Sjögren syndrome and was the only 1 of 2594 registrants with minor salivary gland histopathologic findings supportive of this diagnosis. PMID:23146570
Baer, Alan N; Gourin, Christine G; Westra, William H; Cox, Darren P; Greenspan, John S; Daniels, Troy E
The following report describes two male patients with an ongoing medical history with a predominant laryngeal focus, who were finally diagnosed with IgG4-related disease (IgG4-RD). Their primary symptoms included hoarseness and pain of the throat, and they had undergone multiple laryngeal surgeries and laser treatments due to tumorous growth with limited success. Due to the onset of additional symptoms, they initially received the diagnoses granulomatous polyangiitis (GPA) and Behçet's disease. However, further analysis showed elevated IgG4 levels in serum and infiltration of IgG4-positive plasma cells upon biopsy of laryngeal and pulmonary tissue. Treatment was started with moderate doses of prednisone, leading to a rapid resolution of symptoms. PMID:23813505
Shaib, Yasmin; Ton, Evelien; Goldschmeding, Roel; Tekstra, Janneke
IgG4-related disease (IgG4-RD) is a recently recognized multi-organ fibro-inflammatory lesion characterized by elevated IgG4 serum levels and mass-forming lesions. This condition shows similar histological features independently of the site of origin including storiform fibrosis, obliterative phlebitis, and dense lymphoplasmacytic infiltrate with a conspicuous IgG4-positive plasma cell component. Since this disease has only recently been categorized as a single specific nosologic entity, lesions with these typical morphological features have previously been named in different ways, creating some confusion and making it difficult to identify cases published in the literature. Lesions with features suggesting IgG4-RDs have very rarely been reported in the ureter, and they have been named using the terms "inflammatory pseudotumor" and "idiopathic segmental ureteritis." Herein, we describe the clinicopathological features of ureteral IgG4-RD found in two different patients. An 82-year-old female and a 77-year-old male underwent ureteral resection due to severe ureteral wall thickness and lumen stenosis suggestive of urothelial carcinoma. However, histological examinations showed transmural fibro-inflammatory lesions, with abundant IgG4 plasma cells intermixed with histiocytes, lymphocytes, fibroblasts, and scattered eosinophils. We have also accurately reviewed the literature in order to identify, among lesions diagnosed with different names, examples of ureteral IgG4-related lesions to give the reader a comprehensive overview of this relatively rare inflammatory disease. We suggest using the name "ureteral IgG4-RD" for those lesions showing the same morphological features as IgG4-RDs located elsewhere. PMID:23666067
Marando, Alessandro; D'Ambrosio, Gioacchino; Catanzaro, Francesco; La Rosa, Stefano; Sessa, Fausto
Purpose: To evaluate the long-term treatment outcome and disease behavior of primary ocular adnexal MALT (mucosa-associated lymphoid tissue) lymphoma (POAML) after treatment with radiotherapy. Methods and Materials: Seventy-eight patients (42 male, 36 female) diagnosed with stage I POAML between 1991 and 2010 at Kobe University Hospital were included. The median age was 60 years (range, 22-85 years). The median radiation dose administered was 30.6 Gy. Rituximab-based targeted therapy and/or chemotherapy was performed in 20 patients (25.6%). Local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates were calculated using the Kaplan-Meier method. Results: The median follow-up duration was 66 months. Major tumor sites were conjunctiva in 37 patients (47.4%), orbita in 29 (37.2%), and lacrimal glands in 12 (15.4%). The 5- and 10-year OS rates were 98.1% and 95.3%, respectively. The 5- and 10-year LC rates were both 100%, and the 5- and 10-year RFS rates were 88.5% and 75.9%, respectively. Patients treated with a combination of radiotherapy and targeted therapy and/or chemotherapy had a trend for a better RFS compared with those treated with radiotherapy alone (p = 0.114). None developed greater than Grade 2 acute morbidity. There were 14 patients who experienced Grade 2 morbidities (cataract: 14; retinal disorders: 7; dry eye: 3), 23 patients who had Grade 3 morbidities (cataract: 23; dry eye: 1), and 1 patient who had Grade 4 glaucoma. Conclusions: Radiotherapy for POAML was shown to be highly effective and safe for LC and OS on the basis of long-term observation. The absence of systemic relapse in patients with combined-modality treatment suggests that lower doses of radiation combined with targeted therapy may be worth further study.
Hashimoto, Naoki [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Sasaki, Ryohei, E-mail: email@example.com [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Nishimura, Hideki; Yoshida, Kenji; Miyawaki, Daisuke; Nakayama, Masao; Uehara, Kazuyuki; Okamoto, Yoshiaki; Ejima, Yasuo [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan); Azumi, Atsushi [Division of Ophthalmology, Kobe University Graduate School of Medicine, Hyogo (Japan); Matsui, Toshimitsu [Division of Hematology, Kobe University Graduate School of Medicine, Hyogo (Japan); Sugimura, Kazuro [Division of Radiation Oncology, Kobe University Graduate School of Medicine, Hyogo (Japan)
We herein report a case of IgG4-related autoimmune pancreatitis (AIP). A 72-year-old male with jaundice visited our hospital complaining of epigastralgia. A blood chemistry analysis revealed elevated serum levels of total bilirubin and DUPAN-II. Computed tomography (CT) revealed irregularly shaped pancreatic masses with a stricture of the main pancreatic duct (MPD) in the head and tail that were interposed by marked atrophy with MPD dilation in the body. F-18 fluorodeoxyglucose (FDG)-positron emission tomography/CT revealed abnormally intense FDG uptake only at the masses. During surgery, another small tumor was also found in the atrophied body; therefore, a total pancreatectomy was performed under the diagnosis of multiple pancreatic cancers. The histological analysis revealed fibrosis with dense and diffuse infiltrations of lymphocytes and IgG4-positive plasma cells. The pancreatic parenchyma of the body was firmly replaced by fibrosis. AIP can lead to the formation of multiple pancreatic lesions, and thus the correct diagnosis is occasionally difficult to establish in atypical cases. PMID:23549930
Kimura, Akifumi; Yamamoto, Junji; Hatsuse, Kazuo; Aosasa, Suefumi; Nishiyama, Kiyoshi; Maejima, Tadashi; Ogata, Sho; Shimazaki, Hideyuki; Kawaguchi, Atsushi; Hase, Kazuo
Adnexal torsion is a gynecological emergency caused by the torsion of the ovary over its pedicle producing lymphatic and venous stasis, later it develops into ischemia and necrosis, when is not treated. Until recently, the treatment for adnexal torsion has been adnexectomy. This paper report three cases treated successfully with conservative treatment. It is essential to establish a protocol for adnexal torsion management where radical treatments are abandoned and conservative surgeries, such as detorsion and plication, are performed. We suggest as a first choice management adnexal detorsion, in case malignity is suspected to have intraoperative pathologic analysis, and based on the results to decide to preserve the adnexal or remove it for definitive cure. PMID:23819427
Sánez, Henry Aristóteles Mateo; Taboada-Pérez, Grecia Carolina; Hernández-Arroyo, Lysandra; Mateo-Madrigal, Melissa; Mateo-Madrigal, Victoria
IgG4-related systemic disease (IgG4-RD) is an inflammatory condition of unknown etiology that has been identified as the cause of tumefactive lesions in a number of tissues and organs. The role of the IgG4 remains to be clarified fully, but the histopathologic diagnosis hinges upon the finding of IgG4-bearing plasma cells in addition to characteristic morphologic features, with or without elevated seum IgG4. We present a 56-year-old man with orbital pseudotumor in whom, after 30 years of intractable disease, biopsy showed IgG4-RD involving the lacrimal gland, extraocular muscles, intraconal fat, and trigeminal nerve. Six months after initiating treatment with rituximab, his disease remained dormant, with improvement in his proptosis and normalization of serum IgG4 levels. We review the differential of idiopathic orbital inflammatory disease, including IgG4-RD, and emphasize the need for biopsy for accurate diagnosis and to guide appropriate treatment. PMID:22018678
Wallace, Zachary S; Khosroshahi, Arezou; Jakobiec, Frederick A; Deshpande, Vikram; Hatton, Mark P; Ritter, Jill; Ferry, Judith A; Stone, John H
Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat
A Neil Crowson; Cynthia M Magro; Martin C Mihm
Background: Riedel's thyroiditis (RT) is a very rare chronic fibrosing disorder of unknown etiology that is often associated with multifocal fibrosclerosis (MFS). IgG4-related sclerosing disease (IgG4-RSD), a new clinico-pathological entity also associated with MFS, is characterized by IgG4+ plasma cell infiltration and fibrosis in one or more organs. Although the association of RT and IgG4-RSD has been suggested, it has seldom been studied or reported. We report a classical case of RT with serological (IgG4 levels) and immunohistochemical (IgG and IgG4) assessment, in search of an underlying IgG4-RSD. Patient: The patient was a 57-year-old female who underwent a subtotal thyroidectomy for a long-standing goiter with a rapidly enlarging isthmic nodule. Results: Histopathological examination of the surgical specimen revealed all of the morphological features of RT and IgG4-RSD, including partial fibrosis of the thyroid gland with destruction of the thyroid follicular architecture; obliterative phlebitis; and a mixed infiltrate composed of lymphocytes, eosinophils, and plasma cells. The fibro-inflammatory process extended beyond the thyroid capsule into the surrounding tissues. Immunohistochemical examination revealed up to 70 IgG4+ plasma cells per high power field with an IgG4/IgG ratio of 35%. Although serum levels of IgG4 were normal (20 mg/dl), total IgG levels were slightly elevated (1,370 mg/dl). There was no evidence of involvement of other organs at the time of RT diagnosis. Conclusions: The morphological similarities between RT and IgG4-RSD suggest that these entities are closely related. Therefore, RT with increased IgG4+ plasma cells, with or without elevated IgG4 serum levels, may represent the first clinical manifestation of an underlying IgG4-RSD. However, due to the rarity of both conditions and the limited specificity and sensitivity of both IgG4 serum levels and IgG/IgG4 immunohistochemistry in the diagnosis of IgG4-RSD, further studies are needed to verify this hypothesis. PMID:22612375
Pusztaszeri, Marc; Triponez, Frederic; Pache, Jean-Claude; Bongiovanni, Massimo
Background\\/Aims: To report serious fireworks-related eye and adnexal injuries presenting to the Department of Ophthalmology in the Royal Victoria Hospital, Belfast. To assess the effect of lifting of the legislative ban on fireworks in Northern Ireland in 1996. Method: Twelve year retrospective review from 1990 to 2001 inclusive of all ocular and adnexal injuries from fireworks requiring hospitalisation to the
W. C. Chan; F. A. Knox; F. G. McGinnity; J. A. Sharkey
Two patients with orbital or ocular adnexal neonatal hemangiomas were treated with intralesional injection of triamcinolone acetonide. Injection of steroids was started at 2 mg\\/kg twice a week. The doses of this drug were decreased gradually over a four week period. A dramatic reduction of the lesion was evident without a rebound phenomenon: however growth delay continued for only three
OBJECTIVE The objective of this article is to provide a practical review of the incremental benefit of MRI in the assessment of adnexal masses in pregnancy. CONCLUSION MRI can assist sonographic assessment of adnexal masses in pregnancy by depicting the characteristic findings of exophytic leiomyoma, red degeneration of leiomyoma, endometrioma, decidualized endometrioma, and massive ovarian edema. Accordingly, MRI should be considered as a useful adjunct when sonography is inconclusive or insufficient to guide management of adnexal masses discovered in pregnancy.
Telischak, Nicholas A.; Yeh, Benjamin M.; Joe, Bonnie N.; Westphalen, Antonio C.; Poder, Liina; Coakley, Fergus V.
Purpose: To describe six cases of anterior orbital and adnexal amyloidosis and to report on proteomic analysis to characterize the nature of amyloid in archived biopsies in two cases. Materials and Methods: The clinical features, radiological findings, pathology, and outcome of six patients with anterior orbit and adnexal amyloidosis were retrieved from the medical records. The biochemical nature of the amyloid was determined using liquid chromatography/mass spectroscopy archived paraffin-embedded tissue in two cases. Results: Of the six cases, three had unilateral localized anterior orbit and lacrimal gland involvement. Four of the six patients were female with an average duration of 12.8 years from the time of onset to presentation eyelid infiltration by amyloid caused ptosis in five cases. CT scan in patients with lacrimal gland involvement (n = 3) demonstrated calcified deformable anterior orbital masses and on pathological exmaintionamyloid and calcific deposits replaced the lacrimal gland acini. Ptosis repair was performed in three patients with good outcomes. One patient required repeated debulking of the mass and one patient had recurrenct disease. Proteomic analysis revealed polyclonal IgG-associated amyloid deposition in one patient and AL kappa amyloid in the second patient. Conclusion: Amyloidosis of the anterior orbit and lacrimal gland can present with a wide spectrum of findings with good outcomes after surgical excision. The nature of amyloid material can be precisely determined in archival pathology blocks using diagnostic proteomic analysis.
Al Hussain, Hailah; Edward, Deepak P.
We aimed to evaluate the influence of surgical intervention on gestational and neonatal outcomes in women who underwent elective surgery in the second trimester of gestation because of an adnexal mass. We retrospectively reviewed the hospital records of women who underwent elective surgery for adnexal masses in the second trimester of gestation between 2006 and 2012. The ages of the women ranged between 17 and 33 years. Eight women underwent a laparotomy, and one woman, who aborted on the day of the operation, underwent a laparoscopy. Dermoid cysts, cystadenoma and borderline ovarian tumours were present in four, two and two of the women, respectively. Eight women had no complications after surgery and delivered healthy newborns at term. We concluded that elective surgery on an adnexal mass in the second trimester of gestation is safe for both the mother and the fetus. PMID:23814228
Telli, E; Yalcin, O T; Ozalp, S S; Hassa, H
Lymphomas of the ocular adnexa are a heterogeneous group of malignancies, composing approximately 1% to 2% of non-Hodgkin lymphomas (NHLs) and 8% of extranodal lymphomas. The most common subtype, accounting for up to 80% of cases of primary ocular adnexal lymphoma, is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. In the recent past, there have been significant advances in our understanding of the clinical characteristics, morphology and phenotype, etiology, pathogenesis, diagnosis, natural history, treatment approaches, outcome, and prognostic factors of this disease entity. Novel immunologic and molecular techniques have aided in the distinction between MALT lymphoma and other lymphoproliferative disorders and led to the identification of tissue markers of prognostic significance. Modern imaging modalities provide invaluable tools for accurate staging and treatment planning. Besides radiotherapy and chemotherapy, a variety of new treatment options have emerged in the management of patients with ocular adnexal MALT lymphoma, especially monoclonal antibody therapy and antibiotic therapy against Chlamydia psittaci, which has been associated with the pathogenesis of ocular adnexal lymphomas in some parts of the world. In this review, we present a state-of-the-art summary of ocular adnexal MALT lymphomas.
This review discusses in detail robotic tubal reanastomosis as one of the classic reproductive surgery procedures. Other applications of robotics in adnexal surgery are also reviewed, including adult and pediatric adnexectomy, resection of endometriosis, benign ovarian mass resection, early ovarian cancer resection and staging, ovarian transposition, and treatment of ovarian remnant syndrome and ovarian vein syndrome. PMID:23687555
Tusheva, Olga A; Gargiulo, Antonio R; Einarsson, Jon I
This review discusses in detail robotic tubal reanastomosis as one of the classic reproductive surgery procedures. Other applications of robotics in adnexal surgery are also reviewed, including adult and pediatric adnexectomy, resection of endometriosis, benign ovarian mass resection, early ovarian cancer resection and staging, ovarian transposition, and treatment of ovarian remnant syndrome and ovarian vein syndrome.
Tusheva, Olga A; Gargiulo, Antonio R; Einarsson, Jon I
A 36-year-old man was treated by radiotherapy for tinea capitis many years before discovery of microcystic adnexal carcinoma (MAC). Because of patient's refusal of any surgical intervention, we were able to follow the natural course of this tumor for 13 years. This case emphasizes the typical slow development of (MAC). The implication of the association of MAC and radiotherapy are
AMIRAM BORENSTEIN; DANIEL S. SEIDMAN; HENRI TRAU; HAGGAI TSUR
OBJECTIVE: Our purpose was to describe pregnancy-associated adnexal masses in eastern North Carolina.STUDY DESIGN: A retrospective study was performed of 60 adnexal masses resected during pregnancy at a regional referral hospital from January 1990 to March 2002.RESULTS: Adnexal masses occurred in 0.15% of pregnancies. Average gestational age at diagnosis and surgery was 12 and 20 weeks, respectively. Fifty percent of
Gordon B Sherard; Charles A Hodson; H. James Williams; Diane A Semer; Hamid A Hadi; David L Tait
Our purpose was to evaluate the pathologic features and outcome of pregnancies that were complicated with adnexal masses and\\u000a were managed surgically. A review of patients who had persistent adnexal masses during pregnancy and needed surgical removal\\u000a of tumours was performed from January 1998 to April 2001. There were 14 cases of persistent adnexal masses identified among\\u000a 2000 deliveries. There
Nutan Agarwal; Parul; Alka Kriplani; Neerja Bhatla; Anjali Gupta
Adnexal masses are common in adolescents. Certain conditions will require immediate intervention, including possible torsion, medically refractory tuboovarian abscess, intra-abdominal hemorrhage with hemodynamic instability, or possible ectopic pregnancy. Further evaluation of other masses, including additional imaging or tumor markers may be indicated, especially if masses are complex, solid, or have features characteristic of benign or malignant neoplasms. Otherwise, expectant management and surveillance allow for spontaneous resolution of most masses, especially cystic masses, and prevents unnecessary surgical intervention with its potential risks and sequelae. Laparoscopy can be done in many patients, and conservative, adnexal-sparing surgery should be encouraged when possible. In addition, physicians should be familiar with signs and symptoms of postoperative complications to allow for early diagnosis and intervention. PMID:15625992
Powell, Jill K
A 36-year-old man was treated by radiotherapy for tinea capitis many years before discovery of microcystic adnexal carcinoma (MAC). Because of patient's refusal of any surgical intervention, we were able to follow the natural course of this tumor for 13 years. This case emphasizes the typical slow development of (MAC). The implication of the association of MAC and radiotherapy are discussed. PMID:2012112
Borenstein, A; Seidman, D S; Trau, H; Tsur, H
Objective: To determine factors predicting the persistence of sonographically identified adnexal masses in pregnancy.Methods: All patients from March 1988 to April 1993 diagnosed with an adnexal mass by obstetric sonography were reviewed. Examinations had been entered prospectively into our sonography database. Follow-up data were collected from the database, from hospital and pathology department records, and from interviews with referring obstetricians.
Lisa M Bernhard; Peggy K Klebba; Diana L Gray; David G Mutch
Two further cases of 'female adnexal tumour of probable Wolffian origin' are described Both were retroperitoneal and presented a unique histology of uniformly close-packed bland spaces. solid islands, cords, and diffuse areas. A small hamartoma in a female fetus, part of which resembled the tumours, was traced to an area of near apposition with some paroophoron canals, providing further evidence of a Wolffian origin. The literature of this and some other putative Wolffian tumours is briefly reviewed, and the relation to rete adenomas is discussed. Images Fig. 2 Fig. 3 Fig. 1 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9
Sivathondan, Y; Salm, R; Hughesdon, P E; Faccini, J M
Objective The aim of this study was to identify the sonographic features of solid ovarian masses and to determine whether they may be\\u000a managed conservatively.\\u000a \\u000a \\u000a \\u000a \\u000a Study design Sixty-three patients from September 1999 to September 2008 with solid adnexal masses demonstrating acoustic attenuation, absent\\u000a Doppler vascularity and minimal or no cystic component were retrospectively reviewed. 20 patients without pathologic results\\u000a or follow-up studies
Shengfu Wang; Samuel Johnson
A 28-year-old healthy female presented to her primary care physician with lymphadenopathy, fatigue, malaise, and night sweats. Symptoms persisted despite conservative treatment and eventually the patient underwent multiple lymph node resections and a bone...
B. Smith M. B. Carroll
Introduction: Single-site laparoscopy is gaining acceptance in many surgical fields including gynecology. The purpose of this report is to demonstrate the technique and outcome for removing a large adnexal mass through a single site. Case Description: A 41-y-old female was referred to gynecology oncology for increased abdominal girth for 3 mo. An ultrasound confirmed a benign-appearing, 37-cm left adnexal mass. The mass was removed through a single-site laparoscopic incision with the aid of drainage and a morcellator. The operating time was 84 min. The patient was discharged 2 h and 35 min later with full return to normal activity in 5 d. Conclusion: Large, benign-appearing adnexal masses can be managed safely with superior cosmetic results using single-site laparoscopy.
Scribner, Dennis R.; Weiss, Patrice M.
Widespread use of ultrasound in early pregnancy has led to the detection of incidental adnexal masses more frequently. This article reviews the diagnosis and management options for adnexal masses in pregnancy. The availability of high-resolution ultrasound has made observation to be a viable option in some cases. However, for those masses suspicious of malignancy, at risk of torsion, rupture, or clinically symptomatic, surgical treatment is warranted. Laparoscopy has been successfully used in pregnancy and is safe in experienced and trained hands in properly equipped units.
Yakasai, Ibrahim Adamu; Bappa, Lawal Abdullahi
Two unusual Carney complex patients are described. In one of them, several cutaneous biopsies revealed myxoid lesions that were rather more close to authentic adnexal neoplasms with myxoid stroma than to a "myxoma with an epithelial component." These included lesions resembling trichofolliculoma, infundibular cyst, and trichodiscoma. Additionally, 1 soft tissue myxoma was unique in the sense that it greatly resembled a cardiac myxoma, begging the question whether this could represent an embolus from the patient's cardiac myxoma. Given the large size and complexity and heterogeneity of the cutaneous lesions, the authors suggest that these may represent authentic cutaneous neoplasms accompanied by myxoid stroma and not adnexal elements induced by the stroma. However, the latter mechanism is well recognized and demonstrated by our second patient in whom adnexal-type elements in the cutaneous lesion were clearly induced by the myxoid stroma but were unusually complex by manifesting panfollicular and also sebaceous differentiation. PMID:22588545
Kacerovska, Denisa; Requena, Luis; Michal, Michal; Grossmann, Petr; Treskova, Inka; Roucka, Patrik; Kazakov, Dmitry V
Perineural cysts may be discovered incidentally on pelvic sonography and can easily mimic more common gynecologic masses. We report the complex cystic adnexal mass like appearance of these incidentally noted cysts which mimicked malignancy on sonography in a postmenopausal female, with stage I breast cancer and vaginal spotting. PMID:22105304
Saboo, Sachin S; Di Salvo, Donald
INTRODUCTION More commonly, a vaginal cuff dehiscence is a complication of robotic or laparoscopic hysterectomy while dehiscence is less commonly observed following total abdominal or vaginal hysterectomies. PRESENTATION OF CASE Three years after an uncomplicated total abdominal hysterectomy for fibroid uterus, a 50 year old female with a known, large adnexal mass presented with vaginal cuff dehiscence and prolapse of the adnexal mass through the vaginal cuff. DISCUSSION We discuss surgical risk factors including route of hysterectomy, method of colpotomy and vaginal cuff closure as contributing factors for vaginal cuff dehiscence in our patient. CONCLUSION Any large pelvic mass that may potentially exert pressure necrosis on the vaginal cuff, even remote from hysterectomy may result a vaginal cuff dehiscence. Emergent surgical intervention is warranted.
Nguyen, My-Linh T.; Anyikam, Adanna L.; Paolucci, Michele
Sixty-seven patients selectively chosen from 354 undergoing conventional transabdominal (TA) sonography for evaluation of a clinically suspected adnexal mass subsequently underwent transvaginal (TV) sonography either because the TA sonograms were technically suboptimal or because it was not possible to characterize with certainty an abnormality identified with TA sonography. TV sonography added diagnostically useful information in 25 of 28 patients with cystic pathologic changes in the adnexa uteri. Eight of 12 patients with tuboovarian abscess and nonspecific adnexal masses visualized with TA sonography had tube-shaped fluid collections characteristic of pyosalpinx identified with TV sonography. TV sonography added diagnostically useful information in all seven patients with diseases of the cul-de-sac (rectouterine fossa) and allowed differentiation of adnexal from primary uterine disease in three patients with TA sonograms on which findings were equivocal. It also expedited the diagnosis of a tubal pregnancy in ten of 14 patients and was useful in the detection of adhesions and perforated intrauterine devices. These results indicate that adjunctive TV sonography can provide important diagnostic information. PMID:3275977
Lande, I M; Hill, M C; Cosco, F E; Kator, N N
Ocular involvement of sarcoidosis is frequent, and it is often the initial clinical manifestation of the disease. The most common ocular lesions include granulomatous uveitis associated with iris and trabecular nodules, string of pearl-type vitreous opacities, retinal paerivasculitis mainly affecting veins, and patchy retino-choroidal exudates. A half of the patients with typical ocular lesions suggestive of sarcoidosis did not show the systemic evidence, and they remained as sarcoidosis suspects. Risks of visual deterioration are secondary glaucoma, vitreous opacities, cystoid macular edema, and retinal neovascularization. Thirty-four % of the patients were treated with systemic corticosteroids, and some patients required other treatment such as methotraxate. Twenty-one% of the patients resulted in the poor visual acuity of less that 0.5. PMID:12233079
Ocular toxocariasis is an uncommon worldwide parasitic infection that affects mostly children and is found in both rural and metropolitan areas. In many parts of the world, parasitic infections of the eye are a major cause of blindness. The diagnosis of toxocariasis is essentially clinical, based on the lesion morphology and supportive laboratory data such as serum enzyme-linked immunosorbent assay (ELISA) titers and ELISA Toxocara titers on aqueous humor; other diagnostic methods are imaging studies including optical coherence tomography, fluorescein angiography, computed tomography, and ocular ultrasound. Treatment is directed at complications arising from intraocular inflammation and vitreous membrane traction. Early vitrectomy may be of value both diagnostically and therapeutically. PMID:22938514
Arevalo, J Fernando; Espinoza, Juan V; Arevalo, Fernando A
Cancers of the endometrium, cervix, and ovaries account for nearly 25,000 annual deaths among women in the United States. In recent years, better understanding of the causes and risk factors associated with gynecologic malignancies has contributed to more effective screening and early diagnosis. Abnormal uterine bleeding, a palpable adnexal mass, or vague abdominal complaints in women older than 40 can be signs of cancer. Regular pelvic examination, combined with appropriate use of the Papanicolaou's smear, endometrial biopsy, transvaginal sonography, and other tests, is recommended. PMID:9628962
Crohn’s disease (CD), or regional enteritis, is a segmentary granulomatous inflammatory bowel pathology of unknown etiology\\u000a although autoimmunity is probably involved. In addition, there are extraintestinal manifestations, such as arthritis, cutaneous\\u000a lesions, and hepatic, renal, and ocular involvement. The incidence of the latter, manifested as uveitis, scleritis, and episcleritis,\\u000a is about 2–9% of the cases of CD [1–4]. Moreover, 30–40%
Vincenzo Petitti; Stefano Tamburi
Fungal keratitis is one of the most challenging types of microbial keratitis for the ophthalmologist to diagnose and treat. Fungi causing human keratitis take the form of either yeasts or mold. Candida, the major pathogenic yeasts, can be detected in the normal ocular surface flora. Preceding ocular surface disorder, the wearing of contact lenses and the use of antibiotic/steroid eye drops may lead to candida keratitis. Infectious focus caused by Candida tends to melt the corneal stroma. Keratitis caused by mold often develops after an injury caused by soil and/or a plant. Mold can reach the anterior chamber without destroying the stromal layer of the cornea, which results in distinctive clinical features such as endothelial plaque and hyphate ulcer. Fungal keratitis needs to be managed by antifungal agents, most of which must be prepared by ourselves to apply to the ocular surface. Candida keratitis should be managed with azoles. If the infection seems to be caused by mold, several antifungal drugs including pimaricin, which is the only agent officially applicable to the eye, should be used. Some cases of mold keratitis need to have therapeutic penetrating keratoplasty because of their lack of response to intensive medication. Mold causing keratitis is variegated. Fusarium and Aspergillus can reach the intraocular space rapidly. Alternaria and some other unclassified molds remain in the superficial layer of the cornea for a long time. Our experiments indicate that the progress of focus in the cornea is regulated by the receptiveness of mold against temperature. PMID:18689966
Canine herpesvirus-1 (CHV-1) is an alphaherpesvirus with a host range restricted to canids. Latent CHV-1 infection is endemic in domestic dog populations worldwide. The role of CHV-1 in severe systemic neonatal infections and as an aetiology of infectious infertility and abortion has been appreciated for decades; however, ocular diseases of mature dogs conclusively associated with CHV-1 infection were only recently described. Clinically, CHV-1 infection may produce a diverse range of adnexal and ocular surface lesions in mature dogs, including blepharitis, conjunctivitis, ulcerative keratitis, and nonulcerative keratitis. These conditions can develop during primary or recurrent ocular CHV-1 infection. Recurrent CHV-1 infections associated with reactivation of latent virus may be observed during a variety of situations and in association with numerous different viral reactivation stimuli, including the administration of immunosuppressive pharmaceuticals. The understanding of CHV-1 pathophysiology and ocular infections in mature dogs has expanded rapidly during the past few years, but much remains to be elucidated. As the number of dogs living with chronic immunomodulatory systemic diseases and receiving immunosuppressive therapeutics continues to grow, the clinical importance of CHV-1 ocular infections is also likely to increase. PMID:23438442
Ledbetter, E C
... FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES IMMUNOLOGY AND MICROBIOLOGY DEVICES Tumor Associated Antigen immunological Test Systems Â§ 866.6050 Ovarian adnexal mass assessment score...
Objective: To compare diagnostic performance of color Doppler ultrasound and CA-125 in suspicious adnexal masses on B-mode sonography. Materials and methods: Data on 94 patients (mean age: 47.4 years, range: 17–79 years. Fifty-two (55.3%) premenopausal and 42 (44.7%) postmenopausal women) managed in our institution because of a suspicious adnexal mass were reviewed. All patients were evaluated by transvaginal color Doppler
J. L. Alcázar; T. Errasti; A. Zornoza; J. A. M??nguez; M. J. Galán
Swollen eyelids are commonly ascribed to allergic conjunctivitis, contact dermatitis, eczema, angioedema, or acute sinusitis. The differential diagnosis extends to thyroid eye disease; blepharitis; Sjögren's syndrome; Churg-Strauss vasculitis; Wegener's granulomatosis; Gleich syndrome; orbital and ocular lymphoid hyperplasia or adnexal lymphoma; idiopathic orbital inflammatory disease/idiopathic sclerosing orbital inflammation; rarely, orbital parasitosis; and IgG4-related diseases. The likely diagnosis proceeds from the more to the less common in patients without a history of allergy or infection. Both ocular lymphoid hyperplasia and ocular adnexal lymphoma must be considered in the differential diagnosis of persistent disease, and neither of these entities can be recognized or differentiated from one another clinically or radiologically. Early diagnosis is essential because therapy may consist of frequent follow-up and/or active intervention. Outcomes in patients treated early and appropriately are often favorable. PMID:22525399
Ricketti, Anthony J; Cleri, Dennis J; Moser, Robert L; Bilyk, Jurij R; Vernaleo, John R; Unkle, David W
Retinal and choroidal vascular diseases constitute the most common causes of moderate and severe vision loss in developed countries. They can be divided into retinal vascular diseases, in which there is leakage and/or neovascularization (NV) from retinal vessels, and subretinal NV, in which new vessels grow into the normally avascular outer retina and subretinal space. The first category of diseases includes diabetic retinopathy, retinal vein occlusions, and retinopathy of prematurity, and the second category includes neovascular age-related macular degeneration (AMD), ocular histoplasmosis, pathologic myopia, and other related diseases. Retinal hypoxia is a key feature of the first category of diseases resulting in elevated levels of hypoxia-inducible factor-1 (HIF-1) which stimulates expression of vascular endothelial growth factor (VEGF), platelet-derived growth factor-B (PDGF-B), placental growth factor, stromal-derived growth factor-1 and their receptors, as well as other hypoxia-regulated gene products such as angiopoietin-2. Although hypoxia has not been demonstrated as part of the second category of diseases, HIF-1 is elevated and thus the same group of hypoxia-regulated gene products plays a role. Clinical trials have shown that VEGF antagonists provide major benefits for patients with subretinal NV due to AMD and even greater benefits are seen by combining antagonists of VEGF and PDGF-B. It is likely that addition of antagonists of other agents listed above will be tested in the future. Other appealing strategies are to directly target HIF-1 or to use gene transfer to express endogenous or engineered anti-angiogenic proteins. While substantial progress has been made, the future looks even brighter for patients with retinal and choroidal vascular diseases. PMID:23329331
Campochiaro, Peter A
Autoimmune pancreatitis (AIP) is a peculiar type of pancreatitis of presumed autoimmune etiology. Many new clinical aspects\\u000a of AIP have been clarified during the past 10 years, and AIP has become a distinct entity recognized worldwide. However, its\\u000a precise pathogenesis or pathophysiology remains unclear. As AIP dramatically responds to steroid therapy, accurate diagnosis\\u000a of AIP is necessary to avoid unnecessary
Terumi Kamisawa; Atsutake Okamoto
Mikulicz's disease (MD) has been included within the diagnosis of primary Sjögren's syndrome (SS), but it represents a unique\\u000a condition involving persistent enlargement of the lacrimal and salivary glands characterized by few autoimmune reactions and\\u000a good responsiveness to glucocorticoids, leading to the recovery of gland function. Mikulicz's disease was recently reported\\u000a to be associated with elevated immunoglobulin G4 (IgG4) concentrations
Motohisa Yamamoto; Hiroki Takahashi; Mikiko Ohara; Chisako Suzuki; Yasuyoshi Naishiro; Hiroyuki Yamamoto; Yasuhisa Shinomura; Kohzoh Imai
Mikulicz's disease (MD) has been considered part of primary Sjögren's syndrome (SS) since Morgan's report in 1953. MD represents a unique condition involving enlargement of the lacrimal and salivary glands, as is also seen in SS; however, MD is characterized by few autoimmune reaction and its good responsiveness to glucocorticoid. Recent reports have shown that the frequency of apoptosis in
Motohisa Yamamoto; Hiroki Takahashi; Susumu Sugai; Kohzoh Imai
IgG4 interstitial nephritis is a recently described entity. A middle-aged gentleman with bilateral parotid enlargement, hepatosplenomegaly and generalized lymphadenopathy was referred to us for evaluation of renal failure. He had trace proteinuria and large kidneys. Kidney biopsy revealed interstitial nephritis with characteristic storiform fibrosis. Immunohistochemistry demonstrated intense staining for IgG4-secreting plasma cells in the interstitium.
Gopalakrishnan, N.; Abraham, A.; Balasubramaniyan, T.; Dineshkumar, T.; Dhanapriya, J.; Malathy, N.; Haris, M.; Prasad, N. D. Srinivasa
Background Autoimmune pancreatitis (AIP) is occasionally associated with other autoimmune diseases. Methods To investigate the pathophysiology of AIP, we immunohistochemically examined the pancreas and other organs in eight patients with AIP, and in controls, using anti-CD4-T and CD8-T cell subsets, as well as IgG4 antibodies. Results In AIP patients, severe or moderate infiltration of IgG4-positive plasma cells associated with CD4-
Terumi Kamisawa; Nobuaki Funata; Yukiko Hayashi; Yoshinobu Eishi; Morio Koike; Kouji Tsuruta; Atsutake Okamoto; Naoto Egawa; Hitoshi Nakajima
Ocular dysfunction accounts for nearly 70% of the initial manifestations of myasthenia gravis. Since the prevalence rate of myasthenia gravis is two to 10 cases per 100,000 population, it is important for clinicians to be cognizant of this disorder and its varied ocular presentations. The clinical manifestations, diagnosis, treatment, and prognosis of ocular myasthenia gravis are reviewed.
March, G. A.; Johnson, L. N.
Distinction of primary skin adnexal carcinomas from cutaneous metastasis of adenocarcinomas is challenging. In this study, we evaluated podoplanin immunoreactivity in a series of primary skin adnexal tumors and adenocarcinomas metastatic to skin using a D2-40 antibody. The initial test series were composed of a total of 93 cases including 32 primary skin adnexal carcinomas, 46 benign primary adnexal tumors, and 15 cutaneous metastatic adenocarcinomas. We found that variable D2-40 reactivity was seen in all of the primary cutaneous carcinomas including sebaceous carcinomas (10/10), squamous cell carcinomas (10/10), porocarcinomas (4/4), trichilemmal carcinomas (4/4), skin adnexal carcinomas not otherwise specified (4/4), and in the majority of benign skin adnexal tumors. In contrast, no podoplanin immunoreactivity was seen in any of the 15 (0/15) cutaneous metastases. To confirm the initial findings and to further explore the utility of podoplanin reactivity in the distinction of these tumors, we also examined a test set of 35 unknown cases, including 21 adenocarcinomas metastatic to skin and 14 primary adnexal tumors, in a blinded fashion. In this test set of cases, podoplanin was negative in 22 cases and positive in 13 cases. Of the 22 podoplanin negative cases, 20 were proven to be metastatic adenocarcinoma. Of the 13 D2-40 positive cases, 12 were proven to be primary adnexal tumors. Our results suggest that podoplanin can be a useful tool to distinguish primary skin adnexal carcinomas form adenocarcinomas metastatic to skin with high sensitivity (94.5%) and specificity (97.2%). PMID:17255777
Liang, Haohai; Wu, Hong; Giorgadze, Tamar A; Sariya, Dinesh; Bellucci, Kirsten S W; Veerappan, Ranjitha; Liegl, Bernadette; Acs, Geza; Elenitsas, Rosalie; Shukla, Shruti; Youngberg, George A; Coogan, Philip S; Pasha, Theresa; Zhang, Paul J; Xu, Xiaowei
p63, a recently identified homologue of the p53 gene, has been reported to be essential in the development of epithelia and is mainly expressed by basal and myoepithelial cells. The purpose of this study was to investigate the pattern of p63 expression in cutaneous adnexal neoplasms and to assess its possible value in the differential diagnosis of primary cutaneous neoplasms
Doina Ivan; A Hafeez Diwan; Victor G Prieto
Purpose: To report a series of patients with periocular microcystic adnexal carcinoma (MAC) treated with Mohs’ micrographic surgery (MMS). Design: Prospective, interventional case series. Methods: This series included all patients treated with MMS for periocular MAC, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. Results: There were 5 patients (4 males, 1 female) with
Igal Leibovitch; Shyamala C. Huilgol; Shawn Richards; Robert Paver; Dinesh Selva
The Food and Drug Administration (FDA) is proposing to amend the regulation classifying ovarian adnexal mass assessment score test systems to restrict these devices so that a prescribed warning statement that addresses a risk identified in the special controls guidance document must be in a black box and must appear in all labeling, advertising, and promotional material. The black box warning......
Retinal infection with Toxoplasma gondii is the most important cause of posterior uveitis, whereby prevalence and incidence of ocular symptoms after infection depend on socio-economic factors and the circulating parasite genotypes. Ocular toxoplasmosis is more common in South America, Central America, and the Caribbean and parts of tropical Africa as compared to Europe and Northern America, and is quite rare
E. Petersen; A. Kijlstra; M. Stanford
Background. To validate feasibility, efficacy, and safeness of laparoscopic treatment of benign adnexal diseases through a single transumbilical access (LESS) in a prospective series of patients. Methods. A prospective clinical trial including 30 women has been conducted at the Division of Gynecology of Catholic University of Sacred Hearth of Rome. Patients underwent different laparoscopic procedures by LESS utilizing a multiport trocar and conventional straight laparoscopic instrumentation. Intra and perioperative outcome has been reported. Results. Ten mono/bilateral adnexectomies and 20 cystectomies have been performed by LESS approach. Laparoscopic procedures were completed through a single access in 28 cases (93.4%). No major intra- or postoperative complications were observed. Mean hospital stay was 1.3 days. Conclusions. LESS approach is feasible to treat benign adnexal disease with a very low conversion rate and no early or late complications. More clinical data are needed to confirm these advantages compared to standard laparoscopic technique. PMID:20169051
Fagotti, Anna; Fanfani, Francesco; Rossitto, Cristiano; Marocco, Francesco; Gallotta, Valerio; Romano, Federico; Scambia, Giovanni
Adnexal torsion may occur in girls and adolescents. Often it is associated with ovarian diseases resulting in ovarian enlargement. Adnexal torsion may involve the ovary, fallopian tube or both, and the main symptom is acute pelvic pain. An 8-year-old girl complaining of acute pelvic and abdominal pain, who was previously diagnosed with precocious puberty and who received treatment with a GnRH analog, is reported. Ultrasound demonstrated a normal-sized uterus and bilaterally enlarged ovaries with multiple internal cysts. At laparotomy, we found a complete torsion in the right adnexa. The histological examination revealed massive edema associated with multiple antral follicles and reduction of the follicular reserve. PMID:15286832
Carvalho, Jesus Paula; Diegoli, Mara Solange; Carvalho, Filomena Marino; Diegoli, Carlos Alberto
Transvaginal natural orifice transluminal endoscopic surgery (NOTES) with pneumoperitoneum has been used in cholecystectomies, appendectomies, and nephrectomies, but transvaginal NOTES using a single port in gynecologic procedures has not been described despite gynecologist familiarity with the vaginal approach. We performed transvaginal single-port NOTES in 10 women with benign uterine adnexal disease: oophorectomy in 3 patients, salpingostomy and salpingectomy in 2 each, and ovarian cystectomy, paratubal cystectomy, and ovarian wedge resection in 1 each. The patients were discharged at 1 or 2 days postoperatively, and were satisfied, with minimal pain, no abdominal scar, and no complications at 2-month follow-up. We conclude that transvaginal single-port NOTES to treat benign uterine adnexal disease is a feasible and attractive option. PMID:22763314
Ahn, Ki Hoon; Song, Jae Yun; Kim, Sun Haeng; Lee, Kyu Wan; Kim, Tak
Adnexal tumors with follicular differentiation in the breast parenchyma are rarely encountered. The authors present a unique case arising in a 64-year-old woman, in whom they observed composite differentiation toward follicular germinative cells of the hair follicle with focal areas of outer root sheath differentiation and pilar-type keratinization. The histogenesis of this tumor is analyzed in light of the peculiar pathological, immunohistochemical, and molecular genetic findings. PMID:19468034
Gököz, Ozay; Presenti, Loretta; Gambacorta, Giuseppina; Zolfanelli, Federica; Tricarico, Rossella; Nistri, Roberto; Baroni, Gianna; Bianchi, Simonetta; Massi, Daniela
Purpose: To assess the feasibility of making a diagnosis of adnexal and orbital diseases by Tele-ophthalmological means. Materials and Methods: Tele-consultation for eye diseases was done for 3497 patients from remote areas of Tamilnadu as part of the rural tele-ophthalmology project of a tertiary eye care hospital during a period of nine months from October 2004 to June 2005. These patients were comprehensively examined on-site by optometrists. Using digitized images sent by store and forward technique and videoconferencing, the ophthalmologist made a diagnosis and advised treatment. Results: Adnexal or orbital diseases were detected in 101 out of 3497 patients (2.88%). Medical treatment was advised to 13 of 101 patients (12.8%). Surgery was advised in 62 of 101 patients (61.28%) whereas 18 of 101 patients (17.8%) required further investigations at a tertiary center. Conclusion: It was feasible to apply the satellite based tele-ophthalmology set-up for making a presumptive diagnosis and planning further management of adnexal and orbital diseases based on live interaction and digital still images of the patients.
Verma, Malay; Raman, Rajiv; Mohan, Ravindra E
Objective To compare the feasibility and safety of the laparoscopic management of adnexal masses appearing preoperatively benign with those suspicious for malignancy. Methods Retrospective study of 694 women that underwent laparoscopic management of an adnexal mass. Results Laparoscopic management of an adnexal mass was completed in 678 patients. Six hundred and thirty five patients had benign pathology (91.5%) and 53 (7.6%) had primary ovarian cancers. Sixteen patients (2.3%) were converted to laparotomy; there were 13 intraoperative (1.9%) and 16 postoperative complications (2.3%). Patients divided in 2 groups: benign and borderline/malignant tumors. Patients in the benign group had a higher incidence of ovarian cyst rupture (26% vs. 8.7%, p<0.05). Patients in the borderline/malignant group had a statistically significant higher conversion rate to laparotomy (0.9% vs. 16.9%, p<0.001), postoperative complications (1.9% vs. 12.2%, p<0.05), blood loss, operative time, and duration of hospital stay. The incidence of intraoperative complications was similar between the 2 groups. Conclusion Laparoscopic management of masses that are suspicious for malignancy or borderline pathology is associated with an increased risk in specific intra-operative and post-operative morbidities in comparison to benign masses. Surgeons should tailor the operative risks with their patients according to the preoperative likelihood of the mass being carcinoma or borderline malignancy.
Gad, Mohamad S.; El Khouly, Nabih I.; Soto, Enrique; Brodman, Michael; Chuang, Linus; Nezhat, Farr R.
The main purpose of this study was to determine whether three-dimensional contrast-enhanced ultrasound (3D-CEUS) can provide useful information to distinguish malignant from benign adnexal masses (?4 cm). Forty-seven patients with 51 adnexal masses were examined with 3D-CEUS. The sonographic features of masses were analyzed. All diagnoses were confirmed by surgical pathology and long-term follow-up results. The 51 masses included 43 benign and 8 malignant lesions. On 3D-CEUS images, benign lesions appeared as round structures formed by sparse and straight capillary vessels. Malignant lesions showed irregular stereo structures with dense and tortuous vascular distribution. A 3D-CEUS scoring system was established. There were no statistically significant differences in scores at each time point between the 20th and 70th seconds, and the area under the receiver operating characteristic curve for this time period was the largest (0.995). A cut-off score of 8 was established, with scores ?8 being suggestive of malignancy. The 3D-CEUS scoring system had a high sensitivity (100%) and specificity (98%). 3D-CEUS is likely to be the new tool to distinguish malignant from benign small adnexal masses and diagnose early ovarian cancer. PMID:23453372
Xiang, Hong; Huang, Rui; Cheng, Jingxin; Gulinaer, Shahai; Hu, Rong; Feng, Yuling; Liu, Hui
Paintball sport-related ocular injuries represent an increasing problem as the popularity of the sport increases and the number of participants grows. Although eye protective devices designed specifically for paintball sports are extremely effective in preventing such injuries, the failure to properly wear these devices has resulted in an alarming number of severe ocular injuries. Recent trends have indicated that an increasing percentage of paintball sport-related ocular injuries have occurred in unsupervised, noncommercial settings (i.e., backyard games) where the use of eye protective devices is not required. Paintball industry standards for eye protection have recently been developed and should be implemented for all participants. PMID:11389344
Fineman, M S
Presumed ocular histoplasmosis syndrome is a macular hemorrhagic choroiditis of the young adult. The etiology of this syndrome is uncertain, but can be correlated with some positive reactions to histoplasmosis. The study was carried out on 12 patients, each of them was investigated by functional and objective ocular examinations, laboratory tests, fluorescein angiography and ultrasound examinations. The clinical signs of this syndrome of presumed ocular histoplasmosis were: macular focal lesions, subretinian hemorrhages, detachment of the retinal neurosensorial layer, presence of disseminated choroiditis scars and subretinian neovascularization. The correct evaluation of the choriocapillary perfusion is helpful to institute a proper therapy. PMID:15341107
Seceleanu, Andreea; C?lug?ru, M; Kaucsar, Emese; C?lug?ru, D
Ocular recognition is a new area of biometric investigation targeted at overcoming the limitations of iris recognition performance in the presence of non-ideal data. There are several advantages for increasing the area beyond the iris, yet there are also key issues that must be addressed such as size of the ocular region, factors affecting performance, and appropriate corpora to study these factors in isolation. In this paper, we explore and identify some of these issues with the goal of better defining parameters for ocular recognition. An empirical study is performed where iris recognition methods are contrasted with texture and point operators on existing iris and face datasets. The experimental results show a dramatic recognition performance gain when additional features are considered in the presence of poor quality iris data, offering strong evidence for extending interest beyond the iris. The experiments also highlight the need for the direct collection of additional ocular imagery.
Pauca, V. Paúl; Forkin, Michael; Xu, Xiao; Plemmons, Robert; Ross, Arun A.
The authors present a case of ocular myastenia, suspected by an ophthalmologist and confirmed as diagnosis by a neurologist. There are discussion regarding the latest possibilities of treatment. PMID:22642135
Stefanescu, Andreea-Madalina; Ungureanu, E; Tugui, Alina; Gradinaru, Sanziana-Luminita
This article reviews the pharmacotherapeutics of verteporfin (Visudyne), Novartis Pharma AG) used in ocular photodynamic therapy. The chemistry, pharmacokinetics and pharmacodynamics of the drug are reviewed. The article highlights and summarises the results of the multi-centre, randomised, controlled clinical trials with verteporfin to treat subfoveal choroidal neovascularisation in age-related macular degeneration, ocular histoplasmosis syndrome and pathologic myopia. In addition, the safety profile and side effects of verteporfin are discussed. PMID:14680447
Bakri, Sophie J; Kaiser, Peter K
Environmental microbial assays of industrial microscope eyepieces were conducted following reports of multiple intershift ocular infections. Pathogenic Staphylococcus aureus was identified among the microorganisms cultured. This paper suggests that direct contact with industrial microscope eyepieces provides a potentially significant route of transmission of both bacterial and viral ocular infections. An industrial hygiene ocular health questionnaire was distributed to a first and second shift manufacturing operation to assess the incidence of ocular infections. These data were compared to the questionnaire responses of 122 control manufacturing workers who did not use microscopes. Based on self-reporting by employees, those who used microscopes were found to have statistically significant incidence of sites and conjunctivitis that was 8.3 times that of the control group. Sterilization of eyepieces by ethylene oxide, formaldehyde and isopropyl alcohol were considered, but ultimately rejected. These biocides were found respectively to damage ocular lens coatings, contribute to volatile organic emissions, or be ineffective against spore-forming bacteria. This article presents a detailed evaluation of a commercially available ultraviolet sanitization unit (manufactured by the King Bactostat Corp., 7115 Armistad Street, El Paso, TX 79912). This ultraviolet disinfection process proved to be rapid and emission free; it also yielded eyepieces free of residual chemical biocides that have the potential for ocular irritation. Field tests involving 60 eyepieces demonstrated effective disinfection by a Chi-Square statistical comparison, at values greater than 95% confidence level, as compared to unirradiated eyepieces. PMID:3591662
Olcerst, R B
Objective: The aim of this study was to assess the complementary use of ultrasonographic end points with the level of circulating CA 125 antigen by multivariate logistic regression analysis algorithms to distinguish malignant from benign adnexal masses before operation. Study Design: One hundred ninety-one patients aged 18 to 93 years with overt adnexal masses were examined by transvaginal ultrasonography with
Dirk Timmerman; Thomas H. Bourne; Anil Tailor; William P. Collins; Herman Verrelst; Kamiel Vandenberghe; Ignace Vergote
Background The burden and pattern of ocular trauma in China are poorly known and not well studied. We aimed at studying the epidemiological characteristics of patients hospitalized for ocular trauma at major ophthalmology departments in the largest industrial base of plastic toys in China. Methods A retrospective study of ocular trauma cases admitted to 3 tertiary hospitals in China from 1st January 2001 to 31st December 2010 was performed. Results The study included a total of 3,644 injured eyes from 3,559 patients over the 10-year period: 2,008 (55.1%) open-globe injuries, 1,580 (43.4%) closed-globe injuries, 41 (1.1%) chemical injuries, 15 (0.4%) thermal injuries and 678 (18.6%) ocular adnexal injuries. The mean age of the patients was 29.0±16.8 years with a male-to-female ratio of 5.2?1 (P?=?0.007). The most frequent types of injury were work-related injuries (1,656, 46.5%) and home-related injuries (715, 20.1%). The majority of injuries in males (56.2%) and females (36.0%) occurred in the 15–44 age group and 0–14 age group, respectively. The final visual acuity correlated with the initial visual acuity (Spearman’s correlation coefficient?=?0.659; P<0.001). The Ocular Trauma Score also correlated with the final visual acuity (Spearman’s correlation coefficient?=?0.655; P<0.001). Conclusions This analysis provides an epidemiological study of patients who were hospitalized for ocular trauma. Preventive efforts are important for both work-related and home-related eye injuries.
Cao, He; Li, Liping; Zhang, Mingzhi
Objective Trichothiodystrophy (TTD) is a rare autosomal recessive disorder characterized by sulfur-deficient brittle hair and multisystem abnormalities. Many TTD patients have a defect in known DNA repair genes. This report systematically evaluates the ocular manifestations of the largest-to-date cohort of TTD patients and xeroderma pigmentosum (XP)/TTD patients. Design Case Series Participants Thirty-two participants, ages 1 to 30 years, referred to the National Eye Institute for examination from 2001 to 2010: Twenty-five had TTD, and 7 had XP/TTD. Methods Complete, age- and developmental stage-appropriate ophthalmic examination. Main Outcome Measures Visual acuity (VA), best corrected VA, ocular motility, state of the ocular surface and corneal endothelial cell density, corneal diameter, lens assessment. Results Developmental abnormalities included microcornea (44% TTD), microphthalmia (8% TTD, 14% XP/TTD), nystagmus (40% TTD), and infantile cataracts (56% TTD and 86% XP/TTD). Corrective lenses were required by 65% of the participants, and decreased best-corrected VA was present in 28% of TTD patients and 71% of XP/TTD patients. Degenerative changes included dry eye (32% TTD, 57% XP/TTD) and ocular surface disease identified by ocular surface staining with fluorescein (32% TTD), that usually are exhibited by much older patients in the general population. The two oldest TTD patients exhibited clinical signs of retinal/macular degeneration. Four XP/TTD patients presented with corneal neovascularization. Conclusions TTD and XP/TTD study participants had a wide variety of ocular findings including refractive error, infantile cataracts, microcornea, nystagmus, and dry eye/ocular surface disease. While many of these can be ascribed to abnormal development—likely due to abnormalities in basal transcription of critical genes—patients may also have a degenerative course.
Brooks, Brian P; Thompson, Amy H; Clayton, Janine A; Chan, Chi-Chao; Tamura, Deborah; Zein, Wadih M; Blain, Delphine; Hadsall, Casey; Rowan, John; Bowles, Kristen E; Khan, Sikandar G.; Ueda, Takahiro; Boyle, Jennifer; Oh, Kyu-Seon; DiGiovanna, John J; Kraemer, Kenneth H
The ocular toxicity of fluoroquinolones and the risks of their use in the treatment of ocular infection were reviewed. Systematic identification, selection, review and synthesis of published English-language studies relating to fluoroquinolone use and safety in animals and humans was conducted. Although not free of complications, fluoroquinolones are generally safe when used to treat ocular infection. Ocular toxicity appears to be dose-dependent and results from class-effects and specific fluoroquinolone structures. Phototoxicity and neurotoxicity have been reported, and toxic effects on ocular collagen may be associated with Achilles tendinopathy. Corneal precipitation may provide an advantageous drug depot but delay healing and result in corneal perforation in approximately 10% of cases. Although human toxicity studies are limited, the current recommended dose for intracameral injection of ciprofloxacin is less than 25 microg. Intravitreal injections of ciprofloxacin 100 microg, ofloxacin 50 microg/mL, trovafloxacin 25 microg or less, moxifloxacin 160 microg/0.1 mL or less and pefloxacin 200 microg/0.1 mL are considered safe. PMID:17760640
Thompson, Andrew M
Microcystic adnexal carcinoma of the skin is a very rare malignant tumour arising from the sweat glands. As far as we know, the MRI features of this tumour have not been described in the literature before. In this report we present the MRI features and pathological description of a case of a microcystic adnexal carcinoma in the cheek that was incidentally imaged during brain MRI examination. A review of the relevant literature as well as a discussion of MRI of skin tumours is also presented.
Tawfik, A M; Kreft, A; Wagner, W; Vogl, T J
A 67-year-old myopic man presented to the Ophthalmology Department of a teaching hospital in the mountainous state of Sikkim with complaints of red eye, ocular discomfort, and sensation of something moving in his right eye that led to occasional visual blurring from the previous four days. His symptoms started after washing his face in a stream. Clinical diagnosis was a leech in the limbus of the right eye at the 12 o'clock position. Ocular leech infestation should be considered in a patient with a history of swimming or face washing in streams and lakes. Herein we report a case of ocular leech infestation that presented as red eye with intermittent blurring of vision in the affected eye, and discuss the differential diagnosis and clinical significance. PMID:20804315
Dey, Rubi; Dey, Subhajeet
Pregnancy is often associated with ocular changes, most often transient in nature, though occasionally permanent. It can be associated with development of new conditions, or can exacerbate pre-existing conditions. The ocular effects of pregnancy may be divided into physiologic changes, pathologic conditions or modifications of pre-existing conditions. Pathologic conditions include entities such as pre-eclampsia and eclampsia, along with conditions that are seen with increased frequency during pregnancy such as central serous retinopathy. The most significant modified pre-existing condition is diabetes mellitus. The various effects of pregnancy on the eye will be reviewed in this article. PMID:11734686
Sheth, B P; Mieler, W F
The purine analogs, fludarabine and cladribine represent an important class of chemotherapy agents used to treat a broad spectrum of lymphoid malignancies. Their toxicity profiles include dose-limiting myelosuppression, immunosuppression, opportunistic infection and severe neurotoxicity. This review summarizes the neurotoxicity of high- and standard-dose fludarabine, focusing on the clinical and pathological manifestations in the eye. The mechanisms of ocular toxicity are probably multifactorial. With increasing clinical use, an awareness of the neurological and ocular vulnerability, particularly to fludarabine, is important owing to the potential for life- and sight-threatening consequences.
Ding, Xiaoyan; Herzlich, Alexandra A; Bishop, Rachel; Tuo, Jingsheng; Chan, Chi-Chao
This report is a supplement to Proceedings of Conference conducted October 20-21, 1980. Contents include: (1) Ocular Effects of Relatively 'Eye Safe' Lasers; (2) Bioeffects Concerning the Safe Use of GaAs Laser Training Devices; (3) Laser Flash Effects; (...
E. S. Beatrice
Ocular inflammation and infection may involve any part of the eye and surrounding tissue. A complete examination, including visual acuity, extraocular movements, pupillary response, slit lamp examination, and fluorescein staining, is often required to establish the diagnosis. Pain relief may be achieved with oral analgesics and cycloplegics. In most cases, prompt follow-up is required. PMID:23601478
Deibel, Jonathon P; Cowling, Kathleen
Human infection by toxocara larvae has been thought to be predominantly a disease of young children, but the percentage of the population with antibodies to this nematode worm has recently been shown to increase with age. Although a definite diagnosis of ocular toxocariasis can be made only by identifying the larva histologically, the evidence in three cases presenting with recent
E R Raistrick; J C Hart
Background Bimanual, three?dimensional robotic surgery has proved valuable for a variety of surgical procedures. Aims To examine the use of a commercially available surgical robot for ocular microsurgery. Methods Using a da Vinci surgical robot, ocular microsurgery was performed with repair of a corneal laceration in a porcine model. The experiments were performed on harvested porcine eyes placed in an anatomical position using a foam head on a standard operating room table. A video scope and two, 360°?rotating, 8?mm, wrested?end effector instruments were placed over the eye with three robotic arms. The surgeon performed the actual procedures while positioned at a robotic system console that was located across the operating room suite. Each surgeon placed three 10?0 sutures, and this was documented with still and video photography. Results Ocular microsurgery was successfully performed using the da Vinci surgical robot. The robotic system provided excellent visualisation, as well as controlled and delicate placement of the sutures at the corneal level. Conclusions Robotic ocular microsurgery is technically feasible in the porcine model and warrants consideration for evaluation in controlled human trials to deploy functioning remote surgical centres in areas without access to state?of?the?art surgical skill and technology.
Tsirbas, A; Mango, C; Dutson, E
Numerous systemic medications have a potential ocular toxicity leading to permanent visual loss. Physiopathologic mechanisms associated with these toxic effects are yet unclear and, besides discontinuation of the drug, when possible, there is no current validated treatment once visual loss is present. Prevention lies on an awareness of potential risks of both the patient and the practitioner, a constant evaluation of the risk/benefice ratio of any treatment and, for some drugs, regular visual evaluations according to now more standardized protocols. In that respect, a tight link between the ophthalmologist and the referring practitioner is critical. Among oculotoxic drugs, anti-malarial treatment represents the most commonly prescribed. A better recognition of clinical characteristics of ocular toxicity along with progress in functional and structural evaluation of the visual system has modified follow-up protocols to obtain the earliest detection but a better knowledge in toxic mechanisms is still necessary. PMID:23457830
Keratoconus is the most common corneal ectatic disorder, the cause of which is largely unknown. Many factors have been implicated, and the ocular allergy is being one of them. The commonly proposed pathogenesis includes the release of inflammatory mediators due to eye rubbing which may alter the corneal collagen and lead to corneal ectasias. The onset of keratoconus is often early in cases associated with allergy and routine corneal topography may detect subtle forms of keratoconus. These cases may require early keratoplasty and are at an increased risk of having acute corneal hydrops. Surgical outcomes are similar to primary keratoconus cases. However, post-operative epithelial breakdown may be a problem in these cases. Control of allergy and eye rubbing is the best measure to prevent corneal ectasias in cases of ocular allergy.
Sharma, Namrata; Rao, Kavita; Maharana, Prafulla K; Vajpayee, Rasik B
1. The frequency of eye injuries in children is high. The frequency and severity of at least 90% of these injuries, however, could be prevented. 2. Toys, especially bicycles and BB guns, are a major source of eye injury. Another major cause of ocular trauma is sports-related injuries. 3. Ophthalmic professionals should emphasize the role of spectacles as a protective device for children and advise parents of the advantages of polycarbonate spectacles. PMID:7966381
Kutschke, P J
The use of choroidal excavation and vascular pulsations in the ultrasonic diagnosis of tumors has been a helpful diagnostic feature. Evaluation of choroidal tumors is presently performed with A-, B- and M-scan techniques. Solid tumors of high homogeneity produce characteristic hollows or acoustic quiet zones that replace the normal choroidal pattern. M-scan patterns of vascular pulsations are also useful in demonstrating vascularity or choroidal tumors. Color displays accentuate amplitude variations in ocular tumors. PMID:1131209
Coleman, D J
Three cases of peritoneal benign cystic mesotheliomas in women 32-34 years of age and one case of peritoneal malignant mesothelioma in a 47-year-old woman are reported. All cases presented with abdominal discomfort and/or pain and the physical and radiological diagnostic methods showed adnexal tumors. The cystic mesotheliomas developed in the cul-de-sac and the right pelvic sidewall, presented as multiple small cysts or large multilocular cystic mass. The malignant mesothelioma showed extensive infiltration of the omentum the intestinal loops and the surface of the uterus and adnexa, with bilateral hydrosalpinx and ascites. All cases presented histological and immunohistochemical characteristics consistent with tumors of mesothelial origin. No history of asbestos exposure was reported. The correct diagnostic and therapeutic approaches to these neoplasms are discussed. PMID:22439416
Dellaportas, D; Kairi-Vassilatou, E; Lykoudis, P; Mavrigiannaki, P; Mellou, S; Kleanthis, C K; Kondi-Pafiti, A
Ocular migraine, an uncommon cause of transient monocular visual loss, is an entity physicians should be able to recognize\\u000a in order to provide appropriate treatment and to avoid unnecessary testing. The following text provides an overview of ocular\\u000a migraine, including discussion of accepted terminology, clinical presentation, and pathophysiology. An ocular and systemic\\u000a differential diagnosis, appropriate evaluation, therapy, and prognosis are
Shilpi Pradhan; Sophia M. Chung
Ocular imaging plays a key role for the diagnosis of various ocular diseases. In this work, we have developed an ocular imaging system based on the photoacoustic tomography. This system has successfully imaged the entire eye of a mouse, from its iris to the retina region, and the imaging is label-free and non-invasively. The resolution of this system reaches several micron meters, allowing the study of microstructures in various ocular tissues. Our system has the potential to be a powerful non-invasive imaging method for the ophthalmology.
Ye, Shuoqi; Wu, Ning; Ren, Qiushi; Li, Changhui
Ocular trauma is a topic of unresolved controversies and there are continuous controversial and debatable management strategies for open-globe injuries (OGIs). International classification of ocular trauma proposed almost 15 years ago needs to be reviewed and to be more robust in predicting the outcome in the setting of OGIs. Anterior segment trauma involves controversies related to patching for corneal abrasion, corneal laceration repair, and medical management of hyphema. Timing of cataract surgery and intraocular lens implantation in the setting of trauma is still debated worldwide. There are unresolved issues regarding the management of OGIs involving the posterior segment. Timing of vitrectomy has been and will continue to be debated by proponents of early versus delayed intervention. The use of prophylactic cryotherapy and scleral buckle is still practiced differently throughout the world. The role of intravitreal antibiotics in posterior segment trauma in the absence of infection is still debated. Similarly, the use of vitrectomy versus vitreous tap in the setting of traumatic endophthalmitis is not fully resolved. In optic neuropathy, the role of intravenous methylprednisolone versus conservative management is always debated and still there are no evidence-based guidelines about the beneficial role of pulse steroid therapy. The role of optic canal decompression in the setting of acute traumatic optic neuropathy is also not conclusive. Orbital and adnexal trauma has been shown to adversely affect the outcome of OGI patients but both lids and orbital injury are not taken as preoperative variables in international ocular trauma classification. The timing of intervention in blow-out fracture is still debated. The pediatric age group, owing to the high risk of amblyopia and intraocular inflammation as well as strong vitreoretinal adhesions, has to be managed by different principles. Although the risk of sympathetic ophthalmia is very rare, it is always one of the key debated issues while managing traumatized eyes with no light perception vision. Prospective, controlled clinical studies are not possible in the OGI setting and this article reviews pertinent data regarding these management issues and controversies, and provides recommendations for treatment based on the available published data and the authors' personal experience. PMID:23338232
Agrawal, Rupesh; Shah, Mehul; Mireskandari, Kamiar; Yong, Goh Kong
Objectives To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. Design Prospective temporal and external validation of simple ultrasound rules to distinguish benign from malignant adnexal masses. The rules comprised five ultrasonic features (including shape, size, solidity, and results of colour Doppler examination) to predict a malignant tumour (M features) and five to predict a benign tumour (B features). If one or more M features were present in the absence of a B feature, the mass was classified as malignant. If one or more B features were present in the absence of an M feature, it was classified as benign. If both M features and B features were present, or if none of the features was present, the simple rules were inconclusive. Setting 19 ultrasound centres in eight countries. Participants 1938 women with an adnexal mass examined with ultrasound by the principal investigator at each centre with a standardised research protocol. Reference standard Histological classification of the excised adnexal mass as benign or malignant. Main outcome measures Diagnostic sensitivity and specificity. Results Of the 1938 patients with an adnexal mass, 1396 (72%) had benign tumours, 373 (19.2%) had primary invasive tumours, 111 (5.7%) had borderline malignant tumours, and 58 (3%) had metastatic tumours in the ovary. The simple rules yielded a conclusive result in 1501 (77%) masses, for which they resulted in a sensitivity of 92% (95% confidence interval 89% to 94%) and a specificity of 96% (94% to 97%). The corresponding sensitivity and specificity of subjective assessment were 91% (88% to 94%) and 96% (94% to 97%). In the 357 masses for which the simple rules yielded an inconclusive result and with available results of CA-125 measurements, the sensitivities were 89% (83% to 93%) for subjective assessment, 50% (42% to 58%) for the risk of malignancy index, 89% (83% to 93%) for logistic regression model 1, and 82% (75% to 87%) for logistic regression model 2; the corresponding specificities were 78% (72% to 83%), 84% (78% to 88%), 44% (38% to 51%), and 48% (42% to 55%). Use of the simple rules as a triage test and subjective assessment for those masses for which the simple rules yielded an inconclusive result gave a sensitivity of 91% (88% to 93%) and a specificity of 93% (91% to 94%), compared with a sensitivity of 90% (88% to 93%) and a specificity of 93% (91% to 94%) when subjective assessment was used in all masses. Conclusions The use of the simple rules has the potential to improve the management of women with adnexal masses. In adnexal masses for which the rules yielded an inconclusive result, subjective assessment of ultrasonic findings by an experienced ultrasound examiner was the most accurate diagnostic test; the risk of malignancy index and the two regression models were not useful.
In this activity, learners will perform various investigations to understand the vestibular-ocular reflex and learn about the importance of visual cues in maintaining balance. During the two-part activity, learners will compare the stability of a moving image under two conditions as well as compare the effects of rotation on the sensation of spinning under varying conditions. This lesson guide includes background information, review and critical thinking questions with answers, and handouts. Educators can also use this activity to discuss how the brain functions in space and how researchers study the vestibular function in space.
Marlene Y. Macleish, Ed D.; Bernice R. Mclean, M. E.
A case of ocular quinine toxicity is described which showed the typical acute visual loss and subsequent recovery. Vermiform motion of the pupil was noted 48 hours after overdose. This acute effect has not been reported before. Although acute systemic intoxication may respond to removal of quinine from the gut and circulation, there is no evidence that any treatment affects the visual prognosis. The action of quinine on the retina is unknown. We suggest it may block cholinergic neurotransmission in the inner synaptic layer.
Canning, C R; Hague, S
This paper reviews anticardiolipin antibodies and ocular disease. Its aim is to present the latest knowledge regarding the relationship between the two. It focuses mainly on ocular features and treatment, but also describes the epidemiology, main systemic features, immunology, and immunopathology of the antiphospholipid syndrome. PMID:16159716
Lima Cabrita, Filipe Vieira; Foster, C Stephen
Conventional pharmacokinetic methods for studying ocular drug delivery are invasive and cannot be conveniently applied to humans. The advancement of MRI technology has provided new opportunities in ocular drug-delivery research. MRI provides a means to non-invasively and continuously monitor ocular drug-delivery systems with a contrast agent or compound labeled with a contrast agent. It is a useful technique in pharmacokinetic studies, evaluation of drug-delivery methods, and drug-delivery device testing. Although the current status of the technology presents some major challenges to pharmaceutical research using MRI, it has a lot of potential. In the past decade, MRI has been used to examine ocular drug delivery via the subconjunctival route, intravitreal injection, intrascleral injection to the suprachoroidal space, episcleral and intravitreal implants, periocular injections, and ocular iontophoresis. In this review, the advantages and limitations of MRI in the study of ocular drug delivery are discussed. Different MR contrast agents and MRI techniques for ocular drug-delivery research are compared. Ocular drug-delivery studies using MRI are reviewed.
Li, S. Kevin; Lizak, Martin J.; Jeong, Eun-Kee
Purpose. To assess the repeatability of measurements of ocular aberrations using wavefront sensing in a small group of observers and to assess the potential effect of measurement error on custom corneal correction due to this variability. Method. A Shack-Hartmann wavefront sensor was used to measure the ocular wavefront in nine eyes. Head position was stabilized using a dental bite bar,
NIGEL DAVIES; LUIS DIAZ-SANTANA; DAVID LARA-SAUCEDO
What are the consequences of suddenly legalizing fireworks sales in a largely rural society? Would the spectrum of ocular injuries caused by fireworks differ from those found in the Western world? This is the first study on ocular injuries caused by fireworks conducted in the Republic of South Africa. We analyzed the presenting features and prospectively followed up all patients
Lewis Mark Levitz; Joanne Karen Miller; Matthias Uwe Harald Drüsedau
Postmenopausal women with adnexal masses suspicious for malignancy must undergo surgery for histopathologic confirmation. The low positive predictive value for malignancy of the currently available preoperative examinations results in 5 to 220 surgeries performed for each case of pelvic malignancy detected, depending on the evaluation method and patient selection. Although extensively reviewed as an effective tool for the investigation and treatment of adnexal masses, laparoscopy is still underused for this purpose in postmenopausal women. Some reasons are uncertainty about the incidental diagnosis of a malignant lesion during laparoscopy, concern about the effect of laparoscopy over the course of a pelvic malignant lesion, and inadequate referral of patients at high risk to specialized centers with oncologic gynecologists. Identification of patients at low risk might also be inadequate, causing them to undergo unnecessary laparotomy. Herein we demonstrate through a comprehensive literature review that laparoscopy is a highly effective tool for investigation and treatment of suspected adnexal masses in postmenopausal women, both in general medical settings without oncologic backup and in specialized centers. The indications for laparoscopy in this context can be further expanded without oncologic harm if patients at low and high risk are appropriately selected for surgery at general and specialized settings, respectively. PMID:22818540
Zanatta, Alysson; Rosin, Mateus Moreira Santos; Gibran, Luciano
Ocular surface reconstruction (OSR) is now a standard procedure in the treatment of severe ocular surface disorders. The past few years have revealed the long-term results of patients who were operated on during the early stages of OSR development, and we now have a more realistic view of the benefits and limits of the procedure. On the other hand, further understanding of the physiologic role played by the amniotic membrane (AM) has opened doors to further refined techniques in treating these patients. This review will introduce some of the major contributions made during the past years in the advancement of OSR. Clinically, we are at a stage of reviewing the pros and cons of the various transplantation techniques. Identification of factors crucial for a successful OSR procedure will further improve surgical results. Basic researchers are on the verge of identifying the so-called limbal stem cells, and further understanding of AM physiology will lead the way to tissue engineering techniques as another alternative in OSR surgery. PMID:12165702
Shimmura, Shigeto; Tsubota, Kazuo
Data from the United States Consumer Product Safety Commission indicate that air-powered guns were responsible for 22,800 injuries treated in emergency rooms during 1981, of which 1255 were eye injuries. From 1970 to 1981, 32 patients have undergone surgical intervention at the Wilmer Eye Institute for airgun-related eye injuries. Of the 22 patients with penetrating injuries from the pellets, 19 eyes were enucleated; final vision in the three remaining eyes was worse than 5/200. Of seven patients with nonpenetrating injuries, six had final vision of 20/40 or better. All three patients with penetrating injuries from shattered spectacle lenses had final vision of 20/40 or better. Histopathologic examination of the enucleated specimens demonstrated severe disruption of intraocular contents, particularly posteriorly. Despite the potential ocular dangers of airguns, only 11 states have enacted legislation that regulates their sale or use. BB injuries represent a devastating form of ocular trauma which can be prevented by adoption and enforcement of appropriate legislation. PMID:6514290
Sternberg, P; de Juan, E; Green, W R; Hirst, L W; Sommer, A
Accurate and reliable staging methods are crucial for optimal care of patients with ocular and orbital malignancies. Positron emission tomography/computed tomography (PET/CT) has recently emerged as a staging tool in the field of ophthalmic oncology. For detecting primary ocular or orbital lesions, PET/CT does not seem to provide an advantage over clinical ophthalmologic examination or conventional imaging studies such as CT or magnetic resonance imaging of the orbit. However, PET/CT may detect distant metastatic lesions that conventional imaging studies miss. For orbital and ocular adnexal lymphoma, use of PET/CT has been proven to be feasible and is now accepted both as a standard part of the initial staging work-up and for the assessment of response to therapy. For other ophthalmic tumors, PET/CT seems most appropriate for advanced metastatic tumors of the orbit, eyelid, and eye, for which the detection of distant metastasis with 1 comprehensive study may be preferable to performing multiple CT scans with contrast.
Hui, Ka-Hoi; Pfeiffer, Margaret L.; Esmaeli, Bita
The eye is an easily accessible, highly compartmentalised and immune-privileged organ that offers unique advantages as a gene therapy target. Significant advancements have been made in understanding the genetic pathogenesis of ocular diseases, and gene replacement and gene silencing have been implicated as potentially efficacious therapies. Recent improvements have been made in the safety and specificity of vector-based ocular gene transfer methods. Proof-of-concept for vector-based gene therapies has also been established in several experimental models of human ocular diseases. After nearly two decades of ocular gene therapy research, preliminary successes are now being reported in phase 1 clinical trials for the treatment of Leber congenital amaurosis. This review describes current developments and future prospects for ocular gene therapy. Novel methods are being developed to enhance the performance and regulation of recombinant adeno-associated virus- and lentivirus-mediated ocular gene transfer. Gene therapy prospects have advanced for a variety of retinal disorders, including retinitis pigmentosa, retinoschisis, Stargardt disease and age-related macular degeneration. Advances have also been made using experimental models for non-retinal diseases, such as uveitis and glaucoma. These methodological advancements are critical for the implementation of additional gene-based therapies for human ocular diseases in the near future.
Liu, Melissa M; Tuo, Jingsheng; Chan, Chi-Chao
Ocular bobbing is a distinctive movement disorder occurring in a variety of related forms herein classified as `typical', `monocular', and `atypical'. `Typical' ocular bobbing occurs in patients with paralysis of horizontal conjugate eye movements and consists of abrupt, spontaneous downward jerks of the eyes with a slow return to the mid position. The `monocular' type reflects co-existing unilateral third nerve paresis in addition to the bobbing. The `atypical' type includes either a variation unexplained by associated oculomotor palsy, or bobbing with intact spontaneous or reflex horizontal eye movements. The clinical spectrum of ocular bobbing, its varied causes, and its prognostic significance are exemplified in a report of nine cases.
Susac, John O.; Hoyt, William F.; Daroff, Robert B.; Lawrence, William
From August 2010 to June 2011, 10 consecutive patients underwent transvaginal NOTES of the adnexa, including tubal sterilization in 3, salpingectomy because of ectopic pregnancy in 3, and ovarian tumor enucleation in 4. The mean (SD; 95% CI) age of the patients was 34.8 (9.7; 27.9-41.8) years, and their body mass index was 21.6 (2.8; 19.4-23.8). In 9 of the 10 patients, the procedure was completed. The 3 tubal sterilization procedures were completed in 18 to 30 minutes, with negligible blood loss. Operative time for the 3 salpingectomies because of ectopic pregnancy was 62 to 116 minutes. One of these procedures included management of 2000 mL hemoperitoneum. Three of the 4 attempts at ovarian enucleation were successfully completed within 64 to 162 minutes, with estimated blood loss ? 50 mL. One NOTES procedure failed because of a misdiagnosed peritoneal mucinous tumor located anterior to the uterus and inaccessible, leading to subsequent conversion to transabdominal laparoscopy. Our preliminary results show that purely transvaginal NOTES is feasible and safe for use in performing uterine adnexal procedures in selected patients. However, the procedure cannot be used in patients with cul-de-sac disease, and could have limited use in treating lesions located anterior to the uterus. PMID:22425142
Lee, Chyi-Long; Wu, Kai-Yun; Su, Hsuan; Ueng, Shir-Hwa; Yen, Chih-Feng
A 36-year-old female presented with constant, worsening left lower quadrant pain without associated fever or vaginal discharge. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large complex cystic structure in the left adnexa with peripheral flow on color Doppler imaging. Given the sonographic appearance and patient symptoms, possibilities included endometrioma or hemorrhagic cyst. Tubo-ovarian abscess (TOA) and other cystic ovarian masses were considered less likely. Two days later, the patient returned with severe pelvic pain as well as fever and leukocytosis. Follow-up ultrasound showed enlargement of the mass and a tubo-ovarian abscess (TOA) was suspected. Ultrasound-guided transvaginal abscess drainage was performed with removal of purulent fluid. The case demonstrates that the radiological features of TOA may mimic those of adnexal cystic masses such as an endometrioma or hemorrhagic cyst. A complementary case is also included which demonstrates similar sonographic findings in a patient with endometrioma. In addition to sonographic imaging, a thorough clinical and laboratory evaluation is important in differentiating these entities. Furthermore, we provide a comprehensive discussion about imaging features of cystic ovarian mass on different imaging modalities.
Velcani, Artur; Conklin, Patrick; Specht, Neil
Syringocystadenoma papilliferum is a rare adnexal tumor that often occurs as a solitary tumor in the head and neck region, although occurrences on other anatomical locations have been described. Linear configurations have been described, but an agminated form is a more rare and underreported variant of this tumor. We describe a case of a healthy 10-year old female with agminated syringocystadenoma papilliferum occurring on her left supraclavicular region, with the clinical appearance of grouped molluscum contagiosum papules.Case synopsis A healthy 10-year-old girl was referred for the treatment of a "collection of molluscum contagiosum" of the left supra clavicular region of several years duration. The lesions were asymptomatic and refractory to cryotherapy. The patient was a healthy girl with no significant systemic findings. Cutaneous exam revealed a clustered group of pink, dome shaped, umbilicated papules over a 1.5 x 1 cm area within the left supraclavicular fossa (Figure 1a). An excisional biopsy was performed. Routine H&E stained sections revealed cystic epidermal invaginations with papillary projections. The superficial portions of the cyst were lined by stratified keratinizing epithelium, whereas the deeper papillated portion exhibited a double layer of basal-like cells and luminal eosinophilic columnar cells with focal decapitation secretion. The papillary structures contained fibrovascular cores and lymphoplasmacytic infiltrates. A component of hamartomatous follicular growth was not identified (Figure 1b-d.). A diagnosis was made of agminated syringocystadenoma papilliferum. PMID:24021448
Ogunrinade, Kunle; Blobstein, Steven H; Desman, Garrett T
Behcets disease is a systemic inflammatory vascular disorder characterized by recurrent oral and genital ulcers, eye lesion, arthritis and skin lesions. We report a case of Behcets disease with ocular manifestation in an 8 year old boy. PMID:16208057
A, Sam Ebenezer; Moses, Prabhakar D; George, Renu
Objective: To analyze the ocular findings in aplastic anemia. Design: Eighteen patients with aplastic anemia were examined. Results: Ocular findings included cotton wool spots (38%), nerve fiber layer or preretinal hemorrhages (67%), vitreous hemorrhages (13%), a picture resembling central retinal vein occlusion (13%) and optic disk edema (6%). Preretinal hemorrhages were the presenting sign of aplastic anemia in 2 patients
Ahmad M. Mansour; Haytham I. Salti; Dennis P. Han; Albert Khoury; Scott M. Friedman; Ziad Salem; Khaled Ibrahim; Ali Bazerbachi; Nagi Saghir
Purpose: To determine the prevalence of ocular manifestations in Marfan's syndrome. Methods: This cross-sectional study was performed on 43 patients referred to ophthalmology clinics of Yazd Medical University over 27 months. Common ocular manifestations of Marfan's syndrome including lens dislocation, corneal disorders, retinal conditions, glaucoma were evaluated. Results: The study included 24 female (55.8%) and 19 male (44.2%) subjects with
This proceedings contains papers on the following topics: ocular hazards, ocular dynamics, ocular damage thresholds, optical coherence tomography, corneal exposures, corneal damage thresholds, laser eye protection research.
Stuck, Bruce E.; Belkin, Michael
The aim of this study was to examine growth of the human eye globe and cornea from early in gestation to late in adult life. Globe antero-posterior length, horizontal and vertical diameters, corneal horizontal and vertical (white to white) diameters and posterior pole to limbus distances were measured using digital calipers (±0.01 mm) in 541 postmortem eyes. Additional pre- and postnatal data for some of the dimensions were obtained from the literature. All dimensions examined increase rapidly during prenatal development but postnatal growth differs. Growth of globe antero-posterior length, vertical and horizontal diameters as well as corneal vertical and horizontal diameters stops within 1 year after birth. Logistic analysis is consistent with an asymptotic prenatal growth mode and no further growth after its completion around 1 year after birth. Horizontal and vertical globe diameters are the same at all ages but the corneal horizontal diameter is always larger than the vertical diameter. No differences could be detected between males and females in any of the ocular dimensions. Globe and corneal growth take place primarily during the prenatal growth mode and dimensions reach their maxima, shortly after birth. It is suggested that cessation of a growth stimulating signal at birth marks the end of the prenatal growth mode and that the small increases over the next year are due to cells already stimulated. Male and female eyes of the same age have the same globe and cornea dimensions.
Augusteyn, Robert C.; Nankivil, Derek; Mohamed, Ashik; Maceo, Bianca; Pierre, Faradia; Parel, Jean-Marie
The pregnancy is associated with modifications involving multiple systems and organs, including the eye. The retinal vascular changes are present in 30-100% of the PE cases. The most frequent ocular modification is the vasoconstriction of the retinal arterioles. The exudative retinal detachment is a rare cause (under 1%) of visual loss in the PE-E syndrome, being produced by the involvement of the choroidal vascularization. Most cases of blindness during pregnancy have been determined by cortical, occipital anomalies, the used terminology in these circumstances being cortical blindness. The pathogenesis of the Purtscher retinopathy is the embolism of the retinal arterioles, by leucocytic aggregation, as a response to the activation of the complement. The evaluation of the ophthalmic arterial flow by eco Doppler might offer new perspectives regarding the understanding of the physiopathology, the diagnosis and the quantification of the PE severity. The decrease of the IP values and the increase of the median velocity in the ophthalmic artery in pregnant women with PE, suggest a hyperperfusion process and the decrease of the vascular resistances at the level of the orbital vessels, but also in the CNS. In the severe forms of PE, the increase of the impedance of the orbital vessels has been noted. The described vascular changes cannot disappear completely 6 weeks after birth; a residual arteriolar constriction might persist, as a permanent stigma of the PE. The evaluation, monitoring, therapeutical approach of the patients with PE must be performed by a complete team: obstetrician, ophthalmologist, neurologist, radiologist, in order to decrease the materno-fetal risks and improve the prognosis of PE. PMID:19065909
Mihu, D; Mihu, Carmen Mihaela; T?lu, Simona; Costin, N; Ciuchin?, S; M?lu?an, A
The systemic side effects of oral contraceptives are mentioned, and the incidence and variety of ocular complications are discussed. Experimental studies on the ocular effects of oral contraceptives in laboratory animals have shown only increased permeability of the lens and possibly vascular dilatation. Numerous case reports, however, have been published which describe neuroophthalamic, vascular, retinal and macular, aqueous humor dynamic, cornea and contact lense, lens, color vision, and other miscellaneous effects. These reports are reviewed as are the 6 reported prospective studies. These prospective studies reveal only changes in kerotometry readings. Thus the large number of case reports may represent a low overall incidence or may be normal findings in the population as a whole or may be caused by other systemic factors. Until multicenter prospective studies provide definitive guidelines, the risk associated with oral contraceptive use must be kept in its proper perpsective and ocular histories should contain information on oral contraceptive use. PMID:306593
Wood, J R
An intact cerebellum is a prerequisite for optimal ocular motor performance. The cerebellum fine-tunes each of the subtypes of eye movements so they work together to bring and maintain images of objects of interest on the fovea. Here we review the major aspects of the contribution of the cerebellum to ocular motor control. The approach will be based on structural–functional correlation, combining the effects of lesions and the results from physiologic studies, with the emphasis on the cerebellar regions known to be most closely related to ocular motor function: (1) the flocculus/paraflocculus for high-frequency (brief) vestibular responses, sustained pursuit eye movements, and gaze holding, (2) the nodulus/ventral uvula for low-frequency (sustained) vestibular responses, and (3) the dorsal oculomotor vermis and its target in the posterior portion of the fastigial nucleus (the fastigial oculomotor region) for saccades and pursuit initiation.
Kheradmand, Amir; Zee, David S.
The purpose of this study is to discuss the surgical treatment for ovarian torsion in children and adolescents with a focus on the procedures of adnexal conservation surgery and its frequency in the literature of the last 10 years. We retrospectively reviewed the medical charts of 127 operative ovarian lesions including 30 ovarian torsions (23.6%) treated in two pediatric centers over a 10-year period. Age at presentation, presenting symptoms, diagnostic studies, surgical procedure and pathological findings were analyzed. Mean age was 13.7 years. Conservative surgery has been performed in 46.7% of the cases and laparoscopic approach in 40%. Ovarian torsion occurred in 56.7% on ovaries with functional lesion, in 23.3% on normal adnexa and in 20% on ovaries with benign neoplasm. The article includes a literature review (2000-2010) and a statistical analysis which shows a slow increase in conservative surgery from 28 to 45%. Laparoscopic surgery accounts for 23.5%. Literature review shows 40.5% normal adnexa, 33.2% non-neoplastic lesions, 25.3% benign neoplasms and 1% malignant neoplasms. The surgical treatment of children and adolescents presenting adnexal torsion should be practiced as an emergency and it should be more conservative as possible in order to maximize the future reproductive potential. PMID:22817767
Spinelli, Claudio; Buti, Irene; Pucci, Valentina; Liserre, Josephine; Alberti, Elisabetta; Nencini, Luca; Alessandra, Martin; Lo Piccolo, Roberto; Messineo, Antonio
Granular cell tumor (GCT) is an uncommon tumor and is believed to be of schwannian origin. GCT is benign but rare malignant cases are recorded. GCT occurs in almost any part of the body. The common sites are the tongue, skin, and subcutaneous tissue. GCT of hand is an extremely rare. Till date only 17 cases are reported in the literature. Preoperative diagnosis of GCT is important, because GCT mimics dermal adnexal tumor in subcutaneous tissue, other soft tissue tumor or inflammatory lesions. GCT is composed of large polygonal cells with eosinophilic granular cytoplasm and these cells are often immunoreactive for the S-100 protein. Fine-needle aspiration cytology has been suggested to be diagnostic modality of choice and this would undoubtedly aid the correct diagnosis. Excision with wide surgical margins is curative for benign GCT. Recurrence and malignant transformation requires regular follow-up. Here, this communication documents a case of cytological diagnosis of the granular cell tumor of hand in a 21-year-old female, clinically suspected to be a dermal adnexal tumor.
Nasit, Jitendra G.; Chauhan, Sanjaykumar; Dhruva, Gauravi
PURPOSE: This investigation retrospectively examined ocular injuries associated with air bag deployment to gain a better appreciation of potential risk factors in motor vehicle accidents. National statistics regarding the efficacy of air bags were reviewed. METHODS: Review of the literature from 1991 to 1998 identified 44 articles describing 97 patients with air-bag-induced ocular injuries. Variables extracted from each case were age, sex, height, position in the car, eye wear, vehicle impact speed, visual acuity, and specific ocular injuries. RESULTS: Corneal abrasions occurred in 49% of occupants, hyphemas in 43%, vitreous or retinal hemorrhages in 25%, and retinal tears or detachments in 15%. The globe was ruptured in 10 patients. Patients involved in higher-speed accidents (over 30 mph) sustained a greater percentage of vitreous or retinal hemorrhages and traumatic cataracts, while those at slower speeds were more prone to retinal tears or detachments. In a subset of 14 patients with serious ocular injuries, the impact speed of 11 patients was recorded at 30 mph or less. Slower speed may be a risk factor for some ocular injuries. Occupant height was not a significant factor. National statistics confirm that air bags reduce fatalities in motor vehicle accidents. However, children sitting in the front seat without a seat belt and infants in passenger-side rear-facing car seats are at risk for fatal injury. CONCLUSION: Air bags combined with seat belts are an effective means of reducing injury and death in adults during motor vehicle accidents. However, this study has documented a wide variety of ocular injuries associated with air bag deployment. It is hoped that researchers can develop modifications that continue to save lives while minimizing additional harm. Images FIGURE 1 FIGURE 2A FIGURE 2B FIGURE 2C FIGURE 2D FIGURE 3A FIGURE 3B FIGURE 4 FIGURE 5 FIGURE 7 FIGURE 8
Stein, J D; Jaeger, E A; Jeffers, J B
The intraocular patches were prepared using gelatin as the polymer. Ocular patch were prepared by solvent casting method. The patches were prepared for six formulations GP1, GP2, GP3, GP4, GP5 and GP6. Petri dishes were used for formulation of ocular patch. Gelatin was used as a polymer of choice. Glutaraldehyde used as cross linking agent and (DMSO) dimethylsulfoxide used as solubility enhancer. The elasticity depends upon the concentration of gelatin. 400 mg amount of polymer i.e gelatin gave the required elasticity for the formulation. PMID:23066196
Upreti, Kamalesh; Dabral, Prashant; Rana, Vinod; Upadhyaya, Kumud; Badhani, Anjali
This paper presents an ocular system to provide improved mobility of the ocular implant. A person with one eye missing, through various reasons, may suffer severely. Patients with such defects may withdraw from society. The loss of an eye can be solved by the ocular implant cosmetically. The prosthesis appears natural, but it is static. There were other groups of
J. Gu; M. Meng; A. Cook; M. G. Faulkner
We report an atypical presentation of Toxoplasma retinochoroiditis with associated scleritis in a young and immunocompetent patient. The diagnosis was done on the basis of Polymerase chain reaction of vitreous sample, and the clinical response to specific treatment. This case highlights the unusual presentation of ocular toxoplasmosis as scleritis.
Kamath, Yogish S; Rathinam, S R; Kawali, Ankush
Drugs acting on various parts of the body may also affect the eye insidiously. Increased awareness of such drug toxicity by the prescribing doctor should encourage him to consider effects on the cornea, lens, retina, optic nerve and elsewhere when checking the patient's progress. The following review concerns adverse ocular effects of systemic drug administration.
Spiteri, M. A.; James, D. G.
A detailed ophthalmic evaluation including slitlamp biomicroscopy, measurement of corneal sensitivity using Cochet and Bonnet aesthesiometer, Schirmer's test and Goldmann applanation tonometry was carried out in 89 patients of Hansen's disease attending the leprosy clinic with or without ocular symptoms and willing to undergo eye evaluation. Thirty-one patients had lepromatous leprosy (8 with erythema nodosum leprosum), 56 patients had borderline
G. Chandra Sekhar; G. Vance; S. Otton; S. Vinay Kumar; J. N. A. Stanley; G. N. Rao
Although new drugs have recently been developed within the field of ophthalmology, the eye's various defense mechanisms make it difficult to achieve an effective concentration of these drugs within the eye. Drugs administered systemically have poor access to the inside of the eye because of the blood-aqueous and blood-retinal barriers. And although topical instillation of drugs is very popular in ophthalmology, topically applied drugs are rapidly eliminated from the precorneal area. In addition, the cornea, considered a major pathway for ocular penetration of topically applied drugs, is an effective barrier to drug penetration, since the corneal epithelium has annular tight junctions (zonula occludens), which completely surround and effectively seal the superficial epithelial cells. Various drug-delivery systems have been developed to increase the topical bioavailability of ophthalmic drugs by enhancement of the ocular drug penetration. The first approach is to modify the physicochemical property of drugs by chemical and pharmaceutical means. An optimum promoiety can be covalently bound to a drug molecule to obtain a prodrug that can chemically or enzymatically be converted to the active parent drug, either within the cornea or after the corneal penetration. Along these same lines, the transient formation of a lipophilic ion pair by ionic bonding is also useful for improving ocular drug penetration. The second approach is to modify the integrity of the corneal epithelium transiently by coadministration of an amphiphilic substance or by chelating agents that act as drug-penetration enhancers. The third approach modifies the integrity of the corneal epithelium transiently by physical techniques including iontophoresis and phonophoresis. This paper reviews the absorption behavior and ocular membranes penetration of topically applied drugs, and the various approaches for enhancement of ocular drug penetration in the eye. PMID:10099899
Sasaki, H; Yamamura, K; Mukai, T; Nishida, K; Nakamura, J; Nakashima, M; Ichikawa, M
This study aimed to explore and evaluate the feasibility and safety of laparoscopic adnexal surgery using a two-port technique with a multichannel port, using a wound retractor, as previously reported. A series of patients undergoing two-port laparoscopy for a benign pelvic mass were enrolled in this study. To perform two-port laparoscopic surgery, the ancillary 5-mm trocar was inserted at the left iliac fossa under laparoscopic view after umbilical trocar insertion. The inserted umbilical trocar was removed and the skin incision was extended about 1.5 cm with index-finger-passable width. An Alexis wound retractor XS (Applied Medical, Santa Rancha Margarita, CA) was inserted through the umbilical wound. Two trocars were inserted into two fingers of a no. 6 surgical rubber glove and ligated with rubber bands. The wrist portion of the rubber glove covered the wound retractor, and the edge of the wound retractor was clamped with three Babcock clamps to prevent carbon-dioxide gas leakage. Both a 10-mm laparoscope and atraumatic forceps were inserted through the umbilical multichannel port. Laparoscopic adnexal surgery was performed in the usual manner. A total of 19 patients were enrolled. The operative procedures were adnexectomy (n = 8), myomectomy (n = 1), and ovarian cystectomy and/or salpingectomy (n = 10). There were no operative complications, conversion to laparotomy, or additional trocar insertions. The mean operation time was 81.3 +/- 28.7 min. The pathologic diagnosis were mature cystic teratoma (n = 6), benign cyst (n = 4), endometrial cyst (n = 3), serous cystadenoma (n = 3), mucinous cystadenoma (n = 1), leiomyoma (n = 1), and tubo-ovarian abscess (n = 1). The mean postoperative hospital stay was 4.0 +/- 1.3 days. This two-port method seems to be safe and needs no additional cost from the use of the conventional laparoscopic instruments. It is also cosmetically effective and highly appreciated by patients, leaving minimal abdominal scarring. PMID:19694570
In ocular tissue, arachidonic acid is metabolized by cyclooxygenase to prostaglandins which are the most important lipid derived\\u000a mediators of inflammation. Presently nonsteroidal anti-inflammatory drugs (NSAIDs) which are cyclooxygenase (COX) inhibitors\\u000a are being used for the treatment of inflammatory disorders. NSAIDs used in ophthalmology, topically, are salicylic-, indole\\u000a acetic-, aryl acetic-, aryl propionic- and enolic acid derivatives. NSAIDs are weak
Munish Ahuja; Avinash S. Dhake; Surendra K. Sharma; Dipak K. Majumdar
In ocular tissue, arachidonic acid is metabolized by cyclooxygenase to prostaglandins which are the most important lipid derived mediators of inflammation. Presently nonsteroidal anti-inflammatory drugs (NSAIDs) which are cyclooxygenase (COX) inhibitors are being used for the treatment of inflammatory disorders. NSAIDs used in ophthalmology, topically, are salicylic-, indole acetic-, aryl acetic-, aryl propionic- and enolic acid derivatives. NSAIDs are weak acids with pKa mostly between 3.5 and 4.5, and are poorly soluble in water. Aqueous ophthalmic solutions of NSAIDs have been made using sodium, potassium, tromethamine and lysine salts or complexing with cyclodextrins/solubilizer. Ocular penetration of NSAID demands an acidic ophthalmic solution where cyclodextrin could prevent precipitation of drug and minimize its ocular irritation potential. The incompatibility of NSAID with benzalkonium chloride is avoided by using polysorbate 80, cyclodextrins or tromethamine. Lysine salts and alpha-tocopheryl polyethylene glycol succinate disrupt corneal integrity, and their use requires caution. Thus a nonirritating ophthalmic solution of NSAID could be formulated by dissolving an appropriate water-soluble salt, in the presence of cyclodextrin or tromethamine (if needed) in mildly acidified purified water (if stability permits) with or without benzalkonium chloride and polyvinyl alcohol. Amide prodrugs met with mixed success due to incomplete intraocular hydrolysis. Suspension and ocular inserts appear irritating to the inflamed eye. Oil drop may be a suitable option for insoluble drugs and ointment may be used for sustained effect. Recent studies showed that the use of colloidal nanoparticle formulations and the potent COX 2 inhibitor bromfenac may enhance NSAID efficacy in eye preparations. PMID:18437583
Ahuja, Munish; Dhake, Avinash S; Sharma, Surendra K; Majumdar, Dipak K
Amiodarone is an effective antiarrhythmic agent. During therapy, intracytoplasmic lamellar deposits occur in the cornea, lens, retina, and optic nerve. The most common symptom, reported by 1.4–40.0% of patients, is colored rings around lights. The most common ocular finding is corneal epithelial opacities resembling a cat’s whiskers in 70–100% of patients; however, lens opacities have been reported in 50–60% of
Purpose To evaluate the outcome of treatment with methotrexate for noninfectious ocular inflammation. Design Retrospective cohort study. Participants Patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to add methotrexate as a single, noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007, inclusive. Methods Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage, route of administration of methotrexate, and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures Control of inflammation, corticosteroid-sparing effects, and incidence of and reason for discontinuation of therapy. Results Among 384 patients (639 eyes) observed from the point of addition of methotrexate to an anti-inflammatory regimen, 32.8%, 9.9%, 21.4%, 14.6%, 15.1%, and 6.3%, respectively, had anterior uveitis, intermediate uveitis, posterior or panuveitis, scleritis, ocular mucous membrane pemphigoid, and other forms of ocular inflammation. In these groups, complete suppression of inflammation sustained for ?28 days was achieved within 6 months in 55.6%, 47.4%, 38.6%, 56.4%, 39.5%, and 76.7%, respectively. Corticosteroid-sparing success (sustained suppression of inflammation with prednisone ?10 mg/d) was achieved within 6 months among 46.1%, 41.3%, 20.7%, 37.3%, 36.5%, and 50.9%, respectively. Overall, success within 12 months was 66% and 58.4% for sustained control and corticosteroid sparing ?10 mg), respectively. Methotrexate was discontinued within 1 year by 42% of patients. It was discontinued owing to ineffectiveness in 50 patients (13%); 60 patients (16%) discontinued because of side effects, which typically were reversible with dose reduction or discontinuation. Remission was seen in 43 patients, with 7.7% remitting within 1 year of treatment. Conclusions Our data suggest that adding methotrexate to an anti-inflammatory regimen not involving other noncorticosteroid immunosuppressive drugs is moderately effective for management of inflammatory activity and for achieving corticosteroid-sparing objectives, although many months may be required for therapeutic success. Methotrexate was well tolerated by most patients, and seems to convey little risk of serious side effects during treatment. Financial Disclosure(s) The authors have no proprietary or commercial interests in any of the materials discussed in this article.
Gangaputra, Sapna; Newcomb, Craig W.; Liesegang, Teresa L.; COT; CRC; Kacmaz, R. Oktay; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Foster, C. Stephen; Kempen, John H.
Purpose To evaluate the outcomes of cyclophosphamide therapy for non-infectious ocular inflammation. Design Retrospective cohort study Participants Two hundred fifteen patients with non-infectious ocular inflammation observed from initiation of cyclophosphamide. Methods Patients initiating cyclophosphamide, without other immunosuppressive drugs (other than corticosteroids), were identified at four centers. Dose of cyclophosphamide, response to therapy, corticosteroid-sparing effects, frequency of discontinuation and reasons for discontinuation were obtained by medical record review of every visit. Main Outcome Measures Control of inflammation, corticosteroid-sparing effects, discontinuation of therapy. Results The 215 patients (381 involved eyes) meeting eligibility criteria carried diagnoses of uveitis (20.4%), scleritis (22.3%), ocular mucous membrane pemphigoid (45.6%) or other forms of ocular inflammation (11.6%). Overall, approximately 49.2% (95% confidence interval (CI): 41.7%-57.2%) gained sustained control of inflammation (for at least 28 days) within 6 months, and 76% (95% CI: 68.3%-83.7%) within 12 months. Corticosteroid-sparing success (sustained control of inflammation while tapering prednisone to 10 mg or less among those not meeting success criteria initially) was gained by 30.0% and 61.2% by six and 12 months respectively. Disease remission leading to discontinuation of cyclophosphamide occurred at the rate of 0.32/person-year (95% CI: 0.24 -0.41), and the estimated proportion with remission at or prior to 2 years was 63.1% (95% CI: 51.5%-74.8%). Cyclophosphamide was discontinued by 33.5% of patients within one year because of side effects-usually of a reversible nature. Conclusions Our data suggest that cyclophosphamide is effective for the majority of patients for controlling inflammation and allowing tapering of systemic corticosteroids to 10 mg of prednisone or less, although a year of therapy may be needed to achieve these goals. Unlike with most other immunosuppressive drugs, disease remission was induced by treatment in the majority of patients who were able to tolerate therapy. In order to titrate therapy properly and to minimize the risk of serious potential side effects, a systematic program of laboratory monitoring is required. Judicious use of cyclophosphamide appears beneficial for severe ocular inflammation cases where the potentially vision-saving benefits outweigh the substantial potential side effects of therapy, or when indicated for associated systemic inflammatory diseases.
Pujari, Siddharth S.; Kempen, John H.; Newcomb, Craig W.; Gangaputra, Sapna; Daniel, Ebenezer; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Foster, C. Stephen
The main aim of pharmacotherapeutics is the attainment of an effective drug concentration at the intended site of action for a sufficient period of time to elicit the response. A major problem being faced in ocular therapeutics is the attainment of an optimal concentration at the site of action. Poor bioavailability of drugs from ocular dosage forms is mainly due to the tear production, non-productive absorption, transient residence time, and impermeability of corneal epithelium. This article reviews: (1) the barriers that decrease the bioavailability of an ophthalmic drug; (2) the objectives to be considered in producing optimal formulations; and (3) the approaches being used to improve the corneal penetration of a drug molecule and delay its elimination from the eye. The focus of this review is on the recent developments in topical ocular drug delivery systems, the rationale for their use, their drug release mechanism, and the characteristic advantages and limitations of each system. In addition, the review attempts to give various analytical procedures including the animal models and other models required for bioavailability and pharmacokinetic studies. The latter can aid in the design and predictive evaluation of newer delivery systems. The dosage forms are divided into the ones which affect the precorneal parameters, and those that provide a controlled and continuous delivery to the pre- and intraocular tissues. The systems discussed include: (a) the commonly used dosage forms such as gels, viscosity imparting agents, ointments, and aqueous suspensions; (b) the newer concept of penetration enhancers, phase transition systems, use of cyclodextrins to increase solubility of various drugs, vesicular systems, and chemical delivery systems such as the prodrugs; (c) the developed and under-development controlled/continuous drug delivery systems including ocular inserts, collagen shields, ocular films, disposable contact lenses, and other new ophthalmic drug delivery systems; and (d) the newer trends directed towards a combination of drug delivery technologies for improving the therapeutic response of a non-efficacious drug. The fruitful resolution of the above-mentioned technological suggestions can result in a superior dosage form for both topical and intraocular ophthalmic application. PMID:12098838
Kaur, Indu Pal; Kanwar, Meenakshi
Purpose To study the effect of bimatoprost 0.03% (Lumigan) on ocular hemodynamics in patients with open-angle glaucoma or ocular hypertension. Methods One randomly selected eye of each of 26 patients with open-angle glaucoma or ocular hypertension was enrolled. Each patient received a drop of bimatoprost 0.03% once daily for 1 month. The effect of bimatoprost on ocular circulation was assessed
Cengiz Akarsu; Sevda Y?lmaz; Pelin Taner; Ahmet Ergin
Paratesticular cystadenomas with ovarian stroma, metaplastic serous Müllerian epithelium, and male adnexal tumor of probable wolffian origin: A series of 5 hitherto poorly recognized testicular tumors.
We present 5 paratesticular tumors, which manifested ovarian-type stroma and various serous müllerian epithelial structures including serous fallopian-like epithelium and proliferations closely mimicking cystic serous borderline tumors of the ovary. In addition, 3 of the tumors in our series revealed a solid epithelial component, which was morphologically and immunohistochemically similar to so called "female adnexal tumor of probable wolffian origin," which is a rare neoplasm described so far only in the female genital tract, retroperitoneum, and the pelvic cavity. In analogy with mixed epithelial and stromal tumors of the kidney, which are renal neoplasms producing ovarian-type stroma, we suggest to designate the above paratesticular tumors containing ovarian-type stroma as "mixed epithelial and stromal tumors of the paratestis with features of cystic serous borderline tumor" (cases 1 and 2) and "mixed epithelial and stromal tumors of the paratestis with male adnexal tumor of probable wolffian origin" (cases 3-5). PMID:23020997
Michal, Michal; Kazakov, Dmitry V; Kacerovska, Denisa; Kuroda, Naoto; Lovric, Eva; Wachter, David L; Agaimy, Abbas; Hes, Ondrej
...2010-04-01 2010-04-01 false Ocular surgery irrigation device. 886.4360 Section...Surgical Devices Â§ 886.4360 Ocular surgery irrigation device. (a) Identification. An ocular surgery irrigation device is a device...
Objective: The aim of the present study was to determine to what extent ovarian reserves are affected by ischemia-reperfusion injury, evaluating the number of growing follicles and the serum levels of the ovarian hormones. Study Design: Thirty female fertile adult Wistar albino rats, weighing 200 to 220 g, were previously numbered to randomization, and then randomly divided into 3 equal groups (n = 10): sham, torsion, and detorsion groups. In torsion and detorsion groups, bilateral adnexal torsion (3-hour ischemia) was carried out. Bilateral adnexal detorsion (3-hour reperfusion) was performed in the detorsion group. Results: The mean number of preantral and small antral follicles in detorsion group were lower than those of the sham group (P < .01). After torsion, anti-Müllerian hormone (AMH), estradiol, and inhibin B levels decreased significantly compared to the preoperative and postoperative periods (P = .003, P = .032, and P = .014, respectively). In detorsion group, only AMH levels were found to decrease significantly following the 3-hour ischemia and 3-hour reperfusion (P < .05). Conclusion: After adnexal torsion, a significant decrease in ovarian reserve has been detected for the first time in this study. Additionally, the results of this study suggest that conservative surgery alone is insufficient to protect ovarian reserve. PMID:23585344
Ozler, Ali; Turgut, Abdulkadir; Soydinç, Hatice Ender; Sak, Muhammet Erdal; Evsen, Mehmet Siddik; Alabalik, Ulas; Basarali, Mustafa Kemal; Deveci, Engin
Glaucoma is a progressive optic neuropathy of unknown origin. It has been hypothesized that a vascular component is involved in glaucoma pathophysiology. This hypothesis has gained support from studies showing that reduced ocular perfusion pressure is a risk factor for the disease. The exact nature of the involvement is, however, still a matter of debate. Based on recent evidence we propose a model including primary and secondary insults in glaucoma. The primary insult appears to happen at the optic nerve head. Increased intraocular pressure and ischemia at the post-laminar optic nerve head affects retinal ganglion cell axons. Modulating factors are the biomechanical properties of the tissues and cerebrospinal fluid pressure. After this primary insult retinal ganglion cells function at a reduced energy level and are sensitive to secondary insults. These secondary insults may happen if ocular perfusion pressure falls below the lower limit of autoregulation or if neurovascular coupling fails. Evidence for both faulty autoregulation and reduced hyperemic response to neuronal stimulation has been provided in glaucoma patients. The mechanisms appear to involve vascular endothelial dysfunction and impaired astrocyte-vessel signaling. A more detailed understanding of these pathways is required to direct neuroprotective strategies via the neurovascular pathway. PMID:23009741
Cherecheanu, A Popa; Garhofer, G; Schmidl, D; Werkmeister, R; Schmetterer, L
Animals provide indispensable models to translate basic mechanistic discoveries and realize their therapeutic potential in humans. Conversely, advances in human medicine often inform management of similar conditions in clinical veterinary medicine. In this paper, key experimental model species are introduced, with emphasis on genetic contributions of the mouse. Its role and those of larger animal models are described in common ocular research areas including intraocular neoplasia, corneal epithelial and stromal disease, cataract, uveitis, glaucoma, and retinal dystrophies. Emphasis is placed on those conditions shared by humans and domestic animals, with the intent of exploring how the study of comparable conditions in humans, domestic animals, and laboratory animals informs one another. PMID:23750503
Zeiss, Caroline J
Purpose To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inflammation Design Retrospective cohort study Participants Three hundred seventy-three patients with non-infectious ocular inflammation managed at four tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single non-corticosteroid immunosuppressive agent to their treatment regimen, between 1979-2007 inclusive. Methods Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Results Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by six months and 51.9% by one year gained sustained, complete control of inflammation over at least two visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone 10 mg/day or less) was achieved by 22.1% by six months and 36.1% within one year. Toxicity led to discontinuation of therapy within one year by 10.7% of the population. Patients over 55 years of age were over 3-fold more likely to discontinue therapy because of toxicity than patients ages 18-39 years. Doses of 151-250 mg/day tended to be more successful than lower doses, and were not associated with a higher discontinuation for toxicity rate; higher doses did not appear to offer a therapeutic advantage. Conclusion Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151-250 mg/day. While cyclosporine was tolerated by the majority of patients, toxicity was much more frequent with increasing age; alternative agents may be preferred for patients over 55 years of age.
Kacmaz, R. Oktay; Kempen, John H.; Newcomb, Craig; Daniel, Ebenezer; Gangaputra, Sapna; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Foster, C. Stephen
Aim In this paper, we will try to highlight the importance of various investigations and their crucial role in identifying whether the defect is structural or functional. Case history A 24-year-old woman presented with ocular complications after bungee jumping. Subsequently, although all ophthalmic signs resolved, she complained of decreased vision in her left eye. Conclusion Initial ophthalmic injury was detected by optical coherence tomography scan showing a neurosensory detachment of the fovea. This was not initially detected on slit-lamp examination or fluorescein angiography. On later examination, although the optical coherence tomography scan showed no structural damage, electrodiagnostic tests showed a functional defect at the fovea.
Hassan, H Mohammed J; Mariatos, Georgios; Papanikolaou, Theocharis; Ranganath, Akshatha; Hassan, Hala
Compared with other skeletal muscles, extraocular muscles have fundamentally distinct properties that make them selectively vulnerable to certain neuromuscular disorders. When the oculomotor signs are predominant, their temporal progression allows the clinician to make the distinction between a muscular disease (mitochondrial disorder, oculopharyngeal muscular dystrophy...) and a disorder of the neuromuscular junction (myasthenia gravis, botulism...). In other instances, such as myotonic dystrophy or facioscapulohumeral dystrophy, the ocular signs are not in the forefront but must be recognized by the ophthalmologist as hallmarks of a muscular disorder. In all cases, the collaboration between the neurologist and the ophthalmologist is fruitful. PMID:18808764
Pénisson-Besnier, I; Lamirel, C
Metabolic syndrome is a cluster of diseases including central obesity, dyslipidemia, hyperglycemia, and high blood pressure. People with metabolic syndrome have been shown to be at an increased risk of developing cardiovascular disease, beyond the risk associated with individual components of the syndrome. The association of diabetes and hypertension with retinopathy, cataract, and raised intraocular pressure is well known. This review highlights the association of metabolic syndrome, including all its components, with various ocular conditions such as retinopathy, central retinal artery occlusion, cataracts, and raised intraocular pressure.
Chopra, Rupali; Chander, Ashish; Jacob, Jubbin J.
We have undertaken a clinical ground study of proton-induced light flashes (phosphenes). Patients treated at the Institut Curie - Centre de Protonthérapie in Orsay, France, received radiation therapy to cure ocular and skull-base cancers. Sixty percent of the patients treated for choroidal melanomas using 73 MeV protons report anomalous phosphenes. Delivering a radiation dose on the retina only is not sufficient to trigger the light flash. The present study may be the first indication of phosphenes triggered by protons of few tens of MeV.
Khan, E.; Maréchal, F.; Dendale, R.; Mabit, C.; Calugaru, V.; Desjardin, L.; Narici, L.
Cognitive activities influence the rate and direction of eye movements, but the effect of various levels of eye activity on cognition has not been tested. Jacobson (1938) claimed to have reduced cognitive activity with some eye exercises by decreasing ocular motility. The current study assessed the effects of ocular relaxation eye exercises, adapted from Jacobson, on two subjects with a
Kenneth L. Lichstein; James F. Sallis
Most diseases of the eye and periocular regions that cause blindness are relatively painless. Headache pain of ocular and periocular origin represent a special challenge to the clinician. For patients with ocular and periocular pain that is unrelated to primary eye disease, identification and treatment of the painful condition usually become the responsibility of the clinician. PMID:23419627
Waldman, Corey W; Waldman, Steven D; Waldman, Reid A
Lymphocytes from individuals with inactive macular disciform lesions of presumed ocular histoplasmosis challenged with three histoplasmin antigens incorporated tritiated thymidine at a significantly higher rate than histoplasmin-stimulated lymphocytes of matched control and peripheral scar groups. This finding is consistent with the etiologic association of the disciform ocular syndrome and previous systemic infection with Histoplasma capsulatum. The disciform group had a
J. P. Ganley; G. J. Nemo; G. W. Comstock; J. A. Brody
Eight children with the fetal alcohol syndrome are described with ocular anomalies. They all had a strong history of maternal alcohol abuse throughout pregnancy, especially in the first trimester. All the children had eye abnormalities. These included external eye lesions, Peters' anomaly, lens opacification, ocular motility disorders, and optic nerve hypoplasia.
T Chan; R Bowell; M OKeefe; B Lanigan
A variety of ocular drug delivery systems, including a controlled release of the drug, drug targeting, and penetration enhancement of the drug, have been investigated. Biodegradable polymers have been widely used as the drug carrier for controlled-release systems. Biodegradable polymers release the drug as they themselves degrade and are finally absorbed within the body. Several ocular drug delivery systems using
Hideya Kimura; Yuichiro Ogura
The ocular surface is constantly exposed to a wide array of microorganisms. The ability of the outer ocular system to recognize pathogens as foreign and eliminate them is critical to retain corneal transparency, hence preservation of sight. Therefore, a combination of mechanical, anatomical, and immunological defense mechanisms has evolved to protect the outer eye. These host defense mechanisms are classified
E K Akpek; J D Gottsch
Objetivo: Estudar a ocorrência de trauma ocular provocado por corpos estranhos superficiais durante a realização de atividades ocupacionais. Métodos: Estudo prospectivo de pacientes portadores de trauma ocular ocupacional atendidos no serviço de urgência do Hospital Getúlio Vargas (HGV) \\/ Universidade Federal do Piauí (UFPI), no período de outubro de 1997 a março de 1999. Os seguintes dados foram coletados: idade,
Fernando Antônio de Macedo Leal; Arthur Pereira da Silva e Filho; Daniela Martins Neiva; Josilene Carvalho Soares Learth; Durwagner Barros da Silveira
Purpose: To investigate the relation between axial length (AL) and ocular parameters. Methods: Measurements of ocular biometric parameters were performed with an optical biometer, pachymeter, optical coherence tomography, and an automatic refractometer. AL, refractive error (RE), central corneal thickness, anterior chamber depth (ACD), corneal curvature (CC), white-to-white distance (WWD), and retinal nerve fiber layer (RNFL) thickness were measured. AL was
Sang Hoon Park; Ki Ho Park; Joon Mo Kim; Chul Young Choi
Aim To study the epidemiology of ocular injuries in patients with major trauma in the UK, determining the incidence and causes of ocular injuries, and their association with facial fractures. Methods A retrospective analysis of the Trauma Audit Research Network database from 1989 to 2004, looking at data from 39?073 patients with major trauma. Results Of the 39?073 patients with major trauma, 905 (2.3%) patients had associated ocular injuries and 4082 (10.4%) patients had a facial fracture (zygoma, orbit or maxilla). The risk of an eye injury for a patient with a facial fracture is 6.7 times as that for a patient with no facial fracture (95%, confidence interval 5.9 to 7.6). Of the patients with major trauma and an eye injury, 75.1% were men, and the median age was 31?years. 57.3% of ocular injuries were due to road traffic accidents (RTAs). Conclusion The incidence of ocular injuries in patients with major trauma is low, but considerable association was found between eye injuries and facial fractures. Young adults have the highest incidence of ocular injury. RTAs are the leading cause of ocular injuries in patients with major trauma. It is vital that all patients with major trauma are examined specifically for an ocular injury.
Guly, C M; Guly, H R; Bouamra, O; Gray, R H; Lecky, F E
The purpose of this study was to investigate clinical and immunological responses to Demodex on the ocular surface. Thirteen eyes in 10 patients with Demodex blepharitis and chronic ocular surface disorders were included in this study and treated by lid scrubbing with tea tree oil for the eradication of Demodex. We evaluated ocular surface manifestations and Demodex counts, and analyzed IL-1?, IL-5, IL-7, IL-12, IL-13, IL-17, granulocyte colony-stimulating factor, and macrophage inflammatory protein-1? in tear samples before and after the treatment. All patients exhibited ocular surface manifestations including corneal nodular opacity, peripheral corneal vascularization, refractory corneal erosion and infiltration, or chronic conjunctival inflammatory signs before treatment. After treatment, Demodex was nearly eradicated, tear concentrations of IL-1? and IL-17 were significantly reduced and substantial clinical improvement was observed in all patients. In conclusion, we believe that Demodex plays an aggravating role in inflammatory ocular surface disorders.
Kim, Jae Hoon; Chun, Yeoun Sook
The goal of palliative care is the achievement of the best quality of life for patients and their families. Eyes are generally the first features of the face to be noticed. Loss of an eye is a traumatic event which has a crippling effect on the psychology of the patient. Several ocular and orbital disorders require surgical intervention that may result in ocular defects. An ocular prosthesis is fabricated to restore the structure, function, and cosmetics of the defects created by such conditions. Although an implant eye prosthesis has a superior outcome, due to economic factors it may not be a feasible option for all patients. Therefore, a custom-made ocular prosthesis is a good alternative. This case report presents a palliative treatment for a patient with an enucleated eye by fabricating a custom ocular prosthesis which improved his psychological, physical, social, functional, emotional and spiritual needs.
Thakkar, Prachi; Patel, JR; Sethuraman, Rajesh; Nirmal, Narendra
We investigated the effects of refractive correction and refractive defocus on the assessment of sensory ocular dominance. In 25 healthy subjects (4 males and 21 females) aged between 20 and 31 years, a quantitative measurement of sensory ocular dominance was performed with refractive correction and the addition of a positive lens on the dominant eye. Sensory ocular dominance was measured with a chart using binocular rivalry targets. The reversal point changed after the addition of a +1.00 D lens on the dominant eye in all subjects. However, sighting ocular dominance and stereopsis did not change after the addition of a positive lens on the dominant eye ( P > 0:05, Wilcoxon test). These results suggest that refractive correction affects sensory ocular dominance, indicating the possible development of a new type of occlusion for amblyopia in the future.
Nakayama, Nanami; Kawamorita, Takushi; Uozato, Hiroshi
The purpose of this study was to prepare and characterize an ocular effective prolonged-release liposomal hydrogel formulation containing ciprofloxacin. Reverse-phase evaporation was used for preparation of liposomes consisting of soybean phosphatidylcholine (PC) and cholesterol (CH). The effect of PC/CH molar ratio on the percentage drug encapsulation was investigated. The effect of additives such as stearylamine (SA) or dicetyl phosphate (DP) as positive and negative charge inducers, respectively, were studied. Morphology, mean size, encapsulation efficiency, and in vitro release of ciprofloxacin from liposomes were evaluated. For hydrogel preparation, Carbopol 940 was applied. In vitro transcorneal permeation through excised albino rabbit cornea was also determined. Optimal encapsulation efficiency of 73.04 +/- 3.06% was obtained from liposomes formulated with PC/CH at molar ratio of 5:3 and by increasing CH content above this limit, the encapsulation decreased. Positively charged liposomes showed superior entrapment efficiency (82.01 +/- 0.52) over the negatively charged and the neutral liposomes. Hydrogel containing liposomes with lipid content PC, CH, and SA in molar ratio 5:3:1, respectively, showed the best release and transcorneal permeation with the percentage permeation of 30.6%. These results suggest that the degree of encapsulation of ciprofloxacin into liposomes and prolonged in vitro release depend on composition of the vesicles. In addition, the polymer hydrogel used in preparation ensure steady and prolonged transcorneal permeation. In conclusion, ciprofloxacin liposomal hydrogel is a suitable delivery system for improving the ocular bioavailability of ciprofloxacin. PMID:20151337
Hosny, Khaled Mohamed
Summary Ocular ischemic syndrome is a rare condition, which is caused by ocular hypoperfusion due to stenosis or occlusion of the common or internal carotid arteries. Atherosclerosis is the major cause of changes in the carotid arteries. Ocular ischemic syndrome is manifested as visual loss, orbital pain and, frequently, changes of the visual field, and various anterior and posterior segment signs. Anterior segment signs include iris neovascularization and secondary neovascular glaucoma, iridocyclitis, asymmetric cataract, iris atrophy and sluggish reaction to light. Posterior eye segment changes are the most characteristic, such as narrowed retinal arteries, perifoveal telangiectasias, dilated retinal veins, mid-peripheral retinal hemorrhages, microaneurysms, neovascularization at the optic disk and in the retina, a cherry-red spot, cotton-wool spots, vitreous hemorrhage and normal-tension glaucoma. Differential diagnosis of ocular ischemic syndrome includes diabetic retinopathy and moderate central retinal vein occlusion. Carotid artery imaging and fundus fluorescein angiography help to establish the diagnosis of ocular ischemic syndrome. The treatment can be local, for example, ocular (conservative, laser and surgical) or systemic (conservative and surgical treatment of the carotid artery). Since the condition does not affect the eyes alone, patients with ocular ischemic syndrome should be referred for consultation to the neurologist, vascular surgeon and cardiologist.
Terelak-Borys, Barbara; Skonieczna, Katarzyna; Grabska-Liberek, Iwona
The eye is an easily accessible, highly compartmentalised and immune-privileged organ that offers unique advantages as a gene therapy target. Significant advancements have been made in understanding the genetic pathogenesis of ocular diseases, and gene replacement and gene silencing have been implicated as potentially efficacious therapies. Recent improvements have been made in the safety and specificity of vector-based ocular gene transfer methods. Proof-of-concept for vector-based gene therapies has also been established in several experimental models of human ocular diseases. After nearly two decades of ocular gene therapy research, preliminary successes are now being reported in phase 1 clinical trials for the treatment of Leber congenital amaurosis. This review describes current developments and future prospects for ocular gene therapy. Novel methods are being developed to enhance the performance and regulation of recombinant adeno-associated virus- and lentivirus-mediated ocular gene transfer. Gene therapy prospects have advanced for a variety of retinal disorders, including retinitis pigmentosa, retinoschisis, Stargardt disease and age-related macular degeneration. Advances have also been made using experimental models for non-retinal diseases, such as uveitis and glaucoma. These methodological advancements are critical for the implementation of additional gene-based therapies for human ocular diseases in the near future.
Liu, Melissa M; Tuo, Jingsheng; Chan, Chi-Chao
The effect of insulin solution on the reduction of blood glucose concentration was studied after the administration of insulin solution through various routes-subcutaneous (SV), intravenous (IV), and ocular. Ocular administration of free insulin (400 U/mL) to normal rabbits produced no change in blood glucose level unless permeation enhancer was included in the dosing solution. Various concentrations of insulin were studied for their effectiveness on ocular administration and 10 U/kg dose was found to be optimum for ocular instillation. Among various penetration enhancers, poIyoxyethylene-9-lauryl ether (POE) in 0.8% w/w concentration exhibited better ocular compatibility and penetration-enhancing effect. The effectiveness of liposomes in aiding ocular absorption of entrapped insulin was studied in normal rabbits. Administration of insulin entrapped in positively charged liposomes composed of egg phosphatidylcholine with cholesterol and stearylamine (10: 2:1, in weight ratio) to normal rabbits produced substantial reduction in blood glucose concentration 90-120 min after the instillation of the formulation. In conclusion, it seems that administration of insulin in liposomes not only promotes the ocular absorption, but also controls and prolongs the drug action. PMID:19570017
Srinivasan, R; Jain, S K
56-years-old patient, which worked 12 years ago in Congo, has acused during the last 10 years repeated fever states, and recidived cutaneous nodules at inferior members with papulosquamous reaction. Since 1992 he has had right serofibrinous pleurisy and pain, intense pruritus and lacrimation at the ocular level, together the diminish of the vision; the ophthalmoscopy revealed retinal detachment at both eyes. The blood examination shows eosinophilia and the examination in thick drop shows Loa loa filaria, and bancrofti filaria. The treatment using diethilcarbamasine (Luxuran) was inefficient at this stage of the disease and the patient died. The conclusion is that endemic tropical affections, such as filariasis, must not to be considered anymore as being limited into certain geographical areas and must be knows by the ophthalmologists. PMID:8338821
Cârstocea, B; Pintiliei, E
Hantavirus infections are an emerging infectious disease that is beginning to be recognized both worldwide and in India as a cause of hemorrhagic fever that may present as a pulmonary syndrome or as a renal syndrome. Reports of ocular involvement are rare and include transient myopia, low intraocular pressure, conjunctival hemorrhages and changes of intraocular dimensions. Eleven patients (10 males, one female, mean age 37.6 years) were admitted to the intensive care unit for pyrexia of unknown origin or hemorrhagic fever following exposure to flood waters. Five male patients (mean age 31.6 years) were identified as suffering from hantavirus infection. In one patient, dot and blot intraretinal hemorrhages were seen in the macula of one eye and streak hemorrhages of the disc in the other. In the remaining four, no fundus abnormalities were seen. Ophthalmologists should be aware of these features. PMID:17699950
Mehta, Salil; Jiandani, Prakash
Chemical burns represent potentially blinding ocular injuries and constitute a true ocular emergency requiring immediate assessment and initiation of treatment. The majority of victims are young and exposure occurs at home, work place and in association with criminal assaults. Alkali injuries occur more frequently than acid injuries. Chemical injuries of the eye produce extensive damage to the ocular surface epithelium, cornea, anterior segment and limbal stem cells resulting in permanent unilateral or bilateral visual impairment. Emergency management if appropriate may be single most important factor in determining visual outcome. This article reviews the emergency management and newer techniques to improve the prognosis of patients with chemical injuries.
Singh, Parul; Tyagi, Manoj; Kumar, Yogesh; Gupta, K. K.; Sharma, P. D.
We present the case of a 65 years old pacient which was admitted for the sudden decrease of visual acuity in the left eye, accompanied by ocular pain and conjunctival hiperemia, simptoms appeared after an ocular trauma. After the clinical and paraclinical examination we determined the diagnosis of OS: Penetrating ocular trauma with retention of a foreign body; posttraumatic cataract. Surgical treatement was warrented and we performed OS : Facoemulsification + PFK implant in sulcus + 23 Ga posterior vitrectomy + peeling of the posterior hyaloid membrane + extraction of the foreign body + LASER endofotocoagulation + transscleral cryotherapy + SF6 gas injection. The post-operatory evolution was favorable. PMID:22888689
Musat, O; Ochinciuc, Uliana; Gutu, Tatiana; Cristescu, T R; Coman, Corina
The realism of an ocular prosthesis is limited by the immobility of the pupil. Our method to solve this problem is to use a liquid crystal display (LCD) to control the pupil size as a function of the ambient light. This study demonstrates the first LCD to our knowledge surviving the ocular prosthetic manufacturing steps. The dynamic pupil is controlled by a novel, entirely autonomous and self-powered passive electronic circuit using photodiodes in a high voltage configuration. Future work for a complete prosthesis with a dynamic pupil is discussed. Finally, a standard device for the mass production of ocular prostheses is presented.
Lapointe, J.; Harhira, A.; Durette, J.-F.; Beaulieu, S.; Shaat, A.; Boulos, P. R.; Kashyap, R.
Iris recognition is a well-known technique to identify persons. However this technique requires high resolution images in order to automatically segment the iris. In some scenarios obtaining the required resolution may be difficult. In this paper, we investigate the recognition of ocular regions using correlation filters without segmenting the iris region. This method uses the whole eye region and surrounding areas, i.e., the ocular region, for identification. In our experiments we use the recently developed Quadratic Correlation Filter and show that at low resolutions segmentation-free ocular recognition can succeed while iris segmentation fails.
Rodriguez, Andres; Panza, Jeffrey; Vijaya Kumar, B. V. K.
%PURPOSE: To report a case of anterior uveitis and ocular hypotony during HPMPC treatment of a cytomegalovirus infection without ophthalmic involvement.METHODS: A 61-year-old bisexual white man with AIDS presented with moderate anterior uveitis and ocular hypotony after 8 weeks of intravenous HPMPC and oral probenecid co-treatment of a presumed recurrence of cytomegalovirus encephalitis.RESULTS: There was no evidence of an ocular
Robert A. H Scott; Carlos Pavesio
A five year study on the ocular complications of diabetes compared results of eye examinations and biochemical analyses of diabetics with eye disease to nondiabetics with the same prognoses. For the same two populations, results of cataract surgery and po...
T. H. Kirmani
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Sinus surgery has multiple potential ocular complications including visual loss, diplopia, infection, hemorrhage, and epiphora. We report six patients with ocular motility problems secondary to sinus surgery, review the literature on ocular motility disorders secondary to sinus surgery, and propose an approach for management of those ocular motility problems following sinus surgery. Intranasal sinus surgery was found to be the most common procedure resulting in injury to an extraocular muscle and the ethmoid sinus the most common structure being operated on when injury occurred. The medial rectus was the muscle most commonly injured and it had the poorest prognosis for recovery of functional vision free of diplopia. Optimal timing for repair depends on the structure injured, but early recognition and management appear to be a key to the best outcome for these injuries. PMID:8443115
Penne, R B; Flanagan, J C; Stefanyszyn, M A; Nowinski, T
The Collaborative Ocular Melanoma Study (COMS) is a multicenter investigation designed to evaluate therapeutic interventions for patients who have choroidal melanoma. Two randomized controlled trials are currently being conducted. Eligible patients for th...
PurposeTo raise awareness of potential significant ocular damage and visual loss secondary to paintballs in those not wearing ocular protection and to report high incidence of chorioretinitis sclopetaria from paintball contusion.MethodsWe reviewed cases of eye injury presenting to a single institution from 2000 to 2005. Those cases in which the injury was attributed to paintballs were identified and evaluated to
M Taban; J E Sears
Purpose: To report four cases of penetrating ocular injuries from fish-hooks. Methods: The case records of four patients who attended the ophthalmology department with ocular fish-hook injuries were reviewed.\\u000a Results: Individuals were male, between the ages of 9 and 67. All cases had anterior segment involvement and the hooks were extracted\\u000a by backing them out through the primary incision. Final
F. Angela Knox; Wing C. Chan; Clara E. McAvoy; Susan E. Johnston; John H. Bryars
This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the significance placed upon facial beauty in today's society, it becomes incumbent upon us to recognize the ingenuity and skill of those in the past to gain appreciation for the present state of the art and to provide incentive for improving facial and ocular prosthetic restorations in the future. PMID:2248700
Reisberg, D J; Habakuk, S W
Millipore filters were used to obtain sheets of cells from the ocular surface. Using Periodic Acid Schiff-haematoxylin the intracellular neutral mucus of the goblet cells stains a brilliant, bright pink and the cell nuclei dark blue making it possible to observe the epithelial cells and the goblet cell population.In certain ocular surface diseases the size of the PAS-haematoxylin staining goblet
G G W Adams; P N Dilly; GGW Adams
The aim of current study was to evaluate the incidence and characteristics of ocular sarcoidosis in a Korean population. We conducted a retrospective study of 104 consecutive patients with biopsy-proven sarcoidosis seen at Asan Medical Center in Seoul, Korea, from 1993 to 2007. Medical records, photographs, and fluorescein angiograms were reviewed. Of 104 patients, 22 (21%) had intraocular involvement with female predominance (86%, M:F=3:19). Of the 39 eyes with ocular involvement, 16 (41%) eyes had isolated anterior uveitis, 12 (31%) eyes had intermediate uveitis, 6 eyes (15%) had panuveitis with retinal vasculitis, and 5 (13%) eyes had panuveitis with punched multifocal choroiditis. Mean duration of ophthalmologic follow-up was 62 months. All ocular inflammation was well managed with topical steroid and/or systemic steroid with relatively good final visual outcomes. Ocular complications such as cataract (12 eyes, 30%), glaucoma (6 eyes, 15%), vitreous opacity (1 eye, 3%), cystoid macular edema (3 eyes, 7%), neovascularization (2 eye, 5%), and epiretinal membrane (4 eye, 10%) were related to ocular sarcoidosis. In Korea, where sarcoidosis is very rare, our study indicates relatively low ocular and predominantly non posterior segment involvement with relatively good visual prognosis.
Lee, Sun Young; Lee, Hee Gyung; Kim, Dong Soon; Kim, June-Gone; Chung, Hyewon
Ocular absorption of timolol in rabbits was studied after topical ocular administration of 3H-timolol in an eyedrop or in silicone cylindrical devices that released timolol at 7.2 micrograms/h. The devices were applied in either the inferior or superior conjunctival sac. Timolol concentrations were nearly equal in the inferior and superior portions of ocular tissues when the drug was administered in an eyedrop. Administration in the devices resulted in unequal timolol distribution in the cornea, conjunctiva, sclera, and iris-ciliary body. Timolol concentrations were higher in the part of each tissue that was closer to the site of the device application. Unequal concentrations of timolol in the superior and inferior part of the eye and very low timolol concentrations in the aqueous humor indicated that timolol was absorbed mainly via a noncorneal route from the device placed in the inferior conjunctival sac. Induced blinking at one minute intervals did not change ocular absorption of timolol. Compared with inferior conjunctival sac applications, placement of the devices in the superior conjunctival sac resulted in increased corneal and total ocular absorption of timolol as indicated by higher timolol concentrations in the aqueous humor and by a smaller difference between concentrations in the superior and inferior portions of the examined tissues. The application site dependent ocular absorption indicated that controlled release of timolol in the tear fluid did not result in a uniform timolol distribution in the preocular tear fluid of rabbit eyes. PMID:3246568
Urtti, A; Sendo, T; Pipkin, J D; Rork, G; Repta, A J
Background: Cysticercosis is a common parasitic infection involving multiple systems and caused by Cysticercus cellulosae, the larval form of the cestode, Taenia solium. The humans become infected by ingesting its eggs from contaminated food. Here, we present a case of ocular cysticercosis which presented with mild pain, ptosis, inflammation of upper eyelid and slightly restricted ocular motility. Case: A twelve-year-old girl presented with mild pain, unilateral ptosis and inflammation of the right upper eyelid for seven months. There was no history of diurnal variation and trauma. There was neither protrusion of the eyeball nor any mass was palpable in periorbital area. Visual acuity in both the eyes was normal. Periocular and ocular examination revealed a slightly restricted ocular motility in the right upward gaze and a reduced vertical fissure height a with good levator palpebrae function. The Bell's phenomenon was good. The magnetic resonance imaging of the orbit showed an intra-conal retro-orbital mass involving the superior rectus muscle of the right eye suggestive of ocular cysticercosis. The orbital sonogram revealed a cystic lesion in the superior rectus muscle with an echogenic intramural nodule. The enzyme-linked immunosorbent assay for serum antibodies against the cysticercus was positive. The ptosis improved with a therapeutic trial of albendazole and oral steroids for 6 weeks. Conclusion: Extra-ocular cysticercosis can be treated with oral steroid and albendazole. PMID:23584662
Labh, R K; Sharma, A K
Familial amyloid polyneuropathy (FAP) or transthyretin (TTR) amyloid polyneuropathy is a progressive sensorimotor and autonomic neuropathy of adult onset, which is transmitted as an autosomal dominant trait. In addition to neurologic symptoms, FAP may be associated with weight loss, cardiac and renal failure and ocular complications. FAP is a devastating disease, causing death within 10years after the first symptoms. The TTR Val30Met mutation is the most common of more than 100 amyloidogenic mutations identified worldwide. Liver transplantation (LT) is currently the only treatment for preventing synthesis of the amyloidogenic variants of TTR. LT can halt progression of the neuropathy in up to 70% of cases and doubles the overall median survival of young Val30Met patients. Oral administration of tafamidis, which prevents deposition of mutated TTR, is now available to delay neurologic complications in early stages of the disease. Ocular manifestations of FAP are frequent and mainly include keratoconjunctivitis sicca, secondary glaucoma, vitreous deposits and pupillary abnormalities. Retinal and choroidal vascular abnormalities are more rare. Since ocular TTR is synthesized, at least in part, in the retinal pigment epithelium, LT does not influence the course of ocular involvement. The effects of tafamidis on the latter are still unknown. Because LT and symptomatic treatments greatly improve life expectancy of patients with FAP, ocular involvement is becoming a more frequent challenge to address. This review summarizes the pathophysiology, clinical findings and possible treatments of ocular manifestations of FAP. PMID:24144522
Rousseau, A; Kaswin, G; Adams, D; Cauquil, C; Théaudin, M; Mincheva, Z; M'garrech, M; Labetoulle, M; Barreau, E
We characterize objectively the state of focus of the human eye, utilizing a bull's eye photodetector to detect the double-pass blur produced from a point source of light. A point fixation source of light illuminates the eye. Fundus-reflected light is focused by the optical system of the eye onto a bull's eye photodetector [consisting of an annulus (A) and a center (C) of approximately equal active area]. To generate focus curves, C/A is measured with a range of trial lenses in the light path. Three human eyes and a model eye are studied. In the model eye, the focus curve showed a sharp peak with a full width at half maximum (FWHM) of +/-0.25 D. In human eyes, the ratio C/A was >4 at best focus in all cases, with a FWHM of +/-1 D. The optical apparatus detects ocular focus (as opposed to refractive error) in real time. A device that can assess focus rapidly and objectively will make it possible to perform low-cost, mass screening for focusing problems such as may exist in children at risk for amblyopia. PMID:15447031
Hunter, David G; Nusz, Kevin J; Gandhi, Nainesh K; Quraishi, Imran H; Gramatikov, Boris I; Guyton, David L
Triethylene thiophosphoramide, an alkylating agent of value as a palliative in cases of neoplastic disease and reticulosis, has been effective in preventing vascularization of the cornea when used locally. Since recurrent pterygium, a persistent clinical problem, particularly in the Western states, is preceded by corneal vascularization and fibroplastic proliferation, it is possible that this drug when used topically may be useful in obviating to some extent the use of radiation, which must be used with great caution to avoid the production of cataract. In the treatment of gram-negative bacterial infection, especially Pseudomonas aeruginosa, the drug colistin has been known to be effective in some cases which were not helped by other antibiotics, including polymixin B. In the field of virus infections, a major breakthrough may have come about by the discovery that 5-iodo-2-deoxyuridine (IDU) attacks the herpes cirrus in the cornea as a metabolic antagonist. Animal experiments and some clinical studies have confirmed its effectiveness as compared with other therapeutic measures in selected cases. In the treatment of ocular problems resulting from systemic disease fibrinolysin (plasmin) has apparently caused dissolution of the clot and restoration of circulation in some cases of retinal artery occlusion. Severe diabetic retinopathy in younger diabetic patients has been shown to regress in certain cases treated by hypophysectomy or radiation of the pituitary gland employing the cyclotron. This gland is also associated intimately with the exophthalmos of thyroid origin, and its action may be aggravated by the use of ACTH or steroids.
Trowbridge, Dwight H.
Purpose To compare ocular biometric parameters in primary angle closure suspects (PACS), primary angle closure glaucoma (PACG) and acute primary angle closure (APAC). Methods This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) were measured with an ultrasonic biometer. Lens-axial length factor (LAF), relative lens position, corrected ACD (CACD) and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors. Results No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons). However, eyes with APAC had thicker cornea (P=0.001), thicker lens (P<0.0001), shallower ACD (P=0.009), shallower CACD (P=0.003) and larger LAF (P<0.0001). Based on ROC curve analysis, lower ACD, and larger LT, LAF and CCT values were associated with APAC. In the APAC group, LAF (P<0.0001) and CCT (P=0.001) were significant risk factors. Conclusion This study revealed no significant difference in biometric characteristics in eyes with PACS and PACG. However, larger LAF and CCT were predictive of APAC.
Razeghinejad, Mohammad Reza; Banifatemi, Mohammad
Ocular Microtremor (OMT) is a continual, high frequency physiological tremor of the eye present in all subjects even when the eye is apparently at rest. OMT causes a peak to peak displacement of around 150nm-2500nm with a broadband frequency spectrum between 30Hz to 120Hz; with a peak at about 83Hz. OMT carries useful clinical information on depth of consciousness and on some neurological disorders. Nearly all quantitative clinical investigations have been based on OMT measurements using an eye contacting piezoelectric probe which has low clinical acceptability. Laser speckle metrology is a candidate for a high resolution, non-contacting, compact, portable OMT measurement technique. However, tear flow and biospeckle might be expected to interfere with the displacement information carried by the speckle. The paper investigates the properties of the scattered speckle of laser light (? = 632.8nm) from the eye sclera to assess the feasibility of using speckle techniques to measure OMT such as the speckle correlation. The investigation is carried using a high speed CMOS video camera adequate to capture the high frequency of the tremor. The investigation is supported by studies using an eye movement simulator (a bovine sclera driven by piezoelectric bimorphs). The speckle contrast and the frame to frame spatiotemporal variations are analyzed to determine if the OMT characteristics are detectable within speckle changes induced by the biospeckle or other movements.
Al-Kalbani, M.; Mihaylova, E.; Collins, N.; Toal, V.; Coakley, D.; Boyle, G.
Recent evidence tends to suggest that ocular tremor can be present in patients with Parkinson's disease (PD). This ocular tremor may have frequency characteristics similar to those of PD limb tremor. This fact was recently challenged in an article demonstrating that ocular tremor could simply be the consequence of vestibulo-ocular reflex activity induced by head movement. Although this hypothesis can be valid in some circumstances, we previously presented evidence that, in fact, these ocular may exist. Here, we address the shortcomings of previous studies describing the possible origins of these ocular tremors and propose solutions to circumvent those shortcomings. PMID:23674505
Objective To describe the ocular signs and symptoms of patients complaining of eye irritation due to volcanic fog (vog). Methods The study utilized a non-comparative, retrospective chart review of 30 patients who had a chief complaint of eye irritation, which the subjects attributed to vog. Ocular signs and symptoms are described and related to the ambient concentration of sulfur dioxide (SO2), particulate matter sized 2.5 microns (PM2.5), and vog visibility in O‘ahu during the period of the study. Results Ocular signs noted were conjunctival injection (100%), clear mucous discharge (100%), papillary reaction (100%), punctal edema (80%), eyelid swelling (73.3%) and chemosis (63.3%). Ocular symptoms were itchiness (100%), foreign body sensation (100%), tearing (96.6%) and burning sensation (90%). All patients had concurrent respiratory symptoms. During the period of study, the highest 24-hour average concentration of particulate matter sized 2.5 microns (PM2.5) was 49.04 µg/m3 and vog was visually present. Conclusions Patients complaining of eye irritation due to vog have observable ocular signs and symptoms.
Lagunzad, John Kenneth D
This second annual report summarizes research on ocular effects of radiation in five distinct but inter-related research areas. The first deals with experimental verification of theoretical predictions on effects of ocular blood flow on laser-induced reti...
J. S. Connolly J. A. Zuclich A. D. Nawrocki H. W. Hemstreet V. E. Sanders
Gene therapy holds promise for the treatment of many inherited and acquired diseases of the eye. Successful ocular to targeted cells with minimal toxicity. A major gene therapy interventions depend on challenge is to overcome both intracellular and extracellular barriers associated with ocular gene delivery. Numerous viral and nonviral vectors were explored to improve transfection efficiency. Among nonviral delivery systems, polymeric vectors have gained significant attention in recent years owing to their nontoxic and non-immunogenic nature. Polyplexes or nanoparticles can be prepared by interaction of cationic polymers with DNA, which facilitate cellular uptake, endolysosomal escape and nuclear entry through active mechanisms. Chemical modification of these polymers allows for the generation of flexible delivery vectors with desirable properties. In this article several synthetic and natural polymeric systems utilized for ocular gene delivery are discussed.
Tamboli, Viral; Mishra, Gyan P; Mitra, Ashim K
Lymphocytes from individuals with inactive macular disciform lesions of presumed ocular histoplasmosis challenged with three histoplasmin antigens incorporated tritiated thymidine at a significantly higher rate than histoplasmin-stimulated lymphocytes of matched control and peripheral scar groups. This finding is consistent with the etiologic association of the disciform ocular syndrome and previous systemic infection with Histoplasma capsulatum. The disciform group had a higher mean response than the other two groups to pokeweed mitogen but not to phytohemagglutinin and had higher mean counts per minute to the specific antigens Toxoplasma gondii, Blastomyces dermatitidis, Cryptococcus neoformans, Mycobacterium tuberculosis, M battery, and M gaus, but not to Candida albicans. These data would suggest that individuals with the disciform lesion of presumed ocular histoplasmosis have a hyperreactive cellular immune response; this response may play an important role in the development of the disciform.
Ganley, J.P.; Nemo, G.J.; Comstock, G.W.; Brody, J.A.
We present an analytical approach for studying the coupled development of ocular dominance and orientation preference columns. Using this approach we demonstrate that ocular dominance segregation can induce the stabilization and even the production of pinwheels by their crystallization in two types of periodic lattices. Pinwheel crystallization depends on the overall dominance of one eye over the other, a condition that is fulfilled during early cortical development. Increasing the strength of intermap coupling induces a transition from pinwheel-free stripe solutions to intermediate and high pinwheel density states. PMID:19519077
Reichl, Lars; Löwel, Siegrid; Wolf, Fred
Laser hazards on the modern battlefield include numerous applications with the potential for eye damage from both pulsed and high luminance continuous energy laser devices. The multitude of laser devices deployed both by friendly and threat forces represent a significant hazard to vision, and consequently duty performance. Increased application of high luminance devices for tactical use may result in accidental exposure and temporary or persistent symptoms. These symptoms may be confounded by ongoing ocular retinal disorders. The management of these patients requires additional laser training to prevent injury as well as more experience and training for first responders in order to triage individuals with vision disturbances thought secondary to ocular laser exposure.
Hacker, Henry D.; Lund, Jack; Cheramie, Rachel; Stuck, Bruce E.
Background To describe the occurrence of ocular hypertension in four patients following injection of ranibizumab intravitreally.\\u000a \\u000a \\u000a \\u000a Methods Case series.\\u000a \\u000a \\u000a \\u000a Results Four patients had high intraocular pressure after intravitreal ranibizumab 0.5 mg. Ocular hypertension occurred 1 month after\\u000a the second ranibizumab injection in patients 1 and 3, and 1 month after the first ranibizumab in patient 2. In patient 4,\\u000a it occurred several hours after the first
Sophie J. Bakri; Colin A. McCannel; Albert O. Edwards; Darius M. Moshfeghi
Genetic factors determining the pathogenesis and course of ocular toxoplasmosis are poorly understood. In this study, we explored the development of experimental ocular pathogenesis in genetically dissimilar mice infected with either the RH strain, the PLK strain, or the immunodominant surface antigen 1 (SAG1 (P30))- deficient mutant of the RH strain of Toxoplasma gondii. At 11 days postinfection, ocular infection
Fangli Lu; Shiguang Huang; Mark S. Hu; Lloyd H. Kasper
Lyme disease is an emerging new spirochaetal disease in which ocular complications may arise. We have seen a 45-year-old woman who developed unilateral endophthalmitis leading to blindness during the course of this disease. Ocular tissue showed the characteristic spirochete. A literature review shows that the commonest ocular manifestation of Lyme disease is a mild conjunctivitis, but other symptoms may include
D J Kauffmann; G P Wormser
There seems to be no decrease in the incidence of serious eye injuries. Although recent developments in technology now allow salvage of eyes that would have been lost only a few years ago, certain rules must be followed to achieve optimal outcome. Damage control surgery in ocular traumatology means that the ophthalmologist understands that eye injuries must be treated only
Ferenc Kuhn; Zlatko Slezakb
Background/aims: Any information on eye diseases in schoolchildren in Nepal is rare and sketchy. A programme to provide basic eye screening to schoolchildren with an aim to provide services as well as gather information on ocular morbidity has been started. Methods: All the children in the schools visited are included in the study. This programme is targeted at poor government schools, which are unable to afford this service. A complete eye examination is given to all the children including slit lamp examination, fundus evaluation and retinoscopy, and subjective refraction. Results: A total of 1100 children from three schools are included in this report. 11% of our schoolchildren have ocular morbidity, 97% (117 out of 121) of which is preventable or treatable. Refractive error is the commonest type of ocular morbidity (8.1%). Myopia is the commonest type of refractive error (4.3%) as opposed to hypermetropia (1.3%). 12.4% of children with refractive error have already developed amblyopia. Strabismus is the second commonest type of ocular disability (1.6%). Alternate divergent squint is the commonest type of strabismus (1.4%). Traumatic eye injuries (0.54%), xerophthalmia (0.36%), and congenital abnormalities (0.36%) are much less common. Conclusion: A school eye screening cum intervention programme with periodic evaluation seems to be appropriate for countries like Nepal as most of the eye diseases found are preventable or treatable.
Nepal, B P; Koirala, S; Adhikary, S; Sharma, A K
Objective: The static ocular counterroll (OCR) reflex generates partially compensatory torsional eye movements during head roll. It is mediated by the utricle in the inner ear. Skew deviation is a vertical strabismus thought to be caused by imbalance in the utriculo-ocular pathway. We hypothesized that if skew deviation is indeed caused by damage to this reflex pathway, patients with skew deviation would show abnormal OCR. Methods: Eighteen patients with skew deviation caused by brainstem or cerebellar lesions and 18 normal participants viewed a target at 1 m. Ocular responses to static passive head roll-tilts of approximately 20° were recorded using search coils. Static OCR gain was calculated as the change in torsional eye position divided by the change in head position during sustained head roll. Perception of the subjective visual vertical (SVV) was also measured. Results: Group mean OCR gain was reduced by 45% in patients. At an individual level, OCR gains were asymmetric between eyes and between torsional directions in 90% of patients. In addition, the hypotropic eye incyclotorting gain was lower than the hypertropic eye excyclotorting gain during head roll toward the hypotropic eye in 94% of patients. No consistent pattern of gain asymmetry was found during head roll toward the hypertropic eye. The SVV was tilted toward the hypotropic eye. Conclusion: Static OCR gain is significantly reduced in skew deviation. Interocular and directional gain asymmetries are also prevalent. The asymmetries provide further evidence that disruption of the utriculo-ocular pathway is a mechanism for skew deviation.
Chandrakumar, M.; Blakeman, A.; Goltz, H.C.; Sharpe, J.A.
OBJECTIVE: To determine the incidence and describe ocular abnormalities in a cross-section of the population of Rocky Mountain Horses. Design: Prospective study. Animals: Five-hundred and fourteen Rocky Mountain Horses. Procedure: Ophthalmic examinations were performed using a slit-lamp biomicroscope and an indirect ophthalmoscope. Intraocular pressures were measured by applanation tonometry. Eyes from six horses were obtained for histologic examination. RESULTS: Cysts of the posterior iris, ciliary body, and peripheral retina were detected most frequently (249 horses), and were always located temporally. Curvilinear streaks of retinal pigmented epithelium extending from the peripheral temporal retina marked the boundary of previous retinal detachment in 189 horses. Retinal dysplasia was detected in 125 horses. Multiple ocular anomalies were evident in 71 horses and were always bilateral and symmetrical. Affected eyes had a large, clear cornea that protruded excessively and had an apparent short radius of curvature, a deep anterior chamber, miotic and dyscoric pupil, and iris hypoplasia. Pupillary light responses were decreased or absent and pupils failed to dilate after repeated instillation of mydriatic drugs in horses with multiple ocular anomalies. Less frequently encountered abnormalities included peripheral iridocorneal adhesions and goniosynechiae. Congenital cataract was always present in eyes with multiple abnormalities. Intraocular pressures did not differ among horses with normal eyes and horses with multiple ocular abnormalities. Histologic examination of eyes corroborated the clinical appearance. PMID:11397242
Ramsey, D.T.; Ewart, S.L.; Render, J.A.; Cook, C.S.; Latimer, C.A.
Three case reports of patients with bronchial carcinoma who presented with visual disturbances due to ocular metastases are described. The reasons for the rarity of this syndrome are discussed and its frequent association with cerebral metastases is explained. Cytotoxic drugs provide short-term effective therapy. Images
Evans, C. C.; Mearns, A. J.; Delaney, J.; Littler, W. A.
Four cases of presumed ocular histoplasmosis like retinopathy are presented. A detailed immunological assessment was carried out on the patients and a control group: lymphocyte immunophenotyping; flow cytometric analysis; HLA typing and T cell receptor variable region (TCR V region) expression were assessed. Analysis of TCR V region expression revealed no significant preferential expression. HLA typing also failed to reveal
P R Hodgkins; I H Chisholm; M J Absolon; A R Elkington; J L Smith
An automatic and objective system for measuring ocular refractive errors (myopia, hyperopia and astigmatism) was developed. The system consists of projecting a light target (a ring), using a diode laser , at the fundus of the patient's eye. The light beams scattered from the retina are submitted to an optical system and are analysed with regard to their vergence by
Liliane Ventura; Sidney Julio de Faria e. Sousa; Jarbas Caiado de Castro
Psycho-visual problems associated with utilization of monocular, bi-ocular, and binocular visual systems are reviewed in the context of present knowledge. It is noted that simply because an instrument has been designed to be binocular, it is not necessari...
G. S. Harker
...Class III (premarket approval). (c) Date PMA or notice of completion of PDP is required. A PMA or notice of completion of a PDP is required...ocular plethysmograph shall have an approved PMA or declared completed PDP in effect before...
|A simple test of ocular dominance in infants is described. In the test, a small point of light is gradually brought closer to the observer along the medial plane. As the light draws closer, in typical cases, one eye will cease to converge, or frequently, it will break from convergence suddenly. The eye which ceases converging or breaks away from…
In the brainstem, lateral and vertical eye movements are controlled by separate structures, the former mainly in the pons and the latter in the midbrain. The abducens nucleus (VI) in the pons controls all ipsilateral eye movements, i.e., ipsilateral saccades as well as the horizontal vestibulo-ocular reflex (VOR). This nucleus contains the abduction motoneurons, but also the internuclear neurons involved
We report the first case of human ocular sparganosis in the state of Santa Catarina, southern Brazil. A young female patient presented with three periocular moveable inflammatory masses in her right eye, during two years. By surgical excisional biopsy, a helminth larval stage was removed and identified as sparganum. Clinical, laboratory and epidemiological data on this parasite are presented. PMID:21412620
Mentz, Márcia Bohrer; Procianoy, Fernando; Maestri, Marcelo Krieger; Rott, Marilise Brittes
An argon-ion laser was used to investigate the ocular effects of repetitive laser pulses on rhesus monkeys. The primate eyes were irradiated by trains of pulses held constant at 10 milliseconds, and the duration of the trains was kept uniform at 0.5 sec. ...
C. H. Skeen G. G. Garza J. H. Tips M. G. Smith W. R. Bruce
Postoperative diplopia and strabismus may result from a variety of ocular surgical procedures. Common underlying mechanisms include sensory disturbance, scarring, direct extraocular muscle injury, myotoxicity from injections of local anesthesia or antibiotics, and malpositioning of extraocular muscles by implant materials. The most common patterns are vertical and horizontal motility disturbance. Treatment options include prisms, botulinum, occlusion, or surgery. PMID:20452637
Guo, Suqin; Wagner, Rudolph; Gewirtz, Matthew; Maxwell, Dawn; Pokorny, Kathryn; Tutela, Arthur; Caputo, Anthony; Zarbin, Marco
Takayasu arteritis is a relatively rare inflammatory arteritis that can be associated with ocular manifestations. We report four patients with proven Takayasu arteritis; two patients manifested hypoperfusive ocular manifestations of ocular ischemic syndrome and anterior ischemic optic neuropathy whilst two others had exudative retinal detachment and papilledema as a result of severe hypertension. The ischemic ocular manifestations were a result of hypoperfusion of the ocular structures due to occlusive arteritis of the aortic arch and its branches. The exudative retinal detachment and papilledema were manifestations of severe hypertension due to renal arterial involvement. Patients with Takayasu arteritis should be referred for ophthalmic assessment and screening for hypoperfusive and hypertensive manifestations.
Peter, Jayanthi; David, Sarada; Joseph, George; Horo, Saban; Danda, Debashish
Amongst the various routes of drug delivery, the field of ocular drug delivery is one of the most interesting and challenging endeavors facing the pharmaceutical scientist. Recent research has focused on the characteristic advantages and limitations of the various drug delivery systems, and further research will be required before the ideal system can be developed. Administration of drugs to the ocular region with conventional delivery systems leads to short contact time of the formulations on the epithelium and fast elimination of drugs. This transient residence time involves poor bioavailability of drugs which can be explained by the tear production, non-productive absorption and impermeability of corneal epithelium. Anatomy of the eye is shortly presented and is connected with ophthalmic delivery and bioavailability of drugs. In the present update on ocular dosage forms, chemical delivery systems such as prodrugs, the use of cyclodextrins to increase solubility of various drugs, the concept of penetration enhancers and other ocular drug delivery systems such as polymeric gels, bioadhesive hydrogels, in-situ forming gels with temperature-, pH-, or osmotically induced gelation, combination of polymers and colloidal systems such as liposomes, niosomes, cubosomes, microemulsions, nanoemulsions and nanoparticles are discussed. Novel ophthalmic delivery systems propose the use of many excipients to increase the viscosity or the bioadhesion of the product. New formulations like gels or colloidal systems have been tested with numerous active substances by in vitro and in vivo studies. Sustained drug release and increase in drug bioavailability have been obtained, offering the promise of innovation in drug delivery systems for ocular administration. Combining different properties of pharmaceutical formulations appears to offer a genuine synergy in bioavailability and sustained release. Promising results are obtained with colloidal systems which present very comfortable conditions of use and prolonged action. PMID:23153114
Achouri, Djamila; Alhanout, Kamel; Piccerelle, Philippe; Andrieu, Véronique
Aim To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. Methods 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross?sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (?20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4?dB), moderate (mean defect 4–12?dB) or severe (mean defect >12?dB). Results 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. Conclusion In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.
Scherrer, Janine; Iliev, Milko E; Halberstadt, Markus; Kodjikian, Laurent; Garweg, Justus G
Normal vision depends on the optimal function of ocular barriers and intact membranes that selectively regulate the environment of ocular tissues. Novel pharmacotherapeutic modalities have aimed to overcome such biological barriers which impede efficient ocular drug delivery. To determine the impact of ocular barriers on research related to ophthalmic drug delivery and targeting, herein we provide a review of the literature on isolated primary or immortalized cell culture models which can be used for evaluation of ocular barriers. In vitro cell cultures are valuable tools which serve investigations on ocular barriers such as corneal and conjunctival epithelium, retinal pigment epithelium and retinal capillary endothelium, and can provide platforms for further investigations. Ocular barrier-based cell culture systems can be simply set up and used for drug delivery and targeting purposes as well as for pathological and toxicological research.
Barar, Jaleh; Asadi, Masoud; Mortazavi-Tabatabaei, Seyed Abdolreza; Omidi, Yadollah
Sensory experience profoundly shapes neural circuitry of juvenile brain. Although the visual cortex of adult rodents retains a capacity for plasticity in response to monocular visual deprivation, the nature of this plasticity and the neural circuit changes that accompany it remain enigmatic. Here, we investigate differences between adult and juvenile ocular dominance plasticity using Fourier optical imaging of intrinsic signals in mouse visual cortex. This comparison reveals that adult plasticity takes longer than in the juvenile mouse, is of smaller magnitude, has a greater contribution from the increase in response to the open eye, and has less effect on the hemisphere ipsilateral to the deprived eye. Binocular deprivation also causes different changes in the adult. Adult plasticity is similar to juvenile plasticity in its dependence on signaling through NMDA receptors. We propose that adult ocular dominance plasticity arises from compensatory mechanisms that counterbalance the loss of afferent activity caused by visual deprivation. PMID:18842887
Sato, Masaaki; Stryker, Michael P
An animal model has been developed using enucleated porcine eyes to evaluate ocular trauma. The eyes were pressurized to approximately 18 mmHg and mounted in a container with a 10% gelatin mixture. The corneas of sixteen pressurized eyes were impacted by a blunt metal projectile (mass of 2.6 gm, 3.5 gm or 45.5 gm) at velocities of 4.0 to 38.1 m/s. The impacted eyes were evaluated by an ophthalmologist. A numerical classification scheme was used to categorize the severity of the ocular injury. A chi-squared test indicates that the injury level is associated with the kinetic energy (KE) and not the momentum of the projectile. The enucleated eyes began to experience lens dislocations when the KE of the projectile was approximately 0.75 Nm, and retinal injuries when the KE was approximately 1.20 Nm. PMID:11558084
Scott, W R; Lloyd, W C; Benedict, J V; Meredith, R
BACKGROUND—The influence of diabetes mellitus on ocular pulse amplitude (OPA), an indirect measure of choroidal perfusion, is unclear.?METHODS—OPA, using the Langham ocular blood flow (OBF) system, applanation intraocular pressure (IOP), systemic blood pressure (BP), heart rate, and haemoglobin (Hb) A1c were measured in patients with insulin dependent diabetes mellitus (IDDM) with no (DR-0, n = 22) non-proliferative (DR-1, n = 24), and proliferative (DR-2, n = 18) diabetic retinopathy.?RESULTS—Neither local (OPA, IOP) nor systemic perfusion parameters (BPs, HR) nor HbA1c were significantly altered in DR-0, DR-1, or DR-2 IDDM patients.?CONCLUSION—Choroidal circulation remains unaffected as diabetic retinopathy advances.??
Schmidt, K.; von Ruckmann, A.; Kemkes-Matthes, B.; Hammes, H.
The continued study of immunology and its relationship to diseases of the eye will hopefully give some insight into the pathogenic mechanisms of certain ocular diseases of many species, including the horse. It may lead to a better understanding of equine recurrent uveitis, a disease that has remained an enigma for years and that now appears to be an immunologic hypersensitivity response to a number of varied antigens. The precise mechanism of the inflammation is still unclear, and the immunologic response may be variable or mixed depending upon the inciting antigen. Other ophthalmic diseases in the horse, such as conjunctivitis, chorioretinitis, and less well-defined entities such as superficial punctate keratitis, may also have an immunologic component in their pathogenesis. An appreciation of immunopathologic mechanisms may thus enhance the veterinarian's understanding of the pathophysiology and treatment of equine ocular disease. PMID:6393544
Hines, M T
Ocular neuromyotonia (ONM) is a rare but distinctive clinical entity characterized by involuntary episodic contraction of one or more muscles supplied by the ocular motor nerves. A retrospective review was conducted on all patients with ONM seen by the neuroophthalmology service in the past 20 years. Ten patients were identified with ONM; six affecting vertical muscles (superior oblique; inferior rectus; superior rectus) and four affecting lateral rectus muscles. Case 1 has been reported previously. Most episodes occurred every 10-40?min, lasted a few seconds to several minutes, and were repeated throughout the day. Only two patients had previously undergone cranial radiation. Two had thyroid eye disease. One patient presented with superior oblique myokymia and subsequently developed ONM. Membrane stabilizing medications were prescribed in 7 of the 10 patients with varied success. ONM episodes ceased after extraocular muscle surgery in one patient with thyroid eye disease. PMID:23713937
Roper-Hall, Gill; Chung, Sophia M; Cruz, Oscar A
Sensory experience profoundly shapes neural circuitry of juvenile brain. Although the visual cortex of adult rodents retains a capacity for plasticity in response to monocular visual deprivation, the nature of this plasticity and the neural circuit changes that accompany it remain enigmatic. Here we investigate differences between adult and juvenile ocular dominance plasticity using Fourier optical imaging of intrinsic signals in mouse visual cortex. This comparison reveals that adult plasticity takes longer than in the juvenile mouse, is of smaller magnitude, has a greater contribution from the increase in response to the open eye, and has less effect on the hemisphere ipsilateral to the deprived eye. Binocular deprivation also causes different changes in the adult. Adult plasticity is similar to juvenile plasticity in its dependence on signaling through NMDA receptors. We propose that adult ocular dominance plasticity arises from compensatory mechanisms that counterbalance the loss of afferent activity caused by visual deprivation.
Sato, Masaaki; Stryker, Michael P.
Multiple sclerosis is the most common disabling neurological disease in young people. Many neuro-ophthalmological manifestations can occur during the course of the illness, and optic neuritis is both the most frequent and the best known. However, some ocular motility disorders can also occur, but since there may be no symptoms, they often remain underdiagnosed. These eye movement disorders are mostly related to brain-stem and cerebellum lesions. They can be acute, indicating a spatial dissemination of the demyelinating disease, and consequently may indicate the need for systemic treatment of multiple sclerosis. More often, they evolve slowly, progressing with the multiple sclerosis. In this case, they could provide a clue to the prognosis of the disease. In this survey, we discuss the two major symptoms of ocular motor disorders likely to occur during multiple sclerosis: oscillopsia and diplopia. PMID:18971858
Rougier, M-B; Tilikete, C
Fluctuations in accommodation have been shown to be correlated in the two eyes of the same subject. However, the dynamic correlation of higher-order aberrations in the frequency domain has not been studied previously. A binocular Shack-Hartmann wavefront sensor is used to measure the ocular wavefront aberrations concurrently in both eyes of six subjects at a sampling rate of 20.5 Hz. Coherence function analysis shows that the inter-ocular correlation between aberrations depends on subject, Zernike mode and frequency. For each subject, the coherence values are generally low across the resolvable frequency range (mean 0.11), indicating poor dynamic correlation between the aberrations of the two eyes. Further analysis showed that phase consistency dominates the coherence values. Monocular and binocular viewing conditions showed similar power spectral density functions. PMID:18795011
Chin, S S; Hampson, K M; Mallen, E A H
AIMSTo evaluate the efficacy of amniotic membrane transplantation (AMT) for ocular surface reconstruction.METHODS10 consecutive patients who underwent AMT were included. The indications were: group A, cases with persistent epithelial defect after corneal abscess (n=1), radiation (n=1), or chemical burn (n=3); group B, cases with epithelial defect and severe stromal thinning and impending or recent perforation, due to chemical burn (two
Augusto Azuara-Blanco; C T Pillai; Harminder S Dua
Objectives—To determine the recent incidence of eye injury due to sport in Scotland, identify any trend, and establish which sports are responsible for most injury? The type of injury and final visual outcome is also evaluated.Methods—A prospective observational study of ocular injuries sustained during sport was performed over a one year period. Only patients requiring hospital admission were included. Data
A Barr; P S Baines; P Desai; C J MacEwen
PurposeTo describe the ocular findings in subjects with congenital heart disease (CHD).Methods In a prospective study, the same observer examined 240 consecutive patients with CHD admitted to the medical centre. Two independent geneticists performed identification of syndromes.ResultsThe commonest anatomic cardiac anomalies were ventricular or atrial septal defects (62), tetralogy of Fallot (39), pulmonary stenosis (25), and transposition of the great
A M Mansour; F F Bitar; E I Traboulsi; K M Kassak; M Y Obeid; A Megarbane; H I Salti
We report two personal cases of intra ocular cysticercosis typical by their sub retinal and intra vitreous localization. After a short review of epidemiology and biological diagnostic we propose a treatment which associates a medical part with Praziquantel, killing the larva and a surgical part with pars plana vitrectomy allowing the control of the inflammation, contemporary of the larva's death and the intra-vitreous cysticercosis extraction. PMID:2263392
Berche, M; Hayot, B; Mokrane, M; Najjar, G; Bouzas, E
Friedreich ataxia (FRDA) is the most common genetic cause of ataxia with a prevalence of approximately 1 in 29,000. Ocular\\u000a motor abnormalities are common in FRDA and include fixation instability, saccadic dysmetria, and vestibular dysfunction. It\\u000a has not yet been determined whether aspects of spatial attention, which are closely coupled to eye movements, are similarly\\u000a compromised in FRDA. This study
Darren R. Hocking; Joanne Fielding; Louise A. Corben; Phillip D. Cremer; Lynette Millist; Owen B. White; Martin B. Delatycki
Transparency of the cornea on the front surface of the eye is essential for vision. A variety of blinding ocular surface diseases involve the cornea. This review focusses on vision loss caused by disruption of the integrity and function of the outermost corneal layer (the epithelium) and the stem-cell-based therapeutic strategies in use and under development to restore sight in affected patients. PMID:20149892
Ahmad, Sajjad; Kolli, Sai; Lako, Majlinda; Figueiredo, Francisco; Daniels, Julie T
Selenium is an essential mineral and severe selenium deficiency is known to cause significant health problems. It has been well documented that New Zealand soil is low in selenium. Recent studies have addressed the roles of selenoproteins in the eyes, with evidence suggesting that selenium supplementation may have a role in preventing cataract formation and age-related maculopathy. This paper summarises the role of selenium in ocular and general health and discusses selenium supplementation in a New Zealand specific context. PMID:20648102
Sheck, Leo; Davies, Jo; Wilson, Graham
A total of 21 patients suffering from drug-induced rashes from practolol have been seen over the past two years. The clinical manifestations varied, with the morphological appearances of the rash resembling those of eczema, lupus erythematosus, lichen planus, and a highly characteristic toxic erythematous psoriasiform eruption. Persistent ocular damage was a feature in three cases. ImagesFIG. 1FIG. 2FIG. 3
Felix, R. H.; Ive, F. A.; Dahl, M. G. C.
BACKGROUND: Bungee jumping is a well-established recreational activity in New Zealand and Australia which may be associated with injuries to the eyes and other tissues. CASE HISTORY: A patient with a retinal haemorrhage which resulted from bungee jumping is reported and the clinical characteristics described. DISCUSSION: There have been several reports of injury due to bungee jumping. The types of ocular injury are reviewed and the aetiological theories discussed. PMID:12482279
Curtis, Edward B; Collin, H Barry
In this study, ocular bacterial flora was determined for 126 healthy subjects before and after wearing soft contact lenses for 3, 6, and 9 months. The lenses were polyhydroxyethyl methacrylate with a water content of 55%. The care system used polyaminopropyl biguinide as the preservative.Our results indicate the presence of microorganisms such as Staphylococcus epidermidis (40.03%), Corynebacterium xerosis (2.78%), Corynebacterium
Josefa Velasco Cabrera; Javier Bermúdez Rodriguez
AimTo evaluate ocular surface molecules after transconjunctival pars plana vitrectomy (PPV).MethodsA total of 28 eyes of 28 patients who received PPV were examined. Tears (10 ?l) were collected before and after 20-gauge PPV or 23-gauge PPV. The concentrations of interleukin (IL)-1?, IL-6, IL-8, IL-10, IL-12p70 and tumour necrosis factor (TNF)-? were measured. The concentrations of each cytokine before and after
Atsuko Fujita; Eisuke Uchino; Hiroki Otsuka; Noboru Arimura; Yoshihiro Noda; Tatsuro Ishibashi; Taiji Sakamoto
ObjectiveLymphoproliferative lesions of the ocular adnexa were analyzed to examine (1) the suitability of the Revised European-American Lymphoma (REAL) classification for the subtyping of the lymphomas in these sites; (2) the predictive value of the REAL classification for the evolution of these tumors; and (3) the frequency and prognostic impact of tumor type, location, proliferation rate (Ki-67 index), p53, and
Sarah E Coupland; Lothar Krause; Henri-Jacques Delecluse; Ioannis Anagnostopoulos; Hans-Dieter Foss; Michael Hummel; Norbert Bornfeld; William R Lee; Harald Stein
Purpose To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). Methods Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. Results In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20–42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury. In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twenty-two (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4–34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (<5/200, P<0.05). In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P>0.05). Conclusion Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.
Erdurman, F C; Hurmeric, V; Gokce, G; Durukan, A H; Sobaci, G; Altinsoy, H I
The case of a 5-month-old black female child with a linear sebaceous naevus syndrome and multiple congenital anomalies is presented. Ocular malformations consisted of colobomatous changes of the lid and retina, dermoid of the conjunctiva, chorioretinal changes, and peripapillary atrophy of the optic nerve. Systemic findings included midline cleft of the secondary palate with involvement by the naevus, bilateral hearing loss, asymmetrical skull bones, ventricular septal defect, epidermal inclusion cyst, and developmental delay without seizures. Images
Insler, M S; Davlin, L
High-order monochromatic aberrations could potentially influence vision-dependent refractive development in a variety of ways. As a first step in understanding the effects of wave aberration on refractive development, we characterized the maturational changes that take place in the high-order aberrations of infant rhesus monkey eyes. Specifically, we compared the monochromatic wave aberrations of infant and adolescent animals and measured the longitudinal changes in the high-order aberrations of infant monkeys during the early period when emmetropization takes place. Our main findings were that (1) adolescent monkey eyes have excellent optical quality, exhibiting total RMS errors that were slightly better than those for adult human eyes that have the same numerical aperture and (2) shortly after birth, infant rhesus monkeys exhibited relatively larger magnitudes of high-order aberrations predominately spherical aberration, coma, and trefoil, which decreased rapidly to assume adolescent values by about 200 days of age. The results demonstrate that rhesus monkey eyes are a good model for studying the contribution of individual ocular components to the eye’s overall aberration structure, the mechanisms responsible for the improvements in optical quality that occur during early ocular development, and the effects of high-order aberrations on ocular growth and emmetropization.
Ramamirtham, Ramkumar; Kee, Chea-su; Hung, Li-Fang; Qiao-Grider, Ying; Roorda, Austin; Smith, Earl L.
Ocular films of pefloxacin mesylate were prepared with the objectives of reducing the frequency of administration, to improve patient compliance, obtaining controlled release and greater therapeutic efficacy in the treatment of eye infections such as conjunctivitis, keratitis, kerato conjunctivitis, corneal ulcers etc. Polymers such as HPC, HPMC, PVP and PVA were used in different ratios to prepare the ocular films. They were evaluated for drug content which varied from 96-104%. Those which consisted of flexible and transparent films were subjected to in vitro release studies. The formulations which prolonged the release for eight hours were selected. The average weight and thickness of these were found to be 38.92-49.71 mg and 31.68-46.08 microns, respectively. The intactness of the formulations was confirmed by IR and TLC studies. In vivo studies carried out in the eyes of rabbits showed controlled release upto 8-9 h. There was a good correlation between the in vitro and in vivo data (r = 0.97-0.995). A minimum of 1 Mrad was found to be necessary for the sterilization of ocular films by gamma radiation. They were found to be stable at temperatures below 45 degrees C. PMID:9987797
Bharath, S; Hiremath, S R
Ocular drug transport barriers pose a challenge for drug delivery comprising the ocular surface epithelium, the tear film and internal barriers of the blood-aqueous and blood-retina barriers. Ocular drug delivery efficiency depends on the barriers and the clearance from the choroidal, conjunctival vessels and lymphatic. Traditional drug administration reduces the clinical efficacy especially for poor water soluble molecules and for the posterior segment of the eye. Nanoparticles (NPs) have been designed to overcome the barriers, increase the drug penetration at the target site and prolong the drug levels by few internals of drug administrations in lower doses without any toxicity compared to the conventional eye drops. With the aid of high specificity and multifunctionality, DNA NPs can be resulted in higher transfection efficiency for gene therapy. NPs could target at cornea, retina and choroid by surficial applications and intravitreal injection. This review is concerned with recent findings and applications of NPs drug delivery systems for the treatment of different eye diseases.
Zhou, Hong-Yan; Hao, Ji-Long; Wang, Shuang; Zheng, Yu; Zhang, Wen-Song
Ocular fundus imaging plays a key role in monitoring the health status of the human eye. Currently, a large number of imaging modalities allow the assessment and/or quantification of ocular changes from a healthy status. This review focuses on the main digital fundus imaging modality, color fundus photography, with a brief overview of complementary techniques, such as fluorescein angiography. While focusing on two-dimensional color fundus photography, the authors address the evolution from nondigital to digital imaging and its impact on diagnosis. They also compare several studies performed along the transitional path of this technology. Retinal image processing and analysis, automated disease detection and identification of the stage of diabetic retinopathy (DR) are addressed as well. The authors emphasize the problems of image segmentation, focusing on the major landmark structures of the ocular fundus: the vascular network, optic disk and the fovea. Several proposed approaches for the automatic detection of signs of disease onset and progression, such as microaneurysms, are surveyed. A thorough comparison is conducted among different studies with regard to the number of eyes/subjects, imaging modality, fundus camera used, field of view and image resolution to identify the large variation in characteristics from one study to another. Similarly, the main features of the proposed classifications and algorithms for the automatic detection of DR are compared, thereby addressing computer-aided diagnosis and computer-aided detection for use in screening programs. PMID:21952522
Bernardes, Rui; Serranho, Pedro; Lobo, Conceição
Purpose To describe an unusual form of acquired ocular motor apraxia. Methods Case reports with electronic eye movement recordings. Results Three patients had surgery to repair aortic root or arch dissections or aneurysms. A few days after surgery, all had ophthalmoplegia. Neuro-ophthalmic examination found complete absence of horizontal and vertical volitional and reflex saccades in 1 patient and slow, hypometric saccades in 2 others. However, smooth pursuit, slow phases of optokinetic nystagmus, and the vestibulo-ocular response (VOR) were intact. Fast phases of the VOR were absent in 2 patients but were intact in the other. Video and electronic eye movement recordings documented the findings. Magnetic resonance imaging (MRI) in 1 patient showed small infarcts in a cerebellar hemisphere, pons, and cerebral hemispheres. The other patients’ MRIs showed no significant lesions. Conclusions Acquired ocular motor apraxia with profoundly impaired volitional saccades after aortic surgery is a distinctive syndrome, but its pathophysiology is unclear. Studies of neurologic damage in animals and patients undergoing similar surgical procedures provide conflicting data. However, knowledge about the complex neural pathways generating saccades from animal and human studies, and detailed clinical observations, as in the patients described here, can help to determine the location of lesions. Based on the 3 cases reported here, we propose that this syndrome might be due to damage to excitatory burst and/or omnipause neurons in the brainstem or by damage to pathways from the frontal eye fields to the brainstem.
Yee, Robert Donald; Purvin, Valerie Ann
Objectives: This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen. Methods: This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist. Results: A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients’ eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%). Conclusion: Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment.
Salem, Raga A. A.
Ophthalmic liposomes of ganciclovir (GCV) were prepared by the reverse phase evaporation method, and their ocular pharmacokinetics in albino rabbits were compared with those obtained after dosing with GCV solution. The in vitro transcorneal permeability of GCV liposomes was found to be 3.9-fold higher than that of the solution. After in vivo instillation in albino rabbits, no difference was found in the precorneal elimination rate of GCV from liposome vs solution dosing. The aqueous humor concentration-time profiles of both liposomes and solution were well described by 2-compartmental pharmacokinetics with first-order absorption. The area under the curve of the aqueous humor concentration-time profiles of GCV liposomes was found to be 1.7-fold higher than that of GCV solution. Ocular tissue distribution of GCV from liposomes was 2 to 10 times higher in the sclera, cornea, iris, lens, and vitreous humor when compared with those observed after solution dosing. These results suggested that liposomes may hold some promise in ocular GCV delivery. PMID:18170984
Shen, Yan; Tu, Jiasheng
Mechanisms that maintain ocular immune privilege may contribute to ocular tumor progression by inhibiting tumoricidal immune responses. Consistent with that notion are observations from transplantable tumor models in mice demonstrating that the tumoricidal activity of CD8+ cytolytic T lymphocytes (CTL) may be inhibited directly by interfering with CTL effector function in the eye or indirectly by abrogating the effector function of CD8+ T cell-activated intratumoral macrophages that are critical for ocular tumor rejection. In addition, epigenetic gene regulation by factors within the ocular tumor environment favors the generation of tumor variants that are resistant to CD8+ CTL. Intratumoral macrophages may be essential for eliminating these variants because, unlike CTL, their tumoricidal activity is nonspecific. Hence, the inhibition of macrophage effector function within the eye, presumably to preserve immune privilege by minimizing ocular immunopathology, may hasten the outgrowth of tumor escape variants which contributes to ocular tumor progression.
McKenna, Kyle C.; Chen, Peter W.
Ocular interferometry has potential value in a variety of ocular measurement applications, including measuring ocular thicknesses, topography of ocular surfaces or the wavefront of the eye. Of particular interest is using interferometry for characterizing corneal shape and irregular corneal features, making this technology attractive due to its inherent accuracy and spatial resolution. A particular challenge of designing an ocular interferometer is determining safe laser exposure levels to the eye, including both the retina and anterior segment. Described here are the laser exposure standards relevant in the interferometer design and the corresponding calculations and results. The results of this work can be used to aid in the design of similar laser-based systems for ocular evaluation.
Primeau, Brian C.; Goldstein, Goldie L.; Greivenkamp, John E.
Introduction. The objective of this work was to demonstrate a high spectral and spatial resolution fundus imager and to assess its utility in visualizing and characterizing normal anatomical and pathological tissue classes in the human ocular fundus. The ocular fundus (posterior portion of the eye) affords a unique opportunity to directly observe neural and vascular tissue in vivo. Many ocular and systemic diseases manifest changes in the normal fundus anatomy. Current examination techniques are not optimized to detect changes prior to the formation of damaging lesions. Spectral imaging may allow visualization of disease states before the onset of traditional clinical signs. Normal tissue in the eye has distinct spectral characteristics determined by specific structural organization and the presence of specific chemical substances and ocular pigments. Pathological states result in physical and chemical changes to the tissue. Spectral imaging exploits the differences in the spectral characteristics to separate different classes of material. When these spectral properties are combined with the spatial context of the image, improved visualization and detection is possible. Methods. Two independent spectral imaging devices were developed and integrated to a commercially available Zeiss fundus camera. Spectral data were collected in order to characterize the normal anatomical tissue classes and to assess the usefulness of spectral features for improved class discernment. Spectral images were collected for 14 subjects Diabetic Retinopathy were imaged. Mean spectral curves were produced for each class and for each subject. These spectral curves were normalized to remove the contribution from the pigment melanin (the major pigment associated with variation in fundus pigmentation) and modeled with a piece-wise linear function consisting of a DC offset and four slopes. Results. Differences in the shape of the spectral curve exist between macular edema and normal macular and between types of drusen. The mean spectral curves of the normal anatomical tissue showed a strong correlation with fundus pigmentation for classes greatly affected by melanin with significantly less correlation for classes not affected by melanin. Inter-subject variability was greatly reduced in the melanin-normalized curves. The simple piece-wise linear model captured the first order shape properties of the spectral curves and the first three principle components of the model coefficients produced good and consistent class separation. Conclusion. High-resolution spectral imaging of the ocular fundus produces features that are useful in separating fundus tissue classes for classification and visualization. Images at wavelengths in excess of 600 nm allow non-invasive visualization of the important choroidal circulation. The data further suggest spectral features that can be used to detect macular edema pre-clinically and spectral features that can be used to detect macular edema pre-clinically and quantitatively classify drusen sub-types.
Truitt, Paul Wiley
BACKGROUNDStandard therapy for severe, immune mediated, ocular inflammation has significant side effects, and may fail to control the disease. T cell directed monoclonal antibody (mAb) therapy can provide long term remission of inflammatory disease in experimental models. The Campath-1H mAb was administered to patients with severe, refractory, ocular inflammation.METHODS10 patients with severe, refractory, non-infectious ocular inflammatory disease were treated with
Andrew D Dick; Paul Meyer; Teife James; John V Forrester; Geoff Hale; Herman Waldmann; John D Isaacs
BACKGROUND\\/AIMSAlthough human ocular toxocariasis causes severe vision defect, little is known about its aetiology, diagnosis, and treatment. To develop a new animal model for human ocular toxocariasis, ophthalmological findings of fundi in Mongolian gerbils, Meriones unguiculatus, and BALB\\/c mice were investigated following infection withToxocara canis.METHODSUsing an ophthalmoscope, which was specifically developed to observe the fundi of small animals, ocular changes
Tomoko Hara Takayanagi; Nobuaki Akao; Ryoko Suzuki; Misato Tomoda; Setsuko Tsukidate; Koichiro Fujita
The purpose of this report is to summarize an understanding of the ocular motor system in patients with albinism. Other than the association of vertical eccentric gaze null positions and asymmetric, (a) periodic alternating nystagmus in a large percentage of patients, the ocular motor system in human albinism does not contain unique pathology, rather has “typical” types of infantile ocular oscillations and binocular disorders. Both the ocular motor and afferent visual system are affected to varying degrees in patients with albinism, thus, combined treatment of both systems will maximize visual function.
Hertle, Richard W.
The purpose of this report is to summarize an understanding of the ocular motor system in patients with albinism. Other than the association of vertical eccentric gaze null positions and asymmetric, (a) periodic alternating nystagmus in a large percentage of patients, the ocular motor system in human albinism does not contain unique pathology, rather has "typical" types of infantile ocular oscillations and binocular disorders. Both the ocular motor and afferent visual system are affected to varying degrees in patients with albinism, thus, combined treatment of both systems will maximize visual function. PMID:24014991
Hertle, Richard W
Current biomaterial approaches for repairing the cornea's ocular surface upon injury are partially effective due to inherent material limitations. As a result there is a need to expand the biomaterial options available for use in the eye, which in turn will help to expand new clinical innovations and technology development. The studies illustrated here are a collection of work to further characterize silk film biomaterials for use on the ocular surface. Silk films were produced from regenerated fibroin protein solution derived from the Bombyx mori silkworm cocoon. Methods of silk film processing and production were developed to produce consistent biomaterials for in vitro and in vivo evaluation. A wide range of experiments was undertaken that spanned from in vitro silk film material characterization to in vivo evaluation. It was found that a variety of silk film properties could be controlled through a water-annealing process. Silk films were then generated that could be use in vitro to produce stratified corneal epithelial cell sheets comparable to tissue grown on the clinical standard substrate of amniotic membrane. This understanding was translated to produce a silk film design that enhanced corneal healing in vivo on a rabbit injury model. Further work produced silk films with varying surface topographies that were used as a simplified analog to the corneal basement membrane surface in vitro. These studies demonstrated that silk film surface topography is capable of directing corneal epithelial cell attachment, growth, and migration response. Most notably epithelial tissue development was controllably directed by the presence of the silk surface topography through increasing cell sheet migration efficiency at the individual cellular level. Taken together, the presented findings represent a comprehensive characterization of silk film biomaterials for use in ocular surface reconstruction, and indicate their utility as a potential material choice in the development of innovative procedures and technologies for corneal repair.
Lawrence, Brian David
AIMS—To evaluate the efficacy of amniotic membrane transplantation (AMT) for ocular surface reconstruction.?METHODS—10 consecutive patients who underwent AMT were included. The indications were: group A, cases with persistent epithelial defect after corneal abscess (n=1), radiation (n=1), or chemical burn (n=3); group B, cases with epithelial defect and severe stromal thinning and impending or recent perforation, due to chemical burn (two patients, three eyes) or corneal abscess (n=2); group C, to promote corneal epithelium healing and prevent scarring after symblepharon surgery with extensive corneo-conjunctival adhesion (n=1). Under sterile conditions amniotic membrane was prepared from a fresh placenta of a seronegative pregnant woman and stored at ?70°C. This technique involved the use of amniotic membrane to cover the entire cornea and perilimbal area in groups A and B, and the epithelial defect only in group C.?RESULTS—The cornea healed satisfactorily in four of five patients in group A, but the epithelial defect recurred in one of these patients. After AMT three patients underwent limbal transplantation and one penetrating keratoplasty and cataract extraction. In group B amniotic membrane transplantation was not helpful, and all cases underwent an urgent tectonic corneal graft. Surgery successfully released the symblepharon, promoted epithelialisation and prevented adhesions in the case of group C.?CONCLUSION—AMT was effective to promote corneal healing in patients with persistent epithelial defect, and appeared to be helpful after surgery to release corneo-conjunctival adhesion. Most cases required further surgery for visual and ocular surface rehabilitation. Amniotic membrane used as a patch was not effective to prevent tectonic corneal graft in cases with severe stromal thinning and impending or recent perforation.?? Keywords: amniotic membrane; cornea; ocular surface; epithelial defect
Azuara-Blanco, A.; Pillai, C; Dua, H.
OBJECTIVE: To evaluate the frequency and characteristics of ocular manifestations in outpatients with systemic sclerosis. METHODS: In this cross-sectional study, 45 patients with systemic sclerosis were enrolled. Data regarding demographics, disease duration and subtype, age at diagnosis, nailfold capillaroscopic pattern and autoantibody profile were collected, and a full ophthalmic examination was conducted. Parametric (Student's t-test) and nonparametric (Mann-Whitney U test) tests were used to compare continuous variables. Fisher's exact test was used to compare categorical data. P values < 0.05 were considered significant. RESULTS: Twenty-three subjects (51.1%) had eyelid skin changes; 22 (48.9%) had keratoconjunctivitis sicca, 19 (42.2%) had cataracts, 13 (28.9%) had retinal microvascular abnormalities and 6 (13.3%) had glaucoma. Eyelid skin changes were more frequent in patients with the diffuse subtype of systemic sclerosis and were associated with a younger age and an earlier age at diagnosis. Cataracts were presumed to be age-related and secondary to corticosteroid treatment. There was no association between demographic, clinical or serological data and keratoconjunctivitis sicca. The retinal microvascular abnormalities were indistinguishable from those related to systemic hypertension and were associated with an older age and a severe capillaroscopic pattern. CONCLUSIONS: Eyelid skin abnormalities and keratoconjunctivitis sicca were the most common ocular findings related to systemic sclerosis. Some demographic and clinical data were associated with some ophthalmic features and not with others, showing that the ocular manifestations of systemic sclerosis are characterized by heterogeneity and reflect the differences in the implicated pathophysiological mechanisms.
de A. F. Gomes, Beatriz; Santhiago, Marcony R; Magalhaes, Priscilla; Kara-Junior, Newton; de Azevedo, Mario N L; Moraes, Haroldo V
Purpose. Parstatin is a 41-mer peptide formed by proteolytic cleavage on activation of the PAR1 receptor. The authors recently showed that parstatin is a potent inhibitor of angiogenesis. The purpose of the present study was to evaluate the therapeutic effect of parstatin on ocular neovascularization. Methods. Choroidal neovascularization was generated in mice using laser-induced rupture of Bruch's membrane and was assessed after 14 days after perfusion of FITC-dextran. Oxygen-induced retinal neovascularization was established in neonatal mice by exposing them to 75% O2 at postnatal day (P)7 for 5 days and then placing them in room air for 5 days. Evaluation was performed on P17 after staining with anti-mouse PECAM-1. The effect of parstatin was tested after intravitreal administration. The effects of subconjunctival-injected parstatin on corneal neovascularization and inflammation in rats were assessed 7 days after chemical burn-induced corneal neovascularization. Retinal leukostasis in mice was assessed after perfusion with FITC-conjugated concanavalin A. Results. Parstatin potently inhibited choroidal neovascularization with an IC50 of approximately 3 ?g and a maximum inhibition of 59% at 10 ?g. Parstatin suppressed retinal neovascularization with maximum inhibition of 60% at 3 ?g. Ten-microgram and 30-?g doses appeared to be toxic to the neonatal retina. Subconjunctival parstatin inhibited corneal neovascularization, with 200 ?g the most effective dose (59% inhibition). In addition, parstatin significantly inhibited corneal inflammation and VEGF-induced retinal leukostasis. In all models tested, scrambled parstatin was without any significant effect. Conclusions. Parstatin is a potent antiangiogenic agent of ocular neovascularization and may have clinical potential in the treatment of angiogenesis-related ocular disorders.
Huang, Hu; Vasilakis, Panagiotis; Zhong, Xiufeng; Shen, Ji-Kui; Geronatsiou, Katerina; Papadaki, Helen; Maragoudakis, Michael E.; Gartaganis, Sotirios P.; Vinores, Stanley A.
To date, sildenafil citrate (Viagra) gives every evidence of being a safe drug for the eye despite a series of expressed concerns. A review of how its ocular safety profile has been identified offers insights into the strengths and weaknesses of present systems and resources for judging the ocular safety of Viagra or, for that matter, of any new drug. Such insights include: The great value of careful, informed assessment of preclinical information gleaned from laboratory experiments. By and large, such assessments point the way toward appropriate clinical evaluation. For Viagra, early in its development it was noted that besides exerting a major inhibitory effect on the intended target, the vascular-associated enzyme phosphodiesterase 5 (PDE5), the drug also exerts a lesser but definite inhibitory effect on the closely related PDE6, located in the retina. For this reason, preclinical evaluation of the drug included electroretinography plus postmortem histology. In addition, an extended eye examination was incorporated into clinical protocols. The often chaotic but invaluable information stream that becomes available once marketing approval has been gained and large populations begin to use a drug. False alarms, misattribution, and erroneous information are the order of the day. Nevertheless, as information accumulates, patterns of response clarify and the true nature of special susceptibility for subpopulations, if any, becomes apparent. A role for the astute clinician remains: Subtle changes or unusual risks for subpopulations can be missed entirely for long periods of time. A manifest need for improvement in evaluation of postmarketing side-effects. This need has led to the establishment of a new discipline: pharmacoepidemiology. In ophthalmology, the National Registry of Drug Induced Ocular Side-Effects maintains a constant and invaluable surveillance. Examples are supplied to illustrate each of these major points: Our presentation will include data gleaned from clinical trials plus postmarketing information on the incidence, duration, and type of color vision defects observed at different doses of Viagra.
Laties, A M; Fraunfelder, F T
One 5-month-old female native Korean calf and a 2-year-old female Holstein cow raised in two farms about 4 km apart from each other in Korea, were found to have the left eye opaque, which included motile white worms in the aqueous humor. The parasite removed from the left eye of the calf was identified as Setaria digitata based on both light and electron microscopic features. The ocular infection with S. digitata reported herein may document the first aberrant case in Korean cattle. PMID:11853150
Shin, Sung-Shik; Cho, Kyoung-Oh; Wee, Sung-Hwan
The authors report a case series of presumed ocular histoplasmosis syndrome (POHS) from India. Patients with progressive diminution of vision and having subretinal neovascularisation (SRNVM) were evaluated thoroughly to look for signs of POHS. Three patients had features suggestive of POHS, which to the best of the authors' knowledge is the first case series reported from India. This study shows that patients with clinical features suggestive of POHS do exist in India. A thorough fundus examination of young adults with supposedly idiopathic SRNVM may help to uncover more cases of POHS in India. PMID:17763129
Sinha, Rajesh; Raju, S; Garg, S P; Venkatesh, Pradeep; Talwar, Dinesh
Background The global society is aging at an increasing rate, with a continually larger proportion of the population consisting of those\\u000a over the age of 65. Age-related vascular changes have been demonstrated in ocular tissue, and the incidence and prevalence\\u000a of diseases such as macular degeneration, glaucoma and vascular occlusive diseases increase significantly with age.\\u000a \\u000a \\u000a \\u000a Methods This article reviews the current body
Rita Ehrlich; Nisha S. Kheradiya; Diana M. Winston; Daniel B. Moore; Barbara Wirostko; Alon Harris
Background The dynamics of the humoral immune response in ocular toxoplasmosis (OT) are poorly understood. We therefore investigated\\u000a this process in a rabbit model of the disease.\\u000a \\u000a \\u000a \\u000a Materials and methods Of 24 infection-naïve adult rabbits, 12 were left untreated and 12 were systematically infected with 5,000 tachyzoites of\\u000a the non-cyst-forming BK strain of Toxoplasma gondii. Three months later, all rabbits were inoculated
Justus G. Garweg; Matthias Boehnke
Epigenetics has become an increasingly important area of biomedical research. Increasing evidence shows that epigenetic alterations influence common pathologic responses including inflammation, ischemia, neoplasia, aging, and neurodegeneration. Importantly, epigenetic mechanisms may have a pathogenic role in many complex eye diseases such as corneal dystrophy, cataract, glaucoma, diabetic retinopathy, ocular neoplasia, uveitis, and age-related macular degeneration. The emerging emphasis on epigenetic mechanisms in studies of eye disease may provide new insights into the pathogenesis of complex eye diseases and aid in the development of novel treatments for these diseases.?
He, Shikun; Li, Xiaohua; Chan, Nymph
A bilateral leukemic hypopyon can be inaugural in the child's leukemia or reveal a relapse. A five years old child with acute lymphoblastic leukemia presented after 30 months of treatment a bilateral hypopyon. Anterior chamber paracentesis with cytological survey revealed leukemic cells and confirmed the ocular relapse. The treatment included the association of topical corticosteroids, chemotherapy and radiotherapy. This child died unfortunately 16 months later following a medullar relapse. We remind the different clinical aspects of leukemic invasion of the anterior segment and the therapeutic methods for this relapse. PMID:12564314
Charif, Chefchaouni M; Loughzail, K; Benkirane, N; Berraho, A
Background To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation. Methods A retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database. Results Among 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35). Conclusions Smoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.
Galor, Anat; Feuer, William; Kempen, John H; Kacmaz, R Oktay; Liesegang, Teresa L; Suhler, Eric B; Foster, C Stephen; Jabs, Douglas A; Levy-Clarke, Grace A; Nussenblatt, Robert B; Rosenbaum, James T; Thorne, Jennifer E
Ocular surface temperature (OST) has been studied with numerous approach and Infrared (IR) thermography has proved to be the best way to capture temperature distribution over some surfaces. It is applied to a number of biomedical applications including studies in the field of ophthalmology. However, the analysis of an ocular thermogram is largely in nascent stage, and is usually achieved
Jen-Hong Tan; E. Y. K. Ng; U. Rajendra Acharya; C. Chee
Ocular melanoma, the most common primary adult intraocular neoplasm, has a very high morbidity and mortality despite multiple alternative therapies. Consequently, we decided to study Gamma Knife radiosurgery (GKR) for the treatment of ocular melanoma in a clinical trial format. We describe the modifications of standard GKR to treat intraocular tumors, the objective, inclusion and exclusion criteria, treatment parameters, measurement
S. Logani; T. K. Helenowski; H. Thakrar; B. Pothiawala
A healthy ocular surface environment is essential to preserve visual function, and as such the eye has evolved a complex network of mechanisms to maintain homeostasis. Fundamental to the health of the ocular surface is the immune system, designed to respond rapidly to environmental and microbial insults, whereas maintaining tolerance to self-antigens and commensal microbes. To this end, activation of
M E Stern; C S Schaumburg; R Dana; M Calonge; J Y Niederkorn; S C Pflugfelder
Purpose: To determine the effect of caffeine on microcirculation in the human ocular fundus.Methods: The microcirculation in the ocular fundus of 10 healthy volunteers (10 eyes) was studied using a laser speckle tissue circulation analyzer. Caffeine or placebo (100 mg) was administered orally in a double-masked manner. Square blur rate (SBR), a quantitative index of blood flow velocity, was measured
Takashi Okuno; Tetsuya Sugiyama; Mika Tominaga; Shota Kojima; Tsunehiko Ikeda
Albinism has historically been divided into ocular (OA) and oculocutaneous (OCA) types based on the presence or absence of clinically apparent skin and hair involvement in an individual with the ocular features of albinism. The major genes for OCA include the tyrosinase gene in OCA1 and the P gene in OCA2. X-linked and autosomal recessive OA have been described and
R. A. King; C. G. Summers; W. S. Oetting
Delivery of drugs into eyes using conventional drug delivery systems, such as solutions, is a considerable challenge to the treatment of ocular diseases. Drug loss from the ocular surface by lachrymal fluid secretion, lachrymal fluid-eye barriers, and blood-ocular barriers are main obstacles. A number of ophthalmic drug delivery carriers have been made to improve the bioavailability and to prolong the residence time of drugs applied topically onto the eye. The potential use of microemulsions as an ocular drug delivery carrier offers several favorable pharmaceutical and biopharmaceutical properties such as their excellent thermodynamic stability, phase transition to liquid-crystal state, very low surface tension, and small droplet size, which may result in improved ocular drug retention, extended duration of action, high ocular absorption, and permeation of loaded drugs. Further, both lipophilic and hydrophilic characteristics are present in microemulsions, so that the loaded drugs can diffuse passively as well get significantly partitioned in the variable lipophilic-hydrophilic corneal barrier. This review will provide an insight into previous studies on microemulsions for ocular delivery of drugs using various nonionic surfactants, cosurfactants, and associated irritation potential on the ocular surface. The reported in vivo experiments have shown a delayed effect of drug incorporated in microemulsion and an increase in the corneal permeation of the drug.
Hegde, Rahul Rama; Verma, Anurag; Ghosh, Amitava
BackgroundOcular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen.
Richard Trevino; Ricardo Salvat
We describe the case of a patient with both pemphigus vulgaris limited to the oral cavity and ocular cicatricial pemphigoid. The diagnoses were established by means of histopathologic examination and direct and indirect immunofluorescence studies and confirmed by immunoblot analysis of serum. Treatment with dapsone resulted in a prolonged remission of the ocular cicatricial pemphigoid. The pemphigus vulgaris has remained
Jean Buhac; Kailash Bhol; Tomas Padilla; C. Stephen Foster; A. Razzaque Ahmed
Specific colours observed in images of the ocular fundus depend on the architecture of its layers and the optical properties and quantities of any pigments present. These colours can be predicted from the parameters describing the ocular tissue composition using a physics-based model of light transport. This paper reports preliminary results of the application of the inverse process by which
Felipe Orihuela-Espina; Ela Claridge; Stephen J. Preece
Delivery of drugs into eyes using conventional drug delivery systems, such as solutions, is a considerable challenge to the treatment of ocular diseases. Drug loss from the ocular surface by lachrymal fluid secretion, lachrymal fluid-eye barriers, and blood-ocular barriers are main obstacles. A number of ophthalmic drug delivery carriers have been made to improve the bioavailability and to prolong the residence time of drugs applied topically onto the eye. The potential use of microemulsions as an ocular drug delivery carrier offers several favorable pharmaceutical and biopharmaceutical properties such as their excellent thermodynamic stability, phase transition to liquid-crystal state, very low surface tension, and small droplet size, which may result in improved ocular drug retention, extended duration of action, high ocular absorption, and permeation of loaded drugs. Further, both lipophilic and hydrophilic characteristics are present in microemulsions, so that the loaded drugs can diffuse passively as well get significantly partitioned in the variable lipophilic-hydrophilic corneal barrier. This review will provide an insight into previous studies on microemulsions for ocular delivery of drugs using various nonionic surfactants, cosurfactants, and associated irritation potential on the ocular surface. The reported in vivo experiments have shown a delayed effect of drug incorporated in microemulsion and an increase in the corneal permeation of the drug. PMID:23936681
Hegde, Rahul Rama; Verma, Anurag; Ghosh, Amitava
PURPOSE. TO compare the reproducibility of laser interferometric measurements of fundus pulsa- tion, pneumatonometric measurement of pulse amplitude (PA) and pulsatile ocular blood flow (POBF), and Doppler ultrasonic measurements of blood flow velocity in the ophthalmic artery (OA) and the posterior ciliary arteries (PCAs) and to investigate the association of the results obtained with these methods and to characterize ocular
Leopold Schmetterer; Susanne Dallinger; Oliver Findl; Karin Strenn; Ursula Graselli; Hans-Georg Eichler; Michael Wolzt
Uptake of iodine-123-iodoamphetamine has been demonstrated in malignant melanoma using planar imaging techniques and has been used to detect an ocular melanoma at 12 hr postinjection. Using SPECT technique, an ocular melanoma is identified in a 64-yr-old male at 1 hr postinjection.
Dewey, S.H.; Leonard, J.C. (Department of Veterans Affairs Medical Center, Oklahoma City, OK (USA))
ULTRASONOGRAPHY of the eye aids the assessment and management of many ocular conditions, and is well tolerated by most dogs and cats. The principal indication for ocular ultrasonography is inability to see into the eye because of conditions affecting the cornea, anterior chamber or lens. Ultrasonography may also help to distinguish between various anterior segment entities that may appear similar
Denise Moore; Chris Lamb
This study was designed to compare the sensitivity and specificity of enzyme linked immunosorbent assay (ELISA) for the serodiagnosis of ocular toxocariasis using Toxocara canis embryonated egg antigen (TEE) and toxocara excretory-secretory or exoantigen (TEX) produced in vitro. TEE and TEX ELISA were comparably sensitive, but TEX ELISA was better able to discriminate between serum samples from patients with ocular
L T Glickman; R B Grieve; S S Lauria; D L Jones
A 65-year-old woman with ocular myasthenia gravis (MG) and thymic tumor underwent expanded thymectomy. Histologically the tumor was thymic cyst and thymolipoma. To our knowledge, there has been no case reported in medical literatures, which is thymic cyst & thymolipoma with ocular MG. This case suggests some effect of steroid therapy. PMID:8478577
Yamamura, M; Shimizu, Y; Suehiro, S; Miyamoto, T; Nakamura, K
We evaluated the effects of the erbium:YAG laser (2.9 µm wavelength) on ocular structures. Energy was successfully transmitted through a fiberoptic bundle for intraocular and extraocular applications. The wavelength was strongly absorbed by ocular tissues, producing ablations with minimal thermal damage. Our results indicated that the erbium: YAG laser may have potential uses as a photoablative tool to reshape the
Gholam A. Peyman; Naoko Katoh
A patient developed severe ocular vaccinia via autoinoculation after acquiring unrecognized contact-transmitted vaccinia from wrestling with vaccinated members of his unit. This case highlights both the need to reinforce infection-control measures among vaccinees and the need for providers to be familiar with the identification and treatment of cutaneous and ocular vaccinia infection. PMID:21702392
Montgomery, Jay R; Carroll, Robert B; McCollum, Andrea M
The objective of the present investigation was to prepare and evaluate ocular inserts of moxifloxacin. An ocular insert was made from an aqueous dispersion of moxifloxacin, sodium alginate, polyvinyl alcohol, and dibutyl phthalate by the film casting method. The ocular insert (5.5 mm diameter) was cross-linked by CaCl2 and was coated with Eudragit S-100, RL-100, RS-100, E-100 or L-100. The in vitro drug drainage/permeation studies were carried out using an all-glass modified Franz diffusion cell. The drug concentration and mucoadhesion time of the ocular insert were found satisfactory. Cross-linking and coating with polymers extended the drainage from inserts. The cross-linked ocular insert coated with Eudragit RL-100 showed maximum drug permeation compared to other formulations. PMID:22472452
Pawar, Pravin K; Katara, Rajesh; Majumdar, Dipak K
Background. Visceral metastatic spread of ocular melanoma most commonly occurs via hematogenous route to the liver. Lymphatic spread of ocular melanoma into abdominal lymph nodes has not been reported previously. Case Presentation. A 47-year-old man with a history of ocular melanoma presented with a soft tissue mass on CT scan. The mass encased the portal structures of the hepaticoduodenal ligament. Image-guided biopsy revealed it to be a metastatic melanoma to lymph nodes. The patient underwent surgery with the intent to prolong disease-free survival. On final pathological examination, two lymph nodes were found harboring metastatic melanoma. Conclusion. Extrahepatic lymphatic intra-abdominal spread of ocular melanoma is not impossible. Since this mode of spread is rare, the oncologic significance of surgical resection of isolated intra-abdominal nodal with metastatic ocular melanoma is difficult to determine at the present time.
Meir, Karen; Lotem, Michal M.; Appelbaum, Liat; Merhav, Hadar
Human amniotic membrane (AM) is frequently used as a substrate for ocular surface reconstruction. Its disadvantages (e.g., reduced transparency and biomechanical strength, heterogeneity depending on donor) create the need for standardized alternatives. Keratin from hair or wool has been proposed as an appropriate material for producing films or cell cultivation scaffolds. The current study was performed to develop transparent, stable and transferable films based on human hair keratin that support cellular adhesion and proliferation. The films were engineered by a multi-step procedure including keratin extraction, neutral and alkaline dialysis, drying and a curing process. Keratin films were investigated by SDS-PAGE, SEM and X-ray analyses. Furthermore, swelling and water absorption of the films were studied, as were tensile strength and light transmission (UV/VIS). Finally, the growth behavior of corneal epithelial cells on the keratin films and AM was estimated in proliferation studies. In addition, we assessed the seeding efficiency and cell detachment behavior during trypsinization. The film-forming process resulted in transparent films composed of nanoparticulate keratin structures. The film characteristics could be varied by changing the protein composition, adding softening agents or varying the curing temperature and duration. Based on these findings, an optimized protocol was developed. The films showed improved light transmission and biomechanical strength in comparison to AM. Furthermore, cell behavior on the films was similar to that found on AM. We conclude that keratin films may represent a new, promising alternative for ocular surface reconstruction. PMID:21316757
Reichl, Stephan; Borrelli, Maria; Geerling, Gerd
To investigate the role of cellular immunodeficiency in recurrent toxoplasmic retinochoroiditis, six Cynomolgus monkeys (Macaca fascicularis) with healed toxoplasmic lesions of the retina were immunosuppressed by total lymphoid irradiation. Three months prior to irradiation 30,000 Toxoplasma gondii organisms of the Beverley strain had been inoculated onto the macula of eye in each monkey via a pars plana approach. Toxoplasmic retinochoroiditis developed in each animal, and lesions were allowed to heal without treatment. During total lymphoid irradiation animals received 2000 centigrays (cGy) over a 7-week period. Irradiation resulted in an immediate drop in total lymphocyte counts and decreased ability to stimulate lymphocytes by phytohemagglutinin. Weekly ophthalmoscopic examinations following irradiation failed to show evidence of recurrent ocular disease despite persistent immunodeficiency. Four months after irradiation live organisms were reinoculated onto the nasal retina of the same eye in each animal. Retinochoroidal lesions identical to those seen in primary disease developed in five of six animals. Toxoplasma organisms therefore were able to proliferate in ocular tissue following the administration of immunosuppressive therapy. This study fails to support the hypothesis that cellular immunodeficiency alone will initiate recurrent toxoplasmic retinochoroiditis. Results suggest that reactivation of disease from encysted organisms involves factors other than suppression of Toxoplasma proliferation. If reactivation occurs by other mechanisms, however, cellular immunodeficiency then may allow development of extensive disease.
Holland, G.N.; O'Connor, G.R.; Diaz, R.F.; Minasi, P.; Wara, W.M.
This article discusses three largely unrecognized aspects related to fluid movement in ocular tissues; namely, a) the dynamic changes in water permeability observed in corneal and conjunctival epithelia under anisotonic conditions; b) the indications that the fluid transport rate exhibited by the ciliary epithelium is insufficient to explain aqueous humor production; and c) the evidence for fluid movement into and out of the lens during accommodation. We have studied each of these subjects in recent years and present an evaluation of our data within the context of the results of others who have also worked on electrolyte and fluid transport in ocular tissues. We propose that 1) the corneal and conjunctival epithelia, with apical aspects naturally exposed to variable tonicities, are capable of regulating their water permeabilities as part of the cell-volume regulatory process, 2) fluid may directly enter the anterior chamber of the eye across the anterior surface of the iris, thereby representing an additional entry pathway for aqueous humor production, and 3) changes in lens volume occur during accommodation, and such changes are best explained by a net influx and efflux of fluid.
Candia, Oscar A.; Alvarez, Lawrence J.
ObjectiveSynchronous extraocular muscle activity can be recorded from around the eyes at the beginning of a vestibular-evoked eye movement (ocular vestibular evoked myogenic potentials, OVEMPs). As galvanic vestibular stimulation (GVS) evokes the vestibulo-ocular reflex, we wished to investigate GVS-evoked OVEMPs.
Sally M. Rosengren; Peter Jombik; G. Michael Halmagyi; James G. Colebatch
Aim: To analyse how it is performed, from expert evidence view point, the assessment of ocular injuries and after- effects due to traffic accidents in our area. Method: We have accomplished a retrospective study of 127 reports on ocular injuries, carried out in the Ophthalmologic Section of the Medical Forensic Clinic of Madrid for five years -from 2002 to 2006-,
Severe chemical burns of the ocular surface frequently result in long-standing and ongoing disorders of the conjunctiva and the cornea including conjunctival scarring with shortening of the fornix, cicatricial entropion, complications caused by trichiasis and scarring or chronic ulceration of the cornea. Advanced destruction of limbal stem cells leads to limbal stem cell deficiency with conjunctivalization of the cornea. Surgical therapy aims at the correction of malpositioning of the lids, the reconstruction of the conjunctiva and the fornix utilizing applicable tissue grafts and the reestablishment of a stable, avascular and transparent corneal epithelium by e.g. transplantation of epithelial stem cells. Progressive corneal ulcerations unresponsive to medical therapy can be treated by amniotic membrane transplantation, corneal transplantation or by conjunctival covering depending on the extent of damaged tissue. The surgical therapy of patients after severe chemical burns of the ocular surface is generally performed in specialized centers and occasionally requires a multidisciplinary approach. PMID:22037726
Bachmann, B; Cursiefen, C
Epithelia of the cornea, lens and retina contain a vast array of ion channels and pumps. Together they produce a polarized flow of ions in and out of cells, as well as across the epithelia. These naturally occurring ion fluxes are essential to the hydration and metabolism of the ocular tissues, especially for the avascular cornea and lens. The directional transport of ions generates electric fields and currents in those tissues. Applied electric fields affect migration, division and proliferation of ocular cells which are important in homeostasis and healing of the ocular tissues. Abnormalities in any of those aspects may underlie many ocular diseases, for example chronic corneal ulcers, posterior capsule opacity after cataract surgery, and retinopathies. Electric field-inducing cellular responses, termed electrical signaling here, therefore may be an unexpected yet powerful mechanism in regulating ocular cell behavior. Both endogenous electric fields and applied electric fields could be exploited to regulate ocular cells. We aim to briefly describe the physiology of the naturally occurring electrical activities in the corneal, lens, and retinal epithelia, to provide experimental evidence of the effects of electric fields on ocular cell behaviors, and to suggest possible clinical implications.
Zhao, Min; Chalmers, Laura; Cao, Lin; Viera, Ana C.; Mannis, Mark; Reid, Brian
West Nile virus (WNV), a mosquito-borne RNA virus for which there is no treatment, began emerging as a threat to health in the United States in 1999. Since then, its frequency and apparent clinical severity have increased. Patients with severe disease may experience ocular complications that include pain, vitreous inflammation, nonrelapsing chorioretinitis, retinal vasculitis, chorioretinal scarring, optic neuritis, and retinal hemorrhages. Age appears to be a risk factor for the development of ocular symptoms. Most patients with ocular involvement report floaters or decreased vision. Many ocular inflammatory conditions with an associated underlying systemic cause often present with chorioretinitis. However, the characteristic distribution and linear array or scattered pattern of the chorioretinal lesions seen in WNV is distinctive. The foregoing notwithstanding, other multifocal choroidopathies must be considered including syphilis, ocular histoplasmosis, multifocal choroiditis, tuberculosis, and sarcoid. Although topical steroids were reported to resolve WNV-induced uveitis and its associated keratic precipitates, most cases resolved irrespective of treatment, and relapses were uncommon. It is important for the eye care professional to be alert to the possible presence of WNV, particularly in older patients who present with ocular symptoms during mosquito season. Thus, a thorough ocular evaluation should include a dilated fundus examination and, when indicated, fluorescein angiography should be performed in patients suspected of being infected with WNV. PMID:16230277
Koevary, Steven B
Ocular cicatricial pemphigoid is a chronic scarring inflammation of the ocular mucosae that can lead to blindness. Although cicatricial pemphigoid has been classified clinically, histopathologically, and immunopathologically, no definite initiating factor or precipitating factor has been identified. In this report, we describe five cases of ocular cicatricial pemphigoid that developed following an acute episode of severe ocular inflammatory injury secondary
Lawrence S. Chan; H. Kaz Soong; C. Stephen Foster; Craig Hammerberg; Kevin D. Cooper
Ocular toxocariasis named also ocular larva migrans is caused by larvae of the roundworm Toxocara spp. The purpose of this study was to find out the seroprevalence of Toxocara antibodies in patients suspected of ocular toxocariasis. Between January 2001 and December 2003, sera from 239 ocular patients, aged 3 to 80 years, were examined by ELISA and confirmed by Western
Jernej Logar; Barbara Šoba; Aleksandra Kraut; Branka Stirn-Kranjc
Background/aim: Intraocular pressure (IOP) is not a fixed constant value but rather has pulsatile components associated with cardiac action. The SmartLens dynamic observing tonometer (odc, Ophthalmic Development Company AG, Zurich, Switzerland) can measure and record simultaneously IOP and ocular pulse amplitude (OPA). It was the aim of this study to evaluate OPA in patients with primary open angle glaucoma (POAG) and high IOP, normal tension glaucoma (NTG), and ocular hypertension (OHT). Furthermore, the authors examined whether there were any correlations with blood pressure. Methods: 80 subjects were divided into four groups (n=20): 20 patients each with POAG, NTG, and OHT and 20 volunteers without any ocular pathology except for cataract served as a control group. Results: The OPA of the POAG group was not statistically significant different from the control group and from the OHT group. However, OPA was statistically significant lower (p<0.01) in the NTG group compared with all other groups. The OPA of the OHT group was slightly higher compared to the healthy volunteers (p=0.09) and to the POAG patients (p=0.09). No statistically significant correlations with blood pressure could be detected. A logistic regression model was established which identified OPA as an independent risk factor for NTG. Conclusions: The study demonstrated a decrease in OPA of patients suffering from NTG. Thus, measuring of OPA by the SmartLens dynamic observing tonometer could be helpful in the detection of NTG patients.
Schwenn, O; Troost, R; Vogel, A; Grus, F; Beck, S; Pfeiffer, N
Background Short monocular deprivation (4 days) induces a shift in the ocular dominance of binocular neurons in the juvenile mouse visual cortex but is ineffective in adults. Recently, it has been shown that an ocular dominance shift can still be elicited in young adults (around 90 days of age) by longer periods of deprivation (7 days). Whether the same is true also for fully mature animals is not yet known. Methodology/Principal Findings We therefore studied the effects of different periods of monocular deprivation (4, 7, 14 days) on ocular dominance in C57Bl/6 mice of different ages (25 days, 90–100 days, 109–158 days, 208–230 days) using optical imaging of intrinsic signals. In addition, we used a virtual optomotor system to monitor visual acuity of the open eye in the same animals during deprivation. We observed that ocular dominance plasticity after 7 days of monocular deprivation was pronounced in young adult mice (90–100 days) but significantly weaker already in the next age group (109–158 days). In animals older than 208 days, ocular dominance plasticity was absent even after 14 days of monocular deprivation. Visual acuity of the open eye increased in all age groups, but this interocular plasticity also declined with age, although to a much lesser degree than the optically detected ocular dominance shift. Conclusions/Significance These data indicate that there is an age-dependence of both ocular dominance plasticity and the enhancement of vision after monocular deprivation in mice: ocular dominance plasticity in binocular visual cortex is most pronounced in young animals, reduced but present in adolescence and absent in fully mature animals older than 110 days of age. Mice are thus not basically different in ocular dominance plasticity from cats and monkeys which is an absolutely essential prerequisite for their use as valid model systems of human visual disorders.
Lehmann, Konrad; Lowel, Siegrid
Blindness is a major health concern worldwide that has a powerful impact on afflicted individuals and their families, and is associated with enormous socio-economical consequences. The Middle East is heavily impacted by blindness, and the problem there is augmented by an increasing incidence of diabetes in the population. An appropriate drug/gene delivery system that can sustain and deliver therapeutics to the target tissues and cells is a key need for ocular therapies. The application of nanotechnology in medicine is undergoing rapid progress, and the recent developments in nanomedicine-based therapeutic approaches may bring significant benefits to address the leading causes of blindness associated with cataract, glaucoma, diabetic retinopathy and retinal degeneration. In this brief review, we highlight some promising nanomedicine-based therapeutic approaches for drug and gene delivery to the anterior and posterior segments. PMID:23580849
Xu, Qingguo; Kambhampati, Siva P; Kannan, Rangaramanujam M
The integrity and normal function of the corneal epithelium are essential for maintaining the cornea's transparency and vision. The existence of a cell population with progenitor characteristics in the limbus maintains a dynamic of constant epithelial repair and renewal. Currently, cell-based therapies for bio-replacement, such as cultured limbal epithelial transplantation and cultured oral mucosal epithelial transplantation, present very encouraging clinical results for treating limbal stem cell deficiencies. Another emerging therapeutic strategy consists of obtaining and implementing human progenitor cells of different origins using tissue engineering methods. The development of cell-based therapies using stem cells, such as human adult mesenchymal stromal cells, represents a significant breakthrough in the treatment of certain eye diseases and also offers a more rational, less invasive and more physiological approach to ocular surface regeneration. PMID:23257987
Casaroli-Marano, Ricardo P; Nieto-Nicolau, Nuria; Martínez-Conesa, Eva M
Blindness is a major health concern worldwide that has a powerful impact on afflicted individuals and their families, and is associated with enormous socio-economical consequences. The Middle East is heavily impacted by blindness, and the problem there is augmented by an increasing incidence of diabetes in the population. An appropriate drug/gene delivery system that can sustain and deliver therapeutics to the target tissues and cells is a key need for ocular therapies. The application of nanotechnology in medicine is undergoing rapid progress, and the recent developments in nanomedicine-based therapeutic approaches may bring significant benefits to address the leading causes of blindness associated with cataract, glaucoma, diabetic retinopathy and retinal degeneration. In this brief review, we highlight some promising nanomedicine-based therapeutic approaches for drug and gene delivery to the anterior and posterior segments.
Xu, Qingguo; Kambhampati, Siva P.; Kannan, Rangaramanujam M.
We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.
Kolomeyer, Anton M.; Szirth, Bernard C.; Nayak, Natasha V.; Khouri, Albert S.
Corneal opacification due to limbal stem cell deficiency (LSCD) is an important cause for ocular morbidity, resulting from a number of intrinsic and extrinsic factors. While the extrinsic factors include conditions such as chemical or thermal injuries, intrinsic include dysfunction, or reduction in the number of stem cells either due to pathological changes in autoimmune diseases or secondary to certain clinical conditions such as diabetes, dry eye disorders, or multiple previous eye surgeries. LSCD is characterized by a classic triad of signs -- conjunctivalization, neovascularization and decrease in vision. With the increasing knowledge of limbal stem cells, the treatment of this condition has evolved from simple debridement to use of biological materials, direct transplantation of the healthy limbal tissue from the contralateral eye, or allogenic source to the use of cultivated limbal epithelial sheets. This chapter provides an update on the disease pathology, various treatment methodologies, with specific emphasis on the fast developing field of cell therapy and tissue engineering. PMID:19491055
Vemuganti, Geeta K; Fatima, Anees; Madhira, Soundarya Lakshmi; Basti, Surendra; Sangwan, Virender S
Research on the anti-inflammatory effects of prednisolone sodium phosphate and prednisolone acetate is reviewed critically and methodological problems in the study of ocular drugs are identified. A pharmacokinetic model of the absorption of water-insoluble drugs, such as prednisolone acetate, and water-soluble drugs, such as prednisolone sodium phosphate, is presented. The steps in the model are the drug elimination rate in the precornea and anterior chamber, the rate of drug dissolution, the rate of drug penetration into the cornea, and the rate of drug transport into the aqueous humor. Both prednisolone sodium phosphate and prednisolone acetate have been shown to have moderate to high anti-inflammatory effects, but it is concluded that the drug solution (prednisolone sodium phosphate) has certain advantages over the drug suspension (prednisolone acetate). PMID:2328525
Olejnik, O; Weisbecker, C A
Context: Boston ocular surface prosthesis (BOSP) is a scleral contact lens used in the management of patients who are rigid gas permeable (RGP) failures as with corneal ectasias such as keratoconus and in those patients who have ocular surface disease such as Stevens–Johnson syndrome (SJS). Aim: To report utilization of BOSP in a tertiary eye care center in India. Materials and Methods: We retrospectively reviewed charts of 32 patients who received BOSP from July 2008 to May 2009. Indications for fitting these lenses, improvement in visual acuity (VA) before and after lens fitting and relief of symptoms of pain and photophobia were noted. Paired t-test was used for statistical analysis using SPSS version 16.0 for Windows. Results: Thirty-two patients (43 eyes) received these lenses. These consisted of 23 eyes of 17 patients who failed RGP trials for irregular astigmatism and corneal ectasia such as keratoconus and post radial keratotomy and scar and 20 eyes of 15 patients with SJS. Mean age of RGP failures was 27.94 years. Pre- and post-BOSP wear mean LogMAR VA was 1.13 and 0.29, respectively, in RGP failures. The P value was statistically significant (P < 0.001). In patients with SJS, LogMAR VA was 0.84 ± 0.92 before and 0.56 ± 0.89 after lens wear. The P value was statistically significant (P < 0.001). VA improved by >2 lines in 7/20 eyes (35%) with SJS, with improvement in symptoms. Conclusion: BOSP improves VA in patients who have irregular astigmatism as in ectasias and RGP failures and improves vision and symptoms in patients with SJS.
Rathi, Varsha Madanlal; Mandathara, Preeji Sudharman; Dumpati, Srikanth; Vaddavalli, Pravin K; Sangwan, Virender S
SUMMARY The aim of this study was to investigate risk factors for ocular toxoplasmosis (OT) in patients who received medical attention at a public health service. Three hundred and forty-nine consecutive patients, treated in the Outpatient Eye Clinic of Hospital de Base, São José do Rio Preto, São Paulo state, Brazil, were enrolled in this study. After an eye examination, enzyme-linked immunosorbent assay (ELISA) was used to determine anti-Toxoplasma gondii antibodies. The results showed that 25·5% of the patients were seronegative and 74·5% were seropositive for IgG anti-T. gondii antibodies; of these 27·3% had OT and 72·7% had other ocular diseases (OOD). The presence of cats or dogs [odds ratio (OR) 2·22, 95% confidence interval (CI) 1·24-3·98, P = 0·009] and consumption of raw or undercooked meat (OR 1·77, 95% CI 1·05-2·98, P = 0·03) were associated with infection but not with the development of OT. Age (OT 48·2 ± 21·2 years vs. OOD: 69·5 ± 14·7 years, P < 0·0001) and the low level of schooling/literacy (OT vs. OOD: OR 0·414, 95% CI 0·2231-0·7692, P = 0·007) were associated with OT. The presence of dogs and cats as well as eating raw/undercooked meat increases the risk of infection, but is not associated with the development of OT. PMID:23507508
Ferreira, A I C; De Mattos, C C Brandão; Frederico, F B; Meira, C S; Almeida, G C; Nakashima, F; Bernardo, C R; Pereira-Chioccola, V L; De Mattos, L C
Allergic diseases have greatly increased in industrialized countries. About 30% of people suffer from allergic symptoms and 40%–80% of them have symptoms in the eyes. Atopic conjunctivitis can be divided into seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). The treatment of SAC is simple; antihistamines, anti-inflammatory agents, or chromoglycate. In severe cases of SAC, subcutaneous or sublingual immunotherapy is helpful. PAC needs longer therapy, often year round, with mast cell stabilizers, antihistamines, and sometimes local steroids. Atopic keratoconjunctivitis is a more severe disease showing chronic blepharitis often connected with severe keratitis. It needs, in many cases, continuous treatment of the lid eczema and keratoconjunctivitis. Blepharitis is treated with tacrolimus or pimecrolimus ointment. Conjunctivitis additionally needs corticosteroids and, if needed, cyclosporine A (CsA) drops are administered for longer periods. Basic conjunctival treatment is with mast cell-stabilizing agents and in addition, antihistamines are administered. Vernal keratoconjunctivitis is another chronic and serious allergic disease that mainly affects children and young people. It is a long-lasting disease which commonly subsides in puberty. It demands intensive therapy often for many years to avoid serious complicating corneal ulcers. Treatment is mast cell-stabilizing drops and additionally antihistamines. In relapses, corticosteroids are needed. When the use of corticosteroids is continuous, CsA drops should be used, and in relapses, corticosteroids should be used additionally. Nonallergic eosinophilic conjunctivitis (NAEC) is a less known, but rather common, ocular disease. It affects mostly middle-aged and older women. The eye symptoms of NAEC are largely similar to those seen in chronic allergic conjunctivitis. Basic therapy is mast cell-stabilizing drops. Eosinophilic inflammation needs additional corticosteroids. In severe cases, CsA drops are recommended. Antihistamines should be avoided. It is important to recognize the different forms of allergic ocular diseases and to start the treatment early and intensively enough to avoid chronicity of the disease and accompanying tissue destruction.
Kari, Osmo; Saari, K Matti
There is little information regarding ocular anatomy and histology in many of the rodent species. Histological analyses for morphologic features were performed in 31 globes from 18 rodent species submitted to and archived at the Comparative Ocular Pathology Laboratory of Wisconsin. The following measurements were taken: thickness of the cornea, corneal epithelium, corneal stroma, Descemet's membrane, and retina. H&E sections were evaluated for the following anatomical features: presence of pigmented epithelial cells in the peripheral cornea, presence and location of Schlemm's canal, presence of iridal sphincter and dilator and ciliary body muscles, presence of pars plicata and plana, presence of retinal vessels, presence of lamina cribrosa, and presence of tapetum lucidum. The springhaas was the only rodent in our collection that presented a well-developed tapetum lucidum fibrosum. The presence of retinal vessels was variable: vessels were observed in all of the members of the mouse-related clade, except the springhaas and the beaver, in all of the squirrel-related clade members, and in none of the Ctenohystrica. In the flying squirrels, blood vessels extended to the outer limiting membrane in the photoreceptor layer. Beavers, chinchillas, capybara, and guinea pigs lacked vessels within the retina; however, they had vessels within the optic nerve head. Ground squirrels have an optic nerve head, which is linear in the horizontal plane and an asymmetric retina. The tree-dwelling squirrels have a rounded but still elongated optic nerve, and the flying squirrel has a round optic nerve head like all the other rodents. PMID:23734597
Rodriguez-Ramos Fernandez, Julia; Dubielzig, Richard R
We review laser applications for primarily in vivo ocular imaging techniques, describing their constraints based on biological tissue properties, safety, and the performance of the imaging system. We discuss the need for cost effective sources with practical wavelength tuning capabilities for spectral studies. Techniques to probe the pathological changes of layers beneath the highly scattering retina and diagnose the onset of various eye diseases are described. The recent development of several optical coherence tomography based systems for functional ocular imaging is reviewed, as well as linear and nonlinear ocular imaging techniques performed with ultrafast lasers, emphasizing recent source developments and methods to enhance imaging contrast.
Elsner, Ann E.; Muller, Matthew S.
We document the recurrence of a CSMD in a patient subsequent to the instillation of topical ocular hypotensive medications and its resolution on discontinuation of therapy. An independent cause or causes contributing to the development of CSMD other than the use of topical ocular hypotensive medications cannot be ruled out in this case, neither can it be considered dissociated from the use of these drugs. We recommend that patients with VTS, those with a history of CSMD or having developed recurrent episodes of CSMD requiring management with topical ocular hypotensive medications, be cautiously monitored for the possible occurrence or exacerbation of CSMD. PMID:18537988
Besada, Eulogio; Shechtman, Diana; Frauens, Barry J
Background Ocular trauma is one of the important causes of preventable blindness and visual impairment among children worldwide. Prevalence\\u000a of pediatric ocular trauma associated with toy guns appear to be on the rise, although they are fully preventable. The purpose\\u000a of this study is to report ocular trauma secondary to toy-gun pellets in Kuwait.\\u000a \\u000a \\u000a \\u000a Methods We conducted a non-comparative case series based
Manal Bouhaimed; Manar Alwohaib; Shaikhah Alabdulrazzaq; Mohammad Jasem
Objective To evaluate the efficacy of Systane® Lubricating Eye Drops in improving the symptoms of moderate ocular dryness. Methods Fifty subjects with moderate symptoms of ocular dryness were enrolled in this open label study. The mean age of subjects was 57.6 ± 15.4 years. To be eligible, subjects’ tear film break-up time (TFBUT) had to be <10 seconds, and subjects had to have at least one ocular discomfort symptom in addition to dryness. Saline was used for a washout period of 3–5 days. Subjects were re-examined, and those continuing to meet the inclusion criteria were dispensed Systane® and re-examined again after 28 days. At each visit, slitlamp examination was conducted, and ocular discomfort symptoms and TFBUT were evaluated. Subjects rated their overall satisfaction at baseline and on the last visit. Results No significant changes in TFBUT or ocular discomfort symptoms were observed after saline use, compared with screening visit. After 28 days of Systane® use there was statistically significant improvement of TFBUT (p = 0.0001) compared with baseline. Subjects experienced significant symptomatic relief for all 6 ocular discomfort symptoms at the endpoint visit. Conclusion Systane® effectively relieved the symptoms associated with moderate ocular dryness, with measurable improvement in objective TFBUT, subjective symptoms, and overall satisfaction.
Versura, Piera; Profazio, Vincenzo; Campos, Emilio C
This document is the study general handbook for The Studies of the Ocular Complications of AIDS (SOCA), which oversees the conduct of trials and observational studies regarding the ocular complications of AIDS. SOCA is a collaborative multi-center researc...
P. E. Scott
Ocular toxoplasmosis results from retinal infection with the protozoan, Toxoplasma gondii. This parasite, which exists as multiple clonal subpopulations and in three stages, is capable of replication in any nucleated cell of its primary feline or multiple paratenic hosts. Human seroprevalence of toxoplasmosis is high across the globe, but with geographic variation. While prevalence of ocular toxoplasmosis is not well documented, toxoplasmic retinochoroiditis is the commonest form of posterior uveitis in many countries. Correlation of parasite genotype with disease is an important area of new research. Ocular infection with T. gondii often follows ingestion of bradyzoites in undercooked infected meat. Oocysts may survive for an extended period in the environment, and water contaminated with oocysts is an important source in toxoplasmosis epidemics. Ocular toxoplasmosis is preventable by a combination of community activities and personal measures. Public health action is well justified by the considerable burden of congenital and postnatal infections. PMID:22594908
Furtado, João M; Winthrop, Kevin L; Butler, Nicholas J; Smith, Justine R
The overarching objective of this study is to characterize abnormalities of vestibulo-ocular reflexes (VOR) in Autism Spectrum Disorder (ASD). Specific aim 1: Characterize horizontal VOR post-rotary nystagmus without optokinetic feedback using a velocity ...
K. D. White
Abstract Purpose: Acne rosacea is a common dermatological conditions associated with blepharitis. Current treatments include artificial tears, lid hygiene, and systemic doxycycline. In this study the authors evaluate the effectiveness of topical azithromycin in ocular rosacea. Methods: The authors enrolled 37 ocular rosacea patients: 12 were treated with systemic doxycycline, 16 with azithromycin eyedrops, and 9 did not receive medical treatments. Ocular signs and symptoms and side effects were evaluated at baseline and at 1-month follow-up. Results: A significant improvement in TF-BUT, meibomian gland plugging, and Oxford score associated with symptom reduction was reported by all patients after 1 month. All treatments were well tolerated, with mild gastro-intestinal symptoms in 33% of the doxycycline group and mild burning after instillation in the azithromycin group. Conclusions: Topical azithromycin may represent an additional treatment for ocular rosacea, with a shorter duration of treatment and absence of gastrointestinal side effects as compared to systemic doxycycline. PMID:23875944
Mantelli, Flavio; Di Zazzo, Antonio; Sacchetti, Marta; Dianzani, Caterina; Lambiase, Alessandro; Bonini, Stefano
Trabeculectomy, despite producing an effective reduction in intraocular pressure, may not prevent continued visual field loss. This may be because of the presence of other factors in the pathogenesis of glaucoma. Vascular factors have been suggested as being particularly important. To study the effect of trabeculectomy on ocular blood flow the technique of ocular pulse analysis has been used to derive a measure of pulsatile ocular blood flow in 17 patients (average age 65.6 (SD 1.8) years) undergoing trabeculectomy. A significant increase in pulsatile ocular blood flow of 29% was observed in the group as a whole in the standing position following operation but in some individuals blood flow changed only slightly despite a large reduction in intraocular pressure. The significance of these findings in relation to the prognosis of visual field preservation following trabeculectomy is discussed.
James, C B
The incidence of ocular complications in cerebro-spinal meningitis was described following a study on 700 cases. It is advisable that every patient with meningitis be ophthalmologically examined. This is especially valuable where fundus changes begin to d...
L. S. Hanna N. I. Girgis A. Hassan W. Yassin J. E. Sippel
The report summarizes the following research areas: Molecular and perimacular vascular remodeling; natural course of sickle retinopathy; conjunctival angiography; sickle cell trait and retinopathy; therapy of sickle cell retinopathy; and related ocular fu...
M. F. Goldberg
The ocular of any microscope may be used for the purpose of photography through the device if the camera utilizes the given optical conditions like an observer eye concerning aperture and focal length.
K. E. Schirmer; L. Y. Jacques
...SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices Â§ 886.4360 Ocular surgery irrigation device...surgery to deliver continuous, controlled irrigation to the surgical field. (b) Classification. Class I (general...
Thirty patients with ocular hypertension were tested for contrast sensitivity loss. Seventeen were not on treatment, and thirteen were receiving some form of pressure reducing therapy. The contrast sensitivity results of 63% of ocular hypertensive eyes were abnormal (greater than 2 SDs from the age matched norm). Thus it appears that contrast sensitivity can detect early visual loss in patients who have normal visual fields and it is suggested that this test might be used as a criterion for therapy in ocular hypertension. There was no significant difference in the intraocular pressures between patients who gave abnormal contrast sensitivity results and those who did not in the untreated group (p greater than 0.05), suggesting that intraocular pressure level is a poor predictor of optic nerve fibre damage in patients with ocular hypertension.
Ross, J E; Bron, A J; Reeves, B C; Emmerson, P G
The Collaborative Ocular Melanoma Study (COMS) is a multicenter investigation designed to evaluate therapeutic interventions for patients who have choroidal melanoma. Two randomized controlled trials are currently being conducted. Eligible patients for th...
The Collaborative Ocular Melanoma Study (COMS) is a multicenter investigation designed to evaluate therapeutic interventions for patients who have choroidal melanoma. Two randomized controlled trials are currently being conducted. Eligible patients for th...
\\\\s=b\\\\Two hundred twenty in-use medica- tions from 101 patients with nonmicro- bial ocular surface disease were studied by culturing the bottle caps, a drop pro- duced by simple inversion, and the interi-
Oliver D. Schein; Patricia L. Hibberd; Tomy Starck; Ann S. Baker; Kenneth R. Kenyon
Ocular trauma is an important cause of vision loss. The agents incriminated in such injuries are diverse. We present a case of ocular trauma with a metallic spoon causing deep laceration of lid and temple region with sclerocorneal laceration. After assessment of the general condition and stabilization of the systemic parameters the operative procedure was undertaken on elective basis. Though the final visual outcome was not rewarding due to the severity of the injury, any potential hemostatic catastrophe was averted.
Bhaduri, Gautam; Chattopadhyay, Soumya Swarup; Ghosh, Rudra Prasad; Saurabh, Kumar; Goyal, Mukesh
As the most common form of ocular albinism, ocular albinism type I (OA1) is an X-linked disorder that has an estimated prevalence of about 1:50,000. We searched for mutations through the human genome sequence draft by direct sequencing on eighteen patients with OA1, both within the coding region and in a thousand base pairs upstream of its start site. Here,
Cristin Roma; Paola Ferrante; Ombretta Guardiola; Andrea Ballabio; Massimo Zollo
Objective:Patients with superior canal dehiscence (SCD) have large sound-evoked vestibular reflexes with pathologically low threshold. We wished to determine whether a recently discovered measure of the vestibulo-ocular reflex—the ocular vestibular evoked myogenic potential (OVEMP)—produced similar high-amplitude, low-threshold responses in SCD, and could differentiate patients with SCD from normal control patients.Methods:Nine patients with CT-confirmed SCD and 10 normal controls were stimulated
S M Rosengren; S T Aw; G M Halmagyi; N P McAngus Todd; J G Colebatch
ObjectiveThe cervical vestibular evoked myogenic potential (cVEMP) is sensitive to lower brainstem lesions affecting the vestibulo-collic pathway. We wished to determine whether the ocular VEMP (oVEMP), a recently-described otolith–ocular reflex, is also abnormal in patients with brainstem lesions. We tested patients with internuclear ophthalmoplegia (INO), caused by a brainstem lesion in the medial longitudinal fasciculus (MLF), to investigate whether the
S. M. Rosengren; J. G. Colebatch
PURPOSE. In the past few decades, the automobile has become an increasingly more popular means of transport, which has led to an increasing number of rear-end collisions and conse- quently has resulted in more patients with whiplash-associated disorders (WADs). Recently, it was found that the gain of one of the ocular stabilization reflexes—the cervico-ocular reflex (COR)—is elevated in patients with
Inger Montfoort; Willem P. A. Kelders; Jos N. van der Geest; Inger B. Schipper; Louw Feenstra; Chris I. de Zeeuw; Maarten A. Frens
PURPOSE: To report pathologic examination of an excised choroidal neovascular membrane in a patient with ocular histoplasmosis syndrome that demonstrated granulomatous inflammation.METHOD: Case report. A 50-year-old woman with sudden vision loss in her left eye demonstrated clinical and fluorescein angiographic findings characteristic of choroidal neovascularization secondary to ocular histoplasmosis syndrome.RESULTS: Histopathologic examination of the surgically excised choroidal neovascular membrane disclosed
Eric S Mann; Steven J Fogarty; Marilyn C Kincaid
Klinefelter syndrome is caused by the presence of one or more additional X chromosomes in an affected male. Patients often exhibit gynecomastia, small testes, and infertility. Though the characteristics of Klinefelter have been well-documented, associated ocular abnormalities have been only occasionally reported. Here we present a 2-month-old infant with Klinefelter syndrome and a unique combination of ocular abnormalities including microphthalmia, cataracts, and malformed pupils. PMID:22486321
Juhn, Alexander T; Nabi, Naeem U; Levin, Alex V
The in vitro activity of thimerosal versus those of amphotericin B and natamycin was assessed against 244 ocular fungal isolates. The activity of thimerosal against Fusarium spp., Aspergillus spp., and Alternaria alternata was 256 times, 512 times, and 128 times, respectively, greater than that of natamycin and 64 times, 32 times, and 32 times, respectively, greater than that of amphotericin B. Thimerosal's antifungal activity was significantly superior to those of amphotericin B and natamycin against ocular pathogenic fungi in vitro.
Xu, Yan; Pang, Guangren; Zhao, Dongqing; Gao, Chuanwen; Zhou, Lutan; Sun, Shengtao; Wang, Bingliang
The in vitro activity of thimerosal versus those of amphotericin B and natamycin was assessed against 244 ocular fungal isolates. The activity of thimerosal against Fusarium spp., Aspergillus spp., and Alternaria alternata was 256 times, 512 times, and 128 times, respectively, greater than that of natamycin and 64 times, 32 times, and 32 times, respectively, greater than that of amphotericin B. Thimerosal's antifungal activity was significantly superior to those of amphotericin B and natamycin against ocular pathogenic fungi in vitro. PMID:19841144
Xu, Yan; Pang, Guangren; Zhao, Dongqing; Gao, Chuanwen; Zhou, Lutan; Sun, Shengtao; Wang, Bingliang
There is a growing body of evidence suggesting that vascular dysfunction is related to several prominent ophthalmic diseases, including glaucoma. The vast majority of studies providing data on ocular circulation and disease pathophysiology use a relatively small number of complicated ocular blood flow imaging techniques. Although these imaging technologies are not commonly used in clinical settings, understanding the medical literature characterizing ocular blood flow requires familiarity with their methodology and function. This review highlights the imaging technologies most commonly used to investigate ocular blood flow, including color Doppler imaging, confocal scanning laser ophthalmoscopic angiography with fluorescein and indocyanine green dye, Canon laser blood flowmetry, scanning laser Doppler flowmetry, and retinal photographic oximetry. Each imaging technique's ability to define vascular function and reveal pathology is discussed as are limitations inherent to each technology. The ultimate goal of this review is to provide the physician with a clinically relevant foundation for differentiating the various ocular blood flow outcome measures often presented in the literature and determine how they are related to ocular health and disease. PMID:18443609
Harris, Alon; Kagemann, Larry; Ehrlich, Rita; Rospigliosi, Carlos; Moore, Danny; Siesky, Brent
Purpose. To describe integration of fundus autofluorescence (FAF) imaging into an ocular screening program. Methods. Fifty consecutive screening participants were included in this prospective pilot imaging study. Color and FAF (530/640?nm exciter/barrier filters) images were obtained with a 15.1MP Canon nonmydriatic hybrid camera. A clinician evaluated the images on site to determine need for referral. Visual acuity (VA), intraocular pressure (IOP), and ocular pathology detected by color fundus and FAF imaging modalities were recorded. Results. Mean ± SD age was 47.4 ± 17.3 years. Fifty-two percent were female and 58% African American. Twenty-seven percent had a comprehensive ocular examination within the past year. Mean VA was 20/39 in the right eye and 20/40 in the left eye. Mean IOP was 15?mmHg bilaterally. Positive color and/or FAF findings were identified in nine (18%) individuals with diabetic retinopathy or macular edema (n = 4), focal RPE defects (n = 2), age-related macular degeneration (n = 1), central serous retinopathy (n = 1), and ocular trauma (n = 1). Conclusions. FAF was successfully integrated in our ocular screening program and aided in the identification of ocular pathology. Larger studies examining the utility of this technology in screening programs may be warranted.
Kolomeyer, A. M.; Nayak, N. V.; Szirth, B. C.; Khouri, A. S.
Purpose. To describe integration of fundus autofluorescence (FAF) imaging into an ocular screening program. Methods. Fifty consecutive screening participants were included in this prospective pilot imaging study. Color and FAF (530/640?nm exciter/barrier filters) images were obtained with a 15.1MP Canon nonmydriatic hybrid camera. A clinician evaluated the images on site to determine need for referral. Visual acuity (VA), intraocular pressure (IOP), and ocular pathology detected by color fundus and FAF imaging modalities were recorded. Results. Mean ± SD age was 47.4 ± 17.3 years. Fifty-two percent were female and 58% African American. Twenty-seven percent had a comprehensive ocular examination within the past year. Mean VA was 20/39 in the right eye and 20/40 in the left eye. Mean IOP was 15?mmHg bilaterally. Positive color and/or FAF findings were identified in nine (18%) individuals with diabetic retinopathy or macular edema (n = 4), focal RPE defects (n = 2), age-related macular degeneration (n = 1), central serous retinopathy (n = 1), and ocular trauma (n = 1). Conclusions. FAF was successfully integrated in our ocular screening program and aided in the identification of ocular pathology. Larger studies examining the utility of this technology in screening programs may be warranted. PMID:23316224
Kolomeyer, A M; Nayak, N V; Szirth, B C; Khouri, A S
In vitro organotypic models for testing ocular irritants have warranted sufficient interest as methods to replace in vivo ocular testing. The in vitro organotypic models claim to maintain short-term normal physiological and biochemical function of the mammalian cornea in an isolated system. In these test methods, damage by the test substance is assessed by quantitative measurements of changes in corneal opacity and permeability using opacitometry and spectrophotometry, respectively. Both measurements are used quantitatively for irritancy classification for prediction of the in vivo ocular irritation potential of a test substance. Examples of organotypic models that incorporate these criteria include: the bovine corneal opacity and permeability (BCOP) assay, the isolated chicken eye (ICE) test method and the isolated rabbit eye (IRE) assay. A fourth method, the hen's egg test-chorioallantoic membrane (HET-CAM) assay, differs in the evaluation criteria but is also normally included among this class of in vitro protocols. Each of these protocols is discussed in detail as representative candidate in vitro methods for assessing ocular irritation and corrosion. The methodologies, protocol details, applications, and their validation status are discussed. A brief historical perspective of the development of original in vitro ocular testing models is also mentioned. More importantly, improvement and troubleshooting the current techniques, in order to present the models as stand-alone in vitro tools for ocular toxicity assessment, is emphasized.
Barile, Frank A.
There are four members of the bestrophin family of proteins in the human genome, of which two are known to be expressed in the eye. The gene BEST1 (formerly VMD2) which encodes the protein bestrophin-1 (Best1) was first identified in 1998. Mutations in this gene have now been associated with four clinically distinguishable human eye diseases, collectively referred to as "bestrophinopathies". Over the last decade, laboratories have sought to understand how Best1 mutations could result in eye diseases that range in presentation from macular degeneration to nanophthalmos. The majority of our knowledge comes from studies that have sought to understand how Best1 mutations or dysfunction could induce the classical symptoms of the most common of these diseases: Best vitelliform macular dystrophy (BVMD). BVMD is a dominant trait that is characterized electrophysiologically by a diminished electrooculogram light peak with a normal clinical electroretinogram. This together with the localization of Best1 to the retinal pigment epithelium (RPE) basolateral plasma membrane and data from heterologous expression studies, have led to the proposal that Best1 generates the light peak, and that bestrophins are a family of Ca(2+) activated Cl(-) channels (CaCCs). However, data from Best1 knock-out and knock-in mice, coupled with the recent discovery of a recessive bestrophinopathy suggest that Best1 does not generate the light peak. Recently Best2 was found to be expressed in non-pigmented epithelia in the ciliary body. However, aqueous dynamics in Best2 knock-out mice do not support a role for Best2 as a Cl(-) channel. Thus, the purported CaCC function of the bestrophins and how loss of this function relates to clinical disease needs to be reassessed. In this article, we examine data obtained from tissue-type and animal models and discuss the current state of bestrophin research, what roles Best1 and Best2 may play in ocular epithelia and ocular electrophysiology, and how perturbation of these functions may result in disease. PMID:19398034
Marmorstein, Alan D; Cross, Harold E; Peachey, Neal S
There are four members of the bestrophin family of proteins in the human genome, of which two are known to be expressed in the eye. The gene BEST1 (formerly VMD2) which encodes the protein bestrophin-1 (Best1) was first identified in 1998. Mutations in this gene have now been associated with four clinically distinguishable human eye diseases, collectively referred to as “bestrophinopathies”. Over the last decade, laboratories have sought to understand how Best1 mutations could result in eye diseases that range in presentation from macular degeneration to nanophthalmos. The majority of our knowledge comes from studies that have sought to understand how Best1 mutations or dysfunction could induce the classical symptoms of the most common of these diseases: Best vitelliform macular dystrophy (BVMD). BVMD is a dominant trait that is characterized electrophysiologically by a diminished electrooculogram light peak with a normal clinical electroretinogram. This together with the localization of Best1 to the retinal pigment epithelium (RPE) basolateral plasma membrane and data from heterologous expression studies, have led to the proposal that Best1 generates the light peak, and that bestrophins are a family of Ca2+ activated Cl- channels (CaCCs). However, data from Best1 knock-out and knock-in mice, coupled with the recent discovery of a recessive bestrophinopathy suggest that Best1 does not generate the light peak. Recently Best2 was found to be expressed in non-pigmented epithelia in the ciliary body. However, aqueous dynamics in Best2 knock-out mice do not support a role for Best2 as a Cl- channel. Thus, the purported CaCC function of the bestrophins and how loss of this function relates to clinical disease needs to be reassessed. In this article, we examine data obtained from tissue-type and animal models and discuss the current state of bestrophin research, what roles Best1 and Best2 may play in ocular epithelia and ocular electrophysiology, and how perturbation of these functions may result in disease.
Marmorstein, Alan D.; Cross, Harold E.; Peachey, Neal S.
Purpose To estimate the risk of structural ocular complications and loss of visual acuity in cases of Behçet’s Disease (BD); to evaluate potential risk and protective factors for these events Design Retrospective cohort study Methods Setting Five academic center ocular inflammation subspecialty practices Study Population A total of 168 consecutive patients with BD-associated ocular inflammation Procedures Clinical data on these patients were ascertained by standardized chart review Outcome Measures Visual acuity, structural ocular complications of inflammation, intraocular pressure (IOP) Results Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.45/eye-year (EY). Rates of loss of visual acuity to 20/50 or worse and to 20/200 or worse were 0.12/EY and 0.09/EY respectively. Risk factors for loss of visual acuity during follow-up were persistent inflammatory activity, presence of posterior synechiae, presence of hypotony, and presence of elevated IOP. In a time-dependent analysis, current activity of ocular inflammation was associated with an increased risk of loss of visual acuity to 20/50 or worse (RR = 2.45, 95% CI: 1.1–5.5, p = 0.03) and to 20/200 or worse (RR = 2.67, 95% CI: 1.2–5.8, p = 0.01). Conclusions Loss of visual acuity and occurrence of ocular complications were common in patients with ocular inflammation associated with Behçet’s Disease, even with aggressive therapy. Ongoing inflammation during follow-up, presence/occurrence of posterior synechiae, hypotony, and elevated IOP were associated with an increased risk of loss of visual acuity.
Kacmaz, R. Oktay; Kempen, John H.; Newcomb, Craig; Gangaputra, Sapna; Daniel, Ebenezer; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Foster, C. Stephen
Automated computer-aided procedure for component selection, optical design, and optimization was developed and used to produce prototype ocular optics of a head-mounted display for biomedical imaging, with the field of view and resolution approaching those of normal human vision. The new display has the potential to dramatically increase the amount and fidelity of real-time visual information presented to the user. The selected approach was based on a tiled configuration and "optically stitched" virtual image, resulting in seamless imagery generated by multiple micro-displays. Several optical configurations were studied in the design stage, to arrive at the optimal optical layout. The automated procedure provided for extensive search of the best candidate stock components out of thousands of candidate lenses offered by different vendors. At each iteration, the candidate lens was "digitally inserted" in the optical layout, its position was optimized, and the achieved merit function characterizing the quality of the stitched image was stored, along with the design prescription. A few best designs were then closely evaluated in a traditional "manual" procedure. The design effort was followed by experimental demonstration and tests of a limited prototype optical system.
Gutin, Mikhail; Gutin, Olga
Astigmatism is a refractive defect whose origin is not always purely corneal, and is sometimes the result of corneal, crystalline lens or mixte contributions. The aim of our study is to report, through two cases, ocular lesions associated with a lenticular astigmatism and their evolution after treatment. In the first observation, it is a 25-year-old patient with a unilateral extra corneal astigmatism within the framework of the "tilted disc syndrome" associated with bilateral myopia. This patient has received treatment by Lasik. The postoperative course was good with a decline of 5 ans. The second observation is that of a patient aged 35 years without having a general history with a posterior lenticonus associated with keratoconus responsible for a major mixed astigmatism. She received combined surgery: penetrating keratoplasty with lens extraction and implantation of an artificial lens. The evolution was good with good visual recovery. The balance of internal astigmatism must include the systematic achievement of a subjective and objective refraction under cycloplegia and corneal topography. The search for etiology is critical to screen for eye or general disease and guide the therapeutic strategy. Knowledge of the refractive power of the cornea and crystalline lens of astigmatism separately would be important for surgery refractive and crystalline lens surgery. PMID:22424808
Limaiem, R; Baba, A; Bouraoui, R; Mghaieth, F; El Matri, L
Intravitreal 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl] guanine (DHPG) has been advocated as an alternative mode of therapy in cytomegalovirus (CMV) retinitis in the acquired immunodeficiency syndrome (AIDS) because of toxic neutropenia which is a complication of systemic intravenous DHPG. The recommended regimen requires injection of 200 micrograms DHPG intravitreally twice a week for a period of several weeks to months to control the progression of CMV retinitis. A previous study performed to determine the safe dose of intravitreal DHPG was based on a single intravitreal dose study; it does not consider the toxicity which may arise from multiple intravitreal injections of DHPG as it is utilized in the treatment of patients with CMV retinitis. In our study, intravitreal injections of 1000, 400, 200, 100, 50, and 25 micrograms DHPG were administered weekly for a period of 5 weeks in rabbit eyes. Ocular toxicity was monitored using slit-lamp biomicroscopy, indirect ophthalmoscopy, electroretinography, and light and electron microscopy. Electroretinographic evidence of retinal toxicity was found with doses as low as 100 micrograms. Electron-micrographic studies of retinal tissue from the eyes injected with even lower doses (as low as 25 micrograms) also showed evidence of toxic vacuolization in the inner segments of the photoreceptor. PMID:2401420
Yoshizumi, M O; Lee, D; Vinci, V; Fajardo, S
Ocular microtremor (OMT) is a biological high frequency (up to 150Hz) low amplitude (25-2500nm peak to peak) involuntary motion of the human eye. Clinical OMT investigations to date have used eye-contacting mechanical piezoelectric probes or piezoelectric strain gauges. Before contact can be made, the eye must first be anaesthetized. In some cases, this eyelid spasms occur making it impossible to measure OMT. Using the contact probe method, the eye motion is mechanically loaded. Results from clinical studies with this method to date have given electrical signal amplitudes from the probe proportional to the displacement, but not the exact displacement information. Recent studies suggest a number of clinical applications for OMT, these include monitoring the depth of anesthesia of a patient in surgery, prediction of outcome in coma, diagnosis of brain stem death. In addition to this, in patients with neurological disorders such as Multiple Sclerosis and Parkinson's disease, abnormal OMT frequency content is present. In this paper, we design a compact non-contact phase modulating optical fiber speckle interferometer to measure eye motions. We simulate OMT motion using a calibrated piezoelectric vibration simulator and compare results produced using a contact method with those using our optical non-contact method.
Ryle, James P.; Al-Kalbani, Mohammed; Collins, Niamh; Gopinathan, Unnikrishnan; Boyle, Gerard; Coakley, Davis; Sheridan, John T.
Purpose To determine the normal reference range of pulsatile ocular blood flow (POBF) values in healthy Korean subjects and to find out the factors that may affect them. Methods A total of 280 eyes of 280 normal subjects were included in this study. Best corrected visual acuity (BCVA), intraocular pressure (IOP), axial length, POBF, systemic blood pressure, and pulse rate were measured. The mean, standard deviation, range, and the 5th and 95th percentiles of POBF were calculated, and the influences of various parameters to POBF were determined by multiple regression analyses. Results The mean POBF value was 766.0±221.6 µl/min in men and 1021.1±249.5 µl/min in women. The 5th and 95th percentiles for POBF values were 486.0 µl/min and 1140.0 µl/min in men and 672.0 µl/min and 1458.0 µl/min in women. The POBF values were significantly influenced by gender, mean blood pressure, pulse rate, and axial length. Conclusions Even though the POBF values were influenced by gender, BP, and axial length, we could define the normal reference range of POBF in healthy Koreans.
Kim, Seung Kab; Cho, Byung Joo; Hong, Samin; Kang, Sung Yong; Kim, Jae Sung; Kim, Chan Yun
Is the concept of integrative, preventive and personalised medicine applicable to the relationship between retinitis pigmentosa (RP) and ocular blood flow (OBF)? RP encompasses a group of hereditary diseases of the posterior segment of the eye characterised by degeneration, atrophy and finally loss of photoreceptors and retinal pigment epithelium, leading to progressive visual loss. Many different mutations affecting different genes can lead to the clinical picture of RP. Even though the disease has a clear genetic background, there are obviously other factors influencing the manifestation and progression of RP. In this review, we focus on the role of OBF. There is evidence that, in PR patients, OBF is more reduced than one would expect secondary to the retinal atrophy. The main cause of this additional component seems to be primary vascular dysregulation (PVD) syndrome. As PVD syndrome is partly treatable, a vascular evaluation of RP patients is meaningful. Based on the outcome, a targeted individualised, preventive or supportive treatment might be introduced in selected RP patients.
Aims: To assess the aetiological factors associated with the occurrence of perforating ocular injuries in children in an urban setting and to assess the visual outcomes of such injuries. Methods: All cases of perforating ocular injury presenting to a single paediatric hospital (age less than 16 years) over a 17 year period were identified by a medical record search. All new cases of perforating ocular injury identified were included. All information was obtained retrospectively from the medical records. Results: There were 72 cases identified. The commonest causes of perforating ocular injury were sharp tools (knives/scissors) poked by the child into his/her own eye (17%), or objects thrown at the child (17%). Injuries were most likely to have occurred at home (58%). The age range for injuries was 8 months to 14 years 8 months. Perforating ocular injury was most frequent in the 3–6 year group (32%) followed by the 6–9 year group (25%). Males were more frequently involved than females (48–24). There was no correlation between the laterality of the eye, the time of day of the occurrence, or the day of the week of the occurrence. The final acuity achieved was better or equal to 6/12 in 36% and less than 6/60 in 31%. Injuries occurred more frequently on weekends than on weekdays. There were six enucleations (8%). Follow up was for an average period of 25 months. Conclusions: Penetrating ocular injury occurs most frequently in the home setting and mostly as the result of the use of sharp tools or by thrown objects. Prevention of penetrating ocular injury requires greater education of children and their carers especially on the potential dangers within the home.
Thompson, C G; Kumar, N; Billson, F A; Martin, F
To investigate the expression profiles of efflux transporters in human ocular tissues, quantitative real-time polymerase chain reaction, Western blotting, and immunohistochemistry were used to obtain the relative mRNA and protein expressions of various efflux transporters in human ocular tissues. The cornea, conjunctiva, iris-ciliary body (ICB), retina and choroid, human corneal epithelial cell line (HCEC), and human retinal pigment epithelial cell line (ARPE-19) were examined for the expressions of multidrug resistance-associated proteins 1-7 (MRP1-7), multidrug resistance 1 (MDR1) P-glycoprotein, lung resistance protein (LRP), and breast cancer-resistance protein (BCRP). The expression sites and patterns of efflux transporters were significantly different in ocular tissues, HCEC, and ARPE-19, as well as the expression profiles of efflux transporters in mRNA and protein levels in ocular tissues. At the protein level, MRP1-7, MDR1, and LRP were expressed in the corneal epithelium; MRP1-7, MDR1, LRP, and BCRP were expressed in the conjunctival epithelium; MRP1-2, MRP6-7, MDR1, and LRP were expressed in the ICB; MRP1-3, MRP6-7, MDR1, and LRP were expressed in the retina; MRP1-3, MRP6-7, MDR1, and LRP were expressed in the HCEC; and MRP7, MDR1, LRP, and BCRP were expressed in the ARPE-19. This quantitative and systematic study of efflux transporters in normal ocular tissues and cell lines provides evidence of cross-ocular tissue transporter expression differences, implying that efflux transporter expression variability should be taken into consideration for better understanding of ocular pharmacokinetic and pharmacodynamic data. PMID:23979916
Chen, Peng; Chen, Hao; Zang, Xinjie; Chen, Min; Jiang, Haoran; Han, Shasha; Wu, Xianggen
Many studies have been devoted to the identification of genes involved in experience-dependent plasticity in the visual cortex. To discover new candidate genes, we have reexamined data from one such study on ocular dominance (OD) plasticity in recombinant inbred BXD mouse strains. We have correlated the level of plasticity with the gene expression data in the neocortex that have become available for these same strains. We propose that genes with a high correlation are likely to play a role in OD plasticity. We have tested this hypothesis for genes whose inactivation is known to affect OD plasticity. The expression levels of these genes indeed correlated with OD plasticity if their levels showed strong differences between the BXD strains. To narrow down our candidate list of correlated genes, we have selected only those genes that were previously found to be regulated by visual experience and associated with pathways implicated in OD plasticity. This resulted in a list of 32 candidate genes. The list contained unproven, but not unexpected candidates such as the genes for IGF-1, NCAM1, NOGO-A, the gamma2 subunit of the GABA(A) receptor, acetylcholine esterase, and the catalytic subunit of cAMP-dependent protein kinase A. This demonstrates the viability of our approach. More interestingly, the following novel candidate genes were identified: Akap7, Akt1, Camk2d, Cckbr, Cd44, Crim1, Ctdsp2, Dnajc5, Gnai1, Itpka, Mapk8, Nbea, Nfatc3, Nlk, Npy5r, Phf21a, Phip, Ppm1l, Ppp1r1b, Rbbp4, Slc1a3, Slit2, Socs2, Spock3, St8sia1, Zfp207. Whether all these novel candidates indeed function in OD plasticity remains to be established, but possible roles of some of them are discussed in the article.
Rietman, M. Liset; Sommeijer, J.-P.; Levelt, Christiaan N.; Heimel, J. Alexander
In the brainstem, lateral and vertical eye movements are controlled by separate structures, the former mainly in the pons and the latter in the midbrain. The abducens nucleus (VI) in the pons controls all ipsilateral eye movements, i.e., ipsilateral saccades as well as the horizontal vestibulo-ocular reflex (VOR). This nucleus contains the abduction motoneurons, but also the internuclear neurons involved in adduction, passing through the contralateral medial longitudinal fasciculus (MLF) before relaying in the third-nerve nucleus in the midbrain. Lesions affecting the abducens nucleus result in complete ipsilateral eye movement paralysis, and lesions damaging the MLF result in internuclear ophthalmoplegia, whereas an association of these two lesions leads to the "one-and-a-half" syndrome. Ipsilateral saccades are controlled by the ipsilateral paramedian pontine reticular formation located close to the sixth nucleus, whereas the ipsilateral VOR is controlled by the contralateral medial vestibular nucleus. Vertical eye movements are controlled by the third- and fourth-nerve nuclei in the midbrain. A lesion unilaterally affecting the third-nerve nucleus results in an ipsilateral third-nerve paralysis and a contralateral upgaze paralysis because of the decussation of the superior rectus motoneurons, at the level of the third-nerve nuclei. Vertical saccades are controlled by the rostral interstitial nucleus of the MLF (riMLF) located close to the third-nerve nucleus. Downward and upward saccade paralysis results from bilateral riMLF damage whereas upgaze paralysis usually results from a unilateral lesion affecting the region of the posterior commissure, suggesting that the suprareticular control of these two types of vertical saccade is distinct. PMID:21601072
To report severe ocular complications and their management after self-administered topical kermes dye eye drops. A case report of a 55-year-old man who suffered severe ocular surface damage after application of topical kermes eye drops to his left eye. Active compounds of the kermes eye drops were studied for their composition. Patient reported decreased vision in the affected eye and the external eye examination revealed complete corneal abrasion, cicatrization of the conjunctiva, and symblepharon formation. The patient required immediate cleansing of the ocular surface along with irrigation. He was treated with topical corticosteroids and frequent lubrication. Gas chromatography/mass spectrometry analysis of the retrieved topical material revealed the presence of acid. The patient’s visual acuity improved from 20/200 before treatment to 20/25 after treatment. Topically administered kermes eye drops may cause severe ocular injuries. Public education, early recognition of such injuries, and timely intervention may prevent permanent damage to the ocular adnexae.
Al-Ghadeer, Huda A.
Poor drug delivery to lesions in patients’ eyes is a major obstacle to the treatment of ocular diseases. The accessibility of these areas to drugs is highly restricted by the presence of barriers, including the corneal barrier, aqueous barrier, and the inner and outer blood–retinal barriers. In particular, the posterior segment is difficult to reach for drugs because of its structural peculiarities. This review discusses various barriers to drug delivery and provides comprehensive information for designing nanoparticle-mediated drug delivery systems for the treatment of ocular diseases. Nanoparticles can be designed to improve penetration, controlled release, and drug targeting. As highlighted in this review, the therapeutic efficacy of drugs in ocular diseases has been reported to be enhanced by the use of nanoparticles such as liposomes, micro/nanospheres, microemulsions, and dendrimers. Our recent data show that intravitreal injection of targeted liposomes encapsulating an angiogenesis inhibitor caused significantly greater suppression of choroidal neovascularization than did the injection of free drug. Recent progress in ocular drug delivery systems research has provided new insights into drug development, and the use of nanoparticles for drug delivery is thus a promising approach for advanced therapy of ocular diseases.
Honda, Miki; Asai, Tomohiro; Oku, Naoto; Araki, Yoshihiko; Tanaka, Minoru; Ebihara, Nobuyuki
The purpose of this study was to investigate electrooculography (EOG) as a measurement of ocular vergence in both collimated and projected simulator environments. The task required participants to shift their gaze between a central fixation point and a target appearing at one of three eccentricities. EOG was effective in recording ocular vergence. The EOG results were similar between collimated and projected displays, except for differences in vergence changes during lateral movement of the eyes, and ocular excursions downward elicited a greater EOG response than the reverse upward movement. The computer-based technique of recording vergence was found to produce measurable traces from a majority of participants. The technique has potential for further development as a tool for measuring ocular vergence in virtual environments where methods that require the wearing of head-mounted apparatus to track ocular structures (e.g., the pupil), which cannot be worn at the same time as a flight or flight-simulator helmet, are unsuitable. PMID:9849100
Morahan, P; Meehan, J W; Patterson, J; Hughes, P K
Anti-neutrophil cytoplasmic antibody (ANCA)-positive vasculitis—the term recently applied to Wegener's granulomatosis—is a rare multi-system inflammation characterized by necrotizing granulomas and vasculitis. We investigated the ocular manifestations of this disease in a group of patients drawn from five inflammatory eye disease clinics across the United States. Of 8,562 persons with ocular inflammation, 59 individuals were diagnosed with ANCA-positive vasculitis; 35 males and 21 females, aged 16 to 96 years, were included in this study. Ocular diagnoses were scleritis (75.0%), uveitis (17.9%), and other ocular inflammatory conditions (33.9%) including peripheral ulcerative keratitis and orbital pseudotumor. Mean duration of ocular disease was 4.6 years. Oral corticosteroids and other systemic immunosuppressive agents were used by 85.7% and 78.5% of patients, respectively. Over time, patients with ANCA-positive vasculitis experienced 2.75-fold higher mortality than other patients with inflammatory eye disease.
Watkins, Angela S.; Kempen, John H.; Choi, Dongseok; Liesegang, Teresa L.; Pujari, S. S.; Newcomb, Craig; Nussenblatt, Robert B.; Rosenbaum, James T.; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Suhler, Eric B.
Ocular symptoms often accompany allergic rhinitis and can be as or even more bothersome for the patient than the actual nasal symptoms. Ocular manifestations of allergic rhinoconjunctivitis may result from both direct allergen-mediated mast cell stimulation on the surface of the eye and naso-ocular reflexes--histamine being one of the mediators of symptoms onset. An H1 antihistamine would be the first line treatment for allergic conjunctivitis. Since allergic conjunctivitis is always (or almost always) accompanied by nasal symptoms, a second-generation H1 antihistamine administered via oral route is the drug of choice for jointly managing both the nasal and the ocular symptoms--minimizing the impact of the effects inherent to first-generation H, antihistamine, including particularly drowsiness. Bilastine is a new H1 antihistamine with an excellent safety profile, developed for the treatment of allergic rhinoconjunctivitis and urticaria, with potency similar to that of cetirizine and desloratadine, and superior to that of fexofenadine. This new drug has been shown to be effective in controlling the ocular symptoms of allergic rhinoconjunctivitis. PMID:22185047
Bartra, J; Mullol, J; Montoro, J; Jáuregui, I; del Cuvillos, A; Dávila, I; Ferrer, M; Sastre, J; Valero, A
Ocular toxicity is a common, but poorly understood, sequela from CMF chemotherapy. We investigated this toxicity in patients receiving CMF therapy. Detailed interviews in 210 patients revealed that new, unpleasant ocular symptoms developed in 42% of patients receiving CMF, in 39% of subjects receiving other regimens containing 5-fluorouracil (5-FU), and only in 18% of subjects receiving a variety of chemotherapy regimens not containing 5-FU. CMF-associated ocular symptoms usually consisted of mild to marked tearing, ocular pruritus, and/or burning. These toxicities usually began 11-17 days after starting a cycle of CMF and lasted for 10-15 days. 5-FU was detected in the tears of 12 tested patients within several minutes after intravenous 5-FU (peak concentrations as high as 60 micrograms/ml). 5-FU tear concentrations did not correlate with the presence or absence of ocular toxicity. There is no established antidote for this toxicity although some patients have reported subjective benefit from cryotherapy, applied around the period of 5-FU injections, or cromolyn sodium eye drops. PMID:2124943
Loprinzi, C L; Love, R R; Garrity, J A; Ames, M M
Ocular surface defects represent one of the most common causes of impaired vision or even blindness. For treatment, keratoplasty represents the first choice. However, if corneal defects are more extensive and associated with a limbal stem cell (LSC) deficiency, corneal transplantation is not a sufficient therapeutic procedure and only viable approach to treatment is the transplantation of LSCs. When the LSC deficiency is a bilateral disorder, autologous LSCs are not available. The use of allogeneic LSCs requires strong immunosuppression, which leads to side-effects, and the treatment is not always effective. The alternative and perspective approach to the treatment of severe ocular surface injuries and LSC deficiency is offered by the transplantation of autologous mesenchymal stem cells (MSCs). These cells can be obtained from the bone marrow or adipose tissue of the particular patient, grow well in vitro and can be transferred, using an appropriate scaffold, onto the damaged ocular surface. Here they exert beneficial effects by possible direct differentiation into corneal epithelial cells, by immunomodulatory effects and by the production of numerous trophic and growth factors. Recent experiments utilizing the therapeutic properties of MSCs in animal models with a mechanically or chemically injured ocular surface have yielded promising results and demonstrated significant corneal regeneration, improved corneal transparency and a rapid healing process associated with the restoration of vision. The use of autologous MSCs thus represents a promising therapeutic approach and offers hope for patients with severe ocular surface injuries and LSC deficiency. PMID:23733704
Holan, Vladimir; Javorkova, Eliska
A series of 1,438 parents and 2,663 other relatives of retinoblastoma patients have been followed up to ascertain the incidence among them of non-ocular cancer. Among 117 of these relatives who were known carriers of the mutation of the retinoblastoma gene 23 cases of non-ocular cancer developed during the follow-up period of the study. This compares with an expected number of 2.3, a relative risk of 9.9. A total of 25 deaths among these carriers included 21 from non-ocular cancer; the expected number was 1.8, a relative risk of 11.6. Relatives who are carriers are about 15 times more likely to die from lung cancer than the general population. Previous findings of an association of melanoma and bladder cancer with retinoblastoma are borne out in this study. The incidence of non-ocular cancer among relatives of hereditary cases who are not definitely known to be carriers shows an excess risk of 1.6: it is concluded that a proportion of these relatives are in fact carriers of the mutated retinoblastoma gene. For relatives who are not gene carriers there appears to be no excess risk of developing cancer. Carriers relatives who are not themselves affected with retinoblastoma may be inherently less liable than affected carriers to the further genetic changes which lead to the development of both retinoblastoma and subsequent non-ocular cancer.
Sanders, B. M.; Jay, M.; Draper, G. J.; Roberts, E. M.
Epidemiological studies demonstrate a prevalence of Adamantiades-Behçets disease (MAB) in the range of 0.12-420 per 100,000 inhabitants with the highest rates in Istanbul, Turkey and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for MAB in Germany because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants and its multiethnic character renders it uniquely appropriate for epidemiological studies on MAB. This article summarizes the most important epidemiological data of 140 patients (63 female and 77 male) with a mean follow-up of 6.4 years (range 0.5-22 years) which we have recently published. The mean age was 23 years at the first manifestation and 32 years when the fully developed disease was recorded. The mean age at onset of ocular involvement was 30 years, 56% of patients developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3%. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in MAB is 1.77/100,000 inhabitants for the population of Berlin. PMID:22699944
Kneifel, C E; Köhler, A-K; Altenburg, A; Zouboulis, C C; Krause, L
Beginning in early 2006, an ocular disease of unknown etiology was routinely observed in American crocodiles (Crocodylus acutus) inhabiting the highly polluted Tarcoles River in west-central Costa Rica. We examined the nature and incidence of ocular disease in Tarcoles crocodiles and assessed the possible association between the disease and accumulation of chemical pollutants in diseased individuals. During 12-15 September and 12-13 December 2007, crocodiles were captured and examined for ocular disease and sampled to determine environmental contaminant accumulation. Three of 11 (27.3%) crocodiles captured (all males) exhibited unilateral ocular disease, primarily characterized by corneal opacity and scarring, anterior synechia, and phthisis bulbi. Multiple pollutants were detected in crocodile caudal scutes (organochlorine pesticides [OCPs] and metals), crocodile blood (OCPs), and sediments (OCPs and metals) from the Tarcoles, but no associations were found between contaminant accumulation and the incidence of eye disease. On the basis of the limited number of diseased animals examined and the potential exposure of crocodiles to pathogens and other pollutants not targeted in this study, we cannot rule out infection or chemical toxicosis as causes of the eye lesions. However, circumstantial evidence suggests that the observed ocular disease is likely the result of injury-induced trauma (and possibly secondary infection) inflicted during aggressive encounters (e.g., territorial combat) among large adult crocodiles living at relatively high densities. PMID:21441195
Rainwater, Thomas R; Millichamp, Nicholas J; Barrantes, Luz Denia Barrantes; Barr, Brady R; Montero, Juan R Bolaños; Platt, Steven G; Abel, Mike T; Cobb, George P; Anderson, Todd A
BACKGROUND—Lyme arthritis is the most frequent late manifestation of Lyme borreliosis and has been associated with ocular inflammation.?METHODS—A group of 153 children and adolescents with arthritis, 84 of whom had Lyme arthritis and 69 other causes of arthritis, were followed prospectively for 22-73 (median 44) months in the course of a national study.?RESULTS—Three of 84 patients with Lyme arthritis had ocular inflammation (4%), including keratitis, anterior uveitis, and uveitis intermedia. All three had symptoms of decreased visual acuity. Whereas anterior uveitis disappeared without sequelae, a corneal scar and a permanent loss of visual acuity in the patients with keratitis and intermediate uveitis remained. Systematic examination of all patients revealed no further ocular involvement. Of 69 patients with other causes of arthritis who were followed in parallel as a control group, four of 15 patients with early onset pauciarticular juvenile rheumatoid arthritis had chronic anterior uveitis and two of 12 patients with juvenile spondyloarthropathy had acute anterior uveitis.?CONCLUSIONS—Ocular involvement with keratitis, anterior uveitis, and intermediate uveitis may occur in children and adolescents with Lyme arthritis. Visual loss appears to be symptomatic, making regular ocular screening of such patients unnecessary.??
Huppertz, H.; Munchmeier, D.; Lieb, W.
While airbags have saved many lives and are clearly beneficial overall, sodium hydroxide (NaOH) powder produced by the inflation reaction can cause significant alkali ocular injury if not irrigated promptly. Here we report a case of severe airbag related ocular alkali injury as a way to bring attention to the need for prompt ocular irrigation following motor vehicle accidents (MVA) with airbag deployment. A 47-year-old man was involved in a MVA with airbag deployment in a rural setting. Attention was paid to several other life-threatening traumatic injuries, however, ocular irrigation was not performed until some 6-7 hours after the MVA. Over the course of 6 months, airbag related alkali injury caused severe limbal ischemia, conjunctivalization of the cornea, corneal epithelial defects, cicatricial scarring, haze, and corneal/limbal vascularization despite amniotic membrane graft. Awareness of the importance of ocular irrigation following airbag deployment must be raised both in the ophthalmology and emergency medicine communities. PMID:22900239
Barnes, Shawn S; Wong, William; Affeldt, John C
Proper availability of drug on to corneal surface is a challenging task. However, due to ocular physiological barriers, conventional eye drops display poor ocular bioavailability of drugs (< 1%). To improve precorneal residence time and ocular penetration, earlier our group developed and evaluated in situ gel and nanoparticles for ocular delivery. In interest to evaluate the combined effect of in situ gel and nanoparticles on ocular retention, we combined them. We are the first to term this combination as “nanoparticle laden in situ gel”, that is, poly lactic co glycolic acid nanoparticle incorporated in chitosan in situ gel for sparfloxacin ophthalmic delivery. The formulation was tested for various physicochemical properties. It showed gelation pH near pH 7.2. The observation of acquired gamma camera images showed good retention over the entire precorneal area for sparfloxacin nanoparticle laden in situ gel (SNG) as compared to marketed formulation. SNG formulation cleared at a very slow rate and remained at corneal surface for longer duration as no radioactivity was observed in systemic circulation. The developed formulation was found to be better in combination and can go up to the clinical evaluation and application.
Gupta, Himanshu; Aqil, Mohammed; Khar, Roop K.; Ali, Asgar; Bhatnagar, Aseem; Mittal, Gaurav
An object of the invention is to provide a method for the treatment of various ocular diseases. Another object of the present invention are to provide a method for effectively treating ocular diseases while lowering the risks of undesirable physiological ...
R. B. Nussenblatt A. G. Palestine
The ability of the ocular surface to mount an immune response is in part attributed to a family of proteins called toll-like receptors (TLRs). The latter are evolutionary conserved receptors that recognize and respond to various microbes and endogenous ligands. In addition to their recognition function, TLR activation triggers a complex signal transduction cascade that induces the production of inflammatory cytokines and co-stimulatory molecules, thus initiating innate and adaptive immunity. Toll-like receptor expression at the ocular surface is modulated during infection (e.g. Herpes simplex, bacterial keratitis and fungal keratitis) as well as during various inflammatory conditions (allergic conjunctivitis and dry eye syndrome). Here recent findings regarding TLR expression and their involvement in various ocular surface diseases are discussed.
Redfern, Rachel L.; McDermott, Alison M.
The Hutchinson-Gilford progeria (HGP) syndrome is an extremely rare genetic condition characterized by an appearance of accelerated aging in children. The word progeria is derived from the Greek word progeros meaning ‘prematurely old’. It is caused by de novo dominant mutation in the LMNA gene (gene map locus 1q21.2) and characterized by growth retardation and accelerated degenerative changes of the skin, musculoskeletal and cardiovascular systems. The most common ocular manifestations are prominent eyes, loss of eyebrows and eyelashes, and lagophthalmos. In the present case some additional ocular features such as horizontal narrowing of palpebral fissure, superior sulcus deformity, upper lid retraction, upper lid lag in down gaze, poor pupillary dilatation, were noted. In this case report, a 15-year-old Indian boy with some additional ocular manifestations of the HGP syndrome is described.
Chandravanshi, Shivcharan L; Rawat, Ashok Kumar; Dwivedi, Prem Chand; Choudhary, Pankaj
The early focus of contact lens wear and ocular health was on oxygen delivery. However, as we learn more about how the eye works, and investigate how the contact lens interacts with the cornea, the role of the tear film has risen in prominence. A healthy tear film is critical for normal ocular homeostasis, and abnormalities of the tear film are the primary cause of dry eye. In order to improve patient eye health and comfort during lens wear, we need to further elucidate the relationship among contact lenses, contact lens solutions, the tear film, and the corneal epithelium, and find ways to maintain homeostasis of the ocular surface. In this section, we review the latest data and opinions on this complex relationship between contact lenses and lens care solutions. PMID:23347575
Efron, Nathan; Brennan, Noel A; Bright, Frank V; Glasgow, Ben J; Jones, Lyndon W; Sullivan, David A; Tomlinson, Alan; Zhang, Jinzhong
The normal gene expression profiles of the tissues in the eye are a valuable resource for considering genes likely to be involved with disease processes. We profiled gene expression in ten ocular tissues from human donor eyes using Affymetrix Human Exon 1.0 ST arrays. Ten different tissues were obtained from six different individuals and RNA was pooled. The tissues included: retina, optic nerve head (ONH), optic nerve (ON), ciliary body (CB), trabecular meshwork (TM), sclera, lens, cornea, choroid/retinal pigment epithelium (RPE) and iris. Expression values were compared with publically available Expressed Sequence Tag (EST) and RNA-sequencing resources. Known tissue-specific genes were examined and they demonstrated correspondence of expression with the representative ocular tissues. The estimated gene and exon level abundances are available online at the Ocular Tissue Database. PMID:23500522
Wagner, Alex H; Anand, V Nikhil; Wang, Wan-Heng; Chatterton, Jon E; Sun, Duo; Shepard, Allan R; Jacobson, Nasreen; Pang, Iok-Hou; Deluca, Adam P; Casavant, Thomas L; Scheetz, Todd E; Mullins, Robert F; Braun, Terry A; Clark, Abbot F
A compact and robust instrument for measuring the alignment of ocular surfaces has been designed and used in living eyes. It is based on recording Purkinje images (reflections of light at the ocular surfaces) at nine different angular fixations. A complete analysis on the causes of misalignments of Purkinje images and its relations with those physical variables to be measured (global eye tilt, lens decentration and lens tilt) is presented. A research prototype based on these ideas was built and tested in normal and pseudophakic eyes (after cataract surgery). The new analysis techniques, together with the semicircular extended source and multiple fixation tests that we used, are significant improvements towards a robust approach to measuring the misalignments of the ocular surfaces in vivo. This instrument will be of use in both basic studies of the eye’s optics and clinical ophthalmology.
Tabernero, Juan; Benito, Antonio; Nourrit, Vincent; Artal, Pablo
Colchicine has been reported to destroy ganglion cells (GCs) in the retina of hatchling chicks. We tested whether colchicine influences normal ocular growth and form-deprivation myopia, and whether it affects cells other than GCs. Colchicine greatly increased axial length, equatorial diameter, eye weight, and myopic refractive error, while reducing corneal curvature. Colchicine caused DNA fragmentation in many GCs and some amacrine cells and photoreceptors, ultimately leading to the destruction of most GCs and particular sub-sets of amacrine cells. Colchicine-induced ocular growth may result from the destruction of amacrine cells that normally suppress ocular growth, and corneal flattening may result from the destruction of GCs whose central pathway normally plays a role in shaping the cornea. PMID:10341956
Fischer, A J; Morgan, I G; Stell, W K
When geriatric patients with maxillofacial defects are handled, the clinician must be confident of addressing and managing the psychology of these patients. It is also required that the clinician must understand and be sensitive to the medical and financial states of geriatric patients. The loss of an eye has a far-reaching impact on an individual's psychology and an immediate replacement is necessary to promote the physical and psychological healing of the patient and to improve his/her social acceptance. Special approaches and treatment goals are considered while treating geriatric patients with ocular defects and special consideration is given to the appointment length, the number of appointments and their medical and financial statuses. This article presents the prosthetic rehabilitation of a geriatric patient with an ocular defect, with a customized stock ocular prosthesis, by using a minimal intervention geriatric approach. PMID:23905149
Kamble, Vikas B; Kumar, Mukesh; Panigrahi, Debashis
Dry eye disease is a multifactorial disorder of the tears and ocular surface characterized by symptoms of dryness and irritation. Although the pathogenesis of dry eye disease is not fully understood, it is recognized that inflammation has a prominent role in the development and propagation of this debilitating condition. Factors that adversely affect tear film stability and osmolarity can induce ocular surface damage and initiate an inflammatory cascade that generates innate and adaptive immune responses. These immunoinflammatory responses lead to further ocular surface damage and the development of a self-perpetuating inflammatory cycle. Herein, we review the fundamental links between inflammation and dry eye disease and discuss the clinical implications of inflammation in disease management.
Stevenson, William; Chauhan, Sunil K.; Dana, Reza
The ocular insert represents a significant advancement in the therapy of eye disease. Ocular inserts are defined as sterile, thin, multilayered, drug-impregnated, solid or semisolid consistency devices placed into the cul-de-sac or conjuctival sac, whose size and shape are especially designed for ophthalmic application. They are composed of a polymeric support that may or may not contain a drug. The drug can later be incorporated as dispersion or a solution in the polymeric support. They offer several advantages as increased ocular residence and sustained release of medication into the eye. The insert includes a body portion sized to position within a lachrymal canaliculus of the eyelid. The inserts are classified according to their solubility as insoluble, soluble, or bioerodible inserts. The release of drug from the insert depends upon the diffusion, osmosis, and bioerosion of the drug, and this article is an attempt to present a brief about this newer drug delivery system.
Kumari, Anita; Sharma, Pramod K.; Garg, Vipin K.; Garg, Garima
The endogenous production of taurine and gamma-aminobutyric acid (GABA) in rat ocular tissues was investigated. The activities of taurine-producing enzyme, cysteine sulfinic acid decarboxylase (CSAD), and GABA-synthesizing enzyme, glutamic acid decarboxylase (GAD), were observed in the retina, lens, iris-ciliary body and cornea. The highest specific activity of CSAD was in the cornea and that of GAD in the retina. The discrepancy between CSAD activity and taurine content within the ocular tissues indicates that intra- or extraocular transport processes may regulate the concentration of taurine in the rat eye. The GAD activity and the content of GABA were distributed in parallel within the rat ocular tissues. The quantitative results suggest that the GAD/GABA system has functional significance only in the retina of the rat eye. PMID:3364118
Heinämäki, A A
Although the incidence of ocular trauma has been clearly described in developed countries, few published data are available on the epidemiology and the effects of parameters that can influence the incidence and severity of ocular injuries in Iran. The present study tried to determine epidemiological aspects of ocular traumatic injuries and evaluate their effects on different types of ocular injury. The case series included 1950 consecutive patients with acute ophthalmic trauma presented to the emergency ward of Farabi Hospital in Tehran. Information was collected by interviewing patients and having them fill in a questionnaire. The final diagnosis was made by a medical resident. If there was a difficulty or doubt in diagnosis or classification, confirmation of diagnosis was made by senior faculty. Ocular injuries were classified into globe and non-globe injuries according to the site of injury. Mechanical globe injuries were classified according to Birmingham Eye Trauma Terminology (BETT) into closed and open injuries. The mean age of patients was 28.8 ± 12.8 years; 87.6% were male. The most common causes of injury were work-related (49.0%) and chance events (42.0%). The most frequent ocular injury was globe injury (95.6%), including mechanical (77.6% closed and 5.9% open), chemical (7.6%), photic (2.3%) and thermal (2.2%) injuries. Non-globe injury also occurred in 10.8% of patients; both globe and non-globe injuries occurred in 6.5% of patients. The hospitalization rate in all patients was 8.8%. Previous history of eye trauma was significantly more common in the group with isolated globe injuries (P < 0.001). History of eye trauma is a risk factor for globe injuries and female gender is a risk factor only for non-globe injuries. These two factors may predict future eye injury and increase its risk by 5.2 and 1.6 times, respectively. PMID:20924645
Jafari, Alireza Keshtkar; Anvari, Faramarz; Ameri, Ahmad; Bozorgui, Shima; Shahverdi, Nooshin
Laboratory rabbits are commonly used for ocular drug and device studies. The purpose of this study was to determine the incidence of spontaneous ocular lesions in laboratory rabbits with respect to sex, breed, and supplier. We retrospectively evaluated ophthalmic examination records of rabbits screened between April 2008 and April 2010. These 1840 records represented 572 black Dutch belted (DB), 1022 New Zealand white (NZW), and 246 NZW × New Zealand red F1 crosses (WRF1). Rabbits were between 6 and 16 wk of age and had been received from 5 suppliers. Ocular structures evaluated were the cornea, lens, iris and vitreous with respect to sex, breed and supplier. A total of 177 rabbits (9.6%) and 233 eyes (6.3%) were effected. Of total rabbits, 15.3% males and 7.3% females were affected. The most common structure affected was the cornea in 5.7% of rabbits, (DB 11.7%, NZW 3.0%, and NZR 3.3%). The lens at 3.6% was second most common (DB 2.1%, NZW 4.6%, and NZR 3.3%). Both iris (0.2%) and vitreous (0.3%) were not significantly affected. Significant sex-breeder-supplier combinations were: cornea DB supplier D, supplier D females, supplier D males, DB males and NZR females; and lens: NZW females; and at least one affected ocular structure: NZW supplier D, supplier D females, DB males, NZW females, and NZR females. Breed, sex, and supplier were significant variables of ocular lesions in laboratory rabbits. Investigators should consider each of these variables when choosing rabbits for ocular studies.
Holve, Dana L; Mundwiler, Karen E; Pritt, Stacy L
Nine lesions, four ocular (three melanomas, one hemangioma) and five orbital (two perioptic meningiomas, one hemangioma, one pseudotumor, one mucocele), were evaluated by magnetic resonance surface coil imaging at 1.5 T. Small ocular lesions with 3.9-4.5-mm-elevation were demonstrated. The use of two different pulse sequences resulted in separation of melanoma from adjacent retinal detachment. Contrast obtained between orbital lesions and the adjacent normal structures was better than that demonstrated with high-resolution computed tomography. PMID:4023227
Bilaniuk, L T; Schenck, J F; Zimmerman, R A; Hart, H R; Foster, T H; Edelstein, W A; Goldberg, H I; Grossman, R I
The cervico-ocular (COR) and active and passive vestibulo-ocular reflexes (VOR) were measured in seven patients with spasmodic torticollis (ST) and six normal controls. The COR was found to be weak or absent in both groups. The VOR gain was similar in the two groups but five patients had a significant asymmetry of the response. There was no evidence of abnormal cervico-vestibular interaction during active head rotation. The study suggests that the VOR asymmetry frequently found in ST cannot be explained on the basis of an abnormal cervical input.
Stell, R; Gresty, M; Metcalfe, T; Bronstein, A M
The theoretical rationale, the histopathologic evidence, and the preliminary clinical studies related to krypton red laser (KRL) photocoagulation of the ocular fundus are reviewed. The authors report on their experience with currently available laser systems using this wavelength (647.1 nm) for photocoagulation of retinal vascular proliferative diseases and chorioretinal diseases associated with exudative manifestations. A histopathologic and clinical comparison of argon blue-green laser (ABGL), the pure argon green laser (AGL), and the krypton yellow laser (KYL), with reference to photocoagulation treatment of the ocular fundus is also discussed. PMID:22451947
Yannuzzi, Lawrence A; Shakin, Jeffrey L
Background Patients with ocular toxoplasmosis (OT) develop autoreactivity to several retinal antigens, including retinal S-antigen. By\\u000a establishing an experimental rabbit model of systemic and of primary and secondary ocular toxoplasmosis, we wished to investigate\\u000a the onset and development of humoral response to retinal S-antigen.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Of twelve infection-naïve rabbits, six were left untreated, and the other six were infected subcutaneously with 5,000
Justus G. Garweg; Yvonne de Kozak; Brigitte Goldenberg; Matthias Boehnke
Summary The effect of ocular artefacts on spectral EEG parameters is assessed statistically. These artefacts are caused by movements of the eyeball and\\/or of the lid. Further, methods for correcting ocular artefacts are presented and evaluated. This methodological study is based on data from an investigation comparing the EEG of schizophrenic patients (n=17) with healthy controls (n=15). Ocular artefacts are
Theo Gasser; Peter Ziegler; Wagner F. Gattaz
Human ocular toxocariasis is diagnosed using ophthalmologic and immunologic examinations. Many researchers have suggested that intraocular parasite-specific antibody levels are indicative of ocular toxocariasis, but little is known about the time course of the changes in these levels. We therefore investigated the anti-Toxocara canis antibody profile in the aqueous humor in an animal model of ocular toxocariasis. We intravitreally injected
Takashi Akiyama; Nobuo Ohta
In a patient with ocular melanoma, scintigraphy with N-isopropyl-p-(/sup 123/I)-iodoamphetamine (( /sup 123/I)IMP) clearly delineated the histologically proven ocular lesion. In a tissue distribution study, using the resected specimen, a significantly high accumulation of the radioactivity was confirmed in tumor tissue. Thus, (/sup 123/I)IMP scintigraphy provided specific localization of an ocular melanoma.
Ono, S.; Fukunaga, M.; Otsuka, N.; Nagai, K.; Morita, K.; Furukawa, T.; Muranaka, A.; Yanagimoto, S.; Tomomitsu, T.; Tabuchi, A.
We evaluated the ability of functional and structural technologies to detect early damage in ocular-hypertensive (OHT) eyes with normal standard automated perimetry (SAP) in 48 normal and 130 ocular-hypertensive subjects. We found that optical imaging devices may detect early damage in the RNFL and the optic nerve head in ocular-hypertensive eyes with no defect in SAP. PMID:20214046
Pueyo, Victoria; Polo, Vicente; Larrosa, Jose M; Pablo, Luis Emilio; Ferreras, Antonio; Honrubia, Francisco M
Purpose. To evaluate the effect of drug ionization on the ocular hypotensive activity of topical carbonic anhydrase inhibitors. Methods. Ocular normotensive New Zealand albino and ocular hypertensive Dutch Belted pigmented rabbits were used. Tonometric intraocular pressure levels were taken after topical application of 50 nl of drug (at various concentrations and pH values) to one eye with the contralateral eye
William F. Brechue; Thomas H. Maren
A total of 466 leprosy patients in Nepal, some advanced cases, were surveyed for ocular lesions. 74.2% were found with ocular features, and 12.7% of the eyes were blind. The patients were classified in tuberculoid, borderline-borderline, and lepromatous groups. Lepromatous leprosy is responsible for major ocular complications and blindness.
Malla, O K; Brandt, F; Anten, J G
Objective: To examine the differences between war and domestic ocular injuries during the Lebanese Civil War in terms of baseline characteristics, treatment provided and prognosis. Methods: We retrospectively reviewed the charts of subjects with traumatic ocular injuries referred to a major medical center from 1980 to 1996. The variables were tabulated according to the international classification of ocular trauma. Results:
Ahmad M. Mansour; Wadih M. Zein; Tarek A. Sibai; Abla Mehio-Sibai; Hussein Ismail; Sawsan Bu Orm
Hydroxyapatite ocular implants are replicas of lamellar bone tissue derived from the exoskeleton of a reef-building coral by a hydrothermal chemical exchange reaction. Attached to the eye muscles, they act as a passive framework for fibrovascular ingrowth and can be drilled to hold the visible part of the artificial eye and allow synchronous eye movement. Fibrovascular ingrowth has to be
T. Leitha; A. Staudenherz; U. Scholz
Ocular and cardiovascular effects of topical and intravenous pindolol have been studied in a balanced cross-0ver double-blind trial in 6 healthy volunteers. When applied to 1 eye pindolol lowered intraocular pressure in both the treated and untreated eyes with only minimal reduction in resting pupil diameter and light reflex response. The concentration in plasma was much lower and inhibiton of
S E Smith; S A Smith; F Reynolds; V B Whitmarsh
Using a piezoelectric transducer, the frequency and pattern of ocular microtremor (OMT) between 50 normal subjects and 50 patients with multiple sclerosis were compared. Controls were age matched. All records were analysed blindly. The frequency of OMT in the normal group was 86 (SD 6) Hz, which was significantly different from that of the multiple sclerosis group (71 (SD) 10
Ciaran Bolger; Stana Bojanic; Noirin Sheahan; James Malone; Michael Hutchinson; Davis Coakley
Summary — Ocular irritation testing has been one of the animal test methods most criticised by animal welfare advocates. Additional criticism has arisen from within the scientific community, based on the vari- ability of the animal test results and the questionable relevance of the extremely high dose levels employed. As a result, the Draize eye irritation test has been one
Rodger D. Curren; John W. Harbell
To study genes that are specifically expressed in the eyes, we employed microarray and in situ hybridization analyses to identify and characterize differentially expressed ocular genes in eyeless masterblind (mbl-/-) zebrafish (Danio rerio). Among 70 differentially expressed genes in the mbl-/- mutant identified by microarray analysis, 8 down-regulated genes were characterized, including 4 eye-specific genes, opsin 1 short-wave-sensitive 1 (opn1sw1), crystallinbetaa1b (cryba1b), crystallinbetaa2b (cryba2b), and crystallingamma M2d3 (crygm2d3); 2 eye and brain genes, ATPase, H+ transporting, lysosomal, V0 subunit c (atp6v0c) and basic leucine zipper and W2 domains 1a (bzw1a); and 2 constitutive genes, heat shock protein 8 (hspa8) and ribosomal protein L7a (rpl7a). In situ hybridization experiments confirmed down-regulation of these 8 ocular formation genes in mbl-/- zebrafish and showed their ocular and dynamic temporal expression patterns during zebrafish early development. Further, an automated literature analysis of the 70 differentially expressed genes identified a sub-network of genes with known associations, either with each other or with ocular structures or development, and shows how this study contributes to the current body of knowledge. PMID:18356958
Wang, Han; Kesinger, Jason W; Zhou, Qingchun; Wren, Jonathan D; Martin, George; Turner, Sean; Tang, Yuhong; Frank, Mark Barton; Centola, Michael
We are developing prosthetics for patients suffering from peripheral vestibular dysfunction. We tested a sensory-replacement prosthesis that stimulates neurons innervating the vestibular system by providing chronic pulsatile stimulation to electrodes placed in monkeys' lateral semicircular canals, which were plugged bilaterally, and used head angular velocity to modulate the current pulse rate. As an encouraging finding, we observed vestibulo-ocular reflexes that
Daniel M. Merfeld; Csilla Haburcakova; Wangsong Gong; Richard F. Lewis
Purpose To evaluate the effectiveness and risk of complications of high-dose intravenous pulsed corticosteroids for non-infectious ocular inflammatory diseases. Methods Retrospective cohort study. One hundred four eyes of seventy patients who received high-dose intravenous corticosteroids for treatment of active ocular inflammation were identified from five centers. The main outcome measures were control of inflammation and occurrence of ocular or systemic complications within one month after treatment. Results Within ?1 month of starting treatment, 57% of eyes achieved complete control of inflammation (95% confidence interval (CI): 33-83%), improving to 82% when near-complete control was included (95% CI: 61-96%). Most eyes (85%; 95% CI: 70-95%) gained clinically significant improvement in anterior chamber inflammation. One patient developed a colon perforation during treatment. No other major complications were recorded. Conclusions Treatment of ocular inflammation with high-dose intravenous corticosteroids resulted in substantial clinical improvement for most cases within one month. Complications of therapy were infrequent.
Charkoudian, Leon D.; Ying, Gui-shuang; Pujari, Siddharth S.; Gangaputra, Sapna; Thorne, Jennifer E.; Foster, C. Stephen; Jabs, Douglas A.; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Kempen, John H.
AIM—To explore the pathogenic role of delayed tear clearance.?METHODS—By comparing 10 patients with punctal obstruction and 20 asymptomatic normals, delayed tear clearance was diagnosed in 70 patients without apparent punctal obstruction using fluorescein clearance test.?RESULTS—The majority were older (71.4 (SD 1.2) years) and women (66%). Frequent complaints included redness, itching, mucus discharge, and crusting, which tended to be worse upon awakening. Common associated problems were medicamentosa (13%), drug induced pseudo pemphigoid, ocular hypertension (27%), and glaucoma (7%). Topical non-preserved 1% methylprednisolone resulted in subjective (83%) and objective (80%) improvement and resolution of delayed tear clearance (87%).?CONCLUSION—These results indicate strong association of delayed tear clearance with intrinsically and extrinsically generated ocular surface inflammation. The presence of delayed tear clearance may set up a vicious cycle to aggravate the existing inflammation. Future prospective studies are needed to delineate the pathogenic role of delayed tear clearance in various ocular surface disorders.?? Keywords: medicamentosa; ocular irritation; tear clearance; tear turnover
Prabhasawat, P.; Tseng, S.
The eye is a unique organ because of its constant exposure to radiation, atmospheric oxygen, environmental chemicals and physical abrasion. That oxidative stress mechanisms in ocular tissues have been hypothesized to play a role in diseases such as glaucoma, cataract, uveitis, retrolental fibroplasias, age-related macular degeneration and various forms of retinopathy provides an opportunity for new approaches to their prevention
Sunny E. Ohia; Catherine A. Opere; Angela M. LeDay
'Paintball' is a war game in which 2 teams use special carbon dioxide or air compressed guns to shoot gelatin or latex balls filled with paint. The balls rupture on impact marking the victim with the extruded dye. Ocular paintball injuries are increasingly being reported, probably due to the popularity and unrestricted use of this game without consideration for safety.
The microenvironments of the eye and brain are physiologically adapted to protect their delicate structures and functions from damaging immunogenic inflammation (delayed-type hypersensitivity). This adaptation is immune privilege. Aqueous humor, the fluid filling the ocular anterior chamber, suppresses antigen-stimulated primed T cells from mediating inflammation by inhibiting the production of the proinflammatory lymphokine interferon gamma. This suppression is mediated by
Andrew W. Taylor
Many ocular diseases, such as retinitis pigmentosa and age-related macular degeneration, reflect damage to specific cells that are not normally repaired or replaced. Preliminary results of animal studies suggest that these degenerative diseases may be treatable by transplantation of healthy fetal cells. However, obtaining a sufficient number of suitable donor cells remains a problem. The isolation of human embryonic stem (ES) cells has drawn much attention because of their potential clinical application for patients with these degenerative diseases. Because ES cells have the potential to generate all adult cell types, ocular diseases resulting from the failure of specific cell types would be potentially treatable through the transplantation of differentiated cells derived from ES cells. In addition, because ES cells can proliferate indefinitely in their undifferentiated state, they are expected to alleviate the problem of the shortage of donor cells for cell-replacement therapy. Recently, reproducible and efficient differentiation methods for the generation of lens cells, retinal neurons, and retinal pigment epithelial (RPE) cells from ES cells have been developed. This review focuses especially on these ocular cells differentiated from ES cells. We will also discuss the potential therapeutic uses of ES cells for the treatment of ocular diseases. PMID:15804840
AIM To evaluate the incidence and risk factors of hypotony in patients with blunt ocular trauma. METHODS The medical records of 145 patients with blunt ocular trauma were reviewed. Hypotony was defined as an average intraocular pressure (IOP) of 5mmHg or less for three times. RESULTS Among these 145 patients, hypotony was noted in 10 (6.9%) patients. The rate of hypotony in patients with ciliochoroidal detachment was 66.7% (2 out of 3 eyes), and 5.6% (8 out of 142 eyes) in patients without ciliochoroidal detachment, the difference was statistically significant (P=0.003). The rate of hypotony in patients with traumatic retinal detachment was 18.5% (5 out of 27 eyes), and 4.2% (5 out of 118 eyes) in patients without traumatic retinal detachment, the difference was statistically significant (P=0.026). The rate of hypotony in the patients with anterior proliferative vitreoretinopathy was 42.9% (3 out of 7 eyes) and 5.1% (7 out of 138 eyes) in the patients without anterior proliferative vitreoretinopathy, the difference was statistically significant (P=0.002). CONCLUSION Ocular hypotension is a complication of blunt ocular trauma. The risk factors include ciliochoroidal detachment, traumatic retinal detachment, and anterior proliferative vitreoretinopathy.
Ding, Chun; Zeng, Jun
Topical ophthalmic delivery of active ingredients can be achieved using cationic nanoemulsions. In the last decade, Novagali Pharma has successfully developed and marketed Novasorb, an advanced pharmaceutical technology for the treatment of ophthalmic diseases. This paper describes the main steps in the development of cationic nanoemulsions from formulation to evaluation in clinical trials. A major challenge of the formulation work was the selection of a cationic agent with an acceptable safety profile that would ensure a sufficient ocular surface retention time. Then, toxicity and pharmacokinetic studies were performed showing that the cationic emulsions were safe and well tolerated. Even in the absence of an active ingredient, cationic emulsions were observed in preclinical studies to have an inherent benefit on the ocular surface. Moreover, clinical trials demonstrated the efficacy and safety of cationic emulsions loaded with cyclosporine A in patients with dry eye disease. Ongoing studies evaluating latanoprost emulsion in patients with ocular surface disease and glaucoma suggest that the beneficial effects on reducing ocular surface damage may also extend to this patient population. The culmination of these efforts has been the marketing of Cationorm, a preservative-free cationic emulsion indicated for the symptomatic treatment of dry eye.
Lallemand, Frederic; Daull, Philippe; Benita, Simon; Buggage, Ronald; Garrigue, Jean-Sebastien
PurposeTo develop a model for estimating the global risk of disease progression in patients with ocular hypertension and to calculate the “number-needed-to-treat” (NNT) to prevent progression to blindness as an aid to practitioners in clinical decision making.
Robert N. Weinreb; David S. Friedman; Robert D. Fechtner; George A. Cioffi; Anne L. Coleman; Christopher A. Girkin; Jeffrey M. Liebmann; Kuldev Singh; M. Roy Wilson; Richard Wilson; William B. Kannel
The ocular findings in 2 patients with sickle cell-haemoglobin O Arab disease are described. One patient had proliferative sickle cell retinopathy with extensive autoinfarction of lesions. Sickle cell-haemoglobin O Arab disease must be added to the list of conditions that may be associated with proliferative sickle cell retinopathy. Images
Condon, P. I.; Serjeant, G. R.
Our goal was to evaluate an alternative to current methods for detecting deception in security screening contexts. We evaluated a new cognitive-based test of deception that measured participants' ocular-motor responses (pupil responses and reading behaviors) while they read and responded to statements on a computerized questionnaire. In Experiment 1, participants from a university community were randomly assigned to either a "guilty" group that committed one of two mock crimes or an "innocent" group that only learned about the crime. Participants then reported for testing, where they completed the computer-administered questionnaire that addressed their possible involvement in the crimes. Experiment 2 also manipulated participants' incentive to pass the test and difficulty of statements on the test. In both experiments, guilty participants had increased pupil responses to statements answered deceptively; however, they spent less time fixating on, reading, and rereading those statements than statements answered truthfully. These ocular-motor measures were optimally weighted in a discrimination function that correctly classified 85% of participants as either guilty or innocent. Findings from Experiment 2 indicated that group discrimination was improved with greater incentives to pass the test and the use of statements with simple syntax. The present findings suggest that two cognitive processes are involved in deception-vigilance and strategy-and that these processes are reflected in different ocular-motor measures. The ocular-motor test reported here represents a new approach to detecting deception that may fill an important need in security screening contexts. PMID:22545928
Cook, Anne E; Hacker, Douglas J; Webb, Andrea K; Osher, Dahvyn; Kristjansson, Sean D; Woltz, Dan J; Kircher, John C
Antimicrobial peptides (AMPs) such as defensins and cathelicidins are small peptides with broad-spectrum activity against bacteria, fungi and viruses. In addition, several AMPs modulate mammalian cell behaviours including migration, proliferation and cytokine production. This review describes findings from recent studies showing the presence of various AMPs at the human ocular surface and discusses their mechanism of antimicrobial action and potential
Alison M. McDermott
Five cases of subretinal neovascular membranes in the macula associated with punched out chorioretinal scars and linear streaks were seen in five Dutch patients. Clinically the fundus lesions are consistent with those of presumed ocular histoplasmosis syndrome (POHS) seen in the United States of America. Cutaneous serological testing for histoplasmin reactivity was negative in the three patients tested. Of special
F G Bottoni; A F Deutman; A L Aandekerk
Visual loss may be caused by a variety of ocular diseases and places a significant burden on society. Replacing or regenerating epithelial structures in the eye has been demonstrated to recover visual loss in a number of such diseases. Several types of cells (e.g., embryonic stem cells, adult stem/progenitor/differentiated epithelial cells and induced pluripotent cells) have generated much interest and research into their potential in restoring vision in a variety of conditions: from ocular surface disease to age-related macular degeneration. While there has been some success in clinical transplantation of conjunctival and particularly corneal epithelium utilizing ocular stem cells, in particular, from the limbus, the replacement of the retinal pigment epithelium by utilizing stem cell sources has yet to reach the clinic. Advances in our understanding of all of these cell types, their differentiation and subsequent optimization of culture conditions and development of suitable substrates for their transplantation will enable us to overcome current clinical obstacles. This article addresses the current status of knowledge concerning the biology of stem cells, their progeny and the use of differentiated epithelial cells to replace ocular epithelial cells. It will highlight the clinical outcomes to date and their potential for future clinical use. PMID:22050528
Mason, Sharon L; Stewart, Rosalind M K; Kearns, Victoria R; Williams, Rachel L; Sheridan, Carl M
Oral dapsone was used to treat five patients who presented in the acute inflammatory phase of ocular pemphigoid. The diagnosis was made clinically by identifying cicatricial changes which were in some cases difficult to find. In all cases it was the inflammatory rather than the cicatricial features which responded to treatment. An initial dose of 100 mg\\/day was effective without
A. I. Fern; J. L. Jay; H. Young; R. MacKie
KIT mutations are known to occur in ?15% of chronic sun damaged cutaneous, mucosal, and acral melanomas. Melanomas with demonstrated activating mutations in KIT or platelet-derived growth factor receptor A (PDGFRA) may benefit from treatment with tyrosine kinase inhibitors. Currently, the limited data regarding KIT mutational status in ocular melanoma suggest that activating mutations are extremely rare. PDGFRA mutational status
Michelle L Wallander; Lester J Layfield; Lyska L Emerson; Nick Mamalis; Don Davis; Sheryl R Tripp; Joseph A Holden
The administration of two oral contraceptives to female dogs for 5 years did not produce ocular lesions. Corneal and lenticular opacities occurred with equal frequency in control and treated groups, and fundic lesions, including papilledema, venous dilatation, and venous or arterial retinal thrombosis, were not produced by doses of Enovid-E or Ovulen 1, 10, and 25 times the human dose. PMID:1183645
Drill, V A; Rao, K S; McConnell, R G; Souri, E N
Ocular refractive errors (myopia, hyperopia and astigmatism) are automatic and objectively determined by projecting a light target onto the retina using an infra-red (850 nm) diode laser. The light vergence which emerges from the eye (light scattered from the retina) is evaluated in order to determine the corresponding ametropia. The system basically consists of projecting a target (ring) onto the
Liliane Ventura; Caio Chiaradia; Sidney J. de Faria E. Sousa; Jarbas C. de Castro
We measured the ocular wavefront aberration at six different visible wavelengths (between 450 and 650 nm) in three subjects, using a spatially resolved refractometer. In this technique, the angular deviation of light rays entering the pupil at different locations is measured with respect to a target viewed through a centered pupil. Fits of the data at each wavelength to Zernike
Susana Marcos; Stephen A. Burns; Esther Moreno-Barriusop; Rafael Navarro
Although constantly exposed to the environment and "foreign bodies" such as contact lenses and unwashed fingertips, the ocular surface succumbs to infection relatively infrequently. This is, in large part, due to a very active and robust innate immune response mounted at the ocular surface. Studies over the past 20 years have revealed that small peptides with antimicrobial activity are a major component of the human innate immune response system. The ocular surface is no exception, with peptides of the defensin and cathelicidin families being detected in the tear film and secreted by corneal and conjunctival epithelial cells. There is also much evidence to suggest that the role of some antimicrobial peptides is not restricted to direct killing of pathogens, but, rather, that they function in various aspects of the immune response, including recruitment of immune cells, and through actions on dendritic cells provide a link to adaptive immunity. A role in wound healing is also supported. In this article, the properties, mechanisms of actions and functional roles of antimicrobial peptides are reviewed, with particular emphasis on the potential multifunctional roles of defensins and LL-37 (the only known human cathelicidin) at the ocular surface. PMID:17216098
McDermott, Alison M
BackgroundToxocara canis is a parasite that can infect the eye and create a significant inflammatory response that can be detrimental to the patient's vision. Its clinical presentation can mimic other causes of uveitis, and its diagnosis and treatment can be challenging. Prompt and accurate diagnosis of ocular toxocariasis is essential to prevent permanent visual loss.
Marcela Frazier; Michelle L. Anderson; Sophocles Sophocleous
Background: Ocular disease is a frequent manifesta- tion of congenital Toxoplasma gondii infection. There are only limited data available in the literature concerning early stages of this disease in fetuses and infants. The pur- pose of our study was to characterize histopathological features in the eyes of 10 fetuses and 2 infants with con- genital toxoplasmosis. Methods: Fifteen eyes from
Fiona Roberts; Marilyn B. Mets; David J. P. Ferguson; Richard O'Grady; Carol O'Grady; Philippe Thulliez; Antoine P. Brezin; Rima McLeod
Activation of the gravity sensors in the inner ear-the otoliths-generates reflexes that act to maintain posture and gaze. Ocular counter-rolling (OCR) is an example of such a reflex. When the head is tilted to the side, the eyes rotate around the line of ...
B. Cohen G. Clement S. Moore I. Curthoys M. Dai I. Koizuka T. Kubo T. Raphan
The understanding of dry eye disease has advanced recently through increasing recognition that the etiology of the condition involves both tear evaporation and insufficient tear production, and that tear film instability and inflammation play roles in the various stages of the disease. Of significance, it has been recognized that lipid layer thickness correlates with tear film stability. The management of dry eye involves various strategies and therapeutic approaches that address one or more etiopathological components of the disease. Th