Dorzolamide effect on ocular blood flow.

PURPOSE: To evaluate the effect of dorzolamide on ocular blood flow in normal and glaucomatous eyes. METHODS: Twenty-six eyes with documented open-angle glaucoma of 26 patients and 13 normal control eyes of 8 age-matched subjects were included in this study. All eyes underwent color Doppler imaging for measuring peak-systolic velocity, end-diastolic velocity, and resistance index in the ophthalmic and central retinal arteries and the maximal and minimal velocities in the central retinal vein. Eyes were grouped in control and initial and advanced glaucoma categories. Measurements were made in all groups before and after application of topical dorzolamide. Intragroup comparisons between baseline and dorzolamide conditions were made using paired Student's t-test. Intergroup comparisons under baseline conditions between normal and glaucomatous eyes were made by using the one-way ANOVA test. Statistical significance was set at P < 0.05. RESULTS: The peak-systolic velocity of the central retinal artery in glaucomatous eyes and the end-diastolic velocity of the ophthalmic and central retinal arteries in all groups were significantly higher after application of dorzolamide. The minimal velocity of the central retinal vein showed significantly higher values after dorzolamide, whereas the maximal velocity remained unchanged. The peak-systolic velocity of the ophthalmic artery in all groups and the peak-systolic velocity of the central retinal artery in normal eyes also remained unchanged. The resistance index was significantly lower in the ophthalmic and central retinal arteries in all groups after dorzolamide. The intraocular pressure was significantly reduced in all groups after dorzolamide. Under baseline conditions normal control eyes and glaucomatous eyes showed differences in various measurements. Peak-systolic velocity was significantly lower in glaucomatous eyes than in normal control eyes with the exception of the ophthalmic artery in the initial glaucoma group. End-diastolic velocity was lower in glaucomatous eyes than in control eyes in both arteries. Maximal and minimal velocities of the central retinal vein were lower in glaucomatous eyes than in normal control eyes. Resistance index was higher in glaucomatous eyes than in normal control eyes in the ophthalmic artery but not in the central retinal artery. CONCLUSIONS: Most hemodynamic parameters of intraocular and periocular vessels improve after application of topical dorzolamide in both normal control and glaucomatous eyes. Dorzolamide should be regarded as a useful drug for treatment of glaucoma not only because it reduces intraocular pressure but also because it improves the ocular blood supply.

Ultrasound biomicroscopy in the diagnosis of supraciliochoroidal fluid after trabeculectomy.

PURPOSE: To report supraciliochoroidal effusion after trabeculectomy with the use of ultrasound biomicroscopy. METHODS: In a prospective study, 28 eyes of 19 patients with primary open-angle glaucoma that underwent trabeculectomy were evaluated preoperatively and postoperatively by ultrasound biomicroscopy. RESULTS: Four eyes showed a hypoechogenic suprachoroidal space that remained stable for 6 months postoperatively. These four eyes had intraocular pressures of 11 mm Hg or less on no antiglaucoma medications and without signs of choroidal detachment. CONCLUSION: Ultrasound biomicroscopy proved to be a useful method of detecting, after trabeculectomy, supraciliochoroidal fluid without clinically detectable choroidal detachment. This fluid may signify an iatrogenic cyclodialysis during surgery or, less likely, subclinical ciliochoroidal detachment.

Iris metastasis from endometrial carcinoma.

PURPOSE: To report a case of metastasis to the iris from endometrial carcinoma. METHOD: Case report. A 67-year-old woman with a history of endometrial carcinoma and local recurrence after surgery presented 11 months later with two yellow-pink nodules on the iris of the right eye. RESULTS: Systemic medical evaluation demonstrated no other metastases. The iris tumors were removed surgically, and histology demonstrated adenocarcinoma consistent with endometrial carcinoma. CONCLUSIONS: Endometrial carcinoma can metastasize to the iris. This possibility should be considered because the frequency of endometrial carcinoma is increasing.

Changes in anterior chamber depth and angle width after filtration surgery: a quantitative study using ultrasound biomicroscopy.

PURPOSE: To evaluate the anterior chamber configuration by means of ultrasound biomicroscopy in patients with glaucoma and control subjects, and to determine quantitative changes in this configuration after glaucoma filtration surgery (trabeculectomy) and combined cataract and filtration surgery. METHODS: The study included 33 eyes of 33 patients with glaucoma (diagnosed with primary open-angle or exfoliative glaucoma) in which filtration surgery (n = 17) or combined cataract and filtration surgery (n = 16) was performed, and 25 eyes of 25 age-matched control subjects. Ultrasound biomicroscopy was used to measure anterior chamber depth and the angle width at 500 microm from the scleral spur in all eyes. The patients with glaucoma were examined 2 days before surgery and 3 and 6 months after surgery. RESULTS: There were no significant differences in anterior chamber depth and angle width between patients with glaucoma before surgery and control subjects. Postoperative values for anterior chamber depth were significantly greater in patients with glaucoma who underwent combined surgery, but no significant changes were observed in those who underwent filtration surgery alone. In contrast, angle width was significantly greater after surgery both in patients who underwent combined surgery and in those who underwent filtration surgery alone. CONCLUSION: On ultrasound biomicroscopic evaluation, there were no differences in anterior chamber depth and angle width between patients with glaucoma and control subjects. Trabeculectomy alone widens the angle but does not affect the anterior chamber depth; however, combined surgery both deepens the anterior chamber depth and widens the angle.

Simultaneous bilateral "malignant glaucoma" attack in a patient with no antecedent eye surgery or miotics.

Malignant glaucoma is a term commonly used to describe a condition characterized by a sudden increase in intraocular pressure, usually occurring after eye surgery. This report describes a case of malignant glaucoma simultaneously presenting in both eyes, with no antecedent eye disease, medication or surgery. As far as we know this is the first report of spontaneous bilateral glaucoma. Both eyes were operated on according to the technique described by Chandler et al. (1), and the condition was solved. We suggest that, despite its rarity in eyes with no antecedent disease or ocular therapy, a surgeon should be aware of this condition.

Granular cell tumor of the eye (myoblastoma): ultrastructural and immunohistochemical studies.

The clinical and pathological characteristics of a myoblastoma of the orbital are described. The tumor presented as a painless hard mass in the left orbit of a 56-year-old caucasian male, causing diplopia and hypertrophy of the left eye in the primary visual position. Light microscopy studies revealed a typical granular cell tumor with PAS-positive intracytoplasmic granules. Immunoperoxidase studies showed positivity for S-100 protein and desmin. Electron microscopy studies showed numerous intracellular myelin degenerative bodies. The patient developed an epidermoid cyst at the site of initial surgery, but has no signs of local or distant disease two years after initial treatment.

Repair of scleral perforation with preserved scleral and amniotic membrane in Marfan's syndrome.

To describe the surgical technique used in the repair of a large scleral perforation in a patient with Marfan's syndrome and a past history of various surgical interventions in both eyes. Scleral homograft and amniotic membrane transplant were used to reconstruct the large scleral defect present in his left eye. One month after surgical intervention, the patient showed excellent restoration of the scleral perforation without signs of inflammation or infection. The combination of scleral homograft and amniotic membrane transplant constitute an effective alternative to autologous scleral and conjunctival grafts when these cannot be used.

[Functional consequences of focal photocoagulation in diabetic macular edema]. / Retentissement fonctionnel de la photocoagulation focale dans l'oedème maculaire diabétique.

We studied the iatrogenic effect of focal photocoagulation in the treatment of diabetic macular edema in 74 eyes followed from 1 to 6 months. We measured visual acuity, Amsler test and static perimetry, before and after photocoagulation. In the same periods we obtained retinographies. One month after photocoagulation visual acuity was the same or better in 97.2% of the patients followed and after six months in 95.5%. Hard exudates diminished or disappeared in 48.5% of the patients in the first month, in 77.2% in the third month and in 82.4% of the patients followed during six months. In the analysis of static perimetry we found that 33% of the patients showed absolute scotomas, 40% of the patients showed relative scotomas related to photocoagulation areas. The exploration with Amsler test showed that 9% of the patients had absolute scotomas and 41% relative scotomas.

[Retinitis pigmentosa: results of rhodopsin gene analysis in the Galician population]. / Retinosis pigmentaria: resultados del análisis del gen de la rodopsina en la población gallega.

PURPOSE: Retinitis pigmentosa (RP) is the most prevalent inherited degeneration in the retina. The clinical manifestations are variable in terms of severity, age of onset and progression. The clinical variation is paralleled by genetic heterogeneity (more than 20 different loci have been described to date). The aim of this work was to identify mutations in rhodopsin gene and to determine the frequencies of the different genetic forms of RP in the Galician population. METHODS: 47 previously diagnosed RP patients and their relatives were studied. Genetic forms of RP were identified by recording full family history and clinical examination. DNA samples from patients with RP and control individuals were screened for point mutations in the rhodopsin gene by using PCR SSCPs (Single Strand Conformation Polymorphisms) and direct sequencing in 36 unrelated nonsyndromic RP patients. RESULTS: We report the frequency distribution of the different genetic RP forms. In the SSCPs analysis of rhodopsin gene we found different mobility shifts: one variant in the 5'-untranslated region of the gen and one variant in the third intron. Direct sequencing revealed an A269-->G and an C3982-->T transitions, respectively. Additionally, we observed a single base change in codon 160 (C-->A) of this gene. CONCLUSIONS: Polymorphisms are commom findings in the exon 1 and 3 of rhodopsin gene. They are neutral variations and do not represent a change in the protein. No significant differences in the frecuencies of A269-->G and C3982-->T polymorphisms among the three groups of RP patients (ADRP, ARRP, Esporadic RP) and normal individuals were found. There was no significant deviation from Hardy-Weinberg's equilibrium in each genotype in any group.

Novel splice donor site mutation in MERTK gene associated with retinitis pigmentosa.

BACKGROUND/AIM: Mutations in MERTK, a member of the MER/AXL/TYRO3 receptor kinase family, have been associated with disruption of the Retinal Pigment Epithelium (RPE) phagocytosis pathway and settling of autosomal recessive RP (arRP) in humans. This study reports a novel MERTK mutation (IVS16+1G>T) in a Spanish consanguineous family presenting arRP. METHODS: 21 genes were screened by high-throughput SNP multiplexing assay. Subsequent direct sequencing was performed in exons and intronic boundaries of the cosegregating gene. The effect of the mutation in mRNA splicing was confirmed by cDNA analysis. RESULTS: Haplotypic data revealed MERTK cosegregation with RP in affected individuals. MERTK sequencing showed a G-to-T substitution at the first nucleotide of intron 16. Finally, cDNA analysis confirmed the lack of exon 16 in the mRNA splicing process. CONCLUSIONS: IVS16+1G>T disrupts the splice donor site causing exon 16 skipping. Absence of exon 16 causes a frameshift and, subsequently, the introduction of a premature termination codon into exon 17 creating an altered mRNA transcript with a seriously affected tyrosine kinase domain.

Levels of pentosidine in the vitreous of eyes with proliferative diabetic retinopathy, proliferative vitreoretinopathy and retinal detachment.

BACKGROUND: Advanced glycosylation end products (AGEs) are thought to play an important role in the pathophysiology of diabetes. Particularly, these products have been implicated in the pathogenesis of proliferative diabetic retinopathy. The majority of these products are formed from a vast range of precursor molecules, the variable chemical nature of which contributes to AGE heterogeneity. There is a growing population of structurally defined AGE adducts such as pyrraline, pentosidine, CML and crossline that have been found to be elevated in diabetic tissues. In the present study, the levels of the glycoxidation product pentosidine were determined in vitreous samples obtained during vitrectomy from eyes with proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and retinal detachment (RD). Samples from cadaveric control eyes were also included in the study. The levels of pentosidine were compared among the groups. METHODS: Seventy-three vitreous samples were collected from eyes undergoing vitrectomy for PDR (n=33), PVR (n=28) and RD (n=12). Eighteen samples from cadaveric control eyes were also included in the study. A modified Bradford's method was used to assay protein content, and vitreous levels of pentosidine were determined by high-performance liquid chromatography after acid hydrolysis and pretreatment with SP-Sephadex. Statistical analyses were performed using a two-sided Mann-Whitney U test. RESULTS: The levels of pentosidine [median (interquartile range)] were 0.92 (0.55-1.26) pmol/mg of protein in the PDR cases, 1.12 (0.46-1.80) pmol/mg of protein in PVR, and 1.02 (0.24-1.44) pmol/mg of protein in RD. In the cadaveric control eyes pentosidine levels were 0.97 (0.68-1.30) pmol/mg of protein. The pentosidine levels of the four groups did not differ significantly. CONCLUSIONS: The levels of the glycoxidation product pentosidine (expressed as pmol/mg of protein) in the vitreous of eyes with PDR do not differ significantly from those in the vitreous of eyes with PVR, RD or cadaveric control eyes. Although these results do not refute the findings of previous studies that evaluated globally total AGE levels and the existence of diabetic vitreopathy, further investigation is needed to fully understand their relevance in this multifactorial disorder.

Natural evolution of massive vitreous hemorrhage in diabetic retinopathy.

A study of 131 eyes with massive vitreous hemorrhage of diabetic origin showed that 3 months after the hemorrhage visual acuity had improved in 34 eyes (25.9%), was unchanged in 82 (62.6%), and had worsened in 15 (11.4%). The number of eyes improving between 3 and 6 months post-hemorrhage was the same as the number whose visual acuity worsened, 19 (14.5%). After 6 months, the proportion of worsening eyes was much greater than that of improving eyes, so that 2 years post-hemorrhage, 48.8% of the 86 eyes remaining in the study had visual acuity of below hand-movements standard, and 29.1% visual acuity better than hand-movements standard, as against respectively 22.1% and 38.2% of the original 131 eyes 6 months post-hemorrhage.

Histopathological and ultrasound biomicroscopy findings in a case of irreversible mydriasis after keratoplasty in keratoconus.

This report describes the histopathological and ultrasound biomicroscopy findings of a 35-year-old woman with keratoconus who developed an irreversible mydriasis after keratoplasty.

Dynamic register in ocular ultrasonography: combining A- and B-scan techniques.

We present the results obtained after studying two groups of patients with dynamic register techniques, using A-scan, standardised A-scan following Ossoinig's procedure and B-scan. One group comprised 50 patients with retinal detachment and proliferative vitreoretinopathy while the other consisted of 15 patients with choroidal melanoma. In the group of patients with retinal detachment and proliferative vitreoretinopathy 90% of cases demonstrated waves with 100% amplitude on A-scan when the ultrasound beam was directed perpendicularly over the detached retina. Likewise in these same 90% of cases we observed a small split in the wave peak during the after movements. Conversely on B-scan 80% of these patients with retinal detachment and proliferative retinopathy showed retinal mobility. In the group of patients with choroidal melanoma rapid spontaneous movements were detected in the internal echoes on A-scan and standardised A-scan. Moreover in 3 of the 15 cases (those of greatest size) movement could also be detected on B-scan.