Outcomes of extremely premature infants related to their peak serum bilirubin concentrations and exposure to phototherapy.

OBJECTIVES: To analyze, in extremely low birth weight infants, associations between peak bilirubin concentration and evidence of brain damage, and between peak bilirubin concentration and blindness attributable to retinopathy of prematurity. METHODS: Retrospective study of 128 infants of /=9.4 mg/dL (odds ratio [OR] confidence interval [CI] 4.48 [1.15-17.43])), low gestational age (OR [CI] per week 1.95 [1.05-3.63]), and longer duration of phototherapy (OR [CI] per 10 hours 1.17 [1.02-1.33]). The association of neurodevelopmental impairment with grades 3 and 4 intraventricular hemorrhage was statistically significant (OR 5.39 [1.83-15.84]), but with high-peak serum bilirubin concentration >/=11.7 mg/dL (>/=200 micromol/L), was not significant (OR 2.89 [0. 87-9.53]). CONCLUSIONS: In these infants, prolonged phototherapy and low-peak serum bilirubin concentrations were associated with severe visual loss attributable to retinopathy of prematurity. The findings should be interpreted with caution until the evidence is reinforced in other patient populations.

Management of ophthalmic complications of homocystinuria.

OBJECTIVE: To determine the safety and efficacy of surgical versus medical management in the treatment of ophthalmic complications of homocystinuria, and also to document ocular complications of homocystinuria other than lens dislocation. DESIGN: Retrospective case series. PARTICIPANTS: Forty-five patients with ophthalmic complications of homocystinuria participated. INTERVENTION: Eighty-four surgical procedures were performed on 40 patients. There were 82 procedures done with the patients under general anesthesia and 2 with the patients under local anesthesia. Medical therapy was attempted initially in all patients with lens dislocation and was the sole therapy used for five patients. MAIN OUTCOME MEASURES: Complications resulting from medical or surgical treatment and final visual acuity were studied. RESULTS: All patients had a history of lens subluxation or dislocation. Fourteen (31%) were receiving dietary treatment at the time of presentation and 29 (64%) were mentally retarded. Eighty-two procedures were performed with the patients under general anesthesia with 2 surgical complications and 1 postsurgical complication. Lens dislocation into the anterior chamber was the most frequent indication for surgery (50%) followed by pupillary block glaucoma (12%). Prophylactic peripheral iridectomy was not successful in preventing lens dislocation into the anterior chamber in five patients. Anesthetic precautions such as stockings to prevent deep venous thrombosis, preoperative hydration, or aspirin were given in 85% of cases. Other common ophthalmic complications found include optic atrophy (23%), iris atrophy (21%), anterior staphylomas (13%), lenticular opacities (9%), and corneal opacities (9%). CONCLUSION: Laser iridectomy was unsuccessful in preventing lens dislocation into the anterior chamber. With appropriate anesthetic precautions and modern microsurgical techniques, the risks associated with the surgical management of ocular complications of homocystinuria are reduced. Surgical treatment should be considered, especially for cases of repeated lens dislocation into the anterior chamber or pupillary block glaucoma. If a conservative, nonsurgical approach is undertaken, these patients must be observed carefully for repeat episodes of lens dislocation.

Fibroblast and endothelial outgrowth from human Tenon's explants: inhibition of fibroblast growth by 5HT receptor antagonism.

Tenon's layer capsule is a major source of fibroplasia associated with post-traumatic wound healing in the external eye and failure of filtration surgery for glaucoma (trabeculectomy). We have investigated the cell types involved in outgrowth from human Tenon's layer explants in culture. Outgrowth from explants maintained in fetal bovine serum (5%) and fibroblast conditioned medium (25%) consisted of endothelial cells exhibiting factor VIII antibody staining and were located to sectioned capillary ends. In media supplemented with human serum (10%), fibroblast outgrowth was observed from the entire perimeter of explants. The mitogenic stimulus of human serum on fibroblasts, monitored by 3H-thymidine uptake, was dose-dependent and accompanied by a 200% increase in inositol phosphate production. 5HT induced a significant increase in fibroblast proliferation and 5HT receptor antagonism with methysergide (20 microM) reduced serum-induced mitogenesis by 30%. These findings support the role of fibroblasts in failure of filtration surgery for glaucoma and suggest a role for 5HT in serum-derived Tenon's fibroplasia.