Visual functioning and quality of life in the SubFoveal Radiotherapy Study (SFRADS): SFRADS report 2.

AIMS: To determine whether or not self reported visual functioning and quality of life in patients with choroidal neovascularisation caused by age related macular degeneration (AMD) is better in those treated with 12 Gy external beam radiotherapy in comparison with untreated subjects. METHODS: A multicentre single masked randomised controlled trial of 12 Gy of external beam radiation therapy (EBRT) delivered as 6 x 2 Gy fractions to the macula of an affected eye versus observation. Patients with AMD, aged 60 years or over, in three UK hospital units, who had subfoveal CNV and a visual acuity equal to or better than 6/60 (logMAR 1.0). METHODS: Data from 199 eligible participants who were randomly assigned to 12 Gy teletherapy or observation were available for analysis. Visual function assessment, ophthalmic examination, and fundus fluorescein angiography were undertaken at baseline and at 3, 6, 12, and 24 months after study entry. To assess patient centred outcomes, subjects were asked to complete the Daily Living Tasks Dependent on Vision (DLTV) and the SF-36 questionnaires at baseline, 6, 12, and 24 months after enrolment to the study. Cross sectional and longitudinal analyses were conducted using arm of study as grouping variable. Regression analysis was employed to adjust for the effect of baseline co-variates on outcome at 12 months and 24 months. RESULTS: Both control and treated subjects had significant losses in visual functioning as seen by a progressive decline in mean scores in the four dimensions of the DLTV. There were no statistically significant differences between treatment and control subjects in any of dimensions of the DLTV at 12 months or 24 months after study entry. Regression analysis confirmed that treatment status had no effect on the change in DLTV dimensional scores. CONCLUSIONS: The small benefits noted in clinical measures of vision in treated eyes did not translate into better self reported visual functioning in patients who received treatment when compared with the control arm. These findings have implications for the design of future clinical trials and studies.

Metabolic fates of ammonia-N in ruminal epithelial and duodenal mucosal cells isolated from growing sheep.

The objective of this experiment was to determine the capability of ruminant gut tissues to detoxify ammonia-N using short-term incubations of isolated cells in vitro. Ruminal epithelial cells (REC) and duodenal mucosal cells (DMC) were isolated from growing Texel-Polypay ram lambs (n = 4) fed a pelleted forage:concentrate-based diet. Immediately after isolation, primary cells were incubated for 60 min with glucose (1mM), glutamate (1mM), [15N]ammonium chloride (5, 10, 20, or 40 mM), and 1 of 4 combinations of substrates (1 mM each) that could support urea synthesis [control, N-carbamoylglutamate (NCG); NCG + ornithine (ONCG); and ONCG + aspartate (AONCG)]. Treatments were arranged in a 4 x 4 factorial design. Incorporation of ammonia-15N into alanine, citrulline, arginine, and urea was determined by gas chromatography-mass spectrometry. For both cell types, ammonia-N transfer to alanine was lower when incubation medium contained NCG compared with control, whereas use of ammonia-N for net alanine synthesis increased quadratically with ammonia concentration regardless of substrate treatment. For REC, ammonia-N was not incorporated into citrulline, arginine, or urea, nor into arginine or urea by DMC. Ammonia-N use for net citrulline synthesis exhibited an inverse relationship with ammonia concentration, decreasing linearly as media ammonia concentration increased. Thus, ala-nine synthesis may be a significant metabolic pathway for ruminant gut tissues to detoxify ammonia-N when it is presented luminally at high concentrations as compared with detoxification by the ornithine-urea cycle. Furthermore, DMC do exhibit a metabolic capability to incorporate ammonia-N into citrulline, but low or absent activity of downstream enzymes of the ornithine-urea cycle appears to limit ammonia-N transfers to urea.

Laser treatment in subjects with high-risk clinical features of age-related macular degeneration. Posterior pole appearance and retinal function.

OBJECTIVES: To verify that a few laser lesions in the posterior pole can cause drusen to resolve in patients with age-related macular degeneration, and to document central retinal sensitivity as drusen resolve. DESIGN: In a pilot study, 12 patients considered to be at high risk for sight-threatening complications from age-related macular degeneration were treated with 12 argon laser lesions in the posterior pole, with review for 12 to 24 months. RESULTS: Choroidal neovascularization developed in 1 patient 8 months after treatment, with consequent loss of central vision. In 9 of the remaining 11 patients, high-risk characteristics of drusen were reduced. Four patients had retinal pigment epithelial depigmentation, and all maintained 20/40 visual acuity at 12 months. One patient lost 3 lines of vision due to geographic atrophy after 12 months. Scotopic retinal threshold was elevated before treatment in 8 patients, compared with an age-matched comparison group. Of these, 4 patients underwent retesting 3 to 6 months after treatment, and all had improved thresholds, but only 1 patient sustained the improvement at 12 months. At 12 months, 3 of the 8 patients showed an improvement in their mean retinal threshold. Of those in whom the mean retinal threshold worsened, the mean elevation in threshold was not more than 0.6 log units. CONCLUSIONS: A few laser lesions in the posterior pole leads to resolution of drusen. There does not appear to be an increased risk for choroidal neovascularization. Retinal threshold measurements show no indication of geographic atrophy at 1 year, but cannot be excluded as a late outcome. Laser treatment may reduce the risk for profound sight-threatening lesions in age-related macular degeneration.

Subfoveal choroidal neovascular membranes in age-related macular degeneration. Visual prognosis in eyes with relatively good initial visual acuity.

We determined the visual prognosis of 94 eyes in 92 patients having age-related macular degeneration, a discrete choroidal neovascular membrane directly under the center of the foveal avascular zone (subfoveal), and an initial visual acuity of 20/100 or better. Of the patients who were reexamined 24 months following their initial presentation, 77% had lost at least four lines of vision and 64% had lost at least six lines. Estimation of visual loss using a conservative assessment procedure showed four-line visual loss in 65% of the patients and six-line loss in 50%. In general, the better the visual acuity at the initial examination, the more likely the patient was to have a smaller choroidal neovascular membrane. These results suggest that it may be reasonable to consider a randomized clinical trial of laser photocoagulation for this group of patients with a relatively poor visual prognosis.

Visual outcomes in the subfoveal radiotherapy study: a randomized controlled trial of teletherapy for age-related macular degeneration.

OBJECTIVE: To determine whether teletherapy with 6-mV photons can reduce visual loss in patients with subfoveal choroidal neovascularization in age-related macular degeneration. DESIGN: A multicenter, single-masked, randomized controlled trial of 12 Gy of external beam radiation therapy delivered to the macula of an affected eye vs observation only. SETTING: Three United Kingdom-based hospital units. PARTICIPANTS: Patients with age-related macular degeneration, aged 60 years and older, who had subfoveal choroidal neovascularization and a visual acuity of 20/200 (logMAR 1.0) or better. METHODS: Two hundred three patients were randomly assigned to radiotherapy or observation. Treatment was undertaken at designated radiotherapy centers, and patients assigned to the treatment group received a total dosage of 12 Gy of 6-mV photons in 6 fractions. Follow-up was scheduled at 3, 6, 12, and 24 months. After excluding protocol violators, the data from 199 patients were analyzed. MAIN OUTCOME MEASURES: The primary outcome measure was mean loss of distance visual acuity in the study eye at 12 and 24 months. Other outcome variables analyzed were near visual acuity and contrast sensitivity. The proportions of patients losing 3 or more or 6 or more lines of distance and near acuity and 0.3 or more or 0.6 or more log units of contrast sensitivity at each follow-up were also analyzed. RESULTS: At all time points, mean distance visual acuity was better in the radiotherapy-treated group than in the control group, but the differences did not reach statistical significance. At 24 months, analysis of the proportions of patients with loss of 3 or more (moderate) (P =.08) or 6 or more (severe) (P =.29) lines of distance vision showed that fewer treated patients had severe losses, but there was no statistically significant difference between groups. For near visual acuity, although there was no evidence of treatment benefit at 12 and 24 months, a significant difference in favor of treatment was present at 6 months (P =.048). When analyzed by the proportions of patients losing 3 lines of contrast sensitivity, there was a significant difference in favor of treatment at 24 months (P =.02). No adverse retinal effects were observed during the study, but transient disturbance of the precorneal tear film was noted in treated patients. CONCLUSION: The results of the present trial do not support the routine clinical use of external beam radiation therapy in subjects with subfoveal choroidal neovascularization in age-related macular degeneration.

Allopurinol inhibition of neutrophilic alveolar response during hyperoxia.

Allopurinol is a potent xanthine oxidase inhibitor that has been administered to animals to protect tissues from oxidant injury. We hypothesized that allopurinol may protect against oxidant injury by inhibiting the inflammatory response. Male Sprague-Dawley rats were injected daily with vehicle or allopurinol and compared with noninjected controls. Animals were exposed to room air or 90% oxygen for 14 days. At the end of the exposure period, all animals were lavaged and bronchoalveolar lavage fluid (BALF) was examined for cell counts, lactate dehydrogenase (LDH), and protein. BALF neutrophils were significantly increased in oxygen-exposed noninjected controls (33 +/- 7 x 10(3)/mm3) and also in the vehicle-inoculated oxygen-exposed animals (43 +/- 6 x 10(3)/mm3). Allopurinol treatment resulted in a decrease in the neutrophilic alveolar response in oxygen-exposed animals (5.3 +/- 4 x 10(3)/mm3, P < 0.001). These data reveal that oxygen exposure produces a neutrophilic alveolar response that is attenuated by allopurinol treatment. BALF protein and LDH were significantly increased in all inoculated and noninoculated oxygen-exposed animals compared with air-exposed animals. Therefore, allopurinol decreases the neutrophilic alveolar response produced by a hyperoxic exposure in the rat but does not decrease lung injury as assessed by alveolar LDH and protein release.

Central serous retinopathy in a 7-year-old girl.

A 7-year-old girl experienced sudden loss of central visual acuity in one eye. Ophthalmoscopy disclosed a serous detachment of the sensory retina, and fluorescein angiography showed many areas of focal dye leakage through the pigment epithelium. Visual acuity returned to 6/7.5 (20/25), and the subretinal fluid was reabsorbed completely over the next two months. To our knowledge, this is the youngest patient with central serous retinopathy ever described.

Idiopathic preretinal gliosis.

Of 89 patients with idiopathic preretinal gliosis examined between 1970 and 1978, 52 were examined within six months of the onset of symptoms. Forty-seven patients were men and 42 were women; 83 (93%) were more than 50 years old. Initial visual acuities were 6/12 (20/40) or better in 60 of 98 eyes (61%). Nine patients had initial bilateral involvement, and the second eye became involved in one other patient during the follow-up period. Posterior vitreous detachment was present in 59 of the 64 eyes (92%) for which the state of the vitreous had been recorded; 16 of 74 eyes (21%) had fluorescein leakage into the macula. During a mean follow-up period of 31.1 months, the appearance of the fundus remained unchanged in 65 of 72 eyes (90%). Fifty-one of the 72 eyes (71%) had final visual acuities within one line of those recorded at the first examination. Spontaneous improvement of two lines or more occurred in only two patients, accompanied in both cases by an apparent decrease in the severity of the retinal wrinkling. Although these data indicated that idiopathic preretinal gliosis is generally a nonprogressive condition that does not cause serious visual loss, those patients followed up for more than three years did have a small overall decline in visual acuity.

Hemorrhagic complications of optic nerve drusen.

We found hemorrhages in 13 eyes of 57 patients with optic disk drusen. In seven eyes, the hemorrhages originated in peripapillary choroidal neovascular membranes. In the other six eyes, no neovascular membrane was present. Hemorrhages that occurred in the absence of choroidal new vessels caused no visual symptoms in any patient. All resolved without sequelae. Hemorrhages originating in choroidal neovascular membranes commonly caused visual symptoms; however, six of seven eyes retained visual acuities of 6/12 (20/40) or better without any therapy. Thus, despite potential submacular hemorrhage, we do not recommend routine photocoagulation for peripapillary choroidal neovascular membranes secondary to optic disk drusen.

Fluorescein angiographic abnormalities after prophylactic macular photocoagulation for high-risk age-related maculopathy.

PURPOSE: Initial studies suggest that drusen associated with age-related maculopathy resolve in response to laser photocoagulation; there are conflicting reports regarding whether this treatment might prevent neovascular complications and blindness. The goal of the Drusen Laser Study is to maintain good visual acuity in eyes at the highest risk for neovascular complications of age-related maculopathy. In this report, we alert the ophthalmic community to possible laser-induced complications in patients treated within the context of this clinical trial. METHODS: A double-masked, randomized, controlled clinical trial of prophylactic macular photocoagulation for high-risk age-related maculopathy is in progress. Patients randomly assigned to treatment received a ring-type distribution of 12 light spots of argon laser photocoagulation. Drusen were treated directly only if they were present at the protocol treatment locations. Fluorescein angiography was performed in all patients at yearly review, and at nonprotocol visits if symptoms or clinical examination were suggestive of choroidal neovascularization. RESULTS: Fluorescein angiographic abnormalities suggestive of choroidal neovascularization have been seen in treated eyes only: one patient in the pilot study and six patients in the Drusen Laser Study. No fluorescein angiographic abnormalities were seen in eyes of control subjects. CONCLUSIONS: Laser photocoagulation in high-risk age-related maculopathy may induce choroidal neovascularization and, therefore, is not recommended outside the context of a randomized, controlled clinical trial.

Choroidal neovascularization as a late complication of ocular toxoplasmosis.

Macular detachment caused by choroidal neovascularization in eyes with previous toxoplasmic infections is one possible explanation of sudden loss of visual acuity. Three patients with quiescent chorioretinal scars, presumed to be toxoplasmic in origin, developed choroidal neovascular membranes that caused sudden loss of visual acuity. In none of the three cases was there any ophthalmoscopic evidence of intraocular inflammation. In two patients, the choroidal neovascularization was subfoveal and, therefore, not suitable for photocoagulation. However, visual acuity in each of the affected eyes was only partially impaired (6/15 [20/50] in one patient and 6/30 [20/100] in the other). In the third patient, the choroidal neovascular membrane was treated with argon-laser photocoagulation. Two months after treatment, visual acuity in that eye was 6/9 (20/30), and there was angiographic evidence that the neovascular membrane had closed.

Prophylactic laser treatment to fellow eyes of unilateral retinal pigment epithelial tears.

PURPOSE: To evaluate prophylactic laser treatment of the macula in reducing the risk of visual loss in the fellow eye of patients with a retinal pigment epithelial tear caused by age-related macular degeneration in the first eye. METHODS: In a prospective study, 12 patients with a retinal pigment epithelial tear in one eye caused by age-related macular degeneration and drusen in the fellow eye received prophylactic laser treatment of the retina in their fellow eyes and were followed up for 2 years or more after prophylactic treatment. RESULTS: In 12 fellow eyes that received prophylactic laser treatment, a reduction in best-corrected visual acuity to 20/80 or worse occurred in one (8%) of 12 eyes in the first year and two (18%) of the remaining 11 eyes in the second year after treatment. The cumulative risk of visual loss in the treated fellow eye was 25% in 2 years. CONCLUSIONS: In historical control subjects in a natural history study of patients with retinal pigment epithelial tear in one eye, central visual loss occurred in 16 (37%) of 43 eyes in the first year and in seven (30%) of 23 eyes in the second year for a cumulative loss of 59% in the first 2 years. Compared with these historical control subjects, our findings suggest that visual loss in the fellow eyes of patients with a retinal pigment epithelial tear in the first eye is reduced by prophylactic low intensity laser photocoagulation of the macula.

Vanishing retinal arterial aneurysms: a case report.

An 18-year-old woman with retinal vasculitis developed multiple retinal arterial aneurysms over a period of 3 years. Subsequently she developed macular oedema, peripheral neovascularisation, and vitreous haemorrhage and was treated with systemic steroids, laser photocoagulation, and vitreoretinal surgery. No systemic cause for vasculitis was found. Serial fluorescein angiography demonstrated gradual resolution of the arterial aneurysms over the subsequent 7 years.

Long-term follow-up of central serous chorioretinopathy.

The Wilmer Retinal Vascular Center's experience with central serous chorioretinopathy from 1970 to the end of 1979 was reviewed and compared with previous studies. Retrospective analysis of 73 patients seen at follow-up suggests no clinically significant effect of focal argon laser photocoagulation on final visual acuity or recurrence rate. Patients with initial visual acuity of 20/20 remained at that level, and patients with initial visual acuity of less than 20/30 gained, on average, two to three Snellen lines at follow-up. Approximately one-third of both untreated and treated patients had recurrence or presumed persistence during the follow-up period. With the inclusion of episodes that occurred before the first Wilmer Institute visit about half of each group had recurrence or presumed persistence. Recurrences were most often due to leakage from a site within one disc diameter of the original site of leakage.

Ocular manifestations in autosomal dominant retinitis pigmentosa with a Lys-296-Glu rhodopsin mutation at the retinal binding site.

A lysine to glutamic acid substitution at codon 296 in the rhodopsin gene has been reported in a family with autosomal dominant retinitis pigmentosa. This mutation is of particular functional interest as this lysine molecule is the binding site of 11-cis-retinal. The clinical features of a family with this mutation have not been reported previously. We examined 14 patients with autosomal dominant retinitis pigmentosa and a lysine-296-glutamic acid rhodopsin mutation. Four had detailed psychophysical and electrophysiological testing. Most affected subjects had severe disease with poor night vision from early life, and marked reduction of visual acuity and visual field by their early forties. Psychophysical testing showed no demonstrable rod function and severely reduced cone function in all patients tested.

Modified atmosphere packaged cheddar cheese shreds: influence of fluorescent light exposure and gas type on color and production of volatile compounds.

The influences of fluorescent light exposure and packaging atmosphere on the headspace volatiles and color of Cheddar cheese shreds were evaluated using gas chromatography-mass spectrometry and spectrocolorimetry, respectively. Cheddar cheeses were packaged under atmospheres of 100% carbon dioxide or 100% nitrogen and stored at 4 degrees C under fluorescent light for 6 weeks. Cheeses stored under carbon dioxide contained higher concentrations of aldehydes and fatty acids and lower concentrations of alcohols and esters than cheeses stored under nitrogen. Carbon dioxide atmospheres potentiated light-induced oxidation in shredded Cheddar cheeses, as evidenced by aldehyde and fatty acid headspace volatiles measured following storage. Color bleaching occurred only in cheeses packaged under carbon dioxide and exposed to light. The shift in color is proposed to be due to an interaction between carbon dioxide and high-intensity light, leading to the oxidation of the pigment molecule, bixin. The results have significant implications for procedures used to handle and store pigmented cheeses to ensure desirable flavor and consumer acceptability.

Effects of high-energy electron irradiation of chicken meat on Salmonella and aerobic plate count.

Four experiments were used to determine the effects of high-energy irradiation on the number of aerobic microorganisms and Salmonella on broiler breasts and thighs. Irradiation ranging from 100 to 700 kilorads (krads) was provided by a commercial-scale, electron-beam accelerator. Irradiation of broiler breast and thigh pieces with electron beams at levels of 100, 200, 300, 400, 500, and 600 krads showed that levels as low as 100 krads would eliminate Salmonella. When 33 thighs were tested after irradiation at 200 krads, only one thigh tested presumptive positive. The total number of aerobic organisms was reduced by 2 to 3 log10 cycles at irradiation levels of 100, 200, 300, 400, 500, 600, and 700 krads. Increasing the dose above 100 krads gave little if any additional benefit.

Effect of high-energy electron irradiation of chicken meat on thiobarbituric acid values, shear values, odor, and cooked yield.

Experiments were conducted to determine whether electron-beam irradiation would affect shear values, yield, odor, and thiobarbituric acid (TBA) values of chicken tissues. Broiler breasts (pectoralis superficialis) and whole thighs were irradiated with an electron-beam accelerator at levels to produce adsorbed doses of 100, 200, and 300 krads on the surface of the sample. The thigh samples were stored for 2, 4, and 8 days before testing for TBA values. The depth to which the radiation had penetrated the pectoralis superficialis muscle was also determined. Radiation penetrated 22 mm into slices of pectoralis superficialis muscle when 100 krad was absorbed by the surface of the tissue. The dose absorbed beneath the tissue surface to a depth of 10 mm was larger than the dose absorbed at the surface. The absorbed dose decreased as the depth of penetration increased. For cooked breast tissue, the shear values and moisture content were not affected by the absorbed radiation. Cooking losses of aged breast tissue were not affected by irradiation, but cooking losses were reduced in breast tissue that had not been aged. Irradiating uncooked thigh and uncooked breast samples produced a characteristic odor that remained after the thighs were cooked but was not detectable after the breast samples were cooked. With two exceptions, no significantly different TBA values were found that could be attributed to irradiation.

Elevated plasma corticosterone concentrations influence the onset of rigor mortis and meat color in broilers.

This experiment was conducted to determine the effect of elevated plasma corticosterone (CORT) levels on meat quality characteristics. Male broilers (Arbor Acres) were either 1) fed a diet containing corticosterone (CORT) prior to processing, 2) transported by truck for 3 h before processing, or 3) processed without either of the above treatments. Six crates of birds (10 birds per crate; two crates per treatment) were stunned or killed using CO2 gas. Six birds per crate were processed and blood samples were collected during exsanguination for plasma CORT analysis. Meat samples were collected from carcasses either at 20 min or at 4 h post-mortem. At each sampling time (ST), Pectoralis superficialis samples were collected and either individually quick frozen (IQF) in liquid nitrogen or aged on ice (AOI) for 24 h prior to pH, ratio of inosine to adenosine nucleotides (R-value), cooking loss, shear value, and color analyses. The IQF Biceps femoris samples were used for pH, R-value, color, and heme pigment analysis. Mean (+/- SEM) CORT concentrations were 12.9+/-2.57, 11.7+/-1.38 and 7.9+/-0.79 ng/mL, respectively, in the CORT, transported, and control groups. There were significant treatment by ST (P < 0.05) and ST (P < 0.001) effects on the R-value of IQF P. superficialis samples. The CORT group had the highest L* value (P < 0.01) and the lowest a* value (P < 0.06). There was also a significant main effect of ST on shear values (P < 0.05) of AOI P. superficialis samples, with the means higher at 4 h than at 20 min post-mortem. The R-value of IQF B. femoris samples was markedly influenced by treatment (P < 0.001) and ST (P < 0.001). The results indicate that artificially elevating circulating CORT concentrations results in lighter meat color in broilers.

Immunological alterations in the lungs of mice following ozone exposure: changes in immunoglobulin levels and antibody-containing cells.

Ozone was added to the air of the environmental chambers containing specific pathogen-free mice. At levels of 0.5 and 0.8 ppm the oxidant was seen to have inflammatory effects, as shown by rising serum albumin levels in lung lavage fluid. Fluorescein conjugated anti-heavy chain sera were used to detect cells containing IgM, IgG, and IgA in measured lung areas termed Pulmonary Units. Antigenic stimuli occurred along the airways, with significant increases of IgA-containing cells in the bronchus-associated lymphoid tissue. The numbers of IgM- and IgG-containing cells did not increase. Immunodiffusion analyses for immunoglobulins in lung lavage fluid indicated increases of IgG1, IgG2, and IgA in lung secretions. The calculation of changing Ig/Alb ratios suggested that the IgA present was largely the result of local synthesis, while IgG molecules were mainly of serum origin. Possible sources of antigenic stimuli to ozone-exposed lungs are discussed.