Expression of the inducible isoform of nitric oxide synthase in the retinas of human subjects with diabetes mellitus.

PURPOSE: Inducible nitric oxide synthase has been implicated in the pathogenesis of cerebral ischemic damage, in the angiogenic process and in diabetic vascular damage. This study was undertaken to determine whether inducible nitric oxide synthase is present in the retinas from human subjects with diabetes mellitus. METHODS: This was an experimental immunohistochemical prospective study. Ten postmortem eyes from five subjects with diabetes mellitus, 10 eyes from five subjects without diabetes and without known ocular disease, and two eyes from one subject with unilateral ocular ischemic syndrome secondary to severe carotid artery obstruction were examined. We used immunohistochemical techniques and antibodies directed against inducible nitric oxide synthase, glial fibrillary acidic protein, and vimentin. The main outcome measure was immunoreactivity for these antibodies. RESULTS: Immunoreactivity for inducible nitric oxide synthase was not observed in retinas from all subjects without diabetes and without ocular disease. Six retinas from three subjects with diabetes and nonproliferative retinopathy, and the retina from the eye with ocular ischemic syndrome showed immunoreactivity for inducible nitric oxide synthase in cells with elongated processes. Based on morphology and on glial fibrillary acidic protein and vimentin immunoreactivity, this inducible nitric oxide synthase immunoreactivity appeared to localize to retinal Müller glial cells. CONCLUSIONS: These observations suggest that Müller cells may be involved in the microvascular remodeling of the diseased retina and that high concentrations of nitric oxide produced by inducible nitric oxide synthase could contribute to neurotoxicity and angiogenesis that occur in diabetic retinopathy.

Monocyte chemotactic protein-1 in proliferative vitreoretinal disorders.

PURPOSE: To investigate whether the chemokines monocyte chemotactic protein-1 (MCP-1) and interleukin-8 (IL-8) are involved in the pathogenesis of proliferative vitreoretinal disorders and to study their possible interaction with IL-6. METHODS: In a prospective study of 125 consecutive patients (125 eyes), vitreous and paired serum samples were obtained and were assayed for MCP-1 and IL-8. Levels of IL-6 were determined by proliferation of the IL-6-dependent hybridoma cell line 7TD1. RESULTS: Monocyte chemotactic protein-1 was detected in 13 (48%) of 27 vitreous samples from patients with retinal detachment, in five (63%) of eight samples from patients with macular pucker, in 31 (72%) of 43 samples from patients with proliferative vitreoretinopathy, and in 32 (76%) of 42 samples from patients with proliferative diabetic retinopathy, but not in samples from five patients with idiopathic epiretinal membrane. There was a significant (P = .049) correlation between the incidence of MCP-1 detection in retinal detachment, macular pucker, and proliferative vitreoretinopathy groups and the severity of proliferation. Interleukin-8 was detected in two vitreous samples from eyes with retinal detachment, in two samples from eyes with proliferative vitreoretinopathy, and in three samples from eyes with proliferative diabetic retinopathy. Monocyte chemotactic protein-1 levels in the vitreous samples were positively correlated with IL-6 levels (r = .31, P = .01). Interleukin-6 levels were significantly (P = .0097) greater in vitreous samples with than without detectable levels of MCP-1. CONCLUSION: Monocyte chemotactic protein-1 is present in a substantial percent of vitreous samples from eyes with proliferative vitreoretinal disorders and may help in stimulating the infiltration of monocytes and macrophages into eyes with these disorders.

Gelatinase B in proliferative vitreoretinal disorders.

PURPOSE: To investigate whether gelatinases A and B are involved in the pathogenesis of proliferative vitreoretinal disorders. METHODS: In a prospective study of 101 consecutive patients, vitreous and paired serum samples were obtained from 38 patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy, 25 patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy, and 38 patients with proliferative diabetic retinopathy. Gelatinase activities were determined by quantitative zymography. RESULTS: All vitreous samples contained comparable levels of the constitutive gelatinase A. Inducible gelatinase B was detected in eight (32%) of 25 vitreous samples from patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy (mean +/- SD, 319.5 +/- 521.0 scanning units), in 17 (44.7%) of 38 vitreous samples from patients with proliferative vitreoretinopathy (560.6 +/- 718.9 scanning units), and in 34 (89.5%) of 38 vitreous samples from patients with proliferative diabetic retinopathy (1,707.2 +/- 1,220.3 scanning units). The incidence of detection of gelatinase B in proliferative diabetic retinopathy cases was significantly higher than it was in rhegmatogenous retinal detachment with no proliferative vitreoretinopathy and proliferative vitreoretinopathy cases (P < .001). Gelatinase B levels in the vitreous samples of patients with proliferative diabetic retinopathy were higher than the levels found in patients with rhegmatogenous retinal detachment with no proliferative vitreoretinopathy and in patients with proliferative vitreoretinopathy (P = .0152). Gelatinase A was detected in all the tested sera, whereas none of the tested paired serum samples contained detectable gelatinase B activity. CONCLUSIONS: Gelatinase B may play an important role in extracellular matrix degradation associated with neovascularization in proliferative diabetic retinopathy.

Sudden blindness in a child: presenting symptom of a sphenoid sinus mucocele.

A 10-year-old girl with no nasal or respiratory symptoms developed a headache lasting a few hours. The next day she became totally blind in the right eye and over 5 days vision in the left eye deteriorated to bare light perception. The diagnosis of a sphenoid sinus mucocele was made radiologically and drainage via an endonasal sphenoidectomy produced 12 ml of brownish fluid. Endoscopic biopsy of the wall confirmed the diagnosis of a mucocele. Steroid treatment was given postoperatively, but vision recovered to 6/12 in the left eye only. The importance of urgent clinical diagnosis and treatment is stressed.

Treatment of glaucoma in children with Sturge-Weber syndrome.

BACKGROUND: Sturge-Weber syndrome is a rare congenital neuro-oculocutaneous disorder. Ocular involvement can include glaucoma and vascular malformations of the conjunctiva, episclera, choroid, and retina. METHODS: The records of 19 Sturge-Weber syndrome patients (mean age 8.2 years) treated at our institution were reviewed to determine the incidence of ophthalmologic manifestations in Sturge-Weber syndrome. RESULTS: Glaucoma occurred in 42% of all patients and was more frequent in patients with a port-wine stain involving both upper and lower eyelids. Other ocular manifestations included conjunctival/episcleral hemangioma, choroidal hemangioma, iris heterochromia, retinal detachment, strabismus, and homonymous hemianopia. In 7 of 8 patients with glaucoma, topical pharmacotherapy (beta-blockers and carbonic anhydrase inhibitors) alone failed to normalize intraocular pressures. In those patients, cryocoagulation of the ciliary body was performed. Mean postoperative intraocular pressure after a mean follow-up of 4-5 years was <22 mm Hg in 6 patients. CONCLUSIONS: Cryocoagulation of the ciliary body combined with topical medication is an effective and safe treatment option in the management of glaucoma in children with Sturge-Weber syndrome.

[Syndromes of the vitreo-macular interface]. / Syndromes interface vitréomaculaire.

Macular pucker, the vitreomacular traction syndrome and the macular hole are three conditions related to the vitreomacular interface. The role of the vitreous is different for each of these syndromes. Vitreous surgery aims at improving vision in the first two conditions. The role of preventive vitrectomy in the impending macular hole syndrome is still a matter of debate. The authors report their own experience and give a review of the recent literature on the subject.

Pitfalls in the diagnosis of craniopharyngioma: 2 case reports.

Two cases of craniopharyngioma with delayed diagnosis are presented. Patient 1 had mild visual loss that initially had been attributed to pigment epithelial detachment in the macular area. Patient 2 had blurred vision in the left eye, although visual acuity was 10/10 at both eyes. She had a history of a posttraumatic neurosurgical procedure and was treated for blepharospasm. Both patients had initially negative CT imaging. Visual field defects suggested a chiasmal lesion and incited to additional neuroradiological investigation. Magnetic resonance imaging revealed a craniopharyngioma in both cases.

The use of optical coherence tomography in macular diseases.

With optical coherence tomography (OCT), a new technique has emerged that allows imaging of a transverse section of the retina with a resolution that has not been reached by other imaging techniques. The OCT technique can be used in the diagnosis and assessment of various diseases of both the anterior segment and the ocular fundus. This paper demonstrates that OCT can deliver useful information in the diagnosis and follow-up of several macular diseases that cannot be obtained with other fundus imaging techniques. The optical principle of OCT is based on visible-light interference. OCT allows imaging of the anatomical foveal appearance. This normal foveal appearance is disrupted when macular edema occurs, leading to thickening of the neuroretina and cyst formation. The anatomical difference between a neuro-retinal elevation and RPE elevations can be demonstrated using OCT. Epiretinal membranes and pseudo-macular holes can easily be visualized. Perhaps the most interesting addition of OCT in the retinal diagnostic field is the imaging of vitreo-macular traction syndromes and staging of macular holes, which are both difficult with ophthalmoscopy and fluorescein-angiography. Each of the above mentioned macular diseases will be illustrated by a typical case.

Management of psoteriorly dislocated crystalline lenses or lens fragments.

The authors conducted a retrospective study during a 4-year period (jan. 91-dec. 94) of the charts of 26 patients (27 eyes) treated by pars plana vitrectomy for posteriorly dislocated crystalline lenses or lens fragments. One patient had a spontaneous lens luxation on both eyes and 3 patients presented with a posttraumatic dislocation of their lens. Twenty one eyes had retained intravitreal lens material after cataract surgery and 1 after perforating injury. Six eyes received an intraocular lens (IOL) at the end of the vitrectomy procedure; in 11 eyes an IOL had already been inserted at the time of primary cataract surgery. Ten eyes were left aphakic. Surgical details and visual outcome are discussed.

Non-arteritic anterior ischemic optic neuropathy and refraction.

A small cup-disk ratio has been reported as a risk factor in non-arteritic anterior ischemic optic neuropathy. Hyperopia is possibly related with a small cup-disk ratio. The purpose of the present study is to compare the refraction of 37 eyes with non-arteritic anterior ischemic optic neuropathy with a sex and age matched control group of 74 eyes. In our study, mild hyperopia was more frequently observed in the anterior ischemic optic neuropathy group than in the control group.

Hyaluronidase induced orbital pseudotumor as complication of retrobulbar anesthesia.

The authors describe 5 patients who developed an orbital pseudotumor as a complication of retrobulbar anesthesia. Allergy tests revealed a hypersensitivity to hyaluronidase, suggesting an immunoallergic etiology of the pseudotumor, which needed to be differentiated from other causes of proptosis after retrobulbar injection.

[Detachment with giant tear]. / Décollement sur déchirure géante.

The authors report their experience in treating 39 eyes in 36 patients suffering a retinal detachment with giant tear. Follow-up has been from 7 to 54 months with a mean of 25 months. The different surgical procedures are compared and evaluated.

Diplopia from skew deviation in Ramsey-Hunt syndrome. A case report.

OBJECT: Presentation of a 34-year-old pregnant woman with skew deviation due to peripheral vestibular dysfunction caused by herpes zoster oticus. METHODS: A multidisciplinary approach (neuroophthalmology, otorhinolaryngology, neuroradiology) revealed the diagnosis of Ramsey-Hunt syndrome. CASE REPORT: The patient presented with painful herpes zoster vesicles of the left ear, associated with a rotatory vertigo and hearing loss. Otorhinolaryngological examination showed a unilateral peripheral vestibular loss, a nystagmus towards the unaffected right side, no facial nerve dysfunction and a left perception hearing loss, mainly in the frequencies between 2-6 KHz. The patient was treated with Zovirax IV. Neuroradiological examination (MRI without contrast) revealed no abnormalities. Vertical diplopia from skew deviation was noted +/- 10 days after onset of herpes zoster oticus. Neuroophthalmological and orthoptic examination showed a comitant right hypertropia of 6 diopters and a spontaneous nystagmus to the right. CONCLUSION: Skew deviation can be caused by a sudden unilateral cochleo-vestibular loss as described by A.B. Safran. (4,6,7,8).

Retrolental white mass.

From 1985 till 1990 twenty-three children aged seven weeks to six years presented with a retrolental white mass. Six children had retinoblastoma, six Coats' disease, five retinopathy of prematurity, four persistent hyperplastic primary vitreous, one cysticercosis and one retinal detachment. Retinoblastoma and Coats' disease was only seen in children over eight months, whereas persistent hyperplastic primary vitreous and retinopathy of prematurity all presented before the age of six months. Differentiation between Coats' disease and retinoblastoma is not always easy. Most helpful for the diagnosis is to perform funduscopy under general anaesthesia with special attention to the vasculature. Ultrasounds are helpful, but can give confusing results. Cytological analysis of subretinal fluid is useful in Coats' disease.

Septo-optic dysplasia.

The authors present three patients with the diagnosis of septo-optic dysplasia or 'de Morsier' syndrome. They stress the important role of the ophthalmologist in the diagnosis. With the advent of MRI, subtle central nervous system abnormalities have been recognized. A close ophthalmological and endocrinological follow-up is necessary.

Four cases of Wolfram syndrome: ophthalmologic findings and complications.

The association of diabetes insipidus, diabetes mellitus, optic atrophy and deafness (DIDMOAD) is known as Wolfram syndrome. The ophthalmic signs are progressive decrease in visual acuity, constriction of the peripheral visual field with or without central scotoma, colour vision disturbances and bilateral optic disc atrophy. Diabetic retinopathy is a rare complication. We describe the ophthalmological complications in four patients with this syndrome.

Therapeutic possibilities and limits of vitreoretinal surgery after expulsive choroidal hemorrhage.

The aim of this retrospective study was to demonstrate that in certain cases of expulsive choroidal hemorrhage (ECH) anatomical success and useful vision can be obtained with repeated vitreoretinal surgery. The authors report on their experience in 8 patients who were treated following ECH over the past 3 1/2 years. Three types of ECH could be identified. Two cases with massive hemorrhage and expulsion of retinal tissue (type 1) developed phthisis bulbi. Five patients with vitreous loss and an abolished vitreous cavity due to the extent of the ECH (type 2) needed early and usually several interventions to achieve a stable anatomical and functional outcome. Three out of the 4 cases who were anatomically successful had useful vision (1/10, 2/10 en 8/10). One patient with a less extensive choroidal hemorrhage and a partially preserved vitreous cavity (type 3) had a visual acuity of 8/10 after the intervention.

Spontaneous evolution of stage I and II macular holes.

To ascertain the natural outcome of stage I impending and stage II macular holes, 28 eyes (26 patients) were reviewed and followed up for an average of 23 months. Of the 21 stage I lesions, 10 (47.6%) progressed and the others regressed. In the stage II group (9 eyes), 5 lesions (55.5%) progressed, 2 (22.2%) regressed and 2 (22.2%) remained stable during a follow-up period of 7.75 months. Patients with stage II macular holes seem to be more likely to benefit from surgery than patients with stage I lesions. However, even in stage II macular holes, regression may be observed and the possible benefit from surgery must be weighed against the known complications and risk factors.

"Optic neuritis": a masquerading disease.

Optic neuritis is a clinical entity with specific characteristics. Many disease can be associated with the symptomatology. We retrospectively selected the files of 16 persons out of 60 optic neuritis patients. Selection was based on the detection of a non-common etiology. As underlying etiology for "optic neuritis" we found e.g.: histiocytosis, intracerebral aneurysm, spongioblastoma.

Bromovinyldeoxyurdine treatment of outer retinal necrosis due to varicella-zoster virus: a case-report.

In December 1995, a 70-years old male was referred to us because of rapid visual loss in the right eye, one month after a central retinal artery occlusion in the left eye. This renal transplant patient, with limited renal function, was on immunosuppressive therapy. The diagnosis of bilateral progressive outer retinal necrosis (PORN) due to varicella-zoster virus (VZV) was confirmed by polymerase chain reaction (PCR) detection of VZV DNA in the aqueous fluid. As retinitis progressed despite of intravenous acyclovir administration, the antiviral therapy was switched to oral bromovinyldeoxyuridine (BVDU). This case-report demonstrates that oral BVDU can be a good alternative to acyclovir for the treatment of VZV retinal infections.