Radiation-induced eye lens changes and risk for cataract in interventional cardiology.

BACKGROUND: Recent studies have reported a significant increase in eye lens opacities among staff in the cardiac catheterization laboratory but indicated further studies are needed to confirm the findings. OBJECTIVE: To evaluate the prevalence of opacities in eyes of cardiologists, radiographers and nurses working in interventional cardiology. METHODS: The eyes of 52 staff in interventional cardiology facilities and 34 age- and sex-matched unexposed controls were screened in a cardiology conference held in Kuala Lumpur by dilated slit-lamp examination, and posterior lens changes were graded. Individual cumulative lens X-ray exposures were calculated from responses to a questionnaire in terms of workload and working practice. RESULTS: The prevalence of posterior lens opacities among interventional cardiologists was 53%, while in nurses and radiographers it was 45%. Corresponding relative risks were 2.6 (95% CI: 1.2-5.4) and 2.2 (95% CI: 0.98-4.9), for interventional cardiologists and support staff, respectively. CONCLUSIONS: This study confirms a statistically significant increase in radiation-associated posterior lens changes in the eyes of interventional cardiology staff.

Aqueous humour levels of cytokines are correlated to vitreous levels and severity of macular oedema in branch retinal vein occlusion.

AIM: To investigate whether the aqueous levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) are correlated to the vitreous levels of these substances and to the severity of macular oedema in branch retinal vein occlusion (BRVO). METHODS: Aqueous and vitreous samples were obtained during cataract and vitreous surgery from 24 patients (24 eyes) with macular oedema in BRVO. The VEGF and IL-6 levels in aqueous humour, vitreous fluid, and plasma were determined by enzyme-linked immunosorbent assay. The degree of retinal ischaemia was evaluated in terms of the area of capillary nonperfusion using the Scion Image. The severity of macular oedema was evaluated using the OCT. RESULTS: The aqueous level of VEGF was significantly correlated with the vitreous level of VEGF (P<0.0001). Vitreous levels of VEGF and IL-6 were significantly correlated with the nonperfusion area of BRVO (P<0.0001, P=0.0061, respectively), as were the aqueous levels of VEGF and IL-6 (P<0.0001, P=0.0267, respectively). Furthermore, the vitreous levels of VEGF and IL-6 and the aqueous level of VEGF were significantly correlated with the severity of macular oedema of BRVO (P=0.0001, P=0.0331, P=0.0272, respectively). CONCLUSION: Our results suggest that the aqueous level of VEGF may reflect its vitreous level. Measurement of the aqueous level of VEGF may be clinically useful to indicate the severity of macular oedema with BRVO.

Subretinal neovascularization associated with retinochoroidal coloboma.

PURPOSE: To report a case of subretinal neovascularization associated with retinochoroidal coloboma. METHODS AND RESULTS: A 44-year-old female presented with metamorphopsia in her right eye for 4 weeks. Funduscopic examination revealed bilateral inferior retinochoroidal coloboma. Fluorescein angiography disclosed foci of subretinal neovascularization at the margin between the colobomatous defect and the normal-appearing retina. Five month later, multiple small areas of subretinal hemorrhages were noted. The hemorrhage was gradually absorbed. Six years after initial presentation, subretinal hemorrhage did not recur and her right VA was 0.2. CONCLUSIONS: Ophthalmologists should be aware of this rare but important complication of retinochoroidal coloboma.

Cataract in atomic bomb survivors.

PURPOSE: Ophthalmologic examinations were conducted on atomic bomb (A-bomb) survivors 55 years after exposure. MATERIALS AND METHODS: A-bomb survivors who had been exposed before 13 years of age at the time of the bombings in 1945 or who had been examined in a previous study between 1978 and 1980. The examinations, conducted between June 2000 and September 2002, included slit-lamp examination, digital photography and a cataract grading system for three parts of the lens (nucleus, cortex and posterior subcapsule) as an outcome variable. Proportional odds logistic regression analysis was conducted using the lowest grading class as a reference and included explanatory variables such as age, sex, city, dose and various cataract-related risk factors. When the grades in an individual differed, the worst grade was used. RESULTS: Results indicate that odds ratios (ORs) at 1 Sv were 1.07 (95% confidence intervals [CI] 0.90, 1.27) in nuclear colour, 1.12 (95% CI 0.94, 1.30) in nuclear cataract, 1.29 (95% CI 1.12, 1.49) in cortical cataract and 1.41 (95% CI 1.21, 1.64) in posterior subcapsular cataract. The same was true after excluding 13 people whose posterior subcapsular cataracts had been previously detected. CONCLUSION: Significant radiation effects were observed in two types of cataracts in A-bomb survivors.

Characteristics and surgical outcomes of paediatric retinal detachment.

PURPOSE: To report the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the paediatric population. METHODS: A retrospective review of children (aged 0-15 years) who underwent primary surgical repair for RRD at the Hiroshima University Hospital between 1988 and 2001. RESULTS: In all 53 eyes of 49 patients were identified; paediatric RRD accounted for 3.1% of 1779 eyes with RRD operated on during this period. The causes of RRD included blunt trauma (27%), myopia (25%), idiopathic (20%), familial exudative vitreoretinopathy (13%), and others. Among 55 eyes, 12 (22%) already had proliferative vitreoretinopathy (PVR) of grade C or D preoperatively. The median initial visual acuity (VA) was 0.3. Retinal reattachment was achieved with a single operation in 78%. Final retinal reattachment was achieved in 87%. Retinal reattachment rates with and without PVR were 42% and 100%, respectively (P<0.01). Median final VA was 0.7. Final VA was > or =0.1 in 73% and > or =0.5 in 53%; four eyes had a final VA of no light perception. The presence of preoperative PVR (P=0.03) and the initial VA (P<0.0001) significantly affected final VA. CONCLUSIONS: Paediatric RRD is characterised by a delay in diagnosis, as evidenced by the high rate of PVR at presentation. Retinal reattachment was adversely affected by the presence of PVR. Final VA correlated with the initial VA and was significantly affected by preoperative PVR. Early diagnosis may improve the visual prognosis of paediatric retinal detachment.

Growth regulation of bovine retinal pericytes by transforming growth factor-beta2 and plasmin.

PURPOSE: Transforming growth factor -beta2 (TGF-beta2) is a predominant isoform of TGF-betas in the eye and plasmin is a peptidase with many functions. To better understand the pathogenesis of retinal microcirculation disorders, the effects of TGF-beta2 and plasmin on cultured bovine retinal pericytes were investigated. METHODS: Exogenous TGF-beta2 or plasmin was added to some cultures, DNA synthesis during cell cycle progression was investigated using [(3)H]thymidine incorporation. Anti-TGF-beta2 antibody was added to neutralize the effects of TGF-beta2. TGF-beta2 in the culture medium was measured using enzyme-linked immunosorbent assay (ELISA). RESULTS: Exogenous TGF-beta2 (10 pg to 100 ng/mL) suppressed DNA synthesis. Pericytes produced TGF-beta2. Anti-TGF-beta2 antibody neutralized TGF-beta2 and accelerated DNA synthesis, which shows that pericytes regulate their own cell cycle by action of the autocrine and/or paracrine system of TGF-beta2. Plasmin (0.2 to 0.5 U/mL) accelerated DNA synthesis in a dose-dependent manner, while addition of aprotinin, a protease inhibitor, counteracted this effect of plasmin. The concentration of TGF-beta2 in the culture medium decreased with the addition of plasmin. Simultaneous addition of both plasmin and anti-TGF-beta2 antibody accelerated DNA synthesis. High and low glucose concentrations of the culture medium did not affect DNA synthesis. CONCLUSIONS: Our results suggest that TGF-beta2 and plasmin respectively decrease and increase DNA synthesis. In a retinal microcirculation disorder, they may play competitive roles in the cell cycle of pericytes.

Involvement of CD8+ RT1.B+ and CD4+ RT1.B+ cells of cervical lymph nodes in the immune response after corneal transplantation in the rat.

Graft rejection reactions have been observed with concomitant lymphocyte infiltrations after allogenic corneal transplantation, although the cornea is considered to be relatively protected from the systemic immune response. In order to characterize the lymphocytes that accumulate in cervical lymph nodes following transplantation, we used a model of orthotopic penetrating keratoplasty in inbred rats. After grafting, the time course of the pathological scoring was monitored, and subpopulations of CD4+ RT1.5+ and CD8+ RT1.B+ cells were analyzed in the cells harvested from the cervical lymph nodes. The number of CD8+RT1.B+ cells increased 1 week after grafting, reaching the maximum at 3 weeks; whereas CD4+ RT1.B+ cells were induced 1 week after the grafting and remained constant during the next 3 weeks. There were four times as many CD4+ RT1.B+ cells as CD8+ RT1.B+ cells 1 week after grafting when there was no rejection. Therefore, it appears that CD8+RT1.B+ and CD4+RT1.B+ cells in the cervical lymph nodes do participate in ocular immunologic responses.

Ultrasound biomicroscopy in the diagnosis of persistent hypotony after vitrectomy.

PURPOSE: To describe a case of persistent hypotony after an otherwise successful vitreous surgery for epiretinal membrane, in which ciliochoroidal detachment was detected by ultrasound biomicroscopy but not by ophthalmoscopy. METHOD: We used ultrasound biomicroscopy to determine the cause of persistent postoperative hypotony. RESULTS: Ultrasound biomicroscopy clearly disclosed ciliochoroidal detachment. In an attempt to resolve ciliochoroidal detachment, we performed vitrectomy and fluid-gas exchange combined with diathermy around the sites of sclerotomy. Postoperatively, the regression of ciliochoroidal detachment was confirmed by ultrasound biomicroscopy. CONCLUSIONS: Using ultrasound biomicroscopy, we were able to visualize ciliochoroidal detachment and its regression clearly, which we had not observed during ophthalmoscopy.

Postoperative posterior retinal holes after pars plana vitrectomy for primary retinal detachment.

BACKGROUND: Although retinal breaks occur frequently during vitrectomy, the postoperative occurrence of new retinal holes close to the vascular arcade after vitrectomy for rhegmatogenous retinal detachment rarely has been reported. METHODS: Three patients with rhegmatogenous, retinal detachment were treated by vitrectomy. More than 49 days after vitrectomy, posterior retinal holes with no retinal detachment occurred halfway between the vascular arcade and the chorioretinal scar around the extrusion hole or the primary retinal tear. RESULTS: These new holes were effectively managed with photocoagulation. CONCLUSION: New hole formation could be caused by the technique of the internal drainage, the contraction of the photocoagulation scar, or epiretinal membrane contraction. Another possibility is that new holes occur through two opposite tangential traction contractile forces: one induced by the contraction of the photocoagulation scar, the other caused by the contraction of the premacular cortical vitreous attached to the vascular arcade.

Effect of FK 506 administered topically versus intramuscularly on suppression of the corneal immune reaction in rats.

The immunosuppressive effect of FK 506 on penetrating keratoplasty in rats was evaluated following intramuscular and topical administration. Implanted corneal grafts were inspected weekly by clinical evaluation for 3 weeks. Cytotoxic T lymphocyte (CTL) activity was measured in the spleen on postoperative day 21, and the grafts were examined histologically. A dose of FK 506, 0.1 mg/kg given intramuscularly, only moderately suppressed CTL activity and the graft failed. In contrast, doses of either 0.024 mg/day topically or 0.3 mg/kg intramuscularly suppressed CTL activity and the grafts remained intact. Results suggest that FK 506 administered topically would be effective in preventing failure of human corneal grafts.

Bilateral choroidal osteomas associated with histiocytosis X.

A 15-year-old Japanese girl complained of decreased visual acuity in the left eye of 1-month duration. Histiocytosis X had been diagnosed when she was 2 years old based on examination of biopsies of skin and cervical lymph nodes and bone marrow aspirations. She had been in complete remission for 7 years. She exhibited the characteristic ophthalmoscopic, ultrasonographic, and radiologic features of bilateral choroidal osteomas.

Suppression of corneal graft rejection by subconjunctival injection of FK-506 in a rat model of penetrating keratoplasty.

The usefulness of the subconjunctival injection of FK-506 for suppression of allograft rejection was investigated in a rat model of orthotopic penetrating keratoplasty. Fischer rats were used as donors and Dark Agouti rats, as recipients. FK-506 was administered subconjunctivally in a dosage of 0.3 mg/kg/day for 15 consecutive days after penetrating keratoplasty was performed. Allograft rejection occurred within 8 to 10 days after keratoplasty in all untreated rats (n = 6). None of the FK-506-treated rats (n = 6) exhibited graft rejection during the 3-week observation period. Histologic examination showed marked infiltration of mononuclear cells in the stroma of corneal grafts from untreated rats 3 weeks after grafting. Inflammatory cells were only occasionally observed in grafts from FK-506-treated rats. Donor-specific cytotoxic T lymphocyte activity was completely suppressed in FK-506-treated rats 3 weeks after grafting. Our results indicated that subconjunctival injection of FK-506 effectively prevented corneal allograft rejection in a rat model of penetrating keratoplasty.

Computerized tomography of two patients with morning glory syndrome.

Morning glory syndrome (MGS), an uncommon optic disc anomaly, is characterized by a funnel-shaped, excavated optic disc surrounded by chorioretinal pigmentary disturbance. Generally, it is an isolated ocular abnormality. The authors describe two patients in whom MGS developed in association with brain abnormalities. In both cases, there was enlargement of the optic nerve that showed increased radiodensity similar to that of sclera and cavum vergae in the brain cavity present in computerized tomography (CT). To our knowledge, the coexistence of MGS, cavum vergae and an enlarged retrobulbar optic nerve showing increased radiodensity have not been previously reported. The findings suggest that MGS may be based on a developmental anomaly involving the brain, and the enlarged optic nerve may be associated with sclera because of the isodensity in CT.

Retinal detachment with tear in the posterior fundus following ocular contusion.

Two unusual cases of rhegmatogenous retinal detachment following contusion to the eyeball showed retinal tears at the posterior fundus close to the optic disc and the large retinal blood vessels. In both cases, the tears were not detected immediately after the injury due to a coexisting vitreous hemorrhage. Both patients were successfully treated by pars plana vitrectomy, air-fluid exchange, and endolaser photocoagulation. During vitrectomies, an adhesion of the vitreous to the flap or the operculum of the tear was observed, with detachment of the remainder of the posterior vitreous from the retina. Vitrectomy allowed a more complete resolution of posterior tractional forces than scleral buckling, and eliminated the vitreous hemorrhage.

Induction of cytotoxic T lymphocytes from splenocytes after orthotopic penetrating keratoplasty in the rat.

We used a rat model of orthotopic penetrating keratoplasty to study splenic cell cytotoxicity in the host. DA (RT1avl) rats received grafts of Fischer (F344, RT1lv1) rat corneas. Cytotoxic T lymphocyte (CTL) activity was measured by the cell-mediated lymphocytotoxicity assay using 4/4R.M.-4 cells as target cells. CTL activity became detectable in vitro 2 weeks after grafting and peaked at 3 weeks. This simple method of quantifying CTL activity in the orthotopic penetrating keratoplasty model should provide a reliable tool for studying the CTL response in corneal transplantation.