Effective and selective prevention of retinal leukostasis in streptozotocin-induced diabetic rats using gliclazide.

AIMS/HYPOTHESIS: Early stage leukocyte entrapment in the retinal microcirculation (retinal leukostasis) is considered to be one of the important pathogenetic events in diabetic retinopathy. Gliclazide, a sulphonylurea, was reported to reduce leukocyte adhesion to endothelial cells in hyperglycaemia in vitro, thus suggesting possible selective efficacy of this sulphonylurea in preventing leukostasis in diabetic patients. This study evaluated the effectiveness and selectivity of gliclazide treatment on retinal leukostasis of diabetic rats in vivo. METHODS: Streptozotocin (STZ) (65 mg/kg)-induced diabetic rats were divided into three groups (n = 8 each): an untreated diabetic group, a gliclazide-treated diabetic group, and a glibenclamide-treated diabetic group. Gliclazide or glibenclamide was administered orally during a 3-week period. Non-diabetic rats were used as a control (n = 8). Retinal leukostasis was quantitatively evaluated in vivo by acridine orange leukocyte fluorography using a scanning laser ophthalmoscope. RESULTS: The number of leukocytes trapped in the area around the optic disc in the untreated diabetic group (36.9 +/- 5.1 cells) increased significantly compared with the non-diabetic control group (21.9 +/- 2.9 cells; p = 0.0007). The number of leukocytes trapped in the gliclazide-treated diabetic group (23.5 +/- 4.0 cells) decreased significantly compared with untreated diabetic group ( p = 0.0008). In contrast, no reduction of retinal leukostasis was found in the glibenclamide-treated diabetic group (37.8 +/- 5.8 cells; p = 0.7923). CONCLUSION/INTERPRETATION: This suggests that gliclazide could directly improve abnormalities in the retinal microcirculation independent of blood glucose control and possibly have selective therapeutic benefits in preventing early, critical events in diabetic retinopathy compared with other sulphonylurea drugs.

Stromal keratitis and anterior uveitis due to herpes simplex virus-2 in a young child.

BACKGROUND: An uncommon case of stromal keratitis and anterior uveitis due to herpes simplex virus type 2 (HSV-2) is reported. CASE: The patient was a 3-year-old boy admitted for conjunctival injection of the right eye of unknown cause, accompanied by corneal opacity and anterior uveitis. OBSERVATIONS: High titers of antibodies against HSV and Epstein-Barr virus (EBV) were found in blood samples. Polymerase chain reaction (PCR) for the detection of HSV-1, -2, and EBV genome fragments was carried out using an anterior chamber sample as a template. An HSV-2 genome fragment was amplified by PCR. Administration of acyclovir and betamethasone was started, with the consequent elimination of corneal opacity, inflammatory cells, and keratic precipitates. CONCLUSION: PCR clearly showed that HSV-2 was the causative pathogen of the stromal keratitis and anterior uveitis in this young patient. Systemic EVB infection may induce systemic immunocompromised conditions that can lead to reactivation of HSV-2 followed by ocular disorders.

Combined system of biomicroscopic vitreous videography and photography.

PURPOSE: To combine the techniques of biomicroscopic vitreous videography and vitreous photography when examining patients with age- or disease-related vitreous changes. METHODS: We performed biomicroscopic vitreous videography and photography using the newly developed digital photo camera (one-half-inch three-charged coupled device camera with high resolution of 800 x 800 television lines) connected to a slit-lamp biomicroscope and compared it with conventional 35-mm slit-lamp photography in 24 consecutive eyes of 19 patients with idiopathic macular breaks. RESULTS: Stage 1 macular breaks were found in three eyes, stage 2 in four eyes, stage 3 in 11 eyes, and stage 4 in six eyes. Both vitreous videographs and still photographs were recorded and reviewed rapidly in one system. Using this system, dynamic vitreous changes and still vitreous images were documented clearly with real-time television monitoring without using flash illumination. The still images obtained from this system were better than those obtained using conventional 35-mm slit-lamp photography in cases with stage 1, 2, and 3 macular breaks (P = 0.0000000001 by Fisher's exact test). CONCLUSION: This combined system of biomicroscopic vitreous videography and photography may become the standard system of biomicroscopic vitreous examination.

[Long-term visual prognosis after successful vitrectomy for proliferative diabetic retinopathy].

We evaluated visual prognosis in 50 eyes of 47 patients which underwent successful vitrectomy for proliferative diabetic retinopathy and were followed for more than five years. It was found that the latest visual acuity was worse than the best visual acuity by more than three lines after vitrectomy in 14 eyes (28%) except for the eyes with decreased vision due to cataract. The causes of decrease in visual acuity were optic atrophy in seven eyes, macular degeneration in five eyes, branch retinal vein occlusion in one eye, and submacular hemorrhage in one eye. Risk factors for postoperative decrease in visual acuity were thought to be preoperative macular detachment, subretinal proliferation, and postoperative high intraocular pressure. Therefore, even after successful vitrectomy, there is some risk that the best postoperative visual acuity may deteriorate in cases with severe preoperative retinopathy with these risk factors. This finding suggests that the vitrectomy should be performed before the development of these risk factors for the maintenance of good postoperative visual acuity.

Predictive value of floaters in the diagnosis of posterior vitreous detachment.

PURPOSE: To evaluate Weiss ring and floaters as indexes of posterior vitreous detachment. METHODS: Using biomicroscopy and indirect ophthalmoscopy, we examined the posterior vitreous in 200 consecutive eyes with posterior vitreous detachment. RESULTS: In 200 eyes with posterior vitreous detachment, biomicroscopy disclosed complete, incomplete, and no Weiss ring in 102 (51%), 72 (36%), and 26 (13%) eyes, respectively. Indirect ophthalmoscopy showed the glial ring in 58 (56.9%) and 16 (22.2%) of the eyes, with a complete (102 eyes) and incomplete (72 eyes) Weiss ring, respectively. Although the incidence of floaters was significantly correlated with the presence of the glial ring (P = .0014), 60 (58.8%) and 49 (68.1%) of the eyes with a complete (102 eyes) and incomplete (72 eyes) glial ring, respectively, had no floaters. CONCLUSION: Detecting the detached posterior vitreous cortex by biomicroscopy is essential regardless of the presence of Weiss ring or floaters.

[Results of vitreous surgery for idiopathic macular holes and retinal sensitivity].

We evaluated the visual outcome in 16 eyes with idiopathic full-thickness macular holes. Phacoemulsification and posterior chamber intraocular lens implantation was also performed, if cataract was present. Closure of the macular hole was obtained in 12 eyes, 75%. Postoperative visual acuity improved by 2 lines or more in 14 eyes, (87.5%), 0.5 or better in 9 eyes, (56.2%), and 0.8 or better in 6 eyes, 37.5%. The correlation values between postoperative visual acuity and size of hole, % decrease of macular retinal sensitivity, macular retinal sensitivity, preoperative visual acuity, size of fluid cuff, and duration were -0.766, 0.710, 0.696, 0.676, -0.665, and -0.313, respectively. Measurement of macular retinal sensitivity with macular hole size could be very useful for predicting postoperative visual acuity.

[Glaucoma with Axenfeld-Rieger syndrome in three generations. Aqueous humor dynamics].

A 21-year-old woman was diagnosed as having glaucoma associated with Axenfeld-Rieger syndrome. Her family was examined and 3 additional patients with Axenfeld-Rieger syndrome were found in three generations. All of them had glaucoma with various types of onset. Aqueous humor dynamics were studied in 5 eyes of 3 patients using fluorophotometry. The basic secretion of aqueous humor in 5 eyes was 4.18 +/- 1.13 microliter/min. Averaged uveoscleral outflow in 3 eyes with low transtrabecular outflow facility was 61% of total aqueous outflow. It appeared that uveoscleral outflow was increased to compensate for the impaired transtrabecular outflow route.