Conjunctival swabs and corneoscleral rim cultures from corneal transplantation donors as possible early indicators for posttransplant endopthalmitis.

PURPOSE: To determine by microbiological examinations the rate of conjunctiva and corneoscleral rim contamination of cadaver donor tissues. METHODS: A prospective review of culture results for 98 cadaver donor conjunctival swabs [mean age 76.4 ± 12.9 years (±SD)]. Transplant patients were evaluated both before and after disinfection with gentamicin. Individual parameters evaluated included detection rates of bacteria, variety of detected bacteria, time interval from donor death to tissue harvest and age of donors. RESULTS: Before disinfection, 60 out of 98 conjunctival swabs exhibited microbial growth, while only 36 out of 98 exhibited growth after disinfection (p = 0.0006). Longer intervals between death and tissue harvest were associated with higher positive microbial growth rates. Prior to disinfection, culture-positive donors (74.1 ± 13.6 years) were significantly younger than culture-negative donors (79.8 ± 10.8 years) (p = 0.024). Positive donor rim cultures were noted in 2 out of the 22 corneal transplantations. Microorganisms isolated from the corneal grafts matched those found in the conjunctiva. CONCLUSIONS: It is recommended that the corneoscleral buttons be removed as soon as possible. Cultures of conjunctival swabs collected from donors after disinfection may be useful in determining treatment for postoperative infections occurring after corneal transplantation.

Long-term follow-up of full macular translocation for choroidal neovascularization.

PURPOSE: To report the long-term (>5 years) results of full macular translocation in patients with choroidal neovascularization (CNV). DESIGN: Retrospective, interventional case series. METHODS: This study involved 32 eyes of 32 patients who had undergone full macular translocation for CNV. The median follow-up was 6.5 years (range, 5.2 to 7.7 years). We evaluated the best-corrected visual acuity, fundus examination results obtained before and 1 and 5 years after operation, and postoperative complications. RESULTS: At the 1-year follow-up, foveal retinal pigment epithelium atrophy was observed in only 3 eyes (12%), and the mean logarithm of the minimal angle of resolution (logMAR) visual acuity (VA) at that time (1.39 +/- 0.67) was not significantly changed from that before surgery (logMAR, 1.31 +/- 0.66) in 25 eyes with age-related macular degeneration (AMD). However, at 5-year follow-up, foveal retinal pigment epithelium atrophy increased (18 eyes; 72%), and final mean logMAR VA (1.88 +/- 0.76) was significantly lower (P < .01). Five eyes with myopic CNV maintained their VA from before operation (mean logMAR, 0.88 +/- 0.35) until final follow-up (mean logMAR, 0.73 +/- 0.31). The final VA was significantly better in myopic CNV than in exudative age-related macular degeneration on multiple regression analysis (P = .019). CONCLUSIONS: Long-term follow-up of full macular translocation showed that the final VA was poor in age-related macular degeneration, but relatively better in myopic CNV.

Visual field defects after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling.

PURPOSE: To report visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling. DESIGN: Interventional consecutive case series. METHODS: A retrospective review of 140 eyes with macular hole after vitrectomy with ILM peeling. The group with 0.25% of ICG for ILM peeling consisted of 96 eyes. The group without ICG consisted of 44 eyes. RESULTS: Nasal visual field defects occurred in 11 eyes, temporal visual field defects in seven eyes, and concentric visual field defects in one eye. In the group with ICG, nasal visual field defects were far higher in the left eye than in the right eye. CONCLUSIONS: We speculate that the postoperative nasal visual field defects were caused by the enhanced toxicity of ICG resulting from the exposure to illumination.

Topographic and age-dependent expression of heme oxygenase-1 and catalase in the human retinal pigment epithelium.

PURPOSE: To investigate the hypothesis that there are topographic and age-related changes in the expression of heme oxygenase (HO)-1 and catalase in the RPE. METHODS: Cryosections of the macula and periphery of human eyes (n = 18; aged 27-87 years) were subjected to a high-sensitivity digoxigenin (DIG)-labeled cRNA in situ hybridization protocol to determine the expression of HO-1 and catalase. The immunoreactivity of HO-1 and catalase were also investigated in the same sample set. Specimens were examined by light microscopy, and images were captured with a digital camera. The total number of RPE cells and HO-1- and catalase-labeled RPE cells was counted in each section, and the ratio of labeled RPE cells to total RPE cells was calculated in both the macular and the peripheral regions of each donor eye. RESULTS: There was a mosaic pattern of mRNA and protein expression of HO-1 and catalase in macular and peripheral RPE. Topographical differences in the expression of HO-1 at the mRNA level and catalase at both the mRNA and protein levels was also observed. The topographical differences between the expression of HO-1 in the macula and periphery protein were not statistically significant but showed similar trends. For HO-1, the only significant age-related decline in expression was observed in the macula and periphery. Expression of HO-1 at the protein level and that of catalase at both the mRNA and protein levels showed no significant decline with age. CONCLUSIONS: There is a possible age-related decline in HO-1 expression, whereas catalase expression remains unchanged with aging. Both exhibit mosaic patterns in the RPE monolayer.

Light and electron microscopic findings in a patient with orbital myolipoma.

BACKGROUND: This report describes the pathology of myolipoma, which is a benign soft tissue tumor and is a very rare tumor of the orbit. METHODS: A 41-year-old woman complained of exopthalmos of her right eye. By MRI (magnetic resonance imaging) examination, the tumor (30x20 mm) was located in the extraconus of four recti muscles. A part of the tumor was excised and examined with both light and electron microscopes and immunohistochemically. RESULTS: Light microscopic inspection revealed the tumor was formed by spindle-shaped cells, which were adipocytes and smooth muscle. Electron microscopy showed the cytoplasm contained parallel filaments associated with fusiform densities. Immunohistochemical staining showed smooth muscle stained with SMA (smooth muscle actin). Angiomyolipoma was excluded by negative staining for HMB45, Melan A. CONCLUSION: To our knowledge, only one case of orbital myolipoma has been reported. The intimate relationship between the two cell types led us to conclude that the tumor was dimorphic and could be classified correctly as a myolipoma.

Human RPE cells express the FGFR2IIIc and FGFR3IIIc splice variants and FGF9 as a potential high affinity ligand.

The expression of splice variants of FGF receptors, which differ in the third Ig domain, was investigated in retinal pigment epithelium (RPE) cells in vitro and in vivo. This region of the protein determines ligand-binding specificity. Additionally, the expression of potential ligands for these receptors was investigated. Expression of FGF receptor transcript alternative splicing was analyzed by RT-PCR/Southern analysis in RPE cells in vitro and in vivo. The expression of FGFs by RT-PCR, in situ hybridization, and immunohistochemistry in sections of the human posterior pole was also investigated. The ARPE-19 cell line expresses only the FGFR2IIIc splice variant and does not express any FGFR3 splice variants in vitro. Two in vivo samples exhibited expression of the FGFR2IIIc and FGFR3IIIc splice variants and no evidence of the corresponding IIIb splice variant. The results from previous studies for these receptors imply that FGF9 or FGF4 could act as ligands. We demonstrated that FGF9 is expressed in a subpopulation of the RPE, as well as photoreceptors and other neurons of the retina. FGF4 was not detected by RT-PCR analysis in RPE cells in vitro. These data suggest that FGF9 may be an autocrine/paracrine factor in the outer retina.

The retinal pigment epithelium of Cr-deficient rats.

The purpose of this study is to investigate the effect of Cr deficiency on the rat retina. Three-week-old Wistar Kyoto rats were divided into 2 groups. Cr-deficient rats were fed AIN-93G diet without Cr and deionized distilled water. Control rats were fed AIN-93G diet and deionized distilled water. The Cr and sugar concentrations in the whole blood and cholesterol concentration in the serum were measured. We observed the retina with an electron microscope, and counted phagocytized lamellar structures in the retinal pigment epithelium (RPE) before and after the start of light exposure on negative electron microscopic films. The whole blood Cr level of Cr-deficient rats was less than 0.2 microg/l. The blood sugar level of Cr-deficient rats was significantly higher than that of normal rats (p < 0.05). There were significantly more phagocytized lamellar structures in the RPE of Cr-deficient rats 1, 2, 7, 11 and 12 h after the start of light exposure than in that of normal rats (p < 0.05). However, no morphological abnormalities were found in the photoreceptor cells of Cr-deficient rats. Phagocytosis in the photoreceptor outer segment discs in the RPE was accelerated, but the pattern of the retinal circadian rhythm with maximum phagocytosis 2 h after exposure to light was unchanged. The Cr-deficient state may cause the membrane to degenerate, and phagocytosis of the photoreceptor outer segment discs in the RPE may be accelerated. This study provided an evidence of the nutritional importance of Cr in rat retina.

Retinal vascular obstruction and asymptomatic cerebral infarction.

PURPOSE: The purpose of this study is to clarify the relationship between retinal vascular obstruction and asymptomatic cerebral infarction (ACI). METHODS: Forty-three patients (27 men and 16 women) with retinal vascular obstruction were examined by magnetic resonance imaging (MRI) at the Department of Ophthalmology of Nagasaki University Hospital in Nagasaki, Japan. Patients with a history of neurological signs and symptoms were excluded from this study. The control group consisted of 93 male and 49 female patients who were examined by MRI for routine brain screening examinations at the Takaki Neurosurgical Clinic in Fukuoka, Japan. We investigated the incidence of ACI, and the risk factors and characteristics of this condition. RESULTS: ACI was more common in patients with retinal vascular obstruction than in normal adults at all ages. The incidence of hypertension in the patients with ACI tended to be higher than in the patients without ACI. CONCLUSION: ACI appears more frequently in patients with retinal vascular obstruction than in normal adults. Our results indicate that either retinal artery occlusion or retinal vein occlusion should be considered a sign of ACI and systemic diseases such as arteriosclerosis.