A SECOND CASE OF BILATERAL RHEGMATOGENOUS RETINAL DETACHMENTS REPAIRED WITH SIMULTANEOUS BILATERAL PNEUMATIC RETINOPEXY.

BACKGROUND/PURPOSE: To present a case of a patient with simultaneous bilateral retinal detachments treated successfully with bilateral pneumatic retinopexy. STUDY DESIGN: Case report. RESULTS: This is a case of an otherwise healthy 49-year-old woman with no remarkable ocular history that presented with simultaneous phakic superior bilateral rhegmatogenous retinal detachments. Treatment on the day of presentation included laser retinopexy of the inferior lattice degeneration in the left eye and bilateral intravitreal injection of 0.4 cc of 100% C3F8 gas preceded by topical anesthesia. After 48 hours, both retinas were completely reattached, and bilateral laser retinopexy was performed to the superior tears. DISCUSSION: After a review of the literature, the authors could find only two reported cases of simultaneous bilateral retinal detachments treated successfully with pneumatic retinopexy. This is not only a cost-effective procedure but also allows treatment when there is no immediate operating room availability or a when a quick referral for surgery is not possible.

Structural and functional changes to the retina and optic nerve following panretinal photocoagulation over a 2-year time period.

PurposeTo evaluate long-term structural and functional changes to the retina and optic nerve following panretinal photocoagulation (PRP) in diabetic retinopathy (DR) patients.MethodsParticipants were patients with DR requiring PRP and control patients with DR not requiring PRP. The Heidelberg retinal tomography (HRT) and optical coherence tomography (OCT) were performed to analyze the optic nerve and macula. Best-corrected visual acuity (BCVA) and visual field (VF) testing were done to measure central and peripheral vision. Wide-field fluorescein angiogram was performed to monitor the progression of diabetic ischemia. The primary outcome measure was to determine the degree of retinal and optic nerve changes before and after PRP.ResultsThere was a non-significant thickening of the macula and retinal nerve fiber layer at 6 months post laser that recovered by 24 months. Mean perfused ratio was significantly increased (P=0.02) at 12 and 24 months post laser. Independently grading patient stereophotographs, grader 1 indicated there was a non-significant increase in cup to disk ratio post laser, while grader 2 indicated a significant increase at 6 (P=0.04), 12 (P=0.02), and 24 months (P=0.005). There was a significant VF decrease (P≤0.02) at 12 and 24 months post laser with BCVA showing a non-significant trend of deteriorating results.ConclusionDespite an improvement in peripheral perfusion, there was a significant progressive decline of peripheral VF over the study period. Clinical grading of the optic nerve was more unreliable following PRP, despite the absence of significant morphological changes as detected by the OCT and HRT.

Promotion of incompatible allograft acceptance in rhesus monkeys given posttransplant antithymocyte globulin and donor bone marrow. I. In vivo parameters and immunohistologic evidence suggesting microchimerism.

This report extends previous studies demonstrating that prolonged acceptance of incompatible kidney allografts in rhesus monkeys can be achieved by a short recipient rabbit antithymocyte globulin (RATG) treatment course followed by donor bone marrow infusion on day 12 without a requirement for chronic immunosuppression. Serial studies of antilymphocyte cyctotoxic antibody in recipients' sera following RATG injections showed pan-lymphocyte-reactive antibody present until day 10 posttransplant. On days 11 and 12, pan-lymphocyte-reactive antibody was no longer detectable, but cytotoxic antibody specific for mature T cells remained in recipients' sera. These findings might explain the critical time relationship between antithymocyte globulin treatment and donor bone marrow infusion, and further suggest that the tolerance-promoting cell in donor bone marrow is not a mature T cell, but rather a pre-T or a non-T cell. Finally, it was found that this treatment protocol resulted in development of lymphoid nodules in the transplanted kidney that express a CD8-positive, FcIgG-receptor-positive phenotype and appear to be of donor origin. The possibility of a veto cell type of mechanism is discussed as an explanation for the promotion of allograft acceptance in this model.

Heterotransplantation of human choroidal melanoma into the athymic "nude" mouse.

The investigation of the structure and behavior of malignant melanoma of the uveal tract in man has been limited by the lack of a ready source of human tumor and an animal model in which the tumor resembles that in the human choroid. We now report the observation that fresh surgical specimens of human choroidal melanoma can be successfully transplanted into the posterior segment of the "nude" mouse (a homozygous mutant, nu/nu, with a defect in cellular immunity) and can be serially transplanted. This model utilizing human melanoma should be useful for the study of the natural history of this disease, as well as the response to various chemotherapeutic agents.

Induction of ocular neoplasms in Fischer rats by intraocular injection of nickel subsulfide.

Nickel subsulfide, alpha Ni3S2, was administered to albino Fischer rats by a single injection into the vitreous body of the right eye (0.5 mg alpha Ni3S2/rat, suspended in 20 microliter of NaCl vehicle). Control rats received a similar injection of the vehicle. Malignant tumors developed in the injected eyes of 14/15 alpha Ni3S2-treated rats by 8 months (vs. 0/11 controls, p less than 0.001). Five of the injected eyes of alpha Ni3S2-treated rats contained multiple tumors. The 21 eye tumors that were induced by alpha Ni3S2 included 11 melanomas, four retinoblastomas, three gliomas, and three unclassified malignant neoplasms. Three of the melanomas developed extraocular extensions; one of the melanomas metastasized to lungs and brain. Although the melanomas arose from amelanotic uveal melanocytes, melanosomes were observed in electron micrographs of the tumor cells. This study provides a new experimental model for chemical induction of ocular neoplasms. As a procedure to test the carcinogenicity of nickel compounds, intraocular injection has the advantages of short latency period, high tumor incidence, and ease of tumor detection.

Effects of synthetic ovine CRF on ACTH, cortisol and blood pressure in sheep.

Intravenously administered synthetic ovine CRF at doses of 0.1, 1.0 and 10.0 micrograms/kg increased plasma ACTH and cortisol concentrations in a dose-dependent fashion in unanesthetized sheep. In two unanesthetized sheep, aortic blood pressure remained relatively unaffected after the intravenous administration of CRF at 5 and 20 micrograms/kg. These results suggest that peripherally administered ovine synthetic CRF specifically stimulates the sheep pituitary-adrenal axis. Unlike other species receiving intravenous synthetic ovine CRF, sheep did not show hypotensive effects.

Bilateral ocular melanocytosis with malignant melanoma of the choroid.

A woman with bilateral ocular melanocytosis developed a malignant melanoma of the choroid in one eye. The ocular melanotic hyperpigmentation, present since childhood, clinically involved the conjunctiva and episcleral and uveal tract of both eyes. To our knowledge this is only the second reported case of a uveal malignant melanoma in a patient with bilateral ocular melanocytosis. There is evidence that patients with ocular of oculodermal melanocytosis have an increased incidence of malignant melanoma of the uvea. It is possible that patients with bilateral ocular melanocytosis have a greater chance of developing of uveal malignant melanoma than do those with unilateral involvement.

Giant retinal tears, retinal detachment and retinitis pigmentosa.

A patient with retinitis pigmentosa and sensorineural deafness presented with bilateral giant retinal tears and a unilateral retinal detachment. The peripheral visual field loss could have been erroneously ascribed to the primary retinal dystrophy. A retinal detachment must be considered in patients with a sudden loss of visual acuity or field even if they have a primary retinal dystrophy.

Ocular sarcoidosis presenting as a solitary choroidal mass.

Ocular sarcoidosis presenting as a solitary choroidal mass without other signs of intraocular inflammation is a rare manifestation of systemic sarcoidosis. The authors describe a 26-year-old man who presented with a solitary choroidal tumour. Ocular and general physical examination as well as serum chemistry studies and pathological examination of a lymph node biopsy specimen confirmed sarcoidosis as the cause of the mass. Treatment with systemic steroids resulted in improvement in the appearance of the lesion; however, the visual acuity remained impaired. Other such cases reported in the literature are reviewed.

Low-dose tamoxifen retinopathy.

A 68-year-old woman with metastatic breast carcinoma manifested bilateral tamoxifen-induced retinopathy after 9 years of low-dose therapy. Treatment with the drug was stopped, with partial resolution of the retinopathy and improvement in visual acuity over 2 1/2 years of follow-up.

Successful treatment of the ocular ischemic syndrome with panretinal photocoagulation and cerebrovascular surgery.

The ocular ischemic syndrome is a manifestation of chronic vascular insufficiency. The natural history is for progressive visual loss. The authors describe 12 patients (13 eyes) who presented with at least one asymmetric ocular finding, including midperipheral dot and blot hemorrhages (hypoperfusion retinopathy) (in 8), iris neovascularization (in 7), neovascular glaucoma (in 3) and vitreous hemorrhage (in 1). Cerebral angiography revealed stenosis or occlusion of the ipsilateral carotid artery in all cases. The treatment was panretinal photocoagulation (in four cases), cerebrovascular surgery (in three) or both (in six). All but one patient showed stabilization of visual acuity (20/60 or better in nine cases) and regression of proliferative retinopathy and of iris neovascularization. The results underline the importance of early recognition and treatment of the ocular ischemic syndrome.

Ocular and oculodermal melanocytosis.

Thirty-three cases of ocular (27) or oculodermal (6) melanocytosis were reviewed to determine the ocular structures involved by the melanocytic hyperpigmentation. The hyperpigmentation was clinically documented to involve all quadrants of the eye in the majority of the subjects; however, nine persons had sectorial involvement. The choroid and episclera were involved diffusely or sectorially in all the subjects, and the anterior chamber angle and iris were involved in most cases. The conjunctiva, lens and optic disc were less frequently involved. Ten persons had a uveal malignant melanoma in the hyperpigmented eye, and in three of the cases the melanoma had arisen in the hyperpigmented sector. Melanocytic involvement of the trabecular meshwork was not clinically correlated with elevated intraocular pressure.

Oxygen-induced proliferative retinopathy in the newborn rat.

The neonatal rat, which has an immature retinal vasculature at the time of birth, is a potential animal model for retinopathy of prematurity since it has an established spindle cell retinal vasoformation pattern similar to that seen in the human. To determine if proliferative oxygen-induced retinopathy can be produced in the rat, 40 newborn rat pups were exposed from birth either to air for 25 days or to an 80% oxygen environment for 10 days, followed by 15 days in air. Extraretinal neovascularization was observed in 80% (16/20) of the rat pups exposed to hyperoxia (p less than 0.001) with a bilaterality of 87.5% (14/16). Mild to moderate vitreous hemorrhage was seen in only three eyes. Mesenchymal shunt or ridge formation was not demonstrated, nor was retinal detachment.

Endophthalmitis due to Oerskovia xanthineolytica.

Unilateral endophthalmitis developed in a 47-year-old man following an intraocular eye injury with a metallic foreign body. Eventually, Oerskovia xanthineolytica was isolated from the vitreous humour. To our knowledge this is the first documented case of endophthalmitis caused by this organism in humans. The clinical course and management of this opportunistic infection are discussed.

Trans-scleral neodymium: YAG retinal photocoagulation in rabbit eyes.

To assess the ability of trans-scleral application of the continuous-wave neodymium: YAG laser to produce retinal ablation with reproducible chorioretinal scars, retinal photocoagulation with the YAG laser was done in four Dutch-belted rabbits (eight eyes). Sharply defined, reproducible lesions were produced that were identical to those found following conventional treatment with the argon laser. At 0.2 J there was destruction of the outer retinal layers with sparing of the inner retinal layers. At 3.0 J full-thickness retinal reorganization was noted; however, even at this energy setting there was minimal histologic evidence of scleral damage. Focused laser energy produced distinctly more retinal destruction and obliteration of the retinal pigment epithelium than unfocused energy. The results suggest that trans-scleral photocoagulation with the YAG laser may be possible and would be particularly applicable in situations in which media opacities preclude visualization of the retina.

Leiomyoma of the iris.

A 77-year-old white woman presented with a lightly pigmented iris lesion assumed clinically to be an iris melanoma. Light microscopy of the excised tumour showed it to be a spindle-cell tumour. Electron microscopy confirmed the diagnosis of leiomyoma of the iris.

Effect of vitrectomy and cytopreparatory techniques on cell survival and preservation.

Obtaining vitreous fluid by means of vitrectomy frequently results in a specimen that is difficult to assess cytologically. We devised an experimental model to examine the effect of the vitrector on human leukemic cancer (HL60) cells in suspension and to evaluate the cytopreparatory techniques of membrane filtration and cytocentrifugation. Eighteen 3-mL specimens of cells at concentrations ranging from 1 to 9 x 10(5)/mL were vitrectomized, and eighteen 3-mL control samples matched for cell concentration were obtained atraumatically. No significant difference in cell loss, as determined by means of staining with nigrosin vital dye, was found at any cell concentration between the vitrectomized and control specimens. The specimens were then processed cytologically. On cytologic assessment it was not possible to distinguish the vitrectomized and control specimens. A higher degree of cell preservation was noted at higher cell concentrations regardless of the cytopreparatory technique, but at lower concentrations membrane filtration resulted in a higher proportion of cytologically assessable specimens than did cytocentrifugation (42% vs. 22%). The results suggest that the vitrector causes minimal cellular damage and that to obtain optimal results both cytopreparatory techniques should be used with all vitrectomy specimens.

Evulsion of the optic nerve: a clinicopathological study.

Four patients with evulsion of the optic nerve caused by blunt trauma were clinically evaluated. The evulsion was complete in two of the patients and incomplete in the other two. The patients' visual acuity ranged from counting fingers to no light perception. In addition, two eyes were histopathologically studied. Several explanations of the exact cause and the extent of the evulsion are advanced within this report.

Central retinal vein obstruction associated with mitral valve prolapse.

Fifteen patients under age 50 years with central retinal vein obstruction (CRVO) and no obvious predisposing ocular or systemic condition underwent a comprehensive medical investigation, including platelet function studies and, in 11 cases, echocardiography. Only 1 patient was found to have a systemic disease (hyperlipoproteinemia), but 11 patients (73%) were found to have abnormalities of platelet function, usually platelet coagulant hyperactivity. Of the 11 patients who underwent echocardiography, 7 (64%) were found to have mitral valve prolapse, a condition predisposing to vascular occlusion, and 4 (60%) of the 7 had abnormalities of platelet function. These findings suggest that mitral valve prolapse contributes to platelet hyperactivity and, ultimately, CRVO.

Ocular involvement in thrombotic thrombocytopenic purpura: the angiographic and histopathological features.

We report two cases of thrombotic thrombocytopenic purpura (TTP). The first case illustrates the clinical findings and fluorescein angiographic features of this disease, notably the serous macular detachments and focal areas of choriocapillaris occlusion. The second case demonstrates a more severe case of TTP, with neurologic complications that led to death; histopathological examination of the eyes showed serous retinal detachments and choriocapillaris occlusion, with electron microscopic evidence of intravascular fibrin-platelet thrombi.