Immunohistochemical localization of low density lipoprotein receptor-related protein 1 and alpha(2)-Macroglobulin in retinal and choroidal tissue of proliferative retinopathies.

The immunolocalization of the low density lipoprotein receptor-related protein 1 (LRP1) and its ligand alpha 2-Macroglobulin (alpha(2)M) was examined in tissues from human donor eyes of normal, diabetic and sickle cell disease subjects. Streptavidin alkaline phosphatase immunohistochemistry was performed with a mouse anti-human LRP1 and rabbit anti-human alpha(2)M antibodies. Retinal and choroidal blood vessels were labeled with mouse anti-human CD34 antibody in adjacent tissue sections. Mean scores for immunostaining from the pathological and control eyes were statistically compared. LRP1 immunoreactivity was very weak to negative in the neural retina of normal subjects except in scattered astrocytes. LRP1 expression in diabetic eyes was detected in the internal limiting membrane (ILM), astrocytes, inner photoreceptor matrix, choriocapillaris and choroidal stroma. The ligand alpha(2)M, however, was limited mainly to blood vessel walls, some areas of the inner nuclear layer (INL), photoreceptors, RPE-Bruch's membrane-choriocapillaris complex, intercapillary septa, and choroidal stroma. In sickle cell eyes, avascular and vascular retina as well as choroidal neovascularization (CNV) were analyzed. In avascular areas, LRP1 immunoreactivity was in innermost retina (presumably ILM, astrocytes, and Muller cells) and INL as well as RPE-Bruch's membrane-choriocapillaris complex and choroidal stroma. alpha(2)M was very weak in avascular peripheral retina compared to vascularized areas and limited to stroma in choroid. In contrast, in areas with CNV, LRP1 immunoreactivity was significantly decreased in overlying retina and in RPE-Bruch's membrane and choroidal stroma compared to the controls, while alpha(2)M was elevated in RPE-Bruch's membrane near CNV compared to normal areas in sickle cell choroid. The mean scores revealed that LRP1 and alpha(2)M in neural retina were significantly elevated in astrocytes and ILM in diabetic eyes (p < or = 0.05), whereas in sickle cell eyes scores were elevated in ILM and INL (p < or = 0.05). In addition, alpha(2)M immunoreactivity was in photoreceptors in both ischemic retinopathies. In choroid, the patterns of LRP1 and alpha(2)M expression were different and not coincident. This is the first demonstration of the presence of LRP1 and alpha(2)M in human proliferative retinopathies. Elevated LRP1 expression in sickle cell neural retina and diabetic inner retina and choroid suggests that LRP1 plays an important role in ischemic neovascular diseases.

Therapeutic benefit of melatonin in refractory central serous chorioretinopathy.

PURPOSE: To evaluate the efficacy and safety of melatonin for the treatment of chronic central serous chorioretinopathy (CSCR). METHODS: Prospective comparative case series. A total of 13 patients with chronic CSCR were treated for 1 month: 8 patients were treated orally with 3 mg melatonin t.i.d., and 5 with placebo. All patients had 20/40 or worse Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) in the affected eye or presented an incapacitating scotoma. Most of the patients had previous failed treatments for their condition. Observational procedures included ETDRS BCVA, and complete ophthalmic examination. Optical coherence tomography (OCT) was performed at day 1 and week 4. Fluorescein angiography was performed at baseline only for diagnostic purposes. Data were subjected to two-sample t-test statistical analysis. P-values of <0.05 were considered statistically significant. RESULTS: At 1-month follow-up, BCVA significantly improved in 87.5% of patients treated with melatonin (7 of 8 patients, P<0.05). All patients showed a mean significant reduction (P<0.01) of central macular thickness (CMT) when compared with the baseline, with 3 patients (37.5%) exhibiting complete resolution of subretinal fluid at 1-month follow-up. No significant side effects were observed. No changes in BCVA or CMT were noted in the control group. CONCLUSIONS: These results suggest that melatonin is safe, well tolerated, and effective in the treatment of chronic CSCR, as it significantly improved BCVA and CMT in patients with this pathology. Further evaluations with longer follow-up and a larger patient population are desirable.

An ultrastructural study of melanocytomas (magnocellular nevi) of the optic disk and uvea.

We examined by light and electron microscopy five melanocytomas from four patients. Two types of cells were observed in each tumor. The predominant cell type in most of the tumors studied consisted of plump polyhedral nevus cells that contained numerous giant melanosomes. These cells showed advanced differentiation. They appeared to be metabolically inactive and to have been the cause of the heavy pigmentation and benign nature of these tumors. The second variant of melanocytoma cells were smaller spindle-shaped cells that were lightly pigmented. Other morphologic features of these cells such as high nucleus-cytoplasm ratio, prominent nucleolus, nuclear membrane infolding, numerous mitochondria, prominent rough endoplasmic reticulum, and free ribosomes, indicated a metabolically active cell, which may explain the infiltrating behavior of these tumors.

Mycobacterium chelonae keratitis following laser in situ keratomileusis.

Corneal infection after laser in situ keratomileusis (LASIK) is rare. However, surgical trauma or breakdown of epithelium increases the risk of surface infection. We present the case of a 45 year old woman who developed keratitis due to Mycobacterium chelonae 1 month after LASIK with the Mini-Laser Sight 2000 excimer laser. After an initial improvement following antibiotic therapy the infection progressed until it was necessary to perform penetrating keratoplasty, with a successful result.

Laser in situ keratomileusis for myopia and hyperopia using the Lasersight 200 laser in 300 consecutive eyes.

PURPOSE: To evaluate effectiveness, safety, predictability, and short-term stability of laser in situ keratomileusis (LASIK) using the LaserSight Compac-200 Mini excimer laser with software version 9.0, for all refractive errors. METHODS: One hundred fifty consecutive patients (300 eyes) that received bilateral LASIK for myopia, hyperopia, and astigmatism were studied prospectively. A new 9.0 software version applying a modified nomogram that takes advantage of bilateral surgery was used. Follow-up at 6 months was available for 267 eyes (89%). RESULTS: Six months postoperatively, 131 eyes (96.32%) in the low to moderate myopia group (-1.00 to -5.99 D; n=136) had a spherical equivalent refraction within +/-1.00 D, and 123 eyes (90.44%) were within +/-0.50 D of emmetropia. In the high to extreme myopia group (-6.00 to -25.00 D; n=114), 97 eyes (87.08%) had a spherical equivalent refraction within +/-1.00 D and 78 eyes (68.42%) were within +/-0.50 D of emmetropia. In the hyperopia group (+1.00 to +6.00 D; n=50), 44 eyes (88%) had a postoperative spherical equivalent refraction within +/-1.00 D, and 31 eyes (62%) were within +/-0.50 D of emmetropia. Mean change in spherical equivalent refraction at 6 months was less than -0.50 D in the low to high myopia groups and -1.16 +/- 0.55 D in the extreme myopia group. At 6 months follow-up, uncorrected visual acuity was 20/20 or better in 73 eyes (54%) in the low to moderate myopia groups and 21 eyes (18%) in the high to extreme myopia groups. In the hyperopia group at 6 months follow-up, uncorrected visual acuity was 20/20 or better in 31 eyes (62%) and 20/40 or better in 41 eyes (82%). Only two eyes had a temporary loss of two or more lines of spectacle-corrected visual acuity due to corneal folds that were surgically treated. Six months after LASIK, no eye had lost any lines of best spectacle-corrected visual acuity in this series. CONCLUSIONS: Our modified LASIK nomogram with the 9.0 software of the LaserSight 200 excimer laser (with a larger and smoother ablation pattern) resulted in safe and effective outcomes for the treatment of low to high myopia, astigmatism, and hyperopia.

Full-thickness eye-wall biopsy: long-term results in 9 patients.

Nine patients who had an eye-wall biopsy were evaluated for long-term results. The follow-up time ranged from 2 1/2 months to 7 years. Six patients were followed up for more than 2 years. Few operative and postoperative complications were observed. Except for 1 patient with reticulum cell sarcoma, all eyes retained preoperative visual acuity. Tractional retinal detachment occurred only in 1 patient, who had vitreous bands around the biopsy site and did not undergo a simultaneous vitrectomy during the biopsy operation.

Secondary pupillary membranes treated by the pars plana/pars plicata approach: long-term results of 108 cases.

One hundred and eight pupillary membranes treated with the vitrophage through a pars plicata or pars plana approach were evaluated for long-term results. The average follow-up was 3.86 years, with a range of 1 to 7 years. No major operative complications were encountered. Anatomical success was achieved in all cases. Vision improved in 67.5% of eyes. In 4 cases (3.7%) postoperative visual acuity was worse, because of glaucoma secondary to previous blunt ocular trauma. Six cases showed delay rhegmatogenous retinal detachment postoperatively. These could not be attributed to the surgical procedure per se.

Resection of uveal melanocytoma: clinicopathological correlation.

Four patients had pigmented lesions in the anterior uveal tract and choroid which presented clinically as malignant melanomas. All the lesions were successfully removed by local excision. Histopathological studies showed the tumours to be melanocytomas, indicating that enucleation or irradiation would have been contraindicated. The 3 patients with iris and ciliary body melanocytomas continue to maintain corrected visual acuities of 20/30 or better. In the patient with choroidal melanocytoma central visual acuity was compromised owing to cystoid macular oedema. All 3 melanocytomas involving the anterior segment were located inferiorly. Biomicroscopically, they were chocolate coloured (not black) and resembled malignant melanomas of the same location. The choroidal melanocytoma also resembled a malignant melanoma by ophthalmoscopic and angiographic criteria, and did not have the jet black or homogeneous pigmentation that characterises most melanocytomas of the disc.

Effects of topical diclofenac and prednisolone eyedrops in laser in situ keratomileusis patients.

PURPOSE: To compare the effects of a topical nonsteroidal anti-inflammatory agent, diclofenac, and prednisolone acetate on wound healing, postoperative inflammation, and other clinical parameters in laser in situ keratomileusis (LASIK) patients. SETTING: Fundación VER, Córdoba, Argentina. METHODS: Laser in situ keratomileusis for myopia was performed simultaneously in both eyes of 16 patients by 1 surgeon. Patients were prospectively randomized to receive diclofenac eyedrops in the right eyes and prednisolone acetate eyedrops in the left. Postoperatively, the drops were administered topically every 2 hours the first day, every 6 hours the first week, every 8 hours the second week, and once a day the fourth week. Preoperatively and at each postoperative visit, evaluation of visual acuity, slitlamp biomicroscopy, corneal topography, and clinical scoring (0-III) of pain and photophobia were done; epithelial interface opacities were objectively evaluated. Follow-up was at 24, 48, and 72 hours, 1, 2, and 3 weeks, and 1, 2, 3, and 6 months. A paired t test was used for statistical analysis. RESULTS: Mean age of the 16 patients was 29.4 years +/- 6.5 (SD). Preoperatively, mean spherical equivalent was -5.83 +/- 3.61 diopters (D) in the right eyes and -6.96 +/- 4.66 D in the left eyes. At 6 months postoperatively, it was -1.83 +/- 1.87 D and -1.88 +/- 2.13 D, respectively. In the first 24 hours, there were significant clinical symptoms in the diclofenac group. CONCLUSIONS: Wound healing was stable, with no regression, in the diclofenac and prednisolone groups. Both anti-inflammatory agents worked well in LASIK patients.

Laser in situ keratomileus using the LaserSight 200 laser: results of 950 consecutive cases.

PURPOSE: To examine the refractive outcome in 950 consecutive eyes having laser in situ keratomileusis (LASIK) by 1 surgeon with experience in keratomileusis. SETTING: Outpatient excimer laser surgical facility. METHODS: This study comprised 950 consecutive eyes of 475 patients having LASIK as a primary procedure with a LaserSight 200 excimer laser (8.51 software). A nasal hinged flap and a Chiron microkeratome were used. Preoperative cycloplegic refraction was done only in patients younger than 25 years and in all hyperopic cases. Subjective preoperative and postoperative manifest refractions were done after autorefractometry in all cases. In cases of hyperopia, the software was modified by adding 30% to the refractive error. Enhancement results are not included. RESULTS: Of the 950 eyes, 893 (94.00%) were myopic and 57 (6.00%), hyperopic. In the low myopia group (1.00 to 3.99 D) of 223 eyes (24.97%), mean spherical equivalents (SEs) were -2.90 D +/- 0.56 (SD) preoperatively, -0.46 +/- 0.6 D 3 months postoperatively, and -0.41 +/- 0.5 D 6 months postoperatively. In the moderate myopia group (4.00 to 5.99 D) of 205 eyes (22.96%), respective mean SEs were -4.90 +/- 0.7 D, -0.90 D +/- 0.9 D, and -0.67 +/- 0.7 D. In the high myopia group (6.00 to 9.99) of 266 eyes (25.30%), the respective means were -7.70 +/- 1.3 D, -0.76 +/- 0.99 D, and -0.60 +/- 0.8 D. In the extreme myopia group (10.21 to 30.00) of 199 eyes (22.28%), the respective means were -13.30 +/- 2.9 D, -1.30 +/- 1.4 D, and -1.13 +/- 1.3 D. For the entire myopic group, the mean astigmatism was +1.55 +/- 1.38 D, +1.09 +/- 0.92 D, and +0.87 +/- 0.77 D, respectively. The low hyperopia group (1.00 to 2.99 D) of 39 eyes (68.42%) had a mean preoperative SE of +1.80 +/- 0.59 D and mean postoperative SEs of +1.00 +/- 0.76 D at 3 months and +1.16 +/- 0.52 D at 6 months. The respective means in the moderate hyperopia group (3.00 to 6.00) of 18 eyes (31.57%) were +4.62 +/- 1.19 D, +3.71 +/- 1.12 D, and +4.00 +/- 1.07 D. CONCLUSIONS: Laser in situ keratomileus for myopia using the LaserSight 200 excimer laser was stable with time and safe for the correction of different degrees of myopia. In the hyperopic group, marked regression occurred in a large percentage of patients. Thus, we will not perform LASIK for hyperopia until the software improves.

Intravitreal triamcinolone acetonide injection in blind painful eyes. Intraocular steroids as a treatment for blind painful red eyes.

PURPOSE: Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes. METHODS: Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years. RESULTS: Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found. CONCLUSIONS: Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.

Experimental retinopathy of prematurity: angiostatic inhibition by nimodipine, ginkgo-biloba, and dipyridamole, and response to different growth factors.

PURPOSE: To investigate whether commonly used vasodilating drugs ameliorate angiogenesis in experimental retinopathy of prematurity (ROP), and to study the response of these drugs to different growth factors. METHODS: We used a rat and mouse model of oxygen-induced ischemic retinopathy. Animals were treated with nimodipine, gingko-biloba and dipyridamole intraperitoneally starting the day before exposure to room air (day 1). Controls were injected with vehicle solution only. Eyes were processed histopathologically with serial sections and neovascularization was measured by counting the nuclei within the retinal internal limiting membrane, by a masked observer. Retinal and vitreous tissues were assayed by ELISA for VEGF, PDGF and TGFbeta2. RESULTS: Nimodipine significantly inhibited the growth of new vessels in rats. The number of nuclei was 310 +/- 69 in the control group (n:14) and 121 +/- 53 in the treated ones (n:14), (p<0.0005). Similar results were found with ginkgo-biloba extracts: 344 +/- 53 (n:15) in controls, and 136 +/- 29 (n:11) in treated ones (p<0.0005), and with dipyridamole: 303 +/- 69 (n:13) in controls, and 131 +/- 48.5 in treated rats (p<0.0005). Results were similar in mice. 186 +/- 45 (n:7) nuclei counted in controls against 90 +/- 25 (n:6) for dipyridamole treated (p<0.0005); and 81 +/- 21 for ginkgo-biloba treated animals (p<0.0005). A gradual, very significant increase in VEGF values in response to relative hypoxia (room air) contrasted with the significant inhibition noted both with ginkgo-biloba extracts and dipyridamole. TGFbeta2 and PDGF both showed a gradual increase in relative hypoxia at days 2 and 4 of room air (p<0.0005). Treated animals showed marked inhibition of the three growth factors. CONCLUSIONS: All three drugs markedly inhibited angiogenesis in experimental ROP. Growth factors were elevated in hypoxic conditions. Treated animals showed significant decreases of PDGF, VEGF, and TGFbeta2 in retinal and vitreous tissues.

Intraconal amphotericin B for the treatment of rhino-orbital mucormycosis.

Rhino-orbital-cerebral mucormycosis is a disease that is frequently fatal. A 39-year-old man with diabetic ketoacidosis was referred to the authors' ophthalmic service with fever, orbital apex syndrome in the right eye, lethargy, and a black eschar in the palate. He was treated with systemic and local (intraconal) amphotericin B and his ketoacidosis was controlled; exenteration was not performed. Biopsy of the palate proved mucormycosis. Eighteen months later the patient was still alive and had a blind, anatomically preserved right eye with ptosis and intact extraocular muscle function without proptosis or pain. The authors propose this alternative means of treatment to achieve higher doses of the drug at the site of infection and better cosmetic and psychological results.

[Bilateral surgery: an efficient manner of creating LASIK nomograms]. / Cirugía bilateral: el mejor modo de realizar nomogramas personalizados de LASIK.

OBJECTIVE: Taking advantage of bilateral surgery, an efficient and predictable manner of doing Laser-assisted-in situ keratomileusis (LASIK) nomograms, is described. METHODS: We used our current technique of nomogram development with an example to described it. To evaluate a change made in the software of our LaserSight excimer laser unit: sixteen consecutive patients, operated on bilaterally, by the same surgeon, within statistically similar clinical, refractive, and surgical settings, were randomized with different nomogram for the right (OD), with a newer ablation pattern randomized in the (OS) the older sequential. Pattern. (Sequential overlapping burns) The refractive results were studied for statistical significance at 4 weeks and 6 months. The data was analyzed, using a student T test and two way Anova. RESULTS: Pre-operative refractive data showed a mean sphere in OD of -10.917 +/- 1.749, and OS of -10.89 +/- 1.717, p < NS. The mean preoperative spherical equivalent OD was -9.81 +/- 1.62 and OS of -9.93 +/- 2.02, p < NS. Post-operative mean spherical equivalent at 4 weeks in OD was +1.54 +/- 1.52, and in OS was +0.43 +/- 1.9, p < 0.05. At 6 months OD randomized was of +1.20 +/- 1.24 and, OS sequential of +0.14 +/- 1.70, p < 0.05. On the cylinder component of the refraction the values were equally corrected at both time points with p < NS. CONCLUSION: In a small group of patients, one current technique we use for nomogram development is described. Having similar statistical parameters, a significant overcorrecting with the new randomized ablation was observed, when surgery is carried out bilaterally. The change to the nomogram need then to be applied, so final refractive results are equal or better than the previous older sequential pattern. Four weeks results appeared to be time enough, since no statistical difference were observed at 6 months.

Bilateral macular hemorrhage after laser in situ keratomileusis.

BACKGROUND: This is the first report of a bilateral submacular hemorrhage after LASIK surgery in an extreme myo pic patient. A 31-year-old man underwent bilateral surgery for correction of -16.75+0.75x70 degrees and -16.50+0.50x55 degrees. METHODS: Case report. RESULTS: One day after surgery the patient's uncorrected visual acuity was in the 20/50 range OU and by 17 days after surgery his visual acuity had declined to 20/200 range. Fundus examination showed multifocal subretinal macular and posterior pole hemorrhages. Fluorescein angiography showed some macular lesions compatible with lacquer cracks. CONCLUSIONS: Preoperative and postoperative fundus examination is important to detect this phenomenon. Patients should be informed of this rare complication.

Effects of argon and krypton laser on experimentally detached retinas.

Krypton and argon laser photocoagulation on the foveas and blood vessels of experimentally detached monkey retinas were studied clinicopathologically. In this manner heat transmission from the retinal pigment epithelium (RPE) to the overlying sensory retina was avoided. Krypton lesions bypassed the sensory retina on every occasion to produce major photocoagulative effects at the level of the RPE and choroid. Argon laser wavelengths damaged the overlying retina in the foveal areas as well as in perivascular structures. Although the krypton laser appears preferable for treatment of macular diseases, proper parameters should be used to avoid serious complications.

Ten years experience with eye wall resection for uveal malignant melanomas.

Thirty-four patients underwent eye wall resection for choroidal malignant melanoma over a period of more than ten years. Of these, 11 eyes were later enucleated for complications. Average mean follow-up has been more than 5.3 years. Postoperative visual acuity ranged from light perception to 20/30. Two patients developed liver metastasis 4 years following eye wall resection and later died. However, no local metastasis has been observed. Two patients died from unrelated causes.