Exudative retinal detachment and retinitis associated with acquired syphilitic uveitis.

PURPOSE: To describe three cases of exudative retinal detachment and focal retinitis associated with acquired syphilitic uveitis. METHODS: Three patients who were referred for evaluation of uveitis were examined. Slit-lamp examination, ophthalmoscopy, B-scan ultrasonography, fundus photography, and fluorescein angiography were performed before and after therapy. RESULTS: Each patient had uveitis with exudative retinal detachment, periphlebitis, and focal retinitis. Laboratory testing (fluorescent treponemal antibody absorption) revealed positive serology for active syphilis in all cases. Human immunodeficiency virus antibody testing was negative in all patients. Retinal detachment resolved in all cases after treatment with intravenous penicillin. Despite resolution of subretinal fluid, visual acuity remained poor in eyes in which the macula was detached. CONCLUSION: Syphilis is a cause of exudative retinal detachment. Antibiotic therapy can lead to retinal reattachment. Early recognition and treatment may prevent severe vision loss.

Appearance and rapid growth of retinal tumor (reactive astrocytic hyperplasia?).

BACKGROUND: Tumors of the retina are often seen in association with systemic syndromes such as neurofibromatosis, tuberous sclerosis, and von Hippel-Lindau disease. These masses are either astrocytic hamartomas or capillary hemangiomas. Retinal tumors unassociated with other systemic disease have also been reported. METHODS: The ophthalmologic evaluation and clinical course of a 65-year-old woman who developed an epiretinal membrane followed by a vascularized retinal mass in the macular area are described. RESULTS: Appearance and rapid growth of the lesion were documented with fundus photography and fluorescein angiography. The lesion was treated with photocoagulation following growth that threatened the foveal region. Choroidal neovascularization subsequently developed toward the fovea, and visual acuity has remained poor. After 4 years of follow-up no local recurrence or systemic disease possibly related to the tumor has occurred. CONCLUSIONS: This is the first report of documented appearance and rapid growth of a retinal tumor that resembles a reactive astrocytic hyperplasia.

Adaptation to monocular torsion after macular translocation.

PURPOSE: To document the functional outcome of two patients following successful macular translocation for the treatment of severe subretinal hemorrhage in age-related maculopathy. METHODS: The retina was surgically rotated around the optic nerve with translocation of the fovea either upward or downward to an area of healthy retinal pigment epithelium. In the postoperative period, visual function was carefully studied with emphasis on adaptation to torsion. RESULTS: Visual acuity in one patient improved from 20/200 to 20/80 and the other patient remained at 20/200. Both patients developed horizontal and vertical strabismus with torsion of up to 55 degrees. After a prolonged period of occlusion of the unoperated eye, both patients were subjectively able to adapt to monocular torsion. However, adaptation under binocular conditions did not occur. CONCLUSION: Macular translocation was successful in improving visual acuity in one patient, with no improvement in the second. Both patients had significant ocular torsion and strabismus, but under monocular conditions they were successful in perceptually adapting to the change in the visual environment. Fear of cyclotorsion should not be a deterrent to considering macular translocation as a possible treatment option for severe subretinal macular hemorrhage if the patient is willing to accept monocular vision.

Long-term visual results of children after initially successful vitrectomy for stage V retinopathy of prematurity.

PURPOSE: To assess the effectiveness of vitrectomy for stage V retinopathy of prematurity (ROP) at the authors' institution, 33 patients with ROP who had initially successful total or partial anatomic retinal attachments (51 eyes) were evaluated for visual function and long-term anatomic stability. In addition, this study was an attempt to differentiate levels of visual function in children with very low vision and attendant developmental delays. METHODS: Visual function was assessed before retinal examination by an experienced pediatric vision specialist. The behavioral visual assessment was divided into seven segments with two to five tasks in each segment designed to establish a level of functional vision, ranging from light perception to form identification (and ambulation). The status of the retina was classified by the patient's retinal surgeon. RESULTS: The median follow-up was 61 months, and median age at the time of examination was 68 months. Of 51 eyes treated, form identification was achieved in 5, and all five patients had ambulatory vision. Of 51 eyes, 15 had no light perception, 11 had light perception, 6 could localize light, 10 could follow lights, and 4 were able to detect form. Only one eye in ten children with comparable ROP in each eye underwent surgery, and vision improved in six of ten of the surgical eyes. Redetachment was high, with 35 retinas totally or partially detached and only 13 retinas fully attached 61 months after surgery. CONCLUSION: The visual results are very low and disappointing. Initially successfully attached retinas can detach. There is some evidence that vitrectomized eyes function better than nonvitrectomized eyes. There is also evidence that visual function lower than form identification is useful to these children and that they are able to use their limited vision better than previously though.

Growth inhibition of human Tenon's capsule fibroblasts and rabbit dermal fibroblasts with non-carcinogenic N-alkylated anthracyclines.

Bleb fibrosis after glaucoma filtering surgery and proliferative vitreoretinopathy after retinal detachment surgery are complications caused by proliferation of fibroblasts or fibroblastlike cells. The anthracycline daunomycin (DNM) has been used for treatment of those proliferative processes in humans. However, complications such as conjunctival necrosis and corneal or scleral ulcerations have been reported after administration of DNM to glaucoma patients. Intravitreal administration of DNM in rabbit eyes resulted in morphological and functional retinal damage. DNM also has the undesired general effect of carcinogenicity. N-Alkylation of the aminosugar moiety of DNM results in reduction or loss of carcinogenicity. We evaluated the inhibitory effect of the new non-carcinogenic N-alkylated analogues aclacinomycin A (ACA), N,N-dimethyladriamycin (AD280), and N-trifluoroacetyladriamycin-14-O-hemiadipate (AD143) on the growth of cultured human Tenon's capsule fibroblasts and rabbit dermal fibroblasts. Using DNM as a positive control, we conducted proliferation assays that demonstrated that ACA and AD280 inhibited fibroblast growth as effectively as DNM. AD143 was less efficacious. The magnitude of cellular growth inhibition was concentration dependent for all drugs tested. Extension of exposure times resulted in increased rates of cell death. Our in vitro studies suggest that further evaluation of ACA and AD280 should be carried out in animal models of ocular proliferative disorders.

The efficacy of silicone oil for complicated retinal detachments in the pediatric population.

OBJECTIVE: To evaluate the efficacy of silicone oil as an intraocular tamponade for complicated retinal detachments in the pediatric population. DESIGN: Case series. SETTING: Referral practice at a major university hospital eye center. PATIENTS: Consecutive referred sample of 48 cases of complicated retinal detachments in children 16 years old or younger. Forty-two percent of the patients had traumatic injuries, and 35 of the eyes had undergone at least one previous retinal surgery. The minimum follow-up was 6 months, with an average follow-up of 23 months. INTERVENTIONS: Pars plana vitrectomy, silicone oil injection, and advanced vitreoretinal surgical techniques. MAIN OUTCOME MEASURES: Successful repair of complicated retinal detachment, improved visual acuity post-operatively, and frequency of complications. RESULTS: The postoperative visual acuity at the last follow-up examination was counting fingers or better in eight (17%) of the 48 cases, and only two eyes saw 20/200 or better. In the 46 eyes in which the retinal status could be determined, 16 retinas (35%) were successfully reattached at last follow-up. Significant complications included corneal opacification (62%) and hypotony (58%). Postoperative glaucoma was not a problem. CONCLUSIONS: In the pediatric population with complicated retinal detachments, silicone oil used for intraocular tamponade has disappointing results due to a low rate of sustained retinal reattachment, poor visual rehabilitation, and a high complication rate.

Treatment and pathogenesis of traumatic chorioretinal rupture (sclopetaria).

Eight eyes (seven patients) with traumatic chorioretinal rupture (sclopetaria) from severe ocular trauma were examined. All seven patients were referred with diagnoses of retinal detachment, giant retinal tear, or ruptured globe. Instead, all eyes had large, peripheral, full-thickness breaks of the choroid and retina without retinal detachment. Seven of eight eyes were initially managed by observation only; one eye was treated with a scleral buckling procedure. The retina remained attached in all eyes for at least six months. Late retinal detachment (more than one year after initial injury) occurred in two eyes because of retinal breaks at a site distant from the original chorioretinal rupture. Two eyes later developed vitreous hemorrhage associated with posterior vitreous detachment and one of these eyes required vitrectomy to clear the visual axis. The pathogenesis of sclopetaria appears to be mechanical disruption and retraction of tissue rather than acute tissue dissolution. The risk of acute retinal detachment is low. We recommend nonsurgical management for the initial treatment of these patients, with continued observation for complications that may later occur.

GRAVIRESPONSES IN PARAMECIUM CAUDATUM AND DIDINIUM NASUTUM EXAMINED UNDER VARIED HYPERGRAVITY CONDITIONS

The swimming behaviours of two species of ciliates characterized by different mechanosensory and ciliary motor properties were investigated under hypergravity up to 5.4 g. The experiments were designed to examine large numbers of cells using video recording, digital data processing and statistics for the documentation of the rates and orientations of swimming. The gravikinetic responses (change in active swimming rates) were calculated from (1) the velocities of vertical swimming in the gravity field, (2) sedimentation of Ni2+-immobilized cells and (3) the intrinsic rate of propulsion, independent of gravity. Propulsion was determined from the intersection of regression lines of the gravity-dependent upward and downward swimming velocities. The rates of swimming and sedimentation, and consequently the gravikineses, were linear functions of gravitational acceleration. Comparisons of cell populations from different cultures suggest that there is an age-dependent change in gravikinesis. In starved Paramecium caudatum (7-day cultures), the kinetic responses antagonizing sedimentation (negative gravikinesis) increased with acceleration. In Didinium nasutum, negative gravikinesis was documented at 1 g in downward-swimming specimens only, which agrees with the mechanosensory organization of this cell. Hypergravity induced the gravikinesis of Didinium to change sign. In both species, and at all accelerations tested, a neutral gravitaxis was documented. Such behaviour incorporates distinct acceleration-dependent orientational and velocity responses, keeping populations of cells stationary in the gravity field (taxis coefficients close to zero).

Retinal separation, retinotomy, and macular relocation: I. Experimental studies in the rabbit eye.

An animal model in the rabbit eye was utilized to study mobilization and relocation of the fovea as a potentially beneficial surgical approach to age-related macular disease. After lentectomy and vitrectomy, the retina was completely separated from the pigment epithelium by means of infusion into the subretinal space. A 360 degrees peripheral retinotomy was performed. The retina was rotated up to 60 degrees around the optic nerve as axis and reattached. Scanning and transmission electron microscopy revealed the relative intactness of outer segments and pigment epithelium after this procedure, both acutely and 3 days following reattachment.

Retinal separation, retinotomy, and macular relocation: II. A surgical approach for age-related macular degeneration?

Three cases of age-related maculopathy with severe and recent massive submacular hemorrhage were treated by performing complete vitrectomy. A total retinal detachment was created by infusion of fluid underneath the retina, followed by a peripheral circumferential retinotomy. This allowed access to the subretinal space for removal of blood and membranes and, more importantly, permitted rotation of the retina with relocation of the fovea. Rotations between 30 degrees and 80 degrees were achieved. One patient with 5 months' follow-up had a visual improvement from 1/200 to 20/80 and excyclorotation of images. The other two patients developed proliferative vitreoretinopathy after initially successful rotation. Their retinas were reattached after surgical removal of the membranes and silicone oil tamponade, but visual function remained low. The rationale for this treatment is that relocating the fovea to an area where pigment epithelium is less diseased than in the central area may allow for recovery of some useful vision.

Ocular toxicity of daunomycin: effects of subdivided doses on the rabbit retina after vitreous gas compression.

Daunomycin is a potent antiproliferative agent which has been shown to prevent experimental proliferative vitreoretinopathy. However, toxic effects on the rabbit retina have been reported even for the lowest effective doses. In a previous report we demonstrated that subdivided doses rather than single doses of daunomycin improves the efficacy in prevention of experimental proliferative vitreoretinopathy. To evaluate whether dose subdivision would also have an alleviating effect on drug toxicity, we administered 15 nmol daunomycin in doses of 10 nmol and 5 nmol 4 h apart into the vitreous cavity of rabbit eyes which had previously undergone vitreous gas compression. All contralateral eyes received sham treatment. Simultaneous electroretinographic recordings from both eyes on days 0, 3, 7, and 14 demonstrated a significant b-wave decline in drug-exposed eyes. Morphological studies on these eyes revealed no retinal damage. Our findings suggest that dose subdivision does not eliminate the retinal toxicity of daunomycin.