Transillumination for accurate placement of radioactive plaques in brachytherapy of choroidal melanoma.

PURPOSE: To present a technique for accurate plaque placement in episcleral brachytherapy of choroidal melanoma. METHODS: The tumor margins are marked on the scleral surface, and a dummy plaque is temporarily sutured to the globe. A fiber optic light pipe is then wedged into the space between the sclera and the plaque. Because of the reflecting inner surface of the plaque, the perimeter of the plaque can easily be observed during indirect ophthalmoscopy as a circle of light surrounding the tumor. By this method, it is possible to determine the exact position of the entire plaque in relation to the tumor and make the necessary adjustments. When the correct position is found, the dummy plaque is replaced by a radioactive plaque. RESULTS: Since 1993, we have routinely used this procedure in episcleral brachytherapy. CONCLUSION: This modified transillumination technique facilitates a correct positioning of episcleral plaques.

Simultaneous, bilateral rhegmatogenous retinal detachment.

PURPOSE: To examine the incidence, the preoperative findings and the surgical outcome of patients presenting with simultaneous, bilateral retinal detachment. METHODS: A retrospective analysis of the medical records of patients undergoing surgery for rhegmatogenous retinal detachment between 1990 and 1998. RESULTS: During this period a total of 827 operations for rhegmatogenous retinal detachment were done in 791 consecutive patients. Eighteen patients (2.3%) had simultaneous, bilateral retinal detachment, giving an annual incidence of 0.35 patients per 100,000 population. They all presented with unilateral symptoms. Compared with the group of unilateral or consecutive, bilateral retinal detachments, patients suffering from simultaneous, bilateral retinal detachments were significantly younger, with a mean age of 40.3 years. Thirteen patients had multiple, round retinal holes associated with lattice degeneration. Sixteen patients were myopic, ranging from -3 to -9.25 diopters. The retina was reattached in 35 (97%) of the 36 eyes operated on during the study period. CONCLUSION: Simultaneous, bilateral retinal detachment is usually found in relatively young, myopic patients with round, atrophic retinal holes, presenting with unilateral visual symptoms.

Exudative retinal detachment in nanophthalmos.

PURPOSE: To report the treatment of exudative retinal detachment in a patient with nanophthalmos. METHODS: A 46-year-old man with bilateral nanophthalmos suffered from acute angle-closure glaucoma in his left eye. The first day after a peripheral iridectomy an exudative retinal detachment was observed. Two months later a partial thickness sclerectomy with a central sclerostomy, covered by a thin film of absorbable gelatine, was performed in each quadrant of the left eye. RESULTS: The retinal detachment gradually resolved and after eight months the retina was completely reattached. Vision, which had been limited to hand movements, improved to 6/18 with correction. CONCLUSION: Scleral resections are effective in the treatment of nanophthalmic retinal detachment. The use of absorbable gelatine film to cover the sclerectomized area may prevent regeneration of scleral tissue and recurrence of the exudative retinal detachment.

Retrobulbar anesthesia with and without adrenaline in extracapsular cataract surgery. A prospective, randomized, double-blind study.

Seventy-five patients with senile cataract underwent a planned extracapsular cataract extraction. They were randomly divided into two groups, receiving retrobulbar anesthesia (4 ml lidocaine 2% and 250 IU hyaluronidase) with or without adrenaline. Patients in the adrenaline group had the lowest mean intraocular pressure after the retrobulbar injection (p < 0.02) and they required a shorter time of digital bulbar massage to reduce tension before surgery (p < 0.01). They also appeared to have a deeper anterior chamber during the first part of surgery, although the difference was not statistically significant. The duration of postoperative analgesia was significantly prolonged in patients receiving adrenaline. Different mechanisms explaining the effects of adrenaline in retrobulbar anesthesia are discussed.

[Primary intraocular lymphoma]. / Primaert intraokulaert lymfom.

Primary intraocular lymphoma can arise as an isolated clinical entity or in combination with lymphomas in the central nervous system. The symptoms are usually floaters in the visual field and reduced visual acuity. The condition is commonly misdiagnosed as chronic uveitis in spite of unresponsiveness to corticosteroids. The authors discuss a case of primary intraocular lymphoma diagnosed in a 65 year old male patient. He had bilateral intraocular lesions in addition to two brain tumours. He went into complete remission after radiation therapy, but experienced later a recurrence in one eye. A course of chemotherapy using cytarabin (cytosine arabinoside) intravenously has kept the patient in remission for four months. The authors also discuss the diagnostic and therapeutic problems connected with this rare condition.

Retrobulbar anesthesia with and without hyaluronidase in extracapsular cataract surgery. A prospective, randomized, double-blind study.

Eighty patients with senile cataract were subjected to a planned extracapsular cataract extraction (ECCE) with implantation of a posterior chamber intraocular lens. Retrobulbar anesthesia was administered by injection of 4 mg lidocaine 2% with adrenalin. In 40 patients 150 I.U. hyaluronidase (Kinetin) was added to the anesthesia. The hyaluronidase group had a significantly lower frequency of iris prolapse, and deeper anterior chamber, both before and after expression of the lens nucleus. Possible mechanisms explaining the beneficial effect of hyaluronidase in extracapsular cataract surgery are discussed.

Indirect spectral transmission ratio measurements of the aging crystalline lens nucleus.

A new objective approach to characterize color and opalescence in the lens nucleus, using wavelength indexed transmission ratios (TR) is described. Transmission ratios, i.e. the transmissivity per unit lens thickness, for the whole visible spectral range (390-720 nm) were calculated using fast scanning spectral colorimetry (FSSC). The lowest transmission ratios values were obtained in the blue part of the spectrum in general and at 450 nm in particular. They inversely followed the subjectively determined LOCS II color grading. The difference between transmission ratios at the absorbed part of the spectrum (less than 500 nm) and the non-absorbed part (greater than 550 nm) also reflects the LOCS II color grading. The overall mean transmission ratios for all wavelengths in the spectrum gives an index that closely followed the nuclear opalescence grading of the LOCS II system. The transmission ratios are theoretically independent of the spectral characteristics of the incident light as long as it contains suprathreshold energies in the whole measured spectral range.

The lens capsule and zonulae.

The embryology and natural history of the lens capsule and the zonular apparatus have been described according to the present knowledge of the subject. Clinical evidence pointing towards an active turnover of lens capsule material is presented.

[Diagnosis of Spielmayer-Vogt disease. Electron microscopy of conjunctival biopsy]. / Diagnostikk av Spielmeyer-Vogts sykdom. Elektronmikroskopi av konjunktivalbiopsi.

The authors describe ultrastructural changes in conjunctival specimens from five patients with Spielmeyer-Vogt-Batten's disease. Four of the specimens contained lysosomal "fingerprint-bodies", regarded as a specific lesion for this disease. When the biochemical defect remains unknown, the recognition of these ultrastructural changes is a valuable diagnostic tool to supplement clinical and electrophysiological examinations.

The ultrastructural changes in the exfoliation syndrome.

Exfoliation fibrils have a characteristic ultramicroscopic appearance. They are 20-30 nm thick with 10 nm subunits and may be 800 or 900 nm long. They sometimes have a characteristic banding periodicity of about 50 nm. The fibrils have been located in the lens capsule, zonular threads, iris, ciliary body and trabecular meshwork. Extraocular locations have also been found in conjunctival vessels and retroorbital tissue.

A new high precision fingertip controlled aspiration device for extracapsular cataract surgery.

The electronically foot-switch controlled irrigation/aspiration instruments have several disadvantages due to the big 'dead space' between the pump and the aspiration cannula. A new high precision fingertip controlled aspiration system is described. A specially designed ball valve connects the aspiration cannula directly to the vacuum reservoir, thereby almost eliminating the dead space. The system is nonelectric, it has no moving parts, it is easy to operate and highly cost efficient.

Acute glucose-derived osmotic stress in rabbit lenses.

The morphological changes observed in rabbit lenses incubated without corpus vitreum in medium whose glucose concentration varied cyclically between normoglycaemia and hyperglycaemia were analyzed for the location of light scattering vacuoles. Minimal changes were seen in the epithelial cells, the external bow fibres and the lens nucleus, while maximal changes with vacuolization and damage were seen in the posterior part of the inner bow fibres. It was shown that the exchange of water takes place mainly across the posterior capsule. The susceptibility of this region in part may be due to the low aldose reductase activity in this region of the lens.

Deposits on hydrophilic 'bandage' lenses. A scanning electronmicroscopic and x-ray microanalytic study.

Scanning electronmicroscopy of 34 continuously worn Sauflon PW 'bandage' lenses showed an initial deposition of cellular debris, followed by an increasing, general, non-penetrating, organic coating, particularly on the anterior lens surface. No microorganisms were found. X-ray microanalysis of the 34 Sauflon PW lenses as well as 11 daily worn Hydroflex m lenses showed that elements may be added to or 'washed out' from the lenses during storage before preparation for microscopy. The elements obtained were constituents of both normal tear fluid and lens storage solutions. Only sulphur appeared firmly bound in the deposits, probably as sulphur-containing macromolecules of ocular mucus. Calcium was only detected in a few cases.

The effect of freezing on human cortical cataracts.

To ascertain a direct relationship between the light scattering intensity and the particle scattering the light, thin (6-20 micrometers) sections were cut from frozen human cataracts. Freezing for 15 min (-10 C) and then thawing had no effect on the clarity or light scattering properties of nuclear cataracts. Cortical cataracts treated in the same manner appeared to be much clearer than they were prior to freeze-thawing. Light scattering measurements were obtained as a function of scattering angle, both in the I parallel and I perpendicular mode; a He-Ne laser was used. Results showed a reduction in the light scattering intensity in the I parallel and I perpendicular modes with repeated cyclical freezing and thawing and that this decrease was most pronounced at higher scattering angles. Morphologic data showed that much of the anatomical heterogeneity present in the human cortical and rat lens osmotic cataract disappeared upon freeze-thawing. However, even though the anatomical heterogeneity was less, there was persistence of serious cellular anatomical disorganization in grossly transparent parts of the cortex. This suggests that transparency is not dependent upon the presence of intact fiber cells. The importance of these findings to studies of light scattering, cataract classification and analysis of cryoextracted human lenses is discussed.

Cataracts in the exfoliation syndrome (fibrillopathia epitheliocapsularis).

The histopathological features of the lenticular part of the exfoliation syndrome includes active production of pathological capsular substance in the epithelial cells in the zona germinativa. Analysis of the cataract pattern of 431 exfoliation lenses and 1776 control lenses extracted at the Massachusetts Eye and Ear Infirmary shows a significant difference. Cortical and supranuclear cataract is less common and severe in the exfoliation syndrome, while the reverse is true for nuclear cataract. Posterior subcapsular cataract shows no difference while the anterior variety is slightly more common in the control group. It is suggested that the high level of epithelial metabolic activity may be beneficial for the ionpumps and electrolyte environment of the cortical fibres.

Timolol maleate in treatment of open angle glaucoma.

The effect of Timolol maleate on the intraocular pressure in open angle glaucoma has been examined in 37 patients, of these simple glaucoma in 26 (48 eyes), capsular glaucoma in 9 (14 eyes) and chronic secondary glaucoma in 2 patients (2 eyes). These cases constituded a group which was relatively difficult to manage. The average pressure reduction caused by Timolol maleate alone was about 23%. In 18 patients the intraocular pressure was adequately controlled on Timolol as the only drug and in 10 on additional drug therapy. Five patients failed on drug treatment, and the remaining four failed on one eye while the fellow eye was well regulated. Tonography indicates that the effect is caused by a reduction of the aqueous humour production. Side effects of locally applied Timolol maleate have not been observed. This drug may be the drug of choice in many instances.

Histopathology of the lens capsule in fibrillopathia epitheliocapsularis (FEC) or so-called senile exfoliation or pseudoexfoliation. An electron microscopic study.

Twenty lenses from cataractous eyes have been subjected to enzymatic breakdown by collagenase and alpha-chymotrypsin in order to remove part of the lens capsule and the zonular apparatus. Twelve of the lenses had clinical fibrillopathia epitheliocapsularis (FEC syndrome). In addition four FEC lenses and four ordinary cataractous lenses served as controls. A characteristic fibrillar substance was found in the FEC lenses located to circular epithelium-near areas varying in size from 10 micrometers to 150 micrometers. The circular areas were found in zona germinativa in front of the bow region and corresponded to the discoid plaques of the deep layer. The ultrastructure of the finely fibrillar material of the deep layer were indistinguishable from that of the surface material of the peripheral band and the central disc. A connection between the discoid plaques of deep layer and the peripheral granular band were demonstrated in the form of radial "cobble-stone" sectors seen in partially digested FEC capsules. An increased amount of age dependent spindleshaped formed bodies were also found in FEC lenses. The evidence presented points towards a lenticular origin of the Busacca-bushes in the peripheral ganular band of the lens capsule.

The ultrastructure of the human lens capsule. I. Cataractous lenses from eyes with simple glaucoma. A transmission electron microscopic study.

The lens capsules from five cataractous lenses removed from eyes with glaucoma simplex have been compared with capsules from five cataractous lenses removed from eyes without glaucoma. Glaucoma simplex, cataracta senilis or the treatment of the glaucoma by drug therapy or surgical intervention do not seem to influence the ultrastructure of the lens capsule. The findings are identical with those observed in the normal aging human lens.