Comparative study of retinal nerve fiber layer loss in normal-tension glaucoma and chronic open-angle glaucoma.

PURPOSE: To clarify whether loss of the retinal nerve fiber layer in normal-tension glaucoma (NTG) differs from that in chronic open-angle glaucoma (COAG). METHODS: Using a scanning laser polarimeter, retinal nerve fiber layer thickness (RNFLT) was measured in 21 patients with NTG, 21 patients with COAG and 21 normal controls. The three groups were matched for age, and the NTG and COAG groups were matched for visual field loss. RESULTS: The mean RNFLT was significantly less in the NTG than in the control group and less in the COAG than in the controls and NTG group. Although the correlations between the parameters of RNFLT and homotopic visual field measurements were significant in COAG, none of the correlations were significant in NTG. CONCLUSIONS: The present results suggest that loss of the retinal nerve fiber layer in NTG differs from that in COAG.

Asymmetries of the retinal nerve fibre layer thickness in normal eyes.

AIMS: To investigate the variation in the retinal nerve fibre layer thickness in detail in normal eyes with a scanning laser polarimeter. METHODS: The retinal nerve fibre layer thickness (RNFLT) was measured in 94 normal volunteers with a scanning laser polarimeter. The mean RNFLT around a 10 pixel-wide ellipse located concentrically with the disc of 1.5 disc diameters was calculated for 16 sectors each of 22.5 degrees. The symmetry of the RNFLT distribution with respect to the horizontal midline for individual eyes and to the vertical meridian for the two eyes was examined. RESULTS: The RNFLT was thicker on the inferior side than on the superior side for the temporal four pairs of 22.5 degrees sectors, and the differences were significant in two of the four temporal pairs (p<0.007). The RNFLT was thicker in the superior than in the inferior side for the nasal four pairs of the sectors, and the differences were significant in three of the four nasal pairs (p<0.04). The mean RNFLT was significantly thicker in the right eyes than in the left eyes in the four temporal sectors (p<0.02), and significantly thicker in the left eyes than in the right eyes in the inferior two nasal sectors (p<0.01). CONCLUSIONS: Asymmetries of the RNFLT in normal eyes with respect to the horizontal midline and to the vertical meridian for the two eyes were found. These asymmetries should be considered when retinal nerve fibre layer loss is evaluated during the course of a disease process.

Expression of cell cycle-related genes in dying cells in retinal ischemic injury.

PURPOSE: To investigate whether cell cycle-related genes play a role in neuronal cell death in retinal ischemia-reperfusion injury. METHODS: Retinal ischemia-reperfusion injury was induced in rats by a ligation method and also by increasing the intraocular pressure. After 1 hour-of ischemia, cell death in the retina was studied using the TdT-dUTP terminal nick-end labeling (TUNEL) method, propidium iodide (PI) staining, DNA ladder formation, and ultrastructural studies. Immunohistochemical studies using antibodies against cell cycle-related genes were conducted. Changes in expression of cyclin D1 mRNA were quantitated using competitive quantitative polymerase chain reaction. RESULTS: At 3 hours after reperfusion, cells in the ganglion cell layer were the first to die, followed by those in the inner nuclear layer (at 6 hours) and outer nuclear layer (at 9 hours). Ultrastructural studies revealed condensed nuclei and relatively preserved mitochondria; DNA ladder formation was also detected. Immunostaining was positive for the cell cycle-related gene products c-Jun, cyclin B1, and cyclin D1. The time course of TUNEL-positive cells and that of cells positive for c-Jun or cyclin D1 in the inner nuclear layer was similar. A double-labeling study, using PI or TUNEL, and immunohistochemical analysis revealed that dying cells expressed c-Jun and cyclin D1, whereas cyclin B1 expression was observed in Müller cells. Quantitation of cyclin D1 mRNA revealed an approximate 4-fold increase at 24 hours after reperfusion. CONCLUSIONS: Aberrant expression of cell cycle-related genes may play an important role in the cell death that accompanies retinal ischemia-reperfusion injury.

Electron microscopic immunohistochemistry of ocular and extraocular pseudoexfoliative material.

To investigate the nature of extraocular pseudoexfoliative (PSX) material, and to validate the hypothesis that the PSX syndrome is a systemic disorder, we studied the immunoreactivity of intraocular and extraocular PSX material from patients with the PSX syndrome using antibodies against proteins of extracellular matrices. Surgical specimens of four different tissues were obtained from human eyes with the PSX syndrome: nine trabecular tissues, three cataractous lenses, six bulbar conjunctivas, and seven lid skins. These tissues were processed for electron microscopic immunohistochemistry, and stained with antibodies against vitronectin, fibronectin, laminin, and elastin, by an indirect immunogold procedure. Density of the gold particles located on the PSX material was estimated by video image analysis. Statistical analysis of the data revealed that the PSX material from trabecular tissues, lenses, bulbar conjunctivas, and lid skins had almost identical immunoreactivity to the antibodies studied. PSX materials of trabecular tissues, lenses, bulbar conjunctivas, and lid skins were found to have not only a similar ultrastructure, but also almost identical immunohistochemical characteristics. These results support the hypothesis that the PSX syndrome is a systemic disorder.

Electron microscopic lectin histochemistry of the trabecular meshworks in human eyes.

Ten normal human trabecular meshworks were examined by electron microscopy using avidin-biotin complex in order to investigate the localization of binding sites of eight lectins. The tissue specimens were fixed in paraformaldehyde and glutaraldehyde mixture and embedded in Lowicryl K4M at low temperature. The ultrathin sections were stained with biotin labelled lectins and colloidal gold labelled streptoavidin and were observed with the conventional transmission electron microscope. Some lectins such as ABA, ConA and DSA were localized on fine fibrils underneath the endothelium of the trabecular wall of the Schlemm's canal, electron-dense cores of elastic fibers, fine granular like materials, basement membranes, collagen fibers and the long-spacing fibers. However, the other lectins such as DBA, SBA, Lotus, UEA-I and RCA60 were not specifically localized in these tissues. From the results it was demonstrated that the differential ultrastructural localization of glycoconjugate residues in the human trabecular meshworks can be revealed using this lectin staining.

Lectin electron microscopic histochemistry of the pseudoexfoliative material in the skin.

PURPOSE: To investigate the hypothesis that pseudoexfoliation (PSX) syndrome is a systemic disorder, the authors studied the composition of glycoconjugates in the intraocular and extraocular PSX material at the electron microscopic level, using a panel of lectins as cytochemical probes. METHODS: The authors examined 8 lid skins, 11 trabecular tissues, and 3 cataractous lenses from human eyes with PSX syndrome. Tissues were processed for electron microscopical histochemistry and stained with PNA, RCA120, DBA, SBA, ConA, WGA, UEA-I, and Lotus, with an indirect lectin-colloidal gold technique. RESULTS: Both the intraocular and extraocular PSX materials manifested almost identical reactivity to lectins, which indicated that glycoconjugates in the PSX material contained with sugar residues of galactose (PNA, RCA120), alpha-mannose (ConA), and N-acetyl-D-glucosamine (WGA). On the other hand, it was indicated that sugar residues of N-acetyl-D-galactosamine (DBA, SBA) and fucose (UEA-I, Lotus) were absent. Granular inclusions and microfibrils in the capsule and ocular zonules were stained similarly and weakly. CONCLUSIONS: The intraocular and extraocular PSX materials contained the same sugar residues of glycoconjugates, which suggested that those materials had the same nature. This study, the first documentation of lectin-binding sites on the extraocular PSX material, supported the hypothesis of PSX syndrome as a systemic disorder.

Localization of elastin in the normal and glaucomatous human trabecular meshwork.

PURPOSE: The extracellular materials (ECMs) in the trabecular meshwork (TM) are thought to play a crucial role in aqueous outflow resistance. Immunohistochemical localization of elastin, one of the major ECMs in the normal and glaucomatous human TM, was examined ultrastructurally. METHODS: Eight normal eye bank eyes and 16 trabeculectomy specimens of primary open angle glaucoma (POAG, 11 eyes from 8 cases), congenital glaucoma (2 eyes from 1 case), and juvenile glaucoma (3 eyes from 2 cases) were embedded in Lowicryl K4M at low temperature. The distribution of elastin was studied by the protein A-gold technique. RESULTS: In normals, the gold particles indicating the antigenic sites for elastin existed mainly in the central amorphous element of the elastic-like fibers, and a few gold particles were observed within the area containing fine granular-like material and fine fibrillar-like material. No labeling was observed in cellular materials or other ECMs. In congenital and juvenile glaucoma, labeling was similar to that observed in normals. In POAG specimens compared to normals, there was an increased amount of elastin-bound immunogold particles along the inner canal endothelium. The increased gold particles, which did not have a fibrillar arrangement and were not enclosed by electron-dense microfibrils, were found within the area containing fine fibrillar-like material. However, labeling within the elastic-like fibers was similar to that observed in normals. CONCLUSIONS: Under electron microscopy, elastin could be localized in the normal and glaucomatous human TM. The results of this investigation suggest that elastin may play an important role in the etiology of POAG.

Dominance of activated T cells and interleukin-6 in aqueous humor in Vogt-Koyanagi-Harada disease.

PURPOSE: To determine the immunopathologic role of the lymphocytes and lymphokines in aqueous humor (AH) of patients with Vogt-Koyanagi-Harada disease (VKH). METHODS: The distribution of leukocyte subsets in the peripheral blood and AH was examined using fluorescein isothiocyanate-conjugated monoclonal antibodies. The levels of lymphokines, such as interleukin-2 (IL-2) and interleukin-6 (IL-6), in the sera, AH, and cerebrospinal fluid from the patients with VKH were determined using an enzyme-linked immunosorbent assay. RESULTS: T cells constituted the majority of lymphocytes within AH. The value for CD4+ cells (helper/inducer T lymphocytes) in AH was 51.7% +/- 14.9% (mean +/- SD) and that for CD8+ cells (cytotoxic/suppressor T lymphocytes) was 31.1% +/- 13.0%. The percentage of HLA-DR+ cells (B lymphocytes, monocytes, macrophages, and activated T lymphocytes) in AH (50.8% +/- 24.9%) significantly exceeded (P < 0.001) that in blood (13.1% +/- 4.2%). The percentage of CD8+ cells in AH from three patients with the delayed type of VKH rose during their clinical course. The level of IL-6 was significantly elevated in AH from the patients with VKH. The level of IL-6 in AH correlated with the number of lymphocytes in AH, and it reflected the severity of the inflammatory response in AH of patients with VKH. The level of IL-2 in the sera, AH, and cerebrospinal fluid was in the normal range. CONCLUSIONS: Aqueous humor lymphocytes from the patients with VKH were more activated than were peripheral blood lymphocytes. IL-6 may play an important role as an inflammatory mediator in VKH. It may be useful to analyze the lymphocyte subsets and the levels of lymphokines, especially of IL-6, at the site of inflammation in uvea to improve the criteria for assessing the prognosis of VKH.

[Ultrastructural immunohistochemical localization of elastin in the human trabecular meshwork].

An electron microscopy study on the distribution of elastin in the trabecular meshwork of normal human eyes and in that of eyes with primary open angle glaucoma (POAG) was done using a protein-A gold immunohistochemical method with antiserum to either alpha-elastin or tropoelastin. Four types of elastic fibers were found to have elastin: (1) elastic-like fibers without the sheath, (2) fibers surrounded with a sheath of periodic structure, (3) fibers surrounded with fine granular-like material, and (4) connecting fibrils. No individual differences were observed in the labeling for these four types of elastic fibers. Antigenic sites against elastin of the elastic fibers were observed mainly in the low electron density amorphous elements. In the subendothelial layer of Schlemm's canal of the eyes with POAG, a marked increase of elastin was noted within the area containing fine fibrillar-like material. This phenomenon did not occur in age-matched normal eyes. The results suggest that elastin plays an important role in the development of POAG.