Absence of estrogen and progesterone receptors around the affected vessels of angioma serpiginosum: case report.

Angioma serpiginosum is a disorder of dilated superficial dermal capillaries. The disease is considered by some authors to be a consequence of increasing levels of estrogens. We present a case of angioma serpiginosum in a 46-year-old White woman. The lesions consisting of red-purple puncta were grouped as vaguely annular and angular patches with serpiginous borders, located on the right side of the neck, the right side of the abdomen, and on the left arm. Histopathologic examination revealed clusters of dilated capillaries in the dermal papillae, without endothelial proliferation. Periodic acid-Schiff (PAS) stain-positive deposits were noted around the affected blood vessels. However, immunohistochemical analysis revealed the absence of estrogen and progesterone receptors within the involved blood vessels. Hormonal assays were also normal. Our observations suggest that a hormonal stimulus probably plays no role in the pathogenesis of angioma serpiginosum. The significance of PAS-positive deposits as a diagnostic marker for angioma serpiginosum needs further confirmation.

Silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction.

PURPOSE: To evaluate the technical properties and clinical efficacy of bicanalicular silicone intubation with the Ritleng method in children with congenital nasolacrimal duct obstruction. METHODS: The Ritleng method was used for lacrimal intubation in 50 eyes of 42 consecutive patients (mean age, 37.3 months). All procedures were done by or under the supervision of one surgeon. The hollow Ritleng probe was inserted via the canaliculus into the inferior meatus. The polypropylene (Prolene) thread-guide, attached to the silicone tube, was advanced through the probe. Either the Prolene emerged from the nose spontaneously or it was retrieved using a hook without visualization. The tube ends were sutured to the nasal wall. Tube removal was planned for 3 months postoperatively. Resolution of signs and symptoms of lacrimal obstruction was assessed. The mean follow-up time was 18.1 months (range, 3 to 48 months). RESULTS: The silicone tube was placed successfully in all eyes except 1 (98%). The mean procedure time was 26 minutes for each eye (range, 15 to 45 minutes). Both Prolene guides spontaneously emerged from the nose in only 8 eyes (16%). In the others, one or both Prolene guides were retrieved with a hook. Inadvertent tube dislodgement occurred in 21% of the eyes and required early tube removal. Success, ie, relief of signs and symptoms, was achieved in 86% of eyes. CONCLUSIONS: The Ritleng method of intubation for congenital nasolacrimal duct obstruction yields a high rate of success. Contrary to previous reports, our experience suggests that the surgeon must be prepared to retrieve the Prolene guide from the nose.

Effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics.

OBJECTIVES: To determine the effect of oxymetazoline nasal spray on intraocular pressure and retrobulbar hemodynamics in patients with open-angle glaucoma and to compare the results with those measured in healthy control participants. STUDY DESIGN: Controlled, prospective clinical trial. SETTING: University hospital. METHODS: Thirty patients with open-angle glaucoma and 30 healthy volunteers as controls were topically self-administered oxymetazoline nasal spray three times a day (one spray in each nostril of 0.05% concentration) for 5 days continuously. MAIN OUTCOME MEASURES: Intraocular pressure and retrobulbar hemodynamics were measured in glaucomatous and normal eyes at baseline and at the end of oxymetazoline application . RESULTS: Oxymetazoline nasal spray lowered intraocular pressure significantly in both the glaucoma group (p = .02) and the control group (p = .001) after 5 days of treatment. The systemic parameters in the glaucoma and control groups (systolic blood pressure, p = .14 and p = .17; diastolic blood pressure, p = .18 and p = .49; and pulse rate, p = .06 and p = .50, respectively) did not show statistically significant differences during the study period. Additionally, except with a significant decrease in the resistivity index of the central retinal artery in the glaucoma patients (p = .001), oxymetazoline nasal spray did not result in any significant changes in the retrobulbar hemodynamics in both the glaucoma and control groups. CONCLUSIONS: This study showed that a 5-day treatment with oxymetazoline nasal spray reduced intraocular pressure in both healthy controls and patients with glaucoma under treatment. In addition, it had no significant adverse effects on the retrobulbar hemodynamics.

Changes in cerebral and ocular hemodynamics in Behçet's disease assessed by color-coded duplex sonography.

AIM: To quantify the cerebral and retrobulbar hemodynamics in Behçet's disease with and without ocular involvement and compared with that of healthy controls. MATERIALS AND METHODS: Of 51 people studied, 17 had Behçet's disease with ocular involvement, 17 had Behçet's disease without ocular involvement, and 17 were healthy controls. A single eye was examined in each patient. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (Tamax), and resistance index (RI) were evaluated in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA) and middle cerebral artery (MCA). Additionally, the average blood flow velocities in the central retinal vein (CRV), and acceleration time (AT) and pulsatility index (PI) in the MCA were calculated. RESULTS: The mean EDV in the PCA was 25% lower and RI was higher in patients with ocular involvement of BD than in patients without involvement (p = 0.006 and p = 0.005, respectively) and in healthy controls (p = 0.003 and p = 0.004, respectively). Differences were smaller in comparisons of the CRA and absent on comparisons of the OA and MCA. The acceleration time of the MCA was significantly higher in patients with Behçet's disease than in healthy controls (p = 0.03). CONCLUSION: This study suggests that the flow hemodynamics in retrobulbar circulation has more altered Behçet's disease with ocular involvement than without ocular involvement and healthy control. Additionally, the cerebral hemodynamic might be affected in patients with Behçet's disease compared with healthy controls.

Clinical and histopathological findings in Bannayan-Riley-Ruvalcaba syndrome.

Bannayan-Riley-Ruvalcaba syndrome is a rare autosomal dominant genodermatosis with the classical triad of macrocephaly, genital lentiginosis, and intestinal polyposis. Characteristic mucocutaneous manifestations include vascular malformations, lipomatosis, speckled lentiginosis of the penis or vulva, facial verrucae-like or acanthosis nigricans-like lesions, and multiple acrochordons of the neck, axilla, and groin. We present a case of Bannayan-Riley-Ruvalcaba syndrome with macrocephaly, abnormal facies, lipoma, tender and painful arteriovenous hemangiomas, lymphangiokeratomas, musculoskeletal abnormalities, and localized myopathy. We also describe previously unreported findings, including peripheral neuropathy, punctate cystic changes in acral tubular bones, and enostosis of talus. Bannayan-Riley-Ruvalcaba syndrome needs recognition by dermatologists because affected patients may present with mucocutaneous and subcutaneous lesions that may simulate other dermatological disorders.

Bilateral upper eyelid edema in Melkersson-Rosenthal syndrome.

Melkersson-Rosenthal syndrome is an uncommon disorder characterized by a triad of facial nerve palsy, orofacial edema, and fissured tongue. A 42-year-old woman with Melkersson-Rosenthal syndrome presented with painless, nonpitting, bilateral asymmetric upper eyelid edema. The left eyelid was a bit larger than the right eyelid. CT and MRI demonstrated periorbital soft tissue thickening compatible with the microscopic findings of infiltration of lymphocytes, edema, and cystic dilatation of lymphatic vessels. After treatment by systemic doxycycline and corticosteroid, she showed some improvement of the eyelid edema. Isolated bilateral eyelids swelling may be observed in Melkersson-Rosenthal syndrome. In the case of unexplained nonpitting eyelid edema, biopsy should be performed.

Cerebral hemodynamics in ocular hypertension.

PURPOSE: To evaluate the cerebral blood flow velocity in patients with ocular hypertension. MATERIAL AND METHODS: Twenty-four ocular hypertensive patients and 24 age- and sex-matched healthy volunteers were recruited in a prospective comparative study. All subjects had normal findings on full-threshold visual field tests and clinically normal optic nerves. All patients with ocular hypertension had an intraocular pressure (IOP) of >21 mmHg on three separate occasions without treatment. Systolic and diastolic blood pressure by cuff, heart rate by palpation, IOP by Goldmann applanation tonometry, central corneal thickness by ultrasound pachymetry, blood flow velocities, and pulsatility index of the ipsilateral middle cerebral artery by transcranial color Doppler were measured. RESULTS: Systolic and diastolic blood pressures (P=0.40 and P=0.45, respectively), heart rate (P=0.30), and central corneal thickness (P=0.23) were similar in each group. Peak and end-diastolic blood flow velocities in the middle cerebral artery did not differ between ocular hypertensives and controls (P=0.37 and P=0.87, respectively). In addition, pulsatility index did not significantly differ between ocular hypertensives and controls (P=0.61). CONCLUSIONS: The results of this study suggest that ocular hypertension is not associated with reduction in blood flow velocity and elevation of resistance in the middle cerebral artery.

Color Doppler imaging in optic neuritis with multiple sclerosis.

PURPOSE: To evaluate the retrobulbar hemodynamics in eyes with optic neuritis with multiple sclerosis and to compare these values with those of the unaffected fellow eyes and healthy control eyes. METHODS: Thirty-four eyes of 17 patients with unilateral optic neuritis and multiple sclerosis and 16 eyes of 16 normal healthy subjects were recruited from the Departments of Ophthalmology and Neurology. The peak systolic and end-diastolic blood flow velocities and resistivity indices of the ophthalmic artery, posterior ciliary arteries and central retinal artery were measured in each eye with optic neuritis, using color Doppler imaging. Then, they were compared with those of the unaffected fellow eyes and healthy control eyes using paired and unpaired Student's t-tests, respectively. RESULTS: The mean retrobulbar blood flow velocities and mean resistivity index in the ophthalmic artery in the eyes with optic neuritis were not significantly different from the unaffected fellow eyes and healthy control eyes, as well (P>0.05). The mean end-diastolic blood flow velocity in the central retinal artery (P=0.04) was lower and mean resistivity indices in the central retinal (P=0.02) and posterior ciliary arteries (P=0.009) were higher in the eyes with optic neuritis than in the control eyes. In patients with multiple sclerosis, the eyes with optic neuritis had higher resistivity indices in the posterior ciliary (P=0.02) and central retinal arteries (P=0.04) than did the unaffected fellow eyes. The retrobulbar blood flow velocities and resistivity indices of all vessels in the unaffected fellow eyes did not significantly differ from the control eyes (P>0.05). CONCLUSIONS: This study suggests that optic neuritis with multiple sclerosis is associated with impaired retrobulbar hemodynamics, especially in the posterior ciliary and central retinal arteries when compared with the contralateral unaffected eyes as well as healthy control eyes.

The effects of darkness on retrobulbar hemodynamics in patients with early stages retinitis pigmentosa.

PURPOSE: To investigate the retrobulbar hemodynamic changes occurring in light and darkness in patients with early stages retinitis pigmentosa (RP). METHODS: Eleven early stages RP patients were enrolled in the study. The peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI) and resistivity index (RI) of the ophthalmic artery (OA) and central retinal artery (CRA) were measured by color Doppler imaging in light and darkness. The results were compared with that of 10 age-matched normal subjects. RESULTS: PSV and EDV of the OA did not show significant differences in both groups. However, PSV and EDV of the CRA in RP patients decreased significantly in darkness (p = 0.001, p < 0.001, respectively). In addition, we found a significant increase in RI of the CRA in RP patients in darkness (p = 0.003). On the contrary, PSV and EDV of the CRA in control subjects showed a significant increase (p = 0.002, p < 0.001, respectively) and RI showed a significant decrease in darkness (p = 0.004). CONCLUSIONS: Darkness causes a decreased blood flow in the CRA in early stages of RP.

Effects of moderate smoking on the central visual field.

PURPOSE: To investigate whether moderate cigarette smoking has any effects on the central visual field. METHODS: This study included 30 healthy, moderate cigarette smokers (10-20 cigarettes per day for at least the past 5 years) and 22 healthy non-smokers. After two training test sessions, all individuals underwent computerized visual field examinations (Humphrey 30-2 Full Threshold Test) with both white-on-white (W-W) perimetry and blue-on-yellow (B-Y) perimetry. One eye of each subject with reliable visual field test results was evaluated. The foveal threshold, mean deviation (MD), pattern standard deviation (PSD), short-term fluctuation (SF), corrected pattern standard deviation (CPSD), glaucoma hemifield test (GHT) and number of significantly depressed points deviating at p < 5%, p < 2%, p < 1% and p < 0.5% on the pattern deviation probability map of the smokers were compared with those of the non-smokers. RESULTS: When the results of W-W perimetry were analysed, the smokers were found to have significantly lower foveal thresholds (p = 0.001) and mean retinal sensitivity (p = 0.02), and higher PSD (p = 0.002) and CPSD (p = 0.01) than the non-smokers. Short-term fluctuation was similar in both groups (p = 0.55). The number of significantly depressed points deviating at p < 5%, p < 2% and p < 1% on the pattern deviation probability map was similar for both groups (p > 0.05). The number of depressed points deviating at p < 0.5% on the pattern deviation probability map was higher for the smokers than for the non-smokers (p = 0.03). The results of B-Y perimetry showed the smokers to have a significantly lower foveal threshold than the non-smokers (p = 0.03). However, there were no significant differences in the global indices of the two groups (p > 0.05). The number of significantly depressed points deviating at p < 5%, p < 2%, p < 1% and p < 0.5% on the pattern deviation probability map was similar in both groups (p > 0.05). No significant difference in GHT was determined with either perimetry for the smokers compared with the non-smokers (p > 0.05). CONCLUSION: This study suggests that moderate cigarette smoking is associated with both diffuse and localized reductions in retinal sensitivity with W-W perimetry. Only reduction in the foveal threshold was observed with B-Y perimetry, with no hints of diffuse and localized reductions.

Unilateral hyperhydrosis in Pourfour du Petit syndrome.

Upper limp hyperhydrosis is an idiopathic disease with bilateral involvement. However, Pourfour du Petit syndrome, the opposite of Horner syndrome, may result in unilateral upper limb hyperhydrosis. It occurs following hyperactivity of the sympathetic cervical chain as a consequence of irritation secondary to trauma. We report herein two cases with Pourfour du Petit syndrome showing unilateral upper limb hyperhydrosis. The patients presented with right-sided mydriasis and ipsilateral hemifacial hyperhydrosis. The onset of disease was followed by a trauma in both patients. They underwent upper thoracic sympathectomy with favorable outcome. A history of an antecedent trauma in patients with unilateral upper limb hyperhydrosis and anisocoria may imply a possible diagnosis of Pourfour du Petit syndrome.

The effects of hormone replacement therapy on ocular surface and tear function tests in postmenopausal women.

PURPOSE: To prospectively investigate the impact of various hormone replacement therapies (HRT) on ocular surface and tear function tests. METHODS: A total of 70 women in the postmenopausal period were enrolled in the study. The groups consisted of 16 women who were not on HRT (group 1), 29 women who were on HRT with tibolone (group 2) and 25 women who received estradiol plus medroxyprogesterone acetate treatment (group 3). All patients underwent tear film break-up time (TFBUT), Schirmer's test and conjunctiva cytology at the time of enrollment and at 6 months' follow-up. RESULTS: Patients in group 2 showed improved Schirmer's test and TFBUT results (p < 0.001); however, no significant changes occurred in group 1 and group 3 patients (p > 0.05). Conjunctival cytology scores did not differ at the time of enrollment and at 6 months' follow-up in all groups. CONCLUSIONS: This is the first comparative clinical study on the effects of tibolone and estradiol plus medroxyprogesterone acetate on ocular surface and tear function tests. HRT with tibolone seems to improve tear function tests in postmenopausal women.

Short-term effect of latanoprost on ocular circulation in ocular hypertension.

PURPOSE: To determine the short-term effects of latanoprost on retrobulbar circulation in ocular hypertension. METHODS: Forty-six eyes of 23 consecutive bilateral ocular hypertensive patients with an intraocular pressure (IOP) of greater than 22 mmHg were evaluated in a prospective controlled study. All subjects received a single drop of latanoprost 0.005% in one eye and placebo in the fellow control eye. Systemic circulatory parameters, intraocular pressure, blood flow velocities, and resistance indices of the ophthalmic, short posterior ciliary and central retinal arteries were measured using colour Doppler imaging at baseline and 2 h and 8 h after dosing. RESULTS: Latanoprost lowered IOP significantly after 2 h and 8 h (P < 0.01). The mean IOP reduction was 6.7 mmHg 8 h after dosing. At baseline, there were no statistically significant differences in any retrobulbar vessels of eyes that received a single drop of latanoprost when compared with the eyes that received placebo (P > 0.05). Comparisons with baseline and latanoprost conditions revealed that latanoprost did not alter the blood flow velocities and resistance indices in the ophthalmic (P > 0.05), posterior ciliary (P > 0.05) and central retinal (P > 0.05) arteries 2 h and 8 h after dosing. The systolic and diastolic blood pressures (p = 0.74, p = 0.29, respectively) and pulse rate (p = 0.68) remained unchanged over the 8-h period. CONCLUSIONS: This study found that a single drop of latanoprost significantly reduces intraocular pressure 8 h after dosing. However, it does not have any short-term effects on the retrobulbar haemodynamics in ocular hypertensive eyes.

Effect of bimatoprost on ocular circulation in patients with open-angle glaucoma or ocular hypertension.

PURPOSE: To study the effect of bimatoprost 0.03% (Lumigan) on ocular hemodynamics in patients with open-angle glaucoma or ocular hypertension. METHODS: One randomly selected eye of each of 26 patients with open-angle glaucoma or ocular hypertension was enrolled. Each patient received a drop of bimatoprost 0.03% once daily for 1 month. The effect of bimatoprost on ocular circulation was assessed by color Doppler imaging (CDI), which measured peak systolic, end-diastolic blood flow velocities and resistance indices in the ophthalmic, posterior ciliary and central retinal arteries. Retrobulbar hemodynamics by CDI, intraocular pressure by Goldmann applanation tonometer, blood pressure by cuff, and heart rate by palpation were measured at baseline and at 1 month after bimatoprost treatment. RESULTS: Blood flow velocities and resistance indices in all retrobulbar vessels showed no statistically significant differences between baseline and bimatoprost condition (P>0.05). Bimatoprost lowered intraocular pressure significantly (P<0.001), with a mean change of 6.5 mmHg (27%) after 1 month of treatment. The systolic (P=0.38) and diastolic (P=0.74) blood pressures and pulse rate (P=0.94) did not show statistically significant differences during the study period. CONCLUSIONS: The results of this study suggest that topical bimatoprost 0.03% significantly reduces intraocular pressure in patients with open-angle glaucoma or ocular hypertension. However, it does not have any effect on retrobulbar hemodynamics in open-angle glaucoma and ocular hypertension.

Effects of hypertension and antihypertensive treatment on retrobulbar circulation detected on Doppler sonography.

OBJECTIVE: To study the effect of antihypertensive drugs in essential hypertension and in the central retinal, posterior ciliary, and ophthalmic arteries by using Doppler sonography. METHODS: Thirty patients with essential hypertension and 32 control subjects were enrolled in the study. The pulsatility and resistive indices were evaluated in the central retinal, posterior ciliary, and ophthalmic arteries before and 2 months after treatment with antihypertensive drugs as well as in the control group. The pulsatility and resistive index values for each artery in each group were compared statistically. RESULTS: There were significant differences in the retrobulbar pulsatility and resistive index values in each artery among the patients with initially diagnosed hypertension and the control group (P < .05). There were significant reductions in the resistive and pulsatility index values of the posterior ciliary and ophthalmic arteries after treatment (P < .05). For the ophthalmic artery, posttreatment pulsatility and resistive index values did not reach the level of flow measured in the control subjects. CONCLUSIONS: The alteration of Doppler parameters of medication-free patients with hypertension may result from a peripheral vasospasm in the retrobulbar circulation, and the improvement in the Doppler parameters with oral antihypertensive drugs may indicate the importance of early diagnosis in ameliorating hypertension-induced retrobulbar circulation changes.

Color Doppler imaging in ocular hypertension and open-angle glaucoma.

PURPOSE: To quantify the retrobulbar hemodynamics of patients with ocular hypertension and open-angle glaucoma and to compare it with that of normal subjects. METHODS: Nineteen eyes of 19 ocular hypertensive patients, 19 eyes of 19 open-angle glaucoma patients and 19 eyes of 19 normal subjects were recruited from our clinic and underwent color Doppler imaging evaluation of the ophthalmic, posterior ciliary, and central retinal arteries. The peak systolic and end-diastolic blood flow velocities and resistivity indices of all retrobulbar vessels were measured. RESULTS: The retrobulbar blood flow velocities were lower and resistivity indices were higher in all retrobulbar vessels in ocular hypertensive patients than in normal subjects. The differences, however, did not reach statistical significance ( P>0.05). Glaucoma patients had lower end-diastolic velocities and higher resistivity indices than did normal subjects in the ophthalmic ( P=0.003 and P=0.003, respectively), posterior ciliary ( P=0.001 and P<0.001, respectively), and central retinal arteries ( P=0.03 and P=0.04, respectively). Glaucoma patients had significantly lower end-diastolic velocity and higher resistivity index than did patients with ocular hypertension in the posterior ciliary artery ( P=0.04 and P=0.001, respectively). CONCLUSIONS: This study suggests that ocular hypertensive patients have more normal blood flow than do glaucoma patients, because all retrobulbar homodynamic measurements in ocular hypertension range between glaucoma and normal subjects. On the other hand, glaucoma is associated with blood-flow velocity reduction and resistivity index elevation in all retrobulbar arteries.

5-Fluorouracil as chemoadjuvant for primary pterygium surgery: preliminary report.

PURPOSE: To investigate the safety and efficacy of intraoperative application of 5-fluorouracil as an adjuvant in primary pterygium surgery and to evaluate the effect of postoperative subconjunctival 5-fluorouracil injections on the recurrent pterygium. METHODS: Of 25 consecutive white patients, 28 eyes with primary pterygium underwent pterygium excision with intraoperative application of 5-fluorouracil (25 mg/mL for 3 minutes). The superior and inferior conjunctiva was approximated to cover the scleral bed within 1 mm of the limbus. Recurrence of pterygium was defined as postoperative fibrovascular growth more than 1 mm onto the cornea. Eyes with recurrence less than 2 mm were treated with subconjunctival 5-fluorouracil injections. RESULTS: After a mean follow-up of 14.1 +/- 3.9 months (mean +/- standard deviation), 7 recurrences (25%) were observed. All recurrences were detected within 12 months. In 4 of 7 recurrences, the fibrovascular growths were less than 2 mm. We, therefore, performed subconjunctival 5-fluorouracil injections. In 3 (75%) of 4 recurrences, the fibrovascular growths became atrophic. No serious complications were observed during and after the surgery. However, superficial punctate keratitis, pain, and hyperemia were detected in all patients in the early postoperative period. As a result, of 28 eyes, 4 (14%) had unacceptable cosmetic results and growing recurrences. CONCLUSIONS: This study suggests that intraoperative applications of 5-fluorouracil is both efficient and safe in the treatment of primary pterygium. Additionally, postoperative subconjunctival 5-fluorouracil injections may prevent the progression of fibrovascular tissue.

Postoperative 5-fluorouracil versus intraoperative mitomycin C in high-risk glaucoma filtering surgery: extended follow up.

PURPOSE: To compare the long-term efficacy and safety of postoperative subconjunctival 5-fluorouracil (5-FU) injections with that of intraoperative mitomycin C (MMC) in eyes at high risk for failure of trabeculectomy. METHODS: In a retrospective, non-randomized comparative trial, 36 eyes of 36 consecutive patients at high risk for failure of trabeculectomy underwent glaucoma filtering surgery with either postoperative subconjunctival 5-FU injections (19 eyes) or intraoperative application of MMC (17 eyes). Intraocular pressure, number of postoperative antiglaucoma medications, postoperative visual acuity, interventions, and complications were evaluated. RESULTS: Overall success (intraocular pressure 0.05) between the groups. CONCLUSIONS: These results suggest that both postoperative 5-FU injections and intraoperative MMC application have long-term success in high-risk patients. However, MMC results in a greater decrease in intraocular pressure than 5-FU.

Effects of thick Tenon's capsule on primary trabeculectomy with mitomycin-C.

PURPOSE: To investigate the effects of thick Tenon's capsule on primary trabeculectomy with adjunctive mitomycin-C. METHODS: In this prospective interventional case series of 45 consecutive uncomplicated glaucoma patients, 45 eyes with thick Tenon's capsule underwent primary trabeculectomy with intraoperative mitomycin-C (0.4 mg/ml for 3 min). Success was defined as intraocular pressure (IOP)