Macular spectral-domain optical coherence tomography in patients with X linked retinoschisis.

AIM: To evaluate macular anatomy in patients with X linked retinoschisis (XLRS) using spectral-domain optical coherence tomography (SD-OCT). METHODS: Consecutive observational case series. Clinical features were obtained through retrospective chart review. Only eyes without prior surgical interventions and those scanned with SD-OCT were included. The OCT images were analysed. RESULTS: Fourteen eyes of seven males with XLRS scanned with SD-OCT, age 5 to 45 years, were identified. On clinical examination, stellate spoke-like cystic maculopathy was present in nine eyes, and an atrophic foveal lesion in five eyes. SD-OCT revealed cystoid spaces accounting for retinal splitting in the inner nuclear layer in 12 eyes, and outer plexiform layer in two eyes of one patient. A few small cysts, not accounting for the foveal splitting, were seen in the outer nuclear layer in four eyes and in the ganglion cell layer and/or nerve fibre layer in six eyes. CONCLUSIONS: SD-OCT localised the foveomacular retinoschisis in XLRS to the retinal layers deeper than the nerve fibre layer. In the present study, the foveomacular schisis was seen most frequently in the inner nuclear layer.

Stability of corneal polarization axis measurements for scanning laser polarimetry.

OBJECTIVE: Corneal polarization axis (CPA) has been reported to affect retardation measurements obtained with scanning laser polarimetry. The purpose of this investigation was to evaluate the longitudinal stability of CPA measurements. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Persons with normal corneas were enrolled; eyes with less than 1 year of follow-up from the initial CPA measurement were excluded. INTERVENTION: We constructed a noninvasive slit-lamp-mounted device incorporating two crossed linear polarizers and an optical retarder to measure the slow axis of corneal birefringence, or CPA. MAIN OUTCOME MEASURES: Corneal polarization axis measurements. RESULTS: Seventy-one eyes of 40 individuals (23 female, 17 male) were enrolled in this investigation (mean age, 42.9 +/- 13.6 years; range, 22-85 years). Initial CPA measurements (mean, 24.0 +/- 18.0 degrees nasally downward; range, 67 degrees downward to 13 degrees nasally upward) were strongly associated (R2 = 0.88; P < 0.0001) with repeat CPA measurements (mean, 20.9 +/- 14.6 degrees nasally downward; range, 59 degrees nasally downward to 14 degrees nasally upward). The mean change in CPA was 4.1 +/- 3.2 degrees (range, 0-13 degrees ). Corneal polarization axis stability was statistically associated with the mean (initial and repeat) CPA (R2 = 0.1; P = 0.009), but not associated with age (R2 = 0.0003; P = 0.9) or gender (R2 = 0.03; P = 0.2). CONCLUSIONS: Corneal polarization axis measurements have good 1-year stability. These data suggest that CPA should not contribute significantly to longitudinal measurements of retinal nerve fiber layer thickness obtained with scanning laser polarimetry.

Field-scale preferential transport of water and chloride tracer by depression-focused recharge.

A tracer study was initiated in November 1993 to investigate depression-focused recharge and to monitor solute movement through the vadose zone into the shallow ground water in southeastern North Dakota. Granular potassium chloride (KCl) was surface-applied to two areas overlying subsurface drains and to one area instrumented with soil solution samplers, ground water monitoring wells, time domain reflectometry (TDR) probes, and temperature probes. One of the subsurface drain tracer plots was located on level ground while the other two sites were in small topographic depressions. Formation of ground water mounds beneath the depressions indicated that these areas are recharge sites. The applied Cl- tracer was found to move rapidly to the shallow ground water under the depressional areas after infiltration of spring snowmelt in 1994. Excessive rainfall events were also responsible for focused recharge and the rapid transport of the applied Cl- tracer. Water flow through partially frozen soil at the bottom of the depressions during thaw enhanced preferential movement of the tracer.

Daunorubicin cardiotoxicity: evidence for the importance of the quinone moiety in a free-radical-independent mechanism.

Anthracyclines, such as daunorubicin (Daun), and other quinone-containing compounds can stimulate the formation of toxic free radicals. The present study tests the hypothesis that the quinone moiety of Daun, by increasing free-radical production, disrupts sarcoplasmic reticulum (SR) function and thereby inhibits myocardial contractility in vitro. We compared Daun with its quinone-deficient analogue, 5-iminodaunorubicin (5-ID), using experimental interventions to produce various contractile states that depend on SR function. At concentrations of Daun or 5-ID that did not alter contractility (dF/dt) of steady-state contractions (1 Hz) in electrically paced atria isolated from adult rabbits, only Daun significantly attenuated the positive inotropic effects on dF/dt of increased rest intervals (PRP; post-rest potentiation) or increased stimulation frequencies. Attenuation was to 98+/-6% at 1 Hz, and 73+/-8 and 67+/-8% for 30 and 60 sec PRP, respectively, and 73+/-3 and 63 +/-3% at 2 and 3 Hz, respectively, for 88 microM Daun (P<0.05, vs pre-drug baseline values, mean +/- SEM). These effects of Daun were similar to those of caffeine (2 mM), an agent well known to deplete cardiac SR calcium. We also examined the effect of Daun in isolated neonatal rabbit atria, which lack mature, functional SR; Daun did not alter the force-frequency relationship or PRP contractions. Additional studies in Ca(2+)-loaded SR microsomes indicated that both Daun and 5-ID opened Ca(2+) release channels, with Daun being 20-fold more potent than 5-ID in this respect. Neither anthracycline, however, induced free-radical formation in SR preparations (assayed via nicking of supercoiled DNA) prior to stimulating Ca(2+) release. Thus, our results indicate that Daun impairs myocardial contractility in vitro by selectively interfering with SR function; the quinone moiety of Daun appears to mediate this cardiotoxic effect, acting through a mechanism that does not involve free radicals.

The effects of experimental tear film removal on corneal surface regularity and barrier function.

PURPOSE: To evaluate corneal surface regularity and asymmetry, corneal thickness, barrier function, and contrast sensitivity after experimental removal of the precorneal tear layer. DESIGN: Prospective, clinic-based, nonrandomized (self-controlled) comparative trial. PARTICIPANTS: Six eyes of six healthy volunteers (three males, three females; age range, 29-40 years). METHODS: A precorneal tear lesion was created by pressing a sterile Biopore (Millipore, Bedford, MA) Teflon membrane against the central cornea. Corneal topography with both the Topographic Modeling System (TMS-1; Computed Anatomy, Tomey Technology, Cambridge, MA) and the Orbscan (Orbscan Inc., Salt Lake City, UT) were performed before the lesion was created and 30 seconds, 1 hour, and 4 hours after the lesion was created. Surface regularity and surface asymmetry indices were evaluated by the TMS-1 topography system. Maximum and minimum keratometric readings, corneal fluorescein staining, contrast sensitivity, and corneal thickness were evaluated before and after the tear lesion. Cytologic membranes were stained for MUC4 mucin using an indirect immunofluorescent staining technique. Confocal microscopy was performed to evaluate the integrity of the corneal epithelium in two eyes. Analysis of variance with polynomial contrasts was used to examine time trends of the outcome variables. MAIN OUTCOME MEASURES: The change in corneal surface regularity and asymmetry indices, corneal thickness, permeability to fluorescein dye, and contrast sensitivity before and after the lesion was made were compared. RESULTS: The corneal epithelium in the area of the lesion showed intense fluorescein staining 30 seconds postlesion but appeared normal by 4 hours. Confluent, homogeneous staining for MUC4 mucin was observed on the membranes used to create the lesion in all cases. The surface regularity index measured with the TMS-1 increased after the lesion was created and decreased toward normal by 4 hours (P = 0.017). Corneal thickness measured by the Orbscan instrument significantly increased in the central (P = 0.001), superior (P = 0.006), inferotemporal (P < 0.001) and superotemporal (P = 0.001) cornea immediately following the lesion and returned to normal by 4 hours. The lesion caused a decrease in visual acuity at 6.30%, 4% and 2.5% contrast sensitivities 1 hour postlesion and these measurements returned to prelesion values by 4 hours (P = 0.085, P = 0.005, P = 0.043). CONCLUSIONS: The precorneal tear layer serves as a permeability barrier and is essential for maintaining a smooth quality optical surface.

Effect of corneal polarization axis on assessment of retinal nerve fiber layer thickness by scanning laser polarimetry.

PURPOSE: Scanning laser polarimetry uses an anterior segment compensating device that assumes a fixed axis of corneal birefringence, which we call the corneal polarization axis. The purpose of this investigation was to establish the distribution of corneal polarization axes among a population of normal eyes and to evaluate the relationship between corneal polarization axis and posterior segment retardation. METHODS: We constructed a noninvasive slit lamp-mounted device incorporating two crossed linear polarizers and an optical retarder in order to measure the slow axis of corneal birefringence. Normal subjects underwent corneal polarization axis measurement. A subset of eyes underwent scanning laser polarimetry of the peripapillary retinal nerve fiber layer (n = 32) and macula (n = 29), and retardation measurements were evaluated in each group. RESULTS: One hundred eighteen eyes of 63 normal subjects (35 female, 28 male) underwent corneal polarization axis measurement (mean age, 45.5 +/- 17.1 years). Six eyes (5.1%) demonstrated unmeasurable corneal polarization. In the remaining 112 eyes, the mode of the corneal polarization axis distribution was 10 to 20 degrees nasally downward (range, 90 degrees nasally downward to 54 degrees nasally upward). A significant (P <.0001) correlation was observed between fellow eyes (R(2) =.52), with a mean difference of 11.2 +/- 10.5 degrees (range, 0-52 degrees). Corneal polarization axis was significantly associated (R(2) =.52-.84) with retinal nerve fiber layer and macula summary retardation parameters (average thickness, ellipse average, superior and inferior average, superior and total integral; P <.0001 for all groups). CONCLUSIONS: The mean corneal polarization axis among normal corneas is nasally downward; however, considerable intraindividual and interindividual variability exists. The linear relationship between corneal polarization axis and posterior segment retardation parameters is responsible, in part, for the wide distribution of retinal nerve fiber layer thickness data generated by scanning laser polarimetry.

Herbicide movement and dissipation at four Midwestern sites.

This study was conducted to evaluate atrazine (2-chloro-4-ethylamino-6-isopropyl-1,3,5-triazine) and alachlor (2-chloro-N-(methoxymethyl)acetamide) dissipation and movement to shallow aquifers across the Northern Sand Plains region of the United States. Sites were located at Minnesota on a Zimmerman fine sand, North Dakota on Hecla sandy loam, South Dakota on a Brandt silty clay loam, and Wisconsin on a Sparta sand. Herbicide concentrations were determined in soil samples taken to 90 cm four times during the growing season and water samples taken from the top one m of aquifer at least once every three months. Herbicides were detected to a depth of 30 cm in Sparta sand and 90 cm in all other soils. Some aquifer samples from each site contained atrazine with the highest concentration in the aquifer beneath the Sparta sand (1.28 microg L(-1)). Alachlor was detected only once in the aquifer at the SD site. The time to 50% atrazine dissipation (DT50) in the top 15 cm of soil averaged about 21 d in Sparta and Zimmerman sands and more than 45 d for Brandt and Hecla soils. Atrazine DT50 was correlated positively with % clay and organic carbon (OC), and negatively with % fine sand. Alachlor DT50 ranged from 12 to 32 d for Zimmerman and Brandt soils, respectively, and was correlated negatively with % clay and OC and positively with % sand.

An optical model of the human retinal nerve fiber layer: implications of directional reflectance for variability of clinical measurements.

PURPOSE: The reflectance of the retinal nerve fiber layer is highly directional--that is, it depends strongly on the angles of illumination and viewing. This study explored and illustrated the implications of this directional reflectance for nerve fiber layer measurements in the human eye. METHODS: The retina was modeled as a sphere centered on the optic axis of a schematic eye. Nerve fiber ribbons were projected onto the retina and cylindrical light scattering was calculated along each ribbon. The reflectance along the ribbon was then determined for the illuminating and viewing apertures of two hypothetical optical instruments, a fundus camera and a confocal scanning laser ophthalmoscope. Results were displayed as reflectance maps. RESULTS: Uniformly illuminated nerve fiber ribbons exhibited a nonuniform reflectance pattern that was very sensitive to the location in the pupil of the instrument apertures. Ribbon reflectance at the superior and inferior disc margins varied with ribbon orientation, being higher with temporal tilt and lower with nasal tilt. Ribbons nasal to the disk could be quite dim. CONCLUSIONS: In quantitative nerve fiber layer assessment technologies, the observed reflectance depends on the configuration of the illuminating and viewing apertures of the measuring instrument and on the retinal position and orientation of each nerve fiber bundle. In clinical practice, this dependence may cause significant measurement variability that can be reduced by specific measurement maneuvers.

Visible and near-infrared imaging of the nerve fiber layer of the isolated rat retina.

PURPOSE: To develop an isolated rat retina preparation suitable for the study of the reflectance of the mammalian retinal nerve fiber layer (RNFL). METHODS: A rat retina with a short piece of optic nerve attached was dissected free from the eye and stretched over a slit in a black membrane. The retina was placed in a black chamber perfused with warmed and oxygenated physiologic solution. Imaging microreflectometry was used to acquire images of the RNFL at wavelengths from 400 to 830 nm and over time. RESULTS: At all wavelengths the isolated retina provided high-contrast images of nerve fiber bundles against a uniform, dark background. The nerve fiber bundles had a speckled texture, especially at long wavelengths. Time-lapse movies showed that over a period of several minutes the speckle pattern slowly changed. Although the general appearance of the bundles was similar at two closely spaced wavelengths (660 and 680 nm), the detailed patterns were completely different. CONCLUSION: The isolated retina preparation is well suited to the study of the optical properties of the RNFL. The speckled texture of nerve fiber bundles probably results from optical interference in the scattered light. The slow change in pattern implies that the size and/or shape of the scattering structures must change with time.

Directional and spectral reflectance of the rat retinal nerve fiber layer.

PURPOSE: To measure and describe the reflectance properties of a mammalian retinal nerve fiber layer (RNFL) and to determine the mechanisms responsible for the RNFL reflectance. METHODS: An isolated rat retina suspended across a slit in a black membrane and mounted in a black perfusion chamber provided high quality images of the RNFL. Imaging microreflectometry was used to measure RNFL reflectance at wavelengths from 400 nm to 830 nm and as a function of illumination angle. RESULTS: The directional reflectance of rat RNFL at all wavelengths was consistent with the theory of light scattering by cylinders; each nerve fiber bundle scattered light into a conical sheet coaxial with the bundle. There was no evidence of a noncylindrical component at any wavelength. Measured reflectance spectra were consistent between animals, similar to ones previously measured in macaque, and varied with scattering angle. All spectra could be described by a two-mechanism cylindrical scattering model with three free parameters. CONCLUSIONS: At all wavelengths the reflectance of rat RNFL arises from light scattering by cylindrical structures. The highly directional nature of this reflectance can be an important source of measurement variability in clinical assessment of the RNFL. The reflectance spectra reveal a combination of mechanisms: At wavelengths shorter than approximately 570 nm the reflectance comes from cylinders with diameters much smaller than the wavelength, but at wavelengths longer than approximately 680 nm the reflectance comes from cylinders with effective diameters of 350 nm to 900 nm.

Microtubule contribution to the reflectance of the retinal nerve fiber layer.

PURPOSE: The reflectance of the retinal nerve fiber layer (RNFL) arises from cylindrical light scattering elements distributed throughout its thickness. To determine whether these elements include axonal microtubules, eyecup preparations of the toad Bufo marinus were treated with the microtubule depolymerizing agent colchicine. METHODS: Some eyecups were incubated for various times in different colchicine concentrations and then fixed and prepared for electron microscopy (EM). In other eyecups the reflectance of the RNFL at 440 nm was measured by means of imaging microreflectometry. After a period of baseline measurements, the bathing solution was changed either to one of identical composition (control experiments) or to one containing 10 mM colchicine. Measurements then continued for 2 to 3 hours. RESULTS: Quantitative EM showed that colchicine caused the density of axonal microtubules to decrease by approximately one third in 2 hours. Reflectometry showed, in control experiments, that the RNFL reflectance remained near baseline for the duration of an experiment. In contrast, after changing to colchicine solution, the RNFL reflectance declined to a level 37% to 55% below baseline. CONCLUSIONS: Microtubules made a major contribution to the 440-nm reflectance of the unmyelinated axons of the toad RNFL and could make a similar contribution to the reflectance of human RNFL.

Reproducibility of laser Doppler flowmetry in the human optic nerve head.

PURPOSE: We sought to demonstrate reproducibility of the noninvasive laser Doppler flowmetry technique for measuring microvascular hemodynamics of the optic nerve head in human subjects. METHODS: Laser Doppler flowmetry was performed by four examiners on four human optic nerve heads during multiple sessions. Intersubject, interexaminer, intersession, and intrasession variabilities were calculated for velocity, blood volume, and blood flow (flux). RESULTS: Initial variability of measurements improved after 3 months' experience. The standard deviation of the intrasession variation for single readings was 18% of the velocity mean value and 24% of the flow (flux) mean value. Based on this, a sample size of 17 (power beta = 0.8, alpha = 0.05, paired t test) will demonstrate a 10% physiologic change in flux within a session if the average of five readings is used before and after the experimental perturbation. The intersession variation was 12% and 32% for velocity and flux, respectively. Because of this, a larger sample size or additional measurement sessions are required for detection of an experimental influence between two sessions. The coefficient of variation among subjects for single readings was 7% and 10% for velocity and flux, respectively. CONCLUSIONS: Reproducibility of velocity measurements is better than reproducibility of flux measurements. After experience with the method, laser Doppler flowmetry is sufficiently precise to permit feasible studies of human optic nerve head microvascular hemodynamics when physiologic perturbations are applied.

Autoregulation of human optic nerve head circulation in response to increased intraocular pressure.

The following experiments were undertaken to determine if blood flow is maintained by autoregulation in the human optic nerve head when circulation is challenged by elevated intraocular pressure, and to determine if the presence or absence of autoregulation is universal. Laser Doppler flowmetry was used to determine the average velocity, the number of moving erythrocytes, and the volume of flow in the capillary bed of the optic disc. These parameters were measured in 10 subjects at spontaneous levels of intraocular pressure (IOP), and at pressures artificially elevated to 25, 35, 45 and 55 mm Hg with a scleral suction cup. Four subjects (two who showed autoregulation and two who did not) were studied on six additional occasions to determine consistency of the findings. In these same four subjects a second location on the disc was also measured on six occasions to determine if the IOP-effect on blood flow varied by location. Of the 10 subjects initially studied, seven maintained the baseline level of blood flow over the lower part of the range of elevated intraocular pressure (evidence of autoregulation), but showed a decline in flow by the time IOP reached 45 or 55 mm Hg. Two subjects showed a linear decline in blood flow beginning with the smallest increment of elevation of IOP (no autoregulation), and one showed an uninterpretable result. The two individuals who showed the linear decline and two of those who showed efficient autoregulation were remeasured, and each showed consistently the same pattern as before when restudied on six different occasions each. However, at a different location on their discs, autoregulation was manifest in all of these four individuals. When challenged by elevated IOP, the optic nerve head typically maintains a steady-blood flow over a range of IOP, but fails to maintain the same flow by the time IOP reaches 45 or 55 mm Hg. Some disc locations, at least in some individuals, do not show this autoregulation, but exhibit a decline in blood flow linearly related to IOP, even with the modest elevation of IOP.

Light scattering and form birefringence of parallel cylindrical arrays that represent cellular organelles of the retinal nerve fiber layer.

The retinal nerve fiber layer (RNFL) comprises bundles of unmyelinated axons that run across the surface of the retina. The cylindrical organelles of the RNFL (axonal membranes, microtubules, neurofilaments, and mitochondria) as seen by electron microscopy were modeled as parallel cylindrical arrays in order to gain insight into their optical properties. Arrays of thin fibrils were used to represent organelles that are thin relative to wavelength, and the model took into account interference effects that may arise from spatial order. Angular and spectral light-scattering functions were calculated for the backscattering hemisphere. Scattering was much larger from axonal membranes than from microtubules or neurofilaments. Spectra from 400 to 700 nm show that scattering increases at shorter wavelengths for both axonal membranes and microtubules. At 560 nm, scattering from mitochondria modeled as thick cylinders was approximately the same as that from microtubules but showed little wavelength dependence. The model reveals differences in backscattered polarization ratios that may permit experimental discrimination between microtubule and membrane mechanisms for the RNFL reflectance. Calculated backscattering exceeds measured values by at least 1 order of magnitude, but calculated form birefringence for microtubule arrays is approximately the same as measured birefringence.

Laser Doppler flowmetry measurement of changes in human optic nerve head blood flow in response to blood gas perturbations.

PURPOSE: The objective of this study was to establish the ability of laser Doppler flowmetry to detect relative changes in human optic nerve head hemodynamics caused by physiologic blood gas perturbations. METHODS: Laser Doppler flowmetry permits the noninvasive assessment of relative blood velocity, volume, and flow (flux) in a sample volume of the nerve head. Such measurements were performed in two groups of healthy subjects. The first group (n = 11) was tested during normal room air breathing and then while breathing 100% oxygen (isocapnic hyperoxia). The second group (n = 10) was also tested under normal conditions as well as during isoxic hypercapnia (+ 15% end-tidal carbon dioxide). Results were analyzed by paired t tests. RESULTS: Hyperoxia created a significant 25% (p = 0.002) decrease in optic nerve head blood flow, with blood volume decreased by 9% (p = 0.095) and blood velocity reduced by 13% (p = 0.154) compared to the room air condition. During hypercapnia, optic nerve head blood flow was increased by 28% (p = 0.012), with blood volume increased by 22% (p = 0.017) and blood velocity increased by 9% (p = 0.218) as compared to the normal room air condition. CONCLUSION: Blood flow in the optic nerve head capillaries changes in response to hyperoxia and hypercapnia as demonstrated in the brain and retina. Laser Doppler flowmetry permits the noninvasive assessment of these responses in humans under conditions within the physiologic range.

The relation between the reflectance and thickness of the retinal nerve fiber layer.

PURPOSE: This study examined quantitatively the commonly held assumption that the reflectance of the retinal nerve fiber layer is proportional to its thickness. METHODS: The reflectance of the retinal nerve fiber layer of an in vitro vertebrate cyecup preparation was measured with an imaging microreflectometer, an instrument that provided quantitative images of a small retinal area and allowed precise control of the directions of illumination and observation. After an experiment, the eyecup was fixed and embedded for histology. A direct correspondence between the measured images and the histologic sections was established by serial reconstruction of the retinal blood vessel pattern. The thickness of the previously imaged nerve fiber bundles was measured from photomicrographs of the histologic sections. RESULTS: The reflectance of the retinal nerve fiber layer was proportional to its thickness in areas where nerve fiber bundles were parallel. When bundles were not parallel, the directional reflectance of the retinal nerve fiber layer caused a failure of proportionality for a single illumination angle. When multiple angles of illumination were used to find the peak reflectance, this peak reflectance was again proportional to the thickness of the retinal nerve fiber layer. CONCLUSION: These results indicate that the reflectance of the retinal nerve fiber layer arises from throughout its thickness, and have implications for assessment methods designed to identify the surface of the retinal nerve fiber layer. In addition, they indicate that control of observation geometry may be an important means to reduce variability in clinical assessment systems.

Numerical approximation of light scattering from tenuous cylindrical membranes at normal incidence.

A numerical method has been developed to calculate the scattered field from a complex matrix of cylindrical membranes that are thin relative to wavelength with a refractive index close to that of the medium. The membranes are broken into a collection of adjacent parallel thin fibers, each fiber is assigned an internal field, and vector summation of the fields scattered by each fiber is used to calculate the total scattered field. For an incident wave in the TM mode the internal field of each membrane fiber is chosen to be equal to the incident field (the Born approximation). For the TE mode the internal field is determined by the local membrane orientation (φ) and relative refractive index (m) according to A sin 2φ for the component in the direction of incidence and 1 - A(1 - cos 2φ)for the transverse component, where A = (m(2) - 1)/2m(2). The method has application to light scattering by cell membranes in bundles of nerve axons.

Use of the potential acuity meter and laser interferometer to predict visual acuity after macular hole surgery.

PURPOSE: As reported anatomic success rates for macular hole surgery increase, a method of accurately predicting postoperative visual acuity has increased clinical utility. METHODS: A series of 18 patients undergoing vitrectomy for idiopathic macular holes was evaluated prospectively for best refracted preoperative visual acuity, potential acuity meter (PAM) reading, and laser interferometer (LI) reading. Best refracted visual acuity after surgery was recorded and analyzed to assess the predictive value of the PAM and LI readings. RESULTS: The LI correctly predicted the final visual result in 6 of the 10 patients who achieved a final visual acuity of 20/50 or better (P = < 0.011). The PAM did not accurately predict postoperative visual acuity for any of the eyes with a final visual acuity of 20/50 or better. Both correctly predicted outcome in the 7 patients with final visual acuity worse than 20/50. The LI prediction was within 2 lines of final visual acuity in 12 (70%) of 17 anatomically successful cases, and the PAM was within 2 lines of final visual acuity in 11 (64%) of 17 cases. CONCLUSION: Both the LI and PAM were modestly accurate in predicting final visual acuity after macular hole surgery, but the LI was more accurate in predicting a visual acuity of 20/50 or better.

Retinal morphology and visual pigment levels in 6- and 12-month-old rhesus monkeys fed a taurine-free human infant formula.

Rhesus monkey infants were raised from birth until 6 or 12 months of age on a taurine-free soy protein-based human infant formula or on the same formula supplemented with taurine. An additional group received taurine-free formula until 6 months and then the supplemented diet from 6 until 12 months. The densities of rod and cone visual pigments were measured by fundus reflectometry at 6 and 12 months, and retinal morphology was then examined by light and electron microscopy. The densities of rhodopsin, measured in the near periphery after a white bleach, and of cone pigment, measured in the macula after a red bleach, were significantly reduced in the taurine-deprived monkeys at 6 months but not at 12 months. The retinas of 6-month-old taurine-deprived infants showed degenerative morphological changes in photoreceptors, particularly in cones in the foveal region, which were somewhat less severe than those seen in a previous study at 3 months of age. The prevalence and degree of these abnormalities continued to decrease with age in taurine-deprived animals, but changes persisted in some animals at 12 months. Recovery was more complete in monkeys reversed to the supplemented diet from 6 to 12 months. Thus, monkey infants are dependent on dietary taurine to maintain normal retinal structure until at least 6 months of age; the effects of taurine deprivation regress spontaneously but incompletely by 12 months.

Insensitivity of color Doppler flow imaging for detection of acute calf deep venous thrombosis in asymptomatic postoperative patients.

PURPOSE: Although color Doppler flow imaging (CDFI) has been shown to accurately depict calf vein thrombosis in symptomatic patients, this technique has not been proved accurate for detection of calf vein thrombosis in a population restricted to asymptomatic postoperative patients. PATIENTS AND METHODS: To evaluate the accuracy of CDFI in asymptomatic postoperative patients, both CDFI and contrast venography were performed on 78 limbs of 76 patients without symptoms of deep venous thrombosis (DVT) who had undergone either hip or knee replacement. CDFI and venographic examination were interpreted blindly with respect to the results of the other modality or clinical findings. Venography was the standard for comparison of results. RESULTS: Fifty-six percent of CDFI examinations of the calf vein were technically adequate. The remaining studies were compromised technically by limb swelling and/or obesity. For the technically adequate CDFI studies, calf vein thrombosis was detected in eight of 10 patients. Calculated sensitivity in this cohort was 80%, and specificity was 97%. The sensitivity of CDFI for acute calf DVT in all patients, regardless of image quality, was 42%. CONCLUSION: These observations suggest that state-of-the-art CDFI is not an accurate examination for acute calf vein DVT in asymptomatic postoperative patients. CDFI is associated with a high rate of technically compromised studies and relatively low sensitivity in studies that are deemed technically satisfactory. These observations do not preclude the use of CDFI in postoperative patients for detection of thrombus extension into the popliteal vein or for detecting thrombosis of more proximal lower extremity veins.