[Non-penetrating deep sclerectomy without collagen implant for glaucoma, as single or combined surgery].

Deep sclerectomy (DS) can be used in glaucoma with increased intraocular pressure when medical treatment fails. It involves removing part of the ocular drainage apparatus. Resistance to intraocular fluid drainage is decreased, improving drainage and decreasing intraocular pressure. By avoiding anterior chamber penetration, DS diminishes frequency of the complications of filtering surgery. 24 eyes of 23 patients underwent DS for primary or secondary open angle glaucoma with elevated intraocular pressure not controlled medically. It included preparation of a 4.0 x 4.0 mm limbal-based external scleral flap, dissecting and removing most of an internal scleral flap (leaving it 1 mm smaller than the external flap), unroofing Schlemm's canal and removing fine endothelial tissue lining its inner walls. The external scleral flap was then repositioned and sutured. Collagen implants were not used. In some cases DS was combined with extracapsular cataract extraction and intraocular lens implantation. Mean intraocular pressure decreased from 24.8 +/- 3.9 mmHg initially to 12.8 +/- 4.4 mmHg 6 months after operation (p < 0.0001). There was no difference in postoperative intraocular pressure between DS as a single procedure or as part of a combined operation. Complications were mild and of short duration. If long-term follow-up shows that lowered intraocular pressures are maintained, DS should be a surgical option in earlier stages of glaucoma.

[Coloring the floor of Schlemm's canal in deep sclerectomy].

Increased intraocular pressure in glaucoma, resistant to maximal tolerated medical therapy, can be relieved by deep sclerectomy. Its advantage over classical trabeculotomy is fewer postoperative complications. This probably results from its being relatively noninvasive, since the anterior chamber is not penetrated. Successful deep sclerectomy requires preservation of the trabeculo-descemetic membrane, which forms part of the floor of Schlemm's canal. Aqueous flows from the anterior chamber across the trabeculo-descemetic membrane and into the ocular venous drainage. Despite the importance of its preservation, during deep sclerectomy it is perforated in 10-15% of cases. Coloring the endothelium lining the floor of the canal with gentian violet solution improves visualization of the membrane and thus aids in its preservation. Its use makes the procedure easier and should improve results.

The effect of normal childbirth on eyes with abnormalities predisposing to rhegmatogenous retinal detachment.

BACKGROUND: Pregnant women who have high myopia, a history of retinal detachment or retinal holes, or have known lattice degeneration are frequently referred to an ophthalmologist for advice concerning the management of pregnancy and labor, i.e. whether a spontaneous vaginal delivery can be allowed and whether prophylaxis for high-risk retinal pathology is indicated. Many obstetricians still believe that pregnant women with ocular abnormalities predisposing to rhegmatogenous retinal detachment should have an instrumental delivery, and a few even advocate cesarian section. Very little has been written about the management of pregnant women with high-risk retinal pathology, and opinions differ considerably. Patient data on this subject are scarce. METHODS: We studied 10 women who had 19 deliveries (10 prospective and 9 retrospective) and who had a history of retinal detachment, had been diagnosed as having extensive lattice degeneration, or had been treated for symptomatic retinal holes or breaks. The women were followed from the third trimester of pregnancy through labor and delivery into the postpartum period, looking for changes in the retinal status. RESULTS: We found no changes in the retinal status in the postpartum examination. CONCLUSION: We conclude that prenatal treatment of asymptomatic retinal pathology is not indicated and that spontaneous vaginal delivery may be allowed to take place in women with high-risk retinal pathology.

A conceptual and empirical exploration of personal autonomy issues within family caregiving relationships.

We explored personal autonomy issues within family caregiving relationships and found little evidence of significant autonomy conflicts. Findings did suggest, however, that family members were more sensitive to autonomy issues than were their frail older relatives and that both groups defined the disability itself as the major impediment to autonomy in later life. Findings support the usefulness of an expanded definition of autonomy, emphasizing the importance of goal-directed behavior, which may be inhibited by intrinsic conditions as well as external forces.

Essential thrombocythemia: a rare case of central retinal artery occlusion.

Essential thrombocythemia is a myeloproliferative disorder with an increased amount of abnormal platelets, causing both hemorrhagic and thrombotic pathology. Some of its systemic complications include deep vein thrombosis, pulmonary emboli, myocardial infarcts, and renal vessel thrombosis among others. We present the rare case of a woman suffering from essential thrombocythemia with the sudden loss of vision in her right eye, caused by central retinal artery occlusion. A possible connection between these two disorders is discussed.

Retinal detachment with high myopia in the Rubinstein-Taybi syndrome.

A case of rhegmatogenous retinal detachment with high myopia is presented in a 17 year old boy with the typical characteristics of the Rubinstein-Taybi syndrome. Although multiple eye anomalies are known to occur in this syndrome, the occurrence of retinal detachment has not been reported up to now. The importance of including a thorough fundus examination in the routine eye examination of these patients is emphasized.

[Hypoglycemia due to ophthalmic timolol in a diabetic].

In a 65-year-old man with insulin-dependent diabetes there was an increase in the severity and frequency of hypoglycemic attacks during treatment with ophthalmic timolol maleate for glaucoma. When timolol was stopped hypoglycemic attacks ceased. While recurrent exacerbation of hypoglycemia and its symptoms in insulin-dependent diabetics is a relatively common side-effect of systemic beta-blockers, there are scarcely any reports attributing this phenomenon to topical ophthalmic beta-blockers. Topical as well as systemic beta-blocking agents must be used with great caution in diabetics receiving insulin.

Effects of zinc and copper metabolism in highly myopic patients.

There is considerable evidence supporting a link between abnormalities in zinc and copper metabolism and some disorders of the retinal pigment epithelium. Anatomical studies in highly myopic eyes show important changes in this retinal layer. We measured the blood concentrations of zinc and copper and the urine concentration of copper in different groups of highly myopic patients from Caucasian and African populations, and in highly myopic patients with retinal detachment. In the Caucasian myopic groups, many patients showed high levels of zinc and low levels of copper in serum. In the high myopic group with retinal detachment, serum zinc and copper concentrations were significantly elevated. The importance of our findings and their connection to the retinal pigment epithelium is discussed.

Mitral valve prolapse (Barlow's syndrome) and retinal emboli.

Mitral valve prolapse (M.V.P.) is a noninflammatory degeneration of the mitral valve leaflets which results in a billowing of the redundant valve tissue toward the left atrium during the systolic phase. Mitral valve prolapse can be diagnosed by echocardiography or by auscultation where a characteristic mid-systolic click and late systolic murmur can be heard. Ophthalmic complications of MVP include chronic external progressive ophthalmoplegia and an association with keratoconus. In this case we present a case of a young woman who presented with sudden recurrent decrease in vision secondary to retinal arterioli emboli associated with the mitral valve prolapse syndrome.

A metabolic analysis of high myopia and senile macular degeneration.

Abnormal zinc and copper metabolism have been described in several retinal disorders affecting the retinal pigment epithelium. An infrequent presentation of senile macular degeneration in high myopia is well known. We examined the blood for zinc and copper and the urine for copper of three groups of patients, one consisting of high myopia, another with high myopia and primary retinal detachment and the other a group of patients with senile macular degeneration. When comparing the above groups of patients, we found statistically elevated values of serum zinc (p = less than 0.005) in the group of patients with senile macular degeneration. The significance of these findings, and a correlation with the pathogeneses of high myopia and senile macular degeneration is discussed.

Changes in the zinc and copper metabolism after panretinal photocoagulation in the rabbit.

In a previous work on a group of patients with diabetic retinopathy, the effect of laser photocoagulation on the serum zinc and copper levels was evaluated. In many of those patients, an increase in the serum zinc and copper levels was found one day after the laser treatment. In the present work, changes in the serum concentration of these metals after xenon arc photocoagulation were assessed in the rabbit. A significant rise was found one day after the treatment in the level of serum copper (P less than .005), and one week thereafter in the level of serum zinc (P less than .005). The significance of these results and their connection to the retinal pigment epithelium and choroid is discussed.

Chorioretinitis and extrapulmonary tuberculosis.

A case of tuberculous uveitis that presented 34 years after a primary articular focus is evaluated. The pathogenesis of the infection and the role of the tuberculin skin test in the diagnosis are discussed. Isoniazid was used with good therapeutic results. Fluorescein angiography was found to be essential in the follow-up of the choroidal lesions. Subretinal neovascularization was managed with argon laser photocoagulation.

Recurrent tears following successful retinal detachment surgery.

In 17 cases of recurrent retinal tears occurring after successful retinal detachment surgery, the new tears developed on or near the treated primary tear in seven cases and away from the treated tear in ten cases. It took an average of 25.6 months for the second tears to develop, and almost all of the recurrent tears were the same distance from the limbus as the primary tear. The benefit of the 360 degree encircling band and the relationship of the thermal injury to production of a second tear is discussed.

Zinc and copper metabolism in oculocutaneous albinism in the Caucasian.

Abnormalities in the zinc and copper metabolism have been described in some pigmentary retinopathies. In these eye disorders changes in the Retinal Pigment Epithelium are a common finding. Albinism is a manifestation of a metabolic disorder with abnormalities of pigment formation which also occurs in this mentioned retinal layer. Recently, we described abnormalities in the metabolism of these metals in black albino patients. In them, elevated values of ceruloplasmin were found. In the present study we performed a similar work among Caucasians. When both the Caucasian albino and control groups were compared, no statistical difference in the ceruloplasmin, serum zinc and copper and their concentration in urine was present. However, in 7 patients of the Caucasian albino group the serum zinc was distinctly elevated. The mean concentration of ceruloplasmin was high as well. No definitive correlation in regard to the positivity or negativity of tyrosinase was observed. Our findings may support our previous observations regarding albinism as a possible primary abnormality of zinc and copper metabolism.

Copper and zinc metabolism in high myopic patients with retinal detachment evaluation of the Cu/Zn ratio.

In a previous work abnormalities in the copper and zinc metabolism in high myopic patients were found. Primary Retinal Detachment is a common complication of High Myopia. In order to establish further their relationship, a study of the metabolism of these metals was performed in myopic patients with Retinal Detachment. A significant high copper and zinc concentration in the urine of these patients was found. An inverse ratio of copper and zinc between their concentration in the subretinal fluid and their concentration in serum was present as well. The significance of these findings and their connection to the Retinal Pigment Epithelium is discussed.

A metabolic aspect of high myopia.

Abnormal zinc and copper metabolism has been described in some retinal disorders affecting the retinal pigment epithelium. Anatomic studies in high myopic eyes, show important changes in this retinal layer. We examined the blood for zinc and copper and urine for copper in different groups of high myopic black and white patients, and high myopic white patients with primary retinal detachment. In the white myopic groups, many of the patients showed high serum zinc and low serum copper values. In the high myopic patients with primary retinal detachment, the serum zinc and copper were found to be distinctly elevated and of statistical significance. A relative inverse copper/zinc ratio between the concentration of these metals in serum and their concentration in the subretinal fluid was noted as well. The significance of these findings and their connection to the retinal pigment epithelium is discussed.