The effects of subconjunctival mitomycin-C on glaucoma filtration surgery in rabbits.

A prospective, randomized, masked, placebo-controlled study was performed to determine whether a single, intraoperative subconjunctival application of a 0.5-mg/mL solution of mitomycin-C enhances the success of full-thickness filtration surgery in rabbits. Compared with control eyes, mitomycin-C-treated eyes showed significant increases in bleb duration from 8.1 +/- 2.4 to 68.0 +/- 20.8 days and in intraocular pressure reduction from 6.0 +/- 3.0 to 63.6 +/- 21.5 days. Histopathologic evaluation confirmed the inhibitory effects of mitomycin-C on fibrovascular, fibrocellular, and collagenous organization of the filtering blebs that resulted in their preservation. Transient, superficial, corneal vascularization anterior to the bleb occurred in all mitomycin-C-treated eyes. No other clinical or pathologic signs of undesirable side effects were noted. We studied the effectiveness and safety of a single intraoperative application of mitomycin-C in prolonging the success of filtration surgery in rabbits and its potential for similar use in humans.

Late ophthalmic manifestations of the shaken baby syndrome.

We examined six children between 12 and 55 months after an initial shaking injury to determine whether visually significant retinal abnormalities persisted, despite clearing of intraocular hemorrhage. In two children (age 21 months and 6.7 years at follow-up), visual acuity was reduced due to macular folds occurring in the region of previous large subhyaloid hemorrhages. A third child (age 3.2 years) had a midperipheral lacunar defect of the retinal pigment epithelium which was not visually significant. Cerebral injury was responsible for an apparent profound visual loss in three children. Our findings indicate that both macular folds and cortical injury are functionally significant complications of the shaken baby syndrome.

Retinal hemorrhage predicts neurologic injury in the shaken baby syndrome.

Shaken baby syndrome consists of intracranial and intraocular hemorrhage in the absence of signs of direct trauma in infants who have sustained whiplash/shaking injuries. We evaluated 14 consecutive cases of presumed shaken baby syndrome seen at the University of Michigan Hospitals, Ann Arbor, between August 1983 and March 1988, to determine if the severity of retinal hemorrhage was predictive of the severity of acute neurologic injury. The severity of retinal hemorrhage was based on the type and size of hemorrhage and the extent of fundus involvement. We found a significant correlation between retinal hemorrhage severity and acute neurologic findings. Diffuse fundus involvement, vitreous hemorrhage, or large subhyaloid hemorrhages were associated with more severe acute neurologic injury.

Retinal and choroidal vascular occlusion secondary to corticosteroid embolisation.

We report a case of visual loss following intranasal injection of triamcinolone acetonide and phenylephrine hydrochloride in a 22-year-old female with chronic sinusitis. Clinical examination and fluorescein angiography revealed vascular occlusions which involved multiple small branches of both the choroidal and retinal circulations. The mechanism of such a complication probably involves inadvertent intra-arterial injection into the anterior or the posterior ethmoidal artery, with retrograde flow into the opthalmic arterial system. Precautions can be taken to avoid such complications.