Role of ICAM-1 in impaired retinal circulation in rhegmatogenous retinal detachment.

Many studies have demonstrated that rhegmatogenous retinal detachment (RRD) leads to impaired retinal circulation. However, the involvement of inflammation in the RRD-induced worsening of retinal circulation was obscure. This retrospective observational study included 150 patients with primary RRD (macula-on, n = 63; macula-off, n = 87) who underwent 25-gauge microincision vitrectomy surgery (25G MIVS). Total retinal blood flow was represented by the mean blur rate (MBR) of the optic nerve head vessel, measured by laser speckle flowgraphy preoperatively and until 6 months postoperatively. Aqueous humor samples were obtained during surgery to determine cytokine concentrations by enzyme-linked immunosorbent assay. At 3 and 6 months postoperatively, there were no significant differences between eyes with macula-on RRD and fellow eyes. However, in macula-off RRD, MBR remained significantly lower in RRD eyes 6 months postoperatively (P < 0.05). Log-transformed levels of soluble intercellular adhesion molecule-1 (sICAM-1) were negatively correlated with relative MBR (r-MBR, RRD eye/fellow eye) before surgery (r = - 0.47, P = 0.01) in macula-on, but not macula-off, RRD. Six months postoperatively, r-MBR correlated significantly with sICAM-1 levels (r = - 0.36, P = 0.02) in macula-off RRD. ICAM-1 may play a role in RRD-induced deterioration of retinal circulation.

A Novel Biomarker in Diabetic Macular Edema with Serous Retinal Detachment: Serum Chitinase-3-Like Protein 1.

PURPOSE: To determine whether serum chitinase-3-like protein 1 (CHI3L1) and interleukin-6 (IL-6) levels correlate with serous retinal detachment (SRD) in diabetic macular edema (DME) using spectral-domain optical coherence tomography (SD-OCT). METHODS: In this cross-sectional case-control study, 394 patients (treatment-naive DME patients, n = 218; diabetic patients without DME, n = 96; nondiabetic controls, n = 80) were included in the study. Eyes were classified according to SD-OCT features of DME: SRD, cystoid macular edema (CMO), and diffuse retinal thickness (DRT). Serum concentrations of CHI3L1 and IL-6 were analyzed using enzyme-linked immunosorbent assay. RESULTS: Serum CHI3L1 and IL-6 levels were significantly higher in DME with SRD compared to patients with CMO and DRT (p < 0.001 for all groups). Multivariate regression analysis showed that CHI3L1 and IL-6 had a stronger influence on the presence of SRD in DME (r = 1.162, p = 0.026, and r = 1.242, p = 0.016, respectively). Serum concentration of CHI3L1 was significantly correlated with that of IL-6 (r = 0.386, p = 0.0015). CONCLUSIONS: Our data suggest that serum concentrations of CHI3L1 and IL-6 are involved in the process of SRD in DME. CHI3L1 can be investigated further as a new diagnostic biomarker for DME with SRD.

The use of emergency apheresis in the management of plasma cell disorders.

Hyperviscosity syndrome (HVS) develops most commonly in Waldenström's macroglobulinemia (WM) and multiple myeloma (MM). Plasmapheresis is the immediate therapy and very effective at relieving symptoms by removing paraprotein. The most commonly used replacement fluid is 4%-5% human albumin in physiologic saline. FFP may be used in patients with coagulation abnormalities. Plasmapheresis should be continued until acute symptoms abate. Hyperviscosity impairs the circulation in the retina and causes hemorrhages around the small retinal vessels. Early diagnosis and urgent plasmapheresis may reduce blindness caused by retinal hemorrhages and/or retinal detachment. In HCV related mixed cryoglobulinemias, plasmapheresis is indicated if rapidly evolving life-threatening disease with immunosuppressive agent exists. In non-infectious mixed cryoglobulinemia plasmapheresis is indicated when the disease manifestations are severe, as a second line option. In WM patients with hyperviscosity symptoms and IgM > 4 g/dL, preemptive plasmapheresis is recommended to prevent an IgM flare with rituximab. Certain IgG/A MGUS-associated neuropathy patients may benefit from plasmapheresis. For cast nephropathy (suspected or biopsy proven), plasmapheresis is recommended when the sFLC ≥ 500 mg/l and as early as possible (<1 month with kidney injury). Theoretically, extracorporeal removal alone, without efficient tumor killing, could not reduce sFLC due to high production by the tumor mass and rapid rebound between compartments.

Osteoporosis in Stickler syndrome. A new family case with bone histology study.

The Stickler syndrome (SS) has been described as a "hereditary progressive arthro-ophtalmopathy" by Stickler in 1965, due to mutations on the collagen genes. Currently about 40 different genes have been identified which encode for at least 27 different collagens. The majority of mutations occur in the COL2A1 gene on chromosome 12q13 (SS type I). Mutations in COL11A1 are less frequent (SS type II). More recently, mutations in COL11A2 and in the COL9A1 gene have been reported with particular phenotypes. The main features of this autosomal inherited disease are ocular, auditory with orofacial abnormalities and early-onset osteoarthritis. We report the clinical presentation of an adult and his son, with a particular focus on the bone status of the father, radiography, bone densitometry and transiliac bone biopsy showing that he was suffering from osteoporosis. The lumbar bone mineral density was low with a Z-score at -2.9. Transiliac bone biopsy showed a dramatic decrease of trabecular bone volume (8.6%; Nl: 19.5±4.9%), thin trabeculae and a disorganized trabecular network. A slight increase of osteoid parameters was observed. Bone resorption was markedly increased with an excessive number of active (TRAcP+) osteoclasts. The cortical width was normal, but a slight increase of cortical porosity was found. Osteoporosis has been rarely described in the SS. It might be useful to systematically perform a bone densitometry in all patients with SS and to discuss the indication of a transiliac bone biopsy in severe cases.

Bevacizumab in macular serous detachments associated with Waldenstrom's macroglobulinemia.

Waldenström's macroglobulinemia (WM) is a lymphoproliferative B-cell disorder characterized by monoclonal proliferation of immunoglobulin M. WM can be associated with impressive hyperviscosity retinopathy and a unique tendency to develop serous macular detachments. These have been described as immunogammopathy maculopathy and portend a poor visual prognosis, often persisting despite multiple plasmapheresis treatments. In this case report, the authors demonstrate the accelerated resolution of hyperviscosity retinopathy and associated macular detachments in a patient with WM with marked visual improvement. This case report serves to raise awareness of the potential role of anti-vascular endothelial growth factor modulation in the treatment of patients with hyperviscosity retinopathy associated with WM.

Elevated hydrogen sulfide levels in vitreous body and plasma in patients with proliferative diabetic retinopathy.

PURPOSE: Hydrogen sulfide (H2S), a colorless gas, has been confirmed to be a gaseous messenger molecule and an endogenous stimulus for angiogenesis recently. This study was performed to investigate the role of H2S in diabetic retinopathy. METHODS: Blood samples were collected from normal controls and patients with diabetes. Vitreous samples were collected from patients with proliferative diabetic retinopathy (PDR) and patients with rhegmatogenous retinal detachment. Patients were grouped into diabetic patients without diabetic retinopathy (non-DR), with nonproliferative DR, and with PDR. Concentrations of H2S and vascular endothelial growth factor in the plasma and vitreous body were detected using a spectrophotometer. RESULTS: A decreased H2S level in the plasma was observed in non-DR group (41.89 ± 8.52 µM, P < 0.05), and an increased H2S level in the plasma was observed in PDR group (60.49 ± 11.14 µM, P < 0.001), when compared with that in normal controls (49.67 ± 9.72 µM). There was no difference in plasma H2S level between patients with nonproliferative DR (54.13 ± 8.61 µM) and normal controls. In the vitreous body, H2S levels in PDR group were significantly higher (76.80 ± 24.08 µM, P < 0.001) than that in rhegmatogenous retinal detachment group (24.37 ± 11.25 µM). Levels of vascular endothelial growth factor in plasma from patients with diabetes were significantly lower (P < 0.001) than that in normal controls. Vascular endothelial growth factor levels in the vitreous body from diabetic patients with PDR were significantly higher (885.61 ± 190.41 pg/mL, P < 0.001) than that from patients with rhegmatogenous retinal detachment (89.98 ± 19.56 pg/mL). Seven days after an intravitreal injection of ranibizumab, a significantly decreased H2S level (55.58 ± 7.20 µM, P < 0.05) was observed in the vitreous body in patients with PDR when compared with that (75.07 ± 12.95 µM) in the vitreous body collected just before intravitreal injection. CONCLUSION: These results indicated that anti-vascular endothelial growth factor may downregulate the H2S level in the vitreous body, and H2S may play a role in the development of DR. Hydrogen sulfide may be a novel target for the therapy of DR.

Kininogen 1 and insulin-like growth factor binding protein 6: candidate serum biomarkers of proliferative vitreoretinopathy.

BACKGROUND: The aim was to validate whether kininogen 1 (KNG1) or insulin-like growth factor binding protein 6 (IGFBP-6) are serum biomarkers of proliferative vitreoretinopathy (PVR). METHODS: Samples from vitreous and corresponding serum samples were collected from patients with PVR. The donor vitreous samples and serum samples from healthy volunteers and volunteers who had undergone vitrectomies for other conditions were used as controls. The samples were subsequently analysed using Western blotting (WB) and enzyme-linked immunosorbent assay. RESULTS: The Western blotting outcomes indicated both IGFBP-6 and KNG1 could be specifically detected in the vitreous and serum samples of patients with PVR. The concentrations of KNG1 and IGFBP-6 were significantly higher in both vitreous and serum samples from patients with severe PVR than in the samples from patients with moderate PVR. The serum concentrations of KNG1 or IGFBP-6 had decreased by the post-vitrectomy examinations. The receiver operating characteristic (ROC) analyses when the concentrations of IGFBP-6 or KNG1 were greater than 181.4 pg/ml or 441.75 ng/ml, respectively, predicted severe PVR with both a sensitivity and specificity of over 70 per cent. When the concentrations of IGFBP-6 or KNG1 were greater than 98.5 pg/ml or 88.5 ng/ml, respectively, they predicted the PVR prognosis with both a sensitivity and specificity of 80 per cent. CONCLUSIONS: KNG1 and IGFBP-6 may be candidate serum biomarkers of PVR.

Comparison of vitreous and plasma levels of vascular endothelial growth factor, interleukin-6 and hepatocyte growth factor in diabetic and non-diabetic retinal detachment cases.

We compared the vitreous and plasma levels of proinflammatory cytokines in diabetic patients who underwent pars plana vitrectomy. Levels of proinflammatory cytokines in the vitreous were higher in the diabetic patients than the non-diabetics while the levels of plasma cytokines were similar. It is thought that this increase in the vitreous is effective in the progression of angiogenesis and the development of proliferative diabetic retinopathy.

Deletion of the basement membrane heparan sulfate proteoglycan type XVIII collagen causes hypertriglyceridemia in mice and humans.

BACKGROUND: Lipoprotein lipase (Lpl) acts on triglyceride-rich lipoproteins in the peripheral circulation, liberating free fatty acids for energy metabolism or storage. This essential enzyme is synthesized in parenchymal cells of adipose tissue, heart, and skeletal muscle and migrates to the luminal side of the vascular endothelium where it acts upon circulating lipoproteins. Prior studies suggested that Lpl is immobilized by way of heparan sulfate proteoglycans on the endothelium, but genetically altering endothelial cell heparan sulfate had no effect on Lpl localization or lipolysis. The objective of this study was to determine if extracellular matrix proteoglycans affect Lpl distribution and triglyceride metabolism. METHODS AND FINDINGS: We examined mutant mice defective in collagen XVIII (Col18), a heparan sulfate proteoglycan present in vascular basement membranes. Loss of Col18 reduces plasma levels of Lpl enzyme and activity, which results in mild fasting hypertriglyceridemia and diet-induced hyperchylomicronemia. Humans with Knobloch Syndrome caused by a null mutation in the vascular form of Col18 also present lower than normal plasma Lpl mass and activity and exhibit fasting hypertriglyceridemia. CONCLUSIONS: This is the first report demonstrating that Lpl presentation on the lumenal side of the endothelium depends on a basement membrane proteoglycan and demonstrates a previously unrecognized phenotype in patients lacking Col18.

Preoperative duration of retinal detachment and subretinal immunoreactive endothelin-1: repercussion on logarithmic visual acuity.

PURPOSE: To analyze whether preoperative duration of primary rhegmatogenous retinal detachment (RD) influences endothelin-1 (ET-1)--a vasoactive, mitogenic, and pro-apoptotic peptide- levels with repercussions on logarithmic (LogMAR) visual acuity (VA). METHODS: Prospective clinical cohort study on 66 healthy patients [33 with proliferative vitreoretinopathy (PVR) and 33 with no PVR] with unilateral RD candidates for scleral buckling (SB) surgery. Using radioimmunoassay, immunoreactive ET-1 (IR-ET-1) was tested in both plasma and subretinal fluid (SRF) of these RD patients. Pearson's correlations were evaluated between preoperative RD duration and each IR-ET-1 level (plasma, SRF and the difference SRF minus plasma) and also between both variables and the LogMAR VAs (preoperative, postoperative 8 months, and the difference: postoperative 8 months minus preoperative). RESULTS: PVR was associated with higher preoperative RD duration, higher LogMAR VA values (pre- and postoperative 8 months) and higher IR-ET-1 values (plasma, SRF and the difference: SRF minus plasma) than no-PVR IR-ET-1 levels (plasma and SRF) were only correlated (r = 0.462, p = 0.007; r = 0.397, p = 0.022 respectively) with preoperative RD duration in the no-PVR group. IR-ET-1 values (plasma, SRF and the difference:SRF minus plasma) showed statistically significant correlations with pre- and with postoperative 8 months LogMAR VAs in no-PVR and with postoperative 8 months LogMAR VA and LogMAR VA difference in PVR The highest correlation between IR-ET-1 levels and LogMAR VAs was found between SRF IR-ET-1 and postoperative 8 months LogMAR VA in PVR (cases with macula-on) (r = 0.956, p < 0.0001). CONCLUSIONS: Preoperative RD duration showed statistically significant positive correlations with pre- and with postoperative 8 months LogMAR VAs in both the no-PVR and the PVR groups and with IR-ET-1 measurements (plasma and SRF: lower correlations) only in the no-PVR group. These findings support the idea of doing primary and prompt vitrectomy for RD and perhaps using coadjutant pharmacologic therapy in order to improve visual results.

Subretinal fluid from rhegmatogenous retinal detachment and blood induces the expression of ICAM-1 in the human retinal pigment epithelium (ARPE-19) in vitro.

PURPOSE: To evaluate the effect of subretinal fluid (SRF) from rhegmatogenous retinal detachment (RRD) and blood on the expression of intercellular adhesion molecule-1 (ICAM-1) in the retinal pigment epithelium. METHODS: The study included 22 patients who had experienced RRD within 1 month before the study and 14 patients with macular holes or pucker. SRF was collected during surgery to repair RRD and the vitreous was collected during vitrectomy. The SRF was cocultured with ARPE-19 cells with and without glucosamine sulphate (GS) and triamcinolone acetonide (TA). Blood from peripheral veins and blood components (red blood cells, platelet-poor plasma, and platelet-rich plasma) were also cocultured with ARPE-19 cells. Vitreous samples were cocultured with ARPE-19 cells in the control. The expression of ICAM-1 was detected and quantified by using flow cytometry. RESULTS: The expression of ICAM-1 in RPE cells was significantly higher (P<0.05) after 24-h incubation of 40% SRF with ARPE-19 cells. In addition, the expression of ICAM-1 in retinal pigment epithelium (RPE) cells significantly increased (P<0.01) when cocultured with blood and blood components. However, there were no differences (P>0.05) in ICAM-1 expression when RPE cells were cocultured with or without GS or TA. CONCLUSIONS: SRF and blood enhanced the expression of ICAM-1 in RPE cells in this study and the increased expression of ICAM-1 by SRF is not inhibited by GS or TA.

Theoretical estimation of retinal oxygenation during retinal detachment.

The aim of the present work was to simulate the oxygenation of the whole retina during different degrees of retinal detachment. A differential equation describing the oxygenation of the whole retina, at different degrees of detachment, was set up and solved numerically. The results show that the choroid can supply the outer retina with a fairly large amount of oxygen as long as the detachment height is lower than about 1mm. This study thus supports the view that hyperoxia may well prove to be clinically beneficial.

Fibrinolytic response to retinal detachment surgery under general or local anesthesia.

PURPOSE: To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery under general or local anesthesia. PATIENTS: Prospective study of 81 patients (43 male, 38 female), aged from 15 to 82 (mean 50.7 SD = 17.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia (group A), and 14 patients (6 male, 8 female) aged from 15 to 78 (mean 52.9, SD =19.8) years, operated under local anesthesia (group B). Excluded were patients with venous or arterial disease or other factors that could change the parameters investigated. METHODS: Blood was sampled from a cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and after the operation (on days 1 and 4). In patients' citrated plasma, tissue plasminogen activator antigen (t-PA-Ag), plasminogen activator inhibitor type 1 antigen (PAI-1 Ag) and activity (PAI-1), fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS. The pattern of changes in perioperative fibrinolytic activity was similar in both groups. Intraoperative levels of FDP were significantly higher and ELT shorter than preoperatively. In both groups t-PA Ag concentration was significantly increased on the first postoperative day. There were no changes in PAI-1 in both groups. Postoperatively, the FDP concentration was reduced and ELT prolonged. CONCLUSIONS: Retinal detachment surgery induces intraoperative activation of fibrinolysis in the systemic circulation regardless of the type of anesthesia.

[Coagulation factors and fibrinolytic system in subretinal liquid in patients with rheumatogenous retinal detachment]. / Faktory svertyvaiushchei i fibrinoliticheskoi sistem v subretinal'noi zhidkosti u bol'nykh s regmatogennym otsloniem setchatki.

The work deals with estimation of some factors of blood coagulation and fibrinolytic systems, which include antithrombin III, factor X, prothrombin, plasminogen, protein C concentrations in the subretinal fluid of the patients with rhegmatogenous retinal detachment retina. The tendency to increase of the blood coagulation and fibrinolysis factor levels, except protein C, was revealed in the patients with complicated forms of the disease. The investigations mentioned above are capable of serving as a diagnostical and forecasting test characterizing the rhegmatogenous retinal detachment retina and surgical treatment proceeding.

Fibrinogen and detached retina with or without proliferation.

PURPOSE: Fibrinogen is a multifunctional molecule, participating in processes such as wound healing, inflammation and cell proliferation. Therefore a comparative study of plasma fibrinogen levels was performed on patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy after RRD (PVR). METHOD: Plasma fibrinogen levels were measured preoperatively in three groups of patients; twenty-two (n=22) patients from the ORL department of our hospital, serving as a control group; twenty-eight (n=28) patients with RRD; and twenty (n=20) patients with PVR after RRD. Patients' ages were matched for all three groups; diabetics and patients with cardiovascular disease were excluded. T-Student's test was performed for the comparison of the plasma fibrinogen mean values of the aforementioned groups. RESULTS: Statistically significant (p value: 0.013) elevation of fibrinogen plasma levels was observed in patients with RRD compared to those of the control group. In addition, patients with PVR had significantly higher plasma fibrinogen levels (p value: 0.03) than RRD patients. CONCLUSION: The results suggest a correlation between fibrinogen plasma levels and the development of RRD and PVR.

Alterations in antithrombin III activity and other blood coagulation parameters after retinal detachment surgery.

PURPOSE: To evaluate perioperative changes in blood coagulation in patients undergoing retinal detachment surgery. MATERIALS: Prospective study of 56 patients, aged from 19 to 82 (mean +/- S.D. 53 +/- 16.8) years, undergoing retinal detachment surgery (encirclement with scleral buckling) under general anesthesia. Excluded were patients with venous or arterial disease and any other factors that could affect the parameters under consideration. METHODS: Blood was sampled from the cubital vein one day before surgery, immediately after induction of anesthesia but before surgery, immediately after completion of the operation but before the termination of anesthesia and on days 1 and 4 after the operation. We measured antithrombin III activity (AT III), platelet count, fibrinogen concentration, activated partial thromboplastin time (aPTT) and prothrombin time (PT). RESULTS: Intraoperative AT III activity and platelet count were significantly lower, aPTT was shortened and PT prolonged, although all values remained within the normal range. These results indicate moderate activation of coagulation during retinal detachment surgery. On the first postoperative day coagulation activity was reduced, with increases in AT III activity, fibrinogen concentration and platelet count and prolongation of aPTT. CONCLUSIONS: During retinal detachment surgery there is moderate activation of coagulation in the systemic circulation.

The influence of retinal detachment surgery on perioperative blood fibrinolysis.

PURPOSE: To evaluate perioperative changes in fibrinolysis in patients undergoing retinal detachment surgery. MATERIAL: Prospective study of 56 patients (30 male, 26 female), aged from 19 to 82 (mean: 53, SD = 16.8) years, subjected to retinal detachment surgery (encirclement with scleral buckling) performed under general anaesthesia. Excluded were patients with vein or arterial disease and with other factors which could change evaluated parameters. METHOD: Blood was sampled from cubital vein one day before surgery, immediately after induction of anaesthesia but before surgery, immediately after the completion of the operation but before the termination of anaesthesia and after operation (on the 1(st) and 4(th) day). In the citrate plasma of patients studied, tissue plasminogen activator (t-PA), plasminogen activator inhibitor type 1 (PAI-1), plasmin-alpha(2)-antiplasmin (PAP) complexes, fibrin-fibrinogen degradation products (FDP) and euglobulin lysis time (ELT) were measured. RESULTS: In the group studied intraoperative values of t-PA Ag, PAP and FDP were significantly higher, PAI-1 Ag concentration decreased and ELT was reduced. These results indicate a significant activation of fibrinolysis during the retinal detachment surgery. On the first postoperative day the fibrinolytic activity was reduced (decrease in t-PA Ag and FDP concentration and prolongation of ELT). CONCLUSION: During retinal detachment surgery the patients reveal activation of fibrinolysis in systemic circulation.

The effect of silicone ocular surgical devices on serum IgG binding to silicones.

PURPOSE: To determine whether silicone materials used in retinal detachment repair and cataract surgery increase serum IgG binding to silicone and identify correlations with complications of ocular surgery. METHODS: Serum from 49 patients who had ocular surgery using silicone materials was examined. Patient groups included scleral buckling (n = 25), silicone oil tamponade (n = 3), scleral buckling and silicone oil tamponade (n = 9), and silicone lens implants after cataract extraction (n = 12). Convalescent samples for all patients and preoperative samples from 19 patients (18 scleral buckling and one silicone oil tamponade) were examined. Postoperative complications were monitored for up to 108 months (mean, 10.7 months; mode, 1.5 months; range, 1 to 108 months). Samples were evaluated for the extent of IgG binding to silicones using a micromodification of a previously described enzyme-linked immunosorbent assay method. RESULTS: In 19 patients, IgG binding levels in preoperative samples were 21 arbitrary units (AU) or less. Of the 25 buckling patients, one developed complications; however, in all patients the postoperative levels of IgG binding to silicone were low (2.2 to 20.0 AU). Although four silicone lens patients developed mild complications, none displayed postoperative IgG binding levels of greater than 20 AU. Three patients who underwent both scleral buckling and silicone oil tamponade developed complications; one of these patients, who was also noted to have systemic connective tissue disease, had a significant elevation in postoperative serum IgG binding to silicone. CONCLUSIONS: Statistically significant elevations of serum IgG binding to silicone were noted postoperatively in only one patient who had a systemic connective tissue disease. The complication rate and frequency of enhanced serum IgG binding to silicone was low, making correlations to surgical complications difficult. Examination of matched samples suggested that if ocular exposure to silicone implants enhances the level of serum IgG binding to silicones, it must be a rare event that should not alter the clinical use of these important devices.

[The effect of total protein and albumin levels in serum on retinal detachment due to EPH-gestosis]. / Wplyw poziomu bialka calkowitego oraz albumin w surowicy krwi na przebieg odwarstwienia siatkówki w wyniku EPH-gestozy.

The purpose of the report is to describe a 31-year-old pregnant woman with EPH-gestosis presenting typical clinical features of bilateral retinal detachment. We noticed that it was associated with low degree of total protein and albumin in serum. Shortcoming protein balance was associated with adhibition of retinae. Attention is paid to the fact that elevation of retinal detachment responded to the treatment involving parenteral administration of albumin. In this case we achieved reattachment of retinae and regained full visual acuity.

The occurrence of retinol and carotenoids in human subretinal fluid.

PURPOSE: To investigate if retinol and carotenoids are present in the subretinal space following rhegmatogenous retinal detachment. METHODS: Blood and subretinal fluid were collected from patients at the time of surgical repair of retinal detachment. After removal of cellular contents in a specimen by centrifugation, the supernatant fraction was analyzed by liquid chromatography using a silica column eluted by 16% dioxane in hexane. Retinol and carotenoids were identified in the chromatograms based on their retention time and absorption spectrum. RESULTS: The retinol concentrations (mean+/-SD) in the serum and subretinal fluid were 305+/-144 and 166+/-96 ng/ml respectively. The 450 nm chromatogram had 7 peaks with the characteristic absorption spectrum of carotenoids. Peak 1 and 7 coincided with the retention time of beta-carotene (1.8 min) and lutein (10.8 min) respectively. The concentrations of beta-carotene and lutein in serum were 161+/-63 and 142+/-98 ng/ml respectively. There was very little beta-carotene in subretinal fluid (4.7+/-2.4 ng/ml). Lutein was the major carotenoid peak in subretinal fluid (41.4+/-14.1 ng/ml). The minor carotenoid peaks of serum were not observed in subretinal fluid. CONCLUSION: There is a substantial amount of retinol and lutein in subretinal fluid. The high proportion of lutein and very low amount of beta-carotene in the subretinal fluid support the occurrence of a highly selection transport mechanism of lutein from the blood to the retina.