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The cyclops material consists of 4 sectioned fetal heads and a dried cyclops skull. The skeleton of the proboscis is formed by the nasal capsule. The base of the proboscis lies in the floor of the anterior cranial fossa filling an extended ethmoidal notch and contributing to the roof of the median orbit anterior to the fused lesser wings of sphenoid. The cavity of the proboscis is lined with squamous epitheliumrespiratory and olfactory mucosa. Olfactory fibres pass from the proboscis into the extradural space of the ethmoidal notch forming a collection of tissue similar to the inferior layer of the normal olfactory bulb. The data indicate that the proboscis represents the anterosuperior part of the normal nasal cavity developed in the absence of median components. |
De novo vitreous amyloid opacities may occur several years after pars plana vitrectomy. Amyloid deposition in vitreous cavity was observed only in strong vitreous adherence locations (behind posterior lens capsule and at vitreous base area). The authors expect that this procedurean extensive re-vitrectomy associated with posterior capsulectomywill prevent de novo vitreous amyloid opacities.To report management of de novo vitreous amyloid opacities after previous pars plana vitrectomy in familial amyloidotic polyneuropathy transthyretin Val30Met.This work is a retrospective observational consecutive case series of five eyes of four patients. Demographic datatransthyretin mutation involvedage at the beginning of diseaseduration of diseasetreatment (liver transplant or tafamidis)time between vitrectomy and re-interventionand ophthalmologic changes were evaluated. Surgical re-intervention included phacoemulsification with intraocular lens implantation in phakic eyesre-vitrectomy as complete as possible with posterior capsulectomyand internal limiting membrane peeling if wrinkling of internal retinal surface was present.All patients had transthyretin Val30Met mutationand three were women. Mean age of onset of the disease was 52 ± 11.0 yearsand average evolution time of the disease was 8 years. Three patients had been submitted to liver transplant 49and 15 years before. Time between first vitrectomy and surgical re-intervention was longer than 2 years in all cases. Two eyes had amyloid deposits on anterior lens surface and pupillary border with scalloped pupil. Two eyes were phakic. Glaucoma was present in two eyes; one of them had previous trabeculectomy. All cases had vitreous opacities behind posterior lens capsule and at vitreous base area. After re-interventionno further recurrence was observed (average follow-up of 10 months). |
Further data to the aetiologypathogenesis and therapy of infectious bovine keratoconjunctivitis. Out of a total of 224 bovine eye secretions126 Moraxella bovis and 64 Neisseria ovis strains were isolated. The pathogenesis and histological lesions caused by Neisseria ovis have been studied on the eyes of three calves naturally affected with IBKusing electron microscopy. Neisseria ovis caused in 1-12 weeks old calves acutetransient and mostly benign serous conjunctivitis with only slight affection of the cornea. More rarely erosions and even ulceration of the cornea have been observed. Moraxella bovis and Neisseria ovis strains proved nearly unanimously sensitive in vitro to chloramphenicolneomycinoxytetracyclinnitrofurantoinerythromycin and cefoperazone. Other antibiotics and chemotherapeutics inhibited the growth of these agents only partly or were ineffective. Experimental therapy has been carried out using a single i.m. injection of TerramycinLA inj. (Pfizer) in a dose of 20 mgkg body massrepeated if necessary after 72-96 h. This formulation proved more effective and practical than treatments used earlier. |
Optic nerve head drusen in black patients. Several studies have suggested racial differences in the prevalence of optic nerve head drusen We aimed to determine the percentage of patients with who are black and to describe the clinicalophthalmoscopicand perimetric findings in these patients.We conducted a retrospective chart review of all patients with seen at our institution between 1989 and 2010. Only black patients with confirmed on either funduscopy or B-scan ultrasonography were included. Demographic and clinical findings in these patients were recorded and analyzed.Of the 196 patients with confirmed were black. This included 7 females and 3 males with ages ranging from 8 to 61 years. Six of the 10 patients had bilateral The were buried in 11 of 16 eyes and exposed in 5 of 16 eyes. Fifteen of 16 eyes with had small cupless optic nerve heads. Visual fields were normal in 4 of 16 eyes with In the remaindervisual field defects included an enlarged blind spot (5 eyes)constricted field (5 eyes)nasal defect (2 eyes)central defect (1 eye)and generalized depression (1 eye). Visual field defects were present in 4 of 5 eyes with exposed and 8 of 11 eyes with buried None of the patients were relatedand none of their examined family members had exposed on funduscopic examination.ONHD are rare in blackspossibly due to the presence of a larger cup-to-disc ratio or a lack of predisposing genetic factors. Visual field defects are common in black patients with both exposed and buried |
Endoscopic orbital decompression. Exophthalmos from Graves' disease can result in visual disability and cosmetic deformity. Surgical treatment of this disorder is now possible through an intranasal endoscopic approach that allows removal of the medial orbital wall and floor without an external incision. Endoscopic orbital decompression was performed on 22 orbits in 14 patients for treatment of progressive exophthalmos. Local anesthesia was used in five cases. Sixteen procedures involved a concurrent lateral orbital decompression performed through an external approach. There were no intraoperative or postoperative complications. Visual acuity remained stable or improved in all cases. Proptosis was reduced an average of 3.2 +- 1.1 mm (range 2 to 4.5 mm) by endoscopic decompression alone. When a lateral decompression was also performedproptosis was reduced by an additional 2.4 mmfor an average improvement of 5.6 +- 1.7 mm (range 2 to 8 mm). Endoscopic orbital decompression appears to be a safe technique for the treatment of exophthalmos that can be performed effectively with the patient under general or local anesthesia. |
Dissociated vertical deviation. Treatment with the faden operation of Cuüppers. Thirty-four patients (49 eyes) who had dissociated vertical deviation were treated with faden operation of Cüppers. The median follow-up period was 14 months. The operation produced good results in 23 of the patientssome improvement in sevenand did not help four. The posterior fixation suture was placed 14 mm behind the superior rectus muscle insertion and the superior rectus muscle was recessed. |
Angiotensin-Receptor-Associated Protein Modulates Ca2+ Signals in Photoreceptor and Mossy Fiber cells. Fastprecise and sustained neurotransmission requires graded Ca2+ signals at the presynaptic terminal. Neurotransmitter release depends on a complex interplay of Ca2+ fluxes and Ca2+ buffering in the presynaptic terminal that is not fully understood. Herewe show that the angiotensin-receptor-associated protein localizes to synaptic terminals throughout the central nervous system. In the retinal photoreceptor synapse and the cerebellar mossy fiber-granule cell synapsewe find that is involved in the generation of depolarization-evoked synaptic Ca2+ transients. Compared to wild typeCa2+ imaging in acutely isolated preparations of the retina and the cerebellum from knockout mice reveals a significant reduction of the sarcoendoplasmic reticulum Ca2+-ATPase activity. Thusin addition to its conventional role in angiotensin signalingATRAP also modulates presynaptic Ca2+ signaling within the central nervous system. |
after retinal detachment surgery. may be considered for treatment of myopia in eyes that have had previous surgery for retinal detachment. Howeverthe risk of regression may be higher in such eyes than in eyes with no previous scleral buckling surgery.To comparein the same individualsthe safety and efficacy of laser in situ keratomileusis in eyes with and without previous retinal detachment surgery.In a prospective clinical trialseven myopic patients who had previously undergone scleral buckling surgery in one eye underwent conventional surgery in both eyes. Uncorrected visual acuity (UCVA)best corrected visual acuity (BCVA)refractionOrbscan topography and pachymetry were recorded before and 136 and 12 months after surgery. The eyes were divided into two groups: group 1 consisted of eyes that had undergone previous surgery for retinal detachmentand group 2 consisted of the fellow eyes of the same patientswhich had not undergone any previous ocular surgery. Student's t-test for match-paired data was used to evaluate the significance of differences.LASIK was performed successfully in all patients. The improved in all eyes in both groups. The mean change in the spherical equivalent between 1 and 12 months after surgery was 1.7 +- 1.1 and 0.6 +- 0.5 diopter in groups 1 and 2respectively (p = 0.019). |
Intraocular pressure and superior ophthalmic vein blood flow velocity in Graves' orbitopathy: relation with the clinical features. In all patientsa full ophthalmic examination including and Hertel measurements was performed. was analyzed with color Doppler sonography.The Hertel valueIOP in primary and upgaze position were higherand was lower in moderate and severe Graves' orbitopathy cases that showed statistical significance from mild casesand controls (p = 0.001). Additionallystatistically significant positive correlation was detected between Hertel values and SOV-BFV(r = 0.402,p = 0.007).There was a statistical difference between type 1 and 2 cases in Hertel values(p = in upgaze position (p = 0.026) and (p = 0.003). of the eyes showing dysthyroid optic neuropathy was statistically lower than eyes without dysthyroid optic neuropathy (p = and have significant association with the clinical features of Graves' orbitopathy. The decrease in increases the severity of Graves' orbitopathyand may have a role in the clinical course of dysthyroid optic neuropathy. |
Membrane properties of excitatory and inhibitory neurons in the rat prepositus hypoglossi nucleus. The prepositus hypoglossi nucleus is thought to be a neural structure involved in transforming eye or head velocity signals into eye position signals for horizontal eye movements. Three types of voltage response propertiesnamely afterhyperpolarization (AHP)firing patternand response to hyperpolarizing current pulseswere characterized in each neuron. Following analysiswe identified neurons as either glutamatergic (n = 22) or GABAergic (n = 43)although a small number of cholinergic (n = 2) and glycinergic neurons (n = 1) were also identified. Both glutamatergic and GABAergic neurons showed a wide variety of membrane properties; howeverwe found several characteristic relationships between neuronal type and membrane properties. Most neurons exhibiting (i) without a slow component(ii) a firing pattern with a delay in the generation of the first spike(iii) a firing pattern with a transient burst and (iv) a firing pattern with a prolonged initial interspike interval were GABAergic. On the other handglutamatergic neurons were primarily characterized by a low firing rate. These results indicate that there is a close relationship between specific electrophysiological membrane properties and expression of chemical markers in some types of glutamatergic and GABAergic neurons. |
For epithelial and subepithelial rejections, which have a higher rate of reversibility, topical corticosteroids can be used six times per day, with a tapered dosing over 6-8 weeks. In contrast, severe endothelial rejection requires topical corticosteroids prescribed hourly (prednisolone acetate 1% q1h or difluprednate 0.05% q2h) in combination with systemic therapy; either 40 to 80mg of oral prednisone daily or a single-pulse or three-pulse intravenous dose of 500mg of methylprednisolone with or without subconjunctival betamethasone 3mg in 0.5mL. Topical tacrolimus can also be considered.Given the high side effect profile of prolonged corticosteroid use including, cataract formation, glaucoma, impaired wound healing, and immunosuppression, alternative therapeutics are being investigated.Calcineurin inhibitors, including cyclosporine (CsA) and tacrolimus (FK-506), are viable options for patients in whom corticosteroids are contraindicated. Although the efficacy of cyclosporine A 0.5% is mixed; it may be substituted for topical corticosteroids to aid in the management of steroid response and post-keratoplasty glaucoma . However, there was a rejection rate of 12% (6 out of 52 eyes) of patients while on topical cyclosporine alone, five of which were reversed with the reintroduction of topical corticosteroids. Tacrolimus can be used topically or systemically. One study demonstrated that topical 0.03% tacrolimus was effective in preventing irreversible rejection in patients with high-risk corneal transplantation without increasing IOP. Systemic administration of oral tacrolimus (2–12mg daily) is also beneficial in preventing and treating graft rejection in high-risk patients, with a clear graft survival rate of 65%.Corneal neovascularization is a strong determinant of graft survival and poses a challenge to reinstating ocular immune privilege after surgery. Fasciani et al demonstrated promising results of using anti-VEGF agents as a preconditioning treatment in patients affected by high immune risk and corneal neovascularization. Compared to controls that directly underwent penetrating keratoplasty, patients who underwent three subconjunctival intrastromal injections of 5mg in 0.2ml bevacizumab experience no episodes of corneal graft rejection at a mean follow up of 26 months. In contrast six of thirteen eyes (46%) in the control group showed evidence of graft rejection at a mean follow up of 3.8 months. |
Examining First Night Effect on Sleep Parameters with hd-EEG in Healthy Individuals. Difficulty sleeping in a novel environment is a common phenomenon that is often described as the first night effect Previous works have found on sleep architecture and sleep power spectra parametersespecially during non-rapid eye movement sleep. Howeverthe impact of on sleep parametersincluding local differences in electroencephalographic activity across nightshas not been systematically assessed. Herewe performed high-density sleep recordings on 27 healthy individuals on two nights and examined differences in sleep architectureNREM (stages 2 and 3) power spectraand power topography across nights. We found higher wakefulness after sleep onset (WASO)reduced sleep efficiencyand less deep sleep (stage 3)along with increased high-frequency power during the first night of sleepcorresponding to small to medium effect sizes (Cohen's d ≤ 0.5). Altogetherthese findings suggest the is characterized by less efficientmore fragmentedshallower sleep that tends to affect especially certain brain regions. The magnitude and specificity of these effects should be considered when designing sleep studies aiming to compare across night effects. |
Retinal arterioles narrow with increasing duration of anti-retroviral therapy in infection: a novel estimator of vascular risk in infection is associated with an increased risk of age-related morbidity mediated by immune dysfunctionatherosclerosis and inflammation. Changes in retinal vessel calibre may reflect cumulative structural damage arising from these mechanisms. Retinal vessel calibre was measured using computer-assisted techniques to determine mean arteriolar and venular diameters of each eye.The median age was 40 years 35-48 years). Among HIV-infected adults87.1% were receiving highly active antiretroviral therapy (median duration58 months)their median count was 468 cellsµLand 84.3% had undetectable plasma viral load. Unadjusted mean retinal arteriolar diameters were 163.67±17.69 µm in cases and 161.34±17.38 µm in controls (p = 0.15). Unadjusted mean venular diameters were 267.77±18.21 µm in cases and 270.81±18.98 µm in controls (p = 0.07). Age modified the effect of retinal arteriolar and venular diameters in relation to statuswith a tendency towards narrower retinal diameters in cases but not in controls. Among casesretinal arteriolar diameters narrowed with increasing duration of HAARTindependently of age (167.83 µm <3 years of vs. 158.89 µm >6 yearsp-trend = 0.02)and with a viral load >10,000 copiesmL while on (p = 0.05). HIV-related venular changes were not detected.Narrowing of retinal arteriolar diameters is associated with duration and viral loadand may reflect heightened inflammatory and pro-atherogenic states of the systemic vasculature. Measurement of retinal vascular calibre could be an innovative non-invasive method of estimating vascular risk in HIV-infected individuals. |
Induced astigmatism and its decay with a frown incision. Forty consecutive patients selected for cataract extraction by phacoemulsification were studied to evaluate prospectively the amount of and changes in surgically induced astigmatism from a 5 mm to 6 mm pocket incision with the external opening made convex against the limbus (frown incision). All incisions had an internal corneal valve and were closed by a single X-stitch to counteract the relaxing effect of the pocket in the 90-degree meridian. Surgically induced astigmatism calculated by simple subtraction was 0.64 +- 0.90 diopters < .0001) on the first postoperative day0.03 +- 0.58 = .75) six weeks after surgeryand -0.18 +- 0.44 = .01) six months after surgery. Calculated from polar equivalentsthe induced astigmatism on the first postoperative day was 0.98 +- 1.03 = .0001)after six weeks -0.11 +- 0.64 = .30)and after six months -0.28 +- 0.49 = .0009). On the first postoperative day 42% of eyes had less than 0.5 of induced astigmatism68% had less than 1.0 Dand 79% had less than 1.5 After six weeks the respective percentages increased to 61%97%and 97% and after six months to 84%100%and 100%. The distribution of patients with against-the-ruleobliqueand with-the-rule astigmatism preoperatively was nine20and 11respectivelyand 1119and nine after six months. The amount of astigmatism induced from the 5 mm to 6 mm frown incision did not differ from that found in previously published studies of smaller incisions (to about 4 mm). 250 |
[Applications of noninvasive high-resolution ultrasound imaging in ophthalmology]. While ultrasonography has been applied to eye examination since the beginning of medical applications of ultrasoundthe use of high frequencies is relatively recent in this context. Recent developments since the 1990s have made devices available that are well suited for examining the anterior segment as well as the posterior poleproviding precise data for corneal lesionsirischamber angleand ciliary body abnormalitiesand lesions of the papilla and macula. |
The retinal branch arteries are usually narrower and more shiny than the veins. This signifies significant hypertension or ageing and is a risk factor for retinal vein occlusion. Look also for sheathing, with a narrow cuff of silvery thickening along the edges of the vessels. This is prominent in disorders which have caused leak- age into the vessel wall at some time, and implies significant damage either from hypertension or previous branch vessel occlusion. Accelerated hypevtension is uncommon in the now that blood pressure is widely screened and treated, but remains a very important signal that blood pressure is dangerously high or that there may be an underlying renal disorder. The retinal features are its hallmark, so they are particularly important. Look for small flame-shaped haemor- rhages around the major vessel trunks and for fluffy pale cotton-wool spots scattered amongst them, especially between branches of vessels . If the optic nerve margin is blurred the need for treatment is even more urgent. The catch is that vision is often normal in these patients as the fovea is not usually affected and the retinopathy is not noticed unless carefully looked for, prefer- ably after pupil dilatation. As a rough guide, ac- celerated retinal changes are uncommon unless the diastolic pressure is consistently above 110mmHg and all patients with pressures above this level should have their fundi examined. Fig. Any patient with a retinal vas- cular disorder should have at least urinalysis, if not a formal blood sugar measurement. If diabetes is then suspected, test a fasting level. Cranial nerve palsies causing double vision may be asso- ciated with diabetes or hypertension. checking, particularly in younger patients with retinal artery or vein occlusion. Eye signs may be an important clue to the diagnosis. The same is true of xanthelasmas, the fatty deposits in the skin in or around the eyelids . Raised lipids may be found in patients with retinal vascular occlusions and are worth Haematological disorders The retinal vessels may be affected in blood condi- tions associated with hyperviscosity or with a bleeding tendency. The hyperclotting states Fig. Fig. Fig. Fig. Erythrocyte sedimentation rate was IlOmm. High red or white cell or platelet counts can cause retinal haemorrhages. Anaemia or a low platelet count make haemorrhages more likely. |
[Dosed physical exercise in the early detection of cor pulmonale in chronic bronchitis patients]. All indices in nonobstructive chronic bronchitis slightly changed as compared to controls. Most of the patients with bronchial obstruction at the peak of exercise demonstrated distinct signs of respiratory insufficiencyan increase in bronchial obstructionpulmonary hypertension and right ventricular hypertrophy. conclusion was made of the necessity of a wide use of bicycle ergometry in early diagnosis of cor pulmonale. In genesis of the latter the leading role was played by bronchial permeability disorder. |
Mutation survey of known genes and loci in the Saudi Arabian population. In additionfamilies without mutations identified were further screened with markers around these 13 known genes and two loci.Disease-causing mutations were identified in nine of the 37 families: five in TULP1two in CRB1one in RPE65and one in Mutations in known genes only accounted for 24% of the Saudi familiesmuch less than what has been observed in the European population . Phenotype-genotype analysis was carried out to investigate the disease penetrance for all families whose mutations identified. All identified mutations were found to segregate perfectly with the disease phenotype. On the other handseverity of the disease varies for different patients carrying the same mutation and even within the same family. Furthermoreperfect segregation between mutation and disease indicates that is fully penetrant. Howeverphenotypic variations among patients carrying the same mutation suggest that at least some of the variations in the clinical phenotype is due to modification from the genetic backgroundenvironmentor other factors. |
"One-and-a-half" syndrome after a resection of a midline cerebellar astrocytoma: case report and discussion of the literature. This report describes a rare complication after the resection of a tumor of the posterior fossathe "one-and-a-half" syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headachesdiplopiaand blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancingmixed densitymidline mass of the cerebellum. After a resection of the massan anaplastic astrocytomathe patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndromeleft peripheral facial paralysisdysarthriadysphagiamild left hemiparesisdysmetria of the left upper limband truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-upthe one-and-a-half syndrome had not improvedeven though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculusthe ipsilateral paramedian pontine reticular formationor the ipsilateral abducens nucleus. Multiple sclerosis and brain stem infarction are the most common causes of the one-and-a-half syndrome. Less frequentlyit is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarelythe one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown. |
Numerical models for the simulation of flexible artificial heart valves: part Icomputational methods. numerical model of the coupled motion of a flexing surface in a high Reynolds number flow is presented for the simulation of flexible polyurethane heart valves in the aortic position. This is achieved by matching a Lagrangian dynamic leaflet model with a panel method based flow solver. The two models are coupled via the time-dependent pressure field using the unsteady Bernoulli equation. Incorporation of sub-cycling in the dynamic model equations and fast pre conditioning techniques in the panel method solver yields efficient convergence and near real-time simulations of valve motion. The generality of dynamic model allows different material properties andor geometries to be studied easily and interactively. This interactivity is realized by embedding the models within a design environment created using the software Explorer. Two flow domains are developedan infinite domain and an internal domain using conformal mapping theory. In addition bending stress on the valve is computed using a simple stress model based on spline and circle equation techniques. |
Efficacy of inferior oblique belly transposition combined with inferior oblique recession for asymmetric inferior oblique overaction. To evaluate the efficacy of inferior oblique belly transposition combined with inferior oblique recession in treating bilateral asymmetric inferior oblique overaction retrospective review. The data of 14 patients who underwent on the mild side of and recession on the severe side for bilateral asymmetric were analyzed retrospectively. The main surgical results including the correction of IOOAhypertropiahorizontal deviationV patternand fovea-disc angle were observed.The corrected the preoperative grade of the mild-side to a postoperative grade (+0.07 ± 0.27; p < 0.001)and the severe-side was corrected from a grade of +3.14 ± 0.53 to a postoperative grade of +0.14 ± 0.36 by the recession (p < 0.001). The vertical deviation at distance in the primary position was decreased from 8.43 ± 4.05 preoperatively to 1.21 ± 1.48 postoperatively (p < 0.001). The mean pattern was 25.00 ± 11.62 preoperatively and 3.18 ± 2.18 postoperatively (p < 0.001). The mean preoperative on the side where was performed was -10.47 ± 5.85 degreesand the postoperative was -7.82 ± 6.42 degrees (p = 0.023). The mean on the side with recession was -11.05 ± 5.14 degrees before surgery and -6.09 ± 4.52 degrees after surgery (p = 0.001). The overall success rate was 71.4% (10 of combined with recession is effective and safe in eliminating hypertropiaV patternand extorsion with bilateral asymmetric |
[Intraocular antibiotic administration for prevention of fibrin reaction after extracapsular cataract extraction? Postoperative fibrinoid reactions are regarded as a localized form of endophthalmitis caused by microbial contamination of the capsular bag during intraocular lens implantation. The incidence of early fibrinoid reactions within the first 6 postoperative days following extracapsular cataract extraction was examined after intraocular administration of antibiotics vs placebo. In a double-blind randomized trial2 mg cefamandol or a placebo was administered in a 0.4-ml volume at the end of the operation. group of 28 patients received the antibiotic (mean age 74.6 years; 15 f13 m)while 33 patients received the placebo (mean age 72,1 years; 21 f12 m). Fibrinoid reactions were observed in 8 out of 61 patients during the first 6 postoperative days. There was no significant difference between the antibiotic group and the placebo group = 0.31). We were unable to reduce the incidence of fibrinoid reactions although we had selected a broad-spectrum cephalosporin for antibiotic treatment. The results give rise to the suspicion that most of the early postoperative fibrinoid reactions we observed were not caused by contamination with bacteria of low pathogenicity. |
Ursodeoxycholic acid suppresses the formation of fructosestreptozotocin-induced diabetic cataract in rats. The diabetic model was induced through the administration of 10% fructose in drinking water for 2 weeks followed by streptozotocin injection (intraperitoneal). One week laterhyperglycemia was assisted and diabetic animals were treated with either as local eye drops (0.5% solutionfour timesday) or orally (100 mgkg b.w.). Cataract formation was monitored biweekly and scored into four stages. After 12 weeks of treatmentrats were subjected to ophthalmological examinationand thentheir blood and lenses were prepared for biochemical analysis of glucoseinsulinreduced glutathionetotal antioxidant capacitymalondialdehydehydrogen peroxidecaspase-12and lenticular total proteins. In additiontertiary structure and conformational changes of lenticular soluble proteins were analyzed using and absorption while changes in lenticular α-crystallin structure were investigated using intrinsic tryptophan fluorescence. Results demonstrated that both local and oral restored the normal levels of lens and caspase-12 and improved noticeably the levels of the lens and total proteins. In additionconformational and tertiary structure changes of soluble lens proteins were significantly reduced in UDCA-treated groups. Morphological examination of lenses revealed decreased score of cataract progression in UDCA-treated groups compared to animals. It was concluded that decreased the incidence of diabetic cataract by maintaining the antioxidant statusreducing the endoplasmic reticulum stressand suppressing the structural changes of soluble lens proteins. |
Gross anatomy of the brachial plexus sheath in human cadavers. Major nerves and vessels run alongside each other in a "neurovascular bundle" kept together by connective tissue that is often referred to by anatomistssurgeonsand anesthesiologists as the "sheath." Our goal was to macroscopically demonstrate the brachial plexus sheath in embalmed and fresh cadaver dissections.Systematic dissections were performed on 11 embalmed cadavers (6 females and 5 males)plus one freshunembalmed male cadaver. Dissections were started in the armand progressed proximally to the axilla and the supraclavicular area. Notes and photographic documentation were obtained.A sheath around the neurovascular bundle of the brachial plexus was visible to the naked eye in every dissection. The sheath had a fibrous external appearanceand was filled with loose connective tissue. No evidence of septa was found.We observed a macroscopic fibrous structure surrounding the plexuswhich was filled with loose connective tissue lacking any apparent organization. |
Successful retinal blood flow augmentation after extracranial-intracranial bypass. 61-year-old woman visited us with recent onset right-side weakness. Magnetic resonance imaging showed ischemic changes at the left internal border zone due to occlusive disease affecting the left proximal internal carotid artery. Prompt oral dual antiplatelet therapy and intravenous fluid were administered with subsequent induced hypertension and without reperfusion therapy. Although the hemiparesis was improvedshe complained of a new-onset transient left-side monocular visual loss. Fluorescein angiography confirmed delayed perfusion in the left eye. We performed extracranial-intracranial bypass for flow augmentation. After bypassthe amaurosis fugax resolved. Follow-up retinal fluorescein angiography also showed improved retinal perfusion. |
Radiation therapy for macular degeneration: technical considerations and preliminary results. The premise of the treatment is that radiation induces regression andor promotes inactivation of the subretinal neo-vasculatureresulting in reabsorption of fluid and blood thus reducing the risk for further leakage or bleedingas well as subretinal fibrosis. Clinicallythe beneficial effect could be translated into stabilization of visual acuity and prevention of progression of the wet type of with the possibility for some visual improvement.Allegheny University HospitalsHahnemannDepartment of Radiation Oncologytreated 278 patients prospectively beginning in January 1995 with low-dose irradiation for wet-type macular degeneration. Two hundred forty-nine patients were treated with a total dose of 14.40 Gy in eight fractions of 1.80 Gy over 10-13 elapsed daysand 27 patients with 20 Gy at 2 Gy per fraction over 12-15 days. The first two patients were treated to a total dose of 10.00 Gy in five fractions of 2.00 Gy. Patients were evaluated at 2-3 weeks and 2-3 months. Subjective visual acuity and toxicity data was collected on all patients.At 2-3 weeks after treatment 195 patients retained their visual acuity without change68 patients stated they had improved visionand 15 patients stated their vision continued to decrease. Two to 3 months after treatment183 patients had no change in their vision75 patients had an improvement in their visionand 20 patients had a decrease in visual acuity. Transient acute reactions occurred in 14 of the 278 patients treated. |
Quantitative Oculomotor Assessment in Hereditary Ataxia: Systematic Review and Consensus by the Ataxia Global Initiative Working Group on Digital-motor Biomarkers. Oculomotor deficits are common in hereditary ataxiabut disproportionally neglected in clinical ataxia scales and as outcome measures for interventional trials. Quantitative assessment of oculomotor function has become increasingly available and thus applicable in multicenter trials and offers the opportunity to capture severity and progression of oculomotor impairment in a sensitive and reliable manner. One-hundred-and-seventeen articles reporting on subjects with genetically confirmed (n=1134) or suspected hereditary ataxia (n=198)and degenerative ataxias with sporadic presentation (n=480) were included and subject to data extraction. Based on robust discrimination from controlscorrelation with disease-severitysensitivity to changeand feasibility in international multicenter settings as prerequisite for clinical trialswe prioritize a core-set of five eye-movement types: (i) pursuit eye movements(ii) saccadic eye movements(iii) fixation(iv) eccentric gaze holdingand (v) rotational vestibulo-ocular reflex. We provide detailed guidelines for their acquisitionand recommendations on the quantitative parameters to extract. Standardization of quantitative oculomotor assessments will facilitate their implementationinterpretationand validation in clinical trialsand ultimately advance our understanding of the evolution of oculomotor network dysfunction in hereditary ataxias. |
Benzalkonium chloride induces subconjunctival fibrosis through the COX-2-modulated activation of a TGF-β1Smad3 signaling pathway. The purpose is to investigate the mechanism of subconjunctival fibrosis caused by benzalkonium chloride (BAC)which is the most common preservative in ophthalmic preparations.The left eyes of male Sprague-Dawley rats were topically treated with 0.01% or twice daily for 1 month. Primary conjunctival fibroblasts (CFs) were exposed for 24 hours to 0.00005% + (a selective transforming growth factor β receptor type inhibitor); 0.000075% + (a selective cyclooxygenase-2 inhibitor) and PBSrespectively. The pathological changes of the bulbar conjunctival tissue of rats were examined using hematoxylin-eosin (HE)Van Gieson's (vG)periodic acid-Schiff stainsor immunohistochemisty The expression of the extracellular matrix (ECM)the transforming growth factor β (TGF-β) signaling pathway-related moleculesand cyclooxygenase-2 in bulbar conjunctival tissues and CFs were detected using Western blot and quantitative real-time (qRT-PCR).Rats treated with 0.01% exhibited a slight increase of the fibroblast density and a more compact collagen deposition in the bulbar subepithelial connective tissues in comparison with rats treated with Western blot and qRT-PCR analyses showed that the expression of ECMTGF-β signaling pathway-related moleculesand were markedly increased in the bulbar conjunctival tissues of rats exposed to 0.01% and in CFs exposed to 0.00005% and 0.000075% In conjunctival fibroblastsBAC-induced expression was clearly decreased by LY2157299while the BAC-induced activation of the TGF-β1Smad3 signaling pathway was greatly attenuated by NS-398.Subconjunctival fibrosis BAC-induced is a consequence of excessive production of CFs through the COX-2-modulated activation of a TGF-β1Smad3 signaling pathway. |
Color vision: Parsing spectral information for opponent color vision in the fish retina. Environmental light carries spectral informationperceived as color. |
Association of Scleral Deformation Around the Optic Nerve Head With Central Visual Function in Normal-Tension Glaucoma and Myopia. Swedish interactive thresholding algorithm 24-2 and 10-2 were both performed to compare the central with peripheral Optic disc torsiontiltand peripapillary atrophy area were calculated in 2-dimensional disc photographs. The most posterior point-that isthe deepest point of the eye (DPE)-was identified in 3-dimensional en face optical coherence tomography results and related measurements were calculated using built-in software.Forty-two eyes had worse 10-2 mean deviation than 24-2 and they were assigned to the central dominant defect group. The central dominant defect group had larger disc torsion and tilt angle and shallower disc-DPE depth than the peripheral dominant defect group. According to logistic regression analysislarge tilt angle and shallow disc-DPE depth were significant factors associated with central visual function impairment.Subjects with worse central than peripheral showed greater peripapillary scleral deformationsuch as in torsion and tilt. Their posterior scleral deformation appeared to be closer to the Scleral deformation around the may be associated with papillomacular bundle and central defects. |
Multiple xanthogranulomas in an adult. Xanthogranulomas develop in adults as well as in children; howeveradult cases with multiple lesions are very rare. We report an adult who developed both multiple cutaneous lesions on the face and trunk and lesions on the conjunctivaoral mucosa and genitalia. We believe that this is the first such case described. |
Neutral amino acid uptake by the isolated perfused sheep choroid plexus. 1. The uptake of neutral amino acids from the blood into the cells of the choroid plexus was studied by means of the rapid (less than 40 s) single-circulation paired-tracer dilution technique in the isolated perfused choroid plexus of the sheep. 2. 3. In the terms of Christensen's classification the presence of L-amino acid carrier systems for large neutral amino acids with bulky side chains has been demonstrated. 4. No measurable uptake of methyl amino isobutyric acid (MeAIB) during a single passage through the choroid plexus circulation was demonstrated which indicates the probable absence of a significant transport system. 5. The uptake of small neutral amino acids such as glycine and L-alanine was shown to be carrier-mediated. Results suggest that these amino acids are mainly transported by the glycine and carrier systemsrespectively. 6. The results suggest that there is a similarity between the transport systems for neutral amino acids on the blood side of both the blood-brain barrier and blood-cerebrospinal fluid barrierthe exception being for the presence of a glycine carrier on the blood side of the choroid plexus. |
Long-term effect of acetazolamide in a patient with retinitis pigmentosa. The authors studied the therapeutic effect of acetazolamide on a patient with autosomal dominant retinitis pigmentosa complicated by retinal edema. In addition to reduction of macular edema and some improvement of central visionthey found an unexpected progressive increase in extrafoveal retinal sensitivity with prolonged medication. It is proposed that the therapeutic effect is mediated by alteration of retinal pigment epithelial function and that disturbed polarity is restored to a more normal state. |
New evidence on the mechanisms underlying bradykinin-mediated contraction of the pig iris sphincter in vitro. We have reported previously that bradykinin induces potent and reproducible concentration-dependent contractions of the pig iris sphincter muscle in vitro through the activation of receptors. Here we attempted to investigate additional mechanisms by which induces contraction of the in vitro. BK-mediated contraction of the relied largely on the external Ca2+ influx by a mechanism sensitive to the and P-type of Ca2+ channel selective blockers. LikewiseBK-induced contraction of the was greatly inhibited by the or receptor antagonists 142801)and to a lesser extent by the antagonist 888). Capsaicin desensitization of or capsazepine pre-incubation also significantly reduced BK-mediated contraction in the FurthermoreKT 5720 or (the protein kinase and inhibitorsrespectively) also significantly inhibited BK-mediated contraction. Taken togetherthese results indicate that BK-mediated contraction of the seems to be mediated primarily by the release of and tachykinins from sensory nerve fibersand relies largely on extracellular Ca2+ influx via activation of and P-type of Ca2+ channels. Finallythese responses are mediated by activation of both protein kinase and C-dependent mechanisms. |
The measurement of bulbar hyperemia: challenges and pitfalls. To review methods of assessing bulbar rednessparticularly with respect to the practicality of comparing different rating systems.The published literature was reviewed and discussed by a panel of experts and a narrative review prepared.Bulbar hyperemia is a common clinical sign and an important indicator of ocular disease. As bulbar hyperemia is a frequent side effect of topical glaucoma medicationsaccurate objective measurement is important to allow comparison of clinical studies. The scales are subject to an intrinsic subjectivity and are suboptimal in differentiating the physiologic phenomenon of bulbar hyperemia. There is also a degree of interobserver and intraobserver variation; in some studiesaverage variation in scores exceed half the extent of the whole scale. Moreovera lack of interscale validation has led to confusion in comparing the results from clinical studies that use different scales. In a recent series of studiescross-calibration between the various scales in use has been attempted.Whereas naive comparisons between the results obtained in studies using different bulbar redness scales can lead to erroneous conclusionsthe tools exist to permit meaningful comparisons between rating systems and scales. |
Coats' disease in Tanzania: first case report and literature review. Coats' disease is an important differential diagnosis of retinoblastoma. Delay to detect Coats' disease leads to vision loss which necessitates eye enucleation as was in this child.Coats' disease is an exudative retinal detachment with vascular telangiectasis occurring mostly in male childrenthe age group most affected by retinoblastoma.Compare the differential diagnoses of Coats' disease Establish recommendation to early disease detection.A 3-year-old female child was referred to Muhimbili National Hospital (MNH)Tanzaniain September 2011. She had presented at the peripheral hospital with gradual onset of left eye leukocoria for 1 year and pain for 2 months. B-scan showed a mass in the left eye. clinical diagnosis of retinoblastoma was made. Left eye enucleation was performed; the patient was referred to MNHwith the enucleated specimen.Brain and orbits scan revealed no residual tumour. The globe measured 2 x 1.8 cmthe optic nerve stump measured 3 mm. whitish mass filled the vitreouswith complete retinal detachment. Microscopy showed retinal gliosisdetachment with sub retinal positive exudatesvacuolation and cholesterol clefts. Foreign body giant cells were present; telangiectatic thin-walled blood vessels were identified. Clinico-pathological findings were of stage 4 Coats' disease. |
Sunscreen usewearing clothesand number of nevi in 6- to 7-year-old European children. Previous epidemiologic studies have suggested that sunscreen use is associated with an increased risk of melanoma skin cancer. Independentlyparents were interviewed regarding sun exposuresunscreen useand physical sun protection of their child.After adjustment for sun exposure and host characteristics (e.g.skin phototypeeye color)the relative risk for high nevus count on the trunk was 1.68 (95% confidence interval = 1.09-2.59) for the highest level of sunscreen use and 0.59 (95% = 0.36-0.97) for the highest level of wearing of clothes while in the sun. The sun protection factor had no effect on nevus counts despite a high median value of 17.4. Sunburn number was not associated with nevus count. The highest risk associated with sunscreen use was found among children who had never experienced sunburn.In whiteEuropean childrensunscreen use appears to be associated with development of neviprobably because it allows longer sun exposures. Wearing clothes may be an effective way to prevent proliferation of nevi. Since a high nevus count is a strong predictor of melanomasunscreen use may be involved in melanoma occurrence because it may encourage recreational sun exposure. |
Consequences of a Rare Complement Factor Variant for Age-Related Macular Degeneration in the Amish. Genetic variants in the complement factor gene have been consistently implicated in age-related macular degeneration risk. Howevertheir functional effects are not fully characterized. We previously identified a rareAMD-associated variant in (P503Ars570523689) in 19 Amish individualsbut its functional consequences were not investigated.We performed genotyping for in 1326 Amish individuals to identify additional risk allele carriers. We examined differences for age at diagnosis between carriers and noncarriers. In blood samples from risk allele carriers and noncarrierswe quantified (i) expression(ii) protein expressionand (iii) C-reactive protein expression. Potential changes to the protein structure were interrogated computationally with Phyre2 and Chimera software programs.We identified 39 additional carriers from Amish communities in Ohio and Indiana. On averagecarriers were younger than noncarriers at diagnosisbut this difference was not significant. transcript and protein levels in blood samples from Amish carriers and noncarriers were also not significantly different. levels were also comparable in plasma samples from carriers and noncarriers. Computational protein modeling showed slight changes in the protein conformation that were predicted to alter interactions between the 503 residue and other neighboring residues.In totalwe have identified 58 risk allele carriers for in the Ohio and Indiana Amish. Although we did not detect significant differences in age at diagnosis or expression levels of in blood samples from carriers and noncarrierswe observed modest structural changes to the protein through in silico modeling. |
The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and ophthalmologists. The new laweffective April 11987 redefines the conditions of optometric participation and expanded coverage to include all Medicare covered services for which optometrists are authorized to perform under the state law. Payments to optometrists increased from $12 million in 1986a year before the Medicare Amendment to $81 million in 1988the first full year after the law's implementation increasing their market share of Medicare payments from 2.6% to 11.1%. Ophthalmology incurred a significant decrease in market share from 97.9% to 88.9% during this period. |
Decreased fibronectin levels in aqueous humor after corneal injury. Fibronectin plays an important role in wound healing and cell differentiation. In response to transcorneal freezing treatmentsa thickened scar-like matrix is deposited on the posterior surface of rabbit corneas. This posterior collagenous layer is visible grossly and has a uniform diameter. Aqueous humor from eyes with established posterior corneal scarring has significantly less fibronectin compared with control eye aqueous humor. Tissue culture experiments show that corneal endothelial cells from control eyes and PCL-associated cells from injured eyes produce similar amounts of fibronectin. The marked decline in fibronectin levels in aqueous humor in scarred corneas supports the hypothesis that fibronectin plays a role in the pathological events which result from corneal injury. |
[Is the animal in hibernal sleep awake?]. It has been recognized for a long time that hibernation and slow wave sleep are homologous processes for energy conservation. Numerous studies have demonstrated that during entrance into hibernation rapid eye movement sleep disappeared under cerebral temperature below 25 degrees and that in deep hibernationanimals were preferentially in sleep. Hibernation was thought to be an extension of sleep. Neverthelessother observations suggest that hibernation is not an homogeneous state. For examplein deep hibernation the activity of single thalamic units occurs with periods of activation and decline. High unit activity is associated with high electromyographic activitywhereas low unit activity is associated with low activity. To test the hypothesis that sleep would have a restorative functionthe activity delta power) was recorded during an arousal from hibernation and the following euthermic bout. Contrary to expectationsEEG was maximal after an arousal and declined during the euthermic period. These findings suggest that a bout of hibernation is not sleepbut would be the equivalent of a sleep debt. |
induces diabetic retinal inflammation by activating Profilin-1. Diabetic retinopathy (DR)the most common cause of irreversible blindness in working-age adultsresults in central vision loss that is caused by microvascular damage to the inner lining of the back of the eyethe retina. The aim of this work was to assess the temporal relationships between angiopoietin-like protein-4 (ANGPTL-4)a novel adipocytokine factorand diabetic retinal inflammation and microvascular dysfunction. The downstream pathway(s) and upstream mediator(s) of were then determined under high glucose conditions. Diabetic rats and control animals were randomly assigned to receive hypoxia inducible factor-1 alpha (HIF-1α) blockade (doxorubicin or shRNA) or vehicle for 8 weeks. Human retinal microvascular endothelial cells (HRMECs) were incubated with normal or high glucosewith or without blockade or recombinant proteinsfor ANGPTL-4HIF-1αand vascular endothelial growth factor The levels of ANGPTL-4profilin-1HIF-1αVEGFinterleukin 1 beta (IL-1β)IL-6and intercellular adherent molecule 1 in the rat retinas and extracts were examined by Western blotting and real-time The levels of ANGPTL-4profilin-1HIF-1αand protein and mRNA were significantly higher in the diabetic rats and HG-exposed HRMECs. was a potent modulator of increased inflammationpermeabilityand angiogenesis via activation of the profilin-1 signaling pathway. Our results showed that upregulation was induced by HGwhich was dependent on HIF-1α activation that was also triggered by HGboth in vivo and in vitro. Our results suggest that targeting ANGPTL-4alone or in combination with profilin-1may be an effective therapeutic strategy and diagnostic screening biomarker for proliferative diabetic retinopathy and other vitreous-retinal inflammatory diseases. |
Binding properties of bovine ocular lens zeta-crystallin to right-handed B-DNAleft-handed Z-DNAand single-stranded Bovine zeta-crystallin has the ability to bind with different DNAs. Initiallythis protein was named regulatory factor 36 (Kang et al.1985)but it has been shown to be an ocular lens zeta-crystallin (Jörnvall et al.1993)which is considered an enzyme-crystallin (Rodakanaki et al.1989). The enzyme-linked immunosorbent assay was used to quantitate the binding of bovine zeta-crystallin to purified high molecular weight double-stranded (ds-) and single-stranded (ss-) (bovine and synthetic quantitation was achieved by the addition of anti-zeta-crystallin antibodies to the DNA-zeta-crystallin complexusing a novel immunochemical avidin-biotin method. Zeta-crystallin shows much greater binding intensity for ss-DNA and for ds-Z-DNA than for ds-B-DNA. It also reacts slightly more with ds-Z-DNA than ss-DNA. Thereforewe speculate that zeta-crystallin may act as a transcriptional enhancer (outer lens cortex)possibly binding to regulatory elements within lens crystallin genes. It may also act to protect from endogenous DNase activity and as a unwinding (destabilizing) protein also involved with transcriptionoccurring in normal adult bovine lens nucleated secondary fiber cells. |
Assessment of Meibomian Gland Impairment Among Seasonal Allergic Conjunctivitis Patients. Allergic conjunctivitisone of the frequently occurring ocular surface diseasescan cause mucus dischargeitchy sensationconjunctival hyperemiaand papillary formation. Seasonal allergic conjunctivitis is associated with xerophthalmia and instability of tear film. Meibomian gland can secrete lipids to avoid xerophthalmia. Howeverthere have been few reports on morphological alterations of patients. The symptoms were assessed by ocular surface disease index questionnaire. Thenthe tests shown below were carried outincluding tear evaporation rate from the ocular surface (TEROS)slit-lamp examinationbreak-up time of tear filmSchirmer test Ivital stainingmeibographyand meibum expression grading. was examined with laser scanning confocal microscopy Relative to the control groupthe was significantly higher in the group. valuesBUTvital stainingMG expressionMG distortion ratesand dropout grades were significantly worse in the group compared with the control group. As suggested by patients had markedly worse averages of parameters compared with controls. The patients with have more significant morphological and cytological changes in the The Keratograph system and are effective methods for evaluating status and ocular surface diseases. |
Molecular cloning and characterization of human keratan sulfate Gal-6-sulfotransferase. We have previously cloned chondroitin 6-sulfotransferase cDNA from chick embryo chondrocytes. catalyzes sulfation of chondroitinkeratan sulfateand sialyl N-acetyllactosamine oligosaccharides. This new sulfotransferase cDNA clone was obtained from a human fetal brain library by cross-hybridization with chick cDNA. The cDNA clone obtained contains a single open reading frame that predicts a type transmembrane protein composed of 411 amino acid residues. When the cDNA was introduced into a eukaryotic expression vector and transfected in cellskeratan sulfate sulfotransferase activity was overexpressedbut activity was not increased over that of the control. Structural analysis of 35S-labeled glycosaminoglycanwhich was formed from keratan sulfate by the reaction with 35S-labeled 3'-phosphoadenosine 5'-phosphosulfate and the recombinant sulfotransferaseshowed that keratan sulfate was sulfated at position 6 of Gal residues. On the basis of the acceptor substrate specificitywe propose keratan sulfate Gal-6-sulfotransferase (KSGal6ST) for the name of the newly cloned sulfotransferase. KSGal6ST was assigned to chromosome 11p11. 1-11.2 by fluorescence in situ hybridization. Among various human adult tissuesa 2.8-kilobase message of KSGal6ST was expressed mainly in the brain. When poly(A)+ RNAs from the chick embryo cornea and brain were probed with the human KSGal6ST cDNA in Northern hybridizationa clear band with about 2.8 kilobases was detected. These observations suggest that KSGal6ST may participate in the biosynthesis of keratan sulfate in the brain and cornea. |
Retinal projections in the house musk shrewSuncus murinusas determined by anterograde transport of Retinal projections in the house musk shrew (Suncus murinus) were determined by the anterograde transport of wheat germ agglutinin conjugated to horseradish peroxidase Unilateral injection of into the vitreous body resulted in the terminal labeling of the optic projections in the suprachiasmatic nucleus (SCH)the ventral (CGLv) and dorsal (CGLd) lateral geniculate nucleithe intergeniculate leaflet (IGL)the pretectumthe superficial layers of the superior colliculus (CS)and the dorsal terminal nucleus of the accessory optic system Labeling of the was bilateralwith ipsilateral predominanceand covered the whole dorsoventral extent of the nucleus. Immunohistochemical studies revealed that VIP-like immunoreactive neurons and fibers were present in almost all parts of the No hypothalamic regions other than the received the optic fibers. The ipsilateral projections to the CGLvCGLdand were sparseand a considerable number of uncrossed retinal fibers were found in the pretectal olivary nucleus. No retinal projections to the lateral posterior thalamic nucleus were found. Ipsilateral optic fibers projected sparsely to the medial part of the The consisted of a small with a very few crossed retinal projections but no lateral and medial terminal nuclei. In additionthe had no inferior fascicle. |
Incidence of redetachment 6 months after scleral buckling surgery. Conventional surgery is a reliable procedure in a selected group of eyes with primary Howeverin eyes with a retinal tear with a cumulative size of more than three disc diametersa primary vitrectomy should be considered. Taking into account that 7% of eyes developed redetachment after 6 monthsa longer follow-up period seems necessary to evaluate the anatomical and visual outcomes after surgery.The preoperative and intraoperative clinical variables associated with redetachment andor a poor visual outcome following scleral buckling surgery for rhegmatogenous retinal detachment have mainly been studied after a short follow-up. Postoperative data were collected at 3-month intervals.After a mean follow-up period of 51 monthsanatomic reattachment was achieved in 76% after one procedurewith a final reattachment rate of 97% after additional vitreoretinal procedures. In total104 eyes developed redetachment during follow-up. After more than 6 and 12 months of follow-up32 eyes and 20 eyes respectivelydeveloped redetachment. Multivariate regression analysis showed that recurrent redetachment and more than 7 days of visual field loss were significant predictors for a poor postoperative visual outcome at 12 months. cumulative size of the tear of more than three disc diameters was a significant predictor of recurrent |
What does the phenol red thread test actually measure? It is probable that the measures uptake of a (small) amount of fluid residing in the eyestimulates a low degree of reflex tearingand reflects the absorption characteristics of the thread dependent on the biophysics or composition of tears. |
Optical coherence tomography of the human retina. Optical coherence tomography is a potentially useful technique for high depth resolutioncross-sectional examination of the fundus.To demonstrate optical coherence tomography for high-resolutionnoninvasive imaging of the human retina. |
Lacrimal Gland Epithelial Cells Shape Immune Responses through the Modulation of Inflammasomes and Lipid Metabolism. Lacrimal gland inflammation triggers dry eye disease through impaired tear secretion by the epithelium. As aberrant inflammasome activation occurs in autoimmune disorders including Sjögren's syndromewe analyzed the inflammasome pathway during acute and chronic inflammation and investigated its potential regulators. Bacterial infection was mimicked by the intraglandular injection of lipopolysaccharide and nigericinknown to activate the inflammasome. Acute injury of the lacrimal gland was induced by interleukin (IL)-1α injection. Chronic inflammation was studied using two Sjögren's syndrome models: diseased NOD.H2b compared to healthy BALBc mice and Thrombospondin-1-null compared to mice. Inflammasome activation was investigated by immunostaining using the R26ASC-citrine reporter mouseby Western blottingand by RNAseq. LPSNigericinIL-1α and chronic inflammation induced inflammasomes in lacrimal gland epithelial cells. Acute and chronic inflammation of the lacrimal gland upregulated multiple inflammasome sensorscaspases 14and interleukins Il1b and Il18. We also found increased IL-1β maturation in Sjögren's syndrome models compared with healthy control lacrimal glands. Using RNA-seq data of regenerating lacrimal glandswe found that lipogenic genes were upregulated during the resolution of inflammation following acute injury. In chronically inflamed NOD.H2b lacrimal glandsan altered lipid metabolism was associated with disease progression: genes for cholesterol metabolism were upregulatedwhile genes involved in mitochondrial metabolism and fatty acid synthesis were downregulatedincluding peroxisome proliferator-activated receptor alpha (PPARα)sterol regulatory element-binding 1 (SREBP-1)-dependent signaling. We conclude that epithelial cells can promote immune responses by forming inflammasomesand that sustained inflammasome activationtogether with an altered lipid metabolismare key players of Sjögren's syndrome-like pathogenesis in the NOD.H2b mouse lacrimal gland by promoting epithelial dysfunction and inflammation. |
Alcohol-induced lipid and morphological changes in chick retinal development. Alcohol exposure causes alterations in the lipid content of different organs and a reduction of long-chain fatty acids. During embryo developmentthe central nervous system is extremely vulnerable to the teratogenic effects of alcoholand the visual system is particularly sensitive.White Leghorn chick embryos were injected with 10- and 20-microl alcohol doses into the yolk sac at day 6 of incubation. The lipid composition of the retina was analyzed in embryos at day 7 of incubation (E7)E11E15and The percentages of phospholipidsfree cholesterolesterified cholesteroldiacylglyceridesand free fatty acids were estimated by using an Iatroscan thin layer chromatography flame ionization detector. Gas chromatography and mass spectrometry were used to determine fatty acid composition. Diacylglycerides and free fatty acids tend to increase. Phosphatidylcholine and phosphatidylethanolamine decreasewhereas phosphatidylserinesphingomyelinand phosphatidylinositol increase. The main fatty acids of the retina also undergo changes. At E7myriotic acid increasesand oleic acid and polyunsaturated fatty acids such as arachidonic acid and docosahexaenoic acid decrease. From onwardthere is some recoveryexcept for fatty acidswhich recover earlier. From a morphological point of viewalcohol effects on retinal development are various: increase of intercellular spaces in all cell layerspyknosis with loss of cellularity in the inner nuclear cell layer and ganglion cell layerretarded or disorderly cell migrationearly cell differentiationand loss of immunoreactivity for myelin oligodendrocyte-specific protein.Acute alcohol exposure during embryo development causes the lipid composition of the retina to changewith a trend to recovery in the last stages. These alterations are in line with the changes observed at a morphological level. |
The use of combined nasolabial advancement and glabellar flaps for large medial canthal defects. This combination has many advantages over skin grafts and other local flaps. It is easy to designreliableand offers good cosmetic results. This combination is recommended to plastic surgeons as a safe and effective procedure for reconstruction of medial the canthal area.Reconstruction of the medial canthal area presents many challenges for surgeons. It has many functional and cosmetic peculiarities. The combined use of glabellar and nasolabial advancement flaps is an effective method for repairing large medial canthal defects.To describe and illustrate a technique to repair medial canthal defects.Our experience with combined usage of nasolabial flap and glabellar flaps for medial canthal closure after tumor resection in 23 patients is reported.All resections and reconstructive procedures were performed under local anesthesia. All patients were treated without any complications such as flap losswound dehiscencelymphedemaor ectropion. Fine results were achieved from both the functional and aesthetic point of view. |
Event Perception and Memory. Events make up much of our lived experienceand the perceptual mechanisms that represent events in experience have pervasive effects on action controllanguage useand remembering. Event representations in both perception and memory have rich internal structure and connections one to anotherand both are heavily informed by knowledge accumulated from previous experiences. Event perception and memory have been identified with specific computational and neural mechanismswhich show protracted development in childhood and are affected by language useexpertiseand brain disorders and injuries. Current theoretical approaches focus on the mechanisms by which events are segmented from ongoing experienceand emphasize the common coding of events for perceptionactionand memory. |
Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery. Management after transection of the varies widely. The duct may be simply transected or marsupializedor a formal dacryocystorhinostomy can be performed. The surgeon must also choose whether to place a stent. Based on our small series and review of the literaturemarsupialization or simple transection of the results in a low rate of postoperative epiphora in the setting of endoscopic sinus and skull base surgery.To evaluate rates of epiphora after transection and marsupialization of the nasolacrimal duct during endoscopic sinus and skull base surgery.The nasolacrimal canal forms part of the medial wall of the maxillary sinus. Transecting the is sometimes necessary for tumor resection or surgical access to maxillary sinus and infratemporal fossa pathology. There is no consensus for the endoscopic management of the when only the duct is transected without involving the nasolacrimal sac.Medical records of 29 patients from 2 academic institutions who underwent endoscopic sinus and skull base surgery with transection of the were retrospectively reviewed. Whether the duct was marsupialized or simply transected was recordedand the postoperative rate of epiphora was calculated.Mean age was 59 years (range14-86 years). Mean follow-up was 10.5 months (range1-33 months). The was marsupialized in 16 and simply transected in 13 patients. Six patients underwent postoperative radiation. No patients in the marsupialization group had epiphora postoperativelyall with Munk score of 0. One patient in the transection group developed postoperative epiphora with Munk score of 1. Pathology included inverted papilloma acute on chronic inflammation B-cell lymphoma juvenile nasopharyngeal angiofibroma squamous cell carcinoma Schneiderian papilloma metastatic melanoma HPV-related carcinoma adenocarcinoma benign epithelial cyst adenoid cystic carcinoma and erosive chronic sinusitis without nasal polyposis . |
The embryonic human choriocapillaris develops by hemo-vasculogenesis. Markers of endothelial cells (CD34CD31vWf)angioblasts and (CD39)leukocytes (CD45)erythroblasts (epsilon chain of hemoglobinHb-e)proliferating cells (Ki67)and were employed. At 6-7 WGmany erythroblasts were observed within islands of precursor cells in the choriocapillaris layer and others were independent from the islands. Many erythroblasts (Hb-epsilon were also positive for markers andor By 8-12 WGmost of the Hb-epsilon cells had disappeared and vascular lumens became apparent. At 14-23 WGsome were proliferating on the scleral side of choriocapillaris in association with forming deeper vessels. In conclusionembryonic choriocapillaris appears to form initially by hemo-vasculogenesis (blood vessels and blood cells form simultaneously from common precursors) while angiogenesis appears to be the mode of intermediate and large choroidal vessel development in the fetus. |
Flving fox — - intimately supplied with choroidal capillaries ; to a certain extent, also, the irregular arrangement of the visual cells in the hills and craters may act as an accommodative device. It is interesting that Rohen found in the dog thick longitudinal mviscular layers in the walls of the posterior ciliary arteries and in the arteries of the posterior part of the choroid which he interpreted as a vascular shunt apparatus regulating the flow of blood into the choroid. Such a mechanism he failed to find in the cat, rabbit, rat or guinea-pig, or in man. The size and topograph} of the ciHary regionin Placentals vary considerably, the dominating factor being the presence or absence of an accommodative mechanism. Derived from noc-sence or absence of an accommodative mechanism. Derived from nocturnal ancestors few Placentals, particularly of the lower species, have turnal ancestors few Placentals, particularly of the lower species, have any marked degree of accommodative activity ; this, indeed, is found Fig. 582. The inner aspect of the anterior part of the eye showing the ora serrata, the pars plana, ciliary processes and posterior surface of the iris. only in the squirrels (Sciuridae), the large Carnivores and the Primates. On this essentially depend the size of the ciliary body, its musculardevelopment, the prominence of the ciliary processes, a.nd the conIn most small-eyed In most small-eyed figuration of the angle of the anterior chamber. primitive tyjes with comparatively large lenses (Insectivores, Rodents, etc.) the ciliary body is small and narrow with miniature processes ; In in the slu'ews it is a simple roll without processes, as in snakes. large-eyed Placentals, it assumes the prominent triangular shape with well-developed processes such as are seen in man. - p. 386. — the pupil relatively immobile, wliile in many species (Ungulates and Carnivores) tlie tendency towards nasal asymmetry of the globe in the interests of binocular vision results in a curtailment of the ciliary region and the practical disappearance of the orbicular zone on the nasal side . The main determinant in the configuration of tliis region is the degree of development of the ciliary muscle (FigS- 583-90). |
Long-term homeostasis of extracellular glutamate in the rat cerebral cortex across sleep and waking states. Neuronal firing patternsneuromodulatorsand cerebral metabolism change across sleep-waking statesand the synaptic release of glutamate is critically involved in these processes. Extrasynaptic glutamate can also affect neural function and may be neurotoxicbut whether and how extracellular glutamate is regulated across sleep-waking states is unclear. To assess the effect of behavioral state on extracellular glutamate at high temporal resolutionwe recorded glutamate concentration in prefrontal and motor cortex using fixed-potential amperometry in freely behaving rats. Simultaneouslywe recorded local field potentials (LFPs) and electroencephalograms (EEGs) from contralateral cortex. We observed dynamicprogressive changes in the concentration of glutamate that switched direction as a function of behavioral state. Specificallythe concentration of glutamate increased progressively during waking (0.329 +- 0.06%min) and rapid eye movement sleep (0.349 +- 0.13%min). This increase was opposed by a progressive decrease during non-REM sleep (0.338 +- 0.06%min). During a 3 h sleep deprivation periodglutamate concentrations initially exhibited the progressive rise observed during spontaneous waking. As sleep pressure increasedglutamate concentrations ceased to increase and began decreasing despite continuous waking. During sleepthe rate of decrease in glutamate was positively correlated with sleep intensityas indexed by slow-wave activity. The rate of decrease doubled during recovery sleep after sleep deprivation. Thusthe progressive increase in cortical extrasynaptic glutamate during EEG-activated states is counteracted by a decrease during sleep that is modulated by sleep pressure. These results provide evidence for a long-term homeostasis of extracellular glutamate across sleep-waking states. |
Intravitreal dexamethasone implant-associated endophthalmitis in the setting of systemic immunosuppression is a rare and challenging situation. Both local and systemic immunosuppression may delay wound healingpredisposing to wound leakage and consequent endophthalmitis. Despite repeated intravitreal antimicrobial injection and vitrectomy with implant removalA. defectiva endophthalmitis carried a poor visual outcome.To present a case of endophthalmitis caused by Abiotrophia defectiva after repeated injections of dexamethasone intravitreal implant (Ozurdex)in a patient already on systemic immunosuppressive therapyand discuss the management of this challenging situation.Case report and review of literature.A 70-year-old female patient with history of idiopathic pulmonary fibrosis presented for urgent evaluation due to left eye vision loss and mild discomfort 12 days after receiving her seventh dexamethasone implant injection. Ocular history was pertinent for recurrent macular edema resulting from a remote branch vein occlusion. Twelve days after her last injectionvisual acuity decreased from 2030 to counting fingers at 5 feet. Slit-lamp examination showed anterior chamber cell without fibrinoid membranes or hypopyon. Within hoursthe patient's clinical appearance progressed. vitreous tap followed by intravitreal injection of vancomycin (1 mg0.1 mL) and ceftazidime (2.25 mg0.1 mL) was performed. The culture from the vitreous sample revealed heavy growth of defectiva. Owing to limited improvementpatient was taken to the operating roomand the presence of a full-thickness scleral defect at the site of most recent dexamethasone implant injection was confirmed. Vitrectomy with removal of implantclosure of all sclerotomiesincluding nonhealing full-thickness scleral defectand repeated intravitreal antibiotic injection were performed. At the 3-month follow-upno inflammation was observedbut visual acuity remained poor. |
Correction is obtained by placement of a “minus,” or concave, lens in front of the eye, thus adding divergence to the incoming light rays and moving the focused image onto the retina. Hyperopia, or farsightedness, is a refractive condition of the eye in which the axial length is too short, the cornea is too flat, or the lens has too little refractive power to focus the image on the retina. The image is therefore focused posterior to the retina. This condition is corrected by addition of a “plus,” or convex, lens to the optical system, which provides additional convergence to the light rays entering the eye, thereby moving the image forward onto the retina. In astigmatism, the refractive power of the eye in one plane (or meridian) is different from the refractive power in a different meridian. This results in essentially two ent from the refractive power in a different meridian. This results in essentially twofocal planes from these two meridians, causing a blurred, distorted image. The disparity is corrected by placement of a cylindrical lens in front of the eye. parity is corrected by placement of a cylindrical lens in front of the eye. Pinhole testing generally demonstrates correction of any uncorrected refractive errors. If correction is not seen, the examiner must ascertain whether rected refractive errors. If correction is not seen, the examiner must ascertain whether a pathologic cause of decreased visual acuity such as unclear ocular media (e.g., a cataract), optic nerve disease, or retinal disease is present. Too often the acronym (pupils equal, round, and reac-rior visual pathways. Too often the acronym (pupils equal, round, and reactive to light and accommodation) is noted and substituted for an accurate assessment tive to light and accommodation) is noted and substituted for an accurate assessment of pupil function. The first step in examining the pupils is to measure pupil size in dim light with the patient’s gaze fixed on a distant object. The examiner directs a penlight at each pupil and notes the rapidity and amount of pupil constriction in each eye.Anisocoria, or a difference in pupil size, may be a normal finding (physiologic or essential anisocoria) but also may be a sign of ocular or neurologic disease (see Chapter tial anisocoria) but also may be a sign of ocular or neurologic disease (see ). As a general rule, a pupil that reacts poorly to direct light is abnormal. |
The influence of spatial coordinates in a case of an optic ataxia-like syndrome following cerebellar and thalamic lesion. We report the case of a patient whoafter a lesion involving the midbrainthalamusand cerebellum on the left sidewas unable to reach a target at which he was not directly gazing. When attempting to do so with either handhe showed an optic ataxia-like behaviour: rightward deviation was manifest with respect to the real position of the target objectaccuracy being worse for the right than for the left hand and for the right than for the left hemifield. To assess whether S.C.'s reaching accuracy was affected by the position of the target with respect to the retinaeyesandor headhe was asked to perform a pointing task in different conditions. By manipulating eyes and head positionthe relative location of the target with respect to these body parts was altered. Furtherto verify the relevance of the visual feedback for the accuracy of the reaching responsesthe task was also performed either with or without vision of the performing hand (closed- and open-loop conditions). The results showed that the patient's reaching impairment reflects a deficit in spatio-motor coding mainly within head-centred coordinates. The lack of visual feedback about the hand spatial location worsened the reaching performance. This new pattern of reaching deficits is discussed in relation to the theoretical framework of both parietal optic ataxia and cerebellar ataxia. |
Vitreous and Vision Degrading Myodesopsia. Macromolecules comprise only 2% of vitreousyet are responsible for its gel statetransparencyand physiologic function(s) within the eye. Myopia and aging alter collagen and hyaluronan association causing concurrent gel liquefaction and fibrous degeneration. The resulting vitreous opacities and collapse of the vitreous body during posterior vitreous detachment are the most common causes for the visual phenomenon of vitreous floaters. Previously considered innocuousthe vitreous opacities that cause floaters sometimes impact vision by profoundly degrading contrast sensitivity function and impairing quality-of-life. While many people adapt to vitreous floatersclinically significant cases can be diagnosed with Vision Degrading Myodesopsia based upon echographic assessment of vitreous structure and by measuring contrast sensitivity function. Perhaps due to the ubiquity of floatersthe medical profession has to date largely ignored the plight of those with Vision Degrading Myodesopsia. Improved diagnostics will enable better disease staging and more accurate identification of severe cases that merit therapy. laser treatments may occasionally be slightly effectivebut vitrectomy is currently the definitive cure. Future developments will usher in more informative diagnostic approaches as well as safer and more effective therapeutic strategies. Improved laser treatmentsnew pharmacotherapiesand possibly non-invasive optical corrections are exciting new approaches to pursue. Ultimatelyenhanced understanding of the underlying pathogenesis of Vision Degrading Myodesopsia should result in preventionthe ultimate goal of modern Medicine. |
Does lagophthalmos change on lying supine after upper eyelid platinum segment chain loading? Facial nerve palsy often significantly affects blink. Platinum segment chains improve lagophthalmoshoweverdebate exists as to the effectiveness of weights when the patient lies supine.Prospective case series of patients with following insertion. Lagophthalmos on blinkgentle and forced closure was observed in the seated positionlying flat supine at 0 degreeslying supine with one pillow underneath the head and lying on the sidewith the non-facial palsy side to the pillow. This side was chosen to account for the effect that the pillow may have on lagophthalmos.Twenty eyes with for facial palsy related lagophthalmos were assessed in 19 patients. Clinically12 out of the 20 eyes had no change in lagophthalmos on gentle closure when sitting up compared to supine (no pillow). The remaining 8 eyes had an increase of lagophthalmos of mean 2.3 mm (range 1-6 mm) when supine. There was no statistical difference in the amount of lagophthalmos between sitting up and lying flat with no pillow on gentle closure value = .0804) and blink value = .1567). About 50% of patients have ongoing requirements for evening lubricating ointment application but only one patient in our cohort experienced morning ocular symptoms. No patient was taping their eyelids. Statisticallythere is no difference between gentle closure in the sitting and supine position. |
Subthreshold microstimulation in frontal eye fields updates spatial memories. The brain's sensitivity to self-generated movements is critical for behaviorand relies on accurate internal representations of movements that have been made. Stimulation duringbut not beforethe memory period caused small but consistent displacements of memory-guided saccade endpoints. This displacement was in the opposite direction of the saccade that was evoked by stronger stimulation at the same sitesuggesting that weak stimulation induced an internal saccade signal without evoking an actual movement. Consistent with this ideathe stimulation effect was nearly absent on a task where an animal was trained to ignore self-generated eye movements. These findings support a role for the frontal eye fields in accounting for self-generated movementsand indicate that corollary discharge signals can be manipulated independent of motor output. |
Local tumor control after 106Ru brachytherapy of choroidal melanoma. The low rate of local tumor recurrence suggests that ruthenium plaque radiotherapy is effective with good case selection and if special measures are taken to ensure that the plaque is positioned correctly.To report on local tumor control after Ru brachytherapy for choroidal melanoma.A total of 458 patients with choroidal melanoma were treated at a single institution between January 1993 and December 2001. The tumors had a median longest basal dimension of 10.6 mm and a median height of 3.2 mm. The brachytherapy was administered using a 15- or 20-mm plaque. For posterior tumorsthe plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin to reduce the radiation dose to the optic disk and fovea. minimal scleral dose sufficient to cause visible choroidal atrophy provided a permanent ophthalmoscopic record of the distribution of choroidal irradiation. If radiotherapy to the posterior tumor was uncertainadjunctive transpupillary thermotherapy was administered 6 months postoperatively.The actuarial rates of tumor recurrence were 1%2%and 3% at 25and 7 yearsrespectively. Local tumor recurrence correlated with the longest basal tumor dimension (Cox univariate analysisp = 0.02risk ratio 1.4195% confidence interval 1.06-1.88). Seven of the nine eyes with recurrent tumor were salvaged with additional conservative therapy. |
Subcellular organization of camkii in rat hippocampal pyramidal neurons. Calciumcalmodulin-dependent protein kinase (CaMKII) plays a key role in N-methyl-D-aspartate receptor-dependent long-term synaptic plasticity; its location is critical for signal transductionand may provide clues that further elucidate its function. We therefore examined the subcellular localization of CaMKII in stratum radiatum of adult rat hippocampusby using immuno-electron microscopy after chemical fixation. When tissue was fixed quicklythe concentration of CaMKIIα (assessed by pre-embedding immunogold) was significantly higher in dendritic shafts than in spine heads. Howeverwhen tissue was fixed 5 minutes after perfusion with normal salinethe density of labeling decreased in dendritic shaft while increasing in spine headsimplying rapid translocation into the spine during brief perimortem stress. Likewisein quickly fixed tissueCaMKII within spine heads was found at comparable concentrations in the "proximal" half (adjacent to the spine neck) and the "distal" half (containing the postsynaptic density )whereas after delayed fixationlabel density increased in the distal side of the spine headsuggesting that CaMKII within the spine head moves toward the during this interval. To estimate its distribution at the synapse in vivowe performed postembedding immunogold staining for CaMKII in quick-fixed tissueand found that the enzyme did not concentrate primarily within the central matrix of the Insteadlabeling density peaked ∼40 nm inside the postsynaptic membraneat the cytoplasmic fringe of the Labeling within 25 nm of the postsynaptic membrane concentrated at the lateral edge of the synapse. This lateral core" pool of CaMKII may play a special role in synaptic plasticity. |
Behçet disease has a low prevalence in the Spanish population. Only a few reports have been published on the clinical features of in our country. Statistical analysis was carried out using the chi2 test.Seventy four patients (40 male and 34 female) were studied. The most frequent manifestations were oral and genital aphthae followed by cutaneous lesions ocular lesions fever and vascular manifestations . Venous manifestations were more frequent than arterial events. Gastrointestinal lesions occurred more frequently in females compared with males (p = 0.002). Vascular and ocular manifestations were more severe in males than in females. With respect to cardiovascular risk factors32.4% of patients were smokers20.3% were hyperlipidemic19% hypertensive13.5% obese and 9.5%diabetic. Cardiovascular risk factors were not related to thrombotic events or posterior uveitis in these patients (p > in patients in the community of Valencia is characterized by a variety of clinical manifestations similar to other geographical areas. Gastrointestinal manifestations occur more frequently in female patientsand venous thrombotic manifestations were more frequent than arterial events. Cardiovascular risk factors do not seem to play a role in the development of thrombotic events and posterior uveitis in these patients. |
Effect of irrigating solution and irrigation temperature on the cornea and pupil during phacoemulsification. Long-term results were equally favorable in all 4 groups. However Plus induced less short-term corneal swelling than Ringer's solution. From these findingsit appears that Plus may decrease corneal risk in cases with compromised corneas or prolonged surgery.To evaluate the effect of irrigation solution and temperature on pupil diametercorneal endotheliumand corneal pachymetry during and after phacoemulsification.Klinik DardenneBonnGermany.Eighty patients who had cataract surgery by phacoemulsification were assigned to 1 of 4 cross-classified groups and had intraoperative irrigation with room-temperature or refrigerated fortified balanced salt solution Plus) or modified Ringer's solution. Pupil diameters were recorded at different stages during the surgery. Epithelial cell counts and pachymetry were determined before and 1 day after surgery.The solution temperature did not affect any parameter. The type of solution did not influence endothelial cell loss; howeverthe solution had a significant effect on corneal pachymetry 1 day postoperatively. The corneas irrigated with Plus were less swollen than the corneas irrigated with Ringer's solution. By day 14corneal thickness was equal among all groups. |
Iridoschisis: case report and review of the literature. Iridoschisis is a rare condition that consists of the separation of the anterior mesodermic layer of the iris. In more than two-thirds of cases it is associated with glaucoma. We report the case of an 80-year-old patient who had bilateral iridoschisis and presented with acute angle-closure glaucoma. The patient was free from a history of ocular trauma or of heritable ocular disease. Chronic open-angle glaucomaas well as intermittent angle-closure glaucomashould be excluded in all patients with iridoschisisand regular follow-up should be established upon diagnosis of the entity. |
Increased ligand in patients with acute anterior uveitis. Patients with had increased expression of the ligand on T-cells in the blood and expressed higher levels of the ligand when stimulatedcompared to ophthalmological inflammatory controls and healthy controls. The data suggest that the ligand is involved in the development of AU.The inflammatory response in acute anterior uveitis is believed to be primarily mediated by autoreactive T-cells. We wanted to evaluate whether the T-cell activation marker ligand is involved in the immunopathogenesis.We evaluated the expression of the ligand on T-cellsCD8+ T-cells and B-cells on peripheral blood mononuclear cells using flow cytometry in six patients with unilateral AUsix patients with monosymptomatic optic neuritis as inflammatory controlsand in six healthy controls. The ex vivo induction of the ligand on T-cells in patients and controls was also studied.A significantly higher expression of the ligand on both (p < 0.05) and (p < 0.05) T-cells in patients with compared to patients and healthy controls was found. There was a significantly higher induction of the ligand on T-cells in patients compared to patients and healthy controls (p < 0.01). No differences in the B-cell population were observed between the three groups. |
No clear adaptive matching of the visual pigments to ambient light, as demonstrated in fish, has ever been found in butterflies. In cichlids, visualsystem spectral sensitivities also seem to match the ambient light environments of these species. In butterflies, the ent light environments of these species. In butterflies, the limited evidence available to date suggests that visual pigment diversity may be driven by the social signalingand foraging needs of the animals rather than their particular light environment. ticular light environment. Like many other insects, butterflies utilize vision for a whole range of tasks. They use vision to locate foodsources, select suitable oviposition sites, and in intraspecific communication. Papilio butterflies use two of their cific communication. Papilio butterflies use two of their duplicated opsins to see in the green part of the light spectrum when ovipositing and foraging. Importantly, opsin gene duplications resulting in the diversification ofphotoreceptor types have clearly impacted on the foraging behavior of butterflies. ing behavior of butterflies. Mate choice in many butterfly species also occurs via color-based signaling. For example, Heliconius butterflies appear to use both colored and polarized light for finding mates. The size of UV-reflecting eye spots on the wings seems to correlate with mating success in Bicyclus anynana. These observations suggest that there might be selective pressure for visual systems to evolve to detect the specific spectral signals of wings. Correlative evidence suggests that photoreceptor sensitivities have evolved in tandem with wing coloration but empirical evidence is needed. Visual system diversity has been achieved primarily through opsin gene duplication, positive selection at single opsin loci, and heterogeneous expression of filtering pigments in photoreceptors. The evolutionary basis of this patternof diversification has recently received significant attention, however the exact molecular basis of spectral tuning tion, however the exact molecular basis of spectral tuning of butterfly visual pigments remains unknown. Butterfly visual systems offer an excellent opportunity to study the evolutionary and functional genetic links from genotypeto phenotype through to behavioral and ecological consequences. To this end, further work is required to explic-sequences. To this end, further work is required to explicitly link the pattern of photoreceptor diversification in itly link the pattern of photoreceptor diversification in different butterflies to their ecology, behavior, and lifehistory traits. Only then will we gain a complete understanding of the evolutionary significance of visual system standing of the evolutionary significance of visual system diversification in these insects. |
Cortical-like receptive fields in the lateral geniculate nucleus of marmoset monkeys. Most neurons in primary visual cortex exhibit high selectivity for the orientation of visual stimuli. In contrastneurons in the main thalamic input to V1the lateral geniculate nucleus (LGN)are considered to be only weakly orientation selective. Here we characterize a sparse population of cells in marmoset that show orientation and spatial frequency selectivity as great as that of cells in The recording position in and histological reconstruction of these cells shows that they are part of the koniocellular pathways. Accordingly we have named them K-o ("koniocellular-orientation") cells. Most K-o cells prefer vertically oriented gratings; their contrast sensitivity and tuning are similar to those of parvocellular cellsand they receive negligible functional input from short wavelength-sensitive ("blue") cone photoreceptors. Four K-o cells tested displayed binocular responses. Our results provide further evidence that in primates as in nonprimate mammals the cortical input streams include a diversity of visual representations. The presence of K-o cells increases functional homologies between pathways in primates and "sluggishW" pathways in nonprimate visual systems. |
Neuroprotective effects of memantine in a mouse model of retinal degeneration induced by rotenone. This is the first report of the in vivo effectiveness of memantine as a neuroprotective agent against rotenone-induced retinal toxicity. We tested the hypothesis that uncompetitive blockade with memantine prevents mitochondrial dysfunction-related neurodegeneration in vivousing a mouse model of retinal ganglion cell layer degeneration induced by rotenonea mitochondrial complex inhibitor. Rotenone induced an increase in cell death and oxidative stress in compared to controlsand these changes were prevented by the co-administration of memantine. The neurotoxic effect of rotenone was also reflected as a decrease in total cell density in and GCL+nerve fiber layer thickness. These changes were also prevented by co-administration of memantine in a dose-dependent manner. In additionmemantine induced an increase in long-term retinal energy metabolic capacity. The results suggest that activation contributes to cell death induced by mitochondrial dysfunction and that uncompetitive blockade may be used as a neuroprotective strategy against mitochondrial dysfunction in neurodegenerative diseases. |
Two Novel Heterozygous Mutations in Association With D-Bifunctional Protein Deficiency: Case Report and Literature Review. Background: D-Bifunctional protein deficiency is an autosomal recessive disorder caused by peroxisomal β-oxidation defects. According to the different activities of 2-enoyl-CoA hydratase and 3-hydroxyacyl-CoA dehydrogenase protein unitsD-bifunctional protein defects can be divided into four types. The typical symptoms include hypotonia and seizures. The gene that encodes was HSD17B4which is located in chromosome 5q23.1. Case Presentation: We report the first case of in a Chinese patient with neonatal onset. Cosmetic malformationssevere hypotonia and seizures are prominent. The blood bile acid profile showed increased taurocholic acidglycocholic acidand taurochenodeoxycholic acid. Very-long-chain fatty acids (VLCFAs) revealed significant increases in hexacosanoic acid (C26:0)tetracosanoic aciddocosanoic acid (C24:0C22:0)and hexacosanoic aciddocosanoic acid Cranial revealed bilateral hemispheric and callosal dysplasiawith schizencephaly in the right hemisphere. showed loss of sleep-wake cycle and epileptiform discharge. Other examinations include abnormal brainstem auditory evoked potentials (BAEPs) and temporal pigmented spots on the optic disc in the right eye. After analysis by whole-exome sequencingheterozygous c.972+1G>T in the paternal allele and c.727T>A (p.W243R) in the maternal allele were discovered. He was treated with respiratory supportformula nasogastric feedingand antiepileptic therapy during hospitalization and died at home due to food refusal and respiratory failure at the age of 5 months. Conclusions: Whole-exome sequencing should be performed in time to confirm the diagnosis when the newborn presents hypotoniaseizuresand associated cosmetic malformations. There is still a lack of effective radical treatment. Supportive care is the main treatmentaiming at controlling symptoms of central nervous system like seizures and improving nutrition and growth. The disease has a poor outcomeand infants often die of respiratory failure within 2 years of age. |
Effect of retinoic acid on epithelial differentiation and mucin expression in primary human corneal limbal epithelial cells. Retinoic acid is essential for epithelial differentiation and maintenance of the mucous phenotype. Stratified HCLECs were examined using immunohistochemical or immunofluorescent staining for p63ABCG2CK3CK19and Western blotting for and to assess differentiation. Ultrastructural morphology was investigated using scanning and transmission electron microscopy. They were incubated with rose bengal dye to examine barrier function. The effects of on the expression of MUC1-4and -16 were analyzed by immunohistochemistryquantitative real-time and Western blot analysis.HCLEC grown without showed hyperkeratosiswhereas those grown with 10 to 10 induced non-keratinized stratified epithelium with a normal appearance. Under these conditionsp63ABCG2CK3CK19MUC1-4and -16 staining patterns were similar to in vivo limbal epithelium. higher concentration of resulted in abnormal differentiation. HCLECs grown with were tightly apposed and maintained intact barrier function against dye penetration. Alsoour results suggested modulating effect of on differentiation and mucin expression in corneal epithelium. |
Awareness of Age-Related Macular Degeneration in Community-Dwelling Elderly Persons in Germany. Background: Due to current demographic trends age-related macular degeneration is becoming more prevalent. When disease progresses to late-stage neovascular AMDrapid initiation of treatment is required to achieve optimal outcomes. Howevermany affected individuals may be unaware of their disease impeding and delaying care seeking. Methods: Participants were recruited in eleven seniors' community centers. Participants underwent a standardized interview followed by non-mydriatic fundus photography of the macula and the optic disc in both eyes (Canon CR-2AFCanonNew YorkUSA). The images were graded by an ophthalmologist and the data were analyzed descriptively. Results: total of 281 participants (73.9 ± 8.1 years; 71.9% women) underwent bilateral fundus photography. The fundus photographs of 208 participants (74%; 73.6 ± 7.0 years; 73.1% women) could be graded. In a third (32.2%n = 67) no pathological changes were detected. was present in 24.5% of the examined subjects (n = 51). Half of the cases had early followed by intermediate and late Only one third (n = 1631.4%) were aware of their disease. Conclusions: quarter of community dwelling elderly had but only a third of these were aware of being affected with This confirms previous studies demonstrating low awareness for age-related eye diseases in the community. Considering the increase in population agingawareness campaigns for are needed. |
Outbreak of acute hemorrhagic conjunctivitis in Maharashtra and Gujarat states of Indiacaused by Coxsackie virus variant. Acute hemorrhagic conjunctivitis is associated with enteroviruses. Among theseCoxsackie variant and Enterovirus-70 are known to cause epidemics and pandemics. An outbreak of acute hemorrhagic conjunctivitis occurred in August-September 2003 in Maharashtra and Gujarat states of India. The present investigation was carried out to determine the viral etiological agent associated with the epidemic. Virus isolates were obtained from 11 eye swabs of conjunctivitis patients using HeLa Hep-2 cell lines. The isolates were characterized by serological and mouse pathogenecity testsRT-PCR using enterovirus common primers specific primers (3C-proteinase region)EV-70 primers followed by sequencingand phylogenetic analysis. The virus was characterized as a Coxsackie variant (CA-24v) and none of the isolates were found to be positive for Sequencing of the products derived from all the 11 isolates revealed 98.4% 0.20) nucleotide identity within the Indian strains and 98.6% and 94.4% nucleotide identity respectively with the West Indies and Asian strains reported worldwide. The findings suggest that the outbreak of acute hemorrhagic conjunctivitis that occurred in Maharashtra and Gujarat states of India during August-September 2003 was caused by the Coxsackie variant (CA-24v). |
[Multivariate analysis of the clinical signs in late cortical cerebellar atrophy in Japancompared with olivo-ponto-cerebellar atrophy and hereditary cortical cerebellar atrophy We investigated the clinical features of 179 patients with late cortical cerebellar atrophy comparing with 382 patients with olivo-ponto-cerebellar atrophy and 91 patients with hereditary cortical cerebellar atrophy using multivariate analysis. They had no significant difference in durations from onset. Disorders of finger-nose test were of more severity and disorders of heel-knee test were less involved in than in Eye movements tended to be normal in showed more depressive and euphoric character than and Analysis of and demonstrated that revealed hypotonia in musclesnormal or weak reactions of muscle stretch reflexes. There existed 21.4 percent of cases which could not be discriminated by multivariate analysis using clinical signs in and Multivariate analysis of and HCCAwhich are very similar in clinical signsshowed 66.3 percent of discriminatory rate. Thuswe could diagnose them to a certain extent only by clinical signs. |
Inhibition of cell-induced vitreous contraction by synthetic peptide derived from the collagen receptor binding sequence. Cell-mediated tractional retinal detachment is the end result of various intraocular proliferative disorders. Interactions between cells and extracellular matrix via cellular surface receptorsintegrinsplay an important role. Anti-adhesion therapy has been suggested as a promising way to treat the integrin-dependent pathological events. We tested three synthetic peptidesGly-Arg-Gly-Asp-Ser (GRGDS)derived from the fibronectin receptor binding domain; Try-Ile-Gly-Ser-Arg (YIGSR)from the laminin receptor binding domainand Ala-Asp-Gly-Glu-Ala (ADGEA)from the collagen receptor binding domainto evaluate their inhibitory effect on cell-mediated matrix attachment and vitreous contraction in vitroand on cell-induced in rabbit eyes in vivo. Indirect immunofluorescent stain demonstrated both bovine retinal pigment epithelial cells and rabbit dermal fibroblasts expressed the alpha 2 beta 1alpha 5 beta 1 and alpha 6 beta 1 integrinsthe collagenfibronectinand laminin receptorsrespectively. exhibited a broad spectrum of inhibitory activity on cell attachment to extracellular matrices. specifically inhibited cell attachment to lamininwhereas inhibited cell attachment to collagen type and inhibited cell-induced vitreous contraction in a dose-dependent mannerwhereas and had no effect. (1250 microgramsmL) delayed the development of but did not prevent it. was nontoxic to cells and retinaas demonstrated by cytotoxicity tests and histological examination. The synthetic peptideADGEAand its analogs may be potential candidates for the treatment of cell-mediated collagenous contraction in the ocular tissues. |
How important are lens oxygen ratings? They are one of many performance factors. To prevent corneal edema in most patientscontact lenses must transmit oxygen to the following minimum degree: (a) in daily wear24.1 x 10 (cm x ml O2)(s x ml x mm Hg)and (b) in extended wear34.3 x 10 (cm x ml O2)(s x ml x mm Hg). High DkL ratings are particularly important for patients wearing extended wear lenses and for those with exceptionally high corneal oxygen demand. Neverthelessit is well known that other lens performance properties can be compromised by manipulating material or design parameters to increase the DkL rating. Increasing the DkL of hydrogel lensesfor examplemay lead to problems such as fragilitydehydrationand corneal adherence. Similarlyhigh-DkLrigid gas-permeable lenses may exhibit poor surface wettability and flexural resistancebase curve radius changesand possible corneal adherence. Because such problems can compromise visual acuityaffect ease of handlingor decrease comfortnonoxygen factors may exert a stronger influence on successful lens wear than high oxygen transmissibility alone for most patients. Among the nonoxygen factors important for contact lens wear are good movementsurface wettabilityresistance to deposit buildupand flexural resistance. Clinicians must consider these propertiesalong with oxygen transmission ratingswhen fitting patients with contact lenses. Lenses that exhibit good overall performancein my viewprovide the greatest probability of successful wear. |
Predicting eyes at risk for rapid glaucoma progression based on an initial visual field test using machine learning. To assess whether machine learning algorithms can predict eyes that will undergo rapid glaucoma progression based on an initial visual field test.Retrospective analysis of longitudinal data.175,786 VFs (22,925 initial VFs) from 14,217 patients who completed ≥5 reliable VFs at academic glaucoma centers were included.Summary measures and reliability metrics from the initial and age were used to train designed to predict the likelihood of rapid progression. Additionallythe neural network model was trained with point-wise threshold data in addition to summary measuresreliability metrics and age. 80% of eyes were used for a training set and 20% were used as a test set. test set performance was assessed using the area under the receiver operating curve Performance of models trained on initial data alone was compared to performance of models trained on data from the first two VFs.Accuracy in predicting future rapid progression defined as worsening more than 1 dByear.1,968 eyes underwent rapid progression. The support vector machine model 0.72 [95% 0.70-0.75]) most accurately predicted rapid progression when trained on initial data. Artificial neural networkrandom forestlogistic regression and naïve Bayes classifiers produced of 0.720.700.690.68 respectively. Models trained on data from the first two VFs performed no better than top models trained on the initial alone. Based on the odds ratio from logistic regression and variable importance plots from the random forest modelolder age 1.41 per 10 year increment [95% 1.34 to 1.08]) and higher pattern standard deviation 1.31 per 5-dB increment [95% 1.18 to 1.46]) were the variables in the initial most strongly associated with rapid progression.MLA can be used to predict eyes at risk for rapid progression with modest accuracy based on an initial test. Incorporating additional clinical data to the current model may offer opportunities to predict patients most likely to rapidly progress with even greater accuracy. |
Natural therapies for ocular disorderspart two: cataracts and glaucoma. Pathophysiological mechanisms of cataract formation include deficient glutathione levels contributing to a faulty antioxidant defense system within the lens of the eye. Nutrients to increase glutathione levels and activity include lipoic acidvitamins and Cand selenium. Cataract patients also tend to be deficient in vitamin and the caroteneslutein and zeaxanthin. The vitamin riboflavin appears to play an essential role as a precursor to flavin adenine dinucleotide (FAD)a co-factor for glutathione reductase activity. Other nutrients and botanicalswhich may benefit cataract patients or help prevent cataractsinclude pantethinefolic acidmelatoninand bilberry. Diabetic cataracts are caused by an elevation of polyols within the lens of the eye catalyzed by the enzyme aldose reductase. Flavonoidsparticularly quercetin and its derivativesare potent inhibitors of aldose reductase. Glaucoma is characterized by increased intraocular pressure in some but not all cases. Some patients with glaucoma have normal but poor circulationresulting in damage to the optic nerve. Faulty glycosaminoglycan synthesis or breakdown in the trabecular meshwork associated with aqueous outflow has also been implicated. Similar to patients with cataractsthose with glaucoma typically have compromised antioxidant defense systems as well. Nutrients that can impact GAGs such as vitamin and glucosamine sulfate may hold promise for glaucoma treatment. Vitamin in high doses has been found to lower via its osmotic effect. Other nutrients holding some potential benefit for glaucoma include lipoic acidvitamin B12magnesiumand melatonin. Botanicals may offer some therapeutic potential. Ginkgo biloba increases circulation to the optic nerve; forskolin (an extract from Coleus forskohlii) has been used successfully as a topical agent to lower and intramuscular injections of Salvia miltiorrhiza have shown benefit in improving visual acuity and peripheral vision in people with glaucoma. |
Are iris mammillations correlated with keratoconus? To describe the presence of iris mammillations in keratoconus.Retrospective case series and literature review.This is a retrospective case series of eight patients presenting with keratoconus and IMwho were examined between January 2016 and December 2017 in the ophthalmology outpatient clinic. They had a median age of 14 and all had bilateral keratoconus and diffusely distributed The had similar presentations and similar iris colors. None had relevant medical or family diseases associated with Three eyes previously had penetrating keratoplasty. Four out of 13 eyes had mean keratometry (Km) > 55Dand 4 had the thinnest pachymetry between 300 and 400μm.To the best of our knowledge this is the first time that was observed in association with keratoconus patients. The possibility that is an early finding in otherwise healthy patients may help to predict the future diagnosis of keratoconus. Future studies are needed to show the frequency and possible association between and a keratoconus prognosis. This may also demonstrate that there is a subgroup of patients with a distinct etiology of keratoconus. |
Immunological detection of N-formylkynurenine in porphyrin-mediated photooxided lens α-crystallin. Crystallin proteins are responsible for maintaining lens transparency and allowing the lens to focus light undistorted onto the retina. The α-crystallins are the major lens crystallinsand function as both structural proteins and chaperones to protect all lens proteins from damage leading to lens deterioration. Because lens crystallin proteins do not turn overthe damage they accumulate can lead to cataractsthe world's leading cause of blindness. Photosensitizing porphyrins can accumulate in the eye through either endogenous metabolism or through therapeutic or diagnostic procedures. Porphyrin buildup exacerbates lens aging through increased levels of singlet oxygenresulting in protein polymerization and amino acid residue alteration. Tryptophans oxidize to kynurenine and N-formylkynurenine causing irreversible changes in the refractive index of the normally transparent lensleading to development of cataracts. AdditionallyNFK is itself a photosensitizerand its presence exacerbates lens deterioration. In vitro experiments show that four biologically interesting porphyrins mediate α-crystallin polymerization and accumulation of both protein radicals and Confocal microscopy of cultured human lens epithelial cells indicates that while all four porphyrins photosensitize cellular proteinsnot all oxidize the tryptophans of cellular α-crystallin to |
Latest statistics suggest that threequarters of a million people in England remain at risk of losing quarters of a million people in England remain at risk of losing their sight because they are not being screened for diabetic retinopathy (Diabetes 2008). This situation poses an enormous future challenge for ophthalmic practitioners in the Currently, attempts are being made to meet this challenge by providing and developing nurse-led approaches to diabetes retinal screening. In doing this, a vitally important contribution is being made to the national screening programme for diabetics at risk of developing diabetic retinopathy (Watkinson and Chetram, 2005). Furthermore, their future role will be significant in providing effective evidence-based care as a basis for preventing blindness and maximising long-term quality of life for patients with diabetic retinopathy. The risk of visual impairment and blindness is substantially reduced by a care programme that combines methods for early detection with effective treatment of the diabetic retinopathy 2002). Screening and treatment for diabetic retinopathy will not eliminate all cases of sight loss, but can play an important part in minimising the number of patients with sight loss due to retinopathy. Treatment options include laserphotocoagulation for focal and diffuse maculopathy, and proliferative retinopathy. Maculopathy is the major cause of visual loss for ative retinopathy. Vitrectomy is performed for persistent vitreous haemorrhage and tractional retinal detachment involving the macula. Although these treatment strategies are successful, older people need to be made aware of a number of risk factors as part of a preventative programme. Health education is clearly anotherimportant current and future challenge for ophthalmic practitioners. Older patients and their families will require reliable evidence ers. Older patients and their families will require reliable evidence and advice about the need to maintain good blood glucose and blood pressure control. Maintaining good blood pressure is also important. If eye damage is already present, it is recommended the blood pressure be maintained at or below 13080mmHg. Where no eye damage is present, an ideal target is at or below 14080mmHg 2008). Encouraging the regular checking of visual acuity to assess the onset of any severe pathological changes in the retina, and encouraging patients to keep their future hospital appointments, are also part of the nurse’s role as a health educator. The condition causes a gradual loss of vision and eventually blindness, which is largely curable. |
Neuronal Reprogramming for Tissue Repair and Neuroregeneration. Stem cell and cell reprogramming technology represent a rapidly growing field in regenerative medicine. number of novel neural reprogramming methods have been establishedusing pluripotent stem cells (PSCs) or direct reprogrammingto efficiently derive specific neuronal cell types for therapeutic applications. Both in vitro and in vivo cellular reprogramming provide diverse therapeutic pathways for modeling neurological diseases and injury repair. In particularthe retina has emerged as a promising target for clinical application of regenerative medicine. Hereinwe review the potential of neuronal reprogramming to develop regenerative strategywith a particular focus on treating retinal degenerative diseases and discuss future directions and challenges in the field. |
Removal of retained subretinal perfluorocarbon liquid. With the technique presentedretained subretinal perfluorocarbon liquid can be successfully removed with minimal trauma to adjacent tissues.To report a case series in which a modified technique was used to remove retained subretinal perfluorocarbon liquid.In three patients with retained subretinal perfluorocarbon liquida three-port pars plana vitrectomy approach was used to perform a small self-sealing retinotomy adjacent to the perfluorocarbon liquid bubble. The tip of a glass micropipette connected to an active suction system was inserted in the bubbleand the liquid was aspirated.Successful removal of subretinal perfluorocarbon liquid was achieved in all cases with no complications. Visual acuity improved in all patients. |
Reflectance evaluation of eye fundus structures with a visible and near-infrared multispectral camera. We examined the spectral reflectance of fundus structures in the visible and near-infrared (400-1300 nm) range for contributing to the medical diagnosis of fundus diseases. Spectral images of healthy eye fundus and other ocular diseases were acquired using a novel multispectral fundus camera. Reflectance metrics were computed based on contrast to analyze the spectral features. Significant differences were observed among the structures in healthy and diseased eye fundus. Specificallynear-infrared analysis allows imaging of deeper layerssuch as the choroidwhichto datehas not been retrieved using traditional color fundus cameras. Pathological structureswhich were hardly observable in color fundus images owing to metamerismwere also revealed by the developed multispectral fundus camera. |
Developmental homeostasis of mouse retinocollicular synapses. Spontaneous retinal waves during development are thought to provide an instructive signal for precise retinotopic mapping by correlating the activity of neighboring retinal ganglion cells. In mutant mice (beta2--) that lack correlated wavesretinocollicular map refinement is impaired. In vivo recordings reveal that neurons in the superior colliculus of beta2-- mice have large receptive fields and low peak visual responsesresulting in a conservation of total integrated response. We find that this "response homeostasis" is maintained on a cell-by-cell basisand argue that it does not depend on regulation from the visual cortex during adulthood. Insteadin vitro recordings show that homeostasis arises from the conservation of total synaptic input from the retinaand that it is maintained via different mechanisms over development. In the absence of correlated retinal wavesbeta2-- neurons sample a larger number of weaker retinal inputs relative to controls after the first postnatal week. Once retinal waves are restoreddevelopmental learning rules and homeostasis drive refinement so that fewerstronger synapses are retainedas in wild-type micebut from a larger retinal area. Homeostasis in neurons has been shown previously to regulate the gain of synaptic transmission in response to perturbations of activity. Our results suggest that during the development of sensory mapsa unique consequence of homeostatic mechanisms is the precise shaping of neuronal receptive fields in conjunction with activity-dependent competition. |
mutations in two Japanese patients with Bietti's crystalline dystrophy. Bietti's crystalline dystrophy is an autosomal-recessive retinal dystrophy characterized by numerous glistening intraretinal dots scattered over the fundusparticularly in the posterior pole. and analyses were conducted using blood samples from two unrelated Japanese patients with (a 46-year-old female and a 52-year-old male). In the female patienta homozygous deletioninsertion mutation (g.IVS6-8_-1delc.802_810delinsGC) including the 3 -acceptor splice site was identified. Reverse transcription-PCR analysis revealed that the complete length of exon 7 (186 bp)is skippedresulting in the in-frame deletion mutation (p.V268_E329del). Converselythe male patient was a compound heterozygote for the deletioninsertion and novel nonsense (p.W340X) mutations. Clinicallythe female patient had decreased visual acuityconstriction of visual fieldsseverely reduced amplitudes in both rod and cone electroretinograms (ERGs). Despite being 6 years olderthe male patient presented with milder clinical manifestations having good visual acuity and substantial amplitudes in both rod and cone ERGs. Because the truncated protein with the p.W340X mutation lacks 186 amino acids at the C-terminusif expressedit retains 62 amino acids encoded in exon 7which are important for enzymatic activity. In the male patientexpression of both mutant alleles may compensate for the malfunction of each mutated protein and could explain why a milder form of results from compound heterozygosity. |
The SmartSight Project: Use of Electronic Glasses to Improve Impaired Fields of Vision. Electronic glasses use advanced assistive technology that can improve function for persons with visual impairments. In a pilot test of the electronic glassespromising results were found that imply a big difference for persons with impaired vision. The outcome of the SmartSight project might change the clinical practise on treatment and rehabilitation of persons with impaired fields of visionand on how the support services are organised. |
Magnetic stimulation allows focal activation of the mouse cochlea. Cochlear implants (CIs) provide sound and speech sensations for patients with severe to profound hearing loss by electrically stimulating the auditory nerve. While most users achieve some degree of open set word recognition under quiet conditionshearing that utilizes complex neural coding (e.g.appreciating music) has proved elusiveprobably because of the inability of CIs to create narrow regions of spectral activation. Several novel approaches have recently shown promise for improving spatial selectivitybut substantial design differences from conventional CIs will necessitate much additional safety and efficacy testing before clinical viability is established. Outside the cochleamagnetic stimulation from small coils (micro-coils) has been shown to confine activation more narrowly than that from conventional microelectrodesraising the possibility that coil-based stimulation of the cochlea could improve the spectral resolution of CIs. To explore thiswe delivered magnetic stimulation from micro-coils to multiple locations of the cochlea and measured the spread of activation utilizing a multielectrode array inserted into the inferior colliculus; responses to magnetic stimulation were compared to analogous experiments with conventional microelectrodes as well as to responses when presenting auditory monotones. Encouraginglythe extent of activation with micro-coils was 60% narrower compared to electric stimulation and largely similar to the spread arising from acoustic stimulation. The dynamic range of coils was more than three times larger than that of electrodesfurther supporting a smaller spread of activation. While much additional testing is requiredthese results support the notion that magnetic micro-coil CIs can produce a larger number of independent spectral channels and may therefore improve auditory outcomes. Furtherbecause coil-based devices are structurally similar to existing CIsfewer impediments to clinical translational are likely to arise. |
Elevated intraocular pressure is a major risk factor for glaucomaa leading cause of blindness. heritability has been estimated to up to 67%and to date only 11 loci have been reportedaccounting for 1.5% of variability. Multiple longitudinal measurements were collected through electronic health records andin total356,987 measurements were included. We further examine their effect on the risk of glaucoma within our discovery sample. Using longitudinal measurements from electronic health records improves our power to identify new variantswhich together explain 3.7% of variation. |
[Sudden left-sided vision loss. Occlusion of the left central retinal artery]. 77 year old female patient was admitted to our hospital because of a rapid onset left-sided visual loss. Occlusion of the left central retinal artery was confirmed by the consultant ophthalmologist. The patient was further evaluated to exclude a thromboembolic event. Chest x-ray was consistent with pulmonary hypertension. Doppler echocardiography revealed a secundum atrial septal defect with a bi-directional shunt. In this 77 year old patientarterio-arterial embolism from atherosclerotic plaques is the most probable cause of her central retinal artery occlusion. Yetparadoxical embolism might be another reason for acute visual loss in this settingwhichhoweveris difficult to confirm definitively. |
Whitecoat Adherence in Patients With Primary Open-Angle Glaucoma. We documented the presence of whitecoat adherence in this cohort. Due to its potential impact on clinical outcomes and decisionsproviders should remain vigilant for this phenomenon and prioritize it during patient-provider discussions.Whitecoat adherence refers to improved medication adherence in the days surrounding clinic visits. This may lead to clinical measures that are not representative of those outside of clinical encounters. In glaucomawhitecoat adherence to prescribed hypotensive therapy may lead to intraocular pressure readings within the target rangewhich may impact clinical decision-making. Adherence within the implementation phase was measured using Medication Event Monitoring System caps. Wilcoxon tests were used to compare mean adherence between the following periods: Pre14-4 (days 14 to 4 preceding the clinic visit) and Pre3-1 (days 3 to 1 preceding the visit); Post1-3 (days 1 to 3 following the clinic visit) and Post4-14 (days 4 to 14 following the visit). Analyses were performed in the full sample and in patients with optimal (≥80%n = 49) and suboptimal adherence (<80%n = 17).Sixty-six patients were includedof which 51.5% were female. Mean age was 70.8 ± 8.1 years. In the 6 months evenly bracketing the clinic visitmean and median adherence were 86.3% (standard deviation = 17.7) and 95.6% (interquartile range = 21.2)respectively. Overallmean adherence increased from Pre14-4 to Pre3-1 (85.5% ± 21.2 to 88.5% ± 23.2p = 0.01) and decreased from Post1-3 to Post4-14 (87.0 ± 23.9 to 84.9 ± 23.3p = 0.02). In patients with optimal adherenceadherence increased from Pre14-4 to Pre3-1 (94.0 ± 11.7 to 97.7 ± 7.4p = 0.001) and from Post1-3 to Post4-14 (95.2 ± 12.0 to 95.4 ± 5.7p = 0.007). Whitecoat adherence was not observed in patients with suboptimal adherence. |
20-year experience of ocular herpes virus detection using immunofluorescence and polymerase chain reaction. Efficacy and accuracy of the polymerase chain reaction assay was greater compared to the immunofluorescence assay for detection of herpes virus in corneal scrapingscorneal grafts of suspected herpetic keratitis patients. Although the immunofluorescence assay is a rapid test for the detection of herpes virus in suspected herpetic keratitis patientsa combination of polymerase chain reaction with immunofluorescence assay will provide higher reliable and accurate results.To detect the presence of herpes virus in corneal scrapingscorneal grafts of suspected herpetic keratitis patients attending the outpatient departmentcasualty of the Dr Rajendra Prasad Centre for Ophthalmic SciencesAll India Institute of Medical SciencesNew Delhi for the past 20 years with immunofluorescence assay and to analyse the efficacy of polymerase chain reaction over immunofluorescence for routine laboratory diagnosis in some of the specimens.Corneal scrapings and corneal grafts were collected by the ophthalmologists from 1,926 suspected herpetic keratitis patients between 1996 and 2015among whom 1,863 patients were processed with immunofluorescence assay and 302 patients were processed with polymerase chain reaction assay for the detection of herpes virus. Of the 302 patientsclinical specimens from 239 patients were analysed by both polymerase chain reaction and immunofluorescence assay.Of the 1,863 suspected herpetic keratitis patients diagnosed with immunofluorescence assay277 (14.9 per cent) were found positive for herpes simplex virus 1 antigen. Similarlyof the 302 suspected herpetic keratitis patients diagnosed by polymerase chain reaction70 (23.2 per cent) were found positive for herpes simplex virus Of the 239 patients diagnosed by both polymerase chain reaction and immunofluorescence assay35 (14.6 per cent) were found positive with immunofluorescence assay59 (24.7 per cent) were found positive with polymerase chain reaction30 (12.5 per cent) were positive with both immunofluorescence and polymerase chain reaction assay. |
flow inside the was severely impairedwhereas flow outside the correlated poorly with both integrity and visual acuity. Fellow eye symmetry suggests that monitoring may be a relevant clinical end point in interventional studies.To examine the retinal and choroidal foveal and parafoveal vasculature in patients with bilateral geographic atrophy secondary to age-related macular degeneration using optical coherence tomography angiography (OCTA).Fourteen eyes from 7 patients with and without fovea-sparing bilateral at St. Erik Eye Hospital. All patients were examined by optical coherence tomography angiographyen face and fundus autofluorescence Segmented optical coherence tomography angiography flow scans were obtained from the superficial retinal vascular layer and the choriocapillaris and correlated with areas of retinal pigment epithelial loss on fundus autofluorescence. The foveal avascular zone was measured on superficial retinal vascular layer scans and compared to the area of each patient.No significant correlation (r = = 0.58) was found between superficial retinal vascular layer foveal avascular zone (0.49 mm ± 0.23 mm) and area (7.36 mm ± 4.36 mm). Absent or severely impaired flow was observed inside all lesions and to varied extent outside the margins including areas of fovea sparing. high level of symmetry was observed in flow between fellow eyes. |
The human pineal gland: relationships with surrounding structures and blood supply. After a short overview of the history of our knowledge of the pineal glandits anatomy and its functionthis work is primarily devoted to the relationships of the pineal gland to the nerve structures which delineate the pineal region. The complex surrounding blood vessels located in the quadrigeminal cistern are described with a special focus on the numerous venous trunks. Finallythe pineal blood supply is studied in three steps: The arterial supply obtained through several groups of pineal arteries stemming mainly from the medial posterior choroidal arteries; The venous drainage by the lateral pineal veins flowingin most casesinto the cerebral vein of Galen; The intrapineal vascular architecture with specific features concerning the central part of the gland highly vascularized by large sinusoid capillaries and its peripheral part poorly vascularized by small and fine blood vessels. |
Eye opening induces a rapid dendritic localization of in central visual neurons. The membrane-associated guanylate kinase scaffolds N-methyl-d-aspartate receptors to cytoplasmic signaling moleculesand associates with other glutamate receptors at central synapses. Howeverregulation of in vivo is poorly understood. We provide evidence of an activity-dependent redistribution of to dendrites in central visual neurons that is tied to eye opening. Six hours after eye openingincreased dendritic coimmunoprecipitates with the same proportions of stargazinincreased proportions of the N-methyl-d-aspartate receptor subunit NR2Aand decreased proportions of Sustained high levels of in dendrites are dependent on continued pattern vision in juvenile but not mature animalssuggesting that the stabilization of at synapses may be involved in the control of developmental plasticity. |
They are made at a line perpendicular to the intersection of two lateral eyelid incisions and the two medial incisions while the eyelid is placed in the desired normal position. Blunt dissection is carried out to make pockets for the fascial knots. The two ends of a strip are then passed from the outer eyelid incisions to the central eyelid incision using a Wright’s fascia lata needle. The needle is passed in the submuscular plane from the lateral brow incision to emerge from the lateral incision in the lid. The fascia is threaded through the eye of the needle and is pulled through. The procedure is repeated on the medial side (Figures and The fascial strips are pulled up and a single tie is made so as to place the eyelid margins as high as possible without lifting the eyelid from the globe (Figures and After a single tie the position and contour of the eyelid is assessed. Required adjustments are made. Presence of good lid crease is ensured at this stage. The excess of skin created by shortening of the posterior lamina is judged and excised by removing a spindle of skin from above the eyelid crease. Eyelid incisions require no closure. Patients are prescribed oral antibiotics and antiinflammatory agents. An appropriate selection and meticulous matory agents. An appropriate selection and meticulous execution of surgical technique hold the key to obtain excellent functional and cosmetic results in patients with ptosis. and Fascia lata needle is passed through submuscular plane on medial side and strip pulled. Needle passed from brow incision to medial lid incision. Fascial strips pulled from both medial and lateral brow incisions. Knot tightened and secured to get proper lid position. and Preoperative and postoperative: Upward gaze. and Preoperative and postoperative: Downward gaze. The patient can be taught to bend his head down instead of turning the eyes down (Figure 26). 2. Lagophthalmos: Normally the patient has little difficulty with lid closure as the eyeball rolls upward sufficiently to protect the cornea though the sclera may remain exposed (Figure 27). Undercorrection: Usually due to failure to raise the lid sufficiently high or due to placement of lid at a lower position due to improper judgement under (Figure 28). 2. Overcorrection: Overcorrection is not a common complication. It results due to excessive tightening of the sling. |
Clinically Focused Molecular Investigation of 1000 Consecutive Families with Inherited Retinal Disease. Each patient was assigned to 1 of 62 diagnostic categoriesand this clinical diagnosis was used to define the scope and order of the molecular investigations that were performed. The number of nucleotides evaluated in a given subject ranged from 2 to nearly 900 000.Sensitivity and false genotype rate.Disease-causing genotypes were identified in 760 families . These genotypes were distributed across 104 different genes. More than 75% of these 104 genes have coding sequences small enough to be packaged efficiently into an adeno-associated virus. Mutations in were the most common cause of disease in this cohort (173 families)whereas mutations in 80 genes caused disease in 5 or fewer families (i.e.0.5% or less). Disease-causing genotypes were identified in 576 of the families without next-generation sequencing This included 23 families with mutations in the repetitive region of exon 15 that would have been missed by Whole-exome sequencing of the remaining 424 families revealed mutations in an additional 182 familiesand whole-genome sequencing of 4 of the remaining 242 families revealed 2 additional genotypes that were invisible by the other methods. Performing the testing in a clinically focused tiered fashion would be 6.1% more sensitive and 17.7% less expensive and would have a significantly lower average false genotype rate than using whole-exome sequencing to assess more than 300 genes in all patients (7.1% vs. 128%; < 0.001).Genetic testing for inherited retinal disease is now more than 75% sensitive. clinically directed tiered testing strategy can increase sensitivity and improve statistical significance without increasing cost. |
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