bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of interleukin‐6 and estradiol with hepatocyte growth factor in peritoneal fluid of women with endometriosis
Authors: Khan Khaleque Newaz , Masuzaki Hideaki , Fujishita Akira , Hamasaki Tetsushi , Kitajima Michio , Hasuo Atsuko , Miyamura Yasutake , Ishimaru Tadayuki
Published: March 2003

Background.  Different cytokines and ovarian steroid hormones have been reported to regulate the growth and maintenance of endometriosis. We determined the relationship between peritoneal fluid concentrations of interleukin‐6, ovarian steroids and hepatocyte growth factor in different revised American Fertility Society (AFS) staging and morphologic appearances of endometriosis.

Methods.  Peritoneal fluid was collected from 30 women with endometriosis and 20 women without endometriosis during laparoscopy, and hepatocyte growth factor, interleukin(IL)‐6 and ovarian steroids were measured in peritoneal fluid. The concentrations of hepatocyte growth factor and IL‐6 in peritoneal fluid were measured by ELISA, and that of estradiol and progesterone by using the immulyze‐enzyme amplified luminescence system. Changes in peritoneal fluid concentrations of hepatocyte growth factor, IL‐6, estradiol and progesterone in different stages and morphologic appearances of endometriosis were examined to demonstrate their differences in early and advanced endometriosis.

Results.  Peritoneal fluid levels of hepatocyte growth factor in women with stage I–II endometriosis were significantly higher than in both women with stage III–IV endometriosis and without endometriosis. A similar significant increase in stage I–II endometriosis was also observed for IL‐6 and estradiol. When we divided the women according to different morphologic appearances of endometriosis, we found significantly higher concentrations of hepatocyte growth factor (HGF), IL‐6, estradiol and progesterone in women containing red lesions compared with other pigments or without endometriosis. A positive correlation was observed between peritoneal fluid levels of IL‐6 and hepatocyte growth factor only but not between other markers. Although estradiol levels in peritoneal fluid showed an increased tendency to elevate in the proliferative phase of endometriosis women, hepatocyte growth factor and progesterone displayed higher concentrations in the secretory phase of the menstrual cycle. After adjusting different variables in peritoneal fluid, multiple analysis of covariance indicated that hepatocyte growth factor levels in peritoneal fluid were independently involved in the red morphologic activity of endometriosis.

Conclusions.  Early staging and red color appearance of endometriosis are associated with the elevation in peritoneal fluid concentrations of hepatocyte growth factor, IL‐6 and estradiol, demonstrating the combined effect of these cytokines and ovarian steroids in the production of hepatocyte growth factor from endometrial tissues in active endometriosis.
Immunohistochemical staining of IGF‐I, IGF‐binding proteins‐1 and ‐3, and transforming growth factor beta‐3 in the umbilical cords of preeclamptic patients
Authors: Inan S. , Vatansever S. , Kuscu N. K. , Laçin S. , Ozbilgin K. , Koyuncu F.
Published: March 2003

Background. To detect the immunoreactivity of insulin‐like growth factor‐I, insulin‐like growth factor‐binding proteins‐1 and ‐3 and transforming growth factor beta‐3 in the umbilical cords of normal and preeclamptic patients.

Methods. Umbilical cords were obtained from 15 normal and 15 preeclamptic patients. Immunoreactivities were determined using either indirect immunofluorescence or immunoperoxidase techniques on formalin‐fixed, paraffin‐embedded sections. Staining intensity was graded by a semiquantitative scoring method. The results were compared by Mann–WhitneyU‐test.

Results. The umbilical cords were thinner and the vessels were hypoplastic in the preeclamptic group. Moderate staining intensity for insulin‐like growth factor‐I, insulin‐like growth factor binding protein‐1 and ‐3 and transforming growth factor‐beta 3 was observed in normal patients. The preeclamptic group had mild and strong intensities for insulin‐like growth factor‐I and insulin‐like growth factor binding protein‐1, respectively, and intensity for insulin‐like growth factor binding protein‐3 did not change, but diffuse and increased intensity was observed for transforming growth factor‐beta 3.

Conclusion. Changes in the intensity of insulin‐like growth factor‐I and its major binding protein and the transformation of growth factor‐beta 3 may play a role in the pathogenesis of preeclampsia by altering the structure and responsiveness of the umbilical cord
Knowledge and attitudes about the Pap‐smear screening program: a population‐based study of women aged 20–59 years
Authors: Ideström Monica , Milsom Ian , Andersson‐Ellström Agneta
Published: March 2003

Background.  The aim of the Papanicolau (Pap)‐smear screening program is to reduce morbidity and mortality resulting from cervix cancer. Compliance to screening has previously been suggested to be associated with women's knowledge. The aim of this study was to investigate knowledge about and attitudes to gynecologic Pap‐smear screening among women in a Swedish region where a screening program has been in existence since 1970.

Material and methods.  Questionnaires were mailed to a random sample of 400 women born 1940–79. Replies were received from 275 of the 392 (70%) available for evaluation.

Results.  Ninety‐five percent of the responders had a registered Pap smear in the pathology database. Women's knowledge and concerns were age‐dependent. Ninety‐five percent stated that they knew the purpose of screening but only 62% could indicate which type of cancer the screening actually examined. The majority (82%) did not experience anxiety while awaiting the test result. Almost all women knew that dysplasia may not give symptoms but 10% did not consider seeking a doctor when experiencing postcoital bleeding. Fifty percent thought that their life‐style may be of importance for developing dysplasia but only 13% were aware of the protective effect of a condom.

Conclusion.  Although the vast majority of the women had experience of participating in the screening program, one in three of the women were unaware of which type of cancer she was being screened for and only half of the women were aware of the connection between dysplasia/cervix cancer and life‐style factors. It is particularly important to provide better information about life‐style factors in order to give women the opportunity of acting accordingly.
Monoamniotic twins: diagnosis and management
Authors: Su Lin Lin
Published: March 2003

Monoamniotic twins, although uncommon, are associated with high antenatal and perinatal morbidity and mortality. The associated complications include cord entanglement, congenital anomalies, twin–twin transfusion syndrome, intrauterine growth retardation and preterm delivery. A thorough literature search using Medline and OVID was performed to look at the current diagnostic criteria for monoamniotic twins and the subsequent management. Specific criteria are employed during ultrasonography for making the diagnosis. Different opinions in the literature exist regarding the proper antepartum monitoring of monoamniotic twins, the optimal timing and the mode of delivery. Generally, it is agreed that there should be regular antepartum fetal heart trace monitoring and serial sonograms with umbilical artery Doppler flow study. Most studies advocate delivery at 32 weeks to reduce the risk of intrauterine deaths related to cord entanglement. Cesarean section is the preferred mode of delivery even though cases of successful vaginal delivery have been reported.
A new induction‐based impact method for measuring intraocular pressure
Authors: Kontiola Antti Ilmari
Published: March 2003

Purpose: An improved induction‐based impact method for measuring intraocular pressure is presented.

Methods: A light probe containing a permanent magnet is launched towards the eye using a solenoid. The probe hits the eye and bounces back. The same solenoid, inside which the probe moves, is used to detect the movement and impact of the probe, because the moving magnet induces voltage in the solenoid. In the clinical study, the Goldmann applanation tonometer was used as a standard. Handheld and fixed tonometers were also compared by means of measurements in pressurized pig eyes.

Results: At a low intraocular pressure (IOP), there is a longer impact time than at a high IOP. A handheld tonometer causes more variation in impact times, especially at low intraocular pressure (IOP), than a fixed tonometer.

Conclusions: The new induction‐based impact method can be used to measure IOP. When a fixed tonometer is used, there is less variation in impact times.
Immunolocalization of transforming growth factor‐β1 and tenascin in human secondary cataract
Authors: Latvala Terho , Uusitalo Marita , Puolakkainen Pauli , Kivelä Tero , Tervo Timo
Published: March 2003

Purpose: This study was carried out to investigate the distribution of transforming growth factor‐β1 (TGF‐β1) and the extracellular matrix (ECM) glycoprotein tenascin in secondary cataract and anterior subcapsular cataract.

Methods: Twenty‐four pseudophakic human eyes with secondary cataract, obtained at autopsy 1 d to 10 yr (mean 2.4 yr) after cataract surgery, were studied. Additionally, a specimen from an anterior subcapsular cataract was included. Immunohistochemistry was used to localize TGF‐β1 and tenascin in secondary cataract and in anterior subcapsular cataract.

Results: Polyclonal antibody to TGF‐β1 immunolabelled spindle‐shaped cells in the plaques of secondary cataract in all eyes. Instead, the cells present in Soemmering's ring cataract were not labelled. The ECM in the plaques of secondary cataract was immunoreactive for tenascin in all eyes. In anterior subcapsular cataract spindle‐shaped cells and ECM showed similar immunoreactivity.

Conclusion: Spindle‐shaped cells that are immunolabelled with TGF‐β1 and ECM showing tenascin‐like‐immunoreactivity are present in secondary cataract and in anterior subcapsular cataract, thus implicating a possible role in secondary cataract.
Extramedullary plasmacytoma of the orbit
Authors: Uceda‐Montañés A. , Blanco G. , Saornil M. A. , Gonzalez C. , Sarasa J. L. , Cuevas J.
Published: March 2003

Purpose: To report a case of extramedullary plasmacytoma of the orbit.

Methods: A 71‐year‐old patient presented with diplopia eyelid fullness and limitation of ocular motility in the left eye. Visual acuity was counting fingers, intraocular pressure 34 mmHg and fundus eye examination showed choroidal folds in the involved eye.

Results: CT scan showed a mass filling the superior and external left orbit without bone destruction. A biopsy was performed revealing that the tumour was composed of plasmacytoid cells positive with immunohistochemical stains for Kappa light chains and epithelial membrane antigen. Systemic work up was negative. The diagnosis of extramedullary orbital plasmacytoma was made. The patient was treated with external beam radiotherapy (40 Gy) and has remained disease free for four years (49 months).

Conclusion: Extramedullary plasmacytomas of the orbit are extremely rare tumours. Accurate and early diagnosis is essential for the therapeutic approach. Extensive medical work up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving the orbit is needed when the diagnosis of orbital extramedullary plasmacytoma is suspected because treatment and prognosis are very different.
Regional differences in optic disc and retinal circulation
Authors: Schwartz Bernard , Harris Alon , Takamoto Takenori , Kagemann Larry , Evans David , Chung Hak S.
Published: March 2003

Purpose: To determine regional differences in the circulation of the optic disc, the peripapillary choroid and the retinal vessels using the techniques of computerized image analysis and fluorescein angiography.

Methods: Ten young normal subjects were studied. Fluorescein angiography was performed with a scanning laser ophthalmoscope. The rate of filling of fluorescein or slope was measured in the four quadrants of the optic disc, the peripapillary choroid and the major retinal arteries and veins. A total of 125 points was measured from each image of the fluorescein angiograms for a total of 20 to 30 images. Retinal vessel width was measured using computerized image analysis.

Results: Comparison of the rates of filling of fluorescein or slopes showed significant differences from zero among the four quadrants of the optic disc (p=0.01 to <0.02), of the peripapillary choroid (p=0.01 to <0.05) and among the major retinal arteries (p=0.01 to <0.02) and retinal veins (p=0.02 to <0.05). No significant differences were noted between the quadrants for retinal arterial width with the retinal veins only showing a significant difference between the inferior nasal and inferior temporal vein (p=0.02 to <0.05).

Conclusion: Evaluation of the circulation of the optic disc, retina, and peripapillary choroid should take into account regional differences among these structures.
Bacteriology and antibiotic therapy in congenital nasolacrimal duct obstruction
Authors: Kuchar Andreas , Lukas Julius , Steinkogler Franz Josef
Published: March 2003

Aims: To determine the current bacteriology of mucopurulent discharge in congenital nasolacrimal duct obstruction (CNDO), the in vitro response to different antibiotics and clinical effectiveness of the antibiotics used to relieve babies from mucopurulent discharge.

Methods: A clinical study evaluated the effectiveness of local antibiotic agents clinically and in vitro. 50 samples were obtained from the lacrimal sac in 47 young children with CNDO. The patients' mean age was 21.45±17.09 months. The cultures were incubated and the infectious agents isolated. Sensitivity testing was performed in each case, testing 10 different local antibiotics. A control group of 10 babies expected for cataract surgery was constituted.

Results: Cultures were positive for bacteria from 72.64% of the samples. 73 isolates were recovered from the 50 samples. The bacterial species most frequently cultured was Streptococcus pneumoniae, representing 35.4% of the isolates, followed by Haemophilus influencae (19.6%). The sensitivity testing revealed ofloxacin and tetracycline to be the most effective drugs as monotherapy. Clinically the combination of bacitracin and neomycin, primarily used in half of the patients as initial therapy, was successful in curing the dacryocystitis in 82.5% of all patients.

Conclusion: Chronic dacryocystitis due to CNDO is associated with an equal proportion of Gram positive and negative bacteria, which can be treated with a high effectiveness by a combination drug of bacitracin and neomycin.
Role of Histamine in Allergic Conjunctivitis
Authors: Leonardi Andrea
Published: March 2003

ABSTRACT. Histamine remains the main mediator released by both specific allergic and non‐specific mast cell activation. Histamine is the classic mediator of itching, flare and redness. The effects of histamine in allergic conjunctivitis are mediated by H1‐receptor activation on blood vessels and nociceptive nerves. Histamine effects may be prolonged and exaggerated since a defect in the histaminase enzymes has been recently demonstrated in VKC. The effects of histamine on conjunctival tissues may be more complex than those manifested by the simple symptom of itching. In fact, proinflammatory effects of histamine on conjunctival epithelial cells and fibroblasts have been demonstrated. Preliminary results showed that the H1 antagonist, emedastine, reduces significantly cytokine production from histamine‐stimulated fibroblasts.
Comparative Study of Clinical Efficacy and Tolerance in Seasonal Allergic Conjunctivitis Management with 0.1% Olopatadine Hydrochloride versus 0.05% Ketotifen Fumarate
Authors: Aguilar Alejandro J.
Published: March 2003

Objective: To compare the clinical efficacy and tolerance of 0.1% olopatadine hydrochloride (OHC) versus 0.05% ketotifen fumarate (KF) in the management of allergic conjunctivitis.

Materials and Methods: Eighty adult patients with a history of allergy (allergic conjunctivitis, hay fever, asthmatic bronchitis and dermatitis) that were showing allergic conjunctivitis signs and symptoms (itching, hyperemia, mucous discharge and tearing) at the time of inclusion in this study were evaluated. Patients were divided in two groups, A and B. Group A patients were treated with OHC and group B patients were treated with KF. Both groups received one drop in the affected eye every 12 hrs. The start time of this study was the first patient visit, in which the medication was instilled for the first time. Both groups of patients were evaluated 30 min, 48 hr., 7 days and 14 days later. Local tolerance of each medication was evaluated.

Results: Clinical improvement of the signs and symptoms of allergic conjunctivitis occurred in 42.5% to 62.5% of the patients in Group A when assessed 30 min following the first topical ocular dose of olopatadine. However, mucous discharge was not affected. Forty‐eight (48) hrs. after the first instillation, improvements in 57.5% to 75% of the patients were shown in every evaluated parameter. After 7 days of treatment, positive clinical results were observed in 80% to 87.5% of the treated patients. Except for the patients that were dismissed from the study before the seventh day of treatment due to the absence of therapeutic response (4/40), all patients satisfactorily completed the therapeutic plan by the seventh day. No intolerance reactions were observed in patients of this group.

In Group B patients (KF), clinical improvement of the signs and symptoms measured in the study was shown in 20.0% to 47.5% 30 min after instillation. As observed with olopatadine, no improvement in the number of patients showing mucous discharge was noted at the 30‐min time point. At 48 hr. after the first instillation, 27.5% to 48% of patients showed improvement in every evaluated parameter. After 7 days of treatment, improvement was observed in 60% to 75% of patients. On Day 14, positive responses were observed in 67.5% to 75% of patients. Seventeen and one‐half percent of the patients were dismissed from the study before the seventh day of treatment due to the absence of a therapeutic response. Approximately 23% of the patients had mild reactions of intolerance (stinging) which was not a cause to discontinue the treatment.

Conclusion: Olopatadine hydrochloride controlled allergic conjunctivitis symptoms and signs more rapidly and to a greater extent than ketotifen fumarate. Fewer cases of treatment failure were noted with OHC, and no local intolerance reactions were observed, while KF triggered mild reactions (stinging) in 23% of patients.
Reversible bilateral internuclear ophthalmoplegia following head injury
Authors: Hsu Huan‐Chen , Chen Han‐Jung , Lu Kang , Liang Cheng‐Loong
Published: March 2003

ABSTRACT. Purpose: Internuclear ophthalmoplegia is a syndrome produced by a lesion in the medial longitudinal fasciculus. Head trauma is a rare cause. We describe an unusual case of bilateral internuclear ophthalmoplegia as an isolated sequela following a minor head injury that resolved completely 3 months later.

Methods: Case report. Magnetic resonance images.

Results: A 34‐year‐old male developed typical bilateral internuclear ophthalmoplegia after closed head injury. Attempted convergence was normal. Magnetic resonance imaging clearly delineated the focal hemorrhage in the medial longitudinal fasciculus region by showing a small bright lesion in the pontomesencephalic junction in the midline on both T2‐weighted and T1‐weighted images. The diplopia resolved 4 weeks later. Three months after the accident, his versions were completely normal.

Conclusion: Isolated internuclear ophthalmoplegia should be considered in the differential diagnosis when one encounters an adduction deficit in a recently traumatized patient. Magnetic resonance images enhance the ability to correlate the clinical findings with the anatomic lesion.
Effect of localized defocus on detection thresholds for different sized targets in the fovea and periphery
Authors: Anderson Roger S. , McDowell D. Rodney , Ennis Fergal A.
Published: March 2003

ABSTRACT. Purpose: Previous studies of optical blur in perimetry have measured the effect of foveal refractive error on peripheral perimetric detection thresholds. Since peripheral refractive error can be significantly different from that of the fovea we wished to remove the ambiguity of previous results by correcting the actual peripheral refractive error first before adding blur.

Methods: We measured detection thresholds in the fovea and at 30 degrees in the horizontal temporal field in two trained observers. Peripheral refractive error was determined at each location and thresholds measured at the same locations for stimuli ranging in size from 0.2 to 6.4 degrees and refractive errors between ±4.00 diopters.

Results: Foveal thresholds increased immediately with increasing refractive error, particularly for smaller stimulus sizes. At 30 degrees, thresholds for smaller stimuli were less affected by defocus initially and then increased more sharply. Larger stimuli were relatively unaffected by defocus such that when stimulus size reached 1.6 degrees there was little or no increase in threshold for refractive error between ±4.00 diopters.

Conclusions: Peripheral refractive error, largely forgotten by perimetrists, has a significant effect on performance, particularly for smaller stimuli. Differences in foveal vs peripheral viewing can be explained by differences in ganglion cell receptive field sizes.
The impact of glaucoma on the quality of life of patients in Norway
Authors: Odberg Tor , Jakobsen Jan Erik , Hultgren Staale J. , Halseide Reidar
Published: March 2003

ABSTRACT.Purpose:To elucidate the relationship between the visual difficulties reported by patients treated for glaucoma and their objective functional damage, and to evaluate the reliability of the patient responses.

Methods:Questionnaires concerning quality of life filled in at home by 589 patients treated for chronic open angle glaucoma were correlated to corresponding questionnaires returned from their ophthalmologists.

Results:Few of our patients had a visual field damage judged to be of functional significance. There was a weak to moderate association between both visual field defects and decreased visual acuity and self‐reported visual difficulties.

A high proportion of the patients had normal binocular visual field and a stable disease, raising the suspicion that some of them were treated for ocular hypertension. The agreement between the responses from the patients and the ophthalmologists concerning the topical treatment was good, regarding treatment duration and other diseases of the patients the agreement was moderate.

Conclusion:The association between subjective visual disability and presence of visual field defects was weak to moderate in our patients treated for glaucoma, and this association was further weakened by adjusting for visual acuity. Some patients might be treated unnecessarily, and a favourable prognosis might be given to most of them. The reliability of the patients in general was good.
An evaluation of the retinal nerve fiber layer thickness by scanning laser polarimetry in individuals with dementia of the Alzheimer type
Authors: Kergoat Hélène , Kergoat Marie‐Jeanne , Justino Lisette , Chertkow Howard , Robillard Alain , Bergman Howard
Published: March 2003

ABSTRACT. Purpose: To determine, using scanning laser polarimetry, whether or not the retinal nerve fiber layer (RNFL) is altered in dementia of the Alzheimer type (DAT).

Methods: Thirty individuals with mild to moderate DAT and 30 healthy age‐matched controls participated in the study. Fundus images were acquired with a Nerve Fiber Analyzer. RNFL thickness measurements were obtained under an ellipse located 1.75 disc diameter from the optic nerve head (ONH) center.

Results: No differences in RNFL thickness were observed between DAT and healthy subjects. The regional distribution of RNFL thickness was similar between the two test groups, with the RNFL being thickest in the superior and inferior retinal segments relative to the nasal and temporal regions.

Conclusions: Our data indicate that the RNFL is not altered in DAT, at least in the earlier stages of the disease.
Rieger syndrome is associated with PAX6 deletion
Authors: Riise Ruth , Storhaug Kari , Brøndum‐Nielsen Karen
Published: March 2003

ABSTRACT. Purpose: Rieger syndrome is an autosomal dominant condition defined by anterior segment dysgenesis in combination with facial, dental, skeletal and umbilical abnormalities. To date Rieger syndrome has been associated with mutations in the PITX2 gene at chromosome 4q25 and a second locus has been found at chromosome 13q14.

Methods: We describe a Rieger syndrome case with all the typical dysmorphic features and the molecular genetic finding by use of FISH analysis of the PAX6 gene.

Results: An eight‐year‐old girl had iris stroma hypoplasia, corectopia and iridogoniodysgenesis. She had an underdeveloped premaxilla and a congenital absence of nine teeth in the maxilla. The front teeth in the mandible were peg‐shaped and all teeth were small. There was failure of involution of the periumbilical skin. FISH analysis using probes for the PAX6 gene showed a small deletion for the PAX6 gene on one homologue of chromosome 11.

Conclusion: Rieger syndrome can – in addition to PITX2 gene mutations and abnormalities at chromosome 13q14 – be associated with PAX6 gene abnormalities.
The visual field following acute primary angle closure
Authors: Aung Tin , Looi Audrey L. G. , Chew Paul T. K.
Published: March 2003

ABSTRACT. Purpose: To determine the frequency and type of visual field loss six months after an episode of acute primary angle closure (APAC), and to identify risk factors for the development of such field loss.

Methods: This was a cross sectional observational study. All patients who suffered from an episode of APAC at two Singapore hospitals over a one‐year period underwent static automated threshold perimetry six months after presentation.

Results: 38% of (29) patients with APAC have significant visual field defects six months after the acute episode. The majority of those with abnormal fields had hemifield defects, consistent with nerve fiber bundle pattern loss. Those with pre‐existing chronic glaucoma or who develop a rise in intraocular pressure during follow‐up are at risk of visual field loss. The risk of visual field loss is also significant if the duration of symptoms exceeds 7 days.

Conclusions: The frequency of visual field loss at 6 months after APAC was low at only 38%. As the majority of eyes have no evidence of detectable functional damage developing as a consequence of the acute episode, APAC may not be blinding if treated promptly and adequately.
Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion
Authors: Cursiefen Claus , Hammer Thomas , Küchle Michael , Naumann Gottfried O. H. , Schlötzer‐Schrehardt Ursula
Published: March 2003

Purpose: To determine histopathologically the prevalence of pseudoexfoliation (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to evaluate eyes with PEX material in the anterior segment and CRVO ultrastructurally for PEX deposits in the vicinity of central retinal vessels. These deposits could explain an association of CRVO and PEX.

Methods: All surgically enucleated eyes with secondary angle closure glaucoma due to rubeotic iris secondary to ischemic CRVO (1981–1998) available were re‐analyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9±8.5 years [range: 51–91]). Eyes with PEX in the anterior segment and available optic nerve cross sections were examined by electron microscopy for PEX material in the retrolaminar (n=7) and intralaminar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981–1998) with sections available served as age‐matched controls (n=107; 76.4±5 years [range: 70–91]).

Results: PEX material was present light microscopically in the anterior segment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age‐matched eyes with choroidal malignant melanoma (1.9%; p<0.05). Electron microscopically, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra‐ and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment and CRVO analyzed.

Conclusions: Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intraocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small number of optic nerves analyzed here, there seems to be no morphologically evident PEX vasculopathy in the central retinal vessels both within and immediately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.
Short wavelength automated perimetry
Authors: Wild John M.
Published: March 2003

ABSTRACT. Short Wavelength Automated Perimetry (SWAP) utilizes a blue stimulus to preferentially stimulate the blue cones and a high luminance yellow background to adapt the green and red cones and to saturate, simultaneously, the activity of the rods. This review describes the theoretical aspects of SWAP, highlights current limitations associated with the technique and discusses potential clinical applications. Compared to white‐on‐white (W‐W) perimetry, SWAP is limited clinically by: greater variability associated with the estimation of threshold, ocular media absorption, increased examination duration and an additional learning effect. Comparative studies of SWAP and W‐W perimetry have generally been undertaken on small cohorts of patients. The conclusions are frequently unconvincing due to limitations for SWAP in the delineation of abnormality and of progressive field loss. SWAP is almost certainly able to identify glaucomatous visual field loss in advance of that by W‐W perimetry although the incidence of progressive field loss is similar between the two techniques. Increasing evidence suggests that functional abnormality with SWAP is preceded by structural abnormality of the optic nerve head and/or the retinal nerve fibre layer. SWAP appears to be beneficial in the detection of diabetic macular oedema and possibly in some neuro‐ophthalmic disorders.
Increased aqueous humor basic fibroblast growth factor and hyaluronan levels in relation to the exfoliation syndrome and exfoliative glaucoma
Authors: Gartaganis S. P. , Georgakopoulos C. D. , Exarchou A. M. , Mela E. K. , Lamari F. , Karamanos N. K.
Published: March 2003

Purpose: To quantify the concentrations of basic fibroblast growth factor (bFGF) and hyaluronan (HA) in the aqueous humor of patients with the exfoliation syndrome (XFS) or exfoliative glaucoma (XFG).

Methods: Aqueous humor bFGF and HA levels were measured in 13 patients with XFS and in 7 patients with XFG. The results were compared with those obtained from 17 healthy controls.

Results: Mean bFGF levels were significantly higher in the XFG patients than those in the XFS patients, which in turn were higher than the bFGF levels in the healthy individuals. Aqueous humor HA levels in both patients with the XFS and the XFG were significantly higher compared to the controls.

Conclusion: We suggest that bFGF plays an important role in the pathogenesis of XFS and XFG, as well as in the synthesis of secreted HA, which may result in connective tissue degradation that affects the ocular anterior segment.
Emergency treatment of chemical and thermal eye burns
Authors: Kuckelkorn Ralf , Schrage Norbert , Keller Gabriela , Redbrake Claudia
Published: March 2003

Chemical and thermal eye burns account for a small but significant fraction of ocular trauma. The speed at which initial irrigation of the eye begins, has the greatest influence on the prognosis and outcome of eye burns. Water is commonly recommended as an irrigation fluid. However, water is hypotonic to the corneal stroma. The osmolarity gradient causes an increased water influx into the cornea and the invasion of the corrosive substance into deeper corneal structures. We therefore recommend higher osmolarities for the initial rinsing to mobilize water and the dissolved corrosives out of the burnt tissue. Universal systems such as amphoteric solutions, which have an unspecific binding with bases and acids, provide a convenient solution for emergency neutralisation. Both conservative anti‐inflammatory therapy and early surgical intervention are important to reduce the inflammatory response of the burnt tissue. In most severe eye burns, tenonplasty re‐establishes the conjunctival surface and limbal vascularity and prevents anterior segment necrosis.
Cataract surgery on diabetic patients. A prospective evaluation of risk factors and complications
Authors: Flesner Per , Sander Birgit , Henning Vibeke , Parving Hans‐Henrik , De La Cour Morten Dornonville , Lund‐Andersen Henrik
Published: March 2003

Purpose: This study presents an evaluation of cataract surgery on diabetic patients. One experienced surgeon carried out phaco emulsification on all subjects and the same surface‐coated one‐piece PMMA‐lens‐type was implanted. The lens fluorescence and the blood‐aqueous barrier (BAB) were then evaluated as experimental preoperative risk indicators.

Results:
  During follow‐up, 10 out of 39 diabetic patients progressed unilaterally in diabetic retinopathy or developed macular oedema, a significant relative risk. Neither lens fluorescence, BAB, HbA1c, level of retinopathy, type/duration of diabetes, diabetes treatment or antihypertensive treatment differed significantly between the group of patients with postoperative progression of retinopathy/macular oedema and those without. Results indicated NIDDM (non‐insulin‐dependent diabetes mellitus/type 2 diabetes) patients might have increased risk of a postoperative macular oedema.

Conclusion: When diabetic retinopathy (DR) is not in a proliferative phase it should not be regarded as a contraindication to modern cataract surgery. Neither lens fluorescence nor BAB is valuable as a risk indicator for postoperative progression of DR.
Primary transpupillary thermotherapy (TTT) for malignant choroidal melanoma
Authors: Stoffelns B. M.
Published: March 2003

Purpose:  To evaluate the efficacy of transpupillary thermotherapy (TTT) as the only method of treatment for small choroidal melanoma.

Patients and Methods:  In a prospective non‐randomized analysis, 20 patients with primary choroidal melanoma (posterior to the equator with base ≤ 2 and thickness ≤ 4.5 mm) were treated with TTT as the only method of treatment (diode laser at 810 nm, beam diameter 3 mm, power setting 0.3–0.9 W, exposure time 20–37 min). During follow‐up of at least 6 months, clinical aspects, ultrasonographic tumour thickness, fluorescein and indocyanine green angiographic patterns, visual acuity and ocular side‐effects were recorded.

Results:  In 17 eyes the tumour regressed significantly within 3 months after one treatment session (to a flat chorioretinal scar in 15 eyes). Despite a clinically flattened chorioretinal scar, fluorescein and indocyanine green angiography revealed that choriocapillary vessels in the heat‐treated areas of 15 eyes remained perfused. Three amelanotic melanomas showed almost no response to TTT after repeated treatment at higher power settings. Visual acuity remained unchanged or improved in 12 eyes. Ocular side‐effects included posterior synechia of the iris (1), macular oedema (2) and temporary retrobulbar pain (2). No patient showed tumour recurrence or metastases during follow‐up.

Conclusions:  Preliminary results obtained by this study demonstrate good efficacy and visual outcome following TTT as the only method of treatment for small choroidal melanoma. However, indocyanine green angiographic findings suggest that tissue damage in the choroidal layer might be less effective, which perhaps may lead to a higher rate of tumour regrowth. Long‐term follow‐up is required to obtain data on late ocular side‐effects, tumour recurrence and metastasis.
Vitreous surgery combined with internal limiting membrane peeling for traumatic macular hole with severe retinal folds
Authors: Ikeda Tomohiro , Sato Keiko , Otani Hiroshige , Yu Saiyuu , Ikeda Naohiro , Mimura Osamu
Published: March 2003

Purpose: To report a case of a traumatic macular hole with severe retinal folds in which vitreous surgery combined with internal limiting membrane (ILM) peeling was beneficial. To demonstrate that the area from which the ILM was peeled can be clearly differentiated by scanning laser ophthalmoscopy.

Methods:
A posterior hyaloid detachment was created during vitreous surgery on a 34 year old man with a traumatic macular hole. The remaining vitreous was resected and the ILM was peeled. The fundus was examined through a scanning laser ophthalmoscope before and after the surgery.

Results: The retinal folds disappeared concurrently with the detachment of the ILM, resulting in closure of the macular hole. The area from which the ILM was peeled was clearly observed through the scanning laser ophthalmoscope.

Conclusion: In this patient, it was helpful to perform not only posterior hyaloid detachment but also ILM peeling. The scanning laser ophthalmoscope was highly useful for observing the area from which the ILM was peeled.
A case of Coats' disease with a peeling of premacular fibrosis after photocoagulation
Authors: Sugimoto Masahiko , Sasoh Mikio , Ito Yoshikazu , Miyamura Masataka , Uji Yukitaka , Chujo Shinya
Published: March 2003

We report a 26‐year‐old man with Coats' disease associated with premacular fibrosis. As an initial treatment, the peripheral exduative area was treated with argon laser photocoagulation. Six weeks later, the premacular fibrosis was peeled off and the posterior vitreous membrane was also detached. The patient's visual acuity improved to 20/20. We also observed a change of the vitreous component before and after the treatment that was similar to posterior vitreous detachment (PVD). This is the first reported case in which a distinct vitreous change was observed after premacular fibrosis peeling in Coat's disease.
Acquired anomalous head posture following loss of vision in one eye
Authors: Nucci Paolo , Rosenbaum Arthur
Published: March 2003

Background:  We studied the anomalous head postures (AHPs) of five monocular viewing patients and investigated the possible causes and the appropriate surgical strategies to correct each condition.

Methods:  Five patients with acquired visual loss in one eye and associated head tilt and/or turn were examined and treated for correcting the head posture according to the etiology of their respective AHPs.

Results:  Three types of anomalous head position have been detected: head tilt related to cyclotropia, face turn associated with adduction blocked monocular nystagmus, and face turn to centre the visual field. Surgical plans were prepared according to the mechanism of the AHP in question. After surgery, all patients showed a marked reduction of the head tilt, except one who had a recurrence of the face turn 1 week postoperatively. Mean follow‐up time was 19 months.

Horizontal transposition of the vertical muscles for correcting cyclotropia offered stable normalization of the AHP in three monocular viewing patients with head tilt, and represents a safe, viable and easy alternative to the Harada Ito procedure. Horizontal recession of the medial rectus of the fixing eye minimized the abduction nystagmus and relieved the need to adduct the fixing eye and subsequently rotate the head toward the fixing eye in one patient. Recurrence of the AHP occurred in one patient.

Conclusion:  Different mechanisms may account for AHP in monocular viewing patients. Different surgical procedures may be used to correct the anomalous position. Careful patient selection and etiological diagnosis of AHP is required prior to developing a surgical strategy.
John G. Lindberg and the discovery of exfoliation syndrome
Authors: Tarkkanen Ahti , Kivelä Tero
Published: March 2003

John G. Lindberg, a young Finnish ophthalmology resident, started a research project in 1914 aiming at an academic dissertation. His plan was to elucidate Axenfeld's observations on iris changes in senile eyes. Axenfeld had described two types of degeneration of the iris: a hyaline degeneration of the iris pupillary zone causing poor pupillary dilatation with mydriatics and an atrophy of the iris pigment epithelium at the pupillary border. For his research Lindberg had to construct a slit‐lamp biomicroscope by studying Gullstrand's monograph on the matter; slit‐lamp biomicroscopes were not commercially available at that time. A Sach's lamp was used for transillumination of the iris. While conducting his research Lindberg paid attention to greyish flakes and fringes at the pupillary border. He also noted how this strange material formed a membrane on the anterior lens surface. Documentation was made by skilful hand drawings. The new phenomenon was found to be as common in cataract patients as in non‐cataractous controls older than 55 years. The phenomenon was observed in 50% of glaucoma patients. Age was the decisive factor; the phenomenon was more prevalent with advancing age. Lindberg published his results as a thesis at the University of Helsinki in 1917. When attending a Nordic Congress of Ophthalmology in 1921, Lindberg met Norwegian ophthalmologist, Birger Malling, and gave him his thesis and explained the new findings. In 1920–21 Lindberg worked at Axenfeld's clinic in Freiburg, Germany. During this period he met in Basel, Switzerland, a Swiss ophthalmologist, Alfred Vogt. He told Vogt about his research and provided him with copies of his thesis. Both Malling and Vogt published papers on exfoliation in 1923 without referring to Lindberg's work. Lindberg did not, however, interfere with these papers. Thus Lindberg was forgotten by his contemporaries as a scientist. However, his main conclusions on exfoliation are still valid today. The life of this remarkable ophthalmologist is described in the present paper.
Uveal effusion and ultrasonic imaging: a clinical series
Authors: Fledelius Hans C. , Fuchs Helle Josefine , Jensen Peter Koch , Scherfig Erik
Published: March 2003

Purpose:  To establish the diagnostic role of imaging by ultrasound for the diagnosis of uveal effusion syndrome.

Methods:  Using ultrasonic imaging features as the main criteria for evaluation, the recorded data from 16 patients with presumed uveal effusion seen between 1994 and 2000 were reviewed and analysed for clinical manifestations and current diagnostic suggestions. Eventually, as cumulating experience suggested that ultrasound is capable of indicating uveal effusion, the study set‐up became in part more prospective.

Results:  The two main ultrasonic features found were: (1) extended multi‐layered detachment patterns by B‐scan, often kinetically mobile; (2) a spongy oedematous ciliary body region, often with interstitial lacunae, as demonstrated by high‐resolution ultrasound biomicroscopy (50 Mhz).

Conclusions:  In patients with visual loss and ambiguous detachment‐like fundus pathology, ultrasonic features are often of practical guidance for diagnosing uveal effusion syndrome.
Cataract in children after bone marrow transplantation: relation to conditioning regimen
Authors: Holmström Gerd , Borgström Birgit , Calissendorff Berit
Published: March 2003

Purpose:  To compare the frequency of cataract development in bone marrow transplanted children who have been given either total body irradiation (TBI) or busulphan as conditioning treatment before bone marrow transplantation (BMT).

Material and methods:  Forty‐five children who underwent BMT between 1987 and 1994 were included in the study. Twenty‐one children were conditioned with TBI and 24 with busulphan before BMT. All children underwent an ophthalmic examination before BMT in order to exclude lens opacities. Yearly examinations for 2–10 years were performed after BMT.

Results:  Cataracts developed in 20 of the 21 (95%) children conditioned with TBI and in five of the 24 (21%) children conditioned with busulphan. There was no relationship between cataract development and age at BMT, or between cataract development and prednisolone given before or after BMT.

Conclusion:  The present study confirms earlier reports of the high risk of cataract development after TBI and suggests that busulphan is related to cataract development, although less frequently than TBI. The report discusses the possible additive effect of the disease itself, of any corticosteroid treatment and of other cytostatic drugs. It then stresses the importance of early diagnosis of cataracts in children in order to prevent the development of amblyopia.
ON‐pathway disturbance in two siblings
Authors: Shinoda Kei , Ohde Hisao , Inoue Rikako , Ishida Susumu , Mashima Yukihiko , Oguchi Yoshihisa
Published: March 2003

Purpose:  To present two clinical cases diagnosed with predominant cone dystrophy and demonstrating early disturbance in the on‐centre bipolar cells (ON‐pathway).

Methods:  Electrophysiological findings are presented in two siblings with predominant cone dystrophy. The subjects showed no remarkable ophthalmoscopic or fluorescein angiographic retinal changes, but demonstrated progressive visual disturbance during their 20s.

Results:  The electroretinograms (ERGs) showed reduced dark‐adapted responses but the positive component of the photopic ERG was absent. Response to 30 Hz flicker was severely reduced. Electroretinograms elicited by long‐duration stimuli showed a loss of the b‐wave, and the off‐response was slightly reduced. In both patients, multifocal ERGs (m‐ERGs) were more reduced within the central 10 °, where the ON‐pathway is normally a major contributor.

Conclusion:  We conclude that these patients may be affected by an abnormality of the synapses of the cone receptors and that their decrease in vision might, at least initially, be due to selective ON‐pathway dysfunction.
Comparison of the cardiovascular effects of unoprostone 0.15%, timolol 0.5% and placebo in healthy adults during exercise using a treadmill test
Authors: Stewart William C. , Stewart Jeanette A. , Crockett Steve , Kubilus Christine , Brown Alison , Shams Naveed
Published: March 2003

Purpose: To compare the cardiovascular effects of unoprostone 0.15%, timolol 0.5% and placebo in healthy adults during exercise using a treadmill test.

Methods:  Thirty subjects aged 18–37 years (mean age = 24.1 years) were randomized to one of six treatment sequences in a three‐treatment, three‐period crossover study (William's design). Study medication was instilled b.i.d. for 5 days before visits 2, 3, and 4. Between treatments, study medication was washed out for 9–10 days. Each subject underwent a submaximal treadmill test at visits 2 through 4, 15 min after dosing.

Results:  After 15 min of exercise, average heart rates were 143.1 ± 21.2, 134.5 ± 20.0 and 145.4 ± 20.8 bpm for the unoprostone, timolol and placebo treatments, respectively. At no timepoint was there a statistically significant difference between the unoprostone and placebo treatments (p > 0.05). Beginning with the second minute of exercise, timolol produced a greater decrease in heart rate at all timepoints from placebo than unoprostone (p < 0.05). No consistent differences in systolic or diastolic blood pressure were observed between drug treatments (p > 0.05).

Conclusions:  Unlike timolol, unoprostone 0.15% does not reduce exercise‐induced heart rate, indicating a lack of clinical effect on systemic β‐adrenergic receptors in young and healthy subjects.