Metabolic, pediatric, and systemic ophthalmology最新文献

A severe, bilateral, posttraumatic recurrent corneal erosion in a 29-year-old woman was treated by bilateral lamellar keratectomy. The surgical procedure was performed first in the right eye. Under local anesthesia the defective corneal region stained by fluorescein was completely removed. It comprised a lamella measuring 2 X 3 mm and included epithelium and underlying superficial stroma, both of which showed abnormal features. Following this procedure, her right eye was asymptomatic for over 6 yr. Surgical procedure in the left eye was performed in the same manner except that only a part of the stained cornea containing superficial layers of epithelium was removed, in order to prevent central scarring. Despite surgery, the recurrent painful attacks in this eye continued.

Five groups of kittens (N = 13) were dark reared for 9.5-20 months following normal binocular exposure of 0-85 days after natural eye opening and 1 month of monocular deprivation. For comparison, kittens monocularly deprived (MD) for 10 months (N = 2) and normal adult cats (N = 13) served as controls. The ocular dominance distribution of cortical cells showed a clear (although small) bias in the first group of kittens which received the minimal exposure. A striking effect was obtained in the proportion of visually unresponsive cells (55.1%) in this first group of cats. Concerning orientation and direction selectivity, the highest proportions of nonselective cells, 16.1% and 33.3%, were obtained in the first two groups of cats respectively. It was concluded that periods of monocular deprivation shorter than that used in the present study (4 weeks) and without any previous visual experience would be ineffective if followed by a year or more of total absence of visual experience. Prolonged dark rearing therefore, masks the effect of prior monocular deprivation to a large extent. In addition, the results emphasize the fact that the age factor is more important than the duration of the monocular visual experience.

The effect of subconjunctivally injected hyaluronidase on ocular hydrodynamics was tested in 30 living human normal and 30 open-angle glaucoma eyes. It was found that after 1,500 TU of hyaluronidase injected subconjunctivally, the outflow resistance was significantly lowered: 34% in normal eyes, on the average; and by about 57% in the glaucomatous eyes. The possibility of either a higher amount of hyaluronic acid in the glaucomatous eyes or a normal amount of hyaluronic acid in the presence of compromised trabeculum is discussed. Clinical applications and further research are advocated.

Forty-four patients with periorbital cellulitis or abscess were admitted to the hospital for treatment in a five-year period. Twenty-five patients were less than 5 years old; nine were more than 20 years old. Skin infection or trauma, upper respiratory tract infection, and sinusitis were the most common predisposing causes. Staphylococcus aureus was cultured in 13 patients and Haemophilus influenzae in nine patients. Ampicillin and methicillin were the chief antibiotics used. Ten patients required surgical drainage.

The in vitro response of white blood cells of maturity onset diabetics to corticosteroids was the subject of these experiments; the response was assessed with the leucocyte migration inhibition assay. Leucocytes from patients with nonproliferative retinopathy demonstrated increased responsiveness to corticosteroids in comparison with the white cell response of both controls and patients with proliferative retinopathy. Similarly leucocyte migration inhibition was greater in the insulin independent than in insulin dependent diabetics. Furthermore leucocyte migration responsiveness may be related to duration of the diabetic state. This preliminary study points to the possible importance of corticosteroids and their receptors in retinopathy and angiopathy.

A 17-year-old man underwent five perforating keratoplasties. The first operation was due to keratoconus and the first two grafts were rejected. Five months after the second operation, the patient complained of severe ocular pains and retrocorneal and iris membranes were noted. Because of acute glaucoma, a peripheral iridectomy was performed, followed by by trabeculectomy due to persistent high pressure. After the third keratoplasty, a diagnosis of epithelial downgrowth was histopathologically established. Fourth and fifth keratoplasties were done because of corneal abscesses, this time combined with membrane peeling from the vitreous cavity. Epithelial cells were diagnosed again in histopathological examination of material removed from the vitreous. The rarity of epithelial downgrowth after surgically uncomplicated keratoplasty and the importance of the symptom of severe disabling pain are stressed.

The results of a survey of 50 cases of endophthalmitis following surgery, trauma, corneal ulcers, or of endogenous origin are described. Most of the post-surgical cases followed intracapsular cataract surgery and in 48.1% of the eyes, the predominant organisms were gram positive bacteria. In cases where the infected eyes were treated with topical, intravenous and subconjunctival injections of antibiotics, 57.2% of the eyes were lost; however, in 6 cases, where vitrectomy and intravitreal injection of antibiotics was performed, only 1 of the 6 eyes was lost (16.6%). In this eye, however, the vitreous removal and antibiotic injection was done in advanced stage of the disease. In one case where the vitrectomy and antibiotic therapy was performed early, the patient attained good vision.

Effects of adrenergic and cholinergic drugs and prostaglandin E1 on cyclic nucleotide accumulation and parameters of growth and basement membrane synthesis were examined in corneal epithelial cell cultures. 8-bromo-cGMP significantly (p less than 0.05) enhanced incorporation of labeled thymidine and leucine, as did acetylcholine and carbamylcholine, which elevated cGMP and decreased cAMP/cGMP ratio. Responses to acetylcholine were abolished by atropine and alpha-bungarotoxin. Precursor incorporation was inhibited by dibutyryl cAMP and adenosine 5'-monophosphate and by norepinephrine, epinephrine, prostaglandin E1, and theophylline, which significantly elevated cAMP levels and cAMP/cGMP ratio. Propranolol, but not phenoxybenzamine, blocked responses to effective concentrations of norepinephrine. Norepinephrine, PGE1, and dibutyryl cAMP also significantly elevated uptake of labeled glucosamine and incorporation of labeled proline into collagenase-sensitive protein or the hydroxyproline fraction of protein hydrolysates, while acetylcholine had no effect on parameters of basement membrane synthesis. Propranolol blocked responses to norepinephrine. Results were consistent with a cGMP-mediated stimulatory role of the cholinergic transmitter in corneal epithelial growth regulation, cAMP-mediated beta-adrenergic suppression of regrowth and increased basement membrane production after initial injury to the corneal epithelium, and potentiation of the adrenergic effect by prostaglandins.