Schlerochorioretinal biopsy: an approach to tissue diagnosis and study of choroidal and retinal disease.
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Biomedical subjects
Publications and source records attributed to D R Sanders.
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The first histopathologic specimen form the eye of a patient with Goldmann-Favre syndrome was obtained by full-thickness eye-wall biopsy. Diagnosis was established by an early history of night blindness, characteristic clinical features including atypical pigmentary retinopathy, peripheral retinoschisis, opaque "sclerotic-appearing" peripheral retinal vessels, vitreous changes including liquefaction and condensed vitreous bands and a non-detectable electroretinogram (ERG). Histopathologic changes from a 4 mm peripheral area included diffuse degenerative changes involving predominantly the sensory retinal layers with a relatively normal pigment epithelium and choroid. Vascular changes included thickened retinal vessel basement membranes and areas of vascular occlusion. These findings are compatible with a primary photoreceptor involvement in addition to a vascular component. A thick preretinal membrane of glial tissue was an additional finding.
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Glutatione-bicarbonate-Ringer solution (GBR), GBR deficient in adenosine and glutathione, and a newly proposed glucose-phosphate-Ringer solution (GPR) have been found to maintain lens function and corneal endothelial viability with approximately equal efficacy during prolonged periods of incubation. Currently used intraocular irrigating solutions do not perform as well in maintaining the function of borderline decompensated lenses and in sustaining endothelial viability.
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A total of 125 consecutive eyes, all registered blind with diabetic vitreous haemorrhage, underwent pars plana vitrectomy with the vitrophage. Sixty-six per cent experienced some improvement in their visual acuity; 24 per cent were unchanged and 10 per cent were worse postoperatively. The major surgical complication was controllable haemorrhage (23 per cent). No retinal dialysis occurred. Significant postoperative complications were transient (71 per cent) and persistent (11 per cent) corneal oedema, early (8 per cent) and late (13 per cent) vitreous haemorrhage, transient (30 per cent) and persistent (6 per cent) rise in intraocular pressure, and rubeosis iridis (5 per cent).
Two children with persistent hyperplastic primary vitreous (PHPV) underwent vitrectomy and lensectomy via the pars plana to remove the fibrovascular stalk. Postoperatively the eyes were quiet, only a slight vitreous haze obscured the fundus view in the immediate postoperative period, and the stumps of the stalks retracted. Early surgical treatment of PHPV may prevent later serious complications.
Results of a pars plana approach using the Peyman vitrophage to treat various anterior segment diseases are presented in 48 patients (50 eyes). These included cases of ocular trauma, congenital cataracts, complications following unplanned and planned extracapsular cataract extractions and phacoemulsification, and dense secondary membranes. Visual acuity improved in 86%, remained unchanged in 10% and worsened in 4% of all eyes.
We have developed a scleral-indentor-illuminator which, when combined with indirect ophthalmoscopy, gives better visualization of some choroidal lesions than conventional ophthalmoscopy. The thin, angulated probe tip allows for extreme posterior placement.
We wished to know if excision of artificially produced intravitreal vessels would cause bleeding and if the hemorrhage could be controlled by increasing the intraocular pressure. In 17 rabbit eyes, the distal end of several intravitreal blood vessels was excised and removed by the Peyman vitrophage. No significant bleeding occurred from the vessels in 13 eyes, and in the remaining four bleeding stopped after 30 seconds or less of increased intraocular pressure. In one month of observation after surgery, there was no evidence of delayed hemorrhage. Electron microscopy of several transected intravitreal vessels revealed that vessel constriction, platelets and fibrin strands contributed to the prevention of immediate and delayed hemorrhage.
The usefulness of a technique for scleral-chorioretinal biopsies was evaluated on a human eye destined for enucleation due to a malignant melanoma of the choroid. The operative procedure was without complication. The biopsy specimen was removed and carefully evaluated both by light and electron microscopy. The underlying choroid and retinal tissues were successfully preserved by this technique.
Toxicity of intravitreal urokinase was studied by injection of various doses of urokinase in primate eyes. Doses of 22,500 CTA units or less produced no toxic effects on the eye. Higher doses caused retinal degeneration, transient lens opacities, and cloudy vitreous. Urokinase was ineffective in clearing experimentally induced vitreous hemorrhage if injected as early as 24 hours after the intravitreal blood or as late as six months thereafter.
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