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At least 343 records · Page 19Linked to original sources

Mechanism of retinal ganglion cell loss in inherited retinal dystrophy.

To study the inner retinal layers in RCS rats, which suffer major loss of retinal photoreceptors during the first 3 months of life, retinal ganglion cells (RGC) were labelled with fluorogold and their axons were immunoreacted with an antibody against neurofilaments. The retinal vessels were stained with horeseradish peroxidase and the RGC layer was stained with methylene blue. Animals more than 6 months of age showed areas devoid of fluorogold-labelled cells that extended from the optic disc to the periphery. The course of the RGC axons was also abnormal and showed tortuosities, dilatations and signs of abortive regeneration at sites where most inner retinal vessels cross the axons. We conclude that some months after photoreceptor degeneration has concluded in dystrophic animals, some retinal vessels compress the RGC axons and cause retrograde degeneration of their parent cells.

Animals↗

Retinal endovascular surgery for central retinal vein occlusion: initial experience of four surgeons.

PURPOSE: The rate and magnitude of spontaneous visual recovery are very poor in central retinal vein occlusion (CRVO). In the first follow-up year, the Central Vein Occlusion Study Group reported that only 6% of eyes recovered > or = 3 lines of vision and none recovered > or = 8 lines of vision. Retinal endovascular surgery (REVS) is vitrectomy followed by cannulation of retinal vessels with injection of tissue plasminogen activator. After reports of one surgeon's experience suggested that the procedure promotes recovery of vision, other surgeons began to offer REVS to their patients. This report discusses the initial experience of four surgeons using REVS to treat CRVO. METHODS: In this prospective, consecutive case series, patients with CRVO for > 1 week and visual acuity of < 20/50 were offered REVS and were followed by the authors. The main outcome measure was recovery of visual acuity. RESULTS: This series represents the initial 25 consecutive REVS cases of the 4 authors (5-7 cases per author). The median CRVO duration was 2 months (mean 2.9, months), and the average preoperative visual acuity was 20/400 (< or = 20/200 in 80% of cases). Intravitreal triamcinolone acetonide (IVTA) was administered intraoperatively in three cases and at some time postoperatively in six cases. Overall, 18 eyes (72%) recovered > or = 3 lines of visual acuity, and 9 (36%) recovered > or = 8 lines of vision. Among the surgeons, the rates of > or = 3-line visual recovery ranged from 57% to 100%, and the rates of > or = 8-line visual recovery ranged from 14% to 71%. Of the 22 eyes that initially underwent REVS without intraoperative IVTA injection, 13 (59%) recovered > or = 3 lines of vision and 5 (23%) recovered > or = 8 lines of vision. Complications included macular edema (28%), anterior segment or retinal neovascularization (24%), and subsequent cataract surgery (5 [23%] of the 22 preoperatively phakic eyes). One eye had an intraoperative retinal detachment that was treated but recurred 4 months after REVS, and two of the eyes with anterior segment neovascularization developed late-onset traction retinal detachments (at 8 and 13 months after REVS). CONCLUSION: Although the authors were on the "learning curve" of experience during this series, REVS appears to promote visual recovery far in excess of what would be expected to occur spontaneously, and IVTA injection greatly improved outcomes. We believe that mastery of REVS techniques and the inclusion of IVTA injection may lead to better visual results and lower complication rates.

Adult↗

Conditioned medium from mixed retinal pigmented epithelium and Müller cell cultures reduces in vitro permeability of retinal vascular endothelial cells.

AIM: To investigate the in vitro effect of laser photocoagulation on blood-retinal barrier permeability. METHODS: Retinal capillary endothelial cells were exposed to supernatants from long term co-cultured cells that were argon laser treated. Endothelial cell permeability was analysed by (1) measurement of transendothelial electrical resistance and (2) equilibration of [(3)H] inulin and [(14)C] albumin across the cell monolayer. RESULTS: Laser photocoagulation of various retinal cells and control ECV304 cells in the lower chamber did not appreciably improve permeability of the endothelial cell monolayer compared with that of unlasered cells. However, medium that was conditioned by mixed retinal pigmented epithelium and Müller cells significantly reduced both inulin (43.2% (SD 6.5%) equilibration in mixed cultures v 59.8% (SD 7.0%) control cells, p<0.05) and albumin (15.1% (SD 3.8%) v 31.1% (SD 6.7%), p<0.05) permeability of the endothelial cell monolayers. A fourfold increase in transendothelial electrical resistance was also seen. CONCLUSIONS: These results are consistent with the hypothesis that interaction of Müller cells with retinal pigmented epithelium induced by laser treatment results in secretion of soluble factor(s), which reduces permeability of retinal vascular endothelium. Identification of these factor(s) may have implications for the clinical treatment of macular oedema secondary to diabetic retinopathy and other diseases.

Animals↗

Cellular and humoral immune parameters among patients with retinitis pigmentosa and other retinal disorders.

Patients with retinitis pigmentosa, other retinal degenerations and a group of normal volunteers were included in a masked study designed to examine the existence of autoimmune reactions toward retinal antigens and the possible defect in lymphokine production (IL-1, IL-2 and gamma interferon). The results obtained did not show any specific anamnestic response to the retinal S-Ag nor any outstanding defect in gamma interferon production by the lymphocytes of patients with retinitis pigmentosa. It is suggested that a larger masked study be conducted as soon as possible in order to clarify these aspects of immune aberrations in patients with retinitis pigmentosa.

Antibody Formation↗

[Surgical treatment of retinal detachment with bilateral idiopathic retinal dialysis].

The retrospective study was aimed at demonstrating anatomical and functional results of surgical treatment in patients with bilateral idiopathic retinal dialysis (BIRD). In the period of 1985-2001 the authors operated on BIRD in 10 eyes of five patients (three men and two women). No eye injury or inflammation was present in the case history of the patients. The age of the patients was between 11 and 30 years, the mean age was 19.2 years. The symptoms typical for retinal detachment were present in four eyes only and absent in the other six eyes. Hyperopia of both eyes in analogy with myopia of both eyes was observed in two patients, respectively, whereas emmetropia was present in one patient. The retinal dialysis (RD) occurred in lower temporal quadrant in all eyes (100%), in one eye (10%) it also occurred together with an discontinuous RD in upper temporal quadrant and in another eye it was extended into lower nasal quadrant. Demarcation lines were present in 5 eyes (50%), subretinal solid strands in 1 eye (10%). Scleral buckling procedures were performed as the primary surgical procedure in all 10 eyes of 5 patients. Eight eyes was operated on with the use of segmental circumferential sponge buckles of silicone and two eyes with the use of encircling elements of solid silicone. Retina was successfully reattached postoperatively in 9 eyes (90%) and remained detached in one eye (10%). The visual acuity preoperatively 6/12 or better remained unchanged postoperatively in 8 eyes (80%). The visual acuity postoperatively improved in 1 eye (10%) and in 1 eye (10%) visual acuity was decreased. The mean period of observation of the patients was 86 months. The necessity of a routine examination of the extreme retinal periphery of the fellow asymptomatic eye of the young adult with no history of trauma and with the retinal detachment associated with retinal dialysis in one eye is also discussed.

Adolescent↗

Surgical treatment of retinal detachment following acute retinal necrosis syndrome: surgical results in four patients.

BACKGROUND: Acute retinal necrosis (ARN) syndrome is an uncommon but severe ocular disease that typically affects otherwise healthy individuals. It is frequently complicated with retinal detachment and the visual prognosis in such patients is usually poor. METHODS: We operated on four eyes in four patients from 1999 through 2001. Three ophthalmologists in our hospital did these operations, respectively. The surgical methods included pars plana vitrectomy, lensectomy, encircling scleral buckling combined with membrane dissection, air-fluid exchange, endolaser photocoagulation, and retinal tamponade with silicone oil or perfluoropropane gas. RESULTS: Three patients received one operation and the other one needed a second operation to release the retinal traction. One patient needed a lensectomy at the time of vitrectomy. Macular attachment was achieved in all four eyes (100%). Vision improved in two patients but none achieved visual acuity better than 20/200. The complications were cataract in three patients, macular pucker in three, and silicone keratopathy in one. CONCLUSION: Our results suggest that modern vitrectomy techniques provide a very high retinal attachment rate in patients with retinal detachment following ARN syndrome.

Adult↗

Rod electroretinograms in an elevated cyclic guanosine monophosphate-type human retinal degeneration. Comparison with retinitis pigmentosa.

Unusual rod electroretinogram (ERG) intensity-response functions were recorded from three female patients with retinal degeneration who had visual acuities of 20/200, retinal arteriolar narrowing, and diffuse granularity of the retinal pigment epithelium. All three patients had rod b-waves that were profoundly subnormal in amplitude and markedly delayed in implicit time to bright stimuli. Rod a-wave slopes were reduced 50% below normal, indicating photoreceptor involvement. These unusual rod ERG intensity-response functions are similar to those previously reported for the isolated cat eye with elevated retinal cyclic guanosine monophosphate (cGMP) after perfusion with isobutylmethylxanthine. This finding supports the idea that these three patients may have an elevation of retinal cGMP. Their rod ERG intensity-response functions are contrasted with those recorded from some patients with retinitis pigmentosa.

1-Methyl-3-isobutylxanthine↗

The patency of the retinal vasculature to erythrocytes in retinal vascular disease.

This paper presents the first evidence that in retinas with experimentally induced vascular disease some vessels contain only plasma. This was demonstrated by a histologic technique developed specifically to test the hypothesis that at some stage in retinal vascular disease, vessel patency to erythrocytes is lost before vessels close to plasma. Using this technique, we visualized three major components of the circulation at all retinal locations: the erythrocytes; the plasma as marked by the presence of 0.2-micron fluorescent microspheres; and all functioning endothelial cell nuclei, which were marked by the fluorochrome bis-Benzimide. It was assumed that the distributions of the erythrocytes and small particles in retinal whole mounts reflected accurately the true in vivo distributions at the moment of circulation arrest. Postenucleation the retina can be viewed and photographed within 45 min of circulation arrest. The technique was used on normal rats and on rats induced with a fast-developing model of retinal vasculopathy. With this model, we demonstrated retinal vascular segments perfused by plasma but containing no erythrocytes with functioning endothelial cells in the vessel walls. This may mean that an early factor in some retinal vascular pathologies is tissue hypoxia caused by reduced erythrocyte perfusion.

Alloxan↗

Breakdown of the blood-retinal barrier in a model of retinal neovascularization.

Breakdown in the blood-retinal barrier occurs in retinal neovascularization in a number of diseases. To study the anatomic basis of this breakdown, we examined retinal neovascularization induced by injection of 250,000 homologous fibroblasts into the vitreous cavity of pigmented rabbits. Neovascularization is evident by electron microscopy in this model 3 days after fibroblast injection. Fluorescein angiography followed by intravenous horseradish peroxidase (HRP) injection was performed prior to enucleation on 2, 3, 5, 7, and 14 days after fibroblast injection. Fluorescein leakage from retinal vessels occurs early (at day 1) and persists as the neovascularization progresses. The leakage in the early stages is concentrated near puckers from the medullary wings. In the later stages, fluorescein leakage is most prominent in the developing tips of the new vessels. Horseradish peroxidase was not observed to leak from the lumen of new vessels. "Gaps" or separations in the endothelial cell junctions were not observed in developing vessels. The breakdown of the blood-retinal barrier in this model of retinal neovascularization is therefore selective, (ie, fluorescein leaks but not HRP) and it is not due to gaps or fenestrations between endothelial cells in developing vessels.

Animals↗

Diabetes as a risk factor for retinal neovascularization in retinal vein occlusion.

We evaluated a series of patients with retinal vein occlusive disease to determine whether diabetic patients with vein occlusions developed retinal neovascularization more frequently than did nondiabetics. Retinal neovascularization occurred in 68.8% of diabetics after central retinal vein occlusion compared with 27.8% of nondiabetics. Diabetics with branch retinal vein occlusions showed no greater likelihood for subsequent retinal neovascularization than did nondiabetics.

Diabetic Retinopathy↗

Retinal detachment in retinitis pigmentosa.

Three cases of retinal detachment occurring in patients with retinitis pigmentosa are presented and three previously reported cases reviewed. All the detachments were rhegmatogenous. One patient had a horseshoe tear, one had oral bay tears, two had dialyses, one a giant tear and in one case the break was not specified. Three patients were high myopes. All the patients were young males. The five operable cases all responded satisfactorily to conventional surgery. Histologically apparent adhesions between retinal pigment epithelium and neuroretina have been described in advanced cases of retinitis pigmentosa in older patients and may not be present in younger patients with less advanced disease. Until these adhesions occur patients with retinitis pigmentosa may have no additional protection against retinal detachment.

Adolescent↗

[Prognosis of retinal detachment in cytomegalovirus retinitis].

PURPOSE: To evaluate the incidence and the prognosis of retinal detachment in CMV retinitis in AIDS. To test intravitreal injections of ganciclovir into the vitreal cavity filled with silicone. METHODS: Among 136 eyes with CMV retinitis, 15 (11%) had retinal detachment. Ten eyes underwent intraocular surgery with injection of silicone oil, one extraocular surgery and four eyes were not operated. Later, four eyes filled with silicone received intravitreal injections of ganciclovir. RESULTS: At 2 months, the retina was flat in all the operated eyes, with a visual acuity improved or stabilized in 8 cases (73%). Conversely, visual acuity was lost in all the unoperated eyes. The 14 intravitreal injections of ganciclovir performed in four eyes (which received 2, 3, 3 or 6 injections, respectively) were well tolerated. CONCLUSION: Surgery of retinal detachment in CMV retinitis usually allows the conservation of ambulatory visual acuity. Its indications must be discussed together with the patient, the ophthalmologist and the physician. Intravitreal injections of ganciclovir in vitreal cavity filled with silicone oil are possible.

AIDS-Related Opportunistic Infections↗

Conventional retinal surgery for rhegmatogenous retinal detachment with proliferative vitreoretinopathy.

During the last two years, 79 consecutive patients (i.e. eyes) with rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR), stages B and CP according to the classification of Machemer and associates, were treated. Conventional retinal surgery (scleral buckling) was used. Retina was successfully reattached in 54 (68.4%) eyes in the early postoperative period. Thirty-five (81.4%) out of 43 patients with PVR detachment stage B, and 19 (52.8%) out of 36 patients with PVR detachment stage CP achieved total retinal attachment. The difference was statistically significant (p = 0.006). In stage CP, larger areas of retinal involvement by fixed retinal folds are inversely related to the rate of anatomical success. A higher degree of preoperative PVR means less success of conventional retinal detachment surgery, so it is advised to apply a conventional surgical technique up to CP-6 stage of PVR, whereas in more advanced stages of PVR pars plana vitrectomy is needed.

Adult↗

Management of silicone-induced cataract in AIDS patients treated for viral retinitis-associated retinal detachment.

BACKGROUND AND OBJECTIVE: To evaluate the outcome of cataract surgery for patients with acquired immunodeficiency syndrome (AIDS) who underwent vitrectomy and silicone tamponade for viral retinitis-associated retinal detachment. PATIENTS AND METHODS: The authors retrospectively reviewed the data of five AIDS patients (five eyes) who had cataract within a mean period of 4 months following vitrectomy and silicone oil tamponade for viral retinitis-associated retinal detachment. Phacoemulsification and implantation of a poly-methylmethacrylate posterior chamber intraocular lens were performed. The mean postoperative follow-up was 3 months. RESULTS: Neither silicone oil loss nor retinal redetachment were reported postoperatively. Visual acuity improved in two eyes and remained unchanged in one eye. Total blindness occurred in two eyes. CONCLUSION: Although cataract surgery in these eyes is a relative easy procedure and does not interfere with the retinal status, visual outcome remains poor because of possible postoperative optic atrophy.

AIDS-Related Opportunistic Infections↗

Retinal aneurysms in adult cytomegalovirus retinitis.

We observed aneurysms of the retinal arteries, capillaries, and venules occurring in a patient with cytomegalovirus retinitis. These aneurysms were caused by involvement of the retinal vascular endothelium resulting in focal weaknesses in the vascular walls. The clinical appearance of this retinitis superficially resembled retinal branch vein occlusion.

Aneurysm↗

Activated microglia in human retinitis pigmentosa, late-onset retinal degeneration, and age-related macular degeneration.

Many gaps exist in our knowledge of human retinal microglia in health and disease. We address the hypothesis that primary death of rod photoreceptors leads to activation of resident microglia in human retinas with retinitis pigmentosa (RP), late-onset retinal degeneration (L-ORD), or age-related macular degeneration (AMD). Regions of ongoing photoreceptor cell death were studied by immunocytochemistry with microglia- and other retinal cell-specific markers. In normal human retinas, quiescent microglia were small, stellate cells associated with inner retinal blood vessels. In retinas with RP, L-ORD, or AMD, numerous activated microglia were present in the outer nuclear layer in regions of ongoing rod cell death. These microglia were enlarged, amoeboid cells that contained rhodopsin-positive cytoplasmic inclusions. We conclude that activated microglia migrate to the outer nuclear layer and remove rod cell debris. In other central nervous system diseases such as stroke, activated microglia phagocytose debris from the primary injury and also secrete molecules that kill nearby normal neurons. By analogy with these diseases, we suggest that microglia activated by primary rod cell death may kill adjacent photoreceptors. Activated microglia may be a missing link in understanding why initial rod cell death in the human diseases RP, L-ORD, and AMD leads to death of the cones that are critical for high acuity daytime vision.

Adult↗

Coats' disease of the retina (unilateral retinal telangiectasis) caused by somatic mutation in the NDP gene: a role for norrin in retinal angiogenesis.

Coats' disease is characterized by abnormal retinal vascular development (so-called 'retinal telangiectasis') which results in massive intraretinal and subretinal lipid accumulation (exudative retinal detachment). The classical form of Coats' disease is almost invariably isolated, unilateral and seen in males. A female with a unilateral variant of Coats' disease gave birth to a son affected by Norrie disease. Both carried a missense mutation within the NDP gene on chromosome Xp11.2. Subsequently analysis of the retinas of nine enucleated eyes from males with Coats' disease demonstrated in one a somatic mutation in the NDP gene which was not present within non-retinal tissue. We suggest that Coats' telangiectasis is secondary to somatic mutation in the NDP gene which results in a deficiency of norrin (the protein product of the NDP gene) within the developing retina. This supports recent observations that the protein is critical for normal retinal vasculogenesis.

Amino Acid Substitution↗

Retinal periphlebitis resembling frosted branch angiitis with nonperfused central retinal vein occlusion.

PURPOSE: To report the unusual association between severe retinal periphlebitis resembling frosted branch angiitis and nonperfused central retinal vein occlusion (CRVO). METHODS: Observational case reports. RESULTS: Patient 1 was a 28-year-old man who presented with extensive sheathing involving all retinal veins in one eye followed by nonperfused CRVO. Twenty-seven months after initial presentation, he developed perfused CRVO in the other eye followed by periphlebitis that progressed into nonperfused CRVO. Patient 2 was a 47-year-old man who presented with unilateral severe retinal periphlebitis associated with nonperfused CRVO. Despite systemic administration of corticosteroid therapy, rubeosis iridis developed in both patients and neovascular glaucoma developed in Patient 1 despite full panretinal photocoagulation. Extensive systemic workup and coagulation studies were unremarkable except for the presence of antiphospholipid antibodies in both patients and elevated plasma homocysteine level in Patient 2. CONCLUSIONS: Severe retinal periphlebitis complicated by nonperfused CRVO is associated with poor visual outcome despite appropriate medical and surgical treatment.

Adult↗