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PubMed2004

[Quantitative determination of aqueous flare and cells in the eyes of patients with inflammation of anterior uvea].

OBJECTIVE: To quantify aqueous flare and cells in the eyes of patients with inflammation of anterior uvea by FC-2000 laser flare cell meter (LFCM), and to compare these results with those obtained with slit lamp microscopy. METHODS: Aqueous flare and cells of 194 eyes of 110 patients with inflammation of anterior uvea and 52 eyes of 52 healthy subjects were graded into 0, 1+, 2+, 3+ and 4 + scale based on a previously described system using slit lamp microscopy. LFCM was also used for evaluation of aqueous flare and cells. RESULTS: All eyes in normal individuals were graded as "0" scale of both flare and cells by silt lamp microscopy. Flare of grade 0, 1+ and 2+ were noted in 74, 98 and 18 eyes, and cell of grade 0, 1+, 2+, 3+ and 4+ were noted in 124, 26, 19, 14 and 11 eyes in uveitis patients, respectively. LFCM examination revealed that the mean flare values in uveitis eyes with flare of grade 0, 1+ and 2+ were 7.9, 29.5 and 189.0 photon count/ms, respectively. In patients with flare of grade 3+ and 4+, LFCM readings were unreliable because of increased background noise. There was significant correlation between slit lamp examination and the laser flare measurement for flare of grade 0, 1+ and 2+ (r = 0.75, P < 0.001). The mean flare values were significantly higher in patients with flare of grade 0, 1+ and 2+ than that in normal controls (5.3 pc/ms) (t = 5.872, P < 0.05). The mean cell numbers in the eyes with cell of grade 0, 1+, 2+, 3+ and 4+ were 1.5, 12.1, 33.9, 84.9 and 193.1 count/0.5 mm(3), respectively. The results of slit lamp examination showed significant correlation with laser cell counts measurement (r = 0.72, P < 0.001). The mean cell numbers were significantly higher in uveitis patients than that in normal controls (0.9 count/0.5 mm(3)) (t = 7.351, P < 0.05). CONCLUSIONS: Our results indicate that LFCM is able to evaluate precisely the mild and moderate breakdown of blood aqueous barrier and inflammation of the anterior uvea tract, therefore it provides an important parameter for the treatment of anterior uveitis.

Adolescent↗
PubMed1997

Cornea and iris changes in congenital ectropion uvea after trabeculotomy.

This article details a previously undescribed complication of trabeculotomy occurring in a patient with congenital ectropion uvea and discusses its possible association with an anterior chamber membrane. A 6-year-old boy with congenital ectropion uvea underwent trabeculotomy. After the trabeculotome was swept into the anterior chamber, multiple ovoid and round endothelial and posterior stromal opacities developed in the cornea, and new areas of iris surface irregularities appeared. This is the first reported case of corneal endothelial and iris changes occurring in a patient with congenital ectropion uvea after trabeculotomy without direct endothelial or iris contact from the trabeculotome. The exact cause of these changes is unknown.

Child↗
PubMed1986

Human sympathetic ophthalmia. Immunologic analysis of the vitreous and uvea.

The inflammatory cell reaction within the vitreous and uvea of a human eye with atypical sympathetic ophthalmia was studied immunohistologically and with the fluorescence-activated cell sorter. The uveal infiltrate consisted predominantly of T cells of the helper/inducer subset, with less than 5% of the cells characterized as B cells, plasma cells, or monocytes. These results suggest that T cells perform an important role in atypical human sympathetic ophthalmia. A similar population of mononuclear cells was observed in the vitreous inflammatory infiltrate, in marked contrast to the peripheral blood, where there was a significant depression of circulating T cells. The similarity between the inflammatory cell populations within the vitreous cavity and uvea, in contrast to the peripheral blood, underlines the importance of studying the intraocular inflammatory reaction in uveitis to gain further insight into the mechanism of this disease.

Autoimmune Diseases↗
PubMed1991

The 1990 Endre Balazs Lecture. Effects of some neuropeptides on the uvea.

This lecture summarizes studies on the effects of some of the neuropeptides which seem to be present in somatosensory and autonomic nerves in the uvea. Release of these peptides is likely to explain nerve induced effects in the eye which are not due to classical transmitters. Trigeminal nerve fibres in the eye seem to contain substance P (SP), calcitonin gene-related peptide (CGRP), and cholecystokinin (CCK), parasympathetic nerve fibers from the facial nerve seem to contain vasoactive intestinal polypeptide (VIP), and peptide with histidine and isoleucine terminals (PHI), and sympathetic nerves seem to contain neuropeptide Y (NPY). Retrograde trigeminal nerve stimulation in rabbits causes hyperemia, miosis, a breakdown of the blood-aqueous barrier to plasma proteins and a rise in intraocular pressure (IOP). There is release of SP and CGRP or related peptides. The miosis seems to be due to SP and the other effects to CGRP and small amounts of arachidonic acid metabolites released by the peptides. SP has no miotic effect in monkeys and cats. However, CCK is a potent miotic in monkeys and causes contraction of the human pupillary sphincter muscle. It has no such effect in the lower species. The effect of CCK in primates seems to derive from the presence of CCK receptors of the A-type on the pupillary sphincter muscle, and can be blocked by lorglumide. Miosis can be produced in cats by the peptide endothelin; this effect is due to release of arachidonic acid metabolites. Facial nerve stimulation causes vasodilation in the uvea of rabbits, cats and monkeys. The effect cannot be abolished by muscarinic blocking agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1983

Neuropeptide Y-immunoreactive nerves in the uvea of guinea pig and rat.

Neuropeptide Y (NPY)-immunoreactivity has been localized to a rich network of fibres in the uvea of guinea pig and rat. In the iris, NPY-immunoreactive nerves were present in iridial smooth muscle and around blood vessels; similarly throughout the choroid a dense network of NPY-immunoreactive fibres was found surrounding the choroidal vascularization. Following sympathectomy a marked decrease of NPY-immunoreactivity, in particular in the iris and less marked in the choroid, was noted, indicating that these fibres may originate at least in part from neuronal cell bodies in the superior cervical ganglion. The close relationship of the NPY-immunoreactive fibres to blood vessels in both anterior and posterior uvea is consistent with the established vasoconstrictor action of this peptide.

Animals↗
PubMedDate not supplied

Pars plana filtration with multiple laser perforation of the uvea for neovascular glaucoma following proliferative diabetic retinopathy.

PURPOSE: To evaluate the effect of pars plana filtration with multiple laser perforation of the uvea in neovascular glaucoma patients following proliferative diabetic retinopathy. METHODS: In 18 eyes of 13 patients, after a fornix-based conjunctival incision, two 9 x 3 mm, thin, rectangular scleral flaps were created 3-6 mm posterior to the limbus. The remaining layers of sclera under each flap were removed. The exposed uvea was irradiated at a mean of 60.6 spots with an argon laser just to the point of perforation. After the posterior chamber fluid escaped, the flaps were sutured. RESULTS: The mean preoperative intraocular pressure (IOP) was 36.4 +/- 9.0 mm Hg. After an average follow-up of 16.6 +/- 5.9 months, the mean final postoperative IOP was 16.6 +/- 4.4 mm Hg. The postoperative IOP was below 21 mm Hg in 3 (16.7%) of the 18 eyes without medication, in 14 (77.8%) on anti-glaucoma eye drops, and in 16 (88. 9%) on anti-glaucoma eye drops and an oral carbonic anhydrase inhibitor. Snellen visual acuity improved by more than 2 lines in 7 of the 18 eyes, worsened by this amount in 3, and remained within baseline +/- 2 lines in 8. CONCLUSION: This procedure is an effective treatment for neovascular glaucoma patients following proliferative diabetic retinopathy.

Acetazolamide↗
PubMed1997

[Clinically unexpected malignant melanomas of the uvea. 1981-1995, Erlangen Ophthalmopathologic Laboratory/D].

PURPOSE: The aim of this study was to investigate the incidence of unexpected malignant uveal melanoma in the age of ultrasound diagnostics and to highlight the reasons for misdiagnosis. PATIENTS AND METHODS: All eyes were surgically removed and histologic examination was performed between 1981 and 1995. The eyes were investigated for the incidence of uveal melanoma, and the history of the unexpected malignant melanoma of the uvea or ciliary body highlighted. RESULTS: 225 (18.7%) eyes with malignant melanoma out of 2583 enucleated eyes were found. Eight (3.6%) of 225 were clinically unexpected. The clinical misdiagnoses were secondary angle closure or open angle glaucoma (6), retinal detachment (5), iritis (1), scleritis (1), cataract (4) and an intraocular mass that was believed to be a metastasis of a colon carcinoma. Seven of eight eyes were blind, and one eye had light perception only. The longest follow up before enucleation was 13 years. On three eyes diagnostic ultrasound was reportedly performed without specific diagnosis of uveal melanoma. Surgery was performed on four eyes for reasons of uncontrollable intraocular pressure or retinal detachment up to five years before enucleation. Histologic diagnoses were 3 epitheloid-type, 2 spindel-type and 3 necrotic melanoma of the uvea. Four eyes showed scleral invasion by tumor cells and one eye an invasion into the episcleral space. CONCLUSIONS: Even today the rate of unexpected uveal melanoma, according to our study is 3.6%. Therefore, all blind eyes without visualisation of the posterior pole should be examined with ultrasound in order to diagnose an uveal melanoma prior to enucleation.

Adult↗
PubMed1986

[Intraocular ossification in clinically unsuspected malignant melanoma of the uvea and in phthisis bulbi].

Phthisical eyes of 2 patients revealed clinically unsuspected, partially necrotic and partially vital malignant melanomas of the uvea and extensive intraocular ossification. Both eyes had had recurrent intraocular inflammatory episodes for years before they were enucleated because of pain. Intraocular ossification does not rule out the presence of clinically unsuspected malignant melanoma of the uvea.

Aged↗
PubMed1985

The uvea-touch syndrome and how to avoid it. Personal thoughts about lens implantation.

For successful lens implantation, the quality of the cataract extraction needed to be improved. The debate whether to perform extracapsular or intracapsular extraction has not yet come to an end. For better understanding a classification of lenses is necessary in view of the clinical consequences. The contact of the lens with the eye (read: the site of lens support) determines the long-term fate of an eye with a lens. All lenses in contact with uveal tissue may cause symptoms that together constitute the uvea-touch syndrome. Capsular support is to be preferred over uvea-support. The all-in-the-bag position of a lens is superior. This can be achieved with so-called inter-capsular surgery. A new lens design that is adapted to inter-capsular surgery is presented and its use described in detail (the 'Moustache' lens). There are few restrictions to its use.

Atrophy↗
PubMed1988

Nerve fibers showing immunoreactivities for thyrosine hydroxylase and dopamine-beta-hydroxylase re-appear in the guinea pig uvea after sympathectomy.

After sympathectomy we have studied the re-appearance of nerve fibers showing catecholaminergic characteristics in the uvea of the guinea pig. Immunoreactivities for two catecholamine symthetizing enzymes, tyrosine hydroxylase (TH) and dopamine-beta-hydroxylase (DBH), were used as markers. Both TH-like and DBH-like immunoreactive nerve fibers disappeared after the extirpation of ipsilateral superior cervical ganglion. In the choroid the TH-like and DBH-like immunoreactive nerve fibers re-appeared within 2 weeks. In the iris and the ciliary body both of these types of immunoreactive nerve fibers re-appeared 10 weeks after the denervation. The morphological appearance of these re-appearing nerve fibers was not similar to those in the non-denervated uvea.

Animals↗
PubMed1987

Cyclo-oxygenase and lipoxygenase pathways in cynomolgus and rhesus monkey conjunctiva, anterior uvea and eyelids.

The capacity of cynomolgus and rhesus monkey conjunctiva, anterior uvea and eyelids to synthesize cyclo-oxygenase and lipoxygenase products from arachidonic acid was assessed. Both conjunctiva and eyelid tissues of cynomolgus and rhesus monkeys synthesized detectable amounts of cyclo-oxygenase and lipoxygenase products, indicating the presence of cyclo-oxygenase and 5- and 12-lipoxygenase activities in these tissues. In comparison, cynomolgus anterior uvea synthesized a considerably lesser amount of cyclo-oxygenase products. The cyclo-oxygenase activity was considerably greater than the lipoxygenase activity in cynomolgus and rhesus conjunctiva and eyelids.

Animals↗
PubMed1986

Active transport of beta-adrenergic blocking agents in the anterior uvea of albino rabbit.

Transport of timolol and befunolol in the anterior uvea of the albino rabbit was studied in vitro. Also, the mode of timolol elimination from the living eye was investigated. The isolated iris-ciliary body incubated at 37 degrees C accumulated 14C-timolol and 14C-befunolol against the concentration gradient, and the tissue-to-medium ratio was 5.45 +/- 0.29 and 5.46 +/- 0.44, respectively. The accumulation of both drugs was significantly suppressed by incubation at 0 degrees C and also by pretreatment with ouabain or cyanine but not with probenecid. The relationship between the initial velocities of accumulation and medium drug concentrations conformed with saturation kinetics, indicating the presence of mediated transport of these drugs. The apparent Km was 1.08 X 10(-6) mole per liter for timolol and 8.00 X 10(-7) for befunolol, and the Vmax was 5.46 X 10(-9) mole per g per hour for timolol and 1.52 X 10(-8) for befunolol. A mixture of 14C-timolol and 3H-sucrose was injected into the center of the vitreous cavity of the living rabbit. Timolol was lost from the vitreous at a rapid rate of about 36% per hour, while sucrose was lost very slowly, at about 5% per hour. Thus it was thought that an energy-requiring carrier-mediated transport system is operative in the anterior uvea of the albino rabbit, and that this would account for the rapid removal of the beta-blockers out of the eye.

Adrenergic beta-Antagonists↗
PubMed1987

In situ immune complex formation within the uvea. Potential role of cationic antibody.

A murine model has been developed to study the role of immunoglobulin charge in the regulation of the intraocular distribution of circulating IgG antibodies. Intravenously injected cationic antibodies to the tracer enzyme horseradish peroxidase bind within the ciliary body and choroid (CB/Ch). These cationic antibodies can selectively entrap and bind circulating antigens forming immune complexes (IC) within the uveal tissues. The structure of the uvea with its fenestrated CB/Ch capillaries and fixed anionic sites (within Bruch's membrane and the stroma of the CB and processes) may predispose the CB/Ch to in situ IC formation. Local IC formation mediated initially by deposition of cationic antibodies within the uvea may play an important role in the immunopathogenesis of some forms of uveitis.

Animals↗
PubMed2002

Extranodal marginal zone B cell lymphomas of the uvea: an analysis of 13 cases.

The majority of primary lymphoproliferative lesions of the uvea represent low-grade B cell lymphomas and often display a prominent plasmacellular differentiation. The purpose of the current study was to classify the uveal lymphoproliferations according to the REAL classification; examine the immune profile of the plasmacellular differentiated tumour cells using the plasma cell-related antigens multiple myeloma oncogene-1-protein (MUM1), Vs38c, CD38 and CD138; and to compare this profile with that of mature reactive plasma cells. Following fixation, 13 lymphoproliferative lesions of the uvea were categorized on the basis of their morphology and immunophenotype according to the REAL classification. Included in the immunohistochemistry were B cell-specific activator protein (BSAP), MUM1, Vs38c, CD38 and CD138. Nested polymerase chain reaction (PCR) was also performed on DNA extracted from paraffin sections for the detection of gene rearrangements of the heavy immunoglobulin chain (IgH). All of the 13 uveal tract lymphoproliferative lesions represented malignant lymphoma of B cell non-Hodgkin type and could be diagnosed as 'extranodal marginal zone B cell lymphomas' (EMZL). The degree of plasmacellular differentiation varied between the tumours. In contrast to their non-plasmacytoid counterparts, the 'plasmacytoid' EMZL tumour cells were negative for the B cell markers CD20 and BSAP, and demonstrated heterogeneous positivity for the markers MUM1, Vs38c, CD38 and CD138. The most consistent marker was MUM1, being observed in all tumours. Co-expression of all plasma cell markers was observed in four (31%) uveal EMZL. Loss of CD138 expression was observed in six (46%) tumours, of Vs38c expression in five (38%) and of CD38 in one (7%) tumour. Although the diagnosis of malignant lymphoma was unequivocally based on morphological and immunophenotypical features, the molecular analysis was able to demonstrate clonal B cell populations in only one uveal EMZL. All uveal lymphoid proliferations investigated represented EMZL, with the corresponding morphology and immunophenotype as seen in EMZL in other extranodal locations. MUM1, followed by CD38 expression, were the most constant plasma cell antigens in the plasmacytoid EMZL tumour cells, with both Vs38c and CD138 positivity being lost in many tumours. Aberrant immune profiles of plasma cell-related antigens may be of help in the establishment of malignancy in uveal lymphoproliferative lesions, particularly where interpretation of light chain expression and/or PCR results is difficult.

ADP-ribosyl Cyclase↗
PubMed1992

Mast cells in the anterior uvea of the rabbit. Intraocular effects of compound 48/80 in the rabbit.

In the present study, the presence and localization of mast cells and the intraocular effects of compound 48/80 have been studied in detail in the rabbit eye using histochemical and physiological methods. In histochemical studies mast cells were localized in the anterior uvea, especially in the ciliary and iridial processes. Intracamerally injected, compound 48/80 caused an increase in the intraocular pressure, disruption of the blood-aqueous barrier and an increase in the cAMP content in the aqueous humour. Miosis was observed only after higher doses of compound 48/80 (greater than 100 micrograms) and even then only one-half of the eyes responded. The intraocular effects, excluding miosis, of compound 48/80 resembled an on/off-type of response, where 20 micrograms caused only minor changes, if any, and 50 micrograms gave a maximal response. The ocular hypertensive reaction developed a tachyphylaxis so that the second and third consecutive dose of compound 48/80 (100 micrograms) produced no significant change in IOP. The results indicate that mast cells, which are present in the anterior uvea in an extent not known previously, might be involved in certain inflammatory reactions in the rabbit eye. The inconsistent and slight miosis after the intracameral application of compound 48/80 indicates that the mechanism is different from that caused by sensory nerve stimulation. The rapid development of tachyphylaxis after consecutive application of compound 48/80 suggests that mast cells are easily depleted which might be useful for further studies to evaluate the functional role of mast cells in different pathophysiological conditions in the rabbit eye.

Animals↗
PubMed2001

Metastatic adenocarcinoma of the prostate to the uvea as the initial presenting symptom in a 49-year-old man.

We report a case of a 49-year-old man who presented with symptoms related to his right eye. Subsequent workup revealed carcinoma of the prostate metastatic to the uvea. On ophthalmologic evaluation, choroidal metastasis was noted. His prostate was firm on digital rectal examination, and the serum prostate-specific antigen level was 124 ng/mL. Prostate biopsy was consistent with adenocarcinoma, Gleason score 9. The patient was treated with total androgen blockade and radiation to the eye. Although his ocular lesions disappeared, the patient died of hormone-refractory disease 32 months after the diagnosis. The first case of prostate cancer metastatic to the uvea was reported more than 1 century ago; however, only a few cases have been reported subsequently. To our knowledge, we present the first published report in the urological literature of a patient in whom ocular complaints were the presenting symptoms that led to the diagnosis of prostate cancer. The urologist should be cognizant of the distinct possibility of ocular metastasis if a patient with prostate cancer presents with complaints related to the eye.

Adenocarcinoma↗
PubMed1979

Diagnosis and management of cancer metastatic to the uvea: a study of 70 cases.

Although metastatic cancer to the uvea is reported to be the most common intraocular malignancy, most ophthalmologists have had little experience with its diagnosis and treatment. This report describes our experience with the diagnosis and management of 70 patients with metastatic cancer to the uvea. Many patients were evaluated with modern diagnostic modalities such as fluorescein angiography, ultrasonography, and the 32P test when indicated. Thirty-one percent of patients had no history of previous malignancy, and the ocular complaints represented the first symptoms of systemic cancer. The ocular malignancy often simulated better-known ophthalmic entities, and the referring diagnosis was correct in only 38% of cases. This series, therefore, reflects the clinical problem confronting the practicing ophthalmologist. About one-half of the patients were treated with external beam irradiation to the involved eye(s), which often resulted in dramatic resolution of the tumor and visual return. Other patients had either no treatment, chemotherapy, or enucleation in selected instances.

Adult↗
PubMed1988

["Biocytology" of diffuse malignant melanomas of the anterior uvea (preliminary report)].

Between 1983 and 1986, six eyes with diffuse malignant melanomas of the anterior uvea were enucleated at the Eye Hospital of the University of Erlangen-Nürnberg. The characteristic clinical findings were a monolateral open-angle glaucoma in the same eye and a diffuse spreading of malignant melanocytes on the inner walls of the anterior chamber. These cells can be differentiated biomicroscopically (40 x magnification, Zeiss slit-lamp) from melanin granula and benign melanocytes. Findings in two patients show that individual cells can be biocytologically classified in this way. Malignant cells are characterized by large, prominent nuclei and long cytoplasmic processes. Biocytological evaluation of individual melanocytic cells can be helpful in the differential diagnosis of melanocytic processes of the anterior uvea.

Adult↗