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At least 595 records · Page 33Linked to original sources
PubMed2000

Transplantation of autologous iris pigment epithelium after removal of choroidal neovascular membranes.

BACKGROUND: Transplantation of autologous iris pigment epithelium (IPE) into the subretinal space has been suggested as one approach for the treatment of age-related macular degeneration, as well as for other conditions in which loss of retinal pigment epithelium (RPE) occurs. Surgical removal of choroidal neovascular membranes is associated with traumatic loss of the RPE cell layer, disruption of the integrity of the photoreceptor-RPE complex, and limited visual outcome. OBJECTIVE: To examine whether IPE cells can substitute for RPE cells to be transplanted to the subretinal space of patients with either RPE degenerative disease or traumatic loss of the RPE cell layer after subretinal surgery. METHODS: Autologous IPE cells were transplanted to the subretinal space in 20 consecutive patients undergoing removal of subretinal fibrovascular membranes using pars plana vitrectomy. Autologous IPE cells were harvested by iridectomy, isolated, and transplanted directly to the subretinal spaces. Transplants were evaluated for 6 to 11 months by funduscopy, fluorescein angiography, and scanning laser ophthalmoscopic (SLO) microperimetry. RESULTS: For the entire follow-up period, no evidence of any immunologic response was observed. Revisional surgery was necessary in 3 patients because of complications (rhegmatogenous retinal detachment [n = 1]; proliferative vitreoretinopathy [n = 1]; and macular pucker [n = 1]); 1 patient did not receive IPE cells. Five of 19 phakic eyes underwent cataract surgery; in 1 case this was combined with the vitrectomy. Five patients showed improved visual acuity of 3 to 4 lines, 13 patients had stable visual acuity (+/-2 lines), and 2 patients had reduced visual acuity of 6 lines. CONCLUSIONS: In this pilot study, the transplantation of autologous IPE cells was done as an addition to conventional surgical excision of choroidal neovascular membranes. Transplanted cells were well tolerated in the subretinal space and did not adversely affect the function of the photoreceptors, since improvement or stable visual acuity was observed in 18 patients after IPE transplantation. These results suggest that autologous IPE cells may be used as a substitute for autologous RPE cells to transplant to the subretinal space to treat age-related macular degeneration.

Adult↗
PubMed2000

Iris varix simulating an iris melanoma.

Iris varix is rare and little is known about its clinical characteristics. We treated a thrombosed iris varix that simulated an iris melanoma. A 53-year-old man developed a dark brown iris mass and hyphema in his left eye. Ultrasound biomicroscopy revealed a circumscribed mass of the iris stroma. Because of suspicion for melanoma, it was removed by sector iridectomy. Histopathologic examination disclosed an extensive focus of stromal hemorrhage, partially surrounded by endothelial cells that showed immunoreactivity to vascular markers. The histopathologic diagnosis was thrombosed iris varix. Iris varix is a rare condition that should be included in the differential diagnosis of iris melanoma.

Diagnosis, Differential↗
PubMed2003

Precision and safety of the pulsed electron avalanche knife in vitreoretinal surgery.

BACKGROUND: We have developed a new surgical instrument, called the pulsed electron avalanche knife (PEAK; Carl Zeiss Meditec, Jena, Germany), for precise, "cold," and tractionless dissection of tissue in liquid media. OBJECTIVE: To evaluate the 3-dimensional damage zone induced by the PEAK compared with 2 other standard intraocular surgical instruments, diathermy and retinal scissors. METHODS: Damage zone and minimum safe distance were measured in vitro on chick chorioallantoic membrane and in vivo on rabbit retina with the use of propidium iodide staining. RESULTS: The PEAK produced a paracentral zone of cellular structure disruption surrounding a crater and a peripheral zone of structurally intact but abnormally permeable cells. The instrument induced a damage radius that varied from 55 to 300 micro m for the range of voltages and pulses typically used during surgery. For comparison, damage radius for microsurgical scissors was 50 micro m, and for diathermy, 400 to 850 micro m. The PEAK also damaged tissue up to 1.4 mm away by the creation of water flow that formed at the tip of convex probes during collapse of a cavitation bubble. Concave probes, which prevent formation of the water jet, eliminated this effect. CONCLUSIONS: The PEAK operated well within accept-able safety limits and may greatly facilitate both posterior segment surgeries (eg, membrane dissection and sheathotomy) and anterior segment procedures (eg, capsulotomy, nonpenetrating trabeculectomy, and iridectomy).

Allantois↗
PubMed1977

Anterior chamber depth alteration after retinal photocoagulation.

Anterior chamber shallowing is a syndrome that may occur after retinal photocoagulation for diabetic retinopathy. Angle closure glaucoma may occur. Peripheral iridectomy is not indicated, as the condition is self-limited and will resolve with or without medical therapy within a few days. A vascular occlusive phenomenon leading to congestion in the choroidal system is postulated as the cause of this phenomenon. The ciliary body may be shifted anteriorly and rotated inwardly to produce the anterior chamber changes observed.

Adult↗
PubMed1977

Induction of subcapsular cataracts in cynomolgus monkeys by echothiophate.

Sixteen eyes of 13 cynomolgus monkeys were treated topically twice daily with echothiophate iodide. The dosages were increased gradually over several weeks to plateau levels ranging from 125 to 500 mug daily. The opposite eyes of the ten unilaterally treated monkeys received a control solution (DILUENT) identical save for the absence of echothiophate. All 16 echothiophate-treated eyes developed posterior subcapsular cataracts and 15 developed anterior subcapsular cataracts. The lenses in all ten DILUENT-treated eyes remained clear. The cataracts in the echothiophate-treated eyes strongly resembled those attributed to cholinesterase inhibitors in humans. They were first noted from 2 1/2 to 14 weeks after beginning echothiophate treatment. Prior total iridectomy caused a more rapid progression and/or greater severity of lens changes. Higher echothiophate dosages caused the cataracts to appear more rapidly.

Animals↗
PubMed1978

Chandler's syndrome as a variant of essential iris atrophy. A clinicopathologic study.

Trabeculectomy and peripheral iridectomy specimens from one male and two female patients with Chandler's syndrome (age, 30 to 42 years) showed that all had unilateral corneal endothelial "dystrophy," corneal edema, mild to moderate iris atrophy without holes, peripheral anterior synechiae, and glaucoma. In one, fluorescein angiography of the iris disclosed a sector filling delay of limbal and conjunctival vessels and pupillary and extrapupillary leakage. Histopathologic examination showed a layer of degenerated corneal endothelium and Descemet's membrane extending across the inner uveal trabeculum. Descemet's membrane displayed irregular, nodular, scroll-like excrescences in some cases, and thinner placoid configurations with abnormal widely spaced collagen (100 nm) in others. Corneal endothelial cells exhibited increased microvilli, widened cellular interdigitations, and occasional shrunken cells with enlarged or disrupted cytoplasmic blebs. Peripheral iris specimens displayed mild to moderate stromal atrophy without vascular occlusions. Pigment epithelium was normal.

Adult↗
PubMed1978

Thymoxamine test. Differentiating angle-closure glaucoma form open-angle glaucoma with narrow angles.

To help differentiate mild angle-closure glaucoma from open-angle glaucoma in patients with elevated intraocular pressure (IOP) and angles so narrow that the structures cannot be seen adequately, we used a thymoxamine hydrochloride eyedrop that induces miosis and tends to widen the angle. Thymoxamine does not contract the ciliary muscle and does not alter the IOP or facility of outflow in open-angle glaucoma, but it can relieve angle-closure glaucoma. A test with thymoxamine was performed in 26 patients because of this differential diagnostic dilemma. When gonioscopic, tonometric, and tonographic findings appeared to indicate a diagnosis of angle-closure glaucoma, a peripheral iridectomy was done. Subsequent (one to 27 months) observations have substantiated that testing with thymoxamine is a helpful aid in this differential diagnosis, and merits more widespread evaluation.

Adult↗
PubMed1978

Argon laser iridotomy on primary angle closure or pupillary block glaucoma.

Scanning and transmission electron microscopy were performed on peripheral iridectomy specimens from seven patients with failed pulsed argon laser iridotomies. Four to seven hours after the laser, severe edema, coagulation necrosis, focal vascular occlusion, and hemorrhage were present. Five days after the laser, cell detritus and collapsed cell processes were noted. Forty-two days after the laser, the anterior iris surface appeared considerably thinned and irregular. Eight and one-half months after the laser, the burn site displayed a dense matted appearance. Two years after the laser, the anterior iris showed a depression with pigment dispersion, irregular stroma, and disruption of the dilator muscle. The lack of inflammation could be due to the use of pulsed argon laser heat delivered at very short intervals, with deep penetration and minimal heat dispersion, since the beam is highly collimated.

Follow-Up Studies↗
PubMed1979

Hypotony due to inadvertent cyclodialysis after intraocular lens implantation.

Six patients had hypotony from inadvertent cyclodialysis after intraocular lens implantation. Factors that may have contributed to the formation or persistence of the cyclodialysis are scleral cataract incision, prolonged postoperative course of corticosteroid treatment, intraocular lens weight, iridectomy, and maneuvers related to insertion and fixation of the intraocular lens. Closure of these cyclodialysis clefts may be a lengthy process involving various treatment modalities. Fortunately, cyclodialysis with hypotony, although increased in incidence with intraocular lens surgery over routine extraction, occurs rarely.

Aged↗
PubMed1980

Glaucoma due to endothelialization of the anterior chamber angle. A comparison of posterior polymorphous dystrophy of the cornea and Chandler's syndrome.

Posteroir polymorphous dystrophy (PPMD) and Chandler's syndrome are separate ocular diseases with certain clinical features in common. Both may cause endothelial dystrophy, corneal edema, iridocorneal adhesions, and glaucoma. Differences between the two disorders include the morphology of the endothelial dystrophy, hereditary transmission, laterality, and rate of progression. Histopathologic examination of trabeculectomy and iridectomy specimens from two patients with Pmd and one patient with Chandler's syndrome disclosed a common basic pathologic process--endothelialization of the anterior chamber angle. Ectopic corneal endothelium and abnormal Descemet's membrane extended across the trabecular meshwork and onto the anterior surface of the iris. The appearance of the endothelial cells, however, was strikingly different in the two conditions. The endothelial cells in PPMD had ultrastructural characteristics of epithelial cells. Those in Chandler's syndrome were degenerated but retained ultrastructural features of endothelial cells.

Anterior Chamber↗
PubMed1982

Argon laser peripheral iridotomies in the treatment of primary angle closure glaucoma. Long-term follow-up.

We analyzed the long-term results after argon laser peripheral iridotomy in 98 eyes of 54 patients with primary angle closure glaucoma. During a mean follow-up period of about five years, visual acuity, intraocular pressure, medication changes, and the need for filtration surgery or cataract surgery were used to evaluate the amount of possible damage that had resulted from laser iridotomy. Eyes treated with the argon laser did not appear to differ significantly from those of similar patients, described in other series, in which surgical iridectomy had been used as the therapy of choice. Argon laser peripheral iridotomy appears to be a laser peripheral iridotomy appears to be a safe and effective means of treating primary angle closure glaucoma.

Adult↗
PubMed1982

Hyphema complicating laser iridotomy.

Hyphema resulting from a laser iridotomy (iridectomy) occurred in a patient with chronic subclinical angle closure glaucoma. This complication has been described previously in patients with rubeosis iridis and uveitis and in patients receiving anticoagulant drugs, but to our knowledge, this is the first report of a hyphema resulting from a laser iridotomy in a patient having no known predisposing pathological condition, either ocular of systemic, While no complications of hyphema were encountered in this patient, we recommend that this rare complication be kept in mind whenever a laser iridotomy is contemplated.

Female↗
PubMed1983

Histoplasmic endophthalmitis. A clinicopathologic correlation.

A patient had a 12-year history of relapsing disseminated histoplasmosis. None of the characteristic lesions of the presumed ocular histoplasmosis syndrome were present in either eye. Ocular involvement began as a peripheral focal retinitis associated with vitreitis and iritis. Histoplasma capsulatum organisms grew in cultures from aqueous and vitreous and were demonstrated histologically in an iridectomy specimen. Despite intraocular and subconjunctival administration of amphotericin B, intractable pain associated with progressive necrotizing granulomatous iridocyclitis necessitated enucleation. Histoplasma capsulatum organisms were seen extracellularly in the vitreous cavity and both intracellularly and extracellularly in areas of granulomatous inflammation involving the iris, ciliary body (diffusely), and the retina (focally). The choroid was not involved.

Adult↗
PubMed1984

Anterior chamber dimensions in patients with narrow angles and angle-closure glaucoma.

The anterior chamber depths, volumes, and diameters were studied photogrammetrically in 273 patients with the clinical diagnosis of narrow angles (dome and plateau iris configuration) and acute, subacute, or chronic angle-closure glaucoma. The anterior chamber depths, volumes, and diameters of all of these patients were significantly smaller than age-, sex-, and refractive error-matched normal controls. Peripheral iridectomy significantly increased the peripheral depth of the anterior chamber and increased the volume of the anterior chamber by 14 microL without changing the central depth.

Adult↗
PubMed1984

Leprosy in a trachomatous population.

In an Egyptian leprosy hospital, 17% of 133 patients had a visual acuity of less than 3/60. Corneal opacity, phthisis bulbi, and cataract accounted for 85% of blindness. Leprosy and trachoma together produce blinding corneal opacity by exposure, leprous keratitis, and trichiasis and entropion. Inturned lids, a late result of conjunctival scarring due to childhood trachoma, were less frequent in patients with lepromatous leprosy than in patients with tuberculoid leprosy; because conjunctival scarring from trachoma depends on cell-mediated immunity, patients with lepromatous leprosy may not have had severe trachomatous scarring develop due to their lifelong abnormality in cellular immunity. In patients with leprosy, even when complicated by trachoma, simple measures to prevent or restore vision include medical treatment of leprosy, surgical correction of lid deformities, sector iridectomy for constricted pupils or central corneal opacities, and cataract extraction.

Adult↗
PubMed1984

Angle-closure glaucoma in adults with cicatricial retinopathy of prematurity.

Acute angle-closure glaucoma developed in three adults who were being followed up for stable cicatricial retinopathy of prematurity. After medical therapy succeeded in breaking the attack of angle-closure glaucoma, two of the patients were treated with surgical peripheral iridectomy and one patient was treated by argon laser iridotomy. All three of the patients had stabilization of their intraocular pressure and preservation of their visual acuity during follow-up of 2 1/2 to five years' duration.

Adult↗
PubMed1984

Glioneuroma of iris and ciliary body.

A 20-year-old woman was noted to have progressive cataractous changes in the left eye for two years. Ophthalmic examination showed a yellow-pink mass in the iris root (between the 8- to 10- o'clock positions, facing the patient). No associated colobomatous defect was present. A sector iridectomy with partial cyclectomy was performed. Histopathologically the mass, which was composed of an admixture of glial cells and neurons, was diagnosed as glioneuroma. It was believed the tumor had been incompletely excised at the posterior margin of surgical resection. No additional therapy was instituted. When the patient was reexamined 6 1/2 years later, the residual mass remained unchanged. Four previously reported cases of glioneuromas of the iris and ciliary body are summarized.

Adult↗
PubMed1984

Retinal microincarceration with penetrating diathermy in the management of giant retinal tears.

A technique for repair of giant retinal breaks with detachment involves the performance of lensectomy-sector iridectomy, vitrectomy, and scleral buckling behind the equator. Total fluid-gas exchange is performed while the patient is turned to the prone position on a rotating table. Penetrating diathermy is used to fix the retina and to create retinal microincarceration while air is simultaneously injected into the eye.

Adolescent↗