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PubMed2000

High frequency color Doppler image of choroidal detachment.

PURPOSE: To study the Color Doppler Image (CDI) characteristics of choroidal detachment and the applied value of CDI. METHODS: Seventy-two cases (74 eyes) of choroidal detachment were studied retrospectively. RESULTS: The typical ultragraph of chroridal detachment displayed one or several smooth hemispherical or lobuler circular thick bands, with convex side toward vitreous cavity. Most of the choroidal detachments were located before the equator, a few of them were beyond the equator. CDI displayed blood flow singnal in the band. Pulse Doppler showed the frequency spectrum features of retinal detachment band were similar to those of central retinal vessels, whereas the frequency spectum features of choroidal detachment bend resembled those of ciliary artery in some cases of retinal detachment (RD) accompanied by choroidal detachment. CONCLUSION: CDI could make a correct and precise diagnosis of choroidal detachment.

Adolescent↗
PubMed2003

Golden Jubilee Lecture. Randomised clinical trials of choroidal melanoma treatment.

PURPOSE: To illustrate an approach to evidence-based medical practice by reporting the Collaborative Ocular Melanoma Study (COMS) randomised clinical trials and cohort studies of choroidal melanoma. METHODS: COMS randomised clinical trials of Iodine-125 (I-125) brachytherapy, adjunctive cohort study of visual acuity in eyes treated with brachytherapy and adjunctive natural history study. COMS randomised clinical trial of pre-enucleation radiation. RESULTS: The COMS I-125 brachytherapy trial (N = 1,317 patients) of medium-sized choroidal melanoma showed 5-year all-cause mortality of 18% [95% Confidence Interval (CI), 16-20%] and no statistically significant difference in mortality following I-125 brachytherapy or enucleation. Adjunctive cohort natural history study (N-42 patients) of patients eligible for the I-125 brachytherapy trial who deferred treatment or had no melanoma treatment had a 5-year all-cause mortality of 30% (95% CI, 18-47%). The COMS pre-enucleation radiation trial (N = 1,003 patients) of large-sized choroidal melanoma showed 5-year all-cause mortality of 40% (95% CI, 37-44%). CONCLUSIONS: Evidence derived from randomised clinical trials and cohort studies shows the need for longterm (> or = 5 years) follow-up to determine the efficacy of treatment for choroidal melanoma by any modality. The rather similar 5-year mortality for treated and untreated medium melanoma patients suggests that metastatic dissemination may occur at an early stage of choroidal melanoma. To increase longterm survival, ocular treatment of choroidal melanoma must strive for diagnosis and treatment of melanoma at an early stage when metastasis is less likely and be combined with measures to detect and treat micrometastasis.

Brachytherapy↗
PubMed2003

Choroidal osteoma in Oriental patients.

BACKGROUND: Choroidal osteoma is a rare tumour of the choroid. This is the first report of cases of choroidal osteoma in Thai patients. OBJECTIVE: To report the clinical characteristics, imaging findings and long-term follow-up of choroidal osteoma in four Oriental patients. METHOD: Four cases of choroidal osteoma were observed for 5 years or more. RESULTS: All patients were young female patients whose ages ranged from 24 to 37 years. Three were unilateral and one was bilateral. The tumors were located at the juxtapapillary and macular area with overlying serous retinal detachment. Two patients had previous thyroid diseases and one was pregnant when the tumors were diagnosed. Osteoma did not develop in the vicinity of posterior staphyloma of high myopic eyes. Echography showed acoustic features of a plano-convex sonically dense lesion with high reflectivity echoes which persisted despite lower system sensitivity. None had subretinal neovascularization. Subretinal fluid disappeared spontaneously within one to 14 months in three patients. Gradual growth of the tumor in a pseudopodium manner developed from two to six years after initial examination. Decalcification occurred spontaneously or after laser ablation. CONCLUSIONS: The authors presented four Oriental patients with choroidal osteoma who were observed for at least 5 years. Echography is the best method for identifying this lesion and has unique acoustic features. Subretinal fluid can be seen in the absence of subretinal neovascularization and resorbs spontaneously. Decalcification occurred as a natural process or after laser ablative treatment. Hormonal changes may implicate the development of this tumor.

Adult↗
PubMed1992

Protein synthesis at the blood-brain barrier. The major protein secreted by amphibian choroid plexus is a lipocalin.

Among the proteins secreted by choroid plexus of vertebrates, one protein is much more abundant than all others. In mammals, birds, and reptiles this protein is transthyretin, a tetramer of identical 15-kDa subunits. In this study choroid plexus from frogs, tadpoles, and toads incubated in vitro were found to synthesize and secrete one predominant protein. However, this consisted of one single 20-kDa polypeptide chain. It was expressed throughout amphibian metamorphosis. Part of its amino acid sequence was determined and used for construction of oligonucleotides for polymerase chain reaction. The amplified DNA was used to screen a toad choroid plexus cDNA library. Full-length cDNA clones were isolated and sequenced. The derived amino acid sequence for the encoded protein was 183 amino acids long, including a 20-amino acid presegment. The calculated molecular weight of the mature protein was 18,500. Sequence comparison with other proteins showed that the protein belonged to the lipocalin superfamily. Its expression was highest in choroid plexus, much lower in other brain areas, and absent from liver. Since no transthyretin was detected in proteins secreted from amphibian choroid plexus, abundant synthesis and secretion of transthyretin in choroid plexus must have evolved only after the stage of the amphibians.

Amino Acid Sequence↗
PubMed1992

Fluorescence characteristics of drusen during indocyanine-green angiography and their possible correlation with choroidal perfusion.

The fluorescence of drusen and their correlation with choroidal perfusion was investigated using indocyanine-green videoangiography in 37 patients (mean age, 66 +/- 16 years) with juvenile and senile drusen. Most senile drusen (89%) blocked choroidal indocyanine-green fluorescence, and only three patients had small, weakly hyperfluorescent drusen at the vascular arcade. In contrast, all juvenile drusen (patients aged 31-52 years) demonstrated strong hyperfluorescence. Impaired choroidal perfusion was not detected. In 33% of the patients, all of them older than 60 years, moderate choroidal hypofluorescence could be explained by the presence of confluent drusen and/or a thickening of the pigment epithelium-Bruch's membrane complex. The results of the present study demonstrate that indocyanine-green angiography enables the differentiation of juvenile drusen from senile drusen, which could be an indication of a differing pathogenesis for the two diseases. Indocyanine-green hyperfluorescence of drusen must be caused by the transmission of choroidal fluoresence. This jeopardizes the hypothesis that the fluorescein fluorescence of drusen is invariably caused by storage of the dye. Our results contradict previous fluorescein studies that have demonstrated impaired choroidal perfusion in patients with age-related macular degeneration.

Adult↗
PubMed2004

Early transcriptional changes of retinal and choroidal TGFbeta-2, RALDH-2, and ZENK following imposed positive and negative defocus in chickens.

PURPOSE: Imposing defocus to the retina results in compensatory changes of axial eye growth. It is not clear which factors initially contribute to this process and whether they act on the post-translational, translational, or transcriptional level. We have measured early changes in mRNA levels, in response to imposed negative and positive defocus, of the transcription factor ZENK, the retinoic acid synthesis enzyme RALDH-2, and the growth factor TGFbeta-2. METHODS: Chickens 11 days of age were unilaterally treated with positive or negative spectacle lenses of 7 D power. After 0, 15, 30, and 120 min, mRNA was extracted from retina and choroid, and the concentration of the mRNAs of the three candidates was measured by quantitative real time PCR in both eyes. RESULTS: ZENK in the retina and RALDH-2 in the choroid displayed parallel signs of defocus dependent changes in mRNA levels after 15 or 30 min, respectively. ZENK mRNA levels were reduced in the retina after 15 min with both types of lenses but were then up regulated at 30 min with positive lenses and down regulated with negative lenses, similar to the previously observed changes in ZENK protein levels. Changes of RALDH-2 and TGFbeta-2 mRNA levels were confined to the choroid. Treatment with negative lenses resulted in a rapid (15 min) and persistent decrease in TGFbeta-2 mRNA concentration in the choroid. Negative lenses provoked parallel but less pronounced alterations in the open fellow eyes. CONCLUSIONS: Imposed defocus triggers extensive transcriptional changes of ZENK in the retina, and of TGFbeta-2 and RALHD-2 in the choroid. Changes in retina and choroid are rapid, show no phase delay with respect to each other, and can be considered, in the case of RALDH-2 and ZENK, as specific for the sign of imposed defocus. They occur prior to any morphological changes. This is consistent with a role in causing or controlling later changes in eye growth.

Aldehyde Oxidoreductases↗
PubMed2005

[Gene expression patterns of choroidal neovascularization induced by krypton laser photocoagulation].

OBJECTIVE: To explore the gene expression patterns of choroidal neovascularization with gene chip technology. METHODS: Total RNA was isolated from normal choroid and choroid tissues with neovascularization induced by krypton laser photocoagulation in Brown Norway rat. The mRNA was purified and was reversely transcribed to cDNA to prepare for hybridization probes. In choroidal neovascularization, the differentially expressed genes were assayed with gene chips which contained 5705 rat genes. RESULTS: There were 46 genes expressed differentially in choroidal neovascularization. Of these, the expression of 3 genes was upregulated and 43 genes downregulated. These genes were involved in the function of transport, signal, metabolism, development and differentiation of cell adhesion. CONCLUSION: Numerous genes are involved in the development of choroidal neovascularization induced by krypton laser photocoagulation.

Animals↗
PubMed1992

Autoregulation of choroidal blood flow in the rabbit.

Previous studies show that choroidal blood flow is not autoregulated when intraocular pressure (IOP) is increased to raise venous pressure and lower the perfusion pressure gradient. However, the autoregulatory response to changes in mean arterial pressure (MAP) is unclear. In the current study, the perfusion pressure gradient (MAP-IOP) was altered by (1) decreasing MAP while IOP was held at 5, 15, and 25 mmHg, and (2) increasing the IOP at the prevailing MAP in anesthetized rabbits (n = 8). An occluder on the thoracic vena cava was used to vary MAP; this was monitored through an ear artery catheter. Two catheters were inserted in the vitreous to monitor and control IOP. Choroidal blood flow was measured by laser Doppler flowmetry using a slender stainless-steel probe positioned next to the retinal surface. The efficacy of autoregulation depended on the IOP. When IOP was held constant at 5 mmHg, choroidal blood flow did not fall until the perfusion pressure gradient was less than 40 mmHg. The pressure-flow relationship became progressively more linear (ie, the efficacy of autoregulation decreased) when the IOP was held constant at 15 and 25 mmHg. When IOP was varied and MAP was held constant, the pressure-flow relationship was linear at IOPs greater than 20-25 mmHg. However, choroidal blood flow was pressure independent when the IOP was less than 20-25 mmHg. Simultations using a myogenic mathematic model of the choroid gave results similar to the experimental observations. It was concluded that a myogenic mechanism may be responsible for the autoregulation of choroidal blood flow in the rabbit.

Animals↗
PubMed2005

The role of choroidal and retinal biopsies in the diagnosis and management of atypical presentations of uveitis.

PURPOSE: Choroidal and retinal biopsies are often the investigation of last resort in evaluating patients with uveitis, because of the possible morbidity of the procedure. The most common indication is atypical uveitis, in which a diagnosis of malignancy or infection may be suspected. Here, we describe our experience at the Casey Eye Institute. METHODS: This was a retrospective case series from January 2000 through October 2004. Cases labeled as "retinal or choroidal biopsy" were drawn from the pathology database at the Casey Eye Institute, and the pathology and clinic charts were reviewed. In all cases, the retinal and choroidal biopsies were obtained via an internal approach with a three-port pars plana vitrectomy. RESULTS: Eight cases of atypical uveitis were found for which choroidal biopsies were performed. Five patients had had previous vitrectomies, in which examination of the vitreal sample had been inconclusive. Five patients had a definitive diagnosis after the biopsy and a good response to tailored therapy. In one case, diagnosis was made after biopsy, but clinical improvement was minimal despite appropriate treatment. One case had an inconclusive biopsy that enabled the exclusion of malignancy and infection with good response to immune suppression. In another case, choroidal biopsy was inconclusive and the eventual diagnosis was made only after enucleation. CONCLUSION: Retinal and choroidal biopsies can be extremely useful in the diagnosis and further management of atypical, aggressive presentations of uveitis. In this small series, risk of complications was low. However, in patients with an inconclusive biopsy, an additional biopsy or enucleation should be considered in cases that progress or behave atypically on treatment based on the initial biopsy findings.

Adolescent↗
PubMed1991

[Effects of cigarette smoking on ocular circulation chronic effect on choroidal circulation].

The effects of long-term smoking on choroidal circulation were studied. For this purpose, Wistar rats were made to inhale mainstream smoke for 30 minutes daily. After periods of inhalation (16 weeks and 25 weeks), choroidal blood flow (CBF) was measured by the hydrogen clearance method and the index of choroidal vascular resistance (systolic tail arterial pressure/CBF) was calculated. There was no significant difference in CBF between either smoking group (16 weeks and 25 weeks) and controls. However the index of choroidal vascular resistance increased significantly after inhalation of smoke for 25 weeks. No histopathological abnormalities were detected in the choroid and outer layer of the retina. The results suggested that long-term smoking might induce disturbance of choroidal circulation.

Animals↗
PubMed1991

Fetal lateral ventricle choroid plexus cysts: the dilemma of amniocentesis.

Although lateral ventricle choroid plexus cysts in the second-trimester fetus have been considered a benign developmental phenomenon of no clinical significance, an association with trisomy 18 has been suggested. We designed a prospective study to determine whether karyotype analysis is indicated when such cysts are encountered on prenatal sonogram. During a 20-month period, 5400 low-risk pregnant women were examined sonographically in the second trimester to evaluate the prevalence of fetal lateral ventricle choroid plexus cysts and the incidence of ultrasonographic anomalies associated with such cysts in fetuses with trisomy 18 referred from cytogenetic laboratories. Thirty cases of fetal lateral ventricle choroid plexus cysts (0.6%) were detected during the study period; 28 newborns were normal and two had trisomy 18. One of the affected infants had other associated ultrasonographic abnormalities suggesting aneuploidy, whereas no detectable abnormalities could be found in the other. Three other pregnant women were referred to us from the cytogenetics services because fetal karyotype revealed trisomy 18; in all three cases lateral ventricle choroid plexus cysts and other sonographic abnormalities were observed. In total, we scanned five fetuses with trisomy 18, of which all had lateral ventricle choroid plexus cysts and four had associated detectable anomalies. We could not find any association between cyst size, number, or laterality and trisomy 18. In addition to the five cases of trisomy 18 described, we found 33 other fetuses reported with trisomy 18 in the second trimester; of this total, 25 (66%) had lateral ventricle choroid plexus cysts and 30% had no other detectable abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Choroid plexus tumors in infancy].

Twelve infants with choroid plexus tumors were reviewed retrospectively. Enlarging head circumference, bulging fontanelle, and vomiting were the major symptoms and signs appearing 2 to 5 weeks (mean = 3.7 weeks) before diagnosis. The average age at diagnosis was 7.7 months. Total removal was performed in 11 patients with choroid plexus papilloma, and partial removal was achieved in 1 patient with a choroid plexus carcinoma. A cerebrospinal fluid (CSF) diversionary shunt was placed temporarily in 6 infants and permanently in 4. Of the two patients not requiring CSF diversionary shunt, 1 needed a subdural-peritoneal shunt postoperatively. Histologically, 11 of 12 tumors were choroid plexus papillomas, and one was a choroid plexus carcinoma. All 12 patients were followed up for 4 months to 11 years (mean = 5.6 years). Eleven of 12 patients were alive at the time of their last check-up. All 11 survivors had normal psychomotor and neurological development. The treatment and outcome of choroid plexus tumors and management of associated hydrocephalus are discussed.

Carcinoma↗
PubMed1991

[Histopathological study on the monkey retina and choroid by diode laser endophotocoagulation].

The fundi of three cynomolgus monkeys were coagulated using a diode laser endophotocoagulator. The histopathological changes of the retina and the choroid were investigated periodically up to 3 months. The damage of the retina extended into the outer plexiform layer following mild burn, into the inner nuclear layer with moderate burn and into the nerve fiber layer on severe burn. The pigment epithelium proliferated with multiple layer cells 1-3 months after the irradiation. The choriocapillaries were obstructed, regardless of the degree of burns, immediately after the irradiation, but recanaliculation was observed at the mild and moderate burns 1-3 months after the irradiation. The effects on the choroid were localized to the inner layer following mild burn, but the damage extended into the outer layer with moderate burns. Following severe burns obstruction of the medium size vessels was observed. The fibrous changes of the choroid increased in accordance with the degree of the burn. The damaged melanophore in the choroid recovered considerably 1 month after the mild burn. On the other hand, many macrophages still remained in moderate and severe burn lesions. These results suggested that diode laser photocoagulation might be effective for the treatment of the choroidal diseases rather than retinal diseases, because diode laser photocoagulation produced the considerable change in the choroid as well as in the retina.

Animals↗
PubMed1990

[Alterations of atrial natriuretic peptide receptor in the choroid plexus of rats with congenital hydrocephalus (LEW-HYR and HTX)].

By using quantitative receptor autoradiography, specific atrial natriuretic peptide (ANP) binding sites in the choroid plexus of congenital hydrocephalic rats (LEW/HYR and HTX strains) were analyzed. The effect of ANP on cyclic GMP production in the choroid plexus of these rats were also examined. The number of 125I-ANP binding sites in the choroid plexus of rats with congenital hydrocephalus (both LEW/HYR and HTX strains) was significantly lower, at 0.3 nM 125I-ANP concentrations, when compared with those in the age-matched control rats. This alteration was specific in the choroid plexus, since no significant difference in the binding of 125I-ANP was observed in the olfactory bulb. On the other hand, in spite of lower number of 125I-ANP binding sites in the choroid plexus, cyclic GMP response to ANP in these rats was similar to that of age-matched control Lewis rats. These results suggest that ANP receptor may play a role in the regulation of cerebrospinal fluid production. Alterations in ANP receptor in the choroid plexus might be involved in the development of congenital hydrocephalus.

Animals↗
PubMed1990

Presumed choroidal metastasis of Merkel cell carcinoma.

Merkel cell carcinoma is a rare skin tumor of neural crest origin and is part of the amine precursor uptake and decarboxylase system. It typically occurs on the face of elderly people. Distant metastasis is almost uniformly fatal. Choroidal metastasis, to our knowledge, has not been described. We report a patient with Merkel cell carcinoma who had a synchronous solid choroidal tumor and a biopsy-proven brain metastasis. Our 56-year-old patient presented with a rapidly growing, violaceous preauricular skin tumor. Computed tomography of the head disclosed incidental brain and choroidal tumors. Light and electron microscopy of biopsy specimens of both the skin and the brain lesions showed Merkel cell carcinoma. Ophthalmoscopy, fluorescein angiography, and A and B echography revealed a solid choroidal mass. The brain and skin tumors responded well to irradiation. A radioactive episcleral plaque was applied subsequently to the choroidal tumor. All tumors regressed, and the patient was doing well 28 months later. To our knowledge this is the first case of presumed choroidal metastasis of Merkel cell carcinoma.

Biopsy↗
PubMedDate not supplied

The bright choroid plexus on MR: CT and pathologic correlation.

Fourteen patients studied with MR imaging were found, incidentally, to have unusually bright, large choroid plexus glomera on T2-weighted sequences. A group of 167 patients was then examined retrospectively for size and intensity of the choroid plexus glomera on T2-weighted images. In the latter group of 167 patients, 66 (39.5%) had bright choroid plexus glomera. Of those who had bright choroid plexus glomera, eight of the 14 initial group and 11 of the 66 patients studied retrospectively had previous CT scans. The typical CT appearance of these bright glomera consisted of nonenhancing central regions of low (but not negative) attenuation with peripheral calcifications in the majority. The remainder showed noncalcified glomera. Fifty-two glomera were obtained at autopsy and examined retrospectively. Eight showed small, variably sized masses with lipid deposits, neuroepithelial microcysts, and peripheral psammoma body calcifications. One patient who died had a bright choroid plexus glomus on MR, and his glomera showed the same pathologic findings. The autopsy findings were believed to be typical pathologically for early xanthogranulomata formation. These early xanthogranulomatous changes appear to be of little clinical significance but must be differentiated from other lesions that can produce bright or enlarged choroid plexus glomera on MR.

Adolescent↗
PubMed1988

[Ossified choroid plexus papilloma--case report].

While the calcification has been documented radiologically in 4 - 25 percent of the cases with choroid plexus papilloma, the ossification of choroid plexus papilloma has been reported only in 3 cases on literature. In this paper, we present a case of large ossified choroid plexus papilloma in the right lateral ventricle. A 35-year-old man was admitted with left hemiparesis and headache. Skull X-rays showed an abnormal calcified mass (25 mm x 23 mm x 14 mm) in the right temporal region. CT scan revealed an abnormal high density area protruding into the right lateral ventricle, and a low density area at the right corona radiata. Operation was carried out with a right temporal craniotomy. The mass was yellowish-elastic hard and protruded into the right inferior horn of the lateral ventricle. The histological examination of surgical specimen showed an ossified choroid plexus papilloma with some bone marrow formation and numerous calcification. Calcification of choroid plexus papilloma is found frequently, but ossification is a very rare neuropathological abnormality. Bone and/or cartilage formation in neuroepithelial neoplasms is an unusual event histopathologically. Several mechanisms have been proposed, such as (1) metaplasia of connective tissue, (2) transformation of neuroepithelial cells to mesenchymal tissue, (3) teratomatous nature, (4) heteroplasia, (5) mixed mesenchymal-neuroepithelial nature, and (6) ossification as an end stage of mucoid degeneration. In our case, it was considered that the bone formation resulted from metaplasia of connective tissue of choroid plexus papilloma.

Adult↗
PubMed1986

Retinal pigment epithelial lipofuscin and melanin and choroidal melanin in human eyes.

Optical measurements of the pigments of the retinal pigment epithelium (RPE) and choroid were made on 38 human autopsy eyes of both blacks and whites, varying in age between 2 wk and 90 yr old. Lipofuscin in melanin-bleached RPE was measured as fluorescence at 470 mm following excitation at 365 nm and was found to be proportional to fluorescence measured at 560 nm in unbleached tissue. Transmission measurements of RPE and choroidal melanin were converted and expressed as optical density units. The choroidal melanin content increased from the periphery to the posterior pole. RPE melanin concentration decreased from the periphery to the posterior pole with an increase in the macula. Conversely, the amount of RPE lipofuscin increased from the periphery to the posterior pole with a consistent dip at the fovea. There was an inverse relationship between RPE lipofuscin concentration and RPE melanin concentration. The RPE melanin content was similar between whites and blacks. Lipofuscin concentration was significantly greater (P = 0.002) in the RPE of whites compared to blacks; whereas blacks had a significantly greater (P = 0.005) choroidal melanin content than whites. The amounts of both choroidal and RPE melanin showed a trend of decreasing content with aging, whereas the amount RPE lipofuscin tended to increase (whites greater than blacks). Per fundus area, the amount of choroidal melanin was always greater than that in the RPE. There was a statistically significant (P = 0.001) increase in RPE height with age, most marked in eyes of whites after age 50 and correlated with the increase in lipofuscin concentration.

Adolescent↗