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A molecular description of how noble gases and nitrogen bind to a model site of anesthetic action.

UNLABELLED: How some noble and diatomic gases produce anesthesia remains unknown. Although these gases have apparently minimal capacities to interact with a putative anesthetic site, xenon is a clinical anesthetic, and argon, krypton, and nitrogen produce anesthesia at hyperbaric pressures. In contrast, neon, helium, and hydrogen do not cause anesthesia at partial pressures up to their convulsant thresholds. We propose that anesthetic sites influenced by noble or diatomic gases produce binding energies composed of London dispersion and charge-induced dipole energies that are sufficient to overcome the concurrent unfavorable decrease in entropy that occurs when a gas molecule occupies the site. To test this hypothesis, we used the x-ray diffraction model of the binding site for Xe in metmyoglobin. This site offers a positively charged moiety of histidine 93 that is 3.8 A from Xe. We simulated placement of He, Ne, Ar, Kr, Xe, H2, and N2 sequentially at this binding site and calculated the binding energies, as well as the repulsive entropy contribution. We used free energies obtained from tonometry experiments to validate the calculated binding energies. We used partial pressures of gases that prevent response to a noxious stimulus (minimum alveolar anesthetic concentration [MAC]) as the anesthetic endpoint. The calculated binding energies correlated with binding energies derived from the in vivo (ln) data (RTln[MAC], where R is the gas constant and T is absolute temperature) with a slope near 1.0, indicating a parallel between the Xe binding site in metmyoglobin and the anesthetic site of action of noble and diatomic gases. Nonimmobilizing gases (Ne, He, and H2) could be distinguished by an unfavorable balance between binding energies and the repulsive entropy contribution. These gases also differed in their inability to displace water from the cavity. IMPLICATIONS: The Xe binding site in metmyoglobin is a good model for the anesthetic sites of action of noble and diatomic gases. The additional binding energy provided by induction of a dipole in the gas by a charge at the binding site enhanced binding.

Anesthetics↗

Evaluation of retinal exposures from repetitively pulsed and scanning lasers.

Threshold damage in the macaque retina is shown to be equivalent for the argon-krypton (Ar-Kr) 647 nm and the helium-neon (He-Ne) 632.8-nm lines for exposures to continuous wave (CW) radiation from 1 to 1,000 s. This equivalence allows interpolation from experiments with 647-nm, exposures at power levels that are unavailable with the He-Ne laser. To simulate He-Ne laser scanner exposures, 40-microseconds pulses of 647-nm light transmitted through a revolving disk with holes in the periphery were used to expose the retinas of monkeys under deep anesthesia at pulse repetition frequencies (PRFs) of 100, 200, 400, and 1,600 Hz for exposure durations of 1, 10, 100, and 1,000 s. The thresholds between laser exposure at 488 nm (Ar-Kr) and between laser exposure at 647 nm (Kr) are compared to assess thermal versus photochemical effects on the retina. The threshold for 488-nm pulses was consistently lower than that for 647-nm pulses at all PRFs and exposure times. The difference in thresholds increased with exposure time and PRF. The sharp decreases in 488-nm thresholds at 100-s exposure times for each PRF can be interpreted as a basically photochemical effect. The radiant exposure required for damage at 647 nm was several orders of magnitude above the radiant exposure from typical He-Ne scanner applications. From the similarity of the macaque retina to the human retina, it is concluded that no realistic ocular hazard exists from exposure to scanning laser systems of 1 mW or less, operating at higher than 100 Hz.

Animals↗

Laser-induced chromatic adaptation.

Detecting a target in a visually noisy back-ground depends on the ability of the observer to discriminate the target from the surrounding terrain. Visible laser irradiation at less than damage levels may act as a masking source by reducing the observer's ability to resolve differences in the visual scene. The experiment reported here specifically investigates the comparability of shuttered CW and Q-switched visible lasers to alter/degrade color discrimination. Visual evoked potentials (VEP's) were used to examine the short time course effects in monkeys of luminance-matched flashes from a 694 nm ruby Q-switched laser and 100 ms shuttered krypton CW laser (676, 568, and 531 nm lines). The test stimulus was a shifting pattern of alternating luminance-matched 510 and 550 nm green bars. With flashes equated to 4.8 log T-s, similar flash effect curves were seen, demonstrating 1.5-s changes in response magnitude. This level of flash did not extinguish the response to the stimulus. The flash effects curve was "W"-shaped, with an intermediate signal peak occurring at approximately 500 ms after the flash and whose level exceeded the baseline magnitude. The hypothesized mechanism for this result is an induced luminance imbalance caused by a transient shift in the peak color responsiveness of the visual system, which recovers with two different time constants. It is concluded that red and green colored laser flashes shift the color balance transiently in the visual system (yellow flashes to a lesser extent); thus, targets may change both hue and brightness after an observer receives colored flashes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Ocular↗

Role of lasers in eye care.

This review discusses the role of lasers in eye care under five headings: Absorption of laser radiation by ocular tissues. Types of lasers include: ruby, argon, gas, organic dye, krypton, Nd:YAG, excimer, and infrared. Applications of lasers for examining the eye include: laser refraction, determining visual acuity by laser fringes, measuring retinal blood flow, scanning laser ophthalmoscopy and tomography, measuring aqueous flare, ocular holography, measuring retinal absorption, measuring visually evoked potentials, and measuring corneal sensitivity. Applications of laser radiation for ocular surgery include: photocoagulation, destruction of tumors, reattaching the retina, treating glaucoma by producing an iridotomy or by trabeculoplasty or by cyclodestruction. Lasers can be used to remove surface irregularities or superficial opacities from the cornea or eyelids. Other uses are for producing a capsulotomy and for altering corneal curvature as a means of correcting ametropia. Potential adverse effects of laser radiation on the eye are summarized.

Eye Diseases↗

An untreated macular hole with adjacent choroidal neovascularization.

BACKGROUND: Choroidal neovascularization (CNV) occurs in association with a variety of retinochoroidal disorders. However, it is not normally known to form after an untreated macular hole. CASE REPORT: A 75-year-old black male presented with a 12-month history of visual loss in his right eye. Funduscopy showed a full-thickness macular hole in the right eye. No treatment was recommended because the decrease in vision appeared to be long standing. Fourteen months later, the patient was noted to have a subretinal hemorrhage superior to the macular hole. Fluorescein angiography revealed an adjacent choroidal neovascular membrane, and focal krypton laser photocoagulation was performed. Recurrent CNV was noted 6 months later, and additional photocoagulation was performed. DISCUSSION: This case represents the 10th case reported of CNV with a full-thickness macular hole and only the second of a patient with an untreated macular hole and no other risk factors for CNV.

Aged↗

Laser photocoagulation for choroidal new vessel membrane complicating age-related macular degeneration associated with pigment epithelial detachment.

We studied 124 consecutive eyes that had laser photocoagulation for choroidal new vessel membranes (NVM) associated with pigment epithelial detachment (PED). In many cases, the extent of the NVM was uncertain. We thought it was not subfoveal in all cases but it possibly may have been subfoveal in one subgroup of cases. With a mean follow-up of 16 months, vision was stable or improved in 53% of the treated eyes. There was no difference in outcome between argon-treated and krypton-treated eyes. On the basis of fluorescein angiograms, we classified 86 of the eyes into four nonexclusive groups. Vision was stable or improved in 68% of eyes with juxtafoveal or extrafoveal PED, 48% with subfoveal PED, 76% with juxtafoveal or extrafoveal NVM, and 50% of eyes with possibly subfoveal NVM. A randomized clinical trial of laser photocoagulation for NVM in PED is both indicated and warranted. A pilot study under the auspices of the Macular Photocoagulation Study is now under way to determine the feasibility of and develop a protocol for such a trial.

Aged↗

Regression of disc neovascularization by photocoagulation in the acute retinal necrosis syndrome.

Disc neovascularization developed in one eye of a 40-year-old white woman with the acute retinal necrosis syndrome. Krypton laser scatter photocoagulation was placed in areas of nonnecrotic and segmentally nonperfused retina that were demonstrated by fluorescein angiography. Marked reduction in disc neovascularization was noted clinically 16 days after laser treatment and was confirmed angiographically 4 weeks after treatment. Neovascularization was completely regressed at 9 weeks after treatment. The authors postulate that the retinal vasculitis and nonperfusion produced retinal ischemia which stimulated neovascular proliferation, and that photocoagulation caused regression of the neovascularization.

Adult↗

Clinicopathologic findings in a patient with serpiginous choroiditis and treated choroidal neovascularization.

We present the ocular clinicopathologic features of the left eye of a patient who, during a 29-year period, developed the characteristic features of progressive serpiginous choroiditis. Two areas of choroidal neovascularization were successfully treated by laser photocoagulation. The larger area of neovascularization, located in and inferior to the maculopapillary bundle area and treated with argon laser, resulted in a scar composed of hyperplastic retinal pigment with persistence of neovascularization and full-thickness destruction of the retina. A smaller area of neovascularization, located temporal to the fovea and treated by krypton laser, resulted in a fibrous scar with obliteration of the new vessels and preservation of the inner retinal layers. A diffuse and focal infiltrate of lymphocytes was present in the choroid. Often, larger aggregates of lymphocytes were present at the margin of the serpiginous lesions. The serpiginous lesions were characterized by loss of retinal pigment epithelium and the photoreceptor cell layer. The margins of most lesions had variable degrees of hyperplastic retinal pigment epithelium and some had defects in Bruch's membrane, through which fibroglial scar tissue extended into the choroid.

Choroid↗

Photocoagulation scar expansion after laser therapy for choroidal neovascularization in degenerative myopia.

The authors performed a prospective study of 36 eyes affected by pathologic myopia with macular subretinal neovascularization (SRNV) successfully treated with either argon green, dye orange (590 nm), or krypton red lasers. Re-treated eyes were excluded. Evolution of the laser scar was carefully monitored for 12 months. Scar expansion was noted in 35 cases (97%), without a significant loss of visual acuity during the first year after treatment. The scar enlarged more conspicuously during the first 3 months after photocoagulation, with a mean increase of 103% in the first year. Expansion was not related to laser wavelength, patient age, SRNV size, or degree of myopia. Scar enlargement was greatest in the same direction as that of maximal extension of the myopic peripapillary crescent; inspection of the morphologic configuration of the peripapillary crescent before laser treatment may be helpful in evaluating the potential risk of post-laser scar expansion toward the fovea.

Adult↗

Visual results after laser treatment for peripapillary choroidal neovascular membranes.

To investigate the potentially harmful effects of laser photocoagulation in the papillomacular bundle (PMB), the records of patients treated for idiopathic neovascular membranes or membranes secondary to histoplasmosis extending into the PMB were reviewed. Twenty-eight eyes of 27 patients were identified. Most eyes (75%) were treated with the krypton red laser, while the remainder (25%) were treated with either argon green (18%) or a combination of the two (7%). After treatment 21 eyes (75%) had stable or improved visual acuity and three eyes (11%) lost more than three lines. Four eyes (14%) had changes in the optic disc and one eye developed a permanent arcuate scotoma. These data suggest that severe visual loss and extensive visual field defects occur rarely after photocoagulation of peripapillary choroidal neovascular membranes.

Adult↗

Clinicopathologic studies of treated choroidal neovascular membranes. A review and report of two cases.

The previously reported and two additional clinicopathologic studies of treated choroidal neovascular membranes were reviewed. Laser photocoagulation can obliterate choroidal neovascular membranes, but persistent and recurrent neovascularization contiguous with the treated area or the development of a new area of neovascularization contiguous or not contiguous with the treated area was seen histopathologically in nine of 12 (75%) lesions of 10 eyes. The scar that ensues after photocoagulation resembles the naturally occurring scar associated with choroidal neovascularization. Portions of the scar are comprised of hyperplastic retinal pigment epithelium. The inner retinal layers are more likely to be preserved after krypton red photocoagulation. Full-thickness destruction of the retina occurs with argon blue-green and argon green photocoagulation at levels of energy in which the end point is a uniform, white lesion.

Aged↗

Surgical treatment of retinal detachment in the choroidal colobomas.

Seven eyes from seven patients with retinal detachment and choroidal coloboma (with or without optic disc involvement) were treated. The retinal break was always inside the colobomatous area, except in the cases with evidence of peripheral retinal breaks. In order to produce reattachment of the retina, vitrectomy procedures with removal of posterior hyaloid were used. Drainage of subretinal fluid was performed through the break in the area of the coloboma, with simultaneous fluid-air exchange. Previously undetected retinal breaks were identified by inspecting for the presence of schlieren in the colobomatous area during fluid-air exchange. A peripheral scleral buckle was then applied. Argon laser endophotocoagulation was performed, but when the coloboma involved the optic disc, red krypton endophotocoagulation was used. Retinal reattachment was achieved in all cases.

Adult↗

Clinicopathologic correlation of laser lesion expansion after treatment of choroidal neovascularization.

The clinicopathologic features of photocoagulation lesion expansion after two separate sessions of krypton red laser for choroidal neovascularization (CNV) in an eye with age-related macular degeneration are presented. The area of expansion is characterized by retinal pigment epithelial atrophy and loss of the photoreceptor cell layer. A thin margin of retinal pigment epithelium hypopigmentation and variable photoreceptor cell layer degeneration also borders the lesion in some areas.

Aged↗

Lacquer cracks following laser treatment of choroidal neovascularization in pathologic myopia.

BACKGROUND: Lacquer cracks are breaks in the retinal pigment epithelial-Bruch's membrane-choriocapillaris complex and are manifestations of pathologic myopia. Progressive posterior segment elongation, uveal scleral thinning, and retinal pigment epithelial degeneration are thought to create a predisposition for crack formation in these eyes. In turn, choroidal neovascularization (CNV) may develop within the cracks to produce disciform scarring of the macula. This study examined lacquer cracks as a possible consequence of laser photocoagulation of CNV. METHODS: From the files of two retinal referral practices, five patients were located in whom lacquer cracks developed or expanded after laser photocoagulation for macular CNV in pathologic myopia. The mean age of the patients was 54.8 years. Four patients were treated with krypton red laser and one with an argon laser. Laser settings were available for only one of the patients. RESULTS: After laser photocoagulation, lacquer cracks were noted to expand in one or two directions from the laser scar between 10 days and 3 months of the treatment. The cracks also served as a pathway for progressive or recurrent neovascularization. CONCLUSIONS: Although lacquer cracks occur spontaneously in pathologic myopia, expansion, elongation, or simple development of a crack may occur as a result of laser photocoagulation of CNV. The new cracks also serve as a potential risk for recurrent neovascularization. This potential adverse complication should be considered in the management of CNV in pathologic myopia with laser treatment.

Adult↗

Squalamine lactate reduces choroidal neovascularization in a laser-injury model in the rat.

PURPOSE: To determine if systemically administered squalamine lactate, a novel aminosterol with antineoplastic and antiangiogenic activity, inhibits the development of experimental choroidal neovascularization membranes (CNVMs) induced by laser trauma in a rat model. METHODS: Twenty anesthetized male Brown-Norway rats received a series of 8 krypton red laser lesions per eye (647 nm, 0.05 second, 50 microm, 150 mW). One half the animals received an intraperitoneal injection of squalamine and the other one half received an injection of 5% dextrose in water, all performed in a masked fashion. Fundus photography and fluorescein angiography were performed at postlaser treatment days 14 and 28, and ocular tissues were processed for light microscopic examination following euthanasia of the rats on postlaser treatment day 28. RESULTS: Although fundus photography and fluorescein angiography yielded no statistically significant quantitative differences between the two groups, histologic analysis of the lesion sites revealed a partial but statistically significant reduction of experimental CNVM development in the squalamine-treated population. In particular, the squalamine-treated eyes (n = 20) demonstrated lesions (n = 149) with a mean CNVM thickness +/- SD of 47 +/- 11 microm, as compared with the control eyes (n = 20) that had lesions (n = 142) with a mean CNVM thickness +/- SD of 63 +/- 14 microm (P < 0.001). CONCLUSION: Systemically administered squalamine lactate partially reduced choroidal neovascular membrane development induced by laser trauma in this animal model. In conjunction with other existing and developing therapies, this agent may have a potential role in the treatment of human CNVM formation. Further study of squalamine lactate for treatment of neovascular eye disease is warranted.

Angiogenesis Inhibitors↗

Incidence of laser photocoagulation and photodynamic therapy with verteporfin at a tertiary retinal center.

PURPOSE: To examine the influence of photodynamic therapy (PDT) with verteporfin on the indication and frequency of conventional thermal krypton laser photocoagulation in choroidal neovascularization. METHODS: A retrospective chart review was performed comparing laser indication and frequency 1 year before and 2 years after PDT started to be used routinely following the guidelines of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy Study Group and the Verteporfin in Photodynamic Therapy Study Group. RESULTS: Similar frequencies of laser treatment were seen in the year before and during the first year after PDT was commenced (301 [7.1% of all patients] to 281 [6.9%]). In the year thereafter, however, there was a marked decrease in laser treatments (174 [3.9%]). Interestingly, there was a steady increase in the relative frequency of laser treatments of extrafoveal and parapapillary lesions in the years after PDT was commenced (29.2%, year 1; 30.6%, year 2; and 39.6%, year 3). CONCLUSION: PDT has led to a decrease in conventional laser photocoagulation at one large tertiary retinal center in Austria. Moreover, it is our belief that patients are now referred at earlier stages of the disease, which has resulted in a shift in thermal laser indications.

Aged↗

Ultrastructural analysis of rabbit retina irradiated with a new 670-nm diode red laser at different powers.

PURPOSE: Diode lasers have compact dimensions, efficient electric-optical conversion, absence of major cooling requirements, long useful life, and minimal maintenance. We verified the structural and ultrastructural effects of diode red laser emissions at 670 nm on pigmented rabbit retina. METHODS: Transpupillary laser pulses were applied to rabbit retinas at variable powers with a spot size of 500 microm ( approximately 1,000 microm at the retina level) and duration of 200 milliseconds. Light and electron microscopic analyses were performed. RESULTS: Subthreshold non-visible lesions were produced using a power of 200 mW. Ophthalmoscopically visible lesions were produced using a power of 400 mW. More prominent lesions were obtained using a higher power (600 mW). Structural and peculiar ultrastructural changes correlated with the power used. In general, damage was incurred by the retinal pigment epithelium with extension into the superficial choroid posteriorly and into the outer retina anteriorly. The inner retina was involved at higher power levels. CONCLUSIONS: Ultrastructural analysis of rabbit retina treated with the 670-nm diode laser adds newer insights on tissue changes after thermal irradiation. The effects observed are consistent with those reported for the krypton red laser. The 670-nm diode laser is an economic small-size photocoagulator that appears to be a promising modality for transpupillary laser photocoagulation of the retina.

Animals↗

Resonance Raman spectroscopy: a new technology for tissue oxygenation monitoring.

OBJECTIVE: To evaluate resonance Raman spectroscopy for the detection of changes in sublingual mucosal hemoglobin oxygen saturation (Smo2) in response to hemorrhage and resuscitation, and to compare Smo2 with other indicators of tissue oxygenation including central venous oxygen saturation (Scvo2), lactate, base excess, and shed blood volume. DESIGN: Prospective single group pilot study. SETTING: University laboratory. SUBJECTS: Five Sprague-Dawley rats. INTERVENTIONS: Animals were anesthetized and instrumented for measurement of arterial and central venous blood gases. Raman spectroscopy was performed using a krypton ion laser providing excitation at 406.7 nm (5 mW). A 1-mm2 region of the sublingual tongue surface was chosen for investigation. Animals were subjected to stepwise hemorrhage until approximately 50% of the blood volume was removed. At each hemorrhage and resuscitation interval, Raman spectroscopy was performed and corresponding arterial and central venous blood gas and lactate measurements were made. Smo2 was calculated as the ratio of the oxygenated heme spectral peak height to the sum of the oxy- and deoxyhemoglobin spectral peak heights. Raman spectroscopy-derived Smo2 measurements were compared with Scvo2 as well as with other indicators of oxygenation. MEASUREMENTS AND MAIN RESULTS: The mean difference between Smo2 and Scvo2 for all paired measurements was 5.8+/-11.7 absolute saturation points. Smo2 was significantly (p<.0001) correlated with Scvo2 (r=.80), lactate (r=-.78), base excess (r=.80), and shed blood volume (r=-.75). Smo2 and Scvo2 showed similar levels of precision for predicting elevated lactate and base deficit. CONCLUSIONS: These studies demonstrate the ability of Raman spectroscopy to noninvasively track microvascular hemoglobin oxygenation in tissue and favorably correlate with other important indicators of tissue oxygenation such as Scvo2, lactate, base deficit, and shed blood volume. The technique shows promise as a method to noninvasively monitor tissue oxygenation.

Animals↗