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PubMed1987

Enlargement of melanocytic iris lesions.

We evaluated the natural history of 175 melanocytic lesions (nevus or melanoma) of the iris which were managed initially by observation without surgical intervention. Only eight of the 175 lesions (4.6%) enlarged during a median follow-up interval of 3.9 years. Univariate Cox regression analysis revealed that tumor location in the medical portion of the iris (P = 0.047) and pigment dispersion from the lesion onto the adjacent iris and trabecular meshwork (P = 0.056) were the only significant clinical conditions predictive of tumor enlargement. Based on these findings, we recommend conservative management of most melanocytic lesions of the iris.

Adult↗
PubMed1987

Failed laser trabeculoplasty requiring surgery in open-angle glaucoma.

Argon laser trabeculoplasty (ALT) has been successful in controlling open-angle glaucoma, but a significant number of patients still require filtration surgery. Concern that post-laser inflammatory changes or alterations of structural anatomy with damage to the trabecular meshwork may adversely affect the outcome of filtration surgery prompted a retrospective review of 87 consecutive eyes with open-angle glaucoma that required filtration surgery following failed ALT. The follow-up period was at least 6 months, with a mean of 18 months (6 to 38 months). Posterior lip sclerectomy was chosen for 69 eyes and trabeculectomy for 18 eyes. The overall success rate of filtration surgery during the follow-up period was 92%. There was no recognized difference in the response to filtration surgery following ALT.

Evaluation Studies as Topic↗
PubMed1985

The corneal endothelium and Descemet's membrane in the iridocorneal endothelial syndrome.

A 39-year-old woman with progressive left unilateral glaucoma associated with corneal edema, iris changes, and peripheral anterior synechia formation underwent a left trabeculectomy and iridectomy in an attempt to control the intraocular pressure. Shortly after surgery the edema worsened despite low intraocular pressure measurements. A repeat trabeculectomy combined with a full thickness keratoplasty was performed 11/2 years later. The posterior corneal surface was found to be covered by a partially doubled layer of endothelial cells with ultrastructural features resembling epithelium. Similar cells were not noted on the surface of the initial trabecular meshwork and iris specimens, but were seen on the surface of the specimens obtained at the second trabeculectomy. The anterior and middle portions of Descemet's membrane, formed during perinatal and early adult life, appeared normal, but its posterior portion appeared abnormal. The ultrastructural changes in the endothelial cells and the abnormalities observed in Descemet's membrane suggest that the endothelial cells were initially normal but subsequently acquired epithelial-like features as they degenerated and proliferated. The continued presence of corneal edema despite the hypercellularity of the endothelium suggests that the proliferating cells were permeable to aqueous.

Adult↗
PubMed1985

The epidemiology of the pseudo-exfoliation syndrome.

The pseudo-exfoliation syndrome is characterized by the deposition of light gray or white dandruff-like flakes on various intraocular structures, most clinically apparent on the anterior lens capsule and pupillary margin but more significantly on the trabecular meshwork and ciliary processes. Its prevalence in various populations and relationship to age, sex, geography, heredity, and particularly to glaucoma have been the subject of numerous studies. Its prevalence is generally variable (depending on the subject population) and ranges from 1 to 8 percent, increasing with age. It is positively associated with higher levels of intraocular pressure and open-angle glaucoma. Although further carefully-controlled studies of prevalence and their relationship with glaucoma are desirable, patients with evidence of pseudo-exfoliation should be treated as glaucoma suspects.

Humans↗
PubMed1986

Flash and pattern electroretinograms in normal and laser-induced glaucomatous primate eyes.

Experimental glaucoma was produced in one eye of five cynomolgus monkeys with the argon laser delivering 100-200 50-mu spots at 1200-1500 mW power and 0.5 sec to 360 degrees of the mid-trabecular meshwork. Monocular electroretinograms (ERGs) were recorded prior to and 2, 3, and 4 mo following the laser treatment. In the laser-treated (glaucoma) eyes, normal flash ERGs were observed using 1-Hz stimulation; however, pattern ERGs (PERGs) elicited using steady-state counterphase modulation of a 0.51 cpd square wave grating showed statistically significant reductions of amplitude. Only small reductions of PERG amplitude were seen with a 1.25 cpd grating. In three animals, abnormalities of the PERG occurred prior to clinically significant cupping of the optic nervehead. Moreover, reductions of PERG amplitude were progressive and associated with the magnitude of cupping of the optic nervehead and elevation of intraocular pressure. PERG amplitude did not change following acute reductions in intraocular pressure in the glaucoma eyes. Several control experiments were conducted to insure that results were not due to alterations in pupil size, refractive state, or accommodation in the glaucoma eyes. The authors believe they now have a monkey model for the electrophysiologic study of glaucoma.

Animals↗
PubMed1985

Ocular and oculodermal melanocytosis.

Thirty-three cases of ocular (27) or oculodermal (6) melanocytosis were reviewed to determine the ocular structures involved by the melanocytic hyperpigmentation. The hyperpigmentation was clinically documented to involve all quadrants of the eye in the majority of the subjects; however, nine persons had sectorial involvement. The choroid and episclera were involved diffusely or sectorially in all the subjects, and the anterior chamber angle and iris were involved in most cases. The conjunctiva, lens and optic disc were less frequently involved. Ten persons had a uveal malignant melanoma in the hyperpigmented eye, and in three of the cases the melanoma had arisen in the hyperpigmented sector. Melanocytic involvement of the trabecular meshwork was not clinically correlated with elevated intraocular pressure.

Eye↗
PubMed1985

A re-appraisal of the development of the anterior chamber.

The development of the anterior chamber passes through distinct well orchestrated phases. It is a dynamic transition from an embryonic cleft to the adult anterior chamber. The cornea, lens, tunica vasculosa lentis, the iris, the ciliary epithelium, and the trabecular meshwork all play important roles in the development of the anterior chamber. Apart from these morphological changes that occur, the hydrodynamics of the transudate (from the tunica vasculosa lentis) and the aqueous humor from the ciliary epithelium appear to be essential components in the maintenance of the integrity of the anterior and posterior chambers.

Anterior Chamber↗
PubMed1985

Inheritance and the pigmentary dispersion syndrome.

The authors studied 33 patients in five families and have found that 14 of these patients fulfill criteria for the pigmentary dispersion syndrome. Affected patients had characteristics associated with the pigmentary dispersion syndrome, which are: peripheral slit-like iris transillumination defects, increased trabecular meshwork pigmentation, Krukenberg spindle, myopia, and elevated intraocular pressure. The authors observed this syndrome to be transmitted in a direct linear manner from parent to sibling in three of the four families. The transmission of this syndrome was found to be independent of refractive error, iris color, and sexual predilection, all of which are presented.

Female↗
PubMed1979

Uveoscleral flow of aqueous humor in the normal dog.

Fluorescein-labeled dextran and sodium fluorescein perfused in the posterior chamber of the normal dog eye egressed through the trabecular meshwork and intrascleral plexus, as well as posteriorly through the ciliary body into the suprachoroidal space and the sclera. Intraocular pressures of 20, 25, 30, and 60 mm of Hg did not produce detectable changes in the fluorescein-labeled dextran movement. Topical 1% atropine and 10% phenylephrine did not affect posterior passage of sodium fluorescein; 2% pilocarpine impeded posterior passage, causing an accumulation of sodium fluorescein and associated fluorescence in the anterior ciliary body.

Animals↗
PubMed1977

[Clinical results of the goniothrephining with scleral flap (author's transl)].

During 1971-1976 407 goniotrephinings e.g. "Elliot with scleral flap", were performed at the Univ. Eye Hospital Münster. In a follow-up study of 306 operated cases we found 81% primary glaucoma (62.7% simple glaucoma, 18.3% chronic congestive glaucoma) and 19% secondary glaucoma. In 77% of the operated cases the anterior chamber was restored within the first postoperative day. Gonioscopically in 85% the trephining hole was placed within the trabecular meshwork. Nevertheless, this position of the hole had no decisive influence on the later filtration. Postoperatively 2/3 of cases developed a characteristic flat filtering bleb. In 90.4% of the eyes the postoperative IOP was within normal limits. Postoperative follow-up of the visual acuity remained within the limits of age deterioration. Concerning the secondary glaucoma, the pigmentary glaucoma, the traumatic glaucoma and the glaucoma after uveitis, had good results. The results in cases of buphthalmos and hemorrhagic glaucoma were worse. The advantages of goniotrephining are the rapid restoring of the anterior chamber, the protection of the trephining hole by the scleral flap as well as the well "protected" flat and infections-resisting bleb.

Anterior Chamber↗
PubMed1983

Pediatric aphakic glaucoma.

Three cases of pediatric open-angle aphakic glaucoma are presented. These patients had congenital cataracts extracted by the extracapsular techniques of phacofragmentation or irrigation and aspiration. Each required a secondary membranectomy and had development of glaucoma six to 25 months after cataract extraction. Surgical therapy was required in each case of glaucoma, and multiple procedures were necessary. Visual outcome in the involved eye was less than 20/400. The cause of the open-angle aphakic glaucoma is most likely secondary to damage to the trabecular meshwork initiated by uveitis and lens remnants. We urge ophthalmologists who perform pediatric cataract surgery to use phacofragmentation of the cataract and posterior capsule and anterior vitrectomy with vitrectomy instrumentation. This should reduce the incidence of secondary membranes and glaucoma. Ophthalmologists should be aware of this complication and the necessity of prolonged patient follow-up.

Cataract Extraction↗
PubMed1983

Inheritance and the pigmentary dispersion syndrome.

We studied 23 patients in four families and have found that ten of these patients fulfill criteria for the pigmentary dispersion syndrome. Affected patients had characteristics associated with the pigmentary dispersion syndrome, which are: peripheral slit-like iris transillumination defects, increased trabecular meshwork pigmentation, Krukenberg spindle, myopia, and elevated intraocular pressure. We observed this syndrome to be transmitted in a direct linear manner from parent to sibling in three of the four families. The transmission of this syndrome was found to be independent of refractive error, iris color, and sexual predilection; all of which will be presented.

Adult↗
PubMed1983

Protein glaucoma as a possible mechanism in a case of glaucomatocyclitic crisis and periphlebitis.

A case of glaucomatocyclitis crisis with recurrent episodes of increased I0P, abnormal appearance of the angle structure and periphlebitis was presented. Some of these episodes involving first one eye and later occurring bilaterally were characterized by absence of flare in the anterior chamber. It is suggested that protein leakage following retinal periphlebitis or an inflammatory reaction involving the ciliary body might be the underlying mechanism for the elevated ocular pressure. The abnormal angle structure in our patient favored this protein glaucoma. A permanent increase in I0P observed at the latter stages of the disease indicate that the trabecular meshwork might be damaged irreversibly by protein glaucoma.

Adult↗
PubMed1984

Effectiveness of nonpenetrating trabeculectomy in aphakic patients with glaucoma.

Nonpenetrating trabeculectomy was performed on 28 aphakic eyes consisting of 18 with chronic open-angle glaucoma and 10 with secondary and/or complicated glaucoma. The canal of Schlemm and the juxtacanalicular trabecular meshwork were excised for a length of 4 mm beneath a 6 mm x 6 mm scleral flap. At one year postoperatively, 72.0% of all patients were controlled, 24% required no antiglaucoma medications. However, 88% of chronic simple glaucoma patients were satisfactorily controlled. The mean follow-up period was 1.4 years. Minimal complications have been encountered to date. Nonpenetrating trabeculectomy may be valuable as an initial procedure in aphakic patients who require glaucoma filtration surgery.

Adult↗
PubMed1984

Spontaneous remission of glaucoma in scleromalacia perforans: a case report.

Spontaneous resolution of glaucoma in a patient with scleromalacia perforans is described. Fluorophotometric measurements established the presence of normal aqueous production. The reduced intraocular pressure is ascribed to either autolysis of the trabecular meshwork and/or maximization of the uveoscleral pathway.

Aged↗
PubMed1978

Ocular complications of electroconvulsive therapy.

Multiple cardioversion shocks were recently reported to cause disruption of the iris pigment epithelium. Pigment debris was deposited on the anterior lens surface, iris stroma, corneal endothelium, and trabecular meshwork. Similar findings were observed in 3 of 4 patients receiving more than 10 electroconvulsive therapy shocks and in a fifth patient who became attached to an electrified fence.

Adult↗
PubMed1983

[Subarticular spongiosa and its relation to the remaining internal structure of the calcaneus in the human].

The subarticular cancellous bone of the human calcaneus has been investigated in sixty nine cases of known age and sex. In addition eleven calcanei without corresponding informations were used. The three forms of cancellous bone and their threedimensional junctions were analysed by means of the dental burr. It is shown an age bound transformation of the roundmeshed cancellous bone into tubular structures and finally into bone plates or an trabecular network. A tubular construction is presumed as intermediate stage changing by osteolysis into bone plates or trabecular meshwork. The conception of the trajectorial structure presented by Gierse (1976) is more differentiated and enlarged. Considering the calcaneus the normal osteoporosis of old age can be understood to be an age controlled exactly adjusting process. The findings of wide spaced an enlarged cancellous bone elements in a few elder individuals is thought to be a secondary adaptation after preceding normal reduction. Histologic and biometric investigations of this subject will be following.

Adolescent↗
PubMed1982

Cytochalasin B and D dose-outflow facility response relationships in the cynomolgus monkey.

Total outflow facility was determined by two-level constant-pressure perfusion in cynomolgus monkeys for 30 to 40 min before and after intracameral infusion of cytochalasins B and D (CB, CD). CB and CD dose-facility response relationships were defined. CB doses of 0.1, 0.2, and 0.5 micrograms were subthreshold; 1, 2, 5 and 10 micrograms were effective, with 5 micrograms probably supramaximal. CD at 0.02 microgram was probably subthreshold; 0.1, 0.5, 1, 2.5, and 5 micrograms doses were effective, with 0.1 microgram being near or above maximum. Although the maximum effects of both agents were quantitatively similar, approximately doubling-starting facility, CD Was about 25 times more potent. Therefore, CB- and CD-induced facility increases are presumably due largely to interference with formation, structure, and function of actin filaments in the endothelial cells of the trabecular meshwork and inner wall of Schlemm's canal.

Animals↗