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Abnormal polarization and axon outgrowth in retinal ganglion cells lacking the POU-domain transcription factor Brn-3b.

The POU domain transcription factor Brn-3b (also called Brn-3.2) is essential for the normal development of retinal ganglion cells (RGCs) in the mouse. Without Brn-3b, RGCs commit to their fate and migrate to the ganglion cell layer, but most cells die during fetal development. An earlier report (L. Gan et al., 1999, Dev. Biol. 210, 469-480) suggested that cell death was caused by abnormal axon formation. Here, we use retinal explants from wild-type and mutant embryos to show that brn-3b-deficient RGCs are not properly polarized and tend to form dendrites rather than axons. Compared with wild-type explants, neurites of RGCs from brn-3b-deficient retinal explants grew slower, were shorter, and did not fasciculate properly. Mutant neurites had more microtubules than wild-type controls, and the arrangement of microtubules and neurofilaments was characteristic of dendrites rather than axons. Neurites from individual mutant RGCs displayed abnormal polarity and had dendrite-like branches extending outward from their main axis. Most mutant RGCs exhibited abnormal migratory behavior, and their neurites labeled intensely with the dendrite marker MAP-2. A small number of mutant RGCs were not migratory, and their neurites were longer and labeled positively for the axon marker tau-1, suggesting that some RGCs were not as severely affected by the absence of Brn-3b as others. Although tau-1 was not observed in most mutant neurites, it did accumulate in mutant cell bodies, implying that the absence of Brn-3b caused a defect in axon transport. Thus, Brn-3b appears to control the activity of genes that function in establishing RGC polarity, and without Brn-3b, RGCs cannot extend normal axons.

Animals↗

The electro-oculogram in central retinal vein occlusion.

As part of a prospective masked study, the electro-oculogram (EOG) was recorded from 28 patients within 48 days of developing central retinal vein occlusion (CRVO). The EOG light peak/dark trough ratio (Lp/Dt) x 100 was significantly lower in the affected than in the unaffected eyes of patients (p < 0.001), and abnormally low in absolute terms in 20 patients (71%). All unaffected fellow eyes had a normal EOG ratio. The mean Lp amplitude of affected eyes was significantly smaller than that of unaffected eyes (p < 0.001), whereas the differences in mean Dt amplitudes between affected and unaffected eyes were not statistically significant. The Lp amplitude in the affected eye was 48% or less of that in the unaffected eye in the eight patients (29%) who developed rubeosis iridis during the 9 month follow-up, and in six others. No patient whose Lp amplitude in the affected eye was greater than 48% of that in the unaffected eye, developed rubeosis. It is concluded that the Lp amplitude is abnormal in patients with acute CRVO. The degree of this abnormality bears a relation to the development of rubeosis, which might prove a useful indicator of whether to institute or withhold panretinal photocoagulation.

Acute Disease↗

Histologic correlation of human neural retinal transplantation.

PURPOSE: To describe the histologic findings of the transplanted eye of a 94-year-old man with neovascular age-related macular degeneration, who 3 years earlier underwent subretinal transplantation of both a fetal neural retinal sheet and a retinal microaggregrate suspension. METHODS: Serial sections of the posterior segment of the eye and the transplanted areas were processed and studied by routine histologic techniques, including both light and transmission electron microscopy (TEM). Transplanted areas were also examined for the presence of glial, neuronal, and photoreceptor cell markers by standard immunohistochemical methods. RESULTS: After transplantation in this patient, there was no visual improvement. Light microscopic examination disclosed survival of the transplanted cells in the subretinal space with no evidence of inflammation or rejection. The neural retinal sheet transplant developed a layered configuration. The retinal pigment epithelium (RPE) was absent over much of the posterior pole, including the area of transplantation. TEM examination and immunohistochemical analysis disclosed the presence of neuronal and glial cells within the transplant. A few transplant neuronal cell processes overlying a focus of residual RPE cells were positive for S-antigen, but well-developed photoreceptor outer segments were not present. CONCLUSIONS: Long-term survival of transplanted neural retinal tissue can be achieved in human patients without immunosuppression. The lack of photoreceptor development in this patient may be the result of absent or dysfunctional RPE. Nonetheless, the long-term survival of grafted tissue in the human subretinal space in the absence of immunosuppressive treatment is promising for future efforts in the field of neural retinal transplantation.

Aged↗

Retinal blood flow indices in patients infected with human immunodeficiency virus.

AIMS/BACKGROUND: Abnormal blood flow dynamics are believed to contribute to the development of retinal microvascular disease in patients infected with human immunodeficiency virus (HIV). In this study, the scanning laser ophthalmoscope (SLO) was used, combined with fluorescein angiography, to measure retinal blood flow indices in HIV seropositive patients. METHODS: Arteriovenous passage time (AVP) and perifoveal capillary blood flow velocity (CFV) were measured in 23 HIV infected patients and 23 control subjects with SLO fluorescein angiography. RESULTS: No significant difference in AVP was found between the two groups. However, CFV was significantly reduced in HIV infected patients (p = 0.013). CONCLUSION: Patients infected with HIV show abnormal haemodynamics at the level of the perifoveal capillaries.

Adult↗

Development of dendritic trees of rabbit retinal alpha ganglion cells: relation to differential retinal growth.

To provide a quantitative description of the postnatal development of dendritic trees in alpha ganglion cells of the rabbit retina, these cells were stained either by intracellular injection of Lucifer yellow or by application of the lipophilic dye DiI. This was done at three developmental stages: postnatal day (P) 8/9, P 16/17, and in adults. For different retinal locations we quantified the alpha cell dendritic field area, the number of dendritic branch points, and the average dendritic length between branch points. According to the alpha cell location, the data were collected in three groups representing the retinal center, midperiphery, and far periphery, respectively. The data were then correlated with the postnatal retinal expansion which is known to differ among the above topographic regions of the retinae (Reichenbach et al., 1993). Our results show that the growth of alpha ganglion cell dendrites is not proportional to, but significantly exceeds, that of the local retinal tissue. Between P 8/9 and adulthood, the area of central alpha cells increases almost six-fold from 26,000 to 144,000 microns 2 (retinal expansion: 2.2-fold), and that of peripheral cells more than 15-fold from 35,000 to 556,000 microns 2 (retinal expansion: four-fold). During this period, the coverage factor of alpha cell dendritic fields increases about three-fold, and reaches adult levels of about 3 (retinal center) and 2.2 (periphery), respectively. The number of dendritic branch points remains nearly constant, and the distance between them increases by a factor close to the square root of the factor by which the dendritic field area grows. Thus, it appears that, from the second postnatal week on, dendritic trees of rabbit alpha ganglion cells increase by intense "interstitial growth," rather than by outgrowth of (new) dendritic branches. This growth pattern is different from that of some other rabbit retinal ganglion cell types, and of alpha ganglion cells of the cat retina, whose dendritic trees expand at a rate equal to or less than that of the surrounding retinal tissue. The consequences for synaptic contacts with bipolar and amacrine cells are discussed; they suggest a high degree of synaptic plasticity during normal postnatal retinal growth.

Animals↗

Iritis associated with intravenous cidofovir.

OBJECTIVE: To report two patients with AIDS and cytomegalovirus retinitis who developed iritis after receiving intravenous cidofovir. Both experienced recurrent symptoms upon rechallenge. CASE SUMMARIES: Two HIV-positive patients with cytomegalovirus retinitis infections previously controlled with intravenous ganciclovir or foscarnet were treated with intravenous cidofovir. Symptoms of iritis developed after the second or third dose of cidofovir. One patient experienced symptoms unilaterally, while the other patient had bilateral symptoms. In both patients, the iritis resolved with topical ophthalmic therapy, but recurred following subsequent infusions of cidofovir. Therapy with cidofovir was discontinued, and no further recurrences of iritis were noted. One patient had post-inflammatory fixed dilated pupils. CONCLUSIONS: Iritis can uncommonly occur in patients receiving intravenous cidofovir and oral probenecid. With prompt drug discontinuation and administration of topical corticosteroids and/or mydriatic agents, symptoms are usually reversible.

AIDS-Related Opportunistic Infections↗

Pneumatic retinopexy with drainage of subretinal fluid.

Thirty bullous retinal detachments were treated with pneumatic retinopexy and drainage of subretinal fluid. Patient selection criteria were similar to pneumatic retinopexy. All the eyes were reattached after the first operation. In three (10%) eyes new breaks with retinal detachment developed within two months after the initial operation and were treated with scleral buckling. One of these three eyes developed proliferative vitreoretinopathy grade D3 two months after scleral buckling. Twenty-nine (96.7%) out of thirty eyes were eventually reattached. The follow-up period was at least nine months. Visual acuity was maintained or improved in 29 (96.7%) eyes. Complications developing due to subretinal fluid like extension of detachment, persistence of subretinal fluid, subretinal gas, reopened retinal breaks were not encountered. By applying cryotherapy to a reattached retina after drainage of subretinal fluid, retinal pigment epithelial dispersion is decreased and the so-called steamroller technique is avoided. Drainage of subretinal fluid did not prevent a good success rate and did not result in additional complications.

Body Fluids↗

Clinical variation within sibships in Fukuyama-type congenital muscular dystrophy.

A family in which three siblings were affected with severe cerebral malformations in association with ocular anomalies and muscle disease is reported. One sibling was diagnosed as having Fukuyama type congenital muscular dystrophy (FCMD) because he showed severe hypotonia with dystrophic findings on a muscle biopsy in addition to pachygyria on CT. At the age of 3 years, retinal detachment developed in both eyes. Another sibling exhibited at birth such characteristic features as pachygyria, cephalocele, hydrocephalus, retinal detachment in both eyes, elevated serum creatine kinase activity and arthrogryposis multiplex congenita. We consider these findings to be more consistent with Walker-Warburg syndrome (WWS) than with FCMD. Anencephaly found in the third sibling was regarded as WWS with extreme brain abnormality. The appearance of two syndromes (FCMD and WWS) in the three members of the same family suggests that these syndromes could be allelic with variable phenotypes.

Brain↗

[Clinical predictors of retinal detachment after open globe injury].

BACKGROUND: A retinal detachment after open globe injury has important prognostic and therapeutic implications. MATERIAL AND METHODS: To determine whether retinal detachment following open globe injury could be predicted by clinical factors, we retrospectively evaluated 52 patients (52 eyes) with open globe injury admitted to our department. The Birmingham Eye Trauma Terminology System was used. Only patients which open eye injuries were evaluated. The results were registered during the 7 days after the accident. RESULTS: In the week after the open globe injury, retinal detachment was present in 40.3 %. 100 % of the patients with previous cataract operation (with IOL) developed a retinal detachment (p < 0.01). Retinal detachment also correlated significantly with visual acuity less than hand movement and retained intraocular foreign bodies. 19 (95 %) of the 20 patients with a visual acuity less than hand movement had retinal detachment versus only 2 (9 %) patients with visual acuity of hand movement or better (p < 0.01). 6 (66.6 %) of the 9 patients with intraocular foreign bodies had retinal detachment compared to 15 (34.8 %) of the 46 patients without intraocular foreign bodies (p=0.01). Logistic regression analysis confirmed this variables as independent predictors of retinal detachment. CONCLUSION: We conclude that previous cataract operation, versus less than hand movement and the presence of intraocular foreign bodies are predictive to retinal detachment.

Adolescent↗

Argon laser photocoagulation of symptomatic flap tears and retinal breaks of fellow eyes.

A series of 95 eyes (93 patients) with retinal breaks, high-risk candidates for rhegmatogenous retinal detachment, were treated prophylactically with argon laser photocoagulation (ALP). Group A comprised 74 eyes with flap symptomatic tears. In 28 of these (subgroup A (1)) the size of the tear was smaller than 1 disc diameter and greater than 1/3 disc diameter. In 46 eyes (subgroup A (2)) the size of the tear was at least 1 disc diameter but not greater than 3 disc diameters. Group B comprised 21 fellow eyes with 34 retinal breaks in patients who had retinal detachment in the other eye. One patient of subgroup A (1) developed a rhegmatogenous retinal detachment 6 days after ALP treatment. One patient of group B developed a retinal detachment after cataract extraction. This detachment was unrelated to the previously treated retinal break. In the series of group A the mean follow-up period was 27.8 months. From previously reported follow-up data it is probable that at least in the case of flap symptomatic tears our results can be considered conclusive. There were no complications related to the prophylactic treatment of dangerous retinal breaks with ALP. This form of treatment is accurate, easy to use, and comfortable for the patient. ALP would appear to be superior to xenon arc photocoagulation and cryopexy.

Argon↗

Retinal detachment in axial myopia.

A retrospective review of the complications of extracapsular cataract extraction in 127 cases followed between August 1980 and February 1985 is presented. The incidence of retinal detachment in eyes with axial length greater than 25.00 mm was found to be 9.59%, while no detachments occurred in eyes less than 25.00 mm. All of the patients with detached lenses were male. Extracapsular cataract extraction, an intact capsule, and placement of a posterior chamber lens do not prevent retinal detachment. A male with an axial length greater than 25.00 mm is more predisposed to develop a retinal detachment following cataract extraction and should therefore be counseled regarding the symptoms of retinal detachment and followed with careful ophthalmoscopy.

Cataract Extraction↗

[Acute retinal necrosis with varicella zoster dermatitis in the fellow eyelid].

BACKGROUND: We report a case of acute retinal necrosis with contralateral varicella zoster dermatitis. CASE: The patient, a 61-year-old man, developed acute retinal necrosis in the right eye 1 month after varicella zoster dermatitis in the left eyelid. PROGRESS: Intravenous acyclovir, corticosteroids, and laser photocoagulation were effective without any surgical treatment. CONCLUSION: We suggest that ophthalmoscopic examination of both eyes is needed in cases with varicella zoster dermatitis.

Eyelid Diseases↗

Scleral folding: a manifestation of orbital lymphoma.

A 72-year-old man with rapidly progressing, undifferentiated right orbital lymphoma is described. This was manifested by marked exophthalmos and a large inferior scleral fold, both of which responded rapidly to chemotherapy. The usual response of the globe to a localized mass is the development of retinal striae or choroidal folds. This case, however, was unusual in that a large scleral fold developed and resolved without any lasting deficit.

Aged↗

Retinal detachment in the morning glory anomaly.

The morning glory anomaly is a rare congenital clinical entity that results from abnormal optic nerve development. In our series of 30 patients, followed for a mean duration of 10.3 years, 11 developed associated retinal detachments. These detachments followed a variable clinical course, including spontaneous reattachment and even redetachment, and may result from an abnormal communication between the subarachnoid space of the optic nerve and the subretinal space, allowing cerebrospinal fluid to accumulate subretinally. The clinical findings (including ultrasonography, computed tomography, and electrophysiologic testing), natural history, complications, and therapeutic indications are discussed.

Adolescent↗

Early neural activity and dendritic growth in turtle retinal ganglion cells.

Early neural activity, both prenatal spontaneous bursts and early visual experience, is believed to be important for dendritic proliferation and for the maturation of neural circuitry in the developing retina. In this study, we have investigated the possible role of early neural activity in shaping developing turtle retinal ganglion cell (RGC) dendritic arbors. RGCs were back-labelled from the optic nerve with horseradish peroxidase (HRP). Changes in dendritic growth patterns were examined across development and following chronic blockade or modification of spontaneous activity and/or visual experience. Dendrites reach peak proliferation at embryonic stage 25 (S25, one week before hatching), followed by pruning in large field RGCs around the time of hatching. When spontaneous activity is chronically blocked in vivo from early embryonic stages (S22) with curare, a cholinergic nicotinic antagonist, RGC dendritic growth is inhibited. On the other hand, enhancement of spontaneous activity by dark-rearing (Sernagor & Grzywacz (1996)Curr. Biol., 6, 1503-1508) promotes dendritic proliferation in large-field RGCs, an effect that is counteracted by exposure to curare from hatching. We also recorded spontaneous activity from individual RGCs labelled with lucifer yellow (LY). We found a tendency of RGCs with large dendritic fields to be spontaneously more active than small-field cells. From all these observations, we conclude that immature spontaneous activity promotes dendritic growth in developing RGCs.

Action Potentials↗

Ocular manifestations of von Hippel-Lindau disease: clinical and genetic investigations.

PURPOSE: To describe the clinical spectrum of lesions involving the visual system in von Hippel-Lindau (VHL) disease, the genetic alterations, and the molecular genetic properties of retinal hemangioblastomas. METHODS: In this prospective case-series, 406 patients with VHL disease had systemic and ocular evaluations. Genetic mutations within six pathological specimens were evaluated, using microdissection and polymerase chain reaction amplification. RESULTS: Half of the 406 patients (199 families) with VHL disease had ocular involvement. Visual acuity was 20/20 or better in 170 patients (84.5%) with hemangioblastomas; six (3%) were legally blind. Thirty-three (8.2%) had unilateral enucleations. Genetic mutations were detected in all VHL patients. The patients with complete deletion were less likely to have ocular VHL compared with those patients with partial deletion, missense, and nonsense mutation (9% versus 45%) (P < .0001), suggesting the importance of the gene or areas of genes on chromosome 3 for the development of retinal hemangioblastomas. The molecular genetic assessments of the pathology specimens showed that the foamy "stromal" cells were affected with the genetic mutations. There is an up-regulation of vascular endothelial growth factor, which was expressed in the ocular lesions. CONCLUSIONS: In this series, the largest of its kind, patients with ocular lesions of VHL disease are referred mostly from physicians. The systemic genetic mutation evaluations suggest that a certain gene or groups of genes in chromosome 3p are crucial for both the development and maintenance of the retinal tumor. This is the first series to find a difference between the phenotype and genotype.

Adolescent↗

Serum triglycerides are a predictive factor for the development and the progression of renal and retinal complications in patients with type 1 diabetes.

OBJECTIVES: It is controversial that serum lipIds affect the development and progression of microvascular complications in patients with type 1 diabetes. METHODS: We prospectively followed 297 patients with type 1 diabetes without end-stage renal disease for 7 Years (range: 2-10). Serum lipIds were measured at baseline (total and HDL-cholesterol, triglycerIdes and calculated LDL-cholesterol, Lipoprotein (a)). The primary end-point was the occurrence of a renal event and the secondary end-point was the occurrence of a retinal event, defined as the progression to a higher stage of diabetic nephropathy or retinopathy, respectively. RESULTS: Serum triglycerIde (TG) levels were higher in patients who progressed in nephropathy than in those who dId not [median 1.21 (range 0.41-2.96) vs 0.91 (0.31-11.07) mmol/l; p=0.0037] and in those who developed retinal events than in those who dId not [1.05 (0.46-8.27) vs 0.87 mmol/l (0.31-11.07); p=0.0302], both in the whole cohort and in patients with normoalbuminuria at baseline. After adjustment for systolic blood pressure (SBP), diabetes duration, gender, stage of complications at baseline and glycohemoglobin (HbA1c), the relative risk for progression was 2.01 (95% CI: 1.07-3.77) for nephropathy and 2.30 (95% CI: 1.03-5.12) for retinopathy for patients having serum TG in the highest tertile, compared to the others. This result persisted when only patients with normoalbuminuria were consIdered. CONCLUSION: High triglycerIde levels are an independent predictive factor of both renal and retinal complications in patients with type 1 diabetes.

Adult↗

Traumatic retinal angiopathy--associated with wearing of car seat belts.

Three patients who were involved in road traffic accidents and sustained seat belt related injuries developed a retinal angiopathy characterised by retinal haemorrhage, oedema and focal ischaemia. Significant unilateral visual loss (2/60 - 6/18) was reported 1-48 hours following injury and central or paracentral annular scotomata were present. Although there was good recovery of visual acuity all patients had permanent scotomata, colour vision defects and loss of contrast sensitivity. Residual retinal microvascular and haemodynamic changes were noted on fluorescein angiography and the visually evoked responses were uniformly depressed. The structural and functional alterations in the retina of patients who have sustained seat belt injuries have important medico-legal implications.

Accidents, Traffic↗