Asunto(s)
Células Fotorreceptoras de Vertebrados , Cuidados Preoperatorios , Oclusión de la Vena Retiniana/diagnóstico , Oclusión de la Vena Retiniana/cirugía , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Oclusión de la Vena Retiniana/fisiopatologíaRESUMEN
Basic fibroblast growth factor (bFGF) stimulates angiogenesis and induces neural cell regeneration. We investigated the effects of bFGF on diabetic neuropathy in streptozotocin-induced diabetic rats. Diabetic rats were treated with human recombinant bFGF as follows: 1) intravenous administration, 2) intramuscular injection into thigh and soleus muscles with cross-linked gelatin hydrogel (CGH), and 3) intramuscular injection with saline. Ten or 30 days later, the motor nerve conduction velocity (MNCV) of the sciatic-tibial and caudal nerves, sensitivity to mechanical stimuli, sciatic nerve blood flow (SNBF), and retinal blood flow (RBF) were measured. Delayed MNCV in the sciatic-tibial and caudal nerves, hypoalgesia, and reduced SNBF in diabetic rats were all ameliorated by intravenous administration of bFGF after 10, but not 30, days. Intramuscular injection of bFGF with CGH also improved sciatic-tibial MNCV, hypoalgesia, and SNBF after 10 and 30 days, but caudal MNCV was not improved. However, intramuscular injection of bFGF with saline had no significant effects. bFGF did not significantly alter RBF in either normal or diabetic rats. These observations suggest that bFGF could have therapeutic value for diabetic neuropathy and that CGH could play important roles as a carrier of bFGF.
Asunto(s)
Inductores de la Angiogénesis/uso terapéutico , Diabetes Mellitus Experimental/fisiopatología , Neuropatías Diabéticas/prevención & control , Factor 2 de Crecimiento de Fibroblastos/uso terapéutico , Animales , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Reactivos de Enlaces Cruzados , Combinación de Medicamentos , Factor 2 de Crecimiento de Fibroblastos/administración & dosificación , Gelatina/administración & dosificación , Inyecciones Intramusculares , Masculino , Conducción Nerviosa/efectos de los fármacos , Ácido Poliglutámico/administración & dosificación , Ratas , Ratas Wistar , Vasos Retinianos/efectos de los fármacos , Vasos Retinianos/fisiopatologíaRESUMEN
PURPOSE: To determine the effect of radial optic neurotomy (RON) on retinal blood flow (RBF) and macular edema in eyes with a central retinal vein occlusion. DESIGN: Prospective interventional study. METHODS: Seven eyes of seven patients with central retinal vein occlusion underwent RON and vitrectomy and were followed for at least 6 months. The RBF was calculated from dye dilution curves of video fluorescein angiograms. The foveal thickness was determined by optical coherence tomography. RESULTS: At 1 week after surgery, the RBF was significantly reduced from 28.5 +/- 5.4 to 21.1 +/- 6.6 pixel(2)/s (P < .01). At 6 months after surgery, the RBF (26.0 +/- 7.7 pixel(2)/s) was not significantly different from the preoperative RBF, although chorioretinal anastomoses were found in all seven eyes. The foveal thickness was significantly decreased from 711 +/- 271 to 488 +/- 182 mum (P = .03). The postoperative visual acuity was better than the preoperative visual acuity by two or more lines in three out of seven eyes, and was worse in two eyes. CONCLUSIONS: Neither RON nor chorioretinal anastomoses improved the RBF but macular edema was improved. These findings suggest that removal of the vitreous could reduce macular edema as in diabetic macular edema. However, we cannot exclude the possibility that the changes represent the natural course of this disease.
Asunto(s)
Descompresión Quirúrgica , Edema Macular/fisiopatología , Disco Óptico/cirugía , Oclusión de la Vena Retiniana/cirugía , Vasos Retinianos/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Oftalmoscopía , Disco Óptico/irrigación sanguínea , Estudios Prospectivos , Flujo Sanguíneo Regional , Oclusión de la Vena Retiniana/fisiopatología , Tomografía de Coherencia Óptica , Agudeza Visual , VitrectomíaRESUMEN
PURPOSE: To report a case of central retinal vein occlusion (CRVO) that had vitrectomy with radial optic neurotomy (RON), but the retinal blood flow (RBF) was still reduced 1 year later. DESIGN: Interventional case report. METHODS: An 80-year-old woman had undergone vitrectomy and RON for a CRVO. She had a complete ophthalmic examination, including the RBF analysis using the dye dilution method before and after RON. RESULTS: Seven months after RON, her visual acuity improved from 20/50 to 20/25, and her foveal thickness was decreased from 733 to 213 microm. Indocyanine green angiography demonstrated chorioretinal anastomoses. At 1 year postoperatively, the RBF was reduced from 23.2 to 18 0.1 pixel(2)/s, and the foveal thickness was increased to 767 microm. Her visual acuity decreased to 20/100. The chorioretinal anastomoses were still patent. CONCLUSIONS: These results demonstrate that a further reduction of RBF can occur after RON, and blood flow in the chorioretinal anastomoses may be insufficient to prevent the event.
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Nervio Óptico/cirugía , Complicaciones Posoperatorias , Oclusión de la Vena Retiniana/etiología , Oclusión de la Vena Retiniana/fisiopatología , Vasos Retinianos/fisiopatología , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Femenino , Angiografía con Fluoresceína , Humanos , Procedimientos Quirúrgicos Oftalmológicos , Nervio Óptico/irrigación sanguínea , Flujo Sanguíneo Regional , Oclusión de la Vena Retiniana/cirugía , Agudeza Visual , VitrectomíaRESUMEN
PURPOSE: To determine the effect of arteriovenous sheathotomy on retinal blood flow (RBF) in eyes with branch retinal vein occlusion (BRVO). DESIGN: Interventional case series. METHODS: Seven eyes of 7 patients with BRVO underwent sheathotomy and were followed for more than 6 months. RESULTS: At 1 week postoperatively, the RBF in the affected vessels was significantly improved from 14.1 +/- 5.7 to 27.3 +/- 11.3 pixel(2)/sec (P < 0.01), and the foveal thickness (FT) was significantly reduced from 536 +/- 84 to 366 +/- 134 microm (P = 0.03). However, the RBF was reduced again to 11.7 +/- 7.7 pixel(2)/sec at 1 month postoperatively, and the FT was increased to 424 +/- 184 microm. CONCLUSIONS: Arteriovenous sheathotomy led to a transient improvement of the RBF and was effective in reducing macular edema. It is not clear whether the transient effect of sheathotomy affects the long-term visual acuity and macular edema.
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Malformaciones Arteriovenosas/cirugía , Tejido Conectivo/cirugía , Edema Macular/fisiopatología , Arteria Retiniana/anomalías , Oclusión de la Vena Retiniana/fisiopatología , Vena Retiniana/anomalías , Anciano , Velocidad del Flujo Sanguíneo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Proyectos Piloto , Flujo Sanguíneo Regional , Arteria Retiniana/fisiología , Vena Retiniana/fisiología , Tomografía de Coherencia Óptica , Agudeza VisualAsunto(s)
Membrana Epirretinal/cirugía , Glucocorticoides , Perforaciones de la Retina/cirugía , Triamcinolona Acetonida , Anciano , Membrana Basal/patología , Membrana Basal/cirugía , Drenaje , Membrana Epirretinal/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perforaciones de la Retina/diagnóstico , Coloración y Etiquetado/métodos , Agudeza Visual , Vitrectomía/métodosRESUMEN
OBJECTIVES: To determine the effect on the visual outcome after macular hole surgery when staining the internal limiting membrane (ILM) with indocyanine green (ICG) dye and to study the mechanism of the adverse effects. PATIENTS AND METHODS: We studied 40 eyes of 38 patients with an idiopathic macular hole (size, <0.5 disc diameter; duration, <12 months). The concentration, exposure time, and amount of the ICG solution that was minimally required to make the ILM visible were determined. The patients were randomly divided into group 1 (20 eyes of 19 patients) who underwent ILM peeling without ICG staining, and group 2 (20 eyes of 19 patients) who underwent ILM peeling with ICG staining. Routine examinations were conducted during the 12-month follow-up period. Multifocal electroretinogram, optical coherence tomography, and fluorescein angiography were performed on 31 eyes of 30 patients. RESULTS: The macular hole was closed in all patients. Visual acuity was improved in both groups, but it was significantly better in group 1 (median, 0.85) than in group 2 (median, 0.60; P =.02) after 12 months. The improvement of visual acuity in group 1 (logarithm of the minimum angle of resolution [logMAR] units [SD], 0.82 [0.19]) was significantly better than that in group 2 (logMAR units, 0.67 [0.21]; P =.30). The multifocal electroretinogram and optical coherence tomographic findings were not significantly different in the 2 groups. Fluorescein angiogram showed only weak hyperfluorescence at the macula in some patients of both groups. CONCLUSIONS: The results suggest that ICG staining should not be used as long as the visibility of the retinal surface is good. However, ICG staining may be acceptable at a low concentration when a clear view of the retinal surface is unattainable. The results of the multifocal electroretinogram, optical coherence tomography, and fluorescein angiography suggest that the differences in visual recovery were caused not only by pigment epithelial cell damage or retinal toxic effect but also probably by the effect of ICG staining on ganglion cells and their axons.
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Colorantes , Verde de Indocianina , Perforaciones de la Retina/cirugía , Agudeza Visual/fisiología , Axones/efectos de los fármacos , Membrana Basal/patología , Electrorretinografía , Femenino , Angiografía con Fluoresceína , Humanos , Masculino , Persona de Mediana Edad , Epitelio Pigmentado Ocular/efectos de los fármacos , Estudios Prospectivos , Células Ganglionares de la Retina/efectos de los fármacos , Perforaciones de la Retina/fisiopatología , Coloración y Etiquetado/métodos , Tomografía de Coherencia Óptica , VitrectomíaRESUMEN
PURPOSE: To evaluate the physiological characteristics of the macula in patients with Vogt-Koyanagi-Harada disease during the convalescent stage with specific reference to the kinetics of foveal cone photopigment regeneration. METHODS: Six eyes of three patients at the convalescent stage of Vogt-Koyanagi-Harada disease were studied. All the eyes had best corrected visual acuity of 1.0 or better and had had no recurrence of inflammation for at least 12 months after the last episode. Foveal cone densitometry (FCD), focal macular electroretinograms, color vision tests, two-color perimetry, and optical coherence tomography (OCT) were performed. RESULTS: No regeneration of cone photopigments was detected within the 7-minute testing time by FCD in all eyes at the first examination after the last episode. However, the other functional tests were normal, and the OCT-determined macular morphology was also normal. The regeneration kinetics of the foveal cone photopigment improved in three of six eyes at 36, 37, and 19 months after the last episode, whereas the other three remained delayed at 18, 18, and 49 months. CONCLUSIONS: These findings suggest that a disorder of the foveal cone photopigment regeneration, and its recovery, requires a significantly longer time than that of other macular functions in some patients with Vogt-Koyanagi-Harada disease.
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Fóvea Central , Células Fotorreceptoras Retinianas Conos/fisiología , Opsinas de Bastones/fisiología , Síndrome Uveomeningoencefálico/fisiopatología , Adulto , Anciano , Recuento de Células , Pruebas de Percepción de Colores , Convalecencia , Electrorretinografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Regeneración , Tomografía de Coherencia Óptica , Agudeza Visual , Pruebas del Campo VisualRESUMEN
PURPOSE: To report a new method to perform intraoperative video fluorescein angiography (VFA) using an optical fiber-free intravitreal surgery system (OFFISS) and retinal blood flow analysis during surgery. DESIGN: Observational case series. METHODS: Four eyes of four patients with macular edema as a result of branch retinal vein occlusion underwent vitrectomy and intraoperative VFA with a bolus of 0.8 ml fluorescein dye. The segmental blood flow was calculated using dye dilution technique. Intraocular pressure was maintained at 15 mm Hg. RESULTS: The VFA was clearly recorded with stable excitation light and very little eye movement under retrobulbar anesthesia. The segmental blood flow of the affected vessels (6.1 +/- 1.2 pixel(2)/s) was significantly lower than that of the healthy vessels (17.9 +/- 7.9 pixel(2)/s) (P < .05). CONCLUSION: The combination of VFA and OFFISS can facilitate intraoperative VFA, and may be useful for evaluating retinal blood flow during surgery.
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Angiografía con Fluoresceína/métodos , Vasos Retinianos/fisiología , Anciano , Velocidad del Flujo Sanguíneo , Catarata/complicaciones , Catarata/fisiopatología , Catarata/terapia , Humanos , Presión Intraocular , Periodo Intraoperatorio , Edema Macular/etiología , Edema Macular/fisiopatología , Edema Macular/cirugía , Persona de Mediana Edad , Facoemulsificación , Flujo Sanguíneo Regional , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Oclusión de la Vena Retiniana/cirugía , Grabación en Video , VitrectomíaRESUMEN
PURPOSE: To determine whether the single-flash electroretinogram (ERG) can predict the postoperative outcome in diabetic cases where massive vitreous hemorrhage precludes fundus observation. METHODS: Eighty-five diabetic patients (105 eyes) who underwent vitrectomy due to dense vitreous hemorrhage were studied retrospectively. Eyes with postoperative complications were excluded. Preoperative ERGs (mixed cone-rod ERG with maximum flash intensity) were classified as: Group A, the b-wave/a-wave ratio (b/a ratio) was > or =1.0 and the oscillatory potentials (OPs) were clearly recordable (22 eyes); Group B, the b/a ratio was > or =1.0 and the OPs were markedly reduced (33 eyes); and Group C, the b/a ratio was <1.0 (50 eyes). RESULTS: The postoperative visual acuity in Group C (hand motion to 1.5) was significantly worse than in Group A (0.4-.2) (P<.01) or Group B (0.08-1.0) (P<.01). Thick preretinal membrane causing retinal traction around the optic disc was found intraoperatively in 1 eye (4.5%) in Group A, 9 eyes (27.3%) in Group B, and 28 eyes (56.0%) in Group C (P=.0132). CONCLUSION: Our findings suggested that the configuration of the single-flash ERG can provide important preoperative information for a functional prognosis following vitrectomy in diabetic patients with vitreous hemorrhage.
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Retinopatía Diabética/fisiopatología , Células Fotorreceptoras de Vertebrados/fisiología , Agudeza Visual/fisiología , Hemorragia Vítrea/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Retinopatía Diabética/complicaciones , Retinopatía Diabética/cirugía , Electrorretinografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estimulación Luminosa , Hemorragia Posoperatoria , Cuidados Preoperatorios , Pronóstico , Estudios Retrospectivos , Vitrectomía , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaRESUMEN
Increases in leukostasis/monocyte adhesion to the capillary endothelium (leukostasis) and decreases in retinal blood flow may be causally associated and are implicated in the pathogenesis of diabetic retinopathy. In this study, we demonstrate that increases in leukostasis are observed in insulin-resistant states without diabetes, whereas decreases in retinal blood flow require diabetes and hyperglycemia. Microimpaction studies using beads mimicking retinal capillary obstruction by leukocytes did not affect retinal blood flow. In diabetic rats, treatment with the antioxidant alpha-lipoic acid normalized the amount of leukostasis but not retinal blood flow. In contrast, treatment with D-alpha-tocopherol and protein kinase-C beta-isoform inhibition (LY333531) prevented the increases in leukostasis and decreases in retinal blood flow in diabetic rats. Serum hydroxyperoxide, a marker of oxidative stress, was increased in diabetic rats, but normalized by treatment with antioxidants alpha-lipoic acid and D-alpha-tocopherol and, surprisingly, PKC beta-isoform inhibition. These findings suggest that leukostasis is associated with endothelial dysfunction, insulin resistance, and oxidative stress but is not related to retinal blood flow and is not sufficient to cause diabetic-like retinopathy. Moreover, treatment with PKC beta inhibition is effective to normalize diabetes or hyperglycemia-induced PKC beta-isoform activation and oxidative stress.