Asunto(s)
Infecciones por Actinomycetales/microbiología , Actinomycetales/aislamiento & purificación , Endoftalmitis/microbiología , Cuerpos Extraños en el Ojo/microbiología , Infecciones Bacterianas del Ojo , Lesiones Oculares Penetrantes/microbiología , Infección de Heridas/microbiología , Infecciones por Actinomycetales/terapia , Adulto , Antibacterianos , Quimioterapia Combinada/administración & dosificación , Endoftalmitis/terapia , Cuerpos Extraños en el Ojo/cirugía , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/terapia , Lesiones Oculares Penetrantes/cirugía , Humanos , Inyecciones , Masculino , Metales , Vitrectomía , Cuerpo Vítreo , Infección de Heridas/terapiaRESUMEN
BACKGROUND: Tumors of the retina are often seen in association with systemic syndromes such as neurofibromatosis, tuberous sclerosis, and von Hippel-Lindau disease. These masses are either astrocytic hamartomas or capillary hemangiomas. Retinal tumors unassociated with other systemic disease have also been reported. METHODS: The ophthalmologic evaluation and clinical course of a 65-year-old woman who developed an epiretinal membrane followed by a vascularized retinal mass in the macular area are described. RESULTS: Appearance and rapid growth of the lesion were documented with fundus photography and fluorescein angiography. The lesion was treated with photocoagulation following growth that threatened the foveal region. Choroidal neovascularization subsequently developed toward the fovea, and visual acuity has remained poor. After 4 years of follow-up no local recurrence or systemic disease possibly related to the tumor has occurred. CONCLUSIONS: This is the first report of documented appearance and rapid growth of a retinal tumor that resembles a reactive astrocytic hyperplasia.
Asunto(s)
Astrocitoma/patología , Neoplasias de la Retina/patología , Anciano , Astrocitoma/cirugía , Neovascularización Coroidal/etiología , Membrana Epirretinal/etiología , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Hiperplasia , Coagulación con Láser/efectos adversos , Reoperación , Neoplasias de la Retina/cirugía , Agudeza VisualRESUMEN
OBJECTIVE: Silicone oil frequently is used as a vitreous substitute after complex vitreoretinal procedures. The authors sought to study the effect of short- and long-term exposure to silicone oil on polymethyl methacrylate (PMMA, MC60BM; Alcon, Ft. Worth, TX), silicone (SI-30NB; AMO, Irvine, CA), and soft acrylic (MA60BM; Alcon) intraocular lenses (IOLs). DESIGN: An experimental animal study. INTERVENTION: Forty-one New Zealand white rabbits underwent lensectomy, vitrectomy, capsulotomy, and placement of one of the three types of IOLs into the ciliary sulcus. All lenses were weighed before implantation and 24 hours after explanation. In the short-term study, an fluid-air exchange was performed followed by the use of silicone oil (1000 centistokes) to coat the posterior lens surface. Immediately thereafter, an air-fluid exchange was performed and the remaining silicone on the posterior lens surface was aspirated or wiped or both for 1 minute using a soft-tipped extrusion cannula for 1 minute. In the long-term study, the posterior segment was filled with 1000 centistokes silicone oil after fluid-air exchange. Animals were observed by slit-lamp biomicroscopy and photographed at 1 week, 1 month, and 3 months after surgery. At 3 months, all animals underwent silicone-fluid exchange, an attempt to manually remove any remaining silicone oil, and lens explanation. RESULTS: In the short-term study, no silicone oil remained after manual wiping and/or aspiration in any of the four rabbits implanted with PMMA or acrylic IOLs. In the animals with silicone IOLs, a significant amount of silicone oil remained on the posterior lens surface of all lenses (P < 0.01 for silicone vs. acrylic and silicone vs. PMMA). No statistically significant difference was found when comparing the lens weights in each group before and after implantation. In the long-term study, aqueous droplet formation was found on the posterior lens surface of six of nine PMMA IOLs and ten of ten silicone IOLs at 3 months. No opacities were observed in the group with acrylic IOLs (P < 0.001 for acrylic vs. silicone, P = 0.0018 for acrylic vs. PMMA, and P = 0.047 for PMMA vs. silicone). Adherent silicone oil remained on two of nine PMMA IOLs and on none of ten acrylic IOLs. In contrast, a significant amount of silicone oil remained on the posterior lens surface of ten of ten silicone IOLs (P < 0.001 for silicone vs. acrylic and silicone vs. PMMA). Furthermore, there was a statistically significant increase in lens weights before and after implantation in the silicone IOL group but not in the PMMA or acrylic group (P < 0.01). CONCLUSIONS: It is extremely difficult or impossible to remove remaining silicone oil from the posterior surface of a silicone IOL after short- or long-term exposure to silicone oil. This oil may interfere with the surgeon's view of the retina and may diminish the patient's visual acuity. In contrast, oil is readily removed from the posterior surface of an acrylic IOL. The authors therefore recommend the use of a soft acrylic or PMMA IOL over a silicone IOL when choosing a lens for implantation in patients who may require vitreoretinal procedures with silicone oil tamponade.
Asunto(s)
Resinas Acrílicas , Humedad/efectos adversos , Lentes Intraoculares , Polimetil Metacrilato , Elastómeros de Silicona , Aceites de Silicona , Animales , Capsulorrexis , Estudios de Seguimiento , Complicaciones Intraoperatorias , Implantación de Lentes Intraoculares , Conejos , VitrectomíaRESUMEN
Several authors have reported significant exposure rates using the hydroxyapatite orbital implant in the treatment of the anophthalmic socket. Histologic studies by ourselves and others have suggested that lack of fibrovascular ingrowth into the implants may contribute to conjunctival breakdown and exposure. Recently, much attention has been given to angiogenic factors, such as rTGF-beta 2 and those found in plasma, in accelerating wound healing and fibrovascular ingrowth. This pilot study compares the rate of vascularization of hydroxyapatite orbital implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution with that in untreated controls ina population of New Zealand albino rabbits. Hydroxyapatite orbital spheres were implanted subcutaneously and in enucleated orbits. Untreated implants were used as a control. Implants pretreated with plasma, rTGF-beta 2, and a saline/gentamicin solution were removed and examined histologically at weekly intervals for the first 3 weeks after implantation. Histologic studies demonstrated that the rate of vascularization significantly increased between 2 and 3 weeks postoperatively in all study groups. Pretreating the implants with rTGF-beta 2 in phosphate buffered solution (PBS) or autogenous plasma did not significantly increase the rate of vascularization in comparison with controls at weeks 1 and 2. However, pretreating the implants with a saline/gentamicin solution or PBS alone was associated with an increased rate of vascularization at weeks 2 and 3. No statistically significant difference in vascularization was noted between the subcutaneous and orbital implants at any week. Hydroxyapatite implants pretreated with saline/gentamicin or phosphate buffered solutions underwent more rapid vascularization at weeks 2 and 3 in comparison with controls. Additionally, all groups were noted to have a more rapid rate of ingrowth between weeks 2 and 3 than between weeks 1 and 2. Plasma and rTGF-beta 2 (at the dose used) did not significantly alter the rate of vascularization of hydroxyapatite implants during the first 2 to 3 weeks. The significance of these findings is discussed.
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Sangre , Durapatita , Gentamicinas/farmacología , Neovascularización Fisiológica/fisiología , Prótesis e Implantes , Factor de Crecimiento Transformador beta/farmacología , Animales , Materiales Biocompatibles , Órbita/irrigación sanguínea , Órbita/cirugía , Oseointegración/efectos de los fármacos , Proyectos Piloto , Complicaciones Posoperatorias/prevención & control , Conejos , Proteínas Recombinantes , Cloruro de Sodio/farmacologíaRESUMEN
OBJECTIVE: To determine the efficacy and pharmacokinetics of an intravitreal sustained-release triamcinolone acetonide and 5-fluorouracil (TA/5-FU) codrug in the treatment of experimental proliferative vitreoretinopathy (PVR). METHODS: The therapeutic efficacy of the TA/5-FU codrug was determined in a rabbit model that simulates human PVR. Intravitreal levels of triamcinolone and 5-fluorouracil were measured at different time points and drug release in vitro was tested. Toxic effects were evaluatedby electroretinograpy, clinical examination, and light microscopy. RESULTS: Both the severity of PVR grade and the percentage of eyes with moderate or worse tractional detachment were significantly less in eyes treated with the codrug. The therapeutic effect of the intravitreal codrug was paralleled by sustained intravitreal levels of triamcinolone and 5-fluorouracil. There were no drug-related toxic effects evident on clinical or histopathologic examination of eyes containing the TA/5-FU codrug. CONCLUSIONS: The intravitreal sustained-release TA/5-FU codrug effectively inhibits the progression of PVR in a rabbit model that closely resembles PVR in humans. The TA/5-FU codrug may simultaneously target different components of the wound-healing response.
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Fluorouracilo/administración & dosificación , Glucocorticoides/administración & dosificación , Inmunosupresores/administración & dosificación , Triamcinolona/administración & dosificación , Vitreorretinopatía Proliferativa/tratamiento farmacológico , Animales , Cromatografía Líquida de Alta Presión , Preparaciones de Acción Retardada , Modelos Animales de Enfermedad , Implantes de Medicamentos , Quimioterapia Combinada , Electrorretinografía , Fluorouracilo/farmacocinética , Glucocorticoides/farmacocinética , Inmunosupresores/farmacocinética , Inyecciones , Conejos , Resultado del Tratamiento , Triamcinolona/farmacocinética , Vitreorretinopatía Proliferativa/metabolismo , Vitreorretinopatía Proliferativa/patología , Cuerpo Vítreo/metabolismoRESUMEN
A 49-year-old woman received an autologous transplant for breast cancer. Six weeks later she noticed visual disturbance of the left eye which correlated with a visual field abnormality. There was a milder degree of visual disturbance in the right eye. Treatment with high-dose steroids partially stabilized the problem, which was felt to be an ischemic optic neuropathy. She ultimately died of respiratory failure. Pathology of the optic nerves revealed demyelination. Visual disturbances following high-dose chemotherapy are uncommon; the pathology to date has not been elucidated. Steroid therapy may be useful.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Trasplante de Médula Ósea , Neoplasias de la Mama/terapia , Enfermedades Desmielinizantes/inducido químicamente , Trasplante de Células Madre Hematopoyéticas , Isquemia/inducido químicamente , Nervio Óptico/irrigación sanguínea , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Terapia Combinada , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Enfermedades Desmielinizantes/diagnóstico , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Resultado Fatal , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Isquemia/diagnóstico , Mastectomía Radical Modificada , Metotrexato/administración & dosificación , Metotrexato/efectos adversos , Persona de Mediana Edad , Síndromes Paraneoplásicos/diagnóstico , Insuficiencia Respiratoria/etiología , Escotoma/inducido químicamente , Acondicionamiento Pretrasplante , Campos VisualesRESUMEN
PURPOSE: To determine the cause of spontaneous choroidal hemorrhage in a 67-year-old man after a myocardial infarction and administration of tissue plasminogen activator. METHODS: The patient underwent ocular examination. RESULTS: The patient retained excellent visual acuity and the choroidal hemorrhage resolved completely within two months. CONCLUSION: The administration of tissue plasminogen activator was responsible for the large extent of hemorrhage and should be considered in the differential diagnosis of hemorrhagic choroidal detachment.
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Hemorragia de la Coroides/inducido químicamente , Activadores Plasminogénicos/efectos adversos , Activador de Tejido Plasminógeno/efectos adversos , Anciano , Coroides/diagnóstico por imagen , Enfermedades de la Coroides/inducido químicamente , Enfermedades de la Coroides/diagnóstico por imagen , Hemorragia de la Coroides/diagnóstico por imagen , Hemorragia de la Coroides/fisiopatología , Fondo de Ojo , Humanos , Masculino , Infarto del Miocardio/tratamiento farmacológico , Activadores Plasminogénicos/uso terapéutico , Activador de Tejido Plasminógeno/uso terapéutico , Ultrasonografía , Agudeza VisualRESUMEN
PURPOSE: To characterize the ocular toxicity of a bone marrow transplant regimen does not include total body or focal head irradiation. METHODS: Nine patients with advanced breast cancer were referred for visual symptoms after high-dose chemotherapy with cisplatin, cyclophosphamide, and carmustine and autologous bone marrow transplantation without total body irradiation or local head irradiation. RESULTS: Symptoms consistent with optic neuropathy and retinopathy developed in five patients. Retinopathy alone developed in three patients and optic neuropathy alone developed in one. Retinal abnormalities included cotton-wool spots, intraretinal hemorrhages, and macular exudate. Optic nerve findings included disk swelling and subsequent pallor. Symptoms and signs associated with retinopathy were generally reversible, whereas those associated with optic neuropathy often were permanent. Retinopathy and/or optic neuropathy developed in all of the patients from 1 to 5 months after bone marrow transplantation. Resolution or stabilization of findings was observed 2-4 months after presentation. Two patients with optic neuropathy showed progression of field and acuity loss after 4 months. When compared with control subjects, the exposure of patients to cyclophosphamide and carmustine was no different. However, cisplatin exposure was 1.2-fold higher in patients with ocular toxicity compared with control subjects. CONCLUSION: Optic neuropathy and retinopathy are presumed to arise from the administration of a high-dose chemotherapy regimen. As techniques in supportive care improve, long-term adverse effects of these therapies now are becoming apparent.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Trasplante de Médula Ósea , Neoplasias de la Mama/terapia , Carcinoma Ductal de Mama/terapia , Enfermedades del Nervio Óptico/inducido químicamente , Enfermedades de la Retina/inducido químicamente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carmustina/efectos adversos , Carmustina/uso terapéutico , Cisplatino/efectos adversos , Cisplatino/uso terapéutico , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Femenino , Angiografía con Fluoresceína , Estudios de Seguimiento , Fondo de Ojo , Humanos , Persona de Mediana Edad , Trasplante Autólogo , Agudeza VisualAsunto(s)
Glaucoma de Ángulo Abierto/etiología , Nevo de Ota/complicaciones , Neoplasias Cutáneas/complicaciones , Segmento Anterior del Ojo/patología , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Glaucoma de Ángulo Abierto/patología , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Nevo de Ota/patología , Soluciones Oftálmicas , Disco Óptico/patología , Esclerótica/patología , Neoplasias Cutáneas/patología , Timolol/uso terapéuticoAsunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias de la Coroides/secundario , Glaucoma de Ángulo Cerrado/etiología , Carcinoma de Células Escamosas/complicaciones , Enfermedades de la Coroides/diagnóstico por imagen , Enfermedades de la Coroides/etiología , Neoplasias de la Coroides/complicaciones , Glaucoma de Ángulo Cerrado/complicaciones , Humanos , Presión Intraocular , Neoplasias Pulmonares , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
A condition similar to proliferative vitreoretinopathy (PVR) in man can be produced by injecting 25,000 homologous dermal fibroblasts into rabbit eyes following gas compression of the vitreous. Daunorubicin (15 nmol) was effective in preventing retinal detachment in this model when injected simultaneously with the fibroblasts or in two doses (10 nmol followed by 5 nmol 4 h later) on the 3rd day after fibroblast injection. A single dose of 15 nmol on the 3rd day was not effective in preventing retinal detachment. These results suggest that daunorubicin may be clinically useful in preventing PVR when given by injection both at the time of vitrectomy as well as later, when protein exudation and pigment clumps in the vitreous cavity herald the onset of PVR.
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Daunorrubicina/uso terapéutico , Enfermedades de la Retina/tratamiento farmacológico , Cuerpo Vítreo , Animales , División Celular , Modelos Animales de Enfermedad , Esquema de Medicación , Oftalmopatías/tratamiento farmacológico , Fibroblastos , Conejos , Distribución Aleatoria , Desprendimiento de Retina/prevención & controlRESUMEN
We developed a reproducible model of traction retinal detachment (TRD) in the cat eye by creating a serous retinal detachment and then injecting 2.5 x 10(5) kitten dermal fibroblasts into the vitreous cavity at the site of a retinal wound. Serous detachments were produced by exposing an area of retina to focused light after intravenous injection of rose bengal (a photosensitizing dye). TRD developed rapidly within the first 2 weeks after fibroblast injection, accompanied by the formation of vitreoretinal strands and, to a lesser degree, epiretinal and/or subretinal proliferation. Histopathology demonstrated fibroblasts within the vitreous or along the posterior hyaloid face. Focal deposits of fibroblasts were occasionally found on the inner surface of the retina and/or in the subretinal space. Fibroblast proliferation was confirmed by uptake of radiolabeled thymidine. Deposition of collagen was noted at as early as 3 days after fibroblast injection. Neovascularization was not observed. Control eyes that did not receive fibroblasts showed resolution of serous detachment without retinal traction. In all eyes, retinal degeneration and thinning were seen in the area of previous photodynamic treatment. In this model of TRD, anteroposterior traction (due to vitreous strands) predominates, as is observed in experimental posterior penetrating ocular injury induced by intravitreal blood injection, which also results in vitreous strand formation. Our model, however, enables clinical assessment of TRD in the cat without the media opacification produced by vitreous blood.