This review describes a scheme for diagnosis of glaucoma in population based prevalence surveys. Cases are diagnosed on the grounds of both structural and functional evidence of glaucomatous optic neuropathy. The scheme also makes provision for diagnosing glaucoma in eyes with severe visual loss where formal field testing is impractical, and for blind eyes in which the optic disc cannot be seen because of media opacities.

https://bjo.bmj.com/content/bjophthalmol/86/2/238.full.pdf

The definition and classification of glaucoma in prevalence surveys

Tissue sections from aggressive human intraocular (uveal) and metastatic cutaneous melanomas generally lack evidence of significant necrosis and contain patterned networks of interconnected loops of extracellular matrix. The matrix that forms these loops or networks may be solid or hollow. Red blood cells have been detected within the hollow channel components of this patterned matrix histologically, and these vascular channel networks have been detected in human tumors angiographically. Endothelial cells were not identified within these matrix-embedded channels by light microscopy, by transmission electron microscopy, or by using an immunohistochemical panel of endothelial cell markers (Factor VIII-related antigen, Ulex, CD31, CD34, and KDR[Flk-1]). Highly invasive primary and metastatic human melanoma cells formed patterned solid and hollow matrix channels (seen in tissue sections of aggressive primary and metastatic human melanomas) in three-dimensional cultures containing Matrigel or dilute Type I collagen, without endothelial cells or fibroblasts. These tumor cell-generated patterned channels conducted dye, highlighting looping patterns visualized angiographically in human tumors. Neither normal melanocytes nor poorly invasive melanoma cells generated these patterned channels in vitro under identical culture conditions, even after the addition of conditioned medium from metastatic pattern-forming melanoma cells, soluble growth factors, or regimes of hypoxia. Highly invasive and metastatic human melanoma cells, but not poorly invasive melanoma cells, contracted and remodeled floating hydrated gels, providing a biomechanical explanation for the generation of microvessels in vitro. cDNA microarray analysis of highly invasive versus poorly invasive melanoma tumor cells confirmed a genetic reversion to a pluripotent embryonic-like genotype in the highly aggressive melanoma cells. These observations strongly suggest that aggressive melanoma cells may generate vascular channels that facilitate tumor perfusion independent of tumor angiogenesis.

Vascular Channel Formation by Human Melanoma Cells in Vivo and in Vitro: Vasculogenic Mimicry

Background Ocular trauma or disease may lead to severe corneal opacification and, consequently, severe loss of vision as a result of complete loss of corneal epithelial stem cells. Transplantation of autologous corneal stem-cell sources is an alternative to allograft transplantation and does not require immunosuppression, but it is not possible in many cases in which bilateral disease produces total corneal stem-cell deficiency in both eyes. We studied the use of autologous oral mucosal epithelial cells as a source of cells for the reconstruction of the corneal surface. Methods We harvested 3-by-3-mm specimens of oral mucosal tissue from four patients with bilateral total corneal stem-cell deficiencies. Tissue-engineered epithelial-cell sheets were fabricated ex vivo by culturing harvested cells for two weeks on temperature-responsive cell-culture surfaces with 3T3 feeder cells that had been treated with mitomycin C. After conjunctival fibrovascular tissue had been surgically removed from the ocular surfa...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa040455

Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium.

An Integrated Hypothesis That Considers Drusen as Biomarkers of Immune-Mediated Processes at the RPE-Bruch's Membrane Interface in Aging and Age-Related Macular Degeneration

https://oftalmologiarafaelcaiado.files.wordpress.com/2012/04/anchor-study.pdf

Ranibizumab versus Verteporfin Photodynamic Therapy for Neovascular Age-Related Macular Degeneration: Two-Year Results of the ANCHOR Study

In a series of 1,000 eyes enucleated from children under the age of 15 years, 50% of the eyes were removed because of trauma and 20% because of a neoplastic process. Only 1% of all these specimens contained a totally unsuspected tumor.1 The most common ocular tumor of childhood is retinoblastoma, but it is rarely seen after the first decade. Among Wintersteiner's 400 cases,2only ten patients were older than 9 years of age, and Reese3reported his oldest patient as being 11 years of age. Ocular injury followed by panophthalmitis is a rare cause for enucleation of an eye that contains a retinoblastoma, especially in an 11-year-old child. Report of a Case Clinical History. —An 11-year-old Negro girl was seen because of pain and swelling in the right eye. There was a history of recent "insect" injury to this eye. Examination revealed a large but soft

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=OPHTH&articleId=628585&pdfFileName=archopht_76_4_016.pdf

Unsuspected retinoblastoma. Enucleation in an 11-year-old girl following injury and panophthalmitis.

Purpose The purpose of this study was to asses the functional results of eccentric homologous penetrating keratoplasty in respect of diagnosis as well as position and size of the corneal graft. Patients and methods In this retrospective study, visual acuity and astigmatism of 117 cases of a round eccentric homologous penetrating keratoplasty in 91 eyes of 91 patients were analysed. The PK became necessary because of a corneal ulcer (104), 6 eyes with corneal scars and 7 eyes with ectatic corneal diseases. Using 84 postoperative slides the following parameters were quantified: graft diameter and transparency, distance of the geometric centre of the cornea from the central trephination margin (distance) as well as from the geometric centre of the graft (decentration). Seventeen grafts were classified as eccentric peripheral keratoplasty (mean diameter 5.0 +/- 1.7 mm) with the optical axis through the host cornea and 67 as eccentric central keratoplasty (7.0 +/- 1.3 mm) with the optical axis through the graft. Results The average follow-up period was 25 months. The astigmatism after 3/12/24 months was 6.7/6.3/5.5 D, but was irregular and not measurable in 74 %/52 %/49 %. The astigmatism increased with increasing decentration (24 months, p = 0.04). After 3/12/24 months, the VA in ulcers was 0.1/0.16/0.16, in scars 0.2/0.6/0.5 and in ectatic diseases 0.3/0.5/0.6. The position of graft and the visual acuity did not correlate significantly. After 24 months, larger the graft size was associated with better visual acuity. With increasing decentration the visual acuity decreased (p = 0.02) and was significantly lower (0.15) in the case of - 2.0 2.0 mm (0.4; p = 0.01). Conclusion The diagnosis resulting in eccentric penetrating keratoplasty seems to have a major impact on the long-term functional prognosis of visual acuity. In addition, visual acuity is limited by high and often irregular astigmatism. Our results indicate that an increasing decentration of the graft is not invariably associated with decreasing visual acuity, provided the graft-host junction is not located in direct proximity of the optical axis.

Visus und Astigmatismus nach exzentrischer perforierender Keratoplastik: eine retrospektive Studie an 117 Patienten

A 10-year-old boy was referred to the authors three days after bimedial faden operation (posterior fixation), with a purulent endophthalmitis in his right eye and visual acuity of LP. Systemic combined antibiotics "ad hoc", including cephalosporins and amikacin, were administered in combination with immunosuppressive doses of methylprednisolone after swabs had been taken for bacteriologic workup. Nine days after admission a pars plana vitrectomy was performed. Both the conjunctival swabs and the vitreous aspirate grew coagulase-negative, gram-positive cocci with high colony counts. Traction retinal detachment developed, and 30 days after the squint surgery lensectomy and silicone oil instillation had to be performed. Visual acuity 3 months after squint surgery was RE cc 0.2.

Staphylokokken-Endophthalmitis nach Schieloperation

Background The intraocular manifestations of pseudoexfoliation (PEX) syndrome, with rising incidence with ageing, represent risk factors for patients undergoing intraocular surgery. Therefore we correlated our clinical assessment to transmission-electron microscopy. Patients and methods 150 consecutive patients before extracapsular cataract surgery were examined for the occurrence of deposition of PEX material and other clinical alterations like PEX-phako,-irido,-corneopathy and melanin-dispersion by slit-lamp biomicroscopy. These findings were compared with the electron-microscopic examination of the anterior lens capsules. Results In clinically manifest Mini- or classic PEX the clinical diagnosis was supported in all cases except one by electron microscopy. In EM classic PEX syndrome and precapsular layer was found in 37.3% of the cataract patients in this study group. The patients with the precapsular layer were significantly younger than the patients with classical PEX. The incidence of nuclear cataract, open angle glaucoma, corneal endotheliopathy and phacodonesis were more frequent in eyes where PEX was found on the anterior lens capsule in EM. In 14 of 92 (15.2%) patients the precapsular layer and PEX was not suspected with slit-lamp biomicroscopy. In 15 of 35 (42.8%) patients with suspected PEX the samples of EM of anterior lens capsules did not reveal PEX. Conclusions PEX and its early forms seem to be found more frequently than expected in eyes with cataracts. Although biomicroscopy is a very valuable tool to detect early PEX syndrome, we have to improve the clinical criteria for the early diagnosis.

Zur Frühdiagnose des Pseudoexfoliationssyndroms : Eine klinisch-elektronenmikroskopische Korrelation der zentralen, vorderen Linsenkapsel

Background: Epithelial ingrowth to the anterior chamber is a rare event after ocular injury or intraocular surgery. We report on four patients with primary cystic epithelial ingrowth (with primary curative cystic formation when treated with block excision) who underwent Nd:YAG-laser puncture of the cysts elsewhere. This treatment led to a change from a cystic to a diffuse form with a poor prognosis for the eye. Patients: Three women and one man were seen in our outpatient department. Cystic epithelial ingrowth happened after intraocular surgery (1 x goniotomy, 2 x cataract surgery) or perforating injury (1 x). All four patients were treated elsewhere with puncture of the cysts (by Nd:YAG-laser). At first presentation in our department a change of cystic to diffuse epithelial ingrowth was noticed. Curative treatment by block excision was no longere possible. Diffuse epithelialisation of the anterior chamber resulted in secondary glaucoma with a poor prognosis. Conclusions: In our experience puncture of intraocular epithelial cysts may lead to a transformation to diffuse epithelial ingrowth with possible loss of the eye. Surgical opening of the cyst or subtotal excision is therefore contraindicated from our point of view. In case of cystic epithelial ingrowth of less than 5 hours of the limbal circumference, blbck excision in toto is indicated.

Gottfried O. H. Naumann

Papers

Unsuspected retinoblastoma. Enucleation in an 11-year-old girl following injury and panophthalmitis.

Visus und Astigmatismus nach exzentrischer perforierender Keratoplastik: eine retrospektive Studie an 117 Patienten

Staphylokokken-Endophthalmitis nach Schieloperation

Zur Frühdiagnose des Pseudoexfoliationssyndroms : Eine klinisch-elektronenmikroskopische Korrelation der zentralen, vorderen Linsenkapsel

Umwandlung der zystischen in eine diffuse Epithelinvasion durch Laser-Zysteneröffnung. Bericht über 4 Patienten