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

BACKGROUND Focal malignant melanomas involving only the iris have a very good prognosis. Involvement of the iris and/or diffuse growth makes the prognosis worse. The prognostic parameters of diffusely growing malignant anterior uveal melanomas are analysed. PATIENTS AND METHODS From 1981-1995 serial sections of 39 eyes, 23 women and 16 men, of diffusely growing malignant anterior uveal melanomas were histologically examined. Patients were between 9 and 80 years old (median 56 years). Follow-up was between 2 months and 15 years. At the end of the study, 13 patients had died from metastasis, all showed involvement beyond the iris. Four patients died from other causes. RESULTS The 39 diffuse malignant melanomas were categorized into 10 affecting only the iris, 18 iris and ciliary body and 11 involving iris, ciliary body and choroid. 14 spindle-cell, 23 mixed-cell and 2 epithelioid-cell tumors were identified. We observed between 0 and 4 mitoses in 40 high-power fields. Only 4 melanomas showed more than 100 tumor-infiltrating lymphocytes in 20 high-power fields. Nine tumors showed extra-scleral spread, nine displayed vascular networks. Univariate Kaplan-Meier survival curves showed as significant prognostic factors: localization in the iris only (p = 0.0008), spindle cell type (p = 0.0002) and absence of vascular networks (p = 0.01). This was confirmed by multivariate Cox analysis. CONCLUSION Patients with diffuse malignant melanoma confined to the iris alone have a good prognosis for survival. Diffuse tumor cell spread can be diagnosed at the slitlamp with high magnification. Conservative follow-up is acceptable, as long as ciliary body involvement is ruled out. Eye with medically uncontrollable secondary glaucoma should be enucleated. Anti-glaucoma filtering procedures are contraindicated because of the danger of extraocular spreading malignant cells.

Diffuse maligne Melanome der Uvea : Eine klinisch-histopathologische Studie über 39 Patienten

BACKGROUND: Bilateral stromal corneal opacifications are a differential diagnostical challenge to identify associated systemic diseases. CASE-REPORT: A 47-year old civil engineer (height 167 cm) with bilateral stromal corneal clouding presented with visual loss for the last 27 years: VA 20/100 OD and 20/50 OS (following penetrating keratoplasty OS). The cornea showed milky-whitish, cloudy, diffuse stromal deposits without a separate lipoid arc. The posterior segment showed tapetoretinal degeneration. Scotopic ERG was decreased. A suspicious stiffness of interphalangeal joints on both hands was observed. There was an aortic and mitral insufficiency grade I. Serum levels of LDL, HDL and triglycerides were normal. The biomicroscopical diagnosis of Scheie's syndrome (mucopolysaccharidosis I-S) was confirmed by a deficiency of alpha-L-iduronidase in leukocytes (0.02 nmol/min/mg protein, normal range: 0.3 - 1.5). CONCLUSION: The differential diagnosis of bilateral corneal stromal opacification includes in addition to the mucopolysaccharidoses HDL-deficiency diseases (LCAT deficiency, Tangier disease, Fish eye disease), Schnyder's crystalline stromal dystrophy, cystinosis, gout and mucolipidoses. MPS I-S may easily be detected by alpha-L-iduronidase deficiency in leukocytes and increased mucopolysaccharides in the urine. Furthermore, patients with MPS I-S need general medical care because of cardiovascular abnormalities, joint stiffness and myopathies.

Okuläre Manifestation bei Mukopolysaccharidose I-S (Scheie-Syndrom)

Forty human corneo-scleral rings and 40 whole corneas with scleral rim were preserved in organ culture for up to six weeks in either normal (20%) or low (6%) oxygen concentration in the gas phase of the culture.

Low oxygen prevents epithelial overgrowth of corneas in long-term organ culture.

International Ophthalmology Horizons International Federation of Ophthalmological Societies (IFOS) and International Council of Ophthalmology (ICO)Milestones, Statutes and Regulations

Background: Surgical correction of aphakia following traumatic cataract in children is discussed controversely in literature. This study shows the functional results after cataract surgery with posterior chamber intraocular lens implantation in children under 7 years of age. Patients and methods: This retrospective study analyzes the visual function of 22 children, who were operated after traumatic cataract between 1987 and 1997 at the department of ophthalmology, university of Erlangen-Nurnberg with PCL-implantation. Mean age at injury was 3 years 10 months ± 1 year 8 months (range 15 to 76 months); the interval between injury and cataract surgery: 2.7 ± 4.7 months (range 0 to 17 months). The follow-up time was 5 years and 3 months ± 3 years and 3 months (range 4 to 119 months). The axial length (AL) was measured by A-scan ultrasonography in 95% of the patients, and in 32% consecutive measurements of axial lengths were performed. Results: The mean result of visual acuity in the children with PCL implantation was for far distance 0.47 ± 0.46 (range 0.001 to 1.25), median 0.35 and for near distance 0.37 ± 0.4 (range 0.001 to 1.4), median 0.225. Reading ability (crowded optotype acuity ≥ 0.3) was achieved in 9 of 22 injured eyes (41 %). Binocularity was preserved in 59%, stereo acuity in 55% of the children. Higher values of anisomyopia from - 2.25 to -10.25 were found in 50% of the children. A tendency of eye length enlargement of the operated in comparison with the non operated eye could not be proved in our series. Conclusion: On the basis of PCL implantation a high frequency of eyes with reading ability (crowded optotype acuity ≥ 0.3) and of stereo acuity can be achieved. Risk factors for very low visual acuity are: early age of injury with fast development of strabismus and slow development of cataract in this early age resulting in late cataract operation.

Gottfried O. H. Naumann

Papers

Diffuse maligne Melanome der Uvea : Eine klinisch-histopathologische Studie über 39 Patienten

Okuläre Manifestation bei Mukopolysaccharidose I-S (Scheie-Syndrom)

Low oxygen prevents epithelial overgrowth of corneas in long-term organ culture.

International Ophthalmology Horizons International Federation of Ophthalmological Societies (IFOS) and International Council of Ophthalmology (ICO)Milestones, Statutes and Regulations

[Functional results of posterior chamber lens implantation for traumatic cataracts in 22 children younger than seven years--a retrospective study].