Histologic and Morphometric Comparison of Drusen Associated With Chronic Retinal Detachment and Aging-Associated Drusen.

To assess anatomic outcomes following repair of traumatic retinal detachment (RD) among a cohort of cognitively impaired adolescents with self-injurious behaviors. Main outcome measures in this retrospective, consecutive, interventional case series were retinal attachment and postoperative complications. Complete retinal reattachment was initially achieved in all 9 eyes of 9 patients. Six (67%) eyes had chronic RD at initial presentation, and 7 (78%) patients had limited vision from inoperable RD in the fellow eye. Proliferative vitreoretinopathy led to recurrent RD in 4 (44%) eyes at a mean of 2.7 months. Final total or partial retinal attachment was achieved in 6 (67%) and 3 (33%) eyes, respectively, with a mean of 1.7 procedures over a mean follow-up of 22.4 months. Silicone oil emulsification led to progressive glaucoma in 4 (50%) of 8 eyes in which it was used, requiring silicone oil exchange (2 eyes) or removal (2 eyes). Recurrent RD developed in both eyes from which silicone oil was removed despite prior retinal anatomic stability for more than 6 months. Cognitively impaired adolescents with self-injurious behaviors typically presented with severe visual impairment from chronic traumatic RD in one or both eyes. Despite initial anatomic success, formation of proliferative vitreoretinopathy and further ocular trauma from continued self-injurious behaviors led to a high rate of recurrent RD. Long-term silicone oil tamponade may prevent recurrent RD in this challenging scenario but is associated with vision loss from progressive glaucoma and corneal decompensation.

The myocardium in 50 autopsy cases was studied using immunostaining for copper-zinc superoxide dismutase (CuZn-SOD) and standard histochemical procedures. Mucinous degeneration observed in 42 cases showed moderately enhanced expression of immunoreactive CuZn-SOD in lesions which were stained strongly by periodic acid-Schiff but negative with Heidenhain iron-hematoxylin (HIH), von Kossa and luxol fast blue (LFB) stains, whereas coagulation necrosis in 4 cases revealed almost identical immunostaining for CuZn-SOD and HIH to that of contraction band necrosis, i.e. strongly positive HIH staining but negative immunostaining. Basophilic alteration of the myocardial cells in sections fixed with 4% formalin in 2% calcium acetate was seen in 29 cases, being identified frequently in isolated cells as well as in several foci varying considerably in size. This type of alteration demonstrated significantly enhanced expression of immunoreactive CuZn-SOD and was strongly positive with von Kossa and LFB stains. The present study indicates that the myocardium can be affected by free radicals produced in any organ of the body, and that subsequently, insoluble phospholipids react with calcium ions in the fixative and accumulate in the basophilic sarcoplasm.

Purpose: To report the association of a retinal macrocyst with peripheral retinal neovascularization that occurred secondary to a chronic, subclinical rhegmatogenous retinal detachment and to illustrate the utility of wide-field fundus photography. Methods: Case Report Results: A 37 year-old male was diagnosed with chronic retinal detachment on routine eye examination. Further evaluation revealed intraretinal hemorrhages and a retinal macrocyst. Diagnosis was confirmed with wide-field fundus photography and fluorescein angiography. Surgery was recommended to repair the retinal detachment, to allow spontaneous resolution of the macrocyst. Conclusion: Chronic, subclinical retinal detachments may rarely be associated with retinal macrocysts and retinal neovascularization. This altered retinal morphology can be delineated on wide-field fundus imaging, which aids in diagnosis and management.

Purpose Familial exudative vitreoretinopathy (FEVR) is a rare genetic disorder characterized by incomplete retinal vascular development, leading to ischemia, aberrant neovascularization (NV), and retinal detachment (RD). This report describes a case of RD with concurrent NV and FEVR, successfully managed with encircling scleral buckling (SB) surgery without additional peripheral laser ablation. Case Description A 16-year-old female with high myopia presented with a four-day history of decreased vision in her right eye (RE). Fundus examination revealed subtotal RD involving the inferior and superonasal quadrants, multiple foci of NV in the inferior quadrant, peripheral avascular retina, and a thick subretinal gliotic band. The left eye (LE) displayed an attached retina with similar peripheral avascularity. Fluorescein angiography confirmed extensive peripheral avascularity and leaking neovascular fronds in the RE, consistent with FEVR. The patient underwent SB surgery in the RE using an encircling band without subretinal fluid drainage or transscleral cryotherapy. Over six weeks, serial examinations demonstrated progressive resolution of subretinal fluid, complete retinal reattachment, and regression of NV in the RE without additional laser treatment. Conclusion Early retinal reattachment with SB alone may be sufficient to achieve both anatomical reattachment and regression of NV in selected cases of FEVR-related tractional or rhegmatogenous RD, potentially reducing the need for adjunctive ablative therapy.

Purpose To determine the expression and localization of lymphotoxin alpha (LTα) in human retinas, and investigate the functionality of the LTα rs2229094 (T>C) polymorphism, previously associated to proliferative vitreoretinopathy (PVR) development.Methods Phase I: RNA from 3 healthy human retinas and 2 peripheral blood samples was subjected to reverse transcription polymerase chain reaction (RT‐PCR) analysis. In addition, 3 human eyes with chronic retinal detachment (RD) and one healthy control were subjected to immunohistochemistry (IHC) with specific antibody against LTα. Phase II: Functionality of T and C alleles was assessed by using pCEFL‐Flag expression vector, and transient transfection assays. Besides, expression analysis by RT‐PCR, Western‐blot and subcellular localization of both alleles, by immunofluorescence (IF) assay were performed.Results Phase I: Signals of mRNA LTα below significance levels were detected in healthy human retinas. Peripheral blood analysis showed different LTα transcripts with premature stop codons. IHC staining revealed no differences between human healthy and RD retinas. Phase II: No differences in mRNA and protein expression levels and subcellular localization between both alleles were found. Both alelles showed cytoplasmic LTα localization.Conclusion Although results suggest lack of functionality, and it appears to be no differences regarding LTα expression and localization, this polymorphism could remain as a valid biomarker to identify patients at high‐risk for developing PVR after RD, due to the strong association between PVR and LTα rs2229094 polymorphism previously identified by our group.

Experimental autoimmune encephalomyelitis (EAE) induced with recombinant human myelin/oligodendrocyte glycoprotein in the common marmoset is a useful preclinical model of multiple sclerosis in which white matter lesions can be well visualized with MRI. In this study we characterized lesion progression with quantitative in vivo MRI (4.7 T; T(1) relaxation time +/- Gd-DTPA; T(2) relaxation time; magnetization transfer ratio, MTR, imaging) and correlated end stage MRI presentation with quantitative ex vivo MRI (formaldehyde fixed brains; T(1) and T(2) relaxation times; MTR) and histology. The histopathological characterization included axonal density measurements and the numeric quantification of infiltrated macrophages expressing markers for early active [luxol fast blue (LFB) or migration inhibition factor-related protein-14 positive] or late active/inactive [periodic acid Schiff (PAS) positive] demyelinating lesion. MRI experiments were done every two weeks until the monkeys were sacrificed with severe EAE-related motor deficits. Compared with the normal appearing white matter, lesions showed an initial increase in T(1) relaxation times, leakage of Gd-DTPA and decrease in MTR values. The progressive enlargement of lesions was associated with stabilized T(1) values, while T(2) initially increased and stabilized thereafter and MTR remained decreased. Gd-DTPA leakage was highly variable throughout the experiment. MRI characteristics of the cortex and (normal appearing) white matter did not change during the experiment. We observed that in vivo MTR values correlated positively with the number of early active (LFB+) and negatively with late active (PAS+) macrophages. Ex vivo MTR and relaxation times correlated positively with the number of PAS-positive macrophages. None of the investigated MRI parameters correlated with axonal density.

Investigation of the pathogenesis of Great Pyrenees retinopathy. One male and two female puppies of parents who were affected with Great Pyrenees retinopathy and one 4-year-old affected adult male Great Pyrenees dog. The puppies were examined daily from 7 weeks of age by indirect ophthalmoscopy and their fundi were photographed until the lesions were static. Fluorescein angiography was completed at 7 weeks of age, within 24 h of detection of ophthalmoscopic lesions, and then weekly. The eyes of a 4-year-old and two 20-week-old puppies were examined with light microscopy, and transmitting and scanning electron microscopy. Blocked choroidal fluorescence was detected at 7 weeks of age. The blocked fluorescence enlarged, when the characteristic serous retinal detachments developed at 11 weeks of age. The detachments enlarged in size and number until the puppies were approximately 20 weeks old. Fluorescein pooling confirmed the presence of transient retinal pigment epithelial detachments. Leakage of dye into serous retinal detachments was not detected in this study. Light microscopy and transmitting and scanning electron microscopy confirmed the presence of multifocal serous retinal detachments with focal retinal degeneration that extended to the inner nuclear layer in a 4-year-old dog. The retinal detachments were accompanied by hypertrophy, hyperplasia, increased pigmentation, and vacuolation of the retinal pigment epithelium. Great Pyrenees retinopathy is manifested by multifocal serous retinal and retinal pigment epithelial detachments. These detachments are similar to those noted with central serous retinopathy of humans. The sudden development of multifocal retinal and retinal pigment epithelial detachments, and the serous nature of these detachments, supports a theory that they develop secondary to focal secretion and absorption defects in retinal pigment epithelial cells. Given the age of the puppies when the blocked choroidal fluorescence was noted and maturation of the dog retina at 8 weeks postpartum, this retinopathy is considered to be a retinal pigment epithelial dysplasia. This unique inherited retinopathy offers an opportunity to study retinal pigment epithelial secretion.

Photodynamic therapy for diffuse choroidal hemangioma associated with Sturge Weber syndrome

To evaluate the anatomic and functional outcomes of conventional surgery in silicone oil (SO)-filled eyes with complicated retinal detachment (RD). The records of patients who underwent scleral buckling surgery for complex RD in SO-filled eyes were retrospectively reviewed. Conventional RD surgery involved a 2.5-mm encircling band, 6-mm silicone strip for the inferior quadrants or local sponge implant, subretinal fluid (SRF) drainage, and/or SO aspiration with a 27-G needle. Cryotherapy and/or laser photocoagulation was applied around the tears and 360° of the peripheral retina. In all, 4 of the cases had retinal breaks in the lower quadrants, 1 of which had a macular hole; recurrence was due to proliferative vitreoretinopathy (PVR) in the 3 other cases. Three cases were treated with external SRF drainage, 3 cases with SO aspiration, and 1 case with both external drainage and SO aspiration. The retina was attached at the last follow-up visit in 6 (85.7%) of the 7 eyes. One of the cases required secondary vitreoretinal surgery for recurrent RD due to PVR and still had SO tamponade at last follow-up visit. Mean follow-up period was 17.28 ± 8.64 months. Mean logMAR visual acuity was 1.47 ± 0.47 preoperatively and 1.4 ± 0.97 postoperatively. Inferior RD in eyes treated with silicone oil tamponade, with or without a retinal break, can be treated with scleral buckling surgery, external SRF drainage, and/or pars plana SO aspiration with satisfactory functional and anatomic outcomes in selected complicated RD cases.

目的 探讨准分子激光原位角膜磨镶术(LADIK)后视网膜脱离的临床特征及治疗.方法回顾性分析了我院收治的LASIK术后视网膜脱离17例,观察其临床特点及手术治疗方式及效果.结果17例中圆形裂孔 13例(76.47%),17例中16例行单纯巩膜外加压或联合环扎术,一次手术视网膜解剖复位16例(94.12%).术后视力较术前提高者13例(76.47%),矫正视力≥0.4者7例(41.18%).结论LASIK术后视网膜脱离巩膜扣带术手术成功率高,手术难度不大.但术后可再次造成近视,因此预防LASIK术后视网膜脱离至关重要。

Síndrome de Stickler. Epidemiología del desprendimiento de la retina

Pathological aspects of explanted homograft mitral valve

The current investigation focuses on gross anatomy, light, and scanning electron microscopy (SEM) of the Testudo graeca oropharyngeal floor, with particular reference to the immunofluorescence technique to examine its tongue. The T. graeca oropharyngeal floor showed many anatomical structures: the lower rhamphotheca, paralingual ridge, lower alveolar ridge, tongue, laryngeal mound, and glottis. The lower rhamphotheca appeared as a V-shaped jaw line with a highly serrated edge and a median tomium (beak). SEM observations of the lingual apex and the lingual body showed rectangular and conical filiform papillae with porous surfaces and taste pores. Meanwhile, the lingual root had two wings that carried papillae with different shapes: dagger-shaped, conical, bifurcated, and leaf-like papillae, and these papillae lacked taste pores. The laryngeal mound had openings for the laryngeal mucus gland and its secretions. Light microscopy findings showed mucous glands in the propria submucosa and near the mucosal surface of the lingual apex. The lingual root had lingual papillae and two hyaline cartilaginous skeletons between skeletal muscles, and the lingual papillae were elongated filiform, rectangular filiform papillae, and fungiform papillae. The lamina propria constituted the core of the lingual papillae and the mucous gland, they had a positive reaction with the periodic acid schiff (PAS) reagent. The apical surface of the fungiform papillae had taste pores. Under immunofluorescence, the vimentin was detected in taste bud cells, and synaptophysin reacted to the taste buds and nerve bundles. The current study of the Greek tortoise oropharyngeal floor investigated its herbivorous eating habits using its serrated lower rhamphotheca, a large tongue with differently shaped papillae, and numerous mucous glands. RESEARCH HIGHLIGHTS: The Greek tortoise (T. graeca graeca) oropharyngeal floor showed many anatomical structures: lower rhamphotheca, paralingual ridge, lower alveolar ridge, tongue, laryngeal mound, and glottis. SEM and light microscopy observations of the tongue revealed varied types and shapes of lingual papillae with a porous surface on the tongue apex (rectangular or conical filiform papillae), on the tongue body (filiform and fungiform papillae), and on the tongue root (dagger-shaped, conical, bifurcated, and leaf-like papillae). Light microscopy findings: the lamina propria constituted the core of the lingual papillae and had numerous mucous glands that had a slightly magenta-red color with PAS reagent. The apical surface of the fungiform papillae had taste pores. Vimentin and synaptophysin gave a reaction to the taste buds.

Subretinal Mononuclear Cells in Coats' Disease Studied with RPE65 and CD163: Evidence for Histiocytoid Pigment Epithelial Cells

BACKGROUND Toxocariasis has a wide geographic distribution, with high prevalence in tropical and subtropical regions. Ocular larva migrans is one of the most common manifestations in China and classically presents with peripheral granuloma, posterior granuloma, and chronic endophthalmitis. This report describes an atypical case of ocular toxocariasis in an adolescent male patient, initially misdiagnosed as chronic rhegmatogenous retinal detachment. CASE REPORT A 17-year-old male patient presented to our hospital with a 4-month history of progressive vision loss in his right eye, initially misdiagnosed as chronic rhegmatogenous retinal detachment, at a nearby facility. Scanning laser ophthalmoscopy identified a tractional retinal detachment accompanied by a granulomatous tubercle above the temporal peripheral retina in his right eye. The diagnosis of ocular toxocariasis was established by aqueous humor analysis, which revealed markedly elevated intraocular anti-Toxocara IgG levels and a significantly increased Goldmann-Witmer coefficient. The patient subsequently underwent scleral buckling, and 532 nm retinal laser photocoagulation 1 day after scleral buckling, resulting in successful anatomical reattachment. However, he developed retinal granulomatous lesions and vitritis 5 months following the surgery. Oral prednisone and albendazole effectively controlled intraocular inflammation and prevented further granulomatous progression. CONCLUSIONS Ocular toxocariasis may present with nonspecific findings, and serology and the Goldmann-Witmer coefficient are crucial for diagnosis. Scleral buckling is recommended for proliferative retinal changes, with adjunctive systemic therapy and long-term follow-up to prevent recurrence and preserve vision.