DOCSLIB.ORG

Ultrasound Biomicroscopy of the Peripheral Retina and the Ciliary Body in Degenerative Retinoschisis Associated with Pars Plana Cysts

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ultrasound Biomicroscopy of the Peripheral Retina and the Ciliary Body in Degenerative Retinoschisis Associated with Pars Plana Cysts 976 Br J Ophthalmol 2001;85:976–982 Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts Giuseppe Mannino, Romualdo Malagola, Solmaz Abdolrahimzadeh, Gianfrancesco M Villani, Santi M Recupero Abstract pathogenetic mechanism has been attributed Aim—To evaluate the ciliary body and to circulatory disturbances, the motility of peripheral retina in degenerative retino- accommodation, vitreous traction, holes in the schisis associated with pars plana cysts inner lamina, autolysis of retinal cells in the using ultrasound biomicroscopy (UBM). peripheral retina, osmotic procedures, and Methods—18 eyes of 12 patients with transudate from the choriocapillaris.17 Histo- degenerative retinoschisis associated with chemical studies have shown that the content pars plana cysts were selected through of the cystoid spaces and schisis of the periph- binocular indirect ophthalmoscopy and eral retina is hyaluronic acid.18 The same mate- Goldmann three mirror lens examination, rial had been found in pars plana cysts,18–20 both with scleral depression. These pa- where it would accumulate owing to an active tients were studied in detail with UBM. secretion from the non-pigment epithelium of Results—Study of the ciliary body with the ciliary body and especially of the pars UBM showed pars plana cysts of diVerent plana.19 Subsequent splitting of the ciliary pig- size and uneven shape. In cross sections ment and non-pigment epithelial layers would the morphology of pars plana cysts in lead to pars plana cyst formation. Once the detail and the close relation of the cysts similarity of the content of pars plana cysts and with the oral region and the peripheral of cystoid degeneration and retinoschisis of the retina, where areas of cystoid degenera- peripheral retina had been disclosed, the tion and retinoschisis were present, were hypothesis that retinoschisis also was caused by observed. In transverse sections three a secretory process was advanced.17 21 How- main morphological aspects of pars plana ever, no periodic acid SchiV (PAS) positive cysts could be diVerentiated (“isolated,” cells could be demonstrated within the walls of “confluent,” and “clustered” cysts). Fur- retinoschisis.17 In the past, glial cells, such as thermore, ultrabiomicroscopy allowed astrocytes and Mueller cells, were suggested as diVerential diagnosis between retino- a possible source of hyaluronic acid.16 schisis and associated retinal detachment Pars plana cysts have been reported as com- in six eyes. mon alterations of the posterior ciliary body19 22 Conclusions—The study of peripheral de- of no clinical concern423 that can be seen at generative retinoschisis and pars plana indirect ophthalmoscopy and Goldmann three cysts is possible in vivo by means of UBM, mirror examination.42425 Histologically,22 they showing the detailed morphology of the usually result from the separation of the two lesions (not otherwise evident through epithelial cell layers of the pars plana; less ophthalmoscopic examination) and the frequently, small cysts derive from the coales- close relation between pars plana cysts, cence of vacuoles within adjacent non- cystoid degeneration, and peripheral pigmented cells or alternatively from a general retinoschisis. loosening of cells within an area of epithelial (Br J Ophthalmol 2001;85:976–982) proliferation. In a histopathological study, the cysts were demonstrated to continue posteri- Institute of Ophthalmology, Degenerative retinoschisis is a common pa- orly with an area of cystoid degeneration of the 23 University of Rome thology in the elderly12defined as a splitting of peripheral retina. “La Sapienza,” Rome, the sensory retina.3 It may be better investi- Ultrasound biomicroscopy (UBM) is a pain- Italy gated clinically by means of indirect binocular less and non-invasive diagnostic technique that G Mannino oVers high resolution imaging.11 It has gained R Malagola ophthalmoscopy and Goldmann three mirror S Abdolrahimzadeh lens examination, especially with scleral much popularity not only in the diagnosis of 4–8 11 26 27 G M Villani depression. Both conventional and high anterior segment disorders, among which S M Recupero frequency ophthalmic ultrasound have proved are cysts of diVerent origin,28 but also of the to be helpful in the diagnosis and diVerential pars plana and peripheral retina.11 12 Recently Correspondence to: diagnosis of this condition.9–12 this technique has been applied to the diagno- Professor S M Recupero, 12 29 12 Istituto di Oftalmologia, Retinoschisis has been related to peripheral sis of retinal detachment, retinoschisis, Universita’ di Roma, “La cystoid degeneration,13 14 possibly resulting and detachment of the ciliary epithelium Sapienza,” Policlinico from an exaggerated response to the same fac- among other conditions.30 31 Umberto I, Viale del 15 16 Policlinico 155, Roma tors that cause microcysts. Controversy High resolution imaging of the peripheral 00161, Italy exists in the literature regarding the pathogen- retina and the ciliary body permits study of the [email protected] esis of these degenerative processes, as diVer- morphology of these regions in cases of degen- Accepted for publication ent theories have been put forward but none erative retinoschisis in vivo, providing interest- 26 February 2001 has proved to be unquestionable.13 16 17 The ing clues to the clinical and physiopathological www.bjophthalmol.com UBM of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts 977 understanding of this condition. In the present For both pars plana cysts and retinoschisis report, UBM was added to clinical examina- location was prevalent in the temporal quad- tion to better identify and evaluate the location rants, the upper and lower temporal quadrant and extension of degenerative retinoschisis. being involved almost at the same rate. In six Furthermore, the entire ciliary body, pars eyes, retinal detachment showed a similar pat- plana, and pars plicata were studied in detail. tern of distribution. Pars plana cysts varied in size and shape. The cross sectional images showed that the Methods cysts emerged from the posterior third of the Eighteen eyes of 12 patients with degenerative pars plana in the majority of cases (16/18 eyes) retinoschisis associated with pars plana cysts to extend with a fairly bollous profile to the ora were studied. Six were males and six females, serrata (Figs 1A, 2A). This presented, at times, with an age range from 25 to 78 years (mean a band of microcystic degeneration, where 57.5 years, SD 13.97). Best corrected visual hyperreflective strands of tissue split the acuity was 20/20 in all patients. microcysts (Fig 1A). Beyond the ora, areas of Six patients had been diagnosed with peripheral retinoschisis were clearly imaged as bilateral retinoschisis and six had been diag- a single thin hyperreflective layer (Figs 1A, 2A, nosed with unilateral retinoschisis. They were 3A); thus, UBM examination confirmed the submitted to binocular indirect ophthalmos- ophthalmoscopic findings in all eyes. It was copy and Goldmann three mirror lens exam- notable that pars plana cysts were large and ination, both with scleral depression. UBM of the peripheral retina and the ciliary body was numerous in the same areas where retino- performed on all eyes. The device (UBM 840 schisis was located. Retinoschisis and pars System, Humphrey Instruments, Inc, San plana cysts were found to be adjacent to each Leandro, CA, USA) was adjusted to operate on other (Fig 2A) and sometimes associated a 50 MHz, high (2.5 × 2.5 mm) or medium (5 through a band of microcystic degeneration in × 5 mm) scan format, with a resolution of 50 between (Fig 1A). µm. The theory and technique of UBM is well In transverse sections three main morpho- described in previous works.11 26 27 32 logical patterns of pars plana cysts could be To achieve the best imaging of the peripheral distinguished: retina 24 mm eye cups or at times a water bath (1) “isolated” cysts, either adjacent to each formed with an operating room drape, colloi- other or separated by intact areas of ciliary epi- don around the eye, and a wire speculum, were thelium, presenting an internal wall with a used. The coupling medium between the eye smooth profile and a regular single convexity and the UBM probe was either saline solution, towards the vitreous body (Fig 3C); 2.5% methylcellulose, or both. The distance of (2) “confluent” cysts with an irregular profile the probe from the eye surface was 2–3 mm. of the internal wall which formed a double The patient’s cooperation was always needed convexity towards the vitreous body (Fig 1C); as imaging of the pars plana and the peripheral (3) “clustered” cysts, relatively the largest of retina is gaze dependent. the three types, extending for a few millime- tres, defined by a continuous but ragged inter- nal lamina, presenting multiple convexities Results towards the vitreous (Figs 1D, 2B, 3D). The peripheral retinal lesions and ciliary body On transverse sections, areas of cystoid changes are shown in detail in the Table 1. degeneration in the oral region (Fig 1E) and Table 1 Eighteen eyes of 12 patients with degenerative retinoschisis Sex Age Eye Refraction Peripheral retinal lesions Ciliary body changes 1 M 46 RE +0.50 cil (90) RS from 9 to 2 hr with OLB at 12 hr and RD Pars plana cysts in UN, UT, and LT quadrants from10to2hr;RSfrom6to8.30hr LE +0.75 cil (70) RS from 12 to 2 hr; RS from 4 to 6 hr Pars
Load more

Recommended publications
  • Microscopic Anatomy of the Eye Dog Cat Horse Rabbit Monkey Richard R Dubielzig Mammalian Globes Mammalian Phylogeny General Anatomy Dog
    Microscopic Anatomy of the eye Dog Cat Horse Rabbit Monkey Richard R Dubielzig Mammalian globes Mammalian Phylogeny General Anatomy Dog Arterial Blood Vessels of the Orbit General Anatomy Dog * Horizontal section Long Posterior Ciliary a. Blood enters the globe Short Post. Ciliary a Long Post. Ciliary a. Anterior Ciliary a. Blood Supply General Anatomy Dog Major arterial circle of the iris Orbital Anatomy Dog Brain Levator Dorsal rectus Ventral rectus Zygomatic Lymph node Orbital Anatomy Dog Orbital Anatomy Dog Cartilaginous trochlea and the tendon of the dorsal oblique m. Orbital Anatomy Dog Rabbit Orbital Anatomy Dog Zygomatic salivary gland mucinous gland Orbital Anatomy Dog Gland of the Third Eyelid Eye lids (dog) Eye lids (dog) Meibomian glands at the lid margin Holocrine secretion Eye lids (primate) Upper tarsal plate Lower tarsal plate Eye lids (rabbit) The Globe The Globe Dog Cat Orangutan Diurnal Horse Diurnal Cornea Epithelium Stromal lamellae Bowman’s layer Dolphin Descemet’s m Endothelium TEM of surface epithelium Cornea Doubling of Descemet’s Vimentin + endothelium Iris Walls: The vertebrate eye Iris Sphincter m. Dilator m Blue-eye, GFAP stain Iris Collagen Iris Cat Sphinctor m. Dilator m. Iris Cat Phyomelanocytes Iris Equine Corpora nigra (Granula iridica) seen in ungulates living without shade Ciliary body Pars plicata Ciliary muscle Pars plana Ciliary body Zonular ligaments Ciliary body Primarily made of fibrillin A major component of elastin Ciliary body Alcian Blue staining acid mucopolysaccharides: Hyaluronic acid Ciliary
    [Show full text]
  • Ciliary Body
    Ciliary body S.Karmakar HOD Introduction • Ciliary body is the middle part of the uveal tract . It is a ring (slightly eccentric ) shaped structure which projects posteriorly from the scleral spur, with a meridional width varying from 5.5 to 6.5 mm. • It is brown in colour due to melanin pigment. Anteriorly it is confluent with the periphery of the iris (iris root) and anterior part of the ciliary body bounds a part of the anterior chamber angle. Introduction • Posteriorly ciliary body has a crenated or scalloped periphery, known as ora serrata, where it is continuous with the choroid and retina. The ora serrata exhibits forward extensions,known as dentate process, which are well defined on the nasal side and less so temporally. • Ciliary body has a width of approximately 5.9 mm on the nasal side and 6.7 mm on the temporal side. Extension of the ciliary body On the outside of the eyeball, the ciliary body extends from a point about 1.5 mm posterior to the corneal limbus to a point 6.5 to 7.5 mm posterior to this point on the temporal side and 6.5 mm posterior on the nasal side. Parts of ciliary body • Ciliary body, in cross section, is a triangular structure ( in diagram it can be compared as ∆ AOI). Outer side of the triangle (O) is attached with the sclera with suprachoroidal space in between. Anterior side of the triangle (A) forms part of the anterior & posterior chamber. In its middle, the iris is attached. The inner side of the triangle (I) is divided into two parts.
    [Show full text]
  • Condensed Table of Contents
    Condensed Table of Contents 1 Introduction G.O.H. NAUMANN, FRIEDRICH E. KRUSE 1 2 General Ophthalmic Pathology: Principal Indications and Complications, Comparing Intra- and Extraocular Surgery G.O.H. NAUMANN, F.E. KRUSE 7 3 Special Anatomy and Pathology in Surgery of the Eyelids, Lacrimal System, Orbit and Conjunctiva L.M. HOLBACH 29 3.1 Eyelids L.M. HEINDL, L.M. HOLBACH 30 3.2 Lacrimal Drainage System L.M. HEINDL, A. JÜNEMANN, L.M. HOLBACH 45 3.3 Orbit L.M. HOLBACH, L.M. HEINDL, R.F. GUTHOFF 49 3.4 Conjunctiva and Limbus Corneae C. CURSIEFEN, F.E. KRUSE, G.O.H. NAUMANN 67 4 General Pathology for Intraocular Microsurgery: Direct Wounds and Indirect Distant Effects G.O.H. NAUMANN, F.E. KRUSE 76 5 Special Anatomy and Pathology in Intraocular Microsurgery 5.1 Cornea and Limbus C. CURSIEFEN, F.E. KRUSE, G.O.H. NAUMANN 97 5.2 Glaucoma Surgery A. JÜNEMANN, G.O.H. NAUMANN 131 5.3 Iris G.O.H. NAUMANN 152 5.4 CiüaryBody G.O.H. NAUMANN 176 5.5 Lens and Zonular Fibers U. SCHLÖTZER-SCHREHARDT, G.O.H. NAUMANN 217 Bibliografische Informationen digitalisiert durch http://d-nb.info/973635800 gescannt durch XII Condensed Table of Contents 5.6 Retina and Vitreous A.M. JOUSSEN and G.O.H. NAUMMAN with Contributions by S.E. COUPLAND, E.R. TAMM, B. KIRCHHOF, N. BORNFELD 255 5.7 Optic Nerve and Elschnig's Scleral Ring C.Y. MARDIN, G.O.H. NAUMANN 335 6 Influence of Common Generalized Diseases on Intraocular Microsurgery G.O.H.
    [Show full text]
  • Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical
    Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical Science Course, AAO 2008-2009, Section 2, Chapter 2, pp 43-92. The globe is the home of the retina (part of the embryonic forebrain, i.e.neural ectoderm and neural crest) which it protects, nourishes, moves or holds in proper position. The retinal ganglion cells (second neurons of the visual pathway) have axons which form the optic nerve (a brain tract) and which connect to the lateral geniculate body of the brain (third neurons of the visual pathway with axons to cerebral cortex). The transparent media of the eye are: tear film, cornea, aqueous, lens, vitreous, internal limiting membrane and inner retina. Intraocular pressure is the pressure of the aqueous and vitreous compartment. The aqueous compartment is comprised of anterior(200ul) and posterior chamber(60ul). Aqueous and vitreous compartments communicate across the anterior cortical gel of the vitreous which seen from up front looks like a donut and is called the “annular diffusional gap.” The globe consists of two superimposed spheres, the corneal radius measuring 8mm and the scleral radius 12mm. The superimposition creates an external scleral sulcus, the outflow channels anterior to the scleral spur fill the internal scleral sulcus. Three layers or ocular coats are distinguished: the corneal scleral coat, the uvea and neural retina consisting of retina and pigmentedepithelium. The coats and components of the inner eye are held in place by intraocular pressure, scleral rigidity and mechanical attachments between the layers. The corneoscleral coat consists of cornea, sclera, lamina cribrosa and optic nerve sheath.
    [Show full text]
  • Chapter 1 Anatomy
    LN_C01.qxd 7/19/07 14:37 Page 1 Chapter 1 Anatomy Learning objectives To learn the anatomy of the eye, orbit and the third, fourth and sixth cranial nerves, to permit an understanding of medical conditions affecting these structures. Introduction A knowledge of ocular anatomy and function is important to the understanding of eye diseases. A brief outline is given below. Gross anatomy The eye (Fig. 1.1) comprises: l A tough outer coat which is transparent anteriorly (the cornea) and opaque pos- teriorly (the sclera). The junction between the two is called the limbus. The extra- ocular muscles attach to the outer sclera while the optic nerve leaves the globe posteriorly. l A rich vascular coat (the uvea) forms the choroid posteriorly, which is lined by and firmly attached to the retina. The choroid nourishes the outer two-thirds of the retina. Anteriorly, the uvea forms the ciliary body and the iris. l The ciliary body contains the smooth ciliary muscle, whose contraction allows lens shape to alter and the focus of the eye to be changed. The ciliary epithelium secretes aqueous humour and maintains the ocular pressure. The ciliary body pro- vides attachment for the iris, which forms the pupillary diaphragm. 1 LN_C01.qxd 7/19/07 14:37 Page 2 Chapter 1 Anatomy Cornea Anterior chamber Schlemm's canal Limbus Iridocorneal angle Iris Conjunctiva Zonule Posterior chamber Lens Ciliary body Uvea Ora serrata Tendon of Choroid extraocular muscle Sclera Retina Vitreous Cribriform plate Optic nerve Fovea Figure 1.1 The basic anatomy of the eye. l The lens lies behind the iris and is supported by fine fibrils (the zonule) running under tension between the lens and the ciliary body.
    [Show full text]
  • Corneal Anatomy
    FFCCF! • Mantis Shrimp have 16 cone types- we humans have three- essentially Red Green and Blue receptors. Whereas a dog has 2, a butterfly has 5, the Mantis Shrimp may well see the most color of any animal on earth. Functional Morphology of the Vertebrate Eye Christopher J Murphy DVM, PhD, DACVO Schools of Medicine & Veterinary Medicine University of California, Davis With integrated FFCCFs Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail • Advanced imaging tools such as optical coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application http://dogtime.com/trending/17524-organization-to-provide-free-eye-exams-to-service- • The basis of any diagnosis of “abnormal” is animals-in-may rooted in absolute confidence of owning the knowledge of “normal”. • If you don’t “own” the knowledge of the terminology and normal functional morphology of the eye you will not be able to adequately describe your findings Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail http://www.vet.upenn.edu/about/press-room/press-releases/article/ • Advanced imaging tools such as optical penn-vet-ophthalmologists-offer-free-eye-exams-for-service-dogs coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application • The basis of any diagnosis of “abnormal” is rooted in absolute confidence of owning the http://aibolita.com/eye-diseases/37593-direct-ophthalmoscopy.html knowledge of “normal”.
    [Show full text]
  • Eye Anatomy Slides File
    EYE ANATOMY & PHYSIOLOGY Dr. Cesar Carrillo [email protected] Sight For All **Disclaimer** The images contained in this presentaon are not my own, they can be found on the web Eye Anatomy and Physiology A thorough understanding of the anatomy and physiology of the eye, orbit, visual pathways, upper cranial nerves, and central pathways for the control of eye movements is a prerequisite for proper interpretaon of diseases having ocular manifestaons. Furthermore, such anatomic knowledge is essen;al to the proper planning and safe execu;on of ocular and orbital surgery Eye Anatomy and Physiology Objecves: Brief overview of eye anatomy and relevant physiology — Embriology — The Orbit, Cranial Nerves, Blood supply and Venous drainage — The Ocular Adnexa — The Extraocular muscles — The Conjunc;va, Sclera and Cornea — The Uveal tract — The Lens — The Re;na, Vitreous and Op;c Nerve — The Visual Pathway Embryology The eye is derived from three of the primi;ve embryonic layers: — Surface ectoderm, including its derivave the neural crest — Neural ectoderm — Mesoderm — Endoderm does not enter into the formaon of the eye — Mesenchyme is the term for embryonic connecve ssue. Ocular and adnexal connec;ve ;ssues previously were thought to be derived from mesoderm, but it has now been shown that most of the mesenchyme of all of the head and neck region is derived from the cranial neural crest Embryology Development of the structures of the head and neck occurs between 3-8 weeks of gestation — Eye develops as an ectodermal diverticulum from the lateral
    [Show full text]
  • 2- Basic Anatomy and Physiology Edited.Pdf
    432 Ophthalmology Team 2- Basic Anatomy and Physiology Done by: Fatma Alshehry Revised by: Ghadah Alharbi Team Leader: Shaikha Aldossari Doctor's note Team's note Not important Important 431 teamwork in a yellow box 1 432 Ophthalmology Team The Orbit The Extraocular Muscles The Globe Coats of the Eye Conjunctiva Cornea Eye Chambers Iris and Pupil Embryology of the Eye Basic Anatomy and The Lens Physiology of the Eye Retina and Vitreous Optic Nerve The Visual Pathway The Lacrimal Apparatus Optics of the Eye Intraocular Pressure Vision 2 432 Ophthalmology Team Embryology of the Eye *This highly specialized sensory organ is derived from neural ectoderm, mesoderm and surface ectoderm. *The eye is essentially an outgrowth from the brain (neural ectoderm). *The Optic Nerve started as Optic vesicle connected to the forebrain by Optic stalk. *Surface ectoderm gives cornea and lens. Development of the Eye After Birth At birth, the eye is relatively large in relation to the rest of the body. *The eye reaches full size by the age of 8 years. The size got fixed at 3-6 years *The lens continues to enlarge throughout the life. *The iris has a bluish color due to little or no pigment on the anterior surface. *During early infant life, the cornea & sclera can be stretched by raised IOP → enlargement of the eye due to the high elasticity of the globe. The Orbit - As a socket contains and protect the eye. - The weakest parts are the floor & the medial wall. - Seven bones contribute the bony orbit. - Surrounded by nasal sinuses. - Nasal bone fracture is the most common facial fracture.
    [Show full text]
  • June 2018 Examination
    June 2018 Examination 1 CLINICAL MANAGEMENT GUIDELINES Atopic Keratoconjunctivitis (AKC) Aetiology Severe ocular surface disease affecting some atopic individuals Complex immunopathology Sometimes follows childhood Vernal Keratoconjunctivitis (VKC) (see Clinical Management Guideline on Vernal Keratoconjunctivitis) Predisposing factors Typically affects young adult atopic males There may be a history of asthma, hay fever, eczema and VKC in childhood Most patients have atopic dermatitis affecting the eyelids and periorbital skin There is a strong association with staphylococcal lid margin disease Specific allergens may exacerbate the condition Symptoms Ocular itching, watering, usually bilateral Blurred vision, photophobia White stringy mucoid discharge Onset of ocular symptoms may occur several years after onset of atopy Symptoms usually year-round, with exacerbations Signs Eyelids may be thickened, crusted and fissured Associated chronic staphylococcal blepharitis Tarsal conjunctiva: giant papillary hypertrophy, subepithelial scarring and shrinkage Entire conjunctiva hyperaemic Limbal inflammation Corneal involvement is common and may be sight-threatening: beginning with punctate epitheliopathy that may progress to macro-erosion, plaque formation (usually upper half), progressive corneal subepithelial scarring, neovascularisation, thinning, and rarely spontaneous perforation These patients are prone to develop herpes simplex keratitis (which may be bilateral), corneal ectasia such as keratoconus, atopic (anterior or posterior polar) cataracts,
    [Show full text]
  • Glaucoma Overview
    Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low. We still don’t know the exact mechanism of axonal death in glaucoma—but die they do. Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low. We still don’t know the exact mechanism of axonal death in glaucoma—but die they do. In addition to being the strongest risk factor for glaucoma, IOP has another quality that renders it unique: It is the only glaucoma risk factor that is modifiable in a manner proven to mitigate the risk of glaucoma progression. Thus, at present IOP reduction is the sole arrow in our glaucoma-treatment quiver. IOP reduction can be accomplished via hypotensive drops, laser surgery, or incisional (aka filtering) surgery; which modality is employed depends upon a number of clinical factors including (but far from limited to) glaucoma type and severity. Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low.
    [Show full text]
  • Long-Term Visual Results After Pars Plicata Lensectomy- Vitrectomy for Congenital Cataracts
    Br J Ophthalmol: first published as 10.1136/bjo.72.8.601 on 1 August 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 601-606 Long-term visual results after pars plicata lensectomy- vitrectomy for congenital cataracts STEPHEN A GROSSMAN' AND GHOLAM A PEYMAN2 From the 'Department of Ophthalmology, Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, and 2S U Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans, USA SUMMARY We performed a pars plicata lensectomy-vitrectomy on 32 patients (47 eyes) with congenital cataracts. Ocular abnormalities, mainly nystagmus, strabismus, and microphthalmia, were present in 29 patients. No complications occurred intraoperatively or postoperatively in 39 eyes with up to 81/2 years' follow-up (average 2-2 years). The pars plicata approach is a good surgical technique for the management of congenital cataracts. and developmental Congenital and early developmental cataracts have who have had congenital copyright. resulted in a large percentage of cases of childhood cataracts managed with this approach. blindness.2 The surgical management of such eyes has been debated in the literature for over 50 years. Material and methods Early techniques such as discission, linear extraction, and intracapsular extraction were plagued by a Thirty-two patients (47 eyes) were referred to the persistently high rate of surgical complications.?7 vitreous service of the University of Illinois Eye and More recently the discission and aspiration technique Ear Infirmary between 1974 and 1986. Six patients for congenital cataracts has been advocated.'" between the ages of 5 weeks and 18 years had a http://bjo.bmj.com/ However, the incidence of complications with this unilateral cataract.
    [Show full text]
  • 32 Dimensions of Ciliary Body Structures in Various Axial Lengths In
    Journal of Ophthalmology (Ukraine) - 2017 - Number 6 (479) Dimensions of ciliary body structures in various axial lengths in patients with rhegmatogenous retinal detachment O.S. Zadorozhnyy, CandSc (Med), Alibet Yassine, Postgraduate Student, A.S. Kryvoruchko, G.V. Levytska, CandSc (Med), N.V. Pasyechnikova, DrSc (Med), Prof. Filatov Institute of Eye Disease and Background: Ciliary body size may be objectively assessed by ultrasound scanning Tissue Therapy and near-infrared transpalpebraltransillumination. Purpose: To investigate the dimensions of ciliary body structures in various axial Odessa, Ukraine eye lengths in patients with rhegmatogenous retinal detachment (RRD). Materials and Methods: This study included 35 RRD patients (35 eyes) with an intact fellow eye who were under observation. These were divided into three groups, based on axial length of the eye with RRD. All patients underwent near- E-mail: [email protected] infrared transpalpebraltransillumination (NIRTPT) and ultrasound scanning of the anterior eye. Results: In patients with axial length ranging from 20 mm to 22.9 mm, 23 mm to 24.9 mm, and larger than 25 mm, pars plana width was 3.4 mm, 4.16 mm, and 4.16 mm, respectively, whereas pars plicata width was 1.9 mm, 1.99 mm, and 2.0 mm, respectively, and pars plicata thickness was 0.75 mm, 0.75 mm, and 0.72 mm, respectively. Conclusions: A direct relationship exists between pars plana width and axial length, but pars plicata thickness and width do not depend on the axial length in eyes with RRD. There was no difference in pars plana width or pars plicata width Keywords: between the eye with RRD and unaffected fellow eye.
    [Show full text]