Does vitreous haemorrhage and calcification lead to increased risk of enucleation in advanced retinoblastoma?

PURPOSE

To explore whether varying degrees of vitreous haemorrhage (VH) and calcification act as risk factors for enucleation in patients with advanced retinoblastoma (RB).

METHODS

Advanced RB was defined by the international classification of RB (Philadelphia version). Basic information for retinoblastoma patients diagnosed as groups D and E in our hospital between January 2017 and June 2022 was reviewed by logistics regression models. Additionally, a correlation analysis was performed, excluding variables with a VIF (variance inflation factor) >10 from the multivariate analysis.

RESULTS

A total of 223 eyes diagnosed with RB were included in assessing VH and calcification; of these, 101 (45.3%) eyes experienced VH, and 182 (76.2%) eyes were found to have calcification within the tumour through computed tomography (CT) or B-scan ultrasonography. Ninety-two eyes (41.3%) were enucleated, of which 67 (72.8%) had VH and 68 (73.9%) calcification, both of which were significantly relevant to enucleation (p < 0.001*). Other clinical risk factors, such as corneal edema, anterior chamber haemorrhage, high intraocular pressure during treatment and iris neovascularization, correlated significantly with enucleation (p < 0.001*). Multivariate analysis included IIRC (intraocular international retinoblastoma classification), VH, calcification and high intraocular pressure during treatment as independent risk factors for enucleation.

CONCLUSIONS

Despite identifying different potential risk factors for RB, there remains significant controversy concerning which patients require enucleation, and the degree of VH varies. Such eyes need to be evaluated carefully, and management with appropriate adjuvant therapy may improve the outcome of these patients.

Postoperative Pain Following Eye Enucleation: A Prospective Observational Study

Background and Objectives: Enucleation of an eye is the most invasive procedure in ophthalmologic surgery. It can be the result of various diseases (malignant/chronic/trauma/infection) and is nevertheless relatively rare, but leads to the loss of a strongly innervated neuronal organ. This study systematically evaluates postoperative pain levels following enucleation of the eye globe. Materials and Methods: This prospective single-center study enrolled twenty-four patients undergoing enucleation of the eye globe. Perioperatively all patients completed (preoperative day, day of surgery, 1st, 2nd, and 3rd day following surgery) standardized questionnaires concerning their pain experience and treatment-related side-effects (internal protocol, QUIPS, painDETECT®). Patients received usual pain therapy in an unstandardized individual manner. Results: Preoperatively, mean average pain intensity of all included patients was 3.29 ± 2.46 (range, 0-8), 3.29 ± 3.24 (range, 0-8) on the day of surgery, 4.67 ± 1.90 (range, 2-10) on day 1, 3.25 ± 1.39 (range, 1-6) on day 2, and 2.71 ± 1.30 (range, 1-6) on day 3 after surgery. Mean maximum pain intensity was 4.71 ± 3.28 (range, 0-10) preoperatively, 4.04 ± 3.78 (range, 0-10) on the day of surgery, 5.75 ± 2.01 (range, 2-10) on day 1, 4.25 ± 1.89 (range, 2-10) on day 2, and 3.88 ± 1.54 (range, 2-8) on day 3 after surgery. Nineteen patients (79.2%) stated that they would have preferred more pain therapy. Conclusions: Patients undergoing eye enucleation report pain sensations in need of intervention in this university hospital. Thus, effective standardized pain treatment concepts are now a high priority to be established in an interdisciplinary manner containing standardized regimens and continuous regional procedures. Awareness of this problem in the medical team should be sharpened through targeted training and information.

Surgical outcomes of unwrapped acrylic orbital implants: A review of 192 patients

PURPOSE

The purpose of this study is to report the results in a series of acrylic orbital implant placements without the use of wrapping material.

METHODS

We retrospectively reviewed the records of the patients who underwent enucleation with acrylic orbital implant insertion without scleral wrapping at the Department of Ophthalmology, Poznań University of Medical Sciences, Poland, between 2013 and 2020.

RESULTS

There were 192 patients: 102 women and 90 men, mean age: 60 years (range: 13-90 years). In the majority of cases, the reason for enucleation was uveal melanoma (148 patients-77.1%), followed by secondary glaucoma in 22 patients (11.5%) and painful, phthisical eye in 16 (8.3%). The median follow-up was 23 months (range: 1-96 months). The stability of the implants was satisfactory in the majority of cases, and there were no cases of implant migration identified during the study period. We noted a total of 4 (2%) implant exposures. Other postoperative complaints included eyelid malposition-21 patients (11%), Tenon's capsule thinning (15 patients-7.8%) and post-enucleation eye socket syndrome (PEES)-7 patients (3.6%). The rate of postoperative complications was associated only with a history of previous ocular surgery (P=0.006).

CONCLUSIONS

The stability and functional outcomes of unwrapped acrylic orbital implants in this group of patients were satisfactory during the follow-up period.

[Epidemiological impact of the COVID-19 pandemic on enucleation cases in Germany]

PURPOSE

To determine the rate of enucleation in Germany and the impact that the COVID-19 pandemic may have had on its characteristics.

METHODS

The rates of enucleation in Germany during 2019 and 2020 were extracted from the diagnosis-related groups (DRG) registry using the operation and procedure classification system codes 5‑163.0 through 5‑163.23 and 5‑163.x. The data were statistically analyzed.

RESULTS

The number of enucleations showed a 16.6% reduction from 1295 cases in 2019 compared to 1080 cases in 2020 (p = 0.17). In both years men averaged 54.1% of cases. Patients older than 65 years represented 53% and 56% of cases in 2019 and 2020, respectively. The most common indication for enucleation in both years was phthisis bulbi (n = 373 and n = 307, respectively), accounting for 29.7% of the cases, followed by choroidal malignancies (24%). Enucleation with the simultaneous introduction of an alloplastic orbital implant into Tenon's capsule represented the most common procedure (38.7% combined 2‑year average), followed by a sheathed variant (26.6%) and a bulbar implant made of nonabsorbable microporous material (16.8%), without a significant change between years. Enucleations without the introduction of an implant increased from 7.8% in 2019 to 11.1% in 2020 (p = 0.006). The proportion of patients undergoing a reoperation slightly increased from 5.6% to 8% (p = 0.018). Most procedures (65.6%) were performed in large (> 1000 beds) public hospitals.

CONCLUSION

Despite the decrease in the total number of procedures performed, the rate of enucleation in Germany was not significantly altered by the COVID-19 pandemic. The rate of enucleation without implants and reoperations significantly increased.

A comparison of high risk pathological features between primary and secondary enucleation for retinoblastoma

AIM

To compare the risk and pattern of High-Risk Pathologic Features (HRPF) in retinoblastoma between primary and secondary enucleation.

METHODS

A retrospective analysis of 121 eyes from 118 patients who underwent enucleation at the King Hussein Cancer Center (KHCC) Amman, Jordan, between November 2009 and January 2020. Demographic information, tumor stage, time from diagnosis-to-enucleation, results of pathology, metastasis, and mortality were retrieved.

RESULTS

Patients in the secondary group (49/121 eyes, 40%) were considerably younger at diagnosis (p = 0.0014), had bilateral disease (p = 0.0001), and had less-progressed disease at presentation (p = 0.016) compared to the primary enucleation. Primarily enucleated eyes were more-likely to have massive choroidal invasion (p = 0.0315) and post-laminar optic nerve invasion (p = 0.027), in spite of the finding that the overall prevalence of HRPF was similar between the two groups (35.5 percent vs. 37.5 percent; p = 0.585). The likelihood of anterior chamber invasion, was considerably higher in secondary enucleated eyes (p = 0.013). We evaluated primary and secondary enucleation for each subgroup (D and E) of the International Intraocular Retinoblastoma Classification (IIRC) and found the prevalence of HRPF was comparable (p = 0.58, 1.0, respectively). The difference in time between diagnosis-to-enucleation in secondary enucleation did not predict HRPF (p = 0.50). There was no discernible difference between primary and secondary enucleated eyes in terms of metastasis or survival (p = 0.156 and 0.44, respectively).

CONCLUSION

Systemic chemotherapy has the ability to reduce the extent of tumor expansion that has been pathologically identified. Primary and secondary enucleated eyes are comparable in low metastatic risk only when strict examination and management guidelines are followed.

Globe salvage treatment in group D and group E retinoblastoma

Importance: Globe salvage marks the treatment success of retinoblastoma. Background: To evaluate four treatment strategies in group D and group E retinoblastoma. Design: Retrospective case series in a tertiary hospital. Participants: 81 patients with Group D and Group E retinoblastoma. Methods: Participants were divided into four sets. In set I, eyes received primary intravenous chemotherapy (IVC), cryotherapy (CT), laser therapy (LT) and Intravitreal Chemotherapy with Melphalan (IViC). In set II, primary IVC was combined with second line IVC, CT, LT and IVT-M. Set III eyes received primary IVC and Intra-arterial chemotherapy (IAC), CT, LT and IViC. Set IV eyes received IAC, CT, LT and IViC. Treatment failure was defined as inadequate response during or after IVC or IAC. Main Outcome Measures: globe salvage and enucleation rates. Results: 52 eyes were included in group D and 29 in group E. In group D, globe salvage was obtained in 8 out of 11 eyes in Set I, 13 out of 19 eyes in set II, 5 out 6 eyes in set III, and 13 out of 16 eyes in set IV. In group E, enucleation was performed in 17 eyes. Global salvage was obtained in 0 out of 2 eyes in set I, 2 out of 3 eyes in set II, 3 out of 5 in set III, and in 1 out of 2 eyes in set IV. Conclusions: IVC with adjuvant IAC, LT, CT and IViC has shown favorable results as a treatment method for group D and group E retinoblastoma.

An Overview of Retinoblastoma and Enucleation in Pediatric Patients

Retinoblastoma is a rare malignancy of the eye affecting children, most commonly four years old and younger. Although chemotherapy and radiation treatment aim to spare the eye, in some cases, enucleation (ie, removal of the eye) is required to prevent cancer metastases or recurrence. Enucleation procedures are primarily performed at specialty institutions and may involve the surgical placement of an implant in the orbit of the eye. Unique perioperative considerations are required because of the age of the child at the time of the diagnosis and procedure and the involvement of a parent or caregiver who will be caring for the child postoperatively. This article presents an overview of retinoblastoma and enucleation and discusses the care and management of the unique patient population undergoing enucleation.

Molecular profiling of vitreous fluid by massively parallel sequencing: a case series

INTRODUCTION

In cases of suspected intraocular malignancy, vitreous may be the preferred pathologic sample; however, cellularity may be insufficient for definitive cytopathological diagnosis. Ancillary methodology to study vitreous fluid aspiration for mutational analysis may assist in treatment decisions.

MATERIALS AND METHODS

Three individual patient vitreous humor samples were received in the laboratory for mutation testing. The samples were collected during standard of care and analyzed for routine cytopathology. In each case, cytopathology was inconclusive and mutational analyses to support diagnostic suspicions were clinically requested. Based on the clinically and pathologically suspected diagnoses, an appropriate massively parallel sequencing assay previously validated for clinical use was performed using DNA extracted from vitreous samples that had previously undergone various processing. Nucleic acid yield was assessed by fluorometric or spectrophotometric methods, with yield ranging from 2.7 to 86.5 ng. Library preparations were performed using standard laboratory protocols.

RESULTS

Two of the cases were suspicious for melanoma and a 50-gene solid tumor panel was performed. The third case was worrisome for vitreoretinal lymphoma and a 49-gene myeloid panel was performed.

CONCLUSIONS

In all cases, the molecular profiling assisted with the clinical assessment and/or management of each patient.

HISTOLOGIC FINDINGS IN VITREORETINAL LYMPHOMA: Learning From Enucleation Specimens

PURPOSE

We aimed to describe the clinical and histologic findings in a few enucleation cases with intraocular lymphoma.

METHODS

Retrospective review of pathology files from a 22-year period identified cases with intraocular lymphoma among all enucleation specimens. Patient demographics, clinical findings, laboratory results, radiographic studies, and indication for enucleation were abstracted from electronic health records; slides were reviewed.

RESULTS

Four patients (three women and one man; age range, sixth through eighth decades of life) underwent enucleation with a final diagnosis of intraocular lymphoma. Two patients with primary vitreoretinal large B-cell lymphomas had been treated for refractory uveitis. Specimens showed retinal and subretinal infiltrates by atypical large B-lymphocytes and rare neoplastic cells in the vitreous. The remaining two patients had systemic lymphoproliferative disorders. One patient had chronic lymphocytic leukemia and floaters in his eye; vitreoretinal lymphoma developed, consistent with intraocular Richter transformation. The other had diffuse large B-cell lymphoma in remission; however, blurred vision developed, she was treated for panuveitis without improvement, and was later found to have ocular involvement by diffuse large B-cell lymphoma.

CONCLUSION

Our series details the unusual circumstances when an eye is removed for intraocular lymphoma. Different patterns of ocular tissue involvement were observed when we compared primary and secondary lymphomas.

Orbital myiasis: A case report and literature review

RATIONALE

Myiasis is a parasitic disease caused by fly larvae of the Diptera order that infest human and other vertebrate animal tissues. Orbital myiasis is a potentially destructive infestation of the orbital tissues, which may affect individuals with previous ocular diseases or disorders of consciousness.

PATIENT CONCERNS

A 72-year-old man presented with a complaint of repeated pain for two years after trauma to his right eyelid and aggravated symptoms with larvae wriggling out for 2 days. An orbital computed tomography scan revealed right eyeball protrusion and periocular soft tissue edema. Two days later, magnetic resonance imaging showed that the shape of the right eyeball was changed and that the normal structure of the eyeball could not be identified.

DIAGNOSES

Due to the patient's symptoms and imaging examination results, the diagnosis of orbital myiasis was made.

INTERVENTIONS

The patient was treated by exenteration of the right orbit, and all necrotic tissues and larvae were removed. The defect was repaired via reconstruction with a pedicled musculocutaneous flap from the forehead region. Antibiotics and tetanus toxoid therapy were utilized to prevent potential bacterial infection.

OUTCOMES

The patient recovered well postoperatively and was discharged uneventfully. During the 6-month follow-up period, the wound healed well.

LESSONS

Advanced age and untreated eye trauma are risk factors for orbital myiasis. Timely removal of larvae and elimination of infections are important measures for protecting the eyeball.

Hypertensive Gas Technique for Enucleation of Choroidal Melanomas: A Preliminary Report

The hypertensive gas technique induces avascularity within the eye during enucleation of a melanoma. Before touching the eye for enucleation, pressure is raised to maximum by an intravitreal injection of approximately 1.4 ml of gas (perfluorocarbon, air) resulting in a rock-hard eye. Avascularity persists for the duration of enucleation. From 9/1987 to 6/1989, 15 patients with choroidal melanomas were enrolled in a prospective study with the hypertensive gas technique instead of prior radiotherapy (the death rate in that series was five out of 26 melanoma patients at three years). Inclusion criteria for the hypertensive gas technique study were the same as for our previous irradiation series: (1) absence of detectable metastases and (2) a choroidal melanoma too large for a radioactive plaque. The average base diameter of melanomas measured 13.2 mm, height 8.4 mm. The cytology was: 11x spindle, 3x mixed, 1x epithelioid cells. At re-examination in 7/1991 (average follow-up 33 months) two diabetics had died with no detectable metastases prior to death, and one of the 15 melanoma patients had died with metastases 24 months after enucleation. So far the hypertensive gas technique for enucleation of a melanoma eye seems to have no adverse effect on survival. It seems to be a simple alternative to the precautions taken otherwise and it facilitates enucleation with pratically no bleeding from the globe.

[ADVANCES IN THE TREATMENT OF RETINOBLASTOMA AT HADASSAH IN THE LAST THREE DECADES]

INTRODUCTION

Retinoblastoma (RB) is a malignant tumor presenting in the eyes of infants and children, which endangers life, the eye and vision. The treatment of RB has undergone marked changes in recent years, and great progress has been made in our ability to preserve eyes. Over the last three decades most Israeli patients with RB have been treated in the National Specialty Ocular Oncology Service at the Hadassah-Hebrew University Medical Center in Jerusalem.

AIMS

To describe advances in the primary treatment of RB with an emphasis on eye-preserving treatments.

METHODS

The study included a retrospective cohort of patients who were diagnosed and treated at our center over the last three decades. Review of patients' records was approved by the Hadassah IRB.

RESULTS

From 1988 to 2014 we diagnosed 290 children (138 girls - 47.6%). The mean age at diagnosis (±SE) was 18.1±1.2 months, median 12.5 months. RB was unilateral in 55.6% of the cases, bilateral in 41.3% and unilateral multifocal in 3.1%. There was an even distribution of disease severity (IRB grouping). Since the advent of IV chemotherapy (IVC) there has been a decrease in the rate of eye enucleation from ~90% to ~30% of the children until the year 2000 with a stable rate thereafter. In the years 1990-2000 there was an increase followed by a decrease in the use of primary external beam radiotherapy (EBRT), and a parallel small increase in the use of brachytherapy from the mid '90s until today. The recently introduced novel treatments - intravitreal (IVitC) and intra-arterial chemotherapy (IAC) - were used as a complimentary treatment to IVC, and not yet as a single primary modality until 2014.

CONCLUSIONS

IVC replaced the need to enucleate in most of the cases, but 30% of children still require a primary enucleation.

DISCUSSION

IVC usually requires additive treatments (thermal-cryotherapy, trans-pupillary thermotherapy - TTT, brachytherapy and/or local chemotherapy - IVitC and IAC) and with the use of multi-modal therapy many eyes can be preserved. In the period reported in the current manuscript, the use of IAC as a primary treatment approach was only used in isolated cases. In Summary, There have been significant advances in our ability to save eyes, and the field continues to progress.

Traumatic Ruptured Globe From a .22 Cartridge Casing in a 2-Year-Old Girl

The authors report the case of a 2-year-old girl who presented with an acute ruptured globe secondary to penetration by the casing of a .22 caliber cartridge that was ignited by a car cigarette lighter. Although penetrating injuries are a common mechanism of ocular trauma, open globe induced by cartridge casing represents an unusual and preventable cause. [J Pediatr Ophthalmol Strabismus. 2017;54:e88-e90.].

Consideration for eliminating conjunctival closure in the enucleation procedure

To compare post-operative results and complications in patients who undergo enucleation with or without suture closure of the conjunctiva. This was a retrospective chart review study. Review of 50 cases of enucleation surgery at the University of Arkansas for Medical Sciences and Arkansas Children's Hospital between July 2011 and December 2014. Criteria for inclusion in the study were all cases of enucleation that had extraocular muscles attached to a spherical orbital implant with or without conjunctival closure, and at least 2 months of postoperative follow up. Post-operative complications were evaluated. A total of 36 cases fulfilled the criteria for inclusion in the study; 12 cases with direct sutured layered direct closure of Tenon's and then conjunctiva and 24 cases with Tenon's capsule sutured closure but without direct conjunctival sutured closure. No implant complications were identified in either group (p = 1.0). Mean follow-up for all groups was 16.71 months (range 2 to 43 mo., SD 11.94). Mean follow up for the non-closure group was 14.42 months (range 2.25 to 36 mo., SD 10.35). Two cases in the conjunctival closure group developed a conjunctival cyst, affecting prosthesis fit, approximately 3 months postoperatively: no such cysts were identified in the non-conjunctival closure group. Fisher exact test for cyst formation between the two groups was not statistically significant (p = 0.1048). Direct conjunctival closure following enucleation surgery does not appear to increase the risk of extrusion, exposure, or infection. Foregoing direct closure decreases surgical time and reduces cost. It is unclear if this decreases conjunctival cyst formation.

The Collaborative Ocular Melanoma Study: An Overview

BACKGROUND

The Collaborative Ocular Melanoma Study (COMS) is a 3-arm study that includes two multicenter randomized clinical trials designed to compare the effectiveness of brachytherapy to enucleation for treatment of medium-size choroidal melanomas, and the effectiveness of enucleation with and without preoperative external-beam radiotherapy for large choroidal melanomas. The third arm is an observational study of small choroidal melanomas. Patient accrual ran from 1987 to 1998.

METHODS

A review of COMS published reports was conducted.

RESULTS

There is no difference in 5-year all-cause mortality for large- and medium-size choroidal melanomas with COMS-designated treatments. Preoperative radiation for large choroidal melanomas does not improve survival. The accuracy of the clinical diagnosis of choroidal melanoma is excellent.

CONCLUSIONS

Data from the trials are still being collected and analyzed, but primary outcomes will unlikely change significantly in the future. Similar rates of mortality after treatment with enucleation and brachytherapy shift the emphasis of selection of therapy to secondary outcomes such as preservation of vision. The findings highlight the need to better understand the biological mechanisms and timing of hematogenous dissemination to achieve an appreciable impact on choroidal melanoma survival.

Penetrating Ocular Trauma from a Bean Bag Gun: A Case Report and Review of Less-Lethal Force and Their Consequences

Although bean bag guns are considered a "less-lethal" form of law enforcement, these blunt projectiles have risk. The purpose of this study was to perform a literature review of morbidity and mortality associated with less-lethal munitions and present a case report of a bean bag injury leading to a traumatic globe evisceration and skull base fracture. Patients presenting with bean bag gun associated injuries warrant a high clinical suspicion for injury to deeper structures.

Enucleation for treating rodent ocular disease

Our standard of care for rodent corneal lesions previously included treatment of the primary lesion, application of topical NSAIDs, and systemic NSAIDs in severe cases. When intensive medical management was unsuccessful, animals were euthanized, leading to premature loss of valuable genetically modified animals and those on long-term studies. We investigated enucleation surgery as a treatment for 15 cases of rodent corneal disease that did not respond to medical management. Enucleation was performed under isoflurane anesthesia and involved removal of the globe, extensive hemostasis, and packing the orbital space with absorbable gelatin sponge. The lid margins were closed by tarsorrhaphy and tissue glue. Analgesia was provided by using buprenorphine preoperatively and carprofen chew tabs postoperatively. To date, we have a 100% success rate with this procedure (n = 20; 15 clinically affected rodents [2 rats, 13 mice], 5 healthy controls), which included a 60-d follow-up period. The single complication involved dehiscence of the tarsorrhaphy site and was repaired by trimming the lid margins to provide fresh tissue for closure. Histologic examination at both 1 and 3 mo after surgery revealed no evidence of infection of the enucleation site. Enucleation in rodents is a straightforward procedure that represents a refinement to our current standard of care for rodents, does not cause significant inflammation of remaining periocular structures, and has reduced the number of animals euthanized prior to study endpoint because of severe ocular lesions.

Worldwide enucleation techniques and materials for treatment of retinoblastoma: an international survey

Purpose

To investigate the current practice of enucleation with or without orbital implant for retinoblastoma in countries across the world.

Methods

A digital survey identifying operation techniques and material used for orbital implants after enucleation in patients with retinoblastoma.

Results

We received a response of 58 surgeons in 32 different countries. A primary artificial implant is routinely inserted by 42 (72.4%) surgeons. Ten (17.2%) surgeons leave the socket empty, three (5.2%) decide per case. Other surgeons insert a dermis fat graft as a standard primary implant (n=1), or fill the socket in a standard secondary procedure (n=2; one uses dermis fat grafts and one artificial implants). The choice for porous implants was more frequent than for non-porous implants: 27 (58.7%) and 15 (32.6%), respectively. Both porous and non-porous implant types are used by 4 (8.7%) surgeons. Twenty-five surgeons (54.3%) insert bare implants, 11 (23.9%) use separate wrappings, eight (17.4%) use implants with prefab wrapping and two insert implants with and without wrapping depending on type of implant. Attachment of the muscles to the wrapping or implant (at various locations) is done by 31 (53.4%) surgeons. Eleven (19.0%) use a myoconjunctival technique, nine (15.5%) suture the muscles to each other and seven (12.1%) do not reattach the muscles. Measures to improve volume are implant exchange at an older age (n=4), the use of Restylane SQ (n=1) and osmotic expanders (n=1). Pegging is done by two surgeons.

Conclusion

No (worldwide) consensus exists about the use of material and techniques for enucleation for the treatment of retinoblastoma. Considerations for the use of different techniques are discussed.

[Available approaches to retinoblastoma therapy--literature review]

Retinoblastoma is a malignant tumor and treatment should be started as soon as possible. Currently, the most common approach combines local therapy with chemotherapy. Chemoreduction represents a significant advance in the treatment of retinoblastoma. This paper presents treatment approaches including local chemotherapy, intraarterial and intravitreous chemiotheraphy. retinoblastoma, chemotherapy chemoreduction, brachytherapy, thermotherapy, laser photocoagulation, proton radiotherapy, teleradiotherapy, intraarterial chemotherapy.

Bilateral choroidal melanoma--case analysis and literature review

Uveal melanoma is the most common primary intraocular neoplasm in adults. Its bilateral localization is extremely rare. The aim of the paper is analysis of the cases of bilateral uveal melanoma. Five bilateral uveal melanoma patients were diagnosed in the Department of Ophtalmology and Ocular Oncology beetwen 1980 and 2014. Both eyes of four patients were threated with brachytherapy. Final enulcleation of the one eye was performed in three patients. It was the primary treatment in one patient. The presence of uveal melanoma was confirmed by pathological examination in all cases after surgical removal of eyeball and in one after local resection of iris tumor. Metastatic lesions were diagnosed in lungs and liver in two patients. Three patients are still followed-up at our institution. The possibility of bilateral uveal melanoma should considered although it is extremely rare. bilateral uveal melanoma, brachytherapy, enucleation.

[How to choose appropriate surgical approach in removal of the eyeball]

We often consult patients with non-functional eye caused by trauma, intraocular malignancy, absolute stage of glaucoma and other diseases who need to remove the eyeball in our clinical work. Eye removal is an irreversibly destructive procedure, which mainly include enucleation and evisceration. There are various surgical techniques which are still controversial. Both of the two procedures have their own advantages, disadvantages, indications and contraindications. The ophthalmologists should comprehensively consider the disease situations, medical conditions and the requirements of the patients when choosing appropriate surgical approach to remove the eyeball.

[Survival rates for large choroidal melanomas]

Choosing the treatment method for patients with large choroidal melanomas remains a subject of debate. No literature data can be found on survival of such patients after either eye-preserving surgery or enucleation that takes into account the initial tumor size. The purpose of the study was to analyze the five-year survival rates for large choroidal melanomas (by J.A. Shields) in respect of the provided treatment.

MATERIAL AND METHODS

Medical records of 103 patients who had undergone treatment for choroidal melanoma (initial prominence 5.0-10.2 mm, initial diameter 7.3-20 mm) were studied. Eye-preserving surgery was performed on 60 patients, of whom 46 patients received brachytherapy (single session in 37 cases) and the other 14 patients--brachytherapy in combination with transpupillary thermotherapy (with subsequent endoresection of the tumor in one case). A total of 16 patients from this group required secondary enucleation. Primary enucleation was performed on 63 patients. Histopathological results confirming choroidal melanoma were analyzed in all 79 cases.

RESULTS AND DISCUSSION

The 5-year melanoma-specific cumulative survival rate in the group of eye-preserving surgery was 0.8146, while in the group of primary enucleation it reached 0.8951. The 8-year rate was 0.6921 and 0.7558 correspondingly. However, according to Gehan-Wilcoxon test, the differences were statistically insignificant (p = 0.11). The five-year survival of large choroidal melanoma patients who underwent eye-preserving surgery and no enucleation was 0.7708, 9-year - 0.6175.

CONCLUSION

Since the five-year melanoma-specific survival rate after primary enucleation is higher than that after eye-preserving surgery and secondary enucleation (though the difference is statistically insignificant), treatment options for large choroidal melanomas have to be chosen individually, taking into account the age and attitude of the patient as well as the size of the tumor.

Clinical observation of local resection or enucleation for uveal melanoma

BACKGROUND

Local resection is an effective method for treating the uveal melanoma. The aim of this study is to evaluate the survival and clinical outcomes of patients with uveal melanoma treated by local resection or enucleation.

METHODS

Totally, 167 consecutive patients with uveal melanoma were recruited for the study, of whom 57 patients were treated with local resection and 110 patients were treated with enucleation. The main outcome was measured by the visual acuity, local recurrence, eye retention, metastases, and melanoma-related mortality.

RESULTS

There were statistically significant differences in the largest basal diameter of the tumor (t = -3.441), the tumor thickness (t = -4.140), the ciliary body infiltration (χ(2) = 8.391), and the duration of follow-up (Z = 3.995) between the two groups (P < 0.05). The univariate survival analysis showed that the method of treatment was not significantly associated with metastases. The Cox proportion hazard analysis showed that the risk factors for metastasis involved the age at the time of diagnosis (RR = 1.752, 95% CI 1.066-2.880, P = 0.027), the largest basal diameter of the tumor (RR = 3.508, 95% CI 1.934-6.336, P = 0.000), and the histological type (RR = 2.444, 95% CI 1.106-5.877, P = 0.046). The 5-year metastases rate was 18.60% for the group with local resection and 27.81% for enucleation (χ(2) = 1.214, P > 0.05); the 5-year melanoma-related mortality was 16.27% for the group with local resection and 25.33% for enucleation (χ(2) = 1.304, P > 0.05). The 5-year local tumor recurrence rate was 29.50% and the 5-year accumulated eye retention rate was 69.00% after local resection. The visual acuity which light perception or better of 60 months after local resection was observed in 25 (92.60%) among persons retaining eye.

CONCLUSIONS

The survival outcomes of the patients with local resection were not worse than that of the patients with enucleation, and local resection could make the patient retain eye and partial visual functions. Hence, local resection may be an effective method for patients with uveal melanoma eligible for operation.

[Implants in ophthalmology and potential of visual control]

Results of complex ultrasonic examination in different time after socket reconstruction using biomaterial "Alloplant" are presented. Modified technique of primary socket reconstruction showed good cosmetic result.

[Using the superficial temporal fascia flap in orbital surgery]

The superficial temporal fascia flap gives a fine malleable well vascularized tissue and can be used as a pedicled or a free flap to cover large areas of loss of substance. Its dissection needs a period of training. Its use in orbital surgery is rare. However when it is about an anophthalmic socket following radiotherapy with orbital retraction syndrome, it provides tissue of good quality. This could allow later reconstruction by mucous grafts. When used on cavities of exenteration it allows fast re-epithelialisation even post-radiotherapy, while allowing the monitoring of the cavity and in particular the early detection of any tumor recurrence. Its use is advantageous in unfavorable conditions especially after radiotherapy.

Creb is modulated in the mouse superior colliculus in developmental and experimentally-induced models of plasticity

In the central nervous system long-term plastic processes need the activation of specific gene expression programs and the synthesis of new protein in order to occur. A transcription factor fundamental for several plasticity mechanisms in various CNS areas is the cAMP response element-binding protein, CREB. This factor is activated through phosphorylation at its Serine 133 residue by multiple signaling pathways. Little is known about CREB role in the superior colliculus, a midbrain area considered an experimentally useful model for the study of neuronal plasticity processes. In the present work we studied by Western blot analysis the modulation of CREB expression and activation in the mouse superior colliculus in three models of neuronal plasticity: (1) developmental plasticity; (2) lesion-induced plasticity; (3) and fluoxetine-induced restored plasticity. We used an antibody that detects endogenous level of the total CREB protein (anti-TCREB) to identify possible modulations at CREB expression level, and a second antibody (anti-PCREB) that detects endogenous level of CREB only when it is phosphorylated at Ser133, to identify modifications of CREB activation state. The results showed that: (1) the expression and activation of CREB increase during the development of the superior colliculus in temporal correlation with the plastic process of refinement of retino-collicular projections; (2) the activation of CREB is induced by a monocular lesion performed during the critical period for plasticity in young animals but not when performed in less plastic juvenile mice; (3) the expression and activation of CREB increase in adult animals treated with fluoxetine, known to restore high levels of plasticity in adult animals. These results suggest that CREB transcription factor plays a fundamental role in plasticity processes also at the level of the mouse superior colliculus.

[Morphogenesis of complications after long-term intraocular silicon oil filling (clinical histopathological study)]

The question of necessity and time of silicon oil (SO) removal after tamponade for traumatic retinal detachment (TRD) is still controversial. So the study of changes in the eye filled with SO for a long time is of great interest. Histopathologic analysis of 9 enucleated eyes filled with SO for TRD during long-time period (from 6 months till 30 years) was performed. The characteristic change was inflammatory reaction with fibrin membranes surrounding silicon drops and development of proliferative vitreoretinopathy and tractional retinal detachment in the following. In 2 cases the inflammatory process around SO was associated with bone formation. The most severe complication was the imbibition of retina with SO in a vacuole-like manner associated with total atrophy of neural structures. Obtained data show that time for SO removal should be less than 6 months after surgery.

[Retrospective analysis of causes of enucleations after anti-glaucomatous surgery]

Proximate causes of intraocular pressure (IOP) decompensation accompanied with persistent pain syndrome were determined based on results of morphological examination of 59 eyes enucleated due to terminal previously operated glaucoma and medical history analysis. Excessive scarring, formation of solid hyalinized membrane in the site of filter pad, closure of anterior chamber angle with synechia as an outcome of chronic iridocyclitis and inappropriate surgical approach lead to increase in the resistance of the aqueous humor outflow and result in glaucoma decompensation causing complications that necessitate enucleation. The most common complications are the following: bacterial corneal ulcer with potential perforation and endophthalmitis, hemorrhagic choroidal detachment, vitreous hemorrhage, persistent pain syndrome and phthisis bulbi.

[Ligation of the retrobulbar vascular-nervous bunch during performance of evisceration and enucleation using titanic clips in ophthalmic surgery]

The efficacy of hemostasis achievement during conduction of a retrobulbar vascular-nervous bunch ligation (RVNBL), using titanic clips while evisceroenucleation performance, was studied up. A comparative analysis of clinical and functional results of surgical treatment of 36 patients, suffering terminal dolorous glaucoma and disaster of a sympathetic ophthalmia complication after an eye penetrating wounding occurrence. In 16 patients (the first group) a standard method of a hemostasis achievement was used while doing evisceroenucleation - a deep orbital tamponade for 5 minutes. In 20 patients (the second group) a procedure of RVNBL was conducted, using titanic clips before the bunch transsection doing. There was established, that while doing a RVNPL using titanic clips, a hemorrhage never occurs, a retrobulbar hematoma do not formated, the soft tissues reaction in the early postoperative period is less pronounced, and the patients postoperative rehabilitation period shortens.

Snare Technique for Enucleation of Eyes With Advanced Retinoblastoma

Retrospective analysis of surgical outcomes for enucleation in pediatric retinoblastoma stage 5B using the snare wire loop (n = 55) and standard curved enucleation scissors (n = 22) revealed that a statistically significant longer mean optic nerve length was obtained with the snare (13.35 mm) compared with scissors (11.05 mm; P = .005). Four scissor cases had prolonged bleeding and required thrombin (18.2%), but no snare cases had difficulty with hemostasis (P = .005). More crush artifact was seen with the snare than with scissors (P<.001), but this did not affect the ability to determine tumor involvement at the surgical margin. The enucleation snare should be considered a valuable surgical instrument in the small pediatric orbit since obtaining the longest optic nerve segment has prognostic implications in retinoblastoma.

[Choroidal melanoma stage T2 higher than 6.0 mm: organ-preserving treatment with brachytherapy and transpupillary thermotherapy vs enucleation? Survival analysis]

The aim of the study was to compare survival rates of patients with stage T2 choroidal melanoma (CM) with prominence more than 6.0 mm after eye-preserving treatment using Ru-106 brachytherapy (BT) combined with transpupillary thermotherapy (TTT) and after primary enucleation. The main group included patients treated with BT alone or combined with simultaneous TTT. Patients with CM after primary enucleation served as control. The groups were standardized in terms of age (p = 0.063), mean prominence (p > 0.149), mean maximal base diameter (p > 0.85), number of unfavorable localized tumors (juxtapapillary and ciliochoroidal) (p = 0.246), follow-up duration (p > 0.23). Kaplan-Meier analysis showed 5 year level of metastasing after eye-preserving treatment as high as 16%, after enucleation--13% (p > 0.96). Eye-preserving treatment using BT combined with TTT in patients with CM with prominence less than 10.0 mm (T2N0M0) allows to preserve eye as an organ and to save some degree of useful visual acuity. This treatment strategy can be considered an appropriate option.

[Rationale for implant insertion after enucleation of eyes with uveal melanoma]

Results of retrospective analysis of medical charts of 328 patients after enucleation due to uveal melanoma (UM) are represented. Our study showed that recurrent tumor occurs in 2.44% cases. The main reasons of recurrence are scleral invasion or tumor damage during surgery. After enucleation due to juxtapapillary UM recurrence is rare and occurs after long-term follow-up. Thus after enucleation due to UM implant insertion is possible in case of scleral integrity and absence of macroscopically apparent tumor extension beyond sclera.

The eye amputated - consequences of eye amputation with emphasis on clinical aspects, phantom eye syndrome and quality of life

In this thesis the term eye amputation (EA) covers the removing of an eye by: evisceration, enucleation and exenteration. Amputation of an eye is most frequently the end-stage in a complicated disease, or the primary treatment in trauma and neoplasm. In 2010 the literature is extensive due to knowledge about types of surgery, implants and surgical technique. However, not much is known about the time past surgery.

THE PURPOSE OF THE PHD THESIS WAS

To identify the number of EA, the causative diagnosis and the indication for surgical removal of the eye, the chosen surgical technique and to evaluate a possible change in surgical technique in Denmark from 1996 until 2003 (paper I); To describe the phantom eye syndrome and its prevalence of visual hallucinations, phantom pain and phantom sensations (paper II); To characterise the quality of phantom eye pain, including its intensity and frequency among EA patients. We attempted to identify patients with increased risk of developing pain after EA and investigated if preoperative pain is a risk factor for a later development of phantom pain (paper III); In addition we wanted to investigate the health related quality of life, perceived stress, self rated health, job separation due to illness or disability and socio-economic position of the EA in comparison with the general Danish population (paper IV).

THE STUDIES WERE BASED ON

Records on 431 EA patients, clinical ophthalmological examination and an interview study of 173 EA patients and a questionnaire answered by 120 EA patients.

CONCLUSIONS

The most frequent indications for EA in Denmark were painful blind eye (37%) and neoplasm (34%). During the study period 1996-2003, the annual number of eye amputations was stable, but an increase in bulbar eviscerations was noticed. Orbital implants were used with an increasing tendency until 2003. The Phantom eye syndrome is frequent among EA patients. Visual hallucinations were described by 42% of the patients. The content were mainly elementary visual hallucinations, with white or colored light as a continuous sharp light or as moving dots. The most frequent triggers were darkness, closing of the eyes, fatigue and psychological stress. Fifty-four percent of the patients had visual hallucinations more than once a week. Ten patients were so visually disturbed that it interfered with their daily life. Approximately 23% of all EA experience phantom pain for several years after the surgery. Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n=19); (ii) radiating, zapping or shooting (n=8); (iii) superficial burning or stinging (n=5); or a mixture of these different pain qualities (n=7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 [range: 1-89]. One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress/fatigue were the most commonly reported triggers for pain. Factors associated with phantom pain were: ophthalmic pain before EA, the presence of implant and a patient reported high degree of conjunctival secretion. A common reason for EA is the presence of a painful blind eye. However, one third of these patients continue to have pain after the EA. Phantom sensations were present in 2% of the patients. The impact of an eye amputation is considerable. EA patients have poorer health related quality of life, poorer self-rated health and more perceived stress than does the general population. The largest differences in health related quality of life between the EA patients and the general population were related to role limitations due to emotional problems and mental health. Patients with the indication painful blind eye are having lower scores in all aspects of health related quality of life and perceived stress than patients with the indication neoplasm and trauma. The percentage of eye amputated which is divorced or separated was twice as high as in the general population. Furthermore, 25% retired or changed to part-time jobs due to eye disease and 39.5% stopped participating in leisure activities due to their EAs.

Modified enucleation for choroidal melanoma with large extrascleral extension

PURPOSE

To report the technique and the outcome of modified (enlarged) enucleation via lateral orbitotomy for choroidal melanomas with massive extrascleral extension.

METHODS

5 patients with choroidal malanoma with massive, circumscribed perioptic/posterior extrascleral extension underwent modified enucleation via lateral orbitotomy. After lateral orbitotomy and orbital mass exposure with direct tumor visualization, a long optic nerve stump was cut and the orbital component of the tumor was completely (macroscopically) removed along with the globe in all cases. After haemostasis and orbital reconstruction an orbital implant was then placed. Follow-up was longer than 12 months.

RESULTS

Excellent cosmetic outcome was acheived in all patients (100%) without operative or postoperative complications. At pathologic examination, tumors were completely removed in all cases (100%).

CONCLUSIONS

Modified (enlarged) enucleation via lateral orbitotomy for selectd choroidal melanomas with massive, circumscribed perioptic/posterior extrascleral extension allows complete tumor removal and placement of an orbital implant, avoiding the long healing process of orbital exenteration with excellent clinical and cosmetic outcome.

[Enucleation in patients with intraocular melanomas]

This paper analyzes the data available in the literature on the incidence of uveal melanomas. It historically describes enucleation and the specific features of its performance in patients with and without uveal melanoma. The specific features of enucleation in patients with uveal melanoma, indications for locomotor stump formation, and procedures for calculating the parameters of an implant are considered. Analysis of the data available in the literature shows that there is presently no unambiguous opinion as to the most rational enucleation modes and as to the capacities and types of used implants as a whole. This primarily applies to enucleation used in patients with intraocular neoplasms.

Iridociliary melanoma associated with ocular melanocytosis in a 6-year-old boy

A previously healthy 6-year-old boy presented to the ophthalmologist and was found to have congenital ocular melanocytosis associated with uveal melanoma. He was treated with enucleation of the affected eye and has shown no evidence of tumor recurrence or metastasis through over 20 years of postenucleation follow-up. Ocular melanocytosis can be associated with uveal melanoma even in young children.

Surgical implications of the superior oblique frenulum

BACKGROUND

The superior oblique frenulum is a fascial membrane that prevents substantial separation of the superior rectus muscle and SO tendon.

METHODS

In three patients, the superior rectus muscle was disinserted and temporarily suspended 6, 8, 10, 12, and 14 mm in random order from its insertion. The change in position of the anterior edge of the superior oblique tendon from the superior rectus muscle insertion was measured before and after severing the frenulum structure. In four other patients undergoing superior oblique recession, the superior oblique tendon was disinserted at its insertion temporally. The amount of recession that spontaneously occurred was measured before and after severing the frenulum.

RESULTS

In the first group, there was essentially a one-to-one correlation between the posterior movement of the superior oblique tendon and the amount of superior rectus recession for recessions up to 10 mm. After severing the frenulum, the anterior portion of the superior oblique tendon was positioned less posteriorly. It measured less than 1.2 mm for superior rectus recessions up to 14 mm. For the second group, the mean suspension distance of the cut end of the disinserted superior oblique tendon was 2.4 +/- 0.4 mm before stripping the frenulum as compared with 8.5 +/- 0.7 mm after stripping the frenulum (Student's t-test, p = 0.0011).

CONCLUSIONS

The frenulum pulls the superior oblique tendon posteriorly as the superior rectus muscle is recessed and constrains the superior oblique tendon after disinsertion. How this connection is handled at the time of surgery may have implications for superior rectus recessions and superior oblique tendon surgery.

Providing compassionate care to the pediatric patient undergoing enucleation of the eye

This article focuses on the care of the pediatric patient undergoing enucleation of the eye. It discusses the diagnoses related to the surgical procedure including blind, painful eye and retinoblastoma. It describes the nursing considerations such as impact on both patient and family, postoperative nursing care, emotional issues, teaching and follow-up required to best care for the patient undergoing this life-altering surgery.

[Uveal melanoma in patients with ocular or oculodermal melanocytosis]

PURPOSE

To describe patients with ocular or oculodermal melanocytosis and uveal melanoma.

MATERIAL AND METHODS

In Departament of Ophthalmology in Krakow 4 patients with ocular and 1 with oculodermal melanocytosis and uveal melanoma were diagnosed.

RESULTS

In 4 patients with ocular melanocytosis and 1 with oculodermal melanocytosis the uveal melanoma was recognized and treated. Brachytherapy was used in 3 person, transcleral tumour resection in one case and in one enucleation was performed. During follow-up in two patients metastases to the liver were found.

CONCLUSIONS

Patients with ocular and oculodermal melanocytosis should be regularly controled ophthalmoscopically for the occurrence of uveal melanoma.

Alteration of visual input results in a coordinated reorganization of multiple visual cortex maps

In the adult visual cortex, multiple feature maps exist and have characteristic spatial relationships with one another. The relationships can be reproduced by "dimension-reduction" computational models, suggesting that the principles of continuity and coverage may underlie cortical map organization. However, the mechanisms responsible for establishing these relationships are unknown. We explored whether removing one feature map during development causes a coordinated reorganization of the remaining maps or whether the remaining maps are unaffected. We removed the ocular dominance map by monocular enucleation in newborn ferrets, so that single eye stimulation drove the cortex in a more spatially uniform manner in adult monocular animals compared with normal animals. Maps of orientation, spatial frequency, and retinotopy formed in monocular ferrets, but their structures and spatial relationships differed from those in normal ferrets. The wavelength of the orientation map increased, so that the average orientation gradient across the cortex decreased. The decrease in the orientation gradient in monocular animals was most prominent in the high gradient regions of the spatial frequency map, indicating a coordinated reorganization between these two maps. In monocular animals, the orthogonal relationship between the orientation and spatial frequency maps was preserved, and the orthogonal relationship between the orientation and retinotopic maps became more pronounced. These results were consistent with detailed predictions of a dimension-reduction model of cortical organization. Thus, the number of feature maps in a cortical area influences the relationships between them, and inputs to the cortex have a significant role in generating these relationships.

Diagnosis and management of retinoblastoma

BACKGROUND

Retinoblastoma is a highly malignant tumor of the eye that manifests most often in the first 3 years of life.

METHODS

Published articles were reviewed to evaluate the clinical features and current methods of diagnosis and to assess the trends in management.

RESULTS

This malignancy leads to metastatic disease and death in 50% of children worldwide but in less than 5% of children in the United States and other developed nations with advanced medical care. Over the past decade, there has been a trend away from enucleation and external beam radiotherapy and toward chemoreduction followed by focal therapies. This is largely due to more effective chemotherapeutic regimens, improved focal treatment modalities, and the desire to avoid loss of the globe and/or exposure to radiotherapy. Chemoreduction and focal therapies are most successful for eyes with minimal to moderate retinoblastoma, with enucleation needed in less than 15% of cases. Eyes with very advanced retinoblastoma require enucleation in approximately 50% of cases.

CONCLUSIONS

Progress in the clinical recognition and management of retinoblastoma has led to high survival rates. Improved methods of treatment using chemoreduction and focal treatments without the need for external beam radiotherapy allow preservation of the eye in some cases, often with visual function.

[Echographic determination of the extent of intraocular tumors]

The capacities of current ultrasound technologies in determining the extent of intraocular tumors were clinically studied. The proposed algorithm of ultrasound study of intraocular tumors allows for not only making the exact measurements of a neoplasm, but also for determining the three-dimensional configuration of an object within the eye.

Clinicopathologic correlations in eyes enucleated after uveal melanoma resection with positive surgical margins

We identified three eyes that had undergone enucleation after transscleral resection of uveal melanoma. Two enucleated eyes with microscopically positive margins of resection exhibited no evidence of residual melanoma and these patients were alive without metastasis with at least four years′ follow-up. One eye with a transected melanoma contained residual melanoma and that patient died with metastatic melanoma to the liver three years after enucleation. There appear to be at least two general types of positive surgical margins of resection of uveal melanoma: microscopically positive margins and macroscopically positive (transected) margins of resection.

Posterior uveal melanoma treated with I-125 brachytherapy or primary enucleation

PURPOSE

To study the incidence, clinical findings, and tumour characteristics of posterior uveal melanoma in Western Norway, and to report the results of a consistent treatment strategy (I-125 brachytherapy or primary enucleation) over a 13-year period.

METHODS

The clinical records of all patients with posterior uveal melanoma referred between January 1993 and December 2005 were reviewed. Clinical data, radiation parameters, visual outcome, and mortality were analysed in a dedicated database.

RESULTS

The study included 111 consecutive patients. The annual age-adjusted incidence (per million population) of posterior uveal melanoma was 8.5 for women and 8.9 for men. Fifty-six patients underwent I-125 brachytherapy, 52 were enucleated, and three received no treatment. The median follow-up time was 36 months (mean, 52 months; range, 2 months to 13 years). In the brachytherapy group, two eyes were enucleated owing to tumour recurrence and two because of neovascular glaucoma. A visual acuity of 0.1 or better, present in 87% of the patients before brachytherapy, was retained in 40% after a median follow-up of 61 months. After brachytherapy, the 5- and 10-year melanoma-specific mortality rates were 13.4 and 23.8%, respectively. The corresponding mortality rates for patients treated with primary enucleation were 49.5 and 49.5%.

CONCLUSION

After brachytherapy, many patients lost useful vision due to radiation-induced complications. The probability of retaining the eye was high and only two patients experienced recurrent tumour growth. The mortality rates compare well with published series, and the differences in tumour size explain the difference in mortality between the two treatment groups.

A modified in vitro method for aqueous humor outflow studies in enucleated porcine eyes

The aim of this study was to develop and test a short-term in vitro method for aqueous humour outflow studies using enucleated porcine eyes. The method used was a modification of two methods that have previously been used: whole eyes and anterior segment cultures. The advantage of the model used in this study was that the anterior part of the eye, including the anterior and posterior chambers, remained intact as in whole enucleated eyes, but neither iridotomia nor trephination through the cornea was needed. The deepening of the anterior chamber during perfusion was avoided by regulating the "vitreal" pressure. Test compounds were administered topically or intracamerally to an anatomically normal anterior chamber. Fresh porcine eyes (n = 48) were sectioned at the equator, and the vitreous mass was carefully removed. This anterior bisection was bound around a specific plastic chamber, thus creating a closed eye. The anterior chamber was perfused at a pressure of 15 mmHg. The mean outflow rate in the nonmedicated eye group was 3.7 +/- 0.20 microL/min (mean +/- standard error of the mean), and it increased by 18% during 9 h owing to a wash-out effect. Compounds known to enhance the aqueous outflow were used for testing the validity of the preparation.

Contactin1a expression is associated with oligodendrocyte differentiation and axonal regeneration in the central nervous system of zebrafish

Contactin1a (Cntn1a) is a zebrafish homolog of contactin1 (F3/F11/contactin) in mammals, an immunoglobulin superfamily recognition molecule of neurons and oligodendrocytes. We describe conspicuous Cntn1a mRNA expression in oligodendrocytes in the developing optic pathway of zebrafish. In adults, this expression is only retained in glial cells in the intraretinal optic fiber layer, which contains 'loose' myelin. After optic nerve lesion, oligodendrocytes re-express Cntn1a mRNA independently of the presence of regenerating axons and retinal ganglion cells upregulate Cntn1a expression to levels that are significantly higher than those during development. After spinal cord lesion, expression of Cntn1a mRNA is similarly increased in axotomized brainstem neurons and white matter glial cells in the spinal cord. In addition, reduced mRNA expression in the trigeminal/anterior lateral line ganglion in erbb3-deficient mutant larvae implies Cntn1a in Schwann cell differentiation. These complex regulation patterns suggest roles for Cntn1a in myelinating cells and neurons particularly in successful CNS regeneration.