David E. Eifrig

Idiopathic retinal vasculitis, aneurysms, and neuro-retinitis

Purpose: The authors describe the clinical feature of ten patients with a new syndrome characterized by the presence of retinal vasculitis, multiple macroaneurysms, neuro-retinitis, and peripheral capillary nonperfusion. Methods: The authors evaluated ten patients identified to have clinical features compatible with the syndrome of idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN). Clinical examination findings, sequential fundus photographs (when available), fluorescein angiograms, systemic investigations, response to therapy, and visual outcomes were reviewed. Results: Seven eyes of four patients sustained a marked decrease in visual acuity of 20/200 or worse. Visual loss was due to a combination of an exudative maculopathy and sequelae of retinal ischemia. Capillary nonperfusion was seen in all ten patients and was severe enough to warrant panretinal laser photocoagulation in six patients. Systemic investigations were uniformly noncontributory. Oral prednisone appears to have little beneficial effects on patients with this disorder. Conclusions: Patients with IRVAN have characteristic retinal features that readily identify this syndrome. An increased awareness of this rare syndrome may help to identify sight-threatening complications at an earlier stage. The authors caution against extensive medical investigations. Ophthalmology 1995;102:1089-1097

Capsulorhexis-related lacteocrumenasia

Abstract Three patients who presented with a milky fluid in the space between the posterior surface of an implanted intraocular lens (IOL) and the anterior surface of the distended posterior capsular bag are described. The patients were followed and were noted to have changes in their benign course after several years. The occurrence of this milky‐fluid‐filled capsular bag is extremely uncommon and is difficult to perceive if the observer is not looking for it.

Morphology of pseudophakic precipitates on intraocular lenses removed from human patients

Cellular precipitates on the surface of 52 intraocular lenses removed from human patients for various reasons from one week to five years following implantation were studied with cytologic techniques and scanning electron microscopy. A variety of cellular responses were characterized: mononuclear precipitates composed of lymphocytes and macrophages, multinucleated giant cells, and a fibroblastic proliferation. Polymorphonuclear leukocytes were encountered less frequently. Acellular membranous precipitates were also observed. Cellular response was related to clinical history to correlate temporal and possible etiopathogenic factors in the formulation of these precipitates and their possible relationship to implant failure.

The inflammatory response to secondary methylmethacrylate challenge in lens-implanted rabbits

Polymethylmethacrylate intraocular-lens-implanted rabbits were challenged with subcutaneous polymeric or monomeric methylmethacrylate. The inflammatory response to this secondary challenge was compared to that at the site of sham procedures and to that in control rabbits never exposed to methylmethacrylate. There was a definite granulomatous inflammatory response to both polymeric and monomeric methylmethacrylate. There was, however, no secondary enhancement of this inflammatory response at the site of subcutaneous challenge or exacerbation of intraocular inflammation in lens-implanted rabbits, thus substantiating the nonimmunogenicity of methylmethacrylate.

Two Principles for Repositioning Intraocular Lenses

Les auteurs decrivent 3 cas de cristallins artificiels luxes ou subluxes, qui furent repositionnes avec succes «dans le sulcus»

Effects of Monomeric Methylmethacrylate on Ocular Tissues

Toxic effects of high doses of monomeric methylmethacrylate were demonstrated in rabbit eyes. These effects were not related to surgical manipulation. Monomeric methylmethacrylate caused limbal hyperemia, corneal edema, corneal neovascularization, iris engorgement, anterior chamber inflammation, iris atrophy, and cataract. The doses of monomeric methylmethacrylate needed to produce these lesions were much higher than the amount of monomer available for leaching out of implanted intraocular lenses.

Fibronectin as a component of pseudophakic acellular membranes

ABSTRACT Avidin‐biotin immunohistochemical staining for fibronectin was used to study 17 aphahic intraocular lens implanted globes and 12 explanted intraocular lenses. Fibronectin was identified as a component of acellular pseudophakic membranes and was also observed within lens epithelial cells and macrophages.

Experimental evaluation of a phakic anterior chamber implant in a primate model Part I. Clinical observations

ABSTRACT Anterior chamber intraocular lenses were implanted in phakic eynomolgus monkey eyes and followed clinically over two years. Significant observations included erosion and/or uveal envelopment of the haptic and a decrease in endothelial cell counts. There was good positional stability, no significant inflammation, initial ocular hypotension that returned to normal intraocular pressure, and no evidence of cataracts or cystoid macular edema.

Experimental evaluation of a phakic anterior chamber implant in a primate model Part II. Pathology

ABSTRACT Anterior chamber intraocular lenses were implanted in 50 phakic primate eves and followed by serial histopathology for two years. Significant observations included corneal endothelial alterations, haptic erosion into and encapsulation by peripheral iris and ciliary body, and chronic low grade inflammation.

Intraocular Response to Cotton, Collagen and Cellulose in the Rabbit

Cotton, cellulose and collagen were each implanted into the anterior chamber and anterior vitreous of rabbit eyes. The ocular inflammatory response was studied clinically over a 28-day period and histologically at seven and 28 days. In general, cotton was the least reactive, with collagen and cellulose moderately reactive. Cellulose was associated with progressive inflammation and marked granulomatous response. Vitreous implants showed minimal inflammation, with virtually no response to cotton. These findings support current literature suggesting that the use of cellulose in ophthalmic surgery may increase the risk of postoperative granulomatous inflammation.