Hidehiko Yoshida

Long-Term Results of Retinal Detachment Surgery

Patients treated successfully with retinal detachment surgery 11-39 years earlier were called back and examined. The average age was 35 years at the time of surgery and the average interval between the operation and this follow-up examination was 16 years. The visual acuity had decreased in many patients. The most frequent causes of this fall in visual acuity after surgery were cataract and macular degeneration. Chorioretinal atrophy with blackish pigment spots developed in the reattached retina a long time after surgery and caused defects in the visual fields. This atrophy seems to be related to the long duration of retinal detachment before and after operation, which may cause malnutrition of the detached retina and result in incomplete recovery of visual cells, leading to chorioretinal atrophy. Macular degeneration was caused or accelerated by detachment of the macula. There was no difference in postoperative ocular findings between only diathermy and combination of diathermy with segmental scleral-buckling procedures. However, Arrugas ring suture method induced cataract more frequently than did other surgical procedures.

Subjective and Objective Ocular Disturbances in Reattached Retina after Surgery for Retinal Detachment, with Special Reference to Visual Acuity and Metamorphopsia

A questionnaire about postoperative complaints was given to patients after surgery for retinal detachment. Their visual acuity and visual field problems were analyzed. Only one third of all the patients felt postoperative improvement. Blurred vision and metamorphopsia after operation were complained of in one third of all the patients. Blurred vision was apt to be complained of in patients with macular detachment before operation. About 77% of patients with blurred vision had a visual acuity of less than 0.5. Metamorphopsia was frequently complained of in patients treated with the segmental buckling procedure.

Macular hole in diabetic maculopathy.

Three patients with diabetic maculopathy had macular holes. It is suggested that shrinkage or traction of the fibrous proliferation on the edematous and exudative macula led to the formation of these macular holes. Photocoagulation is recommended in patients with macular holes with progressive diabetic retinopathy and visual acuity of less than 0.1.

Vitreous seeds in retinoblastoma, clinical significance and ultrastructure.

Vitreous seeds in retinoblastoma were studied clinically and pathologically. Vitreous seeds were found in 36.6% of retinoblastoma eyes. When tumors involved more than three quadrants of the retina and vitreous seeds were present, the prognosis was poor. When the tumor involved less than one-quarter of the retina, vitreous seeds were rare. Vitreous seeds were found most frequently in cases of undifferentiated tumor cells and endophytum type of proliferation. Although most vitreous seeds were necrotic tumor cells, some were almost intact tumor cells which were apt to be situated along blood vessels. The blood vessels in vitreous seeds had no pericytes and were derived from the tumor itself. Thus it is possible that tumor cells in the vitreous body can migrate to the anterior segment of the eye. Some tumor cells in vitreous seeds had much cytoplasm which contained mitochondria, ribosomes, fibrils, centrioles, and cilia with a presumed photoreceptor outer segment and intercellular junctions. These cytoplasmic features are very similar to those of neuroepithelial-type retinoblastoma cells. Undifferentiated cells were necrotic. Calcium deposition was found mainly in the necrotic cytoplasm of the tumor cells and occasionally on the chromatin granules of the nucleus. This may provide evidence that calcium can be bound to DNA to form radiopaque masses. No calcium-producing cells were found. Vitreous seeds contain a small number of almost intact tumor cells which are neuroepithelial in type, but most cells are necrotic. Although tumor cells may migrate to the anterior segment of the eye along or through blood vessels, the presence of vitreous seeds in itself is not always a bad prognostic sign. The prognosis is probably more closely related to the extent of the invasion of a tumor associated with vitreous seeds. Glaskörper-Absiedlungen beim Retinoblastom wurden klinisch und histo-pathologisch untersucht. In 36,6% der Fälle wurden bei der klinischen Untersuchung Glaskörper-Absiedlungen in Retinoblastom-Augen gefunden. Wenn die Tumoren mehr als 3 Quadranten der Retina einnahmen und Glaskörper-Absiedlungen vorhanden waren, so war die Prognose schlecht. Wenn der Tumor mehr als 1 Quadranten der Retina befallen hatte, waren Glaskörper-Absiedlungen selten. Glaskörper-Absiedlungen wurden hauptsächlich in Fällen von undifferenzierten Tumorzellen und beim endophytischen Proliferationstyp gefunden. Obwohl die meisten Glaskörper-Absiedlungen nekrotische Tumorzellen waren, so bestanden doch einige aus fast völlig intakten Tumorzellen, die mit Bevorzugung entlang der Blutgefäße lagen. Die Blutgefäße in den Glaskörper-Absiedlungen hatten keine Pericyten und leiteten sich vom Tumor selbst her. Auf diese Weise ist es möglich, daß Tumorzellen im Glaskörperraum wandern können zum vorderen Augensegment. Einige Tumorzellen in Glaskörper-Absiedlungen hatten viel Cytoplasma, welches Mitochondrien, Ribosomen, Fibrillen, Centriolen und Cilien-ähnliche Fortsätze mit einem vermuteten Fotorezeptoraußensegment und intercellulären Verbindungen. Diese cytoplasmatischen Bilder sind sehr ähnlich den Retinoblastomzellen vom neuroepithelialen Typ. Undifferenzierte Zellen waren nekrotisch. Kalkniederschläge wurden vorwiegend im nekrotischen Cytoplasma gefunden und gelegentlich auf den Chromatinkörnern des Nukleolus. Sie mögen zu der Vermutung beitragen, daß Kalzium sich mit DNA verbinden kann, um Massen zu bilden, die im Röntgenbild einen Schatten geben. Zellen, die Kalzium produzieren, wurden nicht gefunden. Zusammenfassend wird festgestellt, daß Glaskörper-Absiedlungen eine kleine Zahl von fast intakten Tumorzellen enthalten, welche vom neuroepithelialen Typ sind; die meisten Zellen sind jedoch nekrotisch. Obwohl Tumorzellen zum vorderen Segment entlang oder mit den Blutzellen wandern können, so ist doch die Anwesenheit von Glaskörper-Absiedlungen selbst nicht immer ein schlechtes prognostisches Zeichen. Die Prognose ist wahrscheinlich eher abhängig von der Ausdehnung des Tumors, welcher von Glaskörper-Absiedlungen begleitet ist.

Ultrastructures of the normal surface of corneal epithelium of the heterozygous rhino mouse with special reference to so-called epithelial holes.

The surface structures of the corneal epithelium of the heterozygous rhino mouse were examined by transmission electron microscopy and scanning electron microscopy. The surface structures of the corneal epithelium were composed of microvilli, microplicae and epithelial holes. Microvilli and microplicae showed the same features as those described previously. However, some microvilli bent at the top or stalk and looked like microplicae by scanning electron microscopy. The structure of epithelial holes was different from that reported previously. Epithelial holes with elevated rim demonstrated by scanning electron microscopy were formed by a large fold or process of epithelial cells in the outermost layer. Microvilli were present on the process (margin) and floor of epithelial holes. Thus microvilli on the floor belong to the outermost layer, not to the second layer. Die Oberflächenstruktur des Cornea-Epithels der Heterozygoten Rhino-Maus wurde transmissionselektronenmikroskopisch und rasterelektronenmikroskopisch untersucht. Die Oberflächenstruktur des Corneaepithels war zusammengesetzt aus Mikrovilli, Mikroplicae und epithelialen Hohlräumen. Die Mikrovilli und Mikroplicae zeigten die gleichen Eigenarten, die schon bisher beschrieben wurden. Einige Mikrovilli, welche an der Spitze oder am Stamm verbogen waren, sahen aus wie Mikroplicae im Rasterelektronenmikroskop. Die Struktur der epithelialen Löcher unterschied sich von den bisher beschriebenen. Epitheliale Hohlraumbildungen mit erhabenem Rand im Rasterelektronenmikroskop stellten sich dar als große Falten oder Fortsätze der epithelialen Zellen in der äußersten Schicht. Mikrovilli fanden sich sowohl am Rande wie auch auf dem Boden der epithelialen Hohlräume. Trotzdem gehören Mikrovilli auf dem Grunde zu der äußersten Zellschicht und nicht zu der zweiten Zellschicht.

Binocular visual function after surgery for detached retina

Binocular visual function after surgery for detached retina was examined in 100 patients with a visual acuity of less than 0.3 in the reattached retina and with a visual acuity of more than 1.0 in the non-detached retina:1) There was no significant sex difference in binocular visual function.2) There was no significant difference in binocular visual function according to postoperative interval.3) Maintenance of postoperative binocular visual function was best in patients under 19 years of age, and grew worse with age.4) In patients with a visual acuity of more than 0.1 in the reattached retina, simultaneous perception was good in 100%, and fusion in more than 80%. However, stereopsis was worse in most cases.5) In patients with a visual acuity of less than 0.1 in the reattached retina, all aspects of binocular visual function were worse, except in those under 19 years of age.6) There was no significant difference in binocular visual function between patients with and without temporary amputation of extrinsic ocular muscles at operation.7) There was no significant difference in binocular visual function between patients with and without macular detachment before operation.8) In the patients who had had an encircling operation, binocular visual function was worse than in those operated on with other procedures, because the former had the severest retinal detachment.

Electron microscopic study of the orbital lesion of Hand-Schüller-Christian disease.

The orbital bone lesion of a patient with Hand-Schüller-Christian disease was examined by electron microscopy. Vacuoles in the cytoplasm of foam cells contained granules which were shown by histochemical examination to be cholesterin. Langerhans cell granules in the histiocytes of Hand-Schüller-Christian disease showed a close resemblance to those in Langerhans cell of the epidermis, eosinophilic granuloma and Letterer-Siwe disease. Charcot-Leyden crystals appeared to be formed in the lysosomes of histiocytes in Hand-Schüller-Christian disease. From histopathological and cytological points of view, eosinophilic granuloma, Hand-Schüller-Christian disease and Letterer-Siwe disease are classified as histiocytosis X. The simultaneous appearance of Langerhans cell granules and Charcot-Leyden crystals is specific in histiocytosis X.

Electron histochemical study on synthesis and breakdown of glycogen in the rabbit cornea

Glycogen synthetase and phosphorylase activity was studied in the rabbit cornea electron histochemically. Glycogen synthetase and phosphorylase were located in the cytoplasmic matrices of the corneal epithelium, but glycogen synthetase was found to be mainly in the superficial half of the epithelium, and phosphorylase mainly in the deep layer. Since the cells in the deep layer of the corneal epithelium contain rich cytoplasmic organelles which have carbohydrate metabolism from glycogen or glucose through the Embden-Meyerhof pathway to the TCA cycle, glycogen synthesized in the superficial half of the corneal epithelium by glycogen synthetase may be transferred to the deep layer of the epithelium and broken down by phosphorylase. Phosphorylase in the superficial half of the corneal epithelium may break down overproduced glycogen so as to avoid the deposition of a large number of glycogen particles for maintenance of corneal transparency.

Histological and scanning electron microscopic study of tissue invasion of Bangerter nylon implant after enucleation.

An incidentally extirpated Bangerter-type nylon implant was examined by light microscopy and scanning electron microscopy. Three months after implantation, the implant was densely filled with tissues, which were shown by light microscopy to be muscle cells in the margin of the implant; the muscle cells were fixed there at the time of implantation, and fibrocytic cells were inside the implant.Scanning electron microscopy showed interlacing fibrous cells with erythrocytes and leukocytes among the nylon fibers, lamellar accumulation of fibrous cells around nylon fibers, and a smooth surface of the margin of the nylon implant. This invasion of fibrous cells into the nylon implant is one reason why the Bangerter type of nylon implant rarely falls out of the orbital socket.

Electron Histochemical Study of Glycogen Synthetase in the Rabbit Cornea

Glycogen synthetase activity in the rabbit cornea was studied electron histochemically with an enzyme synthetic method using glycogen synthetase. Polyglucose particles synthesized from uridine diphosp