Hideya Kimura

Post-traumatic proliferative vitreoretinopathy. The epidemiologic profile, onset, risk factors, and visual outcome

PURPOSEnThe purpose of the study was to characterize the clinical development of proliferative vitreoretinopathy (PVR) after trauma in the human eye.nnnMETHODSnA chart review was performed on the records of 1564 patients with ocular trauma seen at a large metropolitan hospital. The frequency, type of ocular trauma, time to onset, potential risk factors, and visual outcome for PVR were evaluated.nnnRESULTSnProliferative vitreoretinopathy occurred in 71 (4%) of 1654 injured eyes. Of these 71 injured eyes, 30 (42%) resulted from rupture, 15 (21%) from penetration, 13 (18%) from perforation, and 7 (10%) from confusion. Six (9%) were associated with an intraocular foreign body (IOFB). The frequency of PVR following perforation, rupture, penetration, IOFB, and contusion was 43%, 21%, 15%, 11%, and 1%, respectively. Overall, those eyes that developed PVR had a poorer visual outcome, with PVR being the primary reason for visual loss. The time from injury to onset of PVR was shortest after perforation (median, 1.3 months), followed by rupture (2.1 months), IOFB (3.1 months), penetration (3.2 months), and contusion (5.7 months). Vitreous hemorrhage was the strongest independent predictive factor for the development of PVR. A long, posteriorly located wound and persistent intraocular inflammation were also important risk factors for PVR.nnnCONCLUSIONSnThese results suggest that PVR is a common complication following a variety of ocular injuries, and that it is associated with a poor visual outcome. Its frequency, onset, and outcome are strongly dependent on the nature of the trauma. Specific high-risk groups are identified as candidates for more aggressive therapy.

Natural history of choroidal neovascularization induced by vascular endothelial growth factor in the primate.

Abstractu2002Background: A new model of choroidal neovascularization (CNV) has been developed in the primate by implanting vascular endothelial growth factor (VEGF)-impregnated microspheres in the subretinal space. Methods: CNV was induced in Macaca mulatta monkeys by implanting VEGF-impregnated gelatin microspheres in the subretinal space. Progression of CNV was followed for 24 weeks after surgery using fluorescein angiography. Eyes were enucleated at various time points, and lesions were evaluated for evidence of CNV by light microscopy and by immunohistochemical staining. Results: CNV developed in 12 (92%) of 13 eyes. Fluorescein leakage was first observed in the 2nd postoperative week and was apparent for the following 12 weeks. CD31 staining for endothelial cells was first observed at day 7 and was evident for the following 8 weeks. Glial fibrillary acidic protein staining revealed a glial adhesion between the proliferative membrane and the retina at 6 weeks after implantation. Smooth muscle actin-positive cells were found a + 2 weeks and remained prominent for at least the next 6 weeks. Cytokeratin-positive retinal pigment epithelial (RPE) cells, first identified in the proliferative membrane at day 3, predominated throughout the growth of the membrane. Macrophages (RAM-II positive) were present at day 3 but were no longer observed after day 7. Conclusion: In monkeys, subretinal implantation of VEGF-impregnated gelatin microspheres leads to the development of CNV. Early, disciform and reparative stages of CNV were observed, similar to those seen in humans. This model will be useful for studying the pathogenesis of CNV and for evaluating potential treatment strategies.

Hypericin inhibits cell growth and induces apoptosis in retinal pigment epithelial cells: possible involvement of protein kinase C

Proliferative vitreoretinopathy (PVR) is characterized by the proliferation and migration of retinal pigment epithelial (RPE) cells in the vitreous cavity. The drug hypericin, which is already in clinical use as an antidepressant, has shown promise as an antiviral and antineoplastic agent. To investigate the therapeutic potential of hypericin in PVR, we incubated RPE cells in standard medium with various serum concentrations containing 0.5 to 5 microM hypericin. In some experiments we studied the effects of hypericin in conjunction with the RPE growth stimulating cytokine tumor necrosis factor alpha (TNF-alpha). Dose-dependent inhibition of RPE cell proliferation with IC50 values of 0.7 microM and 3.3 microM in 1% and 5% serum respectively, was found. Even in conjunction with TNF-alpha, hypericin inhibited RPE proliferation with an IC50 value of 1.5 microM. The drug inhibited PKC activity in cells treated with a 2.5 microM dose by 72% after 30 min and by 100% after 180 min. Finally, hypericin induced RPE cells to undergo apoptotic cell death, as shown by the presence of DNA laddering. These results suggest that hypericin may have potential as a therapeutic drug for PVR and that its antiproliferative and apoptotic effects on RPE cells in vitro are in part mediated by PKC.

Inhibition of Experimental Proliferative Vitreoretinopathy in Rabbits by Suramin

Proliferative vitreoretinopathy (PVR) is the most common cause for failure of retinal reattachment surgery. In a search for better pharmacologic treatment of PVR, we investigated the effect of intravenous injections of suramin on an experimental rabbit model of PVR. PVR was induced in rabbits by intravitreal injection of autologous fibroblasts. The experimental group (7 eyes) received intravenous injections of suramin (100 mg/kg body weight) every 3 days for 15 days, beginning 3 days before fibroblast injection. The control group (5 eyes) was treated similarly but received intravenous saline solution in place of suramin. A third group (4 eyes) received suramin according to the protocol above but did not receive intravitreal fibroblasts. The animals were examined by indirect ophthalmoscopy every 3 days and were sacrificed 14 days after the injection of fibroblasts. The serum levels of suramin were evaluated by high-performance liquid chromatography. The PVR was classified as stages I-V, based upon clinical findings. PVR developed in both experimental and control animals but was less severe in those treated with suramin. On day 14, the average stage of PVR in the control group was 3.8; in the suramin-treated group, however, the average stage was 2.4, which was significantly less than in the control group (p < 0.02). None of the rabbits in the third group showed pathologic changes. Serum levels of suramin were maintained at an average of 280.2 micrograms/ml and no apparent toxicity was found in the retina by histologic study.(ABSTRACT TRUNCATED AT 250 WORDS)