Lee M. Jampol

Cyclic-AMP in the aqueous humor: The effects of adrenergic agents

Adrenergic agents, which reduced intraocular pressure when applied topically to the rabbit eye, increased the cyclic-AMP concentration in the aqueous humor. The order of potency for both reducing intraocular pressure and increasing cyclic-AMP was: epinephrine > norepinephrine > isoproterenol. Intravenous phenoxybenzamine partially blocked the decrease in intraocular pressure and the increase in cyclic-AMP. Intravenous propranolol was ineffective. Topically applied aminophylline, theophylline, and dibutyryl cyclic-AMP were also ineffective. n nThe time course for the epinephrine induced mydriasis was different from the time course for the decrease in intraocular pressure and the increase in cyclic-AMP. The pupil dilated rapidly and then slowly returned to baseline values over the next 4 hr. The intraocular pressure and cyclic-AMP responses peaked at approximately the same time (1·5 hr) and were sustained for at least 5 hr. n nSubstantial tissue levels of cyclic-AMP were found in the cornea, iris-ciliary body and retina-choroid. However, no differences in tissue level could be demonstrated in the control versus epinephrine-treated eye. Thus the site of production of the increased cyclic-AMP in the aqueous humor is not yet resolved. n nIntracameral injection of high concentrations of cyclic-AMP (estimated final concentration in anterior chamber: 4 × 10−4m) caused a marked decrease in intraocular pressure. Similar injections of 5′AMP into the other eye of the same animal were ineffective. n nThe experiments indicate that cyclic-AMP plays a central role in mediating the action of catecholamines on aqueous humor dynamics. The role of the increase in the aqueous humor and possible sites of production and action of the cyclic-AMP are discussed.

Leber's Congenital Amaurosis

An early stage of Lebers congenital amaurosis, characterized by white spots or lines in the fundus, occurred in two children. Light microscopic examination of eyes obtained from one child, a 16-month-old Japanese girl, revealed subretinal deposits corresponding to the white spots and lines in the fundus deposits. Light and electron microscopic examination of the eye showed distinctive changes in the outer retinal layers and choroid, while the inner retinal layers were nearly normal. Characteristic early lesions of congenital amaurosis appeared to be produced by deposits consisting of loose outer segments and apical processes of the pigmental epithelial cell and macrophages. Undifferentiation in the nuclei of the photoreceptor cell, the inner segment, the pigment epithelial cell, and the choriocapillaris were likely characteristics of the early changes of congenital amaurosis.

Ocular clinical findings and basement membrane changes in Goodpasture's syndrome.

Goodpastures syndrome is a rapidly progressive disease characterized by the onset of pulmonary hemorrhage with glomerulonephritis, leading to pulmonary and renal failure. The hallmark of this disease is linear deposition of antibasement membrane IgG in the basement membranes of the kidney and lung. In two cases of nonrhegmatogenous retinal detachment in patients with Goodpastures syndrome, the first patient demonstrated multiple ischemic areas in the choroid on fluorescein angiography. Histopathologic and immunologic studies of the eyes in the second patient demonstrated macular edema and elevation of the retina in association with choroidal infarction and linear deposition of IgG in Burchs membrane and the basement membranes of the choroidal vessels.

IgA Associated Lymphoplasmacytic Tumor Involving the Conjunctiva, Eyelid, and Orbit

A 65-year-old white man had an unusual disseminated lymphoid tumor that first appeared in the subconjunctival tissues of the right eye. The tumor later appeared in the skin, lymph nodes, and left upper eyelid and orbit. A monoclonal serum IgA spike was present although the urine did not contain Bence Jones proteins. The cells of the tumor appeared to be plasmacytoid lymphocytes. Prominent intranuclear inclusions, or Dutcher bodies, were present. Throughtout the 11-year history, the patient has been treated only with local excision and radiation.

Aqueous humor formation in fish: The role of sodium-potassium-activated adenosine triphosphatase in the spiny dogfish (Squalus acanthias) eye

The anatomy of the fish ciliary body and the distribution of sodium-potassium-activated adenosine triphosphatase in the elasmobranch (Squalus acanthias) eye were studied in an attempt to localize the site of formation of aqueous humor. Both teleosts and elasmobranchs have a ciliary body with a nonpigmented and pigmented epithelium similar to the mammalian pars plana. The fish ciliary body has no processes and little or no smooth muscle. Sodium-potassium-activated adenosine triphosphatase was found in significant levels in the elasmobranch retina, ciliary body and brain, while the iris had little activity. If the elasmobranch eye is similar to the mammalian eye and sodium transport is involved in aqueous humor formation, the ciliary body seems the most likely site of transport.

Gastrointestinal Sarcoidosis Diagnosed by Conjunctival Biopsy

Ophthalmologic examination of a 31-year-old black man presenting with an intractable gastric ulcer revealed small conjunctival nodules in the lower cul-desac that were sarcoid granulomas by microscopy. Previous endoscopic examination had revealed polyps in the gastric antrum, and a biopsy and microscopic examination had revealed granulomatous lesions, but a definite diagnosis could not be made until the ophthalmoscopic examination.