Robert J. Brockhurst

Clinical trial of lutein in patients with retinitis pigmentosa receiving vitamin A.

OBJECTIVE To determine whether lutein supplementation will slow visual function decline in patients with retinitis pigmentosa receiving vitamin A. DESIGN Randomized, controlled, double-masked trial of 225 nonsmoking patients, aged 18 to 60 years, evaluated over a 4-year interval. Patients received 12 mg of lutein or a control tablet daily. All were given 15,000 IU/d of vitamin A palmitate. Randomization took into account genetic type and baseline serum lutein level. MAIN OUTCOME MEASURES The primary outcome was the total point score for the Humphrey Field Analyzer (HFA) 30-2 program; prespecified secondary outcomes were the total point scores for the 60-4 program and for the 30-2 and 60-4 programs combined, 30-Hz electroretinogram amplitude, and Early Treatment Diabetic Retinopathy Study acuity. RESULTS No significant difference in rate of decline was found between the lutein plus vitamin A and control plus vitamin A groups over a 4-year interval for the HFA 30-2 program. For the HFA 60-4 program, a decrease in mean rate of sensitivity loss was observed in the lutein plus vitamin A group (P = .05). Mean decline with the 60-4 program was slower among those with the highest serum lutein level or with the highest increase in macular pigment optical density at follow-up (P = .01 and P = .006, respectively). Those with the highest increase in macular pigment optical density also had the slowest decline in HFA 30-2 and 60-4 combined field sensitivity (P = .005). No significant toxic effects of lutein supplementation were observed. CONCLUSION Lutein supplementation of 12 mg/d slowed loss of midperipheral visual field on average among nonsmoking adults with retinitis pigmentosa taking vitamin A. Application to Clinical Practice Data are presented that support use of 12 mg/d of lutein to slow visual field loss among nonsmoking adults with retinitis pigmentosa taking vitamin A. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00346333.

Angle-Closure Glaucoma in Nanophthalmos

Two patients had nanophthalmos with uveal effusion and angle-closure glaucoma. They were treated with a method based on the use of the laser, not only to perform iridotomy but to shrink the iris stroma, which appears to open the anterior chamber angle even without iridotomy. Additionally, we introduced three factors that may be diagnostic of nanophthalmos.

Fulminant ocular toxoplasmosis.

Seven patients had a destructive and disseminated form of toxoplasmic retinochoroiditis that resulted in loss of useful vision. All had been treated initially with corticosteroids alone. Active Toxoplasma infection, virulent strains of the organism, or both may have contributed to the fulminant course of the disease.

Visual Acuity is Related to Parafoveal Retinal Thickness in Patients with Retinitis Pigmentosa and Macular Cysts

PURPOSE To quantify the prevalence and effect on visual acuity of macular cysts in a large cohort of patients with retinitis pigmentosa. METHODS In 316 patients with typical forms of retinitis pigmentosa, visual acuity was measured with Early Treatment Diabetic Retinopathy Study (ETDRS) charts, macular cysts were detected with optical coherence tomography (OCT), and retinal thicknesses was quantified by OCT. The FREQ, LOGISTIC, and GENMOD procedures of SAS (SAS Institute, Cary, NC) were used to evaluate possible risk factors for cyst prevalence, and the MIXED procedure was used to quantify the relationships of visual acuity to retinal thickness measured at different locations within the macula. RESULTS Macular cysts were found in 28% of the patients, 40% of whom had cysts in only one eye. Macular cysts were seen most often in patients with dominant disease and not at all in patients with X-linked disease (P = 0.006). In eyes with macular cysts, multiple regression analysis revealed that visual acuity was inversely and independently related to retinal thickness at the foveal center (P = 0.038) and within a parafoveal ring spanning an eccentricity of 5 degrees to 10 degrees from the foveal center (P = 0.004). CONCLUSIONS Macular cysts are a common occurrence in retinitis pigmentosa, especially among patients with dominantly inherited disease. Visual acuity is influenced by edema in the parafovea, as well as in the fovea.

Dystrophic Calcification of Silicone Scleral Buckling Implant Materials

In six patients, removal of solid silicone scleral buckling implant materials that had been in place between eight and 21 years disclosed gray-white deposits firmly adherent to the silicone. Four of the six patients had culture-proven infections, whereas two had no evidence of infection and had negative cultures. One of these two patients, however, had intermittent pain, which was the indication for removal of the implant. Analysis of the deposits disclosed that they were calcium phosphate. The exact mechanism responsible for the calcification on the silicone material is unknown. Dystrophic calcification can occur without infection in injured tissue wherein extracellular deposits of devitalized cells, blood cells, and lipids may act as a nidus for calcification. In the presence of infection, bacteria may serve as such a nidus. Additionally, it is possible that biofilm produced by the bacteria had a role in the deposition of calcium phosphate, as well as in its firm adhesion to the silicone materials. We considered the possibility of similar deposits developing on intraocular silicone lenses.

Cicatricial retrolental fibroplasia: Its occurrence without oxygen administration and in full term infants

Six patients demonstrating typical signs of the cicatricial phase of retrolental fibroplasia are presented. None of the patients had received supplemental oxygen treatment after birth, and three patients were full term with birth weights ever 6 1/2 pounds. Two of the three premature patients had been born prior to 1901, before the advent of oxygen therapy for premature infants. It is apparent from these observations that retrolental fibroplasia does occur without oxygen administration and also in full term infants. Sechs Patienten mit den typischen Zeichen einer vernarbten retrolentalen Fibroplasie werden beschrieben. Keiner der Patienten hatte nach der Geburt zusätzlichen Sauerstoff geatmet. Nur drei der Patienten waren Frühgeburten. Die anderen drei hatten ein Geburtsgewicht von mehr als 3 kg. Zwei der drei Frühgeburten waren 1901 geboren, also bevor die Sauerstoffbehandlung frühgeborener Kinder eingeführt worden war. Es ist daher als bewiesen anzusehen, daß die retrolentale Fibroplasie auch ohne Sauerstoffbehandlung und bei termingerecht entbundenen Kindern auftreten kann.

Glial cell component in retinoblastoma

The right eye of a 4-month-old girl with a large, unilateral, sporadic retinoblastoma was enucleated. The tumor was unusual because it contained Flexner-Wintersteiner rosettes with extremely large lumina. Smaller rosettes and undifferentiated tumor cells were observed within the lumina. Also of importance were cells resembling glial cells which were intermixed with more typical cuboidal retinoblastoma cells. These cells had electron microscopic features typical of glial cells and stained positively for glial fibrillary acidic protein in immunohistochemical studies. Rosettes and glial cells continued to be observed in the tumor carried in tissue culture through two passages over a 7-month period. This tumor is presented because of its unusual rosette structures and because it confirms recent reports describing a glial cell component in retinoblastoma.

Television Ophthalmoscopy: Instrumentation and Medical Applications.

This book is unique in that it is the first to deal exclusively with television ophthalmoscopy, a new and virtually untested tool for study of the ophthalmic fundus. With the increasing complexity of various scientific disciplines, there is a growing need for a source of information to bridge the gap which separates workers in different fields who have a common interest. Thus, this book is not exclusively for ophthalmologists who wish to know more about television electronic hardware and how to adapt it to their needs. It also is directed to electronic technicians who do not understand the special problems and limitations which the human eye imposes on television equipment for development of an electronic image of the fundus. It is apparent that television ophthalmoscopy is particularly suitable for repetitive and detailed analysis of fundus images, immediate, simultaneous presentation of fundus findings to a large audience, and a simple method

Illuminated Retractor for Retinal Detachment Surgery

FREQUENTLY during surgery for retinal detachment, it is necessary to operate on the sclera posterior to the equator of the globe, eg, in the treatment of posterior breaks and in release of subretinal fluid. Good illumination of these posterior areas is sometimes difficult to obtain with conventional operating room lighting and accessory illumination may be helpful. A fork-type retractor, which is popular for retinal detachment surgery, has been fitted with a fiberoptic bundle (Fig 1). The fiberoptic bundle is quite flexible, making the retractor easy to manipulate, and affords bright illumination of the scleral area exposed by the retractor (Fig 2). The fiberoptic bundle was provided by the Dynatech Corporation, Cambridge, Mass. Key Words. —Retinal detachment surgery, instrumentation.

COMMENTS ON ARONSON'S ANNUAL REVIEW

In reference to your invitation to comment on the annual review of the Uvea presented by Dr. Aronson in theArchives( 79 :490-501 [April] 1968), I believe that a review limited to those papers which, in the authors opinion, are of major significance is much more interesting for the reader. This is especially true if the author of the review interprets the papers and adds comments based on his own experience. I suppose, however, if this policy is continued, that the reviewer will concentrate on other facets of the uvea in ensuing years, eg, neoplasms, degenerative changes, trauma, clinical aspects of uveitis. This method would then allow for a more comprehensive review of several years work on each type of problem. It is apparent that during a single year there really are not enough new ideas on any one subject to allow real conclusions to be made. Specifically, in regard