Yoshinori Dake

Terson syndrome: A case report suggesting the mechanism of vitreous hemorrhage

OBJECTIVE To present a patient with Terson syndrome and to propose a mechanism for vitreous hemorrhage. DESIGN Observational case report. PARTICIPANT A 50-year-old woman with subarachnoid hemorrhage and unilateral vitreous hemorrhage. METHODS Detailed examination with fluorescein angiography and funduscopy. MAIN OUTCOME MEASURES Site of dye leakage on fluorescein angiography in the eye with vitreous hemorrhage. RESULTS Fluorescein angiography showed the leakage site at the margin of the disc in the eye with vitreous hemorrhage after the vitreous hemorrhage had been removed. CONCLUSIONS The damage to peripapillary tissues demonstrated by fluorescein leakage suggests that intracranial hypertension affects peripapillary structures through the intervaginal space of the optic nerve sheath.

Metastatic orbital tumors in Japan: A review of the literature

A review of reports on metastatic orbital tumors published from 1903 to 1998 in Japan revealed 128 patients, 74 males, 52 females and 2 whose sex was not recorded. The average age was 44.8 years, but varied depending on the primary tumor. Since 1980, metastatic orbital tumors have increased in Japan, especially those from the lung, liver and adrenal gland, while metastasis from the stomach has decreased slightly. Metastasis from the breast is still common. Most metastatic orbital tumors were from the lung, followed, in order, by breast, liver, adrenal gland and stomach. Males had four times as many metastatic orbital tumors from lung cancer than did females; only females had metastases from breast cancer; almost 90% of metastases from hepatoma were in males; metastasis from renal carcinoma was 2–3 times more common in males than in females. Metastasis from the liver and stomach is seen more frequently in Japan than in the United States and Europe. Ocular signs due to orbital metastases from hepatoma, neuroblastoma and gastric cancer were apt to appear earlier than the signs of the primary lesion. Metastases to the orbit were frequently bilateral in patients with neuroblastoma and malignant lymphoma. Specific ocular signs such as ecchymosis and conjunctival hemorrhages were seen in orbital metastasis from neuroblastoma and seminoma, while ocular pain was characteristic of malignant lymphoma. Orbital metastasis was very rare in patients with carcinoma of the uterus, ovaries, bladder, pancreas, colon or rectum in both Japan, the United States and Europe.

Immunohistochemical study of p53, p21 and PCNA in pterygium.

Since mutated p53 is one of the most frequent gene abnormalities in human cancer, we hypothesized that mutation of p53 may play an important role in growth and recurrence of pterygia, a dysplasia of the conjunctiva. Therefore, we compared pterygia of Japanese and Tunisian patients using antibodies against p53, p21 and proliferating cell nuclear antigen (PCNA). In Nagasaki, 21 pterygia of Japanese individuals were removed and in Gabes, 19 primary pterygia of Tunisian individuals. Positive staining of wild type p53 was not found in the Japanese pterygia, whereas 38.1% were positive for mutant p53, none were positive for p21 and 76.2% were positive for PCNA. The incidence of mutant p53-positive staining was 50.0% in males and 22.2% in females, which was statistically significant. In the 19 Tunisian patients, positive staining of wild type p53 was not found, whereas 36.8% were positive for mutant p53, 0% for p21 and 63.1% for PCNA. Differences between Japanese patients and Tunisian patients were not significant. There were 2 types of pterygium. One type did not show mutant p53 and the other showed mutant p53 caused by ultraviolet light. However, damage caused by p53-dependent programmed cell death of pterygium cells may lead to mutations in other genes which may allow the progressive multistep development of limbal tumors. It is possible that mutant p53-positive pterygia can develop into limbal tumors.

Immunohistochemical localization of collagen types I, II, III, and IV in pterygium tissues

Immunohistochemical localization of collagen types I, II, III, and IV in the pterygium was demonstrated by type-specific antibodies. The stromata of pterygium and normal conjunctival tissues contained collagen types I, II, and III, while the normal corneal stroma showed collagen types I and III but not collagen type II. Collagen type IV was located in the epithelial and capillary endothelial basement membranes of pterygium and normal conjunctival tissues. These results suggest that collagens in pterygial tissues are derived from those in the conjunctival tissues.

Electron microscopic study of the optic nerve in copper deficient rats.

The optic nerves of copper deficient rats were investigated by light and electron microscopy. Copper-deficient rats showed neurological disorders and significantly low levels of serum copper throughout the experiment (3-7 weeks). Ultrastructurally, myelin formation was extremely delayed in the postlaminar portion of the optic nerve in copper deficient rats, and myelin structures were damaged and contained many vacuoles. Swollen neurons had few neurotubules and many vacuoles in the prelaminar portion of the optic nerve. Copper deficiency appeared to cause demyelination or dysmyelination in the optic nerves of rats.

Granuloma after augmentation of the eyelids with liquid silicone: an electron microscopic study.

Granuloma after liquid silicone augmentation of the upper eyelids was studied by light and electron microscopy and energy dispersive x-ray analysis. Light microscopy showed proliferation of collagen fibers and many phagocytic macrophages with vacuoles. Electron microscopy showed many vacuoles in phagocytic macrophages, fragmentary myofibrils, and proliferation of collagen fibers. Vacuoles in phagocytic macrophages contained silicone that was demonstrated by energy dispersive x-ray analysis. The present case suggests that liquid silicone injection in the eyelid can induce degeneration of the orbicularis oculi muscle in addition to granuloma formation.

Improved nonpenetrating trabeculectomy with trabeculotomy.

PurposeTo examine surgical effects and complications of improved nonpenetrating trabeculectomy with trabeculotomy in glaucoma patients. MethodsGlaucoma patients in two medical institutions underwent nonpenetrating trabeculectomy with sinusotomy with or without trabeculotomy, and the results were compared retrospectively in the two groups by evaluation of final intraocular pressure, drug score, and occurrence of postsurgical complications. ResultsOf the 63 eyes of 51 patients in this study, 31 were treated with nonpenetrating trabeculectomy with sinusotomy without trabeculotomy and 32 eyes were treated with nonpenetrating trabeculectomy with sinusotomy and trabeculotomy. The mean follow-up period was 17.0 months. The clinical features in both groups were similar in terms of age, presurgical intraocular pressure (P = 0.96), and presurgical drug score. The eyes treated with nonpenetrating trabeculectomy with sinusotomy without trabeculotomy had significantly reduced intraocular pressures from 21.0 ± 4.3 (mean ± SD) to 15.8 ± 6.3 mm Hg (P = 0.0003) and drug scores from 2.4 ± 1.2 to 1.6 ± 1.1 without postsurgical complications. The eyes treated with nonpenetrating trabeculectomy with sinusotomy and trabeculotomy had significantly reduced intraocular pressures from 22.3 ± 7.5 to 12.5 ± 2.3 mm Hg (P < 0.0001) and drug scores from 2.5 ± 1.9 to 0.9 ± 1.3 without postsurgical complications. Thus, the eyes treated with nonpenetrating trabeculectomy with sinusotomy and trabeculotomy had significantly lower intraocular pressures (P = 0.016) and drug scores than did those treated with nonpenetrating trabeculectomy with sinusotomy without trabeculotomy. ConclusionThe authors obtained satisfactory results in reducing intraocular pressure by the combination of nonpenetrating trabeculectomy, sinusotomy, and trabeculotomy.

Pterygium with bulbar conjunctival hemorrhages.

Abstract · Background: This study was carried out to describe the clinical features and electron-microscopic characteristics of the capillaries in pterygium with conjunctival hemorrhage. · Methods: We compared the clinical findings in Japanese and Tunisian primary pterygia and in pterygium with and without bulbar conjunctival hemorrhages. The capillary fine structures of pterygium with bulbar conjunctival hemorrhages were studied by electron microscopy and compared with those without bulbar conjunctival hemorrhages. · Results: Conjunctival hemorrhages were noted in 16.4% of Tunisian patients but not in any Japanese patients. The former pterygia were significantly larger, more vascular and more frequently hyperemic than the latter. Pterygia with bulbar conjunctival hemorrhages were more hyperemic than without hemorrhages. Electron microscopy revealed interruptions of the endothelial cells and basement membrane of the capillaries in the pterygia with bulbar conjunctival hemorrhages, with blood cells escaping through the endothelial interruptions. · Conclusion: Conjunctival hemorrhage in pterygia may be caused by fragility of the endothelial cells and basement membrane in the capillaries, which easily induces hemorrhage when the eyes are irritated by rubbing or by conjunctival foreign bodies. Pterygium with conjunctival hemorrhage is more frequently found in Tunisians than in Japanese.

Circadian rhythm in the retinal pigment epithelium related to vitamin B12

The wake-sleep rhythm is a typical circadian rhythm. It has been reported that severely disturbed wake-sleep rhythms are improved by the administration of vitamin B12. This study was designed to clarify whether vitamin B12 is universally related to the circadian rhythm. Three-week-old male Wistar Kyoto rats were fed a vitamin B12 deficient diet for 3 months. Then some of them were given intraperitoneal injections of vitamin B12. We counted phagocytized lamellar structures in the retinal pigment epithelium after the start of exposure to light in negative electron microscopic films. In vitamin B12 deficient rats, the maximum number of phagocytized lamellar structures in the retinal pigment epithelium appeared 3 hours after the start of light exposure, while in the control and vitamin B12 injected groups the peak occurred at 2 hours. This difference suggests that the retinal circadian rhythm is closely related to the level of vitamin B12.

Cytochrome oxidase in rat ocular tissues with special reference to copper

The localization of cytochrome oxidase, one of the copper metalloenzymes, was determined histochemically and compared with that of copper. Copper and cytochrome oxidase coexisted in the corneal epithelium and endothelium, iris, ciliary body, lens epithelium, and retinal photoreceptor inner segment. In spite of the presence of copper, no cytochrome oxidase was demonstrated histochemically in the retinal pigment epithelium, choroid, sclera, or optic nerve. The coexistence of copper and cytochrome oxidase suggests that copper plays a role in this copper metalloenzyme, while the non-coincidence of localizations of copper and cytochrome oxidase may be attributed to histochemical problems or to some unknown function of copper.