Systemic antibiotic prophylaxis in penetrating ocular injuries. An experimental study

Intraocular concentrations of systemically administered gentamicin and cefazolin in eyes after a standard penetrating ocular injury were measured to determine the effect of eye injury on ocular pharmacokinetics. Twenty pigmented rabbits were divided into two groups. A standard, 8-mm wound was made at the pars plana of one eye in each animal. Group 1 consisted of 10 rabbits that were treated with cefazolin (75 mg/kg), and Group 2 consisted of 10 rabbits that were given gentamicin (2 mg/kg). Fellow eyes, which sustained no trauma, served as control eyes. All groups received intravenous injections every 8 hours for 72 hours, beginning immediately after repair of the wound. After 72 hours, samples were obtained from the anterior chamber, vitreous cavity, and serum. Standardized bioassays for detection of gentamicin or cefazolin were performed. Significant concentrations of intravitreal cefazolin (9.6 micrograms/ml) and gentamicin (0.60 micrograms/ml) were found in the traumatized eyes in comparison to control eyes (P = 0.0001; P = 0.006). Cefazolin exhibited excellent penetration, achieving concentrations well above minimum inhibitory concentration values for most organisms. Gentamicin levels, however, were well below acceptable therapeutic levels. This study suggests that systemically administered cefazolin can achieve significant intravitreal penetration at minimum inhibitory concentrations after penetrating injury.

Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study

This article describes the trial design and baseline results for the Silicone Study, a multicenter, randomized surgical trial designed to compare the effectiveness of silicone fluid versus long-acting gas in the treatment of proliferative vitreoretinopathy (PVR). Design features include (1) standardization of the surgical protocol to reduce intersurgeon variability, (2) formulation of a PVR clinical classification system relevant to modern vitreoretinal surgery, and (3) creation of a photographic protocol to document PVR pathology. Statistical issues affecting the analysis of the outcome data include (1) the addition of a second group of patients with more severely diseased eyes after the trial began, (2) the change to a different long-acting gas during the course of the trial, and (3) recurrent retinal detachments that require reoperations with the randomized treatment, and, in some instances, a crossover from the randomized to the alternate treatment. Demographic and baseline ocular characteristics are presented for the two groups under study.

Synthesis of extracellular matrix by macrophage-modulated retinal pigment epithelium

In proliferative vitreoretinopathy, macrophages and retinal pigment epithelial cells are associated with microfibrillar matrix proteins in the vitreous cavity, but the contribution of this extracellular matrix to the pathophysiology is not known. We used radiolabeling techniques on cultured human retinal pigment epithelial cells to correlate the secretion of extracellular matrix proteins with macrophage-induced modulation of cell proliferation and morphologic features. Retinal pigment epithelial cells incubated in a macrophage-conditioned medium assumed fibrocytelike morphologic characteristics, grew faster, and exhibited a decreased cellular release of fibrillar and nonfibrillar matrix components. However, due to a simultaneous greater increase in cell numbers in these modulated cultures, the total production of fibrillar and nonfibrillar matrix components by the culture population was increased.

Vision research in departments of ophthalmology. An Association of University Professors of Ophthalmology perspective

A research committee of the Association of University Professors of Ophthalmology disseminated a survey questionnaire to determine the state of research in departments of ophthalmology across the United States. The questionnaire contained 71 questions that were designed to assess attitudes and trends within members' departments and to solicit suggestions from the membership. Of the 145 members and affiliates queried, 140 responded. While the results of the survey indicate significant diversity among departments, departmental chairpersons view research as a major priority in the goals of their departments, and they envision maintenance or expansion of research over the next decade. The survey results have been collated and serve now as the basis for this Association of University Professors position article.

Pars plana vitrectomy for acute retinal detachment in penetrating ocular injuries

We studied 41 eyes with acute retinal detachment after penetrating ocular trauma in a retrospective cohort analysis. Pars plana vitrectomy was performed in 28 eyes, while the remaining 13 eyes had only primary repair and closure of the wound. The two groups differed in the type of trauma (more gunshot wounds in the vitrectomy group and more blunt injuries in the nonvitrectomized group). Visual success (visual acuity of 5/200 or better) was observed in 10 (37%) of the eyes treated by vitrectomy compared with one (8%) of the eyes in the nonvitrectomy group. Anatomic success was achieved in 21 (75%) of the eyes in the vitrectomy group but in only one (8%) of those in the nonvitrectomy group. Enucleation or phthisis was observed in seven (54%) of the eyes in the nonvitrectomy group compared with only five (18%) in the vitrectomy group. Significant prognostic factors for anatomic outcome in the vitrectomy group were the location of the laceration and the presence of the lens.

Clearance rate of macrophages from the vitreous in rabbits

Macrophages are usually present in epiretinal membranes from eyes with proliferative vitreoretinopathy (PVR). Information on the kinetics of macrophages in the eye may be of help in identifying their role in this disease. To determine the half-life of macrophages in the vitreous, peritoneal macrophages were labeled by allowing them to phagocytose 141Cerium (gamma-emitter) labeled microspheres, and were then injected into the vitreous of the same rabbit from which they were obtained. The animals were sacrificed at various times post-injection and the radioactivity remaining in the vitreous was measured. Using this procedure, the half-life was found to be 4.8 days.

Pathogenesis of laser-induced choroidal subretinal neovascularization

The early stages (1 day to 3 weeks) in the development of laser-induced choroidal subretinal neovascularization were studied in the monkey eye. Histopathology revealed that the intense laser beam disrupted the choroid/Bruch's membrane/retinal pigment epithelium (RPE) complex and initiated a repair process. Although all lesions received the same energy density, the initial choroidal wound varied among the lesions: in some, the necrotic choroid was surrounded by hemorrhagic retinal detachment with RPE denudation; in others, the necrotic choroid was surrounded only by minimal damage to the RPE monolayer. Formation of the choroidal wound was followed by an inflammatory response. Later, newly formed choroidal tissue filled the wound and continued to proliferate towards the subretinal space. RPE cells from the edges of the wound proliferated over the newly formed subretinal tissue and closed the wound. In lesions with a large area of damaged RPE, coverage of the wound was slow; fluid accumulated in the subretinal space, and the lesions demonstrated pooling of fluorescein on angiography (leaky lesions). In lesions with minimal damage to RPE monolayer, closure of the wound was rapid, and the proliferating choroidal tissue did not reach the subretinal space. There was no subretinal fluid accumulation and no pooling of fluorescein on angiography (nonleaky lesions). Our results indicate that both the amount of damage of the choroid/Bruch's membrane/RPE complex and the ability of RPE cells around the damaged area to proliferate and restore the continuity of the RPE layer determine the evolution of newly formed choroidal fibrovascular tissue into a subretinal membrane with or without pooling.

Ocular trauma in an urban population. Review of 1132 cases

A retrospective survey was done of all ocular and adnexal trauma cases seen at a large metropolitan hospital during a 6-month period. By determining patient demographics, causes of the eye injuries, and extent of ocular damage, the authors hoped to delineate areas where preventive measures might decrease such trauma. Demographic and clinical data on 1132 patients were analyzed. Most patients were in the first three decades of life and were male. Blunt trauma was the most common type of injury. Assault was the most common cause and accounted for the highest number of serious injuries. Eye injuries associated with violence are difficult to prevent using conventional strategies that are usually effective in the home and workplace.

Effects of sodium iodate on experimental subretinal neovascularization in the primate

We investigated the role of the retinal pigment epithelium (RPE) in the development of subretinal neovascularization (SRN) induced by bilateral laser photocoagulation of the retinas in monkeys. RPE function was affected by a unilateral carotid injection of sodium iodate, a selective RPE toxin, before laser photocoagulation. This caused severe RPE damage in the ipsilateral eye, but did not affect the contralateral eye. After laser photocoagulation no SRN was demonstrable clinically or histopathologically in the ipsilateral eye; in contrast, active SRN showing extensive fluorescein leakage was found in the contralateral eye. These results suggest that RPE may play a role in the development of laser-induced SRN.

Activated macrophages in experimental subretinal neovascularization

Laser-induced subretinal neovascularization (SRN) in monkey retinas was investigated by immunohistochemical techniques to identify the presence and location of activated macrophages. Retinal lesions were examined 3, 8 and 14 days after intensive argon laser treatment, and the distribution of interleukin-1 (IL-1)-containing cells in the lesions was determined by the orthogonal reconstruction of serial sections. Macrophages were present in the subretinal space of day 3 and day 8 lesions. These IL-1-containing cells were distributed about the area of rupture of Bruch's membrane and were quite common in lesions taken 3 days following laser treatment. While still apparent, the number was decreased at 8 days, and none were found 14 days after laser treatment. The temporal and spatial distribution of IL-1-staining macrophages paralleled the development of SRN, suggesting a relationship between the presence of activated macrophages and the initiation of neovascularization in this model.

Management of traumatic rupture of the globe in aphakic patients

We report the successful treatment of three cases of traumatic ruptures of the globe complicated by massive choroidal hemorrhage, uveal prolapse and retinal detachment. All three of the eyes were aphakic prior to injury and all patients were age 64 or older. The presenting visual acuity in all patients was light perception. The blunt injury in each case caused a wound dehiscence at the site of previous cataract extraction. All injuries were associated with uveal prolapse. Secondary surgical intervention was performed when the hemorrhagic choroidal detachments had decreased as demonstrated by echography in the suprachoroidal space, occurring at an average of 14 days after injury. The management consisted of surgical drainage of the choroidal hemorrhage combined with vitrectomy and silicone oil injection. Successful reattachment of the retina was achieved in all cases. Postoperative epiretinal membranes formed in two cases but all were anatomically successful at six months. Final visual acuities varied from 20/70 to 1/200, visual acuity being a function of secondary contusive damage to the retina and choroid. We believe that in eyes sustaining severe blunt injuries resulting in rupture of the globe complicated by massive choroidal hemorrhage and retinal detachment, properly timed external drainage of the choroidal hemorrhage combined with pars plana vitrectomy and silicone oil injection is a useful approach.

Vitreous modulation of migration and proliferation of retinal pigment epithelial cells in vitro

Retinal pigment epithelial (RPE) cell migration and proliferation are believed to play a role in the pathogenesis of proliferative vitreoretinopathy (PVR). Since PVR develops in situations where vitreous contacts the RPE, we sought to determine whether human vitreous contains factors that stimulate proliferation and migration of RPE cells. We found that postmortem human vitreous stimulates migration but not proliferation of human RPE cells under serum-free conditions in vitro. Stimulation of proliferation of RPE cells and fibroblasts was observed, however, following admixture of albumin with the vitreous. These findings suggest that vitreous contributes modulators that stimulate some functions of RPE cells that are believed to play a role in the pathogenesis of PVR.

Fibrovascular proliferation and retinal detachment after intravitreal injection of activated macrophages in the rabbit eye

Injection of activated macrophages into the posterior vitreous of the rabbit induced vigorous fibrovascular proliferation over the optic disk and medullary rays, as demonstrated by 3H-thymidine autoradiography. One week after injection, endothelial cells and pericytes of the capillaries near the inner surface of the optic disk and rays were labeled; fibroblast-like cells, which were also labeled, migrated and formed vitreous strands. By the second week after injection, the fibrovascular tissue proliferated most actively, and traction medullary ray detachment and peripapillary retinal fold formation were observed. The cellular proliferation was accompanied by inflammatory cell infiltration. Glial cells within the optic disk, as well as retinal pigment epithelial cells beneath the detached retina, were labeled by 3H-thymidine. These results demonstrate that the fibrovascular proliferation originates from the vessel complex of the optic disk and medullary rays in this experimental model of retinal detachment.

Experimental subretinal neovascularization in the rabbit

Subretinal neovascularization (SRN) in the rabbit was induced by subretinal injection of vitreous without rupture of Bruch's membrane. Eight of 26 eyes developed SRN. The incidence of SRN rose from 33% to 57% in a period of 4-40 weeks. Because of the absence of any fluorescein angiographic indication of SRN, these occult new vessels were identified by light and transmission electron microscopy. Histological examination showed that these newly formed vessels are composed of continuous capillaries with the morphologic characteristics of choriocapillaris, including diaphragmed fenestrations, basement membranes, and junctional complexes. The new vessels originated from the choriocapillaris and penetrated through Bruch's membrane into the subretinal space, where they were associated with the degenerated sensory retina and proliferating glial and/or RPE cells. This experiment provides a model of SRN without breaks in Bruch's membrane.

Morphologic observations of retinal pigment epithelial proliferation and neovascularization in the rabbit

Neovascularization and proliferation of the retinal pigment epithelium (RPE) was induced in the rabbit by subretinal injection of vitreous without rupture of Bruch's membrane. New vessels developed between the layer of RPE and photoreceptor outer segments, but were enveloped in proliferating RPE. For this reason they were occult; no fluorescein leakage was visible by angiography. The vessels were identified only by histologic examinations. Endothelial cell budding was the initial stage of vessel development, first seen two weeks after injection. The new vessels grew from the choriocapillaris, penetrated Bruch's membrane, and spread into the subretinal space, despite the absence of subretinal fluid. Fenestrations with diaphragms were found in the endothelial walls during the earliest stages of vessel formation, and were also present in the fully matured vessels. Intermediate junctional complexes were frequently observed among the endothelial cells. During maturation of these plexi, junctions changed from open to putative tight junctions. The mature vessels were ultimately completely enveloped by collagen and RPE cells. Our results show that all new vessels in this animal model have the morphologic characteristics of choriocapillaris. We assume that they leak fluorescein, as does the choriocapillaris, but that the dye has no opportunity to pool in the subretinal space and thus cannot be seen during angiography.

Investigations on contractile properties of retinal pigment epithelial cells

We have investigated the contractile properties of human and bovine retinal pigment epithelial (RPE) cells in culture. In collagen gels, RPE cells sent out processes which were able to retract the gels. In a glycerinated model of contraction, RPE cells contracted and aggregated into clusters in response to the addition of ATP to the media. This contraction was very likely mediated by contractile proteins which are arranged in circumferential microfilament bundles in RPE cells. SDS-PAGE analysis of the RPE cell cytoskeletal elements showed protein bands of 200 kD and 43 kD, probably heavy-chain myosin and actin, respectively; in human RPE, cells bands of 58 kD and 52 kd, representing intermediate filament subunits, were evident; in bovine cells the 58-kD band was observed.

Macrophage modulation of retinal pigment epithelial cell migration and proliferation

Macrophages are fully differentiated cells that do not synthesize an extracellular matrix and do not contract; they do, however, produce substances that modify the behavior and functions of other cells, particularly those involved in the inflammatory and immune responses. Since macrophages are a ubiquitous component of periretinal membranes, we sought to determine whether they modulate proliferation and/or migration of retinal pigment epithelial (RPE) cells, functions that may be essential for the development of proliferative vitreoretinopathy (PVR). Using an in vitro assay, we found that macrophage supernatant contains factors that stimulate proliferation and migration of cultured human RPE cells. Since interleukin-1 (IL-1) is a product of activated macrophages that modulates a number of cellular functions, we also examined its effect on RPE proliferation and migration. We found that IL-1 increased migration but did not affect proliferation, and thus could not duplicate the effect of macrophage supernatant. Injection of activated macrophages into the vitreous of rabbits which had a retinal hole stimulated RPE cell proliferation in the area of the retinal hole, where the RPE cells were exposed. These findings suggest the ability of macrophages to modulate functions of RPE cells that are thought to be critical for the development of PVR. Macrophages may thus be an important part of the vitreous environment that favors the development of PVR.

Human retinal pigment epithelial cell cultures: phenotypic modulation by vitreous and macrophages

In proliferative vitreoretinopathy (PVR), retinal pigment epithelial (RPE) cells migrate into the vitreous, where they may acquire a fibroblast-like morphology. Such cells may eventually form contractile periretinal membranes, resulting in traction retinal detachment. Among the environmental influences that could cause this change in RPE phenotype, exposure to vitreous and to macrophages is most obvious, as macrophages are invariably found in epiretinal membranes and precede membrane formation in experimental traction retinal detachment. We initiated studies to define modulation of cultured RPE cell morphology by exposure to vitreous or to macrophage-conditioned media. Vitreous, serum, and albumin alone had no effect on the epithelial appearance of RPE cells in vitro. However, macrophage-conditioned media and vitreous-serum or vitreous-albumin mixtures induced a reversible fibroblast-like appearance in these cells. These findings show that macrophages produce a morphoplastic substance for RPE cells, and suggest that vitreous also contains a factor(s) that affects RPE cell shape, and that requires mediation by serum components.

Glial epiretinal membranes and contraction. Immunohistochemical and morphological studies

It has been suggested that glial cells do not contribute substantially to the contractile forces generated by epiretinal membranes. We have established a rabbit model in which epiretinal membranes form on the inferior peripheral retina after the injection of activated macrophages into the vitreous. By two months, the membranes were extensive but without evidence of traction. At four months, however, full-thickness retinal folds were present beneath the thick epiretinal membrane. A homogeneous glial cell composition was suggested by light microscopic examination of serial sections through several membranes. Immunohistochemical staining with anti-glial fibrillary acidic protein and antivimentin and immunoelectron microscopy confirmed that these thick epiretinal membranes were composed entirely of glial cells, which may cause mild traction on the retina; this traction is associated with cell alignment and the tissue bridges connecting the membrane and the retina. The fusiform densities and indented nuclei suggested that the glial cells within the membrane may possess some characteristics of myofibroblasts.

Liquefaction of rabbit vitreous by ferrous ions

Intravitreal injection of 0.7 mumol of ferrous chloride in 0.1 ml into the rabbit eye resulted in liquefaction of the vitreous gel and condensation of vitreous collagen fibrils within two weeks; injection of 0.1 mumol did not cause any obvious vitreous degeneration, although retina damage was noted in the posterior pole. Macrophages migrated at the vitreoretinal interface and local posterior vitreous separation was observed after the injection of ferrous solution. This suggests that the least amount of ferrous ions necessary to cause liquefaction of the rabbit vitreous is in the range of 16.8 to 39.2 micrograms of elemental iron, a concentration of 0.3 to 0.7 mM in the vitreous. Since 0.1 ml of blood contains approximately 50 micrograms of iron, it is possible, at least theoretically, that the iron released by hemoglobin following vitreous hemorrhage could induce liquefaction of the vitreous.

Breakdown of Bruch's membrane after subretinal injection of vitreous. Role of cellular processes

It was recently shown that the injection of autologous vitreous beneath the retina of rabbits leads to retinal degeneration, subretinal cellular proliferation and neovascularization. The current study, using electron microscopy, was designed to determine the cellular processes involved in the breakdown of Bruch's membrane in this model. Bruch's membrane was not mechanically damaged by the injection and appeared intact for the first 1 to 2 days after injection. Subsequently, numerous breaks in Bruch's membrane were found associated with invasion of macrophages and fibroblasts; in addition, budding and penetration of retinal pigment epithelial (RPE) and choroidal endothelial cells into Bruch's membrane were noted. Although it was not proven that these cells, per se, were responsible for the breaks, that these cells actively penetrate Bruch's membrane is a reasonable hypothesis.

Experimental changes resembling the pathology of drusen in Bruch's membrane in the rabbit

Drusen-like changes in Bruch's membrane following subretinal injection of vitreous in the rabbit were studied by electron microscopy. A sequence of changes is seen that closely panellels those observed during drusen formation in primates. The initial event is the budding of retinal pigment epithelial (RPE) cells into Bruch's membrane; the buds, which contain cytoplasm and plasma membrane, are connected to the cytoplasm of the parent RPE cell. Most buds are surrounded by basement membrane, but some penetrate RPE basement membrane into Bruch's membrane. Later, RPE buds completely separate from the parent RPE cell and show degeneration and disintegration. Finally, drusen-like material, including vesicular, granular, tubular and linear structures, is dispersed from the bud remnant into Bruch's membrane. The study described herein thus supports the hypothesis that drusen are the result of budding from the RPE.

Cellular proliferation induced by subretinal injection of vitreous in the rabbit

A new experimental model of subretinal cellular proliferation, based on injection of autologous vitreous into the subretinal space of rabbits, was studied by light and electron microscopy. As early as five days after injection, proliferation of retinal pigment epithelial (RPE) and retinal glial cells was observed in the subretinal space. These morphologically distinct proliferating cells were sometimes joined by junctional complexes. Morphologically, the proliferating RPE cells resembled either RPE cells or fibroblasts. Some proliferating RPE cells also retained their epithelial characteristics (ie, basement membranes and cell junctions), while others were partially dedifferentiated and showed some embryonic features. New formation of melanin could be identified within the proliferated RPE cells, which could account, in part, for the hyperpigmentation at the site of the bleb caused by the injection of vitreous. The results demonstrated that injection of autologous vitreous into the subretinal space can lead to subretinal proliferation of retinal glial and RPE cells in the rabbit.

Morphologic observations on experimental subretinal neovascularization in the monkey

Subretinal neovascularization is a poorly understood and potentially disastrous feature of many eye diseases. We used light and electron microscopy to study the sequence of events that lead to the formation of new vessels after laser photocoagulation of the retina and choroid of primates. In this animal model there is a rapid development of new blood vessels; one day after photocoagulation, endothelial cell degeneration and thrombus formation were observed in the capillaries, venules and arterioles of the choroid around the center of the lesion. Re-endothelialization began in some thrombosed choroidal vessels, with migration of the activated endothelial cells within the old basement membrane. Two days after photocoagulation, re-endothelialization was observed in almost all thrombosed choroidal vessels, and the initial stage of the endothelial cell budding was observed in the pre-existing choroidal vessels; this was especially prominent in venules with pericytes. Three days after photocoagulation, not only the endothelial cells in pre-existing vessels but also those in re-endothelialized vessels showed budding and lumen formation. The lumen of vessels was formed by the budding of adjacent endothelial cells that were coupled by transient intercellular junctions. Mitotic figures were frequently found in the endothelial cells distal to the growing tip. Five to eight days after photocoagulation, many new vessels extended into the subretinal space.

Posterior vitreous separation and retinal detachment induced by macrophages

Macrophages, which migrate into the vitreous in conditions such as vitreous hemorrhage and penetrating ocular injury, may contribute to the development of intravitreous cellular proliferation and posterior vitreous separation. To investigate this possibility, activated macrophages were harvested from the peritoneal cavity and injected into the vitreous of rabbits. As early as 8 days after macrophage injection, posterior vitreous separation and glial epiretinal membrane formation began to occur. Two weeks after injection, vitreous strands that approached the optic disc and medullary rays were evident; fibroblasts proliferated over the disc or rays and induced retinal detachment. These findings support the hypothesis that macrophages in the vitreous may, in part, mediate cellular proliferation and posterior vitreous separation.

Vitreoretinal junction in infectious endophthalmitis in a primate eye

A primate eye affected by postoperative infectious endophthalmitis was studied early in the course of the disease. Retinal perivasculitis, vitreoretinal adhesions along the inflamed vessels, and traction of the partially separated posterior vitreous on the retina at the adhesion sites were observed. It is suggested that such vitreoretinal junction pathology may be responsible for the development of retinal detachment in infectious endophthalmitis.

Alterations in the distribution of fibronectin and laminin in the diabetic human eye

The distribution of fibronectin and laminin in diabetic human eyes was determined by indirect immunofluorescent techniques. The intense fluorescence suggests increased amounts of fibronectin and laminin in the diabetic internal limiting membrane (ILM). A double laminated pattern of fluorescence for both glycoproteins suggests structural abnormalities of the ILM of the posterior retina. Preretinal and subretinal proliferative tissues fluoresced strongly and diffusely with antifibronectin. This study indicates that in diabetic patients, the ILM, especially in the posterior retina, is biochemically and morphologically abnormal.

Immunofluorescent studies of fibronectin and laminin in the human eye

The topographic distribution of fibronectin and laminin in young and old human eyes was determined by indirect immunofluorescent techniques. These two glycoproteins may play a role in the attachment of the vitreous to the internal limiting membrane (ILM) and the internal limiting membrane to the Mueller cell processes. A double-laminated pattern of fluorescence for both glycoproteins was frequently found at the ILM of the posterior retina of aged eyes. This pattern of fluorescence, which was rarely seen in young eyes, may represent senescent changes in the ILM which could predispose the eye to posterior vitreous detachment.

Intraoperative argon endophotocoagulation for recurrent vitreous hemorrhage after vitrectomy for diabetic retinopathy

We reviewed the medical records of 103 consecutive cases of vitrectomy performed for complications of diabetic retinopathy to determine if the introduction of argon laser endophotocoagulation had reduced the incidence of recurrent vitreous hemorrhage. Twenty-six eyes (48%) treated with endophotocoagulation and 35 (71%) eyes not receiving laser treatment had a recurrent hemorrhage. Follow-up was shorter for the eyes treated with endophotocoagulation, but a log-rank analysis to allow for this variable confirmed the benefit of laser photocoagulation (P less than .05). The proportion of eyes requiring surgical removal of the hemorrhage was also significantly lower in the group receiving endophotocoagulation (P less than .05). The beneficial effect of intraoperative laser treatment was independent of the amount of preoperative laser treatment, aphakia, and indications for the original vitrectomy surgery.

Effect of the vitreous on retinal wound-healing

The healing process of experimental retinal wounds in nonvitrectomized and vitrectomized rabbit eyes was compared. Using light, transmission and scanning electron microscopy, a significant difference was observed at the late stages of the healing process. The retinal wounds in the nonvitrectomized eyes healed properly, forming regular and smooth scars, while the scars that developed in the vitrectomized eyes were irregular and hypertrophic. Our observations suggest that the vitreous plays a role in normal healing of retinal wounds.

The role of retinal pigment epithelium in the involution of subretinal neovascularization

The extravascular milieu around laser-induced experimental subretinal neovascularization (SRN) was studied during the evolution of the neovascular membrane from its early leaky stage to its late involuted stage. When the first signs of visible leakage appeared on angiography, newly formed vessels were spread in the subretinal space around the break in Bruch's membrane, fluid was accumulating in the subretinal space, and retinal pigment epithelial (RPE) cells were proliferating in a papillary pattern around the newly formed vessels; the RPE proliferation began with the undamaged cells at the edges of the laser injury. With further maturation, the RPE continued to envelope the subretinal vessels. This RPE proliferation was associated with the disappearance of fluid between the enveloped vessels and the sensory retina, and the gradual cessation of fluorescein leakage during angiography. At the end of the involution process, when the neovascular membrane no longer demonstrated any leakage, the subretinal vessels were found to be tightly enveloped by RPE cells, and no fluid separated them from the sensory retina. The authors' results suggest that involution of the neovascular membrane with maturation, as demonstrated by the cessation of visible fluorescein leakage, is the result of RPE proliferation that tightly envelopes the newly formed vessels and probably resorbs the previously accumulated subretinal fluid, as well as preventing its further accumulation in the subretinal space.

Experimental epiretinal proliferation induced by intravitreal red blood cells

We describe a reproducible animal model of epiretinal proliferation, based on intravitreal injection of red blood cells, that closely simulates the more benign proliferative extraretinopathies. Using light microscopy and scanning and transmission electron microscopy, we monitored the development and behavior of the experimental epiretinal membranes. We found breaks in the integrity of the retinal surface through which glial cells migrated onto the retina, proliferated into thick epiretinal tissue, and contracted to cause retinal pucker. All these steps were associated with the chronic inflammatory response to the long-lasting presence of red blood cells in the vitreous. Thus, the development of epiretinal membranes requires continuous intraocular stimulation in addition to a break in retinal integrity.

Cellular migration, proliferation, and contraction. An in vitro approach to a clinical problem--proliferative vitreoretinopathy

Presently used animal models of proliferative vitreoretinopathy reflect only cell proliferation and contraction. We used an in vitro model that measured cell migration, proliferation, and contraction. The following four drugs were assayed on this system: daunomycin, taxol, colchicine, and cytochalasin B. Daunomycin was the most effective drug against cell proliferation and cell migration but had no effect on cell contraction; taxol and colchicine affected all three parameters. Cytochalasin B was the least effective drug tested.

An intravitreal cannula system: long-term follow-up study

An intravitreal cannula for chronic drug delivery was implanted in the eyes of two rabbits and one monkey. The rabbits were followed up for three years after surgery and the monkey was followed up for two and one-half years. Clinical observations did not reveal any adverse effects from the cannula implantation. Patency of the cannula was demonstrated by using sodium fluorescein. Histopathological studies with light and electron microscopy revealed the scar tissue around the cannula to be minimal and localized to the wound site. The optic nerve and the retina and choroid at the posterior pole did not show any abnormalities. These results suggest that this system can be used for repeated or continuous drug delivery to the vitreous over a long period of time in experimental models.

Morphological study of epiretinal membrane following posterior penetrating injury in the monkey eye

Posterior vitreous detachment (PVD) and epiretinal membranes occur in a number of vitreoretinal diseases. We have developed an experimental model in which we can provide the morphologic correlation of these dynamic processes. The method provides the opportunity to study epiretinal membrane formation with the scanning electron microscope (SEM); with SEM, some epiretinal membranes that could not be readily detected either clinically or by routine light microscopy can now be identified and studied in detail. We performed an experimental posterior penetrating injury with injection of autologous whole blood or blood and lens material into the vitreous. Five eyes with posterior vitreous detachment but no retinal detachment were selected for SEM. A reduction in the cortical vitreous filaments and the presence of epiretinal membranes was apparent with SEM. In most areas the epiretinal membranes were separated from the internal limiting membrane by a narrow cleft; however, limited attachment sites between the epiretinal membranes and retina were observed in areas overlying retinal blood vessels. In two eyes we observed microscopic retinal folds beneath the membranes, demonstrating a possible morphologic correlation between epiretinal cellular contraction and traction on the retina.

Formation of drusen in the human eye

Light and electron microscopy of drusen formation in the human eye showed yellow-white spots in the fundus with two morphologic patterns: that of typical drusen and a nodular accumulation of cellular components beneath the retinal pigment epithelial cells. By electron microscopy, the progression of drusen formation could be classified into four stages. Stage I showed budding or evagination of retinal pigment epithelial cells into the subpigment epithelial space. This evaginated portion was connected to the retinal pigment epithelial cell cytoplasm and was surrounded by its basement membrane. In Stage II the evaginated portion of the cell was completely separate from the cytoplasm of its parent retinal pigment epithelial cell. In Stage III, the evaginated portion showed degeneration and disintegration. Finally, in Stage IV, an accumulation of vesicular, granular, tubular, and linear material was seen free within the nodular space beneath the retinal pigment epithelial cell.

Pathogenesis of drusen in the primate

Two monkey eyes that showed clinical evidence of drusen were studied by light and electron microscopy. The drusen-like spots had several different morphological patterns: the appearance of typical drusen, budding retinal pigment epithelial (RPE) cells, and vacuolation of retinal pigment epithelial cells. Several stages of budding were seen. In some lesions, part of the RPE cell protruded into the sub-RPE space. The upper portion of the budding cell was connected to the cytoplasm of the parent RPE cell and was surrounded by basement membrane of the RPE cell. These budding cells had plasma membranes, cytoplasm that contained organelles, and a nucleus. Disconnected buds, separate from the parent RPE cell, were also seen; these showed degeneration. Finally, an accumulation of vesicular, granular, tubular and linear material was found in the nodular space beneath the RPE cell. It is suggested that this budding of RPE cells is the initial event in drusen-formation.

Newly-formed subretinal vessels. Fine structure and fluorescein leakage

The ultrastructure of experimentally induced newly formed subretinal vessels was correlated with the amount of fluorescein leakage demonstrated by the neovascular membranes during angiography. The membranes that demonstrated leakage contained subretinal vessels with a fenestrated endothelial wall and intermediate interendothelial cell junctions. As these subretinal plexi matured, they stopped demonstrating leakage. This involution process was accompanied by the formation of focal interendothelial tight junctions; however, loss of fenestrations was not observed. The membranes that never demonstrated fluorescein leakage also contained fenestrated subretinal vessels at both early and late stages of development; and their interendothelial junctions showed similar maturation from open to focal tight junctions. Thus all subretinal vessels had "leaky" morphology strongly resembling that of the normal choriocapillaris, whether they demonstrated fluorescein leakage or not. The authors conclude that newly formed subretinal vessels retain the characteristics of the choriocapillaris from which they are believed to proliferate; they have the potential to leak fluorescein at all stages of their development. The absence of fluorescein leakage during angiography cannot always be correlated with the absence of "leaky" morphology.

Retinal wound healing. Cellular activity at the vitreoretinal interface

Cellular activity at the vitreoretinal interface after full-thickness retinal wounds was studied in rabbit eyes, using light and electron microscopy. Glial cell extensions grew initially on the retinal surface around the wound site. This brief period of glial proliferation was associated with the posttraumatic inflammatory response and, more specifically, with phagocytic monocyte accumulation at the vitreoretinal interface. Once the inflammation subsided, this abortive attempt to grow membranes on the retinal surface stopped and true epiretinal membranes did not develop. Our observations suggest that intraocular inflammation and macrophage response determine the extent of healing and scarring on an injured retinal surface, and thus may play a key role in the pathogenesis of epiretinal membranes.

Ornithine decarboxylase activity during formation of experimental epiretinal membranes

This study demonstrates in a rabbit model of epiretinal membrane formation that retinal-associated ODC activity increases during this pathological process. These changes in retinal-associated ODC activity most likely occur in relationship to the proliferative lesion itself, since the retina consists primarily of nonproliferative tissues. Further knowledge of intraocular polyamine metabolism during epiretinal membrane formation which can result in retinal detachment may lead to the development of an effective pharmacological treatment.

Natural history of penetrating ocular injury with retinal laceration in the monkey

In one eye each of four cynomolgus monkeys, an 8-mm penetrating injury was made through the equator; there was retinal perforation with vitreous loss. None of the four eyes with this injury developed posterior vitreous detachment or retinal detachment during a follow-up period of 8 months to 1 year. Another group of 26 monkeys had the same injury but also had 0.5 ml autologous whole blood injected into the vitreous at the time of injury. The eyes were examined weekly and enucleated at scheduled intervals from 1 day to 52 weeks post-injury. Posterior vitreous detachment occurred at the earliest at 2 weeks post-injury, and was ultimately present in 91% of the eyes. Vitreous detachment can occur either as a separation at the level of the internal limiting membrane or as a cleavage within the cortical vitreous. Retinal detachment occurred at the earliest at 8 weeks post-injury, and eventually was present in 50% of the eyes. The retinal detachment was tractional; no retinal breaks were detected in any of the eyes.

Aging changes in Bruch's membrane of monkeys: an electron microscopic study

Bruch's membrane from monkeys of various ages was studied by electron microscopy. In monkeys under 15 years of age, Bruch's membrane rarely contained a small amount of polymorphous material that did not appear to increase with advancing age up to 15 years. However, the polymorphous material did increase over 20 years of age. The accumulation of vesicular, granular, tubular and linear polymorphous material in Bruch's membrane was though to be a result of evagination of a minimal portion of a retinal pigment epithelial (RPE) cell between adjacent basal infoldings, and its subsequent degeneration. The plasma membrane of the evagination seemed to be the primary source of the tubular or linear material, vesicles the main source of vesicular material, and cytosol and basement membranes to be the source of the granular material. The fibrous long-spacing collagen was associated with the basement membrane of the choriocapillaris and RPE cells. The granular deposits between the plasma infoldings and the basement membrane of RPE cells may originate from the basement membrane of the RPE, and could be the initial lesion of basal linear deposits.

Experimental retinal detachment in the rabbit. Penetrating ocular injury with retinal laceration

Retinal detachment was studied in a rabbit model of penetrating ocular injury with retinal laceration. The injury was an 8 mm perforation through the sclera, choroid, and retina with vitreous loss and incarceration. When the injury was located at the equator of the globe, the rate of retinal detachment was 16%, but if located at the ora serrata, the rate was 78%. The higher rate of retinal detachment following injuries located at the ora serrata is probably due to the involvement of the vitreous base.

Vitreous stimulates proliferation of fibroblasts and retinal pigment epithelial cells

In proliferative vitreoretinopathy, retinal pigment epithelial cells and glial cells migrate into the vitreous, proliferate, and assume characteristics of myofibroblasts. The addition of vitreous to the culture media stimulates the proliferation of porcine retinal pigment epithelial cells, bovine and lapine dermal fibroblasts but not the proliferation of bovine aortic endothelial cells and smooth muscle cells. The mitogenic activity is not species-specific, since vitreous from various species stimulates the proliferation of these cells. The mitogenic activity is destroyed by heating at 100 degrees C for 10 min or by trypsin treatment. Since the vitreous, under our assay conditions, was not mitogenic for endothelial cells or smooth muscle cells, the mitogenic activity is probably not derived from leakage into the vitreous of circulating fibroblast, epidermal or platelet-derived growth factor.