Globe Volume Research Articles

Evaluation of Immune Responses Following Whole Eye Transplantation

Introduction The aim of this study was to establish a novel Whole Eye Vascularized Composite Allotransplantation (VCA) model that includes the eyeball, adnexa and soft tissues with optic nerve (ON), to evaluate the immunological, neuroregeneration and graft survival outcomes. Methods Sprague-Dawley rats received heterotopic vascularized Whole Eye Transplants (WET). Each periorbital flap included the globe, and surrounding tissues based on common carotid artery and external jugular vein as vascular pedicle (Figure 1 and 2). Viability was confirmed by angiography, MRI and clinical examination. Histopathology of protocol skin biopsies were scored for Banff grading. The globe, adnexal and ON tissues were analyzed for acute rejection and/or nerve regeneration at endpoint of 30 days or Grade 3 rejection (whichever was earlier).Results Macroscopic evaluation confirmed flap viability (Figure 3). The MR evaluation revealed loss of globe volume by 35% after transplantation. Histological exam of globe and adnexal tissues showed unique and differential patterns of rejection, predominantly involving macrophage and neutrophil infiltration. Optic nerve sectioning revealed a degeneration pattern with no evidence of regeneration.Conclusion This is the first study of successful heterotopic WET in the literature. This model offers promise and potential in immunological, neuroregeneration, drug delivery, cellular therapies, imaging and tissue engineering studies involving optic nerve, retina or eyeball tissues.

Effect of mannitol on globe and orbital volumes in humans.

To determine the effect of intravenous mannitol on globe and orbital volumes. Retrospective chart review of a consecutive series of Cleveland Clinic Neurosurgical Intensive Care Unit patients who underwent computed tomographic imaging before and after intravenous mannitol administration. Volume measurements were performed according to a previously described technique by averaging axial image areas. Measurements before and after mannitol administration were compared using paired t-test. Fourteen patients (28 eyes) met inclusion criteria. Average globe volume decreased 186 mm3 (-2.5%, p = 0.02) after mannitol administration, while average orbital volume increased 353 mm3 (+3.5%, p = 0.04). Average globe volume change for subjects with follow-up scan less than 4.7 hours (mean 1.9 hours; range 0.2-4.5 hours) after mannitol administration was -125 mm3 (-1.7%, p = 0.24) and average orbital volume change was +458 mm3 (+5.1%, p = 0.11). Average globe volume change after mannitol administration for those with follow-up more than 4.7 hours (average 13.9 hours, range 4.9-24.7 hours) was -246 mm3 (-3.3%, p = 0.05) and orbital volume change was +248 mm3 (+2.2%, p = 0.24). Dividing the study population into groups based on mannitol dose did not yield any statistically significant change. Human globe volume decreases after intravenous mannitol administration, while orbital volume increases. These volume changes occur during the time period when intraocular pressure normalizes, after the pressure-lowering effects of the drug. This novel volumetric information improves our understanding of mannitol's mechanism of action and its effects on human ocular and periocular tissues.

Épidémiologie des consultations aux urgences pour une retention aiguë d’urine

Acute urinary retention (AUR) is a common reason for emergency consultation. It may be spontaneous or precipitated and affects both men and women. The purpose of this study was to determine the profile of men visiting emergency departments for an AUR. A retrospective monocentric study including all men who consulted the emergency department between January 2014 and December 2016 for AUR was conducted. In 3 years, 731 patients were admitted for AUR (611 men and 120 women). The mean age was 71.6±14 years with a mean retention volume of 948±668mL drained for 96% of patients (n=584) through a bladder catheter and 4% (n=27) with a suprapubic catheter. Most patients had an urological (66%, n=104) or neurologic (40%, n=242) history and 23% (n=136) already had an episode of AUR. In 28% of cases (n=173), the globe was not painful. A majority of AUR were spontaneous, 53% (n=326) versus 46% (n=279) who were precipitated, secondary to a recent surgical procedure (<1 month) (15%, n=89), hematuria (9%, n=54), or male urinary tract infections (7%, n=42). Patients were treated externally in 71% (n=436), 25% (n=153) were hospitalized with significantly more comorbidities. Men consulting emergency for AUR are 72 years old, with a globe volume of 942mL. Thirty-three percent have a history of BPH, with a prostate treatment like alpha-blockers type. Almost all patients were treated with a bladder catheter and the majority was treated externally. 4.

The validity and reliability of computed tomography orbital volume measurements

PurposeOrbital volume calculations allow surgeons to design patient-specific implants to correct volume deficits. It is estimated that changes as small as 1 ml in orbital volume can lead to enophthalmos. Awareness of the limitations of orbital volume computed tomography (CT) measurements is critical to differentiate between true volume differences and measurement error. The aim of this study is to analyze the validity and reliability of CT orbital volume measurements. Materials and methodsA total of 12 cadaver orbits were scanned using a standard CT maxillofacial protocol. Each orbit was dissected to isolate the extraocular muscles, fatty tissue, and globe. The empty bony orbital cavity was then filled with sculpting clay. The volumes of the muscle, fat, globe, and clay (i.e., bony orbital cavity) were then individually measured via water displacement. The CT-derived volumes, measured by manual segmentation, were compared to the direct measurements to determine validity. Results and conclusionsThe difference between CT orbital volume measurements and physically measured volumes is not negligible. Globe volumes have the highest agreement with 95% of differences between −0.5 and 0.5 ml, bony volumes are more likely to be overestimated with 95% of differences between −1.8 and 2.6 ml, whereas extraocular muscle volumes have poor validity and should be interpreted with caution.

Evisceration With Injectable Hydrogel Implant in a Rabbit Model.

To determine the safety, durability, and biocompatibility of 2.5% polyacrylamide hydrogel (Aquamid, Specialty European Pharma, Ltd., London, UK) as an injectable viscoelastic implant following evisceration in a rabbit model. The protocol was reviewed and approved by the Wake Forest Institutional Animal Care and Use Committee. Adult New Zealand rabbits underwent cornea-sparing evisceration of the right eye with injection of 2.5% polyacrylamide hydrogel implant. The rabbits were sacrificed after 2 weeks (n = 1), 5 weeks (n = 2), 12 weeks (n = 3), 25 weeks (n = 3), and 1 year (n = 3) to evaluate the implant volume and host reaction to the implant. Both eyes were enucleated and their diameters were measured. The eviscerated eyes were fixed in formalin and processed using routine histopathologic methods to assess inflammatory reaction and vascularization. The implant material was well tolerated with a moderate giant cell reaction seen at 6 weeks that improved over time. Extensive vascularization of the implant was noted starting at 6 weeks. There was excellent maintenance of globe volume that did not diminish over time. The relative diameters of the eviscerated eyes compared with control were 89 ± 6% (mean% ± SD) at 12 weeks (n = 3), 94 ± 2% at 25 weeks (n = 3), and 93 ± 4% at 1 year (n = 3). With further study, injectable 2.5% polyacrylamide hydrogel may provide an excellent alternative to solid orbital implants. The implant material was universally well tolerated and maintained appropriate volume in the orbit for the study period of 1 year. Extensive vascularization of the implant was noted indicating biointegration.

Eye Size and Set in Small-Bodied Fossil Primates: A Three-Dimensional Method.

We introduce a new method to geometrically reconstruct eye volume and placement in small-bodied primates based on the three-dimensional contour of the intraorbital surface. We validate it using seven species of living primates, with dry skulls and wet dissections, and test its application on seven species of Paleogene fossils of interest. The method performs well even when the orbit is damaged and incomplete, lacking the postorbital bar and represented only by the orbital floor. Eye volume is an important quantity for anatomic and metabolic reasons, which due to differences in eye set, or position within (or outside) the bony orbit, can be underestimated in living and fossil forms when calculated from aperture diameter. Our Ectopic Index quantifies how much the globe's volume protrudes anteriorly from the aperture. Lemur, Notharctus and Rooneyia resemble anthropoids, with deeply recessed eyes protruding 11%-13%. Galago and Tarsius are the other extreme, at 47%-56%. We argue that a laterally oriented aperture has little to do with line-of-sight in euprimates, as large ectopic eyes can position the cornea to enable a directly forward viewing axis, and soft tissue positions the eyes facing forward in megachiropteran bats, which have unenclosed, open eye sockets. The size and set of virtual eyes reconstructed from 3D cranial models confirm that eyes were large to hypertrophic in Hemiacodon, Necrolemur, Microchoerus, Pseudoloris and Shoshonius, but eye size in Rooneyia may have been underestimated by measuring the aperture, as in Aotus. Anat Rec, 299:1671-1689, 2016. © 2016 Wiley Periodicals, Inc.

Conservative Surgical Management of a Grade III Corneal Dermoid

To present a rare, unique, grade III corneal dermoid treated with conservative surgical management. An 8-month-old boy was admitted to our clinic with a lesion on the central cornea of the right eye and a corneal mass in the left eye. The mass had a skin-like surface and protruded to the outside of the palpebral fissure. MRI (magnetic resonance imaging) of the orbits showed a large cyst covering most of the cornea and the absence of the anterior chamber and lens. The dermoid was excised and sent for histopathological examination. The cornea was reconstructed using the partial thickness scleral graft. The histopathology report confirmed the diagnosis of a grade III corneal dermoid. On examination 1 year after the surgery, the orbital and globe volumes were the same, and the intraocular pressure was normal. This is likely the first report of an unusual case in which a grade III corneal dermoid with an anterior staphyloma was treated by anterior segment reconstruction using an autologous partial thickness scleral graft. We believe that this technique has the advantage that it stimulates orbital and facial development and has good cosmetic results.

Qualitative Insights into GLOBE’s CEO Study of Leadership Behaviour Across Societies

Despite the wealth of information and findings in the three major GLOBE volumes (House et al, 2004; Chhokar et al, 2007; House et al, 2014), numerous questions remain unanswered. While this is to b...

Rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep

The present study aimed to report the occurrence as well as the clinical, laboratorial, pathological and mycological findings of three outbreaks of rhinocerebral and rhinopharyngeal conidiobolomycosis in sheep from Rio Grande do Norte state, Brazil. A total of six sheep with clinical signs of conidiobolomycosis were evaluated, and information on history was obtained from ranchers. Clinical signs included depression, progressive emaciation, sero-sanguinolent nasal discharge, tachycardia, dyspnea, miosis and unilateral exophthalmia with increased ocular globe volume, corneal ulceration and nervous system signs. The main hematological alteration was neutrophilia. Serum biochemical evaluation revealed increased values for AST, GGT, creatinine, urea, and glucose, and decreased total proteins and albumin levels. Cerebrospinal fluid analysis showed the presence of fibrin reticules and pleocytosis. Upon necropsy, longitudinal sections of the head revealed the presence of a nodular mass with a friable consistency and a white-yellowish coloration. Microscopic findings included meningitis, cortex necrosis and encephalitis with the presence of eosinophilic Splendore-Hoeppli substance. Histopathology of the lungs revealed a Splendore-Hoeppli-like material and hyperplasia of alveolar and bronchiolar epithelium. Renal lesions were suggestive of amyloidosis.

Anatomy-Based Surgical Concepts for Individualized Orbital Decompression Surgery in Graves Orbitopathy. I. Orbital Size and Geometry

To analyze orbital morphological parameters that potentially could influence the effect of decompression surgery on exophthalmos reduction in Graves orbitopathy, thus making decompression surgery more predictable. To generate a reference database, a CT-based study was performed in 140 orbits obtained from adult patients with unaffected orbits in a European white ethnicity. The following parameters were chosen: orbital volume, globe volume, globe to orbital volume ratio, and orbital cone angle. Volumes were measured on postprocessed CT data using morphometric techniques. To define the cone angle, a 3-dimensional approach was chosen using the program Amira. Significant interindividual variation was found in orbital volume from 18.9 to 33.4 ml and in globe volume from 6.0 to 10.1 ml. The globe to orbital volume ratio showed a relatively broad variation from 0.25 to 0.4. Differences in the orbital cone angle from 39.7° to 65.7° were observed. The experienced large variations in orbital morphology might significantly influence the degree of exophthalmos reduction, which can be obtained by standardized decompression procedures. Based on our results, a prospective clinical study will be conducted to test our hypothesis.

Tight orbit syndrome: a previously unrecognized cause of open-angle glaucoma: authors reply

hank you for your interest inour article ‘Tight orbit syn-drome: a previously unrecognizedcause of open-angle glaucoma’ (Leeet al. 2010a). We agree it is difficult toprecisely define the mechanism of thissyndrome (Lee et al. 2010b); however,we feel it is related to both eyelid and -orbital factors. Unfortunately, reliev-ing eyelid tension alone is not‘curative’ in these patients. In termsof exophthalmometry, most of thepatients in this series had deeply setglobes, rather than bulging orbits. Theattempt at imaging three of thesepatients did not reveal any consistentrelationship such as a greater axiallength⁄globe volume in a relativelysmall orbital volume. As you suggest,there is much racial variation with nowidely accepted ‘normal’ parameters.We hope that this initial descriptionwill stimulate further case descriptionsand further elucidate this uncommon,but blinding syndrome.

In Vivo Assessment of Postnatal Murine Ocular Development by Ultrasound Biomicroscopy

Purpose: Ultrasound biomicroscopy (UBM) can noninvasively provide anatomical information about mouse ocular structures. We present the quantitation of postnatal murine eye development using UBM.Materials and methods: The eyes from CD-1 mice were examined at 1, 2, 4, 6, and 8 weeks of postnatal development using 40 MHz UBM. Patterns of ocular tissue growth including the lens, globe, and anterior chamber were calculated.Results: Postnatal CD-1 lens and globe volumes are consistent with an exponential decay of growth during the first 8 postnatal weeks. Anterior chamber depth increases most sharply in the first 2 postnatal weeks but continues to increase up to the 8th postnatal week. Anterior segment angle was observed to increase from 1 to 4 weeks.Conclusions: UBM can be used to obtain in vivo quantitative measurements of postnatal murine ocular structures. Our ability to obtain ocular anatomical information will facilitate future assessments of mouse models of human disease.

Stopping Time: The Pro-Slavery and 'Irrevocable' Thirteenth Amendment

In the post-secession winter of 1861, both Houses of Congress approved a proposed thirteenth amendment to the U.S. Constitution. Three northern States even ratified the proposal before the Civil War intervened. That version of the thirteenth amendment, introduced in the House by Representative Thomas Corwin of Ohio, purported to prohibit any future amendment granting Congress power to interfere with slavery in the States. The Congressional Globe volumes for the winter 1861 legislative session include rich debates about whether the amending power could be used to limit future exercise of that same authority. Those forgotten debates offer significant insights for modern controversies about the exclusivity of, and limitations on, the extraordinary power granted in Article V of the U.S. Constitution. Recent years have witnessed an outpouring of academic writing on the amending power. Salient examples of this scholarship are the works of Yale Law School Professors Bruce Ackerman and Akhil Amar, who have raised distinct challenges to the claim that Article V constitutes the sole legitimate means for constitutional revision. Their imaginative and controversial work has in turn prompted vigorous debate among constitutional scholars, political scientists, and historians about the role Article V can and should play in our constitutional order. As voluminous as the recent Article V scholarship has been, at least one fundamental question has gone virtually unnoticed: what, if anything, prevents or limits the use of Article V to make procedural or substantive changes to the amending power itself? This question, which presents problems of the greatest theoretical difficulty, was posed starkly by Mr. Corwin's 1861 proposal. This article uses that Civil War-era proposal as a lens through which to study the tension between the claim that Article V articulates the exclusive procedure by which the Constitution may be amended and our nation's historical commitment to the ideal that the people are sovereign. Revisiting the long-forgotten Corwin Amendment illuminates current debates about the legal and political theory by which the U.S. Constitution can set forth the sole means for its revision. By understanding why the Corwin Amendment would have failed in its stated purpose (because a subsequent Article V amendment would have been sufficient to repeal it and grant Congress power over slavery), we discover certain fundamental constitutional principles. Those principles, important in their own right, also raise novel questions concerning the contemporary claims of Professors Ackerman and Amar that Article V cannot be the exclusive procedure for legitimate constitutional change.

Coats disease: smaller volume of the affected globe.

To determine whether a significant smaller volume of the affected globe, compared with that of the normal globe, is an additional feature of Coats disease. Ocular globe volume was assessed in 13 children (11 boys, two girls; age range, 0.6-14 years; mean age, 4.1 years) with Coats disease and in 18 (eight boys, 10 girls; age range, 0.5-12 years; mean age, 3.6 years) with unilateral retinoblastoma. Orbital computed tomographic scans were available for all children; magnetic resonance images were available for 11 children-seven with Coats disease and four with retinoblastoma. For volume estimation, anteroposterior and equatorial diameters of ocular globes were measured. Statistical analysis was conducted with univariate and multivariate methods. In children with Coats disease, the mean volume of the affected globe was 4,877.03 mm(3) (range, 2,951.47-6,284.70 mm(3)) and that of the normal globe, 6,018.00 mm(3) (range, 4,062.32-7,509.26 mm(3)). In children with retinoblastoma, the mean volume of the affected globe was 4,557.06 mm(3) (range, 1,612.01-7,463.00 mm(3)) and that of the normal globe, 4,402.11 mm(3) (range, 1,360.46- 7,463.00 mm(3)). The Coats disease population had a significantly smaller volume of the affected globe (z = -3.1009; P =.002); the retinoblastoma population did not have a statistically significant trend toward a bigger affected globe volume (z = -1.7064; P =.088). The difference between the affected globe volume and the normal globe volume in children with Coats disease was the only significant independent variable (P =.005). A significantly smaller volume of the affected globe is an additional feature of Coats disease.

Orbital dysmorphology in unilateral coronal synostosis.

Unilateral coronal synostosis (UCS) produces overt craniofacial dysmorphology. UCS surgery in infancy aims to release the osseous restriction and normalize the fronto-orbital deformity. The quantitative effect of this surgery on the orbit and its contents is unknown. This study was conducted to quantify the preoperative orbital dysmorphology and its surgical outcome in patients with unilateral coronal synostosis. Twenty-eight UCS patients had preoperative three-dimensional computerized tomographic (CT) scans (at mean age 4.0 months), cranio-orbital reconstructive surgery (at 4.7 months), and postoperative scans (at 18.1 months). The CT data were analyzed using a computer workstation and AnalyzeTM biomedical imaging software. Four measurements were performed on both ipsilateral (same side as synostosis) and contralateral (opposite to synostosis) orbits of each scan: orbital index (OI, 100 x height/width of orbit), orbital cavity volume (OV), ocular globe volume (GV), and ventral globe Index (VGI, 100 x globe volume ventral to the anterior surface of orbital cavity/GV). The data were analyzed for statistical significance using Student's ttest. Preoperatively, the OI was significantly greater on the ipsilateral than on the contralateral side (113.7 vs. 87.3). There was a significant improvement on both sides of the orbit postoperatively, with ipsilateral 99.1 and contralateral 92.1. However, the difference between both sides remained significant. The OV was smaller in the ipsilateral orbits both pre- and postoperatively, with ipse/contralateral ratios of 95.8 and 95.2, respectively. Importantly, the GV was consistently smaller in the ipsilateral orbits preoperatively, with an ipse/contralateral ratio of 93.3. The ratio increased to 97.1 postoperatively, a statistically significant change. In the ipsilateral orbits, the preoperative VGI was significantly greater. The VGI improved postoperatively. These data indicate that UCS affects the development of the osseous orbit as well as its soft-tissue contents. After cranio-orbital surgery, there is diminution of asymmetry of both the bony orbit and its soft-tissue contents. Partial normalization of orbital dysmorphology occurred during the first postoperative year. UCS surgery in infancy does not prevent growth of orbital hard or soft tissues, and it seems to permit normalization of previously impaired growth.

Orbital Dysmorphology in Unilateral Coronal Synostosis

Unilateral coronal synostosis (UCS) produces overt craniofacial dysmorphology. UCS surgery in infancy aims to release the osseous restriction and normalize the fronto-orbital deformity. The quantitative effect of this surgery on the orbit and its contents is unknown. This study was conducted to quantify the preoperative orbital dysmorphology and its surgical outcome in patients with unilateral coronal synostosis. Twenty-eight UCS patients had preoperative three-dimensional computerized tomographic (CT) scans (at mean age 4.0 months), cranio-orbital reconstructive surgery (at 4.7 months), and postoperative scans (at 18.1 months). The CT data were analyzed using a computer workstation and AnalyzeTM biomedical imaging software. Four measurements were performed on both ipsilateral (same side as synostosis) and contralateral (opposite to synostosis) orbits of each scan: orbital index (OI, 100 x height/width of orbit), orbital cavity volume (OV), ocular globe volume (GV), and ventral globe Index (VGI, 100 x globe volume ventral to the anterior surface of orbital cavity/GV). The data were analyzed for statistical significance using Student's ttest. Preoperatively, the OI was significantly greater on the ipsilateral than on the contralateral side (113.7 vs. 87.3). There was a significant improvement on both sides of the orbit postoperatively, with ipsilateral 99.1 and contralateral 92.1. However, the difference between both sides remained significant. The OV was smaller in the ipsilateral orbits both pre- and postoperatively, with ipse/contralateral ratios of 95.8 and 95.2, respectively. Importantly, the GV was consistently smaller in the ipsilateral orbits preoperatively, with an ipse/contralateral ratio of 93.3. The ratio increased to 97.1 postoperatively, a statistically significant change. In the ipsilateral orbits, the preoperative VGI was significantly greater. The VGI improved postoperatively. These data indicate that UCS affects the development of the osseous orbit as well as its soft-tissue contents. After cranio-orbital surgery, there is diminution of asymmetry of both the bony orbit and its soft-tissue contents. Partial normalization of orbital dysmorphology occurred during the first postoperative year. UCS surgery in infancy does not prevent growth of orbital hard or soft tissues, and it seems to permit normalization of previously impaired growth.

Orbital volume measurements in enophthalmos using three-dimensional CT imaging.

The purpose of this study was to investigate enophthalmos by measuring the volume of various orbital structures using off-line computer techniques on images generated by a CT scanner. Eleven patients with enophthalmos had CT scans of the orbits consisting of 30 to 40 adjacent 1.5-mm slices. The data from the scans were analyzed on a Nova 830 stand-alone computer system using software programs that allowed measurement of total bony orbital volume, total soft-tissue volume, globe volume, orbital fat volume, neuromuscular tissue volume, and apex-to-globe distance in the horizontal plane. These data were analyzed comparing the volumes in the normal eye with the volumes in the enophthalmic eye in each patient. The analysis demonstrated a statistically significant increase in bony orbital volume in the enophthalmic eye, but the total soft-tissue volume, fat volume, neuromuscular tissue volume, and globe volume were the same as in the normal eye. The apex-to-globe distance, a measure of the degree of enophthalmos, was less in the enophthalmic eye than in the normal eye. These results suggest that in the majority of patients, the cause of posttraumatic enophthalmos is increased bony orbital volume rather than by soft-tissue loss or fat necrosis. (Several patients showed no volume discrepancies, and it is likely that cicatricial contracture is responsible for the enophthalmos in these cases.) This study suggests that the objective of surgery for correction of enophthalmos in patients with a volume discrepancy should be to decrease the volume of the bony orbit and to increase the anterior projection of the globe.