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Local choroidal flow has been measured using hydrogen (H2) clearance polarography in dog eyes in vivo and in vitro. The accuracy and reproducibility of the method was checked in the eye in vitro by demonstrating a linear relationship between flow measurements obtained by an absolute method and those obtained by the H2 clearance technique. The H2 electrode was placed through a scleral window and its current response to a bolus injection of H2-saturated saline into a proximal artery was measured. The clearance of H2 from the choroidal circulation in vitro was monoexponential and the reproducibility of the measurements at the same site and in the same eye was good. In vivo the technique was used to measure alterations in local choroidal blood flow produced by acute changes of intraocular pressure. A linear relationship between perfusion pressure and choroidal blood flow was obtained. H2 clearance polarography is shown to be an accurate and reproducible method for determining choroidal flow, with the advantage that localized repeated measurements of flow can be made.

This paper introduces a new method for supplying oxygen directly to ischemic inner retina, using an oxygen source in the vitreous. Acute retinal vascular occlusion was created in cat eyes by direct pressure on the optic disk and its margins with a glass probe. The satisfactory occlusion of the retinal vessels was documented by direct observation, and functionally by recording the ERG. The vascular occlusion caused a large decrease in the size of the ERG b wave, with no change in the a wave amplitude. The oxygen source was a catheter made of strands of an oxygen-permeable membrane which was inserted into the vitreal cavity. After successful vascular occlusion was documented, 100% gaseous oxygen was perfused through the catheter while recording the ERG. In response to the perfused oxygen the b wave partially recovered. Ventilating the animal with 100% oxygen when the retinal vessels were occluded also caused recovery of the b wave amplitude. Termination of the vitreal oxygen source caused a decrease in b wave amplitude to the level previously observed after the occlusion of the retinal vessels. When the retinal circulation was restored by removal of the glass probe the b wave recovered. The results show that it is possible to supply adequate oxygen to the inner retina via the vitreous to replace the oxygen normally supplied by the retinal circulation. Modification of this method may be useful for the treatment of recent and incomplete retinal vascular occlusion.

A new technique, using the principle of dialysis, enables continuous determination of the concentration of compounds within the vitreous humor of the eye. A semipermeable catheter inserted into the cat vitreous cavity was continuously perfused with a normal saline solution. Gentamicin concentration in the dialysate, after subconjunctival or intravitreal injection, was used to calculate gentamicin concentration in the vitreous from the catheter's recovery ratio, as calibrated in vitro. After subconjunctival injection, no gentamicin was detected in the vitreous for up to eight hours. From four to eight hours after intravitreal injection of approximately 100 micrograms of gentamicin sulfate, its vitreal concentration ranged from 30 to 80 mg/L and from nine to 16 hours it fell from 26 to 22 mg/L. This method may prove useful for the study of the pharmacokinetics of many drugs and metabolites in the eye.

A novel device for the continuous intraocular delivery of drugs is described. The active intraocular component of the device is made from hollow haemodialysis fibres. During operation, the drug to be administered diffuses from a small extraocular reservoir to the intraocular fibres, where it passes through the semipermeable walls and into the vitreous body. The delivery of gentamicin by the device into the vitreous body of the cat is compared with direct intraocular injection techniques. Characteristics of the process of drug delivery were influenced by the geometry and design of the device. A reservoir concentration of 10 g/L gentamicin sulphate in a device with four fibres, each 5 mm long, resulted in stable vitreal gentamicin levels of 104 to 128 mg/L at 10 hours. Intravitreal injection of 0.1 ml of a 10 g/L solution of gentamicin caused localised peaks of intravitreal gentamicin concentration in the range 1180 to 3296 mg/L, before falling to 356 to 665 mg/L at 10 hours. The device provides the opportunity of a more controlled and continuous drug delivery, thus avoiding the high localised concentrations that may occur with direct injection techniques in which the required dose is delivered as a bolus. Refinement of a device of this type may result in a clinically useful method of intraocular drug delivery for drugs which present a risk of localised retinal toxicity or require repetitive administration with conventional intraocular injection techniques.

Intravitreal drug administration is the treatment of choice for bacterial endophtalmitis, but improved knowledge of vitreal pharmacokinetics is essential for the development of optimal antibiotic regimes. We used our recently developed sampling device to estimate vitreal gentamicin concentrations for up to 30 hr after an intravitreal bolus injection of gentamicin. The device is based on the principle of dialysis, whereby a constant flow rate of dialysate through a loop of dialysis fiber in the vitreous attains a gentamicin concentration proportional to the intravitreal gentamicin level around the fiber. The dialysate is continuously recovered and the collected samples then assayed for gentamicin. Normal cat eyes and those with induced bacterial endophthalmitis formed the two groups tested. Concentration-time data fitted well to an open single compartment pharmacokinetic model that incorporated the processes of transfer of drug from the injection site to the sampling site (a function of diffusion within the vitreous), and the elimination from the sampling site (a function of elimination from the vitreous). The initial phase of transfer between the injection and sampling site was rapid and rates were comparable in the two groups. Elimination rate constants were uniformly greater in infected eyes than in controls (0.107 hr-1 compared to 0.055 hr-1). Aqueous humor gentamicin concentrations in control eyes varied between 3 and 6 times those found in fellow infected eyes at the end of each experiment. Accelerated elimination of gentamicin from the vitreous body of eyes with endophthalmitis may be explained by increased permeability of the blood-retinal barrier.

The isolated arterially perfused eye preparation has proven to be comparable to the in vivo model in many respects. However, the existence of "supernormal" b-wave amplitudes in the perfused eyes has remained an unexplained functional difference between the two preparations. The term "supernormal" reflected the observation that at high perfusate flow rates the amplitude of the b-wave from the perfused eyes was frequently larger than that recorded in vivo under the same stimulus and adaptation conditions. Recent investigations in this laboratory have demonstrated that the position of the scleral electrode on the isolated eye greatly influences the amplitude of the b-wave obtained. The simple comparison of b-wave amplitudes in vivo and in vitro was therefore not appropriate, due to the different electrode locations used in the two situations. In addition, the relationship between perfusate flow rate and b-wave amplitude at a fixed location has been reinvestigated. In our perfusion system the b-wave amplitude has been shown to saturate at moderate flow rates (1.5 ml/min), considerably lower than those required to maximize the b-wave amplitude in earlier studies. This difference is due to the higher oxygen tension of our perfusate at the entry point to the eye. It is concluded that b-wave stability with increasing perfusate flow can be achieved in vitro, and that the apparently supernormal b-wave amplitudes observed under these conditions can be explained in terms of the different electrode environment in the in vivo and in vitro preparations. The implications of these findings with regard to autoregulation of the retinal circulation are discussed.