Clinical experience with the single-plate Molteno implant in complicated glaucomas

Ninety patients with medically uncontrollable glaucomas and poor surgical prognoses received single-plate Molteno implants (Optomat Supplies, Dunedin, New Zealand) without postoperative adjunctive systemic antifibrosis therapy. Eleven patients had insufficient follow-up for assessment of intraocular pressure (IOP) or visual acuity outcome. The initial Molteno implant procedures in the remaining 79 patients were successful (IOP less than or equal to 21 mmHg with at least 6 months' follow-up) in 26 (63%) of the 41 patients older than 12 years of age with non-neovascular glaucomas in aphakia/pseudophakia; 7 (70%) of the 10 patients older than 12 years of age with non-neovascular glaucomas in phakic eyes after failed filtering surgery; 7 (47%) of the 15 patients with neovascular glaucomas; and 7 (54%) of the 13 patients younger than 13 years of age with non-neovascular glaucomas. The visual acuities remained within one line of their preoperative levels or improved in 31 (76%) of the 41 aphakic or pseudophakic eyes with non-neovascular glaucomas; 3 (30%) of the 10 phakic eyes with non-neovascular glaucomas after failed filtering surgery; 10 (67%) of the 15 eyes with neovascular glaucomas; and 9 (100%) of the 9 eyes with non-neovascular glaucomas in patients younger than 13 years of age on whom Snellen acuity was available.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic factors and postoperative course following single-plate Molteno implantation

We evaluated potential preoperative and early postoperative prognostic indicators for chronic intraocular pressure control in 38 consecutive glaucoma patients undergoing singleplate Molteno implantation. Six months following surgery 22 patients had an intraocular pressure 18 mm Hg and were considered successes. Twelve patients had an intraocular pressure > 18 mm Hg and were considered failures. Factors such as age, race, sex, type of glaucoma, phakic status, eye treated, intraocular pressure, bleb elevation, or number of glaucoma medicines were not significantly related to postoperative intraocular pressure control (p > 0.05). Postoperatively a significant difference in intraocular pressure was not observed between success and failure groups until three (13.8 ± 5.4 versus 20.8 ± 6.4 mm Hg,p = 0.010) and six (11.2 ± 3.3 mm Hg versus 21.2 ± 1.2 mm Hg,p < 0.001) months. Approximately 50% of patients who had an intraocular pressure > 20 mm Hg and 75% of those who measured < 20 mm Hg at any given examination in the early postoperative period were controlled six months postoperatively. Patients controlled at six months maintained control for as long as 43 months postoperatively. This study indicates that in the early postoperative period after a single-plate Molteno implant some patients have an ocular hypertensive phase but may ultimately be controlled, whereas most patients with an intraocular pressure within the normal range maintain control long-term.     

Results of scleral buckling operations in primary rhegmatogenous retinal detachment

Within the scope of a Retinal Fellowship of one year, we evaluated the anatomic and functional results of scleral buckling operations in primary rhegmatogenous retinal detachments. Eighty Consecutive non-selected patients with a primary retinal detachment were operated by one surgeon (Retinal Fellow-ELH). In 55 eyes an encircling band and radial buckle(s) were placed, the other 25 eyes were treated with a segmental buckle or a combination of both. In 62 eyes subretinal fluid was drained, and in 57 eyes air or SF-6 gas was injected. The anatomic success rate after one operation was 81% (65/80 eyes) and the final success rate was 99%. 38/65 (58%) of the eyes obtained a best corrected post-operative visual acuity of 0.4. The most important cause of re-detachment was Proliferative vitreoretinopathy (PVR; 11%). Pre-operative variables that yielded an unfavourable outcome in this study were: PVR, pseudophakic eye, larger breaks, more than one break, longer duration of the detachment, and 3 or more quadrants of detachment. Our anatomic success rate and risk factors are in agreement with findings described in the literature, yet we had a high rate of PVR and many patients with a low visual acuity (58% 0.3) pre-operatively.     

Diode laser photocoagulation for stage 3+ retinopathy of prematurity

Background: Laser photocoagulation in retinopathy of prematurity (ROP) appears to have fewer adverse effects than cryotherapy and seems to be at least as effective. Methods: To evaluate the efficacy and safety of diode laser photocoagulation, we included 42 eyes with stage 3+ ROP of 24 preterm infants (gestational age 24–29 weeks, mean ± SD 26.6 ± 1.3 weeks; birth weight 480–1400 g, 896 ± 196 g) in a prospective clinical study. Photocoagulation treatment was performed using a diode laser (810 nm) with a laser indirect ophthalmoscope delivery system. Follow-up ranged from 3 to 16 months (8.8 ± 4.0 months). Results: In 39 (93%) of 42 eyes ROP regressed after a single laser treatment and the outcome was a flat, attached retina. One eye (2%) had a second laser session and another eye (2%) had additional retinal detachment surgery, resulting in the regression of ROP and a flat, attached retina. Thus, the success rate was 41 (98%) out of 42 eyes. In one (2%) of the 42 eyes treatment failed and ROP progressed to stage 5, although additional retinal detachment surgery was performed. No adverse side effects of diode laser treatment were noticed except for a small amount of retinal/preretinal bleeding in the ridge in five eyes (12%) and a small postoperative anterior chamber hemorrhage in one eye (2%) with dense tunica vasculosa lentis. Neither lenticular opacities nor cataract formation were encountered. Conclusion: Diode laser photocoagulation for stage 3+ ROP showed only minor side effects and was at least as effective as cryotherapy treatment.     

Combined Phacoemulsification, Intraocular Lens Implantation and Trabeculectomy for Chronic Angle Closure Glaucoma

Purpose: To investigate the results of combined phacoemulsification, intraocular lens implantation and trabeculectomy in Asian patients with chronic angle closure glaucoma (CACG). Methods: This was a retrospective non-comparative case series of 55 consecutive patients (57 eyes) who underwent phacoemulsification, posterior chamber intraocular lens implantation and trabeculectomy for CACG at the Singapore National Eye Centre between 1997–1998. The surgical outcome was assessed in terms of intraocular pressure (IOP), the incidence of complications and the visual acuity at last follow-up. Success was defined as final IOP 21 mmHg without medication and qualified success as final IOP 21 mmHg with medication. Patients with final IOP > 21 mmHg who required further glaucoma surgery, lost light perception or became pthisical, were classified as failures. The eyes were further categorized into two groups according to whether single-site or separate-sitesurgery was performed. The outcome was also compared among eyes in which per-operative antimetabolites were applied to the trabeculectomy site and those without antimetabolites. Results: The mean follow up was 22.0 ± 5.6 months (mean ± SD). Success was achieved in 46 (81%) eyes, qualified success in 10 (17%) eyes, and failure in 1 (2%) eye. In terms of IOP outcome, the success rate was similar in the two surgical groups (single-site or separate-site).There was no significant difference in IOP outcome among eyes in which per-operative antimetabolites were used and eyes with no per-operativeantimetabolites use. Forty-one eyes (72%) had 6/12 or better vision. There were no cases of intraoperative complications and the incidence of postoperative complications was low. Conclusions: Combined phacoemulsification, intraocular lens implantation and trabeculectomy is associated with good intraocular pressure control and visual outcome in patients with CACG.     

Baerveldt implant in refractory glaucoma: long-term results and factors influencing outcome

Purpose: To evaluate the clinical outcome of patients who received aBaerveldt implant for refractory glaucoma and to identify factors which mayinfluence the outcome. Methods: Retrospective study including 51 eyesof 51 patients with medically uncontrolled glaucoma who underwent Baerveldtimplant surgery between June 1994 and December 1998. Criteria for successwere intraocular pressure (IOP) 21 mmHg and >6 mmHg, necessityof further antiglaucoma medications, absence of additional glaucoma surgeryand no loss of light perception. Results: Over a mean follow-up of 37.6(SD: ± 18.8) months, the mean intraocular pressure decreased from 34.8(±12.5) mmHg to 14.0 (±4.3) mmHg at month 60. Qualified successrate, achieved when IOP was below 21 mmHg and higher than 6 mmHg withmedications was 25/48 (52%), complete success rate (same IOP limits withoutmedication) was 14/48 (29%). Seven eyes had major complications or lostlight perception. Postoperative visual acuity improved or remained within oneSnellen line of the preoperative visual acuity in 35 patients (73%). Factorsassociated with a better prognosis were a preoperative visual acuity better than 20/400 and etiology of glaucoma. Conclusion: The Baerveldt implant iseffective in lowering intraocular pressure in most patients with refractoryglaucoma. Long-term results are promising with satisfactory IOP control.     

Pulsatile Ocular Blood Flow: Changes Associated with Scleral Buckling Procedures

Purpose To determine the changes in the pulse amplitude (PA) and the pulsatile ocular blood flow (POBF) after scleral buckling (SB).Methods Retrospectively, we studied 24 patients (average age, 52 years) who had undergone SB to repair a retinal detachment in one eye. The patients were divided into two groups: those in whom SB had been performed less than 6 months earlier (n = 10), and those in whom the procedure had been performed more than 6 months previously (n = 14). In each group, the PA and the POBF were determined with a computerized tonometry system, and the values in the SB eyes were compared with those in the control fellow eyes.Results Within 6 months postoperatively, the mean PA in the SB eyes (0.66 ± 0.30mmHg) was significantly lower than that in the control eyes (1.43 ± 0.34mmHg; P < 0.05). The mean POBF in the SB eyes (349.5 ± 154.1µl/min) was also significantly lower than that in the control eyes (631.0 ± 226.6µl/min; P < 0.05). After more than 6 months postoperatively, there were no significant differences in the PA or the POBF between the SB eyes (1.08 ± 0.49mmHg and 612.4 ± 341.2µl/min, respectively) and the control eyes (1.50 ± 0.51mmHg and 589.5 ± 278.4µl/min, respectively).Conclusions These results indicate that the choroidal blood flow decreases after SB but returns to normal levels after 6 months. Jpn J Ophthalmol 2005;49:162–165 © Japanese Ophthalmological Society 2005     

5-Fluorouracil and glaucoma filtering surgery. III. Intermediate follow-up of a pilot study

Ninety-five patients (104 eyes) were enrolled in a pilot study of subconjunctival 5-fluorouracil (5-FU) injections after filtering surgery in eyes with poor surgical prognoses. At least a six-month follow-up was available on 84 patients, of whom four were excluded from the analysis of surgical outcome because they suffered retinal detachments within six months of their filtering surgery. The initial 5-FU procedures on the remaining 80 patients were successful (no further glaucoma surgical procedures were either performed or recommended, and the intraocular pressures [IOPs] were either 21 mmHg or lower with ocular hypotensive medication[s] or 25 mmHg or lower without ocular hypotensive medication) in 33 (68%) of the 48 aphakic eyes with non-neovascular glaucomas, 13 (81%) of the 16 phakic eyes with non-neovascular glaucomas after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with neovascular glaucoma (NVG). The follow-up on the successful eyes ranged from 6 to 34 months (mean +/- SD = 18.5 +/- 7.5). The visual acuities remained within one line of their preoperative levels or improved in 38 (79%) of the 48 aphakic eyes with non-neovascular glaucoma, 11 (69%) of the 16 phakic eyes with non-neovascular glaucoma after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with NVG. The initial 5-FU procedures on the 104 eyes were complicated by the following: corneal epithelial defects (50%); conjunctival wound and suture tract leaks (36%; 2% underwent surgical repair); suprachoroidal hemorrhages (9%); retinal detachments (3%); subepithelial corneal scarring (3%); endophthalmitis (2%); and malignant glaucoma (1%). It is the authors' impression that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control after filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this impression.     

Glaucoma drainage tubes — their role in glaucoma management

The results are presented from 100 eyes operated upon with either the ACTSEB procedure or a one piece tube and plate that have been followed for >12 months. An intraocular pressure control was considered successful if <21 mm Hg.The success varied according to the diagnostic category and its type of operation. One third of the total group did not require antiglaucomatous medications. Higher success rates were found in the one piece than the ACTSEB procedure. Overall success rates at 18 months per diagnostic group ranged between 41% in the neovascular glaucomas to 83% in the chronic simple glaucomas.     

Prevention of hypotony after trabeculectomies with mitomycine

Hypotony with reduced a reduced visual acuity is often seen after trabeculectomy with mitomycine. In this study we describe measures such as reattaching the sleral flap with at least seven nylon sutures and the controlled and delayed use of argon laser suture lysis. With these preventative measures the percentage of hypotonies (IOP 6 mmHg) three months after surgery was reduced from 38 to 15% and chronically reduced visual acuity was reduced from 38 to 5%. With these adaptations in the surgical technique the complication rate of trabeculectomies with mitomycine can be markedly reduced without affecting the mean IOP (10.9 mmHg versus 10.8 mmHg) three months after surgery and the percentage of eyes with IOP 18 mmHg or less without medication (94 versus 91%).     

Non-penetrating deep sclerectomy (NPDS) with or without collagen device (CD) in primary open-angle glaucoma: middle-term retrospective study

The purpose of this study is to evaluate the middle-term tonometric results of a new filtering procedure, the non-penetrating deep sclerectomy with or without collagen device, in primary open-angle glaucoma. This technic aims to eliminate or minimize the complications of classical trabeculectomy. Method: This procedure was carried out by Koslov and colleagues. This is performed under a limbal-based conjunctival flap and a superfical scleral flap, the ablation of a deep scleral flap taking away the external wall of Schlemm's canal, only living in place the Descemet membrane. One must obtain a visible filtration across the opened Schlemm's canal and Descemet membrane. To improve the aqueous filtration, a cylindric collagen device, made from porcine scleral tissue, biocompatible, known for its high water content, is fixed in the deep scleral bed with a 10/0 nylon suture. This device provides a support for the elimination route of aqueous humor and acts like a sponge, carrying the liquid by capillary action. It is sterilized by irradiation. Full guarantee against viral contamination is provided. This procedure ends in one suture (10/0 nylon) of superficial scleral flap and conjunctival closing suture. When NPDS is performed without CD, a sponge of 5FU is used and the superficial scleral flap is not sutured. Retrospective study: Our material included 111 patients, 148 eyes in CD group; 43 patients, 55 eyes in the group without CD. The average follow-up was 13.3 ± 5.8 months in the CD group, 7.2 ± 3.5 months in the group without CD. All patients presented a POAG without risk factors of bleb failure. Results: The average IOP before the operation and at the end of the follow-up period was 7.2 ± 6.3 mmHg in the CD group; 8.3 ± 7.6 mmHg in the group without CD (no significant difference). The probability-success rate with the Kaplan-Meier method (IOP 20 mmHg) was, in the CD group, at 18 months, 68% and 69% in the group without CD, without medical treatment. With monotherapy, the success rate was 85% in the CD group, 74% in the group without CD (p 0.05). Prospective study: Afterwards, we have conducted a prospective study comparing two groups of patients with POAG without risk factors of bleb failure, operated with and without collagen device, without 5FU in the second group. Our material included 31 patients, 31 eyes, one eye for each patient, two surgeons; 17 eyes in the CD group, 14 eyes in the group without CD. The average age was 65.8 ± 8.2 years in the first group; 64.1 ± 10.3 in the second group. The average follow-up was 11 months in both groups. Results: A average IOP was 8.3 ± 5.8 in the CD group; 12.3 ± 6 in the group without CD (p < 0.05). The probability-success rate without treatment at 12 months: 58% in the first group, 90% in the second group (p < 0.05) and with monotherapy: 80% and 90% (N.S.). In both studies, in both groups, except microperforations, more frequent in the prospective group without CD, no complications of the trabeculectomy were observed. The mean change in visual acuity was inferior to 0.1 at the end of the follow-up. A postoperative rise in IOP can occur. It can be due to an internal obstruction (goniosynechiae or bad filtration). It can be treated with Nd-Yag laser. It can also be due to external obstruction, treated by 5FU injections into the bleb. The success of these procedures were similar in the whole group. Conclusion: Non penetrating deep sclerectomy can be considered as an excellent alternative to trabeculectomy in open and wide angles. It does not modify visual acuity. It carries away less complications than trabeculectomy and the use of antimitotic agents is safer. Collagen device does not seem, at middle-term, to improve tonometric results.     

Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto,Japan

Background: The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan. Methods: The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area. Results: From a population of 1 840000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment — nontraumatic phakic, aphakic, and blunt trauma — were 9.8, 0.5, and 0.2 per 100000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes. Conclusion: Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.     

Silent myocardial ischemia in glaucoma and cataract patients

Background: Glaucoma and cataract are multifactorial diseases. They have been described to be associated with cardiovascular risk factors. Methods: Twentyfour-hour ECG monitoring was done in 22 normal-tension glaucoma patients, 27 open-angle glaucoma patients, 25 cataract patients, and 20 normal controls. The frequency of silent myocardial ischemia (SMI) as well as that of ventricular extrasystoles (VES) was evaluated. Results: At least one episode of significant asymptomatic ST-T segment depression occurred in 45% of the normal-tension glaucomas, in 25.9% of open-angle glaucomas, in 12% of cataract patients, and in 5% of normal controls. The frequency of VES was not significantly different among the groups. Conclusions: Glaucoma, especially normal-tension glaucoma, is significantly associated with the occurrence of episodic asymptomatic myocardial ischemias. Cataract patients, however, had only a slightly, statistically not significantly increased frequency of both SMI and VES compared with normals.     

Neuroendocrine alterations in uveitis patients

Experimental models of autoimmune uveitis are consistently associated with pinealitis. To investigate the interaction between the neuroendocrine and immune systems in humans with uveitis, we measured serum levels of the predominant pineal hormone melatonin (MEL), prolactin (PRL) and interleukin-2 (IL-2). A total of 100 patients with different forms of uveitis and 30 age-matched, healthy blood donors were evaluated retrospectively. The day-time MEL was reduced significantly (P 0.01) in patients with iritis and iridocyclitis, and highly significantly (P 0.001) in patients with intermediate uveitis, chorioretinitis and panuveitis. In 38% of patients day-time MEL levels in plasma were below the limit of detection. PRL was significantly reduced (P <0.01) in patients with intermediate uveitis. IL-2 was reduced to about 50% of control values in all groups of patients. The results suggest a possible neuroendocrine-immune interaction in uveitis patients.     

Anterior chamber inflammation after transconjunctival cryosurgery

Background: Inflammation caused by transconjunctival cryotherapy for prophylactic retinal detachment surgery was measured in various conditions. Methods: Thirty-four eyes of 28 patients with peripheral retinal lesions predisposing to retinal detachment were studied by laser flare cell meter before and after treatment. Results: The mean flare value for 34 eyes was 4.06 ± 1.45 photon counts/ms before surgery and 5.72 ± 2.52 pc/ms after surgery (p < 0.05). Flare value was elevated at 1, 2, and 3 weeks after treatment, peaking at 2 weeks (p < 0.05), and normal again at 4 weeks. There were no significant differences in flare increase between eyes with and without retinal breaks, eyes with and without limited retinal detachment, eyes with myopia more and less than – 8.0 D, and eyes with a treatment area limited to one quadrant and extending over more than one quadrant. Conclusion: Transconjunctival cryosurgery caused mild inflammation in the anterior chamber of the eye for 3 weeks. The inflammation was not affected by the presence of retinal break or limited retinal detachment, the degree of myopia, or the extent of the treatment area.     

The effect of thalidomide and supidimide on endotoxin-induced uveitis in rats

Background: Endotoxin-induced uveitis (EIU) is an animal model of ocular inflammation, produced by footpad injection of endotoxin (lipopolysaccharide, LPS) to mimic the human disease of acute anterior uveitis, that is useful for testing new anti-inflammatory therapy. The purpose of this study was to test the anti-inflammatory effect on EIU of thalidomide and one of its derivatives, supidimide. Methods: EIU was produced in rats by hind footpad injection of LPS (100 g/animal). Animals were killed 20 h after LPS injection. Inflammation was evaluated by anterior chamber determination of proteins and cells. Results: A dosage of 400 mg/kg per day of thalidomide was efficient in reducing inflammation whether given in three doses (at – 24 h, – 4 h and + 4 h relative to LPS challenge = THAL-1; p < 0.001 for proteins and cells), in two doses (–4 h and +4 h = THAL-2; p < 0.001 for proteins, p < 0.012 for cells) or in one dose (at +4 h=late THAL; p < 0.001 for proteins, p0.02 for cells). A dosage of 300 mg/kg per day of thalidomide was still efficient (p0.023 for proteins, p0.06 for cells), but 150 mg/kg per day had no effect on inflammation. Supidimide (400 mg/kg per day) had some anti-inflammatory effect (p 0.053 for proteins, p < 0.06 for cells). Conclusion: High-dose thalidomide had a potent anti-inflammatory effect in EIU, but lower doses were not sufficient to reduce inflammation. At similar high doses, supidimide had some effect on EIU but was less effective than thalidomide.These data were presented in part at the first annual ECORA meeting, 4–6 October, 1993, Bonn, Germany     

Corneal Thickness in Eyes Following Pars Plana Lensectomy for Congenital Cataracts

Purpose To evaluate the corneal thickness following pars plana lensectomy for congenital cataracts.Methods The corneal thickness was measured in 24 eyes of 24 patients with congenital cataracts who had undergone pars plana lensectomy at a mean age of 24 ± 32 (SD) months. The mean age at the time of our evaluation was 15 ± 3 years. These measurements were compared with those in 15 eyes of an age-matched group of 15 normal volunteers. The central corneal thickness and endothelium were evaluated in both groups.Results The mean corneal thickness of the cataract-extracted eyes (592 ± 47µm) was significantly greater than that of the controls (529 ± 43µm; P 0.00l). There was no significant difference in the corneal endothelial cell count between cataract-extracted eyes (3420 ± 715/mm²) and the controls (3182 ± 358/mm²; P = 0.49). However, there were significant differences in the frequency of hexagonally shaped endothelial cells (63% ± 8.4%, cataract-extracted eyes; 70% ± 7.7%, controls; P 0.0l), and in the coefficient of variation in the endothelial cell size (33 ± 6.0, cataract-extracted eyes; 26 ± 4.8, controls; P 0.01).Conclusion The central cornea of congenital cataract-extracted eyes was significantly thicker than that of controls. Jpn J Ophthalmol 2004;48:169–171 © Japanese Ophthalmological Society 2004     

Electroretinography in central retinal vein occlusion

In 149 eyes with central retinal vein occlusion (CRVO), we prospectively investigated the role of routine, clinical electroretinography (ERG) in differentiating ischemic (60 eyes) from nonischemic CRVO (89 eyes). Single-flash photopic and scotopic ERGs were recorded. Data for the amplitudes and implicit times of a- and b-waves and for the b-/a-wave amplitude ratio were analyzed in detail. The study revealed that the best ERG parameter (for both photopic and scotopic ERG) for differentiating ischemic from nonischemic CRVO was a subnormal b-wave amplitude (reduced to 60% or by 1 SD from the normal mean value, or 64%–69% of that in the fellow normal eye), with a sensitivity of 80%–90% and a specificity of 70%–80%. ERG findings were correlated with the relative afferent pupillary defect (RAPD). An RAPD of 0.7 log units showed a sensitivity of 88% and a specificity of 90% in differentiating ischemic from nonischemic CRVO. ERG and RAPD findings showed a good correlation. The combined ERG and RAPD tests could differentiate 97%–100% of ischemic from nonischemic CRVO cases, with a specificity of about 70%.Presented in part at the Annual Meeting of the Association for Research in Vision and Ophthalmology, Sarasota, Florida, USA, 2 May 1988Supported by grant EY-1151 from the National Institutes of Health, and in part by unrestricted grants from Research to Prevent Blindness, Inc., and from Alcon Research Institute     

Einfluss von TGF-β<Subscript>2 </Subscript>auf die Phagozytose im bovinen Trabekelwerk

ZusammenfassungZiele der Arbeit Gegenstand dieser Untersuchungen waren die Bestimmung der In-vitro-Effekte von TGF-₂ (Transforming Growth Factor-₂) auf die Phagozytose in kultivierten bovinen Trabekelwerkszellen.Methoden Trabekelwerkszellen wurden aus dem Rinderauge isoliert, in Zellkultur kuliviert und mit unterschiedlichen physiologischen TGF-2 Konzentrationen (0 ng TGF-2/ml Medium [Kontrolle], 0,32 ng/ml, 1,0 ng/ml, 3,2 ng/ml) für 24 Stunden behandelt. Zum Inkubationsmedium wurden Latexkugeln (Beads) gegeben und die Zahl der eingeschlossenen Beads in 20 angrenzenden und benachbarten Zellen nach einer Wright-Färbung unter dem Mikroskop gezählt.Ergebnisse Die durchschnittliche Anzahl der eingeschlossenen Beads in den mit TGF-2 behandelten Trabekelwerkzellen waren in allen 3 Behandlungsgruppen signifikant erhöht (53,1±1,7 Beads/Zelle, 56,4±2,9 Beads/Zelle und 77,9±6,5 Beads/Zelle) im Vergleich zur nicht behandelten Kontrolle (45,5±3,3 Beads/Zelle), TGF-2 erhöhte signifikant in Abhängigkeit der eingesetzten Konzentration die Phagozytoserate in den kultivierten Trabekelwerkzellen.Schlussfolgerung Zusammenfassend ist zu sagen, dass TGF-2 in vitro die Phagozytoserate der kultivierten Trabekelwerkzellen erhöht. Im Weiteren kann TGF-₂ beim zellulären Abbau der Trabekelwerkzellen im Krankheitsbild des primären Weitwinkelglaukoms beitragen, durch eine Unterstützung der lokalen Phagozytoserate. Ob es der Schlüssel zur Behandlung des grünen Stars ist, müssen weiterführende Untersuchungen klären.

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Prognostic importance of retinopathy in acute leukemia

This prospective study evaluates the relationship, between the fundus findings in leukemic retinopathy and the survival in patients with newly diagnosed acute leukemia. Fifty-four newly diagnosed consecutive patients with acute leukemia were included in this study. The patients were examined within few days of initial admission and diagnosis. Leukemic retinopathy was detected in 19 (35%) patients. The observation period ranged from 434 days to 1220 days (mean ± SD 880 ± 225) for those patients who survived. Despite similar chemotherapy regimens, the mean and median survival times were shorter in patients with retinopathy compared to those without retinopathy (332.4 ± 99.6 and 76 vs. 640.7 ± 106 and 192 days respectively) although survival did not differ significantly (p=0.073). Patients with cotton-wool spots had lower mean and median survival times than did those without such lesions (168.8 ± 70.9 and 27 vs. 609.4 ± 91.4 and. 289 days respectively) and survival differed significantly (p=0.04). The presence of cotton-wool spots and age 40 years were the major adverse prognostic factors for survival in multivariate analysis. Cotton-wool spots had a more significant adverse prognostic effect than age 40 years (hazard function coefficients: 1.0708 for cotton-wool spots vs. 0.0355 for age 40 years). The relative odds of dying among patients with cotton-wool spots were about 8 times higher than that for those without this feature, and about 7 times higher in patients aged 40 years than that for patients aged <20 years. Our findings suggest that the presence of leukemic retinopathy in general, and cotton-wool spots, in particular is a poor prognostic sign for survival in acute leukemia.