[Intravitreal administration of triamcinolone and bevacizumab for pigment epithelial detachment in conjunction with AMD]. / Intravitreales Triamcinolon und Bevacizumab bei Pigmentepithelabhebung im Rahmen der AMD.

BACKGROUND: The effect of the vascular endothelial growth factor (VEGF) inhibitors triamcinolone and bevacizumab (Avastin) on serous pigment epithelial detachment (PED) related to age-dependent macular degeneration (AMD) was analysed retrospectively. PATIENTS AND METHODS: Data of 45 patients (45 eyes) were evaluated: 11 patients received an intravitreal injection with triamcinolone and 16 with bevacizumab. The remaining 18 patients received no therapy. Visual acuity (VA), height of the PED, retinal thickness and the cystoid component of the PED were compared after 6 months follow-up. RESULTS: Over 90% showed a stabilisation or improvement in VA after bevacizumab therapy; 63% of those who received triamcinolone showed VA stabilisation. Patients who received no therapy had a significant decrease in VA. CONCLUSIONS: Our data seem to implicate that VA outcome is much better after bevacizumab treatment. VA outcome seems to correlate with the cystoid component of the foveal oedema rather than with the height of PED. A greater number of patients with a longer period of follow-up are necessary to confirm these results.

[Comparison of ILM peeling with and without the use of indocyanine green. Functional results for idiopathic macular hole after pars plana vitrectomy]. / Vergleich des ILM-Peelings mit und ohne Einsatz von Indozyaningrün. Funktionelle Ergebnisse bei idiopathischem Makulaforamen nach Pars-plana-Vitrektomie.

BACKGROUND: Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the best known therapy for idiopathic macular holes. Indocyanine green (ICG) is useful for staining the ILM, although there is a dose related toxic effect on the inner retinal layers. We compared outcome results with and without the use of ICG. METHOD: Data from 61 patients with idiopathic macular holes, who underwent macular hole surgery were analyzed retrospectively. ICG was used on 36 eyes while for 25 eyes it was not used. After calculating logMAR, differences in visual acuity between both groups were analyzed for significance using the Mann-Whitney-U-Test. RESULTS: The logMAR for the entire group was 0.71+/-0.30 (20/100) preoperatively, after 1 month 0.71+/-0.36 (20/100), after 3 months 0.57+/-0.26 (20/80), after 6 months 0.54+/-0.38 (20/66) and after 12 months 0.36+/-0.32 (20/50). There were no significant differences between groups. CONCLUSION: There seem to be no significant differences in the development of visual acuity and the occlusion rate between patients treated with or without the use of ICG.

[Selective retina therapy in central serous chorioretinopathy with detachment of the pigmentary epithelium]. / Selektive Retina-Therapie bei Retinopathia centralis serosa mit Pigmentepithelabhebung.

BACKGROUND: Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT. METHODS: This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (lambda=527 nm, t= 1.7 s, 100 Hz, energy = 150-250 J). RESULTS: Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks. CONCLUSION: SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood-retina barrier.

[Diagnostics of metamorphopsia in retinal diseases of different origins]. / Diagnostik von Metamorphopsien bei Netzhauterkrankungen unterschiedlicher Genese.

We investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the chi(2)-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.

[Selective retina therapy in patients with diabetic maculopathy]. / Selektive Retina-Therapie bei Patienten mit diabetischer Makulopathie.

Selective Retina Therapy (SRT) is a new laser treatment that selectively targets the retinal pigmen epithelium (RPE). In this study, we treated 39 patients presenting with nonischemic, focal and focal-diffuse diabetic maculopathy with SRT. In the main. the results indicate that SRT had stabilizing effects on visual acuity, angiographic leakage, lipid exudation, and foveal retinal thickness. SRT is safe and is especially useful for treating pathologies that are located close to the fovea, which cannot be treated with conventional argon laser photocoagulation.

Intron-specific RNA binding proteins in the chloroplast of the green alga Chlamydomonas reinhardtii.

Mitochondria and chloroplasts both contain group II introns which are believed to be the ancestors of nuclear spliceosomal introns. We used the mitochondrial group II intron rI1 from the green alga Scenedesmus obliquus for biochemical characterization of intron-specific RNA binding proteins. rI1 is correctly spliced from a chloroplast precursor RNA when integrated into the chloroplast genome of Chlamydomonas reinhardtii. Glycerol gradients revealed the sedimentation profile of transcripts containing intron rI1 in native C. reinhardtii extracts and in deproteinized RNA preparations, thus indicating the association of rI1 containing transcripts with high molecular weight ribonucleoprotein complexes in vivo. Furthermore, the specific binding of a 61 kDa protein and a 31 kDa protein with the conserved domain IV was demonstrated using a set of intron derivatives for in vitro RNA binding experiments. We propose that we have biochemically characterized 'general splicing factors', which enable the successful splicing even of mitochondrial introns in chloroplasts.

[The influence of a new surface treatment of silicone intracoular lenses with fluoralkylsitan on the adherence of endophthalmitic bacteria in vitro]]. / Effekt einer neuen Oberflächenbehandlung von Intraokularlinsen aus Silikon durch ein Fluoralkylsilan auf das Adhärenzverhalten Endophthalmitis-relevanter Bakterien in vitro.

INTRODUCTION: Dynasilan is a fluoroalkylsilan which is able to bind to surface active molecules of intraocular lenses (IOLs), thereby offering a new option for surface modification of silicone lenses. The purpose of this in vitro study was to investigate the influence of this new surface treatment on the adherence of two typical endophthalmitis-inducing bacteria ( Staphylococcus epidermidis, Propionibacterium acnes). MATERIALS AND METHODS: A total of 14 Dynasilan-treated and 14 untreated silicone lenses were incubated at 37 degrees C for 24 h in brain heart infusion broth (10(8) CFU/ml) either with Staphylococcus epidermidis or with Propionibacterium acnes for 1 h. Subsequently, the adherent bacteria were resuspended using ultrasonification at 35 kHz for 3 x 45 s. After a dilution series and incubation at 37 degrees C for 24 h or 3 days the colonies were counted. RESULTS: On untreated IOLs incubated with Staphylococcus epidermidis the average number of bacteria was 3.6 x 10(7)/ml, and on treated IOLs the number of counted colonies was reduced to 1.09 x 10(7)/ml. Incubated with Propionibacterium acnes the average number of adherent bacteria on untreated IOLs was 4.75 x 10(4)/ml and on modified IOLs the number was reduced to 2.94 x 10(4)/ml. CONCLUSION: Dynasilan surface treatment may reduce the adherence of Staphylococcus epidermidis and Propionibacterium acnes on silicone intraocular lenses. Further studies regarding the stability of this treatment, its biocompatibility and influence on lens epithelial cell adhesion are in progress.

Ultrastructural analysis of the lamina cribrosa after radial optic neurotomy.

Radial optic neurotomy (RON) has been proposed for alleviation of the "scleral outlet compartment syndrome" at the level of the lamina cribrosa, which is thought to play a pathoetiologic role in central retinal vein occlusion (CRVO). The aim of this study has been to analyze the ultrastructural alterations of the lamina cribrosa after RON to gain new insights in the underlying pathomechanical factors. Fifteen donor eyes underwent a standardized open-sky-vitrectomy and RON after removal of the anterior eye segment for keratoplasty. Using a microvitreoretinal blade, a radial incision was performed on the nasal hemisphere of the optic nerve head radial to the optic disc and parallel to the nerve fibre layer. The lamina cribrosa and the surrounding scleral ring were then prepared for light microscopy, scanning (SEM) and transmission electron microscopy (TEM). Ultrastructural analysis demonstrated that in 60% (n=9) of the evaluated cases the scleral ring was dissected completely and in 40% (n=6) only partially. The adjacent neuronal tissue to the dissection area showed only minimal injury. The central retinal vessels were not injured in all cases. Only complete incision of the circular ring of collagen fibrils surrounding the lamina cribrosa via RON resulted in effective relaxation of the scleral outlet and was achieved in 60% of all eyes under standardized conditions. In all cases the adjacent tissue showed only minimal injury. The high rate of incomplete dissection of the scleral outlet may be an explanation for the variable outcome seen in different studies on RON.

Selective retina therapy in patients with central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) is a disease with a localized breakdown of the outer blood-retinal barrier located within the retinal pigment epithelium (RPE) causing subretinal fluid accumulation. Selective retina therapy (SRT) is a new, minimally invasive laser technology that has been designed to selectively target the RPE. SRT spares retinal tissue. METHODS: Twenty-seven eyes of 27 patients with active CSC were treated with SRT using a pulsed double-Q-switched Nd-YLF prototype laser (lambda=527 nm, t=1.7 micros). At baseline, best-corrected visual acuity was determined and fluorescein angiography and optical coherence tomography were performed. The patients were followed for up to 3 months. RESULTS: After 4 weeks 85.2% of patients showed complete resolution of subretinal fluid and in 96.3% there was no leakage visible on fluorescein angiography. After 3 months 100% of patients demonstrated no subretinal fluid and 100% of patients had no leakage activity on fluorescein angiography. Visual acuity, 20/40 at baseline, improved to 20/28 after 4 weeks and to 20/20 after 3 months. CONCLUSION: SRT is a safe and effective treatment for active CSC. Especially if the RPE leak is located close to the fovea, SRT is the favoured therapeutic option. We recommend earlier treatment of patients with acute CSC in order to prevent development of chronic changes due to CSC with irreversible anatomical and functional damage. SRT might be considered as a first-line treatment for active CSC.

[Micro-perimetric documentation of retinal function in photodynamic therapy of choroid neovascularizations]. / Mikroperimetrische Dokumentation der Netzhautfunktion bei photodynamischer Therapie choroidaler Neovaskularisationen.

PURPOSE: Photodynamic therapy provides occlusion of choroidal neovascularization by intravascular endothelial damage. The photodynamic approach offers the potential to occlude choroidal neovascularization selectively without altering adjacent sensory retina and therefore to preserve visual acuity. To determine the selectivity of photodynamic therapy photoreceptor function was measured by microperimetry allowing topic mapping of retinal function. METHODS: A Rodenstock scanning laser ophthalmoscope was used to document preservation of central visual fields before and after photodynamic therapy. Single photodynamic therapy without known efficient parameters was performed in 13 patients and repeated photodynamic therapy using optimised light doses was performed in 10 patients with subfoveal choroidal neovascularization using benzoporphyrin derivate (verteporfin). Intensity and dimension of central scotomas were measured, using a grading system of stimuli ranging from 0-32 dB. Areas of absolute and relative defect were defined and fixation localisation was monitored. Perimetric testing was done pre photodynamic therapy, one week, one month and three months post photodynamic therapy. RESULTS: Postoperative scotomas after single photodynamic therapy were smaller in 8%, identical in 61% and larger in 31% compared with preoperative findings. After repeated photodynamic therapy postoperative scotomas were smaller in 70%, identical in 30% and larger in no case. The observed increase was less than 25% of the original size. Postoperative defects were always significantly smaller than the entire size of the irradiated area. No new scotomas were found after photodynamic therapy. Angiographically visible occlusion post photodynamic therapy was in general larger than scotoma size. CONCLUSION: Documentation of the retinal function by microperimetry after photodynamic therapy of subfoveal choroidal neovascularization shows no new scotoma in the treated area. This can also be documented in the hypofluorescent area around the lesion one week after the treatment. After repeated treatment a reduced scotoma size due to choroidal neovascularization could be seen in 2/3 of the patients after 3 months. No initial vision loss as seen in conventional photocoagulation could be documented after photodynamic therapy.

Endothelium-dependent phosphorylation of vasodilator-stimulated protein in platelets during coronary passage.

Compounds that elevate intraplatelet guanosine 3',5'-cyclic monophosphate (cGMP) or adenosine 3',5'-cyclic monophosphate (cAMP) stimulate the phosphorylation of a 46- to 56-kDa thrombocyte protein designated "vasodilator-stimulated protein" (VASP), which is most likely involved in the regulation of adhesion/aggregation. We investigated whether endothelium-derived relaxing factor (EDRF)/nitric oxide (NO) and prostaglandin I2 (PGI2) affected VASP phosphorylation in washed human platelets that were injected into the coronaries of saline-perfused rabbit hearts (n = 22) and collected immediately after passage. The endothelial stimulator acetylcholine (ACh; 1 microM) significantly increased the concentration of cGMP (indicating release of EDRF) and PGI2 in the coronary venous effluent, as well as the concentration of cGMP and cAMP in platelets. Phosphorylation state of VASP increased from 32.1 +/- 2.9 to 64.8 +/- 2.7%. Inhibition of EDRF/NO synthesis by NG-nitro-L-arginine (30 microM) completely abolished the ACh-induced cGMP increase, attenuated the cAMP-elevation without affecting PGI2, and caused a 20.5 +/- 5.8% decrease of the phosphorylation state of VASP. Indomethacin (30 microM) virtually abolished ACh-induced increases of PGI2, cAMP (but not cGMP), and phosphorylated VASP. These results indicate that both EDRF/NO and PGI2 contribute to the regulation of VASP phosphorylation in platelets collected after a single coronary passage. Their synergistic inhibitory effects on platelet function may thus be mediated by a common effect on target proteins like VASP as well as by a secondary increase in cAMP in response to cGMP-elevating compounds such as EDRF.

Photodynamic therapy of subfoveal choroidal neovascularization: clinical and angiographic examples.

BACKGROUND: Conventional photocoagulation of subfoveal choroidal neovascularization (CNV) is often accompanied by visual loss due to thermal damage to adjacent retinal structures. Photodynamic therapy (PDT) allows vascular occlusion by selective photochemical destruction of vascular endothelial cells only. In a pilot study we evaluated the use of PDT in CNV. METHODS: In a clinical phase I/II trial, patients with subfoveal CNV were treated with PDT. Benzoporphyrin derivative monoacid ring A (BPD) was used as sensitizer at a drug dose of 6 mg/m2 or 12 mg/m2. Irradiation was performed via a diode laser emitting at 690 nm coupled into a slit lamp. Safe and maximum tolerated light doses were defined by dose escalation from 25 to 150 J/cm2. Photodynamic effects were documented ophthalmoscopically and angiographically. RESULTS: Sixty-one patients received a single course of BPD-PDT. Preliminary results suggest no damage to retinal structures within the treated area clinically. Retinal perfusion was not altered, while CNV demonstrated immediate absence of fluorescein leakage in the majority of lesions subsequent to PDT. At optimized parameters (6 mg/m2 and 50 J/cm2) complete cessation of leakage from classic CNV occurred in 100% of cases at 1 week and in 50% at week 4. In 70-80% of classic CNV, leakage reappeared at week 12, but markedly less than before treatment. CONCLUSION: PDT allows temporary absence of leakage from CNV with preservation of visual acuity. The long-term prognosis of CNV secondary to age-related macular degeneration treated with repeated courses of PDT is being evaluated in a phase III trial.