An intraocular micro light-emitting diode device for endo-illumination during pars plana vitrectomy.

PURPOSE:: Development of a new, fiber-free, single-use endo-illuminator for pars plana vitrectomy as a replacement for fiber-based systems with external light sources. The hand-guided intraocularly placed white micro light-emitting diode is evaluated for its illumination properties and potential photochemical and thermal hazards. METHODS:: A micro light-emitting diode was used to develop a single-use intraocular illumination system. The light-source-on-tip device was implemented in a prototype with 23G trocar compatible outer diameter of 0.6 mm. The experimental testing was performed on porcine eyes. All calculations of possible photochemical and thermal hazards during the application of the intraocular micro light-emitting diode were calculated according to DIN EN ISO 15007-2: 2014. RESULTS:: The endo-illuminator generated a homogeneous and bright illumination of the intraocular space. The color impression was physiologic and natural. Contrary to initial apprehension, the possible risk caused by inserting a light-emitting diode into the intraocular vitreous was much smaller when compared to conventional fiber-based illumination systems. The photochemical and thermal hazards allowed a continuous exposure time to the retina of at least 4.7 h. CONCLUSION:: This first intraocular light source showed that a light-emitting diode can be introduced into the eye. The system can be built as single-use illumination system. This light-source-on-tip light-emitting diode-endo-illumination combines a chandelier wide-angle illumination with an adjustable endo-illuminator.

Multicenter, prospective, open-label, observational study of bimatoprost 0.01% in patients with primary open-angle glaucoma or ocular hypertension.

BACKGROUND: Bimatoprost 0.01% was developed for improved tolerability over bimatoprost 0.03%, while maintaining efficacy in lowering intraocular pressure (IOP). This multicenter, prospective, open-label, observational study was designed to investigate the efficacy and tolerability of bimatoprost 0.01% in routine clinical practice. METHODS: Data were collected from 10,337 patients with primary open-angle glaucoma or ocular hypertension attending 1334 centers in Germany. The primary efficacy outcome was mean change in IOP in each eye from baseline to 10-14 weeks after initiation of bimatoprost 0.01%. Target IOP, prior therapies, additional treatments, and adverse events were also assessed. All treatment decisions were at the physicians' discretion. RESULTS: Bimatoprost 0.01% significantly lowered mean IOP from baseline by -4.1 mmHg (P < 0.0001) in all patients after a mean of 10.45 weeks. In patients without previous treatment, bimatoprost 0.01% reduced mean IOP from baseline by -6.5 mmHg (P < 0.0001). Bimatoprost 0.01% also significantly reduced IOP in patients previously treated with monotherapy of ß-blockers, prostaglandin analogs, carbonic anhydrase inhibitors or bimatoprost 0.03%. No adverse events were reported by 93.9% of patients during treatment with bimatoprost 0.01%; the most commonly reported adverse events were eye irritation (2.0%), ocular hyperemia (1.4%), and conjunctival hyperemia (1.2%). Physicians and patients rated tolerability and adherence as high, and most patients said they would continue with bimatoprost 0.01% treatment. CONCLUSION: Bimatoprost 0.01% can produce additional IOP-lowering effects when used in routine clinical practice in patients who have received prior therapy, in addition to lowering IOP in previously untreated patients. A high rate of continuation of therapy with bimatoprost 0.01% was observed in patients who switched from a variety of different medications. The results suggest that bimatoprost 0.01% is a suitable first-choice therapy in patients with primary open-angle glaucoma or ocular hypertension.

Fixed combination of bimatoprost and timolol in patients with primary open-angle glaucoma or ocular hypertension with inadequate IOP adjustment.

OBJECTIVE: To assess the efficacy and tolerability of a fixed combination of bimatoprost and timolol (BTFC) in a large patient sample in a clinical setting. METHODS: In this multicenter, observational, noncontrolled, open-label study, patients (n = 1862) with primary open-angle glaucoma or ocular hypertension were treated with BTFC. Assessments were made at baseline, six weeks, and three months. RESULTS: Prior to starting BTFC, 92.3% of patients were taking other ocular hypotensive medications. In the overall group at three months, mean intraocular pressure was reduced from baseline (21.7 ± 4.5 mmHg and 21.8 ± 4.9 mmHg for the right and left eye, respectively) to 16.1 ± 3.0 mmHg for each eye (P < 0.0001). The majority of patients (92%) reported no adverse events. The most commonly reported adverse events (in >1% of patients) were eye irritation, and ocular and conjunctival hyperemia. Adherence to treatment was generally better than (35.4%) or the same as (57.5%) with prior therapy. BTFC tolerability was rated as excellent or good by 92.3% of physicians and 85.8% of patients. CONCLUSIONS: In a large group of patients with primary open-angle glaucoma or ocular hypertension, treatment with BTFC was associated with consistent reductions in IOP, improved adherence to treatment, and good tolerability.

Impact of fibronectin on surface properties of intraocular lenses.

PURPOSE: Physical properties of intraocular lens (IOL) surfaces determine biocompatibility. IOL hydrophobicity of commercially available IOLs with and without fibronectin (FN) coating can be determined by surface contact angle (SCA) measurements. SCA data of IOLs may allow for a rational selection of an IOL type as a function of underlying eye disease. SETTING: University Hospital of Saarland, Homburg (Saar), Germany METHODS: Thirteen IOL types were tested. IOLs were made of poly(methyl methacrylate)(PMMA), acrylate, or silicone. Select IOLs were surface modified by the manufacturer with heparin or a polysaccharide coating. SCA values of IOLs, either uncoated or precoated with FN, were determined using the sessile water drop method. RESULTS: SCA values ranged from 61.3 to 116.1 degrees for unmodified IOLs, with PMMA IOLs being more hydrophilic (median SCA, 74.1 degrees ), silicone IOLs more hydrophobic (median SCA, 113.3 degrees ), and acrylate IOLs intermediate (median SCA, 86.6 degrees ). Upon FN coating, all genuine acrylate lenses became significantly more hydrophilic while this effect was either nonsignificant or opposite on some PMMA and silicon IOLs. Heparin or polysaccharide surface modification resulted in significantly reduced SCA values. On acrylate IOLs, SCA values did not correlate with the aqueous content of the material. CONCLUSIONS: This study associates IOL materials, surface modifications, and the role of FN preadsorption with SCA values reflecting surface hydrophobicity versus hydrophilicity. It provides a rationale for specific IOL selection as a function of the clinical setting, and a basis for IOL development using tailored surface physicochemistry to enhance biocompatibility and to reduce susceptibility to implant infection.

Imaging quality of intraocular lenses.

PURPOSE: To compare the imaging quality of several commercially available intraocular lenses (IOLs) using the modulation transfer function (MTF) method according to the requirements of the International Standard European Industrial Norm/International Organization for Standardization 11979. SETTING: Universitat für Technik der Informationsverarbeitung, Universität Karlsruhe, Karlsruhe and Universitäts Augenklinik, Ulm, Ulm, Germany. METHODS: Two refractive powers (+13 diopter [D] and +26 D) of each IOL type were tested. The imaging quality of all tested IOLs was measured before the injection test and in 5-minute intervals after the injection for 40 minutes. The measurement data were analyzed according to 2 quality criteria, Strehl ratio and the ISO condition. For analysis of the type of optical design, SEM images of the central cross section were taken of each IOL. Basic terms in optics such as MTF, resolution, and optical aberration are introduced, and their relevance for ophthalmology is discussed in detail. This paper represents an extensive study comparing the imaging quality of various IOLs including the comparison of measurements before and after injection through a cartridge as used for state-of-the-art implantation techniques. All measurements were performed using an MTF measurement system using a 546 nm optimized laser source and an effective aperture of 3.0 mm on the IOL according to ISO standard. An ISO standard eye model using an artificial cornea (spherical design) and a watery solution to simulate in vivo conditions was used. RESULTS: All IOLs apart from 1 +26 D lens complied with ISO standard requirements. However, the imaging quality varied up to 49% depending on the optical design and the manufacturing quality. CONCLUSION: When the methods and materials recommended by the manufacturer for IOL injection through a cartridge were used, no long-term effect on the imaging quality of the IOLs was observed. However, the basic imaging quality of different designs and different manufacturers varied significantly (up to 50% at +26 D) IOLs and should be considered when choosing an IOL.

Effect of growth factors on bovine retinal pigment epithelial cell migration and proliferation.

BACKGROUND: To examine the effects of platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), acidic fibroblast growth factor (aFGF), insulin-like growth factor-1 (IGF-1), epidermal growth factor (EGF), and transforming growth factor beta 2 (TGF(beta2)) on bovine retinal pigment epithelial (RPE) cell migration and proliferation. MATERIALS AND METHODS: Cultured bovine RPE cells were treated with 10 ng/ml PDGF, bFGF, aFGF, IGF-1, EGF, or TGF(beta2). RPE cell migration studies were performed in multiwell plates confluently covered with RPE cells. After inhibition of proliferation and denudation of half of each well, cells were incubated with various growth factors. Migration was measured as the number of cells that had entered the denuded area after 20 h. RPE cell proliferation was determined by [(3)H]thymidine incorporation after growth factor stimulation for 24 h. RESULTS: RPE cell migration was significantly enhanced after incubation with PDGF (stimulation of 213% compared to the negative control, p = 0.002), bFGF (206%, p = 0.003), aFGF (175%, p = 0.003), IGF-1 (150%, p = 0.003), and EGF (144%, p = 0.003). RPE cell proliferation was stimulated by bFGF (322% compared to the negative control, p < 0.005), PDGF (119%, p < 0.005), aFGF (121%, p < 0.005), and EGF (94%, p < 0.005). IGF-1 showed no significant effect on RPE cell proliferation; TGF(beta2) displayed no effect on RPE cell migration nor on proliferation. CONCLUSIONS: The peptide growth factors PDGF, bFGF, aFGF, IGF-1, and EGF play an important role in initiating RPE cell migration. Basic FGF, PDGF, aFGF, and EGF stimulate RPE cell DNA synthesis.

[Spontaneous dislocation to the anterior chamber of a lens luxated in the vitreous body: two cases]. / Spontane Luxation einer in den Glaskörper luxierten Linse in die vordere Augenkammer: zwei Fallberichte.

BACKGROUND: Compared to lens luxations into the vitreous body, luxations into the anterior chamber are rare. We report on two patients in whom a lens luxation into the vitreous body was followed by a luxation into the anterior chamber. CASE REPORT: In a 61-year old male patient and a 47-year old female patient a lens luxation into the vitreous body occurred after a blunt ocular trauma and as a result of Marfan syndrome, respectively. During follow-up the patients presented with a spontaneous lens luxation into the anterior chamber. In both cases a YAG iridotomy and a surgical lens extraction were immediately performed. CONCLUSION: As a result of whiplash-like movements of the vitreous body, a dislocation of a lens luxated into the vitreous body, into the retroiridal or intrapupillary space may occur. This may be facilitated by focally undamaged zonular fibers. The immediately retroiridal lens position may cause a pupillary block with fluid misdirection into the space behind the iris-lens diaphragm resulting in a consecutive pressure increase in this space. This pressure rise causes an anterior movement of the lens and may be followed by a complete dislocation into the anterior chamber especially in the case of coexisting traumatic mydriasis. As a result of this lens dislocation into the anterior chamber an inverse pupillary block develops. This situation necessitates an iridotomy prior to the surgical lens extraction.

[Recurrent corneal ulcer in a patient with Crohn's disease associated with epidermolysis bullosa acquisita]. / Rezidivierende Hornhautulzera bei Morbus Crohn assoziiert mit Epidermolysis bullosa acquisita.

BACKGROUND: Crohn's disease is a chronic inflammatory bowel disease, leading to ocular manifestations in 4 - 8 % of patients. We report on a patient with Crohn's disease, who developed in association with epidermolysis bullosa acquisita a progressive corneal ulcer. PATIENT: A 26-year old patient with a 3-year history of Crohn's disease presented with a peripheral corneal ulcer of the right eye. The anterior chamber was deep and quiet. Fundus examination was normal. Corneal smears displayed no bacterial growth. Visual acuity of the right eye was 20/25. Examination of the left eye was normal. Furthermore, he had developed cutaneous blisters on the arms and legs. Despite treatment with topical antibiotics and systemic immunosuppressive therapy with tacrolimus, azathioprine and methylprednisolone the corneal manifestation deteriorated. Therefore, an amniotic membrane was transplanted for treatment of the corneal ulcer; however, this was followed by melting of the amniotic membrane within a few days. Additional therapeutic procedures including further amniotic membrane transplantations and autologous conjunctival grafts have been performed. This was regularly unsuccessful. The corneal ulcer increased in size and extended into the sclera. Therefore a tectonic sclerokeratoplasty was necessary. Histologic examination of the excised corneoscleral tissue revealed an extensive stromal thinning associated with inflammatory infiltration of the cornea and sclera. CONCLUSIONS: Corneal complications in patients with Crohn's disease are very rare in contrast to conjunctivitis, episcleritis und uveitis. To the best of our knowledge, this is the first description of a patient with Crohn's disease and epidermolysis bullosa acquisita developing progressive corneal ulcer. How closely an assumed autoimmune mechanism in the cornea is related to Crohn's disease or epidermolysis bullosa acquisita, is not known.

[Manufacture of diamond blades via microsystem technology]. / Diamantklingenherstellung mithilfe der Mikrosystemtechnologie.

PURPOSE: The application of diamond knives has steadily increased in ophthalmic surgery. However, the geometry of the blade, its thickness and the sharpness of the cutting edge are limited by the abrasive diamond polishing process, e. g. the crystalline morphology of the bulk material and the grinding powder used. A new generation of diamond blades is presented herewith allowing free choice of blade shape and thickness and possessing excellent sharpness due to a new polishing process. METHODS: The new production method is based on a high-quality CVD (chemical vapour deposition) diamond film of some tenths of microns thickness, deposited on a silicon wafer as microchip technology. The mechanical properties of this synthetic diamond film are almost equal to those of a natural diamond and the surface of this film is mirror-like after deposition without requiring post-polishing. The shape of the blade can be freely defined and is transferred into the diamond film by a plasma polishing process adopted from microsystem technology. RESULTS: The new production method results in highly reproducible diamond blades. Concave blades and round shapes can now be realised without the restrictions of the conventional production process. The force-free fabrication method even allows realisation of miniaturized blades (e. g. width < 0.125 mm, thickness < 50 microm) far beyond the possibilities of conventional diamond blade production. Plasma polishing by means of gas atoms results in extreme sharpness with the cutting edge radius in the range of approx. 3 nm. CONCLUSIONS: Utilising microsystem technology we were able to manufacture reproducible artificial diamond blades. The new process offers for the first time surgeons a possibility of designing blades with a geometry close to their personal needs. Furthermore, the potential of facet-free ergonomically shaped diamond blades may stimulate further improvements towards novel surgical techniques.

[Successful treatment of a periocular lymphoma with radiotherapy]. / Erfolgreiche Bestrahlung eines periokulären Lymphomes.

BACKGROUND: MALT (mucosa associated lymphoma tissues) reveal specific histological specifications, such as cells like B-lymphocytes with circular structure, B-lymphocytes in the epithelium and a region of larger B-lymphocytes, from the centre to the epithelium. The difference between local and systemic infiltration of tissue is important, and hence MALT must be diagnosed via an interdisciplinary approach. PATIENT: A 45-year old female patient presented initially to our institution in December 1997. She complained of swelling and redness of her upper eyelid which had developed during the last 9 months. Additionally, her visual acuity in the involved eye had decreased steadily over the last 6 months. Ophthalmological examination revealed a swollen right upper eyelid associated with bilateral salmon-coloured conjunctival lesions of the inferior fornices. Additionally, there was a serous detachment of the neurosensory retina in the peripapillary area of the right eye. Systemic work-up including biopsy of the ocular lesions revealed the presence of a localised B-cell lymphoma of the MALT type. Initial treatment with topical and systemic steroids resulted only in a temporary improvement of signs and symptoms. Another treatment trial with steroids was unsuccessful and radiotherapy was therefore performed. Radiotherapy resulted in a complete remission and no signs of recurrent disease during a follow-up period of 4 years. CONCLUSIONS: In patients with isolated MALT lymphomas of the periocular regions radiation may be a successful treatment modality. Side effects as observed in former radiation procedures can be avoided by state-of-the-art treatment modalities. Treatment with steroids may be associated with merely temporary improvement of signs and symptoms. In these patients an interdisciplinary approach utilizing ophthalmology, internal medicine, pathology and radiology is imperative.

In-the-bag dislocation of a hydrophilic acrylic intraocular lens.

We report a case of a dislocated hydrophilic acrylic intraocular lens (IOL) inducing astigmatism and causing chronic pain and cystoid macular edema as a result of a folded haptics, which mechanically irritated the iris. Scanning electron micrographs of the explanted IOL, including the capsular bag, showed a folded IOL haptic incarcerated in the capsular bag.

[Ophthalmia nodosa caused by the hairs of the bird spider (family Theraphosidae) or hairy megalomorph (known in the US as tarantula)--case report and review of the literature]. / Ophthalmia nodosa durch Vogelspinnenhaare.

BACKGROUND: Bird spiders, known in the US as tarantulas, are large hairy spiders that have become increasingly popular as pets in the Western world. We present a patient with a red irritated eye from exposure to the hairs of a spider of the Theraphosidae family, and review the literature. PATIENT AND METHODS: We report on a 28-year old patient who was referred to our clinic with a red irritated eye following playing with a Chilean rose-haired bird spider (known in the US as tarantula). In addition, we reviewed the literature concerning similar cases using the Medline database and cited literature in the retrieved articles. RESULTS: Our patient displayed theraphosidae (tarantula) hairs in the cornea of the right eye and developed a uveitis and a retinochoroiditis with associated vitritis. Treatment with topical corticosteroids resulted in an improvement of signs and symptoms, although the improvement was slow and incomplete. The disease process consists of a granulomatous reaction to the spider hairs. Hairs of Theraphosidae spiders (tarantulas) may cause inflammation at all levels of the eye, from the conjunctiva to retina. We were able to identify 14 cases of Ophthalmia nodosa secondary to the exposure to the tarantula hairs in the literature. Therapy includes removal of the offending hairs when possible and topical treatment with steroids. CONCLUSION: Although the large hairy bird spiders (tarantulas) are considered harmless pets, ophthalmia nodosa is a potential danger when handling them. Ophthalmia nodosa has an unknown prognosis and may be difficult to manage.

[Ultrasound biomicroscopy of conjunctival lesions]. / Ultraschallbiomikroskopie bei Bindehauttumoren.

BACKGROUND: The value of ultrasound biomicroscopy in the diagnosis of conjunctival lesions is not well established. PATIENTS AND METHODS: For the examination of conjunctival lesions, we used an ultrasound biomicroscope (Humphrey, Zeiss, Oberkochen) with a high frequency transducer (30 MHz). Between January 2000 and August 2001, 28 patients (16 female, 12-male) with conjunctival lesions, aged 9 to 81 years, were available for this study. RESULTS: Histological examination of the excised tissue displayed the presence of a compound naevus (8/28), cysts (6/28), inflammatory processes (3/28), granulomatous processes (2/28), lymphomas (2/28), foreign bodies (2/28), a pterygium (2/28), a malignant melanoma (1/28), a primary acquired melanosis (1/28), and a conjunctival amyloidosis (1/28). Using ultrasound biomicroscopy we were able to demonstrate a cystic tumour in the six patients (21 %) with a cyst of the conjunctiva. In patients suffering from solid tumours of the conjunctiva the definite diagnosis could not be made with ultrasound biomicroscopy alone. The eight patients with compound naevus displayed a somewhat heterogeneous sonographic structure within the tumour. In the patient with a foreign body we were able to demonstrate posterior shadowing of the underlying tissue. CONCLUSION: For evaluation of conjunctival lesions caused by a cyst or a solid tumour, ultrasound biomicroscopy may be an additional diagnostic tool, e. g. for assessing the margins of the tumour. However, up to now it is not possible to differentiate between different lesions solely by means of ultrasonography.

[What's new in ophthalmic anaesthesia?]. / Was gibt es Neues in der Ophthalmoanästhesie?

In the past few years, there have been many changes in ophthalmic anaesthesia. Application of drugs in general anaesthesia with excellent controllability enhances patient safety and allows a more efficient OR-management. Regional anaesthesia is gaining widespread use for ophthalmic surgery, especially topical anaesthesia for cataract surgery. Patients for ophthalmic surgery concomitantly often display high age and a high level of co-morbidity and, therefore, belong to the anaesthesiological risk groups ASA III-IV. Life-threatening adverse events including cardiovascular depression are associated with general and regional anaesthesia. Intervention by anaesthesiologists is frequently required for treatment of hypertension or dysrhythmias, and sedation. Thus, monitored anaesthesia care ("standby") is justified. Drugs applied for regional and general anaesthesia may change intraocular pressure. There are a lot of publications about the impact of anaesthesia on intraocular pressure (IOD), however, few on the effects of anaesthesia on pulsatile ocular blood flow. it has to be kept in mind that the effects of anaesthesia on intra-ocular pressure and pulsatile ocular blood flow may diverge. To avoid an increase of the IOD, especially during anaesthesia induction, drugs, such as succinylcholin, rocuronium and opiates, in particular remifentanil, can be applied. In addition, the use of the laryngeal mask may be advantageous compared to general anaesthesia associated with laryngoscopic tracheal intubation. The management of patients treated with anticoagulants and antiplatelet agents, has to be taken on the balance of risks. There are risks not only in continuing therapy, but also in discontinuing it perioperatively. Postoperative nausea and vomiting (PONV) remains a distressing and common problem after strabismus repair in particular in children. The incidence of PONV depends on the type of ophthalmic surgery and drugs applied. To reduce PONV in ophthalmic surgery, application of long-lasting opiates should be avoided, and non-opiate analgesics and, depending on the kind of operation, antiemetic prophylactics are recommended.

Posterior fibrous pseudometaplasia of lens epithelial cells in phacic eyes filled with silicone oil.

BACKGROUND: Today, intravitreal silicone oil injection is a standard procedure for complicated cases of retinal detachment. Although cataract formation is found frequently following this procedure only few studies deal with histological lens changes. METHODS: We report histological findings including ultrastructural studies of a special variety of posterior subcapsular cataract formation in six human eyes filled with silicone oil. RESULTS: In the posterior subcapsular area of the lens we found spindle-shaped cells resembling fibroblasts which were, however, entirely surrounded by basement membrane (a feature of epithelial cells) and were associated with collagen fibrils (a feature of fibroblasts). We termed this phenomenon posterior fibrous pseudometaplasia of lens epithelium, since we presumed a posterior migration of lens epithelial cells followed by production of collagen by these cells, without actual transformation to fibroblasts, however. CONCLUSION: Silicone oil instillation may result in the development of posterior fibrous pseudometaplasia, which is the final common pathway of alteration of lens epithelium and which was interpreted as a partial change, or change of certain characteristics of posteriorly migrated lens epithelial cells due to metabolic alterations.

[Ultrasound biomicroscopy in eyelid lesions - a clinical study on 30 patients]. / Ultraschallbiomikroskopie bei Lidtumoren - eine klinische Studie an 30 Patienten.

BACKGROUND: The value of ultrasound biomicroscopy in the diagnosis of eyelid lesions is not well known. METHODS: For the examination of eyelid lesions, we used an ultrasound biomicroscope (Humphrey, Zeiss, Oberkochen) with high-frequency transducers (30 and 50 MHz). Between November 1998 and December 1999, 30 patients with eyelid lesions, range 8 to 86 years, were available for this study. RESULTS: Histological examination of the excised tissue displayed the presence of chalazion (9/30), basal cell carcinoma (7/30), seborrhoic keratosis (4/30), a granulomatous process (4/30), cysts (2/30), an epidermoid cyst (1/30), a nevus (1/30), a pilomatrixoma (1/30), and a comedo (1/30). With ultrasound biomicroscopy we were able to demonstrate a cyst or a cystic tumour in six patients (20 %); i. e. two patients with a cyst of the eyelid, two patients with chalazion, one patient with a granulomatous process and one patient with an epidermoid cyst. In the patients with solid tumours of the eyelid, final diagnosis with ultrasound biomicroscopy only is not possible. CONCLUSION: For evaluation of cystic or solid eyelid lesions, ultrasound biomicroscopy may be an additional diagnostic tool, e. g. for assessment of the margins of the tumour. However, up to now it is not possible to differentiate tumours if only ultrasound biomicroscopic findings are available.

[Enterococcal endophthalmitis following cataract surgery]. / Enterokokkenassoziierte Endophthalmitis nach Kataraktoperation.

BACKGROUND: Postoperative endophthalmitis can be subdivided into acute and chronic forms which are typically caused by different organisms. Enterococcus faecalis is an organism which normally causes an acute form of endophthalmitis. PATIENTS AND METHODS: We report on four cases of different forms of endophthalmitis following cataract extraction and intraocular lens (IOL) implantation who had been referred to our institution between 1998 and 2001. Enterococcus faecalis was the causative organism in all of them. RESULTS: Two patients presented with an acute form and were immediately treated in our hospital after symptom onset utilizing pars plana vitrectomy with and without IOL explantation. The two other patients were initially treated with subconjunctival and/or systemic antibiotics and steroids over a period of about two months before referral to our hospital. After initial improvement the inflammation exacerbated in these two patients and vitrectomy with or without IOL and capsular bag explantation was performed. The explanted IOL and capsular bag of one patient were examined using scanning electron microscopy and it was shown that the enterococci were adherent to the IOL and the capsular bag. CONCLUSION: Enterococcus faecalis can be the causative organism both of an acute and of a recurrent form of postoperative endophthalmitis. The recurrent form may be caused by organisms which tend to adhere to the IOL and the capsular bag. This should be kept in mind when considering different treatment options.

[Bilateral necrobiotic xanthogranuloma of the eyelids with associated paraproteinemia: Case report and review of literature]. / Bilaterales nekrobiotisches Xanthogranulom der Lider mit Paraproteinämie: Fallbericht sowie Literaturübersicht.

BACKGROUND: Necrobiotic xanthogranuloma is a rare disorder which predominantly affects the periorbital region and is frequently associated with paraproteinemia and lymphoproliferative diseases. PATIENT AND METHODS: A 49-year old woman presented with bilateral, yellowish, subcutaneous lesions involving all four eyelids. These lesions have developed over the last year. Additionally, similar skin lesions developed on the trunk and the lower extremities. Two years ago, the patient had a bilateral episcleritis. An incisional biopsy was taken form the lesion. In addition, we reviewed the literature concerning similar cases. RESULTS: Histologic examination revealed a granulomatous process consisting of histiocytes, foamy cells, multinucleated giant cells (touton- and foreign body-type) and associated with necrobiotic collagen and cholesterol clefts. General examination revealed the presence of a paraproteinemia of the IgG-typ associated with a hyperlipidemia. The patient was treated with a low dose chemotherapy which resulted in improvement of signs and symptoms. We could identify in the literature 75 similar cases. The mean age of those patients was 53 years. CONCLUSION: The clinical and histologic findings in our patient were typical for a necrobiotic xanthogranuloma with associated paraproteinemia. The most favorable treatment response has been reported with low doses of systemic administered chemotherapeutic agents in combination with radiation therapy; however, the mortality due to underlying diseases is high.

Octreotide inhibits growth factor-induced bovine choriocapillary endothelial cells in vitro.

BACKGROUND: Response to growth factors by the choriocapillaris is one of the main aspects in the development and progression of choroidal neovascularization in age-related macular degeneration (AMD). The aim of the study was to examine the effect of octreotide--an analogue of somatostatin with possible favorable effects in the treatment of age-related macular degeneration--on growth factor-activated bovine choriocapillary endothelial cells (BCEC). METHODS: Cultivated BCEC were stimulated with 20 ng/ml VEGF, 5 ng/ml bFGF, 50 ng/ml TGFbeta(2), or 50 ng/ml IGF-I for 24 h. Afterwards, the cells were incubated for a further 24 h with octreotide (10(-6) M). BCEC proliferation was determined by [(3)H]-thymidine incorporation. The experiments were performed in normal conditions and in O(2)-limited (5% O(2)) atmosphere. RESULTS: VEGF, bFGF, and IGF-I significantly stimulated BCEC proliferation under normoxic as well as under hypoxic conditions ( P<0.05); the value for TGFbeta(2)stimulation was not significant. Under normoxic conditions, after addition of octreotide to VEGF-, bFGF-, and IGF-I-stimulated cells there was no longer any significant [(3)H]-thymidine incorporation compared to the control medium. Under hypoxic conditions similar results were obtained after addition of octreotide to VEGF-, bFGF-, and IGF-I-stimulated cells. CONCLUSION: Octreotide has inhibitory properties after activation of BCEC with growth factors under normoxic and hypoxic conditions in vitro. Since activation of these cells is a crucial event in the development and progression of AMD, octreotide may be a potential drug for treatment of choroidal neovascularization in these patients.

Morphometric changes of the choriocapillaris and the choroidal vasculature in eyes with advanced glaucomatous changes.

PURPOSE: In addition to an elevated intraocular pressure a compromise of the ocular blood supply have been implicated in the pathogenesis of primary open-angle glaucoma. The purpose of this study was to quantify morphologic changes in the choroid including choriocapillaris thickness and density and diameter of large choroidal vessels in post mortem eyes with advanced primary open-angle glaucoma. METHODS: We analyzed 20 eye bank eyes (provided from the Georgia Eye Bank in Atlanta) with end stage primary open-angle glaucoma and compared them with 20 age-matched control eye bank eyes. The eyes were processed for light microscopy and following variables were measured with a digital filar micrometer: density and diameter of large choroidal vessels in the macular and equatorial choroid; thickness of the choroid in the macular and equatorial region; density and thickness of choriocapillaris in the macular, peripapillary, and equatorial choroid; and peripapillary capillary-free area nasal and temporal to the optic disk. RESULTS: Eyes with glaucoma displayed a lower density of the capillaries of the choriocapillaris as compared to control eyes in the macular, temporal peripapillary, and equatorial choroid with 0.50-0.55 (p=0.018), 0.46-0.51 (p=0.016), and 0.50-0.55 (p=0.038), respectively. There was no significant difference for the choriocapillaris density in the nasal peripapillary choroid, the thickness of the capillaries of the choriocapillaris in all assessed locations, and the nasal and temporal peripapillary capillary-free zone of the choriocapillaris between eyes with glaucomatous damage and controls. Assessment of large choroidal vessels in the macular choroid showed that eyes with glaucoma had a decreased density of veins (11.7-38.9 mm(-2); p<0.001) and arteries (7.7-12.4 mm(-2); p=0.005) and arteries with a higher diameter (45.6-28.2 microm; p<0.001) as compared to control eyes. The large vessels in the equatorial choroid displayed no significant difference in diameter but a lower density (21.2-44.1 mm(-2); p=0.017) in eyes with glaucomatous damage as compared to controls. CONCLUSION: Eyes with advanced glaucomatous damage after long standing primary open-angle glaucoma exhibit several changes including decreased density of capillaries of the choriocapillaris and decreased density of large choroidal vessels. We cannot conclude from our study whether the observed vascular changes in the choroid are primary pathogenic factors or secondary phenomena.