An in vivo evaluation of Brilliant Blue G in animals and humans.

BACKGROUND/AIMS: To evaluate the retinal toxicity of Brilliant Blue G (BBG) following intravitreal injection in rat eyes and examine the biocompatibility and the staining properties in humans. METHODS: BBG was injected into the 11 rat eyes to evaluate toxic effects with balanced salt solution (BSS) serving as control. Retinal toxicity was assessed by retinal ganglion cell (RGC) counts and by light microscopy 7 days later. In addition, BBG was applied during vitrectomy for macular hole (MH) (n = 15) or epiretinal membranes (ERM) (n = 3) in a prospective, non-comparative consecutive series of patients. Before and after surgery, all patients underwent a complete clinical examination including measurement of best corrected visual acuity (VA) and intraocular pressure, perimetry, fundus photography and optical coherence tomography. Patients were seen 1 day before surgery and then in approximately four weeks intervals. RESULTS: No significant reduction in RGC numbers and no morphological alterations were noted. A sufficient staining of the internal limiting membrane (ILM) was seen in patients with MH, while the staining pattern in ERM cases was patchy, indicating that parts of the ILM were peeled off along with the ERM in a variable extent. All MHs could be closed successfully. VA improved in 10 eyes (56%; 8/15 MH patients, 2/3 ERM patients), was unchanged in four eyes (22%; all MH patients) and was reduced in four eyes (22%; 3/15 MH, 1/3 ERM). No toxic effects attributable to the dye were noted during patient follow-up. The ultrastructure of tissue harvested during surgery was unremarkable. CONCLUSION: Brilliant Blue provides a sufficient and selective staining of the ILM. No retinal toxicity or adverse effects related to the dye were observed in animal and human studies. The long-term safety of this novel dye will have to be evaluated in larger patient series and a longer follow-up.

[Conservative and surgical treatment of neurotrophic keratopathy]. / Konservative und chirurgische Therapie der neurotrophen Keratopathie.

Neurotrophic keratopathy is one of the most challenging conditions among the disorders of wound healing of the ocular surface. In addition to bilateral assessment of corneal sensitivity, tear status and lid function must be analyzed and treated by unpreserved artificial tears and adequate lid surgery. Further conservative treatment options include hyaluronic acid and dexpanthenol as well as autologous serum. Application of recombinant growth factors (especially NGF) represents an interesting perspective. Concerning surgical interventions, temporary or permanent occlusion of the lacrimal punctum may be accompanied by lateral tarsorrhaphy which is easy to perform, potentially reversible, and in most cases successful. Depending on the type of wound healing disorder amniotic membrane transplantation may be helpful either as basal membrane transplant (graft) or as a patch, or in combination (sandwich). A tectonic keratoplasty a chaud should typically be combined with a simultaneous amniotic membrane patch and/or a lateral tarsorrhaphy to avoid persistent epithelial defects.

Amniotic membrane inlay and overlay grafting for corneal epithelial defects and stromal ulcers.

OBJECTIVES: To determine the effect of amniotic membrane transplantation (AMT) on persistent corneal epithelial defects (PEDs) and to compare the efficacy between inlay and overlay techniques. METHODS: Thirty patients (30 eyes) underwent AMT for PED. The use of AMT was restricted to patients in whom all previous measures, including bandage contact lens and tarsorrhaphy, had failed. The amniotic membrane was placed on the surface of the cornea in overlay (group A) or inlay (group B) fashion. RESULTS: The PED healed after the first AMT in 21 eyes (70%) within an average of 25.5 days after surgery and recurred in 6 eyes (29%). Among the 22 eyes treated with an overlay AMT (group A), the PED healed after the first AMT in 14 eyes (64%) within an average of 24.5 days and recurred in 4 eyes (29%). Among the 8 eyes treated with an inlay AMT (group B), the PED healed within an average of 27.4 days after AMT, which did not statistically significantly differ from group A (P = .72). The PED healed after the first AMT in 7 eyes (88%) and recurred in 2 (29%) of 7 eyes. CONCLUSIONS: The AMT can be helpful in the treatment of PED in which all other conventional management has failed. However, the success rate in our study was not as high as that previously reported, and our results showed a high incidence of recurrences of epithelial defects. We did not find any difference between overlay and inlay techniques in terms of healing time and recurrence rate.

Ultrastructure of the vitreoretinal interface following plasmin assisted vitrectomy.

AIMS: To investigate the ultrastructure of the vitreoretinal interface following plasmin induced posterior vitreous detachment. METHODS: Plasmin (1 or 2 U/0.1 ml) was injected into the vitreous cavity of 24 eyes of freshly slaughtered pigs. The 24 fellow eyes received calcium-free and magnesium-free PBS and served as a control. After incubation at 37 degrees C for 30 and 60 minutes, the globes were placed in fixative and hemisected. Specimens for light, scanning, and transmission electron microscopy were obtained from the posterior pole, the equator, and the vitreous base using a corneal trephine. RESULTS: All plasmin treated eyes showed posterior vitreous detachment. However, the inner limiting membrane (ILM) was covered by remnants of cortical vitreous at the posterior pole and at the equator. There was a direct correlation between the concentration and exposure times of plasmin and the degree of vitreoretinal separation. Eyes exposed to 1 U plasmin for 30 minutes had a dense network of residual collagen fibrils while those exposed to 1 U plasmin for 60 minutes had only sparse collagen fibrils covering the ILM. Eyes treated with 2 U plasmin for 60 minutes had a smooth retinal surface, consistent with a bare ILM. At the vitreous base there was no vitreoretinal separation. In all control eyes the vitreous cortex was completely attached to the retina. There was no evidence of retinal damage in any plasmin treated eye. CONCLUSION: Plasmin induces a cleavage between the vitreous cortex and the ILM without morphological changes to the retina. In contrast with previous reports, plasmin produces a smooth retinal surface and additional surgery is not required in this experimental setting. The degree of vitreoretinal separation depends on the concentration and length of exposure to plasmin.

[Minimally invasive therapy for clinically complete central retinal artery occlusion--results and meta-analysis of literature]. / Minimal invasive Therapie bei klinisch komplettem Zentralarterienverschluss--eigene Ergebnisse und Literaturvergleich.

BACKGROUND: Goal of our study was the comparison of the efficacy of various minimal invasive therapeutic regimens for clinically complete central retinal artery occlusion (CRAO) and the comparison with the literature. PATIENTS AND METHODS: In a retrospective study 93 patients treated for CRAO during the period 1994-1998 were identified. 65 of these patients with clinically complete occlusion without a cilioretinal artery were included in the study. Analysis focused on the results of different therapies and the duration of visual impairment till starting treatment. RESULTS: The following therapies were used: acetazolamide (65%), aspirin (60%), bulbus massage (45%), hemodilution (34%), oral pentoxifylline (28%), topical beta blockers (9%), paracentesis (8%), heparin (6%). In 15% of all cases an improvement of at least 3 visual acuity gradations was achieved. No significant positive influence of any treatment method could be identified. Also, a correlation between duration of visual impairment and final visual acuity could not be shown. In the literature very different criteria for inclusion of patients to the studies and for visual acuity improvement are found. When applying comparable criteria to ours most studies show similar results for the therapies listed above as well as for paracentesis and the use of carbogen (95% O2 and 5% CO2). CONCLUSION: The minimal invasive treatments given above do only improve natural course of CRAO in occasional cases. Thus a therapy (-combination) should be chosen, which is adapted to the individual risk factors and is exposing the patient to a low risk by therapy itself.

[Multifactorial analysis of therapeutic outcome of pseudophakic retinal detachment surgery]. / Multifactoririelle Analyse des Therapieerfolges des Pseudoaphakieablatio.

BACKGROUND: Pseudophakic retinal detachment is one of the most severe complications after cataract surgery and is a common cause of permanently reduced visual acuity. We evaluated parameters predicting reduced functional outcome by a model of stepwise regression analysis. PATIENTS AND METHODS: A series of 102 consecutive patients with pseudophakic retinal detachment were analyzed for various parameters regarding cataract surgery, retinal surgery, and retinal detachment features. First, univariate analysis determined the correlations with reduced functional outcome. Secondly, a stepwise regression model analyzed statistically significant variables for their predictive value of a reduced visual outcome. RESULTS: The overall reattachment rate was 99%. In 69% of the patients there was an improvement of more than two lines at the end of the follow-up period. The most predictive factors for reduced functional outcome were the need for a silicone oil tamponade and the visual acuity prior to retinal detachment surgery. When silicone oil tamponade was not needed, the requirement of more than two retinal surgeries was the most predictive factor for reduced visual outcome. CONCLUSION: In our series the strongest predictive factors for a reduced functional outcome were the necessity of silicone oil, reduced visual acuity at the time of retinal detachment, and the requirement of more than two retinal surgeries. These findings suggest that first-line procedures should not be necessarily minimally invasive measurements but rather procedures that result in a stably attached retina in the first instance without permanent silicone oil tamponade, even if this first operation consists of an extended pars plana vitrectomy.

[What is the value of transpupillary thermotherapy in treatment of flat posterior choroid melanomas? A systematic review of the literature?]. / Was kann die Transpupilläre Thermotherapie (TTT) in der Behandlung von flachen posterioren Aderhautmelanomen leisten? Eine systematische Literaturübersicht.

BACKGROUND: Transpupillary thermotherapy is a relatively new method for the treatment of choroidal melanomas. We present a systematic survey of the current literature. METHOD: A temperature rise in the tumor ranging from 45-60 degrees C is achieved by an infrared laser beam delivered through the dilated pupil. With a modified delivery system beam widths between 1 and 3 mm and exposure times of one minute are generated. Thus, tumors of up to 4 mm thickness are treatable. TTT can be used as a single treatment procedure or in combination with brachytherapy. RESULTS: Several studies presented in the literature show a satisfactory local tumor control. However, there is a significant risk of vision threatening side effects like retinal vascular occlusion or retinal traction in selected cases. CONCLUSION: The TTT is a minimal invasive procedure for the treatment of flat choroidal melanomas of the posterior pole which is capable of achieving a good local tumor control. Studies with more patients and longer follow-up will demonstrate if TTT is also beneficial in the longterm management of choroidal melanomas.

Evaluation of atherosclerosis in patients with central retinal vein occlusion by carotid artery duplex scanning and echocardiography: a prospective case-control study.

BACKGROUND AND PURPOSE: Central retinal vein occlusion (CRVO) is a common cause of retinal vascular visual loss second to diabetic retinopathy. Atherosclerotic risk factors are thought to affect vascular flow or cause retinal vascular wall abnormalities, thereby contributing to development of CRVO. Previous studies did not fully evaluate the degree of atherosclerotic disease. The purpose of this study was to determine the degree of atherosclerosis of the carotid artery by duplex scanning and to investigate cardiac manifestations of atherosclerotic risk factors by echocardiography in patients with CRVO. MATERIAL AND METHODS: 39 patients (age 63.1 years [50-84 years], 21 men, 18 women) with CRVO were compared with a control group consisting of 39 individuals (age 59.3 years [49-81 years], 19 men, 20 women) in whom echocardiography was performed to rule out endocarditis. Clinical examination, laboratory testing, carotid artery duplex scanning and echocardiography were performed in all patients. RESULTS: Echocardiography revealed significantly increased prevalence of left ventricular hypertrophy (30.8% in CRVO patients, 5.1% in controls) as a typical sign of hypertensive heart disease in CRVO patients, which is consistent with the increased prevalence of hypertension (HTN) (46.2% in CRVO patients, 15.4% in controls). The prevalence of atherosclerosis of carotid artery and ascending aorta, and all other echocardiographic findings were comparable in CRVO patients and controls: regional wall motion abnormality, left ventricular dilatation, aortic valve calcification, and mitral valve calcification. CONCLUSION: Our study demonstrates that CRVO is not associated with atherosclerosis of large arteries, such as the carotid artery and the ascending aorta. We propose that the retinal artery atherosclerosis seen in most CRVO patients is caused by HTN.

[Fibromyalgia and Sjögren syndrome--clinical and methodological aspects]. / Fibromyalgie und Sjögren-Syndrom--klinische und methodische Aspekte.

The prevalence of fibromyalgia in primary (n = 18) or secondary (n = 20) Sjögren's syndrome was examined. In all patients with Sjögren's syndrome as well as in 31 fibromyalgia patients and 20 healthy individuals measurements of pressure pain threshold were done by palpation and dolorimetry. Widespread pain, functional complaints, as well as depression were determined by a questionnaire. The results show a high frequency of fibromyalgia in the group of patients with pSS (44%), 72% of pSS patients reported widespread pain. Only 5% of the sSS patients fulfilled the ACR criteria for fibromyalgia and 40% of this group reported on widespread pain. Dolorimetry measures at tender or control points revealed that the pressure pain threshold was significantly reduced in all patient groups with healthy controls. There were only small differences between the clinical groups. Within the different groups examined there was a close correlation between dolorimetric threshold at tender and control points. In contrast to self-estimated widespread pain the pressure pain threshold was not closely related to functional complaints in the patient groups. The prevalence of depression was increased in both pSS and FM patients, in contrast to the other groups. The results suggest to include Sjögren's syndrome into the differential diagnosis of FM. The dolorimetric results were interpreted as an argument against the actual tenderpoint concept. They support the view that patients with FM rather represent an arbitrary coincidence of widespread pain and elevated tenderness on pressure.