Intravenous diclofenac as prophylactic treatment for verteporfin-associated low back pain.

PURPOSE: The authors report on the therapeutic effect of intravenous diclofenac on verteporfin associated low back pain (LBP), which is the most frequent adverse effect of photodynamic therapy (PDT) for macular degeneration. METHODS: The authors studied 818 patients who received PDT with verteporfin for choroidal neovascularization. Systemic blood pressures were recorded in all study participants half an hour before PDT treatment. All patients who experienced LBP during verteporfin infusion were asked to grade their pain as mild (1), moderate (2), severe (3), or unbearable (4). RESULTS: Thirty-three patients had LBP during their first verteporfin infusion. Of these, 11 subjects (1.34% of all) reported increased pain scores (level 2 to 4) and received intravenous diclofenac ahead of their next PDT. Patients with LBP during verteporfin infusion had significantly higher systolic blood pressures than uncomplicated cases (180 mmHg vs 155 mmHg, p=0.01). Treatment with intravenous diclofenac short before PDT significantly reduced the patients' mean pain score by 1.8 levels (p=0.0001). CONCLUSIONS: In this study, intravenous application of diclofenac short before verteporfin infusion effectively prevented verteporfin associated LBP in patients with systemic hypertension.

[Fundus autofluorescence in patients with inherited retinal diseases : patterns of fluorescence at two different wavelengths]. / Fundusautofluoreszenz bei erblichen Netzhauterkrankungen : Fluoreszenzmuster in zwei verschiedenen Wellenlängenbereichen.

BACKGROUND: Fundus autofluorescence (FAF) may be excited and measured at different wavelengths. In the present study we compared short wavelength and near-infrared FAF patterns of retinal dystrophies. METHODS: We analysed both eyes of 108 patients with diverse retinal dystrophies. Besides colour fundus photographs, FAF images were obtained with the Heidelberg Retina Angiograph (HRA 2). Excitation wavelengths of 488 nm (blue; filter at 500 nm) and 787 nm (near-infrared; filter at 810 nm) were applied. For improvement of the signal-to-noise ratio a total of nine images were averaged, and the mean images (original grey values, not normalized) were analysed. RESULTS: Useful FAF images of both excitation wavelengths were achieved in all patients. We observed characteristic FAF patterns, which differed between excitation wavelengths depending on the disease. With time, FAF pattern changes and progression could be observed. CONCLUSION: FAF of both wavelengths provided additional information for phenotype description in retinal dystrophies. Other than short wavelength FAF, near-infrared FAF showed different pathological changes, which may be related to changes in RPE melanin. However, any conclusions may be limited by the still incomplete knowledge about the prognostic value of FAF in the diseases studied here.

Analysis of visual pigment by fundus autofluorescence.

This study investigated changes of short-wavelength fundus autofluorescence (SW-AF) by retinal bleaching effects. All measurements were performed with the Heidelberg Retina Angiograph 2 (HRA 2). Initially, experimental imaging was done on a healthy eye after dark adaptation. Photopigment was bleached within the central 30 degrees of the fundus by HRA 2 excitation light. Then SW-AF imaging of this region was performed, and SW-AF of the surrounding, unbleached 25 degrees fundus region was subsequently studied by a wide-field lens. Next, another 30 degrees SW-AF image of the posterior pole was obtained after complete dark adaptation. Then an extra SW-AF examination was performed with 15 degrees temporal eccentricity, overlapping the original examination area. Finally, a successive image series was carried out on the dark-adapted eye to test for bleaching kinetics. The second and third experiments were also performed on eyes with macular dystrophies. Distinct regions of increased SW-AF were observed after strong illumination with the blue excitation light in all eyes studied. During light adaptation mean gray levels showed a saturation plateau after an initial steep increase. The resulting gray-value maps showed significant differences of pixel intensities between bleached and unbleached parts of the fundus. Two-dimensional density difference maps allowed analysis of visual pigment distribution and density in both healthy eyes and eyes with macular dystrophies. Our observations highlight the viability of objective, non-invasive evaluation of visual pigment in the healthy and diseased human retina by means of confocal fundus autofluorescence.

[Malignant glaucoma following blunt trauma of the eye]. / Malignes Glaukom nach stumpfem Bulbustrauma.

PURPOSE: Ciliary block glaucoma most commonly occurs after intraocular surgery. We report a case of malignant glaucoma following blunt trauma of the eye with no previous surgery or laser. PATIENT: A 54-year-old female suffered from acute elevation of intraocular pressure on her right eye after blunt trauma 2 months earlier. As a variety of topical and systemic antiglaucomatous drugs and the presence of a patent iridotomy could not control intraocular pressure (IOP) and the anterior chamber remained flattened, ciliary block glaucoma was diagnosed. Subsequent surgical treatment included pars plana vitrectomy (PPV), phacoemulsification with implantation of an intraocular lens, a second PPV with trabeculectomy and mitomycin-C, eccentric YAG-laser capsulotomy, and a third PPV with zonulo-iridectomy and endolaser-induced zonular shrinkage. After this variety of surgical approaches, a stable and deep anterior chamber could be achieved with an average IOP of 10 mmHg. CONCLUSIONS: Ciliary block glaucoma may occur after blunt trauma of the eye even without a history of intraocular surgery or laser. In addition, our case demonstrates the uncertainty of surgical success in affected patients.

Impact factors on intraocular pressure measurements in healthy subjects.

AIM: To evaluate whether intraocular pressure (IOP) calculation by applanation tonometry is determined more essentially by the subject's neck position or by neck constriction. METHODS: 23 right eyes of 23 healthy subjects (12 male, 11 female) were included. IOP was measured by applanation tonometry with the TonoPen on sitting participants under four different conditions: with open collar upright (A) or with the head in the headrest of a slit lamp (B), with a tight necktie upright (C) or in slit lamp position (D). All measurements with neck constriction were performed 3 minutes after placing the necktie. RESULTS: Mean IOP was 16.9 (SD 2.3) mm Hg (range 11-21 mm Hg) (A), 18.1 (SD 2.2) mm Hg (range 14-22 mm Hg) (B), 17.9 (SD 2.9) mm Hg (range 12-25 mm Hg) (C) and 18.7 (SD 2.7) mm Hg (range 13-24 mm Hg) (D). Mean IOP increased by 1.3 (SD 2.6) mm Hg (p = 0.028, paired t test, range +0.2 to +2.4 mm Hg) if subjects changed position from A to B. There was no statistically significant difference between measurements with or without neck constriction. CONCLUSION: Applanation tonometry may be inaccurate if performed in slit lamp position. In contrast, tight neckties do not significantly affect IOP evaluation in healthy subjects.

Immunohistochemical localization of serine-protease inhibitors in the human placenta.

Proteases and their inhibitors play a pivotal role in developmental and differentiative processes. In the present report we investigated the immunohistochemical localization of alpha 1-antitrypsin, alpha 1-antichymotrypsin and inter-alpha-trypsin inhibitor in first trimester as well as in term human placentas. For this purpose polyclonal antibodies against these serine-protease inhibitors were used. All inhibitors were expressed in the villous syncytiotrophoblast of first and last trimester placentas. Placental fibrinoid was positively stained for alpha 1-antitrypsin and inter-alpha-trypsin inhibitor throughout gestation. alpha 1-Antitrypsin and alpha 1-antichymotrypsin showed a strong immunostaining in the Hofbauer cells (first trimester and full term placentas). Extravillous cytotrophoblast was negative for the three protease inhibitors throughout gestation. The presence of the three inhibitors in the syncytiotrophoblast suggests a role in coagulative, invasive and immunomodulatory processes. Fibrinoid, staining for alpha 1-antitrypsin and inter-alpha-trypsin inhibitor, could also have an important immunoprotective function. The presence of protease inhibitors in the Hofbauer cells suggests an involvement of these cells in villous remodelling and differentiative processes.