Chemokine CXCL-1: activity in the vitreous during proliferative vitreoretinopathy.

The aim of this study was to investigate CXCL-1 chemokine levels in the vitreous during rhegmatogenous retinal detachment (RRD) with and without proliferative vitreoretinopathy (PVR) and identify possible correlations with clinical parameters (extent and duration or RRD and PVR grade). Vitreous samples from patients with primary RRD with or without PVR were collected and assayed using a double antibody enzyme-linked immunosorbent assay (ELISA). Eleven vitreous samples from organ donors were employed as a control group. CXCL-1 levels were measured in 35 vitreous samples from 35 RRD patients. Mean CXCL-1 levels (64·82 ± 6·47 pg/ml) were significantly higher (P = 0·048) compared to controls. There was a significant positive correlation between CXCL-1 levels and the extent of the detachment (r = 0·794, P = 0·006). Peak CXCL-1 levels coincided with 3+ quadrant RRD, an interim of 29-60 days' duration and PVR grade B. Increased CXCL-1 levels may be indicative of mild inflammation in the detached retina and the adjacent vitreous. The results of the present study may provide novel insight into the complex interactions taking place during the early and late stages of RRD complicated by PVR.

[Cross-linking in an artificial human cornea via induction of tissue transglutaminases]. / Vernetzung einer humanen künstlichen Hornhaut durch Induktion von Tissue-Transglutaminasen.

PURPOSE: In recent years many three-dimensional cornea models have been developed. However, they show poor collagen stability in the stroma. Transglutaminases (Tgases) are calcium-dependent proteins which play an important role in cross-linking of the corneal stroma. The purpose of this study was to find out whether it is possible to induce in vitro cross-linking of the stroma in an artificial hemicornea model with the help of Tgases. MATERIALS AND METHODS: For the construction of the hemicornea, human SV40 adenovector corneal epithelial cells (HCE) and human SV40 adenovector corneal keratocytes (HCK) were cultivated. Confluent HCK cells were treated for 24 h with transforming growth factor beta (TGFb) 1, 2 and 3 at different concentrations as well as with other growth factors and the treated cells were compared to untreated cultivated cells. The quantification of the expression of the Tgases by HCKs was examined with the use of real time PCR, Western blot imaging and immunochemistry. RESULTS: All concentrations of TGFbs used resulted in a significant increase of Tgase-mRNA, Tgase protein level and Tgase activity. The Tgases remained unaffected after treatment with other growth factors in comparison to untreated control cells. Treatment of the hemicornea with TGFb2 showed a very strong contraction and haze in comparison to the untreated hemicornea. CONCLUSION: It has been shown for the first time that TGFb induces a strong expression of Tgases in HCK cells. This effect caused an undesired contraction and haze of the human hemicornea model. Further research is necessary in order to find out whether the induction of Tgases in the HCK cells can be regulated without losing stability of the constructed hemicornea.

Mediators involved in retinopathy of prematurity and emerging therapeutic targets.

Retinopathy of prematurity (ROP) is a potentially blinding disease of premature infants and despite timely treatment some infants develop retinal detachment and sight loss. Current treatment utilises laser therapy which causes destruction of treated retinal tissue resulting in field loss. There is considerable research work ongoing on neovascular eye disease which is likely to result in antiangiogenic approaches that will arrest the development of ROP by specifically targeting the involved molecular mediators. Some of these new therapeutic interventions have entered clinical trials. This article reviews new information available on the molecular pathogenesis of ROP which may result in novel treatments for ROP; it does not discuss the well-known role of oxygen in the development of ROP.

Unusual toxoplasmic chorioretinitis in advanced age: a diagnostic problem.

PURPOSE: To raise awareness regarding presentation of toxoplasmic chorioretinitis late in life, and to discuss the invasive diagnostic options. PATIENTS/METHODS: Case report. RESULTS: A 62-year-old patient presenting with posterior vitritis and a focus of retinitis was misdiagnosed and treated with antivirals and corticosteroids. Relapse after initial stabilization justified a vitreous tap for culture and DNA detection of a number of infectious agents, leading to the correct diagnosis of T.gondii infection. CONCLUSIONS: Ocular sampling may be necessary to secure timely diagnosis and treatment of atypical retinitis. Acquired ocular toxoplasmosis may be under-recognized as a cause of infectious posterior uveitis and caution should be applied when administering steroids without a definite diagnosis.

Repeatability and reproducibility of a-scan biometry quantitative findings.

PURPOSE: To determine repeatability and reproducibility of A-scan biometry quantitative findings in order to uniformly evaluate lenticular cataract changes. MATERIALS AND METHODS: Seventeen eyes from seventeen cataract patients were examined by three (trainee ophthalmologists). Results (ratio of mean internal lens spikes height/lens anterior surface spike height) were compared using coefficient of variation (CV), repeatability coefficient (CR), and intraclass correlation coefficients (ICC). RESULTS: Intra-observer consistency was CV = 0.36, CR = 0.49, and ICC = 0.778 for the first operator; CV = 0.33, CR = 0.52, and ICC = 0.642 for the second operator; and CV = 0.32, CR = 0.53, and ICC = 0.567 for the third operator. Concerning inter-observer agreement: CV (in 6 of 7 eyes) was > 8%, CR was > 0.21, and intraclass correlation coefficient for all eyes was < 0.81. CONCLUSIONS: Regarding repeatability and reproducibility, although there is a tendency for statistical significance, variability of the results does not allow the use of the method as a complementary clinical tool for comparing results. Standardization of this procedure, in order to achieve higher test reliability, might be the aim of relevant future studies, although there are a number of points that have to be addressed.

Macular hole surgery without prone positioning.

PURPOSE: To investigate the role of vitrectomy without prone posturing in the anatomic and functional outcome of macular hole surgery (MHS). METHODS: Forty-one consecutive eyes of 41 patients with stage II-IV full-thickness macular holes underwent pars plana vitrectomy and 16% C3F8 tamponade. In 25 cases posturing group (P), subjects were instructed to assume prone positioning for 10 days postoperatively, whereas in 16 cases non-posturing group (NP) patients were advised to avoid lying supine but no other posturing instructions were given. Preoperative, intraoperative and postoperative clinical data were collected, with macular hole closure rate and change in LogMAR visual acuity, contrast sensitivity, metamorphopsia, and 25-Visual Function Questionnaire (VFQ-25) being the primary outcome measures. RESULTS: Over a mean follow-up of 4.21.2 months, anatomical hole closure was noted in 22/25 (88%) and 14/16 (87.5%) in groups P and NP respectively. Visual acuity improved by a mean of eight letters and there was no significant difference in the two groups (P=0.724). Similarly, postoperative prone posturing did not have an effect on the final contrast sensitivity, metamorphopsia, and VFQ-25 composite scores (P=0.238, P=0.472, and P=0.87, respectively). However, eyes in group NP developed significantly more severe cataract in the early postoperative period (P=0.02). CONCLUSIONS: Prone posturing following MHS provides no functional or anatomic benefit but it is associated with slower progression of cataract. Combined phacovitrectomy without face down positioning may be considered for all phakic patients undergoing MHS.

Evolving European guidance on the medical management of neovascular age related macular degeneration.

BACKGROUND: Until recently, only two options were available for the treatment of choroidal neovascularisation (CNV) associated with age related macular degeneration (AMD)-thermal laser photocoagulation and photodynamic therapy with verteporfin (PDT-V). However, new treatments for CNV are in development, and data from phase III clinical trials of some of these pharmacological interventions are now available. In light of these new data, expert guidance is required to enable retina specialists with expertise in the management of AMD to select and use the most appropriate therapies for the treatment of neovascular AMD. METHODS: Consensus from a round table of European retina specialists was obtained based on best available scientific data. Data rated at evidence levels 1 and 2 were evaluated for laser photocoagulation, PDT-V, pegaptanib sodium, and ranibizumab. Other treatments discussed are anecortave acetate, triamcinolone acetonide, bevacizumab, rostaporfin (SnET2), squalamine, and transpupillary thermotherapy. RESULTS: PDT-V is currently recommended for subfoveal lesions with predominantly classic CNV, or with occult with no classic CNV with evidence of recent disease progression and a lesion size

Visual function following transpupillary thermotherapy with adjusted laser parameters for the treatment of exudative age-related macular degeneration: a pilot study.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) using adjusted laser parameters for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration. METHODS: TTT was performed on patients with CNV using a diode laser (810 nm) for 60 s in a subthreshold manner. Power settings were varied between 460 and 1200 mW, depending on lesion size, presence of pigment epithelial detachment and the amount of fundal pigmentation and subretinal fluid. LogMAR visual acuity, contrast sensitivity (Pelli-Robson) and metamorphopsia (Amsler chart) were assessed prior to and 6 months following treatment. Subjects also self-administered the National Eye Institute 25-Item Visual Function Questionnaire. RESULTS: Thirty occult/minimally classic and eight predominantly classic membranes were treated with TTT. At 6 months, absence or significant reduction of fluorescein leakage was observed in 20 (53%) patients. Stabilization of vision (loss of less than 15 letters) was observed in 25/30 (83%) eyes with occult/minimally classic CNV and 5/8 (63%) eyes with predominantly classic CNV. Improvement of contrast sensitivity was noted in 15 (35%) eyes, in 10 (26%) eyes it remained unchanged and in 13 (34%) eyes it deteriorated. There was no statistically significant effect of TTT on the National Eye Institute 25-Item Visual Function Questionnaire composite or subscale scores. CONCLUSIONS: TTT using adjusted parameters depending on fundal characteristics appears to be effective in stabilizing subjective and objective visual ability in a considerable number of patients with subfoveal CNV due to age-related macular degeneration. Larger-scale studies are required to confirm the benefit of this technique as opposed to the natural history of occult CNV.

Effect of laser photocoagulation treatment for diabetic macular oedema on patient's vision-related quality of life.

PURPOSE: To evaluate the effect of laser photocoagulation for diabetic macular oedema (DME) on patients' Vision Related Quality Of Life (VR-QOL) and to investigate associations between changes in self reported VR-QOL and changes in visual acuity following application of laser treatment. METHODS: Prospective cohort study of 55 subjects who underwent laser treatment for DME. Eligible patients with no history of previous laser photocoagulation self-administered the 51-item field-test version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) prior to treatment and 3 months following the last session of laser application. Visual acuity was measured by means of the Early Treatment of Diabetic Retinopathy (ETDRS) chart. Multi-item scales rating different aspects of VR-QOL were compared prior and after photocoagulation and the change in questionnaire's composite score following treatment was correlated to change in visual acuity and other determinants previously reported as risk factors in the diabetic population. RESULTS: Scale scores associated with general vision, near vision, distance vision, peripheral vision, vision-specific social functioning, vision-specific mental health, expectations for visual function and dependency due to vision were significantly improved following laser treatment. Multivariate models revealed that improvement of the NEI-VFQ composite score was significant in subjects younger than 65 years of age (p = 0.04) who received more laser burns (p = 0.02) and had worse vision-related QOL prior to laser treatment as expressed by the baseline NEI- VFQ composite score (p = 0.03). There was no statistically significant association between change in the composite score following laser treatment and stage of diabetic retinopathy, duration of diabetes or laser settings used during photocoagulation. CONCLUSIONS: Photocoagulation for DME has a beneficial effect on patients' subjective perception of visual function. The use of vision-targeted health status questionnaires in conjunction with the clinical examination appears to provide a more comprehensive overview of individuals' daily well- being following laser treatment.

[Entoptic phenomena and potential visual acuity]. / Phénomènes endoptiques et acuité visuelle potentielle.

REVIEW OF PREOPERATIVE EVALUATION OF VISUAL FUNCTION: In the presence of media opacities, the prevision of the potential postoperative visual acuity constitutes often a complicate diagnostic problem. Its solution requires the experience of the ophthalmologist, who should take into account various elements from the patient's visual aggravation progress, the dissociation between far and near vision under mesopic and scotopic conditions, the actual grating acuity and the eventual hand movement and light-perception, as well as, elements from the patient's objective examination, i.e., from the biomicroscopy with direct and indirect illumination through the still transparent media and from the binocular ophthalmoscopy of the fundus. METHODS REVIEWED: Purkinje figure and luminous darting points visualization. POSSIBLE PREDICTIONS: Light induced entoptic imagery, as Purkinje figure and luminous darting points, visualization, helps as a supplementary diagnostic procedure, for the prevision of a low, but socially useful postoperative visual acuity.

[Highly restricted detachment surgery without puncture: long-term results on the topic of postoperative "residual detachment" and late re-detachment]. / Lochbegrenzte Ablatio-Chirurgie ohne Punktion: Langzeit-Ergebnisse zur Frage der postoperativen "Restablatio" und späten Reablatio.

BACKGROUND: Detachment surgery without drainage, a surgery limited to area of break, implies minimization of procedure and complications. In a 1st study (1970-1977) 1,000 consecutive detachments were treated with favorable results (primary reattachment in 83%, after reoperation in 91%, follow-up 4 months-7 1/2 years). A prospective 2nd study (8/1979-1/1980) followed to answer the questions: (1) Differential diagnosis between postoperative "residual detachments" and surgical failure. (2) Is rate of "late" redetachment after minimal segmental buckling greater than after cerclage? PATIENTS AND METHODS: Prospective study of 107 detachments operated 8/1979-1/1980 with follow-up of 11-11 1/2 years. Detachments: 21 eyes with aphakia, 1 with pseudophakia, 16 with PVR stage C1/C2. TREATMENT: cryopexy and segmental buckling or balloon in area of break without drainage, no vitrectomy, no cerclage. Orientation of buckles: 76 radials, 20 circumferentials, 11 radials with circumferentials. RESULTS: After 1 operation retina was reattached in 99 eyes (92.6%), after reoperation of primary failure (confined to original or to previously undetected break) the retina reattached in 104 eyes (97%). Types of postoperative "residual detachments" after non-drainage: (1) convex residual detachment (delayed absorption) or (2) concave residual detachment (traction), both of them with no hole (to observe) and (3) convex residual rhegmatogenous detachment (to reoperate). Longterm results (follow-up 11 years) of 104 reattached retinas: "early" redetachment (2-4 months postoperatively) in 6 eyes or 5.6% because of PVR and "late" redetachment (3 to 7 years postoperatively) in 7 eyes or 6.5% because of new breaks. After reoperation reattachment in 99 eyes (92.6%); only 1 of 107 eyes had 2 reoperations. Reasons for final failure: PVR (3.7%), no hole found (2.8%), massive choroidals (0.9%). CONCLUSION: After detachment surgery without drainage there can be: (1) convex or (2) concave "residual" detachment and (3) rhegmatogenous residual detachment with new contour (reoperation needed). Favorable longterm results after minimal surgery (6.5% "late" redetachment during 11 years postoperatively) and use of minimal surgery as reoperation (50% a balloon) for reattaching the retina do not support the necessity of a prophylactic cerclage as primary operation, even not as reoperation per se. A simple alternative to a surgical prophylaxis represents a so-called "passive" prophylaxis consisting in explaining the visual field to the patient and asking him to test it regularly.

[Prevention of peroperative miosis: comparison between prostaglandin inhibitors. Sodium diclofenac and indomethacin in local application]. / Prévention du myosis peropératoire: comparaison des inhibiteurs de prostaglandines. Diclophénac sodium et indométhacine en application locale.

Diclofenac sodium 0.1% (Voltaren) prevents surgically induced miosis during extracapsular cataract extraction in a more long lasting way than indomethacin 1% (Indocid). Just before the IOL-implantation, in eyes treated with diclofenac sodium eye drops, the apparent mean pupil size was constricted by approximately 1 mm less than in the control group (p.01). At the same critical moment, 50% of the pupils treated with diclofenac sodium and only 20% of the pupils in the control and indomethacin groups were larger than 6 mm.

[Photocoagulation-induced macular scotoma and automated perimetry (Octopus)]. / Photokoagulationsbedingte Skotome der Makula und automatisierte Perimetrie (OCTOPUS).

The size of macular scotomata is determined numerically by a series of parallel F2 programs of the Octopus Perimeter. As long as useful foveolar fixation is maintained, the results are reproducible within the limits due to fluctuation of the retinal sensitivity. The scotomata can be mapped on a fundus photograph either by direct calculation or after perimetric determination of a reference distance, e.g., foveola-disc or between angioscotomata. This method furnishes useful information which can facilitate evaluation of different types of lasers in macular photocoagulation.

[Treatment of exudative hemorrhagic macular degenerations with the krypton laser]. / Le traitement des dégénérescences maculaires exsudatives-hémorragiques au laser à krypton.

Choroidal neovascularization is considered to be the cause of exudate or subretinal hemorrhage formation in the evolution of different types of macular degeneration (exudative senile macular degeneration, idiopathic macular degeneration, presumed ocular histoplasmosis, angioid streaks, etc. The only curative treatment which has proved to be successful is the destruction of subretinal neovascularisation by photocoagulation. The effect of laser photocoagulation depends on the radiation wavelength emitted and the absorption spectrum of the target tissue. It is for this reason that the red krypton laser is recommended for the destruction of subretinal neovascularizations, its action being restricted to the choroid without inflicting damage on the nerve fiber layer.