[LenSx® femto-LASIK, FEMTO LDV Z4® femto-LASIK, and PRK : Comparison of refractive results and an analysis of complications]. / LenSx®-Femto-LASIK, FEMTO LDV Z4®-Femto-LASIK und PRK : Vergleich refraktiver Ergebnisse und Komplikationsanalyse.

BACKGROUND: The aim of this study is to evaluate three refractive procedures: LenSx® (Alcon, Fort Worth, TX, USA) femto-laser in situ keratomileusis (LASIK), FEMTO LDV Z4® (Ziemer, Port, Switzerland) femto-LASIK, and photorefractive keratectomy (PRK) in terms of refractive outcome, perioperative complications, pain, and patient satisfaction. MATERIALS AND METHODS: Data of 168 eyes (myopic n = 84) were included in this retrospective study. Of these, 54 eyes (n = 27, 33.85 ± 7.64 years) were treated with LenSx® femto-LASIK, 60 eyes (n = 30, 35.03 ± 7.46 years) with FEMTO LDV Z4® femto-LASIK, and 54 eyes (n = 27, 33.24 ± 8.52 years) with PRK. Photoablation was induced by a MEL80 Excimerlaser (Zeiss, Oberkochen, Germany). The corrected (Vsc) and uncorrected (Vcc) distance subjective visual acuity, corneal topography (Pentacam® HR; Wetzlar, Germany), and objective astigmatism (ARK-760A Refractometer ; Nidek, Fremont, CA, USA) were measured preoperatively, and 1 day, 1 week, 1 month, and 3 months postoperatively. Subjective pain (verbal rating scale) and patient satisfaction were also recorded. RESULTS: Subjective Vsc showed significantly better results in both femto-LASIK cohorts compared to PRK (p < 0.05) 1 day and 1 week postoperatively. There was no significant difference between the groups in terms of spherical equivalent and astigmatism 3 months postoperatively. The LenSx® femto-LASIK caused flap complications. The highest patient satisfaction results were shown in the LDV Z4® group, followed by the LenSx® and PRK cohorts (p = 0.072). LDV Z4® femto-LASIK showed the lowest pain score 1 day postoperatively (p < 0.001). There was no significant correlation between target refraction and preoperative corneal thickness and astigmatism. DISCUSSION: Femtosecond laser-assisted LASIK is an effective procedure enabling rapid rehabilitation of visual acuity with low postoperative pain compared to PRK. There is no difference between the three techniques regarding refractive outcome after 3 months follow-up. LDV Z4® femto-LASIK can be recommended, if available, due to its low intraoperative complication rate and higher patient satisfaction compared to LenSx® femto-LASIK.

Myoglobin facilitates angiotensin II-induced constriction of renal afferent arterioles.

Vasoconstriction plays an important role in the development of acute kidney injury in rhabdomyolysis. We hypothesized that myoglobin enhances the angiotensin II (ANG II) response in afferent arterioles by increasing superoxide and reducing nitric oxide (NO) bioavailability. Afferent arterioles of C57Bl6 mice were isolated perfused, and vasoreactivity was analyzed using video microscopy. NO bioavailability, superoxide concentration in the vessel wall, and changes in cytosolic calcium were measured using fluorescence techniques. Myoglobin treatment (10-5 M) did not change the basal arteriolar diameter during a 20-min period compared with control conditions. NG-nitro-l-arginine methyl ester (l-NAME, 10-4 M) and l-NAME + myoglobin reduced diameters to 94.7 and 97.9% of the initial diameter, respectively. Myoglobin or l-NAME enhanced the ANG II-induced constriction of arterioles compared with control (36.6 and 34.2%, respectively, vs. 65.9%). Norepinephrine responses were not influenced by myoglobin. Combined application of myoglobin and l-NAME further facilitated the ANG II response (7.0%). Myoglobin or l-NAME decreased the NO-related fluorescence in arterioles similarly. Myoglobin enhanced the superoxide-related fluorescence, and tempol prevented this enhancement. Tempol also partly prevented the myoglobin effect on the ANG II response. Myoglobin increased the fura 2 fluorescence ratio (cytosolic calcium) during ANG II application (10-12 to 10-6 M). The results suggest that the enhanced afferent arteriolar reactivity to ANG II is mainly due to a myoglobin-induced increase in superoxide and associated reduction in the NO bioavailability. Signaling pathways for the augmented ANG II response include enhanced cytosolic calcium transients. In conclusion, myoglobin may contribute to the afferent arteriolar vasoconstriction in this rhabdomyolysis model.

Correlation between anterior chamber characteristics and laser flare photometry immediately after femtosecond laser treatment before phacoemulsification.

PurposeTo assess the anterior chamber (AC) characteristics and its correlation to laser flare photometry immediately after femtosecond laser-assisted capsulotomy and photodisruption.Patients and methodsThe study included 97 cataract eyes (n=97, mean age 68.6 years) undergoing femtosecond laser-assisted cataract surgery (FLACS). Three cohorts were analysed relating to the flare photometry directly post femtosecond laser treatment (flare <100 n=28, 69.6±7 years; flare 100-249 n=47, 67.7±8 years; flare >249 photon counts per ms cohort n=22, 68.5±10 years). Flare photometry (KOWA FM-700), corneal topography (Oculus Pentacam, Germany: AC depth, volume, angle, pachymetry), axial length, pupil diameter, and endothelial cells were assessed before FLACS, immediately after femtosecond laser treatment and 1 day postoperative (LenSx Alcon, USA). Statistical data were analysed by SPSS v19.0, Inc.ResultsThe AC depth, AC volume, AC angle, central and thinnest corneal thickness showed a significant difference between flare <100 vs flare 100-249 10 min post femtosecond laser procedure (P=0.002, P=0.023, P=0.007, P=0.003, P=0.011, respectively). The AC depth, AC volume, and AC angle were significantly larger (P=0.001, P=0.007, P=0.003, respectively) in the flare <100 vs flare >249 cohort 10 min post femtosecond laser treatment.ConclusionsA flat AC, low AC volume, and a narrow AC angle were parameters associated with higher intraocular inflammation. These criteria could be used for patient selection in FLACS to reduce postoperative intraocular inflammation.

[Therapy of the ocular form of Behçet disease with cyclosporin A]. / Therapie der okulären Form des Morbus Behçet mit Cyclosporin A.

Three patients with Behçet's disease and therapy-resistant posterior uveitis have been treated with cyclosporin A (CS-A) for four years. The uveitis has been controlled better, as indicated by the reduced frequency of inflammation, and there was an initial improvement in visual acuity. However, it has not been possible to prevent a slight, gradual loss of visual acuity over the years. Relapses were observed after dose reductions to blood levels below 400-500 ng/ml and following discontinuation of CS-A therapy. Few relapses occurred at higher CS-A concentrations. It was found that both types of relapse could be controlled by increasing the CS-A dose. An at least transitory increase in creatinine levels as a side effect of CS-A was observed in all patients. The authors' results and reports in the literature suggest that CS-A is an effective immunosuppressive therapy in Behçet's disease and is superior to other immunosuppressives used so far.

Predisposing factors in corneal graft rejection.

During a period of 12 years, 390 patients were treated with perforating keratoplasty and given regular annual follow-ups. Of these, 357 records were evaluated, and there was a 20% incidence of immunoreactions. The transplants were assessed according to four criteria and subdivided into a low-risk and a high-risk group. For high-risk patients, the relative risk of developing an immunoreaction was 2.9 times greater with subdivision according to the preoperative diagnosis, 2.1 times greater with a transplant diameter of 7.5 mm or more, 2.6 times greater with compatibility between fewer than two HLA-B or -DR antigens of the donor and recipient, and 4.2 times greater with blood or fibrin in the anterior chamber on the first postoperative day. There was a linear relation between the frequency of being placed into the less-favorable-prognosis group and the occurrence of an immunoreaction.

[Intraocular pressure ten weeks after cataract surgery]. / Tension intra-oculaire dix semaines après opération de la cataracte.

The effect of phacoemulsification and extracapsular cataract extraction on the intra-ocular pressure is analysed for several intra-operative factors. The mean intraocular pressure is significantly reduced ten weeks after the operation in comparison with the preoperative intraocular pressure. This reduction of the intraocular pressure is most significant for eyes with preoperative ocular hypertension and those eyes where leakage of the aqueous humour was evidenced during the immediate postoperative period.

Topical indomethacin: inhibition of corneal wound healing in guinea pigs after severe alkali burn.

Corneae of guinea pigs were burned with 200 microliters 1N-NaOH for 30 seconds. Topical application of 1%, 0.1%, or 0.025% indomethacin (IN) four times daily resulted in a marked delay of corneal re-epithelialization compared to corneae receiving the vehicle only. However, no retardation of corneal wound healing was observed when IN was injected intraperitoneally (5 mg/kg) twice daily, but hyperemia and chemosis were reduced. To study the proportion of retained IN in burned cornea, 0.1% IN was mixed with a tracer dose of [2-14C] IN: 3.4, 1.2, 0.42, and 0.24% of the dose were retained 20, 60, 180, and 360 minutes respectively after topical application of 15 microliters. Twenty minutes after application of 15 microliter 0.1% IN, the concentration of retained IN in the cornea was 31 micrograms/g, which is considerably higher than the average concentration of 0.358 microgram/ml found in human blood plasma after therapeutic doses of IN. Thus, the retardation of corneal wound healing may be explained by a cytotoxic effect of supratherapeutic concentrations of IN.

The alkali burned cornea: electron microscopical, enzyme histochemical, and biochemical observations.

The early phase of wound healing after small central alkali burns of the guinea pig cornea was studied using electron microscopical, enzyme histochemical, and biochemical techniques. In the first phase, which was morphologically characterized by the destruction of the epithelium and keratocytes and by the infiltration of the cornea with polymorphonuclear leukocytes, an increase in the activity of lysosomal phosphatases and glycosidases (beta-D-glucuronidase, acid beta-D-galactosidase, beta-D-N-acetylglucosaminidase) was noticed. In the second phase, the cornea was invaded by capillaries and fibroblasts. In this phase, the activity of proteases (aminopeptidase M, dipeptidyl peptidase IV) increased intra- and extracellularly, suggesting that these enzymes may be involved in the turnover of the collagenous matrix and the ground substance. Using synthetic 4-methoxy-2-naphthylamine substrates and fluorescence-band detection techniques after isoelectric focusing, an increase in the activity of endopeptidases was demonstrated. The decreased activity of gamma-glutamyl transpeptidase may be linked with the activation of latent collagenase.