Glymphatic System in Ocular Diseases: Evaluation of MRI Findings.

BACKGROUND AND PURPOSE: There is growing evidence of leakage of gadolinium in an impaired blood-retina barrier. We investigated gadolinium enhancement in different eye compartments and correlated the enhancement with specific ophthalmologic diseases. MATERIALS AND METHODS: In a prospective clinical study (ClinicalTrials.gov Identifier: NCT05035251), 95 patients (63 with and 32 without ophthalmologic disease) were examined before and after gadolinium administration (20 and 120 minutes) with heavily T2-weighted FLAIR. The cohort was divided according to the location of pathology into anterior and posterior eye compartment groups. Relative signal intensity increase in the anterior eye chamber, vitreous body with retina, optic nerve sheath, and the Meckel cave was analyzed and correlated with the final clinical diagnosis. RESULTS: In patients with a disorder in the anterior eye compartment, significant signal intensity increases were found in the central anterior eye chamber (P 20 minutes = .000, P 120 minutes = .000), lateral anterior eye chamber (P 20 minutes = .001, P 120 minutes = .005), and vitreous body with retina (P 20 minutes = .02) compared with the control group. Patients with pathologies in the posterior eye compartment showed higher signal intensity levels in the central anterior eye compartment (P 20 minutes = .041) and vitreous body with retina (P 120 minutes = .006). CONCLUSIONS: Increased gadolinium enhancement was found in the central and lateral anterior eye compartments and the vitreous body with retina in patients with anterior eye compartment disorders 20 and 120 minutes after contrast application, suggesting impairment of the blood-aqueous barrier. In patients with a disorder in the posterior eye compartment, pathologic enhancement indicated disruption of the blood-retinal barrier that allows gadolinium to diffuse into the vitreous body with retina from posterior to anterior, opposite to the known physiologic glymphatic pathway.

[Comparison of spectral- and time-domain OCT in regard of the automatic detection of central retinal thickness]. / Vergleich von Spektral- und Zeit-Domänen-OCT hinsichtlich der automatisierten Erfassung der zentralen Netzhautdicke.

BACKGROUND: The aim of this study was to compare macular thickness measurements obtained from time-domain optical coherence tomography (OCT) and spectral-domain OCT to evaluate their agreement. MATERIALS AND METHODS: Fifty randomly assigned subjects were included. Twenty-five were male, twenty-five female. In all cases both eyes were measured. Serial measurements were obtained from time-domain (StratusOCT, Zeiss) and spectral-domain OCT (Heidelberg Engineering, Germany). Total and regional macular thicknesses were obtained from both machines. Their agreement was estimated by Bland Altman plots. RESULTS: The foveal and total macular thicknesses measured by 3D OCT were significantly greater than those measured by StratusOCT (p < 0.001). CONCLUSIONS: While both time-domain and spectral-domain OCTs are reliable for macular thickness measurements, spectral-domain OCT delivers significantly higher values for macular thickness compared to the time-domain OCT. Macular measurements obtained from the two OCT systems may not be used interchangeably.

Flexible cystoscopy assisted by hexaminolevulinate induced fluorescence: a new approach for bladder cancer detection and surveillance?

OBJECTIVE: The aim of this study was the assessment of flexible cystoscopy assisted by hexaminolevulinate (HAL) fluorescence. METHODS: This study was a prospective controlled, within-patient comparison of flexible HAL cystoscopy with standard flexible cystoscopy, HAL rigid and standard white light rigid cystoscopy. Eligible patients received an intravesical instillation of 50 ml hexylaminolevulinate 8 mM solution. First flexible than rigid cystoscopy was performed in each patient using a Combilight PDD system (Richard Wolf, Germany), which provided standard white light and blue light at 375 to 440 nm, with mapping of all lesions detected. All tumors and suspicious areas identified under white light and by red fluorescence with flexible or rigid cystoscopy were then resected by TUR or biopsied. The specimen was assessed by an independent blinded pathologist. RESULTS: In the 45 patients studied 41 (91%) patients had exophytic tumors, of which 39 (95.1%) were detected by HAL flexible cystoscopy and 40 (97.5%) by HAL rigid cystoscopy. 17 (37.8%) patients had concomitant or carcinoma in situ only, which was identified by HAL flexible cystoscopy in 14 (82.3%), by HAL rigid cystoscopy in 15 (88.2%), by flexible standard in 11 (64.7%) and by standard white light rigid cystoscopy in 13 (76.7%) patients. CONCLUSION: HAL fluorescence flexible cystoscopy compared to HAL rigid cystoscopy showed almost equivalent results in detecting papillary and flat lesions in bladder cancer patients. Both procedures were superior to standard white light flexible cystoscopy.

[Techniques for preparing postmortem human eyes to perform anterior segment intraocular surgery]. / Técnicas para la preparación de ojos de cadáver utilizadas para practicar cirugía intraocular del segmento anterior.

We describe different methods to prepare postmortem human or animal eyes used at the Center for Research in Ocular Therapeutics and Biodevices at the Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA. These techniques have been utilized for performing different surgical procedures (phacoemulsification, extracapsular cataract extraction, etc.), and for training of surgeons in-transition. Performing these techniques in the wet-laboratory contributed to improve surgical skills to perform the critical steps of the phacoemulsification surgery. Pathological evaluation of pseudophakic postmortem human eyes using the Miyake-Apple posterior view and histology was helpful to analyze postoperative complications of cataract surgery (anterior capsule opacification and posterior capsule opacification) secondary to postoperative proliferation of lens epithelial cells into the capsular bag. Modifications in the surgical techniques and/or lens design may be helpful to reduce these postoperative complications. Implantation of various aphakic and phakic intraocular lenses in postmortem human eyes as well as animal eyes was helpful to analyze the sizing and fitting of new lens designs within the eye.

[Miyake-Apple video analysis of movement patterns of an accommodative intraocular lens implant]. / Miyake-Apple-Video-Analyse des Bewegungsmusters einer akkommodativen Intraokularlinse.

BACKGROUND: The potentially accommodative intraocular lens (IOL) is a new development in IOL design METHODS: We evaluated the new Humanoptics 1CU accommodative IOL in a laboratory study with human post mortem autopsy eyes. Using the Miyake-Apple posterior view video technique, the movement pattern of the IOL was tested and observed from the posterior perspective. RESULTS. A circular bend at the level of the ciliary body applied slight circular force onto the sclera allowing the relaxation of the zonules. The shift of focus was demonstrated by using a reading target. In addition, viscoelastic was injected into the vitreous resulting in the same anterior movement of the IOL optic. CONCLUSIONS: The 1CU Humanoptics accommodative IOL showed potential accommodative behaviour in the laboratory. The accommodative (respectively pseudoaccommodative) effect was based on the anterior shift principle with anterior movement of the IOL-optic in the state of relaxing zonules. Whether this reflects the clinical situation, especially to this extent, must be further evaluated.

[Mono- or bilateral abducens paralysis as the initial symptom of sinus vein thrombosis]. / Ein- oder beidseitige Abduzensparese als Erstsymptom einer Sinusvenenthrombose.

BACKGROUND: Sinus vein thrombosis is a rare intracerebral complication of mastoiditis. We report on the clinical ophthalmologic symptomatology of this secondary illness. HISTORY: two young female patients, aged 14 and 3.5 years, presented at our pediatric ophthalmology section due to diplopia. Both girls had suffered 1-2 weeks earlier from otitis media, which had been treated with antibiotics. Other neurological symptoms were not reported. CLINICAL COURSE: Best corrected visual acuity was 20/20 OD/OS in both patients. Ocular alignment revealed a bilateral abduction deficit in the 14-year-old girl and a monolateral abduction deficit of the right eye in the younger patient. Ophthalmoscopic examination evidenced bilateral papilledema in both patients. Magnetic resonance tomography and magnetic resonance angiography showed mastoiditis and thrombosis of the sigmoid and transverse sinuses. THERAPY: Following mastoidectomy, high-dose antibiotic therapy, and full-dose heparin therapy, rapid improvement occurred. CONCLUSIONS: Thrombosis of the sigmoid sinus following mastoiditis is a rare but severe complication of middle ear inflammation. Immediate surgical and antibiotic therapy is necessary. Symptoms can possibly occur even when the primary focus seems to resolve.

[The life work of Sir Nicholas Harold Lloyd Ridley]. / Zum Lebenswerk von Sir Nicholas Harold Lloyd Ridley.

On may 25th 2001 Sir Harold Ridley died at age 94. With him Ophthalmology lost one of the greatest and most influential Ophthalmologist of the post-war time. He is the founder of modern cataract surgery implanting the first intraocular lens after extracapsular cataract extraction 50 years ago. He pioneered in what became one of the most important success stories in Ophthalmology. His vision and concepts managed to succeed against strong opposition worldwide. Modern cataract surgery and modern refractive IOL surgery would not been possible without his contribution. Sir Harold Ridley reached a high age and was therefore able to see his visions become reality and finally receive all honours and awards he deserved over the past 15 years, including the knighthood by Queen Elisabeth II in the year 2000. The following article gives a summary of his biography and contributions to Ophthalmology.

[Complication profiles of posterior chamber intraocular lenses IOL). An analysis of 586 foldable and 2077 rigid explanted intraocular lenses]. / Komplikationsprofile von Hinterkammerlinsen. Eine Analyse 586 faltbarer und 2.077 rigider (PMMA-)explantierter Intraokularlinsen.

BACKGROUND: Foldable intraocular lenses (IOL) have become increasingly preferred choice for IOL implantation after cataract removal. However, both foldable as well as rigid IOLs are not yet complication-free and may need explanation. MATERIAL AND METHODS: A total of 2663 explanted posterior chamber IOLs (PCIOLs) were accessioned at the Center for Research on Ocular Therapeutics and Biodevices between January 1988 and September 2000. The lenses were examined grossly using a Leitz/Wild M-8-Zoom stereomicroscope. The clinical reasons for explanation were documented for foldable as well as for rigid lenses. RESULTS: Of a total of 2663 explanted PCIOLs, 586 were foldable lenses and 2077 were rigid PMMA lenses The most frequent reason for explantation of all 2663 IOLs studied was decentration/dislocation. Optic and haptic damage and posterior capsule rupture were significantly more often a reason for explantation in several foldable designs compared to rigid PCIOLs. Whereas rigid designs lead more often to corneal decompensation. The percentage of explanted IOLs because of inflammatory reactions decreased significantly from 1994 to 2000. CONCLUSIONS: The complication profiles of rigid and foldable IOLs revealed some apparent differences due to the nature of the IOL biomaterials and designs. IOL optic/haptic damage was a common complication for foldable IOLs, whereas it was only discovered in single digits for rigid PMMA IOLs. The possible explanation for this is, that the soft and flexible biomaterials, from which all the foldable IOLs were manufactured, are easier to be damaged during folding, unfolding and insertion procedure. In our opinion this relative disadvantage of foldable IOLs is by far outweighed by the numerous advantages of the small incision cataract surgery. The decreasing inflammatory reactions can be explained by advances in surgical techniques, especially the secure in-the-bag fixation of IOLs.

[Morphological autopsy findings in human eyes implanted with Ridley intraocular lenses]. / Morphologische Befunde menschlicher Autopsieaugen nach Implantation von Ridley-Intraokularlinsen.

BACKGROUND: Sir Harold Ridley's first cataract extraction with implantation of an intraocular lens (IOL) marked the beginning of a major change in the practice of ophthalmology. MATERIAL AND METHODS: Two human autopsy globes implanted with original Ridley IOLs were grossly examined from behind with the Miyake-Apple photographic technique. The anterior segments were evaluated histologically. One Ridley IOL was examined by scanning electron microscopy. RESULTS: Both IOLs maintained a clear visual axis and had been placed in the capsular sac. The right lens was decentered inferiorly, the left IOL was well centered. The posterior capsule showed only minimal capsular opacification. Scanning electron microscopy (SEM) of the explanted IOL showed a smooth, well polished surface. CONCLUSIONS: In this patient Ridley IOLs maintained an ideal visual rehabilitation of 20/20 in both eyes, 22 and 18 years postoperatively. One surprising finding was the presence of a square, truncated optic edge geometry, very similar to that seen in some modern foldable IOLs. In our opinion the absence of posterior capsule opacification of the Ridley IOL may have partially been a result of this nearly sharp optic edge, that we confirmed by SEM. Even 22 years after implantation the Ridley IOL showed a high finish quality. Many of Sir Harold Ridley's early concepts like the IOL placement in the posterior chamber and endocapsular implantation are now the standard of modern cataract surgery.

[Millenniums update on posterior capsule opacification (PCO) scores, centration, biocompatibility and fixation of foldable intraocular lenses (IOL) - an analysis of 1,221 pseudophakic post mortem globes]. / Nachstarrate, Zentrierverhalten, Biokompatibilität und Fixation intraokularer Faltlinsen - eine Milleniums-Analyse 1221 pseudophaker Autopsieaugen.

BACKGROUND: The ongoing and fast evolution of foldable IOL designs established the necessity to evaluate the different abilities of each lens style. The large IOL database (over 16,500 specimens) acquired in our laboratory, has permitted us to perform a clinico-pathological analysis on pseudophakic autopsy globes provided from sources worldwide, especially many Lions Eye banks in the United States. MATERIAL AND METHODS: We analyzed 6 foldable IOL styles commonly implanted in the United States, using one type of rigid IOL design (1-piece design rigid PMMA optics) as a comparison group. Posterior capsule opacification (PCO) score, decentration, fixation, presence or absence of a Nd:YAG laser posterior capsulotomy and area and intensity of Soemmerring's ring formation was discerned by examination under an operating microscope using the Miyake-Apple posterior photographic technique. RESULTS: The four lenses with the lowest rates ranging between 3.8 % and 21.7 % are modern designs, mostly implanted after 1992. The two lenses with the higher rates ranging between 23.1 % and 30.4 %, were all older designs, already prevalent prior to 1992. IOL fixation with both haptics in the capsular bag showed the best centration values and PCO scores. Our studies to date have shown in a preliminary fashion that the AcrySoftrade mark IOL displays the the lowest (best) biocompatibility score. CONCLUSIONS: Entering the new millenium, with evolution of modern surgical techniques and IOL designs, the incidence of the two major complications of cataract surgery, decentration and PCO are now finally diminishing.

[Postoperative opacification of posterior chamber intraocular lenses - a review]. / Postoperative Trübung von Hinterkammerlinsen - eine Ubersicht.

Postoperative opacification of intraocular lenses (IOLs) is a very unpleasant complication for the ophthalmic surgeon and the patient. We report on our experiences with opacification of different foldable IOL designs and rigid poly (methyl methacrylate) (PMMA) posterior chamber lenses.1. Snowflake degeneration of PMMA IOLs: This condition is an unanticipated and surprising late postoperative finding 8 to 15 years after implantation. In our opinion, this complication is probably not related to the PMMA biomaterial itself, but rather it appears to represent a manufacturing problem that has affected a selected, albeit large number of lenses manufactured in the 1980s-mid 1990s.2. Degeneration of UV absorber material and calcium deposits within the optic of hydrophilic IOLs: Two years postoperatively degenerations of UV absorber material and calcium deposits within the optic of single piece hydrophilic acrylic lenses SC60B-OUV manufactured by MDR (Medical developmental research Inc. Clearwater FL, USA) can occur. Although the precise mechanism is not fully known, it was assumed that these opacifications are due to premature aging of the UV blocking agent incorporated in the lens biomaterial and calcification.3. Calcification on the surface of the Bausch & Lomb Hydroviewtrade mark IOLs: Twelve to 15 months postoperatively granular surface calcifications in Hydroviewtrade mark IOLs occured. The mechanism is not fully understood. According to Bausch and Lomb studies, part of the components of the packaging contained silicone, which may have come off the packaging onto the lens optic, where it then appears to be a catalyst for calcium precipitation. The manufacturer has correlated a change in packaging with the appearance of the opacification. The manufacturer now believes that this problem has been solved. However, final verification will require a careful 1 - 2 years clinical study.4. Glistenings in the hydrophobic acrylic AcrySoftrade mark IOLs: The time frame of glistenings in the AcrySoftrade mark IOLs is highly variable. It has been suggested that the occurrence of glistenings may be related to variations in the temperature of the lens just prior to and or during insertion into the eye. Formation of vacuoles may occur within the submersed acrylic polymer when there is a transient increase and then decrease in temperature during the surgical procedure. "Glistenings" may then subsequently form by ingress of anterior chamber fluid. Contrast sensitivity can been decreased in some patients, but clinically significant decrease of visual acuity has been rare.

[Influence of surgery-related factors on the Nd:YAG laser capsulotomy rates of 3-piece silicone IOLs - analysis of 457 pseudophakic human globes obtained post mortem]. / Einfluss chirurgischer Faktoren auf die Kapsulotomierate dreistückiger Silikon-Intraokularlinsen - Analyse 457 pseudophaker Autopsieaugen12.

BACKGROUND: The purpose of this study was to analyze any possible surgical reasons which may have had caused posterior capsule opacification in 3-piece silicone IOLs that had required Nd:YAG laser treatment. Special attention was given to 1) quality of cortical clean up, 2) type of haptic fixation, and 3) continuous curvilinear capsulorhexis (CCC) size and shape. MATERIALS AND METHODS: Human eyes obtained post-mortem implanted with 3-piece silicone optic - PMMA haptic (SI 40 NB) and 3-piece silicone optic - Prolene haptic (SI 30 NB) designs IOLs, accessioned between January 1993 and December 2000 were evaluated by gross examination from behind under an operating microscope using the Miyake-Apple posterior photographic technique. The area and intensity of Soemmerring's ring and type of fixation was studied in 457 eyes. The mean diameter of the CCC and relation of the CCC edge to the optic rim were analyzed in 221 eyes. RESULTS: 1) The amount of Soemmerring's ring formation was significantly larger in the group of IOLs requiring Nd:YAG capsulotomy in both the SI 40 NB and SI 30 NB design than in the IOLs without capsulotomies. 2) The percentage of not in-the-bag fixated IOLs in both the SI 40 NB and SI 30 NB design was larger in the "Nd:YAG groups", without being statistically significant. 3) The "Nd:YAG groups" showed a significant higher amount of non overlapping clock hours of the CCC edge in relation to the optic rim. CONCLUSION: 1) The data confirm the clinical assumption that the incidence of PCO is correlated with the cortical clean up. 2) Our findings also support the clinical assumption, that poor IOL fixation increases the risk of PCO. 3) This study also verifies the relation of the CCC to PCO, namely a relatively small CCC covering the entire optic rim is best to reduce the Nd:YAG laser rate.

[Embolization of dural carotid cavernous sinus fistulas via the sylvian vein in 2 patients]. / Embolisation duraler Karotis-Sinus-cavernosus-Fisteln via Vena Sylvii bei zwei Patienten.

BACKGROUND: Dural carotid sinus cavernous fistulas account for about 12% of intracranial arteriovenous fistulas. These dynamic shunts are dilemmas not only for the clinical diagnosis but also for the management of ocular complications and in the application of diagnostic and therapeutic techniques. The traditional therapy is transarterial embolisation by an interventional neuroradiologist. We report on the management of two fistulas where the classical therapeutic methods were not possible or failed. PATIENTS AND METHODS: Two patients underwent an osteoplastic pterional craniotomy with cannulation of a vein of the sylvian fissure and controlled embolisation of the fistula with polyvinyl alcohol particles. RESULTS: Successful closure of both arteriovenous shunts was achieved on angiography with normalisation of clinical symptoms. As a severe complication one patient suffered from a stroke after the postoperative angiography. CONCLUSIONS: Arteriovenous fistulas not approachable by traditional therapeutic methods, can be embolised effectively via a superficial vein of the sylvian fissure. This surgical route should only be considered if other therapeutic ways fail or seem impossible.