[Fireworks injuries of the eye: an overview of current diagnostic and treatment options]. / Diagnostik und Akuttherapie von Augenverletzungen durch Feuerwerkskörper.

Fireworks can cause very different eye injuries. The injury patterns range from spontaneously healing conjunctival and corneal lesions up to a burst eyeball with very severe injuries in the posterior ocular section and traumatic enucleation. The precise initial diagnosis in an emergency situation can be a challenge for the ophthalmologist. Children and adolescents are often affected. The patient history with respect to the circumstances of the accident is particularly important to be able to estimate the extent of the injury and to initiate a conservative or, if necessary, emergency operative treatment. This article provides an overview of typical injury patterns and advice for the diagnostics, treatment and complication management.

Cholesterol-induced variations in the domain structure fluctuations and microdynamics of lipid membranes.

Broadband ultrasonic attenuation spectra (100 kHz to 2 GHz) of aqueous solutions of vesicles from 1,2-dimyristoyl-l-3-phosphatidylcholine, with different amounts of cholesterol admixed, have been measured at temperatures between 20 and 28 °C. The spectra have been evaluated in terms of suitable relaxation functions. They are discussed in view of the effect of cholesterol on the membrane behavior around the gel-fluid phase transition temperature T(m). In addition to a frequency-independent asymptotic high-frequency term, all spectra reveal a critical term and a Debye-type relaxation term with relaxation time around 0.5 ns. The former is evaluated in the light of the Bhattacharjee-Ferrell dynamic scaling theory. It is assigned to the critical domain structure fluctuations of the membranes. Critical slowing of fluctuations is demonstrated. Also shown are relations of the critical amplitudes to thermodynamic parameters. The Debye term reflects the rotational isomerization of the phospholipid alkyl chains. The relaxation time of isomerization reveals a significant steplike change at T(m). At moderate cholesterol content an additional Debye relaxation term exists. It is assigned to the axial diffusion of the membrane molecules. Because it likewise shows effects of slowing near T(m), the diffusion appears to be coupled to the domain structure fluctuations. A further relaxation term at small cholesterol concentration is assumed to be due to small-range shape fluctuations of vesicles near the phase transition temperature.

[Prognostic factors for visual outcome after intravitreal drug therapy for chronic diabetic macular oedema]. / Prognostische Faktoren beim chronisch-diabetischen Makulaödem nach intravitrealer Therapie.

BACKGROUND: In recent years, intravitreal bevacizumab and triamcinolone acetonide (TA) have been widely used to treat diabetic macular oedema (DMO). However, the indication criteria are not clear. The purpose of this study was to evaluate factors which are decisive for long-term visual outcome after intravitreal drug treatment for eyes with DMO. MATERIALS AND METHODS: Fifty eyes (37 patients) treated with intravitreal bevacizumab, TA, or sequentially with both for DMO with a minimum follow-up period of 6 months were analysed retrospectively. The eyes with an increase of best-corrected visual acuity (BCVA) at the last visit were classified as gainers, and eyes with stable or decreased BCVA as non-gainers. Clinical and imaging findings were evaluated. RESULTS: BCVA significantly increased in 22 eyes and decreased in 28 eyes after a mean follow-up period of 14.6 ± 6 months after initial intravitreal intervention. Unfavourable for the long-term visual outcome was the presence of cystoid macular oedema (CMO, p < 0.001), whereas an early response at 5 weeks into therapy indicated a positive outcome (p = 0.016). The initial central macular thickness measured by OCT, the type of agent used in monotherapy, age and gender were without influence on long-term visual acuity. CONCLUSIONS: An initial CMO is unfavourable for the prognosis of long-term visual outcome of DMO. Hence, benefit from intravitreal treatment with bevacizumab and/or TA is more likely in the early stages of chronic DMO before CMO has evolved. In eyes without CMO even a low number of injections is beneficial. An early response following intravitreal bevacizumab or TA is a predictor of long-term benefit.

Pressure distribution at the teat-liner and teat-calf interfaces.

During milking, the teat is loaded because of a combination of vacuum and pressure of the collapsing liner. It is assumed that pressure concentrations tend to cause teat-end injuries and hyperkeratosis. The pressure distribution on the bovine teat was measured to test the hypothesis that the pressures of the collapsed liner are unevenly distributed over the teat. With the aid of a pressure-sensitive sensor (approximately 2 gauge points/cm(2)), the pressures at the teat-liner and the teat-calf interfaces were measured at 100 Hz. Pressure distribution over the surface of an artificial teat was measured with 7 different liners, 1 liner at 3 different vacuum levels, and a suckling calf. One cow was equipped with a sensor at a teat during a milking with one of the liners. Conventional round liners concentrated the load over 2 sites at the teat end. Some liners (softer material, reduced tension, smaller barrel, reduced mouthpiece depth) distributed the compressive load over a larger area of the teat. Although all liners distributed the highest pressures at the teat end, some liner designs showed a 25% reduction at the site of interest at vacuum of 44 kPa. The calf forced milk flow by a combination of suckling and overpressure in the teat cistern caused by the tongue. While the calf was swallowing, teat pressure was reduced because of a decrease in vacuum. Moreover, the calf did not load the teat end, probably because the teat canal would be closed and the milk would not flow. The method of using a pressure sensor to analyze teat loading at the teat-liner and the teat-calf interfaces showed potential and is a first step toward developing a natural milking technique.

[Circumscribed retinal detachment after radial optic neurotomy for central retinal vein occlusion]. / Umschriebene hochblasige Netzhautablösung nach radiärer Optikusneurotomie bei Zentralvenenverschluss.

OBJECTIVE: It has been suggested that radial optic neurotomy (RON) may improve the functional outcome of retinal vein occlusions. We report the case of a patient presenting with a high, but circumscribed, peripapillary retinal detachment following RON for central retinal vein occlusion. RESULTS: A 69-year-old man presented with a high retinal detachment 2.5 years after RON for central retinal vein occlusion. It was complicated by a recurring cystoid macular edema; however, best visual acuity was 0.5. The retinal detachment developed slowly. Its location was nasal and superior to the optic disc. It did not extend beyond the equator and had no detectable retinal break. The retinal detachment was successfully treated by an encircling band, pars plana vitrectomy, laser coagulation, and air endotamponade. There was no obvious persisting retinal defect at the RON site. CONCLUSIONS: Although other mechanisms should be taken into account, this case indicates that it might be possible to create a fistula between the subarachnoid and subretinal space, leading to a slowly developing retinal detachment. A similar case report pointed out that special attention should be paid to the depth of the radial incision into the optic nerve head.

[Management of a ruptured globe]. / Management der Bulbusruptur.

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.

[Traumatic Endophthalmitis Prevention Trial (TEPT)]. / Traumatic Endophthalmitis Prevention Trial (TEPT).

AIM: Post-traumatic endophthalmitis is one of the most severe complications occurring in 2-17% after open globe injuries. Early intravenous antibiotics may minimise the risk of post-traumatic endophthalmitis. The design of a new study to evaluate the role of an additional intravitreal antibiotic injection in the prevention of post-traumatic endophthalmitis is presented in this paper. PATIENTS AND METHODS: A prospective, multicentre, randomised controlled study was designed. Patients with penetrating or perforating eye injuries will be included up to the year 2010. The wound closure and IOFB (intraocular foreign body) removal must be performed within 24 hours after the trauma. After grouping into low risk (e. g., metallic IOFB) or high risk patients (e. g., agricultural trauma, organic IOFB) each patient will be randomised for 1) intravenous moxifloxacin only or 2) intravenous moxifloxacin plus intravitreal 1 mg Vancomycin plus 2.25 mg [DOSAGE ERROR CORRECTED] Ceftazidim. RESULTS: 17 European Departments of Ophthalmology have agreed to participate. The rate of post-traumatic endophthalmitis in each group will be statistically compared. The follow-up period of this study will last 6 months. CONCLUSION: Other Departments of Ophthalmology are invited to join the TEPT.

[Severe open globe injury. New treatment concepts]. / Schwere Bulbus eröffnende Augenverletzungen. Aktuelle Behandlungskonzepte.

In spite of the technical progress in vitreoretinal surgery, the anatomical and functional results of severe ocular injuries involving the posterior segment are still discouraging. Perforating injuries and ruptures that extend posterior to the muscle insertions have the worst outcomes. When the secondary intervention is usually performed between days 7 and 14 post trauma, it is not unlikely that a severe proliferative vitreoretinopathy has already occurred. With a new concept--to act rather than to react to alterations secondary to severe posterior segment trauma--the functional results of these injuries may be further improved, according to various studies. The internal reconstruction is in part performed together with the primary wound closure, or, alternatively, within 100 h after the trauma. This idea is currently being further evaluated in a prospective multicenter multinational study conducted by the World Eye Injury Register.

Eye disorders in diabetes: potential drug targets.

Diabetes Mellitus (DM) is a serious medical problem that causes long-term systemic complications and considerable associated morbidity. DM can cause retinopathy (DRP), maculopathy, cataract, optic neuropathy, defects of eye muscles. DM is a risk factor for acute infectious conjunctivitis, bacterial keratitis, herpes virus infections and endophtalmitis. Elevated blood glucose induces structural, physiological and hormonal changes which affect retinal capillaries. DRP is recognized by loss of pericyte function and capillary occlusions together leading to breakdown of blood-retinal barrier, edematous changes and proliferation of vessels and fibrous tissue. Depending on stage of DRP, there are different preferable therapeutic approaches applied. In the case of ETDRS, in the area of leakage focal treatment should be performed, while panretinal photocoagulation is applied towards ischemic areas or beginning proliferations. Vitreal haemorrhage followed by fibroproliferative changes or tractional retinal detachment is treated by vitrectomy alone or in combination with ILM peeling. In pathogenesis of DRP, Insulin Growth Factor (IGF-1) can play an important role in production of VEGF (Vascular Endothelial Growth Factor). Hypoxia can up-regulate VEGF expression levels leading to pathologic ocular neovascularisation. An application of intravitreal corticosteroid treatment modulates vascular permeability by suppressing the production of VEGF, reducing both extracellular matrix metalloproteinase activity and basic fibroblast growth factor, decreasing major histocompatibility complex 2 Ag expression levels, and inhibiting activity of inflammatory cells. Clinical effects of treatment using intravitreal corticosteroids are evaluated by reduction of macular thickness and visual improvement. Intravitreal use of Anti-VEGF drugs, Pegaptanib, Ranibizumab and Bevacizumab can modify vasoproliferation, trigger macular edema, and, therefore, influence a prognosis for visual loss.

[Cost-utility analysis of ranibizumab (Lucentis) in neovascular macular degeneration]. / Was darf Lebensqualität kosten?--Kosten-Nutzwertanalyse von Ranibizumab (Lucentis) bei altersabhängiger Makuladegeneration.

PURPOSE: Ranibizumab (Lucentis) stabilizes or improves visual acuity in a high percentage of patients with age-related macular degeneration (AMD). As this therapy is associated with significant costs, the aim of this study was to provide a cost-utility analysis, which considers both costs and utility of a therapy with ranibizumab in an economic model. METHODS: The incremental utility for the patient was modelled based on visual acuity data of the MARINA and ANCHOR study. The utility data used assume that the better seeing eye is affected. The study groups used for comparison consisted of patients who only received best supportive care, e. g., low-vision aids. The baseline scenario of the model assumes 6 treatments per year over a 2 year time period - based on the assessment of an expert panel. Treatment costs were based on German pharmacy prices and recommendations for reimbursement of the intravitreal injections. In a univariate sensitivity analysis all important parameters were varied to assess the stability of the results. RESULTS: The baseline scenario yields for predominantly classic lesions 16,882 euro/QALY (quality adjusted life year), for minimally classic CNV 24,766 euro/QALY and for occult CNV 26,170 euro/QALY. If a distribution of the CNV types with 18 - 25 - 57 % is assumed, the mean cost of therapy with ranibizumab amounts to 24,147 euro/QALY. Sensitivity analysis showed that all reasonable variations yielded results which are considered cost-effective ( 0.4) visual acuity, for a variation of costs per treatment of +/- 20 %, and a prolonged treatment duration of 3 years. CONCLUSIONS: In the investigated szenario a therapy of neovascular AMD with ranibizumab is cost-effective for all angiographic subtypes as well as in the sensitivity analysis.

[Age-related macular degeneration: a socioeconomic time bomb in our aging society]. / Altersbedingte Makuladegeneration: Sozioökonomische Zeitbombe in der alternden Gesellschaft.

BACKGROUND: More than 50% of all Europeans over 65 years of age have alterations to the fundus that should give rise to the suspicion of incipient age-related macular degeneration (AMD). Demographic changes in the German population and the longer life expectancy now are causing a rapid increase in the absolute number of AMD patients. On the one hand, new treatment options are causing an increase in treatment costs; on the other, social costs are also rising because patients are often left with some sight impairment. The authors attempt to forecast prevalence and incidence on the basis of the epidemiological data known for Germany and, using model calculations, to highlight trends that illustrate the increasing socioeconomic significance of this disease. RESULTS: Forecasts show that the number of patients with advanced AMD will increase from 710,000 at present to over a million by 2020. In the same period, the number of patients with neovascular AMD will increase from 485,000 to 700,000. There are currently 50,000 new cases of neovascular AMD every year in Germany, and it has only just become possible to treat these with the new anti-VEGF drugs. The new treatment options will cause additional annual costs of 1.1-2.9 billion euro for Germany alone. CONCLUSION: The new treatment options for AMD will lead to a pronounced reduction in the number of visually impaired and blind people. However, this progress cannot be achieved without the financial resources dedicated to ophthalmology being approximately doubled.

[Photodynamic therapy in classic chorioidal neovascularisation in patients with angioid streaks]. / Photodynamische Therapie mit Verteporfin bei klassischer chorioidaler Neovaskularisation bei Patienten mit Angioid Streaks.

BACKGROUND: The development of subfoveal or juxtafoveal choroidal neovascularisation (CNV) secondary to angioid streaks poses a great therapeutic challenge. The relevance of the photodynamic therapy (PDT) with verteporfin is still unclear. We present the functional and anatomic outcome of 5 patients with CNV due to angioid streaks treated by PDT. METHODS: We reviewed 4 eyes with subfoveal and 1 eye with juxtafoveal CNV in angioid streaks of 5 patients (4 male, 1 female) treated by PDT between 2000 and 2005. The age ranged from 20 to 74 years (median 63 years). PDT was performed according to the TAP criteria. Best corrected visual acuity was measured using ETDRS charts. RESULTS: Visual acuity (VA) ranged between 20/63 and 20/32 (median 20/32) at first presentation and between 20/2000 (counting fingers) and 20/20 (median 20/400) at last presentation. Median follow-up time was 13 months with a range of 5 to 45 months. The visual acuity in one patient decreased by 1 line, in 3 patients by more than 6 lines whereas VA of one patient (juxtafoveal CNV) increased by 2 lines. PDT was repeated in 4 patients once because of persistent leakage and in one patient twice. At the end of the follow-up period a fibrous disciform lesion was seen in 4 patients, in one patient subfoveal membranectomy was performed due to a recurrence. CONCLUSIONS: In general, PDT of CNV is less favourable in angioid streaks than in AMD. However, in the natural course final VA is counting fingers. Therefore the good results of individual cases justify the PDT under a critical indication.

[Epidemiology of open globe eye injuries: analysis of 1026 cases in 18 years]. / Epidemiologie bulbusöffnender Augenverletzungen: Analyse von 1026 Fällen über 18 Jahre.

BACKGROUND: Ocular trauma has significant impact on the patient's future quality of life. Progress in the treatment of ocular trauma may ameliorate the outcome, but preventive measures are more effective. However, prevention of ocular trauma can only be effective when the current epidemiology of ocular trauma is known. Therefore, we have now collected data on ocular trauma over nearly 20 years. This paper provides an overview on the development of open globe injuries in the past 20 years. PATIENTS: The records of 1026 patients with open globe injuries who were primarily treated at the Universities of Freiburg and Würzburg between January 1, 1981 and December 31, 1999, were sufficiently analyzed. The following parameters were evaluated: age, extent of injury, sex, cause. and activity at the time of injury. RESULTS: After correction for demographic distribution, the risk for open globe injury was highest for young adults and lowest for seniors. In recent years, the risk for severe eye injury is more equally distributed and is increasing for old people. We noted decreasing injuries at work and during traffic accidents, especially for young female front-seat passengers. On the other hand, we observed an increasing proportion of domestic eye injuries related to hobby activities. With increasing age we noted more posterior segment injuries. 9 % of all open globe injuries occurred among seniors (> 65 years old), but 41 % of all ruptures occurred in this age group. Preceding cataract surgery was identified as a risk factor. 38 % of injured persons in this age group had already had intraocular surgery. After the introduction of small incision techniques at the beginning of the 1990 s, the frequency of globe ruptures began to decrease again. 3.6 % of the injured eyes developed an endophthalmitis, in agricultural injuries the rate of endophthalmitis was 12 %. CONCLUSION: There is a relative constant incidence of 3.0 open globe injuries per 100,000 population. The circumstances of the injuries underwent major changes within the period of these observations.

Fast and direct method for measuring 1-octanol-water partition coefficients exemplified for six local anesthetics.

The 1-octanol-water partition coefficients (P(OW)) of six local anesthetics were determined by an improved direct method. In the experimental setup, dialysis tubing is used to separate the aqueous from the octanol phase containing the analyte. This procedure allows the application of ultrasonic agitation to shorten the equilibration time to 2 h. The measurements had a reproducibility of +/- 0.1 log units and showed an excellent agreement with the results obtained with the traditional shake-flask method. However, the correlation with the indirect determination using reversed-phase liquid chromatography was considerably poorer, showing that high-performance liquid chromatography determinations are not always very reliable. Because all the anesthetics used are nitrogen bases, the measurements were performed at two pH values. The method allows a fast and reliable direct determination of partition coefficients.

Development of a simple gradient LC-IR interface for the detection of terpenoids from the alpha-pinene-ozone reaction.

The development of a simple interface between liquid chromatography and infrared spectroscopy (LC-IR) using a coaxial sprayer is described for less volatile analytes. The system consists of a transfer capillary, in which the analytes are transported from the separation column of the gradient-LC to the outlet of the sprayer. This transfer capillary is coaxially surrounded at the outlet by a stainless steel sprayer capillary, which is resistively heated and flushed with nitrogen gas. The samples are sprayed in the manner that the eluent is vaporized by the heated nitrogen when exiting the capillary, while the analytes are deposited on a moving slide made of infrared transparent material (ZnSe or CaF2). Afterwards the deposited compounds are analyzed with an infrared microscope in transmission. First results from reaction products of the gas phase reaction of alpha-pinene with ozone are presented.

Degradation of alpha-pinene on Tenax during sample storage: effects of daylight radiation and temperature.

The behavior of alpha-pinene sampled on adsorption cartridges filled with Tenax TA has been investigated in relation to different storage conditions, focusing on daylight radiation and temperature. After sampling, the respective cartridges containing the terpene were placed in sunlight on the windowsill for up to 1 month. Corresponding samples have been wrapped in aluminum foil to prevent the influence of daylight radiation. Additional sample cartridges with alpha-pinene were stored in the refrigerator at 4 degrees C and a freezer at -18 degrees C. All cartridges were analyzed using thermodesorption injection onto a gas chromatograph, and the compounds were detected using either a cryocondensation-interface to a Fourier transform infrared-spectrometer (GC/FT-IR) or the flame ionization detector (FID). In summary, 12 compounds were detected and identified, from which eight were products that were formed on Tenax through different mechanisms. Two compounds seemed to be formed under the influence of daylight radiation, while the others appear to be mainly autoxidation products. Estimates after 1 month of storage showed recoveries of over 99% for wrapped samples, while for unwrapped cartridges only about 88% of alpha-pinene was found. A pattern of up to five compounds was found that can be used as an indicator for storage reactions.

A "hard/soft" mismatch enables catalytic Friedel-Crafts acylations.

[figure: see text] Cationic complexes of Pt(II) and other late transition metals efficiently catalyze Friedel-Crafts acylations of moderately activated arenes by carboxylic acid anhydrides. The nature of the catalytically relevant species formed from (PhCN)2PtCl2 and AgSbF6 and their interactions with the substrates are studied by NMR and ESI-MS.

[Penetrating and perforating eye injuries in 343 patients due to auto accidents before and after compulsory seat belt legislation resulting in fines (1966-1998)]. / Penetrierende und perforierende Augenverletzungen bei PKW-Unfällen von 343 Patienten vor und nach Einführung des Bussgeldes für "Gurtmuffel" (1966-1998).

BACKGROUND: Constructional improvements of passengers safety in cars alone did not result in a significant decline of open globe injuries in traffic accidents. Only after compulsory seat belt legislation was introduced in Germany and Great Britain, a 60%-75% reduction in ocular injuries was observed. We examined, how the characteristics of severe eye injuries in car accidents changed during the last 28 years. PATIENTS AND METHODS: The case records of 343 patients, who suffered from open globe injuries during car accidents between 1966 and 1993 and were primarily admitted in the University Eye Hospitals of Freiburg and Würzburg, have been analyzed retrospectively. Injuries were evaluated for their extent, time of injury (hour and season), age, sex and outcome of visual acuity after surgery. RESULTS: Between 1966 and 1984 wind-screen injuries declined slowly from 25/year to 16/year. Since the introduction of compulsory seat belt legislation in Germany in 1984 we observed a sudden reduction to 4 injuries/year, followed by an additional slow decline to 2.5 injuries/year. Male/female ratio changed from 2.1/1 before to 9/1 after 1984. Due to the seat belt legislation, injuries declined during summer season (april through september) by factor 7.6, during winter season (october through march) by factor 3.8. Injuries during daylight (6 a.m. to 6 p.m.) decreased more rapidly (by factor 14) than during nighttime (6 p.m. to 6 a.m.: factor 4). The decline of eye injuries was most pronounced among those with an age of less than 23 years (by factor 10.8) and those who were 31-50 years old (by factor 6.8), but least among those between 23 and 30 years of age (2.2). Since 1984, open globe injuries combined with mid-facial and cranial fractures increased resulting in a poorer visual outcome: 29% of eyes became blind before 1984 and 40% since then due to the higher survival probability of very severe accidents. A majority of injured persons still had not fastened their seat belt and about 50% were drunk. CONCLUSION: Compulsory seat belt legislation introduced in Germany in 1984 was most effective in preventing eye injuries among female passengers, during daytime or among persons younger than 23 years. However, 23-30 year old male drivers who had not fastened their seat belt, drove in darkness or during winter and had drunk alcohol, were still at highest risk for an open globe injury. The increase of victims with a combination of open globe injuries and midfacial injuries, polytrauma or cerebral trauma may be related to the airbag and other improved safety measures.