Does ocriplasmin affect the RPE-photoreceptor adhesion in macular holes?

BACKGROUND: To evaluate the anatomical outcome of patients after vitrectomy due to persisting symptomatic vitreomacular traction (VMT), including full-thickness macular holes (FTMHs) of less than 400 µm, after ocriplasmin treatment. METHODS: Retrospective, single centre, consecutive interventional case series. Patients were treated with a single intravitreal injection of ocriplasmin (Jetrea, Thrombogenics Inc, USA, Alcon/Novartis EU). MAIN OUTCOME MEASURES: resolution of VMT, closure of FTMH and anatomical outcome of vitrectomy after unsuccessful treatment with ocriplasmin. RESULTS: Five patients were treated with ocriplasmin injection. VMT persisted in all but one case. Four patients underwent pars-plana vitrectomy (PPV) for treatment of persistent VMT and FTMH (n=2, size of macular hole <400 µm) in spectral-domain optical coherence tomography (SD-OCT). FTMHs were closed in both cases within the first week postoperatively. After PPV, in three eyes newly developed subretinal fluid was detected, which persisted up to several months postoperatively. CONCLUSIONS: Data on ocriplasmin remain controversial. We report on four cases with resolution of VMT following PPV after unsuccessful ocriplasmin treatment. Newly developed subretinal fluid has been described after ocriplasmin treatment, predominantly in cases with resolution of VMT. We also detected this newly developed subretinal fluid after vitrectomy, which persisted for several weeks up to 7 months in two cases with FTMHs. This may be attributable to loosening of the photoreceptor complex due to enzyme activity of ocriplasmin. Long-term effects of ocriplasmin are still to be evaluated using SD-OCT.

Long-term (4 years) results of choroidal hemangioma treated with proton beam irradiation.

BACKGROUND: The aim of this retrospective study was to determine the efficacy of proton beam irradiation in choroidal hemangioma in a long-term follow-up. PATIENTS AND METHODS: A total dose of 20 Cobalt Gray equivalent (CGE) was administered to 50 eyes of 50 patients from September 1998 to September 2010. All treated patients presented with a symptomatic tumor. Nine patients were pre-treated by photodynamic therapy (PDT). Visual outcome, tumor regression, and complications resulting from radiation were investigated. RESULTS: The mean follow-up was 55.4 months (range 13-132). Tumor thickness decreased in all patients. Retinal re-attachment was achieved without evidence of tumor leakage. Visual acuity improved by two lines after one year in 43.4 % of patients and after two years in 36.8 % of patients. During the 55.4 months of long-term follow-up the visual acuity improved from 6/15 to 6/12 after proton therapy. Twenty-three patients (46.0 %) developed radiation retinopathy. According to the Finger classification of 2004, 21 patients (42.0 %) showed a stage 1 or 2 (functionally not relevant) retinopathy, and two patients (4.0 %) presented a stage 3 or 4 (functionally relevant) retinopathy. Further complications included sicca syndrome in nine cases, cataract formation in 10 cases, and radiation optic neuropathy in four cases. CONCLUSION: Proton therapy with 20 CGE is an efficient primary therapy in choroidal hemangioma and is very effective as a secondary treatment after PDT.

[Therapy of neovascular glaucoma. The outcome of IOP using concomitant therapy consisting of retinal kryocoagulation, diode laser coagulation, and intravitreal injection of bevacizumab]. / Therapie des rubeotischen Sekundärglaukoms IOD-Verlauf nach Kombinationstherapie bestehend aus Zyklophotokoagulation (CPC), Kryokoagulation und intravitrealer Bevacizumab-Injektion.

BACKGROUND: Intravitreal Bevacizumab has been used as adjunct treatment to diode laser cyclophotocoagulation and/or retinal photo-/cryocoagulation in eyes with neovascular glaucoma and is discussed to reduce intraocular pressure and rubeosis irides in addition. METHODS: This study investigated the drop of the intraocular pressure of 23 patients who were treated by a concomitant therapy consisting of retinal kryocoagulation, diode laser coagulation and intravitreal injection of Avastin(®) administered in one session. RESULTS: At the time of discharge patients exhibited a 55.1 % (19.7 mmHg) decrease in intraocular pressure and also a 48.7 % (17.4 mmHg) decrease in regard to follow-up results. Topical agents were not significantly decreased with 2.1 agents at the beginning of treatment and 1.9 at the time of discharge. Furthermore, the systemic administration of acetazolamide was reduced from 12 patients at the beginning to 2 patients at the time of discharge. In 21 cases the intraocular pressure returned to normal levels, whereas the other two patients were pain-free after treatment. CONCLUSION: With the administration of triple therapy, the intraocular pressure showed a significant reduction. There were no severe complications and the symptoms also were improved significantly.

Glycation of aspartate aminotransferase and conformational flexibility.

Glycation of proteins alters biological function and changes cellular processes. Our study investigated the conformational changes that accompany glycation using the cardiac aspartate aminotransferase (cAAT). We examined the effects of brief and prolonged exposure of cAAT to glyceraldehyde (Glyc) and ribose 5-phosphate (R5P). When cAAT was briefly incubated (3.5 h) with Glyc (500 microM) or R5P (5 mM) at 37 degrees C, cAAT activity and 1-anilinonaphthalene 8-sulfonate (ANS) binding increased relative to control. After prolonged incubation (64 h) with Glyc (500 microM) or R5P (5 mM) at 37 degrees C, activity and ANS binding decreased relative to control. Furthermore, upon prolonged incubation of cAAT with 500 microM Glyc (14.5 h) or 2 mM R5P (64.25 h) at 37 degrees C, the denaturation curves shifted to the right relative to control. We conclude that upon brief incubation with Glyc and R5P, cAAT exhibited a more open and flexible structure and upon prolonged incubation, a more rigid structure.

O cancer de bexiga no fumante. / Bladder cancer in smokers

Pesquisa de 130 casos de cancer de bexiga atendidos na 31a. Enfermaria da Santa Casa de Misericordia de Porto Alegre, objetivando relacionar a incidencia da doenca cancerosa com o habito de fumar. Os pacientes foram analisados quanto ao habito, idade de maior incidencia do tumor e tipo histologico. Os dados obtidos foram comparados com os de um grupo de controle, observando-se que o tabagismo e mais frequente entre os portadores de tumor de bexiga do que nos pacientes do grupo de controle. Os resultados, embora nao sejam estatisticamente significativos, sugerem uma maior incidencia de neoplasia vesical em fumantes do que em nao fumantes

Valvulas de uretra posterior. / Posterior urethral valves

Os autores revisam a literatura sobre valvulas de uretra posterior (V.U.P.) e analisam oito casos tratados na 31a. Enfermada Santa Casa da Misericordia de Porto Alegre, durante os ultimos dez anos.Em seu trabalho descrevem a tecnica de fulguracao das valvulas de uretra mediante um fio guia introduzido por um cateter ureteral atraves do cistoscopio infantil, enfatizando o bom resultado obtido e a seguranca oferecia por este metodo

Comparison of a new antidepressive, lofepramine, with imipramine in a double-blind multicentre trial.

Lofepramine, an imipramine derivative, shows lower acute toxicity in animals when compared with desipramine and imipramine. Its anticholinergic effect is less pronounced than that of desipramine. In an open clinical trial lofepramine showed a marked antidepressive action. A double-blind multicenter trial of lofepramine v. imipramine, evaluated by means of the AMP system, showed a remarkable degree of concurrence with regards to the effects of those two products.

[Clinical trial of lofepramine versus imipramine]. / Klinische Prüfung von Lofepramin im Vergleich zu Imipramin

Lofepramin is a new derivative of imipramine. Its effects and side effects were compared to those of imipramine in a double-blind trial. 49 hospitalized patients, suffering from endogenous depression, were treated for 20 days with 210 mg lofepramin daily and 52 other patients with 150 mg imipramine daily. The results of the repeated psychiatric examinations were documented using the AMP system. Both substances proved to have high antidepressant effects and showed no significant difference in the quality of their effects.