[Graves' ophthalmopathy]. / Endokrine Orbitopathie.

Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease and the full clinical picture can impair the quality of life of the patients considerably. Active inflammation can often be effectively treated by intravenous steroids/immunosuppression, however does not lead to full remission, since inflammation rather quickly results in irreversible fibrosis and increase of orbital fat. Very important is the control of risk factors (smoking cessation, good control of thyroid function, selenium supplementation) to prevent progression to severe stages. Treatment should rely on a thorough assessment of activity and severity of GO. Rehabilitative surgery (orbital decompression, squint surgery, eyelid surgery) is needed in many patients to restore function and appearance. Anti-thyroid-stimulating hormone (TSH) receptor antibodies do specifically occur in these patients and correlate to the course of thyroid and eye disease. The levels of these antibodies can be used for treatment decisions at certain time points of the disease.

[Long-term results of autologous transplantation of limbal epithelium cultivated ex vivo for limbal stem cell deficiency]. / Langzeitergebnisse zur autologen Transplantation von ex vivo kultiviertem Limbusepithel bei limbaler Stammzellinsuffizienz.

OBJECTIVE: This study reports the long-term clinical outcome of autologous limbal epithelial cells cultivated ex vivo on intact amniotic membranes (AM) for ocular surface reconstruction in limbal stem cell deficiency (LSCD). PATIENTS AND METHODS: A total of 61 eyes from 57 patients (46 males and 11 females) with LSCD were treated by transplantation of autologous limbal epithelial cells cultivated on intact AM. The etiology of the LSCD was chemical and thermal burns (n = 34), recurrent or primary large-sized pterygium (n = 12), mitomycin C and tumor excision-induced LSCD (n = 9), severe infectious keratitis (n = 3), perforating injury, epidermolysis bullosa and contact lens-associated keratopathy (each n = 1). Only eyes with a follow-up time of at least 12 months were included in the analysis. The main outcome end points were restoration of ocular surface integrity and improvement of visual acuity (VA). RESULTS: The mean follow-up time was 50.8 ± 32.7 months. An entirely stable corneal surface was reconstructed in 46 (75.4%) eyes. Visual acuity significantly increased in 40 (65.6 %) eyes, was stable in 12 (19.7%) eyes and decreased in 9 eyes (14.8%). The mean visual acuity significantly increased (p < 0.0001) from 1.4 ± 0.91 LogMAR preoperatively to 0.8± 0.67 LogMAR postoperatively. CONCLUSION: Transplantation of limbal epithelium cultivated ex vivo on intact AM leads to restoration of a stable corneal surface and resulted in a significant increase of visual acuity in most cases of LSCD. Autologous transplantation of cultivated limbal epithelium showed an excellent prognosis and outcome after long-term follow-up.

[Contralateral Recession of the Inferior Oblique Muscle in Grave's Disease Patients with Mild M. rectus inferior fibrosis]. / Prinzip Gegenparese: M.-obliquus-inferior-Rücklagerung bei Patienten mit endokriner Orbitopathie.

INTRODUCTION: The aim of this study was to evaluate the dose effect and the resulting binocular single vision for inferior oblique muscle recession in patients with Grave's orbitopathy. METHODS AND PATIENTS: The evaluation covered all patients (n = 13) between 2010-2013 treated with recession of the inferior oblique muscle for vertical deviation caused by inferior fibrosis of the contralateral eye. The inclusion criterion was a small vertical squint angle with excyclotorsion. The corrected vertical squint angle was 3.75° [7 pdpt] (median, min 1.5° [3 pdpt], max 8° [16 pdpt]) in primary position and 5.5° in adduction [11pdpt] (median, min 3°[6 pdpt], max 9°[18pdpt]). Excyclotorsion was 4° [8 pdpt] (median, min 1° [2 pdpt], max 9° [18 pdpt]). Elevation was only slightly impaired and the side difference was 5° (median). The recession distance was preoperatively determined: 0.5° squint angle reduction per mm recession distance (calculation from patients who received surgery before 2010). RESULTS: Inferior oblique recession generated a good field of binocular single vision (BSV) for all patients. All patients reached BSV in the central area (20°) and within 30° of downgaze. Sixty nine percent of the patients were completely diplopia free in downgaze. Diplopia persisted in more than half of the patients in up gaze outside 15°. Squint reduction was 0.5° [1 pdpt] [0.45-0.67]/per mm recession distance in primary position and 0.65° [1.3 pdpt] [0.55-0.76]/per mm for the vertical deviation in adduction. Excyclotorsion was reduced to ≤ 2° in 77 % of the patients. CONCLUSION: Inferior oblique muscle recession can be very successfully performed on the contralateral eye in patients with mild inferior rectus muscle fibrosis. Surgery at the contralateral yoke muscle prevents the risk of overeffect with resulting diplopia in downgaze, which could occur if small distance recession had been performed at the inferior rectus muscle. An overeffect in relation to inferior oblique recession will only cause diplopia in upgaze, which is much less troublesome in daily routine.

[Short-term and long-term complications after transplantation of cultivated limbal epithelium]. / Kurz- und Langzeitkomplikationen nach Transplantation von kultiviertem Limbusepithel.

Recent advances in tissue engineering have facilitated the development of new strategies in ocular surface reconstruction. Limitations and possibilities of ex vivo cultivation and limbal epithelium cell culture techniques as well as the short and long-term complications after transplantation of ex vivo expansion of cultivated limbal epithelium for the treatment of limbal stem cell deficiency are summarized in this review.

[Results (in vitro and in vivo) of cryopreservation of human thrombocytes with glycerol]. / Ergebnisse (in vitro und in vivo) der Kryokonservierung von Human-Thrombozyten mit Glycerol.

The cryopreservation of human platelets was carried out with a final glycerol concentration of 0.38-0.48 mol/l (3.5-4.5%). The in-vitro-recovery (total platelets, aggregation, 14C-5-HT-uptake, clot retraction, total ATP, morphology) was in the range of 35-93% in comparison with freshly prepared platelet concentrates. The platelet survival was investigated by 51chrom labeling and autologous transfusion. A survival rate of 42% and a mean survival of 79% in comparison with freshly prepared platelets is concentrates are the results. In spite of reduced viability the cryopreservation of platelets is invaluable for providing compatible platelets for alloimmunized patients.

S A G--sucrose medium for red blood cell preservation.

A preservation solution for buffy coat-free red cell concentrates (RCC) was tested. It contained sodium chloride (150), glucose (50), adenine (1.25 mmol/l) and additionally sucrose (30 mmol/l). After 35 days of storage about 50% of the initial ATP were found. The 24-hours post-transfusion survival rate amounted to 76%. The hemolysis rate was 0.25% and only 2% of the red cell membrane were released as microvesicles when plastic bags were used for storage. Sucrose can be replaced by mannitol or sorbitol at the same concentration. Guanosine (0.4 mmol per 1 RCC) slightly but not significantly improved the maintenance of ATP and the morphology as well as the membrane stability.

Preservation of resuspended red cell concentrate. Metabolism and survival rate of stored red cells.

The sucrose-poor, electrolyte-rich SAG-sucrose preservation solution for red cell concentrates (RCC) proves to be superior to the sucrose-rich electrolyte-poor CDS-AG solution. After 35 days about 50% of the initial ATP were found and the 24 hours posttransfusion survival rate amounted to 76%. The replacement of sucrose by mannitol or sorbitol did not influence the metabolism of red cells. Guanosine-final concentration 0.4 mmol/l RCC-slightly improved the maintenance of ATP and morphology.

[Liquid storage of thrombocytes: in vivo survival capability of thrombocytes after storage at +12 degrees C]. / Zur Thrombozytenflüssiglagerung: In-vivo-Uberlebensfähigkeit von Thrombozyten nach Lagerung bei +12 grade C.

Platelet concentrates were prepared from ACD-blood and stored at +12 degrees C for 3 days with gentle agitation. The viability of the platelets was estimated by autologous transfusion of 51chromium-labeled platelets into healthy volunteers. The in vivo recovery amounted to 33.5 +/- 6.9% and mean half survival time T0,5 was 1.1 ++/- 0.2 days on the 3rd day. The control values for freshly prepared platelet concentrates were 52.5 +/- 5.9% and T0.5 3.9 +/- 0.3 days. The decrease of viability due to lowering the temperature to +12 degrees C did not correspond to the pH-value, which was well maintained in the stored platelets.

[Functional characteristic of TTK-lymphocytes in vitro, cytotoxicity and mixed lymphocyte culture (MLC)]. / Funktionelle Eigenschaften von TTK-Lymphozyten in vitro, zytotoxizität und Lymphozytenmischkultur (MLC).

A simple method of cryopreservation (TTK) of lymphocytes is presented. The functional properties of TTK-lymphocytes are examined by the lymphocyte toxicity micro test and in the mixed lymphocyte culture (MLC). 51Cr-release technique is performed as a measure for reversible and irreversible cell damages in the course of the Cryopreservation process.

[Viability, ATP and 2,3-DPG content of resuspended erythrocytes during several-week storage in cold]. / Verhalten von Lebensfähigkeit, ATP-und 2,3-DPG-Gehalt resuspendierter Erythrozyten während mehrwöchiger Kältelagerung.

Leukocyte-and thrombocyte-poor packed red cells obtained from ACD or. ACD-AG blood were resuspended to a hematocrit of about 55% and stored at 4 degrees C. The resuspension solution consisted of xylitol, inorganic phosphate, bicarbonate, adenine (A) and guanosine (G) solved in water. In one case glucose, citrate and sucrose were also added, in another one, sorbitol. The 2,3-DPG and the ATP level remained for a longer period in the sorbitol-xylitol-medium than in the glucose-xylitol-medium. The ATP content in the red cell suspension was higher than in packed cells. Higher ATP values were obtained in red blood cells from whole blood with adenine and guanosine. The survival rate of resuspended red blood cells in glucose-AG-citrate-sucrose medium was about 80--85% after 3 weeks of storage and 77% after 6 weeks with a higher range.