[Correlation between glaucomatous hemifield scotomas and measurements of nerve fiber layer thickness using scanning laser polarimetry]. / Korrelation zwischen glaukomatösen Halbfeldskotomen und Messungen der Nervenfaserschichtdicke mittels Scanning-Laser-Polarimetrie.

BACKGROUND: The purpose of the present study was to investigate wether a reduction of the retinal nerve fiber layer (RNFL) in patients with hemifield scotoma can be measured with scanning laser polarimetry and wether regional RNFL parameters can be correlated with the corresponding visual field indices. PATIENTS AND METHODS: We included one eye from each of 40 normal subjects and one eye from each of 40 glaucoma patients. Automated perimetry was performed and the RNFL was analyzed. RESULTS: HMD values obtained by white-white (W/W) and blue-yellow (B/Y) perimetry failed to correlate significantly with most of the corresponding RNFL parameters obtained with the GDx. Significant correlations were only shown for the inferior HMD (W/W and B/Y) and the superior ratio, superior average, and deviation superior. Furthermore, we found a high correlation between differences of upper and lower GDx parameters and differences of upper and lower visual field indices of W/W and B/Y perimetry. CONCLUSIONS: Scanning laser polarimetry can detect differences in RNFL sectors in patients with functional hemifield differences and carries the potential to detect changes in RNFL thickness at an early stage.

[Differential regulation of expression of PDGF receptors on corneal epithelial cells]. / Differenzielle Regulation der Expression von PDGF-Rezeptoren auf kornealen Epithelzellen.

BACKGROUND: The function of platelet-derived growth factor (PDGF) during corneal wound healing is only incompletely understood to date. Previous studies have shown that the mRNA of PDGF receptor type alpha (PDGFR alpha) and type beta (PDGFR beta) is expressed in cultured corneal epithelial cells (CEP). To add to the current knowledge, the following study was designed to compare the expression of mRNA and protein of both PDGF receptor subtypes in cultured CEPs and in CEPs ex vivo. METHODS: Total RNA and protein were extracted from cultured CEPs and from CEPs ex vivo according to standard protocols. The reverse-transcription polymerase chain reaction (RT-PCR) was applied to detect specific expression of the mRNA of PDGFR alpha and PDGFRss. The expression of the corresponding proteins was detected using Western blotting. RESULTS: MRNA and protein of both PDGF receptor subtypes could be detected in cultured CEPs but not in CEPs ex vivo. CONCLUSION: The present study shows for the first time that mRNA and protein of both PDGF receptor subtypes are expressed in cultured human corneal epithelial cells, while corneal epithelial cells ex vivo do not express these receptors. The differential up-regulation of PDGF receptors in activated cells during wound healing could be of pathophysiological importance.

Evaluation of glaucomatous visual field loss with locally condensed grids using fundus-oriented perimetry (FOP).

PURPOSE: We compared detection rates of glaucomatous visual field defects (VFDs) between a conventional rectangular stimulus grid and locally condensed test point arrangements in morphologically suspicious regions. METHODS: Humphrey Field Analyzer model 630 (HFA I, program 30-2 with a rectangular 6 degrees x 6 degrees grid) was used as the conventional perimetric method. Individual local test-point condensation was realized by fundus-oriented perimetry (FOP) on the Tuebingen Computer Campimeter (TCC). RESULTS: Of a total of 66 glaucoma patients, or suspected sufferers, 23 showed normal findings and 27 showed pathological findings with both methods. In 15 cases we found normal visual fields in HFA 30-2, whereas FOP revealed early glaucomatous functional damage. Only one case showed pathological HFA results, while FOP was normal. Detection rates of VFDs significantly differed between the two methods (p < 0.001; sign test). CONCLUSIONS: FOP, using individually condensed test grids, significantly increases detection rates of glaucomatous VFDs in morphologically suspicuous areas compared with a conventional HFA 30-2 technique using equidistant rectangular (6 degrees x 6 degrees) test point arrangements.

[Secondary ocular syphilis with chorioretinitis of the posterior pole - a case report]. / Sekundäre okuläre Syphilis mit Chorioretinitis des hinteren Poles - ein Fallbericht1.

BACKGROUND: Diagnosis of syphilis is often very difficult due to the absence of typical organ manifestation. In addition syphilis has the ability to imitate any ocular inflammation. This may result in misdiagnosis and delay of appropriate antimicrobial therapy. Up to now the first choice therapy is penicillin. CASE REPORT: We report about an otherwise healthy, 40 year-old-woman, who was referred to the Department of Ophthalmology, University of Tuebingen, due to an unclear loss of visual acuity (OD 0.1 and OS 0.4). The fundus examination disclosed focal chorioretinitis on the posterior pole, which was verified in fluorescein angiography. Secondary syphilis was diagnosed due to positive serological testing. Medical treatment consisted in Penicillin (i.m.) for 2 weeks and additional oral corticosteroids, which were tapered down slowly. After 3 months visual acuity had improved to 0.9 in the right and to 1.0 in the left eye. The former chorioretinitis regions showed only hyperpigmentation. CONCLUSIONS: Laboratory syphilitic testing should be performed in every uveitis.

[Are filtering interventions in glaucoma patients with extensive visual field defects associated with a higher functional risk?]. / Sind filtrierende Eingriffe bei Glaukompatienten mit ausgedehnten Gesichtsfeldausfällen mit einem grösseren funktionellen Risiko verbunden?

BACKGROUND: We evaluated the prevalence of the loss of visual acuity due to loss of the central portion of the visual field and foveolar fixation in the first week after glaucoma filtering surgery. PATIENTS AND METHODS: We included 408 patients, in whom glaucoma filtering surgery was performed between January 1993 and April 1997 at the University Eye Clinic in Tübingen and who had completed 1-year follow-up examinations. The retrospective evaluation included preoperative, intraoperative and postoperative data. We excluded all patients who did not complete 1-year follow-up examinations (12 +/- 3 months), who have died during the 1-year follow-up, who had combined glaucoma and cataract surgery or in whom the Molteno implant procedure was performed. RESULTS: A total of 404 patients (99.3%) did not suffer loss of the central visual field and foveolar fixation in the first week after glaucoma filtering surgery. In 11 cases, loss of visual acuity > 2 dB was due to progressive lens opacification. One patient suffered from postoperative progression of his age-related maculopathy. In one patient (0.2%) progression of a preexisting relative central scotoma occurred immediately after the operation. Two patients (0.5%) suffered from loss of fixation and the central visual field immediately after glaucoma filtering surgery. CONCLUSIONS: Loss of the central visual field and central fixation immediately after glaucoma filtering surgery is a rare complication. Therefore, glaucoma filtering surgery can also be recommended for patients with advanced visual field defects.

Effect of cytokines on regulation of the production of transforming growth factor beta-1 in cultured human Tenon's capsule fibroblasts.

PURPOSE: Transforming growth factor-beta1 (TGF-beta1) is thought to play a pivotal role in the regulation of the wound healing process after glaucoma filtering surgery. The aim of the present study was to investigate whether platelet-derived growth factor isoforms (PDGF-AA, PDGF-BB), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), interleukin-1beta (IL-1beta) and transforming growth factor-beta1 (TGF-beta1) modulate the production of latent and/or active TGF-beta1 by cultured human Tenon's capsule fibroblasts (HTF). METHODS: Human Tenon's capsule fibroblasts were seeded at two different densities (30 cells/mm2 and 150 cells/mm2) and stimulated for five days with PDGF-AA, PDGF-BB, bFGF, EGF, IL-1beta and TGF-beta1. Control cells were treated with serum-free medium (WM/F12). The concentrations of latent and active TGF-beta1 in the medium were determined using an immunoassay before and after activation of TGF-beta1 by transient acidification. RESULTS: The concentration of latent TGF-beta1 in conditioned media from HTF seeded at high density (150 cells/mm2) significantly increased after stimulation with 5 ng/ml TGF-beta1 (151.5 +/-41.7 pg/ml) or 10 ng/ml IL-1beta (45.7+/-8.1 pg/ml). The concentration of active TGF-beta1 in conditioned media also significantly increased after stimulation of HTF with 5 ng/ml TGF-beta1 (48.4+/-27.5 pg/ml). CONCLUSIONS: The present results indicate that TGF-beta1 is the most potent inducer of its own synthesis in HTF. Activation of an autocrine TGF-beta1 loop may play a role in the wound healing response after glaucoma filtering surgery.

Cytokine regulation of hyaluronate production by human Tenon's capsule fibroblasts.

PURPOSE: The high-molecular weight glycosaminoglycan hyaluronate (HA), a component of the extracellular matrix, has been shown to play important roles in many biological processes including cell proliferation, migration and differentiation. In the present study, the effect of cytokines on production of hyaluronate (HA) by human tenon's capsule fibroblasts (HTF) was determined. METHODS: HTF (2(nd) passage) were seeded at a cell density of 30 cells/mm(2) and stimulated by six different cytokines (platelet-derived growth factor (PDGF)-AA, PDGF-BB, basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), interleukin (IL)-1beta and transforming growth factor (TGF)-beta1). Controls were treated with aliquots of serum-free medium only. Concentrations of HA were determined using a radiometric assay based on the specific binding of HA to HA binding proteins. RESULTS: The concentration of HA in conditioned medium of HTF was significantly increased only after stimulation with PDGF-AA [10 and 100ng/ml], IL-1beta [1 and 10ng/ml] and TGF-beta1 [5ng/ml]. CONCLUSIONS: Production of HA by HTF is regulated by PDGF-AA, IL-1beta and TGF-beta1 and is speculated to be involved in the wound healing reaction after glaucoma filtration surgery.

Serum-free cultivation of human Tenon's capsule fibroblasts.

PURPOSE: In the present study, the effect of three different serum-free and one serum-containing control medium on adhesion, proliferation, cryopreservation and PDGF-induced effects on cell proliferation of human Tenon's capsule fibroblasts (HTF) was compared. MATERIALS AND METHODS: Third passage HTF were suspended in four different culture media (WM/F12, WM/F12/FCS 1%, LR-1, DMEM) and plating efficiency was determined after 24h using a cell counter system. Subsequently, cells were seeded at a density of 50/mm2 and cultured for ten days using the different culture media. Cell number was determined at day 2, 4, 7 and 10 after seeding. Furthermore, HTF cultured under the different conditions were stimulated by PDGF-BB [50 ng/ml]. Additionally, cell vitality after two weeks cryopreservation in five different culture media (WM/F12, WM/F12/FCS 1%, WM/F12/FCS 20%, LR-1, DMEM) was determined. RESULTS: The plating efficiency of HTF when seeded in serum-free medium ranged from 55.3% to 59.6%. Using serum containing WM/F12/FCS 1% a slightly higher plating efficiency of 74.8% was obtained. Proliferation assays revealed population doublings of 0.77 with WM/F12/FCS 1% after an incubation period of 10 days. Cultivation of HTF using serum-free conditions did not cause significant cell proliferation but a slight cell loss which ranged from 23.1% to 34%. Addition of PDGF-BB resulted in a significant increase in cell proliferation with WM/F12/FCS 1%, WM/F12 and DMEM. After two weeks of cryopreservation in WM/F12, LR-1, DMEM, WM/F12/FCS 1% and WM/F12/FCS 20%, only the application of high serum concentrations led to sufficient preservation of cell vitality with a plating efficiency of 82.9%. DISCUSSION: The results of the present study demonstrate that the use of serum-containing media is mandatory for cryopreservation of HTF. Seeding of cells can be performed either with serum or without serum. HTF cultured under serum-free conditions can be maintained quiescent with a sufficient number of cells remaining vital. The serum-free media used in this study can be applied for the investigation of cytokine effects on HTF.

[Wound healing after glaucoma filtering surgery--a review]. / Wundheilung nach filtrierenden Glaukomoperationen--eine Ubersicht.

Wound healing after glaucoma filtering surgery is characterized by a complex sequence of molecular and cellular events. Results of recent investigations have shown that the activation, migration, proliferation and differentiation of Tenon's capsule fibroblasts represents the central element of the wound healing response. An exaggerated wound healing will result in the closure of the artificial fistula between the anterior chamber and the subconjunctival space, leading to an increase in intraocular pressure. The present review summarizes the current knowledge regarding the most important cellular and molecular mechanisms, which regulate the postsurgical wound healing response in the subconjunctival space. Special emphasis will be put on the specific role of cytokines during the wound healing response. An extensive understanding of these mechanisms appears pivotal for the development of specific therapeutic strategies to inhibit the events which lead to fibrogenesis and scarring in the wound region after glaucoma filtration surgery. The databank was Medline.

[Prognostic value of anterior chamber hemorrhage following glaucoma filtering surgery]. / Prognostischer Stellenwert der Vorderkammerblutung nach filtrierenden Glaukomoperationen.

PURPOSE: Evaluation of the prognostic significance of a postoperative anterior chamber hemorrhage (ACH) after glaucoma filtering surgery. PATIENTS AND METHODS: Records of 332 patients, who had undergone filtering surgery between 1/1993 and 2/1997, were analyzed retrospectively with particular concern on epidemiologic data, pre- and postoperative regulation of intra-ocular pressure (IOP), complications including ACH, postoperative 5-fluouracil (5-FU) therapy and postoperative IOP lowering therapy. Surgical success was defined as (1) IOP reduction below 21 mm Hg, (2) relative IOP reduction at least 20% and (3) no reoperation to control IOP until the first-year examination. RESULTS: 60 out of 332 patients (18.1%) suffered from ACH after glaucoma filtering surgery. 24 patients with ACH were treated with 5-FU, postoperatively. When all patients with ACH were considered in the evaluation, the difference between the success rate of patients with ACH and the success rate of patients without ACH was not statistically significant. In contrast, when ACH was the only complication in patients, who were not treated with 5-FU, the success rate was significantly worse (38%), when compared with the control group (patients, who did not have ACH or who had other complications in addition to ACH) (67%) (p = 0.008). When patients with these criteria received 5-FU postoperatively, the difference between success rates of both groups was not any longer statistically significant (p = 0.99). DISCUSSION: The postoperative occurrence of anterior chamber hemorrhage is associated with a higher failure rate of filtering surgery. Early administration of 5-FU is recommended in these cases.

Effect of heparin on human corneal fibroblast proliferation in vitro with and without growth factor stimulation.

BACKGROUND: The outcome of keratorefractive procedures such as PRK and LASIK is limited by the wound-healing process in the corneal stroma, which gives rise to complications such as haze formation and regression. The proliferation and matrix synthesis of corneal stromal fibroblasts is the central element of the wound-healing process. In order to develop new therapeutic strategies to reduce wound-healing intensity, we investigated the effect of heparin on the proliferation of cultured human corneal stromal fibroblasts (HCF) alone and in the presence of growth factors. METHODS: Primary cultures of HCF were established using epithelium and endothelium-free explants. Secondary cultures of HCF (first passage), cultured in WM/F12 supplemented with 10 microg/ml transferrin and 10 microg/ml thyroglobulin (LR-1 medium), 1% fetal calf serum (FCS) and 10% FCS were used to determine the effect of heparin on the proliferation of HCF in concentrations ranging from 12.5 microg/ml to 5000 microg/ml. Cell number was determined using the CASY 1 cell counter system. Modulation of HCF proliferation by heparin (50 microg/ml and 2000 microg/ml) was also investigated under serum-free conditions and in the presence of bFGF, EGF and PDGF-BB. RESULTS: Addition of heparin led to a dose-dependent inhibition of proliferation after 6 days of incubation, which was statistically significant for 500-5000 microg heparin/ ml (FCS 1%) and for 200-5000 microg heparin/ml (FCS 10%). IC50 values for this effect were determined to be approximately 700 microg heparin/ml. When cultured under serum-free conditions (LR-1), a significant reduction of cell number was only observed with 5000 microg heparin/ml. There was no significant modulation of PDGF-BB-, bFGF-, or EGF-stimulated cell proliferation by heparin at concentrations of 50 microg/ml and 2000 microg/ml after 6 days of incubation. CONCLUSION: Our observations indicate that heparin can inhibit proliferation of HCF effectively. The results of the present study could eventually pave the way to prevent anterior stromal haze formation and regression after keratorefractive surgery.

Inhibitory effect of Trapidil on the proliferation of bovine corneal fibroblasts in vitro.

BACKGROUND: In order to develop new strategies for the pharmacological modulation of posttraumatic and postsurgical wound healing of the corneal stroma, the effect of Trapidil, a competitive platelet-derived growth factor (PDGF) antagonist, on the proliferation of cultured bovine stromal fibroblasts (BSF) was investigated. METHODS: BSF, obtained from explant cultures, were seeded at a cell density of 100/mm2. The effect of various concentrations of Trapidil on cell viability and cell proliferation was determined using three different culture conditions: (1) serum-free medium (WM/F12), (2) serum-containing medium (WM/F12 + 10% FCS), and (3) serum-free medium + 50 ng/ml PDGF-BB. Trapidil was added in concentrations ranging from 100 micrograms/ml to 400 micrograms/ml. Cell numbers were determined 2 and 5 days after addition of Trapidil, using a computer-based cell-counting system. Cell viability was evaluated morphologically and by means of a repopulation assay. RESULTS: Addition of Trapidil (100-400 micrograms/ml) led to a significant, dose-dependent inhibition of both serum- and PDGF-BB-induced proliferation of BSF. In contrast, treatment of quiescent BSF, cultured in serum-free medium, did not result in a significant reduction of cell number. No cytotoxic effects were observed. CONCLUSION: The results of the present study demonstrate an inhibitory effect of Trapidil on the proliferation of BSF. It can be assumed that application of Trapidil might be a useful tool in the prevention of corneal complications after trauma (e.g., scarring, astigmatism and--with respect to photorefractive procedures--formation of haze and regression of the refractive effect).

[Serum-free cultivation of bovine stromal fibroblasts]. / Serumfreie Kultivierung boviner stromaler Fibroblasten.

UNLABELLED: The purpose of the present study was to conduct a comparative evaluation of the effect of several serum-free culture conditions on adhesion, population doubling, cryopreservation and PDGF-induced effects on cell proliferation of bovine stromal fibroblasts (BSF). Additionally, these effects were compared to serum-containing cultures. METHODS: Only second-passage BSF were used. Cells were cultured using four different culture media (WM/F12, WM/F12 + FCS 1%, LR-1, DMEM). After 24 h, plating efficiency was determined using a cell-counter system. Subsequently, the cells were seeded at a density of 100 cells/mm2 and cultured for 10 days using the different culture media. Cell number was determined at day 2, 4, 7 and 10 after seeding. Furthermore, the effect of 50 ng/ml PDGF-BB on the proliferation of BSF was tested for these conditions. Cell vitality was determined after cryopreservation of two weeks for each culture medium. RESULTS: The plating efficiency of BSF ranged from 50.2 to 55.5% for the serum-free culture media in contrast to serum-containing conditions, where plating efficiency was 94.8%. With WM/F12 + FCS 1%, a population doubling of 1.27 was observed after an incubation period of 10 days. In contrast, cultivation under serum-free conditions caused neither significant cell proliferation nor cell loss. The stimulation of cell proliferation with PDGF-BB was shown to be 28% (LR1), 40% (WM/F12 + FCS 1%) 76% (WM/F12) and 95% (DMEM) compared to the control. While cell vitality after cryo-preservation was found to be 62.7% using WM/F12 + FCS 1%, vitality using serum-free media was 12.6-22.8%. CONCLUSIONS: The results of the present study demonstrate that with respect to optimal cell adhesion and cell vitality after cryo-preservation, serum-containing media should be used. BSF cultured under the serum-free conditions used in the present study can be maintained quiescent and vital for at least 10 days. Therefore, these serum-free media are useful for cell-culture studies (e.g., determination of proliferation and cytotoxicity).

In vitro effect of ascorbic acid on the proliferation of bovine scleral and Tenon's capsule fibroblasts.

The success of glaucoma filtration surgery depends mainly on an incomplete wound healing process in the area of the fistula. Since Kornblueth and Tenenbaum's investigations in 1956 it has been known that aqueous humour has intrinsic antiproliferative properties. It is assumed that ascorbic acid is involved in the regulation of the wound healing process after filtration surgery. To evaluate the antiproliferative effect of ascorbic acid in vitro, we used cultured fibroblasts of bovine Tenon's capsule and bovine sclera. Incubation of these cells with ascorbic acid at concentrations ranging from 0.5 to 3 mM/L led to dose-dependent inhibition of cell proliferation. The half-maximal inhibitory concentration was 1.0 mM/L for both cell types. Physiological concentrations of ascorbic acid may be valuable in the pharmacological prevention of failure of glaucoma filtration surgery. However, extensive clinical investigations are needed to clarify whether topical intraoperative or postoperative as well as oral administration of ascorbic acid inhibits fibroblast proliferation after glaucoma filtration surgery.

Proliferative response of cultured human tenon's capsule fibroblasts to platelet-derived growth factor isoforms.

BACKGROUND: Although platelet-derived growth factor (PDGF) has been thought to be critical in the wound-healing response of Tenon's capsule fibroblasts after glaucoma filtration surgery, no information is currently available concerning the proliferative effect of PDGF isoforms on this cell type. The aim of the present study was to evaluate the proliferative effect of PDGF-AB heterodimer and PDGF-AA and -BB homodimers on cultured human Tenon's capsule fibroblasts. METHODS: Human Tenon's capsule fibroblasts, cultured under serum-free conditions, were stimulated with PDGF-AA, -AB and -BB isoforms in concentrations ranging from 1 to 100 ng/ml. Cell numbers were determined on days 1, 3, 5 and 7, using a cell counter. RESULTS: Addition of PDGF-AB and -BB led to a dose-dependent increase in cell proliferation. A maximal response (79.9% over control) was obtained after 7 days with 30 ng/ml of PDGF-BB, with an EC50 of 8.9 ng/ml. The maximal increase in cell proliferation caused by PDGF-AB (30 ng/ml) was 54.9%, with an EC50 of 12.5 ng/ml. Stimulation with PDGF-AA revealed a significant effect only with concentrations higher than 30 ng/ml. CONCLUSION: Our results indicate that PDGF-AB and -BB isoforms are potent stimulators of proliferation of human Tenon's capsule fibroblasts, suggesting that PDGF-AB and -BB isoforms play an important role in the wound-healing response after glaucoma filtration surgery.

The in vitro effect of platelet-derived growth factor isoforms on the proliferation of bovine corneal stromal fibroblasts depends on cell density.

PURPOSE: Recently, it has been shown that corneal stromal fibroblasts express the mRNA for PDGF-beta-type receptors, while corneal epithelial cells express the mRNA for the PDGF B-chain, suggesting a role of PDGF isoforms in the regulation of corneal homeostasis and wound healing via an unidirectional epithelial to stromal paracrine interaction. The purpose of this study was to characterize the proliferative response of cultured bovine corneal stromal fibroblasts to PDGF isoforms. METHODS: Bovine corneal stromal fibroblasts were seeded at a cell density of 60 cells/mm2 (low density) and 120 cells/mm2 (high density) and were cultured under serum-free conditions. Except for corresponding controls, PDGF AA, BB and AB (obtained by separate expression of cloned genes in E. coli) were added in concentrations ranging from 3.125 to 100 ng/ml. Cell numbers were determined after an incubation period of 6 days using a cell counter. RESULTS: Stromal fibroblasts, when cultured at a high density, revealed constant cell numbers during the whole incubation period. Under these culture conditions, stimulation with PDGF AA, BB and AB led to a significant dose-dependent increase in cell proliferation. When cultured at a low cell density, stromal fibroblasts revealed a significant reduction of cell numbers after 6 days of incubation. This reduction was prevented by PDGF AA and AB isoforms in a dose-dependent manner. In contrast, PDGF BB was not effective. CONCLUSION: The results of the "high-density" assays suggest that PDGF isoforms act as mitogens for stromal fibroblasts during wound healing, when density of fibroblasts is high. The results of the "low-density" assays support the idea that PDGF AA and AB can prevent cell loss during corneal homeostasis when density of keratocytes is low.

Regional glycoprotein expression in the chicken lens.

PURPOSE: Several previous studies have shown that glycoconjugates of extracellular matrix, cell membrane and nucleus play an important role in the mediation of cell proliferation, migration and differentiation. Lens epithelial cells and lens fiber cells show regional differences with regard to these parameters. If glycoconjugates participate in the regulation of these patterns in the lens, there should be regional differences in the expression of glycoconjugates. The investigation was focused on the anterior pole, equator and nuclear bow regions, which differ extensively in lens cell proliferation and differentiation. METHODS: To check this hypothesis, the regional binding pattern of twelve different FITC-conjugated lectins was studied glycohistochemically, using paraffin embedded material. The investigation was focused on the anterior pole, equator and nuclear bow regions. RESULTS: Regional differences in lectin binding patterns were identified in the lens capsule, epithelium and the nuclear bow regions. The lens capsule was fluorescently labeled with GS-I, UEA-I, LPA, MAA, SNA only at the anterior pole and with CON-A, WGA, DBA, SBA only at the equator. Staining of the entire anterior surface of the lens capsule was observed with LFA. Cell membranes of the lens epithelium showed binding of MAA and LFA only at the equator. LFA, LPA, MAA and SNA only stained the nuclei of fiber cells at the nuclear bow region but not of lens epithelial cells. WGA strongly labeled the nuclei of equatorial epithelial cells and fiber cells at the bow region. CONCLUSIONS: It is assumed that the observed regional variations in glycoprotein expression in the extracellular matrix and lens cells contribute to the regulation of cell behavior in different areas of the lens.

[Effectiveness of dorzolamide as added therapy in glaucoma patients with maximum tolerated drug therapy. A pilot study]. / Effektivität von Dorzolamid als Zusatztherapie bei Glaukompatienten mit maximal tolerierter medikamentöser Therapie. Eine Pilotstudie.

BACKGROUND: The purpose of this study was to evaluate prospectively the value of dorzolamid as an adjunct to maximum tolerated medical therapy in glaucoma patients in whom surgery would otherwise be required. METHODS: 32 eyes of 21 patients with primary open angle glaucoma (14 patients), glaucoma in aphakia (3 patients), pigmentary glaucoma (2 patients), juvenile glaucoma (1 patient) and exfoliative glaucoma (1 patient) were included. The effect of additional dorzolamid application on intraocular pressure (IOP) was determined after 2 hours, 4 days, 4 weeks, 3 months and 6 months. After 6 months, visual fields were checked. RESULTS: Average reduction of IOP in eyes in which dorzolamid was continued was determined to be 31% after 2 hours, 18.3% after 4 days, 17.9% after 4 weeks, 12.1% after 3 months and 9.7% after 6 months. 19 (59%) eyes continued to receive dorzolamid after 6 months without being operated. No progression of glaucomatous damage could be detected in these eyes. In 11 (34%) eyes, treatment with dorzolamid was discontinued. 2 patients (4 (12%) eyes) did not tolerate local side effects of dorzolamid. In 7 (22%) eyes reduction of IOP was insufficient and filtration surgery had to be performed immediately. CONCLUSION: The results of the present study demonstrate that dorzolamid represents an alternative to an immediate surgical management in patients on maximum tolerated therapy for at least six months.

[New clinical and epidemiologic aspects of episcleritis and scleritis]. / Neue klinische und epidemiologische Aspekte von Episkleritis und Skleritis.

UNLABELLED: Numerous systemic diseases can cause scleritis or episcleritis. Frequently, symptoms and complications compromising vision can only be managed with systemic immunosuppressants. There are no clear guidelines on the indications for systemic immunosuppressants in patients with episcleritis and scleritis. PATIENTS AND METHODS: The aim of the present retrospective study was to investigate how many patients with episcleritis or scleritis have an associated systemic disease and at what stage it is diagnosed. Secondly, the proportion of patients who present with episcleritis or scleritis in the first instance and then change into the other category during the course of the disease was analyzed. Finally, we checked whether the presence of an associated systemic disease indicates the necessity to treat the patient with nonsteroidal systemic immunosuppressive drugs. RESULTS: Sixty-eight patients with inflammatory scleral diseases were treated at the University Eye Clinic between 1991 and 1995. In 13 patients an associated systemic disease was diagnosed before the appearance of ocular symptoms, and in 8 patients such an illness was diagnosed at a later stage. In 2 cases (3%) the ocular disease category changed during the course of the disease. Neither in the episcleritis nor in the scleritis population was a statistically significant correlation established between the diagnosis of an associated systemic disease and the necessity to treat the patient with nonsteroidal systemic immunosuppressive drugs. CONCLUSION: The small number of patients who changed the ocular disease category may indicate that episcleritis and scleritis are two independent entities, which might even be caused by different mechanisms. The indications for the management of episcleritis and scleritis with immunosuppressive drugs should not only depend on the diagnosis of an associated systemic disease, but also and mainly on the severity of the ocular manifestation.

[Autoantibody pattern in scleritis and episcleritis]. / Autoantikörpermuster bei Skleritis und Episkleritis.

BACKGROUND: Episcleritis and scleritis can be caused by various systemic disorders, which can be triggered by infectious diseases. We studied the autoantibody pattern against various organ-specific and non-organ-specific antigens in episcleritis and scleritis patients. MATERIAL AND METHODS: Sera from 46 patients (episcleritis n = 28, scleritis n = 18) were studied for antibodies against nuclei, smooth muscle cells, mitochondria, endothelial cells, sarcolemma, liver cells, heart muscle fibrils, parietal cells and thyroid cells by immunofluorescence testing. Titers of antibodies against thyroglobulin, laminin, keratin and microsomes were evaluated by ELISA. RESULTS: In patients with episcleritis the pattern of autoantibodies found was different from that in scleritis patients. Thus, in episcleritis the levels of antibodies against sarcolemma (32%), parietal cells (25%), laminin (38%), keratin (58%) and microsomes (28%) were elevated, while scleritis patients, besides keratin antibodies (50%), demonstrated anti-nuclear antibodies (ANA) in 28% of cases. These differences were not significant. Approximately 5% of normal control patients show these antibodies. CONCLUSIONS: Previous studies have shown that episcleritis rarely develops into scleritis. Our results suggest that this may be due to different underlying diseases. While 28% of scleritis patients had ANA, which may suggest an autoimmune disposition related to collagenosis, episcleritis patients had a different autoantibody pattern such as has been found in various infectious diseases and diseases for which triggering by infectious organisms seems possible, such as anterior uveitis, ankylosing spondylitis and Behçet disease. Investigations in larger groups of patients are needed to check the statistical significance of these differences.