The effect of topical steroid on postoperative corneal edema and endothelial cell loss after intracapsular cataract extraction.

In a prospective study of 89 patients the postoperative corneal edema and endothelial cell count was studied after cataract extraction. A double blind investigation was performed as the patients during the first 6 postoperative days were treated with three different types of eye-drops: Maxidex, Pred-Forte 1% or placebo, all containing Benzalkonium Chloride 0.004%. The content of steroid in Maxidex and Pred-Forte was equivalent. We found no significant difference in estimates of endothelial cells in the three groups postoperatively. Corneal edema was less in the two groups treated with steroid. There was no significant difference between the two postoperative groups (p > 0.05) treated with Maxidex and Pred-Forte. The group treated with Pred-Forte showed significantly less postoperative corneal edema, calculated as the graphical area represented by the increase of central corneal thickness (CCT) after operation.

A clinical comparison of optical and ultrasonic pachometry.

Central corneal thickness (CCT) of normal and oedematous corneae was measured in a study comparing a modified Haag-Streit optical pachometer and an ultrasonic pachometer (Teknar Ophthasonic, preset velocity 1630 m/s). Sixty-eight patients were examined before and after cataract extraction with implantation of an anterior chamber lens. Mean values of CCT before operation were 531 +/- 4.9 (SEM) micron by optical pachometry and 524 +/- 4.7 microns when measured by ultrasound (not significantly different). On the first post-operative day the values were 618 +/- 8.4 and 602 +/- 7.6 microns for optical and ultrasonic measurements, respectively (significantly different, 2P less than 0.001). Correlation analysis showed a high dependence between the methods with coefficients of correlation being 0.955 before and 0.958 after the operation. Linear regression analysis revealed small, but significant differences between the techniques. The difference between the two methods increased with increasing corneal hydration, whereas it could not be ascribed to sex, age, or intraocular pressure. It is concluded that for clinical purposes optical and ultrasonic pachometry techniques are comparable.

Macular recovery recorded by nyctometry in insulin-dependent diabetes mellitus.

Macular recovery, recorded by nyctometry, has been studied in children and adults with IDDM. Impaired macular recovery was found only in a few eyes with normal visual acuity without visible signs of retinopathy, in more than one third of the eyes with slight background retinopathy, in the majority of eyes with advanced background retinopathy, and in all eyes with proliferative retinopathy, suggesting that severe neurosensory disturbance accompanies visible vasculopathy in the retina. A significant correlation between impairment of macular recovery and reduction of the oscillatory potentials of the electroretinogram was found in groups with slight background retinopathy, severe background retinopathy, and proliferative retinopathy, suggesting that changes in these two neurosensory variables concurrently reflect abnormalities in the inner part of the retina corresponding to second order interneuronal connections. Near-normal blood glucose control obtained by continuous subcutaneous insulin infusion (CSII) significantly enhanced both normal and impaired macular recovery. This effect was more pronounced in patients with short duration of IDDM; no effect was found by short-term treatment of a selected group of patients with long-standing metabolic dysregulation and long disease duration. Young patients with normal or slightly impaired macular recovery might possibly benefit from sustained near-normal blood glucose control. Large-scale and long-term studies are needed to confirm this assumption. In a 3-year investigation with CSII, progression into proliferative retinopathy could not be prevented in those patients initially displaying severely impaired macular recovery. However, visible retinopathy did not progress in eyes, in which improvement of within normal or slightly reduced recovery performances had been recorded 6 months in advance. It is suggested that a state of irreversibility, 'point of no return', of retinal pathology, indicated by a certain severe impairment of neurosensory function, might exist. Prospective investigations, 5 years with adults, and 6 years with children, revealed progressive decline in recovery performances during the years of observation, even in eyes with no or slight deterioration of the retinal appearance; and in some eyes retaining no or slight retinopathy, severe impairment of performance developed. Both investigations showed significant differences of initial macular performance between the groups developing proliferative retinopathy and the groups remaining non-proliferative in the periods of observation, suggesting that abnormally reduced recovery performance precede by months or a few years the development of proliferative retinopathy. The development into proliferative retinopathy is generally preceded by increasing stages of background retinopathy running parallel to increasingly reduced macular recovery. The present study has demonstrated large variances of performances both in normal and diabetic individuals.(ABSTRACT TRUNCATED AT 400 WORDS)

Macular recovery during onset and development of diabetic retinopathy in childhood and adolescence.

The relationship between the macular recovery recorded by nyctometry and the retinal findings was examined in 60 initially pre-pubescent children with insulin-dependent diabetes mellitus during a 6-year period with special reference to the clinical applicability of nyctometry in selecting children and adolescents at risk of developing proliferative diabetic retinopathy. At the end of the study period the mean age of the patients was 21.9 years (range 18-23 years) and the mean diabetes duration 13.2 years (range 8.1-21.2 years). At the initial recording of macular recovery, only 7% of the children showed retinopathy, and this only in the form of a few microaneurysms or dot haemorrhages. During the study period, however, nearly all (93%) developed retinopathy, and in 9 (14%) the disease progressed into proliferative retinopathy. The initially recorded macular recovery time (MRI) of those children developing proliferative retinopathy was significantly lower (616 +/- 95; X +/- SEM) compared to the initial MRT performances (900 +/- 47) of the rest of the children. However, due to a high coefficient of variation in the material; predictive sensitivity showed low (56%) at a specificity level of 90%, suggesting that nyctometry is less suitable for selecting risk patients in children than in adults.

The effect of short-term near-normal blood glucose control on oscillatory potential and macular recovery time in insulin-dependent diabetic patients with long-standing metabolic dysregulation.

Seven insulin-dependent diabetic patients (mean age 36 years and mean duration of diabetes 19 years) underwent intensified treatment with continuous subcutaneous insulin infusion (CSII) for one week. The patients were selected for the study due to long-standing hypergycemia in an endeavour to determine possible influence on retinal neurosensory function by even short-term near-normalization of blood glucose concentrations. During CSII treatment, near-normalization of the blood glucose levels was obtained (mean blood glucose concentration before treatment; 13.7 +/- 1.6 mmol/l-during treatment; 6.3 +/- 0.4 mmol/l. Recording of the oscillatory potentials by electroretinography and the macular recovery by nyctometry remained about the same in the course of this short-term treatment. Our study suggests that short-term strict metabolic control does not reverse the retinal neural abnormalities in long-standing insulin-dependent diabetes. Consequently; this regimen does not enable prediction of possible beneficial effect of sustained near-normoglycemic treatment.

Treatment of age-related macular degeneration by laser photocoagulation. Visual results 2-8 weeks and 2-4 years after initial laser treatment.

Laser treatment with blue-green argon, green argon and/or krypton red was performed on 578 eyes in 443 patients with neovascular age-related macular degeneration (AMD). The visual acuity was examined in all eyes 2 to 8 weeks after initial treatment and in 204 eyes in 167 patients 2 to 4 years after initial treatment. The short term results were as follow: 91/578 eyes (16%) had improved (greater than or equal to 2 lines on Snellen's charge or equivalent steps), 445/578 eyes (77%) remained unchanged and 42/578 eyes (7%) had deteriorated visual acuity (greater than or equal to 2 lines on Snellen's chart or equivalent steps). The reduction in visual acuity, may in about half of the 42 eyes be caused by too intensive laser application in the beginning of this study in 1983 and 1984 where treatment was applied with blue-green argon, which has now been abandoned. In the group with an observation time of 2 to 4 years, 42/204 eyes (21%) had improved, 119/204 eyes (58%) remained unchanged and 43/204 eyes (21%) had a deteriorated visual acuity. In the 204 eyes the subretinal neovascular lesion(s) were located extrafoveally in 52 eyes, juxtafoveally in 114 eyes and subfoveally in 38 eyes. It is to be pointed out, that even patients with a pre-laser visual acuity of 6/60 or worse obtained an improvement of visual acuity in 12/27 eyes. About 40% of the eyes needed re-treatment from 1 to 8 times. It is unknown whether the obtained results are to be considered marginal or more substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural history of diabetic retinopathy in insulin-dependent juvenile diabetics. A longitudinal study.

In 1975 a prospective longitudinal study of 63 non-pubescent children with insulin-dependent diabetes mellitus (IDDM) was started in order to study the development of retinopathy. This paper presents the results of a 5- and an 8-year follow-up examination concerning the individual development of retinopathy in the patients. At the last follow-up the mean age of the patients was 21.9 years (18-23 years) and the mean diabetes duration 13.2 years (8.1-21.2 years). In 1975 only 5% had developed retinopathy. In 1980 this incidence had risen to 63% and in 1983 to 93% (14% proliferative retinopathy and 79% background retinopathy). In most patients the retinopathy developed slowly, in some patients, however, it deteriorated severely within a few years. A slight regression in the number of microaneurysms and in the number of haemorrhages was observed in a few patients. Microaneurysms seemed in all but one case to be the first pathological element in diabetic retinopathy and developed as a rule several years before other diabetic fundus manifestations occurred. Development of retinopathy was correlated to the duration of diabetes. No correlation could be demonstrated between the progression of retinopathy and the status of regulation. Retinopathy occurred only in 5 patients (8%) before puberty.

Two-year experience with continuous subcutaneous insulin infusion in relation to retinopathy and neuropathy.

Thirty patients with insulin-dependent diabetes mellitus (IDDM) who had advanced background retinopathy were randomized to unchanged conventional treatment (UCT) or to continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 2 yr. The mean blood glucose and hemoglobin A1C (HbA1C) were significantly lower in the CSII group than in the UCT group. The mean blood glucose and HbA1C did not change from the first to the second year in either of the treatment groups in spite of less frequent home-monitoring of blood glucose and less frequent outpatient visits during the second year. Four patients in the CSII group and five in the UCT group developed proliferative retinopathy. However, a marginally significant trend was found toward more frequent improvement of retinal morphology in the CSII group (47%) than in the UCT group (13%). Beat-to-beat variation was found to deteriorate significantly with UCT compared with a nonsignificant improvement with CSII therapy. Vibration sense was unchanged in both treatment groups. It is concluded that near-normal blood glucose levels can be maintained with CSII therapy in spite of less frequent home-monitoring of blood glucose and outpatient visits. Furthermore, established background retinopathy may progress to proliferative retinopathy in spite of 2 yr of near-normal blood glucose levels. However, a marginally significant trend toward more frequent improvement of retinal morphology was found among CSII-treated patients compared with conventionally treated patients. Large-scale, prospective, randomized studies are needed to confirm these results.

Treatment of senile macular degeneration by laser photocoagulation.

117 eyes of 103 patients among 476 patients with senile macular degeneration fulfilled a criterion for treatment with blue-green Argon (n = 20 eyes), green Argon (n = 15 eyes) Krypton-red (n = 58 eyes) and combined treatment (24 eyes). In 50 consecutive treated eyes (= 50 patients) with an observation time exceeding one year a visual acuity greater than or equal to 6/18 was preserved in 34 eyes. This post-laser course differs from the spontaneous course of the disease reported in literature indicating that about 70% of eyes with perifoveal neovascular lesion will develop legal blindness within 2 years. Even though the spontaneous course in this material is unknown, and the comparability to patient material in literature is questionable, it might be concluded that a considerable part of the patients with senile macular degeneration with neovascular lesions might benefit from laser-treatment.

Macular recovery time recorded by nyctometry--a screening method for selection of patients who are at risk of developing proliferative diabetic retinopathy. Results of a 5-year follow-up.

A 5-year study on the predictive value of the macular recovery time, as recorded by nyctometry, in the development of proliferative diabetic retinopathy in insulin-dependent diabetes mellitus has been completed. Seventy-seven patients with a median age of 30,8 years and a median duration of the disease of 15,8 years participated. In the follow-up period, 16 out of 20 patients initially showing abnormally prolonged macular recovery time had developed proliferative diabetic retinopathy the median duration from the initial investigation to the diagnosis of retinal neovascularization being 34 months. Contrary to this finding, only 4 out of 57 patients initially showing normal macular recovery had advanced into proliferative retinopathy, and the median duration until diagnosis of this condition was 45 months. It is concluded that nyctometry can serve as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.

Lacrimal and salivary secretion in Sjögren's syndrome: the effect of systemic treatment with bromhexine.

In a randomized clinical study, 32 patients with Sjögrens syndrome (SS) were given placebo/bromhexine (Bisolvon) 48 mg daily for 3 weeks. Various ophthalmological and oral variables as well as different proteins in tear fluid and saliva were registered. Bromhexine stimulated the tear secretion significantly, presumably without changing the protein composition of the tear fluid. In saliva the IgM concentration in contrast to other proteins decreased in patients with high pre-treatment values. Bromhexine may be of valuable help in the treatment of some patients with SS.

Nyctometry - a new screening method for selection of patients with simple diabetic retinopathy who are at risk of developing proliferative retinopathy. Results of a 3-year follow-up.

A prospective long-term study on the predictive value of nyctometry in the development of proliferative diabetic retinopathy in insulin-dependent diabetes mellitus is in progress. Sixty-one patients participated. At a follow-up 3 years after the initial investigation, none of the patients initially showing results above the lower normal limit had developed proliferative retinopathy, whereas 6 out of 16 eyes initially displaying reduced values of nyctometry had advanced into proliferative retinopathy. It is concluded that nyctometry is valuable as an easily performed screening method in selecting those at risk of developing proliferative retinopathy within a few years.

The effect of strict short-term metabolic control on retinal nervous system abnormalities in newly diagnosed Type 1 (insulin-dependent) diabetic patients.

The oscillatory potential of the electroretinogram and the initial 2-min phase of dark-adaptation were studied in seven newly diagnosed Type 1 (insulin-dependent) diabetic patients before and during initial insulin treatment. Strict metabolic control was achieved in all seven patients using multiple subcutaneous injections of insulin. Seven to 11 days of strict metabolic control improved the added amplitude value of the oscillatory potential from 236 +/- 8 to 268 +/- 8 microV (mean +/- SEM; p less than 0.01) and the dark-adaptation from 90 +/- 5 to 67 +/- 5 s (p less than 0.01). Our study has demonstrated reversible neurophysiological abnormalities in the diabetic retina which are related to metabolic control.

Serum isoamylases in Sjögren's syndrome. Concentration levels and intra-individual variation.

A study of isoamylase in serum from 53 patients with Sjögren's syndrome demonstrated that the levels of both pancreatic type and salivary type amylases remain within reference value limits in most cases. However, abnormal low or high values for pancreatic type amylases were seen more frequently than in the control groups. The intra-individual variation in concentration levels of both isoenzymes among patients with Sjögren's syndrome were significantly greater than in the control groups. These observations are interpreted as signs of subclinical lesions of the pancreas and the salivary glands occurring during the course of the disease. Sjögren's syndrome should be borne in mind and sought in cases of unexplained hypo- or hyperisoamylasemias.

Effect of 1 year of near-normal blood glucose levels on retinopathy in insulin-dependent diabetics.

30 insulin-dependent diabetic patients with background retinopathy were randomised to conventional treatment (UCT) or treatment with continuous subcutaneous insulin infusion (CSII). They were followed prospectively for 1 year with fortnightly seven-sample home blood glucose measurements and retinal examinations every 6 months. Mean blood glucose and stable haemoglobin A1c during months 3-12 were significantly lower in the CSII than the UCT group. Retinal morphology deteriorated during the year with no significant differences between UCT and CSII groups. The frequency of deterioration was highest in the CSII group, especially among the 10 patients with best glycaemic control. Proliferative retinopathy developed in 3 patients--2 of these were CSII treated. Retinal function (oscillatory potential, macular recovery time, and posterior vitreous fluorophotometry) improved significantly with CSII treatment and deteriorated significantly with UCT. Changes in retinal function were most pronounced in patients with the best and the poorest regulated glycaemic control.

Tear absorption into the filter-paper strip used in the Schirmer-I-test. A methodological study and a critical survey.

The absorption of tear fluid into the Schirmer-I-filter paper was evaluated by serial measurements in 5 normal volunteers and in 32 patients with Sjögren's syndrome. The length of wetting was correlated to the weight of tear fluid absorbed in the paper strips. A linear relationship was demonstrated. We conclude that the Schirmer-I-test implies reproducible and fairly precise estimation of the tear flow even in cases of small lengths of wetting. The test is reliable, simple and useful for the diagnosis and follow-up of dry eyes, especially in patients with Sjögrens syndrome.

Cobalamin-binding proteins in serum and saliva from patients with Sjögren's syndrome.

Cobalamin-binding proteins in saliva and in serum were determined in 28 patients with primary Sjögren's syndrome (primary SS), 8 patients with secondary SS and 20 matched healthy controls. The unsaturated transcobalamin II level in serum was significantly increased in patients with secondary SS. The unsaturated cobalamin binding capacity in saliva was increased in patients with primary SS. Considerable interindividual variations were found between patients and in the control group. The local production of cobalamin-binding proteins in SS was sufficient to achieve concentrations in saliva comparable to the control group. The cobalamin-binding capacity in saliva was significantly correlated to the albumin concentration in both primary and secondary SS patients, suggesting a defect in the aqueous phase.