The effect of complement factor H Y402H polymorphism on the outcome of photodynamic therapy in age-related macular degeneration.

PURPOSE: Photodynamic therapy (PDT) has been widely used in the treatment of age-related macular degeneration (AMD). The complement cascade has an important role in the tissue reactions occurring after PDT. The Y402H polymorphism of the complement factor H (CFH) gene has been identified as a risk factor for AMD. Since CFH is central in the regulation of the complement system the authors wanted to analyze whether the CFH Y402H polymorphism modifies the PDT outcome in AMD. METHODS: A total of 88 patients having been treated with PDT and without further scheduled PDT sessions were analyzed. Depending on the situation at their final PDT session the patients were classified retrospectively as PDT-responders or PDT-nonresponders. All patients were genotyped for the CFH Y402H polymorphism. RESULTS: The proportion of PDT-responders was 18/26 (69.2%) in patients homozygous for the CFH Y402H risk allele, 34/50 (68.0%) in heterozygous, and 7/12 (58.3%) in patients with the normal genotype (p=0.520). The median number of PDT treatments of the PDT-responders was three for all the genotypes. CONCLUSIONS: The dysfunction of the CFH related to the risk of AMD and caused by the Y402H polymorphism does not modify the outcome of PDT. Genotyping for CFH Y402H cannot be used to select patients for this treatment.

Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma in children and young adults.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of glaucoma in young patients. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Transscleral contact krypton laser CPC was performed in 27 glaucomatous eyes of 22 young patients (mean age, 10.5 +/- 5.6 years; range, 11 months-19.4 years). METHODS: The treatment was delivered by means of a fiberoptic probe with compression of the sclera by the probe. The power used was 300 to 500 W per application at the tip of the probe with an exposure time of 10 seconds. MAIN OUTCOME MEASURES: The primary outcome measure is a change in intraocular pressure (IOP). RESULTS: Of the patients who received CPC in both eyes, one eye was randomly chosen for statistical analysis. The mean overall follow-up time was 43.3 +/- 25.3 (median, 36.5; range, 1-82) months after the initial CPC. Preoperatively, the mean intraocular pressure was 35.0 +/- 7.9 mmHg (n = 22). After one or more CPCs, the mean IOP was decreased to 21.5 +/- 8.7 mmHg (n = 22) at 1 month (P < 0.001), to 23.4 +/- 8.6 mmHg (n = 18) at 3 months (P < 0.001), to 25.0 +/- 12.1 mmHg (n = 19) at 6 months (P < 0.01), to 22.1 +/- 9.1 mmHg (n = 16) at 1 year (P < 0.01), and to 22.6 +/- 10.3 (n = 11) at 2 years (P < 0.01). After one or more krypton CPCs, but no other glaucoma procedures, an IOP level of 8 to 21 mmHg or a decrease in IOP of more than 30% was obtained in 14 of 22 (64%) eyes at the last follow-up. No permanent hypotonia, phthisis bulbi, or devastating CPC-related complications were noted. CONCLUSIONS: Krypton laser CPC is a well-tolerated means of lowering IOP in young patients with glaucoma, but repeated treatments may be needed.

Transscleral contact krypton laser cyclophotocoagulation for treatment of posttraumatic glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation in the treatment of posttraumatic glaucoma. PATIENTS AND METHODS: A total of 18 eyes of 18 patients with therapy-resistant posttraumatic glaucoma treated with krypton laser cyclophotocoagulation from 1991 to 1996 were included in this review. The krypton laser was delivered by a fiberoptic probe with simultaneous compression of the sclera. The energy used was 3 to 5 J per application at the tip of the probe, with an exposure time of 10 seconds. The treatment covered 90 to 360 degrees of the ciliary body with approximately 10 applications per quadrant. RESULTS: With one or more cyclophotocoagulation treatments, the intraocular pressure decreased from the baseline mean (+/- standard deviation) of 32.6 +/- 12.8 mm Hg to 23.6 +/- 10.3 mm Hg (n = 17) at 1 month, to 21.8 +/- 7.5 mm Hg (n = 13) at 3 months, to 22.5 +/- 7.6 mm Hg (n = 13) at 6 months, and to 19.6 +/- 10.5 mm Hg (n = 18) at the last control visit (mean, 19.4 months; range, 3 weeks to 73 months) after cyclophotocoagulation but no other glaucoma procedure. At baseline, 17 (94%) of 18 patients were taking glaucoma medication, as were 15 (83%) of 18 patients at the last control visit. One (6%) case of phthisis occurred. CONCLUSIONS: Krypton laser cyclophotocoagulation is an effective and reasonably well tolerated means of lowering intraocular pressure in posttraumatic glaucoma. Because of the refractory nature of the disease, repeated treatments may be needed.

Corneal structure and sensitivity in type 1 diabetes mellitus.

PURPOSE: Corneal wound healing is impaired in diabetic cornea. The purpose of this study was to examine patients with type 1 diabetes mellitus for changes in corneal morphology and to correlate corneal sensitivity, subbasal nerve morphology, and degree of polyneuropathy with each other. METHODS: Forty-four eyes of 23 patients with diabetes and nine control eyes were included. Corneal sensitivity was tested with a Cochet-Bonnet esthesiometer (Luneau, Paris, France), and corneal morphology and epithelial and corneal thickness were determined by in vivo confocal microscopy. The density of subbasal nerves was evaluated by calculating the number of long subbasal nerve fiber bundles per confocal microscopic field. The degree of polyneuropathy was evaluated using the clinical part of the Michigan Neuropathy Screening Instrument (MNSI) classification, and retinopathy was evaluated using fundus photographs. RESULTS: A reduction of long nerve fiber bundles per image was noted to have occurred already in patients with mild to moderate neuropathy, but corneal mechanical sensitivity was reduced only in patients with severe neuropathy. Compared with control subjects the corneal thickness was increased in patients with diabetes without neuropathy. The epithelium of patients with diabetes with severe neuropathy was significantly thinner than that of patients with diabetes without neuropathy. CONCLUSIONS: Confocal microscopy appears to allow early detection of beginning neuropathy, because decreases in nerve fiber bundle counts precede impairment of corneal sensitivity. Apparently, the cornea becomes thicker in a relatively early stage of diabetes but does not further change with the degree of neuropathy. A reduction in neurotrophic stimuli in severe neuropathy may induce a thin epithelium that may lead to recurrent erosions.

Early versus late staining of microaneurysms in fluorescein angiography.

PURPOSE: To analyze the appearance and disappearance of microaneurysms in different phases of fluorescein angiography. METHODS: Three fluorescein angiograms were taken at 13-month intervals during a 26-month follow-up period from 13 patients with type I diabetes and mild background retinopathy. Two frames of the angiogram were analyzed: one from the transit phase and the other from the late phase of the angiogram. Individual microaneurysms were identified and localized from each frame using a computerized system for retrieval of the coordinates for each microaneurysm. Microaneurysms identified by their location then were analyzed in relation to the phase of the angiogram in which they were visualized and their disappearance during follow-up study. RESULTS: Thirty-three percent of the microaneurysms were visualized only in the early phase, 31% in only the late phase, and 36% in both phases of the fluorescein angiogram. The microaneurysms frequently changed their phase of appearance in the angiogram during follow-up study. CONCLUSION: During the 26-month follow-up period, between 55% and 80% of the microaneurysms present at baseline disappeared. The phase of the baseline angiogram in which the microaneurysms were visualized did not determine their disappearance rate.

Transscleral contact krypton laser cyclophotocoagulation for treatment of glaucoma.

PURPOSE: To evaluate the usefulness of the krypton laser for transscleral contact cyclophotocoagulation. METHODS: Transscleral contact krypton laser cyclophotocoagulation was performed in 62 eyes of 57 patients with therapy-resistant glaucoma. A minimum follow-up for 6 months was obtained for 59 eyes. The krypton laser was delivered via a fiberoptic probe with compression of the sclera by the probe. The energy used was 4 to 5 J per application at the tip of the probe with an exposure time of 10 seconds. RESULTS: The intraocular pressure (IOP) decreased from the baseline mean of 34.8 +/- 11.0 mmHg to 20.4 +/- 8.3 mmHg within 10 days, to 22.6 +/- 12.5 mmHg at 1 month, to 21.3 +/- 11.3 mmHg at 3 months, and to 20.9 +/- 9.1 mmHg at 6 months postoperatively. Intraocular pressures of 8 to 24 mmHg were obtained in 62% of the eyes at 1 month, 60% at 3 months, and 73% at 6 months postoperatively with one or more cyclophotocoagulations but no other hypotensive procedures. The corresponding success rates after 6 months were 82% for eyes in which the procedure was performed to preserve vision and 50% for eyes in which the procedure was performed to relieve pain. No clinical signs of scleral injury or cyclodestruction-related loss of vision were detected. CONCLUSIONS: Krypton laser cyclophotocoagulation appears to be an effective and well-tolerated means of lowering IOP in therapy-resistant glaucoma. An advantage of the method is that standard retinal krypton photocoagulators can be used for the procedure.

Plasmin in subretinal fluid.

Proteolytic activity was studied in subretinal fluid from 56 eyes with rhegmatogenous retinal detachment without vitreous or subretinal hemorrhage. Active plasmin (1.0-15.2 micrograms/ml) was found in 33 eyes and plasmin-inhibitor complexes in 3 eyes. Plasmin was detected more often in large detachments, but there was no clear correlation with the duration of the detachment or characteristics of the holes in the retina. It seems possible that plasmin in subretinal fluid may enhance release of cells from the pigment epithelium by degrading the extracellular matrix and contribute to the development of proliferative vitreoretinopathy.

Acute posterior multifocal placoid pigment epitheliopathy in connection with acute nephritis.

A relationship between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and systemic infections has been suggested. This report presents a case of APMPPE in connection with acute nephritis in a previously healthy man. The disease started with arthralgia, headache, fever, malaise, and lymphadenopathy. During the following 2 weeks, signs of mild nephritis developed. At the same time the patient noticed acute decrease in vision; the visual acuity being 0.08 (20/250) in both eyes. Mild anterior uveitis and areas of pigment epithelial swelling at the posterior pole corresponding to the picture of APMPPE were observed. Four weeks later, the fundus lesions had healed leaving some pigment epithelial atrophy and pigment dispersion in the macula, and the visual acuity was 0.8 (20/25) in the right and 1.0 (20/20) in the left eye. No systemic therapy was given. This case gives support to the theory of general vasculitis as a cause of APMPPE.