Comparison of Neurovascular Coupling between Normal Tension Glaucoma Patients and Healthy Individuals with Laser Speckle Flowgraphy.

Background: The purpose of this pilot study was to investigate the differences in neurovascular coupling between Caucasian patients with normal tension glaucoma (NTG) and healthy subjects (HS) with laser speckle flowgraphy (LSFG). Methods: Measurement of optic nerve head blood flow was performed with LSFG. The mean blur rate of the whole optic nerve head (MA), of the big retinal vessels (MV) and of the microvasculature (MT) was analysed during continuous flicker light stimulation for four minutes. Results: We included 12 eyes from 12 Caucasian patients with a diagnosis of normal tension glaucoma and 12 eyes from 12 age- and sex-matched healthy individuals. MA, MV and MT all increased significantly in both groups during the observation period with no difference between the groups. Conclusion: Neurovascular coupling is detectable in NTG patients. Flicker light stimulation leads to a comparable increase in ocular blood flow in glaucoma patients and healthy individuals.

[Morphological retinal characteristics of patients with low vision due to diabetic macular edema]. / Morphologische retinale Charakteristika von Patienten mit einer Sehbehinderung infolge eines diabetischen Makulaödems.

BACKGROUND: The World Health Organisation (WHO) defines low vision as a best corrected visual acuity (BCVA) in the better eye between ≥0.5 logMAR and ≤1.3 logMAR. In diabetic macular edema (DME) the correlation between retinal morphology and function is not completely understood in patients with advanced visual impairment. OBJECTIVE: The aim of the study was to describe the pathomorphological similarities of DME in patients with low vision and to correlate them with clinical parameters. MATERIAL AND METHODS: Optical coherence tomography (OCT) and fluorescence angiography (FA) images were graded according to the SAVE protocol and correlated with BCVA, cataract grade and clinical parameters in order to elucidate joint features. RESULTS: Out of a total collective of 65 patients 24 had low vision and 18 of these 24 patients (75%) showed typical signs of atrophic edema according to SAVE protocol criteria (SAVE group 4); however, 6 patients were afflicted with less progressive forms of DME but still suffered from low vision. Common pathomorphological findings were a discontinuity of the ellipsoid zone (EZ; n = 18), loss of pseudosepta (n = 7), layer-disrupting cysts (n = 7) and hard exudates (n = 10). CONCLUSION: It is suggested that a disruption of the EZ, loss of pseudosepta and layer-disrupting cysts are signs of an advanced chronic DME causing low vision. A definition of characteristic pathomorphological patterns of chronic damage in OCT is important for a possible treatment discontinuation in the clinical routine.

[Descemet Membrane Endothelial Keratoplasty]. / Descemet-Membran-Endothelkeratoplastik (DMEK).

Descemet membrane endothelial keratoplasty (DMEK) is the gold standard for the treatment of corneal endothelial disease, first and foremost Fuchs' endothelial dystrophy. Superior visual rehabilitation as well as lower and decreasing complication rates can be obtained with DMEK than with Descemet stripping automated endothelial keratoplasty (DSAEK) - still the most commonly performed type of posterior lamellar keratoplasty. Recent advancements in the DMEK method include the establishment of a standardised and reproducible surgical "no touch" technique and the emerging role of eye banks, which are able to prepare convenient pre-cut DMEK grafts. These developments pave the way for increasing numbers of corneal surgeons to add DMEK to their armamentarium, despite the more challenging nature of this procedure. However, a review of the current literature shows that this fascinating technique still offers certain challenges, which need to be further addressed. For example, graft detachment remains the most commonly encountered complication after DMEK. A plethora of prospective-randomised studies is required to further endorse the evident superiority of DMEK over alternative types of lamellar keratoplasty and to help propagate the practice of this fascinating technique.

Antileishmanial activity in Israeli plants.

Leishmaniasis is a vector-borne disease caused by flagellated protozoan parasites of the genus Leishmania, which affects both humans and other mammals. Most of the available drugs against the disease are toxic and parasite resistance to some of the drugs has already developed. In the present study, the leishmanicidal activities of methanolic extracts of some Israeli plants have been evaluated in vitro, against the free-living promastigotes and intracellular amastigotes of Leishmania major. Of the 41 extracts examined, those of two plants (Nuphar lutea>Withania somnifera) were highly effective (with a maximum inhibitory effect of >50%), those of three other species (Pteris vittata>Smyrnium olusatrum>Trifolium clypeatum) were moderately effective (25%-50%) and another four extracts (Erodium malacoides>Hyparrhenia hirta>Thymelaea hirsuta>Pulicaria crispa) showed a marginal effect (15%-22%) against the parasites. Extracts of nine plant species therefore showed antileishmanial activity but only the extract of N. lutea, used at 1.25 microg/ml, eliminated all the intracellular parasites within 3 days of treatment, with no detectable toxicity to the host macrophages. The mean (S.D.) values recorded for the median inhibitory concentrations of this extract (IC50) against the promastigotes [2.0 (0.12) microg/ml] and amastigotes [0.65 (0.023) microg/ml] and the median lethal concentration (LD50) against macrophages [2.1 (0.096) microg/ml] were encouraging, giving a therapeutic selectivity index [LD50/IC50 for amastigotes)] of 3.23. The extract of N. lutea was, in fact, generally as effective as the paromomycin that was used as the 'gold standard' drug. These results indicate that N. lutea and probably also Withania somnifera might be potential sources of clinically useful, antileishmanial compounds.