[Endonasal dacryocystorhinostomies with transillumination and intubation in patients with combined pathologies of the nose and after revision]. / Endonasale mikroskopische Dakryozystorhinostomie mit Endoillumination und Intubation bei Patienten mit kombinierten Tränenwegspathologien oder Revisionen.

BACKGROUND: The results of endonasal dacryocystorhinostomies (DCR) with transillumination and intubation are presented. MATERIALS AND METHODS: In the period from 1999 to 2009 follow-up examinations of 50 endonasal DCRs were carried out. All patients over 18 were included. The files were systematically evaluated. The follow-up examinations were performed after a minimum of 6 months with anamnesis of epiphora. RESULTS: 50 endonasal DCRs were performed on 40 patients. Initial surgery was performed on 27 lacrimal ducts, 16 patients had already had operations. Corrective surgery was required in 8 cases (7 endonasal DCRs, 1 external DCRs). 78 % women and 22 % men were included. The median age at the time of operation was 48 years; the median duration of preoperative symptoms was 24 months. In 42 % of the cases a chronic dacryocystitis was found. Pre-existing conditions were sarcoidosis in three cases and one case of Wegener's granulomatosis. As well as lacrimal duct obstruction, additional pathologies were treated in the same session [septoplasty (n = 12), sinus operations (n = 10), and cauterisation of the nasal concha (n = 7), removal of a dacryocele (n = 1), conchectomy (n = 1)]. 20 operations were performed on the right side, 26 on the left side and two bilateral. The median duration of the operation was 51 minutes. No operative complications were encountered. The length of stay in hospital was on average four days. The median of follow-up was 23 months. The success rate was 78 %. DISCUSSION: The success rate of endonasal DCRs is about 70 to 95 %. Thus, the achieved rate in this study is acceptable, especially as 16 of 40 patients underwent revision surgery. Probably this is attributed to the technique of transillumination. The safe intraoperative localisation of the lacrimal sac with a light probe seems to have a positive effect on the removal of obstructions.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in adults]. / Evaluation anatomischer Veränderungen des vorderen Augenabschnitts nach Augenmuskelchirurgie bei Erwachsenen mittels optischer Kohärenztomografie.

BACKGROUND: In the light of studies in children which showed no significant changes concerning anterior chamber depth, central corneal thickness and chamber angle width after eye muscle surgery, the aim of this study was to evaluate such changes in adults by means of optical coherence tomography. PATIENTS AND METHODS: Using the Visante™ OCT (Carl Zeiss, Meditec, Jena) we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0° (CW0) and 180° (CW180) in 17 patients who had undergone eye muscle surgery on a minimum of one horizontal muscle preoperatively, one week and four months postoperatively. Exclusion criteria were an age under fifteen years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 43 years (min: 15; max: 67 years). RESULTS: In all eyes (one and two muscles), no significant differences of mean values taken preoperatively, one week and four months postoperatively were seen: CCT: 538 ± 51 mm; 535 ± 39 mm; 535 ± 46 mm (p = 0.77); ACD: 2.98 ± 0.44 µm; 3.01 ± 0.45 µm; 3.01 ± 0.40 µm (p = 0.42); KW 0: 38.0 ± 5.2° 38.4 ± 6.0° 37.8 ± 5.2° (p = 0.98); KW 180: 33.7 ± 5.6° 35.6 ± 5.7° 34.5 ± 6.8° (p = 0.32). The differences between the corresponding data of both subgroups (one vs. two muscles) concerning central corneal thickness (p-value: 0.74; 0.89; 0.42), anterior chamber depth (p-value: 0.31; 0.23; 0.36) as well as chamber angle width at 0° (p-value: 0.73; 0.27; 0.81) and at 180° (p-value: 0.87; 0.67; 0.89) were not significant. CONCLUSION: Using optical coherence tomography of the anterior eye segment in adults after muscle surgery, either in one or in two muscles - in accord with the results in children - no significant changes concerning central corneal thickness, anterior chamber depth and chamber angle width were seen.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in children]. / Veränderungen des vorderen Augenabschnittes nach Augenmuskelchirurgie--Evaluation bei Kindern mittels optischer Kohärenztomografie.

BACKGROUND: The aim of this study was to quantify and to evaluate changes concerning anterior chamber depth, central corneal thickness and chamber angle width because of altered forces on the eye bulb after eye muscle surgery in children by means of optical coherence tomography. PATIENTS AND METHODS: Over the course of four months, we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0 degrees (CW0) and 180 degrees (CW180) in 28 eyes of 28 children, who underwent eye muscle surgery on one horizontal muscle. Measurements were taken preoperatively, one week and four months postoperatively using Visante (TM) OCT (Carl Zeiss, Meditec, Jena). Exclusion criteria were an age under five years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 6.5 years (range: 7.1, max: 8.9; min: 5.3). RESULTS: Mean values taken preoperatively, one week and four months postoperatively were: CCT: 534 +/- 32 microm; 533 +/- 30 microm; 536 +/- 31 microm (p = 0.12); ACD: 2.98 +/- 0.3 mm; 2.97 +/- 0.3 mm; 2.96 +/- 0.4 mm (p = 0.73); CW 0: 38.1 +/- 3.6; 38.9 +/- 4.7; 38.3 +/- 4.7; CW 180: 34.7 +/- 4.2; 35.3 +/- 4.3; 36.2 +/- 5.2; (p = 0.41). The differences between the mean values in all measurement rows were not significant. CONCLUSION: In children who underwent eye muscle surgery on one horizontal muscle this procedure had no significant impact on central corneal thickness, anterior chamber depth and chamber angle width of the operated eyes within a postoperative period of four months.

[Modular semiquantitative quality assessment of ophthalmic health information on the internet--reproducibility and correlation between different assessment categories]. / Modulare semiquantitative Qualitätsbewertung augenheilkundlicher Gesundheitsinformationen im Internet--Reproduzierbarkeit und Korrelation zwischen verschiedenen Bewertungskategorien.

BACKGROUND: Quality evaluation of web-based health information in ophthalmology requires valid standards and reproducible assessment procedures. The objective was to evaluate the interrater-reliability of quality assessment of ophthalmic websites and a possible correlation between the results of the evaluation categories reliability/trustworthiness, quality of medical content and accessibility/usability. MATERIALS AND METHOD: After selection with the search engine "Google" 20 ophthalmic websites had been analysed by two independent evaluators using criteria checklists (modified Afgis transparency criteria, modified BITV test, medical content related to AMD) related to the aforementioned 3 categories. RESULTS: The interrater-reliability was almost perfectly estimated with Kappa-values of 0.91 for reliability/trustworthiness plus 0.89 for accessibility/usability and 0.79 for content. On average 62.5 % (+/- 17.43 %), 27.36 % (+/- 16.5 %) and 59.54 % (+/- 15.73 %) of the quality requirements were fulfilled for reliability/trustworthiness, content and accessibility/usability, respectively. No significant correlation was found between reliability and content (r = -0.039, p = 0.8709), reliability and accessibility/usability (r = -0.284; p = 0.228) plus content and accessibility/usability (r = 0.199; p = 0.4047). CONCLUSION: Sufficiently operationalised criteria are prerequisites for reproducible results of quality assessment of ophthalmic websites between different observers. The assessment within a single category, such as reliability/trustworthiness, does not allow one to draw conclusions on other categories such as content or accessibility/usability or the overall quality of a website. Therefore, simplified tools for quality assessment of health information by laymen and patients may have a limited validity.

[Accessibility of information on eye diseases on the internet for the visually impaired user]. / Zugänglichkeit von Informationsangeboten über Augenerkrankungen im Internet für sehbehinderte Nutzer.

BACKGROUND: The number of visually impaired people who use the internet for obtaining health information around the eye, is rising continuously. For this reason the accessibility for visually impaired persons to such websites is an important factor. Our investigation deals with the question: How good is the accessibility for the visually impaired to gather information on eye diseases on the Internet and how could this be improved? MATERIALS AND METHOD: After identification using the the search engine "Google", 20 websites of German university eye hospitals have been checked for their accessibility using the modified BITV test which is based upon 52 test criteria. RESULTS: On average 70.75 % (+/- 6.19 % min. 56.6 %, max; 86.79 %) of the required accessibility criteria have been fulfilled. This corresponds to an average accessibility value of 70.58 % (+/- 6.69 % min. 56.31 %, max. 89.32 %). According to the BITV test, this means that the average of the analysed websites is not accessible. The improper use of mark-up languages, unclear document or web page titles or missing alternative texts for pictures, graphics and navigation elements and misleading navigational architecture are frequent findings. This builds up the greatest accessibility barriers, although these barriers could be eliminated even with a relatively low expense. CONCLUSION: Good accessibility allows not only a barrier-free access to information for visually impaired users but is also a most important feature related to search engine optimisation.

Aqueous flare in retinitis pigmentosa.

BACKGROUND: The purpose of this study was to quantify blood-ocular barrier impairment by measuring aqueous flare in retinitis pigmentosa (RP) and to search for clinical correlations. METHODS: Forty-nine patients (94 eyes) with RP and 85 normal controls were examined. Aqueous flare was quantified with the noninvasive laser flare-cell meter (FC-1000, Kowa, Japan). Degrees of cystoid macular edema (CME), vitreous pigment dusting (VPD), intraretinal migration of retinal pigment epithelium, and waxy pallor of the optic nerve head were determined semiquantitatively by biomicroscopy. Data were analyzed using the t-test the Mann-Whitney U-test, the chi-squared test and regression analysis by taking into account the dependency of data from two eyes of the same patients. RESULTS: Aqueous flare (photon counts/ms) was significantly higher in RP (mean 10.11 +/- 3.53) than in normals (3.89 +/- 0.94; P < 0.001). Clinically significant CME was present in 26% of eyes with RP, being significantly more frequent in autosomal dominant RP (11 of 16 eyes, 69%) than in other variants (17%; P < 0.005). Multivariate analysis revealed that CME was most strongly associated with flare values (r = 0.84), P < 0.01), whereas--after adjusting for CME--correlations between aqueous flare and other clinical findings did not reach significance. CONCLUSION: RP eyes show increased aqueous flare values, indicating impairment of blood-occur barriers. This appears to be associated with CME and with autosomal dominant RP.

[Comparative laser tyndallometry and fluorophotometry in anterior and posterior uveitis]. / Vergleichende Lasertyndallometrie und Fluorophotometrie bei anteriorer und posteriorer Uveitis.

UNLABELLED: Recent studies have sought to quantify aqueous flare by laser flare measurement. An increase in aqueous flare caused by a rise of protein concentration was frequently found both in anterior and posterior segment disease. This has been interpreted as a break-down of the blood--aqueous barrier (BAB). By measuring the diffusion coefficient of the BAB compared to the aqueous flare value in patients with anterior and posterior uveitis, the extent to which the increase in flare value was related to a possible break down of the BAB was examined. PATIENTS: Thirty-nine normal eyes (23-78 years; 41.6 +/- 18.6), 18 eyes with anterior uveitis (iritis, iridocyclitis; 18-57 years; 35.2 +/- 12.4) and 29 eyes with posterior uveitis (chorioretinitis or retinochorioditis; 18-51 years; 31.7 +/- 10.5). The diffusion coefficient P(a) of the BAB was measured fluorophotometrically, while the flare value was quantified by laser flare measurement. RESULTS: Flare values (1/ms) were found to be significantly increased (p < 0.001) compared to normal eyes (4.6 +/- 1.7) both in anterior uveitis (20.9 +/- 8.5) and in posterior uveitis (17.4 +/- 8.3) but did not significantly differ between them (p = 0.43). The diffusion coefficient P(a) (10(-3)/min) of the BAB was not significantly different (p > 0.05) between normal eyes (0.5 +/- 0.2) and eyes with posterior uveitis (0.9 +/- 0.7), whereas it was significantly increased (p < 0.001) in anterior uveitis (6.5 +/- 5.4) compared to the other groups. CONCLUSIONS: (1) In posterior uveitis, an increased flare value is not necessarily correlated with a breakdown of the BAB; proteins may enter the aqueous from posterior. (2) Assessing the function of the BAB in posterior segment disease using laser measurement should be carried out with caution; if possible, permeability measurements of the BAB should be undertaken separately.

Permeability of the blood-retinal barrier in healthy humans. European Concerted Action on Ocular Fluorometry.

BACKGROUND: The aim of this study was to compare the inward permeability of the blood-retinal barrier in healthy subjects from six European cities. METHODS: Seventy-two healthy subjects (age 20-70 years) were selected. At 30 min and 60 min after fluorescein injection, fluorescein mass in vitreous was calculated from the concentrations measured along the optical axis of the eye. Non-protein-bound fluorescein (NPBF) concentrations were measured in plasma prepared from blood samples taken 7, 15 and 55 min after injection. Blood-retinal barrier permeability (PBRB) was calculated from the vitreous fluorescein mass and the time integral of NPBF and was corrected for the autofluorescence of ocular tissue and for lenticular light transmittance. RESULTS: Mean PBRB values +/- SD (nm.s-1) were 2.07 +/- 0.54 (Coimbra), 2.01 +/- 0.43 (Frankfurt), 2.24 +/- 0.50 (Ghent), 2.37 +/- 0.56 (Herlev), 1.89 +/- 0.44 (Leiden) and 1.74 +/- 0.38 (Porto). Differences between centers were not significant (P > 0.35). Measurements were reproducible and independent of the time after fluorescein injection (P > 0.50). A PBRB higher than 3.16 nm.s-1 or a value which had increased by 32% was considered abnormal (P < 0.05). CONCLUSION: PBRB values were similar in all centers. The results demonstrate that this is a highly sensitive and reliable method for measuring the permeability of the blood-retinal barrier.

[Corneal topography after cataract surgery with tunnel incision on a steeper meridian in inverse and oblique astigmatism]. / Korneale Topographie nach Kataraktchirurgie mit Tunnelschnitt auf dem steileren Meridian bei Astigmatismus inversus und obliquus.

Scleral tunnel incision at the 12 o'clock-position for no-stitch cataract surgery can increase preexisting against-the-rule astigmatism by flattening the vertical corneal meridian. An oblique axis can change by operative induction. We investigated, in a prospective study, whether reduction of such a preoperative astigmatism could be induced by locating the tunnel incision on the steeper meridian. Eighteen eyes with senile cataract and against-the-rule or oblique astigmatism of at least 0.7 diopters were operated with a standardized 5 x 6 mm scleral tunnel incision and a 6 mm PMMA posterior chamber lens. We evaluated the astigmatism with a videokeratoscopy TMS-I preoperatively and about 6 months after the surgery. The mean corneal astigmatism was 1.8 diopters pre- and 1.5 diopters postoperatively. A reduction of keratometric astigmatism was reached in 72% of cases; 17% remained unchanged. The surgically induced astigmatism calculated by Jaffer's and Clayman's vector analysis was 0.68 diopters. The technique of scleral tunnel incision with lateral or oblique approach can reduce a preexisting against-the-rule or oblique astigmatism.

[Intraocular rt-PA injection in fibrin formation after combined glaucoma and cataract operation]. / Intraokulare rt-PA-Injektion bei Fibrinbildung nach kombinierter Glaukom- und Kataraktoperation.

BACKGROUND: The fibrinolytic drug rt-PA, which has been successfully used systemically to treat arterial and venous occlusions, is now available for local, intraocular injection. rt-PA converts plasminogen to plasmin, which in turn is able to lyse fibrin and fibrin clots. Intraocular surgery, trauma and inflammation may lead to intraocular accumulation of fibrin. Treatment of this type of complication with high-dose corticosteroids is protracted and often unsuccessful. PATIENTS: Eight patients (age 59-75 years) with fibrin formation following phacoemulsification and IOL implantation combined with trabeculectomy were treated by intraocular injection of 10 micrograms rt-PA. The intraocular status following the local fibrinolytic therapy was documented by biomicroscopy, photography and laser-flare Tyndallometry on days 1, 2 and 8. RESULTS: In all patients the fibrin clots dissolved completely. Neither relapses nor adverse affects were noted. CONCLUSIONS: The intraocular application of rt-PA results in an efficient fibrinolytic effect, which prohibits potential complications of combined glaucoma and cataract surgery due to fibrin formation.

Diffusion coefficient through the blood-aqueous barrier using a standard protocol.

AIMS/BACKGROUND: Comparison of the diffusion coefficient through the blood-aqueous barrier of healthy volunteers measured in different cities with identical fluorophotometers using a standardised protocol. METHODS: Healthy volunteers aged between 20 and 70 years were studied in seven European cities. The fluorescein concentration in the anterior segment of each eye was measured with a commercial scanning fluorophotometer 30 and 40 minutes after intravenous fluorescein. The decay of non-protein bound fluorescein concentration in blood plasma was determined with the use of three blood samples taken at 7, 15, and 55 minutes after injection. The diffusion coefficient through the blood-aqueous barrier was calculated from the ratio between the fluorescein concentration in the anterior chamber and the time integral of non-protein bound fluorescein concentration in plasma using specially developed software. RESULTS: The mean values of the diffusion coefficient (SD) (X10(-4) min-1) were 4.76 (1.51) (n = 20, Brussels), 5.48 (2.33) (n = 17, Coimbra), 3.47 (2.09) (n = 12, Cologne), 6.09 (2.77) (n = 21, Frankfurt), 3.85 (1.59) (n = 11, Ghent), 4.99 (1.69) (n = 23, Leiden), and 4.87 (1.05) (n = 20, Madrid). The values between centres were similar (Kruskal-Wallis test p > 0.05) except for Cologne and Frankfurt (p = 0.013). No differences were found when repeating measurements (four centres, interval time 1-8 months, Wilcoxon paired test p > 0.39). CONCLUSION: The diffusion coefficients had similar values and standard deviations. The concerted action demonstrated the usefulness of a standardised protocol.

Balloon dacryocystoplasty: an alternative treatment for obstructed tear ducts.

Twenty-two patients with severe epiphora due to relative (n = 13) or absolute (n = 9) stenoses of the nasolacrimal duct were treated by means of radiologically guided balloon dacryocystoplasty. The recanalization was performed with a steerable microguide wire with flexible tip, which was advanced through the lacrimal draining system and manipulated out of the nasal cavity. A 3-mm PTA balloon was then introduced from the nasal site. In 20 of 22 cases the procedure was technically successful. Dacryocystography proved a normal lumen in 9 of 20 patients and an improvement without impairment of flow in another 8 cases. Two months after dilation a clear regression of epiphora could be demonstrated in 17 of 20 patients. The procedure was complicated by the occurrence of 2 reobstructions within the first 3 months; other serious side effects were not observed.

Corneal endothelial permeability and aqueous humor flow using a standard protocol.

BACKGROUND: The study was carried out to compare corneal endothelial permeability and aqueous flow values of healthy volunteers measured in different countries with identical fluorophotometers using a standardized protocol. METHOD: Healthy volunteers aged between 20 and 70 years were studied in five European cities. Fluorescence scans of the anterior segment of both eyes were made using a commercial fluorophotometer. Beginning 4 h after instillation of four drops of fluorescein 10%, 12 scans of the anterior segment of each eye were performed in 2 h. The values of corneal endothelial permeability and aqueous flow were calculated with standardized software from the decay of the fluorescein concentration in the cornea and anterior chamber. RESULTS: The mean permeability values (x 10(-4) cm.min-1) +/- SD were 3.7 +/- 1.6 (n = 19; Coimbra, Portugal), 4.3 +/- 1.1 (n = 19; Frankfurt, Germany), 3.9 +/- 0.9 (n = 19; Leiden, The Netherlands) and 5.4 +/- 1.2 (n = 10; Milan, Italy). The values were not significantly different (ANOVA, P > 0.3), except those in Milan. The mean flow values (microliters.min-1) +/- SD were 2.3 +/- 0.9 (n = 17; Coimbra), 1.9 +/- 0.7 (n = 10; Cologne, Germany), 2.6 +/- 1.2 (n = 19; Frankfurt), 2.0 +/- 0.6 (n = 19; Leiden) and 1.7 +/- 0.8 (n = 10; Milan). The values were not significantly different (Kruskal-Wallis test, P > 0.1). CONCLUSIONS: Permeability and flow values in the different cities had similar values and standard deviations. The Concerted Action demonstrated the usefulness of a standardized protocol.

[The aqueous humor-vitreous body barrier and the blood-aqueous humor barrier after YAG laser capsulotomy in capsular sac vs ciliary sulcus fixation of the intraocular lens]. / Die Kammerwasser-Glasköper-Barriere und die Blut-Kammerwasser-Schranke nach YAG-Laser-Kapsulotomie bei Kapselsack- vs. Sulcusciliaris-Fixierung der IOL.

UNLABELLED: An intact posterior capsule between aqueous and vitreous may act as a barrier to substances of low and high molecular weight, e.g., prostaglandins, hyaluronic acid, or the angiogenic factor. After phacoemulsification followed by posterior YAG capsulotomy, an increased diffusion rate of such molecules into the vitreous and increased permeability of blood aqueous barrier (BAB) may occur. These barriers were quantified in eyes that underwent YAG capsulotomy after sulcus or intracapsular IOL implantation in order to determine the safest surgical procedure with respect of maintenance of these barriers. PATIENTS AND METHODS: Between 2 to 6 h after topical fluorescein application, the time-dependent decrease in dye concentration ratio between aqueous and anterior vitreous leads to the diffusion rate D(av) [10(-3)min-1] between aqueous and vitreous; D(av) was evaluated fluorophotometrically before and 3 weeks after capsulotomy (3 to 5 mm) in human eyes of each group. In order to quantify BAB function, aqueous laser flare was measured in eyes with sulcus and capsular fixation of IOL before, 3 h, and 3 weeks after YAG capsulotomy. RESULTS: After YAG surgery D(av) increased 2.7-fold (P < 0.001) in eyes with a sulcus implant compared to the values obtained in the group that had an intracapsular PCL. Aqueous laser flare was increased to 140% (P < 0.001) in eyes with sulcus fixation and to 95% (P < 0.001) in eyes with capsular fixation of PCL. Laser flare values became normal 3 weeks after laser treatment (P > 0.05). CONCLUSION: Intracapsular PCL implantation more effectively maintains the protective aqueous vitreous barrier and BAB after posterior capsulotomy than sulcus implantation. This possibly reduces the incidence of cystoid macular edema (diffusion of prostaglandins), retinal detachment (loss of hyaluronic acid of the vitreous), endophthalmitis (spread of bacteria) or rubeosis iridis (angiogenic factor) after YAG capsulotomy.

[Balloon dilatation of relative postsaccal lacrimal duct stenoses]. / Ballondilatation relativer postsaccaler Tränenwegstenosen.

In ten patients with incomplete postsaccal stenosis radiology examined by digital subtraction dacryocystorhinography, an overpressure ballooning was done with a small foot vessel balloon with hydrophilic surface under image intensiver control. The balloon was inflated with a diluted suspension for visualization of the balloon and widening of the stenosis. In eight patients recovery was continuous without any treatment, in one with topical application of vasoconstrictor eye drops. In one patient there was a recurrence. Balloon of incomplete postsaccal lacrimal pathway dilatation stenosis is an adequate and minimally invasive therapy.

The blood-ocular barrier in type I diabetes without diabetic retinopathy: permeability measurements using fluorophotometry.

For the evaluation of a possible malfunction of the blood-retinal (BRB) and the blood-aqueous barrier (BAB) in type I diabetes without manifest angiopathy, after i.v. injection of sodium fluorescein, the permeability of BRB (P) and the diffusion coefficient of BAB [P(a)] were studied simultaneously by fluorophotometry in 34 eyes of 34 type I diabetics (HbA1c = 6.6 +/- 0.9%) without retinopathy whose ages ranged from 19 to 38 years (30.5 +/- 5); diabetes' duration was between 5 and 18 years. Fluorescein angiography was performed to exclude nonperfused areas. In all, 34 eyes of 34 healthy volunteers whose ages ranged between 23 and 34 years (28.5 +/- 3.3) served as controls; in this group, fluorophotometry was performed twice to evaluate reproducibility. The mean BAB diffusion coefficient in diabetics [P(a) = 5.3 +/- 1.8/min] was significantly increased (p = 0.00003) as compared to controls [P(a) = 3.7 +/- 0.7/min]; BRB permeability in diabetes (P = 3.2 +/- 1.4 x 10(-7) cm/s) was raised with this elevation being of lower significance (p = 0.019; controls: P = 2.6 +/- 0.7 x 10(-7) cm/s). We found a decrease in BRB permeability depending on diabetes' duration (r = -0.15; p = 0.007) that was not significant in BAB (r = -0.1; p = 0.24). No correlation was found to exist between permeability and HbA1c values either in BAB or in BRB. The reproducibility in controls was 9% in BRB determinations and 12% in BAB measurements. These results may suggest that early structural alterations without the manifestation of retinopathy possibly cause elevation in BRB permeability and are even more obvious in BAB permeability. Whereas the reliability of vitreous fluorophotometry in detecting early BRB malfunction has to be judged critically, anterior segment fluorophotometry is a reliable procedure for the monitoring of BAB affection in type I diabetes without retinopathy.

[Quantification of disorders of the blood-aqueous humor barrier in retinitis pigmentosa--initial results]. / Quantifizierung von Störungen der Blut-Kammerwasser-Schranke bei Retinopathia pigmentosa--Erste Ergebnisse.

BACKGROUND: Clinical findings in patients with retinitis pigmentosa (RP) frequently include cystoid macular edema (CME) and vitreous pigment dusting (VPD) indicating alterations of the blood-ocular barriers. It was the aim of this study to determine whether alterations of the blood-aqueous barrier (BAB) are present in RP. PATIENTS AND METHODS: Aqueous flare was quantitatively determined in 56 eyes of 29 patients (mean age 36.4 +/- 11.2 years) with RP using the noninvasive laser flare-cell photometer (Kowa FC-1000, Tokyo, Japan). All RP patients had common forms of RP with markedly reduced or nondetectable ERG. The presence of CME and VPD was determined semiquantitatively by biomicroscopy. Fifty-eight eyes of 58 normal controls (mean age 38.2 +/- 8.5 y.) were also examined. RESULTS: Aqueous-flare values were significantly higher in RP eyes (mean 9.65 +/- 3.24 photon counts/ms, range 4.0-18.1) than in the normal control eyes (mean 3.89 +/- 1.05, range 1.9-6.0, p < 0.0001, Mann-Whytney test). Forty-eight of the 56 RP eyes (86%) showed increased flare values (> 6.0 photon counts/ms). RP eyes with moderate to marked CME (n = 11) had significantly higher flare values (mean 14.66 +/- 1.92) than RP eyes without or with only questionable CME (8.52 +/- 2.18, p < 0.0001), and RP eyes with moderate to marked VPD (n = 17) had significantly higher (12.05 +/- 2.84) flare values than RP eyes without or with only minimal VPD (8.74 +/- 2.22, p < 0.0005). CONCLUSIONS: Our findings show that the majority of patients with RP have alterations of the BAB with consecutively increased aqueous protein concentrations. The impairment of the BAB appears to be associated with CME and VPD. Measurement of aqueous flare in RP allows quantification of the impairment of the BAB and may be helpful in the future in choosing and monitoring patients with RP and CMP for possible antiinflammatory or antiedematous therapeutic measures.