Cannabinoids and glaucoma.

Glaucoma is one of the leading causes of blindness in the world. In spite of the diverse therapeutic possibilities, new and better treatments for glaucoma are highly desirable. Cannabinoids effectively lower the intraocular pressure (IOP) and have neuroprotective actions. Thus, they could potentially be useful in the treatment of glaucoma. The purpose of this article is to provide the reader with an overview of the latest achievements in research into the potential use of cannabinoids for glaucoma.

[Cyclosporin A 2% eyedrops in therapy of atopic and vernal keratoconjunctivitis]. / Cyclosporin-A-2%-Augentropfen in der Therapie der Keratoconjunctivitis atopica und vernalis.

BACKGROUND: The efficacy of Cyclosporin A 2%eyedrops (CsA2%) as an additive treatment of atopic (AKC) and vernal keratoconjunctivitis (VKC) was evaluated. PATIENTS AND METHODS: The symptoms and findings of 26 patients with AKC and 12 patients with VKC with no improvement under conventional therapy, were additionally treated with CsA2% eyedrops and compared over a minimum follow-up period of 3 months to more than 24 months. RESULTS: The therapy with CsA2% eyedrops was well tolerated and evaluated as effective by the patients. Subtarsal papillae were reduced in 69.2% of the AKC group and in 66.6% of the VKC patients. Trantas dots were reduced or disappeared in about 50% of the AKC group and in the VKC group they had disappeared in more than 50%. Subjective symptoms (e.g. itching) had also been reduced or eliminated. CONCLUSION: CsA2% eyedrops are effective in the treatment of AKC and VKC, reducing objective and subjective signs as well as the need of adding topical steroids in affected patients.

[Conjunctival neuromas and prominent corneal nerve fibers as diagnostic indication of multiple endocrine disease]. / Konjunktivale Neurome und prominente korneale Nervenfasern als diagnostischer Hinweis auf endokrinologische Multiorganerkrankungen.

BACKGROUND: Multiple endocrine neoplasias (MEN-syndromes) represent diverse, mostly autosomal-dominant inherited, seldom sporadic diseases. MEN 2B-syndrome comprises medullary thyroid carcinoma, pheochromocytoma and mucosal neuromas. PATIENT: A 30 year old male patient presented with bilateral chronic irritation of the ocular surface. The biomicroscopy revealed intraconjunctival worm-like alterations, prominent corneal nerves and nodules on the upper lid margins. HISTOLOGY: The performed conjunctival biopsy showed nearly no goblet cells, but prominent intrastromal, immunohistochemical S100-positive neuromas. RESULTS: The initiated investigations revealed bilateral multifocal medullary thyroid carcinoma and a left sited pheochromocytoma. CONCLUSION: Conjunctival neuromas and prominent corneal nerves can be diagnostic for the MEN 2B-syndrom. Early diagnosis and prophylactic thyroidectomy are expected to improve the life expectancy even in asymptomatic gene-carriers.

[Blood-aqueous barrier after phacoemulsification with posterior chamber lens implantation; foldable acrylate lens vs PMMA lens-- a clinical study on 46 eyes]. / Blut-Kammerwasser-Schranke nach Phakoemulsifikation mit Acrylat-Faltlinsen- versus PMMA-Hinterkammerlinsenimplantation--eine klinische Studie an 46 Augen.

BACKGROUND: Cataract surgery leads to a more or less pronounced postoperative inflammation due to breakdown of the blood-aqueous barrier. This alteration of the blood-aqueous barrier can be reduced by minimally invasive surgery. The purpose of this study was to quantify the early course of the postoperative alteration of the blood-aqueous barrier following phacoemulsification with implantation of conventional PMMA posterior chamber lens (IOL) in comparison with foldable acrylic lens implantation. PATIENTS AND METHODS: Forty-six eyes of 46 patients (age 63 +/- 8.8 years) without preexisting deficiences of the blood-aqueous-barrier or previous intraocular surgeries were divided into two groups: group 1 (24 patients): phacoemulsification with one-piece-PMMA-IOL implantation (6.5 mm corneoscleral tunnel incision); group 2 (22 patients): phacoemulsification with foldable acrylic-IOL implantation (3.5 mm incision, 15 patients with corneoscleral tunnel and 7 patients with clear cornea incision). All surgical procedures were performed by one surgeon. The postoperative treatment was standardized. Alteration of the blood-aqueous barrier was quantified by the laser flare-cell meter (Kowa, FC-1000) preoperatively and on the first and the second day after surgery. RESULTS: Preoperative aqueous flare values (photon counts/ms) were comparable in both groups (6.7 +/- 2.7 versus 5.6 +/- 2.7 respectively, p = 0.1). On day 1, aqueous flare in group 1 (9.7 +/- 2.9) was not statistically significantly higher than in group 2 (9.2 +/- 2.2, p = 0.2) and remained relatively constant on day 2 after surgery (9.3 +/- 3.3), whereas the aqueous flare values in group 2 decreased statistically significant (6.7 +/- 2.3, p = 0.01). Postoperatively, there was no statistically significant difference of aqueous flare values between eyes with corneoscleral tunnel incision and eyes with clear corneal incision (p = 0.7) in group 2. CONCLUSIONS: Our study shows that phacoemulsification with foldable IOL implantation leads to a mild and short-lasting alteration of the blood-aqueous barrier. Thus, implantation of foldable IOL may be useful in eyes especially with preexisting alteration of the blood-aqueous-barrier.

[Influence of postoperative topical application of miotics after cataract extraction on intraocular pressure and the blood-aqueous barrier]. / Unmittelbar postoperative Applikation von Miotika nach Katarakt-Extraktion. Einfluss auf Augeninnendruck un Blut-Kammerwasser-Schranke.

BACKGROUND: In the present study we evaluated the influence of topical miotics on intraocular pressure and the blood-aqueous barrier after uncomplicated phacoemulsification and PC-IOL implantation. PATIENTS AND METHODS: Fifty-two eyes were randomized into 2 groups: with miotics (n = 28) and without miotics (n = 24). The IOP was measured before, 6 h, 1 and 2 days after surgery. Measurement of aqueous flare was performed before and on days 1 and 2 after surgery. Patients with glaucoma, PEX or previous intraocular surgery were excluded. RESULTS: In the group without miotics the IOP was 17.9 mm Hg (+/- 3.34) 6 h postoperatively; in the second group it was 15.5 mm Hg (+/- 3.25); P = 0.04. On the first postoperative day the IOP measured in the group without miotics was 15.3 mm Hg (+/- 2.70) and with miotics 13.0 mm Hg (+/- 2. 28); P = 0.007. On the second day in the group without miotics the IOP was 13.9 mm Hg (+/- 3.05) and with miotics 12.60 mm Hg (+/- 2. 19); P = 0.53. The changes in aqueous flare on the first and second day after surgery showed no significant influence of miotics on the blood-aqueous barrier (P > 0.05). CONCLUSIONS: Immediate postoperative application of topical miotics led to a small yet significant reduction of the IOP during the first 24 h after surgery. Our data suggest that there is no need for pharmacological reduction of the IOP after uncomplicated cataract surgery.