1: Graefes Arch Clin Exp Ophthalmol. 2008 May 7; [Epub ahead of print] 

Retinal colour duplex scanning during LASIK-ring suction with different
keratomes.

Schicke SH, Krumeich J, Duncker GI, Scheibel S, Thielscher M.

Klinik u. Poliklinik fur Augenheilkunde der Martin-Luther-Universitat
Halle-Wittenberg, Ernst-Grube-Strasse 40, Halle, 06120, Germany,
mail@schicke.ch.

PURPOSE: The purpose was to measure the blood flow velocity during the suction
phase of LASIK. SETTING: University Eye Hospital, Martin-Luther-University
Halle-Wittenberg, Halle, Germany. METHODS: Papillary blood flow velocity was
measured by colour Doppler sonography. Suction rings of four different
manufacturers were applied in 30 healthy volunteers without eye diseases all of
normal blood and eye pressure. The velocity of the blood flow in the central
retinal artery was measured before, during and after suction. RESULTS: When
Hansatome (Bausch & Lomb) and M2 (Moria) rings were used, no blood flow velocity
was detected during suction in 90% of all cases. These rings were compared to
the SKBM standard suction ring (Alcon) and the Krumeich non-IOP ring, in which
no blood was present in only 56.67% (p < 0.05) and 10% (p < 0.001) of cases
respectively. Moria, Alcon and Krumeich Lasitome rings performed equally well
during the recovery phase compared with the original values. An exception is the
Hansatome ring (Bausch & Lomb), with lower velocities when evaluated after 30
minutes (p < 0.01). CONCLUSIONS: During the ring suction phase of LASIK, the
rings tested reduce velocity differently.

PMID: 18461347 [PubMed - as supplied by publisher]

2: Graefes Arch Clin Exp Ophthalmol. 2008 May 7; [Epub ahead of print] 

Hyalocyte proliferation and ECM accumulation modulated by bFGF and TGF-beta1.

Sommer F, Pollinger K, Brandl F, Weiser B, Tessmar J, Blunk T, Gopferich A.

Department of Pharmaceutical Technology, Institute of Pharmacy, University of
Regensburg, Universitatsstrasse 31, 93040, Regensburg, Germany.

PURPOSE: In cases of severe retinal diseases, the vitreous body has to be
removed and replaced by a suitable biomaterial. Currently, however, no
satisfying long-term vitreous substitute is in clinical use. A novel therapeutic
concept represents the combination of hyalocytes with suitable biomaterials. The
goal of the present study was to evaluate the potential of bFGF and TGF-beta1 as
tools to control hyalocyte proliferation and the accumulation of extracellular
matrix (ECM). METHODS: In vitro investigation on the influence of different
concentrations of bFGF and TGF-beta1 on hyalocyte morphology, proliferation and
ECM production. RESULTS: Both growth factors affected hyalocyte morphology;
small, round cells could be observed after bFGF supplementation, whereas the
cells appeared more completely spread when cultured with TGF-beta1. Hyalocyte
proliferation was increased 3-fold by 10 ng/ml bFGF; 1 ng/ml TGF-beta1 in
contrast reduced cell proliferation to about 40% of the control. Converse
effects of the growth factors could also be observed on the ECM accumulation of
hyalocytes; whereas bFGF halved ECM accumulation, TGF-beta1 enhanced the ECM
production up to 3-fold. Precultivation of hyalocytes with bFGF for two passages
had no influence on their subsequent accumulation of glycosaminoglycans (GAG).
However, cells precultivated with bFGF exhibited a doubled accumulation of
collagen compared to controls. CONCLUSIONS: The observed opposite effects of
bFGF and TGF-beta1 on hyalocyte proliferation and ECM accumulation may allow for
the control of hyaloycte properties. Therefore, these two growth factors seem to
be valuable tools towards the development of a cell-based vitreous substitute.

PMID: 18461346 [PubMed - as supplied by publisher]

3: Graefes Arch Clin Exp Ophthalmol. 2008 May 6; [Epub ahead of print] 

Visual improvement after long-standing central serous macular detachment
associated with an optic disc pit.

Patton N, Aslam SA, Aylward GW.

Department of Vitreoretinal Surgery, Moorfields Eye Hospital, 162 City Road,
London, EC1V 2PD, UK.

BACKGROUND: Approximately 50% of cases of congenital optic disc pits are
associated with serous macular detachment. Long-standing serous detachments
(over 1 year) with poor initial presenting acuity are usually associated with
cystic degeneration of the macula and loss of pigment from the underlying
retinal pigment epithelium, with resultant poor visual outcome. METHODS: A
43-year-old male presented with an optic disc pit and associated serous
elevation of the macular region with cystic changes at the fovea. RESULTS: Over
the following 2 years, the patient was aware of an improvement in vision, and
acuity improved from 1/60 to 6/18 with resolution of subretinal fluid, as
evidenced on optical coherence tomography. CONCLUSIONS: We report an unusual
case of an optic disc pit associated with a long-standing serous macular
detachment that resolved gradually over a 2.5-year period and, despite very poor
presenting visual acuity, demonstrated eventual visual recovery.

PMID: 18458936 [PubMed - as supplied by publisher]

4: Graefes Arch Clin Exp Ophthalmol. 2008 May 6; [Epub ahead of print] 

Cyclosporin A in the ocular fluids of uveitis patients following long-term
systemic administration.

Mora P, Ceglarek U, Manzotti F, Zavota L, Carta A, Aldigeri R, Orsoni JG.

Institute of Ophthalmology, University of Parma, Via Gramsci 14, 43100, Parma,
Italy, paolo.mora@unipr.it.

BACKGROUND/AIMS: To determine the levels of cyclosporin A (CsA) in tears and the
anterior segment of the eye following long-term oral intake for autoimmune
diseases. METHODS: Subjects taking oral CsA to treat relapsing autoimmune ocular
inflammation were included in this study. All of the patients had been quiescent
for at least 6 months. In patients scheduled for cataract extraction (group A),
the CsA levels in the blood, aqueous humour and anterior capsule of the lens
were determined. In subjects not requiring surgical intervention (group B), CsA
was measured in tears and blood. The samples were analysed using turbulent flow
chromatography coupled with liquid chromatography-tandem mass spectrometry
(LC-MS/MS). RESULTS: There were 19 subjects in group A and 43 subjects in group
B. CsA was detectable in all of the tear samples with a mean value of 22.4 +/-
20.2 ng/ml and there was a significant positive correlation between the CsA
levels in tears and blood (P = 0.012). CsA was not detected in any of the
surgical samples. CONCLUSION: LC-MS/MS proved very sensitive for detecting CsA
in low-volume biological samples. CsA was present in human tears in proportion
to the blood level after an average of 12 hours from the last oral intake.

PMID: 18458935 [PubMed - as supplied by publisher]

5: Graefes Arch Clin Exp Ophthalmol. 2008 May 6; [Epub ahead of print] 

Fundus autofluorescence after full macular translocation surgery for myopic
choroidal neovascularization.

Sawa M, Gomi F, Ohji M, Tsujikawa M, Fujikado T, Tano Y.

Department of Ophthalmology, Osaka University Medical School, Room E7, 2-2
Yamadaoka, Suita, Osaka, 565-0871, Japan, sawamiki@ophthal.med.osaka-u.ac.jp.

BACKGROUND: To investigate fundus autofluorescence (FAF) findings in patients
who underwent full macular translocation surgery with 360-degree retinotomy
(MT360) for myopic choroidal neovascularization (CNV). METHODS: Observational
case series. Thirty-one eyes of 31 patients who underwent MT360 for myopic CNV
from February 1999 through September 2005 were included. We measured the
best-corrected visual acuity and obtained color fundus photographs, optical
coherence tomography (OCT) images, and fluorescein angiography images. FAF
imaging by confocal scanning laser ophthalmoscope was obtained postoperatively
in all study eyes and preoperatively in two study participants. FAF features at
the new macula were qualitatively evaluated and compared with preoperative
lesions associated with CNV. The FAF features at the retinal pigment epithelial
(RPE) area with preoperative CNV also were evaluated. RESULTS: The mean interval
between MT360 and the final FAF examination was 58 months (range, 8-94 months).
FAF imaging was almost normal in five eyes (16%), the increased FAF was well
defined at the new macula area in 23 eyes (74%), and the FAF was decreased in
three eyes (10%). Neither newly developed CNV nor subretinal fluid was seen at
the new macular region in any eyes on fluorescein angiography or OCT imaging.
The configurations of well-defined increased FAF in 23 eyes corresponded with
the preoperative CNV in two eyes (9%) and subretinal hemorrhages in five eyes
(22%). Well-defined increased FAF larger than the CNV or subretinal hemorrhage
was seen in 16 eyes (69%). The RPE area located at the area of the preoperative
CNV had a FAF defect or decreased FAF in 30 eyes (97%) on postoperative FAF
imaging; there were no increased FAF changes. CONCLUSIONS: Well-defined
increased FAF at the new macula after MT360 suggests that FAF reflects not only
fluorophores in the RPE but also in the neurosensory retina. These fluorophores
may result from interactions between the retina and CNV/pathologic RPE.

PMID: 18458934 [PubMed - as supplied by publisher]

6: Graefes Arch Clin Exp Ophthalmol. 2008 May 6; [Epub ahead of print] 

Phenotypic non-penetrance in granular corneal dystrophy type II.

Kim JW, Kim HM, Song JS.

Department of Ophthalmology, Korea University College of Medicine, Seoul,
Republic of Korea.

PURPOSE: To report a possible case of phenotypic non-penetrance in granular
corneal dystrophy type II (GCD-II). METHODS: DNA analysis was performed on 11
patients with white granular corneal opacities and 50 normal controls after
informed consent was obtained. The TGFBI gene was analyzed by sequencing DNA
from epidermal keratinocytes obtained using adhesive tape. RESULTS: The
heterozygous R124H mutation of TGFBI gene was found in all 11 patients. Although
49 normal controls had no mutation in the TGFBI gene, one normal control, a
26-year-old man, had the heterozygous R124H mutation of TGFBI gene. His
55-year-old father had the same mutation, but no corneal opacities. CONCLUSION:
As not all mutations are expressed in the phenotype, GCD-II gene mutation may
have non-penetrance. This report documents a possible case of phenotypic
non-penetrance in GCD-II.

PMID: 18458933 [PubMed - as supplied by publisher]

7: Graefes Arch Clin Exp Ophthalmol. 2008 May 6; [Epub ahead of print] 

Fate mapping of neural crest cells during eye development using a protein 0
promoter-driven transgenic technique.

Iwao K, Inatani M, Okinami S, Tanihara H.

Department of Ophthalmology and Visual Science, Kumamoto University Graduate
School of Medical Sciences, 1-1-1, Honjo, 860-8556, Kumamoto, Japan.

PURPOSE: To map neural crest cell fate during eye development. METHODS: Neural
crest cells were tracked in developing mouse eyes using a transgene expressing
Cre recombinase controlled by the Protein 0 promoter and a Rosa26 Cre-responsive
reporter gene that produced beta-galactosidase after Cre-mediated recombination.
RESULTS: beta-galactosidase-positive cells were detected in the periocular
segment on embryonic day (E) 9.5. Several neural crest cell-derived tissues
including corneal stroma, corneal endothelium, iridocorneal angle, ciliary body,
primary vitreous and eyelid were strongly stained on E13.5-E18.5. The staining
decreased in the corneal stroma after birth, but persisted in the presumptive
iridocorneal angle. CONCLUSIONS: Protein 0-Cre transgenic mice offer a
conditional knock-out strategy to investigate anterior eye segment
differentiation.

PMID: 18458932 [PubMed - as supplied by publisher]

8: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 30; [Epub ahead of print] 

Evaluation of different types of lamellar keratoplasty for treatment of
peripheral corneal perforation.

Huang T, Wang Y, Ji J, Gao N, Chen J.

State Key laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen
University, Guangzhou, 510060, China, thuang@vip.163.com.

BACKGROUND: To discuss the efficacy and visual outcomes of different types of
lamellar keratoplasty (LK) for the treatment of peripheral corneal perforation.
METHODS: Sixty patients (67 eyes) with peripheral corneal perforation underwent
semilunar LK (16 eyes), crescentic LK (12 eyes), biconvex LK (13 eyes), annular
LK (11 eyes) and total LK (15 eyes) respectively. The applied type of LK for
each involved eye was decided by different sizes and shapes of corneal
ulceration and perforation. Postoperative visual acuity (VA), corneal
astigmatism and postoperative complications were studied during a 7- to 21-month
follow-up. RESULTS: VA showed no statistical difference preoperatively (P =
0.18), but it was statistically different postoperatively (P < 0.01) in eyes
with different types of LK. Postoperative VA in eyes with semilunar LK,
crescentic LK and total LK was statistically better than that before surgery
(all P values <0.05). Postoperative corneal astigmatism in different types of LK
was statistically different (P < 0.01). Semilunar and crescentic LK had the
lowest astigmatism, while biconvex LK had the highest. The main postoperative
complications were leakage at the graft-host interface, graft rejection and
initial disease recurrence. CONCLUSION: LK is an effective procedure in eyes
with peripheral corneal perforation. Different sizes and shapes of LK can
influence postoperative VA due to different degrees of astigmatism. Yet
postoperative astigmatism can be reduced by making well-matched grafts and
preserving the uninvolved tissue to the largest extent.

PMID: 18446359 [PubMed - as supplied by publisher]

9: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 30; [Epub ahead of print] 

Macular cysts, holes and cavitations : 2006 Jules Gonin Lecture of the Retina
Research Foundation.

Gaudric A.

Hopital Lariboisiere, Service d\'Ophtalmologie, Assistance Publique-Hopitaux de
Paris, Universite Paris 7, 2 rue Ambroise Pare, Paris, 75010, France,
alain.gaudric@lrb.aphp.fr.

PMID: 18446358 [PubMed - as supplied by publisher]

10: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 30; [Epub ahead of print] 

Structure of intracorneal femtosecond laser pulse effects in conical incision
profiles.

Vossmerbaeumer U, Jonas JB.

Department of Ophthalmology, Medical Faculty Mannheim of the
Ruprecht-Karls-University, Heidelberg, Germany,
urs.vossmerbaeumer@augen.ma.uni-heidelberg.de.

PURPOSE: As the applicative potential of femtosecond lasers is to be extended
from LASIK-flap creation into intrastromal ablation uses, the interdependency of
influencing factors has to be understood. We therefore evaluated the
relationship between focus depth, energy level, spatial distribution and
morphology of fs-Laser pulse effects at a given repetition rate in corneal
tissue. METHODS: The experimental study included five porcine corneae obtained
from slaughterhouse pigs. Using a prototype of a femtosecond laser (FEMTEC;
20/10 Perfect Vision AG, Heidelberg, Germany), a conical circular cut was
performed in posterior-anterior direction through the entire corneal profile.
The laser energy applied ranged from 4.0 to 8.5 muJ. Histological sections (n =
337) of a thickness of 7 mum were obtained, stained with hematoxylin/eosin, and
morphometrically evaluated. RESULTS: The intrastromal femtosecond laser effects
were aligned throughout the corneal stroma in a line that followed the
dissection line programmed for the laser. The lesions were mostly of roughly
elliptic shape with a fine dense lining at the inner wall, without evidence of a
collateral damage beyond the disruption cavity. The mean maximal diameter of the
intrastromal laser effects was 34.2 +/- 18.6 mum (range: 9-120 mum), and the
mean maximal lesion diameter was 60.8 +/- 42.6 mum. In multivariate analysis,
the lesion type (single shot cavity, partly confluent lesions, and fully
confluent lesions) was significantly associated with the laser energy applied (P
= 0.027) and the lesion diameter (P = 0.01). CONCLUSIONS: At higher laser
energies, the intrastromal laser lesions were larger and more confluent,
suggesting that, with the prototype of femtosecond laser used, a higher laser
energy may lead to more confluent intrastromal laser effects. It may facilitate
the complete cutting of the corneal tissue with the laser. Neither discernable
debris nor stainable collateral damage were detected, suggesting a purely
mechanical action of the laser.

PMID: 18446357 [PubMed - as supplied by publisher]

11: Graefes Arch Clin Exp Ophthalmol. 2008 Jun;246(6):939-41. 

Eight years of IFOS/ICO Fellowships for ophthalmologists from developing
countries.

[No authors listed]

PMID: 18437410 [PubMed - in process]

12: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 23; [Epub ahead of print] 

Feasibility study of chitosan as intravitreous tamponade material.

Yang H, Wang R, Gu Q, Zhang X.

Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, 430030, China,
hyang@tjh.tjmu.edu.cn.

BACKGROUND: Chitosan can inhibit fibroblastic proliferation by suppressing
fibroblast cells, and has the similar physiological characteristics as normal
vitreous body, so it might have the potential to become vitreous filling
material and might possibly inhibit proliferative vitreous retinopathy. To
investigate the possibility of chitosan as vitreous filling material, this study
was designed to investigate retina, ciliary body, lens and cornea morphology
changes, intraocular pressure and intraocular inflammatory factors fluctuating
after chitosan intravitreous tamponade. METHODS: Fifteen healthy chinchilla
rabbits were chosen; three of them were a blank (negative) control group without
any surgical procedure. The remaining 12 rabbits received vitrectomy on both
eyes; all the right eyes (experimental group) were given 1.2-1.8 ml (average 1.5
ml) of chitosan intravitreously, while sodium hyaluronate were given in the left
eyes (control group). All eyes underwent slit-lamp biomicroscope and indirect
ophthalmoscope examination and intraocular pressure measurement pre- and
post-op. The concentration of IL-6, IL-8 (radioimmunoassay), NO (nitrate
reductase method) in aqueous humor and vitreous body were tested at day 15 and
day 30 post-op. At day 30 post-op, the cornea, ciliary body, and lens were
dissected for light microscopy examination, and the retinal tissues 2PD away
from the optic disc on the vertical orientation of posterior pole were dissected
for light- and electro-microscope examination. RESULTS: The conjunctival
congestion and slight inflammatory response in the anterior chamber disappeared
within 7 days post-op. During the 30-day experiment, cornea, lens and the
filling material in vitreous cavity were transparent in all animals. The retina
was attached without proliferation. The intraocular pressure in the experimental
group post-op fluctuated between 4.55 +/- 2.94 and 6.25 +/- 2.37 mmHg, which was
not significantly different from the situation pre-op (6.18 +/- 1.19 mmHg) (P >
0.05). The intraocular pressure in the control group post-op fluctuated between
5.10 +/- 2.51 and 5.90 +/- 2.49 mmHg, which was not significantly different from
the situation pre-op (6.50 +/- 0.94 mmHg) (P > 0.05). There was also no
significant difference in the intraocular pressure post-op at different time
points between the experimental group and control group (all P > 0.05). At day
15 post-op, IL-6 concentration in aqueous humor were 37.31 +/- 8.59 ng/ml and
39.52 +/- 9.69 ng/ml in experimental group and control group respectively, both
higher than those in the blank control group (26.55 +/- 9.34 ng/ml) (P < 0.05).
IL-8 concentration were 7.00 +/- 3.79 ng/ml and 6.32 +/- 3.68 ng/ml
respectively, no significant difference to the blank control group (4.72 +/-
1.71 ng/ml) (P > 0.05): the concentrations of NO were 63.94 +/- 26.80mumol/ml
and 51.81 +/- 13.19mumol/ml respectively, no significant difference to the blank
control group (50.36 +/- 15.67mumol/ml) (P > 0.05). At day 30 post-op, the
concentrations of IL-6, IL-8 and NO in aqueous humor showed no significant
difference among all three groups (P > 0.05). In vitreous body at day 30
post-op, the concentrations of IL-8 in experimental group and control group were
10.17 +/- 3.63 ng/ml and 10.69 +/- 3.52 ng/ml, and those of NO were 50.23 +/-
19.69 mumol/mL and 50.60 +/- 12.72 mumol/mL respectively, all higher than in the
blank control group (30.37 +/- 14.63 mumol/ml) (P < 0.05); the concentrations of
IL-6 were 24.51 +/- 10.71 ng/ml and 26.36 +/- 13.00 ng/ml, no significant
difference to the blank control group (24.06 +/- 5.98 ng/ml) (P > 0.05). At
various time points, there was no significant difference in the concentrations
of IL-6, IL-8 and NO in aqueous humor and vitreous body in the experimental
group and the control group (P > 0.05). There was no morphological change found
under light microscopy in cornea, ciliary body and lens. The outer plexiform
layer of retina was thinner, but no significant degeneration, necrosis,
karyopyknosis or lysis were found under the ultrastructural microscopy.
CONCLUSION: Chitosan intravitreous tamponade has no significant effect on the
histology of the eye, doesn\'t cause intraocular pressure to fluctuate, and
slightly increases inflammatory factors (IL-6, IL-8, NO) in comparison to the
normal levels, but with no significant difference from the effects caused by
sodium hyaluronate, which indicated chitosan might not lead to a clinically
significant inflammatory response. It suggests that chitosan could be used as
intravitreous tamponade material.

PMID: 18431591 [PubMed - as supplied by publisher]

13: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 23; [Epub ahead of print] 

Proliferation of the vascular endothelium of the iris following total
debridement of the corneal epithelium and limbal excision of rabbits.

Goes RM, Barbosa FL, de Faria-E-Sousa SJ, Kajiwara JK, Haddad A.

Departamento de Biologia, Sao Paulo State University - IBILCE - UNESP, Faculdade
de Medicina de Ribeirao Preto/USP, Ribeirao Preto, SP, Brasil.

BACKGROUND: Damage to the corneal epithelium causes not only a reaction for its
repair but also affects other parts of the cornea as well as different
components of the anterior segment of the eye. The purpose of this investigation
was to analyze the consequences, following epithelial and limbal damage, to the
iris of rabbits (Oryctolagus cuniculus). METHODS: The corneal epithelium was
thoroughly scraped followed by surgical excision of the limbus. Next,
(3)H-thymidine ((3)H-TdR) was injected intravitreally both into the right
(experimental) and left (control) eyes which had their anterior segments
processed for autoradiography at intervals of 2, 7 and 21 days after surgery
(three rabbits per interval). The irises were also examined with
scanning-electron and confocal microscopy after Evans blue injection. RESULTS:
There was a high frequency of labeling in the cells of the iris blood vessels in
the experimental eye, particularly the endothelial ones. The ratio of labeled
cells between experimental and control irises was 40:1, with a population of
nuclei increasing by 25% and remaining labeled up to 21 days. There was also an
increase in the volume of the iris vasculature as shown by confocal microscopy.
The high labeling frequencies of the vascular cells were observed throughout the
iris from the ciliary to the pupillary regions. CONCLUSIONS: The lesions on the
corneal epithelium elicit proliferation of the iris vascular cells, mainly its
endothelium, as well as an early breakdown of the blood-aqueous barrier. The
daughter cells resulting from the damage to the eye surface were detected up to
21 days after a single injection of (3)H-TdR, most likely due to their slow
turnover. As a consequence of this proliferation, the vasculature of the iris
increased in volume.

PMID: 18431590 [PubMed - as supplied by publisher]

14: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 23; [Epub ahead of print] 

High-mobility group box 1 protein in endophthalmitis.

Arimura N, Ki-I Y, Hashiguchi T, Sakamoto T, Maruyama I.

Department of Ophthalmology, Kagoshima University Graduate School of Medical and
Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.

BACKGROUND: High-mobility group box 1 protein (HMGB1) is recently described as a
late mediator of lethal endotoxemia with proinflammatory cytokine-like
properties. The purpose of this study was to determine whether HMGB1 is involved
in endophthalmitis. METHODS: In this retrospective case-control study, vitreous
levels of HMGB1 were measured by an enzyme-linked immunosorbent assay in ten
eyes with endophthalmitis, and in 12 eyes with idiopathic macular holes which
served as controls. Formalin-fixed and paraffin-embedded tissue sections of an
enucleated eye with endophthalmitis, and a control eye with recurrent
conjunctival malignant melanoma, were analyzed by immunohistochemistry with an
anti-HMGB1 antibody. RESULTS: The vitreous HMGB1 level of the patients with
endophthalmitis was 13.96 +/- 17.17 ng/ml (mean+/-SD), which was significantly
higher than that of the controls (0.236 +/- 0.128 ng/ml; P = .0006, Mann-Whitney
U test). There were significant correlations between HMGB1 level and disease
duration, presenting visual acuity, and final visual acuity. In the eye with
endophthalmitis, HMGB1 expression was diffusely observed, particularly in the
extranuclear region of the retina and the choroid with infiltrating inflammatory
cells. CONCLUSION: HMGB1 can be released in the vitreous of eyes with
endophthalmitis depending on inflammation and tissue damage. Our results suggest
that HMGB1 may be a late mediator of endophthalmitis, and related to the
progression of endophthalmitis.

PMID: 18431589 [PubMed - as supplied by publisher]

15: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 23; [Epub ahead of print] 

One-year results of a multicenter controlled clinical trial of triamcinolone in
pars plana vitrectomy.

Yamakiri K, Sakamoto T, Noda Y, Nakahara M, Ogino N, Kubota T, Yokoyama M,
Furukawa M, Ishibashi T.

Department of Ophthalmology, Kagoshima University Graduate School of Medical and
Dental Science, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan.

PURPOSE: To evaluate the 1-year results of using triamcinolone acetonide (TA) in
pars plana vitrectomy (PPV). DESIGN: Multicenter prospective controlled clinical
trial. METHODS: SETTING and STUDY POPULATION: the study population comprised 774
eyes from patients treated at eight Japanese hospitals, among which 391 eyes
underwent TA-assisted PPV and 383 control eyes underwent conventional PPV. The
patients were assigned to the two groups using a single-blind
quasi-randomization approach within the participating clinical centers.
INTERVENTION: intra-operative use of TA to aid visualization of the vitreous.
MAIN OUTCOME MEASURES: changes of visual acuity, post-operative complications
(including additional surgery), and adverse events occurring within 1 year of
the operation were compared between the TA-PPV group and the conventional PPV
group. RESULTS: The visual acuity improved over time, and no significant
differences were found between the two groups (log-rank versus TA, P = 0.98 for
improvement, P = 0.26 for deterioration). The logistic regression model also
showed that the intra-operative use of TA was not a significant factor for the
improvement of visual acuity [P = 0.91, odds ratio (OR) = 1.10, 95% confidence
interval (95%CI) = 0.860-1.183)] after adjustments for age, gender, and
diagnosis. Intra-operative TA was not a significant factor for the need for
additional surgery (log-rank test P = 0.45, logistic regression test P = 0.35,
OR = 1.23, 95%CI = 0.797-1.911]. No serious adverse events related to surgery
were observed. CONCLUSIONS: This 1-year follow-up study of a controlled clinical
trial showed that TA-assisted PPV had neither a positive nor a negative effect
on visual acuity, the incidence of additional surgeries, or adverse events
compared with conventional PPV.

PMID: 18431588 [PubMed - as supplied by publisher]

16: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 23; [Epub ahead of print] 

Combined pars plana vitrectomy and artificial iris diaphragm implant after globe
rupture.

Rossi T, Boccassini B, Iossa M, Lesnoni G, Mutolo MG, Mutolo PA.

Ospedale Oftalmico di Roma, Unita Operativa di Chirurgia Vitreoretinica, Rome,
Italy, tommaso.rossi@usa.net.

BACKGROUND: Retinal detachment (RD) associated with aniridia due to globe
rupture (GR) is an uncommon condition with a severe prognosis. Surgical
technique must address anterior and posterior segment issues secondary to the
altered compartmentalization and increased risk for corneal toxicity. The
purpose of this paper is to report a series of GR patients undergoing combined
pars plana vitrectomy (PPV) and artificial iris diaphragm (AID) implant for the
repair of RD associated to aniridia. METHODS: The authors retrospectively
reviewed 12 consecutive patients operated on by a single surgeon. Surgery
consisted of a standard three-port PPV with extensive bimanual dissection of
vitreous base and ciliary body membrane and combined AID implant. Office visits
included Snellen visual acuity (VA), intraocular pressure measurement,
biomicroscopy and indirect ophthalmoscopy. AID prosthesis included aniridic
IOLs, Heimann\'s PMMA and silicone diaphragm. RESULTS: Mean age was 53 years and
mean follow-up was 19 months. At the end of follow-up, seven patients gained
more than two lines (58.3%), two lost their vision (16.6%) and three were
unchanged (25%). Seven patients (58.3%) had a VA better than 20/400 and one (8%)
20/40 vision. Eight patients (66.6%) retained a clear cornea, two (16.6%) had
minimal corneal oedema and two (16.6%) corneal decompensation. Implanted
prosthesis included two silicone diaphragms, four PMMA diaphragms and six
aniridic IOLs. After an average 1.6 operations, the retina was completely
attached in six patients (50%), partially attached in four (33.3%) and detached
in two (16.6%). CONCLUSION: RD associated to GR carries a guarded prognosis both
due to RD complexity and hypotony. The combined repair of RD and aniridia after
GR offers the advantage of addressing all issues at one time allowing correct
eye compartmentalization and better tamponade effect. Successful anatomical and
functional results can be achieved although multiple surgeries are often needed.

PMID: 18431587 [PubMed - as supplied by publisher]

17: Graefes Arch Clin Exp Ophthalmol. 2008 Jun;246(6):787-801. Epub 2008 Apr 19.


Posterior capsulorhexis combined with optic buttonholing: an alternative to
standard in-the-bag implantation of sharp-edged intraocular lenses? A critical
analysis of 1000 consecutive cases.

Menapace R.

Department of Ophthalmology, University of Vienna Medical School, Waehringer
Guertel 18-20, Vienna, 1090, Austria, rupert.menapace@meduniwien.ac.at.

BACKGROUND: Current after-cataract prevention relies on optimizing the natural
barrier effect of the optic rim against lens epithelial cell (LEC) migration.
However, deficiencies in circumferential capsular bag closure caused by the
intraocular lens (IOL) haptic or delayed secondary re-division of the fused
capsules by Soemmering s ring formation lead to primary or secondary barrier
failure. Consequently, surprisingly high posterior laser capsulotomy rates have
been reported long-term, even with optimal capsular surgery and the most
widespread hydrophobic acrylic IOLs, considered to be the most advanced.
Intraoperative removal of the central posterior capsule has been shown to be
effective in further reducing LEC immigration. However, efficacy has turned out
to be limited because of the propensity of LECs to use the posterior optic
surface as an alternative scaffold. MATERIAL AND METHODS: Technique: in
pediatric cataract surgery, buttoning-in of the optic into an
adequately-centered posterior capsulorhexis opening has been described
previously. This technique was further elaborated and applied as the standard
technique in a large series of adult eyes. In general, the diameter aimed at was
5-6 mm for the anterior, and 4-5 mm for the posterior capsulorhexis. Between
September 2004 and June 2007, 1000 consecutive cases have thus been performed
and systematically evaluated. One hundred and fifty eyes additionally underwent
extensive anterior LEC abrasion. Another sub-series investigated the option of
further reducing capsular fibrosis by creating an anterior capsulorhexis larger
than the optic. Evaluation: special scrutiny was applied to detect postoperative
vitreous entrapment. Regeneratory and fibrotic after-cataract formation were
both meticulously followed-up. Postoperative pressure course, anterior segment
inflammation, macular thickness and morphology, as well as axial optic stability
and optic centration, were evaluated in intraindividual comparison studies.
RESULTS: A low rate of vitreous complications was found, which can be avoided by
appropriate surgery. Vitreous entanglement occurred in six eyes, and vitreous
herniation after PPCCC over-sizing in two. In three, anterior vitrectomy was
performed. There was only one single case of retinal detachment-supposedly
unrelated to the technique itself-and no case of cystoid macular edema.
Retro-optical regenerate formation was completely abolished, while fibrosis was
drastically reduced by the posterior capsule sandwiched in between the anterior
LEC layer on the backside of the anterior capsule and the anterior optic
surface, thereby blocking contact-mediated myofibroblastic LEC
transdifferentiation. Additional capsular polishing further reduced residual
fibrosis emerging from the anterior capsule contacting the optic adjacent to the
haptic junction, as well as regeneratory LEC re-proliferation on the posterior
capsule overlying the optic. Postoperative pressure course was almost identical
to that found after standard in-the-bag implantation of the IOL, as was flare,
and macular thickness and morphology. As opposed to bag-fixated IOLs, no axial
movement of the optic was detected. IOL optics always perfectly centered even
when the capsular opening was not optimally centered. Due to the exquisite
stretchability and elasticity of the posterior capsule, the 6-mm IOL optic could
safely be buttoned-in in a posterior capsulorhexis of 4 mm and smaller.
CONCLUSIONS: Posterior optic buttonholing (POBH) is a safe and effective
technique which not only excludes retro-optical opacification, but also
withholds capsular fibrosis by obviating direct contact between the anterior
capsular leaf and the optic surface. Anterior LEC abrasion significantly reduced
both the residual fibrosis and regeneratory LEC proliferation. Apart from
pediatric cataract, POBH is currently recommended for eyes with
pseudoexfoliation syndrome, high axial myopia, peripheral retinal disease, and
multifocal IOL implantation. Toric IOLs and magnet-driven accommodative IOL
systems are other potential applications. Generally, POBH holds promise for
becoming a routine alternative to standard in-the-bag IOL implantation in the
future.

PMID: 18425525 [PubMed - in process]

18: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 19; [Epub ahead of print] 

Changes in retinal thickness are correlated with alterations of
electroretinogram in eyes with central retinal artery occlusion.

Shinoda K, Yamada K, Matsumoto CS, Kimoto K, Nakatsuka K.

Department of Ophthalmology, Oita University Faculty of Medicine, Oita, Japan,
shinodak@med.oita-u.ac.jp.

BACKGROUND: We investigated the relationship between the retinal thickness and
electroretinogram (ERG) components in patients with central retinal artery
occlusion (CRAO). METHODS: The optical coherence tomographic (OCT) images and
ERGs of the nine patients (six men and three women; mean age, 61.8 years) were
retrospectively analyzed. The thickness of the inner and outer retinal layers at
1 and 2 mm nasal and temporal to the fovea was measured in the horizontally
scanned OCT images. The ratio of the inner layer thickness/sensory retinal
thickness (IT/ST ratio) was calculated. The amplitudes of the a- and b-waves of
the mixed rod-cone ERGs and the photopic negative response (PhNR) of the
photopic ERGs were analyzed. The ratio of the amplitude of each component in the
affected eye to that of the healthy fellow eye (a/f ratio) was calculated.
RESULTS: In the chronic phase (1 to 8 months after onset, eight eyes), the inner
layer was significantly thinner than that in the acute phase (P = 0.0147,
0.0076, 0.002, and 0.0003 for 2 mm nasal, 1 mm nasal, 1 mm temporal, and 2 mm
temporal respectively, within 5 days of onset, six eyes), while the thickness of
outer layer was not significantly changed. The ERGs were recorded 6.4 +/- 1.5
days after the onset of CRAO. The median of the a/f ratio was 0.84 in the
a-wave, 0.56 in the b-wave, and 0.27 in the PhNR. The IT/ST in the chronic phase
was positively correlated with the a/f ratio of the amplitude of the PhNR.
CONCLUSIONS: Measurement of retinal thickness by OCT can be useful for
monitoring the changes following CRAO. The correlation between the retinal
thickness, especially inner layer thickness, and the ERG components was
determined, suggesting that the PhNR in the acute phase might be a good
indicator for predicting the thinning of the damaged retina in the chronic
phase.

PMID: 18425524 [PubMed - as supplied by publisher]

19: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 19; [Epub ahead of print] 

Persisent ocular hypertension following intravitreal ranibizumab.

Bakri SJ, McCannel CA, Edwards AO, Moshfeghi DM.

Department of Ophthalmology, Mayo Clinic, Rochester, MN, 55905, USA,
sbakri@hotmail.com.

BACKGROUND: To describe the occurrence of ocular hypertension in four patients
following injection of ranibizumab intravitreally. METHODS: Case series.
RESULTS: Four patients had high intraocular pressure after intravitreal
ranibizumab 0.5 mg. Ocular hypertension occurred 1 month after the second
ranibizumab injection in patients 1 and 3, and 1 month after the first
ranibizumab in patient 2. In patient 4, it occurred several hours after the
first ranibizumab injection. In all patients, the IOP increase was sustained
across several visits, requiring control with topical glaucoma therapy, and in
two cases the addition of a systemic carbonic anhydrase inhibitor. None of the
patients had a previous history of glaucoma, ocular hypertension or IOP
asymmetry and the IOP was as high as 30, 34, 46, and 50 mmHg in the four
patients. CONCLUSION: Severe and sustained ocular hypertension may occur after
intravitreal ranibizumab. Although the mechanism of the pressure rise is
unknown, all eyes in our series were controlled with medical therapy.

PMID: 18425523 [PubMed - as supplied by publisher]

20: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 19; [Epub ahead of print] 

Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide
injection for treatment of macular edema associated with branch retinal vein
occlusion.

Chung EJ, Lee H, Koh HJ.

Department of Ophthalmology, NHIC Ilsan Hospital, Gyounggi-do, Korea.

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV)
sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the
treatment of macular edema associated with branch retinal vein occlusion (BRVO).
METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were
randomized into two treatment groups. A total of 20 patients received AV
sheathotomy (sheathotomy group), and the second group of 20 patients was treated
with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS)
visual acuity (VA) score, total macular volume measured, and foveal thickness by
3rd generation optical coherence tomography (OCT3) were evaluated as main
outcome measurements. RESULTS: The average changes in ETDRS scores, total
macular volumes, and foveal thicknesses compared to baseline values, were
significant 3 months and 6 months after treatment in both groups (P < 0.05,
paired t-test), but only the IVTA group showed significant improvements 1 month
after treatment. The between-group differences in average ETDRS score, total
macular volume, and foveal thickness changes were significantly better at 1
month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001,
respectively, Student\'s t-test), at which time IVTA patients had better vision
and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS:
After either AV sheathotomy or IVTA treatment, patients with macular edema
secondary to BRVO showed similar functional and anatomical outcomes 6 months
later. When the cost and the risks of vitreoretinal surgery are considered, IVTA
treatment may be a better treatment option, as the drug yields better short-term
outcomes.

PMID: 18425522 [PubMed - as supplied by publisher]

21: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 17; [Epub ahead of print] 

Effect of intravitreal triamcinolone acetonide on retinal apoptosis in
experimental retinal neovascularization.

Spandau UH, Vom Hagen F, Hammes HP, Jonas JB.

Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University
of Heidelberg, Heidelberg, Germany, Ulrich.Spandau@augen.ma.uni-heidelberg.de.

PMID: 18418624 [PubMed - as supplied by publisher]

22: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 15; [Epub ahead of print] 

The neuropeptide NAP provides neuroprotection against retinal ganglion cell
damage after retinal ischemia and optic nerve crush.

Jehle T, Dimitriu C, Auer S, Knoth R, Vidal-Sanz M, Gozes I, Lagreze WA.

University Eye Hospital Freiburg, Killianstrasse 5, 79106, Freiburg im Breisgau,
Germany, thomas.jehle@uniklinik-freiburg.de.

BACKGROUND: NAP, an 8-amino acid peptide
(NAPVSIPQ=Asn-Ala-Pro-Val-Ser-Ile-Pro-Gln) derived from activity-dependent
neuroprotective protein (ADNP), plays an important role in neuronal
differentiation and the survival of neurons in different pathological
situations. We already discovered that NAP increases the survival of retinal
ganglion cells (RGC) in vitro, and supports neurite outgrowth in retinal
explants at femtomolar concentrations. The aim of this study was to investigate
the effects of NAP on RGC survival after transient retinal ischemia and optic
nerve crush. METHODS: RGC of male Wistar rats were labelled retrogradely with 6
l FluoroGold injected stereotactically into both superior colliculi. Seven days
later, retinal ischemia was induced by elevating the intraocular pressure to 120
mm Hg for 60 minutes or by crushing one optic nerve for 10 s after a partial
orbitotomy. NAP was either injected intraperitoneally in the concentration of
100 mg/kg 1 day before, directly after, and on the first and the second days
after damage, or intravitreally (0.05 or 0.5 mug/eye) directly after the optic
nerve crush. Controls received the same concentrations of a control peptide.
Densities of surviving RGC and activated microglial cells (AMC) were quantified
in a masked fashion 10 days after damage by counting FluoroGold-labelled cells.
RESULTS: After retinal ischemia, intraperitoneal injections of NAP increased the
number of surviving RGC by 40% (p < 0.005) compared to the control group. After
optic nerve crush, NAP raised the number of surviving RGC by 31% (p = 0.07) when
injected intraperitoneally and by 54% (p < 0.05) when administered
intravitreally. CONCLUSIONS: NAP acts neuroprotectively in vivo after retinal
ischemia and optic nerve crush, and may have potential in treating optic nerve
diseases.

PMID: 18414890 [PubMed - as supplied by publisher]

23: Graefes Arch Clin Exp Ophthalmol. 2008 Jun;246(6):803-10. Epub 2008 Apr 15. 

Are low inflammatory reactions involved in exudative age-related macular
degeneration? : Morphological and immunhistochemical analysis of AMD associated
with basal deposits.

Lommatzsch A, Hermans P, Muller KD, Bornfeld N, Bird AC, Pauleikhoff D.

Department of Ophthalmology and Ophtha-Lab, St. Franziskus Hospital Munster,
Munster, Germany, Albrecht.Lommatzsch@web.de.

PURPOSE: Basal laminar and linear deposits (BLD) are associated with the
development of choroidal neovascularization (CNV). Therefore, analysis of BLD
composition may provide further information concerning the pathogenesis of BLD
and CNV in age-related macular degeneration (AMD). METHODS: BLD in 25 specimens
of surgically removed CNV were examined, using histochemical and
immunohistochemical methods, for extracellular matrix proteins and their
modulating enzymes, and for cell markers and proteins involved in inflammatory
processes. In addition, ultrastructural electron microscopic analysis (EM) was
performed. RESULTS: The chemical and structural composition of all the BLD was
similar. Only the inner aspect of the BLD contained laminin and collagen IV,
which corresponded to a new RPE basal lamina upon EM analysis. The extracellular
matrix protein predominantly found in all layers of BLD was vitronectin, which
was seen as a homogeneous material within the BLD upon EM analysis. The
metalloproteinases MMP-2 and MMP-9 could only be detected in the inner aspect,
while MMP-7 and TIMP-3 were observed predominantly in the outer aspect of BLD.
In this area, staining for phospholipids and less intensely for neutral lipids
was also visible. The labelling of complement complexes C3 and C5b-9 was
intensely positive, and vascular endothelial growth factor (VEGF) was detected
in all BLDs. CONCLUSIONS: Diffuse deposits such as BLD appear consistently with
the development of CNV in AMD. They consist of extracellular matrix components
and predominantly vitronectin. However, activated complement and VEGF could also
be detected. The results of the current study may support the hypothesis that
inflammatory processes are involved in the pathogenesis of BLD and CNV in AMD.

PMID: 18414889 [PubMed - in process]

24: Graefes Arch Clin Exp Ophthalmol. 2008 Jun;246(6):907-11. Epub 2008 Apr 15. 

Ocular toxicity of intravitreous adalimumab (Humira) in the rabbit.

Manzano RP, Peyman GA, Carvounis PE, Kivilcim M, Khan P, Chevez-Barrios P,
Takahashi W.

Department of Ophthalmology, University of Sao Paulo, Aramanai St. 307, Alto de
Pinheiros, 05450-030, Sao Paulo, SP, Brazil, roberta.manzano@gmail.com.

PURPOSE: To evaluate the ocular toxicity of escalating doses of intravitreous
adalimumab (Humira) in the rabbit eye. METHODS: Twelve New Zealand albino
rabbits received unilateral intravitreous injections of 0.1 ml of adalimumab
0.25 mg (three eyes), 0.50 mg (three eyes), 1.0 mg (three eyes) or 0.1 ml
balanced salt solution (BSS, threeeyes). Slit-lamp biomicroscopy and fundoscopy
were carried out at baseline, day 1, 7 and 14 following intravitreous injection,
while electroretinography (ERG) was carried out at baseline and day 14. Animals
were euthanized on day 14, and histopathological examination of the eyes was
performed. RESULTS: Slit-lamp biomicroscopy and fundoscopy were normal in eyes
having received BSS, 0.25 mg or 0.50 mg adalimumab; however, inflammation was
present in two of three eyes having received 1.0 mg adalimumab. Similarly,
comparison of scotopic and photopic ERG light at baseline and day 14
demonstrated no changes in eyes receiving BSS, 0.25 mg or 0.50 mg adalimumab,
but two of three eyes having received 1.0 mg adalimumab showed a greater than
30% reduction in a and b wave. Finally, histopathology demonstrated no
differences between eyes receiving BSS, 0.25 mg or 0.50 mg of adalimumab, but
two of three eyes injected with 1.0 mg demonstrated inflammatory cell
infiltration of the vitreous and anterior chamber, with one of these eyes
demonstrating retinal necrosis. CONCLUSIONS: Escalating doses of intravitreous
adalimumab in rabbit eyes caused no detectable functional or structural ocular
toxicity up to a dose of 0.50 mg. Administration of 1.0 mg in 0.1 ml was
associated with an inflammatory reaction and retinal necrosis.

PMID: 18414888 [PubMed - in process]

25: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 15; [Epub ahead of print] 

Salivary duct carcinoma metastatic to eyelid and orbit-a case report.

Parikh JG, Burnstine MA, Kase S, Rao NA.

Doheny Eye Institute, and the Department of Ophthalmology, Keck School of
Medicine of the University of Southern California, 1450 San Pablo St. DVRC 211,
Los Angeles, 90033, CA, USA.

BACKGROUND: Salivary duct carcinoma is a rare, extremely aggressive malignant
tumor, demonstrating invasive growth with early regional and distant metastasis.
We describe a case of parotid gland salivary duct carcinoma metastatic to the
eyelid and orbit, as confirmed by immunohistochemical analysis. To the best of
our knowledge, this is the first such case reported in the literature. METHODS:
A 43-year-old male had left lower eyelid and left inferior fornix/anterior
orbital masses. The patient underwent left lower eyelid and anterior orbital
biopsies for histopathological evaluation. Immunohistochemical analysis for
markers like androgen receptors, gross cystic disease fluid protein-15,
cytokeratins, HER-2/neu, epithelial membrane antigen, S-100 proteins,
progesterone receptors, and estrogen receptors were performed to establish
diagnosis. RESULTS: Specimens from the eyelid and orbit revealed lobules of
tumor cells exhibiting solid, micopapillary, and glandular appearance with
central necrosis-comedo patterns. The tumor cells showed immunohistochemical
reactivity to androgen receptor proteins, pankeratin, HER-2/neu and epithelial
membrane antigen. Focal reactivity to gross cystic disease fluid protein-15 was
also present. Immunoreactivity to S-100 proteins, progesterone receptors, and
estrogen receptors were negative. Diagnosis was metastatic paratoid duct
carcinoma to the left lower eyelid and left inferior orbit. CONCLUSIONS:
Although metastatic SDC of the eyelid and orbit is a rare phenomenon, the
possibility of this extremely aggressive entity should be included in the
differential diagnosis when dealing with a patient with an eyelid and/or orbital
tumor.

PMID: 18414887 [PubMed - as supplied by publisher]

26: Graefes Arch Clin Exp Ophthalmol. 2008 Apr 15; [Epub ahead of print] 

A prospective trial of phaco-trabeculotomy combined with deep sclerectomy versus
phaco-trabeculectomy.

Luke C, Dietlein TS, Luke M, Konen W, Krieglstein GK.

Center of Ophthalmology, University of Cologne, Cologne, Germany,
aia18@uni-koeln.de.

BACKGROUND: Combined phacoemulsification, intraocular lens implantation, and
trabeculectomy (PTE) is currently the standard procedure for most ophthalmic
surgeons to treat uncontrolled open-angle glaucoma and cataract at one time.
This study was designed to prospectively compare a new technique of
phaco-trabeculotomy plus deep sclerectomy (PDSTO) with standard
phaco-trabeculectomy (PTE). METHODS: A consecutive series of 43 patients with
uncontrolled open-angle glaucoma and cataract underwent combined glaucoma and
cataract surgery. The procedure started as a two-site approach with
phacoemulsification and IOL implantation through a temporal incision in clear
cornea. Trabeculotomy and deep sclerectomy were performed in the superior
quadrant. Trabeculectomy was also performed in the superior quadrant as a
modified Cairns trabeculectomy. Postoperatively, examinations were performed on
a daily base for 1 week. Follow-up visits were applied 1, 3, 6, and 12 months
after surgery. RESULTS: The mean preoperative intraocular pressure (IOP) was
26.5 mmHg (SD 7.8) for all patients enrolled. The mean IOP was 12.3 mmHg (SD
5.1) 1 day post surgery for the PTE group (p < 0.001) and 14.4 mmHg (SD 4.0) for
the PDSTO group (p < 0.001). At 12 months post surgery the success rate
according to the Advanced Glaucoma Intervention Study (AGIS), defined as an IOP
lower than 18mmHg without medication, was 20% in the PTE group and 50% in the
PDSTO group (p = 0.03). The number of postoperative complications was equally
low for both groups. No severe complications, such as bleb infection,
endophthalmitis, or choroidal hemorrhage were seen in this series. CONCLUSIONS:
PDSTO offered significant IOP reduction and a success rate which was higher than
that of the current standard, PTE. The specific intra- and postoperative
complications of deep sclerectomy, trabeculotomy, and trabeculectomy were seen
in our series, although the overall rate of postoperative complications proved
low.

PMID: 18414886 [PubMed - as supplied by publisher]