28 research outputs found
Assessing full thickness oral mucosal grafting: complications and postoperative outcomes in a broad collective of patients
Background:
Conjunctival defects can be repaired with several mucosal tissues. The simplicity of harvesting oral mucosa and its wide availability makes it the preferred graft tissue for all indications requiring mucosal grafting. Through analysing the postsurgical outcomes and rate of revisions, this study explores the suitability of oral mucosa grafts, depending on the initial diagnosis.
Methods:
We reviewed all the files of patients with a history of oral mucosal graft surgery, performed at our clinic between 2012 and 2018, focusing on complications and revision rates.
Results:
In total, we analysed 173 oral mucosa grafts in 131 patients. The most common initial diagnosis was tumour resection, followed by surgical complications, postenucleation socket syndrome, trauma and ocular surface disorders. Complication and revision rates depended highly on the initial diagnosis. Revision rates were highest if the initial diagnosis included ocular surface disorders or chemical trauma.
Conclusions:
Oral mucosa grafting (OMG) is the most effective treatment for a wide range of ocular conditions involving conjunctival defects. Conjunctival defects that result from trauma or cicatricial surface diseases seem less suitable for OMG and may benefit from alternative graft tissue or treatment options
Photochemical degradation of trypan blue
Purpose To investigate the photochemical degradation of trypan blue (TB) and to identify decomposition products. Methods Defined solution samples of TB and a mixture with lutein/zeaxanthin were exposed to blue light. Thermal degradation processes were ruled out using controls not subjected to irradiation. All samples were analyzed using optical microscopy, UVNis spectroscopy, matrix assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and nuclear magnetic resonance (NMR) spectrometry. Degradation kinetics were determined based on changes in absorbance; intermediates were identified by analyzing mass differences of characteristic fragment ion peaks within the fragmentation patterns, and assignments were verified by NMR. Results TB demonstrated a photochemical degradation, which can be triggered by lutein/zeaxanthin. Intermediates vary depending on the presence of lutein/zeaxanthin. The self-sensitized photodegradation of TB occurs under generation of dimethyl sulfate and presumed formation of phenol. In contrast, within the presence of lutein/zeaxanthin the decomposition of TB indicates the formation of methoxyamine and sulfonyl arin. Thermal degradation processes were not observed. Conclusions TB demonstrated a photodegradation that may be triggered by lutein/zeaxanthin and results in the formation of cytotoxic decomposition products. Our findings contribute to understand degradation mechanisms of TB and may elucidate previous clinical and experimental observations of cellular toxicity after TB application
Exploring the precision of femtosecond laser-assisted descemetorhexis in Descemet membrane endothelial keratoplasty
Objective Descemet membrane endothelial keratoplasty (DMEK) remains a challenging technique. We compare the precision of femtosecond laser-assisted DMEK to manual DMEK. Methods and Analysis A manual descemetorhexis (DR) of 8 mm diameter was compared with a femtosecond laser-assisted DR of the same diameter (femto-DR) in 22 pseudophakic patients requiring DMEK. We used OCT images with a centred xy-diagram to measure the postoperative precision of the DR and the amount of endothelial denuded area. Endothelial cell loss (ECL) and best corrected visual acuity were measured 3 months after surgery. Results In the manual group, the median error of the DR was 7% (range 3%-16%) in the x-diameter and 8% (range 2%-17%) in the y-diameter. In the femto group, the median error in the respective x and y-diameters was 1% (range 0.4%-3%) and 1% (range 0.006%-2.5%), smaller than in the manual group (p=0.001). Endothelial denuded areas were larger in the manual group (11.6 mm(2), range 7.6-18 mm(2)) than in the femto group (2.5 mm(2), range 1.25.9 mm(2)) (p<0.001). The ECL was 21% (range 5%-78%) in the manual DR and 17% (range 6%-38%) in the femto-DR group (p=0.351). The median visual acuity increased from 0.4 logMAR (range 0.6-0.4 logMAR) in both groups to 0.1 logMAR (range 0.4-0 logMAR) in the manual group and to 0.1 logMAR (range 0.3-0 logMAR) in the femto group (p=0.461). Three rebubblings were required in the manual group, whereas the femto group required only one. Conclusion The higher precision of the femto-DR bears the potential to improve DMEK surgery
Virus-associated anterior uveitis and secondary glaucoma: Diagnostics, clinical characteristics, and surgical options
In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time
IgG4-Related Orbitopathy as an Important Differential Diagnosis of Advanced Silent Sinus Syndrome. German version
Background: Immunoglobulin (Ig)G4-related disease is classified as an immune-mediated disease. The etiology of this condition has not been explained to date. Manifestations of the disease are diverse, and simultaneous involvement of multiple organs is not unusual.
Case report: We report the case of a patient referred to us after multiple unsuccessful paranasal sinus operations who presented with enophthalmos and a resultant migratory keratitis with a suspected diagnosis of silent sinus syndrome. Preservation of the orbit was no longer feasible. After five years without a definitive diagnosis, we ascertained that this was a case of IgG4-related disease.
Discussion: IgG4-related disease represents an important element in the differential diagnosis of chronic advanced diseases of the orbit and paranasal sinuses. The diagnosis should be considered in the case of unclear disease presentations. Typical histological findings include a storiform pattern of fibrosis, vasculopathy, and tissue infiltration by IgG4 plasma cells.Hintergrund: Mit Immunglobulin (Ig)G4 assoziierte Erkrankungen werden als immunvermittelte Erkrankungen klassifiziert. Die Ätiologie dieser Krankheiten ist bisher noch nicht geklärt. Sie manifestieren sich auf verschiedene Weise, und die gleichzeitige Beteiligung mehrerer Organe ist nicht ungewöhnlich.
Kasuistik: Es wird der Fall eines Patienten vorgestellt, der in die Klinik der Autoren überwiesen wurde, nachdem mehrere erfolglose Nasennebenhöhlenoperationen bei ihm durchgeführt worden waren; bei Vorliegen eines Enophthalmus und einer resultierenden Durchwanderungskeratitis bestand die Verdachtsdiagnose eines Silent-Sinus-Syndroms. Der Erhalt der Orbita war nicht mehr möglich. Nach 5 Jahren ohne definitive Diagnose wurde nun die Diagnose einer IgG4-assoziierten Erkrankung gesichert.
Diskussion: IgG4-assoziierte Erkrankungen stellen einen wichtigen Baustein bei der Differenzialdiagnose chronischer fortgeschrittener Erkrankungen der Orbita und der Nasennebenhöhlen dar. Bei unklaren Krankheitszeichen sollte diese Diagnose in Erwägung gezogen werden. Zu den typischen histologischen Befunden gehören ein storiformes Muster der Fibrose, Vaskulopathie und Gewebeinfiltration durch IgG4-Plasmazellen
Visual outcomes and complications following posterior iris-claw aphakic intraocular lens implantation combined with penetrating keratoplasty
Abstract Background To evaluate the indication, visual outcome, and complication rate after implantation of a posterior iris-claw aphakic intraocular lens (IOL) during penetrating keratoplasty. Methods This retrospective study comprised 23 eyes (23 patients) without adequate capsule support undergoing posterior iris-claw aphakic IOL implantation (Verisyse™/ Artisan®) during penetrating keratoplasty between 2005 and 2010. Mean follow-up was 18 months (range from 12 to 37 months). Results The IOLs were inserted during an IOL exchange in 17 eyes and as a secondary procedure in six aphakic eyes. Pseudophakic bullous keratopathy with corneal scar after anterior chamber intraocular lens (ACIOL) was the main indication for penetrating keratoplasty in 16 eyes (69.6 %). The final corrected distance visual acuity (CDVA) in logMAR (mean 1.0 ± 0.46) improved significantly (p < 0.05) compared to the preoperative CDVA (mean 1.8± 0.73). Twenty eyes (86.9 %) had a final visual acuity in logMAR better than the pre-operative CDVA. The mean postoperative IOP 16.3 mmHg±4.0 was not significantly (p > 0.05) higher compared to the preoperative IOP 15.6 mmHg±5.1. Complications included slight temporary pupil ovalization in three eyes (13.0 %) and iris-claw IOL sublocation in three eyes (13.0 %); all IOLs could be easily repositioned. Cystoid macular edema occured in one eye (4.3 %) 8 weeks after primary surgery. All grafts remained clear without any sign of graft rejection. Conclusions Retropupillar iris-claw IOL during penetrating keratoplasty provides good visual outcomes with a favorable complication rate, and can be used for a wide range of indications in eyes without adequate capsule support
New strategies for prophylaxis of corneal graft rejection
Aktuelle Ansätze zur Prophylaxe der Immunreaktion nach Keratoplastik
Analyse der aktuelle klinischen Situation
Prophylaxer der Immunreaktion durch lokale Immunreaktion
Prophylaxe der Immunreaktion durch Gentherapie
LiteraturverzeichnisIn dieser Arbeit wurden auf breiter Basis aktuelle Ansätze zur Prophylaxe der
Immunreaktion nach Keratoplastik untersucht. Die AbstoĂźungsreaktion stellt
neben dem chronischen Endothelzellverlust die größte Bedrohung für das klare
TransplantatĂĽberleben und damit fĂĽr den Erfolg der Keratoplastik im Hinblick
auf eine visuelle Rehabilitation dar. Im ersten Abschnitt wurden klinische
Daten aus dem Patientenkollektiv unserer Klinik analysiert. Dabei konnte
gezeigt werden, dass das Glaukom einen schwerwiegenden Risikofaktor fĂĽr den
chronischen Endothelzellverlust darstellt. Daneben konnten unsere Daten
erstmalig belegen, dass der chronischen subklinischen Immunreaktion eine
wesentliche Bedeutung fĂĽr den chronischen Endothelzellverlust nach homologer
Keratoplastik zukommt. Klinische Konsequenzen dieser Ergebnisse sind die sehr
kritische Indikationsstellung zur Keratoplastik bei Patienten mit Glaukom
(insbesondere wenn Schwierigkeiten oder Unsicherheiten bei der
Druckeinstellung auftreten), die Verwendung möglichst kleiner Transplantate
bei gesundem peripheren Empfängerendothel, die dauerhafte Beibehaltung einer
niedrigdosierten lokalen Immunsuppression (Steroide) sowie die Nutzung der
Option der autologen Keratoplastik bei geeigneter Ausgangssituation
(umschriebene Narbe). Im zweiten Abschnitt dieser Arbeit wurden umfangreiche
experimentelle Untersuchungen zum topischen Einsatz von Immunsuppressiva
dargestellt. Im Hinblick auf die zum Teil schwerwiegenden Nebenwirkungen der
systemischen Gabe dieser Substanzen kommt der Ausweitung der lokalen
Einsatzmöglichkeiten dieser Wirkstoffe eine besondere klinische Bedeutung zu.
Explizit wurden im Rahmen dieser Arbeit lokale Präparationen von Mycophenolat
Mofetil sowie von Sirolimus / Everolimus erstmalig hergestellt und untersucht.
Dabei konnte gezeigt werden, dass fĂĽr alle 3 Verbindungen geeignete, lokal
anwendbare Formulierungen herstellbar sind. FĂĽr MMF ist dabei eine
Cyclodextrinformulierung die geeignetste Präparation, während Sirolimus /
Everolimus am gĂĽnstigsten in einer Mikroemulsion lokal angewendet werden. Mit
topisch appliziertem MMF lassen sich hohe Konzentrationen des eigentlichen
Wirkstoffs Mycophenolsäure (MPA) im Kammerwasser erzielen, dagegen penetriert
Sirolimus die Hornhaut nur bei abradiertem Epithel. Da MMF und MPA ĂĽber
verschiedene Penetrationswege nach intraokular gelangen (MPA transkorneal, MMF
parakorneal), lassen sich die Anteile der beiden Penetrationswege
näherungsweise durch den Vergleich von MMF und MPA intraokular und
intrakorneal bestimmen. Bei der experimentellen Keratoplastik sind topisch
appliziertes MMF und Sirolimus im Hinblick auf eine Verlängerung des
Transplantatüberlebens unwirksam. Everolimus zeigt eine eingeschränkte
Wirksamkeit. Die lokale Verträglichkeit von MMF-Cyclodextrin-Komplex-
Formulierung ist im Kaninchenmodell gut. Die Option, eine Kombination zweier
lokaler Immunsuppressiva zur Prophylaxe der Immunreaktion nach Keratoplastik
einzusetzen (z.B. CSA + MMF oder Everolimus + MMF), sollte nach unserer
Ansicht weiter verfolgt werden. DarĂĽber hinaus sind MMF-
Cyclodextrinformulierung und Sirolimus/Everolimus-Mikroemulsion
vielversprechende lokale Präparationen dieser neuen Immunsuppressiva auch für
andere Indikationen. Die Wirksamkeit dieser Präparate bei Erkrankungen der
okulären Oberfläche wie z.B. dem immunologischen Hornhautulcus oder der
atopischen Keratokonjunktivitis sollte weiter untersucht werden. Im dritten
Abschnitt dieser Arbeit wurden die Möglichkeiten des Einsatzes der Gentherapie
zur Prophylaxe der Immunreaktion nach Keratoplastik analysiert. In den eigenen
Untersuchungen zu diesem Themenkomplex konnte erstmalig gezeigt werden, dass
ein Zytokingentransfer mittels Liposomen in korneale Endothelzellen in Kultur
möglich ist. Angesichts der immunstimulatorischen Nebenwirkungen des
adenoviralen Gentransfers kommt der liposomalen Transfektion eine Bedeutung im
Hinblick auf die Suche nach Alternativen zum Einsatz von Adenoviren zu. Im
direkten Vergleich des liposomalen mit dem adenoviralen Gentransfer an der
organkultivierten Hornhaut zeigt sich der virale Gentransfer im Hinblick auf
die Transfektionseffizienz ĂĽberlegen. Durch die Option, das organkultivierte
Hornhauttransplantat ex vivo transfizieren zu können, stellt der Einsatz der
Gentherapie einen vielversprechender Ansatz zur Prophylaxe der Immunreaktion
nach Keratoplastik dar, wenn auch auf dem Weg zum konkreten klinischen Einsatz
noch weitere Probleme gelöst werden müssen.This work analysed new strategies for the prophylaxis of corneal graft
rejection. In the first section clinical data of patients of our clinic were
analysed. It could be demonstrated that glaucoma is a main risk factor for
chronic endothelial cell loss. Moreover our data could show for the first time
that a chronic subclinical immune reaction contributes to endothelial cell
loss of homologous grafts. Broad experimental investigations on topical
application of immunomodulatory substances are described in the second
section. Topical formulations of mycophenolate mofetil (MMF) and sirolimus /
everolimus are demonstrated for the first time. Our examinations showed that
the best preparation of MMF is a cyclodextrin formulation (MMF-CD) whereas
sirolimus / everolimus is best prepared as a microemulsion. Application of
MMF-CD formulation can obtain high concentration in the aqueous humour whereas
topical sirolimus permeates the cornea only after removal of the epithelium.
Topical MMF and sirolimus do not prolong experimental corneal graft survival
in a rat model whereas grafts survive longer under topical therapy with
everolimus. Moreover, topical application of MMF and sirolimus / everolimus
remain interesting therapeutic options for other immune mediated diseases of
the ocular surface like immune mediated corneal ulcers or atopic
keratoconjunctivitis. In the third section therapeutic options of gene
therapeutic strategies for prophylaxis of corneal graft rejection were
analysed. Own investigations on this topic showed that liposome mediated
cytokine gene transfer (interleukin 10) to corneal endothelial cells in
culture is possible. For transfection of organ cultured corneas transfection
efficiency of adenoviral gene transfer is by far higher. Nevertheless on the
way to clinical application of gene therapy for the prophylaxis of corneal
graft rejection numerous further problems have to be solved
Clinical Results and Higher-Order Aberrations after 1.4-mm Biaxial Cataract Surgery and Implantation of a New Aspheric Intraocular Lens
Predictive Factors for Clinical Outcomes after Primary Descemet’s Membrane Endothelial Keratoplasty for Fuchs’ Endothelial Dystrophy
Comparison of ICare and IOPen vs Goldmann applanation tonometry according to international standards 8612 in glaucoma patients
AIM: To compare IOPen and ICare rebound tonometry to Goldmann applanation tonometry (GAT) according to International Standards Organization (ISO) 8612 criteria.
METHODS: Totally 191 eyes (n=107 individuals) were included. Criteria of ISO 8612 were fulfilled: 3 clusters of IOP, measured by GAT, were formed. The GAT results were given as mean±standard deviation.
RESULTS: GAT (19.7±0.5 mm Hg) showed a significant correlation to ICare (19.8±0.5 mm Hg) (r=0.547, P<0.001) and IOPen (19.5±0.5 mm Hg) (r=0.526, P<0.001). According to ISO 8612 criteria in all 3 IOP groups the number of outliers (of the 95% limits of agreement) exceeded 5% for ICare and IOPen vs GAT: No.1 (n=68) 29.4% and 22.1%, No.2 (n=62) 35.5% and 37.1%, No.3 (n=61) 26.2% and 42.6%, respectively.
CONCLUSION: The strict requirements of the ISO 8612 are not fulfilled in a glaucoma collective by ICare and IOPen at present. As long as the Goldmann tonometry is applicable it should be used first of all for reproducible IOP readings. ICare and IOPen tonometry should be considered as an alternative tool, if application of Goldmann tonometry is not possible