Selektive Lasertrabekuloplastik bei Patienten unter maximaler Lokaltherapie: eine retrospektive Analyse

Zusammenfassung: Hintergrund: Hauptziel der Glaukomtherapie ist nach wie vor die erfolgreiche Augendrucksenkung. Ziel dieser retrospektiven Studie war es, die Wirksamkeit der selektiven Lasertrabekuloplastik (SLT) bei Patienten unter maximaler Augendruck senkender Therapie zu untersuchen. Besonderes Augenmerk wurde in der Analyse darauf gelegt, ob präoperativ bekannte Faktoren einen Einfluss auf den IOD-senkenden Effekt haben. Material und Methode: Inkludiert wurden Patienten mit der Diagnose einer okulären Hypertension oder eines Offenwinkelglaukoms (primäres Offenwinkelglaukom, Pseudoexfoliationsglaukom, Pigmentdispersionsglaukom und Normaldruckglaukom), die im Zeitraum von 3/2008 bis 12/2010 aufgrund unzureichender Drucksenkung unter maximaler Lokaltherapie einer SLT unterzogen wurden und die einen Nachbeobachtungszeitraum von mindestens 3Monaten hatten. Die Datenanalyse erfolgte präoperativ, sowie einen Tag, einen Monat und drei Monate nach SLT und dann dreimonatlich bis zu 2,5 Jahre. Hauptmessparameter waren Ausmaß der IOD-Senkung sowie Erfolgsraten (³ 20% Augendruck-Senkung). Eine Re-SLT wurde nicht als Misserfolg gewertet. Resultate: Einhunderteinunddreißig Augen von 98 Patienten (58 Frauen, mittleres Alter 71,6 ± 11,2 Jahre, mittlerer Nachbeobachtungszeitraum 1,05 ± 0,67 Jahre) wurden inkludiert. Mittlerer Augendruck vor SLT war 19,6 ± 4,9mmHg. Bis 1,75 Jahre nach SLT war der Augendruck stets signifikant reduziert (16,6 ± 3,6; p = 0,044). Bis 2 Jahre nach SLT hatten Patienten mit höherem Ausgangs-Augendruck eine signifikant stärkere Drucksenkung (R2  = 0,358; p = 0,009). Es gab keinen signifikanten Unterschied in der Überlebensanalyse sowohl zwischen phaken bzw. pseudophaken Patienten als auch zwischen Patienten mit bzw. ohne Prostaglandintherapie (p = 0,671 und p = 0,994). Zwölf Augen hatten eine zweite SLT (mittlere Zeit bis zur Re-SLT 1,03 ± 0,55 Jahre). Fünfzehn Augen benötigten eine weitere Augendruck senkende Operation (mittlere Zeit bis zum Versagen der SLT 0,84 ± 0,52 Jahre). Schlussfolgerung: SLT kann auch bei Patienten unter maximaler Lokaltherapie noch eine signifikante Drucksenkung bewirken, wobei das Ausmaß der Drucksenkung über die Zeit abnimmt. Die Augendruck senkende Wirkung ist bei Patienten mit höherem präoperativen Augendruck stärker ausgepräg

Meningothelial Cells React to Elevated Pressure and Oxidative Stress

BACKGROUND: Meningothelial cells (MECs) are the cellular components of the meninges enveloping the brain. Although MECs are not fully understood, several functions of these cells have been described. The presence of desmosomes and tight junctions between MECs hints towards a barrier function protecting the brain. In addition, MECs perform endocytosis and, by the secretion of cytokines, are involved in immunological processes in the brain. However, little is known about the influence of pathological conditions on MEC function; e.g., during diseases associated with elevated intracranial pressure, hypoxia or increased oxidative stress. METHODS: We studied the effect of elevated pressure, hypoxia, and oxidative stress on immortalized human as well as primary porcine MECs. We used MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) bioreduction assays to assess the proliferation of MECs in response to treatment and compared to untreated control cells. To assess endocytotic activity, the uptake of fluorescently labeled latex beads was analyzed by fluorescence microscopy. RESULTS: We found that exposure of MECs to elevated pressure caused significant cellular proliferation and a dramatic decrease in endocytotic activity. In addition, mild oxidative stress severely inhibited endocytosis. CONCLUSION: Elevated pressure and oxidative stress impact MEC physiology and might therefore influence the microenvironment of the subarachnoid space and thus the cerebrospinal fluid within this compartment with potential negative impact on neuronal function

'Spontaneous' periocular hemorrhage and macrohematuria

PURPOSE: To report on a 19-year-old man with 'spontaneous' periocular hemorrhage and macrohematuria as the first signs of a bone-marrow-infiltrating rhabdomyosarcoma of the left superior rectus muscle. PROCEDURES: Clinical eye examination, magnetic resonance imaging, laboratory workup and bone marrow biopsy were performed. RESULTS: Magnetic resonance imaging showed a mass lesion in the left superior rectus muscle. While funduscopy had initially been normal, optic disc swelling, retinal hemorrhage and vitreous cell infiltration could be seen in the further course of disease. Laboratory work-up showed macrohematuria, thrombocytopenia and decreased concentration levels of plasma fibrinogen. Thromboplastin time was decreased. A bone marrow biopsy revealed small cell infiltration; using immunohistochemistry, a rhabdomyosarcoma was diagnosed. Unfortunately, the patient died few months later, in spite of chemotherapy. CONCLUSION: 'Spontaneous' periocular hemorrhage and macrohematuria were the first signs of a bone-marrow-infiltrating rhabdomyosarcoma in this young and otherwise healthy patient

Unilateral Optic Disc Swelling with Inhomogeneous Cerebrospinal Fluid Compositon Between the Spinal Theca and the Subarachnoid space (SAS) of the Left Optic Nerve

We report the case of a patient with unilateral optic disc swelling and inhomogeneous cerebrospinal fluid (CSF) composition between the spinal theca and the SAS of the left optic nerve

Assessment of Cyclotorsion Using SLO Fundus Imaging in Patients With and Without Forth Nerve Palsy

Scanning Laser Ophthalmoscopy (SLO) imaging is a new method of foveo-papillary angle (FPA) measurement for objective assessment of cyclotorsion. This case-control study assesses the SLO-based FPA in patients with forth nerve palsy and in healthy controls

Papilledema revisited : is its pathophysiology really understood?

The term 'papilledema' is used to describe swelling of the optic disc that is thought or known to be associated with increased intracranial pressure (ICP) transmitted to the subarachnoid space (SAS) surrounding the optic nerve (ON). In most cases, the diagnosis of increased ICP is confirmed by lumbar puncture, the results of which are believed to represent the pressure in all of the cerebrospinal fluid (CSF) spaces. Until recently, all CSF spaces were thought to communicate freely and that CSF pressure and composition in one location were the same throughout the central nervous system (CNS) unless there was an acquired structural disturbance. However, the concept of continuous CSF flow and pressure throughout the CNS does not explain why some patients with elevated ICP do not develop papilledema, why some patients have highly asymmetrical papilledema, or why some patients with papilledema have normal ICP during 24-hour monitoring. In addition, CSF sampling during lumbar puncture and during ON sheath fenestration demonstrates an increased concentration of lipocalin-like prostaglandin D synthase, a substance toxic to astrocytes, in the SAS of the ON compared with that in the lumbar CSF space, and also a difference in CSF dynamics between the lumbar and ON SAS in some patients with papilledema. We therefore suggest that papilledema does not result from raised ICP alone but in some cases by compartmentation of the SAS of the ON, leading to a toxic milieu around the nerve

Assessment of Cyclotorsion Using SLO Fundus Imaging in Patients With and Without Forth Nerve Palsy

Scanning Laser Ophthalmoscopy (SLO) imaging is a new method of foveo-papillary angle (FPA) measurement for objective assessment of cyclotorsion. This case-control study assesses the SLO-based FPA in patients with forth nerve palsy and in healthy controls

Assessment of Cyclotorsion Using SLO Fundus Imaging in Patients With and Without Forth Nerve Palsy

Scanning Laser Ophthalmoscopy (SLO) imaging is a new method of foveo-papillary angle (FPA) measurement for objective assessment of cyclotorsion. This case-control study assesses the SLO-based FPA in patients with forth nerve palsy and in healthy controls