Femtosekundenlaser-assistierte Kapsulotomie

In dieser prospektiven Studie wurde in vier Untersuchungsgruppen eine Laser-assistierte Kataraktoperation durchgeführt. Es konnten 160 Patienten eingeschlossen werden. Mit der neuen Kapselzentrierungsmethode wurde bei einer Kapsulotomiegröße von 5 mm bei allen Patienten eine komplette Überlappung erreicht. Bei Anwendung der Pupillenzentrierung und dem Einsetzen einer 3-stückigen Intraokularlinse war dies bei 3 Augen nicht der Fall. Beim Einsetzen einer Plattenhaptik-Linse zeigte sich ebenfalls eine komplette Überlappung in allen Fällen, unabhängig vom Zentrierungsverfahren. Durch die dreidimensionale Darstellung des vorderen Augenabschnitts mittels optischer Kohärenztomographie ist es erstmals möglich die vordere Kapsulotomie direkt auf den Kapselsack zu zentrieren und mit großer Wahrscheinlichkeit eine komplette Überlappung der Optik, unabhängig vom Intraokularlinsenaufbau, zu erreichen. Möglicherweise kann mit Hilfe dieser Technologie das postoperative Ergebnis verbessert werden

Anti-inflammatory cytokine and angiogenic factors levels in vitreous samples of diabetic retinopathy patients.

Evaluation of cytokines in patients with diabetic retinopathy (DR) is important for the identification of future additive or alternative treatment options. Therefore, vitreous samples were obtained from patients with DR and patients with macular hole or macular pucker (control group) during 23-gauge-vitrectomy (n = 17/group). The levels of three pro-inflammatory (IL-1ß, IL-6, IFN-γ) and pleiotropic cytokines (IL-2, IL-4, IL-13) as well as VEGF, VEGF-A, and PGF were measured using an enzyme linked immunosorbent assay (ELISA). IL-1ß (p = 0.02) and IFN-γ (p = 0.04), two of the three tested pro-inflammatory cytokines, were elevated in the DR patients, while IL-6 (p = 0.51) level was comparable in both groups. Moreover, in DR samples, a trend towards an IL-13 down-regulation (p = 0.36) was observable. The IL-2 (p = 0.62) and IL-4 (p = 0.78) levels were comparable in both groups. All analyzed angiogenetic factors were up-regulated in DR patients (VEGF: p<0.001; VEGF-A: p = 0.002; PGF: p<0.001). The up-regulation of angiogenetic factors underline their importance in DR development. However, the interaction of the other cytokines showed an interesting pattern. Pro-inflammatory cytokines were also up-regulated, which could be evidence for inflammation processes in the diabetic retina. Furthermore, it seems that a counter response of immunomodulatory cytokines is in an initial process, but not strong enough to regulate the processes. Therefore, to support these anti-inflammatory mechanisms might be additive treatment option in the future

Clinical patient data for both groups: Controls and diabetic retinopathy (DR) patients.

<p>Y = Year; M = male, F = female; OD = right eye; OS = left eye. DR stages are: 1 = mild to moderate NPDR, 2 = severe NPDR, and 3 = PDR.</p

Contribution of pleiotropic immunomodulatory cytokine levels in vitreous samples.

<p><b>A.</b> A difference in IL-2 (p = 0.62) level was not measurable between control and DR patients. <b>B.</b> There was no difference in IL-4 level between control and DR patients (p = 0.78). <b>C.</b> A trend for the down-regulation of IL-13 level (p = 0.36) was noted in DR patients. Each symbol depicts an individual patient. The horizontal bar indicates the mean cytokine concentration per group.</p

Up-regulation of different angiogenic factors in vitreous samples.

<p><b>A.</b> Total VEGF was significantly up-regulated in vitreous samples of DR patients (p = 0.002). B. VEGF-A was also significantly up-regulated in DR patients (p<0.001). <b>C.</b> Additionally, PGF was upregulated in DR samples compared to controls (p<0.001). Each symbol depicts an individual patient. The horizontal bar indicates the mean cytokine concentration per group. **: p<0.01, ***: p<0.001.</p

Anti-inflammatory cytokine and angiogenic factors levels in vitreous samples of diabetic retinopathy patients

Evaluation of cytokines in patients with diabetic retinopathy (DR) is important for the identification of future additive or alternative treatment options. Therefore, vitreous samples were obtained from patients with DR and patients with macular hole or macular pucker (control group) during 23-gauge-vitrectomy (n = 17/group). The levels of three pro-inflammatory (IL-1$\beta$, IL-6, IFN-$\gamma$) and pleiotropic cytokines (IL-2, IL-4, IL-13) as well as VEGF, VEGF-A, and PGF were measured using an enzyme linked immunosorbent assay (ELISA). IL-1$\beta$ (p = 0.02) and IFN-$\gamma$ (p = 0.04), two of the three tested pro-inflammatory cytokines, were elevated in the DR patients, while IL-6 (p = 0.51) level was comparable in both groups. Moreover, in DR samples, a trend towards an IL-13 down-regulation (p = 0.36) was observable. The IL-2 (p = 0.62) and IL-4 (p = 0.78) levels were comparable in both groups. All analyzed angiogenetic factors were up-regulated in DR patients (VEGF: p<0.001; VEGF-A: p = 0.002; PGF: p<0.001). The up-regulation of angiogenetic factors underline their importance in DR development. However, the interaction of the other cytokines showed an interesting pattern. Pro-inflammatory cytokines were also up-regulated, which could be evidence for inflammation processes in the diabetic retina. Furthermore, it seems that a counter response of immunomodulatory cytokines is in an initial process, but not strong enough to regulate the processes. Therefore, to support these anti-inflammatory mechanisms might be additive treatment option in the future

Cytokine concentration (pg/ml) in vitreous samples of control and diabetic retinopathy (DR) patients measured via ELISA.

<p>Significant p-values are in bold.</p