Parkinson's disease (PD) and the atypical parkinsonian syndromes multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) are movement disorders associated ...with degeneration of the central nervous system. Degeneration of the retina has not been systematically compared in these diseases.
This cross-sectional study used spectral-domain optical coherence tomography with manual segmentation to measure the peripapillar nerve fiber layer, the macular thickness, and the thickness of all retinal layers in foveal scans of 40 patients with PD, 19 with MSA, 10 with CBS, 15 with PSP, and 35 age- and sex-matched controls.
The mean paramacular thickness and volume were reduced in PSP while the mean RNFL did not differ significantly between groups. In PSP patients, the complex of retinal ganglion cell- and inner plexiform layer and the outer nuclear layer was reduced. In PD, the inner nuclear layer was thicker than in controls, MSA and PSP. Using the ratio between the outer nuclear layer and the outer plexiform layer with a cut-off at 3.1 and the additional constraint that the inner nuclear layer be under 46 µm, we were able to differentiate PSP from PD in our patient sample with a sensitivity of 96% and a specificity of 70%.
Different parkinsonian syndromes are associated with distinct changes in retinal morphology. These findings may serve to facilitate the differential diagnosis of parkinsonian syndromes and give insight into the degenerative processes of patients with atypical parkinsonian syndromes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PURPOSE:To compare intraocular pressure (IOP) measurements obtained by rebound tonometry (Icare PRO tonometer), applanation tonometry (Goldmann and Perkins tonometry), and dynamic contour tonometry ...in the upright and the supine positions, and to investigate the influence of axial length and central corneal thickness.
METHODS:Ninety-nine right eyes of 99 patients with glaucoma or suspect for glaucoma, admitted to our department between November 2010 and January 2011 to obtain an IOP profile including supine measurements, were included in our study. IOP measurements were obtained in an upright position using an Icare PRO rebound (RTPRO), a Goldmann applanation (GAT), and a Pascal dynamic contour tonometer (DCT). In the supine position, IOP measurements were taken using the RTPRO and a Perkins hand-held applanation tonometer (PAT). The means and SDs for all tonometers were compared. Agreement between the tonometers was calculated using the Bland-Altman method.
RESULTS:The mean IOPs obtained in the upright position were 17.7±8.0 mm Hg (RTPRO), 17.6±7.8 mm Hg (GAT), and 19.9±6.6 mm Hg (DCT). Correlation analysis of these data indicated a good correlation between IOP readings obtained using RTPRO and GAT (r=0.951; P<0.001), and RTPRO and DCT (r=0.897; P<0.001). Bland-Altman analysis revealed mean differences (bias) between RTPRO and GAT, and between RTPRO and DCT of 0.1 mm Hg and −1.8 mm Hg, with 95% limits of agreement of −3.6 to 3.8 mm Hg and −7.3 to 3.6 mm Hg, respectively. In the supine position, the mean IOPs were 19.2±6.4 mm Hg using the RTPRO and 19.6±6.2 mm Hg using the PAT.
CONCLUSIONS:Measurements obtained with the RTPRO, either in the upright or in the supine position, show good correlation and agreement with those provided by applanation and dynamic contour tonometry. The study was registered with the DRKS (German Clinical Trials Register; http://www.germanctr.de; DRKS00000581).
To report the results of the repair of conjunctival erosions resulting from glaucoma drainage device surgery using collagen-glycosaminoglycane matrices (CGM).
Case series of 8 patients who underwent ...revision surgery due to conjunctival defects with exposed tubes through necrosis of the overlying scleral flap and conjunctiva after Baerveldt drainage device surgery. The defects were repaired by lateral displacement of the tube towards the sclera, with a slice of a CGM as a patch, covered by adjacent conjunctiva.
Successful, lasting closure (follow-up of 12 to 42 months) of the conjunctival defects was achieved without any side-effects or complications in all eight cases.
Erosion of the drainage tube, creating buttonholes in the conjunctiva after implantation of glaucoma drainage devices, is a potentially serious problem. It can be managed successfully using a biodegradable CGM as a patch.
Purpose
Myopic glaucoma patients display a considerable risk of complications following antiglaucomatous filtering surgery, e.g., trabeculectomy. Canaloplasty with mitomycin C may reduce this risk by ...avoiding massive overfiltration.
Methods
We performed retrospective analysis of 31 eyes with myopia that underwent canaloplasty modified with mitomycin C in a consecutive single-surgeon case series. Annual data and success rates were analysed. Twenty-three myopic eyes that had received conventional trabeculectomy with mitomycin C were recorded as a comparison.
Results
The 31 eyes with a follow-up of 40 ± 26 months after canaloplasty had a mean spherical equivalent of − 8.4 ± 4.5 dioptres. Intraocular pressure decreased from 32.3 ± 9.6 mmHg (range: 17 to 58) to 16.8 ± 8.1 mmHg (range: 5 to 44) 1 year after surgery (− 46%;
p
< 0.001) with a medication score reduction from 5 to 1.2 (
p
< 0.001). Qualified success rates (Criterion B: no revision surgery, IOP < 21 mmHg, IOP reduction > 20%) were 83% after 1 year and 61% at the 2nd and 3rd years. In 5 eyes (16%), early ocular hypotony (≤ 5 mmHg) was observed. Two eyes (7%) showed transient choroidal detachment and swelling. The 23 eyes that had received trabeculectomy had success rates (Criterion B) of 91% at the 1st and 86% at the 2nd and 3rd years. Hypotony occurred in 10 eyes (44%), and 4 eyes (17%) showed choroidal detachment or macular folds.
Conclusions
Postoperative complications related to overfiltration were less frequent after canaloplasty with mitomycin C. Midterm data proved good efficacy. Pressure reduction, success rates and rates of medication free patients were significantly higher in trabeculectomy compared to modified canaloplasty with mitomycin C.
To evaluate the effect of capsular tension ring (CTR) implantation on refractive outcomes in patients with high myopia.
University of Cologne, Department of Ophthalmology, Cologne, Germany.
...Comparative case series.
The refractive outcomes in myopic eyes were compared between phacoemulsification and IOL implantation with a CTR (CTR group) and without a CTR (control group). Optical biometry (IOLMaster) was obtained. The power of the IOL was used to calculate the predicted postoperative spherical equivalent using the Haigis and SRK/T formulas. The main outcome measures were the mean error and mean absolute error of the refractive prediction error.
The mean axial length was 29.1 mm (range 26.5 to 34.1 mm) in the CTR group and 28.2 mm (range 25.6 to 31.1 mm) in the control group. There was no statistically significant difference in the mean absolute refractive prediction error between the CTR group and the control group with the Haigis formula (P = .921) or SRK/T formula (P = .693). However, there was lower variance in the absolute refractive prediction error in the CTR group with both formulas (P = .014 and P = .027, respectively). Intragroup differences between formulas were not statistically significant (CTR, P = .069; control P = .551).
Implantation of a CTR had no consistent effect on refractive outcomes compared with routine phacoemulsification in highly myopic eyes. There was a tendency toward higher precision in outcomes with a CTR. Results indicate IOL power calculation does not have to be changed when a CTR is used.
ABSTRACT
Choroidal neovascularization (CNV) is responsible for the severe visual loss in age‐related macular degeneration. CNV formation is considered to be due to an imbalance between pro‐ and ...antiangiogenic factors that lead to neovascular growth from the choriocapillaris into the subretinal space. To define whether FasL overexpression in retinal pigment epithelial cells (RPE) can inhibit choroidal neovascularization through Fas‐FasL‐mediated apoptosis, we examined the role of this pathway in a mouse model of laser‐induced choroidal neovascularization. FasL was expressed in the retinal pigment epithelium of transgenic mice. Polymerase chain reaction (PCR), immunoblot, and immunohistochemistry confirmed that the transgene FasL was specifically expressed in RPE. The established laser model was used to induce choroidal neovascularization (CNV) in wild‐type (WT) and transgenic mice. CNV formation was compared with respect to fluorescein angiographic leakage (at days 0 and 14 after laser injury) and histological appearance. The lesions were assessed on RPE‐choroidal flatmounts after CD31‐labeling and with confocal microscopy after perfusion with rhodamine‐labeled concanavalin A (Con A). Apoptosis was quantified by TUNEL positivity and caspase activation. FasL mRNA and protein were highly expressed in the RPE of the transgenic mice before and after laser photocoagulation. In contrast, FasL was only weakly expressed in the RPE layer of WT C57BL/6J mice. While ruptures of Bruch's membrane and CNV formation were observed histologically two weeks after laser photocoagulation in transgenic as well as control eyes, the shape and size of CNV lesions were reduced in the transgenic mice. The area of leakage was decreased by 70% in FasL transgenic mice compared with WT mice (P<0.005). The number of TUNEL‐positive cells was greater in FasL‐overexpressing mice and correlated with the expression of activated caspases. Th expression of other antiangiogenic factors such as PEDF remained unchanged. The specific overexpression of FasL in RPE layer reduced CNV formation in our laser model. Our results strongly point to the FasL‐Fas pathway as a potential therapeutic target in controlling pathological choroidal neovascularization.—Semkova, I., Fauser, S., Lappas, A., Smyth, N., Kociok, N., Kirchhof, B., Paulsson, M., Poulaki, V., Joussen, A. M. Overexpression of FASL in retinal pigment epithelial cells reduces choroidal neovascularization. FASEB J. 20, E950–E962 (2006)
Purpose
To determine differing outcomes among either phakic or pseudophakic patients who received standalone XEN45 Gel Stent (Allergan, an AbbVie Company, CA, USA) implantation and patients who ...underwent combined surgery with phacoemulsification.
Methods
This retrospective single-center study involved 180 eyes of 180 participants who underwent XEN45 Gel Stent implantation, of which 60 eyes received combined surgery with phacoemulsification (combined group). Standalone stent implantation was performed on 60 phakic (phakic group) and on 60 pseudophakic eyes (pseudophakic group). The groups were matched in a ratio of 1:1:1 based on multiple criteria. Successful surgery was defined by three scores: IOP at the longest follow-up of < 21 mmHg (Score A) or < 18 mmHg (Score B) and an IOP reduction > 20% or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). In all scores, one open conjunctival revision was allowed, and additional repeat surgery was considered a failure.
Results
After an average follow-up time interval of 20.6 ± 12.6 months, there was a mean IOP-reduction by 37% among the entire cohort. Comparative analysis between the three groups did not show significant differences regarding postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate or success rate. A dysfunctional stent was detected in eight eyes (4%) during open conjunctival revision in 76 eyes.
Conclusion
The clinical endpoints investigated did not differ significantly among either phakic or pseudophakic patients who received standalone stent implantation and patients who underwent combined surgery. However mean latency between primary stent implantation and first revision surgery after combined surgery was markedly shorter.
PURPOSE:Here we describe intraoperative optical coherence tomography (iOCT) as a novel noncontact imaging tool for intraoperative monitoring and procedure evaluation during canaloplasty, as a ...nonpenetrating surgical technique to treat primary open angle glaucoma.
MATERIALS AND METHODS:Retrospective case report of a patient (63 y, female), who underwent traditional canaloplasty, using a commercially available 840 nm OCT device, mounted to an operating microscope (Rescan 700). Main outcome measures were the intraoperative visibility of chamber angle structures and the ability to conduct surveillance of the surgical procedure through the prepared Descemet window, especially correct suture positioning and visible changes of the Schlemm canal after suture tensioning.
RESULTS:iOCT delivered high-resolution images during canaloplasty after deep sclerectomy through the prepared Descemet window. All structures of the chamber angle, including the Schlemm canal were visible. Moreover iOCT enabled intraoperative noncontact procedure monitoring and a direct control of the correct localization and changes of the Schlemm canal after suture positioning and tensioning.
CONCLUSIONS:iOCT seems to be a helpful intraoperative imaging tool during canaloplasty. iOCT allows for noncontact online evaluation of Schlemm canal localization and noncontact evaluation of suture tension. Shadowing of scleral tissue can be avoided by imaging through the routinely prepared Descemet window to visualize chamber angle structures including the implanted suture.
Purpose
The aim of the underlying study was to present a new surgical method in PreserFlo MicroShunt surgery for glaucoma. A removable polyamide suture was placed into the lumen of the MicroShunt ...during implantation to prevent early postoperative hypotony.
Methods
Thirty-one patients undergoing stand-alone glaucoma surgery with implantation of a PreserFlo MicroShunt and an intraluminal occlusion were retrospectively reviewed and compared to a control group without occlusion. Inclusion criteria were diagnosis of primary open-angle glaucoma or secondary open-angle glaucoma due to pseudoexfoliation or pigment dispersion. Patients with a history of filtrating glaucoma surgery were excluded.
Results
IOP decreased from 26.9 ± 6.6 to 18.0 ± 9.5 mmHg at the first postoperative day after PreserFlo MicroShunt implantation. Postoperative removal of the occluding suture resulted in a mean IOP reduction in 11.1 ± 7.6 mmHg. Mean visual acuity was 0.43 ± 0.24 logMAR during the first postoperative examination. The interval with the occluding intraluminal suture in place varied from days to 2–3 weeks. Patients were followed up to 1 year.
Conclusion
Implantation of a PreserFlo MicroShunt combined with an intraluminal suture prevented postoperative hypotony in all patients. Mean postoperative pressure was reduced despite the occluding suture in place.
Background
To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)‐lowering effectiveness in the first eye has a ...predictive potential for the outcome of the second eye in primary open‐angle glaucoma (POAG).
Methods
This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either ‘success’ or ‘failure’ based on three scores: IOP at follow‐up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re‐surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re‐surgery (Score C).
Results
The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C.
Conclusions
In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP‐lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.
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