A. Wedrich

The role of the carotenoids, lutein and zeaxanthin, in protecting against age-related macular degeneration: A review based on controversial evidence

PurposeA review of the role of the carotenoids, lutein and zeaxanthin, and their function in altering the pathogenesis of age-related macular degeneration (AMD).MethodsMedline and Embase search.ResultsRecent evidence introduces the possibility that lutein and zeaxanthin, carotenoids found in a variety of fruits and vegetables may protect against the common eye disease of macular degeneration. This potential and the lack to slow the progression of macular degeneration, has fueled high public interest in the health benefits of these carotenoids and prompted their inclusion in various supplements. The body of evidence supporting a role in this disease ranges from basic studies in experimental animals to various other clinical and epidemiological studies. Whilst some epidemiological studies suggest a beneficial role for carotenoids in the prevention of AMD, others are found to be unrelated to it. Results of some clinical studies indicate that the risk for AMD is reduced when levels of the carotenoids are elevated in the serum or diet, but this correlation is not observed in other studies. Published data concerning the toxicity of the carotenoids or the optimum dosage of these supplements is lacking.ConclusionAn intake of dietary supplied nutrients rich in the carotenoids, lutein and zeaxanthin, appears to be beneficial in protecting retinal tissues, but this is not proven. Until scientifically sound knowledge is available we recommend for patients judged to be at risk for AMD to: alter their diet to more dark green leafy vegetables, wear UV protective lenses and a hat when outdoors. Future investigations on the role of nutrition, light exposure, genetics, and combinations of photodynamic therapy with intravitreal steroid (triamcinolone-acetonide) injections hold potential for future treatment possibilities.

Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema

AbstractBackground. Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients – especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME) in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery.n Methods. Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retinopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the non-operated fellow eyes.n Results. Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 71%. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (31%), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA.n Conclusion. Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy.

Purpose: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months ± 21 (SD) and the mean follow‐up after phacoemulsification, 23 ± 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow‐up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi‐square test were used. Results: Thirty‐five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P = .04, chi‐square test). At the end of follow‐up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P = .002 and P = .05, respectively). Conclusions: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.

Reduction of intraocular pressure in a glaucoma patient undergoing hormone replacement therapy

OBJECTIVESnTo show the reducing effect of estrogens and progestins on the elevated intraocular pressure (IOP) in the case of a 56-year-old woman showing typical climacteric complaints, who was admitted to the menopause outpatient unit. She also suffered from a primary open-angle glaucoma treated with betaophtiole eye drops with intraocular pressures of 16-20 mmHg under this local therapy.nnnMETHODSnIOP patterns were monitored by means of standardised daily pressure profiles four times a day before as well as 4 and 12 weeks after the beginning of hormone replacement therapy (HRT). The local glaucoma therapy remained unchanged.nnnRESULTSnDuring HRT, IOP levels were reduced from 16-20 mmHg before therapy to 12-15 mmHg at week 4 and to 13-15 mmHg at week 12 after the beginning of HRT.nnnCONCLUSIONnThe finding of a close chronological relationship between the onset of menopause and the development of a glaucoma is a potentially new indication for HRT.

The clinical use of viscoelastic artificial tears and sodium chloride in dry-eye syndrome.

This study was performed to test viscoelastic artificial tears (VAT) based on both subjective and clinical parameters in patients with keratoconjunctivitis sicca (KCS). Twenty-eight patients were evaluated in a randomized double-blind study. Sodium hyaluronate was used in two different concentrations (0.4%, 0.25%) and in combination with chondroitin sulfate. Each preparation was used for one week preceded by another weekly cycle using a sodium chloride solution. Before and after each cycle, clinical examinations were performed: tear film break-up time, Schirmers test, lipid-layer thickness and fluorescein staining. Patients kept a record of the drop-frequency, subjective response and side effects. After the study, they were asked to give a rating of the various preparations. The severity of KCS was expressed based on a sicca score and correlated with response to viscoelastic treatment. Both the subjective and the clinical parameters revealed no statistically significant differences between the various viscoelastic agents or between the viscoelastics and the sodium chloride solutions. Severe side effects did not occur. There was a positive correlation of response to viscoelastic treatment with severe KCS (+ 0.36) but not with mild KCS (-0.07). The VAT seems to be indicated in severe cases of dry-eye syndrome. Sodium chloride solutions may be a useful short-term alternative to other tear formulations.

Dry eye treatment with acupuncture

Dry eye is defined as a disorder of the tear film due to tear deficiency or excessive tear evaporation, which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort.1 Tear film homeostasis is based on an adequate, proper function and balance of at least three systems that produce the lipid, aqueous, and mucus layers of the tear film. Previous studies give evidence that humoral factors—for instance, vasointestinal active peptide, endocrine factors (estrogen, androgens), and the vegetative nerve system—are part of the complex regulatory mechanism of these systems.2

Intraocular silicone lenses in silicone oil : an experimental study

Abstract• Background: To evaluate a potential effect of silicone oil on flexible silicone intraocular lenses, four lenses (STAAR AA-4203) were stored in silicone oil under sterile conditions for periods between 1 month and 3 years.• Method: The edge and surface of the lenses were examined by scanning electron micrography and the findings compared with a lens of the same model which had been stored in Ringers solution for 2 years.• Results: After 1 year of silicone oil exposure, droplets of different sizes adherent to the surface of the lens were found. These changes proceeded to a wave-like appearance of the surface after 2 and 3 years of storage, so that a continuous layer of silicone oil polymers is probably covering the intraocular lens.• Conclusion: Optical interference has to be considered a possibility if it turns out that the droplets cannot be removed during silicone oil evacuation. Consequently silicone intraocular lenses without hydrophilic preparation of the surface should not be implanted in eyes undergoing combined anterior and posterior segment surgery with silicone oil tamponade or in eyes with high risk for vitreoretinal complications.

Estrogen therapy in keratoconjunctivitis sicca.

Recently, attempts have been made to prove the presence of hormone receptors on the eye surface; this would mean that they are able to react to hormone therapy. The abxadsorption of percutaneously or vaginally applied estradiol has already been proved.1,2

Aqueous Flare and Macular Edema in Eyes with Diabetic Retinopathy

Background: The breakdown of the blood-retina barrier in diabetic patients is correlated with a dysfunction of the blood-aqueous barrier. In our study, we wanted to investigate the effect of grid photocoagulation in diabetic macular edema on the aqueous flare. Methods: Modified grid pattern photocoagulation was performed on 20 patients with diabetic macular edema. The aqueous flare intensity was measured by the laser flare cell meter before and 4 months after laser treatment. Results: The mean flare value was 9.8 ± 4.7 photons/ms before laser treatment. After grid photocoagulation, the flare value was 7.1 ± 3.6 photons/ms. Flare values were significantly decreased after laser treatment. Conclusion: Our results suggest a correlation between the effect of grid photocoagulation on the blood-retina barrier and the permeability of the blood-aqueous barrier. The laser flare intensity seems to be a quantitative indicator for the diabetic dysfunction of the blood-retina barrier.

Inflammation after phacoemulsification in diabetic retinopathy: Foldable acrylic versus heparin-surface-modified poly(methyl methacrylate) intraocular lenses

Purpose: To evaluate inflammation after cataract surgery in patients with nonproliferative diabetic retinopathy (NPDR) and compare results with 2 intraocular lenses (IOLs): a foldable hydrophobic acrylic and a heparin‐surface‐modified (HSM) poly(methyl methacrylate) (PMMA). Setting: Department of Ophthalmology, University of Vienna, Vienna, Austria. Methods: Patients with NPDR were randomized for implantation of an HSM PMMA IOL (811C®, Pharmacia) through a 6.0 mm sclerocorneal incision (30 patients) or a foldable hydrophobic acrylic IOL (AcrySof®, Alcon) through a 4.0 mm sclerocorneal incision (32 patients). Both IOLs had 6.0 mm optics. All patients were treated according to a standardized protocol. The degree of flare in the anterior chamber was measured with the Kowa 1000 laser flare–cell meter 1 day preoperatively and 1 day, 1 week, and 1 and 3 months postoperatively. Results: In both IOL groups, flare was highest on the first postoperative day and decreased to preoperative levels by 3 months after surgery. There was no statistically significant difference in relative flare values between the 2 groups. Conclusion: There was no difference in postoperative inflammation in eyes with a foldable hydrophobic acrylic IOL implanted through a small incision and those with a rigid HSM PMMA IOL. Postoperative inflammation results indicate that the lenses are equally suitable for the use in patients with diabetic retinopathy.