Anton Haas

Ozurdex® reduces the retinal thickness in radiation maculopathy refractory to bevacizumab

pathognomonic for classic WD. He was diagnosed with kidney sarcoidosis before the WD diagnosis and was pharmacologically immunosuppressed. After the patient had his first cataract surgery performed, a severe mostly posterior uveitis was diagnosed. It did not respond to neither topical nor systemic immunosuppressive treatment. Case reports have described uveitis after intraocular operations in patients unknown to have WD, only diagnosed later on by vitreous samples. It is uncertain whether it is the operation in itself or the use of post-operative topical steroids that provokes the development of uveitis in these WD patients (Drancourt et al. 2009). In parallel with the eye problems, the patient developed significant neurological symptoms indicating involvement of the brain. WD is a fascinating disease entity with a wide range of clinical manifestations and has been considered to be an extremely rare disease (Raoult et al. 2000). This makes it difficult for clinicians to identify cases, especially the non-classic cases, with more atypical symptoms and findings. New data indicate that Tropheryma whipplei is ubiquitous in the environment (Maiwald et al. 1998). Clinicians treating patients with diffuse symptoms involving the brain and the eyes should not forget about this very rare disease which can be treated effectively with antibiotics.

Combination treatment of photodynamic therapy with verteporfin and intravitreal ranibizumab in patients with retinal angiomatous proliferation.

Purpose:  To investigate the efficacy and safety of initial photodynamic therapy (PDT) with a ranibizumab loading dose of three monthly intravitreal injections and a subsequent PRN ranibizumab regimen in the treatment of retinal angiomatous proliferation (RAP).

Association of Preoperative Optical Coherence Tomography Markers with Residual Inner Limiting Membrane in Epiretinal Membrane Peeling

Purpose To identify preoperative markers on spectral domain optical coherence tomography (SD-OCT) for residual inner limiting membrane (ILM) in epiretinal membrane (ERM) peeling. Methods In this retrospective case series the preoperative SD-OCTs from 119 eyes of 119 consecutive patients who underwent surgery for idiopathic ERM by a single surgeon were evaluated for markers predisposing for ILM persistence after ERM removal. ILM persistence was determined via intraoperative indocyanine green staining. The main outcome measures were correlation of central foveal thickness (CFT), ERM thickness, extent of elevated ERM and retinal folding, intraretinal cysts, and discontinuation of the ERM, with ILM persistence after ERM peeling. Results The persistence of the ILM was found in 50.4% (n = 60). After Bonferroni correction for multiple testing, a greater extent of elevated ERM and thicker ERMs were associated with persistence of the ILM (p<0.005). The other parameters showed no statistically significant correlations with the persistence of the ILM (p≥0.005). Conclusion Residual ILM can be found in nearly half of the eyes after ERM peeling. A loose connection between the ERM and the retinal surface predisposes for ILM persistence. Preoperative SD-OCT is helpful in identifying risk markers for the persistence of the ILM in ERM surgery.

High-Density Lipoprotein Function in Exudative Age-Related Macular Degeneration.

Purpose High-density lipoproteins (HDL) have long been implicated in the pathogenesis of age-related macular degeneration (AMD). However, conflicting results have been reported with regard to the associations of AMD with HDL-cholesterol levels. The present study is the first to assess HDL composition and metrics of HDL function in patients with exudative AMD and control patients. Methods Blood samples were collected from 29 patients with exudative AMD and 26 age-matched control patients. Major HDL associated apolipoproteins were determined in apoB-depleted serum by immunoturbidimetry or ELISA, HDL-associated lipids were quantified enzymatically. To get an integrated measure of HDL quantity and quality, we assessed several metrics of HDL function, including cholesterol efflux capacity, anti-oxidative and anti-inflammatory activities using apoB-depleted serum from study participants. Results In our study, we observed that the HDL associated acute phase protein serum amyloid A (SAA) was significantly increased in AMD patients (p<0.01), whereas all other assessed apolipoproteins including ApoA-I, apoA-II, apoC-II, apoC-III and apoE as well as major HDL associated lipids were not altered. HDL efflux capacity, anti-oxidative capacity and arylesterase activity were not different in AMD patients when compared with the control group. The ability of apoB-depleted serum to inhibit monocyte NF-κB expression was significantly improved in AMD patients (mean difference (MD) -5.6, p<0.01). Moreover, lipoprotein-associated phospholipase A2 activity, a marker of vascular inflammation, was decreased in AMD subjects (MD -24.1, p<0.01). Conclusions The investigated metrics of HDL composition and HDL function were not associated with exudative AMD in this study, despite an increased content of HDL associated SAA in AMD patients. Unexpectedly, anti-inflammatory activity of apoB-depleted serum was even increased in our study. Our data suggest that the investigated parameters of serum HDL function showed no significant association with exudative AMD. However, we cannot exclude that alterations in locally produced HDL may be part of the AMD pathogenesis.

Surgical and Nonsurgical Treatment of Pre-retinal Hemorrhages

Pre-retinal and sub-inner limiting membrane (ILM) hemorrhages are defined as extravasal blood under the posterior hyaloid and under the ILM, respectively. Causes include Terson’s syndrome, valsalva retinopathy, proliferative diabetic retinopathy, and proliferative retinopathy after retinal vein occlusions. Pre-retinal hemorrhages themselves often resolve spontaneously without sequel. However, this can take many months during which the patient might remain severely visually impaired. The treatments commonly used to expedite the recovery are Nd:YAG membranotomy and vitrectomy. Nd:YAG membranotomy punctures the membrane that confines the blood in front of the retina and releases it into the vitreous where it rapidly dilutes. It should be performed within about 1 month from symptom onset. After that the blood has likely clotted and tends to be refractory to a Nd:YAG membranotomy. In these cases and in the presence of additional pathologies that need to be surgically addressed, a vitrectomy should be considered. A vitrectomy is the most reliable way to remove the hemorrhage and allows for additional procedures such as intraoperative photocoagulation, membrane peeling, tamponades, and intravitreal drug delivery.

Apoptotic death ligands and interleukins in the vitreous of diabetic patients

ZusammenfassungHINTERGRUND: Um den Einfluss der Apoptose in der Pathogenese der diabetischen Retinopathie zu untersuchen, wurden Glaskörper-Konzentrationen von Fas ligand (FasL), tumor necrosis factor alpha (TNF-α), lymphotoxin alpha (LT-α) and interleukin 1beta (IL-1β) bei Diabetikern und Nicht-Diabetikern bestimmt. MATERIAL UND METHODEN: In der vorliegenden Fall-Kontroll-Studie wurde die Messung der Glaskörper-Konzentrationen der Apoptose-Faktoren FasL, TNF-α, LT-α and IL-1β unter Verwendung Cytometric Bead Array-Technologie bei 48 Patienten mit Diabetes mellitus (8 nicht-Insulin-abhängigen, 40 insulinpflichtig) und 24 nicht-diabetischen Kontrollpersonen vorgenommen. ERGEBNISSE: Im Glaskörper waren die apoptotischen Faktoren FasL, TNF-α, LT-α and IL-1β weder in den diabetischen Patienten noch in den nicht-diabetischen Kontrollen nachweisbar. SCHLUSSFOLGERUNG: In dieser Studie konnte keine Hochregulation FasL, TNF-α, LT-α and IL-1β im Glaskörper von diabetischen Patienten nachgewiesen werden.SummaryBACKGROUND: To investigate the role of apoptosis in the pathogenesis of diabetic retinopathy we determined vitreous concentrations of Fas ligand (FasL), tumor necrosis factor alpha (TNF-α), lymphotoxin alpha (LT-α) and interleukin 1beta (IL-1β) in diabetic patients and non-diabetic control subjects. MATERIAL AND METHODS: In the present case-control study measurement of vitreous concentrations of the four apoptosis-related factors FasL, TNF-α, LT-α and IL-1β was performed using Cytometric Bead Array technology in 48 patients with diabetes mellitus (8 non-insulin dependent, 40 insulin dependent) and 24 non-diabetic control subjects. RESULTS: FasL, TNF-α, LT-α and IL-1β were not detectable in the vitreous of neither diabetic nor non-diabetic controls samples. CONCLUSION: This study suggests that there is no up-regulation of FasL, TNF-α, LT-α and IL-1β in the vitreous of diabetic patients.

Morbiditätsrate bei Durchblutungsstörungen am Auge

ZusammenfassungDiese retrospektive Fallkontrollstudie erhob die Morbidität von 410 Patienten mit Durchblutungsstörungen am Auge.Es handelte sich dabei um Patienten mit retinalen Arterienverschlüssen (RAV), retinalen Venenverschlüssen (RVV) und der nichtarteriitischen ischämischen Optikusneuropathie (NAION). Die Ergebnisse zeigen, dass Patienten mit Zirkulationsstörung am Auge öfter an Hypertonus (58,8%), Diabetes mellitus (25,6%) und Hypercholesterinämie (64,4%) leiden; der Anteil der Raucher (38,8%) liegt weit über dem Durchschnitt. Die Patienten erlitten häufiger einen Myokardinfarkt (12,0%) und einen zerebralen Insult (11,0%).Die Resultate lassen den Schluss zu, dass Durchblutungsstörungen am Auge ein Indikator für eine erhöhte Morbidität und eine schlechte kardiovaskuläre Situation sind.SummaryThis study aimed at comparing the morbidity of 410 patients with ocular circulatory disturbances such as retinal artery occlusion (RAO), retinal vein occlusion (RVO) and nonarteritic anterior ischaemic optic neuropathy (NAION) with that of an age-matched population.In this retrospective case-control study the results were obtained from 410 patients, who had been diagnosed with ocular vascular occlusion.Our results indicate that patients with vascular occlusions of the eye more frequently suffer from hypertension (58.8%), diabetes mellitus (25.6%), and hypercholesterolaemia (64.4%), and are often found to be smokers (38.8%). Overall, the patients are more likely to suffer from myocardial infarction (12.0%) or cerebral insult (11.0%).The results confirm that ocular circulatory disturbances are indeed an indicator of raised morbidity and a generally deteriorated vascular system.