Bettina Hohberger

Cereblon is expressed in the retina and binds to voltage-gated chloride channels

MINT‐6823070: CIC‐2 (uniprotkb:O54822) physically interacts (MI:0218) with CRBN (uniprotkb:Q0P564) by two hybrid (MI:0018) MINT‐6823160, MINT‐6823197: CIC‐2 (uniprotkb:O54822) physically interacts (MI:0218) with CRBN (uniprotkb:Q56AP7) by pull down (MI:0096) MINT‐6823105: CIC‐2 (uniprotkb:O54822) physically interacts (MI:0218) with IK (uniprotkb:A4FUY8) by two hybrid (MI:0018)

ICE-Syndrome: A Case Report of Implantation of a Microbypass Xen Gel Stent After DMEK Transplantation

Purpose: Treatment of glaucoma eyes with iridocorneal endothelial syndrome is complex. Minimally invasive glaucoma surgery, such as one that implements a novel, microinvasive device, known as Xen gel stents, has shown promise in surgical glaucoma treatment and offers a new therapeutic option. Methods: This is a case report. Results: A successful implantation of Xen45 gel stent in a woman with secondary glaucoma due to unilateral iridocorneal endothelial syndrome after descement membrane endothelial keratoplasty operation, and the follow-up are presented. Conclusions: Implantation of Xen gel stents may be a promising option for minimally invasive glaucoma surgery in difficult situations, as low adverse effects, good postsurgery visual acuity and sufficient regulation of intraocular pressure can be seen.

Choroidal Neovascularization Associated with Punctate Inner Choroidopathy: Combination of Intravitreal Anti-VEGF and Systemic Immunosuppressive Therapy

Purpose: Choroidal neovascularization (CNV) associated with punctate inner choroidopathy (PIC) is a rare clinical entity, yet still a challenge for medical treatment. A case of a young myopic woman developing CNV secondary to unilateral PIC is presented. Clinical morphology, diagnostic procedure and follow-up are reported. Case Report: A 29-year-old woman presented with multiple yellowish dots at the posterior pole. No other signs of inflammation could be seen. Angiography with fluorescein yielded hyperfluorescent signals in the affected areas with a diffuse leak, and SD-OCT showed a slightly elevated retinal pigment epithelial layer, consistent with the diagnosis of PIC. Additionally a classic CNV was observed. Results: Anti-inflammatory therapy with local prednisolone acetate eye drops in combination with intravitreal injection of anti-vascular endothelial growth factor (VEGF, bevacizumab) yielded an increased best-corrected visual acuity. As CNV reappeared, systemic medication with prednisone and azathioprine in combination with two further intravitreal injections of anti-VEGF stabilized CNV and increased visual acuity again. Conclusion: Combined therapy of immunosuppression with intravitreal anti-VEGF injections can be considered as therapeutic strategy in the management of recurrent CNV associated with PIC.

Frequency dependency of temporal contrast adaptation in normal subjects

The aim of this study was to determine the influence of temporal frequency of temporal contrast adaptation on contrast sensitivity in healthy subjects. Temporal contrast sensitivities (TCS) were measured monocularly in seven healthy subjects with a modified ERG full-field bowl stimulator at eight different test temporal frequencies (9, 15, 20, 25, 31, 37, 44, 51 Hz) using a two-alternative-forced-choice strategy. Before each presentation of the test stimulus, a 100% contrast adapting flicker stimulus was presented (frequencies: 9, 15, 20, 25, 31, 37, 44, 51, 100 Hz). At each adapting frequency, a complete set of TCSs was measured. All temporal contrast sensitivities decreased with increasing temporal frequencies. Adaptation led to a general temporal contrast sensitivity decrease. Largest adaptation effects were seen at an adaptation frequency of 25 Hz. Reduction of contrast sensitivity was significantly larger at 25 Hz adaptation than at 9 Hz adaptation (t-test of paired samples, Bonferroni corrected). The results of this study showed a general TCS decrease with the largest effect at an adaptation frequency of 25 Hz. This finding indicates that the contrast adaptation probably occurred in the magnocellular-pathway. In future clinical studies adaptation effects could be investigated in patients with reduced temporal contrast sensitivity.

Glaucoma: Confrontation visual field test using Bagolini striated glasses — a new screening method for detecting visual field defects

INTRODUCTION. Glaucoma diagnosis is based on elevated intraocular pressure, altered morphology of the optic disc, and perimetric visual field defects. Next to funduscopy and optical coherence tomography, perimetric data are important. In developing countries, large parts of the population have only limited access to medical care. Especially in these cases, a quick and affordable method for detecting visual field defects would be desirable. The aim of this study was to investigate the potential use of Bagolini striated glasses in detecting glaucomatous visual field defects. MATERIALS AND METHODS . Ninety subjects of the Erlangen Glaucoma Register (ISSN 2191-5008, CS-2011. ClinicalTrials.gov, Identifier: NCT00494923) were tested using the confrontation visual field test with Bagolini striated glasses [10 normals, 17 ocular hypertensions (OHT), 31 preperimetric open-angle glaucomas (preOAG), 16 normal tension glaucomas (NTG), 16 open-angle glaucomas (OAG)]. All probands underwent standard ophthalmological examination including slit-lamp biomicroscopy, funduscopy, and Goldmann-tonometry. Additionally, standard white-on-white perimetry and measurements of the global retinal nerve fibre layer (RNFL) of the optic disc were performed. RESULTS. 1. All normals, all OHTs, and 96% of preOAGs showed normal Bagolini test results. 2. 74% of NTGs and 73% of OAGs yielded pathological Bagolini test results. 3. Specificity of patients with normal visual fields was 98% and sensitivity was 73–80%. 4. Visual field defects resulted in altered Bagolini test results. 5. Localised visual field defects were detected in 78% (NTG) and 80% (OAG) using Bagolini striated glasses. CONCLUSIONS. Glaucoma-related visual field defects can be detected by confrontation visual field testing using Bagolini striated glasses. This quick, easily performed, and affordable method can be used as a bedside test and is suitable as a screening method for persons in developing countries.

Temporal contrast sensitivity: A potential parameter for glaucoma progression, especially in advanced stages

INTRODUCTION. Previously it could be shown that temporal contrast sensitivity is affected by glaucoma and maximally influenced after 25-Hz adaptation in normals. This study investigated different kinds of 25-Hz temporal contrast adaptation on TCS in patients with ocular hypertension, preperimetric primary open-angle glaucoma, and perimetric open-angle glaucoma. Additionally, correlations of measured data with parameters of glaucoma diagnostic were done and assessed for the potential use of TCS as a parameter for glaucoma progression. MATERIALS AND METHODS. One hundred and four subjects were included: 44 normals, 14 ocular hypertensions, 11 preperimetric primary open-angle glaucomas, and 35 perimetric open-angle glaucomas. Using the Erlangen Flicker Test, temporal contrast sensitivity was measured without adaptation, after pre-adaptation and after pre- and re-adaptations at 25 Hz. Reliability analyses were done. RESULTS. All test strategies showed high reliability (a-Cronbach’s > 0.86). In normals, age-dependency of temporal contrast sensitivity without adaptation (p = 0.052) and after pre- and re-adaptation (p = 0.008) was observed. Temporal contrast sensitivity is significantly reduced after pre-adaptation for all subjects (p < 0.001). Reduction of temporal contrast sensitivity after pre- and re-adaptations was significant in all groups (p < 0.001), but it was smaller than after single pre-adaptation (p < 0.001). Temporal contrast sensitivity without adaptation was significantly reduced in patients with perimetric glaucoma (p = 0.040) but not in patients with ocular hypertension and preperimetric glaucoma. Correlation analyses yielded a significant correlation between temporal contrast sensitivity without adaptation and mean defect (p = 0.003, r = –0.329), loss variance (p = 0.027, r = –0.256), and retinal nerve fibre layer thickness (p < 0.001, r = 0.413) for all subjects and between temporal contrast sensitivity after pre-adaptation and mean defect (p = 0.045, r = –0.239). CONCLUSIONS. Temporal contrast sensitivity seems to be affected in perimetric glaucoma with an overall reduction after adaptation. Significant correlations of temporal contrast sensitivity with perimetric and morphologic parameters offer new aspects of its potential use as a glaucoma progressions marker, especially in advanced stages when perimetric diagnosis is limited.

Fettstoffwechselstörungen und Glaukom

Endothelial dysfunction and vascular dysregulation play a role in the multifactorial pathogenesis of glaucomatous optic nerve atrophy. Dyslipidaemia as a risk factor for endothelial dysfunction is associated with glaucoma and cardiovascular morbidity and mortality. In additional to a genetic disposition, a potential mechanism for the pathogenesis of endothelial dysfunction could be an additive effect of several risk factors, like dyslipidaemia, smoking, arterial hypertension, diabetes and hyperhomocysteinaemia. This paper reviews the literature concerning the association between dyslipidaemia and glaucomatous disease and explains the possible role of dyslipidaemia for the pathogenesis and progression of glaucoma. The role of exogeneous modifiable risk factors for prevention and therapy of glaucoma and their neutralisation by changing life style like weight reduction, modifications of nutrition and physical activity, are discussed.

Netzhautdystrophie mit Nierenerkrankung

Ein 15-jähriges Mädchen wurde konsiliarisch zur Mitbeurteilung aus der Kinderklinik in der Augenklinik des Universitätsklinikums Erlangen vorgestellt. Die Patientin habe bereits im Kleinkindesalter keine Fixation aufnehmen können und war auf beiden Augen Zeit ihres bisherigen Lebens blind. Eine elektrophysiologische Untersuchung (Elektroretinogramm [ERG]) im Rahmen einer Narkoseuntersuchung im Säuglingsalter erbrachte weder skotopisch, noch photopisch eindeutige Potenziale bis zur maximalen Intensität. Im Alter von 9 Jahren war aufgrund einer unklaren Nierendysplasie eine Nierenbiopsie durchgeführt worden, bei welcher die Diagnose einer Nephronophthisis gestellt wurde. In einer gendiagnostischen Untersuchung konnte eine homozygote Mutation NPHP-5 nachgewiesen werden. In den folgenden Jahren hatte sich die Funktion der Niere zunehmend eingeschränkt, sodass eine Nierentransplantation durchgeführt werden musste. Aktuell habe die Patientin Gammunex bei Zustand nach rezidivierenden Borderline-Abstoßungen erhalten.

Levels of aqueous humor trace elements in patients with open-angle glaucoma

PURPOSE Trace elements might play a role in the complex multifactorial pathogenesis of open-angle glaucoma. The aim of this study was to analyze concentrations of trace elements in aqueous humor samples of patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS Thirty-three aqueous humor samples were obtained from patients undergoing cataract surgery: 12 patients with POAG (age 65.3±10.50, female 8, male 4), 10 patients with PEXG (age 65.9±11.27, female 6, male 4) and 11 patients without glaucoma (age 69.5±13.70, female 7, male 4) serving as controls. Aqueous humor levels of cadmium, iron, manganese, cobalt, copper and zinc were measured by Flow-Injection-Inductively-Coupled-Plasma-Mass-Spectrometry (FI-ICP-MS). RESULTS From the statistical evaluation, we observed that patients with POAG had significantly higher aqueous humor levels of zinc (p=0.006) compared to controls. Increased aqueous humor levels of zinc were also observed in patients with PEXG in relation to control (p=0.0006). For iron we observed a significantly reduction in PEXG compared to control (p=0.002) and a significant difference between POAG and PEXG (p=0.0091). No significant differences were observed in aqueous humor levels of manganese, cobalt, copper, cadmium between glaucoma and control patients. No differences were seen for iron (POAG vs. controls). Analysis of trace element ratios was added. CONCLUSION Significant differences in aqueous humor levels of zinc and iron between glaucoma and control patients support the hypothesis that these trace elements are involved in the pathogenesis of open-angle glaucoma.

Aqueous humor selenium level and open-angle glaucoma

PURPOSE Selenium supplementation was seen to be linked to glaucoma disease in a previous study (Lillico A. JE, Reid M et al. (2002) Selenium Supplementation and Risk of Glaucoma in the NPC trial University of Arizona, Tucson, AZ., Arizona Cancer Center). As aqueous humor levels of selenium seemed to be associated with primary open-angle glaucoma (POAG), the aim of this study was to analyze concentrations of selenium in aqueous humor samples of patients with POAG and pseudoexfoliation glaucoma (PEXG) in comparison to normal samples. PATIENTS AND METHODS Thirty-eight aqueous humor samples from patients undergoing cataract surgery were collected: Eleven patients with PEXG (age 65.8 ± 10.69, female 6, male 5), 12 patients with POAG (age 65.3 ± 10.50, female 7, male 5) and 15 patients without glaucoma (age 70.9 ± 12.83, female 10, male 5, controls). Aqueous humor levels of selenium were measured by Flow-Injection-Inductively-Coupled-Plasma-DRC-Mass-Spectrometry (ICP-DRC-MS). RESULTS Maximum likelihood estimation of the least squares means (LS-means) and the relative 95% confidence limits of selenium aqueous humor levels were 6.90 ± 1.03 μg/L (control), 6.74 ± 1.14 μg/L (POAG) and 8.25 ± 1.18 μg/L (PEXG). The data were modeled using a generalized linear model (GLM) analysis, where selenium was set as dependent variable. The model was corrected for group differences in age and gender. The data show no differences among all the calculated differences between the least square means (LS means), taking in consideration the simultaneous 95% confidence limit and the multiple comparison tests with Tukey-Cramer adjustment. The evaluation of the model disclosed that POAG and PEXG patients had no significantly different aqueous humor selenium concentrations compared to controls and to each other. However, the quantile regression analysis of selenium aqueous humor levels showed differences in quantiles for open-angle glaucoma patients considering age and gender. CONCLUSION As no significant difference in aqueous humor concentration of selenium was detected between open-angle glaucoma and controls, however, quantile analysis showed differences in quantiles levels for different age ranges in open-angle glaucoma patients, the trace element selenium seemed to be linked to glaucoma disease, yet not in a major role.