E. Matthé

The regulatory role of prostaglandin E2 in liver (patho) physiology is controlled at its site of synthesis and its action on the receptors

Among the hormone class of the eicosanoids, PGE2 plays a predominant role in liver (patho) physiology. Liver-specific responses, like regulation of blood glucose homeostasis, sinusoidal blood flow within the liver, properties of the transendothelial barrier within the liver, synthesis and release of important other mediators like cytokines, growth factors or nitric oxide, and liver fibrogenesis have been shown to be mediated or regulated by PGE2 [1]. Within the liver, the main producers of PGE2 are the Kupffer cells. The synthesis of PGE2 in Kupffer cells is controlled at multiple levels. The action of PGE2 on its target cells is mediated by 4 classes of PGE2 receptors (EP1, EP2, EP3, EP4). Each of these receptors converts the information of PGE2 by different intracellular signal pathways to a specific cellular response [2].

Retinal venous pressure is higher than the airway pressure and the intraocular pressure during the Valsalva manoeuvre

The aims of this prospective experimental study were to explore the influence of the Valsalva manoeuvre (VM) on retinal venous pressure (RVP) in human volunteers in a university setting and to establish correlations for RVP with the increase in airway pressure (∆AirP) and in intraocular pressure (∆IOP).

Effectiveness of Intravitreal Aflibercept Injections in Patients who had Received 10 and More Ranibizumab Injections in Advance

BACKGROUND Since 2007, the standard treatment for age related macular degeneration has been intravitreal injection of ranibizumab. However, despite continuous treatment, some patients fail to achieve remission or stabilisation of the disease. Since 2012, the recombinant fusion protein aflibercept has been available as an alternative treatment. In this study, we investigated whether patients who appear to be resistant to ranibizumab would benefit from treatment with aflibercept. METHODOLOGY This retrospective study covered 83 eyes of 81 patients, for whom treatment switch from ranibizumab to aflibercept was indicated. Inclusion criteria were an age ≥ 50 years and at least 10 ranibizumab injections before a switch to aflibercept. Patients with severely impaired visual acuity were excluded. Primary outcomes were improvement or loss of visual acuity (VA) and evaluation of central macular thickness (CMT) via SD-OCT. Secondary endpoints were percentage of eyes without activity of the choroidal neovascular membrane after aflibercept injections and loss or gain of letters on the visual chart. Statistical analysis was performed using SPSS. RESULTS VA was 0.83 ± 0.34 logMAR before the first aflibercept injection, with a slight but not statistically significant improvement up to 0.79 ± 0.33 logMAR after the third aflibercept injection (p = 0.205). On the other hand, there was a clear reduction of CMT in OCT, from 451.4 ± 263.0 to 288.2 ± 128.2 µm (p = 0.0001). Overall, 73 % of eyes exhibited better or stable VA and 27 % of eyes lost VA. Interestingly, eyes with worse initial VA gained greater benefit from the switch to aflibercept (p = 0.001). CONCLUSION A switch to aflibercept may lead to stabilisation of choroidal neovascularisation and thus stabilise the visual acuity for patients who appear to be no longer responsive to treatment with ranibizumab.

Retinal Changes in Different Grades of Retinal Artery Occlusion: An Optical Coherence Tomography Study

Purpose To investigate layer-by-layer changes in retinal thickness and reflectivity regarding the severity grade of acute retinal artery occlusion (RAO) using spectral-domain optical coherence tomography (SD-OCT). Methods This study is a retrospective, observational case-control series that took place in an institutional setting and included 148 eyes from 74 patients diagnosed with acute RAO (central or branch). SD-OCT examinations were taken at baseline. Based on OCT findings, RAO was categorized into three grades (incomplete, subtotal, total). The thickness and reflectivity of selected retinal layers were measured from SD-OCT images. The data were compared across the three grades and against the contralateral eyes (controls). The main outcome measures were thickness and reflectivity of selected retinal layers. Results The thickness of the inner and middle retinal layers differed significantly across the three RAO groups (P < 0.001), whereas the outer retinal layer thickness remained not significantly different. Reflectivity values showed statistically significant differences in the inner, middle, and outer retinal layers, but not in the vitreous body (P < 0.001). Conclusions The reflectivity changes of selected retinal layers differ significantly regarding different grades of RAO. SD-OCT reflectivity measurement may be used as a noninvasive method to estimate the grade of retinal ischemia in RAO.

Plötzlicher schmerzloser Visusabfall bei einem Neunjährigen

Der Visus am LA war unkorrigiert auf 0,05 reduziert, Gläser besserten nicht. AmRAbetrug derVisus sc 1,25. Die vorderen Augenabschnitte waren beidseits unauffällig, Tensio beidseits normoton. Die Untersuchung der Augenhinterabschnitte zeigte an beiden Augen (L>R) eine bräunlich gesprenkelt erscheinende Pigmentveränderung imZentrumder Makula (. Abb. 1). Sehnerv und Netzhautperipherie erschienen unauffällig.

Late Stage III Retinal Angiomatous Proliferation with Retino-ChoroidalAnastomosis do not Respond Well to Treatment with Ranibizumab (Lucentisî)

Background: Retinal Angiomatous Proliferations (RAP) is a subgroup of exsudative or “wet” Age-related Macular Degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal Ranibizumab provides a good therapy, but is considered to be not as effective in this class of neovascularization compared to choroidal neovascularization (CNV). We investigated the efficacy of Ranibizumab in late stage III RAP with retino-choroidal anastomosis compared to the outcome of CNV lesions. Methods: Retrospective analysis of the data of all for wAMD with Ranibizumab treated patients. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV types (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. Best-corrected visual acuity (BCVA) was obtained before (“diagnosis”), during (1st, 2nd and 3rd injection) and after upload (“1st control”). Results: Before first injection the visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there is no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). Conclusion: Clinically identified late stage III RAP lesions with retino-choroidal anastomosis respond worse to treatment with monthly Ranibizumab than all other lesion types regardless of their severity. Treatment results in stabiliziation of visual acuity, but – in contrast to other forms of CNV – no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.

Methotrexat bei atypischer nicht arteriitischer anteriorer ischämischer Optikusneuropathie

Background: Optic nerve disease can occur from a variety of different causes, with vascular, inflammatory or toxic pathologies. In such cases, it is hardly possible to clarify the aetiology. These diseases of the optic nerve are usually accompanied by progressive loss of visual field and visual impairment. Patient: We report a case of a 74-year-old woman complaining of loss of visual acuity, visual and blurred vision in the left eye in 2010. We made the diagnosis of non-arteritic ischemic optic neuropathy (NAION). With steroid therapy, there was an improvement in both visual acuity and visual field defects. But if an attempt was made to reduce steroids, her condition progressed. Except for a very small optic disk and arterial hypotension, there were no typical risk factors for NAION. We started treatment with methotrexate (MTX), with a starting dose of 10 mg per week, and observed the patient over two years. Results: Using MTX therapy, the swelling of the optic nerve head and visual field loss were reversible, so we increased the dose of MTX up to 15 mg/week. Steroid therapy could be stopped and the patients visual acuity and visual field have now been stable for two years. There was no visible pallor in the optic nerve head, as normally occurs after AION, so we considered different underlying pathologies, including autoimmune disease. There were no adverse events with MTX therapy. Conclusion: If the course of the disease is atypical, the pathology may include an autoimmune component. Immunosuppressive MTX therapy may be started in order to avoid long-term steroid use. It may then be possible to maintain a stable visual field and prevent remitting episodes.

Visusabfall bei seltenem Sehnerventumor@@@Visual impairment due to rare optic nerve tumor

A 49-year-old male patient presented with acute symptoms of reduced vision and relative afferent pupillary defects. Static perimetry testing revealed severe visual field defects and the diagnosis of neuritis of the optic nerve was suspected. A magnetic resonance imaging (MRI) scan was performed and showed an intraocular right-sided semicircular mass around the optic nerve which was partially calcified in computer tomography (CT). The diagnosis of an optic nerve sheath meningioma was made. The visual acuity and visual field defects improved under therapy with prednisolone. Therapeutic options were discussed in an interdisciplinary board but no intervention is planned so far and only regular follow-up controls have been arranged.

Visual impairment due to rare optic nerve tumor

A 49-year-old male patient presented with acute symptoms of reduced vision and relative afferent pupillary defects. Static perimetry testing revealed severe visual field defects and the diagnosis of neuritis of the optic nerve was suspected. A magnetic resonance imaging (MRI) scan was performed and showed an intraocular right-sided semicircular mass around the optic nerve which was partially calcified in computer tomography (CT). The diagnosis of an optic nerve sheath meningioma was made. The visual acuity and visual field defects improved under therapy with prednisolone. Therapeutic options were discussed in an interdisciplinary board but no intervention is planned so far and only regular follow-up controls have been arranged.

Visusabfall bei seltenem Sehnerventumor

A 49-year-old male patient presented with acute symptoms of reduced vision and relative afferent pupillary defects. Static perimetry testing revealed severe visual field defects and the diagnosis of neuritis of the optic nerve was suspected. A magnetic resonance imaging (MRI) scan was performed and showed an intraocular right-sided semicircular mass around the optic nerve which was partially calcified in computer tomography (CT). The diagnosis of an optic nerve sheath meningioma was made. The visual acuity and visual field defects improved under therapy with prednisolone. Therapeutic options were discussed in an interdisciplinary board but no intervention is planned so far and only regular follow-up controls have been arranged.