Elisabet Granstam

Effects of endothelins (ET-1, ET-2 and ET-3) in the rabbit eye; role of prostaglandins

The effects of intracameral injection of three endothelin isopeptides (ET-1, ET-2 and ET-3) were studied in the rabbit eye. All three peptides at pmol doses caused a dose-dependent rise in intraocular pressure (IOP) and an increase in protein concentration in the aqueous humor, indicating breakdown of the blood-aqueous barrier. Mean arterial blood pressure was not affected. ET-1 was more effective to increase IOP than were ET-2 and ET-3 whose effects seemed to be equal. ET-1 also caused vasodilation in the anterior uvea. The effects of ET-1, ET-2 and ET-3 on the IOP and blood-aqueous barrier, as well as the effects of ET-1 on regional blood flow in the eye, were abolished by pretreatment with indomethacin. Injection of 4 pmol ET-1 into the anterior chamber caused an increase in the concentration of prostaglandin E2 (PGE2) in the aqueous humor, most probably as a result of increased production of PGE2 in the anterior uvea. The results indicate that the effects of ET-1, ET-2 and ET-3 in the rabbit eye are to a large extent mediated by arachidonic acid metabolites.

Non-adrenergic sympathetic vasoconstriction in the eye and some other facial tissues in the rabbit

The effects of unilateral sympathetic nerve stimulation (SNS) on regional blood flow in the rabbit were studied with radioactive microspheres. SNS at 10 or 4 Hz caused an approximately 60% reduction in choroidal blood flow, which was partly resistant to alpha-adrenoceptor blockade with phenoxybenzamine. The vasoconstriction evoked by SNS at 2 Hz was completely abolished by alpha-adrenoceptor blockade. A similar response was seen in the iris, ciliary body, masseter muscle and lacrimal gland. In the harderian gland, however, SNS (2 Hz) after alpha-adrenoceptor blockade caused a significant reduction in blood flow. In the salivary glands, combined beta- and alpha-adrenoceptor blockade with propranolol and phenoxybenzamine revealed a slight non-adrenergic vasoconstriction during SNS at 10 Hz; however, the blood flow was significantly increased during SNS at 4 and 2 Hz following alpha-adrenoceptor blockade. These results indicate that there is a frequency-dependent, non-adrenergic component in the sympathetic vasoconstriction of the eye and several facial tissues. In the salivary glands, beta-adrenoceptor-mediated vasodilatation tends to mask a non-adrenergic vasoconstriction.

Endothelin-induced changes in blood flow in STZ-diabetic and non-diabetic rats: relation to nitric oxide synthase and cyclooxygenase inhibition

In this study, using the microsphere method, the hemodynamic response to endothelin-1 (ET-1) in healthy and streptozotocin (STZ)-diabetic rats was evaluated as well as the influences of inhibition of nitric oxide (NO)-synthase using L-NAME (Nω-nitro-l-arginine methyl ester) and the cyclooxygenase inhibitor indomethacin. Blood flow (Q) was measured in tissues of interest for vascular complications in diabetes such as kidney, eye, brain, heart and skeletal muscle with the main focus on ophthalmic circulation. Under resting conditions, evidence for renal vasoconstriction was found in diabetic animals. In both groups, administration of L-NAME reduced Q in all investigated tissues indicating a basal NO influence. In the normal rats, ET-1 induced a significant increase in blood pressure and intense vasoconstriction in all tissues except in the choroid of the eye and in the brain, where it induced an increased Q. In the STZ-diabetic rats, effects of ET-1 were less pronounced. Pretreatment with L-NAME, but not the cyclooxygenase inhibitor, abolished the ET-1-induced vasodilation in the choroid of both groups. Administration of ET A receptor antagonist BQ-123 reduced the ET-1-induced vasodilation in the choroid only in diabetic animals. In conclusion, evidence for altered vascular endothelial response to ET-1 in STZ-diabetic animals was found particularly in the ophthalmic circulation. The findings suggest differential involvement of receptors in the response to ET-1 in normal and STZ-diabetic animals.

Patient-reported outcomes and visual acuity after 12 months of anti-VEGF-treatment for sight-threatening diabetic macular edema in a real world setting

AIMS To examine objective visual acuity measured with ETDRS, retinal thickness (OCT), patient reported outcome and describe levels of glycated hemoglobin and its association with the effects on visual acuity in patients treated with anti-VEGF for visual impairment due to diabetic macular edema (DME) during 12months in a real world setting. METHODS In this cross-sectional study, 58 patients (29 females and 29 males; mean age, 68years) with type 1 and type 2 diabetes diagnosed with DME were included. Medical data and two questionnaires were collected; an eye-specific (NEI VFQ-25) and a generic health-related quality of life questionnaire (SF-36) were used. RESULTS The total patient group had significantly improved visual acuity and reduced retinal thickness at 4months and remains at 12months follow up. Thirty patients had significantly improved visual acuity, and 27 patients had no improved visual acuity at 12months. The patients with improved visual acuity had significantly improved scores for NEI VFQ-25 subscales including general health, general vision, near activities, distance activities, and composite score, but no significant changes in scores were found in the group without improvements in visual acuity. CONCLUSIONS Our study revealed that anti-VEGF treatment improved visual acuity and central retinal thickness as well as patient-reported outcome in real world 12months after treatment start.

Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery.

To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery.

Visual functioning and health-related quality of life in diabetic patients about to undergo anti-vascular endothelial growth factor treatment for sight-threatening macular edema

PURPOSE To examine patient-reported outcome (PRO) in a selected group of Swedish patients about to receive anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). MATERIAL AND METHODS In this cross-sectional study, 59 patients with diabetes mellitus, who regularly visited the outpatient eye-clinics, were included. Sociodemographic and clinical data were collected and the patients completed PRO measures before starting anti-VEGF treatment. PRO measures assessed eye-specific outcomes (NEI-VFQ-25) and generic health-related quality of life (SF-36). RESULTS The participants consisted of 30 men and 29 women (mean age, 68.5years); 54 (92%) patients had type 2 diabetes; 5 (9%) patients had moderate or severe visual impairment; 28 (47%) were classified as having mild visual impairment. Some of the patients reported overall problems in their daily lives, such as with social relationships, as well as problems with impaired sight as a result of reduced distance vision. CONCLUSIONS Further studies are needed to investigate PRO factors related to low perceived general health in this patient population. It is important to increase our understanding of such underlying mechanisms to promote improvements in the quality of patient care.

Gastric bypass surgery does not increase the risk for sight-threatening diabetic retinopathy

To study the occurrence and level of diabetic retinopathy (DRP) before and after planned bariatric surgery and to investigate potential risk factors for deterioration of DRP.

Reduced occurrence of severe visual impairment after introduction of anti-Vascular Endothelial Growth Factor in wet age-related macular degeneration : a population- and register-based study from northern Sweden

To study the occurrence of severe visual impairment (SVI) and treatment outcome at 12 months in patients treated for wet age‐related macular degeneration (AMD) by use of data from the Swedish Macula Register (SMR) and referrals to the regional low vision clinics in five northern counties.

Treatment for neovascular age‐related macular degeneration in Sweden: outcomes at seven years in the Swedish Macula Register

To present Swedish Macula Register (SMR) data regarding treatment of neovascular age‐related macular degeneration (AMD) in clinical practice since 2008.

Acute retinal pigment epitheliitis: optical coherence tomography findings at onset and follow-up

Acute retinal pigment epitheliitis : optical coherence tomography findings at onset and follow-up