Jurgen Faulborn

Synthesis pattern of matrix metalloproteinases (MMPs) and inhibitors (TIMPs) in human explant organ cultures after treatment with latanoprost and dexamethasone.

Purpose: To determine changes in production of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the ciliary body, the trabecular meshwork and the retinal pigment epithelium induced by both prostaglandins and corticosteroids.Methods: Explant organ cultures were removed by a scleral incision 3 mm posterior to the limbus. Retinal pigment epithelium was grown to confluence. Organ and cell cultures were treated with latanoprost and/or dexamethasone for 72 h. The activity of MMP- 2, -3 and -9 was assessed using zymography. The synthesis pattern of MMPs and TIMP-1 and -2 was identified using immunostaining.Results: Treatment of explant organ cultures with 10 μg/ml of latanoprost induced a mean upregulation of MMP-2 by 36%, MMP-3 by 112% and MMP-9 by 156% as seen by zymography. Dexamethasone 500 nm reduced the amounts of secreted MMP-2 by 13%, MMP-3 by 69%. MMP-9 was not detectable in the media of corticosteroid-treated explant organ cultures. The addition of 10 fLg/ml of latanoprost to dexamethasone-treated cultures increased MMP-2 by 14%, MMP-3 by 43% and MMP-9 by 49%. Using immunohistochemistry we found staining with antibodies against MMP-2, -3, -9 and TIMP-1 and -2 within the ciliary body, and only to a lesser degree in the trabecular meshwork. Latanoprost treatment caused an increase of 29% in MMP-2 (p < 0.0001), 98% in MMP-3 (p < 0.0001) and 108% in MMP-9 (p < 0.0001). Dexamethasone reduced the staining for MMP-2 by 32% (p < 0.0001), for MMP-3 by 33% (p < 0.0001) and for MMP-9 by 83% (p < 0.0001). Almost nochange in staining for MMPs was detectable in the trabecular meshwork. Neither latanoprost treatment nor dexamethasone induced significant changes (p < 0.93) in the secretion of TIMPs. In the media of non-treated retinal pigment epithelium (RPE) cells the only MMP detected was MMP-2. RPE cells in culture did not respond to either treatment with a change in their MMP secretion. Conclusion We detected a profound upregulation of both MMP-3 and MMP-9 and a mild induction of MMP-2 through latanoprost in the ciliary body, but not the trabecular meshwork or RPE cells. Corticosteroids, on the other hand, downregulated MMP expression in both tissues. This inhibiting effect of corticosteroids on MMP production was reversed by latanoprost.

Pupillary block after phakic anterior chamber intraocular lens implantation

A 49-year-old patient developed pupillary block glaucoma with an intraocular pressure (IOP) of 29 mm hg after implantation of a phakic intraocular lens (IOL) (NuVita, Bausch & Lomb) in the left eye. the anterior chamber deepened again, and the iop decreased to 16 mm hg after a neodymium: YAG iridotomy. Pupillary block glaucoma may occur after phakic IOL implantation without iridotomy, and we advocate that routine iridotomy be performed during phakic IOL surgeries.

Destruction of human tear proteins by ozone

By an in vitro system human tears from healthy donors were exposed in a sealed vessel to a single dose of ozone. A marked destruction of tear proteins by ozone was observed as indicated by the disappearance of the protein pattern in polyacrylamide gel electrophoresis compared with the control. Lysozyme, a significant protein in tears, was demonstrated to be susceptible to degradation by O3. The destruction of tear proteins by ozone can be determined quantitatively by radial immunodiffusion as shown for human tear albumin. Variations of ozone concentrations and reaction time showed that destruction of tear proteins by ozone depended on the ozone concentration and occurred within a few minutes of exposure of tears to ozone.

Die radiochirurgische Therapie mit der Leksell Gamma Einheit in der Behandlung von Aderhautmelanomen

ZusammenfassungDie Radiochirurgie mit der Gamma Einheit, vom Schweden Lars Leksell für die Behandlung von Hirntumoren eingeführt, scheint auf Grund ihrer physikalischen Eigenschaften (Emission einer hohen Dosis in einer Sitzung mit scharfem Dosisabfall gegenüber gesundem Gewebe) für die Behandlung von Aderhautmelanomen geeignet.Durch erste positive Erfahrungen von Chinela, Zambrano und Bunge ermutigt, haben wir die neurochirurgische Therapie für die Behandlung von Aderhautmelanomen adaptiert.Die Therapie mit der Leksell Gamma Einheit wird in Anlehnung an ein multizentrisches Protokoll durchgeführt:1.Fixation des Auges in Retrobulbäranästhesie2.Stereotaktische Lokalisation des Tumors mittels CT3.Therapieplanung4.Radiochirurgische Behandlung Zwischen Juni 1992 und Februar 1993 wurden 6 Aderhautmelanome an der Grazer Leksell Gamma Einheit in interdisziplinärer Zusammenarbeit mit der Universitätsklinik für Neurochirurgie und der Abteilung für Strahlentherapie radiochirurgisch behandelt. In 5 Fällen blieb die Prominenz der Tumoren über einen Beobachtungszeitraum von maximal 8 Monaten unverändert, bei 1 Patientin mit einem juxtapapillären Melanom kam es zur Reduktion der Tumorhöhe von 8 auf 4 mm, als frühe Nebenwirkungen wurden bei letzterer Patientin Blutungen im Tumorareal sowie eine seröse Netzhaut- und Aderhautabhebung mit spontaner Rückbildung verzeichnet.Unsere ersten Erfahrungen weisen die Gamma Knife Therapie als vielversprechende alternative Therapie großer Melanome, makulärer und juxtapapillärer Melanome aus, die endgültige Beurteilung bezüglich der Effizienz dieser neuen Therapieform bedarf jedoch großer Fallzahlen über einen längeren Beobachtungszeitraum.SummaryGamma Knife radiosurgery, developed by Lars Leksell for treatment of brain tumors, is useful for treatment of uveal melanomas due to its unique physical features. It allows the delivery of a high single dose with minimum involvement of the surrounding tissue.Encouraged by first positive results by Chinela, Zambrano and Bunge we adopted the procedure for treatment of uveal melanomas.Regarding to a multicentric trial Gamma Knife procedure is performed in 4 steps1.Fixation of the globe with retrobulbar anaestetic block2.Stereotactic location of the tumor by CT3.Calculation of the isodoses4.Radiosurgical procedure Between June 1992 and February 1993 we treated 6 uveal melanomas with the Leksell Gamma Kife together with the Department of Neurosurgery and the Institute of Radiotherapy. In 5 out of 6 cases Gamma Knife therapy could stop further tumor growth. In one case of a juxtapapillary melanoma a reduction of tumor hight from 8 to 4 mm could be achieved; early side effects like serous retinal detachment resolving spontaneously after 4 months and hemorrhage at the base of the tumor were remarkable in this patient.According to our first encouraging results treatment with the Leksell Gamma Knife seems to be an alternative therapeutic modality in larger tumorus or those located at the posterior pole but definite conclusions about the efficiency of this new therapeutic procedure have to be made in a larger number of patients after a longer follow up period.

Diabetic Vitreopathy – Findings Using the Celloidin Embedding Technique

Background: To evaluate the role of the vitreous in diabetic eyes, autopsy eyes from diabetic patients have been examined by means of light and electron microscopy. Methods: Twenty-five eyes were obtained from 19 patients. The duration of diabetes was from 8 to 26 years (average 17 years). All patients had type II diabetes. The glycerol-dehydrated globes were embedded in celloidin and hardened with chloroform. For light microscopy, areas of interest were cut from 200-μm-thick celloidin sections and embedded in paraffin, and 10-μm sections were cut. Such 200-μm and 10-μm sections were also used for scanning electron microscopy. For transmission electron microscopy, areas of interest were cut from thick celloidin sections and embedded in Epon for thin sectioning. Results: The vitreous in diabetic eyes exhibits delayed senile degeneration in case of early onset of diabetes. It shows intensified staining of the vitreous cortex. Posterior detachment is often incomplete without collapse. The vitreous collagen fibers are coarse and aggregated in the centrally located cortical region of the vitreous. Hyalocytes in diabetic eyes have a different shape than normally, and their number seems to be increased. All these structural changes were not demonstrated in nondiabetic eyes. Conclusion: The vitreous in diabetic patients is morphologically different from normal vitreous. Features of the diabetic vitreous are aggregated collagen fibers, increased density of the vitreous cortex and morphological changes of hyalocytes. It is discussed whether these findings arise from nonenzymatic glycosylation of collagen molecules resulting in diabetic vitreopathy.

Degradation of hyaluronate by the concerted action of ozone and sunlight.

The influence of ozone and sunlight in a concerted reaction on hyaluronate solutions was investigated. The kinematic viscosity of hyaluronate solutions is decreased by ozone-air mixtures and simultaneous radiation with sun rays within a few minutes, indicating a depolymerization of the hyaluronate molecule. The reaction is dependent on the concentration of ozone and on the time of exposure to ozone and sunlight. The concerted degradation of hyaluronate is more effective than the reaction with each component, ozone and sun rays, alone. We conclude that hyaluronate depolymerization by ozone and sunlight may be one factor for irritations of the eye by photochemical smog and increased exposure to sun rays.

Untersuchungen über die Zunahme des Syndroms des trockenen Auges in den Jahren 1960–1994

ZusammenfassungEine retrospektive Auswertung der ambulanten Patienten der Universitäts-Augenklinik Graz ergab einen Anstieg der Patienten mit Sicca-Syndrom von 2% im Jahre 1960 auf 5% im Jahre 1989. Prospektiv wurde für März 1993 bis Feburar 1994 die Anzahl der Patienten mit trokkenem Auge mit 6.2% ermittelt. 65% waren Frauen mit einem Altersgipfel zwischen dem 40. und 70. Lebensjahr. Bei den Männern wurde kein Altersgipfel festgestellt. 25% der Sicca-Patienten weisen verschiedene Allergien auf. 15% sind Raucher, 3% tragen Kontaktlinsen. Keine jahreszeitliche Häufung und kein Zusammenhang mit der Berufsausübung konnte festgestellt werden.SummaryIn a retrospective study on the outclinic patients of the University Eye Hospital Graz we determined an increase of patients suffering from the sicca syndrome from 2% in 1960 to 5% in 1989. In a prospective study from March 1993 to February 1994 we found that 6.2% of all outclinic patients showed symptoms of the dry eye. 65% were female with an age summit between 40 and 70 years. The male patients showed no age summit. 25% of the sicca patients suffer from different allergies, 15% are smokers, 3% wear contact lenses. No seasonal frequency and no relationship between the profession and the incidence of the dry eye syndrome was observed.

Sclerotomy in uveal effusion syndrome.

PURPOSE To report visual and anatomic outcomes after modified scleral surgery in patients with uveal effusion syndrome with retinal and choroidal detachment. METHODS In five eyes of four patients with retinal and choroidal detachment and uveal effusion syndrome due to nanophthalmos, we performed pars plana full-thickness unsutured sclerotomies without sclerectomy. RESULTS In all cases, uveal effusion with choroidal and retinal detachment resolved within 3 weeks, and all patients showed improved vision. The functional and anatomic results remained stable for over 2 years. CONCLUSIONS Uveal effusion syndrome that is refractory to medical treatment (high-dose systemic corticosteroids) can be managed effectively by pars plana full-thickness unsutured sclerotomy without sclerectomy.

Application of HELP in nonarteritic anterior ischemic optic neuropathy: A prospective, randomized, controlled study

Abstract• Background: Heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) eliminates selectively fibrinogen, LDL, cholesterol, triglycerides and LP(a) from blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL by about 50% after only one procedure immediately improves the hemorheological situation. • Method: In a prospective, randomized, controlled study over a period of 3 months, 40 patients with nonarteritic ischemic optic neuropathy (NAION) were randomly assigned to either HELP or hemodilution therapy to determine the efficacy of these two treatments on visual acuity and fields. • Results: After transformation of the Snellen acuity into logMAR units the statistical analysis did not show a significant difference between the two groups (P=0.48). An increase of the visual acuity by two or more lines was obtained in 9 patients (47.4%) of the HELP group, 10 (52.6%) remained stable and none got worse. In the hemodilution group, visual acuity increased in patients (33.4%), 9 (42.8%) remained stable and 5 (23.8%) experienced a decrease. The calculated mean sensitivity of visual fields at baseline improved statistically significantly (P<0.01) in the HELP group from 6.83 ±4.52 dB to 8.27±4.89 dB, but did not change significantly in the hemodilution group (6.25 ± 4.12 dB to 6.12±3.92 dB). • Conclusion: The HELP system seems to be safe and more effective than hemodilution in improving the hemorheological and the functional situation in NAION and could be a promising regimen in the treatment, of NAION.

Iodid schützt Tränen vor der Zerstörung durch Ozon und UV-Licht

ZusammenfassungDurch Ozon und UV-Licht werden die Proteine, Lipide und die Mucosubstanzen der Tränenflüssigkeit zerstört. Durch die Aufhebung der Wechselwirkung dieser Träneninhalts Stoffe kommt es zum Aufbrechen des Tränenfilms und zur Bildung trockener Bezirke an der Augenoberfläche, wobei man vom umweltinduzierten trockenen Auge spricht.Setzt man in vitro lodid menschlichen Tränen zu, kommt es zu keiner Zerstörung des Hyaluronats der Tränen durch Ozon und UV-Licht. Diese schützende Wirkung des Iodids auf einen Träneninhaltsstoff kann mittels Viskosimetrie nachgewiesen werden. Die günstige Beeinflussung des trockenen Auges durch Balneotherapie und Ophthalmoiontophorese-Behandlungen mit Iodsole in Bad Hall könnte auch auf die Wirkung des Iodids als Radikalfänger zurückzuführen sein.SummaryBy ozone and UV-light the proteins, lipids and the mucosubstances of the tear fluid are destroyed. By abolishment of the interaction of the tear fluid components a break up of the tear film and the formation of dry areas on the surface of the eye is provoked, leading to the environmental induced dry eye syndrome.By addition of iodide to human tears in vitro, the destruction of hyaluronate of tears by ozone and UV-light is prevented. This protective action of iodide on tear fluid hyaluronate can be determined by viscosimetry.The improvement by balneotherapy and ophthalmoiontophoresis of the dry eye syndrome with iodide solutions in Bad Hall/Austria may also be related to the action of iodide as a radical scavenger.