Karin Kobuch

Biostability of micro-photodiode arrays for subretinal implantation

Micro-photodiode arrays based on semiconductor chip technology are being developed to replace degenerated photoreceptor cells in the retina. Electric current is generated in tiny micro-photodiodes and delivered to the adjacent tissue by micro-electrodes. One of the main requirements of a sub-retinal implantable device is long-term stability versus corrosion in vivo (biostability). Biostability of micro-photodiode arrays (MPDA) was investigated in vitro and in vivo. No significant damage was found on chips immersed for up to 21 months in saline solution. Under in vivo conditions, however, the silicon oxide passivation layer of the chip was dissolved within a period of about 6-12 months. Subsequently, the underlying silicon was corroded. In contrast, stimulation electrodes consisting of titanium nitride were well preserved both in vitro and in vivo. The deterioration of the electrical properties of the micro-photodiodes correlated with the morphological damage observed. Strategies aiming at the development of an improved biostable encapsulation of neurotechnological implants have to be investigated and will be discussed briefly.

Light-Induced Decomposition of Indocyanine Green

PURPOSE To investigate the light-induced decomposition of indocyanine green (ICG) and to test the cytotoxicity of light-induced ICG decomposition products. METHODS ICG in solution was irradiated with laser light, solar light, or surgical endolight. The light-induced decomposition of ICG was analyzed by high-performance liquid chromatography (HPLC) and mass spectrometry. Porcine retinal pigment epithelial (RPE) cells were incubated with the light-induced decomposition products of ICG, and cell viability was measured by trypan blue exclusion assay. RESULTS Independent of the light source used, singlet oxygen (photodynamic type 2 reaction) is generated by ICG leading to dioxetanes by [2+2]-cycloaddition of singlet oxygen. These dioxetanes thermally decompose into several carbonyl compounds. The decomposition products were identified by mass spectrometry. The decomposition of ICG was inhibited by adding sodium azide, a quencher of singlet oxygen. Incubation with ICG decomposition products significantly reduced the viability of RPE cells in contrast to control cells. CONCLUSIONS ICG is decomposed by light within a self-sensitized photo oxidation. The decomposition products reduce the viability of RPE cells in vitro. The toxic effects of decomposed ICG should be further investigated under in vivo conditions.

New substances for intraocular tamponades: perfluorocarbon liquids, hydrofluorocarbon liquids and hydrofluorocarbon-oligomers in vitreoretinal surgery.

Abstract. Perfluorocarbon liquids (PFCLs) and heavy fluorocarbon liquids (HFCLs) are being increasingly used as soft tools during vitreoretinal surgery. However, since long-term intraocular tolerance is still unsatisfactory, at present complete removal at the end of surgery is recommended. With the aim to improve long-term intraocular compatibility and to enlarge the spectrum of clinical applications, modified HFCLs have been developed. HFCL-oligomers with a higher viscosity represent the latest perspective. All three groups of fluorocarbon liquids will be compared with respect to their physical and chemical properties, experimental and clinical results, and prospects for clinical applications. Common features of PFCLs, HFCLs and HFCL-oligomers are biological inertness, specific gravity higher than water, immiscibility with water or blood, and a high gas binding capacity. In PFCLs such as decalin, octane, or phenanthrene, all carbon atoms of the carbon backbone are completely fluorinated. In experimental and clinical use, emulsification, vascular changes and structural alterations of the retina have been described. By only partial replacement of hydrogen atoms by fluorine, the specific gravity of HFCLs is reduced, whereas lipophilic properties increase. Thus HFCLs are potential solvents for intraocular silicone oil remnants. However, after long-term application, side-effects are similar to those observed with PFCLs. Substances of this group, such as F6H6, F6H8, O44, and O62 are used intraoperatively and are currently being investigated for clinical long-term application. With the aim to avoid emulsification and to improve intraocular tolerance, we have developed HFCL-oligomers consisting of 2–4 HFCL molecules with increased viscosity. The oligomers were tolerated well in rabbit eyes for up to 4 months. In contrast to PFCLs or monomers, they did not emulsify nor show vascular alterations. ERGs returned to normal after removal of the oligomer from the eye. Histology of the retina showed mild alterations. Conclusion: according to physical properties, experimental intraocular compatibility and stability against emulsification, HFCL-oligomers are promising candidates for improved long-term tamponade of the lower retina. At present, indications for an application in human eyes have to be determined in clinical trials.

Clinical findings on the use of long-term heavy tamponades (semifluorinated alkanes and their oligomers) in complicated retinal detachment surgery

Abstract Background. Heavy tamponades for pathologies in the lower part of the retina are a new development, and different tamponades have recently come into clinical use: semifluorinated alkanes (F6H6, F6H8) and their oligomers (OL62HV). Method. Nine patients had been operated on using F6H8 (n=5) and by OL62HV (n=4). In all cases the reasons for using the tamponades were complicated retinal detachments in the lower part. In three cases the use was primary and in six cases tamponades were used after reoperations. In all cases the endotamponade was removed within 6 weeks. Fluorescein angiography (FLA) was performed in the F6H8 group. Results. In the F6H8 group dispersion developed in two of the three aphacic patients. In two out of five cases soft epiretinal membranes and cellular material could be found between the substance and the lower periphery. In two membranes examined by light microscopy, cystic cells and amorphous material could be found. In one case (PDRP, aphacic) cyclophotocoagulation had to be performed because of persistent elevated IOP. FLA was unremarkable. In the OL62HV group, severe recurrent PVR reaction occurred in the lower periphery (2/4) and unusual precipitates were observed (4/4). In one case, after a normal postoperative period (VA 0.05 after 5 days) an extensive cellular reaction on the complete surface of the tamponade occurred. After 5 weeks VA was no light perception. During removal of the oligomer unusual adherent cellular components were found on the surface of the retina. The retina appeared necrotic, showed constricted retinal vessels and there was optic atrophy. Histologically, fluffy epiretinal material and a lens capsule obtained from one eye filled with OL62HV resembled the appearance with F6H8. Conclusion. Heavy endotamponades on the basis of semifluorinated alkanes can lead to an unusual biological reaction and need further investigation before clinical use.

Maintenance of adult porcine retina and retinal pigment epithelium in perfusion culture: Characterisation of an organotypic in vitro model *

The purpose of this study was to characterise an ex-vivo adult porcine retina-retinal pigment epithelium (RPE) perfusion organ culture model. Fresh porcine full-thickness retina-RPE-choroid tissue samples were clamped into tissue carriers and mounted in two-compartment containers. The retinal and choroidal sides were continuously perfused with culture medium. pO(2), [Na(+)], [K(+)], [Cl(-)], [glucose], [lactate], and pH were measured in the medium. Tissue samples were examined after 24h, 4, 7, and 10 days in culture. The morphology of the retina and the RPE was examined by light and electron microscopy (LM, EM). The retinal cellular integrity was further examined by immunohistochemistry (Ki 67, GFAP, rhodopsin, synaptophysin, syntaxin, NF 200, TUNEL-test). Fresh porcine full-thickness retina-RPE-choroid tissue samples and tissue samples in static organ culture served as controls. LM, EM, and immunohistochemistry showed intact retinal and RPE cytoarchitecture kept in perfusion culture. Photoreceptor outer segments showed first signs of degeneration after 24h, significant signs of apoptosis and necrosis appeared in the retina after 4 days in perfusion culture. Control tissue samples kept in static culture showed disintegration of the retinal cytoarchitecture after 4 days in culture. The data show that adult porcine retina-RPE tissue can be maintained morphologically intact in perfusion organ culture for at least 10 days. Although first signs of degeneration set in after 24h the structural preservation of the tissue in perfusion organ culture is superior to that in static culture. The perfusion culture model of the retina refines organotypic in vitro test systems and may help to reduce the number of necessary animal experiments in retina and RPE research. It offers new perspectives for the safety testing of substances designed for intraocular application.

Subretinales Mikrophotodioden-Array als Ersatz für degenerierte Photorezeptoren?

ZusammenfassungEs wird eine Übersicht über den Stand der Entwicklungen eines subretinalen, elektronischen Mikrophotodioden-Arrays gegeben, mit dem degenerierte Photorezeptoren ersetzt werden können. Verschiedene Prototypen wurden entwickelt, getestet und bei verschiedenen Versuchstieren bis zur Dauer von 18 Monaten implantiert. Die Tatsache, dass mit subretinalen Elektroden elektrische Antworten vom visuellen Kortex von Schweinen abgeleitet werden können und Antworten auch in vitro in Netzhäuten von Ratten mit Netzhautdegenerationen nachweisbar sind, zeigt die Sinnhaftigkeit dieses Ansatzes. Allerdings sind noch wichtige Fragen der Biokompatibilität, der Langzeitstabilität und der Art des vermittelbaren Bildeindrucks zu bearbeiten, bevor an einen Einsatz beim Menschen zu denken ist.AbstractA survey is given on the status of developments, concerning a subretinal electronic microphotodiode array that aims at replacing degenerated photoreceptors. Various prototypes have been developed, tested, and implanted in various experimental animals up to 18 months. The fact that electrical responses were recorded from the visual cortex of pigs after electrical stimulation by subretinal electrodes and the fact that responses are also recorded in-vitro in degenerated rat retinae, shows the feasibility of this approach. However, there are a number of open questions concerning the biocompatibility, the long-time stability, and the type of transmitted image to be solved before application in patients can be considered.

Histological evidence for revascularisation of an autologous retinal pigment epithelium–choroid graft in the pig

Background: Translocation of a free autologous graft consisting of retinal pigment epithelium (RPE), Bruch’s membrane, choriocapillaris and choroid in patients with exudative age-related macular degeneration is currently being evaluated in clinical practice. Angiographic studies in these patients suggest that their grafts become revascularised. Aim: To investigate the histological evidence of revascularisation of the graft in a porcine model. Methods: In 11 pigs (11 eyes), an RPE–choroid graft was translocated from the mid-periphery to an intact or an intentionally damaged RPE and Bruch’s membrane at the recipient site. The eyes were enucleated 1 week or 3 months after surgery. Tissue sections were evaluated using immunohistochemistry. Results: Bridging vessels between recipient layer and graft were identified from 1 week to 3 months after surgery. This reconnection occurred regardless of whether the Bruch’s membrane of the recipient site was left intact or intentionally damaged at the time of transplantation. The vasculature of the graft appeared open and perfused. Vessels with transcapillary pillars and conglomerates of small new vessels were present in the graft. Conclusions: This study showed histological evidence for revascularisation by angiogenesis of a free autologous RPE–choroid graft.

RPE in Perfusion Tissue Culture and Its Response to Laser Application

Purpose: To study the effects of conventional laser application on the retinal pigment epithelium (RPE) in a perfusion tissue culture model of porcine retinal pigment epithelium without overlying neurosensory retina. Methods: RPE with underlying choroid was prepared from enucleated porcine eyes and fixed in a holding ring (Minusheet®). Specimens were then placed in two-compartment tissue culture containers (MinuCell & Minutissue, Bad Abbach, Germany) and were cultured during continuous perfusion with culture medium at both sides of the entire specimen, the upper RPE and the lower choroid (12 specimens out of 6 eyes). Cultures were kept for 1, 3, 7 and 14 days and were examined histologically. Laser treatment was performed on each tissue ring by application of 3 × 3 laser burns one day after culture began (argon ion laser, wavelength: 514 nm, pulse duration: 100 ms; spot size: 200 µm) using different energy levels (400–1,000 mW); (16 specimens out of 8 eyes). Results: During laser treatment a marked lightening of the RPE with centrifugal spreading was observed. Using higher levels of energy, a contraction of the RPE towards the center of the laser spot was noticed. One day after laser photocoagulation histology revealed destruction of RPE; within 3–7 days of culture, migration and proliferation of neighboring cells was observed in several lesions. After 7 days the initial defect of the irradiated area was covered with dome shaped RPE cells and after 14 days multilayered RPE cells were showing ongoing proliferation. However, there were also cases without proliferation after laser treatment. The non-treated, continuously perfused RPE showed regular appearance in histological sections: during the first 7 days of culture, light microscopy revealed a normal matrix with a well-differentiated RPE monolayer. Subsequently proliferation even without treatment was observed and after 14 days the RPE became multilayered. Conclusion: It was possible to study the early healing response to the effect of laser treatment using the permanently perfused tissue culture system. A marked proliferation and repair of the laser defect could be observed in several but not all lesions. After 14 days even without laser treatment a proliferative multilayered RPE was present. Although this limits the use of the system for longer than 7 days, it seems to be useful for investigation of RPE-related disorders.

Epinephrine, but not dexamethasone, induces apoptosis in retinal pigment epithelium cells in vitro: possible implications on the pathogenesis of central serous chorioretinopathy

Abstract Background: The pathogenesis of central serous chorioretinopathy is poorly understood. It is believed to be due to dysfunction of the retinal pigment epithelium and/or choroid and has been associated with elevated levels of epinephrine and administration of corticosteroids. Epinephrine and corticosteroids have previously been shown to induce apoptosis (programmed cell death) in various types of cells. The objective of this study was to investigate whether these agents can induce apoptosis in cultured retinal pigment epithelium cells. This may help elucidate the pathogenesis of central serous chorioretinopathy. Methods: Third-passage porcine retinal pigment epithelium cells were grown to confluence and incubated for 1–7 days in culture medium containing epinephrine (102–109 pg/ml) or a corticosteroid, dexamethasone (4–4×104 ng/ml). The cultures were evaluated for apoptosis by phase-contrast microscopy and in situ terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling. Results: Epinephrine (7×107– 109 pg/ml) induced apoptosis in a dose- and time-dependent manner. Exposure to lower concentrations of epinephrine (102–6×107 pg/ml) and all tested levels of dexamethasone did not result in apoptosis. Conclusion: Retinal pigment epithelium cells may undergo apoptosis following exposure to elevated levels of epinephrine. These findings suggest a possible pathophysiologic mechanism for the development of central serous chorioretinopathy.

Perfluorohexylethan (O62) as ocular endotamponade in complex vitreoretinal surgery.

Purpose: To investigate the safety and performance of perfluorohexylethan (O62), a partially fluorinated alkane, as an intraoperative tool and heavy ocular endotamponade in complex vitreoretinal surgery. Patients and Methods: In a prospective clinical study, O62 was used as a postoperative ocular endotamponade in 11 eyes of 11 patients after pars plana vitrectomy for the following inferior pathologic conditions, proliferative vitreoretinopathy (n = 8), rhegmatogenous retinal redetachment with inferior tears (n = 1), and inferior giant tear (n = 2). The median duration of the O62 tamponade was 43 days (range, 17–55 days), and the median follow-up period after removal of the tamponade was 16 months. Results: The initial postoperative retinal attachment rate was 100%. In 7 of 11 eyes, the retina remained attached during the O62 tamponade and after its removal. During the tamponade period, no epiretinal membrane formation or macular pucker was observed in these seven eyes. Recurrent retinal detachments with proliferative vitreoretinopathy developed in 4 of 11 eyes under the tamponade. The median follow-up after removal of O62 was 16 months. A secondary cataract developed in all five phakic eyes. Severe emulsification was noted in all patients starting in the second week after surgery causing a decrease of visual acuity and a significantly reduced funduscopic view. In the early postoperative period, a marked inflammatory reaction in the anterior segment was seen in all patients. Slightly whitish precipitates were noted in 2 of 11 eyes. A transient increase in intraocular pressure up to 35 mmHg was observed in 2 of 11 eyes. Conclusion: O62 showed good tamponade properties for the inferior retina over 6 weeks. However, its use as a postoperative retinal tamponade is limited by its severe emulsification propensity and unclear inflammatory potential.