Kerstin Jandrasits

Cataract surgery in patients with diabetic retinopathy: Visual outcome, progression of diabetic retinopathy, and incidence of diabetic macular oedema

AbstractBackground. Compared to non-diabetic patients, outcome after cataract surgery was reported to be worse in diabetic patients – especially in those with diabetic retinopathy. This prospective study was planned to evaluate visual outcome, progression of diabetic retinopathy, and incidence of clinically significant macular oedema (CSME) in a homogenous group of patients with non-proliferative diabetic retinopathy (NPDR) without CSME at baseline 1 year after cataract surgery. Methods. Over a period of 18 months, all consecutive patients with mild-to-moderate diabetic retinopathy who had cataract surgery with phacoemulsification and posterior chamber lens implantation were prospectively followed up. Outcomes were assessed 1 year postoperatively and included visual acuity (VA), progression of retinopathy, and incidence of CSME. Progression of retinopathy and incidence of CSME were compared to the non-operated fellow eyes. Results. Of 50 patients included, 42 completed the 1-year follow-up. VA improved in 85% of patients, and was better than 0,5 in 71%. Progression of retinopathy occurred in 12% of eyes after cataract surgery and in 10.8% of non-operated fellow eyes. No patient developed proliferative diabetic retinopathy in the operated eye. CSME occurred in 13 operated eyes (31%), five of them with retinal ischemia, and in five non-operated eyes (13.5%). Patients with ischemic macular oedema had the worst prognosis regarding VA. Conclusion. Modern cataract surgery seems to have no influence on the progression of diabetic retinopathy. A visual improvement is achieved in the majority of patients with NPDR, but poorer visual outcome is observed in patients developing macular oedema.

The clinical use of viscoelastic artificial tears and sodium chloride in dry-eye syndrome.

This study was performed to test viscoelastic artificial tears (VAT) based on both subjective and clinical parameters in patients with keratoconjunctivitis sicca (KCS). Twenty-eight patients were evaluated in a randomized double-blind study. Sodium hyaluronate was used in two different concentrations (0.4%, 0.25%) and in combination with chondroitin sulfate. Each preparation was used for one week preceded by another weekly cycle using a sodium chloride solution. Before and after each cycle, clinical examinations were performed: tear film break-up time, Schirmers test, lipid-layer thickness and fluorescein staining. Patients kept a record of the drop-frequency, subjective response and side effects. After the study, they were asked to give a rating of the various preparations. The severity of KCS was expressed based on a sicca score and correlated with response to viscoelastic treatment. Both the subjective and the clinical parameters revealed no statistically significant differences between the various viscoelastic agents or between the viscoelastics and the sodium chloride solutions. Severe side effects did not occur. There was a positive correlation of response to viscoelastic treatment with severe KCS (+ 0.36) but not with mild KCS (-0.07). The VAT seems to be indicated in severe cases of dry-eye syndrome. Sodium chloride solutions may be a useful short-term alternative to other tear formulations.

Effect of noradrenaline on retinal blood flow in healthy subjects

PURPOSE To gain insight into the role of circulating catecholamines on retinal blood flow in vivo. DESIGN Nonrandomized, open, crossover design. PARTICIPANTS In 10 healthy male subjects, tyramine and noradrenaline were administered in stepwise increasing doses. These doses were selected to induce comparable changes in systemic blood pressure. METHODS During each infusion step, retinal vessel diameter and retinal venous blood speed were measured with the Zeiss retinal vessel analyzer (Zeiss, Jena, Germany) and laser Doppler velocimetry, respectively. MAIN OUTCOME MEASURES Retinal blood flow through a major temporal vein was calculated. RESULTS As expected, tyramine and noradrenaline induced a systemic hypertensive response. Tyramine caused a moderate increase in noradrenaline plasma levels, whereas exogenous noradrenaline increased noradrenaline plasma levels more than 10-fold. Nevertheless, neither tyramine nor noradrenaline induced any effect on retinal hemodynamic parameters. CONCLUSIONS These data indicate that even high levels of circulating noradrenaline have little impact on retinal vascular tone and retinal blood flow. Hence, the adrenergic system appears not to play a major role in retinal blood flow regulation.

Effects of Atropine and Propranolol on Retinal Vessel Diameters during Isometric Exercise

Purpose: There is controversy regarding the nervous control of retinal blood vessels in humans. Most in vitro studies indicate that the intraocular part of the central retinal artery lacks autonomic innervation. We investigated the response of retinal vessels to isometric exercise during blockade of β-receptors (propranolol) or muscarinic receptors (atropine). Methods: Twelve healthy subjects performed squatting for 6 min during infusion of either propranolol atropine or placebo. Blood pressure and pulse rate were measured non-invasively. Retinal vessel diameters were measured continuously using the Zeiss Retinal Vessel Analyser. Results: Squatting induced a significant increase in blood pressure and pulse rate, which was paralleled by a decrease in retinal vein and artery diameters. Atropine did not change the retinal vessel response to isometric exercise. Propranolol significantly blunted the exercise-induced vasoconstriction in retinal arteries. Conclusion: This result likely indicates propranolol-evoked vasoconstriction in the extraocular parts of the central retinal artery during isometric exercise.

Aqueous Flare and Macular Edema in Eyes with Diabetic Retinopathy

Background: The breakdown of the blood-retina barrier in diabetic patients is correlated with a dysfunction of the blood-aqueous barrier. In our study, we wanted to investigate the effect of grid photocoagulation in diabetic macular edema on the aqueous flare. Methods: Modified grid pattern photocoagulation was performed on 20 patients with diabetic macular edema. The aqueous flare intensity was measured by the laser flare cell meter before and 4 months after laser treatment. Results: The mean flare value was 9.8 ± 4.7 photons/ms before laser treatment. After grid photocoagulation, the flare value was 7.1 ± 3.6 photons/ms. Flare values were significantly decreased after laser treatment. Conclusion: Our results suggest a correlation between the effect of grid photocoagulation on the blood-retina barrier and the permeability of the blood-aqueous barrier. The laser flare intensity seems to be a quantitative indicator for the diabetic dysfunction of the blood-retina barrier.

Psychovegetative Spannung bei Keratoconjunctivitis sicca und Beeinflussung mittels Akupunktur

ZusammenfassungEinleitungDie Keratoconjunctivitis sicca (KCS) ist eine chronische Bindehautentzündung mit Beeinträchtigung des Tränenfilms. Deren Behandlung mit Tränenersatzmittel ist oft unbefriedigend. Vorversuche mit Akupunktur zeigten eine klinische Wirksamkeit auf die KCS, jedoch mit unbekanntem Hintergrund. Da Erb eine erhöhte Spannung bei KCS festgestellt hat, und Akupunktur empirisch einen beruhigenden Effekt hat, sollten nun die Spannungen sichtbar und die Veränderungen nach Akupunktur gemessen werden.MethodeBei vegetativer Dystonie mit Aktivierung des sympathischen Nervensystems kommt es zu vermehrter Schweißbildung und Mydriasis, bei parasympathischer Aktivität zu Abgeschlagenheit und Myosis.Beide Systeme haben Einfluss auf die Tränenbildung. Gemessen wurde der Haut-Kontakt auf der Handfläche mittels Silberchlorid-Elektroden, die Pupillenweite mit TV-Pupillometrie 1050 und die psychische Befindlichkeit mit Fragebogen nach Zerssen.Spaltlampenuntersuchung, Schirmer II, Tränenfilmaufrisszeit(BUT), Lipidinterferenz, Bengalrosa, Impressionszytologie und Tropfprotokoll bestimmten die KCS. Die Tests wurden nach 3 Monaten wiederholt. In der Zwischenzeit erhielt ein Teil der Patienten Akupunkturbehandlungen (10×). Statistisch wurden der Willcoxen Test, t-test und Withney-Mann-Test angewendet.Ergebnisse45 Patienten mit KCS (18 m : 27 w) wurden untersucht, davon 33 mit Akupunktur behandelt. Der Pupillendurchmesser änderte sich im Durchschnitt um 1,3 mm nicht signifikant, gegenüber der 1. Messung und gegenüber der Vergleichsgruppe. Die Schweißbildung verringerte sich, ebenso besserte sich die allgemeine Befindlichkeit (nach Zerssen) signifikant nach Akupunktur gegenüber der Voruntersuchung und gegenüber der Vergleichsgruppe.BUT, Lipidinterferenz und Tropfhäufigkeit verbesserten sich nach Akupunktur mit statistisch signifikantem Unterschied gegenüber der Ausgangslage und gegenüber der Vergleichsgruppe. Impressionszytologie, Bengalrosa-Färbung und Schirmer-Test blieben ohne Signifikaten Unterschied.Die Ergebnisse dieser Beobachtung zeigten einen ersten positiven Einfluss der Akupunktur auf die vegetativen und psychischen Spannungen bei KCS.SummaryIntroductionKeratoconjuctivitis sicca (KCS) treatment with artificial tears is unsatisfying in many cases. Therefore in previous studies acupuncture was used with success on Schirmers test, break up time and drop-frequency. The effect of acupuncture on the tear film is still unknown, but generally patients told of relaxation after the therapy. C. Erb observed elevated psychic tension in patients with KCS. This study was created to observe the influence of acupuncture on this tension.MethodTo observe the tension of the sympathetic system, we measured the skin contact level by attaching agcl electrodes on the tenar and antithenar of the untrained hand. For determination of skin contact level and habituation computer assisted measurement was used. For the computer assisted measurement of the pupillary diameter a TV pupillometer 1050 by whittaker cooperation was used. With a record by Zerssen the psychic condition was observed. For evaluation of mood the self rating well being scale by Zerssen has to be presented by the patients.The teat film was evaluated by slit lamp, Schirmer BUT and Bengal-Rosa staining. These observations were repeated after 3 month. In meantime part of patients was treated by acupuncture for 10 weeks, once weekly. For statistic analyses Wilcoxon matched pair test, withney Mann and t-test were carried out.Results45 patients with KCS (27 women, 18 men) have been observed, 33 of them with acupuncture treatment. After acupuncture the diameter of the pupil reduced 1.3 average and there was no statistical difference (p > 0.05), the habituation and the skin values changed like the emotional persistence (by Zerssen-record) with significant difference. Even the difference after acupuncture was significant more than that of the controll group in the skin reaction and in the psychic reaction.Changes of the BUT, the Lipid-interference and the drop frequency of artifical tears were significant too (p < 0.05). Rosa-Bengal staining, Schirmer test changed without satistical difference.ConclusionAfter this study we could observe a positive influence of acupuncture on the psychic and vegetative tension in patients with KCS. This may be a good usefull additional therapeutical approach in future.

Ocular surface changes and tear film alterations associated with sun gazing during a solar eclipse

ZusammenfassungZiel der Studie war die Beobachtung der Patienten mit ophthalmologischen Beschwerden durch Betrachtung der Sonne während der Sonnenfinsternis über Mitteleuropa am 11. August 1999, wobei das Hauptaugenmerk der Netzhaut und Veränderungen der Augenoberfläche galt.Methode43 Patienten wurden innerhalb einer Woche nach der Sonnenfinsternis primär beobachtet. 33 von ihnen wurden nach einem Jahr nachuntersucht. Untersuchungsparameter waren die Sehschärfe, das zentrale Gesichtsfeld sowie eine Spaltlampenuntersuchung von der Augenoberfläche und vom Fundus. Der Tränenfilm wurde untersucht mittels Schirmer-Test und Tränenfilmaufrisszeit. Die Lipidphase wurde mittels Interferenzmessung an der Spaltlampe sowie mittels Tearoskope® beurteilt.Ergebnisse19 Patienten hatten bei der ersten Beobachtung unspezifische Sehbeschwerden.Bezüglich des Tränenfilms fanden wir in allen 3 Schichten pathologische Veränderungen, im Bereich der wässrigen Phase (Schirmer-Test) in 87%, Tränenfilmaufrisszeit in 85%, der Lipidfilm in 67 bzw 87% im Tearoskope.Nach einem Jahr gab es bei keinem Patienten visuelle Beschwerden, der Tränenfilm erholte sich in allen drei Phasen: am Geringsten im Schirmer-Test, der in 51% noch pathologische Werte anzeigte. Die Tränenfilmaufrisszeit war in 24% und bei der Lipidphase 9% noch pathologisch.ZusammenfassungWir beobachteten Veränderungen an der Augenoberfläche, insbesondere des Tränenfilms nach Sonnenfinsternis. Die Veränderungen wurden verursacht durch eine starke Lichtreizung wie bei der Keratitis photoelectrica und erholten sich innerhalb eines Jahres. Während die wässrige Phase bei vielen Patienten pathologisch blieb, erholten sich Schleim und Lipid fast gänzlich.SummaryPurposeA solar eclipse occurred in central Europe on August 11th, 1999. Following the eclipse, patients with ocular symptoms were investigated. Gazing at the sun without protection is liable to damage the retina. Our attention was focused on changes of the ocular surface and the tear film.MethodsForty-three patients were investigated within one week after the solar eclipse as baseline. 33 of them were followed up one year later. Visual acuity and the central visual-field were measured, and the ocular surface and the fundus were examined using a slit lamp. The quality of the lacrimal tear film was examined using Schirmer’s test for the aqueous layer, break-up time for the mucous layer and interference observation for the lipid layer, measured by a slit lamp and a tearoscope.ResultsAt the baseline 19 patients had non-specific visual problems. Pathological alterations of the tear film were seen in all three tear-film layers: Schirmer’s test was pathological in 87%, break-up time decreased in 85%, the interference pattern of the lipid layer changed in 67% and there were changes in 87% using the tearoscope.One year later the non specific visual disorders had disappeared. Schirmer’s test did not reveal much change from the baseline: 51% pathological. 24% remained pathological in break-up-time and the lipid layer was normalized except in 9%. Using the tearoscope, lipids were better than grade 3 in all patients.ConclusionAfter gazing at a solar eclipse the ocular surface and tear film changed. While the aqueous layer remained pathological in many patients, the lipid layer and the mucous layer recovered spontanously.