Markku Teräsvirta

Silicone tubing is not necessary after primary endoscopic dacryocystorhinostomy: a prospective randomized study.

Background Endoscopic dacryocystorhinostomy (EN-DCR) is an effective procedure when treating saccal and postsaccal obstructions of the nasolacrimal pathway. The benefit of silicone tubing after DCR is still controversial. We conducted a prospective, randomized study to evaluate the necessity of bicanalicular silicone tubes after primary EN-DCR. Methods Forty-six consecutive primary EN-DCR procedures were performed in 42 patients during 2004-2007. The patients were randomized into two study groups according to whether silicone tubing was used or not. Results The overall success rate after primary EN-DCR was 89%: with silicone tubes it was 78%, and without silicone tubes it was 100%. The difference between these two groups was statistically significant (p < 0.049). The follow-up period was 6 months and included three follow-up visits: 1 week, 2 months, and 6 months postoperatively. If inserted, the silicone tubes were removed at the 2-month visit. Conclusion The results of our prospective, randomized study showed that the use of silicone tubes after primary EN-DCR is not necessary.

Matrix metalloproteinases and their inhibitors in the chamber angle of normal eyes and patients with primary open-angle glaucoma and exfoliation glaucoma

BackgroundIn glaucoma, extensive pathological changes occur in the trabecular meshwork (TM) and juxtacanalicular tissue of the chamber angle. Aqueous humor drainage is disturbed due to the accumulation of extracellular matrix (ECM) material in the outflow system. Matrix metalloproteinases (MMPs) remodel ECM material and, thus, they may have a role in regulating outflow facility and intraocular pressure (IOP). This study examined the expression of MMPs and tissue inhibitors of MMPs (TIMPs) in the chamber angle of normal eyes and in primary open-angle glaucoma (POAG) and in exfoliation glaucoma (ExG).MethodsTM tissues were isolated from healthy donor eyes for corneal transplantation. Specimens of the inner wall of Schlemm’s canal and the juxtacanalicular tissue were collected from patients with POAG or ExG during deep sclerectomy operation. Monoclonal antibodies against MMPs (MMP-1, -2, -3, and -9) and antibodies against TIMPs (TIMP-1, -2, and -3) were used for immunohistochemical stainingResultsImmunoreactivity for MMP-2, TIMP-2, or TIMP-3 was observed in human normal TM and in the inner wall of Schlemm’s canal. In general, immunoreactions for all of the tested MMPs were more intense in POAG samples than in ExG samples or in the control group. The only exception was the MMP-2 level, which was the highest in the control group. The staining intensity of MMP-1 or MMP-3 was significantly higher in POAG when compared to ExG. TIMP-1 was significantly increased in POAG compared with ExG and there were no marked differences in the levels of TIMP-2 or TIMP-3 between POAG and ExG. The ratios of MMP-1/TIMP-1 and MMP1+2+3+9 and TIMP1+2+3 were significantly higher in samples from POAG compared to those of ExG.ConclusionsOur results reveal an expression imbalance between MMPs and their endogenous tissue inhibitors in tissue samples from patients with POAG and ExG. Differences in immunohistochemical reactions reflect discrete local pathogenic mechanisms involved in POAG and ExG. With respect to the proposed role of MMPs in the remodeling of ECM material, this may point to a weaker reactivity to the accumulation of ECM material in TM in ExG than POAG eyes.

Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary?

Background Endoscopic dacryocystorhinostomy (EN-DCR) is increasing in popularity as a treatment of nasolacrimal obstructions because it has proven to be an effective and safe procedure. In this study the success of EN-DCR combined with or without bicanalicular silicone stents was evaluated in patients with nasolacrimal obstructions. Methods Forty-two consecutive EN-DCR procedures were performed in 36 patients during 2000–2004. The surgery was primary in 23 cases and revision in 19 cases. Bicanalicular silicone stents were inserted in 18 cases and in 24 cases stenting was avoided. Results The overall success rate after EN-DCR was 81%. The success rate of EN-DCR was 89% with silicone tubing and 75% without silicone tubing. The mean duration of postoperative follow-up was 4 months. Conclusion In our retrospective study no significant statistical differences were seen between the patients with stenting compared with patients without stenting. However, prospective, randomized studies are clearly needed to answer the question of whether the use of stents is advisable.

Geldanamycin increases 4-hydroxynonenal (HNE)-induced cell death in human retinal pigment epithelial cells

Development of age-related macular degeneration (AMD) is associated with functional abnormalities and cell death in retinal pigment epithelial (RPE) cells attributable to oxidative stress. To minimize the adverse effects of oxidative stress, cells activate their defence systems, e.g., via increased expression of heat shock protein (Hsp), activation of stress sensitive AP-1 and NF-kappaB transcription factors. In this study, we examined the accumulation of Hsp70 protein, activation of AP-1 and NF-kappaB transcription factors in human ARPE-19 cells subjected to a 4-hydroxynonenal (HNE)-induced oxidative stress. In addition, the influence of Hsp90 inhibitor geldanamycin (GA) was studied in HNE-treated cells. Mitochondrial metabolic activity and apoptosis were determined to evaluate cell death in the ARPE-19 cells. The ARPE-19 cells showed increased accumulation of Hsp70 protein before of the cytotoxic hallmarks appearing in response to HNE. In contrast, increased DNA-binding activities of AP-1 or NF-kappaB transcription factors were not seen under HNE insults. Interestingly, GA significantly increased cell death in the HNE-treated cells, which was involved in caspase-3 independent apoptosis. This study reveals that the Hsps have an important role in the cytoprotection of RPE cells subjected to HNE-derived oxidative stress.

Hemodynamic variables in progressive and non-progressive low tension glaucoma.

Abstract. Systemic blood pressure and medications for different general diseases were retrospectively examined in 30 low‐tension glaucoma patients. Thirty patients with POAG were used as controls. LTG was divided into a progressive and non‐progressive form on basis of the course of the disease. Systemic blood pressure was higher in POAG and the progressive form of LTG than in the nonprogressive LTG. There was twice as much antihypertensive medication in LTG than POAG patients.

Mitomycin C‐augmented deep sclerectomy in primary open‐angle glaucoma and exfoliation glaucoma: a three‐year prospective study

Purpose:  To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients.

Pigmentation of the anterior chamber angle in normal and pseudoexfoliative eyes.

Abstract. Anterior chamber angle pigmentation was gonioscopically graded in 833 persons recruited for the KEYS (Kuopio Eye Survey) during 1989. Pseudoexfoliation was observed in 8.5% in either eye from those born in 1924, the figure being 13.2% for those born in 1914. Anterior chamber angle pigmentation was found to be significantly heavier in eyes with pseudoexfoliation.

Kuopio Eye Survey (KEYS)

Abstract Mass health screenings for the elderly have been undertaken in Kuopio since 1983. Three different age groups, 65, 70 and 75 years old are called for examination so that each group is examined at 5‐year intervals. In 1989 an ophthalmologic examination was included in the protocol for those born in 1914 and 1924. A total number of 1133 persons were recruited, 833 (73.5%) of which actually participated in the study. Cataract was found to be the most frequent visual handicapper. Of participants with visual acuity < 0.3 at least in one eye, cataract was observed in 41.7% of the younger and in 91.1% of the older group. Age‐dependent macular degeneration and glaucoma were less frequent than cataract. Visual acuity of less than 0.3 in the better eye was observed in 5.5% of the older group.

The Effects of 5-Fluorouracil on Ocular Tissues In Vitro and In Vivo after Controlled Release from a Multifunctional Implant

PURPOSE To evaluate the effects of 5-fluorouracil (5-FU) on ocular cells in vitro and the effects of degradable 5-FU-loaded poly(DL-lactide-co-glycolide; PDLGA) 50:50 implant in the rabbit eye in vivo. METHODS Cytotoxicity was assessed with a tetrazolium salt WST-1 cell proliferation/viability test and a lactate dehydrogenase (LDH) leakage test in rabbit corneal stromal fibroblasts (SIRCs), bovine corneal endothelial cells (BCECs), human conjunctival epithelial cells (IOBA-NHCs), human retinal pigment epithelial cells (ARPE-19), and human corneal epithelial cells (HCECs). The 5-FU-loaded PDLGA implants were surgically placed in rabbit eyes with a deep sclerectomy technique and the histopathology of the eyes was examined. RESULTS In vitro, 5-FU affected cell proliferation and survival in a time- and dose-dependent manner. In the WST-1 test, adverse effects in serum-free conditions started from 0.0005 mg/mL 5-FU in SIRCS and HCECs, whereas in other cell types, 0.005 mg/mL 5-FU hindered cell proliferation. In serum-free conditions 72-hour 5 mg/mL 5-FU treatment decreased cell viability to 40% in BCECs and to 10% to 15% in other cell types. 5-FU had no or very minor effects on LDH leakage. In vivo, the 5-FU implant showed no signs of toxicity in cornea and retina, whereas in the conjunctival stroma near the implantation site, some inflammatory cells and a marked subepithelial condensation of stromal connective tissue was observed during the postoperative period of 4 weeks. CONCLUSIONS 5-FU had a broad therapeutic range, and the 5-FU implant showed only minor tissue reactions in conjunctiva at the surgical site. 5-FU is a possible candidate for controlled drug release.

The laser power needed for optimum results in argon laser trabeculoplasty.

Abstract Ninety‐five successive argon laser trabeculoplasties to as many patients were followed 6 to 18 (mean 8) months. Forty‐eight eyes had capsular glaucoma and 35 simple glaucoma. The power used ranged from 100 mW to 1000 mW and the total energy from 1.0 J to 5.0 J. The success rates between groups were tested with a x2‐test. With laser power of more than 500 mW and energy level more than 3.0 J, the success rates were maximal (77% and 75%).