Norbert Schrage

One year follow up of macular translocation with 360 degree retinotomy in patients with age related macular degeneration

Aim: To evaluate the benefits of macular translocation with 360 degree retinotomy in patients with exudative age related macular degeneration (ARMD). Methods: A consecutive interventional case series was performed on patients who underwent macular translocation between June 1997 and January 2000 at the department of ophthalmology, University of Aachen, Germany. A retrospective pilot study was set up with a minimum follow up of 12 months in 39 consecutive patients with subfoveal choroidal neovascularisation secondary to ARMD. The surgical technique included pars plana vitrectomy, induction of retinal detachment, 360 degree retinotomy, removal of the choroidal neovascular membranes (CNVM), macular translocation, peripheral laser retinopexy, and silicone oil endotamponade. Results: 18 patients showed predominantly occult CNVM, six patients had predominantly classic CNVM, and 15 showed subretinal haemorrhage. At the 12 month follow up 13 patients (33%) showed an improvement in visual acuity of more than three lines (logMAR scale), 18 patients (46%) retained stable visual acuity with a change of equal or less than three lines (logMAR scale), and eight patients (21%) showed a decrease in visual acuity of more than three lines (logMAR scale). Recurrence of CNVM was observed in three (8%) eyes at 5–11 months postoperatively. Other complications included proliferative vitreoretinopathy with retinal detachment (n=10), peripheral epiretinal membranes (n=9), macular pucker (n=2), corneal decompensation (n=2), and hypotony (n=11). 18 patients (46%) complained about persistent diplopia. Conclusion: Macular translocation surgery is able to maintain or improve distant vision in the majority of patients with exudative ARMD. Proliferative vitreoretinopathy and diplopia are the two major complications. A prospective randomised controlled trial comparing macular translocation with observation for patients with the occult form of exudative ARMD may be justified.

Phosphate buffer in alkali eye burns as an inducer of experimental corneal calcification

Corneal calcification is a common problem in severe inflammation, chronic glaucoma, renal disorders and other diseases with disturbed calcium and phosphorus metabolism. The pathogenesis of corneal calcifications in ocular diseases is not yet completely understood. We present a model of an induced corneal calcification by local treatment. In a double-masked experiment 16 rabbits underwent eye burn of one cornea followed by immediate rinsing (160 ml) with isotonic phosphate buffer (n=8) or saline solution (n=8) three time a day for 16 days. Tissues were excised, shock frozen and cut into 10 microm slices, freeze dried and coated with evaporated carbon. In the phosphate buffer group an early onset of corneal opacification occurred resulting in completely white corneas after 16 days, combined with corneoscleral ulceration. The other group showed similar corneal erosion and a little corneal ulceration, but no opacifications. The opacifications of the phosphate buffer group could be identified as calcifications by direct measurements of calcium and phosphate (by energy dispersive X-ray analysis on corneal samples). In conclusion, inappropriate application of phosphate leads to uncontrolled calcifications of the cornea after severe burns to the eye. This reflects clinically observed calcifications after eye burns and possibly the adverse side effects of phosphate buffered eye drops being applied in ophthalmology.

A new way of removing silicone oil from the surface of silicone intraocular lenses

Abstract · Purpose: This study was performed to ascertain the efficacy of Perfluorhexyl-octan, C14F13H17 (F6H8), in dissolving silicone oil from the surface of silicone intraocular lenses. So far F6H8 is the only solvent of silicone oil that is tolerated by intraocular tissues. · Materials and methods: Intraocular silicone lenses (Domilens) were examined after application of small droplets of silicone oil of two different viscosities (AdatoSIL-OL 1000 and 5000) followed by rinsing with F6H8. To allow distinction between silicone oil and F6H8 the silicone oil was stained. Microscopic examination was carried out under video control. · Results: One hundred microliters of AdatoSIL-OL 1000 could be easily removed with about 800 µl of F6H8; 50 µl of AdatoSIL-OL 5000 also disappeared after 800 µl of F6H8. A larger drop of the latter oil could not be removed even after application of 2 ml of F6H8. · Conclusion: Silicone oil 1000 can be easily dissolved by F6H8, whereas silicone oil 5000 is more difficult to remove because of its higher viscosity.

The cornea surface and wound healing

Abstract Wound healing of the corneal is closely associated with the regeneration of the epithelium. It may be impaired by mechanical or chemical damage to the basement membrane, under infections, and in neuroparalytic conditions. Eye burns show such damage. Therefore, experimental models of alkali burns were widely used to investigate wound healing of the ocular surface. Mediators of inflammation play an important part in disease and healing processes. High amounts of inflammatory mediators inhibit the regeneration of the epithelium and induce ulceration. Then, serine and metalloproteinases are released on the ocular surface and inside the tissues. These enzymes melt the stromal matrix. Especially when leukocytes are present, superoxides also appear and destroy the organic substrates of tissues. Therefore, therapeutical support of wound healing on the ocular surface has to take into account many factors. It seems that rather a polyvalent therapy may have a better chance of success. As soon as the epithelial cover is completely closed, stromal wounds heal better, and sometimes inflammation subsides.

Comparison of emergency eye-wash products in burned porcine eyes

Abstract.Background: The long-term prognosis of patients with chemical eye burns depends on immediately rinsing the eye after the trauma. The chemical properties and tolerance of currently used rinsing solutions were examined. Methods: NaCl 0.9%, Ringer lactate, balanced salt solution (Aqsia), phosphate buffer, tap water, and Previn were analyzed. The buffer capacities were determined by titration with HCl and NaOH. The osmolarity of the solutions and the osmolarity of 100 healthy and 100 alkali burned porcine corneas were determined by means of freezing point depression. 56 enucleated porcine eyes were burned and rinsed with NaCl solutions of different osmolarities (0–1200 mosmol/l), Previn, NaCl 0.9% or phosphate buffer, respectively. The different swelling behaviors were determined by pachymetric measurements, and the resulting corneal osmolarity after irrigation was assessed. The effect of Previn as a hyperosmolar solution in comparison with isoosmolar phosphate buffer was examined on 10 healthy human eyes. Results: Only phosphate buffer and Previn show high buffer capacities. The osmolarity of the healthy/burned porcine corneas was 329±61/1203±289 mosmol/kg. Except for Previn (862±3 mosmol/l), all solutions are hypo- or almost isoosmolar in comparison with the healthy cornea. Rinsing of the burned corneas causes swelling in all groups in inverse proportion to the osmolarity of the solution. Thus, the lower the solutions osmolarity, the stronger the swelling reaction of the cornea. The resulting corneal osmolarity following rinsing behaves proportionally to the osmolarity of the rinsing solution. Therefore, a high osmolarity of the rinsing solution correlates with a high corneal osmolarity. No long-term effects in healthy eyes were observed after rinsing with Previn or phosphate buffer. Conclusion: Corneal thickness and osmolarity are significantly correlated to the osmolarity of the rinsing solution. Corneal edema dilutes the agent in the stroma. Therefore, we recommend solutions with low osmolarity (tap water) or high buffer capacity (Previn) for the initial post-trauma irrigation.

Poor prognosis of severe chemical and thermal eye burns: the need for adequate emergency care and primary prevention.

The epidemiology and wound healing following medical and surgical treatment of 101 patients with 131 severely burnt eyes due to chemical or thermal agents have been analyzed. Most of the accidents occurred at work (72.3%); the majority of the burns were chemical (84.2%), of which 79.8% were caused by alkalis. The long average duration of treatment on ward (5.2 ± 4.1 months) and the high number of surgical interventions (8.0 ± 8.0) indicate the difficulties in treatment and the delayed recovery of the affected eyes. Despite improved possibilities of immuno-suppression after keratoplasty (cyclosporin A) and new methods of surgery (Tenon plasty), the possibilities of an optical rehabilitation are still limited. A visual acuity of 6/60 or better was achieved in 39 eyes (32.2%). Immediate irrigation was reported in 56.1% of accidents at the place of work and in 42.8% of accidents sustained at home. There was a significant difference with respect to the extent of damage, the treatment on ward and the number of surgical interventions. The visual prognosis for eyes which received immediate irrigation was significantly improved. Eye protection was not used in any of the 101 cases. Spread of information is necessary for adequate emergency care for eye burns as well as for permanent employment of protective glasses in high-risk occupations.

Translocation of iris pigment epithelium in patients with exudative age-related macular degeneration: long-term results

PurposeTo report the practicability and efficacy of autologous iris pigment epithelium (IPE) translocation in exudative age-related macular degeneration (ARMD) over 1 year.MethodsThe consecutive interventional case series included 56 patients with exudative ARMD. During vitrectomy the submacular neovascular membrane (CNV) was removed and IPE cells, harvested from a peripheral iridectomy, were injected into the submacular space. Included were patients with subfoveal occult CNV (11 eyes), classic CNV (10 eyes), mixed CNV (17 eyes), CNV with a pigment epithelial detachment (13 eyes) or CNV with a hemorrhage (5 eyes). Outcome measures were visual acuity, foveal fixation, size of CNV and rate of recurrence based on fluorescence angiographic imaging.ResultsAll patients underwent successful surgical removal of the CNV with consecutive subretinal IPE injection. Visual acuity was better than 20/100 in 19 patients preoperatively and in 18 patients postoperatively. A visual acuity of 20/100 or less was found in 37 patients preoperatively and in 38 patients postoperatively. Mean preoperative visual acuity (1.0±0.3 logMAR units) did not change significantly after 1 year (1.0±0.3 logMAR units). Ten eyes (18%) developed a recurrence. Fixation within the surgically denuded area could be demonstrated in 25 eyes (45%).ConclusionsAutologous IPE translocation for ARMD over one year can preserve foveal function on a low level, but cannot improve visual acuity. IPE translocation is technically feasible with a low rate of complications. Continued research seems justified to improve functional outcome.

Heavy silicone oil versus standard silicone oil in as vitreous tamponade in inferior PVR (HSO Study): interim analysis.

Purpose:  The Heavy Silicone Oil versus Standard Silicone Oil Study (HSO study) is designed to answer the question whether a heavier‐than‐water tamponade improves the prognosis of eyes with proliferative vitreoretinopathy (PVR) of the lower retina.

Use of an amphoteric lavage solution for emergency treatment of eye burns: First animal type experimental clinical considerations

PURPOSE Severe eye burns occur rarely, but are related to a poor prognosis in rehabilitation. As emergency treatment has been identified as decisive factor for the prognosis of eye burns, new first aid rinsing solutions should be considered carefully in their clinical action. In a first approach, the new drug Diphoterine was subjected to a comparison with saline solution to evaluate the effects in a model of severe eye burns. METHODS In a double-masked experiment 16 rabbits underwent a severe eye burn of one cornea followed by immediate rinsing with 0.9% sodium-chlorine solution (n=8) or Diphoterine (n=8). During 16 days after burn, an irrigation therapy with 0.9% saline solution three times daily 160 ml was applied in both groups following the recommendation of prolonged irrigation therapy performed in our clinic. In a similar setup, 16 eyes were subjected alkali burns with measurements of aqueous humor pH within 30s after burn and after a period of 5 min rinsing with 500 ml saline 0.9% or Diphoterine, respectively. RESULTS The result of the severe eye burn with an opaque cornea was similar in both groups. During rinsing no fibrin precipitates occurred in the Diphoterine rinsed group whereas this was detectable in all eyes rinsed with saline solution. After 16 days there was no difference between both groups indicating no harmful effect of Diphoterine as emergency treatment compared to saline 0.9%. After 30s of burn with 1N NaOH and rinsing with 500 ml of the specified solutions the anterior chamber pH was 10+/-0 in the saline group and 9.35+/-0.3 in the Diphoterine group showing efficacy of the buffering capacity of Diphoterine. CONCLUSION Diphoterine proves to be efficient in the primary treatment of burns. The anterior chamber pH could be lowered by 5min of rinsing. No harmful effects of Diphoterine could be observed compared to rinsing with saline solution in the course of an severe alkali burn of the cornea.

An amphoteric rinse used in the emergency treatment of a serious ocular burn

An amphoteric rinse used in the emergency treatment of a serious ocular burn Max Gerard a,∗, Harold Merle b,1, Frederick Chiambaretta c,2, Daniele Rigal c,3, Norbert Schrage d a Service d’Ophtalmologie, Centre Hospitalier de Cayenne, Rue des Flamboyants, 97300 Cayenne, Guyane Francaise, France b Service d’Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hopital Pierre Zobda Quitman, BP 632, 97261 Fort de France Cedex, France c Service d’Ophtalmologie, Centre Hospitalier Universitaire de Clermont Ferrand, Hopital Gabriel Montpied, Rue Montalembert, BP 69, 63003 Clermont Ferrand Cedex, France d Labor der Augenklinik RWTH, PauwelsstraBe 30, D-52057 Aachen, France