Sven Crafoord

Infectious keratitis treated with corneal crosslinking

Purpose: To describe 7 eyes with severe infectious keratitis treated using collagen crosslinking (CXL) with riboflavin. Materials and Methods: Seven eyes of 6 patients with severe infectious keratitis were treated with corneal crosslinking. Three patients were contact lens users. Symptom duration before CXL ranged between 0 and 7 days. Corneal melting was present in all cases. Photodocumentation of the keratitis was carried out and repeated at follow-up. All but 1 patient received topical antibiotic treatment in addition to the CXL treatment. CXL was conducted according to the standardized protocol for keratoconus. Results: In all but 1 eye, patients experienced improvement in symptoms within 24 hours. Two patients reported no symptoms whatsoever at this time. Corneal melting was arrested and complete epithelialization was achieved in all cases. In the 2 eyes with hypopyon, this regressed completely within 2 days after the CXL. Follow-up ranged between 1 and 6 months. Discussion: Our experience based on the above and other cases suggest that CXL could be an effective tool in battling difficult cases of infectious keratitis. This treatment could present many advantages but will need further investigation.

Electroporation Therapy of Skin Cancer in the Head and Neck Area

BACKGROUND Electroporation therapy is a new cancer treatment modality in which a locally applied electrical field enhances cell membrane permeability, allowing greater intracellular accumulation of a chemotherapeutic agent. OBJECTIVE To evaluate the efficacy of electroporation therapy in treating basal cell and squamous cell carcinomas of the skin. MATERIALS AND METHODS Six patients with skin cancer of the head and neck were treated using electroporation therapy with intratumorally injected bleomycin. Orbital growth, facial nerve proximity, or proximity to cartilage of the external meatus complicated four of these tumors. The intention was curative. The follow‐up period was 24 months and included biopsies after 8 weeks. RESULTS In four of the six patients, one treatment was enough to eradicate the tumor. In one patient, the tumor persisted even after a second treatment with electroporation therapy. A septal cartilage perforation was the only major complication. The cosmetic results were very satisfactory. One additional recurrence was recorded 6 months after the follow‐up period CONCLUSION Electroporation therapy is a promising new cancer treatment that should be further evaluated as an alternative to surgery, especially in complicated skin cancer. Genetronics, Inc. provided financial support for this study and has paid Dr. L. Lofgren an honorarium for work at investigator meetings.

Longterm follow-up of pars plana vitrectomy for vitreous floaters: complications, outcomes and patient satisfaction

Purpose:  Floaters caused by degenerative or postoperative changes in the vitreous can interfere with all aspects of visual functioning. The aim of this study is to report the longterm outcome of pars plana vitrectomy (PPV) for persistent vitreous opacities.

Experts do not agree when to treat retinopathy of prematurity based on plus disease

Objectives To investigate inter-reader agreement on five severity levels of central vascular changes (none, mild, moderate, severe pre-plus disease, plus disease) and aggressive posterior retinopathy of prematurity (ROP), and to see whether an unintended shift in indication for treatment occurred. Methods Four international ROP readers participated. Before the grading of the photographs, the readers were informed that a high proportion of advanced ROP cases were included. In total, 243 photographs/948 quadrants were available from 136 infants. As a standard series of photographs was available, grading was performed under optimised conditions. Results The four readers agreed on the quadrant scores of only 70 (7.38%) of the 948 quadrants—that is, on 1, 5, 15, 4 and 45 quadrants for scores 0, 1, 2, 3 and 4, respectively. The mean scores differed systematically between the readers (permutation test, p<0.0001). Agreement on presence of aggressive posterior ROP from all four readers was not obtained for any of the photographs. Readers scored plus disease in at least two quadrants in 95.5% of the eyes for which treatment was indicated. All four readers agreed on the scoring of indication for treatment for 195 eyes (80.2%); however, treatment was only recommended in 18 (7.4%) eyes. One reader was found to differ systematically from the others in indicating treatment (Rasch analysis; p=0.0001). Finally, a significant shift in indication for treatment occurred between birth period 2000–2002 and 2003–2006 (Mann–Whitney rank sum test, p<0.001). Conclusions Inter-reader agreement on central vascular changes is poor, especially when based on more than two rating categories. The subjective nature of diagnosing such vascular changes possibly resulted in earlier treatment of preterm infants in Denmark over the entire study period (1997–2006). The recent increased incidence of treated infants in Denmark is, at least in part, explained by a significant shift in indication for treatment.

Evaluation of viscoelastic poly(ethylene glycol) sols as vitreous substitutes in an experimental vitrectomy model in rabbits

The aim of this study was to employ an experimental protocol for in vivo evaluation of sols of 5 wt.% poly(ethylene glycol) (PEG) in phosphate-buffered saline as artificial vitreous substitutes. A 20 gauge pars plana vitrectomy and posterior vitreous detachment were performed in the right eye of eight pigmented rabbits. Approximately 1 ml of the viscoelastic PEG sols was then injected into the vitreous space of six eyes. PEG with an average molecular weight of 300,000 and 400,000 g mol(-1) was used in two and four eyes, respectively. Two eyes received balanced salt solution and served as controls. Full-field electroretinography was carried out and intra-ocular pressure (IOP, palpation) measured pre- and post-operatively at regular intervals up to 41 days. The rabbits were killed and the eyes examined by retinal photography, gross macroscopic examination and histology. The viscoelastic sols were successfully injected and remained translucent throughout the post-operative period, with some inferior formation of precipitates. None of the eyes displayed IOP elevation post-operatively, but in three of the PEG sol injected eyes transient hypotony was noted. One eye sustained retinal detachment during surgery and another two in the post-operative period. ERG recordings confirmed preservation of retinal function in three out of four eyes injected with 400,000 g mol(-1) PEG. Histological examination revealed up-regulation of glial acidic fibrillary protein in Müller cells in PEG sol injected eyes, but normal overall morphology in eyes with attached retinas. The viscosity of the sol was not retained throughout the post-operative period, indicating the demand for polymer cross-linking to increase residence time. The results provide promising preliminary results on the use of PEG hydrogels as a vitreous substitute.

Sheathotomy in complicated cases of branch retinal vein occlusion.

Purpose:  To report the clinical experience and results of using a microsurgical technique to decompress the arteriovenous connection in complicated branch retinal vein occlusion (BRVO) combined with haemorrhage, oedema and ischaemia.

Healon® GV in posterior segment surgery

Abstract. Healon®, a viscoelastic preparation of Sodium hyaluronate, has been reported effective in posterior segment surgery for dissection of epiretinal membranes, i.e. proliferative diabetic retinopathy and macular pucker. A more viscous substance might be more effective for this kind of surgery. Therefore, a new Sodium hyaluronate preparation Healon® GV with a ten times greater viscosity at rest than Healon®, was tested in and open clinical study. Twenty‐four patients of both sexes and not younger than 18 years were enrolled. The follow‐up time was three months. The main indications for using Healon® GV were: to separate membranes from the retina, to stop bleeding and to reposition a detached retina. 0.2–0.5 ml of Healon® GV was injected through a 27 gauge bent cannula and at close of surgery irrigated out of the eye. Postoperatively the patients were monitored concerning intraocular pressure, vitreous clarity, anterior chamber flare and visual acuity. Healon® GV was found to make the surgical procedure simpler and safer. No inflammatory reaction and no increase of IOP was observed.

Healon® Yellow as a Surgical Tool in Maneuvering Intraocular Tissues

Tinted sodium hyaluronate (Healon Yellow) was used during posterior segment surgery mainly for the dissection of epiretinal membranes in cases of proliferative diabetic retinopathy and macular pucker. The yellow color facilitated injecting the viscoelastic substance under the membranes and simplified its removal at the end of surgery.

Sealing of retinal breaks with metal tacks: Evaluation of a new procedure in retinal re-attachment surgery

Abstract Metal retinal tacks were used in 18 patients with complicated retinal detachments, such as giant tears (3 cases), severe proliferative vitreoretinopathy (PVR) (7 eyes) and diabetic traction and rhegmatogenous detachment (8 cases). All eyes had undergone vitreous microsurgery, including excision or segmentation of epiretinal membranes, fluid‐air (SF6) or silicone oil exchange. Retinal breaks and the cut edges of retinotomies and retinectomies were successfully sealed by metal tacks. Retinal re‐attachment was achieved in 9 cases and partial re‐attachment in another 5 eyes (follow‐up 3–6 months). Retinal tears in diabetic macular detachment associated with extensive epiretinal fibro‐vascular membranes were also successfully sealed despite persisting traction. Our first experience indicates that the closing of retinal breaks with metal tacks is a major step forward in retinal re‐attachment surgery.

Vasoproliferative retinal tumours in a Swedish population.

Acta Ophthalmol. 2011: 89: 91–94