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INTRODUCTION: Loss of corneal endothelial cells (CECs) is one major factor limiting transplant clarity and survival after keratoplasty. Amongst other factors, apoptosis due to cellular stress is responsible for these problems. This study investigates the possible anti-apoptotic and cytoprotective effects of minocycline on a human corneal endothelial cell line (HCEC-SV40) cultured under oxidative stress and with transforming growth factor beta (TGF-β). METHODS: CECs were treated with 1–150 µM minocycline. Cell viability and the median inhibitory concentration (IC50) were evaluated after 48 h and after H2O2treatment (tetrazolium dye reduction assay and live–dead assay). Expression of B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP) and their mRNA were assessed by reverse transcriptase (RT)-PCR and western blot analysis after treatment with minocycline alone and consecutive incubation with 200 µM H2O2and TGF-β2. A quantitative detection of histone-associated DNA fragmentation by ELISA was performed. RESULTS: Minocycline concentrations from 1–50 µM showed no toxic effects on CECs. Pre-treatment with 10–40 µM minocycline led to an increase in viability after H2O2treatment. In addition, minocycline pre-treatment attenuated the increase of histone-associated DNA fragmentation after treatment with H2O2and TGF-β2 significantly. When CECs were treated with minocycline and then consecutively with H2O2or TGF-β2, RT-PCR and western blot analysis yielded an overexpression of Bcl-2 and XIAP. CONCLUSION: In this study minocycline prevented apoptotic cell death in cultured CECs in vitro. Our results suggest that minocycline might offer cytoprotective properties that might help to prevent loss of corneal endothelial cells in vivo. [ABSTRACT FROM AUTHOR]

Purpose: Cost-utility and cost-effectiveness analyses are of increasing importance to clinicians and health policy experts. This study determines the costs in Germany and other countries in relation to gain of utility for patients with bilateral poor vision owing to corneal disease undergoing penetrating keratoplasty (PK) in 1 eye. Design: A cost-utility analysis was performed using retrospective clinical data and high-level evidence-based data. Participants: Sixty patients (mean age, 46.3 years) with bilateral poor vision who underwent PK for corneal disease. Methods: Visual acuity and utility values were obtained before and 1 year after PK and after suture removal. A 10-year graft survival rate of 80% was assumed. Expenses included costs for the corneal transplant and surgery, medication, and optical rehabilitation. A discount rate of 5% was applied for costs and quality-adjusted life years (QALYs). Cost-utility analysis encompassed a 10-year period after surgery. Main Outcome Measures: The number of QALYs was calculated for the study group undergoing PK. This was divided into the cost of the procedure to get the number of euros spent per QALY gained. Results: Median binocular preoperative visual acuity was −log mean angle of resolution (−logMAR) 0.91±0.53 (Snellen equivalent 20/160) yielding a utility value of 0.67. After suture removal and optical rehabilitation, binocular visual acuity increased to median −logMAR 0.36±0.36 (20/46) with a utility value of 0.79. Over the 10 years after surgery and considering graft survival and discounting, a cost utility of €9551 per QALY was gained (equivalent to US$11 557). One-way sensitivity analysis yielded a range from €7706 to €12874 per QALY, highlighting the robustness of the model. Conclusions: Although an expensive procedure, PK is cost effective in patients with bilateral poor vision. [Copyright &y& Elsevier]

Purpose A close interaction between neurosensory retina and the retinal pigmentepithelium (RPE) is a prerequisite for normal vision. Glaucomatous damage is characterized by neuroretinal degeneration. As a result, an imbalanced interaction exists. However, there is only limited evidence regarding RPE involvement in glaucoma patients' eyes. This study investigates the correlation between retinal nerve fiber layer (RNFL) thickness and RPE alterations as detected by widefield fundus autofluorescence (FAF). Methods Peripapillary RNFL thickness was quantified by optical coherence tomography (OCT). The six corresponding retinal areas were defined by a standardized grid and FAF intensity/irregularities were assessed and correlated to RNFL measurements. Results 84 glaucomatous eyes were investigated. A correlation between RNFL thickness and standardized FAF in the corresponding topographic retina segments was observed. Correlation coefficients ranged between ‐0.12 to 0.35 and were statistically significant in the temporal inferior central field (r=0.35, p=0.02) and the temporal inferior peripheral field (r=0.31, p=0.04). Conclusion This study provides early evidence that in glaucoma RNFL degeneration may be accompanied by corresponding RPE alterations [ABSTRACT FROM AUTHOR]