Search

Levels of vascular endothelial growth factors (VEGF) are regulated in a complex network of adipokines, glucose control, and low grade inflammation together with activated platelets, leucocytes, and endothelial dysfunction. Increased levels of VEGF are associated with enhanced angiogenesis and impaired repair mechanisms of vascular lesions in endorgans. Little is known about the interaction of systemic VEGF levels with quality of diabetes control, biomarkers of inflammation, and diabetic nephropathy. Moreover, it is unclear, whether serum and plasma VEGF levels are similarly suited to reflect risk associated with VEGF.In this case control study, we analyzed these parameters in serum and plasma of age and sex matched controls without diabetes (n=99) and type 2 diabetes (n=302). Serum VEGF-A was significantly increased in patients with T2DM while plasma levels were in the same range as for controls. Individual levels varied in a wide range. Serum levels were 4.9 times higher in controls and 7.3 times higher in T2DM as compared to plasma levels. T2DM was associated with significantly higher levels of hsCRP, ALAT, and albumin/creatinine ratio. When calculated for tertiles of HbA1c, we observed a highly significant increase from tertile one to the upper tertile for serum VEGF-A but not for plasma VEGF-A. Correlation analysis revealed a significant relationship between VEGF-A, HbA1c, inflammation, and diabetic nephropathy. Our results indicate that increased VEGF-A levels in T2DM significantly depend on quality of HbA1c control. Serum levels of VEGF-A, with a strong contribution of platelet derived VEGF, better reflect the glycemic burden than plasma levels of VEGF-A. Mechanistic studies are needed to explore links to inflammation and diabetic nephropathy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Endothelial keratoplasty is a promising surgical procedure which may replace penetrating keratoplasty in cases of endothelial cell diseases of the cornea. This method may thereby help to prevent postoperative astigmatism and transplant rejection., Methods and Results: A survey of publications reporting about results after endothelial keratoplasty shows that the main problem of this transplantation technique is a postoperative endothelial cell loss which is comparable to or even higher than that observed in penetrating keratoplasty. Improving surgical techniques led to a reduction of the endothelial cell loss, however, cell-based strategies to prevent postoperative cell loss or to enhance the cell densities of donor corneas or endothelial lamellae are rare., Discussion: This review presents an overview of clinical results after endothelial keratoplasty. Current strategies in the field of cell biology and tissue cultivation of corneal endothelial cells, genetic manipulation of the corneal endothelium and tissue engineering strategies aiming at the production of transplantable endothelial cell sheets are described., Conclusion: The limited availability of donor corneas makes it mandatory to develop methods in the field of tissue engineering in order to improve corneal endothelial cell survival or to increase corneal endothelial cell density, using interdisciplinary approaches., (© Georg Thieme Verlag KG Stuttgart · New York.)

This review focuses on the scientific background for the use of "yellow artificial lenses". We will address the fact that numerous basic scientific publications point to a rationale for this practice although it is often difficult to derive clear-cut evidence from clinical epidemiological studies for the preventive use of yellow artificial lenses. In the first part we refer to studies showing that especially the shortwave part of the visible spectrum of light can be harmful for the retina and optic nerve. For this, we have screened the literature for the major sources of radical production and for the targets of oxidative stress after impingement of "blue light" on the retina. Furthermore, we can show that many studies in cell and molecular biology, animal experiments and first clinical trials point to a preferential use of yellow-tinted lenses especially in the elderly and AMD patients., (Georg Thieme Verlag KG Stuttgart.New York.)

Retinal surgery of retinal detachment in the inferior part of the eye is often complicated by the development of proliferative vitreoretinopathy. Therefore the heavier-than-water concept using heavy silicone oils is a logical consequence for treatment of otherwise unsuccessful retinal surgery in such cases. While some surgeons already use heavy silicone oils in the clinical routine, others are carefully following complication rates. Even good anatomical and functional results are published as critical case reports. In this report we describe the advantages of the heavy silicone oil endotamponade and our own clinical experiences with Densiron(R) 68. The use of heavy silicone oils turned out to be quite convenient, leading for example to shorter tamponade times, easy handling of the oil, no need for uncomfortable prone-position of the patients. On the other hand one has to consider that Densiron(R) 68 is a mixture which contains 70 % PDMS and 30 % F 6 H8, a heavy fluid that was associated with multiple complications if used as sole long-term endotamponade. Based on these experiences we recommend all users bear in mind possible complications. However, such complications can be prevented.

The use of polydimethylsiloxane (PDMS) as silicone oil endotamponade has become a gold standard in retinal surgery. In cases of complicated retinal detachment with inferior and posterior retinal detachment this tamponade may be insufficient, and heavy silicone oils may be superior in such cases. Monocentric studies about use of the heavy silicone oil Densiron 68, a mixture of PDMS with perfluorohexyloctane (F6 H8), are reviewed. Meanwhile, F 6 H8 is approved as sole endotamponade, but complications such as emulsification and inflammation associated with the use of only F 6 H8 as endotamponade are reported and will also be reviewed. An advantage of heavy silicone oils is the relatively short residence time of the endotamponade. An uncomfortable "head down" position of the patients after surgery is not necessary. Current research focuses on developing new heavy silicone oils with a lower tendency to emulsify.

Round 10-12% of all children who present with signs of uveitis suffer from intermediate uveitis. Compared to uveitis anterior in children, the association of intermediate uveitis to a systemic disease is much more complicated. Most cases of uveitis intermedia are idiopathic and show the signs of a pars planitis. Post-infectious and immunological causes are difficult to detect. In cases of uveitis in children, it is necessary to know the specific symptoms of possible underlying systemic diseases. On this basis, an adequate and specific diagnosis will most probably be successful. This paper presents the different causes of uveitis intermedia in childhood and compares the incidence of the disease in comparison with adults as far as this is mentioned in the literature.

Background: Diffuse and cystic epithelial downgrowth occur rarely, but they represent a mostly preventable potential cause of blindness as sequels to trauma and surgery. The aim of this study is to report on the etiology and course of disease in patients with histologically verified epithelial downgrowth., Patients and Methods: From 1986 until 2000 the ophthalmopathological laboratory of the University Eye Hospital Hamburg-Eppendorf received 13 (4 external) referrals. Ten patients with cystic of diffuse intraocular epithelial downgrowth were treated and 9 eyes were operated on in the Hospital., Results: At presentation 4/10 patients had a visual acuity of < or = 0.1, and 2/10 had no light perception. A cystic epithelial downgrowth was verified histologically in 9/13, and a diffuse form in 4/13 patients. Mucin production was proven histochemically in 1/9 intraocular epithelial downgrowth sections. In one case a spontaneous iris cyst was detected by the immunohistological examinations. Trauma (10/14) and surgery (3/14) were the most frequent causes and were symptomatic on average 17 years after the primary event. A curative surgery was done in 13/14 patients (5 x en bloc excision, 2 x penetrating keratoplasty, 1 x iridectomy, 2 x enucleations, 3 x external) resulting in no recurrences during the follow-up of 4(1/2) years (1 - 12 years). The postoperative visual acuity was ameliorated in 5/9, worsened in 2 patients, and 2 were enucleated., Conclusions: Epithelial downgrowth is a rare but preventable cause of blindness. The most important prophylaxis is meticulous primary surgery including a sufficient wound closure. The visual outcome depends on the preoperative conditions.

Purpose: Development and evaluation of a new photodynamic treatment technique for the laser therapy of liver malignancies, Material and Methods: The combination with new catheter systems enables the use of the photodynamic therapy (PDT) to treat also tumors in parenchymal organs. So far it is mainly used to treat superficial or endoluminal tumors. The presented study is part of a multicenter phase I-study. We treated 5 patients with colorectal liver metastases with the new photosensitizer SQN 400 and following interstitial photodynamic laser treatment. Evaluation of tumors were performed by contrast-enhanced CT scans., Results: In the contrast enhanced CT scans the development of a complete necrosis within a radius of 1 cm around every single fibre could be shown. Additional the ablation of tumors with the combined use of several fibres is possible. Severe complications or toxicities were not observed., Conclusion: The photodynamic laser therapy of liver malignancies is a minimal invasive procedure with little side effects which produces sharply defined yet small volumes of necrosis.

Purpose: To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques., Materials and Methods: In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70(3)) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90(3)) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex*). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated., Results: All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors., Conclusion: MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies.

Purpose: To evaluate the clinical value of the renal clearance using MR imaging with different doses of gadolinium ethoxybenzyl-DTPA (Gd-EOB-DTPA) in comparison to gadolinium DTPA (Gd-DTPA)., Material and Methods: In a double-blind and randomized clinical phase II study. MR imaging at 1.5 T was performed in 61 patients with five different doses of Gd-EOB-DTPA (3, 6, 12.5, 25 and 50 micromol/kg b. w. as a bolus injection). The study protocol comprised T(1)- and T(2)-weighted spin-echo magnetic resonance and two-dimensional fast low-angle shot imaging before and at increasing intervals for up to 45 min after injection of Gd-EOB-DTPA. These images were compared with Gd-DTPA-enhanced imaging (0.1 mmol/kg b. w. as a bolus injection)., Results: After bolus injection of the hepatobiliary MR contrast agent Gd-EOB-DTPA a renal elimination was observed. Immediately after the injection of Gd-EOB-DTPA until the eighth minute a corticomedullary enhancement of the kidney was conspicuous. After the fourth minute a contrast enhancement could be seen in the renal pelvis. The best enhancement was noted after 20 minutes in the FLASH GRE and T(1)-weighted images with good pelvicaliceal contrast. After 45 minutes an outflow of Gd-EOB-DTPA into the ureter could be observed., Conclusion: In addition to the hepatobiliary secretion Gd-EOB-DTPA appears useful for the evaluation of renal structures and renal function on account of the renal excretion without diuretic preparation of the patients.

Purpose: To present the technical data, methods and results of percutaneous laser ablation of malignant tumors., Patients and Methods: In the period from June 1993 to April 2000 a collective of 600 patients with malignant liver tumors and liver metastases from different primary tumors were treated via MR-guided LITT. After sonographically or CT-guided puncture MR-compatible laser catheters were positioned. The tumor destruction was visualized via MR-thermometry. The checkup and the therapy accomplishment ensued in the course of an ambulant therapy concept., Results: In the course of a local accomplished LITT of liver metastases and malignant liver tumors a local tumor control rate of 97.8 % was achieved. The complication rate was extremely low with a value of 2.2 % (1 441 treatments). The lethality rate was 0.1 %. The mean survival time referring to the whole patient collective was 47.7 months, in the case of liver metastases from a colorectal cancer a value of 46.8 months was achieved., Conclusion: MR-guided LITT is a local effective therapy with low morbidity in malignant liver tumors with a maximum quantity of 5 and a size of

Objective: To evaluate the performance of 4 different visualization techniques for multislice CT datasets from the coronary arteries in comparison to coronary angiography., Material and Methods: 42 patients were examined prospectively using both multislice CT and angiocardiography. All CT scans were performed at collimation 4 x 1 mm, pitch 1.5 and a rotation time of 500 msec. Using retrospective ecg-gating, image reconstruction parameters were 1.25 mm slice thickness, 0.5 mm increment and kernel B30. Each patient's CT dataset subsequently was explored using axial, multiplanar, three-dimensional, and virtual endoscopic visualization modes., Results: Axial scans showed the highest sensitivity in the evaluation of stenoses (66.7%), followed by virtual endoscopy (55.9%), multiplanar (48.6%), and three-dimensional reformations (33.3%). With regard to the detection of atherosclerotic plaques, axial scans (71.2%), three-dimensional reformations (70.1%), and virtual endoscopy (69.1%) displayed comparable sensitivities, whereas multiplanar reformations showed distinctly lower results (55.6%). On combining the techniques a sensitivity of 74.2% for the detection of atherosclerotic plaques, of 72.0% for the identification of high-grade stenoses, respectively, was obtained. The specificity of all four visualization modes amounted to 91.9% and above. Best results have been obtained within the RIVA (sensitivity 85.2%)., Conclusion: For the detection of atheromatous changes CT angiocardiography does not achieve a sensitivity as high as angiocardiography and is restricted to the three major branches. At heart rates below 60 bpm axial scans showed the best correlation in the quantification and classification of atherosclerotic plaques.

Background: Ocular cicatrical pemphigoid can lead to severe structural damage or loss of vision at worst. Longterm therapy with dapsone or systemic immunosuppressive therapy, e.g. with cyclophosphamide is often inevitable. Immunosuppression may cause severe side effects in some patients., Patients and Methods: Data are presented on 5 patients with ocular cicatrical pemphigoid who were treated with mycophenolate mofetil 2 g daily. Criterion of effectiveness was the clinical course of the condition defined as nonprogression of the morphologic alterations. Patients were initially examined and interviewed routinely every four weeks for the first four months, then every eight weeks. Patients were asked about side effects and underwent monthly blood checks., Results: All patients were followed for at least 12 months. Mycophenolate mofetil proved to be effective with respect to the clinical course in 9 out of 10 eyes. All patients showed regression of inflammatory conjunctival alteration and improvement of their complaints. In one eye the inflammatory process restarted after surgery due to excessive symblephara had been performed. Gastrointestinal side effects were reported in the initial phase, e.g. lack of appetite, nausea and mild diarrhoea., Conclusions: Mycophenolate mofetil proved to be an effective immunosuppressant for the treatment of ocular cicatrical pemphigoid. Namely side effects were less severe and frequent compared to those known from other currently administered immunosuppressants. Longterm results and larger case numbers are needed to sustain these early results.

Purpose: To evaluate prospectively the volumetric changes of tumor and necrosis in unresectable malignant liver tumors and the clinical aspects after CT-guided direct intratumoral administration of a novel cisplatin/epinephrine injectable gel in a clinical phase II study., Patients and Methods: 8 patients with 17 colorectal liver metastases with a mean volume of 42 ml were treated with a mean of 5.1 injections and 8 patients with 11 HCC nodules (mean volume of 22.1 ml) with a mean of 3.25 treatments with CT-guided local administration of a novel cisplatin/epinephrine gel. This method of administration provides a higher local and lower systemic drug concentration. Volumes of tumor and necrosis prior to and after treatment were measured by computer-generated volumetric analysis., Results: Contrast-enhanced studies verified pretherapeutic tumor necrosis with a value of 12.6% in the metastases and 0.6% in the HCC nodules. Intratumoral drug administration resulted in a necrotic volume of 110% in metastases and 128% in HCC versus the mean initial tumor volume, at least 4 treatments resulted in 122% necrosis in metastases and 130% in HCC. Local therapy control rate for the follow-up to 6 months was 38% and 83.3% for the group of metastases and HCC, respectively., Conclusions: Direct intratumoral injection of a novel cisplatin/epinephrine injectable gel results in an induction of a relevant necrosis in malignant liver tumors, with a substantially higher local therapy control rate for HCC compared to colorectal metastases.

Aim: Several techniques exist to retrieve catheter and guide wire fragments. In this report we summarize our cost-saving method., Materials and Methods: A 7-8F guiding catheter and a self-made loop consisting of a 260 cm/0.035 in. Terumowire was used., Results: 45 of 48 fragments were retrieved completely using this method. For the three remaining fragments (all pacemaker electrodes), retrieval was attempted with a "Goose-Neck" loop, two of them failed. The procedure was well tolerated, there were no severe complications., Conclusion: Usually venous foreign bodies can be retrieved completely by this cost-saving method, the use of expensive industrial loops or baskets can be avoided.

Purpose: Description of local ablative techniques such as laser-induced thermotherapy (LITT) and radiofrequency ablation in the percutaneous interstitial thermotherapy for malignant liver tumors., Patients and Methods: MR-guided LITT is currently performed by means of implantable percutaneous catheter systems. CT is used to control the insertion of the catheter. Irrigated administration systems are available both for LITT and for radiofrequency therapy., Results: At present LITT enables a local tumor control of 97.2% for localized liver metastases without extrahepatic spreading patterns. In a group of 381 patients the average survival times were 45.7 months for patients with liver metastasis, 42.7 months for those with colorectal liver metastases, and 32 months for HCC tumors. The data for radiofrequency ablation confirm the high value for tumor control of hepatocellular carcinomas with poorer results for liver metastases., Conclusions: Percutaneous, MR-guided LITT permits good tumor control of liver metastases smaller than 5 cm and less than 5 in number. For HCC, at present percutaneous injection of alcohol, radiofrequency ablation, and LITT are equally effective.

Background: Gyrate atrophy is a form of choroidal dystrophia characterized by a genetic defect of the mitochondrial matrix enzyme ornithine ketoacidoaminotransferase on chromosome 10. Apart from rare myopathic problems, cases of choroidal, iridal atrophy, complicated subcapsular cataract, optic atrophy, macular edema, reticular retinoschisis, vasculitis and perivasculitis could be observed so far. To our knowledge, rheumatogenous retinal detachment has been described before. We present a 34-year-old female subject with a retinal detachment of the right eye over 3 quadrants with 3 small round foramina in the area 10 to 11 o'clock., Patients: Concentric defects of the visual field had been known since the age of 4; the patient was slightly myopic. At the age of 31, the patient had undergone cataract extraction with implantation of posterior chamber lenses in both eyes. The ophthalmological examination revealed large areas of choroidal atrophia in both eyes. A determination of visual acuity resulted in hand movements in the right eye and 0.1 in the left eye. The ERG was extinguished., Results: The retina could be fully reattached by pars plana vitrectomy and instillation of silicone oil. At the same time, we performed an excision of secondary cataract. On demission, the visual acuity of the right eye was finger counting. Because a brother of the patient had also suffering from a progressive choroidal atrophy since his childhood, an autosomal recessive disease was suspected. The only abnormality detected was strongly elevated plasma levels of ornithin (7.5 to 14 mg/dl, compared to levels of 0.6 to 2.0 in controls). Urinary excretion of ornithin was also strongly increased., Discussion: To our knowledge there was no previous description of a case of atrophia gyrata in association with rhegmatogenous retinal detachment after intraocular surgery. As the pigment epithelium is missing, intraoperative endolaser-coagulation would be useless. For this reason, and since a tendency for reattachment is lacking consistent with one of the characteristics of this disease, the only approach to this case is intraocular tamponade with silicone oil.

Background: During a period of 3 months 20% of patients who received a corneal transplant showed a prolonged postoperative swelling, of the stroma and an increased number of folds in the epithelium was prolonged. These findings were atypical because there were no complications during the operation and the preoperative examination of the donor cornea showed a normal corneal endothelium. All donor corneas were stored in organ culture before transplantation using minimal essential medium supplemented with 2% fetal calf serum (FCS). This method has been used in the university eye clinic of Hamburg since 1981. In order to establish any correlation between the used organ culture conditions and the clinical findings the different components of the culture medium were checked. We noticed that the serum batch used for organ preservation had been changed at the beginning of the above mentioned period., Patients: From April 20th to June 23rd, 28 penetrating keratoplasties were performed at the department of ophthalmology of the University Clinic of Hamburg. No complications during the surgical procedure or postoperative infection were detectable. Four weeks after transplantation all transplants showed a normal swelling., Methods: The quality of media or sera is not guaranteed by the company where the substances were purchased. We performed clonal growth assays using human or porcine corneal endothelial cells to evaluate the quality of different charges of fetal calf serum., Results: It could be demonstrated that the acticity of the serum charge used for organ preservation during the described period had a significantly reduced activity in a clonal growth assay compared with various FCS-charges from different companies., Conclusions: After changing the serum batch the problems described above disappeared. We conclude that quality testing of all supplements of the organ culture medium is necessary in a cornea bank to guarantee a reliable standard of corneal preservation. A clonal growth assay is a sensitive test which is suggested to be useful for quality testing.

The longterm tissue culture is performed at the University Eye-Hospital of Hamburg since 1985 with a standardized procedure. The number of donor material and operations in the first 7 months of 1991 are reported. Preparation, storing and HLA-typing of the tissue are considered. The technical working up of the stored tissue for penetrating and lamellar keratoplasties will be explained.