This review describes a scheme for diagnosis of glaucoma in population based prevalence surveys. Cases are diagnosed on the grounds of both structural and functional evidence of glaucomatous optic neuropathy. The scheme also makes provision for diagnosing glaucoma in eyes with severe visual loss where formal field testing is impractical, and for blind eyes in which the optic disc cannot be seen because of media opacities.

https://bjo.bmj.com/content/bjophthalmol/86/2/238.full.pdf

The definition and classification of glaucoma in prevalence surveys

Tissue sections from aggressive human intraocular (uveal) and metastatic cutaneous melanomas generally lack evidence of significant necrosis and contain patterned networks of interconnected loops of extracellular matrix. The matrix that forms these loops or networks may be solid or hollow. Red blood cells have been detected within the hollow channel components of this patterned matrix histologically, and these vascular channel networks have been detected in human tumors angiographically. Endothelial cells were not identified within these matrix-embedded channels by light microscopy, by transmission electron microscopy, or by using an immunohistochemical panel of endothelial cell markers (Factor VIII-related antigen, Ulex, CD31, CD34, and KDR[Flk-1]). Highly invasive primary and metastatic human melanoma cells formed patterned solid and hollow matrix channels (seen in tissue sections of aggressive primary and metastatic human melanomas) in three-dimensional cultures containing Matrigel or dilute Type I collagen, without endothelial cells or fibroblasts. These tumor cell-generated patterned channels conducted dye, highlighting looping patterns visualized angiographically in human tumors. Neither normal melanocytes nor poorly invasive melanoma cells generated these patterned channels in vitro under identical culture conditions, even after the addition of conditioned medium from metastatic pattern-forming melanoma cells, soluble growth factors, or regimes of hypoxia. Highly invasive and metastatic human melanoma cells, but not poorly invasive melanoma cells, contracted and remodeled floating hydrated gels, providing a biomechanical explanation for the generation of microvessels in vitro. cDNA microarray analysis of highly invasive versus poorly invasive melanoma tumor cells confirmed a genetic reversion to a pluripotent embryonic-like genotype in the highly aggressive melanoma cells. These observations strongly suggest that aggressive melanoma cells may generate vascular channels that facilitate tumor perfusion independent of tumor angiogenesis.

Vascular Channel Formation by Human Melanoma Cells in Vivo and in Vitro: Vasculogenic Mimicry

Background Ocular trauma or disease may lead to severe corneal opacification and, consequently, severe loss of vision as a result of complete loss of corneal epithelial stem cells. Transplantation of autologous corneal stem-cell sources is an alternative to allograft transplantation and does not require immunosuppression, but it is not possible in many cases in which bilateral disease produces total corneal stem-cell deficiency in both eyes. We studied the use of autologous oral mucosal epithelial cells as a source of cells for the reconstruction of the corneal surface. Methods We harvested 3-by-3-mm specimens of oral mucosal tissue from four patients with bilateral total corneal stem-cell deficiencies. Tissue-engineered epithelial-cell sheets were fabricated ex vivo by culturing harvested cells for two weeks on temperature-responsive cell-culture surfaces with 3T3 feeder cells that had been treated with mitomycin C. After conjunctival fibrovascular tissue had been surgically removed from the ocular surfa...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa040455

Corneal reconstruction with tissue-engineered cell sheets composed of autologous oral mucosal epithelium.

An Integrated Hypothesis That Considers Drusen as Biomarkers of Immune-Mediated Processes at the RPE-Bruch's Membrane Interface in Aging and Age-Related Macular Degeneration

https://oftalmologiarafaelcaiado.files.wordpress.com/2012/04/anchor-study.pdf

Ranibizumab versus Verteporfin Photodynamic Therapy for Neovascular Age-Related Macular Degeneration: Two-Year Results of the ANCHOR Study

Eine standardisierte, prospektiv angelegte und EDV-unterstutzte Dokumentation, die die Klinikroutine begleitet, dient nicht nur der gesetzlich vorgeschriebenen Leistungserfassung und Qualitatssicherung, sondern stellt auch ein probates Hilfsmittel zur Identifikation von Risikofaktoren bei der Kataraktchirurgie dar. An der Augenklinik mit Poliklinik der Universitat Erlangen-Nurnberg, Erlangen, wurden 1986 die „Erlanger Augenblatter“ als EDV-unterstutzte standardisierte Patientenakte entwickelt. Sie ermoglichen die prospektive Erfassung der Anamnese-, Diagnose, Operations- und Verlaufsdetails aller Kataraktextraktionen. Diese standardisierte Dokumentation ist mittlerweile in ein Netz mit derzeit 80 Personalcomputern integriert und verknupft mit dem regionalen Rechenzentrum der Universitat. Die Anzahl der bisher erfasten Kataraktextraktionen betragt 11.000. Zu diesen Operationen gehoren 50.000 Einzeldiagnosen und 20.000 postoperative Verlaufsuntersuchungen.

EDV-Voraussetzungen für die prospektive Auswertung großer Operationszahlen am Beispiel der Kataraktchirurgie -10 Jahre Erfahrung

Frühe immunologische Transplantatreaktionen nach perforierender Keratoplastik : Eine prospektive klinische Studie

Die nichtinvasive Laser-Tyndallometrie erlaubt eine quantifizierende Untersuchung der Integritat der Blut-Kammerwasser-Schranke. In der vorliegenden Arbeit werden — anhand von Kasuistiken — die Einsatzmoglichkeiten dieser Methode bei Patienten nach perforierender Keratoplastik und mit akuten endothelialen Transplantatreaktionen illustriert. Funf retrospektiv ausgewahlte Patienten wurden nach perforierender Keratoplastik regelmasig klinisch und tyndallometrisch mit dem Laser Flare-Cell Meter (Kowa FC-1000) untersucht. Bei vier der Patienten entwickelten sich Episoden akuter diffuser endothelialer Transplantatreaktionen, welche unter lokaler und systemischer Steroidtherapie reversibel waren. Wahrend sich die Tyndallometrie-Werte bei komplikationslosem Verlauf postoperativ rasch normalisieren, konnte bei manifester Transplantatreaktion eine deutliche Storung der Blut-Kammerwasser-Schranke nachgewiesen werden. Hierbei korrelierten die Tyndallometrie-Werte gut mit dem klinischen spaltlampenmikroskopischen Eindruck der Schwere der Transplantatreaktion. Die nichtinvasive Tyndallometrie erscheint uns wertvoll fur Verlaufs- und Therapiekontrolle nach perforierender Keratoplastik. Noninvasive measurement of aqueous flare allows quantification of alterations of the blood-aqueous barrier. In the present paper, case reports are used to illustrate the use of this technique following penetrating keratoplasty and in acute endothelial graft rejection. Five retrospectively selected patients underwent regular clinical examination and measurement of aqueous flare with the laser-cell meter (Kowa FC-1000) following penetrating keratoplasty. Four of the patients developed episodes of acute diffuse endothelial graft rejection that were reversed by local and systemic corticosteroid therapy. Flare values showed rapid normalization following uncomplicated keratoplasty but were increased in patients with signs of graft rejection. Flare values corresponded to slit-lamp findings of severity of inflammation. The noninvasive measurement of aqueous flare appears to be useful for follow-up and monitoring of therapy after penetrating keratoplasty.

Tyndallometrie zur Therapiekontrolle nach perforierender Keratoplastik und bei Transplantatreaktion

Background: Increased plasma galactitol levels may lead to development of bilateral pediatric cataract. Patient: A 3-year-old boy was found to suffer from a bilateral zonular cataract. Extracapsular lensectomy with posterior capsulotomy, transpupillar anterior vitrectomy and posterior chamber lens implantation were performed during a 4-month-interval. Results: The epimerase-activity in red cells of the index patient was found to be significantly decreased (11.2 μmol/h/g Hb; normal range: 19-35). From other family members, such as the brother (16.8), the father (16.0) and the grandfather (15.6), a diminished red cell activity was observed. The mother whose epimerase activity was considerably lower than that of the above mentioned family members (13.3) showed also a zonular bilateral cataract. Conclusions: Investigation of enzymes and polyols of galactose metabolism as well as consultation of the concerned families are recommended for clarification of cataract development.

Frühkindliche Katarakt bei familiärem UDP-Galaktose-4-Epimerase-Mangel - eine Kasuistik

Von 1980 bis 1987 gingen 118 Hornhautexzisate von Augen, bei denen nach Kunstlinsenimplantation eine Hornhaut-Endothel-Dekompensation eine perforierende Kerato-plastik erforderlich gemacht hatte, in unserem ophthalmopathologischen Labor ein. Im Rahmen unserer Studie wurden diese Exzisate histologisch anhand von insgesamt 46 zuvor definierten, quantitativen und semiquantitativen Kriterien nachuntersucht und statistisch ausgewertet.

Gottfried O. H. Naumann

Papers

EDV-Voraussetzungen für die prospektive Auswertung großer Operationszahlen am Beispiel der Kataraktchirurgie -10 Jahre Erfahrung

Frühe immunologische Transplantatreaktionen nach perforierender Keratoplastik : Eine prospektive klinische Studie

Tyndallometrie zur Therapiekontrolle nach perforierender Keratoplastik und bei Transplantatreaktion

Frühkindliche Katarakt bei familiärem UDP-Galaktose-4-Epimerase-Mangel - eine Kasuistik

Histologie der Hornhaut-Endothel-Epithel-Dekompensation nach Kunstlinsenimplantation