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Hu X, Meister R, Tode J, Framme C, Fuchs H. Long-term in vitro monitoring of AAV-transduction efficiencies in real-time with Hoechst 33342. PLoS One 2024; 19:e0298173. [PMID: 38427668 PMCID: PMC10906819 DOI: 10.1371/journal.pone.0298173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/19/2024] [Indexed: 03/03/2024] Open
Abstract
Adeno-associated viral transduction allows the introduction of nucleic fragments into cells and is widely used to modulate gene expressions in vitro and in vivo. It enables the study of genetic functions and disease mechanisms and, more recently, serves as a tool for gene repair. To achieve optimal transduction performance for a given cell type, selecting an appropriate serotype and the number of virus particles per cell, also known as the multiplicity of infection, is critical. Fluorescent proteins are one of the common reporter genes to visualize successfully transduced cells and assess transduction efficiencies. Traditional methods of measuring fluorescence-positive cells are endpoint analysis by flow cytometry or manual counting with a fluorescence microscope. However, the flow cytometry analysis does not allow further measurement in a test run, and manual counting by microscopy is time-consuming. Here, we present a method that repeatedly evaluates transduction efficiencies by adding the DNA-stain Hoechst 33342 during the transduction process combined with a microscope or live-cell imager and microplate image analysis software. The method achieves fast, high-throughput, reproducible, and real-time post-transduction analysis and allows for optimizing transduction parameters and screening for a proper approach.
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Affiliation(s)
- Xiaonan Hu
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Roland Meister
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Jan Tode
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Carsten Framme
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Heiko Fuchs
- Institute of Ophthalmology, University Eye Hospital, Hannover Medical School, Hannover, Germany
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Binter M, Langer F, Hu X, Lindziute M, Framme C, Tode J, Fuchs H. A simple dissection method for the isolation of mouse trabecular meshwork cells. PLoS One 2023; 18:e0296124. [PMID: 38128042 PMCID: PMC10734917 DOI: 10.1371/journal.pone.0296124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The outflow pathway, especially trabecular meshwork (TM), plays an essential role in glaucoma, and the availability of TM cells is crucial for in vitro research. So far, the isolation of TM cells from mice has been anything but manageable due to the small size of the eye. Direct isolation using a stereomicroscope and forceps requires a high grade of dexterity. Indirect isolation is based on the phagocytic properties of TM cells and involves injecting magnetic microspheres into the anterior chamber of live mice followed by isolation. Therefore, a simpler, less expensive, and nonexperimental strategy for isolating mouse TM cells would be desirable. METHODS After enucleation, the eyes were cut in half anterior-to-posteriorly. The lens and posterior segment were removed. Iris and the attached ciliary body were gently pulled backward and disconnected from the remaining tissue to expose the TM. By incising through the cornea anteriorly and posteriorly of the TM, the cornea/TM stripe could be isolated. The cornea/TM stripe was cultured with the pigmented side down in a 6-well. The outgrowing pigmented cells were analyzed by immunocytochemistry and mRNA expression for previously described TM cell markers. The phagocytic properties of the cells were additionally confirmed using fluorescent microspheres. RESULTS Pigmented phagocytic cells were the first to grow out of the cornea/TM strips after approximately 4-7 days. Cells were positive for Collagen IV, Fibronectin1, Vimentin, and Actin alpha 2 and could phagocytize fluorescent microbeads. Cross-linked actin networks were visible after 9 days of exposure to TGFB2 (transforming growth factor-beta 2). Additionally, treatment with 500 nM Dexamethasone for one week increased myocilin expression, as previously reported for TM cells. In addition, we proved that this method can also be used in albino mice, which lack pigmentation of the trabecular meshwork. CONCLUSIONS The isolated cells show phagocytic properties and specific expression of markers reported in TM cells. Therefore, our dissection-based method is inexpensive and reproducible for isolating TM cells in mice.
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Affiliation(s)
- Maximilian Binter
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Fridolin Langer
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Xiaonan Hu
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Migle Lindziute
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Carsten Framme
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Jan Tode
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
| | - Heiko Fuchs
- Institute of Ophthalmology, Hannover Medical School, University Eye Hospital, Hannover, Germany
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Hufendiek K, Lindziute M, Kaufeld J, Volkmann I, Brockmann D, Hosari S, Hohberger B, Mardin C, Framme C, Tode J, Hufendiek K. Investigation of OCTA Biomarkers in Fabry Disease: A Long Term Follow-Up of Macular Vessel Area Density and Foveal Avascular Zone Metrics. Ophthalmol Ther 2023; 12:2713-2727. [PMID: 37542614 PMCID: PMC10441980 DOI: 10.1007/s40123-023-00776-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023] Open
Abstract
INTRODUCTION Retinal microvasculature is known to be altered in patients with Fabry disease (FD). We aimed to investigate the long-term changes in macular microvasculature and explore a reliable retinal biomarker for treatment monitoring in FD. METHODS Prospective study of 26 eyes with FD followed up to 48 months (mean 24, range 8-48). OCT angiography (OCTA) images (2.9 × 2.9 mm) were obtained using Heidelberg Spectralis II at baseline and follow-up. Macular vessel area density (VAD, %) was measured in three layers: superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) in three peri-macular circular sectors (c1, c2, c3). Additionally, foveal avascular zone (FAZ) area (mm2) and horizontal and vertical diameters (µm) were assessed. RESULTS VAD decreased over time in SVP, ICP (in sectors c2 and c3) and DCP (all sectors) (p < 0.04). VAD reduction was predominantly seen in treated FD patients. FAZ and horizontal diameters increased at follow-up in FD patients compared to baseline (p ≤ 0.025). Correlation analysis showed a moderate to strong negative correlation between VAD of SVP and DCP in the innermost circle and FAZ in treated patients (r = - 0.6; p < 0.0001). CONCLUSIONS This is the first long-term follow-up OCTA study in FD to our knowledge. A decrease in VAD, pronounced in the peripheral circle and deeper layers, as well as an enlargement of the FAZ could be observed over time. These changes reflect the vascular remodelling during the course of the disease. Interestingly, the reduction of VAD was more pronounced in treated patients. This could be a result of enzyme replacement therapy and could be potentially used as a reliable biomarker for monitoring the treatment of the disease. A baseline examination of VAD and FAZ before treatment initiation is meaningful. Larger studies are needed to establish the use of VAD and FAZ as biomarkers for treatment monitoring.
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Affiliation(s)
| | - Migle Lindziute
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Jessica Kaufeld
- Division of Nephrology, Center for Internal Medicine, Hannover Medical School, Hannover, Germany
| | - Ingo Volkmann
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | | | - Sami Hosari
- Department for General, Visceral and Vascular Surgery, Kantonsspital Baden, Im Engel 1, 5404 Baden, Switzerland
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bettina Hohberger
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Mardin
- Department of Ophthalmology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carsten Framme
- University Eye Hospital, Hannover Medical School, Hannover, Germany
| | - Jan Tode
- University Eye Hospital, Hannover Medical School, Hannover, Germany
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Biedermann I, Tode J. [Follow-up to the VNDA's professional policy discussion in Osnabrück on June 3rd 2023]. Ophthalmologie 2023; 120:970-971. [PMID: 37594596 DOI: 10.1007/s00347-023-01905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/19/2023]
Affiliation(s)
- Imke Biedermann
- Augenärztliche Praxis, AugenNord, Eckernförde, Deutschland, Reeperbahn 25, 24340
| | - Jan Tode
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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Binter M, Lindziute M, Rosenstein C, Framme C, Tode J. Long-Term Multimodal Imaging Analysis of Selective Retina Therapy Laser Lesions. Life (Basel) 2023; 13:life13040886. [PMID: 37109415 PMCID: PMC10146613 DOI: 10.3390/life13040886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/19/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
This study evaluates the long-term effects of selective retina therapy (SRT) on the retinal pigment epithelium (RPE) and neuroretina in patients with central serous chorioretinopathy. SRT was performed on 36 patients using a Nd:YLF-Laser at 527 nm (R:GEN®, Lutronic, Goyang-Si, Republic of Korea). A total of 994 titration spots were examined using up to three years’ multimodal imaging. Leakage in fluorescein angiography (FA) was observed after SRT in 523 lesions and resolved after one month. SRT lesions were not visible clinically, but appeared as brightly reflective areas in infrared and multicolor images. Normal morphology was observed in optical coherence tomography (OCT) immediately after SRT. After one month, thickening of the RPE and interdigitation zone changes were seen and disappeared after 539 ± 308 days. No RPE atrophies occurred during the observation period. Decreased fundus autofluorescence (FAF) was mostly observed directly after SRT followed by increased FAF at one month, which faded over time. A significant decrease in the number of visible lesions in the FA and FAF was observed within the three-year follow-up. OCT findings are consistent with animal studies showing SRT-related defect closure by hypertrophy and migration of neighboring cells without RPE atrophy or photoreceptor damage. This suggests that SRT is a safe treatment option for macular diseases and does not lead to retinal atrophy.
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Framme C, Kuiper T, Lobbes W, Gottschling J, Scheinichen D, Hufendiek K, Palmaers T, Tode J, Volkmann I, Lammert F. [Economics of operating room use at a university eye hospital]. Ophthalmologie 2023; 120:7-19. [PMID: 35925355 DOI: 10.1007/s00347-022-01689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND In ophthalmologic surgery, there are usually short operation times and thus many changes between the individual operations, which are not subject to remuneration. As in maximum care hospitals consecutive different operations with different durations are often performed, emergency operations have to be inserted and further training of colleagues is practiced, it is particularly important to generate the shortest possible transfer times in order to have both sufficient operation time and to be able to treat as many cases as possible. The aim of this work is to evaluate the efficiency of the surgical performance of a university eye hospital. MATERIAL AND METHOD The surgeries performed in 2021 at the MHH Eye Clinic were evaluated with respect to the spectrum, number, surgery duration, transfer times and process times. In terms of personnel, each operating room was staffed with one assistant anesthesiologist, one nurse anesthetist, two operating room nurses, one surgeon, and 20% senior anesthesiologist supervision. Based on a theoretical concept, which provides an increased staffing ratio while maintaining the same infrastructure, it was calculated how many more surgeries could be performed if the transfer time was halved and whether the additional financial expense could be compensated. RESULTS With a total of n = 2712 surgeries performed during regular duty hours (244 working days) in 2 operating rooms (average daily n = 11.1; weekly n = 53.6 and monthly n = 237.1), the average surgery duration was 37 min and the transition time 43 min. This means that the operating rooms were used for surgery for 51% of the total operating time. Main procedures were vitrectomy with n = 1350 and cataract surgery with n = 1308. The new personnel concept provided one additional operating room nurse per operating room and one additional anesthesiologist for both operating rooms. The additional costs for this personnel expenditure were calculated at approx. 300,000 € per year. The halving of the transfer time from 43 min to about 21 min through possible overlapping induction and parallel work, which was not possible until now, results in an additional operation time of about 100 min per operating room, so that at least 4 additional operations can be planned and performed. In this way, with stringent implementation and the same spatial structures with stable fixed costs, n = 976 more operations could be performed, which, minus the personnel costs, the additional material costs for surgery and anesthesia of 557,042 € and the inpatient hotel costs of 600,663 €, with an average length of stay of 2.8 days, would result in an additional revenue of about 2.4 times the additional personnel costs at the current flat rate of 3739.40 € and an average case mix index of the MHH Eye Hospital of 0.649 (total revenue: 2,155,449 €; profit margin II: 701,389 €) for the considered surgical patient collective in 2021. CONCLUSION An increase of the personnel expenditure in the operating room for surgical subjects such as ophthalmology with shorter interventions and many changes is economically worthwhile also for a large hospital in order to enable and optimize overlapping transfers of anesthesia and surgical care. This should therefore also be considered separately, contrary to standardized staffing of the overall hospital, in order to use existing resources with their fixed costs as optimally as possible.
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Affiliation(s)
- C Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - T Kuiper
- Stabsstelle OP-Management, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - W Lobbes
- Stabsstelle OP-Management, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Gottschling
- Stabsstelle Klinische Leistungsentwicklung, Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - D Scheinichen
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - T Palmaers
- Klinik für Anästhesiologie und Intensivmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Tode
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - I Volkmann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - F Lammert
- Vorstandsmitglied für das Ressort Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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Binter M, Lüdtke P, Langer F, Schigiel T, Framme C, Heider M, Tode J. Changes in Intraocular Pressure following Narcosis With Medetomidine, Midazolam, and Fentanyl in Association With Initial Intraocular Pressure in Mice. Curr Eye Res 2022; 47:1553-1558. [PMID: 35943353 DOI: 10.1080/02713683.2022.2101667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 07/06/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE This article describes the development of decreased intraocular pressure (IOP) under general anesthesia with medetomidine, midazolam, and fentanyl in mice with normal and elevated IOP. METHODS IOP was measured using the iCare Tonolab rebound tonometer. Twelve 3-4 months-old male and female C57BL/6J mice were randomized to a control group with physiological IOP and a high IOP group with experimentally induced ocular hypertension using tarsal injections of dexamethasone-21-acetate. For anesthesia, medetomidine and midazolam were used, subgroups additionally received fentanyl. IOP was measured every 2.5 min for 30 min. RESULTS Control group differed with 14.89 mmHg (SEM: 0.58) significantly (p = 0.0002) from the high IOP group with initial 20.44 mmHg (SEM: 0.75). All groups showed a significant (p < 0.05) decrease in IOP under general anesthesia. There was no significant difference in IOP development and decrease between the group additionally receiving fentanyl and the group without fentanyl. The decrease in IOP was highly dependent on the initial value, with the high IOP group showing a greater decrease. After 10 min, no significant difference in IOP could be detected between the high IOP and control group. CONCLUSIONS In mice, general anesthesia with medetomidine and midazolam leads to a declining IOP over time. Adding fentanyl to the anesthesia did not alter these effects. The decline is time-dependent and IOP-dependent.
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Affiliation(s)
- Maximilian Binter
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Philipp Lüdtke
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Fridolin Langer
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Thomas Schigiel
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Carsten Framme
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Miriam Heider
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Jan Tode
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
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von der Burchard C, Sudkamp H, Tode J, Ehlken C, Purtskhvanidze K, Moltmann M, Heimes B, Koch P, Münst M, Vom Endt M, Kepp T, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) for neovascular age-related macular degeneration: a cross-sectional diagnostic accuracy study. BMJ Open 2022; 12:e055082. [PMID: 35760534 PMCID: PMC9237881 DOI: 10.1136/bmjopen-2021-055082] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Self-Examination Low-Cost Full-Field Optical Coherence Tomography (SELFF-OCT) is a novel OCT technology that was specifically designed for home monitoring of neovascular age-related macular degeneration (AMD). First clinical findings have been reported before. This trial investigates an improved prototype for patients with AMD and focusses on device operability and diagnostic accuracy compared with established spectral-domain OCT (SD-OCT). DESIGN Prospective single-arm diagnostic accuracy study. SETTING Tertiary care centre (University Eye Clinic). PARTICIPANTS 46 patients with age-related macular degeneration. INTERVENTIONS Patients received short training in device handling and then performed multiple self-scans with the SELFF-OCT according to a predefined protocol. Additionally, all eyes were examined with standard SD-OCT, performed by medical personnel. All images were graded by at least 2 masked investigators in a reading centre. PRIMARY OUTCOME MEASURE Rate of successful self-measurements. SECONDARY OUTCOME MEASURES Sensitivity and specificity of SELFF-OCT versus SD-OCT for different biomarkers and necessity for antivascular endothelial growth factor (anti-VEGF) treatment. RESULTS In 86% of all examined eyes, OCT self-acquisition resulted in interpretable retinal OCT volume scans. In these patients, the sensitivity for detection of anti-VEGF treatment necessity was 0.94 (95% CI 0.79 to 0.99) and specificity 0.95 (95% CI 0.82 to 0.99). CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination in most patients, and it could become a valuable tool for retinal home monitoring in the future. Improvements are in progress to reduce device size and to improve handling, image quality and success rates. TRIAL REGISTRATION NUMBER DRKS00013755, CIV-17-12-022384.
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Affiliation(s)
| | | | - Jan Tode
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Ophthalmology, Hannover Medical School, Hannover, Germany
| | - Cristoph Ehlken
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | | | - Britta Heimes
- Department of Ophthalmology, St. Franziskus-Hospital, Münster, Germany
| | - Peter Koch
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | | | - Timo Kepp
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | | | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lubeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Lubeck, Germany
| | - Johann Roider
- Department of Ophthalmology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Seifert E, Tode J, Pielen A, Theisen-Kunde D, Framme C, Roider J, Miura Y, Birngruber R, Brinkmann R. Algorithms for optoacoustically controlled selective retina therapy (SRT). Photoacoustics 2022; 25:100316. [PMID: 34926158 PMCID: PMC8649889 DOI: 10.1016/j.pacs.2021.100316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Selective Retina Therapy (SRT) uses microbubble formation (MBF) to target retinal pigment epithelium (RPE) cells selectively while sparing the neural retina and the choroid. Intra- and inter-individual variations of RPE pigmentation makes frequent radiant exposure adaption necessary. Since selective RPE cell disintegration is ophthalmoscopically non-visible, MBF detection techniques are useful to control adequate radiant exposures. It was the purpose of this study to evaluate optoacoustically based MBF detection algorithms. METHODS Fifteen patients suffering from central serous chorioretinopathy and diabetic macula edema were treated with a SRT laser using a wavelength of 527 nm, a pulse duration of 1.7 µs and a pulse energy ramp (15 pulses, 100 Hz repetition rate). An ultrasonic transducer for MBF detection was embedded in a contact lens. RPE damage was verified with fluorescence angiography. RESULTS An algorithm to detect MBF as an indicator for RPE cell damage was evaluated. Overall, 4646 irradiations were used for algorithm optimization and testing. The tested algorithms were superior to a baseline model. A sensitivity/specificity pair of 0.96/1 was achieved. The few false algorithmic decisions were caused by unevaluable signals. CONCLUSIONS The algorithm can be used for guidance or automatization of microbubble related treatments like SRT or selective laser trabeculoplasty (SLT).
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Affiliation(s)
- Eric Seifert
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Jan Tode
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Amelie Pielen
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Dirk Theisen-Kunde
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Carsten Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johann Roider
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße, 24105 Kiel, Germany
| | - Yoko Miura
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Reginald Birngruber
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
| | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
- Institut für Biomedizinische Optik, Universität zu Lübeck, Peter-Monnik-Weg 4, 23562 Lübeck, Germany
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Framme C, Dittberner M, Rohwer-Mensching K, Gottschling J, Buley P, Hufendiek K, Hufendiek K, Junker B, Tode J, Lammert F, Volkmann I. [Performance and cost calculation for a university ophthalmological outpatient clinic]. Ophthalmologe 2022; 119:46-54. [PMID: 34802069 PMCID: PMC8605894 DOI: 10.1007/s00347-021-01529-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 10/28/2022]
Abstract
BACKGROUND Outpatient procedures at a university hospital are generally considered to be unprofitable. In the present publication we evaluate the turnover and costs of the university eye outpatient department of the Hannover Medical School (MHH) in terms of a cost unit accounting as well as providing a summary of the workload. MATERIAL AND METHOD Given the data of the hospital information system (IS-H/i.s.h.med from SAP) and a proprietary software (TimeElement), all patient contacts in the year 2019 were evaluated. The latter software is applied in a standardized manner to record the patient flow of our outpatient service in real time electronically. The total costs consist of personnel, material and room costs including infrastructure of the MHH and are compared to the flat-rate revenues according to the university outpatient contract (HSA) as well as further revenues from internal referral services, self-pay patients, outpatient surgery and cooperation contracts for intravitreal injections (IVOM). RESULTS With an average full-time equivalent (FTE) headcount of 10.63 assistant physicians, 3.6 specialist physicians, and 21 nonphysicians (plus 4 Federal Volunteer Service, BUFDI) in our policlinic, we have determined € 2,927,022 in personnel costs, including overheads, for the entire year. Including infrastructure (€ 524,942), material and equipment costs with overheads and internal cost allocation of € 258.657, the total costs in 2019 resulted in € 3,710,621. In contrast, the total income in 2019 was € 3,524,737 generated through the abovementioned patient segments, resulting in a deficit of € -185,884 (5%). Our data provide evidence that regular outpatient revenues are insufficient and are mainly balanced by outpatient surgery, IVOMs and self-pay patients. In total, there were 19,453 patient contacts during regular office hours (with 17,305 billable cases). At n = 9943, the majority of the contacts were HSA visits; however, only 82% of the cases could effectively be charged due to multiple visits per quarter. The median total patient attendance was 3.21 h (mean 3.38 h). On average, 78 patient contacts were counted per working day. The analysis with TimeElement unveiled a median of n = 2 physician contacts per patient (mean n = 1.91). The median duration per interaction with a physician was 17.98 min (mean 23.23 min). For diagnostics, we counted a median of n = 2 interactions per patient (mean n = 2.31), with an entire interaction lasting a median of 18.30 min (mean 22.60 min). In total n = 37,363 individual diagnostic procedures were recorded in 2019, with SD-OCT being the primary procedure at n = 10,888. CONCLUSION The cost/turnover calculation showed a marginal financial loss through our ophthalmological outpatient department. Thus, the costs of a university eye outpatient department in Lower Saxony do not seem to be sufficiently covered by direct outpatient revenues. Maintaining quarterly flat rates for all cases of the outpatient department would require a fee of about € 214 in our setting to remain cost neutral. Currently, the lower flat rates in the HSA area are compensated by other areas. Obviously, the high content-related workload in our setting requires a high personnel expenditure with a considerable personnel cost contribution of nearly 80%.
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Affiliation(s)
- C Framme
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland.
| | - M Dittberner
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
- TimeElement, Stampfenbachstr. 52/56, 8092, Zürich, Schweiz
| | - K Rohwer-Mensching
- Zentrum für Informationsmanagement (ZIMT), Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Gottschling
- Stabsstelle Klinische Leistungsentwicklung des Vorstands für Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - P Buley
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - K Hufendiek
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - B Junker
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - J Tode
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - F Lammert
- Vorstand für Krankenversorgung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
| | - I Volkmann
- Universitäts-Augenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30652, Hannover, Deutschland
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Richert E, Papenkort J, von der Burchard C, Klettner A, Arnold P, Lucius R, Brinkmann R, Framme C, Roider J, Tode J. Selective retina therapy and thermal stimulation of the retina: different regenerative properties - implications for AMD therapy. BMC Ophthalmol 2021; 21:412. [PMID: 34847865 PMCID: PMC8630886 DOI: 10.1186/s12886-021-02188-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Selective Retina Therapy (SRT), a photodisruptive micropulsed laser modality that selectively destroys RPE cells followed by regeneration, and Thermal Stimulation of the Retina (TSR), a stimulative photothermal continuous wave laser modality that leads to an instant sublethal temperature increase in RPE cells, have shown therapeutic effects on Age-related Macular Degeneration (AMD) in mice. We investigate the differences between both laser modalities concerning RPE regeneration. METHODS For PCR array, 6 eyes of murine AMD models, apolipoprotein E and nuclear factor erythroid-derived 2- like 2 knock out mice respectively, were treated by neuroretina-sparing TSR or SRT. Untreated litter mates were controls. Eyes were enucleated either 1 or 7 days after laser treatment. For morphological analysis, porcine RPE/choroid organ cultures underwent the same laser treatment and were examined by calcein vitality staining 1 h and 1, 3 or 5 days after irradiation. RESULTS TSR did not induce the expression of cell-mediators connected to cell death. SRT induced necrosis associated cytokines as well as inflammation 1 but not 7 days after treatment. Morphologically, 1 h after TSR, there was no cell damage. One and 3 days after TSR, dense chromatin and cell destruction of single cells was seen. Five days after TSR, there were signs of migration and proliferation. In contrast, 1 h after SRT a defined necrotic area within the laser spot was seen. This lesion was closed over days by migration and proliferation of adjacent cells. CONCLUSIONS SRT induces RPE cell death, followed by regeneration within a few days. It is accompanied by necrosis induced inflammation, RPE proliferation and migration. TSR does not induce immediate RPE cell death; however, migration and mitosis can be seen a few days after laser irradiation, not accompanied by necrosis-associated inflammation. Both might be a therapeutic option for the treatment of AMD.
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Affiliation(s)
- Elisabeth Richert
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Julia Papenkort
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Philipp Arnold
- Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute for Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Carsten Framme
- Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany. .,Department of Ophthalmology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Scharf A, Margraf NG, Tode J, Jensen-Kondering U. Multiple retinal aneurysms in probable cerebral amyloid angiopathy. J Neurol Sci 2021; 430:120005. [PMID: 34619621 DOI: 10.1016/j.jns.2021.120005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Amelie Scharf
- Department of Ophthalmology, UKSH Campus Kiel, Germany
| | | | - Jan Tode
- Department for Ophthalmology, Hannover Medical School (MHH), Hanover, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Germany; Institute of Neuroradiology, UKSH Campus Lübeck, Germany.
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13
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von der Burchard C, Moltmann M, Tode J, Ehlken C, Sudkamp H, Theisen-Kunde D, König I, Hüttmann G, Roider J. Self-examination low-cost full-field OCT (SELFF-OCT) for patients with various macular diseases. Graefes Arch Clin Exp Ophthalmol 2021; 259:1503-1511. [PMID: 33346888 PMCID: PMC8166739 DOI: 10.1007/s00417-020-05035-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 11/28/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The treatment guidelines for many macular diseases rely on frequent monitoring with optical coherence tomography (OCT). However, the burden of frequent disease control leads to low therapy adherence in real life. OCT home monitoring would address this issue but requires an inexpensive and self-operable device. With self-examination low-cost full-field OCT (SELFF-OCT), our group has introduced a novel technology that may fulfill both requirements. In this pilot study, we report the initial experiences with a clinical prototype. METHODS Fifty-one patients with different macular diseases were recruited in a cross-sectional study. The most common diseases were age-related macular degeneration (AMD; 39/51), diabetic macular edema (DME; 6/51), and retinal vein occlusion (RVO; 3/51). Patients received a short training in device usage and then performed multiple self-scans with the SELFF-OCT device. For comparison, scans with a standard clinical spectral domain (SD-)OCT were taken. RESULTS After a brief training, 77% of the patients were able to successfully acquire images that were clinically gradable. No significant influence on success could be found for age (p = 0.08) or BCVA (p = 0.97). Relevant disease biomarkers in the most common retinal diseases could be detected. CONCLUSIONS SELFF-OCT was used successfully for retinal self-examination and in the future could be used for retinal home monitoring. Future improvements in technology are expected to improve success rates and image quality. TRIAL REGISTRATION The Trial was registered in the German Trial Register under the number DRKS00013755 on 14.03.2018.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Moritz Moltmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
- University Eye Hospital, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Helge Sudkamp
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Dirk Theisen-Kunde
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Inke König
- Institute of Medical Biometry and Statistics, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Gereon Hüttmann
- Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, Peter-Monnik-Weg 4, 23562, Lübeck, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Richert E, Papenkort J, Klettner A, Tode J, Koinzer S, Brinkmann R, Fink C, Roeder T, Lucius R, Roider J. Response of Retinal Pigment Epithelium (RPE)-Choroid Explants to Thermal Stimulation Therapy of the RPE (TSR). Lasers Surg Med 2020; 53:359-369. [PMID: 32567146 DOI: 10.1002/lsm.23288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/06/2020] [Accepted: 06/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The thermal stimulation therapy of the retinal pigment epithelium (TSR) is a sublethal laser technique for thermal stimulation of the retinal pigment epithelium (RPE)-Bruch's membrane (BrM)-complex. The aim of this study was to investigate the influence of TSR on the release of age-related macular degeneration (AMD)-relevant cell mediators. STUDY DESIGN/MATERIALS AND METHODS Porcine RPE-BrM-choroid explants were irradiated with a 532 nm continuous wave laser using different spot sizes (100-300 µm, duration 100 milliseconds, 15-100 mW). Cell death was investigated by calcein staining. Explants were treated with grids of sublethal spots and cultivated in modified Ussing chambers. The effect on matrix metalloproteinase-2 (MMP-2) and -9 was investigated by zymography and quantitative reverse transcription polymerase chain reaction. Secretion of vascular endothelial growth factor (VEGF), pigment epithelium derived factor (PEDF), and transforming growth factor-β (TGF-β) was analyzed by enzyme-linked immunosorbent assay and expression of HSP70 was examined by western blot. Integrity of the RPE/BrM-complex was analyzed by scanning electron microscopy. RESULTS Laser powers of 15 mW (100 µm) and 45 mW (300 µm) did not induce RPE cell death. The integrity of the RPE/BrM-complex was not impaired after TSR. After TSR with 300 µm spot size, we observed a significant increase of active MMP-2 in the basal compartments. The content of PEDF significantly increased in treated explants in both compartments with 100 and 300 µm spot sizes. VEGF and TGF-β secretion was not triggered by TSR. CONCLUSIONS TSR represents a possible RPE stimulating treatment for dry AMD. TSR increases the basal release of active MMP-2, which might reverse age-related thickening of BrM. VEGF secretion was not triggered by TSR while anti-angiogenic PEDF was increased, indicating an induction of an anti-angiogenic and neuroprotective environment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Elisabeth Richert
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
| | - Julia Papenkort
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
| | - Alexa Klettner
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
| | - Jan Tode
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Peter-Monnik-Weg 4, Lübeck, 23562, Germany
| | - Christine Fink
- Molecular Physiology, Zoological Institute, Christian-Albrechts University of Kiel, Am Botanischen Garten 1-9, Kiel, 24118, Germany
| | - Thomas Roeder
- Molecular Physiology, Zoological Institute, Christian-Albrechts University of Kiel, Am Botanischen Garten 1-9, Kiel, 24118, Germany
| | - Ralph Lucius
- Institute of Anatomy, Christian-Albrechts University of Kiel, Olshausenstraße, Kiel, 24118, Germany
| | - Johann Roider
- Department of Ophthalmology, University Medical Center, Christian-Albrechts University of Kiel, Arnold-Heller-Street 3, House 3B, Kiel, 24105, Germany
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Richert E, von der Burchard C, Klettner A, Arnold P, Lucius R, Brinkmann R, Roider J, Tode J. Modulation of inflammatory processes by thermal stimulating and RPE regenerative laser therapies in age related macular degeneration mouse models. Cytokine X 2020; 2:100031. [PMID: 33604557 PMCID: PMC7885883 DOI: 10.1016/j.cytox.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose Inflammatory processes play a major role within the multifactorial pathogenesis of age-related macular degeneration (AMD). Neuroretina sparing laser therapies, thermal stimulation of the retina (TSR) and selective retina therapy (SRT), are known to reduce AMD-like pathology in vitro and in vivo. We investigated the effect of TSR and SRT on inflammatory processes in AMD mouse models. Methods One randomized eye of 8 months old apolipoprotein (Apo)E and 9 months old nuclear factor (erythroid-derived 2) -like 2 (NRF2) knock out mice were treated by TSR (10 ms, 532 nm, 50 µm2 spot size, mean 4.5 W, ~200 spots) or SRT (~1.4 µs pulses, 532 nm, 50 µm spot size, 100 Hz over 300 ms, mean 2.5 µJ per pulse, ~200 spots). Fellow eyes, untreated knock out mice and wild-type BL/6J mice acted as controls. All mice were examined funduscopically and by optical coherence tomography (OCT) at the day of laser treatment. Mice were euthanized and enucleated either 1 day or 7 days after laser treatment and examined by gene expression analysis of 84 inflammatory genes. Results The inflammatory gene expression profile of both knock out models compared to healthy BL/6J mice suggests a regulation of pro- and anti-inflammatory processes especially concerning T-cell activity and immune cell recruitment. TSR resulted in downregulation of several pro-inflammatory cell-mediators both in ApoE -/- and NRF2-/- mice compared to treatment naïve litter mates one day after treatment. In contrast, SRT induced pro-inflammatory cell-mediators connected with necrosis one day after treatment as expected following laser-induced selective RPE cell death. Seven days after laser treatment, both findings were reversed. Conclusions Both TSR and SRT influence inflammatory processes in AMD mouse models. However, they act conversely. TSR leads to anti-inflammatory processes shortly after laser therapy and induces immune-cell recruitment one week after treatment. SRT leads to a quick inflammatory response to laser induced RPE necrotic processes. One week after SRT inflammation is inhibited. It remains unclear, if and to what extent this might play a role in a therapeutic or preventive approach of both laser modalities on AMD pathology.
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Affiliation(s)
- Elisabeth Richert
- Christian-Albrechts-University of Kiel, Department of Ophthalmology, University Medical Center, Kiel, Germany
| | - Claus von der Burchard
- Christian-Albrechts-University of Kiel, Department of Ophthalmology, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, Department of Ophthalmology, University Medical Center, Kiel, Germany
| | - Philipp Arnold
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute for Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, Department of Ophthalmology, University Medical Center, Kiel, Germany
| | - Jan Tode
- Hannover Medical School, Department of Ophthalmology, Hannover, Germany.,Christian-Albrechts-University of Kiel, Department of Ophthalmology, University Medical Center, Kiel, Germany
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Richert E, Klettner A, von der Burchard C, Roider J, Tode J. CRB1 rd8 mutation influences the age-related macular degeneration phenotype of NRF2 knockout mice and favors choroidal neovascularization. Adv Med Sci 2020; 65:71-77. [PMID: 31918066 DOI: 10.1016/j.advms.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 08/08/2019] [Accepted: 11/03/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE We examined the influence of retinal degeneration 8 (rd8) mutation of crumbs homolog 1 (CRB1) gene on age-related macular degeneration (AMD) phenotype in nuclear factor E2-related factor 2 knock out (NRF2-/-) mouse model. METHODS CRB1rd8 mutation genotype was determined by polymerase chain reaction from tail clips in 73 NRF2-/- mice originating from C57BL/6J background on mixed C57BL/6J and C57BL/6N ancestry. The clinical grade of AMD-like fundus alterations was determined by funduscopy, optical coherence tomography (OCT) and fluorescein angiography (FLA) at the age of 9 or 12 months. RESULTS Twelve NRF2-/- mice were wildtype CRB1+/+, 61 NRF2-/- were homozygous CRB1rd8/rd8. NRF2-/-CRB1rd8/rd8 mice had a significantly higher probability to show an advanced grade (grade 4 and 5) of AMD-like fundus alterations known to appear in NRF2-/- mice. Choroidal neovascularization (CNV) was only detected in NRF2-/-CRB1rd8/rd8 homozygous mice. CONCLUSIONS Homozygous CRB1rd8/rd8 mutation is common in commercial vendor mice strains of C57BL/6J origin if partly on C57BL/6N ancestry. The mutation has an influence on the extent of AMD-like retinal alterations in NRF2-/- mice and favors CNV formation.
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Affiliation(s)
- Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | | | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany
| | - Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Kiel, Germany.
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Tode J, Richert E, Koinzer S, Klettner A, von der Burchard C, Brinkmann R, Lucius R, Roider J. Selective Retina Therapy Reduces Bruch's Membrane Thickness and Retinal Pigment Epithelium Pathology in Age-Related Macular Degeneration Mouse Models. Transl Vis Sci Technol 2019; 8:11. [PMID: 31737435 PMCID: PMC6855371 DOI: 10.1167/tvst.8.6.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/03/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose To investigate the effect of selective retina therapy (SRT) on age-related macular degeneration (AMD)-like alterations of retinal pigment epithelium (RPE) and Bruch's membrane (BrM) in AMD mouse models as therapeutic approach for the treatment of dry AMD. Methods In B6.129P2-Apoetm1Unc/J (ApoE−/−) and B6.129X1-Nfe2I2tm1Ywk/J (NRF2−/−), one randomized eye of each mouse in groups of 15 mice was treated by SRT (532 nm, 300 ms, ∼1.4-μs pulse, 100 Hz, 50-μm spot), the fellow eye and healthy C57BL/6J mice served as controls. Clinical examinations were obtained at treatment day and 1 month later, followed by enucleation to analyze BrM thickness and ultrastructural RPE morphology. Results Nearly all ApoE−/− and NRF2−/− mice showed AMD-like retinal alterations. BrM thickness was increased in both mouse models, RPE had vacuoles within the cell body and shortened apical microvilli. SRT neither affected neuroretinal anatomy nor function. BrM thickness as well as AMD-like ultrastructural alterations of the RPE were significantly reduced in laser-treated eyes compared with fellow control and untreated control eyes. Conclusions SRT reduces BrM thickness and AMD-like RPE alterations in AMD mouse models without damage to structural or functional properties of neuroretina. It may be a prophylactic or therapeutic option for dry AMD. Translational Relevance SRT shows therapeutic effectivity in murine AMD models and might therefore become an option for the treatment of dry AMD.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Claus von der Burchard
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
| | - Ralf Brinkmann
- Institute for Biomedical Optics, University of Lübeck and Medical Laser Center Lübeck GmbH, Peter-Monnik-Weg 4, Lübeck, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Olshausenstr. 40, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Arnold-Heller-Str. 3, Kiel, Germany
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Richert E, Bartsch S, Hillenkamp J, Treumer F, Tode J, von der Burchard C, Brinkmann R, Klettner AK, Roider J. [Effect of Selective Retina Therapy (SRT) on the Inflammatory Microenvironment of the Subretinal Space]. Klin Monbl Augenheilkd 2019; 237:192-201. [PMID: 31049909 DOI: 10.1055/a-0838-5633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the effect of Selective Retina Therapy (SRT) on inflammatory key factors such as complement factor-C3 (CC3), tumor growth factor-beta2 (TGF-β2), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). MATERIALS AND METHODS Porcine RPE-Bruch's membrane-choroid explants were irradiated with two SRT laser systems, SRTYLF and SRTYAG (Nd : YLF laser, wave length 527 nm, pulse duration 1.7 µs and Nd : YAG laser, wave length 532 nm, pulse duration 2.4 - 3 µs). Laser irradiation was performed on a spot size of 200 × 200 µm, 30 pulses, with a repetition rate of 100 Hz, and a radiant exposure of 140 (threshold RPE death) and 180 mJ/cm2 per pulse (above threshold RPE death). Explants were cultivated in modified Ussing chambers and culture viability was assessed by calcein-AM cell staining. Secretion of inflammatory factors was analyzed by ELISA. Protein expression of tissue explants was assessed by Western blot. RESULTS Regeneration of RPE was observed after 4 days. One day after SRT with 140 mJ/cm2 per pulse the secretion of basal CC3 decreased in ELISA. Following 180 mJ/cm2 radiant exposure, the level of IFN-γ decreased at day 4. CONCLUSION SRT does not induce the release of the pro-inflammatory factors analyzed in this in-vitro study.
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Affiliation(s)
- Elisabeth Richert
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Sofya Bartsch
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Jost Hillenkamp
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel.,Augenklinik und Poliklinik, Universitätsklinikum Würzburg
| | - Felix Treumer
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Jan Tode
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Claus von der Burchard
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Ralf Brinkmann
- Institut für Biomedizinische Optik, Universität zu Lübeck
| | - Alexa Karina Klettner
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
| | - Johann Roider
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel
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Seifert E, Tode J, Pielen A, Theisen-Kunde D, Framme C, Roider J, Miura Y, Birngruber R, Brinkmann R. Selective retina therapy: toward an optically controlled automatic dosing. J Biomed Opt 2018; 23:1-12. [PMID: 30392199 DOI: 10.1117/1.jbo.23.11.115002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/04/2018] [Indexed: 06/08/2023]
Abstract
Selective retina therapy (SRT) targets the retinal pigment epithelium (RPE) with pulsed laser irradiation by inducing microbubble formation (MBF) at the intracellular melanin granula, which leads to selective cell disruption. The following wound healing process rejuvenates the chorio-retinal junction. Pulse energy thresholds for selective RPE effects vary intra- and interindividually. We present the evaluation of an algorithm that processes backscattered treatment light to detect MBF as an indicator of RPE cell damage since these RPE lesions are invisible during treatment. Eleven patients with central serous chorioretinopathy and four with diabetic macula edema were treated with a SRT system, which uses a wavelength of 527 nm, a repetition rate of 100 Hz, and a pulse duration of 1.7 μs. Fifteen laser pulses with stepwise increasing pulse energy were applied per treatment spot. Overall, 4626 pulses were used for algorithm parameter optimization and testing. Sensitivity and specificity were the metrics maximized through an automatic optimization process. Data were verified by fluorescein angiography. A sensitivity of 1 and a specificity of 0.93 were achieved. The method introduced in this paper can be used for guidance or automatization of microbubble-related treatments like SRT or selective laser trabeculoplasty.
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Affiliation(s)
- Eric Seifert
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
| | - Jan Tode
- Universitätsklinikum Schleswig-Holstein, Klinik für Ophthalmologie, Arnold-Heller-Strasse, Kiel, Germany
| | - Amelie Pielen
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Carsten Framme
- Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover, Germany
| | - Johann Roider
- Universitätsklinikum Schleswig-Holstein, Klinik für Ophthalmologie, Arnold-Heller-Strasse, Kiel, Germany
| | - Yoko Miura
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
- Universität zu Lübeck, Institut für Biomedizinische Optik, Lübeck, Germany
| | | | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Lübeck, Germany
- Universität zu Lübeck, Institut für Biomedizinische Optik, Lübeck, Germany
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Richert E, Koinzer S, Tode J, Schlott K, Brinkmann R, Hillenkamp J, Klettner A, Roider J. Release of Different Cell Mediators During Retinal Pigment Epithelium Regeneration Following Selective Retina Therapy. Invest Ophthalmol Vis Sci 2018; 59:1323-1331. [PMID: 29625455 DOI: 10.1167/iovs.17-23163] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the effect of selective retina therapy (SRT) on the release of AMD-relevant cell mediators, such as matrix metalloproteinases (MMPs), VEGF, and pigment epithelium derived factor (PEDF) using different laser spot sizes and densities. Methods Porcine RPE-choroid explants were treated with a pulsed 532 nm Nd:YAG laser using (1) large spot sizes, (2) small spot sizes with a high-density (hd) treatment, and (3) small spot sizes with a low-density (ld) treatment. Explants were cultivated in modified Ussing chambers. RPE regeneration and RPE cell death were investigated by calcein-AM staining and immunofluorescence. The MMP release was examined via zymography and immunofluorescence. VEGF and PEDF secretion was analyzed by ELISA. Results During pigment epithelium regeneration (PER), mitosis and RPE cell migration were observed. Four days after SRT (large spot size) the content of active MMP2 increased significantly (P < 0.01). Hd treatment with small spot sizes resulted also in an increase of active MMP2 (P < 0.05). In immunofluorescence explants showed a localized expression of MMP2 within the healing lesions after irradiation. The PEDF level increased significantly (P = 0.01) after SRT with large spot sizes. VEGF secretion decreased significantly (P < 0.05) following SRT with large spot sizes and with hd treatment of small spot sizes. Conclusions SRT induces a cytokine profile, which may improve the flux across Bruch's membrane, slows down progression of early AMD by RPE regeneration, and inhibits the formation of choroidal neovascularization. The cytokine release depends on the size and density of applied laser spots.
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Affiliation(s)
- Elisabeth Richert
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany
| | | | | | - Jost Hillenkamp
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany.,Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Alexa Klettner
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts University Kiel, Kiel, Germany
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von der Burchard CC, Tode J, Koinzer S, Purtskhvanidze K, Roider J. Localized Photoreceptor Damage after Femtosecond Laser Injury. Ophthalmol Retina 2018; 2:751-753. [PMID: 31047387 DOI: 10.1016/j.oret.2018.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/12/2018] [Accepted: 03/13/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, University of Kiel, Kiel, Germany
| | | | - Johann Roider
- Department of Ophthalmology, University of Kiel, Kiel, Germany
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von der Burchard C, Treumer F, Ehlken C, Koinzer S, Purtskhvanidze K, Tode J, Roider J. Retinal volume change is a reliable OCT biomarker for disease activity in neovascular AMD. Graefes Arch Clin Exp Ophthalmol 2018; 256:1623-1629. [PMID: 29915918 DOI: 10.1007/s00417-018-4040-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Current algorithms for automated computer interpretation of optical coherence tomography (OCT) imaging of patients suffering from neovascular age-related macular degeneration (AMD) mostly rely on fluid detection. However, fluid detection itself and correct interpretation of the fluid currently limits diagnostic accuracy. We therefore performed a detailed analysis of the requirements that would have to be met for fluid detection approaches. We further investigated if monitoring retinal volume would be a viable alternative to detect disease activity. METHODS Retrospective analysis and manual grading of 764 OCT volume scans of 44 patients with exudative AMD treated with intravitreal anti-VEGF injections at a pro-re-nata (PRN) treatment regimen for at least 24 months. RESULTS Detection of subretinal fluid (SRF) or intraretinal fluid (IRF) alone is not sufficient for disease detection. A combination of SRF and IRF can detect disease activity with a sensitivity of 98.6% and a specificity of 82%. With further characterization of IRF into exudative and degenerative cysts, specificity can be increased to 100%. However, correct characterization is currently not achieved by published fluid detection approaches. Change of macular retinal volume (MRV) can depict disease activity with sensitivity of 88.4% and specificity of 89.6%. Combination with the detection of SRF can further improve diagnostic accuracy to a specificity of 93.3% and sensitivity of 93.9% without relying on IRF or IRF characterization. CONCLUSION Fluid detection without further characterization is not sufficient for AMD monitoring. Either further distinction between exudative and degenerative cysts is necessary, or other activity markers have to be taken into account. MRV offers good potential to fill this diagnostic gap and might become an important monitoring marker.
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Affiliation(s)
- Claus von der Burchard
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Felix Treumer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Christoph Ehlken
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Stefan Koinzer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Tode J, Richert E, Koinzer S, Klettner A, von der Burchard C, Brinkmann R, Lucius R, Roider J. Thermal Stimulation of the Retina Reduces Bruch's Membrane Thickness in Age Related Macular Degeneration Mouse Models. Transl Vis Sci Technol 2018; 7:2. [PMID: 29736323 PMCID: PMC5931258 DOI: 10.1167/tvst.7.3.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 03/16/2018] [Indexed: 01/04/2023] Open
Abstract
Purpose To investigate the effect of thermal stimulation of the retina (TS-R) on Bruch's membrane (BrM) thickness in age-related macular degeneration (AMD) mouse models as a novel concept for the prophylaxis and treatment of dry AMD. Methods Two knockout AMD mouse models, B6.129P2-Apoetm1Unc/J (ApoE−/−) and B6.129X1-Nfe2I2tm1Ywk/J (NRF2−/−), were chosen. One randomized eye of each mouse in four different groups (two of different age, two of different genotype) of five mice was treated by TS-R (532 nm, 10-ms duration, 50-μm spot size), the fellow eye served as control. Laser power was titrated to barely visible laser burns, then reduced by 70% to guarantee for thermal elevation without damage to the neuroretina, then applied uniformly to the murine retina. Fundus, optical coherence tomography (OCT), and fluorescein angiography (FLA) images were obtained at the day of treatment and 1 month after treatment. Eyes were enucleated thereafter to analyze BrM thickness by transmission electron microscopy (TEM) in a standardized blinded manner. Results Fundus images revealed that all ApoE−/− and NRF2−/− mice had AMD associated retinal alterations. BrM thickness was increased in untreated controls of both mouse models. Subvisible TS-R laser spots were not detectable by fundus imaging, OCT, or FLA 2 hours or 1 month after laser treatment. TEM revealed a significant reduction of BrM thickness in laser-treated eyes of all four groups compared to their fellow control eyes. Conclusions TS-R reduces BrM thickness in AMD mouse models ApoE−/− and NRF2−/− without damage to the neuroretina. It may become a prophylactic or even therapeutic treatment option for dry AMD. Translational Relevance TS-R may become a prophylactic or even therapeutic treatment option for dry AMD.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Claus von der Burchard
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Ralf Brinkmann
- Institute for Biomedical Optics, University of Lübeck, and Medical Laser Center Lübeck GmbH, Lübeck, Germany
| | - Ralph Lucius
- Christian-Albrechts-University of Kiel, Institute of Anatomy, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
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Tode J, Kirillova-Woytke I, Rausch VH, Baron R, Jänig W. Mechano- and thermosensitivity of injured muscle afferents 20 to 80 days after nerve injury. J Neurophysiol 2018; 119:1889-1901. [PMID: 29465328 DOI: 10.1152/jn.00894.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Chronic injury of limb nerves leading to neuropathic pain affects deep somatic nerves. Here the functional properties of injured afferent fibers in the lateral gastrocnemius-soleus nerve were investigated 20 and 80 days after suturing the central stump of this muscle nerve to the distal stump of the sural nerve in anesthetized rats. Neurophysiological recordings were made from afferent axons identified in either the sciatic nerve (87 A-, 63 C-fibers) or the dorsal root L4/L5 (52 A-, 26 C-fibers) by electrical stimulation of the injured nerve. About 70% of the functionally identified A-fibers had regenerated into skin by 80 days after nerve suture; the remaining A-fibers could be activated only from the injured nerve. In contrast, 93% of the functionally identified C-fibers could only be activated from the injured sural nerve after 80 days. Nearly half of the injured A- (45%) and C-fibers (44%) exhibited ongoing and/or mechanically or thermally evoked activity. Because ~50% of the A- and C-fibers are somatomotor or sympathetic postganglionic axons, respectively, probably all injured muscle afferent A- and C-fibers developed ectopic activity. Ongoing activity was present in 17% of the A- and 46% of the C-fibers. Mechanosensitivity was present in most injured A- (99%) and C-fibers (85%), whereas thermosensitivity was more common in C-fibers (cold 46%, heat 47%) than in A-fibers (cold 18%, heat 12%). Practically all thermosensitive A-fibers and C-fibers were also mechanosensitive. Thus, unlike cutaneous axons, almost all A- and C-fibers afferents in injured muscle nerves demonstrate ectopic activity, even chronically after nerve injury. NEW & NOTEWORTHY After chronic injury of a muscle nerve, allowing the nerve fibers to regenerate to the target tissue, 1) most afferent A-fibers are mechanosensitive and regenerate to the target tissue; 2) ectopic ongoing activity, cold sensitivity, and heat sensitivity significantly decrease with time after injury in A-afferents; 3) most afferent C-fibers do not regenerate to the target tissue; and 4) injured C-afferents maintain the patterns of ectopic discharge properties they already show soon after nerve injury.
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Affiliation(s)
- Jan Tode
- Physiologisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel , Germany
| | | | - Vanessa H Rausch
- Physiologisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel , Germany
| | - Ralf Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität zu Kiel, Kiel , Germany
| | - Wilfrid Jänig
- Physiologisches Institut, Christian-Albrechts-Universität zu Kiel, Kiel , Germany
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Stingl K, Schippert R, Bartz-Schmidt KU, Besch D, Cottriall CL, Edwards TL, Gekeler F, Greppmaier U, Kiel K, Koitschev A, Kühlewein L, MacLaren RE, Ramsden JD, Roider J, Rothermel A, Sachs H, Schröder GS, Tode J, Troelenberg N, Zrenner E. Interim Results of a Multicenter Trial with the New Electronic Subretinal Implant Alpha AMS in 15 Patients Blind from Inherited Retinal Degenerations. Front Neurosci 2017; 11:445. [PMID: 28878616 PMCID: PMC5572402 DOI: 10.3389/fnins.2017.00445] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/20/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose: We assessed the safety and efficacy of a technically advanced subretinal electronic implant, RETINA IMPLANT Alpha AMS, in end stage retinal degeneration in an interim analysis of two ongoing prospective clinical trials. The purpose of this article is to describe the interim functional results (efficacy). Methods: The subretinal visual prosthesis RETINA IMPLANT Alpha AMS (Retina Implant AG, Reutlingen, Germany) was implanted in 15 blind patients with hereditary retinal degenerations at four study sites with a follow-up period of 12 months (www.clinicaltrials.gov NCT01024803 and NCT02720640). Functional outcome measures included (1) screen-based standardized 2- or 4-alternative forced-choice (AFC) tests of light perception, light localization, grating detection (basic grating acuity (BaGA) test), and Landolt C-rings; (2) gray level discrimination; (3) performance during activities of daily living (ADL-table tasks). Results: Implant-mediated light perception was observed in 13/15 patients. During the observation period implant mediated localization of visual targets was possible in 13/15 patients. Correct grating detection was achieved for spatial frequencies of 0.1 cpd (cycles per degree) in 4/15; 0.33 cpd in 3/15; 0.66 cpd in 2/15; 1.0 cpd in 2/15 and 3.3 cpd in 1/15 patients. In two patients visual acuity (VA) assessed with Landolt C- rings was 20/546 and 20/1111. Of 6 possible gray levels on average 4.6 ± 0.8 (mean ± SD, n = 10) were discerned. Improvements (power ON vs. OFF) of ADL table tasks were measured in 13/15 patients. Overall, results were stable during the observation period. Serious adverse events (SAEs) were reported in 4 patients: 2 movements of the implant, readjusted in a second surgery; 4 conjunctival erosion/dehiscence, successfully treated; 1 pain event around the coil, successfully treated; 1 partial reduction of silicone oil tamponade leading to distorted vision (silicon oil successfully refilled). The majority of adverse events (AEs) were transient and mostly of mild to moderate intensity. Conclusions: Psychophysical and subjective data show that RETINA IMPLANT Alpha AMS is reliable, well tolerated and can restore limited visual functions in blind patients with degenerations of the outer retina. Compared with the previous implant Alpha IMS, longevity of the new implant Alpha AMS has been considerably improved. Alpha AMS has meanwhile been certified as a commercially available medical device, reimbursed in Germany by the public health system.
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Affiliation(s)
- Katarina Stingl
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | | | | | - Dorothea Besch
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | - Charles L Cottriall
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Thomas L Edwards
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Florian Gekeler
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany.,Department of Ophthalmology, Katharinenhospital, Klinikum StuttgartStuttgart, Germany
| | | | - Katja Kiel
- Städtisches Klinikum Dresden Friedrichstadt, University Teaching HospitalDresden, Germany
| | - Assen Koitschev
- Division Pediatric Otorhinolaryngology and Otology - Olgahospital, Department of Otorhinolaryngology, Klinikum StuttgartStuttgart, Germany
| | - Laura Kühlewein
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - James D Ramsden
- Nuffield Laboratory of Ophthalmology, Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, University of OxfordOxford, United Kingdom
| | - Johann Roider
- Department of Ophthalmology, University of KielKiel, Germany
| | | | - Helmut Sachs
- Städtisches Klinikum Dresden Friedrichstadt, University Teaching HospitalDresden, Germany
| | | | - Jan Tode
- Department of Ophthalmology, University of KielKiel, Germany
| | | | - Eberhart Zrenner
- Centre for Ophthalmology, University of TuebingenTuebingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience, University of TuebingenTuebingen, Germany
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Purtskhvanidze K, Hillenkamp J, Tode J, Junge O, Hedderich J, Roider J, Treumer F. Thinning of Inner Retinal Layers after Vitrectomy with Silicone Oil versus Gas Endotamponade in Eyes with Macula-Off Retinal Detachment. Ophthalmologica 2017; 238:124-132. [DOI: 10.1159/000477743] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/18/2017] [Indexed: 11/19/2022]
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Tode J, Richert E, Koinzer S, Klettner A, Pickhinke U, Garbers C, Rose-John S, Nölle B, Roider J. Intravitreal injection of anti-Interleukin (IL)-6 antibody attenuates experimental autoimmune uveitis in mice. Cytokine 2017; 96:8-15. [PMID: 28267649 DOI: 10.1016/j.cyto.2017.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/29/2017] [Accepted: 02/24/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the effect of an intravitreally applied anti-IL-6 antibody for the treatment of experimental autoimmune uveitis (EAU). METHODS EAU was induced in female B10.RIII mice by Inter-Photoreceptor-Binding-Protein (IRBP) in complete Freund's adjuvant, boosted by Pertussis toxin. Single blinded intravitreal injections of anti-IL-6 antibody were applied 5-7days as well as 8-10days (3day interval) after EAU induction into the randomized treatment eye and phosphate buffered saline (PBS) into the fellow control eye. Clinical and fluorescein angiography scoring (6 EAU grades) was done at each injection day and at enucleation day 14. Enucleated eyes were either scored histologically (6 EAU grades) or examined by ELISA for levels of IL-6, IL-17 and IL-6 soluble Receptor (sIL-6R). RESULTS Uveitis developed in all 12 mice. Clinical uveitis score was significantly reduced (p=0.035) in treated eyes (median 2.0, range 0-4.0, n=12) compared to the fellow control eyes (median 3.0, range 1.0-4.0, n=12). Angiography scores were reduced in 9/12 treated eyes and histological scores in 3/4 treated eyes compared to the fellow control eyes. Cytokine levels were determined in 8 mice, of which 4 responded to anti-IL-6 treatment and 4 did not respond. All mice responding to treatment had a significant reduction of IL-6 (p<0.01) and IL-17 (p=0.01) levels in treated eyes compared to the fellow control eyes. This difference was not seen in non-responding mice. CONCLUSIONS Intravitreal anti-IL-6 treatment significantly attenuates experimental autoimmune uveitis in mice. EAU activity correlates with ocular IL-6 and IL-17 levels.
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Affiliation(s)
- Jan Tode
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany.
| | - Elisabeth Richert
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Stefan Koinzer
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Alexa Klettner
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Ute Pickhinke
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Christoph Garbers
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Stefan Rose-John
- Christian-Albrechts-University of Kiel, Institute of Biochemistry, Kiel, Germany
| | - Bernhard Nölle
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
| | - Johann Roider
- Christian-Albrechts-University of Kiel, University Medical Center, Department of Ophthalmology, Kiel, Germany
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Tode J, Roider J. [Vision Loss in Association with Silicone Oil]. Klin Monbl Augenheilkd 2017; 235:1043-1048. [PMID: 28114699 DOI: 10.1055/s-0042-122341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Silicone oil tamponades have been a key feature of vitreoretinal surgery for more than 40 years. The use of these durable vitreous substitutes has not only been limited to tractive retinal detachments, inflammatory chorioretinopathies or other complicated vitreoretinal diseases, but also to macular holes and rhegmatogenous retinal detachment. During the last 12 years, an increasing number of cases of vision loss during or after the removal of silicone oil have been reported in the literature. In up to one third of patients with uncomplicated macula-attached retinal detachment with good preoperative vision, continuing vision loss is seen. In most of these cases, thinning of the inner retinal layers can be found. The underlying pathological mechanism is unknown. A direct connection to silicone oil is likely, but has not been proven. However, the increasing number of reports raises evidence that silicone oil itself might be the reason for this phenomenon, which is not observed in gas tamponades. Vision loss during or after the removal of silicone oil is an underestimated problem. The safety and toxicity of silicone oil should be reexamined systematically. The search for novel vitreous replacements is indispensable. The use of silicone oil should be strictly evaluated and balanced against other possible tamponades in every individual case.
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Affiliation(s)
- J Tode
- Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - J Roider
- Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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Mulder VC, Tode J, van Dijk EH, Purtskhvanidze K, Roider J, van Meurs JC, Treumer F. Preoperative aqueous humour flare values do not predict proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment. Br J Ophthalmol 2017; 101:1285-1289. [PMID: 28077370 DOI: 10.1136/bjophthalmol-2016-309134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND/AIMS Patients with rhegmatogenous retinal detachment (RRD) who develop postoperative proliferative vitreoretinopathy (PVR) have been found to have higher preoperative laser flare values than patients with RRD who do not develop this complication. Measurement of laser flare has therefore been proposed as an objective, rapid and non-invasive method for identifying high-risk patients. The purpose of our study was to validate the use of preoperative flare values as a predictor of PVR risk in two additional patient cohorts, and to confirm the sensitivity and specificity of this method for identifying high-risk patients. METHODS We combined data from two independent prospective studies: centre 1 (120 patients) and centre 2 (194 patients). Preoperative aqueous humour flare was measured with a Kowa FM-500 Laser Flare Meter. PVR was defined as redetachment due to the formation of traction membranes that required reoperation within 6 months of initial surgery. Logistic regression and receiver operating characteristic analysis determined whether higher preoperative flare values were associated with an increased risk of postoperative PVR. RESULTS PVR redetachment developed in 21/314 patients (6.7%). Median flare values differed significantly between centres, therefore analyses were done separately. Logistic regression showed a small but statistically significant increase in odds with increasing flare only for centre 2 (OR 1.014; p=0.005). Areas under the receiver operating characteristic showed low sensitivity and specificity: centre 1, 0.634 (95% CI 0.440 to 0.829) and centre 2, 0.731 (95% CI 0.598 to 0.865). CONCLUSIONS Preoperative laser flare measurements are inaccurate in discriminating between those patients with RRD at high and low risk of developing PVR.
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Affiliation(s)
- Verena C Mulder
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands
| | - Jan Tode
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Elon Hc van Dijk
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan C van Meurs
- The Rotterdam Eye Hospital/Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University, Rotterdam, The Netherlands
| | - Felix Treumer
- Department of Ophthalmology, University of Kiel, University Medical Center Schleswig-Holstein, Kiel, Germany
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Tode J, Purtskhvanidze K, Oppermann T, Hillenkamp J, Treumer F, Roider J. Vision loss under silicone oil tamponade. Graefes Arch Clin Exp Ophthalmol 2016; 254:1465-1471. [PMID: 27278374 DOI: 10.1007/s00417-016-3405-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to investigate frequency, time course and pathophysiology of vision loss in eyes with macula-on rhegmatogenous retinal detachment operated with vitrectomy and silicone oil tamponade. PATIENTS AND METHODS Fifteen eyes of 15 patients who had been operated with 5,000 centistoke silicone oil between 2006 and 2014 were included in a retrospective case series. Examinations included logMAR best corrected visual acuity (BCVA), visual field testing (VF), spectral domain optical coherence tomography (OCT), electrophysiology, and fluorescein angiography. RESULTS Vision loss was seen in eight (53 %) eyes of 15 patients with symptomatic central scotoma, which was confirmed by VF (5/6). Preoperative median BCVA of these patients was 0.15 (0.5 to 0), prior to oil removal 0.7 (1.0 to 0.5), and 6 weeks post oil removal 1.0 (1.5 to 0.2). BCVA recovered in five patients to a median of 0.15 (0.5 to 0.1), and it remained 1.0 in three (20 %) out of 15 eyes. OCT revealed significant thinning of the foveal and parafoveal combined nerve fiber, ganglion cell and inner plexiform layers in affected eyes (mean 58.3 μm +/-13, horizontal scan through fovea, 500 μm radius) compared to their healthy fellow eyes (mean 84.5 μm +/-12.3; p < 0.01, n = 6 patients, 12 eyes) and compared to eyes with no vision loss under silicone oil. CONCLUSIONS We find persisting vision loss in three out of 15 patients treated for macula-on rhegmatogenous retinal detachment with silicone oil tamponade. Thinning of inner retinal layers possibly evoked by silicone oil tamponade might be a pathophysiological explanation for vision loss in these patients.
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Affiliation(s)
- Jan Tode
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany.
| | - Konstantine Purtskhvanidze
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Till Oppermann
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Felix Treumer
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, Christian-Albrechts-University of Kiel, University Medical Center, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
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Tode J, Zeuner R, Saeger M, Roider J, Nölle B. Tocilizumab and steroid boli for treatment-resistant anterior necrotizing scleritis. Acta Ophthalmol 2015; 93:e683-4. [PMID: 26033325 DOI: 10.1111/aos.12720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jan Tode
- Department of Ophthalmology; University Clinic Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Rainald Zeuner
- Department of Rheumatology; University Clinic Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Mark Saeger
- Department of Ophthalmology; University Clinic Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Johann Roider
- Department of Ophthalmology; University Clinic Schleswig-Holstein; Campus Kiel Kiel Germany
| | - Bernhard Nölle
- Department of Ophthalmology; University Clinic Schleswig-Holstein; Campus Kiel Kiel Germany
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Koinzer S, Heckmann J, Tode J, Roider J. Long-term, therapy-related visual outcome of 49 cases with retinal arterial macroaneurysm: a case series and literature review. Br J Ophthalmol 2015; 99:1345-53. [PMID: 25883085 DOI: 10.1136/bjophthalmol-2014-305884] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 03/21/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE Retinal arterial macroaneurysms (RAMAs) are acquired dilations of branches of the central retinal artery. Treatment depends on vision-limiting complications. We compare the long-term visual acuity (VA) in three groups according to treatment. METHODS 49 charts of patients with RAMA were reviewed. 16 remained untreated, 15 received photocoagulation and 18 vitrectomy. Patients underwent full ophthalmological examinations and up-to-date imaging. We evaluated chosen therapy, complications and final VA at the last visit. RESULTS 65% of the cohort was female, aged 75±11 years (mean±SD). Follow-up was 34±23 months. These parameters did not differ significantly between the three groups. In the observed group, initial VA was 0.48 (mean log MAR) vs 0.35 at the final visit, in the photocoagulation group 0.55 vs 0.59, and in the vitrectomy group 1.8 vs 0.77. VA was significantly worse at enrolment in the vitrectomy group, while all other VA differences were not significant. CONCLUSIONS The overall visual prognosis of RAMA was good, even after macular complications. VA remained unchanged in the observed and the laser groups and was comparable in all groups after 3 years. Based on an individual treatment decision, all therapies were effective and efficient. If subfoveal haemorrhage caused a macular hole, the VA outcome was limited.
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Affiliation(s)
- Stefan Koinzer
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Jan Heckmann
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Jan Tode
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
| | - Johann Roider
- Department of Ophthalmology, University hospital of Schleswig-Holstein, Kiel, Germany
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Kirillova I, Teliban A, Gorodetskaya N, Grossmann L, Bartsch F, Rausch VH, Struck M, Tode J, Baron R, Jänig W. Effect of local and intravenous lidocaine on ongoing activity in injured afferent nerve fibers. Pain 2011; 152:1562-1571. [DOI: 10.1016/j.pain.2011.02.046] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 02/09/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
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Abstract
Injury of limb nerves leading to neuropathic pain mostly affects deep somatic nerves including muscle nerves. Here, we investigated the functional properties of injured afferent fibers innervating the lateral gastrocnemius-soleus muscle 4-13 h [time period (TP) I] and 4-7 days (TP II) after nerve crush in anesthetized rats using neurophysiological recordings from either the sciatic nerve (165 A-, 137 C-fibers) or the dorsal root L(5) (43 A-, 28 C-fibers). Ongoing activity and responses to mechanical or thermal stimulation of the injury site of the nerve were studied quantitatively. Of the electrically identified A- and C-fibers, 5 and 38% exhibited ectopic activity, respectively, in TP I and 51 and 61%, respectively, in TP II. Thus all afferent fibers in an injured muscle nerve developed ectopic activity since ∼ 50% of the fibers in a muscle nerve are somatomotor or sympathetic postganglionic. Ongoing activity was present in 50% of the afferent A-fibers (TP II) and in 53-56% of the afferent C-fibers (TP I and II). In TP II, mechanical, cold, and heat sensitivity were present in 91, 63, and 52% of the afferent A-fibers and in 50, 40, and 66% of the afferent C-fibers. The cold and heat activation thresholds were 5-27 and 35-48°C, respectively, covering the noxious and innocuous range. Most afferent fibers showed combinations of these sensitivities. Mechano- and cold sensitivity had a significantly higher representation in A- than in C-fibers, but heat sensitivity had a significantly higher representation in C- than in A-fibers. These functional differences between A- and C-fibers applied to large- as well as small-diameter A-fibers. Comparing the functional properties of injured muscle A- and C-afferents with those of injured cutaneous A- and C-afferents shows that both populations of injured afferent neurons behave differently in several aspects.
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Affiliation(s)
- Irina Kirillova
- Physiologisches Institut, Christian-Albrechts-Universität zu Kiel, Olshausenstrasse 40, 24098 Kiel, Germany
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Morlat P, Nouts C, Beylot-Barry M, Bezian MC, Tode J, Gellie P, Bernard N, Lacoste D, Beylot J. Méningococcémie chronique chez une jeune femme immunocompétente: une observation inhabituelle. Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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