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Shi X, Li P, Herb M, Liu H, Wang M, Wang X, Feng Y, van Beers T, Xia N, Li H, Prokosch V. Pathological high intraocular pressure induces glial cell reactive proliferation contributing to neuroinflammation of the blood-retinal barrier via the NOX2/ET-1 axis-controlled ERK1/2 pathway. J Neuroinflammation 2024; 21:105. [PMID: 38649885 PMCID: PMC11034147 DOI: 10.1186/s12974-024-03075-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND NADPH oxidase (NOX), a primary source of endothelial reactive oxygen species (ROS), is considered a key event in disrupting the integrity of the blood-retinal barrier. Abnormalities in neurovascular-coupled immune signaling herald the loss of ganglion cells in glaucoma. Persistent microglia-driven inflammation and cellular innate immune system dysregulation often lead to deteriorating retinal degeneration. However, the crosstalk between NOX and the retinal immune environment remains unresolved. Here, we investigate the interaction between oxidative stress and neuroinflammation in glaucoma by genetic defects of NOX2 or its regulation via gp91ds-tat. METHODS Ex vivo cultures of retinal explants from wildtype C57BL/6J and Nox2 -/- mice were subjected to normal and high hydrostatic pressure (Pressure 60 mmHg) for 24 h. In vivo, high intraocular pressure (H-IOP) was induced in C57BL/6J mice for two weeks. Both Pressure 60 mmHg retinas and H-IOP mice were treated with either gp91ds-tat (a NOX2-specific inhibitor). Proteomic analysis was performed on control, H-IOP, and treatment with gp91ds-tat retinas to identify differentially expressed proteins (DEPs). The study also evaluated various glaucoma phenotypes, including IOP, retinal ganglion cell (RGC) functionality, and optic nerve (ON) degeneration. The superoxide (O2-) levels assay, blood-retinal barrier degradation, gliosis, neuroinflammation, enzyme-linked immunosorbent assay (ELISA), western blotting, and quantitative PCR were performed in this study. RESULTS We found that NOX2-specific deletion or activity inhibition effectively attenuated retinal oxidative stress, immune dysregulation, the internal blood-retinal barrier (iBRB) injury, neurovascular unit (NVU) dysfunction, RGC loss, and ON axonal degeneration following H-IOP. Mechanistically, we unveiled for the first time that NOX2-dependent ROS-driven pro-inflammatory signaling, where NOX2/ROS induces endothelium-derived endothelin-1 (ET-1) overexpression, which activates the ERK1/2 signaling pathway and mediates the shift of microglia activation to a pro-inflammatory M1 phenotype, thereby triggering a neuroinflammatory outburst. CONCLUSIONS Collectively, we demonstrate for the first time that NOX2 deletion or gp91ds-tat inhibition attenuates iBRB injury and NVU dysfunction to rescue glaucomatous RGC loss and ON axon degeneration, which is associated with inhibition of the ET-1/ERK1/2-transduced shift of microglial cell activation toward a pro-inflammatory M1 phenotype, highlighting NOX2 as a potential target for novel neuroprotective therapies in glaucoma management.
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Affiliation(s)
- Xin Shi
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany
| | - Panpan Li
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany
| | - Marc Herb
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Goldenfelsstr. 19-21, 50935, Cologne, Germany
- Cologne Cluster of Excellence on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Hanhan Liu
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany
| | - Maoren Wang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, P. R. China
| | - Xiaosha Wang
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany
| | - Yuan Feng
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany
| | - Tim van Beers
- Institut I für Anatomie, Universitätsklinikum Köln (AöR), Cologne, Germany
| | - Ning Xia
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Huige Li
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, 55131, Mainz, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, 50937, Cologne, Germany.
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Azuara-Blanco A, McCorry N, Tatham AJ, Georgoulas S, Founti P, Schweitzer C, Meier-Gibbons F, Denis P, Tuulonen A, Johannesson G, Martínez de la Casa JM, Prokosch V, Giannoulis DA, Abegão Pinto L, Garway-Heath D, Topouzis F. European Glaucoma Society research priorities for glaucoma care. Br J Ophthalmol 2024:bjo-2023-323648. [PMID: 37923373 DOI: 10.1136/bjo-2023-323648] [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: 03/29/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND/AIMS The goal of health research is to improve patients care and outcomes. Thus, it is essential that research addresses questions that are important to patients and clinicians. The aim of this study was to develop a list of priorities for glaucoma research involving stakeholders from different countries in Europe. METHODS We used a three-phase method, including a two-round electronic Delphi survey and a workshop. The clinician and patient electronic surveys were conducted in parallel and independently. For phase I, the survey was distributed to patients from 27 European countries in 6 different languages, and to European Glaucoma Society members, ophthalmologists with expertise in glaucoma care, asking to name up to five research priorities. During phase II, participants were asked to rank the questions identified in phase I using a Likert scale. Phase III was a 1 day workshop with patients and clinicians. The purpose was to make decisions about the 10 most important research priorities using the top 20 priorities identified by patients and clinicians. RESULTS In phase I, 308 patients and 150 clinicians were involved. In phase II, the highest-ranking priority for both patients and clinicians was 'treatments to restore vision'. In phase III, eight patients and four clinicians were involved. The top three priorities were 'treatments to stop sight loss', 'treatments to restore vision' and 'improved detection of worsening glaucoma'. CONCLUSION We have developed a list of priorities for glaucoma research involving clinicians and patients from different European countries that will help guide research efforts and investment.
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Affiliation(s)
| | - Noleen McCorry
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andrew J Tatham
- Ophthalmology Department, Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Stelios Georgoulas
- Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Panayiota Founti
- Glaucoma Service, Moorfields Eye Hospital City Road Campus, London, UK
| | - Cedric Schweitzer
- Ophthalmology, University Hospital Centre Bordeaux, Bordeaux, France
| | | | - Philippe Denis
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Gauti Johannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umea, Sweden
| | | | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Koln, Germany
| | - Dimitrios A Giannoulis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Luis Abegão Pinto
- Department of Ophthalmology, Santa Maria Hospital, University of Lisbon, Lisboa, Portugal
| | - David Garway-Heath
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Prinz J, Walter P, Liu H, Prokosch V. The Impact of Aging on the Function of Retinal Ganglion Cells. Klin Monbl Augenheilkd 2024; 241:162-169. [PMID: 38412980 DOI: 10.1055/a-2239-0290] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Aging is a major risk factor for retinal neurodegenerative diseases. Aged mammalian retinal ganglion cells (RGCs) lack the ability to regenerate axons after injury. Rodent models suggest that older age increases the vulnerability of RGCs to injury and impairs RGC function as well as their functional recovery. Molecular changes - including decreased circulating levels of brain-derived neurotrophic factor (BDNF) - might contribute to impaired RGC dendritic extension during aging. Moreover, age-related mitochondrial dysfunction plays a major role in aging processes, as it leads to reduced adenosine triphosphate and increased generation of reactive oxygen species. Autophagy activity is necessary for the maintenance of cellular homeostasis and decreases with aging in the central nervous system. During aging, vascular insufficiency may lead to impaired oxygen and nutrient supply to RGCs. Microglial cells undergo morphological changes and functional impairment with aging, which might compromise retinal homeostasis and promote an inflammatory environment. Addressing these age-related changes by means of a low-energy diet, exercise, and neurotrophic factors might prevent age-related functional impairment of RGCs. This review focuses on the current understanding of aging RGCs and key players modulating those underlying mechanisms.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Hanhan Liu
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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4
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Erb C, Prokosch V. [Aging as a Risk Factor for Glaucoma]. Klin Monbl Augenheilkd 2024; 241:152-153. [PMID: 38412978 DOI: 10.1055/a-2237-0901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
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Tang J, Sun M, Feng Y, Prokosch V, Cui H, Liu H. Cytokine Profiling in Aqueous Humor of Glaucoma Patients and in Retinas from an Ex Vivo Glaucoma Animal Model. FRONT BIOSCI-LANDMRK 2024; 29:29. [PMID: 38287812 DOI: 10.31083/j.fbl2901029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Although the current role of cytokines and neuroinflammation in glaucoma remains obscure, it represents an expanding field in research. The purpose of this study was to analyze cytokines in the aqueous humor (AH) of glaucoma patients and in retinas from an ex vivo glaucoma animal model, to aid in determining the role of neuroinflammation in glaucoma. METHODS AH samples were collected from 20 patients during cataract surgeries (controls: n = 10, age = 70.3 ± 9.742; glaucoma: n = 10, age: 66.5 ± 8.073) in Shanghai East Hospital, an affiliate of Tongji University, between September 2018 and March 2019 and analyzed in duplicate by Luminex cytokine polystyrene color bead-based multiplex assay. Retinas from female Sprague-Dawley rats (n = 6) were harvested ex vivo and cultured with or without 60 mmHg of hydrostatic pressure for 24 hours. Retinal ganglion cells (RGCs) were quantified using Brn3a staining. Cytokines in the retina and culture medium were analyzed by rat cytokine array (Abcam). RESULTS At baseline, patients with primary angle closure glaucoma (PACG) have significantly lower levels of IL-6 and IP-10 and a higher level of PDGF-BB in their AH, compared to the controls. Postoperatively, patients with PACG have significantly higher levels of IL-1ra, IL-13, and MIP-1α and a lower level of IL-6. Elevated hydrostatic pressure led to significant RGC loss in the retina, ex vivo, as well as the upregulation of ciliary neurotrophic factor (CNTF), IL-6, IL-10, IL-4, and TIMP-1 alongside the downregulation of PDGF-AA, MMP-8, TNF-α, and IFN-γ. Furthermore, eight cytokines were detected as being downregulated in the culture medium, including PDGF-AA, MMP-8, and IL-4. CONCLUSIONS Proinflammatory cytokines showed changes in both AH and ex vivo. Further studies are needed on the role of these cytokines and their corresponding signaling pathways in both neurodegeneration and glaucoma.
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Affiliation(s)
- Jiancen Tang
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, 200120 Shanghai, China
| | - Mengsha Sun
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, 200120 Shanghai, China
| | - Yuan Feng
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
| | - Hongping Cui
- Department of Ophthalmology, Shanghai East Hospital, Tongji University School of Medicine, 200120 Shanghai, China
| | - Hanhan Liu
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
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Kiramira D, Voßmerbäumer U, Pfeiffer N, Linnerth-Braun LKM, Lorenz K, Prokosch V. Mid-term real world outcomes of the Hydrus ® Microstent in open angle glaucoma. Eye (Lond) 2024:10.1038/s41433-023-02920-2. [PMID: 38182656 DOI: 10.1038/s41433-023-02920-2] [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] [Received: 08/14/2022] [Revised: 11/15/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To evaluate the mid-term clinical results and the safety aspects of the Hydrus® Microstent (Ivantis, Inc, Irvine, CA) in a real-life setting. DESIGN Retrospective case series. METHODS Hydrus® Microstent was implanted in phakic eyes (88 eyes, 87.1%) and in pseudophakic eyes (13 eyes, 12.9%), respectively. Mean follow-up time was 16 ± 9 months with 27 eyes having a follow-up time of more than 24 months. MAIN OUTCOME MEASURES The primary endpoint was reduction in IOP compared to baseline. Target IOP levels were set at ≤20 mmHg, ≤18 mmHg and ≤15 mmHg. Kaplan-Meier survival was defined as a reduction in IOP of ≥20% compared to baseline. Secondary endpoints were reduction in number of glaucoma medications and safety assessments addressing visual acuity, adverse events, re-surgery rate and identification of factors that made the implantation more difficult. RESULT 101 eyes underwent Hydrus® implantation. The mean preoperative IOP was 21.60 mmHg (SD 6.6) on 2.18 (SD 1.3) medications. After a mean follow up time of 16 months, the mean IOP was reduced to 14.61 ± 3.7 mmHg on 1.12 (SD 1.1) medication classes (p < 0.001). Mean decrease in IOP was 26.7%. Analysis of the target IOP levels showed that in 29%, 34% and 35% of cases an IOP of ≤15 mmHg, ≤18 mmHg and ≤20 mmHg respectively could be achieved. BCVA improved from 0.56 ± 0.3 at baseline to 0.85 ± 0.3 more than 24 months after surgery (p < 0.001). The rate of re-operation was low at <3%. Adverse events occurred in 4 eyes (<4%). CONCLUSION This study underlines the effectiveness and the safety of the Hydrus® Microstent in an elective setting, but it also demonstrates certain limits and risk factors of this procedure.
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Affiliation(s)
- David Kiramira
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
- Department of Periodontology and Operative Dentistry, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Urs Voßmerbäumer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
- Frankfurt Hoechst Eye Hospital, Frankfurt, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Lea K M Linnerth-Braun
- Department of Periodontology and Operative Dentistry, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Katrin Lorenz
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - Verena Prokosch
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany.
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7
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Prokosch V, Dietlein T, Pfeiffer N. [The use of antimetabolites in filtrating glaucoma surgery (trabeculectomy, XEN, Preserflo)]. Ophthalmologie 2023; 120:1065-1066. [PMID: 37682327 DOI: 10.1007/s00347-023-01916-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Verena Prokosch
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Joseph-Stelzmann Str., 50913, Köln, Deutschland.
| | - Thomas Dietlein
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Joseph-Stelzmann Str., 50913, Köln, Deutschland
| | - Norbert Pfeiffer
- Klinik und Poliklinik für Augenheilkunde, Unimedizin Mainz, Mainz, Deutschland
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8
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Prinz J, Prokosch V, Liu H, Walter P, Fuest M, Migliorini F. Efficacy of citicoline as a supplement in glaucoma patients: A systematic review. PLoS One 2023; 18:e0291836. [PMID: 37768938 PMCID: PMC10538785 DOI: 10.1371/journal.pone.0291836] [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: 08/04/2023] [Accepted: 09/06/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells (RGC), the neurons that connect the eyes to the brain, specifically die in glaucoma, leading to blindness. Elevated intraocular pressure (IOP) is the only modifiable risk factor, however, many patients progress despite excellent IOP control. Thus, alternative treatment strategies to prevent glaucoma progression are an unmet need. Citicoline has demonstrated neuroprotective properties in central neurodegenerative diseases. However, conclusive evidence of the effect of citicoline on glaucoma progression is missing. This systematic review investigates first-time the therapeutic potential of citicoline in glaucoma patients. METHODS The present study was conducted according to the PRISMA 2020 statement. PubMed, Web of Science, Google Scholar, and Embase were accessed in July 2023 to identify all clinical studies investigating the efficacy of citicoline on IOP, the mean deviation of the 24-2 visual field testing (MD 24-2), retinal nerve fibre layer (RNFL), and the pattern electroretinogram (PERG) P50-N95 amplitude in glaucoma patients. The risk of bias was assessed using the Review Manager 5.3 software (The Nordic Cochrane Collaboration, Copenhagen) and the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. RESULTS Ten studies were eligible for this systematic review, including 424 patients. The mean length of the follow-up was 12.1 ± 11.6 months. The overall risk of bias was low to moderate. The mean age of the patients was 56.7 years. There were no significant differences in the IOP, MD 24-2, RNFL, or PERG P50-N95 amplitude between patients receiving citicoline and the control group. There was no improvement from baseline to the last follow-up in IOP, MD 24-2, RNFL, or PERG P50-N95 amplitude. CONCLUSION There is a lack of sufficient evidence to support that citicoline slows the progression of glaucoma.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Hanhan Liu
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic and Trauma Surgery, RWTH Aachen University, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
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Clahsen T, Hadrian K, Notara M, Schlereth SL, Howaldt A, Prokosch V, Volatier T, Hos D, Schroedl F, Kaser-Eichberger A, Heindl LM, Steven P, Bosch JJ, Steinkasserer A, Rokohl AC, Liu H, Mestanoglu M, Kashkar H, Schumacher B, Kiefer F, Schulte-Merker S, Matthaei M, Hou Y, Fassbender S, Jantsch J, Zhang W, Enders P, Bachmann B, Bock F, Cursiefen C. The novel role of lymphatic vessels in the pathogenesis of ocular diseases. Prog Retin Eye Res 2023; 96:101157. [PMID: 36759312 DOI: 10.1016/j.preteyeres.2022.101157] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/22/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 02/10/2023]
Abstract
Historically, the eye has been considered as an organ free of lymphatic vessels. In recent years, however, it became evident, that lymphatic vessels or lymphatic-like vessels contribute to several ocular pathologies at various peri- and intraocular locations. The aim of this review is to outline the pathogenetic role of ocular lymphatics, the respective molecular mechanisms and to discuss current and future therapeutic options based thereon. We will give an overview on the vascular anatomy of the healthy ocular surface and the molecular mechanisms contributing to corneal (lymph)angiogenic privilege. In addition, we present (i) current insights into the cellular and molecular mechanisms occurring during pathological neovascularization of the cornea triggered e.g. by inflammation or trauma, (ii) the role of lymphatic vessels in different ocular surface pathologies such as dry eye disease, corneal graft rejection, ocular graft versus host disease, allergy, and pterygium, (iii) the involvement of lymphatic vessels in ocular tumors and metastasis, and (iv) the novel role of the lymphatic-like structure of Schlemm's canal in glaucoma. Identification of the underlying molecular mechanisms and of novel modulators of lymphangiogenesis will contribute to the development of new therapeutic targets for the treatment of ocular diseases associated with pathological lymphangiogenesis in the future. The preclinical data presented here outline novel therapeutic concepts for promoting transplant survival, inhibiting metastasis of ocular tumors, reducing inflammation of the ocular surface, and treating glaucoma. Initial data from clinical trials suggest first success of novel treatment strategies to promote transplant survival based on pretransplant corneal lymphangioregression.
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Affiliation(s)
- Thomas Clahsen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Karina Hadrian
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Maria Notara
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Simona L Schlereth
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Antonia Howaldt
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Volatier
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Deniz Hos
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Falk Schroedl
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Alexandra Kaser-Eichberger
- Center for Anatomy and Cell Biology, Institute of Anatomy and Cell Biology - Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Steven
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cluster of Excellence: Cellular Stress Responses in Ageing-Associated Diseases, CECAD, University of Cologne, Cologne, Germany
| | - Jacobus J Bosch
- Centre for Human Drug Research and Leiden University Medical Center, Leiden, the Netherlands
| | | | - Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hanhan Liu
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mert Mestanoglu
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hamid Kashkar
- Institute for Molecular Immunology, Center for Molecular Medicine Cologne (CMMC), CECAD Research Center, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Björn Schumacher
- Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany; Cluster of Excellence: Cellular Stress Responses in Ageing-Associated Diseases, CECAD, University of Cologne, Cologne, Germany
| | - Friedemann Kiefer
- European Institute for Molecular Imaging (EIMI), University of Münster, 48149, Münster, Germany
| | - Stefan Schulte-Merker
- Institute for Cardiovascular Organogenesis and Regeneration, Faculty of Medicine, WWU Münster, Münster, Germany
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yanhong Hou
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Xuhui District, Shanghai, China
| | - Sonja Fassbender
- IUF‒Leibniz Research Institute for Environmental Medicine, Duesseldorf, Germany; Immunology and Environment, Life & Medical Sciences (LIMES) Institute, University of Bonn, Bonn, Germany
| | - Jonathan Jantsch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Wei Zhang
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philip Enders
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Björn Bachmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Felix Bock
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center for Molecular Medicine (CMMC), University of Cologne, Cologne, Germany; Cluster of Excellence: Cellular Stress Responses in Ageing-Associated Diseases, CECAD, University of Cologne, Cologne, Germany.
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Wang X, Wang M, Liu H, Mercieca K, Prinz J, Feng Y, Prokosch V. The Association between Vascular Abnormalities and Glaucoma-What Comes First? Int J Mol Sci 2023; 24:13211. [PMID: 37686017 PMCID: PMC10487550 DOI: 10.3390/ijms241713211] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide. While intraocular pressure (IOP) presents a major risk factor, the underlying pathophysiology still remains largely unclear. The correlation between vascular abnormalities and glaucoma has been deliberated for decades. Evidence for a role played by vascular factors in the pathogenesis of glaucomatous neurodegeneration has already been postulated. In addition, the fact that glaucoma causes both structural and functional changes to retinal blood vessels has been described. This review aims to investigate the published evidence concerning the relationship between vascular abnormalities and glaucoma, and to provide an overview of the "chicken or egg" dilemma in glaucoma. In this study, several biomarkers of glaucoma progression from a vascular perspective, including endothelin-1 (ET-1), nitric oxide, vascular endothelial growth factor (VEGF), and matrix metalloproteinases (MMPs), were identified and subsequently assessed for their potential as pharmacological intervention targets.
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Affiliation(s)
- Xiaosha Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Maoren Wang
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hanhan Liu
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Karl Mercieca
- Glaucoma Section, University Hospital Eye Clinic, 53127 Bonn, Germany;
- Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester M13 9WH, UK
| | - Julia Prinz
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, RWTH Aachen University, 52074 Aachen, Germany
| | - Yuan Feng
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; (X.W.); (M.W.); (H.L.); (J.P.); (Y.F.)
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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11
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Prokosch V, Dietlein T, Pfeiffer N. [Comparison of new and old procedures in glaucoma surgery : Trabeculectomy, Preserflo and XEN]. Ophthalmologie 2023; 120:350-357. [PMID: 37052708 DOI: 10.1007/s00347-023-01837-1] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/14/2023]
Abstract
Glaucoma is one of the most frequent causes of irreversible blindness worldwide. The main risk factor of the disease is an individually too high intraocular pressure and pressure reduction is still the only established treatment. If conservative pressure reduction and adherence are insufficient, and if the patient is unable to tolerate conservative treatment, surgical procedures become necessary. There are nowadays more than a dozen different surgical procedures for lowering the pressure. This article presents and discusses the procedures that have a subconjunctival pre-equatorial drainage in common. These include trabeculectomy, the XEN-gel implant and the Preserflo microshunt.
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Affiliation(s)
- Verena Prokosch
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Thomas Dietlein
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Norbert Pfeiffer
- Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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12
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Prokosch V, Dietlein T, Pfeiffer N. [Comparison of new and old procedures for glaucoma surgery : What, when, where, why?]. Ophthalmologie 2023; 120:348-349. [PMID: 37115286 DOI: 10.1007/s00347-023-01836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Verena Prokosch
- Universitätsklinikum Köln, 50937, Köln, Deutschland, Josef Stelzmann Str..
| | - Thomas Dietlein
- Universitätsklinikum Köln, 50937, Köln, Deutschland, Josef Stelzmann Str
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13
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Stingl JV, Wagner FM, Liebezeit S, Baumgartner R, Spät H, Schuster AK, Prokosch V, Grehn F, Hoffmann EM. Long-Term Efficacy and Safety of Modified Canaloplasty Versus Trabeculectomy in Open-Angle Glaucoma. Life (Basel) 2023; 13:life13020516. [PMID: 36836873 PMCID: PMC9963969 DOI: 10.3390/life13020516] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma. METHODS In total, 210 subjects with open-angle glaucoma were included. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. Cases were matched 1:2 by sex and age. RESULTS In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6 [IQR 4.3, 5.05] years and 5.8 [IQR 5.4, 6.3]. Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each p < 0.001). Kaplan-Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty (p < 0.001) and Cox regression analysis revealed an HR of 6.03 (95%-CI 3.66, 9.93, p < 0.001) after canaloplasty. Trabeculectomy showed superiority in terms of IOP decrease (9.2 ± 7.9 mmHg vs. 13.7 ± 10.4 mmHg, p = 0.002), use of AGM (50.0% vs. 10.7%, p < 0.001), and the number of revision surgeries (41.4% vs. 21.4%, p = 0.004). Occurrence of complications was similar in both groups (14.5% vs. 7.5%, p = 0.19). CONCLUSIONS Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty.
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Affiliation(s)
- Julia V. Stingl
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Felix M. Wagner
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | | | | | - Helene Spät
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, 50937 Cologne, Germany
| | - Franz Grehn
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Correspondence:
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14
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Erb C, Prokosch V. [Crosstalk between Primary Open-Angle Glaucoma and Diabetes Mellitus]. Klin Monbl Augenheilkd 2023; 240:123-124. [PMID: 36812924 DOI: 10.1055/a-1989-6285] [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: 02/24/2023]
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15
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Prokosch V, Li P, Shi X. Glaucoma as a Neurodegenerative and Inflammatory Disease. Klin Monbl Augenheilkd 2023; 240:125-129. [PMID: 36265500 DOI: 10.1055/a-1965-0044] [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: 11/05/2022]
Abstract
Glaucoma is a neurodegenerative disease that leads to irreversible loss of vision through degeneration of the retinal ganglia cells (RGCs). Glaucoma is one of the most frequent causes of blindness in the world. Intraocular pressure is the main risk factor for the occurrence and development of this disease. Treatment is largely based on reducing internal optical pressure. However, some patients may deteriorate or become blind, despite normal or reduced internal optical pressure. The pathophysiological details are still unclear. Neuroinflammatory processes are also apparently an additional cause. In principle, innate or local responses of the adaptive immune system can be distinguished. The reaction of the innate immune system, particularly the local microglial cells, has long been studied. The macroglia with the astrocytes and Müller cells and their homeostatic effects have also long been known. On the other hand, it has long been thought that the retina with its RGZs was inert to adaptive immunological reactions - due to the function of the blood brain barrier. However, this system may be disturbed by antigen presentation, leading to a reaction of the adaptive immune system, with B cell and T cell responses. In this context, the key proteins are presumably heat shock proteins. We now know that neuroinflammation is important in glaucoma, as in other neurodegenerative diseases. It is important to increase our understanding of these phenomena. In this review article, we present our current knowledge of the role of the micro- and macroglia, the adaptive immune system, and the heat shock proteins.
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Affiliation(s)
- Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Panpan Li
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Xin Shi
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
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16
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Tang J, Liu H, Sun M, Zhang X, Chu H, Li Q, Prokosch V, Cui H. Aqueous Humor Cytokine Response in the Contralateral Eye after First-Eye Cataract Surgery in Patients with Primary Angle-Closure Glaucoma, High Myopia or Type 2 Diabetes Mellitus. FRONT BIOSCI-LANDMRK 2022; 27:222. [DOI: 10.31083/j.fbl2707222] [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] [Received: 05/16/2022] [Revised: 06/07/2022] [Accepted: 07/06/2022] [Indexed: 11/06/2022]
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17
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Liu H, Bell K, Herrmann A, Arnhold S, Mercieca K, Anders F, Nagel-Wolfrum K, Thanos S, Prokosch V. Crystallins Play a Crucial Role in Glaucoma and Promote Neuronal Cell Survival in an In Vitro Model Through Modulating Müller Cell Secretion. Invest Ophthalmol Vis Sci 2022; 63:3. [PMID: 35816047 PMCID: PMC9284462 DOI: 10.1167/iovs.63.8.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to explore the roles of crystallins in the context of aging in glaucoma and potential mechanisms of neuroprotection in an experimental animal model of glaucoma. Methods Intraocular pressure (IOP) was significantly elevated for 8 weeks in animals at different ages (10 days, 12 weeks, and 44 weeks) by episcleral vein cauterization. Retinal ganglion cells (RGCs) were quantified by anti-Brn3a immunohistochemical staining (IHC). Proteomics using ESI-LTQ Orbitrap XL-MS was used to analyze the presence and abundance of crystallin isoforms the retinal samples, respectively. Neuroprotective property and localization of three selected crystallins CRYAB, CRYBB2, and CRYGB as most significantly changed in retina and retinal layers were determined by IHC. Their expressions and endocytic uptakes into Müller cells were analyzed by IHC and Western blotting. Müller cell secretion of neurotrophic factors into the supernatant following CRYAB, CRYBB2, and CRYGB supplementation in vitro was measured via microarray. Results IOP elevation resulted in significant RGC loss in all age groups (P < 0.001). The loss increased with aging. Proteomics analysis revealed in parallel a significant decrease of crystallin abundance – especially CRYAB, CRYBB2, and CRYGB. Significant neuroprotective effects of CRYAB, CRYBB2, and CRYGB after addition to retinal cultures were demonstrated (P < 0.001). Endocytic uptake of CRYAB, CRYBB2, and CRYGB was seen in Müller cells with subsequent increased secretion of various neurotrophic factors into the supernatant, including nerve growth factor, clusterin, and matrix metallopeptidase 9. Conclusions An age-dependent decrease in CRYAB, CRYBB2, and CRYGB abundance is found going along with increased RGC loss. Addition of CRYAB, CRYBB2, and CRYGB to culture protected RGCs in vitro. CRYAB, CRYBB2, and CRYGB were uptaken into Müller cells. Secretion of neurotrophic factors was increased as a potential mode of action.
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Affiliation(s)
- Hanhan Liu
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Katharina Bell
- Singapore Eye Research Institute and Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Anja Herrmann
- Institute of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Stefan Arnhold
- Institute of Veterinary Anatomy, Histology and Embryology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Karl Mercieca
- Department of Ophthalmology, University Medical Center Bonn, Bonn, Germany
| | - Fabian Anders
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Kerstin Nagel-Wolfrum
- Institute for Molecular Physiology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Solon Thanos
- Department of Ophthalmology, Experimental Ophthalmology, University Medical Center Münster, Münster, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
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18
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Prokosch V, Zwingelberg SB, Mercieca K. [Normal Tension Glaucoma]. Klin Monbl Augenheilkd 2022. [PMID: 35253131 DOI: 10.1055/a-1758-3486] [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] [Indexed: 10/18/2022]
Abstract
Normal tension glaucoma (NTG) is a subvariant of primary open angle glaucoma (POAG) or a separate entity. NTG is defined as chronic open angle glaucoma without elevated intraocular pressure or normal intraocular pressure. Normal intraocular pressure is between 10 and 21 mmHg and is defined as two times the standard deviation of the mean intraocular pressure in the normal population. In addition to the absence of elevated intraocular pressure, all the classic symptoms of glaucoma are otherwise present. These include a conspicuous glaucomatous optic disc excavation, nerve fibre bundle defects, and corresponding visual field defects. Papillary rim haemorrhages are frequently found. The visual field defects in NDG are usually more central compared to POAG and are therefore described as more disturbing by the patient. The anterior chamber angle is open and there are no other changes suggestive of secondary glaucoma (pigment dispersion, pseudo-exfoliation). The exact pathophysiology of NDG is not well understood. Pathophysiologically, circulatory disturbances in the sense of arterial hypo- as well as hypertension may play an essential role or at least increase the susceptibility of the optic nerve to intraocular pressure fluctuations as well as blood pressure dips. Therefore, this requires not only a purely ophthalmologic but also interdisciplinary treatment of the patient with confirmed NDG. The primary goal of treatment is the reduction of intraocular pressure, which can stop the disease. This article gives an overview of epidemiology, aetiology, clinical findings and therapies.
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19
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Prokosch V, Zwingelberg SB, Mercieca K. Normaldruckglaukome. Augenheilkunde up2date 2022. [DOI: 10.1055/a-1262-3134] [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] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDas Normaldruckglaukom wird definiert wird als primär chronisches Offenwinkelglaukom, bei dem kein erhöhter Augeninnendruck vorliegt. Trotz normalem Augeninnendruck ist das primäre Ziel der
Behandlung die Augeninnendrucksenkung, mit der es gelingen kann, die Erkrankung aufzuhalten. Dieser Artikel soll eine Übersicht über Epidemiologie, Ätiologie, Pathogenese, klinische Befunde
sowie Therapien geben.
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20
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Müller A, Wagner FM, Schuster AK, Günal B, Pfeiffer N, Schmidt F, Prokosch V. [Ophthalmic emergencies: training via interactive key feature cases for medical students]. Ophthalmologe 2022; 119:48-55. [PMID: 34057586 PMCID: PMC8763746 DOI: 10.1007/s00347-021-01409-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Autonomous diagnosis and assessment of medical emergencies are important skills to acquire for medical students. Ophthalmology features certain specialty-specific "red flag" signs and symptoms, which pose a challenge for educators in ophthalmology. To support medical students in identifying those "red flags" we developed and implemented interactive cases for our e‑learning platform. MATERIAL AND METHODS A total of seven interactive cases with key feature problems regarding potentially dangerous signs and symptoms, such as painless loss of vision or red eye were developed. Medical students were guided through a case and performed formative assessments. The interactive cases were created with e‑learning authoring software and were available on the learning management system presence of the department of ophthalmology. They were mandatory for medical students in the ophthalmology course. Students evaluated the cases after the course. RESULTS The interactive cases were rated on average at 1.51 ± 0.68 (mean ± standard deviation; n = 163) on a grade scale (1 = best, 6 = worst). On a Likert scale they were perceived as helpful for individual learning at 1.60 ± 0.81 (1 = very helpful, 7 = not helpful at all; n = 164). The information provided on the cases and selection of scenarios was positively evaluated. CONCLUSION To support students in identifying and managing ophthalmic emergencies in the context of limited time in tightly packed curricula, interactive key feature cases can be part of corresponding e‑learning resources. An integration of such cases was evaluated as desirable.
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Affiliation(s)
- Andreas Müller
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Felix M Wagner
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Betül Günal
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Franziska Schmidt
- Zentrum für Qualitätssicherung und -entwicklung, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Verena Prokosch
- Augenklinik und Poliklinik der Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
- Zentrum für Augenheilkunde, Uniklinik Köln, Köln, Deutschland
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21
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Zwingelberg SB, Mercieca K, Elksne E, Scheffler S, Prokosch V. [Attitude of patients to possible telemedicine in ophthalmology : Survey by questionnaire in patients with glaucoma]. Ophthalmologe 2021; 119:374-380. [PMID: 34542691 PMCID: PMC8450718 DOI: 10.1007/s00347-021-01501-6] [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: 04/07/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/04/2022]
Abstract
Hintergrund Die COVID-19-Pandemie im Jahr 2020 und 2021 schränkt die Versorgung augenärztlicher Patienten vielfach ein. Teleophthalmologische Leistungen wie Videokonsultation oder medizinische Telefonberatungen könnten den Mangel an notwendigen Kontrollen bei chronischen Erkrankungen, zumindest teilweise, kompensieren. Teleophthalmologische Angebote sind jedoch in Deutschland aktuell noch deutlich unterrepräsentiert. Ziel der Arbeit Um die Bereitschaft auf Patientenseite zur Telemedizin und virtuellen Klinik zu ermitteln, führten wir bei Patienten der Hochschulmedizin mit bekanntem Glaukom als chronische Erkrankung eine Umfrage mittels Fragebogen während der ersten Welle der COVID-19-Pandemie zum Thema Teleophthalmologie durch. Methoden Es wurden 100 Patienten befragt. Der Fragenkatalog beinhaltete 22 Fragen mit Mehrfachwahl-Antwortmöglichkeiten. Als Einschlusskriterium galten das Vorhandensein eines Glaukoms als chronische Erkrankung, Alter über 18 Jahre sowie eine ausreichende sprachliche Verständigung zur Beantwortung der Fragen. Die Daten wurden anonymisiert erhoben, analysiert und ausgewertet. Ergebnisse In der Patientenumfrage konnte aufgezeigt werden, dass eine hohe Bereitschaft zur Teleophthalmologie bei den Befragten im Bereich des Glaukoms als chronische Erkrankung vorhanden ist und diese in Anspruch genommen werden würde; 74,0 % der Befragten würden Telemedizin und virtuelle Kliniken akzeptieren; 54,0 % der Befragten ophthalmologischen Patienten gab an, dass ihr Arzt‑/Klinikbesuch aufgrund von SARS-CoV‑2 nicht stattfinden konnte; 17,0 % der Patienten gaben an, dass sich durch die SARS-CoV-2-Pandemie ihre Meinung gegenüber der Telemedizin geändert hat. Diskussion Die Akzeptanz der Patienten für Telemedizin bei Patienten mit chronischem Offenwinkelglaukom scheint erstaunlich hoch. Diese ist durch die SARS-CoV-2-Pandemie noch weiter gesteigert worden. Diese Ergebnisse spiegeln eine generelle Bereitschaft bei Patienten mit chronischer Augenerkrankung wider, reflektieren jedoch nicht die Anwendbarkeit sowie die Akzeptanz aus ärztlicher Sicht. Diese Form der virtuellen Konsultation findet jedoch bei einem Großteil der Patienten mit Glaukom Akzeptanz und könnte überdacht werden.
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Affiliation(s)
- Sarah B Zwingelberg
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Karl Mercieca
- Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland
| | - Eva Elksne
- Department of Ophthalmology, Riga Stradins University, Pauls Stradiņš Clinical University Hospital 13, Pilsoņuiela, Riga, Lettland
| | - Stephanie Scheffler
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Verena Prokosch
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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22
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Joachim SC, Prokosch V. [The path to professorship]. Ophthalmologe 2021; 118:517-518. [PMID: 33961114 DOI: 10.1007/s00347-021-01324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stephanie C Joachim
- Universitäts-Augenklinik, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Deutschland.
| | - Verena Prokosch
- Zentrum für Augenheilkunde, Uniklinik Köln, Kerpener Str. 62, 50924, Köln, Deutschland.
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Feng Y, Prokosch V, Liu H. Current Perspective of Hydrogen Sulfide as a Novel Gaseous Modulator of Oxidative Stress in Glaucoma. Antioxidants (Basel) 2021; 10:antiox10050671. [PMID: 33925849 PMCID: PMC8146617 DOI: 10.3390/antiox10050671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
Glaucoma is a group of diseases characterized by the progressive loss of retinal ganglion cells and their axons. Elevated intraocular pressure (IOP) is the main clinical manifestation of glaucoma. Despite being in the focus of the studies for decades, the characteristic and the exact pathology of neurodegeneration in glaucoma remains unclear. Oxidative stress is believed to be one of the main risk factors in neurodegeneration, especially its damage to the retinal ganglion cells. Hydrogen sulfide (H2S), the recently recognized gas signaling molecule, plays a pivotal role in the nervous system, vascular system, and immune system. It has also shown properties in regulating oxidative stress through different pathways in vivo. In this review, we summarize the distribution and the properties of H2S within the eye with an emphasis on its role in modulating oxidative stress in glaucoma.
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Affiliation(s)
| | | | - Hanhan Liu
- Correspondence: ; Tel.: +49-(0)-221-478-96996
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Liu H, Prokosch V. Energy Metabolism in the Inner Retina in Health and Glaucoma. Int J Mol Sci 2021; 22:ijms22073689. [PMID: 33916246 PMCID: PMC8036449 DOI: 10.3390/ijms22073689] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023] Open
Abstract
Glaucoma, the leading cause of irreversible blindness, is a heterogeneous group of diseases characterized by progressive loss of retinal ganglion cells (RGCs) and their axons and leads to visual loss and blindness. Risk factors for the onset and progression of glaucoma include systemic and ocular factors such as older age, lower ocular perfusion pressure, and intraocular pressure (IOP). Early signs of RGC damage comprise impairment of axonal transport, downregulation of specific genes and metabolic changes. The brain is often cited to be the highest energy-demanding tissue of the human body. The retina is estimated to have equally high demands. RGCs are particularly active in metabolism and vulnerable to energy insufficiency. Understanding the energy metabolism of the inner retina, especially of the RGCs, is pivotal for understanding glaucoma’s pathophysiology. Here we review the key contributors to the high energy demands in the retina and the distinguishing features of energy metabolism of the inner retina. The major features of glaucoma include progressive cell death of retinal ganglions and optic nerve damage. Therefore, this review focuses on the energetic budget of the retinal ganglion cells, optic nerve and the relevant cells that surround them.
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Müller A, Schmidt F, Pfeiffer N, Brill A, Prokosch V. [Evaluation of a user habit-based ophthalmologic e-learning platform]. Ophthalmologe 2021; 119:13-19. [PMID: 33404686 PMCID: PMC8763945 DOI: 10.1007/s00347-020-01306-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 08/20/2020] [Revised: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In medical studies digital learning is often achieved by the use of learning management platforms, such as Ilias. Lecture presentations and organizational documents are typical contents. Students use multiple, mostly external learning options for acquisition of knowledge and competences. We present our updated ophthalmology e‑learning environment for medical students and its evaluation. OBJECTIVE Evaluation of an ophthalmology e‑learning platform for medical students, which considers prevalent learning habits. MATERIAL AND METHODS The platform should provide and link a selection of internal and external learning resources following anatomical structures of the eye. For every subject area the platform provides a text with essential matters, clinical cases, lecture presentations, multiple choice questions for practice, links to corresponding chapters of a textbook and the appropriate AMBOSS learning cards (Amboss GmbH, Berlin, Germany). At the end of the semester an evaluation of the platform was carried out. Different statements were rated by the students on ordinal scales and analyzed. RESULTS The platform was rated with 1.47 ± 0.54 (mean ± standard deviation; n = 107) on a German school grade scale (1 = best, 6 = worst). It was perceived as helpful for the individual learning with 1.62 ± 0.77 (1 = very helpful, 7 = not helpful at all). The structuring of the internal and external learning resources was rated as very good 1.44 ± 0.66 (1 = very good, 7 = very bad). The median for subjective amount of usage was 1-5 h (ordinal scale <1, 1-5, 6-10, 15-20, >20 h). CONCLUSION It appears to be meaningful to specifically link external learning resources corresponding to the own curricular structure in order to provide medical students with a modern basis for learning in ophthalmology.
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Affiliation(s)
- Andreas Müller
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Franziska Schmidt
- Zentrum für Qualitätssicherung und -entwicklung, Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Anita Brill
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Verena Prokosch
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.,Zentrum für Augenheilkunde, Uniklinik Köln, Universität zu Köln, Köln, Deutschland
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Müller A, Pfeiffer N, Schmidt F, Prokosch V. [A microsurgical wet lab for medical students increases interest in ophthalmology]. Ophthalmologe 2020; 117:1087-1091. [PMID: 32162089 PMCID: PMC7644471 DOI: 10.1007/s00347-020-01079-5] [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] [Indexed: 11/04/2022]
Abstract
Hintergrund Praktischen Inhalten wird in den Curricula der Humanmedizin zunehmend Platz eingeräumt. Bei verbreitetem Bewerbermangel trägt dies zu einem vermehrten Interesse seitens der Studierenden an den jeweiligen Fachbereichen bei. Einen praktischen Reiz der Augenheilkunde stellt die mikrochirurgische Arbeitsweise dar. Eine Einführung kann beispielsweise mit einem mikrochirurgischen Nahtkurs geleistet werden. Ziel der Arbeit Erfassung des Zugewinns des Interesses an der Augenheilkunde mittels Evaluation eines Nahtkurs-Wetlabs inklusive Nähen unter dem Mikroskop. Material und Methoden Die Daten wurden im Blockpraktikum Augenheilkunde des 6. Semesters an der Universitätsmedizin Mainz im April 2019 erhoben. In einem Fragebogen wurden verschiedene Aussagen auf Ordinalskalen gemeinsam mit dem Zentrum für Qualitätssicherung und -entwicklung der Johannes-Gutenberg-Universität Mainz bewertet und ausgewertet. Ergebnisse Es wurden 64 Evaluationsbögen von 8 Gruppen unterschiedlicher Dozenten zu je 8 Teilnehmern ausgewertet. Das Wetlab wurde im Mittel mit einer Schulnote von 1,24 ± 0,5 (MW±SD) bewertet. Es bestand Zustimmung (1 = stimme völlig zu, 7 = stimme gar nicht zu) zum Wunsch nach weiteren Wetlabs unter dem Mikroskop (1,86 ± 1,28) sowie nach dem Erlernen von mehr augenchirurgischen Techniken (2,02 ± 1,13). Das Interesse an der Augenheilkunde (1 = sehr groß, 7 = sehr gering) nahm von 3,66 ± 1,55 zu Beginn des Kurses auf 2,52 ± 1,00 zu. Diskussion Das Interesse an der Augenheilkunde lässt sich mittels eines mikrochirurgischen Wetlabs steigern. Bei Studierenden kann so das Interesse an der Augenheilkunde geweckt werden, was sich vorteilhaft auf Bewerbersituation und Forschungsarbeiten auswirken kann. So können sich bereits im Studium Erfahrungen und praktische Techniken der Augenheilkunde angeeignet werden.
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Affiliation(s)
- Andreas Müller
- Augenklinik und Poliklinik der Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik der Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Franziska Schmidt
- Zentrums für Qualitätssicherung und -entwicklung, Johannes Gutenberg Universität Mainz, Mainz, Deutschland
| | - Verena Prokosch
- Augenklinik und Poliklinik der Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Liu H, Perumal N, Manicam C, Mercieca K, Prokosch V. Proteomics Reveals the Potential Protective Mechanism of Hydrogen Sulfide on Retinal Ganglion Cells in an Ischemia/Reperfusion Injury Animal Model. Pharmaceuticals (Basel) 2020; 13:ph13090213. [PMID: 32867129 PMCID: PMC7557839 DOI: 10.3390/ph13090213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/28/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
Glaucoma is the leading cause of irreversible blindness and is characterized by progressive retinal ganglion cell (RGC) degeneration. Hydrogen sulfide (H2S) is a potent neurotransmitter and has been proven to protect RGCs against glaucomatous injury in vitro and in vivo. This study is to provide an overall insight of H2S’s role in glaucoma pathophysiology. Ischemia-reperfusion injury (I/R) was induced in Sprague-Dawley rats (n = 12) by elevating intraocular pressure to 55 mmHg for 60 min. Six of the animals received intravitreal injection of H2S precursor prior to the procedure and the retina was harvested 24 h later. Contralateral eyes were assigned as control. RGCs were quantified and compared within the groups. Retinal proteins were analyzed via label-free mass spectrometry based quantitative proteomics approach. The pathways of the differentially expressed proteins were identified by ingenuity pathway analysis (IPA). H2S significantly improved RGC survival against I/R in vivo (p < 0.001). In total 1115 proteins were identified, 18 key proteins were significantly differentially expressed due to I/R and restored by H2S. Another 11 proteins were differentially expressed following H2S. IPA revealed a significant H2S-mediated activation of pathways related to mitochondrial function, iron homeostasis and vasodilation. This study provides first evidence of the complex role that H2S plays in protecting RGC against I/R.
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Affiliation(s)
- Hanhan Liu
- Experimental and Translational Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.L.); (N.P.); (C.M.)
| | - Natarajan Perumal
- Experimental and Translational Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.L.); (N.P.); (C.M.)
| | - Caroline Manicam
- Experimental and Translational Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (H.L.); (N.P.); (C.M.)
| | - Karl Mercieca
- Royal Eye Hospital, School of Medicine, University of Manchester, Manchester M13 9WH, UK;
| | - Verena Prokosch
- Department of Ophthalmology, University Medical Centre of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- Correspondence: ; Tel.: +49-1703862250
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Prokosch V, Brockhaus K, Anders F, Liu H, Mercieca K, Gericke A, Melkonyan H, Thanos S. Elevated intraocular pressure induces neuron-specific β-III-tubulin expression in non-neuronal vascular cells. Acta Ophthalmol 2020; 98:e617-e630. [PMID: 31885180 DOI: 10.1111/aos.14333] [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: 07/30/2019] [Accepted: 11/18/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE Pathological alterations within optic nerve axons and progressive loss of the parental retinal ganglion cell (RGC) bodies are characteristics of glaucomatous neuropathy. Abnormally elevated intraocular pressure (IOP) is thought to be the major risk factor for most forms of glaucomatous changes, while lowering of the IOP is the mainstream of treatment. However, the pathophysiological mechanisms involved in neurodegenerative changes are poorly understood. It remains still a matter of debate whether elevated IOP harms the neurons directly or indirectly through alterations in the retinal vascularization. METHODS We analysed morphological and molecular changes within the retina exposed to elevated IOP in an animal model of glaucoma in vivo, in retinal explants and in cultured dissociated retinal cells each incubated under elevated air pressure in vitro, imitating elevated IOP. RESULTS Although ß-III-tubulin expressing RGCs decreased within the course of the disease, total amount of ß-III-tubulin protein within the retina increased, leading to the assumption that other cells than RGCs abnormally express ß-III-tubulin due to elevated IOP. Surprisingly, we found that β-III-tubulin, a marker developmentally regulated and specifically expressed in neurons under normal conditions, was strongly up-regulated in desmin-, PDGFR-β- and α-SMA-positive pericytes as well as in endothelin-1-positive endothelial cells both in vivo under elevated IOP and in vitro under elevated culture atmosphere pressure that simulated IOP elevation. Beta-III-tubulin-driven signalling pathways (ERK 1/2, pERK1/2 and cdc42/Rac) were also regulated. CONCLUSION The unprecedented regulation of neuron-specific β-III-tubulin in pericytes and endothelial cells is likely associated with a role of the retinal vasculature in the IOP-induced development and manifestation of glaucomatous degenerative optic nerve response.
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Affiliation(s)
- Verena Prokosch
- Institute of Experimental Ophthalmology and DFG-Center of Excellence, Cells in Motion (CIM), School of Medicine, Westfalian-Wilhelms-University of Münster, Munster, Germany.,University Eye Hospital Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Kathrin Brockhaus
- Institute of Experimental Ophthalmology and DFG-Center of Excellence, Cells in Motion (CIM), School of Medicine, Westfalian-Wilhelms-University of Münster, Munster, Germany
| | - Fabian Anders
- University Eye Hospital Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Hanhan Liu
- University Eye Hospital Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - Adrian Gericke
- University Eye Hospital Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Harut Melkonyan
- Institute of Experimental Ophthalmology and DFG-Center of Excellence, Cells in Motion (CIM), School of Medicine, Westfalian-Wilhelms-University of Münster, Munster, Germany
| | - Solon Thanos
- Institute of Experimental Ophthalmology and DFG-Center of Excellence, Cells in Motion (CIM), School of Medicine, Westfalian-Wilhelms-University of Münster, Munster, Germany
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Liu H, Anders F, Funke S, Mercieca K, Grus F, Prokosch V. Proteome alterations in aqueous humour of primary open angle glaucoma patients. Int J Ophthalmol 2020; 13:176-179. [PMID: 31956586 DOI: 10.18240/ijo.2020.01.24] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/23/2019] [Accepted: 11/20/2019] [Indexed: 01/10/2023] Open
Abstract
AIM To unravel the primary open angle glaucoma (POAG) related proteomic changes in aqueous humour (AH). METHODS Totally 35 patients listed for cataract surgery (controls: n=12, age: 67.4±13.6y) or trabeculectomy for POAG (n=23, age: 72.5±8.3y) were included. AH samples of those patients were obtained during cataract surgery or trabeculectomy. AH samples were subsequently pooled into the experimental groups under equal contribution in terms of protein amount of each individual patient. Protein samples were analyzed by a linear trap quadrupol Orbitrap Mass Spectrometry device with an upstream liquid chromatography system. The obtained raw data were analyzed using the Maxquant proteome software and compared. Proteins with a fold-change ratio higher than a cut-off of 2 were considered as noticeably altered. RESULTS A total number of 175 proteins could be identified out of the AH from POAG and cataract by means of quantitative mass spectrometric analysis. Apolipoprotein D (fold change, 3.16 times), complement C3 (2.96), pigment epithelium-derived factor (2.86), dickkopf-related protein 3 (2.18) and wingless-related integration (Wnt) inhibitory factor 1 (2.35) were significantly upregulated within the AH of glaucoma compared to cataract serving as controls. CONCLUSION AH provides a tool to analyze changes in glaucoma and shows striking changes in Wnt signaling inhibitory molecules and other proteins.
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Affiliation(s)
- Hanhan Liu
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany.,Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Fabian Anders
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Sebastian Funke
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Karl Mercieca
- Royal Eye Hospital, School of Medicine, University of Manchester, Manchester M202UL, United Kingdom
| | - Franz Grus
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
| | - Verena Prokosch
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz 55131, Germany
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Lauzi J, Anders F, Liu H, Pfeiffer N, Grus F, Thanos S, Arnhold S, Prokosch V. Neuroprotective and neuroregenerative effects of CRMP-5 on retinal ganglion cells in an experimental in vivo and in vitro model of glaucoma. PLoS One 2019; 14:e0207190. [PMID: 30673694 PMCID: PMC6343933 DOI: 10.1371/journal.pone.0207190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/28/2018] [Indexed: 01/15/2023] Open
Abstract
Purpose To analyze the potential neuro-protective and neuro-regenerative effects of Collapsin-response-mediator-protein-5 (CRMP-5) on retinal ganglion cells (RGCs) using in vitro and in vivo animal models of glaucoma. Methods Elevated intraocular pressure (IOP) was induced in adult female Sprague-Dawley (SD) rats by cauterization of three episcleral veins. Changes in CRMP-5 expression within the retinal proteome were analyzed via label-free mass spectrometry. In vitro, retinal explants were cultured under elevated pressure (60 mmHg) within a high-pressure incubation chamber with and without addition of different concentrations of CRMP-5 (4 μg/l, 200 μg/l and 400 μg/l). In addition, retinal explants were cultured under regenerative conditions with and without application of 200 μg/l CRMP-5 after performing an optic nerve crush (ONC). Thirdly, an antibody against Protein Kinase B (PKB) was added to examine the possible effects of CRMP-5. RGC count was performed. Number and length of the axons were determined and compared. To undermine a signal-transduction pathway via CRMP-5 and PKB microarray and immunohistochemistry were performed. Results CRMP-5 was downregulated threefold in animals showing chronically elevated IOP. The addition of CRMP-5 to retinal culture significantly increased RGC numbers under pressure in a dose-dependent manner and increased and elongated outgrowing axons in retinal explants significantly which could be blocked by PKB. Especially the number of neurites longer than 400 μm significantly increased after application of CRMP-5. CRMP-5 as well as PKB were detected higher in the experimental than in the control group. Conclusion CRMP-5 seems to play an important role in an animal model of glaucoma. Addition of CRMP-5 exerts neuro-protective and neuro-regenerative effects in vitro. This effect could be mediated via activation of PKB affecting intra-cellular apoptosis pathways.
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Affiliation(s)
- Jasmin Lauzi
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Fabian Anders
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Hanhan Liu
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Norbert Pfeiffer
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Franz Grus
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
| | - Solon Thanos
- Department of Experimental Ophthalmology, School of Medicine, University of Münster, Münster, Germany
| | - Stefan Arnhold
- Institute of Veterinary-Anatomy, -Histology and–Embryology, Justus-Liebig-University Gießen, Gießen, Germany
| | - Verena Prokosch
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz
- * E-mail:
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Anders F, Mann C, Liu A, Teister J, Funke S, Thanos S, Grus F, Pfeiffer N, Prokosch V. Correlation of Crystallin Expression and RGC Susceptibility in Experimental Glaucoma Rats of Different Ages. Curr Eye Res 2018; 43:1267-1273. [PMID: 29979889 DOI: 10.1080/02713683.2018.1485950] [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: 12/18/2022]
Abstract
PURPOSE Glaucoma is one of the leading causes of blindness worldwide with age being an important risk factor. However, the pathogenesis remains poorly understood. Aim of this study was to focus on age-dependent molecular changes in an experimental animal model of glaucoma. METHODS Intraocular pressure was elevated in Sprague-Dawley rats aged 3, 14, and 47 weeks for a period of 7 weeks by episcleral vein cauterization. Ganglion cell loss was monitored by an immunohistochemical staining of the Brain-specific homeobox/POU (Pit-1, Oct-2, Unc-86) domain protein 3A positive cells in retinal flat-mounts and spectral-domain optical coherence tomography measuring the retinal nerve fiber layer thickness. Molecular protein alterations were analyzed using a comprehensive mass spectrometric proteomics approach of the retina and vitreous body. RESULTS While juvenile animals did not show a significant loss of retinal ganglion cells due to intraocular pressure elevation, adolescent animals showed a decrease up to 26% (p < 0.05). A shift of retinal crystallin protein expression levels within all protein-family subclasses (α, β, γ) could be observed in the youngest animal group (p < 0.05), while the upregulation of crystallin proteins in older animals was less striking. In addition, numerous crystallin proteins were also detected in the vitreous body. CONCLUSION These results provide insights of a potential correlation of age-related glaucomatous damage and the absence of crystallin proteins in the retina.
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Affiliation(s)
- Fabian Anders
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Carolina Mann
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Aiwei Liu
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Julia Teister
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Sebastian Funke
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Solon Thanos
- b Department of Experimental Ophthalmology, School of Medicine , University of Münster , Münster , Germany
| | - Franz Grus
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Norbert Pfeiffer
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
| | - Verena Prokosch
- a Experimental Ophthalmology, Department of Ophthalmology , University Medical Center of the Johannes Gutenberg University Mainz , Mainz , Germany
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Mann C, Thanos S, Brockhaus K, Grus FH, Pfeiffer N, Prokosch V. [Endothelial Cell Reaction to Elevated Hydrostatic Pressure and Oxidative Stress in Vitro]. Klin Monbl Augenheilkd 2018; 236:1122-1128. [PMID: 29642260 DOI: 10.1055/s-0043-122677] [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: 10/17/2022]
Abstract
INTRODUCTION Endothelial dysfunction has become a strongly discussed factor regarding glaucoma pathogenesis. In addition to peripapillary bleedings as signs of vascular damage, there is a definite correlation between glaucoma and vascular dysregulation syndrome. The aim of this study was to evaluate endothelial cell reaction to moderately elevated hydrostatic pressure and oxidative stress in vitro. METHODS In vitro, primarily dissociated brain microvascular endothelial cells (BMECs) were exposed to moderately elevated hydrostatic pressure (60 and 120 mmHg) in a special pressure chamber. Additionally, cells primarily exposed to pressure, and cells not exposed to pressure, were incubated with low amounts of H2O2. A live/dead assay was performed to evaluate cell viability. Immunohistochemical staining against actin was used for morphological evaluation. RESULTS Neither 60 nor 120 mmHg of elevated pressure had a viability changing effect on primary endothelial cells. Secondary, no big morphological changes could be discovered. However, against a low concentration of oxidative stress, BMECs showed high vulnerability. A difference in reaction to cells stressed with high pressure before could not be shown. CONCLUSION Direct effects, in terms of higher vulnerability or morphological changes of moderately elevated high pressure on endothelial cells, could not be shown. However, the reaction to low amounts of oxidative stress indicates the involvement of endothelial cells in the pathogenesis of glaucoma and the special role of oxidative stress when referring to endothelial dysfunction in glaucomatous disease.
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Affiliation(s)
- Carolina Mann
- Universitäts-Augenklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Solon Thanos
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
| | - Katrin Brockhaus
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
| | - Franz H Grus
- Experimentelle Ophthalmologie, Universitäts-Augenklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Norbert Pfeiffer
- Universitäts-Augenklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
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Mann C, Anders F, Liu H, Brockhaus K, Liu A, Grus FH, Pfeiffer N, Thanos S, Prokosch V. [Morphological and Quantitative Changes in Retinal and Optic Nerve Vessels in Experimental Glaucoma Model with Elevated IOP for 7 Weeks]. Klin Monbl Augenheilkd 2018; 236:871-876. [PMID: 29590684 DOI: 10.1055/s-0044-101617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Glaucoma is characterised by progressive loss of retinal ganglion cells and axons. Experimental research has concentrated on understanding the pathophysiological mechanisms involved in glaucomatous damage. It is still a matter of debate whether neurons or capillaries are primarily damaged by elevated intraocular pressure (IOP). The aim of this study was to detect IOP-induced vascular changes in the vessels of the optic nerve head and the main vessels of the retina in vivo. METHODS Experimental glaucoma was induced in adult Sprague Dawley rats by cauterisation of three episcleral veins of the left eye (n = 3). In vivo, retinal vessel calibre was measured manually using a peripapillary scan with SD-OCT (Heidelberg Engineering) at baseline and after seven weeks of IOP elevation. The animals were then sacrificed and the optic nerve was fixed with 30% glutaraldehyde and cross-sections stained with paraphenylene diamine to mark the vessels. Contralateral eyes served as controls. Pictures were taken and number of vessels, vessel calibre and area were calculated and compared. RESULTS IOP was significantly elevated (p < 0.001). In optic nerve cross sections, the number of capillaries did not differ significantly between animals with elevated IOP and controls. However, vessel calibre and area were significantly reduced (p < 0.001) in glaucomatous optic nerves. The calibre of the retinal vessels was significantly lowered - by 9.22% (p = 0.021). CONCLUSION Retinal arterioles and optic nerve capillaries respond sensitively to abnormal pressure elevation in vivo, showing high and early vulnerability. The vascular responses may influence secondary neuronal responses, which culminate in the death of ganglion cells and blindness, as occurs in clinical glaucoma.
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Affiliation(s)
- Carolina Mann
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Fabian Anders
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Hanhan Liu
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Katrin Brockhaus
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
| | - Aiwei Liu
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Franz H Grus
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Norbert Pfeiffer
- Universitäts-Augenklinik, Experimentelle Ophthalmologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | - Solon Thanos
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
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Anders F, Liu A, Mann C, Teister J, Lauzi J, Thanos S, Grus FH, Pfeiffer N, Prokosch V. The Small Heat Shock Protein α-Crystallin B Shows Neuroprotective Properties in a Glaucoma Animal Model. Int J Mol Sci 2017; 18:E2418. [PMID: 29135941 PMCID: PMC5713386 DOI: 10.3390/ijms18112418] [Citation(s) in RCA: 22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022] Open
Abstract
Glaucoma is a neurodegenerative disease that leads to irreversible retinal ganglion cell (RGC) loss and is one of the main causes of blindness worldwide. The pathogenesis of glaucoma remains unclear, and novel approaches for neuroprotective treatments are urgently needed. Previous studies have revealed significant down-regulation of α-crystallin B as an initial reaction to elevated intraocular pressure (IOP), followed by a clear but delayed up-regulation, suggesting that this small heat-shock protein plays a pathophysiological role in the disease. This study analyzed the neuroprotective effect of α-crystallin B in an experimental animal model of glaucoma. Significant IOP elevation induced by episcleral vein cauterization resulted in a considerable impairment of the RGCs and the retinal nerve fiber layer. An intravitreal injection of α-crystallin B at the time of the IOP increase was able to rescue the RGCs, as measured in a functional photopic electroretinogram, retinal nerve fiber layer thickness, and RGC counts. Mass-spectrometry-based proteomics and antibody-microarray measurements indicated that a α-crystallin injection distinctly up-regulated all of the subclasses (α, β, and γ) of the crystallin protein family. The creation of an interactive protein network revealed clear correlations between individual proteins, which showed a regulatory shift resulting from the crystallin injection. The neuroprotective properties of α-crystallin B further demonstrate the potential importance of crystallin proteins in developing therapeutic options for glaucoma.
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Affiliation(s)
- Fabian Anders
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Aiwei Liu
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Carolina Mann
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Julia Teister
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Jasmin Lauzi
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Solon Thanos
- Department of Experimental Ophthalmology, School of Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Franz H Grus
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Norbert Pfeiffer
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | - Verena Prokosch
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Abstract
Optic disc oedema describes blurred optic disc margins. It describes an unspecific clinical sign with various possible underlying causal mechanisms. The correct diagnosis and the detection of the underlying disease is however of special clinical importance. This article summarizes the most important differential diagnoses and gives advice to find the correct diagnosis.
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Affiliation(s)
- V Prokosch
- Augenklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - D C Dragnea
- Augenklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - S Pitz
- Augenklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Teister J, Anders F, Beck S, Funke S, von Pein H, Prokosch V, Pfeiffer N, Grus F. Decelerated neurodegeneration after intravitreal injection of α-synuclein antibodies in a glaucoma animal model. Sci Rep 2017; 7:6260. [PMID: 28740252 PMCID: PMC5524683 DOI: 10.1038/s41598-017-06702-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 06/19/2017] [Indexed: 01/02/2023] Open
Abstract
Although elevated intraocular pressure (IOP) remains the major risk factor in glaucoma, neurodegenerative processes continue despite effective IOP lowering. Altered α-synuclein antibody (Abs) levels have been reported to play a crucial role. This study aimed at identifying whether α-synuclein Abs are capable to decelerate neuronal decay while providing insights into proteomic changes. Four groups of Sprague Dawley rats received episcleral vein occlusion: (1) CTRL, no intravitreal injection, n = 6, (2) CTRL IgG, intravitreal injection of unspecific IgG, n = 5, (3) Buffer, intravitreal injection of buffer, n = 6, (4), α-synuclein Ab, intravitreal injection of α-synuclein Ab, n = 5. IOP and retinal nerve fiber layer thickness (RNFLT) were monitored and immunohistochemistry, microarray and proteomic analysis were performed. RNFLT was reduced in CTRL, CTRL IgG and Buffer group (all p < 0.01) and α-synuclein Ab group (p = 0.17). Axon and RGC density showed an increased neurodegeneration in CTRL, CTRL IgG and Buffer group (all p < 0.01) and increased neuronal survival in α-synuclein Ab group (p = 0.38 and 0.06, respectively) compared with fellow eyes. Proteomic analysis revealed alterations of cofilin 1 and superoxide dismutase 1 expression. This data indicate that α-synuclein Ab might indirectly modulate the actin cytoskeleton organization and negatively regulate apoptotic processes via cofilin 1 and superoxide dismutase 1.
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Affiliation(s)
- J Teister
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - F Anders
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - S Beck
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - S Funke
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - H von Pein
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - V Prokosch
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - N Pfeiffer
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany
| | - F Grus
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University, 55131, Mainz, Germany.
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Anders F, Teister J, Funke S, Pfeiffer N, Grus F, Solon T, Prokosch V. Proteomic profiling reveals crucial retinal protein alterations in the early phase of an experimental glaucoma model. Graefes Arch Clin Exp Ophthalmol 2017; 255:1395-1407. [PMID: 28536832 DOI: 10.1007/s00417-017-3678-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 12/08/2016] [Revised: 03/12/2017] [Accepted: 04/18/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Clinical glaucoma is difficult to assess in terms of molecular pathophysiology, prompting studies in experimental models of glaucoma. The purpose of this study was to investigate quantitative changes in retinal protein expression at the onset of experimental glaucoma in rats. Analyzing the proteome provides a suitable tool to decipher the pathophysiological processes in glaucomatous degeneration. METHODS Thermic cauterization of episcleral veins was utilized to elevate the intraocular pressure in Sprague Dawley rats. Morphological changes were surveyed on a cellular level with a staining of Brn3a-positive cells. The retinal nerve fiber layer was investigated using optical coherence tomography (OCT, Heidelberg Engineering) and the optic nerve was analyzed by an axonal grading system. Mass spectrometry-featured quantitative proteomics and immunohistochemical staining was used to identify specifically altered proteins in the course of intraocular pressure elevation and initial neurodegeneration. Proteomic data were further analyzed with Ingenuity Pathway Analysis and Cytoscape to analyze further molecular associations. RESULTS The intraocular pressure rose significantly (p < 0.001) for the follow-up period of 3 weeks after which animals were sacrificed. Eyes exposed to an elevated intraocular pressure showed an initial decrease of retinal ganglion cells, retinal nerve fiber layer (p < 0.05) and an impairment of the optic nerve (p < 0.01). Mass spectrometry led to the identification and quantification of 931 retinal proteins, whereas 32 were considerably altered. Bioinformatics-assisted clustering revealed that a majority of these proteins are functionally associated with cell differentiation, apoptosis and stress response. The creation of an interactive protein network showed that numerous altered proteins are connected regarding their cellular function. Protein kinase b, mitogen-activated protein kinase 1 and the NF-κB complex seem to be essential molecules in this context. CONCLUSIONS In conclusion, these results provide further lines of evidence that substantial molecular changes occur at the onset of the disease, identifying potential key players, which might be useful as biomarkers for diagnostics and development of medical treatment in the future.
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Affiliation(s)
- Fabian Anders
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Julia Teister
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Sebstian Funke
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany.,University Eye Hospital Mainz, School of Medicine, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Franz Grus
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Thanos Solon
- Department of Experimental Ophthalmology, University Medical Center, Domagkstraße 15, 48149, Münster, Germany
| | - Verena Prokosch
- Experimental Ophthalmology, Department of Ophthalmology, University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany. .,University Eye Hospital Mainz, School of Medicine, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Brockhaus K, Melkonyan H, Prokosch V, Thanos S. [Elevated Intraocular Pressure Induces Cellular Responses in the Retinal Capillaries]. Klin Monbl Augenheilkd 2017; 234:1266-1275. [PMID: 28470655 DOI: 10.1055/s-0043-105270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background In the early diagnosis of clinical glaucoma, peripapillary bleedings were almost pathognomonic for a capillary insult. In the perfusion diagnostics, it is predominantly accepted that perfusion imbalances and IOP-induced changes occur and play a crucial role. Biomechanical peculiarities of the optic nerve head and cellular responses to astrocytes are also likely involved. Material and Methods We present in vivo and ex vivo models of IOP-elevation to enhance the resolution of examining cellular and molecular changes and to understand the mechanisms of capillary changes due to IOP-elevation. Results The in vivo model consists of cauterization-caused elevation of IOP in rat eyes. Two to 3 veins were cauterized to increase outflow resistance. The retinas were analyzed several weeks later and we found an abnormal expression of the neuron-specific molecule beta-III-tubulin in the capillary endothelium cells and in the vascular pericytes. Combined immunohistochemical stainings with different markers for various retinal cells confirmed the findings. The isolation of capillary endothelium cells and pericytes from rat brains (BMECs) and retinas (RMECs), and their cultivation under elevated IOP in vitro, confirmed the in vivo results. Conclusion The unexpected capillary response to elevation of IOP in vivo and in vitro could be seen as an early response of cells with expression of abnormal proteins. This result may explain clinical observations which dominate as peripapillary bleedings or microinfarctions and are likely associated with the glaucoma-induced opticopathy.
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Affiliation(s)
- Katrin Brockhaus
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
| | - Harutyun Melkonyan
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
| | - Verena Prokosch
- Universitäts-Augenklinik, Johannes-Gutenberg-Universität Mainz
| | - Solon Thanos
- Institut für Experimentelle Ophthalmologie, Westfälische Wilhelms-Universität Münster
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Anders F, Teister J, Liu A, Funke S, Grus FH, Thanos S, von Pein HD, Pfeiffer N, Prokosch V. Intravitreal injection of β-crystallin B2 improves retinal ganglion cell survival in an experimental animal model of glaucoma. PLoS One 2017; 12:e0175451. [PMID: 28384305 PMCID: PMC5383327 DOI: 10.1371/journal.pone.0175451] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 03/27/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose of this study was to investigate firstly specific proteomic changes within the retina in the course of an animal glaucoma model and to identify secondly new approaches for neuroprotective, therapeutic options in glaucoma by addressing those specific changes. Intraocular pressure was elevated through cauterization of episcleral veins in adult Sprague Dawley rats. Molecular and morphological changes were surveyed using mass spectrometry, optical coherence tomography as well as immunohistochemical cross section- and flat mount stainings. By quantifying more than 1500 retinal proteins, it was found that the HspB5 protein and numerous beta-crystallins showed a uniform and unique shifting expression pattern as a result of different periods of elevated IOP exposure. Crystallins showed a significant downregulation (p<0.05) after 3 weeks of elevated IOP and an upregulation after 7 weeks. Counteracting those typical changes, an intravitreal injection of β-crystallin B2 at the time of IOP elevation was found to reduce retinal ganglion cell loss (p<0.05), decrease of the retinal nerve fiber layer (p<0.05) and impairment of the optic nerve. Ultimately, proteomic data revealed that β-crystallin B2 might influence calcium-depended cell signaling pathways with severe effect on apoptosis and gene regulation. In this context especially annexin A5, calcium-transporting ATPase 1 and various histone proteins seem to play a major role.
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Affiliation(s)
- Fabian Anders
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia Teister
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Aiwei Liu
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sebastian Funke
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Franz H. Grus
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Solon Thanos
- Institute for Experimental Ophthalmology, School of Medicine, Westfalian-Wilhelms-University Münster, Münster, Germany
| | - Harald D. von Pein
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Verena Prokosch
- Experimental and Translational Ophthalmology, Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- * E-mail:
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Prokosch V, Dragnea DC, Pitz S. Erratum zu: Differenzialdiagnose der Papillenschwellung. Wichtige Differenzialdiagnosen im Überblick. Ophthalmologe 2017; 114:77-78. [DOI: 10.1007/s00347-016-0429-z] [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: 11/29/2022]
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Termühlen J, Gottschalk A, Eter N, Hoffmann EM, Van Aken H, Grenzebach U, Prokosch V. Does general anesthesia have a clinical impact on intraocular pressure in children? Paediatr Anaesth 2016; 26:936-41. [PMID: 27377361 DOI: 10.1111/pan.12955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Reliable measurement of intraocular pressure (IOP) is crucial in pediatric patients with suspected glaucoma. General anesthesia (GA) is usually needed in infants to allow a thorough examination. However, anesthesia itself may influence IOP, depending on the type used and the depth of sedation. The purpose of this study was to evaluate the normal distribution of IOP during GA in healthy children and to analyze differences in IOP relative to the anesthetics used and the measurement time point. METHODS Approval for this observational study was received from the local institutional review boards and written informed consent was obtained from the children's parents. A total of 100 pediatric patients with no history of glaucoma scheduled for nonintraocular surgery underwent general anesthesia, induced with sevoflurane (s) or propofol (p) and maintained with either sevoflurane with remifentanil (S) or propofol with remifentanil (P). The patients were grouped to one of four subgroups (sS, sP, pP, pS) depending on the anesthetics used during induction and maintenance. Hemodynamic parameters and IOP were measured in both eyes at four defined time points: before anesthesia induction (M1); in apnea immediately after induction and before insertion of a laryngeal mask airway (M2); in deep anesthesia during mechanical ventilation (M3); and after extubation (M4), using a handheld Perkins applanation tonometer. Differences in IOP in both eyes during the measurement periods were analyzed using multivariate repeated-measures analysis of variance and Tukey-HSD as a posthoc test with statistical significance set at P < 0.05. Pearson correlation coefficient was used to investigate further relationships between heart rate, systolic blood pressure, and IOP. RESULTS General anesthesia reduced IOP significantly. The mean IOP was normally distributed, with a mean of 7.4 ± 2.89 mmHg at M1. It decreased significantly to a minimum of 5.6 ± 3.04 mmHg (P < 0.01) at M2 and increased significantly to 7.2 ± 2.51 mmHg (P < 0.01) at M3 and again to 8.4 ± 3.72 mmHg (P = 0.03) at M4. All four subgroups (sS, sP, pP, pS) showed comparable decreases in IOP between M1 and M2. During deep anesthesia (M3) and during reversal (M4), the IOP increased again in all groups. During reversal (M4), however, the sS group had a significantly lower IOP than the pP group (P = 0.001) and sP group (P = 0.02). There were no correlations between changes in IOP and gender, age, or type of surgery. CONCLUSIONS Sevoflurane and propofol, both in combination with remifentanil, significantly lower IOP in children. Individual IOP levels rise and fall during anesthesia, depending on the time point of measurement. The lowest IOP can be measured immediately after induction of anesthesia. This needs to be taken into account when measuring IOP in children.
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Affiliation(s)
- Julia Termühlen
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Antje Gottschalk
- Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, Muenster University Hospital, Muenster, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Esther M Hoffmann
- Department of Ophthalmology, Mainz University Hospital, Mainz, Germany
| | - Hugo Van Aken
- Department of Anesthesiology, Intensive-Care Medicine and Pain Therapy, Muenster University Hospital, Muenster, Germany
| | - Ulrike Grenzebach
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Mainz University Hospital, Mainz, Germany
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Alnawaiseh M, Rosentreter A, Prokosch V, Eveslage M, Eter N, Zumhagen L. Changes in Corneal Densitometry in Patients with Fuchs Endothelial Dystrophy after Endothelial Keratoplasty. Curr Eye Res 2016; 42:163-167. [PMID: 27260144 DOI: 10.3109/02713683.2016.1146774] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 11/13/2022]
Abstract
PURPOSE The aim of the study was to quantify corneal densitometry in patients with Fuchs endothelial dystrophy (FED) after endothelial keratoplasty. MATERIALS AND METHODS We retrospectively reviewed the charts and anterior segment data of patients with FED before and after endothelial keratoplasty. Patients were examined using the Scheimpflug-based Oculus Pentacam corneal densitometry module. Densitometry parameters in different corneal layers and in different annuli were extracted and analyzed. RESULTS 27 eyes of 27 patients after endothelial keratoplasty (11 DSAEK, 16 DMEK) were included. After endothelial keratoplasty the total corneal light backscatter at total corneal thickness in the central cornea (0-2 mm annulus) was significantly lower than before (DSAEK: p = 0.026, DMEK: p = 0.001). In the entire group the total corneal light backscatter at total corneal thickness and at total diameter before surgery correlated with the postoperative values (Pearson correlation = 0.49, p = 0.01). The strongest correlation was found in the central layer in the DMEK group (Pearson correlation = 0.79, p < 0.001). CONCLUSIONS Corneal densitometry is a useful, objective method for quantification of the outcome of posterior lamellar keratoplasty irrespective of visual acuity. There is a significant correlation between preoperative and postoperative corneal light backscatter values after endothelial keratoplasty, especially in the case of the DMEK procedure.
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Affiliation(s)
- Maged Alnawaiseh
- a Department of Ophthalmology , University of Muenster Medical Center , Muenster , Germany
| | - André Rosentreter
- a Department of Ophthalmology , University of Muenster Medical Center , Muenster , Germany.,b Department of Ophthalmology , University of Würzburg , Würzburg , Germany
| | - Verena Prokosch
- a Department of Ophthalmology , University of Muenster Medical Center , Muenster , Germany
| | - Maria Eveslage
- c Institute of Biostatistics and Clinical Research, University of Muenster , Muenster , Germany
| | - Nicole Eter
- a Department of Ophthalmology , University of Muenster Medical Center , Muenster , Germany
| | - Lars Zumhagen
- a Department of Ophthalmology , University of Muenster Medical Center , Muenster , Germany.,d Eye Hospital Castrop-Rauxel , Castrop-Rauxel , Germany
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Jayaram H, Pinto LA, Prokosch V, Matlach J, Skonieczna K, Mercieca K, Digiuni M, Mocan MC, Mahave S, Andersson S, Garway-Heath DF. Circadian Arterial Blood Pressure Variation and Glaucoma Progression: More Questions Than Answers? Am J Hypertens 2015; 28:1182-3. [PMID: 26104787 DOI: 10.1093/ajh/hpv096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hari Jayaram
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, UK; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA;
| | - Luis Abegão Pinto
- Visual Sciences Study Center, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Verena Prokosch
- Department of Ophthalmology, University Hospital, Mainz, Germany
| | - Juliane Matlach
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, UK
| | - Katarzyna Skonieczna
- Department of Ophthalmology, Medical Centre of Postgraduate Education, Warsaw, Poland
| | - Karl Mercieca
- Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Maurizio Digiuni
- Eye Clinic, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Mehmet C Mocan
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Sergio Mahave
- Ophthalmology Department, San Pedro's Hospital, Logroño, Spain
| | - Sabina Andersson
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - David F Garway-Heath
- NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology & Moorfields Eye Hospital, London, UK
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Alnawaiseh M, Böhm MRR, Wieneke AC, Zumhagen L, Merté RL, Eter N, Prokosch V. [Microsurgical Treatment of Canalicular Stenosis: Long-Term Follow-Up]. Klin Monbl Augenheilkd 2015; 232:1082-5. [PMID: 26167632 DOI: 10.1055/s-0035-1546114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Studies about the indication and the functional prognosis of microsurgical treatment of canalicular stenosis (CR) are rare. In this study we determined the cause, recurrence and success rates of CR and compared our results with the results in the literature. METHODS We retrospectively reviewed the medical records of 22 patients who required a microsurgical treatment of canalicular stenosis (CR) from 2009 to 2011. We systematically evaluated the medical data and asked the patients about the recent symptoms via telephone questionnaire. RESULTS 22 patients were included (73 % women; 27 % men; age: 52.8 ± 19.9 years), 12 (55 %) patients had already had operations. The mean postoperative follow-up was 45 ± 9.2 months. The patients were followed for a minimum of 30 months. The success rate was 58 %. CONCLUSION In some cases like long localised canalicular stenosis and especially after traumatic lacerations of the lacrimal canaliculi, a microsurgical treatment of canalicular stenosis is required. The aim of this procedure is to restore the lacrimal mucosa continuity so that a spontaneous lacrimal drainage is possible. The success rate of CR in our study was 58 %.
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Affiliation(s)
- M Alnawaiseh
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - M R R Böhm
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - A-C Wieneke
- Poliklinik für Parodontologie, Universitätsklinikum Münster
| | - L Zumhagen
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - R-L Merté
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - N Eter
- Klinik für Augenheilkunde, Universitätsklinikum Münster
| | - V Prokosch
- Klinik für Augenheilkunde, Universitätsklinikum Münster
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Prokosch V, Stupp T, Spaniol K, Pham E, Nikol S. Angiogenic gene therapy does not cause retinal pathology. J Gene Med 2015; 16:309-16. [PMID: 25322754 DOI: 10.1002/jgm.2806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/14/2014] [Revised: 05/22/2014] [Accepted: 08/26/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The potential negative influence of angiogenic gene therapy on the development or progression of retinal pathologies such as diabetic retinopathy (DR) or age-related macular degeneration (AMD) has led to the systematic exclusion of affected patients from trials. We investigated the role of nonviral fibroblast factor 1 (NV1FGF) in two phase II, multinational, double-blind, randomized, placebo-controlled, gene therapy trials (TALISMAN 201 and 211). METHODS One hundred and fifty-two subjects with critical limb ischemia or claudication were randomized to receive eight intramuscular injections of 2.5 ml of NV1FGF at 0.2 mg/ml or 0.4 mg/dl or placebo. One hundred and fifty-two patients received a plasmid dose of NV1FGF of up to 32 mg or placebo. All patients underwent a systematic ophthalmologic examination at baseline and at 3, 6 or 12 months following gene therapy. Twenty-six of these patients (Münster subgroup) received a retinal fluorescence angiography at baseline and at final examination. RESULTS Among those 26 patients, four of nine patients with diabetes suffered from nonproliferative DR. Three patients showed non-exsudative AMD. No change of retinal morphology or function was observed in Münster subgroup of both TALISMAN trials independent of the intramuscular NV1FGF dosage applied. CONCLUSIONS Angiogenic gene therapy using NV1FGF is safe even in diabetics.
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Spaniol K, Stupp T, Melcher C, Beheiri N, Eter N, Prokosch V. Association between congenital nasolacrimal duct obstruction and delivery by cesarean section. Am J Perinatol 2015; 32:271-6. [PMID: 24971571 DOI: 10.1055/s-0034-1383847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Congenital nasolacrimal duct obstruction (CNDO) is the most common cause of neonatal epiphora. Persistence can lead to chronic dacryocystitis and amblyopia. This study analyzed the association between the incidence of CNDO and delivery by cesarean section. STUDY DESIGN This was a retrospective cohort study of 386 children with CNDO (born between 2000 and 2008). The incidence of the delivery mode in patients with CNDO was compared with data from a corresponding population derived from annual birth statistics. RESULTS There was no statistically significant association between the overall cesarean section rate and the incidence of CNDO, but primary cesarean section was significantly more frequent among patients with CNDO (73.15%, p < 0.05). The difference was significant for both genders for the period from 2000 to 2008 (p < 0.05%). The relative risk for CNDO was 1.7-fold increased in children delivered by primary cesarean section. CONCLUSION Primary cesarean section may be a risk factor for CNDO.
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Affiliation(s)
| | - Tobias Stupp
- University Eye Hospital Münster, Münster, Germany
| | - Carola Melcher
- University Womeńs Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Nicole Eter
- University Eye Hospital Münster, Münster, Germany
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Abstract
PURPOSE Nonarteriitic anterior ischemic optic neuropathy (NAION) is a leading cause of sudden loss of vision, which particularly affects individuals older than 50 years. Up to now there is no treatment that is effective at reversing or limiting the course of this disease. To study the short- and long-term effects of fluocortolone (FC) on the visual outcome of patients with acute NAION compared to standard treatment with pentoxifylline (PFX). METHODS A prospective, quasirandomized intervention trial was conducted involving 60 patients with acute-onset NAION. Patients in the comparison (PFX) group (n = 30) received PFX intravenously and per os for 7 days and then per os for a further 6 months, which is a standard treatment. Patients in the intervention (PFX + FC) group (n = 30) received the standard treatment plus 1 mg/kg FC for 5 days, with a subsequent stepwise dose reduction over time. As a primary outcome measure, the best corrected visual acuity (BCVA) was determined at the initial baseline consultation (i.e., before treatment), and at 3 days and 6 months after therapy onset. Visual field (VF) was analyzed using standard automated perimetry at the initial baseline examination and at 6 month after therapy onset. Changes in BCVA and visual field in the PFX and PFX + FC groups were compared and analyzed statistically. RESULTS Treatment with FC resulted in a significant improvement in BCVA. Patients receiving FC in acute NAION were more likely to experience improvement and less likely to have worsened visual acuity (mean BCVA scores: at baseline, 0.22; after 3 days and 6 months of treatment, 0.33 and 0.43, respectively) than PFX patients (mean BCVA scores: at baseline, 0.33; after 3 days and 6 months of treatment, 0.33 and 0.28, respectively; p < 0.002 and 0.001). The beneficial effect was even more marked 6 months after therapy onset. Remarkably, patients with a baseline BCVA score of >=0.05 profited significantly by FC treatment (p < 0.006 and 0.001), whereas those with a baseline BCVA score of <0.05 did not (p < 0.4). PFX did not improve BCVA. However, VF did not show any significant improvement due to FC therapy. CONCLUSION This is the first prospective randomized intervention trial that demonstrates the distinctive beneficial effects of FC in terms of the visual outcome of patients with NAION compared to standard treatment with only PFX. FC significantly improves both short- and long-term visual acuity in patients with moderate BCVA impairment due to recent onset of NAION, while VF did not show any significant improvement; however, PFX did neither enhance BCVA nor VF. Administration of FC should be seriously considered for the treatment of NAION whenever there are no contraindications.
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Affiliation(s)
- Verena Prokosch
- Institute of Experimental Ophthalmology, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - Solon Thanos
- Institute of Experimental Ophthalmology, Westfälische Wilhelms-Universität Münster, Münster, Germany
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Böhm MRR, Prokosch V, Brückner M, Pfrommer S, Melkonyan H, Thanos S. βB2-Crystallin Promotes Axonal Regeneration in the Injured Optic Nerve in Adult Rats. Cell Transplant 2014; 24:1829-44. [PMID: 25299378 DOI: 10.3727/096368914x684583] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The purpose of the study was to further scrutinize the potential of βB2-crystallin in supporting regeneration of injured retinal ganglion cell axons both in vitro and in vivo. Retinal explants obtained from animals after treatment either with lens injury (LI) alone or with combined LI 5 days or 3 days before or simultaneously with an optic nerve crush (ONC) were cultured for 96 h under regenerative conditions, and the regenerating axons were quantified and compared with untreated controls. These measurements were then repeated with LI replaced by intravitreal injections of γ-crystallin and β-crystallin at 5 days before ONC. Finally, βB2-crystallin-overexpressing transfected neural progenitor cells (βB2-crystallin-NPCs) in the eye were studied after crushing the optic nerve in vivo. Regeneration was monitored with the aid of immunoblotting of the retina and optic nerve both distal and proximal to the lesion site, and this was compared with controls that received injections of phosphate buffer only. LI performed 5 days or 3 days before ONC significantly promoted axonal outgrowth in vitro (p < 0.001), while LI performed alone before explantation did not. Intravitreal injections of β-crystallin and γ-crystallin mimicked the effects of LI and significantly increased axonal regeneration in culture at the same time intervals (p < 0.001). Western blot analysis revealed that crystallins were present in the proximal optic nerve stump at the lesion site in ONC, but were neither expressed in the undamaged distal optic nerve nor in uninjured tissue. βB2-crystallin-NPCs supported the regeneration of cut optic nerve axons within the distal optic nerve stump in vivo. The reported data suggest that βB2-crystallin-producing "cell factories" could be used to provide novel therapeutic drugs for central nervous system injuries.
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Affiliation(s)
- Michael R R Böhm
- Institute for Experimental Ophthalmology, School of Medicine, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
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Prokosch V, Prokosch JE, Promesberger J, Idelevich EA, Böhm MRR, Thanos S, Stupp T. Bacterial Spectrum and Antimicrobial Susceptibility Patterns in Acquired and Connatal Lacrimal Duct Stenosis. Curr Eye Res 2014; 39:1069-75. [DOI: 10.3109/02713683.2014.898312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Prokosch V, Chiwitt C, Rose K, Thanos S. Deciphering proteins and their functions in the regenerating retina. Expert Rev Proteomics 2014; 7:775-95. [DOI: 10.1586/epr.10.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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