[Increased prevalence of congenital dacryostenosis following cesarean section]

BACKGROUND

Congenital nasolacrimal duct obstruction (dacryostenosis) with a persisting membrane at Hasner's valve is the most common cause of persistent tear and ocular discharge in infants.

PURPOSE

To evaluate whether there is an association between congenital dacryostenosis and delivery via cesarean section.

MATERIAL AND METHODS

In a prospective study we examined 107 children (mean age 9.2 ± 7.1 months) with congenital dacryostenosis. We evaluated data about the mode of delivery (vaginal delivery versus cesarean section) and gestational age at the time of birth. Within the first 8 months of life children were treated by probing using local anesthesia, whereas older children were treated using general anesthesia. After the age of 11 months treatment included nasolacrimal duct intubation with a bicanalicular stent. Statistical analyses were performed using binomial tests, Fisher's exact test and the t-test.

RESULTS

In this study 51 children delivered by cesarean section were compared with 56 children delivered by spontaneous vaginal delivery. A total of 44 age-matched pairs from both groups were evaluated in order to eliminate confounding factors due to gestational age at delivery. Based on the published rate of cesarean sections from the same region of the State of Hesse between 2002-2004 we observed a statistically significant association between congenital dacryostenosis and delivery by cesarean section among the 88 age-matched patients (P = 0.009). Moreover, subgroup analysis revealed a significant association between congenital dacryostenosis and delivery by primary cesarean section (P = 0.00004). The prevalence of surgical treatment was not statistically different between both groups based on the mode of delivery (P = 0.8).

CONCLUSION

Our results suggest that delivery via cesarean section is associated with a significantly higher prevalence of congenital dacryostenosis.

[Endonasal dacryocystorhinostomies with transillumination and intubation in patients with combined pathologies of the nose and after revision]

BACKGROUND

The results of endonasal dacryocystorhinostomies (DCR) with transillumination and intubation are presented.

MATERIALS AND METHODS

In the period from 1999 to 2009 follow-up examinations of 50 endonasal DCRs were carried out. All patients over 18 were included. The files were systematically evaluated. The follow-up examinations were performed after a minimum of 6 months with anamnesis of epiphora.

RESULTS

50 endonasal DCRs were performed on 40 patients. Initial surgery was performed on 27 lacrimal ducts, 16 patients had already had operations. Corrective surgery was required in 8 cases (7 endonasal DCRs, 1 external DCRs). 78 % women and 22 % men were included. The median age at the time of operation was 48 years; the median duration of preoperative symptoms was 24 months. In 42 % of the cases a chronic dacryocystitis was found. Pre-existing conditions were sarcoidosis in three cases and one case of Wegener's granulomatosis. As well as lacrimal duct obstruction, additional pathologies were treated in the same session [septoplasty (n = 12), sinus operations (n = 10), and cauterisation of the nasal concha (n = 7), removal of a dacryocele (n = 1), conchectomy (n = 1)]. 20 operations were performed on the right side, 26 on the left side and two bilateral. The median duration of the operation was 51 minutes. No operative complications were encountered. The length of stay in hospital was on average four days. The median of follow-up was 23 months. The success rate was 78 %.

DISCUSSION

The success rate of endonasal DCRs is about 70 to 95 %. Thus, the achieved rate in this study is acceptable, especially as 16 of 40 patients underwent revision surgery. Probably this is attributed to the technique of transillumination. The safe intraoperative localisation of the lacrimal sac with a light probe seems to have a positive effect on the removal of obstructions.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in adults]

BACKGROUND

In the light of studies in children which showed no significant changes concerning anterior chamber depth, central corneal thickness and chamber angle width after eye muscle surgery, the aim of this study was to evaluate such changes in adults by means of optical coherence tomography.

PATIENTS AND METHODS

Using the Visante™ OCT (Carl Zeiss, Meditec, Jena) we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0° (CW0) and 180° (CW180) in 17 patients who had undergone eye muscle surgery on a minimum of one horizontal muscle preoperatively, one week and four months postoperatively. Exclusion criteria were an age under fifteen years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 43 years (min: 15; max: 67 years).

RESULTS

In all eyes (one and two muscles), no significant differences of mean values taken preoperatively, one week and four months postoperatively were seen: CCT: 538 ± 51 mm; 535 ± 39 mm; 535 ± 46 mm (p = 0.77); ACD: 2.98 ± 0.44 μm; 3.01 ± 0.45 μm; 3.01 ± 0.40 μm (p = 0.42); KW 0: 38.0 ± 5.2° 38.4 ± 6.0° 37.8 ± 5.2° (p = 0.98); KW 180: 33.7 ± 5.6° 35.6 ± 5.7° 34.5 ± 6.8° (p = 0.32). The differences between the corresponding data of both subgroups (one vs. two muscles) concerning central corneal thickness (p-value: 0.74; 0.89; 0.42), anterior chamber depth (p-value: 0.31; 0.23; 0.36) as well as chamber angle width at 0° (p-value: 0.73; 0.27; 0.81) and at 180° (p-value: 0.87; 0.67; 0.89) were not significant.

CONCLUSION

Using optical coherence tomography of the anterior eye segment in adults after muscle surgery, either in one or in two muscles - in accord with the results in children - no significant changes concerning central corneal thickness, anterior chamber depth and chamber angle width were seen.

Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas

BACKGROUND AND PURPOSE

Cranial nerve palsies are regularly observed in patients with arteriovenous fistulas of the cavernous sinus. The purpose of our study was to determine the long-term clinical outcome-with a special focus on extra-ocular muscular dysfunctions-in patients who had undergone endovascular treatment of a cavernous sinus fistula with detachable coils.

MATERIALS AND METHODS

Sixteen patients were recalled for an ophthalmoneurologic control examination (mean interval of 4.4 years). The mRS and the EQ-5D questionnaire were used for the description of general outcome. Age, duration of symptoms, character of the fistula (direct, dural), and coil volume were tested to assess their relevance for persistent symptoms.

RESULTS

All patients displayed complete regression of chemosis, exophthalmus, and pulsating tinnitus with no evidence of recurrences. Oculomotor disturbances persisted in 9 of 13 patients and caused permanent diplopia in 7 patients. In 15 patients a mRS score of 1 or 2 was achieved; however, 7 patients reported some limitations in life quality (EQ-5D). A significant correlation was found between coil volume and persistent diplopia (P = .032) and persistent cranial nerve VI paresis (P = .037).

CONCLUSIONS

Coil embolization of the cavernous sinus led to durable closure of AVF and reliable regression of acute symptoms. However, long-term follow-up showed a 44% rate of persistent cranial nerve deficits with disturbances of oculomotor and visual functions. This may be explained by the underlying fistula size itself and/or the space-occupying effect of the coils. As neuro-ophthalmologic outcome is crucial for control of therapeutic success, patients should be routinely examined by ophthalmologists.

Coagulation disorders and the risk of retinal vein occlusion

Over the past years, there has been a dramatic increase in the number of identifiable causes of thrombophilia. However, to date, there are no large, prospective studies to assess an optimal, cost-effective approach with regard to screening and case finding for thrombophilic risk factors in patients presenting with retinal vessel occlusion. Two hundred twenty-eight patients with retinal vein occlusion (RVO) and 130 age-matched healthy controls were prospectively screened for thrombophilic risk factors. Both cohorts were divided into three subgroups, depending on the patients' age at the time of the RVO or a previous thromboembolic event. Patient age < or =45 years was associated with a high prevalence of coagulation disorders (p<0.0001). Among patients < or =45 years and >45 to < or =60 years, a family history of thromboembolism was strongly associated with the presence of thrombophilic disorders. The absence of cardiovascular risk factors was found to be a strong predictor for the presence of coagulation disorders in all patient groups (< or =45 years, p=0.003; >45 to < or =60 years, p=0.0008; >60 years, p=0.001). Multivariate analysis revealed the presence of resistance to activated protein C (p=0.014), antiphospholipid antibodies (p=0.022), and deficiency of the anticoagulant proteins (p=0.05) as independent risk factors for the development of RVO among patients < or =45 years. Our results indicate that thrombophilic disorders are associated with the development of retinal vein occlusion in patients < or =45 years by the time of the RVO or a previous thromboembolic event, in patients with a family history of thromboembolism, or in patients without cardiovascular risk factors.

[Modular semiquantitative quality assessment of ophthalmic health information on the internet--reproducibility and correlation between different assessment categories]

BACKGROUND

Quality evaluation of web-based health information in ophthalmology requires valid standards and reproducible assessment procedures. The objective was to evaluate the interrater-reliability of quality assessment of ophthalmic websites and a possible correlation between the results of the evaluation categories reliability/trustworthiness, quality of medical content and accessibility/usability.

MATERIALS AND METHOD

After selection with the search engine "Google" 20 ophthalmic websites had been analysed by two independent evaluators using criteria checklists (modified Afgis transparency criteria, modified BITV test, medical content related to AMD) related to the aforementioned 3 categories.

RESULTS

The interrater-reliability was almost perfectly estimated with Kappa-values of 0.91 for reliability/trustworthiness plus 0.89 for accessibility/usability and 0.79 for content. On average 62.5 % (+/- 17.43 %), 27.36 % (+/- 16.5 %) and 59.54 % (+/- 15.73 %) of the quality requirements were fulfilled for reliability/trustworthiness, content and accessibility/usability, respectively. No significant correlation was found between reliability and content (r = -0.039, p = 0.8709), reliability and accessibility/usability (r = -0.284; p = 0.228) plus content and accessibility/usability (r = 0.199; p = 0.4047).

CONCLUSION

Sufficiently operationalised criteria are prerequisites for reproducible results of quality assessment of ophthalmic websites between different observers. The assessment within a single category, such as reliability/trustworthiness, does not allow one to draw conclusions on other categories such as content or accessibility/usability or the overall quality of a website. Therefore, simplified tools for quality assessment of health information by laymen and patients may have a limited validity.

[Changes of the anterior eye segment after eye muscle surgery--evaluation by optical coherence tomography in children]

BACKGROUND

The aim of this study was to quantify and to evaluate changes concerning anterior chamber depth, central corneal thickness and chamber angle width because of altered forces on the eye bulb after eye muscle surgery in children by means of optical coherence tomography.

PATIENTS AND METHODS

Over the course of four months, we measured central corneal thickness (CCT), anterior chamber depth (ACD) and chamber angle width at 0 degrees (CW0) and 180 degrees (CW180) in 28 eyes of 28 children, who underwent eye muscle surgery on one horizontal muscle. Measurements were taken preoperatively, one week and four months postoperatively using Visante (TM) OCT (Carl Zeiss, Meditec, Jena). Exclusion criteria were an age under five years at the time of surgery, previous intraocular surgery and other pathological conditions of the anterior segment. The median age at surgery was 6.5 years (range: 7.1, max: 8.9; min: 5.3).

RESULTS

Mean values taken preoperatively, one week and four months postoperatively were: CCT: 534 +/- 32 microm; 533 +/- 30 microm; 536 +/- 31 microm (p = 0.12); ACD: 2.98 +/- 0.3 mm; 2.97 +/- 0.3 mm; 2.96 +/- 0.4 mm (p = 0.73); CW 0: 38.1 +/- 3.6; 38.9 +/- 4.7; 38.3 +/- 4.7; CW 180: 34.7 +/- 4.2; 35.3 +/- 4.3; 36.2 +/- 5.2; (p = 0.41). The differences between the mean values in all measurement rows were not significant.

CONCLUSION

In children who underwent eye muscle surgery on one horizontal muscle this procedure had no significant impact on central corneal thickness, anterior chamber depth and chamber angle width of the operated eyes within a postoperative period of four months.

[Selective thrombophilia screening of young patients with retinal vein occlusion]

BACKGROUND

The potential impact of coagulation abnormalities on retinal vascular occlusive diseases, individually and in combination with cardiovascular risk factors, remains unclear.

PATIENTS AND METHODS

In a prospective case-control study a cohort of 74 young patients with central, hemicentral or branch retinal vein occlusion (RVO) (<or= 45 years at the time of the RVO or a previous thromboembolic event) and 74 subjects matched for age and sex were prospectively screened for thrombophilic risk factors.

RESULTS

Overall, thrombophilic defects were found to be present in 38 of the 74 patients (51.4 %) and in 8 of 74 (10.8 %) controls (p < 0.0001). We found a strong association between the presence of thrombophilic disorders and a family history of thromboembolism (p < 0.0001). Patients without cardiovascular risk factors had a statistically significant higher frequency of coagulation disorders than patients with these risk factors (p = 0.0025).

CONCLUSIONS

Our results indicate that thrombophilic disorders are associated with the development of retinal vein occlusion. Selective screening of young patients, patients with a personal or family history of thromboembolism, and patients without cardiovascular risk factors may be helpful in identifying retinal vein occlusion patients with thrombophilic defects.

[Accessibility of information on eye diseases on the internet for the visually impaired user]

BACKGROUND

The number of visually impaired people who use the internet for obtaining health information around the eye, is rising continuously. For this reason the accessibility for visually impaired persons to such websites is an important factor. Our investigation deals with the question: How good is the accessibility for the visually impaired to gather information on eye diseases on the Internet and how could this be improved?

MATERIALS AND METHOD

After identification using the the search engine "Google", 20 websites of German university eye hospitals have been checked for their accessibility using the modified BITV test which is based upon 52 test criteria.

RESULTS

On average 70.75 % (+/- 6.19 % min. 56.6 %, max; 86.79 %) of the required accessibility criteria have been fulfilled. This corresponds to an average accessibility value of 70.58 % (+/- 6.69 % min. 56.31 %, max. 89.32 %). According to the BITV test, this means that the average of the analysed websites is not accessible. The improper use of mark-up languages, unclear document or web page titles or missing alternative texts for pictures, graphics and navigation elements and misleading navigational architecture are frequent findings. This builds up the greatest accessibility barriers, although these barriers could be eliminated even with a relatively low expense.

CONCLUSION

Good accessibility allows not only a barrier-free access to information for visually impaired users but is also a most important feature related to search engine optimisation.

[Presaccal stenosis as a cause of epiphora]

BACKGROUND

Dacryocystographic evaluation of the location of stenoses of the lacrimal pathways was carried out in patients with epiphora to define the frequency and morphology of canalicular stenosis.

PATIENTS AND METHODS

Digital subtraction angiography (DSA) dacryocystograms of 55 consecutive patients with severe epiphora and stenoses of the lacrimal draining system were reviewed in a consensus between three evaluators to determine radiomorphologic criteria for the diagnosis of canalicular stenosis. In 9 cases 3D rotational dacryocystography was additionally used.

RESULTS

A total of 80 stenotic lesions were detected including 19 (24%) canalicular, 26 (32%) saccal and 35 (44%) ductal stenoses. In 9 of the patients 3D rotational dacryocystography was used to differentiate between canalicular (n=4) and saccal (n=5) stenosis. Increased resistance during continuous injection of contrast material and lack of distension of the distal ductal system were the main criteria for diagnosis of canalicular stenosis.

CONCLUSION

Presaccal stenoses accounted for nearly 25% of the stenoses found in this study. This type of stenosis occurs frequently and should not be overlooked on dacryocystography. 3D rotational dacryocystography may be helpful in unclear cases.

[Examination methods in the diagnosis of uni- and bilateral cataracts in childhood]

Today, the management of congenital and developmental pediatric uni- and bilateral cataract is still a problem, particularly because untreated lens opacity has a high amblyogenic potential. Such irreversible deprivation amblyopia in pediatric cataracts requires an early diagnosis. Due to the increased inflammatory reaction postoperatively, a minimally traumatic operation, intensive occlusion therapy and optimal correction with glasses or contact lenses are also necessary. Uni- and bilateral cataracts and their preoperative diagnostics have to be considered separately.

Chirurgische Therapie der kongenitalen Katarakt

Due to the anatomical dimensions being smaller and the tissue structures being softer and more elastic in the young patient, surgery of paediatric cataracts represents a special challenge for the ophthalmic surgeon. Surgery is performed via a limbal or pars plana approach. The extreme high rate of secondary cataract formation in the paediatric or adolescent eye with closed posterior capsules is countered by means of complicated capsular surgery, special intraocular lens (IOL) implantation techniques, and vitreoretinal surgical procedures. It is customary not to implant IOLs before the children are 1-2 years old as increased axial length growth must be expected during the first 18 months after birth. IOL power is selected so that postoperative refraction is within the hyperopic range and with time, undercorrection will be balanced by bulbus growth. Preoperative and postoperative therapy is highly dependant on the extent of trauma sustained during surgery and should contain anti-inflammatory medication with and without steroids as well as antibiotics. Orthoptic follow-up examinations are also decisive for the long-term result.

Gestörte visuelle Wahrnehmung beim Depersonalisations-Derealisationssyndrom

Disturbances of visual perception like micropsia, macropsia, teleopsia, pelopsia, metamorphopsia or loss of stereoscopic depth perception are usually considered in ophthalmology as symptoms of retinopathy, especially maculopathy or disorders of binocularity. Differential diagnostic considerations include disorders like migraine and epilepsy but not the visual disturbance pertaining to the depersonalization-de-realization syndrome, although the above-mentioned symptoms are more prevalent in this psychogenic disorder. This article gives a review of depersonalization-de-realization in order to enable the ophthalmologist to include this syndrome into his diagnostic considerations.

Eine neue Darstellungsm�glichkeit der Tr�nenwege

BACKGROUND

The aim was to investigate the applicability of a 3D rotation angiography system for imaging lesions of the lacrimal draining system.

PATIENTS AND METHODS

Five patients with stenosis of the lacrimal system were enrolled in this pilot project to undergo a distension dacryocystography as 3D rotation angiography. The 3D reconstructions are derived from 100 radiographic projection images, which are obtained during a 240 degrees rotation of an angiographic C-arm. Volume-rendering techniques show plastic representations of the contrast-enhanced ductal system with the possibility of additional virtual dacryoendoscopy. The adjacent bony structures and the nasal cavity can also be visualized by special window settings and cuts through the 3D data set. Exact calibration of the X-ray system allows for precise measurements of distances. A sufficient 3D representation needs permanent injection of contrast material for about 5.5 s. Outpatient examination under surface anesthesia is well tolerated.

RESULTS

The high-resolution 3D reconstructions show detailed images of lesions of the endoluminal surface and give a plastic impression of the site of obstructions. In contrast to normal DSA dacryocystography, the contrast-enhanced ductal system, the adjacent bone, and even the soft tissues of the nasal cavity are demonstrated simultaneously. A disadvantage is an incomplete representation of the residual lumen of subtotal stenoses and the one and one-half times higher radiation dose compared to normal dacryocystography.

CONCLUSION

Dacryocystography with 3D rotation angiography opens a new dimension of minimally invasive imaging of the lacrimal drainage system, which may be helpful for exact planning of dacryocystorhinostomy procedures.

[Intraocular pressure response after administration of 3 different viscoelastic agents after cataract operation]

By using three different viscoelastics [Adatocel (methylhydroxypropylcellulose), Amvisc Plus (sodium hyaluronate) and Healon (sodium hyaluronate)] a prospective randomized study was conducted to investigate whether postoperative intraocular pressure shows significant differences according to the viscoelastics used after 150 cases of cataract surgery.

PATIENTS AND METHODS

The inclusion criteria for this study were: extracapsular cataract extraction via the usual small-incision techniques and endocapsular posterior-chamber lens implantation. A total of 150 eyes were operated upon. The patients were randomly assigned to three groups according to the viscoelastics, 50 cases used adatocel, 50 Amvisc Plus and 50 Healon. As far as possible, the viscoelastics were sucked out under visual control. Intraocular pressure (IOP) was measured after 6 and 24 h.

RESULTS

Six hours postoperatively, no statistically significant difference between the intraocular pressure after using different viscoelastics (adatocel: 19.6 +/- 9.7 mmHg, Amvisc Plus: 20.5 +/- 9.6 mmHg und Healon: 21.8 +/- 8.8 mmHg) was seen. At 24 h IOP was statistically significant higher for Healon than for adatocel and Amvisc Plus (adatocel: 16.3 +/- 4.8 mmHg, Amvisc Plus: 16.5 +/- 4.6 mmHg and Healon: 19.7 +/- 6.6 mmHg).

CONCLUSIONS

Six hours postoperatively after phacoemulsification there was no significant difference between the IOP using different viscoelastics adatocel, Amvisc Plus and Healon. Twenty-four hours postoperatively a significantly higher intraocular pressure was measured for Healon than for the other viscoelastics.

[Endoscopic laser dacryoplasty. Methodology and outcome after 3 months]

BACKGROUND

After performing endoscopy of the lacrimal passage, the endoscopic system can be connected to an erbium-YAG laser if the indications are appropriate.

MATERIALS AND METHODS

In a bi-center study we performed laser dacryoplasty in 53 cases out of 261 endoscopy procedures (18 stenoses of the canaliculi, 19 stenoses of the sac, 9 stenoses of the nasolacrimal duct, 9 restenoses following DCR). In 35 cases an examination was done and in all 53 cases the results were obtained by means of a questionnaire.

RESULTS

Epiphora and irrigation were improved in more than 75%.

CONCLUSION

Suitable indications are small stenoses in the sac or duct membranes following DCR. Laser dacryoplasty is a promising method, but more studies still need to be conducted to obtain long-term results. The technical system must also still be improved to make it easier to handle.

[Dacryoendoscopy--current status]

In the years from 1995 to 1997 in the eyeclinic of Darmstadt and the eyeclinic of the St. Josef Hospital Hagen 261 dacryoendoscopies were done in a bicentrical study.

PATIENTS AND METHODS

A dacryoendoscopy was done in 261 patients with an average age of 46.6 years (143 women, 93 men and 25 children). In dependance of the assessment of the mucosa conditions intraoperatively in all 261 cases the planed operative strategy was checked and if needed changed. As following surgical interventions of the lacrimal system were seen 70 cases of dacryocystorhinostomia externa, 138 cases of intubation of the lacrimal drainage system and 53 cases of laserdacryoplastic.

RESULTS

The dacryoendoscopy had succeeded as method for the assessment of the mucosa conditions [5, 6]. In a study of 261 dacryoendoscopies an examination of the mucosa was possible in every case. No complications were seen while dacryoendoscopy. With help of the dacryoendoscopy the planed operative strategy was determined. Therefore we had the possibility to choose a minimal invasive operation-procedure in 53 cases.

CONCLUSIONS

The dacryoendoscopy is a new important diagnostic development in diagnosis of diseases of the lacrimal drainage system. With help of better developed endoscopy-systems a much better quality of the picture is attainable. The results of the dacryoendoscopy offer the possibility to check the preoperative indication and to optimate the surgical treatment. At last only with help of the dacryoendoscopy these findings could be ascertained in which case a laserdacryoplastic is senseful.

[Dacryoendoscopy and laser dacryoplasty: technique and results]

BACKGROUND

In a bicentrical study in the eye clinic of Darmstadt and the eye clinic of the St. Josef Hospital Hagen 261 dacryoendoscopies were performed until February 1997.

MATERIALS AND METHODS

In 261 dacryoendoscopies (143 women, 93 men and 25 children, the average age was 46.6 years). In dependence of the assessment of the mucosa conditions intraoperatively in all 261 cases the planed operative strategy was checked and if needed changed. After surgical interventions of the lacrimal system 70 cases of dacryocystorhinostomia externa were seen 138 cases of intubation of the lacrimal drainage system and 53 cases of laserdacryoplastic. Intubation of the lacrimal system was always performed after laserdacryoplastic and after a patency was produced (average age 58.3 years).

RESULTS

Suitable indications for a laserdacryoplastic are: circumscribed stenosis of the distal saccus, point-sized stenosis of the canaliculus, membranous restenosis after dacryocystorhinostomia externa. The method shows no important rate of intraoperative complications, only in one case there was intraoperatively a protrusion bulbi and a haematoma of the eyelid, which postoperatively eased fastly away. The postoperative convalescence is in comparence to conventional surgical interventions of the lacrimal drainage system enormously shortened. The follow-up after 3 months showed a subjective improvement of epiphora in more than 75% of the patients, the success of this intervention therefore could be compared with conventional surgical methods of the lacrimal drainage system.

CONCLUSION

The dacryoendoscopy is a new important diagnostic development, which shows with help of better developed endoscopy-systems compared to previous systems a much better quality of the image and is therefore a valuable diagnostic help. Due to the check of the preoperative indication it is intraoperatively possible to confirm or, if needed, to change the indication after dacryoendoscopy. The laserdacryoplastic is an important new therapeutical development of the dacryoendoscopy and shows in suitable indications a comparable success-rate of conventional surgical interventions of the lacrimal drainage system. Therefore the possibility exists to carry out minimal invasive interventions of the lacrimal drainage.

[Quantification of disorders of the blood-aqueous humor barrier in retinitis pigmentosa--initial results]

BACKGROUND

Clinical findings in patients with retinitis pigmentosa (RP) frequently include cystoid macular edema (CME) and vitreous pigment dusting (VPD) indicating alterations of the blood-ocular barriers. It was the aim of this study to determine whether alterations of the blood-aqueous barrier (BAB) are present in RP.

PATIENTS AND METHODS

Aqueous flare was quantitatively determined in 56 eyes of 29 patients (mean age 36.4 +/- 11.2 years) with RP using the noninvasive laser flare-cell photometer (Kowa FC-1000, Tokyo, Japan). All RP patients had common forms of RP with markedly reduced or nondetectable ERG. The presence of CME and VPD was determined semiquantitatively by biomicroscopy. Fifty-eight eyes of 58 normal controls (mean age 38.2 +/- 8.5 y.) were also examined.

RESULTS

Aqueous-flare values were significantly higher in RP eyes (mean 9.65 +/- 3.24 photon counts/ms, range 4.0-18.1) than in the normal control eyes (mean 3.89 +/- 1.05, range 1.9-6.0, p < 0.0001, Mann-Whytney test). Forty-eight of the 56 RP eyes (86%) showed increased flare values (> 6.0 photon counts/ms). RP eyes with moderate to marked CME (n = 11) had significantly higher flare values (mean 14.66 +/- 1.92) than RP eyes without or with only questionable CME (8.52 +/- 2.18, p < 0.0001), and RP eyes with moderate to marked VPD (n = 17) had significantly higher (12.05 +/- 2.84) flare values than RP eyes without or with only minimal VPD (8.74 +/- 2.22, p < 0.0005).

CONCLUSIONS

Our findings show that the majority of patients with RP have alterations of the BAB with consecutively increased aqueous protein concentrations. The impairment of the BAB appears to be associated with CME and VPD. Measurement of aqueous flare in RP allows quantification of the impairment of the BAB and may be helpful in the future in choosing and monitoring patients with RP and CMP for possible antiinflammatory or antiedematous therapeutic measures.