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El Halabi M, Seitz B, Quintin A, Suffo S, Flockerzi F, Schlötzer-Schrehardt U, Daas L. [Histoacryl adhesive for acute treatment of corneal penetration in necrotizing herpetic keratitis]. Ophthalmologe 2022; 119:59-64. [PMID: 33296016 PMCID: PMC8763725 DOI: 10.1007/s00347-020-01284-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Affiliation(s)
- M El Halabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland.
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - A Quintin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - S Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
| | - F Flockerzi
- Institut für Pathologie, Universitätsklinikum des Saarlandes UKS, Homburg/Saar, Deutschland
| | | | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Gebäude 22, 66421, Homburg/Saar, Deutschland
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Winter L, Unger A, Berwanger C, Spörrer M, Türk M, Chevessier F, Strucksberg KH, Schlötzer-Schrehardt U, Wittig I, Goldmann WH, Marcus K, Linke WA, Clemen CS, Schröder R. Imbalances in protein homeostasis caused by mutant desmin. Neuropathol Appl Neurobiol 2018; 45:476-494. [PMID: 30179276 DOI: 10.1111/nan.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 12/19/2022]
Abstract
AIMS We investigated newly generated immortalized heterozygous and homozygous R349P desmin knock-in myoblasts in conjunction with the corresponding desminopathy mice as models for desminopathies to analyse major protein quality control processes in response to the presence of R349P mutant desmin. METHODS We used hetero- and homozygous R349P desmin knock-in mice for analyses and for crossbreeding with p53 knock-out mice to generate immortalized R349P desmin knock-in skeletal muscle myoblasts and myotubes. Skeletal muscle sections and cultured muscle cells were investigated by indirect immunofluorescence microscopy, proteasomal activity measurements and immunoblotting addressing autophagy rate, chaperone-assisted selective autophagy and heat shock protein levels. Muscle sections were further analysed by transmission and immunogold electron microscopy. RESULTS We demonstrate that mutant desmin (i) increases proteasomal activity, (ii) stimulates macroautophagy, (iii) dysregulates the chaperone assisted selective autophagy and (iv) elevates the protein levels of αB-crystallin and Hsp27. Both αB-crystallin and Hsp27 as well as Hsp90 displayed translocation patterns from Z-discs as well as Z-I junctions, respectively, to the level of sarcomeric I-bands in dominant and recessive desminopathies. CONCLUSIONS Our findings demonstrate that the presence of R349P mutant desmin causes a general imbalance in skeletal muscle protein homeostasis via aberrant activity of all major protein quality control systems. The augmented activity of these systems and the subcellular shift of essential heat shock proteins may deleteriously contribute to the previously observed increased turnover of desmin itself and desmin-binding partners, which triggers progressive dysfunction of the extrasarcomeric cytoskeleton and the myofibrillar apparatus in the course of the development of desminopathies.
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Affiliation(s)
- L Winter
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany.,Neuromuscular Research Department, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - A Unger
- Department of Cardiovascular Physiology, Ruhr-University Bochum, Bochum, Germany.,Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - C Berwanger
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | - M Spörrer
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - M Türk
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - F Chevessier
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
| | - K-H Strucksberg
- Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - I Wittig
- Functional Proteomics, SFB815 Core Unit, Medical School, Goethe University, Frankfurt, Germany
| | - W H Goldmann
- Center for Medical Physics and Technology, Biophysics Group, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - K Marcus
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum, Bochum, Germany
| | - W A Linke
- Department of Cardiovascular Physiology, Ruhr-University Bochum, Bochum, Germany.,Institute of Physiology II, University of Münster, Münster, Germany
| | - C S Clemen
- Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Center for Biochemistry, Institute of Biochemistry I, Medical Faculty, University of Cologne, Cologne, Germany
| | - R Schröder
- Institute of Neuropathology, University Hospital Erlangen, Erlangen, Germany
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Wasielica-Poslednik J, Gericke A, Desuki A, Schlötzer-Schrehardt U, Pfeiffer N, Lisch W. Recurrence of paraproteinemic keratopathy after penetrating keratoplasty and its assessment with confocal microscopy. Am J Ophthalmol Case Rep 2018; 11:87-91. [PMID: 30014052 PMCID: PMC6019764 DOI: 10.1016/j.ajoc.2018.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To report on a case of recurrence of paraproteinemic keratopathy (PPK) associated with monoclonal gammopathy after bilateral penetrating keratoplasty. Observations Penetrating keratoplasty was performed on both eyes of a 45-year-old man due to bilateral progressive corneal stromal clouding. Recurrence of the corneal stromal opacities accompanied by a decrease in visual acuity was observed on slit-lamp examination already two years after penetrating keratoplasty. Confocal laser scanning microscopy (CLSM) of the corneal grafts performed three years after penetrating keratoplasty showed bilateral morphological changes identical to that found in the patient's corneas prior to penetrating keratoplasty. A hematological work-up revealed monoclonal gammopathy of type IgG kappa. The histochemical examination of the explanted corneas confirmed the diagnosis of PPK. Conclusions and importance Paraproteinemic keratopathy is an underdiagnosed ophthalmological condition, which may be associated with potentially life-threatening hematologic disorders. A hematological workup should be performed in patients with corneal opacities of uncertain etiology. Penetrating keratoplasty should be performed with caution in patients with monoclonal gammopathy due to the possibility of a very fast recurrence of PPK in the corneal graft. This is the first presentation of the recurrence of flake-like PPK after penetrating keratoplasty assessed with CLSM.
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Abstract
A 50-year-old white man complained of “inflammation” of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.
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Affiliation(s)
- M Küchle
- Department of Ophthalmology, University of Erlangen-Nürmberg, Germany
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Schlötzer-Schrehardt U, Cursiefen C. [Basic research in ophthalmology in Germany and its international context]. Ophthalmologe 2017; 114:804-811. [PMID: 28730427 DOI: 10.1007/s00347-017-0541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Experimental basic research provides the foundations for the elucidation of pathophysiological mechanisms of diseases and the development of novel diagnostic and therapeutic strategies for ophthalmological diseases. The objective of this contribution is to provide an overview of the international interconnection of basic research in ophthalmology in Germany. METHODS The international context of ophthalmological research conducted in Germany is presented by means of personal experiences and data published by the German Ophthalmological Society (DOG), the German Research Foundation (DFG) and the European Union (EU). Due to the lack of organized databases this article lays no claim to completeness. RESULTS Basic research in ophthalmology in Germany is mainly conducted in university eye departments and is mainly related to the etiology, pathophysiology and therapy development for various ophthalmic diseases. It is primarily funded by the DFG, the Federal Ministry of Education and Research (BMBF) and the EU plays an increasingly important role. Thus, ophthalmological research is integrated into numerous European research networks and beyond that into many international interconnections and relationships. CONCLUSION In Germany, both clinical and basic research in ophthalmology is integrated into many international networks and is only functionally viable in an international context; however, given the increasing impact of ophthalmological research in Asian countries, future strategies require a continued focus on career development, research infrastructure, working environment and international cooperation.
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Affiliation(s)
| | - C Cursiefen
- Zentrum für Augenheilkunde, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Schlötzer-Schrehardt U, Kruse FE. [Stem cell-based approaches to diseases of the ocular surface]. Ophthalmologe 2017; 114:296-297. [PMID: 28405821 DOI: 10.1007/s00347-017-0476-0] [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: 10/19/2022]
Affiliation(s)
- U Schlötzer-Schrehardt
- Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - F E Kruse
- Augenklinik mit Poliklinik der Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland.
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Liravi P, Zenkel M, Kruse F, Schlötzer-Schrehardt U. The pathophysiology of pseudoexfoliation syndrome is affected by interaction of TGF-β1 and LOXL1. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Liravi
- Department of Ophthalmology; University of Erlangen-Nürnberg; Erlangen Germany
| | - M. Zenkel
- Department of Ophthalmology; University of Erlangen-Nürnberg; Erlangen Germany
| | - F.E. Kruse
- Department of Ophthalmology; University of Erlangen-Nürnberg; Erlangen Germany
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Pasutto F, Mauri L, Popp B, Sticht H, Ekici A, Piozzi E, Bonfante A, Penco S, Schlötzer-Schrehardt U, Reis A. Whole exome sequencing reveals a novel de novo FOXC1 mutation in a patient with unrecognized Axenfeld–Rieger syndrome and glaucoma. Gene 2015; 568:76-80. [DOI: 10.1016/j.gene.2015.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/17/2015] [Accepted: 05/07/2015] [Indexed: 02/03/2023]
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Schargus M, Kusserow C, Schlötzer-Schrehardt U, Hofmann-Rummelt C, Schlunck G, Geerling G. Peripheral hypertrophic subepithelial corneal degeneration presenting with bilateral nasal and temporal corneal changes. Eye (Lond) 2014; 29:88-97. [PMID: 25277306 DOI: 10.1038/eye.2014.236] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To characterise the history, clinical and histopathological features of patients with bilateral nasal and temporal peripheral hypertrophic subepithelial corneal degeneration in a German population. METHODS A detailed ophthalmological and dermatological history and clinical findings were recorded of nine patients with bilateral simultaneous nasal and temporal peripheral corneal degeneration from two centers in Germany. Excised tissues were studied by histopathology, immunohistochemistry, and transmission electron microscopy. RESULTS Foreign body sensation and need of artificial tear substitutes were the only symptoms reported regularly. Schirmer's and Jones-test were normal in all, but fluorescein break-up time of >10 s was found in five eyes of four patients. Best corrected visual acuity was reduced only under glare conditions. Corneal topography revealed irregular astigmatism in 13 of 14 eyes. Follow-up median time was 35 months. Most cases were stable within the follow-up period. Light and electron microscopy revealed the findings of superficial vascularised corneal hypertrophic scars, oxytatlan fibers, and discontinued Bowmans layer. CONCLUSION In this series of German patients with peripheral hypertrophic subepithelial corneal degeneration, the changes were predominantly located in the palpebral aperture and often present in both eyes. No associated surface disease could be established in this study. Light and transmission electron microscopy showed histological features that are similar to Salzmann's corneal changes without any inflammation. We hypothesise that light exposure and a localised limbal insufficiency could be involved in the pathogenesis.
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Affiliation(s)
- M Schargus
- 1] Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany [2] Department of Ophthalmology, University of Bochum, Bochum, Germany
| | - C Kusserow
- Department of Ophthalmology, University of Luebeck, Lübeck, Germany
| | | | - C Hofmann-Rummelt
- Department of Ophthalmology, University of Erlangen-Nuernberg, Erlangen, Germany
| | - G Schlunck
- Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany
| | - G Geerling
- 1] Department of Ophthalmology, University of Wuerzburg, Wuerzburg, Germany [2] Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany
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Zimmermann N, Wünscher M, Schlötzer-Schrehardt U, Erb C. [Corneal endothelial cell density and its correlation with the severity of pseudoexfoliation]. Klin Monbl Augenheilkd 2014; 231:158-63. [PMID: 24532404 DOI: 10.1055/s-0033-1360308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pseudoexfoliation (PEX) syndrome is a common, age-related disease which is associated with the multifocal deposition of fibrillar PEX material in intra- and extraocular tissues. Subsequently among others second chronic open-angle glaucoma and corneal endothelial cell loss occurs. The present study analysed whether there is a correlation between the stage of the PEX process and corneal endothelial cell density (cECD), regardless of the non-existence or proof of secondary glaucoma. MATERIALS AND METHODS One eye of 109 Caucasian subjects (mean age 71.7 years) was examined by slit-lamp microscopy and classified based on visible PEX deposits on the lens (mild and severe) and presence of glaucoma in 4 study groups. The control groups were healthy subjects and patients with primary open angle glaucoma (POAG). The cECD was measured with the endothelial cell mirror microscope (SeaEagle). RESULTS All study groups and the POAG group showed a significant cECD reduction compared to the healthy control group: POAG: 6.0 %; PEX syndrome: mild 5.5 % and severe 11.0 %, PEX glaucoma: mild 7.7 % and severe 12.3 %. Further the cECD was significantly lower compared to the POAG group in severe PEX syndrome by 5.4 % and in severe PEX glaucoma by 6.8 %. cECD significantly decreased with increasing PEX stage independently of the presence of glaucoma. These differences remained statistically significant after Bonferroni-Holm correction. The analysis of the entire group of test subjects showed only a weak correlation between mean intraocular pressure and mean cECD. CONCLUSION The results of this study showed a decreasing cECD with increasing PEX stage, regardless of whether glaucoma is present or not. The influence of the PEX process appears to be more pronounced than the influence of intraocular pressure.
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Affiliation(s)
- N Zimmermann
- Augenheilkunde, Augenklinik am Wittenbergplatz, Berlin
| | - M Wünscher
- Augenheilkunde, Augen-Tagesklinik Warschauer Straße, Berlin
| | | | - C Erb
- Augenheilkunde, Augenklinik am Wittenbergplatz, Berlin
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Zimmermann N, Wünscher M, Schlötzer-Schrehardt U, Erb C. Korrelation von Hornhautendothelzelldichte und Schweregrad der Pseudoexfoliation. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363393] [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: 10/25/2022]
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Affiliation(s)
- U Schlötzer-Schrehardt
- Universitäts-Augenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen.
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Abstract
As a result of demographic changes pseudoexfoliation (PEX) syndrome, an age-related systemic disorder of the extracellular matrix, will become an increasingly important issue in clinical practice. Apart from its well-known association with cataract and glaucoma, PEX syndrome predisposes to a broad spectrum of spontaneous and surgical ocular complications due to characteristic alterations of all anterior segment tissues. In view of the high risk of glaucoma development and potential complications during cataract surgery, an accurate and early diagnosis of PEX syndrome is of considerable clinical relevance. Since the characteristic central PEX deposits are lacking in up to 50 % of patients, a reliable diagnosis requires pupillary dilation. Early stages of the disease may be recognized on the basis of subtle alterations of the lens surface in addition to poor pupillary dilation and pigment-related signs including pigment dispersion and peripupillary atrophy. Any asymmetric clinical signs, e.g., regarding pupil width, pigmentation, cataract and intraocular pressure, should alert the ophthalmologist to the potential presence of PEX syndrome. Although the description of PEX syndrome as a systemic disorder of the extracellular matrix associated with the deposition of PEX material in the skin, blood vessel walls and various organ systems dates back to the early 1990s, a causal relationship between the abnormal material deposits and systemic diseases has not yet been clearly established. A growing number of smaller studies have found suggestive evidence for associations between PEX syndrome and cardiovascular/cerebrovascular diseases. The current evidence, however, is ambiguous and requires further investigation through multicenter or population-based, prospective, randomized clinical studies.
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Affiliation(s)
- E Scharfenberg
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig AöR, Liebigstr. 10-14, 04103 Leipzig.
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Menzel-Severing J, Polisetti N, Schlötzer-Schrehardt U, Kruse F. Limbusstammzellen und ihre Nische: Bedeutung für biotechnologischen Gewebeersatz. Klin Monbl Augenheilkd 2012; 229:1191-7. [DOI: 10.1055/s-0032-1315378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | | | - F. Kruse
- Augenklinik, Universitätsklinikum Erlangen
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Abstract
Pseudoexfoliation (PEX) glaucoma is the most common identifiable cause of open-angle glaucoma worldwide, comprising the majority of glaucoma in some countries. The underlying disorder, PEX syndrome, is a generalised, genetically determined, elastotic process of the extracellular matrix characterised by the excessive production and progressive accumulation of a fibrillar material in various tissues including the outflow pathways. Increasing evidence suggests that the oxidative-antioxidative balance is disturbed in patients with PEX syndrome/glaucoma, both in the anterior segment and throughout the body, and that the resulting oxidative stress constitutes a major mechanism involved in the pathophysiology of this fibrotic process. Significantly reduced levels of antioxidants, such as ascorbic acid, glutathione, trace elements, antioxidative enzymes, and total antioxidative capacity in aqueous humor and serum suggest a faulty antioxidative defense system in PEX patients. The down-regulation of antioxidative enzymes in anterior segment tissues also indicates an inadequate cytoprotection against oxidative stress. Concomitantly, levels of oxidants such as hydrogen peroxide or nitric oxide, and oxidative stress markers, including lipid peroxidation products, degradation products of oxidated and methylated proteins, advanced glycation end products, and homocysteine are significantly increased in aqueous humor, tissues, and serum. The available data suggest that chronic oxidative stress in combination with weakened cytoprotective and repair strategies affects the abnormal matrix metabolism by induction of a persistent pro-inflammatory state and activation of the profibrotic growth factor TGF-beta1. Oxidative stress, therefore, appears to represent a modifiable risk factor in the management of patients with PEX syndrome/glaucoma.
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Terai N, Schlötzer-Schrehardt U, Lampel J, Böhm AG, Rummelt C, Schmidt E, Pillunat LE. Effect of latanoprost and timolol on the histopathology of the human conjunctiva. Br J Ophthalmol 2008; 93:219-24. [PMID: 18971237 PMCID: PMC2628534 DOI: 10.1136/bjo.2008.140186] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [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: 11/25/2022]
Abstract
Aim: To investigate the effect of timolol and latanoprost on the extracellular matrix organisation, inflammatory infiltration, and expression of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the human conjunctiva. Methods: Conjunctival biopsies were obtained from the inferior fornix during routine cataract surgery from 20 patients with primary open-angle glaucoma, who had received a monotherapy either with timolol or latanoprost, and from 10 non-glaucomatous patients. Specimens were investigated by light microscopy, immunohistochemistry using antibodies against MMP-1,-3, TIMP-2,-3 and CD 68 antibodies and by quantitative transmission electron microscopy. Results: The number of collagen fibres was significantly decreased in latanoprost-treated conjunctival specimens compared with timolol-treated eyes (p<0.01) but showed no difference to controls. Amorphous material was increased in both treated groups compared with controls (p<0.001) but was less in latanoprost-treated specimens compared with timolol-treated eyes (p<0.001). Optically clear spaces, probably containing glycosaminoglycans, were significantly reduced in both treated groups—with less of a reduction in latanoprost—compared with timolol-treated eyes (p<0.001). A marked upregulation of MMP-1 and MMP-3 and moderately increased staining for TIMP-2 and TIMP-3 was found in epithelial cells and subepithelial stromal cells of latanoprost-treated eyes. A moderate infiltration with macrophages and inflammatory cells was observed in timolol-treated eyes. Conclusions: Latanoprost-treated conjunctival specimens showed a decreased stromal collagen density and a less pronounced inflammatory infiltration. The upregulation of MMP-1 and MMP-3 in latanoprost-treated eyes might explain the reduced extracellular matrix accumulation in the conjunctival stroma. Therefore, latanoprost therapy might have a more favourable effect on the outcome of glaucoma filtering surgery.
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Affiliation(s)
- N Terai
- Department of Ophthalmology, Carl Gustav Carus University Hospital, Fetscherstrasse 74, Dresden, Germany.
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Roedl JB, Bleich S, Schlötzer-Schrehardt U, von Ahsen N, Kornhuber J, Naumann GOH, Kruse FE, Jünemann AGM. Increased homocysteine levels in tear fluid of patients with primary open-angle glaucoma. Ophthalmic Res 2008; 40:249-56. [PMID: 18437035 DOI: 10.1159/000127832] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Indexed: 11/19/2022]
Abstract
AIMS We assessed homocysteine (Hcy) levels in tear fluid and plasma of patients with primary open-angle glaucoma (POAG). We determined the association between Hcy levels, dry eye syndrome and B vitamin status. METHODS This prospective case-control study included 36 patients with POAG and 36 controls. Hcy concentrations were measured by high-performance liquid chromatography. RESULTS Patients with POAG had significantly higher mean Hcy levels both in tear fluid (205 +/- 84 nmol/l; p < 0.001, t test) and in plasma (13.43 +/- 3.53 micromol/l; p = 0.001, t test) than control subjects (130 +/- 53 nmol/l and 10.50 +/- 3.33 micromol/l, respectively). Hcy in tear fluid was significantly correlated with plasma Hcy in POAG patients (r = 0.459; p = 0.005, Pearson's correlation), but not in controls (r = 0.068; p = 0.695). POAG patients with dry eye disease had significantly higher Hcy levels both in tear fluid and plasma than POAG patients without dry eye disease. There was no association between Hcy levels and B vitamin status in subjects with POAG. CONCLUSIONS The study suggests increased Hcy levels in tear fluid and plasma of patients with POAG. Elevated Hcy levels might be a risk factor for POAG and dry eye syndrome in subjects with glaucoma.
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Affiliation(s)
- J B Roedl
- Department of Ophthalmology, University Eye Hospital, Erlangen-Nuremberg, Germany.
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Schlötzer-Schrehardt U, Dietrich T, Saito K, Sorokin L, Sasaki T, Paulsson M, Kruse FE. Characterization of extracellular matrix components in the limbal epithelial stem cell compartment. Exp Eye Res 2007; 85:845-60. [PMID: 17927980 DOI: 10.1016/j.exer.2007.08.020] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 08/22/2007] [Accepted: 08/23/2007] [Indexed: 12/13/2022]
Abstract
A specialized microenvironment or niche, which regulates maintenance, self-renewal, activation, and proliferation of stem cells by external signals, is one of the key prerequisites for stem cell function. However, the parameters determining the limbal stem cell niche are not yet defined. In order to characterize the role of basement membrane (BM) and extracellular matrix components in the generation of a microenvironmental niche for limbal stem and progenitor cells, we extensively analyzed the topographical variations of the BM zone of human ocular surface epithelia using immunohistochemistry and a large panel of antibodies to most of the presently described intrinsic and associated BM components. Apart from BM components uniformly expressed throughout all ocular surface epithelia (e.g. type IV collagen alpha5 and alpha6 chains, collagen types VII, XV, XVII, and XVIII, laminin-111, laminin-332, laminin chains alpha3, beta3,and gamma2, fibronectin, matrilin-2 and -4, and perlecan), the BM of the limbal epithelium shared many similarities with that of the conjunctival epithelium, including positive labelling for type IV collagen alpha1 and alpha2 chains, laminin alpha5, beta2, and gamma1 chains, nidogen-1 and -2, and thrombospondin-4, whereas type IV collagen alpha3, type V collagen, fibrillin-1 and -2, thrombospondin-1, and endostatin were present in the corneal BM, but lacking or more weakly expressed in the limbal and conjunctival BMs. As compared to both the corneal and conjunctival BMs, the limbal BM showed a markedly increased immunoreactivity for laminin alpha1, alpha2, beta1 chains, and agrin, and a specific but patchy immunoreactivity for laminin gamma3 chain, BM40/SPARC, and tenascin-C, which co-localized with ABCG2/p63/K19-positive and K3/Cx43/desmoglein/integrin-alpha2-negative cell clusters comprising putative stem and early progenitor cells in the basal epithelium of the limbal palisades. Components that were particularly expressed in the corneal-limbal transition zone included type XVI collagen, fibulin-2, tenascin-C/R, vitronectin, bamacan, chondroitin sulfate, and versican, all of which co-localized with vimentin-positive cell clusters comprising putative late progenitor cells in the basal epithelium. This pronounced heterogeneity of the BM in the limbal area, both in the region of limbal palisades and the corneal-limbal transition zone, appears to be involved in providing unique microenvironments for corneal epithelial stem and late progenitor cells. Identification of specific niche parameters might not only help to understand limbal stem cell regulation, but also to improve their selective enrichment and in vitro expansion for therapeutic strategies.
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Affiliation(s)
- U Schlötzer-Schrehardt
- Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
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Hirschfeld K, Viestenz A, Meltendorf S, Schlötzer-Schrehardt U, Evert M, Dombrowski F, Behrens-Baumann W. [Unilateral granulomatous keratoconjunctivitis]. Ophthalmologe 2007; 104:1068-70. [PMID: 17453218 DOI: 10.1007/s00347-007-1521-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Hirschfeld
- Augenklinik mit Poliklinik, Otto-von-Guericke-Universität, Magdeburg
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Roedl JB, Bleich S, Reulbach U, Rejdak R, Naumann GOH, Kruse FE, Schlötzer-Schrehardt U, Kornhuber J, Jünemann AGM. Vitamin deficiency and hyperhomocysteinemia in pseudoexfoliation glaucoma. J Neural Transm (Vienna) 2007; 114:571-5. [PMID: 17238009 DOI: 10.1007/s00702-006-0598-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [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: 06/02/2006] [Accepted: 10/28/2006] [Indexed: 01/18/2023]
Abstract
Pseudoexfoliation syndrome (PEX) is a systemic disorder characterized by the deposition of an abnormal fibrillar material in ocular and various extraocular tissues. It represents the most common identifiable cause of glaucoma (PEX glaucoma = PEXG). Due to similar pathogenetic mechanisms, glaucoma has been called "ocular Alzheimer's disease". PEXG and Alzheimer's disease share common associations such as the higher prevalence of hyperhomocysteinemia in both disorders. In order to investigate the cause of hyperhomocysteinemia in PEXG, we evaluated B-vitamin levels (folate, B12, B6) and their associations with homocysteine (Hcy) in plasma of 70 PEXG patients and 70 control subjects. Folate, vitamin B12 and B6 levels were significantly decreased and associated with elevated Hcy levels in PEXG. Low B-vitamin levels in PEX might also help explain, at least in part, the higher prevalence of B-vitamin deficiency in disorders associated with PEX such as Alzhemier's disease.
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Affiliation(s)
- J B Roedl
- Department of Ophthalmology and University Eye Hospital, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany.
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Schlötzer-Schrehardt U. Limbale Stammzellen: Grundlagen und Therapieansätze. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-992949] [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: 10/21/2022]
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23
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Viestenz A, Hirschfeld K, Meltendorf S, Evert M, Schlötzer-Schrehardt U, Behrens-Baumann W. Einseitige granulomatöse Keratokonjunktivitis – Symptom einer Ophthalmia nodosa. Klin Monbl Augenheilkd 2007. [DOI: 10.1055/s-2007-984631] [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: 10/21/2022]
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24
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Roedl JB, Bleich S, Reulbach U, von Ahsen N, Schlötzer-Schrehardt U, Rejdak R, Naumann GOH, Kruse FE, Kornhuber J, Jünemann AGM. Homocysteine levels in aqueous humor and plasma of patients with primary open-angle glaucoma. J Neural Transm (Vienna) 2006; 114:445-50. [PMID: 16932990 DOI: 10.1007/s00702-006-0556-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [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: 04/02/2006] [Accepted: 07/06/2006] [Indexed: 11/29/2022]
Abstract
We determined homocysteine (Hcy) levels in aqueous humor (AH) and plasma and their association with B-vitamin levels in patients with primary open-angle glaucoma (POAG) and controls. Both AH Hcy and plasma Hcy levels were significantly increased in POAG, and elevation of AH Hcy and plasma Hcy was a significant risk factor for POAG. In contrast to controls, neither plasma nor AH Hcy of POAG patients demonstrated a significant association with important non-genetic determinants of elevated Hcy such as low B-vitamin levels, increasing age and caffeine consumption. Considering that Hcy is a neurotoxin that induces apoptotic retinal ganglion cell death via stimulation of the N-methyl-D-asparate (NMDA) receptor, increased Hcy concentrations in AH and plasma might contribute to the optic nerve damage in POAG.
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Affiliation(s)
- J B Roedl
- Department of Ophthalmology and University Eye Hospital, Friedrich-Alexander-University, Erlangen-Nuremberg, Germany
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Schlötzer-Schrehardt U, Zenkel M, Hofmann-Rummelt C, Kruse FE, Naumann GO. [Functional significance of adenosine receptors in the eye and their dysregulation in pseudoexfoliation syndrome]. Ophthalmologe 2006; 102:1074-80, 1082. [PMID: 15830199 DOI: 10.1007/s00347-005-1216-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adenosine regulates many physiologic processes, such as aqueous humor secretion and intraocular pressure, via activation of its receptors. We investigated the expression of the receptor isoforms in eyes with PEX syndrome, which is associated with anterior chamber hypoxia and elevated intraocular pressure. MATERIALS AND METHODS The mRNA and protein expression of the adenosine receptor subtypes in anterior segment tissues of patients with PEX syndrome, glaucomas, and normal control eyes were analyzed comparatively. RESULTS Whereas the receptor subtypes A1, A2a, and A2b displayed no differential expression between PEX and control tissues, expression of the A3 adenosine receptor was consistently enhanced in the nonpigmented ciliary epithelium of all PEX eyes, independent of the presence of glaucoma, compared to normal and glaucomatous control eyes. CONCLUSION Considering the known role of the A3 adenosine receptor in modulating aqueous humor secretion, its selective upregulation in the ciliary epithelium may confer cytoprotection and be accessible to therapeutic intervention in PEX patients.
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Seitz B, Cursiefen C, Hofmann-Rummelt C, Schlötzer-Schrehardt U, Kruse FE. Wann Amnion – Wann Keratoplastik? Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-922292] [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: 10/19/2022]
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27
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Dietrich T, Kottler UB, Blüthner K, Schlötzer-Schrehardt U, Kruse FE. Wirkung von destilliertem Wasser auf kultivierte Linsenepithelzellen. Rückschlüsse von der Zellkultur auf die intraoperative Anwendung. Klin Monbl Augenheilkd 2005. [DOI: 10.1055/s-2005-863965] [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: 10/19/2022]
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Abstract
PURPOSE The purpose of this study was to evaluate the impact of photodynamic therapy (PDT) on the regulation of angiogenic factors such as vascular endothelial growth factor (VEGF) and pigment epithelium derived factor (PEDF) in human eyes. METHODS Eyes of patients with untreatable malignancy served as the study eyes (n = 2), age-matched donor eyes were used as controls (n = 2). Standard Verteporfin-PDT was applied to intact areas of the posterior pole. One week after PDT the eyes were examined by ophthalmoscopy as well as fluorescein (FA) and indocyanine green angiography (ICGA). After enucleation the eyes were processed for LM/EM histology. Immunolabeling using specific antibodies against VEGF and PEDF was performed in PDT-treated areas, untreated collateral areas of study eyes and untreated areas of control eyes. RESULTS All PDT-treated areas demonstrated a typical choroidal hypofluorescence on FA/ICGA. In LM/EM histology a selective damage of choriocapillary endothelial cells was found. VEGF expression was localized only to choriocapillary endothelial cells and focally in larger choroidal vessels of PDT-treated areas. Untreated areas of study eyes and controls were VEGF-negative. PEDF staining was observed in retinas and RPE of all eyes, but only choroidal endothelial cells of PDT-treated areas showed a PEDF-positive reactivity. CONCLUSION PDT not only induces structural and angiographic, but also biological effects in human eyes. VEGF and PEDF expression can be documented in choroidal endothelial cells following PDT and could have an impact on the recovery process after treatment.
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Affiliation(s)
- M Rudolf
- Universitätsklinikum Schleswig-Holstein, Augenklinik Campus Kiel
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Affiliation(s)
- U B Kottler
- Augenklinik und Poliklinik der Universität Erlangen-Nürnberg, Erlangen.
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Nguyen NX, Lattermann V, Schlötzer-Schrehardt U, Seitz B. [Functional outcomes after penetrating keratoplasty in pseudoexfoliation syndrome (PEX)-keratopathy]. Klin Monbl Augenheilkd 2004; 221:819-24. [PMID: 15499516 DOI: 10.1055/s-2004-813705] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Keratopathy in pseudoexfoliation syndrome (PEX-keratopathy) is a particular form of corneal endothelial decompensation, which requires a penetrating keratoplasty (PK) for visual rehabilitation at advanced states. The aim of this study was to evaluate the functional outcome and the development of intraocular pressure (IOP) after PK in patients with PEX-keratopathy depending on the presence of pre-existing glaucoma. PATIENTS AND METHODS This retrospective study included 21 eyes of 21 patients (age 78.6 +/- 7.5 years) with a mean postoperative follow-up of 1.8 +/- 2.2 (median 2) years. The diagnosis of PEX-keratopathy was confirmed clinically as well as by electron microscopy. The recipient and donor trephinations were performed from the epithelial side using an 193 nm excimer laser (n = 11) or mechanically (n = 10). An iridotomy was performed routinely during PK. The postoperative treatment with topical steroid was standardized. RESULTS Preoperatively, a secondary open-angle glaucoma (SOAG) with optic nerve damage was diagnosed in 11 patients (52 %). Topical antiglaucomatous treatment was needed in 81 % of patients with SOAG. Six weeks postoperatively, patients with SOAG showed a higher prevalence of increased intraocular pressure (IOP) and/or antiglaucomatous treatment compared to patients without SOAG (45 % vs. 20 %). Most of the mild-early intraocular pressure elevations were controlled in both groups during the follow-up. From one year post-PK, there was an increased need for topical antiglaucomatous treatment in both patient groups. In all eyes the IOP was controlled by topical antiglaucomatous treatment. Preoperatively, visual acuity was comparable in patients with and without SOAG (0.06 +/- 0.09 vs. 0.08 +/- 0.1, p = 0.7), but increased significantly more in patients without SOAG (0.38 +/- 0.1, median 0.4) than in patients with SOAG (0.2 +/- 0.1, median 0.2; p = 0.01) after PK. Visual acuity remained stable in both groups throughout the follow-up period. During follow-up only one eye developed an episode of reversible endothelial graft rejection 18 months postoperatively. An irreversible graft failure was seen in none of the patients. CONCLUSION The functional outcome after PK in PEX-keratopathy seems to be strongly associated with pre-existing SOAG. Patients without SOAG may expect good visual rehabilitation without persistent postoperative IOP increases. However, patients should be followed-up for a prolonged period of time, because from 1 year following PK the need for topical antiglaucomatous treatment increased significantly.
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Affiliation(s)
- N X Nguyen
- Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Erlangen.
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Viestenz A, Martus P, Schlötzer-Schrehardt U, Langenbucher A, Mardin CY. Einfluss von ProstaglandinF2
α-Analoga und Karboanhydraseinhibitoren auf die zentrale Hornhautdicke - eine Querschnittsstudie an 403 Augen*. Klin Monbl Augenheilkd 2004; 221:753-6. [PMID: 15459842 DOI: 10.1055/s-2004-81361] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Histological changes of, in particular, collagen and extracellular matrix after administration of topical prostaglandin F(2alpha)(PGF (2alpha)) analogues have been reported. In view of this observation, we investigated the influence of PGF(2alpha) analogues on the central corneal thickness. PATIENTS AND METHODS In a non-randomized, controlled, cross-sectional study, 403 eyes from 208 consecutive patients were examined: 149 eyes (normals/controls) and 79 with ocular hypertension (OHT), 119 eyes with primary open angle glaucoma (POAG) and 56 eyes with normal tension glaucoma (NTG). One experienced ophthalmologist measured the central corneal thickness (CCT) using ultrasound pachymetry (Tomey AL-2000, sequence of 5 measurements with an SD < 3 microm). The central corneal power was measured with the Zeiss keratometer. Depending on the topical treatment, the patients were classified into 4 groups: A) PGF(2alpha) analogues (n = 78), B) carbonic anhydrase inhibitors (n = 26), C) combination of PGF (2)(alpha) analogues and carbonic anhydrase inhibitors (n = 41), D) none of these drugs (n = 258). T tests and multiple linear regression analyses were used for statistical analysis. RESULTS CCT was decreased significantly (p < 0.01 each) in eyes treated with PGF(2alpha) analogues (group A: 529 +/- 34 microM), in comparison with the untreated and non-glaucomatous eyes (part of group D: 542 +/- 35 microM, n = 148), untreated glaucomatous/OHT eyes (part of group D: 563 +/- 37 microM, n = 110), eyes treated with carbonic anhydrase inhibitors (group B: 561 +/- 32 microm) and eyes with a topical application of both PGF (2)(alpha) analogues and carbonic anhydrase inhibitors (group C: 555 +/- 48 microM. No correlation was found between CCT and diagnosis (OHT, POAG, NTG, control), gender, central corneal power, and intraocular pressure in a multivariate analysis. CONCLUSIONS The present findings suggest that the topical application of prostaglandin F(2alpha) analogues onto the cornea reduces the central corneal thickness significantly. These changes might be attributed to effects of PGF(2alpha) analogues on the extracellular matrix of the corneal stroma via upregulation of matrix metalloproteinases. In clinical practice, corneal thinning under local PGF (2)(alpha) analogue treatment could result in underestimation of intraocular pressure levels as measured by applanation tonometry.
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Affiliation(s)
- A Viestenz
- Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg.
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Koliakos GG, Konstas AGP, Schlötzer-Schrehardt U, Hollo G, Mitova D, Kovatchev D, Maloutas S, Georgiadis N. Endothelin-1 concentration is increased in the aqueous humour of patients with exfoliation syndrome. Br J Ophthalmol 2004; 88:523-7. [PMID: 15031170 PMCID: PMC1772069 DOI: 10.1136/bjo.2003.028290] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND /aim: Endothelin 1 (ET-1) is considered the most potent vasoconstrictor in the body and the eye. This molecule may play a significant role in the pathobiology of exfoliation syndrome (XFS), a disorder characterised by a progressive iris vasculopathy. The purpose of this study was to investigate the concentration of ET-1 in the aqueous humour of cataract patients with and without XFS. METHODS Aqueous humour samples were obtained from 25 consecutive eyes of 25 cataract patients with XFS and an equal number of age matched controls during phacoemulsification cataract surgery. None of the subjects had elevated intraocular pressure or glaucoma. ET-1 concentration in the aqueous was measured using a specific immunoassay with 100% immunoreactivity for ET-1. Total aqueous humour protein concentration was measured with a microplate Coomassie blue based method and was correlated with ET-1 concentration. RESULTS Mean ET-1 concentration in the XFS aqueous samples (4.6 (SD 2.3) pg/ml) was significantly higher than that measured in the age matched control samples (2.8 (SD 1.71) pg/ml); (p = 0.006). Although total protein concentration was significantly elevated in the XFS samples (0.380 (SD 0.159) v 0.279 (SD 0.144) mg/ml in the controls); (p = 0.023), no correlation was found between aqueous ET-1 and total protein concentration (p = 0.730). CONCLUSION The increased concentration of ET-1 in the aqueous humour of XFS patients suggests that ET-1 may play a role in the pathobiology of XFS.
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Affiliation(s)
- G G Koliakos
- Dept of Biological Chemistry, Aristotle University, Thessaloniki, Greece.
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Stojkovic M, Seitz B, Langenbucher A, Viestenz A, Viestenz A, Hofmann-Rummelt C, Schlötzer-Schrehardt U, Küchle M, Naumann GOH. Q-Switched Erbium:YAG Laser Corneal Trephination. Cornea 2004; 23:50-60. [PMID: 14701958 DOI: 10.1097/00003226-200401000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess stromal thermal damage and cut regularity induced by nonmechanical Q-switched Er:YAG laser corneal trephination for penetrating keratoplasty. METHODS Corneal trephination was performed in 80 enucleated porcine eyes by Q-switched (2.94-microm) Er:YAG laser, along with donor and recipient masks made of metal or ceramic. All combinations of 0.65- or 0.96-mm spot diameter and 45- or 50-mJ/pulse energy setting were used with each of the masks at a 5-Hz repetition rate. Corneas were processed for histologic examinations. Stromal thermal damage was quantified on PAS-stained slides, and cut regularity was assessed semiquantitatively on a scale from 0 (regular) to 3 (highly irregular). Transmission electron microscopy and scanning electron microscopy were performed on selected specimens. RESULTS The least thermal damage (mean +/- SD = 6.2 +/- 0.7 microm) was found in the donor ceramic group with 50-mJ/pulse energy and 0.65-mm spot diameter, while the best regularity of the cut (1.2 +/- 0.4) was found in the donor ceramic group with 45-mJ pulse energy and 0.65-mm spot diameter. Thermal damage was less pronounced in donor than in recipient corneas (P < 0.01). Smaller spot diameter (0.65 mm) led to less thermal damage (P < 0.01) than the use of a 0.96-mm spot diameter. The differences in thermal damage between ceramic and metal masks were minimal. CONCLUSIONS After Q-switched Er:YAG laser corneal trephination for nonmechanical penetrating keratoplasty, reproducible high cut regularity and low concomitant thermal damage were observed. This is an encouraging finding in the search for a nonmechanical trephine for penetrating keratoplasty combining high precision and low cost.
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Affiliation(s)
- M Stojkovic
- Department of Ophthalmology, Friedrich Alexander University University of Erlangen-Nurnberg, Schwabachanlage 6, D-91054 Erlangen, Germany
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Koliakos GG, Konstas AGP, Schlötzer-Schrehardt U, Hollo G, Katsimbris IE, Georgiadis N, Ritch R. 8-Isoprostaglandin F2a and ascorbic acid concentration in the aqueous humour of patients with exfoliation syndrome. Br J Ophthalmol 2003; 87:353-6. [PMID: 12598453 PMCID: PMC1771526 DOI: 10.1136/bjo.87.3.353] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS The authors investigated the concentrations of 8-isoprostaglandin F(2a), a marker of oxidative stress in vivo, and ascorbic acid, a protectant against oxidative damage, in the aqueous humour of patients with exfoliation syndrome (XFS) and cataract and compared the results with those in age matched patients with cataract, but without XFS, to determine whether XFS is associated with increased oxidative stress. METHODS Aqueous humour was aspirated at the beginning of phacoemulsification cataract surgery from 27 eyes of 27 cataract patients with XFS and 27 eyes of 27 age matched cataract patients without XFS. 8-Isoprostaglandin F(2a)concentration in the aqueous was determined with a commercial immunoassay; ascorbic acid concentration was measured with a microplate assay method. RESULTS The mean concentration of 8-isoprostaglandin F(2a)in the aqueous from patients with XFS (2429 (SD 2940) pg/ml; range 400-10500 pg/ml) was significantly higher than that measured in the aqueous of age matched control patients (529.1 (226.8) pg/ml; range 325-1000 pg/ml); (p = 0.0028). Furthermore, mean ascorbic acid concentration in XFS patients (0.75 (0.39) mM; range 0.28-1.70 mM) was significantly lower than that found in control patients (1.19 (0.47) mM; range 0.53-2.4 mM); (p = 0.0005). There was a reverse correlation between 8-isoprostaglandin F(2a)and ascorbic acid concentration. CONCLUSION 8-Isoprostaglandin F(2a)was significantly increased in the aqueous of patients with XFS, and ascorbic acid was decreased, providing evidence of a role for free radical induced oxidative damage in the pathobiology of XFS.
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Affiliation(s)
- G G Koliakos
- Department of Biological Chemistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Cursiefen C, Hofmann-Rummelt C, Küchle M, Schlötzer-Schrehardt U. Pericyte recruitment in human corneal angiogenesis: an ultrastructural study with clinicopathological correlation. Br J Ophthalmol 2003; 87:101-6. [PMID: 12488272 PMCID: PMC1771468 DOI: 10.1136/bjo.87.1.101] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM During angiogenesis-that is, the outgrowth of new from pre-existing blood vessels, new capillaries undergo a period of "fine tuning" when vascular endothelial cells become apoptotic if sufficient supply of angiogenic factors is lacking. Morphologically, this period correlates with the absence of pericyte coverage of new vessels. Mature, pericyte covered vessels, in contrast, do not depend on elevated levels of angiogenic factors for survival. This study analyses whether, and if so when, pathological vessels in human corneal neovascularisation (CN) acquire pericyte coverage. This can be of importance for future angioregressive therapeutic strategies. METHODS Vascularised human corneas obtained by keratoplasty were evaluated by electron microscopy for pericyte coverage of new vessels. These data were correlated with the duration of CN (mean 73 (SD 95) (range 0.5-360) months; n = 15). CN was secondary to keratitis, transplant rejection, aniridia, or trauma. RESULTS Overall, 196 blood vessels were analysed ultrastructurally (72 (37%) capillaries, 122 (62%) venules, and two (1%) arterioles). Electron microscopically, 170 (87%) vessels were covered by pericytes and two (1%) in addition by smooth muscle cells. Pericyte recruitment increased with time, evolving between clinically noted onset of CN and keratoplasty. Already 2 weeks after onset of CN, more than 80% of new vessels were covered by pericytes. CONCLUSION Pathological new vessels in human corneal angiogenesis are rapidly covered by pericytes. Therapeutic strategies aimed at regression of immature, not yet pericyte covered vessels by antagonising angiogenic factors should thus be most effective if applied very early in the course of corneal neovascularisation.
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Affiliation(s)
- C Cursiefen
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Abstract
Secondary chronic open-angle glaucoma associated with pseudoexfoliation (PEX) syndrome accounts for approximately 25% of all glaucomas and represents the most common identifiable cause of glaucoma overall. The underlying disorder, PEX syndrome, is a generalized process of the extracellular matrix characterized by production and progressive accumulation of an abnormal extracellular material in many intra- and extraocular tissues. Recent data support the pathogenetic concept of PEX syndrome as a type of elastosis affecting particularly elastic microfibrils. Active involvement of the trabecular meshwork in this characteristic matrix process may lead to glaucoma development in 40-60% of the patients. In addition, PEX syndrome also represents an important risk factor for a broad spectrum of spontaneous or intra- and postoperative ocular complications as well as for systemic cardiovascular diseases. PEX-associated open-angle glaucoma represents a relatively severe and progressive type of glaucoma with a generally poor prognosis due to high intraocular pressure levels and fluctuations in the diurnal pressure curve. The primary cause of chronic pressure elevation appears to be local production of PEX material by trabecular meshwork cells and Schlemm's canal cells with subsequent degenerative changes of Schlemm's canal and juxtacanalicular tissues. Additional pathogenetic factors contributing to pressure increase include pronounced melanin dispersion, increased protein concentrations of the aqueous humor, vascular factors, and connective tissue alterations of the lamina cribrosa. Other types of glaucoma, such as acute open-angle glaucoma, provoked by melanin showers during diagnostic mydriasis, or secondary angle closure glaucoma due to pupillary or ciliary block, are also common in PEX patients. The pathogenetic factors TGF-beta1 and TIMP-1/2 appear to be causally involved in this fibrotic process and thus may represent potential targets for specific, rational therapeutic approaches.
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Aigner T, Hambach L, Söder S, Schlötzer-Schrehardt U, Pöschl E. The C5 domain of Col6A3 is cleaved off from the Col6 fibrils immediately after secretion. Biochem Biophys Res Commun 2002; 290:743-8. [PMID: 11785962 DOI: 10.1006/bbrc.2001.6227] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In articular cartilage, type VI collagen is concentrated in the pericellular matrix compartment. During protein synthesis and processing at least the alpha3(VI) chain undergoes significant posttranslational modification and cleavage. In this study, we investigated the processing of type VI collagen in articular cartilage. Immunostaining with a specific polyclonal antiserum against the C5 domain of alpha3(VI) showed strong cellular staining seen in nearly all chondrocytes of articular cartilage. Confocal laser-scanning microscopy and immunoelectron microscopy allowed localization of this staining mainly to the cytoplasm and the immediate pericellular matrix. Double-labeling experiments showed a narrow overlap of the C5 domain and the pericellular mature type VI collagen. Our results suggest that at least in human adult articular cartilage the C5 domain of alpha3(VI) collagen is synthesized and initially incorporated into the newly formed type VI collagen fibrils, but immediately after secretion is cut off and is not present in the mature pericellular type VI matrix of articular cartilage.
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Affiliation(s)
- T Aigner
- Cartilage Research Group, Department of Pathology, University of Erlangen-Nürnberg, Erlangen, Federal Republic of Germany.
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Schlötzer-Schrehardt U, Zenkel M, Küchle M, Sakai LY, Naumann GO. Role of transforming growth factor-beta1 and its latent form binding protein in pseudoexfoliation syndrome. Exp Eye Res 2001; 73:765-80. [PMID: 11846508 DOI: 10.1006/exer.2001.1084] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pseudoexfoliation (PEX) syndrome is a common and clinically important systemic condition characterized by the pathologic production and accumulation of an abnormal fibrillar extracellular material in many intra- and extraocular tissues. Recent evidence suggests that it is a type of elastosis associated with the excess synthesis of elastic microfibrillar components such as fibrillin-1. Since transforming growth factor (TGF)-beta is a major modulator of extracellular matrix formation, the potential involvement of TGF-beta and its latent form binding protein (LTBP) in this aberrant matrix process was investigated. The expression of various isoforms of TGF-beta and LTBP was investigated in the anterior segment tissues of PEX and control eyes on the protein and mRNA level by light and electron microscopic immunohistochemistry, in situ hybridization, and semiquantitative RT-PCR. TGF-beta1 and TGF-beta2 levels were measured in aqueous humor and serum of PEX and control patients by ELISA. Cultures of Tenon's capsule fibroblasts were established to study the effect of TGF-beta1 on fibrillin-1 mRNA expression by Northern blot analysis. Significantly increased concentrations of both total and active TGF-beta1 were measured in the aqueous humor of PEX eyes without and with glaucoma as compared to control eyes, whereas levels of TGF-beta2 were not significantly different. The expression of TGF-beta1, LTBP-1, and LTBP-2, but not TGF-beta2, was markedly increased in anterior segment tissues of PEX eyes, particularly in the non-pigmented epithelium of the ciliary body, on both the mRNA and the protein level. Latent TGF-beta1 staining was consistently associated with PEX material deposits and could be released by proteolytic processing. Double immunolabeling revealed clear co-localization of LTBP-1 and -2 with latent TGF-beta1 and with fibrillin-1 on PEX fibrils. The expression of mRNA coding for fibrillin-1 was up-regulated in vitro by TGF-beta1. This study provides evidence for a significant role of TGF-beta1 and the LTBPs 1 and 2 in PEX syndrome. The results suggest that increased levels of latent and active TGF-beta1 in the aqueous humor of PEX patients, derived from enhanced local synthesis and activation, promote the buildup of the abnormal extracellular elastic material characteristic of PEX syndrome. They further support a dual role for LTBPs, both as integral structural components of PEX fibers and as a means of matrix anchorage of latent TGF-beta1, representing one possible mechanism for the regulation of TGF-beta1 activity in PEX eyes. Future therapeutic strategies might focus on TGF-beta1 antagonistic approaches.
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Cursiefen C, Hofmann-Rummelt C, Schlötzer-Schrehardt U, Fischer DC, Haubeck HD, Küchle M, Naumann GO. Immunohistochemical classification of primary and recurrent macular corneal dystrophy in Germany: subclassification of immunophenotype I A using a novel keratan sulfate antibody. Exp Eye Res 2001; 73:593-600. [PMID: 11747360 DOI: 10.1006/exer.2001.1080] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Macular corneal dystrophy (MCD) is an autosomal recessive disease characterized by abnormal deposition of glycosaminoglycans in corneal stroma, keratocytes, Descemet's membrane and corneal endothelium. According to the presence and distribution of sulfated keratan sulfate (KS)-epitopes in serum and cornea (using mAb 5-D-4), MCD can be classified into three immunophenotypes: type I, I A and II. The purpose of this study is to evaluate the immunophenotype of primary and recurrent MCD and to analyze the reactions of a novel KS-antibody in MCD corneas, which recognizes an epitope localized in the binding region of KS-chains to the core protein (mAb 3D12/H7). Indirect immunohistochemistry for KS (mAbs 3D12/H7 and 5-D-4) was performed on 44 corneas of 37 patients with MCD including two recurrences. Immunogold labeling was used to localize KS ultrastructurally within keratocytes. The serum concentration of KS (cKS) was determined in a serum antigen-inhibition assay. Immunohistochemically, no reaction was observed using mAb 5-D-4 in 18 corneas of 16 patients (43% of 37 patients; immunophenotype I). Positive reactions within single keratocytes but not in the stroma, were seen in 22 corneas of 17 patients (46% of 37 patients; immunophenotype I A) and positive reactions in keratocytes and extracellular stroma were found in four corneas of four patients (11% of 37 patients: immunophenotype II). For analysis of cKS a total of seven samples was available. Whereas in the samples of the five patients with immunophenotypes I and I A cKS was below the limit of detection, in the two sera from patients with immunophenotype II, cKS was normal (cKS = 1243 and 1380 nmol l(-1)). The two recurrences demonstrated immunophenotype II. Using mAb 3D12/H7, MCD immunophenotype I A can be further subclassified in type I A 1 (lacking reaction with mAb 3D12/H7 in keratocytes; 77%) and type I A 2 (positive reaction with mAb 3D12/H7 within keratocytes; 23%). MCD immunophenotype I A can not only be found in Saudi Arabia, but is as common as immunophenotype I in German patients. The only recurrences of MCD necessitating regrafting occurred in two patients with immunophenotype II possibly suggesting a higher risk for recurrence in this immunophenotype. The mAb 3D12/H7 allows a further subclassification of immunophenotype I A into type I A1 and 2. This points to a broader spectrum of MCD immunophenotypes and indirectly to a broader corneal proteoglycan pathology in MCD.
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Affiliation(s)
- C Cursiefen
- Department of Ophthalmology and University Eye Hospital, University of Erlangen-Nürnberg, Erlangen, Germany.
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Cursiefen C, Hammer T, Küchle M, Naumann GO, Schlötzer-Schrehardt U. Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion. A histopathologic and electron microscopic study. Acta Ophthalmol Scand 2001; 79:476-8. [PMID: 11594982 DOI: 10.1034/j.1600-0420.2001.790509.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To determine histopathologically the prevalence of pseudoexfoliation (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to evaluate eyes with PEX material in the anterior segment and CRVO ultrastructurally for PEX deposits in the vicinity of central retinal vessels. These deposits could explain an association of CRVO and PEX. METHODS All surgically enucleated eyes with secondary angle closure glaucoma due to rubeotic iris secondary to ischemic CRVO (1981-1998) available were re-analyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9+/-8.5 years [range: 51-91]). Eyes with PEX in the anterior segment and available optic nerve cross sections were examined by electron microscopy for PEX material in the retrolaminar (n=7) and intralaminar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981-1998) with sections available served as age-matched controls (n=107; 76.4+/-5 years [range: 70-91]). RESULTS PEX material was present light microscopically in the anterior segment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age-matched eyes with choroidal malignant melanoma (1.9%; p<0.05). Electron microscopically, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra- and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment and CRVO analyzed. CONCLUSIONS Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intraocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small number of optic nerves analyzed here, there seems to be no morphologically evident PEX vasculopathy in the central retinal vessels both within and immediately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.
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Affiliation(s)
- C Cursiefen
- Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
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Mardin CY, Schlötzer-Schrehardt U, Naumann GO. "Masked" pseudoexfoliation syndrome in unoperated eyes with circular posterior synechiae: clinical-electron microscopic correlation. Arch Ophthalmol 2001; 119:1500-3. [PMID: 11594951 DOI: 10.1001/archopht.119.10.1500] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the prevalence of "masked" pseudoexfoliation (PEX) syndrome in eyes with circular posterior synechiae receiving antiglaucomatous therapy with miotics. DESIGN Cross-sectional prospective study. METHODS Twenty-eight eyes of 27 consecutive patients with circular posterior synechiae and a history of miotic drug use without previous intraocular surgery, inflammation, or trauma, and without conventional signs of PEX material in the anterior chamber were included in the study. All eyes were investigated by slitlamp biomicroscopy and gonioscopy of the anterior chamber before extracapsular cataract surgery for the presence of typical PEX-associated iris pigment epithelial changes, such as peripupillary atrophy and trabecular meshwork melanin granule deposition. The anterior chamber depth, lens thickness, and axial lengths of the eyes were measured by A-scan immersion sonography. The excised anterior lens capsules obtained during extracapsular cataract surgery were investigated for the presence of precapsular fibrillar PEX deposits by electron microscopy. MAIN OUTCOME MEASURE The prevalence of masked PEX syndrome in eyes with circular posterior synechiae receiving antiglaucomatous therapy with miotics. RESULTS Transmission electron microscopy of unselected nonserial sections revealed a precapsular layer consisting of typical PEX fibers or microfibrils, which indicated early stages of PEX syndrome in 18 (64%) of 28 eyes with circular posterior synechiae. Melanin granules were frequently found adhering to the fibrillar layer. Eyes with precapsular fibrillar deposits showed significantly greater trabecular meshwork pigmentation than eyes without such deposits. Differences in age, lens thickness, axial length of the eye, anterior chamber depth, and degree of peripupillary atrophy were, however, not statistically significant between the groups with and without electron microscopic evidence of PEX deposits. CONCLUSIONS Circular posterior synechiae were more frequently associated with manifest or early stages of PEX syndrome. However, the formation of broad posterior synechiae in miosis prevented a definite clinical diagnosis based on the classic changes of the anterior lens capsule. In eyes with spontaneous or miotic-induced circular posterior synechiae without other obvious cause, the masked variant of PEX syndrome should always be considered.
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Affiliation(s)
- C Y Mardin
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
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Maihöfner C, Schlötzer-Schrehardt U, Gühring H, Zeilhofer HU, Naumann GO, Pahl A, Mardin C, Tamm ER, Brune K. Expression of cyclooxygenase-1 and -2 in normal and glaucomatous human eyes. Invest Ophthalmol Vis Sci 2001; 42:2616-24. [PMID: 11581208] [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: 02/21/2023] Open
Abstract
PURPOSE Primary open-angle glaucoma (POAG) is the predominant form of chronic glaucoma, but the underlying pathologic mechanisms are largely unknown. Because prostaglandins (PGs) have been introduced into POAG treatment with remarkable success, this study was undertaken to investigate whether a change in the expression of the PG-synthesizing enzymes cyclooxygenase (COX)-1 and -2 might be involved in the pathogenesis of POAG. METHODS Expression of COX-1 and -2 was assessed by confocal laser microscopy, immunohistochemistry, Western blot analysis, and real-time RT-PCR in human eyes with different forms of glaucoma (primary open-angle, angle-closure, congenital juvenile, and steroid-induced), as well as in age-matched control eyes. Additionally, PGE2 was measured in aqueous humor by means of an enzyme-linked immunoassay as a product of COX activity. RESULTS In normal eyes, ocular COX-1 and -2 expression were largely confined to the nonpigmented secretory epithelium of the ciliary body. By immunohistochemistry and real-time RT-PCR, COX-2 expression was completely lost in the nonpigmented secretory epithelium of the ciliary body of eyes with end-stage POAG, whereas COX-1 expression was unchanged. By immunohistochemistry, in the ciliary bodies of eyes in five patients with diagnosis of early POAG, eyes in two had complete loss of COX-2 expression and in three showed only a few remaining scattered COX-2-expressing cells. COX-2 expression in the ciliary body was also lost in patients with steroid-induced glaucoma and was reduced in patients receiving topical steroid treatment. Eyes of patients with either congenital juvenile or angle-closure glaucoma showed COX-2 expression indistinguishable from control eyes. Aqueous humor of eyes with POAG contained significantly less PGE2 than control eyes. CONCLUSIONS Both cyclooxygenase isoforms are constitutively expressed in the normal human eye. Specific loss of COX-2 expression in the nonpigmented secretory epithelium of the ciliary body appears to be linked to the occurrence of POAG and steroid-induced glaucoma.
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Affiliation(s)
- C Maihöfner
- Department of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nürnberg, Germany
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Groh MJ, Schlötzer-Schrehardt U, Rummelt C, von Below H, Küchle M. [Postoperative opacification of 12 hydrogel foldable lenses (Hydroview(R))]. Klin Monbl Augenheilkd 2001; 218:645-8. [PMID: 11706379 DOI: 10.1055/s-2001-18385] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.
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Affiliation(s)
- M J Groh
- Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen.
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Berlau J, Lorenz P, Beck R, Makovitzky J, Schlötzer-Schrehardt U, Thiesen HJ, Guthoff R. Analysis of aqueous humour proteins of eyes with and without pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2001; 239:743-6. [PMID: 11760034 DOI: 10.1007/s004170100357] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED Pseudoexfoliation syndrome (PEX) has been suggested to represent a blood-aqueous barrier impairment leading to a higher protein content in aqueous humour of eyes with PEX. However, the nature of a prospective PEX protein has not yet been described. We set out to reevaluate protein content and examine protein composition for prospective PEX protein candidates in aqueous humour of eyes with PEX syndrome. Aqueous humour of 52 patients with PEX and 38 without PEX signs was sampled during cataract or glaucoma surgery. Total aqueous protein concentration in the samples was analysed in 43 PEX specimens and 32 non-PEX specimens according to Bradford. Aqueous protein composition of all samples was determined by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS PAGE) and silver staining. Screening for amyloids was performed in nine PEX samples and six non-PEX samples by Congo Red staining and polarised light microscopy. Aqueous protein concentration was not significantly increased in PEX eyes in comparison with non-PEX eyes. Furthermore, we could not detect any characteristic difference in protein band sizes of the two groups after SDS PAGE. However, we were able to show the presence of amyloid exclusively in aqueous humour of PEX patients. CONCLUSION our results do not confirm a generally higher protein concentration in pseudoexfoliation syndrome eyes. This does not necessarily contradict a blood-aqueous barrier impairment but illustrates the variance in protein concentration between and within the two groups. No characteristic protein band allocatable to pseudoexfoliation syndrome proteins could be detected in any of the samples. However, our findings support the theory that the pseudoexfoliation syndrome is associated with an amyloid of a serum protein.
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Affiliation(s)
- J Berlau
- Department of Ophthalmology, University of Rostock, Germany.
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Cursiefen C, Schlötzer-Schrehardt U, Breiteneder-Geleff S, Holbach LM. Orbital lymphangioma with positive immunohistochemistry of lymphatic endothelial markers (vascular endothelial growth factor receptor 3 and podoplanin). Graefes Arch Clin Exp Ophthalmol 2001; 239:628-32. [PMID: 11585321 DOI: 10.1007/s004170100325] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Existence of true orbital lymphangiomas has been questioned in recent years. Therefore an orbital lymphangioma was analyzed with two new specific markers of lymphatic endothelium. METHODS Case-report with clinicopathological, immunohistochemical, and ultrastructural findings. A 25-year-old man presented with recurrent lower lid "hematomas" and a pea-sized tumor palpable in the left lower lid. Magnetic resonance imaging showed an inferonasally located orbital tumor which extended to the posterior pole of the eye. The highly vascularized tumor was excised by medial orbitotomy. RESULTS Histopathologically, the mass consisted of large, erythrocyte-filled cavernous vessels without evidence of smooth muscle cells or pericytes surrounding them. Numerous lymph follicles and small arterioles were scattered between them. Immunohistochemically, endothelial cells lining the lumina of the cavernous vessels were partly positive for podoplanin and vascular endothelial growth factor receptor 3 (flt-4), two markers of lymphatic endothelium. These markers did not react with endothelial cells lining the arterioles. Ultrastructurally, cavernous vessels displayed features characteristic of lymphatic vessels, and the smaller vessels demonstrated signs of arterioles. CONCLUSION Ultrastructural analysis and immunohistochemistry using two new markers of lymphatic endothelium suggest a lymphatic nature of large vessels in an orbital lymphangioma. A greater series of vascular orbital tumors must be studied with these new lymph endothelial markers to confirm the existence of true orbital lymphangiomas and to analyze different profiles of lymph endothelial marker expression.
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Affiliation(s)
- C Cursiefen
- Department of Ophthalmology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany.
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Abstract
BACKGROUND Clinically, most patients with pseudoexfoliation (PEX) syndrome reveal only unilateral ocular involvement. However, the generalized nature of the disorder suggests that PEX syndrome is clinically asymmetric rather than strictly unilateral. OBJECTIVE To perform an ultrastructural study of the contralateral eyes in patients with unilateral PEX syndrome. METHODS Five pairs of donor eyes with slitlamp microscopic, macroscopic, and light microscopic evidence of unilateral PEX syndrome and 6 normal control eyes were investigated by transmission electron microscopy and light and electron microscopic immunohistochemistry using antibodies against the human natural killer (HNK-1) epitope and against latent transforming growth factor beta1-binding protein, both markers for the identification of PEX deposits. RESULTS Ultrastructural alterations were observed in anterior segment tissues of all apparently not involved fellow eyes. These included (1) deposits of typical PEX fibrils on the iris and ciliary epithelia and in the dilator muscle of the iris; (2) increased accumulation of extracellular matrix, including microfibrils and reduplicated basement membrane material in the periphery of iris vessels, in the dilator muscle and in the juxtacanalicular tissue of the trabecular meshwork; and (3) degenerative changes of the iris pigment epithelium and dilator muscle cells. Latent transforming growth factor beta1-binding protein- and HNK-1-positive deposits indicating PEX material accumulations were detected in the periphery of iris vessels and in the dilator muscle in all affected and contralateral eyes, but not in the control eyes. CONCLUSIONS These subclinical alterations of contralateral eyes in clinically so-called unilateral PEX syndrome support the concept that PEX syndrome is a generalized basically bilateral disorder with a clinically marked asymmetric manifestation. The iris changes may account for the clinical signs characteristic of early stages, such as melanin dispersion, peripupillary atrophy, trabecular meshwork pigmentation, and insufficient asymmetric mydriasis. The findings should be considered in the clinical management of the patients. CLINICAL RELEVANCE In view of the fact that PEX syndrome is the most common identifiable cause of open-angle glaucoma worldwide and as it is an important risk factor for a wide spectrum of ocular complications, particularly during cataract surgery, the potential involvement of both eyes in the PEX process is of clinical significance.
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Affiliation(s)
- T Hammer
- Universitätsklinik und Poliklinik für Augenheilkunde der Martin-Luther-Universität Halle-Wittenberg, Magdeburger Strasse 8, 06097 Halle/Saale, Germany.
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Abstract
PURPOSE To document the clinical and histopathologic corneal features of a patient who developed multifocal corneal argyrosis after a chemical explosion injury with unusual involvement of the corneal stroma and keratocytes. METHODS The corneal button was investigated by light and transmission electron microscopy and scanning electron microscopy combined with energy-dispersive x-ray microanalysis. RESULTS Clinically, the patient showed dark discoloration of the lids, periocular skin, episclera, and conjunctiva and had multiple brown dots in the superficial layers of the cornea. Microscopic examination of the cornea showed diffuse deposition of silver particles in the epithelial basement membrane, Bowman's layer, and Descemet's membrane. In the corneal stroma, silver granules accumulated intracellularly within lysosomal structures of degenerative keratocytes and extracellularly in association with collagen fibers and cellular debris. Energy-dispersive x-ray analysis showed peaks of silver and sulfur. CONCLUSION The toxic influence of intracellular accumulation of silver in stromal keratocytes may lead to cell damage and necrosis and result in visual impairment.
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Koliakos GG, Schlötzer-Schrehardt U, Konstas AG, Bufidis T, Georgiadis N, Dimitriadou A. Transforming and insulin-like growth factors in the aqueous humour of patients with exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2001; 239:482-7. [PMID: 11521691 DOI: 10.1007/s004170100287] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Growth factors circulating with the aqueous may play an important role in the pathogenesis of exfoliation syndrome (XFS), which is characterized by excessive synthesis and accumulation of abnormal extracellular material. METHODS We investigated the concentration of three ubiquitous growth factors (TGF-beta1, TGF-beta2 and IGF-1) in the aqueous humour of 50 patients with XFS (27 from Erlangen, 23 from Thessaloniki) and 54 age-matched controls (27 from Erlangen, 27 from Thessaloniki). This study was performed in two centres, independently of each other, using different assay systems. RESULTS In the aqueous humour samples collected in Erlangen, both the levels of total TGF-beta1 (P<0.001) and mature TGF-beta1 (P<0.05) were significantly increased in XFS patients compared with controls. Specifically, for total TGF-beta1 patients with XFS exhibited higher a mean value (90.5 +/- 37.4 pg/ml) than controls (30.2 +/- 8.3 pg/ml). The mean level of mature TGF-beta1 was also higher in XFS (14.2 +/- 2.8 pg/ml) than in controls (4.9 +/- 5.5 pg/ml). No difference was found between XFS and controls in the levels of total or mature TGF beta2 in the aqueous or in the level of these two growth factors in the serum. In aqueous humour samples collected in Thessaloniki a significant difference between XFS and controls was also observed for mature TGF-beta1 (XFS 17.06 +/- 11.02 pg/ml vs controls 9.01 +/- 5.69 pg/ml; P=0.006). No difference was observed in TGF-beta2 concentration or IGF-1 concentration in the aqueous. No correlation could be established between protein concentration and the levels of the three growth factors measured. A significant correlation was found between age and protein concentration in XFS, but not in the controls. CONCLUSION Since TGF-beta1 induces the synthesis and accumulation of extracellular matrix, it is hypothesized that TGF-beta1 plays an important role in the pathogenesis of XFS. Our data suggest that the increased levels of TGF-beta1 are most likely due to enhanced local synthesis.
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Affiliation(s)
- G G Koliakos
- Department of Biological Chemistry, Medical School, Aristotle University of Thessaloniki, Greece.
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Ritch R, Schlötzer-Schrehardt U. Exfoliation (pseudoexfoliation) syndrome: toward a new understanding. Proceedings of the First International Think Tank. Acta Ophthalmol Scand 2001; 79:213-7. [PMID: 11284770 DOI: 10.1034/j.1600-0420.2001.079002213.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Exfoliation (pseudoexfoliation; PEX) syndrome is the single most common identifiable cause of open-angle glaucoma, however, very few investigators are engaged in basic research on this disease. To stimulate the field, the First International Think Tank on Exfoliation Syndrome was held in New York in July 1999, comprising clinicians and scientists. This report is a summary of the proceedings of this meeting.
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Affiliation(s)
- R Ritch
- The Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, NY 10003, USA.
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Budde M, Schlötzer-Schrehardt U, Hofmann-Rummelt C, Holbach LM. [Conjunctival balloon cell nevi--light- and electronmicroscopic findings in 2 patients]. Klin Monbl Augenheilkd 2001; 218:269-72. [PMID: 11392273 DOI: 10.1055/s-2001-14924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
CASE REPORTS Two 19-year-old patients presented with small nasal conjunctival tumors. Histologic examination revealed subepithelial tumors consisting of large cells with deeply basophilic, small, centrally-placed nuclei and abundant, slightly eosinophilic cytoplasm with microvesicles. Electron microscopy showed premelanosomes in some of the balloon cells. CONCLUSION The balloon cell nevus is a rare variant of the conjunctival nevi. The characteristic intracellular microvesicles are probably degenerative remnants of premelanosomes.
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Affiliation(s)
- M Budde
- Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen
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