Matthias C Grieshaber

Universitätsspital Basel, Bâle, Basel-City, Switzerland

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Publications (39)77 Total impact

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    ABSTRACT: PurposeTo study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations.MethodsA total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications.ResultsThe mean IOP before surgery was 42.6 ± 14.2 mmHg for all patients, 29.6 ± 6.6 mmHg for European patients and 48.1 ± 12.9 mmHg for African patients. The follow-up time was 86.2 ± 43.1 months. Mean IOP was 15.4 ± 3.6 mmHg at 5 years, 15.5 ± 4.4 mmHg at 10 years and 16.8 ± 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88–0.96], 70% (95% CI 0.63–0.77) and 43% (95% CI 0.36–0.51) in European patients, and 90% (95% CI 0.87–0.93), 77% (95% CI 0.74–0.81) and 67% (95% CI 0.63–0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 ± 1.9 mmHg to 15.0 ± 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis.Conclusion Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years.
    Acta ophthalmologica 09/2014; · 2.44 Impact Factor
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    Lívia M Brandão, Matthias C Grieshaber
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    ABSTRACT: Traditional glaucoma surgery has been challenged by the advent of innovative techniques and new implants in the past few years. There is an increasing demand for safer glaucoma surgery offering patients a timely surgical solution in reducing intraocular pressure (IOP) and improving their quality of life. The new procedures and devices aim to lower IOP with a higher safety profile than fistulating surgery (trabeculectomy/drainage tubes) and are collectively termed "minimally invasive glaucoma surgery (MIGS)." The main advantage of MIGS is that they are nonpenetrating and/or bleb-independent procedures, thus avoiding the major complications of fistulating surgery related to blebs and hypotony. In this review, the clinical results of the latest techniques and devices are presented by their approach, ab interno (trabeculotomy, excimer laser trabeculotomy, trabecular microbypass, suprachoroidal shunt, and intracanalicular scaffold) and ab externo (canaloplasty, Stegmann Canal Expander, suprachoroidal Gold microshunt). The drawback of MIGS is that some of these procedures produce a limited IOP reduction compared to trabeculectomy. Currently, MIGS is performed in glaucoma patients with early to moderate disease and preferably in combination with cataract surgery.
    Journal of Ophthalmology 01/2013; 2013:705915. · 1.37 Impact Factor
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    ABSTRACT: Activated retinal astrocytes and Müller cells (ARAM) have been found in glaucoma patients. This study investigated whether presumed ARAM can be detected by optical coherence tomography (OCT), and assessed their relationship to the retinal nerve fiber layer (RNFL) thickness. Single-center observational study involving 35 age-matched healthy controls and 19 patients with primary open-angle glaucoma (POAG) between 45 - 82 years of age. Presumed ARAM was defined as patchy, discrete glittering but transparent changes of the macula. The retina was documented by red-free photography to assess distribution of ARAM, and compared to the RNFL thickness measured around the fovea by OCT. A linear mixed effects model was used to detect a difference between eyes with ARAM versus eyes without ARAM. ARAM was not found in healthy subjects. The mean RNFL around the fovea was not significantly thicker in healthy controls (34.01 SD ± 22.24) than in POAG patients with ARAM (30.86 microns SD ± 15.09; p = 0.36) or without ARAM (33.19 microns SD ± 19.87; p = 0.46). Furthermore, the median RNFL thickness was similar to the control group (29 microns) but slightly thinner in POAG patients (each 27 microns with ARAM and without ARAM). In a subgroup analysis of POAG patients with ARAM, the within subject standard deviation of RNFL was significantly lower in areas with ARAM (SD 10.12) than in areas without ARAM (SD 17.30) (p < 0.001). Although the mean and median RNFL thickness was comparable between the groups, the variability of the RNFL thickness was significantly lower in areas with ARAM than in areas without ARAM suggesting that ARAM may mask RNFL loss in POAG patients.
    Klinische Monatsblätter für Augenheilkunde 04/2012; 229(4):314-8. · 0.70 Impact Factor
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    ABSTRACT: Substantial evidence suggests that ocular perfusion is regulated by nitric oxide (NO), and polymorphisms in genes encoding for enzymes involved in NO formation and degradation (endothelial nitric oxide synthase [NOS3] and cytochrome b-235 alpha polypeptide gene [CYBA]) might contribute to vascular dysregulation observed in glaucoma. We therefore assessed the association of glaucoma with polymorphisms of NOS3 and CYBA previously associated with cardiovascular disease. We also compared the distribution of these polymorphisms in patients with high tension glaucoma (HTG) and normal tension glaucoma (NTG) and evaluated its association with vascular dysregulation in a subset of glaucoma patients. Three hundred Caucasian patients with HTG and 127 with NTG were enrolled in the study and genotyped for G894T (rs1799983) and T-786C (rs2070744) in NOS3 and C242T (rs4673) in CYBA. None of these polymorphisms had a different allele or genotype distribution between HTG and NTG patients nor had the presence of vasospasms any impact. We studied the frequencies of a set of relevant polymorphisms of the NO system in a large cohort of glaucoma patients and found no association. These results therefore suggest the absence of a relevant relationship with different glaucoma forms in Caucasians.
    Molecular vision 01/2012; 18:2174-81. · 1.99 Impact Factor
  • Matthias C Grieshaber
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    ABSTRACT: Ab externo Schlemm's canal (SC) surgery (e.g. viscocanalostomy and canaloplasty) is a valuable alternative to glaucoma filtration surgery. It targets the abnormally high resistance to outflow in the trabecular meshwork and reestablishes the physiologic outflow system. In viscocanalostomy, viscoelastic substance is injected to dilate SC which in turn leads to microdisruptions of the inner wall. In canaloplasty, the additional intracanalicular suture stent keeps the canal patent and enhances the circumferential flow. A prerequisite for these procedures to work is the integrity of the distal outflow system, which can be evaluated by two clinical tests before surgery: provocative gonioscopy with blood reflux and fluorescein channelography. Ab externo SC surgery is suitable for open-angle glaucoma, but also for angle closure glaucoma in combination with cataract extraction. IOP reduction to the mid-teens for viscocanalostomy, and to the lower teens for canaloplasty can be expected. The majority of complications seen in filtering surgery are largely eliminated by the nonpenetrating and bleb-independent approach. Postoperative care is minimal as no bleb management like needling is required, and hypotony-related complications are largely avoided by the intrinsic resistance of the physiologic outflow system. For its efficacy and high safety profile, ab externo SC surgery will continue to play an increasing role and will change the current concept of glaucoma surgery towards earlier intervention. Surgeons will be well advised to implement these antimetabolite-free procedures into their armamentarium to meet the expectations of the demanding glaucoma patient.
    Developments in ophthalmology 01/2012; 50:109-24.
  • Matthias C Grieshaber, Andreas Schoetzau, Josef Flammer, Selim Orgül
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    ABSTRACT: Purpose:  To assess risk factors for failure in canaloplasty. Methods:  Nonrandomized prospective study involving 51 eyes of 51 patients with medically uncontrolled primary open-angle glaucoma undergoing canaloplasty. Visual acuity, intraocular pressure (IOP) and slit-lamp examinations were performed before and after surgery at 1 and 7 days, and at 1 month and every 3 months thereafter. Factors like age, gender, preoperative IOP and microhyphema on day 1 were evaluated. Results:  The mean follow-up was 20.6 (SD 8.3) months. The mean preoperative IOP was 26.8 (SD 5.2) mmHg; the mean postoperative IOP was 8.4 (4.2) mmHg at day 1 and 12.7 (1.7) mmHg at month 24. Microhyphema was found in 40 patients (85.1%) on day 1 after surgery. The height of microhyphema was 1.8 mm ± 0.4 (SD) (range 1-2.5), and the time of resorption was 6.6 days ± 2.8 (SD) (range 3-14) on average. No recurrence of hyphema has been observed. IOP < 16 mmHg without medications depended significantly on the presence of microhyphema (hazard ratios, HR 0.03, 95% CI 0.01-0.25, p < 0.001), but not on age (HR 1.00, 95% CI 0.91-1.09, p = 0.32), preoperative IOP (HR 0.98, 95% CI 0.85-1.12, p = 0.80), cup-to-disc ratio (HR 0.15, 95% CI 0.00-20.01, p = 0.45) and gender (HR 0.24, 95% CI 0.05-1.12, p = 0.07). Factors like preoperative IOP, age, gender, cup-to-disc ratio were not associated with microhyphema. There were no significant differences between patients with versus without microhyphema in regard to age, preoperative IOP, morphological and functional glaucomatous damage, number of medications and postoperative day 1 IOP. However, patients with microhyphema had significantly fewer Nd:YAG goniopunctures after surgery than patients without microhyphema (p < 0.001). Conclusion:  Microhyphema the first postoperative day seems to be a significant positive prognostic indicator in uneventful canaloplasty in regard to IOP reduction, possibly representing a restored and patent physiologic aqueous outflow system.
    Acta ophthalmologica 12/2011; · 2.44 Impact Factor
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    ABSTRACT: The distinction of real progression from test variability in visual field (VF) series may be based on clinical judgment, on trend analysis based on follow-up of test parameters over time, or on identification of a significant change related to the mean of baseline exams (event analysis). The aim of this study was to compare a new population-based method (Octopus field analysis, OFA) with classic regression analyses and clinical judgment for detecting glaucomatous VF changes. 240 VF series of 240 patients with at least 9 consecutive examinations available were included into this study. They were independently classified by two experienced investigators. The results of such a classification served as a reference for comparison for the following statistical tests: (a) t-test global, (b) r-test global, (c) regression analysis of 10 VF clusters and (d) point-wise linear regression analysis. 32.5 % of the VF series were classified as progressive by the investigators. The sensitivity and specificity were 89.7 % and 92.0 % for r-test, and 73.1 % and 93.8 % for the t-test, respectively. In the point-wise linear regression analysis, the specificity was comparable (89.5 % versus 92 %), but the sensitivity was clearly lower than in the r-test (22.4 % versus 89.7 %) at a significance level of p = 0.01. A regression analysis for the 10 VF clusters showed a markedly higher sensitivity for the r-test (37.7 %) than the t-test (14.1 %) at a similar specificity (88.3 % versus 93.8 %) for a significant trend (p = 0.005). In regard to the cluster distribution, the paracentral clusters and the superior nasal hemifield progressed most frequently. The population-based regression analysis seems to be superior to the trend analysis in detecting VF progression in glaucoma, and may eliminate the drawbacks of the event analysis. Further, it may assist the clinician in the evaluation of VF series and may allow better visualization of the correlation between function and structure owing to VF clusters.
    Klinische Monatsblätter für Augenheilkunde 04/2011; 228(4):311-7. · 0.70 Impact Factor
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    Matthias C Grieshaber, Ané Pienaar, Jan Olivier, Robert Stegmann
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    ABSTRACT: To study the safety and effectiveness of 360° viscodilation and tensioning of Schlemm canal (canaloplasty) in black African patients with primary open-angle glaucoma (POAG). Sixty randomly selected eyes of 60 consecutive patients with POAG were included in this prospective study. Canaloplasty comprised 360° catheterisation of Schlemm's canal by means of a flexible microcatheter with distension of the canal by a tensioning 10-0 polypropylene suture. The mean preoperative intraocular pressure pressure (IOP) was 45.0 ± 12.1 mm Hg. The mean follow-up time was 30.6 ± 8.4 months. The mean IOP at 12 months was 15.4 ± 5.2 mm Hg (n=54), at 24 months 16.3 ± 4.2 mm Hg (n = 51) and at 36 months 13.3 ± 1.7 mm Hg (n=49). For IOP ≤ 21 mm Hg, complete success rate was 77.5% and qualified success rate was 81.6% at 36 months. Cox regression analysis showed that preoperative IOP (HR = 1.003, 95% CI = 0.927 to 1.085; p = 0.94), age (HR = 1.000, CI = 0.938 to 1.067; p = 0.98) and sex (HR = 3.005, CI=0.329 to 27.448; p=0.33) were all not significant predictors of IOP reduction to ≤ 21 mm Hg. Complication rate was low (Descemet's detachment n=2, elevated IOP n = 1, false passage of the catheter n = 2). Canaloplasty produced a sustained long-term reduction of IOP in black Africans with POAG independent of preoperative IOP. As a bleb-independent procedure, canaloplasty may be a true alternative to classic filtering surgery, in particular in patients with enhanced wound healing and scar formation.
    The British journal of ophthalmology 11/2010; 94(11):1478-82. · 2.92 Impact Factor
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    M C Grieshaber, A Pienaar, J Olivier, R Stegmann
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    ABSTRACT: To compare the safety and efficacy of two polypropylene (Prolene) sutures for tensioning of the inner wall of Schlemm's canal (SC) in black African patients with primary open-angle glaucoma (POAG) undergoing canaloplasty. In a prospective randomised trial of 90 patients, canaloplasty was performed with a flexible microcatheter (iTrack-250A) and sodium hyaluronidate 1.4% (Healon GV). After complete circumferential dilatation of the SC, a Prolene suture, either 6-0 Prolene (group 1) or 10-0 Prolene (group 2), was retracted through the SC and tightened leaving tension on the canal and trabecular meshwork. Nd:YAG laser goniopuncture was not performed postoperatively. The mean preoperative intraocular pressure (IOP) was 42.7 mm Hg+/-12.5 (SD) in group 1 and 45.0 mm Hg+/-12.1 (SD) in group 2 (P=0.70). The mean postoperative IOP without medications was 18.4 mm Hg+/-7.1 (SD) in group 1 and 16.4 mm Hg+/-6.6 (SD) in group 2 at 1 month (P=0.10), 19.2 mm Hg+/-6.4 (SD) in group 1 and 16.4 mm Hg+/-4.9 (SD) at 15 months (P=0.04). Pressures equal or less than 21, 18, and 16 mm Hg without medications (complete success) at 12 months were 51.0% (95% confidence interval (CI) 0.35-0.73), 34.1% (95% CI 0.21-0.56), and 21.2% (95% CI 0.11-0.42) in group 1, and 76.9% (95% CI 0.62-0.96), 68.8% (95% CI 0.54-0.89), and 53.6% (95% CI 0.38-0.76) in group 2, respectively. In the Cox regression analysis, IOP<18 mm Hg without medications depended significantly on the type of Prolene (hazard ratio (HR) 2.60, 95% CI 1.24-5.46, P=0.01) and age (HR 1.3, 95% CI 1.03-1.86, P=0.03), but not on preoperative IOP (HR 1.01, 95% CI 0.99-1.04, P=0.16) and gender (HR 0.67, 95% CI 0.34-1.33, P=0.26). No filtering bleb was observed. Intra- and postoperative complications were similarly rare in the two groups and included partial 'cheese-wiring' (2), Descemet's rupture (2), and hyphaema (3). In this clinical trial, IOP reduction was substantial in canaloplasty and slightly greater in combination with 10-0 Prolene than 6-0 Prolene sutures at an equally low complication rate. Younger age, but not the level of IOP at surgery, had a positive effect on the amount of IOP reduction, thus suggesting that an early surgical intervention to re-establish physiological outflow offers the best prognosis.
    Eye (London, England) 07/2010; 24(7):1220-6. · 1.97 Impact Factor
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    ABSTRACT: To assess the safety and efficacy of canaloplasty (360-degree viscodilation and tensioning of the Schlemm canal) in Whites with open-angle glaucoma (OAG). In a prospective study, 32 consecutive patients with medically uncontrolled OAG underwent primary canaloplasty with a follow-up time of more than 1 year. Laser goniopuncture was performed if postoperative intraocular pressure (IOP) was above 16 mmHg. IOP, number of antiglaucomatous medications, best-corrected visual acuity, and intraoperative and postoperative complications were recorded. Complete success was defined as an IOP ≤21, 18, and 16 mm Hg without medications, and qualified success with or without medications, respectively. The mean IOP dropped from 27.3±5.6 mm Hg preoperatively to 12.8±1.5 mm Hg at 12 months and 13.1±1.2 mm Hg at 18 months (P<0.001). The complete success rate of an IOP ≤21, 18, and 16 mm Hg was 93.8% [95% confidence interval (CI) 0.86-1.0], 84.4% (95% CI 0.73-0.98), and 74.9% (95% CI 0.61-0.92), respectively, at 12 months. Laser goniopuncture was performed on 6 eyes (18.1%) 3.3±2.1 months postoperatively. The mean IOP was 20.6±4.2 mm Hg before and 14.2±2.2 mm Hg after goniopuncture. The number of medications dropped from 2.7±0.5 before surgery to 0.1±0.3 after surgery (P<0.001). The postoperative best-corrected visual acuity at last visit (0.38±0.45; range: 0 to 1.8) was comparable with that of preoperative values (0.36±SD 0.37; range: 0 to 1.6) (P=0.42). In all but 1 eye, canaloplasty was completed. Minor intraoperative or postoperative complications like Descemet membrane detachment in 2 eyes, elevated IOP in 1 eye, and suprachoroidal passage of the catheter in 4 eyes were encountered. In 1 eye, circumferential cannulation of the Schlemm canal was impossible. Canaloplasty seems to be a promising and effective surgical procedure in Whites with OAG. Postoperative IOP levels are in the low-to-mid-teens. The procedure can be regarded as safe, but has its own profile of complications.
    Journal of glaucoma 01/2010; 20(5):298-302. · 1.74 Impact Factor
  • Matthias C Grieshaber, Ané Pienaar, Jan Olivier, Robert Stegmann
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    ABSTRACT: To assess the aqueous outflow pathway in primary open-angle glaucoma (POAG) through provocative gonioscopy and channelography with a flexible microcatheter and fluorescein tracer during canaloplasty. One eye each was randomly selected from 28 consecutive black African POAG patients undergoing canaloplasty. Provocative gonioscopy was performed at the beginning of surgery, and blood reflux from collector channels into Schlemm's canal (SC) was semiquantitatively evaluated. During canaloplasty, a flexible microcatheter injected fluorescein tracer stepwise into SC. The outflow pathway parameters of interest were blood reflux, transtrabecular passage of fluorescein, and episcleral vein filling. Mean age, intraocular pressure (IOP), and cup-to-disc ratio were 45.9 years (SD +/- 13.3), 41.0 mm Hg (SD +/- 11.9), and 0.78 (SD +/- 0.22), respectively. Mean IOP (P < 0.001) and episcleral venous egress (P = 0.01) correlated significantly with blood reflux, but cup-to-disc ratio (P = 0.71), age (P = 0.70), and fluorescein diffusion (P = 0.90) did not. A multinomial regression model showed that higher IOP (P < 0.001, OR, 1.687; 95% CI, 1.151-2.472) was strongly associated with poor blood reflux, independent of the patient's age (P = 0.383, OR, 0.942; 95% CI, 0.823-1.078). No correlation was found between preoperative IOP, transtrabecular passage, episcleral venous egress, and cup-to-disc ratio. The mean IOP was 17.5 mm Hg (SD +/- 3.7) 6 months after surgery. The level of IOP after surgery correlated with the grade of blood reflux and episcleral venous egress (P < 0.001). High mean IOP may be associated with poor blood reflux and filling of SC. A collapsed canal, probably secondary to high IOP, may be an underestimated sign in black African patients with POAG. The quality of blood reflux and episcleral venous egress may both be predictive of the level of IOP after surgery. Provocative gonioscopy and channelography may reflect the function of the outflow pathway and may be helpful in assessing the surgical outcome of canaloplasty.
    Investigative ophthalmology & visual science 11/2009; 51(3):1498-504. · 3.43 Impact Factor
  • Matthias C Grieshaber, Josef Flammer
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    ABSTRACT: Glaucoma, the most common optic neuropathy (GON) is characterised by the loss of retinal ganglion cells and their axons, as well as tissue remodelling of both the retina and the optic nerve head with corresponding visual field defects. Elevated intraocular pressure (IOP) is generally regarded as the major risk factor for glaucoma and its reduction is the most common target for therapy of GON. There are indications that the greater the IOP reduction, the better is the visual field prognosis. This article investigates, on the basis of two beta-blockers, betaxolol and timolol, whether the amount of IOP reduction is truly a good surrogate for successful glaucoma therapy with respect to visual field outcome. Contrary to what is generally expected, our analysis of the literature exemplifies that despite a smaller IOP reduction, patients treated with betaxolol had a smaller rate of visual field deterioration than patients treated with timolol. Based on the dissociation of IOP reduction and visual field prognosis, we postulate that for successful treatment in glaucoma not only the amount of IOP reduction is relevant but also the drug by which the reduction is achieved. This seeming paradox phenomenon highlights that ocular hypotensive drugs have relevant effects on GON other than IOP-related. Some of these effects on retinal ganglion cells (neuroprotection) or on ocular blood flow are mediated by calcium- and sodium channels. Future studies on glaucoma treatment should focus on their effect on visual field function, and not just on IOP. This should particularly be considered when comparing drugs from different classes.
    Progress in Retinal and Eye Research 10/2009; 29(1):79-93. · 9.44 Impact Factor
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    ABSTRACT: The aim of this study was to develop a new animal model to enhance our understanding of the biological pathomechanisms involved in glaucoma. Forty white giant rabbits were divided into a treated (N = 30) and a control group (N = 10). Boli of adrenaline hydrochloride (0.1 mL 0.1% solution) were repeatedly injected into the veins of the ears of the rabbits and physiological saline in the control group, respectively, for three months. Intraocular pressure (IOP) and outflow facility of the aqueous humour were measured prior to, during and after treatment (4-6 months, 7-9 months, 10-12 months). In comparison to the control group, the adrenaline-treated group showed a significant increase in IOP both during treatment (25%) and 12 months after treatment (57%). Comparative analysis further showed that the aqueous humour outflow facility of the treated group increased by 16.5% during the treatment, and showed a continuous decrease of 60 % after treatment. This rabbit model could be useful for further investigations of the pathomechanisms involved in glaucoma.
    Klinische Monatsblätter für Augenheilkunde 05/2009; 226(4):332-6. · 0.70 Impact Factor
  • M C Grieshaber, J Olivier, A Pienaar, R Stegmann
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    ABSTRACT: The aim of this study was to evaluate different methods of intraocular lens (IOL) implantation and posterior capsule management in the absence of vitrectomy with respect to visual axis opacification (VAO) in children. Seventy-three eyes of African children undergoing cataract extraction and IOL implantation between 1998 and 2001 were evaluated. In all eyes, the IOL haptics were placed in the bag and the vitreous was preserved. The IOL optic and posterior capsule were managed in the following 3 ways: The IOL optic was captured behind the posterior capsule in conjunction with posterior capsulotomy (PC) in 47 eyes (group 1). The IOL optic was implanted in the bag with PC in 14 eyes (group 2) and without PC in 12 eyes (group 3). Cox proportional hazard analysis and Kaplan-Meier survival curves were performed to evaluate the incidence of Elschnig pearls (EP) and VAO. Elschnig pearls developed in 14.9 % of the patients in group 1, in 56.8 % in group 2 and in 91.7 % in group 3. The occurrence of EP depended significantly on optic capture (p < 0.001) and child's age (p < 0.05), but not on PC (p = 0.084) and eye side (p = 0.1). The persistence of visual axis clarity depended significantly on optic capture (p < 0.001) but not on PC. In vitreous-sparing cataract surgery, posterior capsule opening does not effectively prevent VAO unless it is in conjunction with IOL optic capture.
    Klinische Monatsblätter für Augenheilkunde 05/2009; 226(4):258-63. · 0.70 Impact Factor
  • P Meyer, P Salzer, M C Grieshaber, A Meyer
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    ABSTRACT: The aim of this study was to assess similarities and differences between the trout eye and the human eye. Gross and microscopic examinations of the formalin-fixed eyes of each five trout and human eyes (donor eyes not suitable for keratoplastic) were carried out. Compared to the human eye, the trout showed a flattening of the anterior-posterior axis, and cartilage-stabilized sclera. The peripheral cornea was much thicker than the central, had a multilayered thick epithelium, a distinct Bowman layer, and an implied Descement membrane. A ring-shaped ligament filled up the angle of the anterior chamber and linked the iris to the cornea. The lens showed a spherical aspect with a thick capsule and missing zonular fibres, however, a suspensory ligament of a superior part of the lens was present. Ventrally, at the end of the falciform process, a small, pigmented structure was in contact with the lens. The retina was similarly differentiated, but the choroid showed special structures like choroidal gland, falciform process and the argentea compared to the human eye. Great variations between the ocular anatomy of the trout and the human exist. However, the retina of the trout is fully differentiated and remarkably similar to that of human eyes.
    Klinische Monatsblätter für Augenheilkunde 05/2009; 226(4):337-40. · 0.70 Impact Factor
  • M C Grieshaber, A Pienaar, J Olivier, R Stegmann
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    ABSTRACT: The aim of this study is to present a new approach to visualize the aqueous outflow system during glaucoma surgery using a flexible microcatheter and fluorescein, called channelography. Schlemm's canal was unroofed in a standard non-penetrating dissection technique in patients undergoing canaloplasty. A flexible microcatheter (iTrack 250A) was introduced into the canal and advanced 360 degrees . Fluorescein sodium tracer was injected through the microcatheter during cannulation and the aqueous outflow pathway was video-recorded and evaluated. In the early phases, episcleral veins which were thinner, branched and fairly straight originating from the limbus could clearly be distinguished from ciliary veins which were thicker, tortuous vessels leaving posterior to the limbus. The filling quality of the episcleral veins varied among glaucoma patients. The permeability of the trabecular meshwork/inner wall of Schlemm's canal determined by fluorescein diffusion into the anterior chamber differed in this regard as well. In the late phases, the sclera stained with fluorescein, and no details were detectable. This qualitative in-vivo method was simple, safe, and enabled us to visualize the details of the aqueous outflow system during canaloplasty. Filling characteristics of episcleral venous network as well as trans-trabecular diffusion may reflect the clinical status of the outflow pathway in glaucoma patients, and may be helpful in the prediction of the surgical outcome in canaloplasty.
    Klinische Monatsblätter für Augenheilkunde 05/2009; 226(4):245-8. · 0.70 Impact Factor
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    ABSTRACT: This study aimed to determine whether ocular pulse amplitude (OPA) measured with dynamic contour tonometry (DCT) is related to systemic blood pressure (BP) parameters. Blood pressure was measured continuously and simultaneously with OPA in one randomly selected eye in 29 healthy subjects. Systemic parameters of interest were: systolic and diastolic BPs and their difference (BP amplitude), and left ventricle ejection time (LVET; defined as the time between the diastolic trough and the incisural notch in the BP curve). In addition, the axial length (AL) of the eye was measured. Associations between OPA, AL and systemic cardiovascular parameters were analysed in a multivariate regression model. Measurements of OPA ranged from 1.0 mmHg to 4.9 mmHg (mean 2.3 +/- 0.9 mmHg, median 1.9 mmHg). In a univariate analysis with one predictor at a time, means of intraocular pressure (IOP) (p = 0.008), AL (p = 0.046) and LVET (p = 0.037) were significantly correlated with OPA, whereas systolic and diastolic BPs and their amplitude were not. A multiple linear regression analysis showed that mean IOP (p < 0.005), AL (p = 0.01) and LVET (p = 0.002) all independently contributed to OPA. The OPA readings measured with DCT in healthy subjects were not related to BP levels and amplitude. It seems that the OPA strongly depends on the time-course of the cardiac contraction. Regulating mechanisms in the carotid system as well as scleral rigidity may be responsible for dampening the direct effect of BP variations.
    Acta ophthalmologica 10/2008; 87(3):329-34. · 2.44 Impact Factor
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    ABSTRACT: An analysis of the pattern of retinal thickness changes in macula in patients with multiple sclerosis (MS) was performed. In fifteen patients with MS retinal thickness measurements in the central (fovea plus inner macular ring) and peripheral (outer ring) macula obtained by ocular coherence tomography (OCT-3 device) were compared to those of 15 age-matched healthy controls. Eyes of MS patients had on the average a thinner macula (241.8 +/- 20.6 micrometers) than control eyes (252.0 +/- 16.4, p value 0.038). Significant segmental differences occurred in the central macula (p = 0.013). Eight eyes with a positive history of optic neuritis (ON) had on average a thinner macula (226.8 +/- 14.0) than eyes of MS patients without a history of ON (non-ON eyes: 247.3 +/- 20.1, p value 0.01). The only measure significantly different between non-ON and control eyes was the ratio between the central and peripheral macular thickness (p = 0.017). Average macular thickness in non-ON eyes, unlike control eyes (r = - 0.63, p = 0.0002), did not correlate with age (r = 0.01, p = 0.97), however, it did show a borderline correlation with disease duration (r = - 0.41, p = 0.056). Preferential thinning in the central relative to the peripheral macular region is present in eyes of patients with MS. The macular thickness pattern is likely due to the histological distribution of nerve fibre layer and retinal ganglion cell in the macular area and seems to be particularly informative of neurodegeneration in the eyes of MS patients without a history of optic neuritis.
    Klinische Monatsblätter für Augenheilkunde 06/2008; 225(5):408-12. · 0.70 Impact Factor
  • K Müller, M C Grieshaber, S Orgül
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    ABSTRACT: Rifabutin-associated uveitis has often been described in patients with HIV. We present the case of a bilateral non-granulomatous uveitis in an HIV negative patient on rifabutin therapy. A 79-year-old man presented with acute pain and decreased vision in the left eye. He had a 2-months history of Mycobacterium avium pneumonia and was treated with rifabutin, clarithromycin and ethambutol since then. At presentation, the visual acuity was hand movement. On biomicroscopy, the anterior chamber showed inflammatory sings such as hypopyon and early posterior synechiae. Ultrasound revealed no vitreal infiltration. The fellow eye was initially without any pathology. Serological testing and blood cultures were negative. The next day, the fellow right eye was also affected showing signs of anterior and posterior uveitis. Following intensive topical steroidal therapy, clinical findings improved within hours. Rifabutin therapy was discontinued. Later on the visual acuity of both eyes improved to 20 / 100. Bilateral rifabutin-associated uveitis may also occur in an HIV negative patient. A toxic reaction due to concomitant clarithromycin therapy might be causal. Well directed history, intensive topical steroids and the cessation of rifabutin therapy are helpful in the management of such rare uveitis.
    Klinische Monatsblätter für Augenheilkunde 06/2008; 225(5):448-50. · 0.70 Impact Factor
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    ABSTRACT: The aim of this study was to compare an event analysis and a trend analysis for the detection of progression in glaucomatous visual field loss. Excluding initial fields (Octopus, Haag-Streit AG, Köniz, Switzerland), baseline was defined as the average result of the second and third examinations. Eyes with at least 6 additional fields entered the study. The event analysis used the method of the Collaborative Normal Tension Glaucoma Study, and the trend analysis was based on a point-wise linear regression analysis. Of 251 glaucoma patients, 235 left eyes and 225 right eyes qualified for the study. Using the event analysis, 44 series suggested a progressive damage, while the point-wise regression approach disclosed only 14 progressing series. In 9 eyes, the two approaches were concordant. Among the latter, 1 - 5 additional fields were necessary in 7 series to disclose progression using the trend analysis. In one series, the event analysis showed progression 7 examinations later. The point-wise linear regression analysis classified fewer cases as progressing than the event analysis and determined progression later.
    Klinische Monatsblätter für Augenheilkunde 06/2008; 225(5):342-5. · 0.70 Impact Factor