J. Nepp

Medical University of Vienna, Wien, Vienna, Austria

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Publications (68)86.06 Total impact

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    ABSTRACT: EinleitungDie Keratoconjunctivitis sicca (KCS) ist eine chronische Bindehautentzündung mit Beeinträchtigung des Tränenfilms. Deren Behandlung mit Tränenersatzmittel ist oft unbefriedigend. Vorversuche mit Akupunktur zeigten eine klinische Wirksamkeit auf die KCS, jedoch mit unbekanntem Hintergrund. Da Erb eine erhöhte Spannung bei KCS festgestellt hat, und Akupunktur empirisch einen beruhigenden Effekt hat, sollten nun die Spannungen sichtbar und die Veränderungen nach Akupunktur gemessen werden. MethodeBei vegetativer Dystonie mit Aktivierung des sympathischen Nervensystems kommt es zu vermehrter Schweißbildung und Mydriasis, bei parasympathischer Aktivität zu Abgeschlagenheit und Myosis. Beide Systeme haben Einfluss auf die Tränenbildung. Gemessen wurde der Haut-Kontakt auf der Handfläche mittels Silberchlorid-Elektroden, die Pupillenweite mit TV-Pupillometrie 1050 und die psychische Befindlichkeit mit Fragebogen nach Zerssen. Spaltlampenuntersuchung, Schirmer II, Tränenfilmaufrisszeit(BUT), Lipidinterferenz, Bengalrosa, Impressionszytologie und Tropfprotokoll bestimmten die KCS. Die Tests wurden nach 3 Monaten wiederholt. In der Zwischenzeit erhielt ein Teil der Patienten Akupunkturbehandlungen (10×). Statistisch wurden der Willcoxen Test, t-test und Withney-Mann-Test angewendet. Ergebnisse45 Patienten mit KCS (18 m : 27 w) wurden untersucht, davon 33 mit Akupunktur behandelt. Der Pupillendurchmesser änderte sich im Durchschnitt um 1,3 mm nicht signifikant, gegenüber der 1. Messung und gegenüber der Vergleichsgruppe. Die Schweißbildung verringerte sich, ebenso besserte sich die allgemeine Befindlichkeit (nach Zerssen) signifikant nach Akupunktur gegenüber der Voruntersuchung und gegenüber der Vergleichsgruppe. BUT, Lipidinterferenz und Tropfhäufigkeit verbesserten sich nach Akupunktur mit statistisch signifikantem Unterschied gegenüber der Ausgangslage und gegenüber der Vergleichsgruppe. Impressionszytologie, Bengalrosa-Färbung und Schirmer-Test blieben ohne Signifikaten Unterschied. Die Ergebnisse dieser Beobachtung zeigten einen ersten positiven Einfluss der Akupunktur auf die vegetativen und psychischen Spannungen bei KCS. IntroductionKeratoconjuctivitis sicca (KCS) treatment with artificial tears is unsatisfying in many cases. Therefore in previous studies acupuncture was used with success on Schirmers test, break up time and drop-frequency. The effect of acupuncture on the tear film is still unknown, but generally patients told of relaxation after the therapy. C. Erb observed elevated psychic tension in patients with KCS. This study was created to observe the influence of acupuncture on this tension. MethodTo observe the tension of the sympathetic system, we measured the skin contact level by attaching agcl electrodes on the tenar and antithenar of the untrained hand. For determination of skin contact level and habituation computer assisted measurement was used. For the computer assisted measurement of the pupillary diameter a TV pupillometer 1050 by whittaker cooperation was used. With a record by Zerssen the psychic condition was observed. For evaluation of mood the self rating well being scale by Zerssen has to be presented by the patients. The teat film was evaluated by slit lamp, Schirmer BUT and Bengal-Rosa staining. These observations were repeated after 3 month. In meantime part of patients was treated by acupuncture for 10 weeks, once weekly. For statistic analyses Wilcoxon matched pair test, withney Mann and t-test were carried out. Results45 patients with KCS (27 women, 18 men) have been observed, 33 of them with acupuncture treatment. After acupuncture the diameter of the pupil reduced 1.3 average and there was no statistical difference (p > 0.05), the habituation and the skin values changed like the emotional persistence (by Zerssen-record) with significant difference. Even the difference after acupuncture was significant more than that of the controll group in the skin reaction and in the psychic reaction. Changes of the BUT, the Lipid-interference and the drop frequency of artifical tears were significant too (p < 0.05). Rosa-Bengal staining, Schirmer test changed without satistical difference. ConclusionAfter this study we could observe a positive influence of acupuncture on the psychic and vegetative tension in patients with KCS. This may be a good usefull additional therapeutical approach in future.
    Spektrum der Augenheilkunde 04/2012; 14(5):244-248. · 0.18 Impact Factor
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    ABSTRACT: Chronic graft-versus-host disease (GVHD) remains a serious complication after allogeneic hematopoietic stem cell transplantation (HCT). In 2005 the National Institutes of Health (NIH) established new criteria for chronic GVHD based on retrospective data and expert recommendations. We prospectively evaluated the incidence of NIH-defined chronic GVHD and its prognostic impact in 178 consecutive patients. The cumulative incidence of chronic GVHD at 3 years was 64, 48 and 16% for chronic classic GVHD and overlap syndrome. Prior acute GVHD and myeloablative conditioning were significantly associated with increased risk of chronic GVHD. Three-year survival (overall survival (OS)) for late-acute GVHD, chronic classic and overlap chronic GVHD when assigned on day 100 were 69, 83 and 73%. OS was significantly worse for patients with platelet counts below 100 g/l at onset of chronic GVHD (35% versus 86%, P<0.0001) and progressive as compared with de novo and quiescent onset of chronic GVHD (54.5% versus 89.5% versus 84%, P = 0.022 and 0.001). Peak severity of chronic GVHD had no impact on non-relapse mortality (NRM) and OS. Recurrent acute GVHD, platelet counts below 100 g/l at diagnosis of chronic GVHD, progressive onset of chronic GVHD and advanced disease stage prior to HCT were significantly associated with increased NRM. This prospective analysis provides for the first-time data on the incidence rates of NIH-defined chronic GVHD categories and identified risk factors for the occurrence of chronic GVHD. A prognostic value of thrombocytopenia and progressive onset type of chronic GVHD for survival after HCT was observed in NIH-defined chronic GVHD.
    Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 09/2011; 26(4):746-56. · 10.16 Impact Factor
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    ABSTRACT: The purpose of the presented investigation was to examine the efficiency of the novel carrier system Bacterial Ghosts (BGs), which are empty bacterial cell envelopes of Gram-negative bacteria to target human conjunctival epithelial cells, as well as to test the endocytic capacity of conjunctival cells after co-incubation with BGs generated from different bacterial species, and to foreclose potential cytotoxic effects caused by BGs. The efficiency of conjunctival cells to internalize BGs was investigated using the Chang conjunctival epithelial cell line and primary human conjunctiva-derived epithelial cells (HCDECs) as in vitro model. A high capacity of HCDECs to functionally internalize BGs was detected with the level of internalization depending on the type of species used for BGs generation. Detailed analysis showed no cytotoxic effect of BGs on HCDECs independently of the used bacterial species. Moreover, co-incubation with BGs did not enhance expression of both MHC class I and class II molecules by HCDECs, but increased expression of ICAM-1. The high rates of BG's internalization by HCDECs with no BG-mediated cytotoxic impact designate this carrier system to be a promising candidate for an ocular surface drug delivery system. BGs could be useful for future therapeutic ocular surface applications and eye-specific disease vaccine development including DNA transfer.
    Journal of Biotechnology 05/2011; 153(3-4):167-75. · 3.18 Impact Factor
  • J NEPP
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    ABSTRACT: Purpose The marginal part of the tarsal conjunctiva forms a lid wiper structure that wipes the ocular surface and distributes the tear film during the blink. It was attempted to investigate whether this region of the upper and lower lid shows specific changes in several kinds of ocular surface diseases.Methods 44 eyes of patients from the outdoor department of the university eye clinic Vienna were observed by slit lamp investigation of the ocular surface, vital staining with fluorescein and lissamin green. It was focused on evaluation of the tarsal conjunctiva including the lid margin and the wiper. Vessel dilatation, teleangiectatic changes and vital staining were each designed in three stages. The patients suffered from inflammation or affections of the lid, the conjunctiva and the cornea including chemical burns, graft versus host disease and injuriesResults Compared to normal eyes dilatation of vessels and staining was observed more in patents with inflammations but although in serious affections like chemical burn or injuries. Even in corneal affections changes of vessels were observed.Conclusion Changes of the wiper can be observed in several diseases of the ocular surface and may be a sign of strain in this region.
    Acta ophthalmologica 09/2010; 88(s246). · 2.44 Impact Factor
  • Focus on Alternative and Complementary Therapies 01/2010; 8(4):525-525.
  • Focus on Alternative and Complementary Therapies 01/2010; 8(1):154-155.
  • Focus on Alternative and Complementary Therapies 01/2010; 7(1):102-102.
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    ABSTRACT: Purpose Evaluation of measuring errors in usage of the meibometer550.Methods Measurements of lipid layer of the ocular surface tear film were done by Meibometer 550. For exact measurement we observed possible disruptions, the calibration, hygienically standards, different sampling, alteration after topical treatment.Before each measurement there must be a calibration by clean lipid -free stripes.We observed the adjustment with two clean stripes by double measurement of each other.Both results must be 0. Hygienically influence is presumed by incorrect handling if objects are touched. Stripes were pressed on objects and measured.Those objects were the table surface, the hand of the observer, the gloves and the disinfectant used.We observed different pressure sampling as pressure may extract more lipids from the lid with touch of the lid and no touch, with pressure and without For the influence of topical treatments we dropped several artificial tears directly on the stripes, watery artificial tears, gels, ointments and drops with lipid portions.Results After double calibration new stripes showed values of nearly 0, elder stripes 10-18 u. Hygienically: in clean tables we measured <28u, even clean hand < 60 u, gloves < 5u. Disinfectant fluids decreased measured lipids from 500 to 100 u. There was a difference in sampling with pressure to samplings without pressure between 50 and 80%. Topical treatments changed different after use of watery drops: 0-15u, lipid spray: change 370 u average, fatty ointments: change of 557u to 751 u.Conclusion It is important to notice the careful handling during measuring the lipid layer with MB 550 to obtain valid measuring data.Commercial interest
    Acta ophthalmologica 09/2009; 87(s244). · 2.44 Impact Factor
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    ABSTRACT: Purpose Quantity of tear film lipids could be estimated optically by colours of interference By photometric evaluation it may be measured. Therefore we compared both measures.Methods Patients with dry eyes were observed by Tearscope and Meibometer 550. For tearscope we used the 4-parted scale of colours. Meibometry was performed with clean stripes, which have touched the tear film. >300 units are said to be normal. We observed the tear film by Schirmer I, Lissamin green and fluorescein staining, and the break up time. We correlated the measurements with Pearson Correlation.Results 85 eyes of 53 patients were observed. Both measurements of the lipids showed positive correlations R=67. There was no Correlation between any lipid measurement and the watery and mucin Layer (R-0,1 - 0,3)Conclusion The measurement of lipids is similar in both measurements. The optical evaluation needs longer experience, the Meibometry needs standards to find reproducible results. The lack of correlation between lipid layer results and the other results of the tear film observation may point at the special function of lipids independent of the other layers of the tear film.
    Acta ophthalmologica 01/2009; 87:0-0. · 2.44 Impact Factor
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    ABSTRACT: Purpose: Introduction: Bone Marrow Transplantation because of Leukemia is followed by changes of the immunological system. Patients suffer from complaints of the disease and its consequences, like Graft versus host reactions. In ophthalmologic observations we often can asses chronic inflammations with dry eyes. Those are induced by stress reaction, any kind of inflammation and any kind of irritations.Now we wanted to know, if there is a correlation of the ophthalmological changes, especially the dryness and the mental state, according to the bone marrow transplantation.Methods: 26 patients were observed, 11 of them in a follow up after 100 days. For ocular evaluations slit lamp obeservation were done. Severeness of Dryness was defined by a Sicca-Score, a mean of results of Schirmer‘s test, break up time, lipid layer thickness, and estimation of the tear meniscus. All results were equated. 0 for normal and 1 for worst possible result.Psychiatric symptoms were assesed by the symptom check list 90R (Derogatis) at baseline and follow up. We compared the results before and 100 days after the transplantation. For statistical analysis students-T-test and the Pearson correlation by SPSS was used.Results: There was a significant aggravation of the dryness in one eye; and there was a correlation in parts of the records between the dryness and the mental state.Conclusions: Bone marrow transplantation is an event, which influences the immunological system, the tearing system and the mental state of health.
    Acta Ophthalmologica Scandinavica 01/2007; 85:0-0. · 1.85 Impact Factor
  • Acta Ophthalmologica Scandinavica 01/2007; 85:0-0. · 1.85 Impact Factor
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    ABSTRACT: We evaluated the validity of calculations for refractive outcome in cataract surgery in silicone oil-filled eyes. The retrosilicone space (RSS) was included in these calculations. In a prospective study the axial length (AL) of silicone oil-filled eyes was measured. with standardized A-scan echography (SAE) and partial coherence interferometry (PCI). Meldrum's formula was used to transform the velocity of ultrasound within the vitreous cavity. To investigate whether refractive outcome can be calculated accurately, we assessed the difference between precalculated and final refractive outcome. Furthermore, we determined the advantages and disadvantages of SAE and PCI. A minor aim was to assess whether the AL of the two eyes differed significantly. In 85% of 117 eyes the difference between precalculated and postsurgical refraction was smaller than 1 diopter spherical and statistically not significant (p>0.2). The mean AL was 24.1 mm (range 20.0-31.4 mm). The difference in outcome between the two methods was without statistical significance: the AL difference was 0.4 (+/-2.6) mm on measurement with SAE and 0.04 (+/-0.46) mm with PCI. PCI has the advantage that it can be performed more easily, without contact, while echography is advantageous in the presence of advanced cataracts. In supine position an oil-free fluid space behind the silicone oil was detected with echography. The mean dimension of this space was 1.9 (+/-0.67) mm and it was taken into consideration for IOL calculation. The mean AL difference between the two eyes was 0.4 mm, but the difference was greater than 1 mm in 26% of the patients. The AL of eyes filled with silicone oil can be measured reliably with SAE and PCI. In supine position the RSS has to be considered to obtain more accurate IOL calculations.
    Albrecht von Graæes Archiv für Ophthalmologie 10/2005; 243(10):967-72. · 1.93 Impact Factor
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    ABSTRACT: To compare the effect of erbium:YAG laser photocapsulotomy (ELC), continuous curvilinear capsulorhexis (CCC), and high-frequency capsulotomy (HFC) on anterior capsule edges using light microscopy (LM) and transmission electron microscopy (TEM). Department of Ophthalmology, Department of Histology and Embryology II, University of Vienna, Vienna, Austria. Five anterior capsule membranes were obtained experimentally by ELC, which was performed with the Oertli MicroLaser photoemulsification tip in eyes from 5 human cadavers. Thirty anterior capsule membranes were obtained during cataract surgery by CCC (n = 15) or, in cases with poor or missing red fundus reflexes, by HFC (n = 15). Continuous curvilinear capsulorhexis was performed conventionally with a manual, bent, 27-gauge cannula, and HFC was performed according to Klöti. Membranes were processed and examined by LM and TEM according to standard procedures. The edges obtained by ELC showed mild signs of denaturation and mechanical disruption, tears, and micro-tears. Lens capsule edges obtained by CCC were smooth with no irregularities in any specimen; the edges were beveled anteriorly to posteriorly with no evidence of tearing. Edges produced by HFC were considerably wider; the surfaces showed distinct denaturation, preformed tears, and micro-tears. The edges were surrounded by a nonhomogeneous mass, which consisted mainly of denatured lens capsule material. Of the 3 techniques, CCC produced the mildest tissue damage. The histological damage at ELC edges was relatively mild and intermediate compared with that seen at CCC and HFC edges. These observations suggest that ELC is an appropriate option for anterior capsulotomy in cataract surgery.
    Journal of Cataract and Refractive Surgery 02/2004; 30(1):67-73. · 2.53 Impact Factor
  • O. Markovic, J. Nepp
    Spektrum Der Augenheilkunde - SPEKTRUM AUGENHEILKD. 01/2004; 18(3):158-162.
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    ABSTRACT: To compare visual outcome and complications of two surgical strategies for patients who needed cataract surgery and silicone oil removal. A prospective, nonrandomized study was performed to compare two groups of patients who had cataract surgery and silicone oil removal from April 1998 to January 2002. From April 1998 to November 1999, patients had two surgical sessions with cataract surgery before silicone oil removal (Group 1), and from December 1999 to January 2002, patients underwent combined cataract surgery and silicone oil removal in a single session (Group 2). Thirty-five patients were included in each group. The postoperative visual acuity improved by at least two lines of Snellen in 13 patients (37.1%) in Group 1 and 15 (42.8%) patients in Group 2 (P=0.63). The mean visual improvement was 0.12 lines and 0.13 lines in groups 1 and 2 (P=0.62). Complications in groups 1 and 2 included transient intraocular pressure rise (25.7% versus 28.5%), retinal detachment (14.2% versus 11.4%), fibrin reaction (5.7% in both groups), and persistent intraocular pressure rise (2.8% in both groups). The visual outcome and complication rates were similar in both groups. Combined surgery offers the advantages of a single surgical event and a faster visual rehabilitation. We therefore suggest a surgical approach with combined cataract surgery and silicone oil removal in selected patients with a stable retinal situation.
    Retina 11/2003; 23(5):647-53. · 2.83 Impact Factor
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    ABSTRACT: To compare measurements performed with the IOLMaster (Carl Zeiss, Meditec AG) with those obtained by applanation ultrasound (US) and manual keratometry and to evaluate the effect of operator experience on US biometry. Department of Ophthalmology, University of Vienna, Vienna, Austria. The axial length (696 eyes) and anterior chamber depth (ACD) (462 eyes) were measured in 377 patients with cataract using the IOLMaster and applanation US. To assess the effect of operator experience on the biometric results, the operators were divided into 2 groups: experienced and less experienced in performing US biometry. The difference in measurements between the methods and the variability of the difference were compared between the 2 groups. Applanation US measured axial length and ACD shorter than the IOLMaster; the mean numerical difference was 0.13 mm and 0.19 mm, respectively (P<.01). For axial length, the absolute difference was smaller with experienced operators than with less experienced operators (0.15 mm versus 0.22 mm) (P<.01). For ACD, experienced operators obtained a smaller difference between measurement techniques (0.21 mm versus 0.29 mm; P<.05). Experienced US operators had less difference and lower variability in the difference between applanation US and IOLMaster readings for axial length and ACD measurements. The noncontact optical method, which is essentially operator independent, gave significantly more reliable biometry before cataract surgery, especially in the case of less experienced operators.
    Journal of Cataract and Refractive Surgery 10/2003; 29(10):1950-5. · 2.53 Impact Factor
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    ABSTRACT: A solar eclipse occurred in central Europe on August 11th, 1999. Following the eclipse, patients with ocular symptoms were investigated. Gazing at the sun without protection is liable to damage the retina. Our attention was focused on changes of the ocular surface and the tear film. Forty-three patients were investigated within one week after the solar eclipse as baseline. 33 of them were followed up one year later. Visual acuity and the central visual-field were measured, and the ocular surface and the fundus were examined using a slit lamp. The quality of the lacrimal tear film was examined using Schirmer's test for the aqueous layer, break-up time for the mucous layer and interference observation for the lipid layer, measured by a slit lamp and a tearoscope. At the baseline 19 patients had non-specific visual problems. Pathological alterations of the tear film were seen in all three tear-film layers: Schirmer's test was pathological in 87%, break-up time decreased in 85%, the interference pattern of the lipid layer changed in 67% and there were changes in 87% using the tearoscope. One year later the non specific visual disorders had disappeared. Schirmer's test did not reveal much change from the baseline: 51% pathological, 24% remained pathological in break-up-time and the lipid layer was normalized except in 9%. Using the tearoscope, lipids were better than grade 3 in all patients. After gazing at a solar eclipse the ocular surface and tear film changed. While the aqueous layer remained pathological in many patients, the lipid layer and the mucous layer recovered spontaneously.
    Wiener klinische Wochenschrift 02/2003; 115(1-2):47-52. · 0.81 Impact Factor
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    ABSTRACT: HintergrundDas Pterygium ist eine degenerative Erkrankung des Auges dessen Ätiologie noch nicht geklärt ist. Insbesondere statistische Erfassungen der in Europa behandelten Patienten sind selten, aber für die Erforschung des Pterygiums notwendig. Ziele der ArbeitDie Schaffung und Evaluierung einer Pterygium-Datenbank. Patienten und Methoden189 Krankengeschichten von Pterygium-Patienten wurden retrospektiv begutachtet. Alle Patienten wurden in der Universitätsklinik für Augenheilkunde und Optometrie, Wien, behandelt. Ergebnisse32,7% der Patienten waren weiblich und 68,3% männlich. 68,3% der Fälle wurden mit der „Baresclera“-Technik, 13,8% mit der „Conjunctival-flap“-Technik und 10,1% mit der „Autologes-Transplantat“-Technik operiert. 9,2% der Patienten stammt aus Westeuropa, 28,6% aus Westasien und 16,9% aus Südeuropa. SchlussfolgerungEin umfassendes Bild über die Häufigkeit der Erkrankung, operativen Behandlungen und demographische Verteilung der Pterygium-Patienten in der Universitätsklinik für Augenheilkunde und Optometrie, Wien, konnte gewonnen werden. Aus diesen Daten kann eine Tendenz bezüglich der Häufigkeit des Pterygiums und deren Abhängigkeit von der Herkunft des Patienten erahnt werden. BackgroundThe Pterygium is a degenerative disease of the eye, its etiology is brought in connection with different factors. There is still a lack of statistical overviews of pterygium patients in Europe. GoalsThe task of this study was to establish and evaluate a pterygium data base. Patients and methods189 records of patients were reviewed retrospectively. All patients were treated in the Department of Ophtalmology, University of Vienna, Medical School. Results32.7% of the patients were female and 68.3% male. The Bare sciera technique was performed in 68.3%, Conjunctival flap in 13.8% and the autologous conjunctival transplantation in 10.1% of the cases. 39.2% of the patients originate from Western Europe, 28.6% from Western Asia and 16.9% from South Europe. ConclusionA comprehensive picture on operational treatment and demographic distribution could be won. Due to these data a tendency can be suspected concerning the origin of the patients and the number of diseases.
    Spektrum der Augenheilkunde 01/2003; 17(6):266-269. · 0.18 Impact Factor
  • Wiener Klinische Wochenschrift - WIEN KLIN WOCHENSCHR. 01/2003; 115:47-52.
  • Spektrum Der Augenheilkunde - SPEKTRUM AUGENHEILKD. 01/2003; 17(6):266-269.