Kristina Holm

Lund University, Lund, Skåne, Sweden

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Publications (16)38.76 Total impact

  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate the influence of ranibizumab on the multifocal electroretinogram (Mf-ERG), full-field electroretinogram (Ff-ERG) and optical coherence tomography (OCT) in diabetic eyes (n = 20) with macular oedema. In 20 eyes (20 diabetic subjects) with no or background diabetic retinopathy and macular oedema (age 65.7 ± 9.8 years, duration 16.5 ± 10.0 years), the change in ETDRS letters, Mf-ERG, Ff-ERG and OCT was analysed, at baseline, 4 weeks after the first injection, (just before the second injection), and 4 weeks after the last injection with ranibizumab. From baseline, mean BCVA improved from 64.0 ± 10.0 ETDRS letters to 75.0 ± 7.3 ETDRS letters (p = 0.005) 1 month after the last injection. Mean OCT thickness reduced after the first injection from 418 ± 117 to 311 ± 126 µm; (p = 0.001) and to 302 ± 74 µm after the third injection. Mf-ERG demonstrated in the innermost three rings a shorter implicit time after the first injection with p values of 0.002, 0.005 and 0.017, respectively. After the third injection, implicit time was prolonged to almost the original levels. Cone implicit time with 30-Hz flicker improved significantly between baseline (35.5 ± 3.6 ms) and final follow-up (34.6 ± 3.1 ms) (p = 0.04). Though the central retinal thickness was reduced after three injections of ranibizumab and the subjects gained a mean of 11 ETDRS letters, there was no significant change in amplitude or implicit time in Mf-ERG. The shortened 30-Hz flicker implicit time might imply that ranibizumab has no negative impact on the entire peripheral cone function, but can improve it instead.
    No preview · Article · Mar 2015 · Documenta Ophthalmologica
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    [Show abstract] [Hide abstract] ABSTRACT: To study the relationship between macular function assessed by multifocal electroretinogram (mfERG) and morphological changes evaluated with optical coherence tomography (OCT) and fundus photography in patients with drusen maculopathy. Ten patients (age 71 ± 5 years) with drusen maculopathy were compared to fifteen healthy control patients (age 67 ± 7 years). One eye per patient was examined with OCT, color fundus pictures, and mfERG (103 hexagons) recorded in nine areas corresponding to the nine areas of the OCT retinal map. Drusen density for every separated area was registered. All nine areas in the maculopathy group demonstrated prolonged implicit time compared to healthy controls; the mean value for the maculopathy group was 31.3 milliseconds (95% confidence intervals [CI]: 30.9-31.6) vs 27.9 milliseconds (95% CI: 27.5-28.2; P = 0.006) for the control group. The amplitude in the foveal area was lower in the maculopathy group; the mean value for the maculopathy group was 25.1 nV/deg(2) (95% CI: 18.4-31.7) vs 33.9 nV/deg(2) (95% CI: 27-40.9; P = 0.03) for the control group. mfERG in the maculopathy group demonstrated no differences in areas with or without drusen. There was no correlation between the retinal thickness assessed with OCT and the mfERG response. Eyes with drusen maculopathy demonstrated functional changes compared to healthy controls evaluated with mfERG. Drusen seems to be associated with general macular dysfunction.
    Full-text · Article · Jul 2013 · Clinical ophthalmology (Auckland, N.Z.)
  • Kristina Holm · Monica Lövestam Adrian
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of the present study was to compare retinal function between the perifoveal nasal and perifoveal temporal areas of diabetic eyes using multifocalERG (mfERG). We included 36 eyes from 27 patients with diabetes (age 58 ± 14 years; duration of diabetes 13 ± 9 years; HbA(1c) 7.1 ± 1.8%) and a control group with 18 eyes from 18 healthy subjects (age 57 ± 11 years). Retinal thickness was assessed with optical coherence tomography (OCT) in the perifoveal areas corresponding to the summed nasal and temporal inner and outer areas. MfERG amplitude and implicit time were recorded from corresponding areas. Diabetic eyes showed lower mfERG amplitude in the nasal area than in the temporal area (14 ± 6 vs 17 ± 7 nV/deg(2); p < 0.0001) and longer implicit time (31 ± 3 vs 30 ± 3 ms; p = 0.005). In the control group, there were no significant differences between the two areas. Diabetic eyes showed lower amplitude and longer implicit time in the nasal area than in the temporal, which might indicate that the nasal area is more vulnerable. These findings may be of importance for evaluation of diabetic maculopathy and outcome after laser treatment.
    No preview · Article · Feb 2012 · Albrecht von Graæes Archiv für Ophthalmologie
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    [Show abstract] [Hide abstract] ABSTRACT: Impact on viability and adhesion of three protein fractions, separated by size, from the coelomic fluid of wounded Asterias rubens', was tested on autologous coelomocytes. In addition antimicrobial property of the protein fractions was tested on the Gram-negative bacterium Vibrio parahaemolyticus. All fractions promoted viability and the larger proteins facilitated adhesion of the coelomocytes. The strongest antimicrobial effect was caused by the fraction with the smallest proteins.
    Full-text · Article · Oct 2010 · Journal of Invertebrate Pathology
  • [Show abstract] [Hide abstract] ABSTRACT: To evaluate the influence of hard exudates on macular function in patients with diabetic retinopathy. Thirty seven eyes from 27 diabetic patients, aged 57 +/- 14 years, diabetes duration 12.5 +/- 9 years, not previously treated with photocoagulation, underwent fundus photography, multifocal electroretinography (mfERG) and optical coherence tomography (OCT). Hard exudates were graded from fundus photography with superimposed OCT and a superimposed hexagonal pattern (mfERG) by one retinal specialist, unaware of mfERG and OCT results. We defined three groups; A = eyes with exudates in the analyzed zone, B = eyes with no exudates in the analyzed zone but elsewhere, and C = eyes with no exudates. The mfERG responses and OCT values from five defined areas in the macula were compared. MfERG showed that the implicit time was significantly prolonged in group A compared to group C in the central, middle and outer areas and in the nasal and temporal area (p = 0.045, 0.019, 0.017 and 0.035 and 0.016 respectively), in group B compared to group C in the central area (p = 0.016), and in group A compared to group B in the outer area (p = 0.035). Amplitude differed between group A and C in the middle area and outer area (14.2 +/- 5.2 nV/deg(2) vs 21.1 +/- 8.7 nV/deg(2), p = 0.037 and 14.1 +/- 3.9 nV/deg(2) vs 17.7 +/- 7.1 nV/deg(2) , p = 0.02 respectively), and between group B and C in the temporal area 14.5 +/- 2.2 nV/deg(2) vs 20.0 +/- 8.7 nV/deg(2), p = 0.017). Macular thickness assessed with OCT was similar between the groups. In eyes with diabetic retinopathy, hard exudates prolong the implicit time assessed with mfERG, compared to eyes without hard exudates, and independently of macular thickness. These results indicate that the hard exudates in the macular region, even at a distance from the fovea centre, have a deleterious effect on macular function.
    No preview · Article · Mar 2010 · Albrecht von Graæes Archiv für Ophthalmologie
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    [Show abstract] [Hide abstract] ABSTRACT: To validate in a prospective study the surveillance algorithm WINROP for detecting infants at risk for proliferative retinopathy of prematurity (ROP). Fifty preterm infants with a mean gestational age of 26 weeks were included. In the first step of WINROP, weekly measures of body weight and serum insulinlike growth factor I (IGF-I) level from birth until postmenstrual age 36 weeks are entered and compared with expected development. If any of the variables show a negative deviation to a certain degree, an alarm is given. In the second step, gestational age, birth weight, and IGF binding protein 3 level are entered. The WINROP algorithm identified all children (100% sensitivity) who were diagnosed with proliferative ROP 1.1 to 21.6 weeks later. No infants with no alarm or with alarm at low risk developed proliferative ROP. Alarm at high risk before postmenstrual age 32 weeks was given for 22 of 50 infants (44%); 9 of these infants developed proliferative ROP (54% specificity), of whom 8 were treated. The WINROP algorithm may be a useful tool for modification of ROP screening.
    Full-text · Article · Jun 2009 · Archives of ophthalmology
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    Monica Lövestam-Adrian · Kristina Holm
    [Show abstract] [Hide abstract] ABSTRACT: This study aimed to evaluate local response on multifocal electroretinography (mfERG) and to assess retinal thickness with optical coherence tomography (OCT) after focal laser treatment in areas with retinal oedema and exudates in patients with diabetic retinopathy. Twelve diabetes patients (aged 60 +/- 14 years, diabetes duration 16 +/- 8 years) treated with focal or grid photocoagulation in areas with retinal oedema and/or exudates underwent mfERG and OCT before and 3 months after treatment. The average thickness (in microm) in any of the nine sectors (defined according to the ETDRS) treated with photocoagulation was measured. Amplitudes and implicit times were analysed in corresponding areas on the mfERG. Mean mfERG amplitudes increased after photocoagulation (21.5 +/- 8.0 nV/deg(2) versus 16.8 +/- 6.1 nV/deg(2); p = 0.012), whereas no difference was seen in implicit times. Mean OCT values in the treated regions were lower at follow-up (272 +/- 23 microm versus 327 +/- 79 microm; p = 0.013). No correlation was seen between changes in mfERG response and changes in OCT values. The decrease in retinal thickness was correlated with the number of laser spots applied (p = 0.002). Focal argon laser treatment is effective in reducing retinal thickness. In addition, treated areas tend to show improved retinal function as demonstrated by increased amplitudes on mfERG.
    Full-text · Article · Mar 2009 · Acta ophthalmologica
  • Kristina Holm · Bodil Hernroth · Michael Thorndyke
    [Show abstract] [Hide abstract] ABSTRACT: Hypoxia, mainly caused by eutrophication, is a common and growing problem on marine soft bottoms. Echinoderms are known for their ability to regenerate tissue after wounding but hypoxia has a negative influence on regeneration and also on reproduction in echinoderms. We have investigated the cellular and molecular responses to wounding stress and hypoxia in the sea star Asterias rubens by using the total coelomocyte count (TCC) and the expression of heat shock proteins (HSPs). As early as 1 h after wounding, sea stars under hypoxic conditions show significantly increased TCC and, after 6 h, cell numbers increase approximately two-fold. After a 3-h hypoxia exposure of wounded animals, Western blot analysis reveals highly elevated coelomocyte cytoplasmic HSP70 expression. Non-wounded sea stars exposed to hypoxia and wounded animals kept in normoxia show enhanced HSP70 expression only after 24 h. Immunocytochemical analysis has not demonstrated any translocation of HSP70 from the cytoplasm to the nucleus. We conclude that both wounding and hypoxia elicit a stress response in sea stars and that the combined stress produces synergistic effects that may inhibit the initial processes of wound healing and regeneration.
    No preview · Article · Oct 2008 · Cell and Tissue Research
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    [Show abstract] [Hide abstract] ABSTRACT: The coelomic fluid of the echinoderm Asterias rubens possesses large populations of circulating coelomocytes. This study aimed to expand the knowledge about the haematopoietic sources of these cells. Injection of the immune-stimulating molecules lipopolysaccharide (LPS) and concanavalin A (ConA) resulted in an increase in coelomocytes. To investigate if these molecules induce cell proliferation in putative haematopoietic tissues (HPTs), short-term exposure of the substitute nucleotide 5-bromo-2'-deoxyuridine (BrdU) was conducted. Immunohistochemical analysis, using fluorescein-labelled antibodies to trace BrdU, showed pronounced cell division in the coelomic epithelium and axial organ. In the pyloric caeca, not considered as an HPT, proliferation was not detected. BrdU labelling of monolayers of cells obtained by collagenase treatment of coelomic epithelium, axial organ and Tiedemann body revealed induced cell proliferation in response to both LPS and ConA while proliferation of pyloric caeca and circulating coelomocytes remained sparse. By using confocal microscopy it was observed that both the morphology and functional behaviour of cells released from explants of coelomic epithelium showed high similarity to those of circulating phagocytes. It was concluded that the increased coelomocyte numbers observed in response to LPS and ConA were reflected in an induced cell proliferation in coelomic epithelium, axial organ and Tiedemann body, which reinforces the idea that these organs are HPTs and the sources of coelomocyte renewal.
    Full-text · Article · Sep 2008 · Journal of Experimental Biology
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    [Show abstract] [Hide abstract] ABSTRACT: Screening examination for retinopathy of prematurity is distressing and painful. The aim of the present study was to investigate whether a Newborn Individualized Developmental Care and Assessment Program intervention during a retinopathy of prematurity examination results in less adverse behavioral, pain, and stress responses as compared with standard care. The first 2 eye examinations in 36 preterm infants were evaluated. The infants were randomly assigned at the first eye examination to receive either Newborn Individualized Developmental Care and Assessment Program care or standard care. At the second examination, crossover of subject assignment was performed. The assessments included behavioral responses; recordings of heart rate, respiration, and oxygenation; pain scores (premature infant pain profile); and salivary cortisol at defined time points up to 4 hours after the eye examination. The nursing support given during the eye examinations (intervention score) were scored using predefined criteria. Altogether, 68 examinations were evaluated. Newborn Individualized Developmental Care and Assessment Program care was associated with better behavioral scores during the examination but there was no difference in heart rate, respiratory rate, oxygenation, or premature infant pain profile score between the 2 care strategies before or after the eye examination. Salivary cortisol increased from baseline to 30 minutes after the eye examination independent of care strategy and decreased significantly between 30 and 60 minutes when infants were subjected to Newborn Individualized Developmental Care and Assessment Program care but not after standard care. During the study period the intervention score for standard care increased and approached the score for Newborn Individualized Developmental Care and Assessment Program care at the later eye examinations. A Newborn Individualized Developmental Care and Assessment Program-based intervention during eye examination does not decrease pain responses but results in faster recovery, as measured by lower salivary cortisol 60 minutes after the examination. The differences were seen despite the influence from the Newborn Individualized Developmental Care and Assessment Program intervention on the standard care treatment that occurred during the study period.
    Full-text · Article · Jun 2008 · PEDIATRICS
  • [Show abstract] [Hide abstract] ABSTRACT: To study the relationship between foveal thickness assessed by optical coherence tomography (OCT) and foveal function measured with multi focal electroretinography (mfERG) in patients with non-proliferative diabetic retinopathy, and with no previous laser treatment. Twenty-six eyes from 18 diabetic patients (13 men), aged 59 years, (range 28-79 years), diabetes duration 15 years, (range 2-27 years), with a macular thickness between 200 and 600 microm were evaluated by mfERG, visual acuity (ETDRS score) and OCT. Mean amplitudes and implicit times of the mfERG responses were analyzed within the four innermost (14 degrees) of the six concentric rings. For comparison with the results from the OCT (diameter of measured area = 6 mm) we analyzed the summed response from the first and second ring (central zone), corresponding to the central area of the OCT. The third(zone 2) and fourth (zone 3)of the four innermost of the six concentric rings measured by the mfERG corresponding to the second and third area of OCT. An increased macular thickness in the central area of the OCT correlated to reduced amplitudes (r = -0.541; P = 0.004) and prolonged implicit times (r = 0.548; P = 0.004) in the central zone of the mfERG, and inversely correlated with visual acuity, -0.49; P = 0.045. Retinal thickness in the second area was correlated to prolonged implicit times in the second mfERG zone (r = -0.416; P = 0.034). No correlations were found for the third area of the OCT. When macular thickness exceeded 300 mum the decrease of amplitudes and prolonged implicit times, measured by mfERG, seemed to be more pronounced. In conclusion increased macular thickness is correlated with reduced amplitudes and prolonged implicit times on the mf ERG and worse visual acuity.
    No preview · Article · Jun 2007 · Documenta Ophthalmologica
  • Patrik Schatz · Kristina Holm · Sten Andréasson
    [Show abstract] [Hide abstract] ABSTRACT: To investigate central and peripheral retinal function after scleral buckling surgery for recent onset rhegmatogenous retinal detachment (RD). Fifteen phakic patients with rhegmatogenous RD for <1 week underwent scleral buckling surgery. Clinical investigation, optical coherence tomography (OCT), full-field electroretinography (ERG), and multifocal ERG (mfERG) with fundus illumination were performed preoperatively and 6 months postoperatively. Anatomical success was achieved in 14 patients. mfERG amplitudes were reduced preoperatively in detached retina, with significant improvement at follow-up (P = 0.002). Foveal amplitudes improved significantly (P = 0.027). There was no significant difference in postoperative mfERG amplitudes between areas that had been preoperatively detached or attached (P = 0.739). In the subgroup of eight patients in whom the detachment engaged the fovea preoperatively, rod function improved significantly as assessed with full-field ERG (P = 0.008). In these patients, the extent of detachment ranged between 4 clock hours and 6 clock hours, as compared with 2 clock hours and 5 clock hours in the remaining patients. OCT showed subretinal foveal fluid in four patients at follow-up. In recent onset rhegmatogenous RD, total rod and localized central retinal dysfunction in detached retina can improve significantly after reattachment. mfERG and OCT are suitable tools for further studies of functional outcomes in RD.
    No preview · Article · Feb 2007 · Retina
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    [Show abstract] [Hide abstract] ABSTRACT: To evaluate the prognostic influence of the presence of an operculum in macular hole and to correlate the prognosis for postoperative visual acuity (VA) with the size of the macular hole, its duration and preoperative VA. We carried out a prospective study of 61 eyes of 59 patients with full thickness macular hole. All patients were examined with optical coherence tomography (OCT) in order to ascertain the presence of an operculum. The VA was measured with the ETDRS chart. A standard pars plana vitrectomy with inner limiting membrane peeling was performed in all cases and 20% C2F6 was used as tamponade. Anatomical closure was obtained after one surgical procedure in 59/61 (97%) patients. Linear regression analysis showed only baseline VA to be predictive of visual outcome (p < 0.001). The presence of an operculum preoperatively did not correlate with VA either pre- or postoperatively, nor with the anatomical closure rate. The finding that postoperative VA in macular hole correlates with preoperative VA seems to allow for good prediction of postoperative VA in macular hole surgery. However, the presence of an operculum is of no prognostic significance.
    Full-text · Article · Jul 2006 · Acta Ophthalmologica Scandinavica
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    [Show abstract] [Hide abstract] ABSTRACT: Manganese (Mn) is one of the most abundant elements on earth, particularly in the soft bottom sediments of the oceans. As a micronutrient Mn is essential in the metabolic processes of organisms. However, at high concentrations the metal becomes a neurotoxin with well-documented effects. As a consequence of euthrophication, manganese is released from bottom sediments of coastal areas and the Norway lobsters, Nephrops norvegicus, can experience high levels of bioavailable Mn(2+). Here, we present the first report showing that Mn also affects several fundamental processes in the mobilisation and activation of immunoactive haemocytes. When N. norvegicus was exposed to a realistic [Mn(2+)] of 20 mg l(-1) for 10 days 24.1 microg ml(-1) was recorded in the haemolymph. At this concentration the total haemocyte count was reduced by ca. 60%. By using BrdU as a tracer for cell division, it was shown that the proliferation rate in the haematopoietic tissue did not increase, despite the haemocytepenia. A gene coding for a Runt-domain protein, known to be involved in maturation of immune active haemocytes in a variety of organisms, was identified also in haemocytes of N. norvegicus. The expression of this gene was >40% lower in the Mn-exposed lobsters as judged by using a cDNA probe and the in situ hybridisation technique. In response to non-self molecules, like lipopolysaccharide (LPS), the granular haemocytes of arthropods are known to degranulate and thereby release and activate the prophenoloxidase system, necessary for their immune defence. A degranulation assay, tested on isolated granular haemocytes, showed about 75% lower activity in the Mn-exposed lobsters than that for the unexposed. Furthermore, using an enzymatic assay, the activation per se of prophenoloxidase by LPS was found blocked in the Mn-exposed lobsters. Taken together, these results show that Mn exposure suppressed fundamental immune mechanisms of Norway lobsters. This identifies a potential harm that also exists for other organisms and should be considered when increasing the distribution of bioavailable Mn, as has been done through recently introduced applications of the metal.
    Full-text · Article · Dec 2004 · Aquatic Toxicology
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    [Show abstract] [Hide abstract] ABSTRACT: The present study describes the prevalence of visual impairment and blindness in a geographically defined population 8 years after the introduction of a screening programme in 1987 for early detection of sight-threatening diabetic retinopathy. Of 374 patients with diabetes, comprising 2.6% of the population in the study community, 72% were examined with fundus photography or biomicroscopy during 1994-95. These patients form the basis of this study. The screening programme was fulfilled by 93% of subjects, all of whom underwent ophthalmic examinations at least every other year. A total of 79 eyes in 52 patients received photocoagulation for macular oedema alone or in combination with severe non-proliferative or proliferative retinopathy. Eight years after the implementation of the programme, only three patients, all with type 2 diabetes (diabetes diagnosed at or after 30 years of age), had visual acuity < or = 0.1. The total number of eyes with visual acuity < or = 0.5 was higher in insulin-treated type 2 diabetic patients (n = 20) than in those on oral treatment (n = 5) or diet treatment only (n = 1) (p = 0.006 in both cases). The only independent risk factor for visual impairment in eyes with sight-threatening retinopathy was age. A small number of older type 2 diabetic patients end up with visual impairment due to unsuccessful photocoagulation of macular oedema.
    Preview · Article · Jun 2002 · Acta Ophthalmologica Scandinavica
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    Kristina Holm
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