Disruption Of Blood-aqueous Barrier Research Articles

Association between blood-aqueous barrier disruption and extent of retinal detachment.

To investigate the association between anatomical features of rhegmatogenous retinal detachment (RRD) and the extent of blood-aqueous barrier disorder measured by non-invasiv laser flare photometry. Retrospective evaluation of consecutive patients with RRD that underwent surgery between November 2016 and October 2018. Descriptive evaluation of pre- and postoperative parameters and correlation to preoperative laser flare value, extent of retinal detachment and re-detachment rate were performed. 266 patients (mean age 62.73 ± 10.40 years, 62.8% male) were included. Mean preoperative flare value was 11.0 ± 11.9 pc/ms. In pseudophakia flare values were higher than in phakia (12.7 ± 10.4 pc/ms versus 9.8 ± 12.9 pc/ms; p = 0.042). Flare increased and correlated significantly with the number of affected retinal quadrants (Q) (1 Q 6.4 ± 3.3 pc/ms; 2 Q 10.5 ± 8.8 pc/ms; 3 Q 15.6 ± 9.1 pc/ms; 4 Q 27.5 ± 33.3 pc/ms; p < 0.001; r = 0.40). Macular status correlated significantly with flare values (macula on 8.6 ± 7.1 pc/ms, off 13.1 ± 15.0 pc/ms; p = 0.004; r = 0.17). The level of objective tyndallometry in RRD seems to be influenced by lens status and extent of retinal detachment. Thus, the greater the affected retinal area is, the more blood-aqueous barrier disruption seems to be present.

Disruption of blood-aqueous barrier in dry eye disease

PurposeTo evaluate level of flare in aqueous humor of dry eye disease (DED) and compare it with normal controls. MethodsIn this cross-sectional study, we compared the anterior chamber flare between 28 patients with DED (the DED group) and 27 normal age- and gender-matched controls (the control group). DED group was divided in Sjӧgren's syndrome dry eye (SDE, n = 10) and non- Sjӧgren's syndrome dry eye (non-SDE, n = 18) groups. ResultsThis study enrolled 55 participants including 28 patients with DED and 27 normal controls. The mean age was 53.4 ± 14.7 years in the DED group and 48.5 ± 14.7 years in the control group (P = 0.086). Mean flare was significantly higher in DED group (12.1 ± 10.2 ph/ms, range 2.7–68.3) compared to the control group (5.0 ± 3.9 ph/ms, range 1.30–30.0, P < 0.001). There was no statistically significant difference in the flare intensity between the Sjӧgren syndrome dry eye (SDE) group (14.5 ± 14.4 ph/ms) and the non-Sjӧgren dry eye (non-SDE) group (10.8 ± 6.9 ph/ms, P = 0.330). A significant correlation was observed between the flare intensity and the ocular surface staining in the SDE group (r = 0.62, P = 0.018). ConclusionThere is a significant increase in aqueous humor flare in patients with DED. Such finding, which is a marker of disruption of blood-aqueous barrier, demonstrates deeper tissue involvement than ocular surface in these patients.

A COMPARISION OF POSTERIOR CAPSULAR OPACITY FORMATION UPTO 1 YEAR IN PATIENTS WITH SMALL INCISION CATARACT SURGERY WITH FOLDABLE INTRAOCULAR LENS AND PHACOEMULSIFICATION WITH THE SAME INTRAOCULAR LENS

Introduction: Cataract is most common cause of curable blindness worldwide and cataract surgery is most common procedure performed in ophthalmology. Posterior capsular opacification (PCO) is most common complication after cataract surgery which is usually treated with Neodymium-doped: Yttrium Garnet (Nd:YAG) laser posterior capsulotomy or occasionally with a surgical capsulotomy. The incidence and severity of PCO correlates to the type of surgical technique, IOL optic edge designs and IOL materials. Material and Methods: 70 eyes of 64 patients operated for age related cataract were studied in this prospective interventional study. Phacoemulsification was done in 35 eyes and SICS in 35 eyes with hydrophobic single piece biconvex foldable intraocular lens. Patients were followed up at 1, 3, 6, 9 and 12 months for the development of PCO. Clinically significant PCO (loss of 2 or more lines of Snellen’s visual acuity chart) was treated with Nd:YAG laser capsulotomy. Results: The overall incidence of PCO was 22.85%. Amongst the patients who developed PCO, SICS and phacoemulsification was performed in 62.5% and 37.5% patients respectively. Result was statistically significant with p value &lt;0.05 using z test. On first postoperative day, patients operated with phacoemulsification had better visual acuity than SICS. Conclusion: Phacoemulsification can provide early and better visual outcome than SICS and has lower incidence of PCO formation which may be due to difference in irrigation and aspiration and less disruption of blood aqueous barrier than SICS. PCO can be reduced by atraumatic surgery and thorough cortical clean up and capsular polishing.

Disorder of blood-aqueous barrier following Ahmed Glaucoma Valve implantation

Background Ahmed Glaucoma Valve implantation (AGVI) is used to treat refractory glaucoma. Breakdown of the blood-aqueous barrier (BAB) has been noted after some surgical techniques. The current study was designed to assess BAB disruption after AGVI. Methods Anterior chamber protein content was measured by the laser flare cell photometry in 22 eyes of 22 patients with refractory glaucoma before AGVI and at each postoperative visit up to 1 month. Results Before AGVI the mean aqueous flare values in all eyes were (15.17±9.84) photon counts/ms[0]. After AGVI, the values significantly increased at day 1, day 3, and week 1 compared to those before AGVI (all P &lt;0.05) with a peak at day 3. They returned to pre-operative levels at week 2, and were lower than preoperative level at month 1. Eyes with previous intraocular surgery history had greater aqueous flare values than those without previous intraocular surgery history, but there were no significant differences at all time points postoperatively (all P &gt;0.05). Furthermore, eyes with shallow anterior chambers had greater aqueous flare values at day 3 and week 1 (all P &lt;0.05). When comparing eyes with other refractory glaucoma conditions, neovascular glaucoma combined with intravitreal bevacizumab injection resulted in lower aqueous flare values after AGVI, but no significant differences were observed at all time points, postoperatively (all P &gt;0.05). Conclusions The BAB was impaired and inflammation was present in the anterior chamber in refractory glaucomatous eyes following AGVI. However, such conditions were resolved within 1 month postoperatively. Intravitreal bevacizumab treatment in neovascular glaucoma eyes before AGVI may prevent BAB breakdown.

Effects of one-week versus one-day preoperative treatment with topical 1% prednisolone acetate in dogs undergoing phacoemulsification

To compare the effects of 2 preoperative anti-inflammatory regimens on intraocular inflammation following phacoemulsification. Randomized controlled trial 21 dogs with immature cataracts. All dogs had cataract surgery via phacoemulsification, and most received prosthetic intraocular lenses. Dogs were randomly divided into 2 groups. Group A dogs were treated topically with prednisolone acetate for 7 days prior to surgery, whereas prednisolone acetate treatment commenced the evening prior to surgery in group B dogs. Postoperative care was identical for both groups. Blood-aqueous barrier breakdown was quantified by use of anterior chamber fluorophotometry, with fluorescein entry into the anterior chamber measured 2 and 9 days after surgery compared with baseline scans obtained prior to surgery. Ophthalmic examinations were performed before surgery and 1 day, 9 days, 3 weeks, 7 weeks, 3 months, and 6 months after surgery. A subjective inflammation score was established at each examination. Intraocular pressures were measured 4 and 8 hours after surgery and at each follow-up examination. There was no difference in the extent of blood-aqueous barrier disruption between the groups at 2 or 9 days after surgery. Subjective inflammation scores were also similar at most time points. Dogs in group A developed postoperative ocular hypertension at a higher frequency (60%) than did those in group B (18%). In dogs that underwent cataract surgery via phacoemulsification, a full week of topical prednisolone acetate treatment prior to surgery did not decrease postoperative inflammation, compared with commencement of topical prednisolone acetate treatment the evening prior to surgery, and was associated with a greater incidence of postoperative ocular hypertension.

Laser flare photometry: why is it going to be the gold standard for the assessment of intraocular inflammation

AbstractPurpose Laser flare photometry is a noninvasive, objective and quantitative method to measure intraocular inflammation.Methods The reproducibility and accuracy of flare measurements was proven by laboratory tests and by clinical studies showing low inter‐ and intra‐observer variability. Laser flare photometry values correlate with clinical grades of flare based on slit lamp examination. However, this technique provides a wide range of values for each clinical grade and there are overlapping ranges between grades. Besides,it allows the detection of subclinical blood aqueous barrier disruption.Results Laser flare photometry has many clinical applications : 1‐Uveitis Laser flare photometry shows better sensitivity than the slit lamp grading of cells and flare in monitoring anterior chamber inflammation, in both acute and chronic inflammation. It helps to define the inflammatory profiles of various types of anterior and posterior uveitis. It allows the assessement of the response to treatment and the prediction of the disease relapse. Relationships of laser flare photometry with complications permit to determine the prognosis of uveitis. 2‐Post‐surgical inflammation An objective evaluation of the blood aqueous barrier disruption after different surgical procedures is provided. The effects of different molecules on the post‐surgical inflammation can be evaluated and compared. 3‐Several other conditions associated with some degree of blood‐aqueous barrier disruption such as diabetic retinopathyConclusion Laser flare photometry is an objective and precise technique. It should be the gold standard for the assessment of intraocular inflammation.

Nepafenac 0.1% versus fluorometholone 0.1% for preventing cystoid macular edema after cataract surgery

To compare a topical nonsteroidal antiinflammatory drug (nepafenac 0.1%) and a topical steroidal antiinflammatory drug (fluorometholone 0.1% ) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract extraction with foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, Japan. Randomized double-masked single-center clinical trial. Patients were randomized to receive nepafenac 0.1% eyedrops or fluorometholone 0.1% eyedrops for 5 weeks after phacoemulsification with foldable IOL implantation. The incidence and severity of CME were evaluated by fluorescein angiography, retinal foveal thickness on optical coherence tomography, and BAB disruption on laser flare-cell photometry. Thirty patients received nepafenac and 29 patients, fluorometholone. Five weeks postoperatively, the incidence of fluorescein angiographic CME was significantly lower in the nepafenac group (14.3%) than in the fluorometholone group (81.5%) (P<.0001). The fovea was thinner in the nepafenac group than in the fluorometholone group at 2 weeks (P=.0266) and 5 weeks (P=.0055). At 1, 2, and 5 weeks, anterior chamber flare was significantly less in the nepafenac group than in the fluorometholone group (P<.0001, P<.0001, and P=.0304, respectively). The visual acuity recovery from baseline was significantly greater in the nepafenac group (80.0%) than in the fluorometholone group (55.2%) (P=.0395). There were no serious side effects in either group. Nepafenac was more effective than fluorometholone in preventing angiographic CME and BAB disruption, and results indicate nepafenac leads to more rapid visual recovery.

Uveal effusion induced by topical travoprost in a patient with Sturge-Weber-Krabbe syndrome

To report a case of uveal effusion with subtotal exudative retinal detachment induced by topical administration of travoprost. A 20-year-old woman with a medical history of right-sided Sturge-Weber-Krabbe syndrome and bilateral aphakia secondary to congenital cataract extraction was referred to our department for retinal detachment associated with uveal effusion of the right eye. The ocular manifestations of Sturge-Weber-Krabbe syndrome in her right eye were glaucoma and diffuse choroidal hemangioma. Antiglaucomatous medications using topical travoprost 0.004%/timolol 0.5% (fixed combination) had been begun 1 week before. An adverse effect of travoprost was suspected and the drug was discontinued. Three weeks later, a fundus examination showed total disappearance of the uveal effusion. Interaction of the effects of topical prostaglandin analogs (blood-aqueous barrier disruption, enhancement of uveoscleral outflow) with both the diffuse choroidal hemangioma and the elevated episcleral venous pressure may lead to uveal effusion in Sturge-Weber-Krabbe syndrome. In spite of their efficiency, prostaglandin F2 analogs (latanoprost, travoprost and bimatoprost) should be used with caution in Sturge-Weber-Krabbe syndrome and particularly in cases of proved diffuse choroidal hemangioma.

The effect of a single dose of topical 0.005% latanoprost and 2% dorzolamide/0.5% timolol combination on the blood‐aqueous barrier in dogs: a pilot study

To determine the effects of 0.005% latanoprost and 2% dorzolamide/0.5% timolol on the blood-aqueous barrier (BAB) in normal dogs. Eight mixed-breed and pure-breed dogs. Baseline anterior chamber fluorophotometry was performed on eight normal dogs. Sodium fluorescein was injected and the dogs were scanned 60-90 min post-injection. Seventy-two hours following the baseline scan, one eye received one drop of latanoprost. Fluorophotometry was repeated 4 h after drug administration. Following a washout period, the identical procedure was performed 4 h after the administration of dorzolamide/timolol. The degree of BAB breakdown was determined by comparing the concentrations of fluorescein within the anterior chamber before and after drug administration. BAB breakdown was expressed as a percentage increase in the post-treatment fluorescein concentration over the baseline concentration: %INC [Fl] = {([Fl](post)-[Fl](baseline))/[Fl](baseline)} x 100. The percentage increase in fluorescein concentration in the treated eye was compared to that in the nontreated eye using a paired t-test with significance set at P < or = 0.05. Following administration of latanoprost, the fluorescein in the treated eyes increased 49% (+/- 58%) from baseline compared to 10% (+/- 31%) in the untreated eyes (P = 0.016). Following administration of dorzolamide/timolol, the fluorescein concentration increased 38% (+/- 54%) compared to baseline vs. 24% (+/- 38%) in the untreated eyes (P = 0.22). The results of this study show that topical latanoprost may cause BAB disruption in normal dogs while topical dorzolamide/timolol may have no effect on the BAB in normal dogs.

Reducing angiographic cystoid macular edema and blood–aqueous barrier disruption after small-incision phacoemulsification and foldable intraocular lens implantation: Multicenter prospective randomized comparison of topical diclofenac 0.1% and betamethasone 0.1%

To compare the effectiveness of a topical nonsteroidal drug (diclofenac 0.1%) and a topical steroidal drug (betamethasone 0.1%) in preventing cystoid macular edema (CME) and blood-aqueous barrier (BAB) disruption after small-incision cataract surgery and foldable intraocular lens (IOL) implantation. Shohzankai Medical Foundation Miyake Eye Hospital, Tokyo, Japan. This multicenter interventional double-masked randomized study comprised 142 patients having phacoemulsification and foldable IOL implantation. Seventy-one patients were randomized to receive diclofenac eyedrops and 71, betamethasone eyedrops for 8 weeks postoperatively. The incidence and severity of CME were evaluated by fluorescein angiography. Blood-aqueous barrier disruption was determined by laser flare-cell photometry. Of the patients, 63 were men and 79 were women. Five weeks after surgery, the incidence of fluorescein angiographic CME was lower in the diclofenac group (18.8%) than in the betamethasone group (58.0%) (P<.001). At 1 and 2 weeks, the amount of anterior chamber flare was statistically significantly less in the diclofenac group than in the betamethasone group (P<.05). At 8 weeks, intraocular pressure was statistically significantly higher in the betamethasone group (P = .0003). Diclofenac was more effective than betamethasone in preventing angiographic CME and BAB disruption after small-incision cataract surgery. Thus, nonsteroidal antiinflammatory agents should be considered for routine treatment of eyes having cataract surgery.

Relationship Between Blood-Aqueous Barrier Disruption and Ischemic Macular Edema in Patients with Branch or Central Retinal Vein Occlusion: Effects of Sub-Tenon Triamcinolone Acetonide Injection

The aim of this study was to study the effects of the sub-Tenon triamcinolone acetonide (STA) injection on ischemic cystoid macular edema (CME) or macular edema (ME) and blood-aqueous barrier (BAB) disruption associated with branch or central retinal vein occlusion (BRVO or CRVO). Prior to, and 1, 2, 3, and 4 months after, STA injection, central retinal thickness was measured by using optical coherence tomography and the amount of aqueous flare by using laser flare metry. In the BRVO group treated by STA, the amount of flare was significantly less at 1, 2, and 3 months after injection than in the untreated BRVO group (P < 0.05). In the CRVO group treated by STA, the amount was significantly less at 1 month after injection than in the untreated CRVO group (P < 0.05). In the BRVO group with STA treatment, central retinal thickness was significantly less at 1 and 2 months after the treatment than in the untreated BRVO group (P < 0.05). In the CRVO group with STA treatment, the thickness was significantly less at 1 month after treatment than in the untreated CRVO group (P < 0.05). A correlation test revealed the amount of aqueous flare and the central retinal thickness to be well correlated (P < 0.01). The effects of STA and its time course on CME or ME correlated well with those on BAB disruption. Since there is the close correlation between the BAB and blood-retinal barrier function, the effects of medical treatment on ME associated with BRVO or CRVO can be evaluated by means of the BAB function.

Laser flaremetric evaluation of experimentally induced blood-aqueous barrier disruption in cats

To determine whether aqueous humor flare, measured by use of laser flaremetry, was proportional to aqueous humor protein concentration and to use laser flaremetry to evaluate disruption of the blood-aqueous barrier (BAB) in cats. 30 healthy adult cats. Laser flaremetry values for all eyes were compared with aqueous humor protein concentrations determined by use of a Coomassie blue microprotein assay. Laser flaremetry was then performed on both eyes before (0 hours) and 4, 8, and 26 hours after initiation of topical application of 2% pilocarpine (q 8 h) to 1 eye of 9 cats or paracentesis of the anterior chamber of 1 eye of 8 cats. Intraocular pressure and pupil size were also determined. Aqueous humor protein concentration was extrapolated from flare values by use of linear regression. There was a linear relationship between flare values and aqueous humor protein concentrations. Topical application of 2% pilocarpine and paracentesis of the anterior chamber caused a breakdown of the BAB that was detected by use of laser flaremetry. The highest mean flare readings after application of pilocarpine or paracentesis were 24.4 and 132.8 pc/ms, respectively, which corresponded to aqueous humor protein concentrations of 85.5 and 434.9 mg/dl, respectively. Paracentesis of the anterior chamber resulted in a more severe breakdown of the BAB in cats than topical application of 2% pilocarpine. Laser flaremetry may be a useful clinical method to detect increases in aqueous flare and, hence, disruptions of the BAB in cats.

Melanocortins are comparable to corticosteroids as inhibitors of traumatic ocular inflammation in rabbits

Melanocyte-stimulating hormone (MSH) is a known anti-inflammatory agent and we investigated whether it reduces the inflammatory reaction following ocular surgery. Rabbits received a perforating corneolimbal cut. Treatment involved topical (10(-8)M) or intramuscular (50 mg/kg/day) MSH, topical steroids or saline. The parameters studied were hyperemia, edema, aqueous protein levels and the number of inflammatory cells in the aqueous, as well as their number determined histologically in the injured cornea. Each parameter was assessed at 24 h post injury. Topically and systematically applied MSH reduced edema to levels 60% and 76%, respectively, of those observed in operated saline-treated eyes (P<0.001), and their efficacy was comparable to that of topical steroids. The decrease in hyperemia brought about by MSH was more pronounced than that produced by steroids. Aqueous protein levels were reduced by a similar degree in the steroid- and MSH-treated eyes as in the saline group (P<0.001 for each treatment group); In MSH- and ste-roid-treated eyes the number of inflammatory cells in the aqueous was reduced by 80% and 50%, respectively. We demonstrated that MSH reduced the clinical signs of ocular inflammation, curtailed blood-aqueous barrier (BAB) disruption, and reduced aqueous inflammatory cell number. The efficacy of MSH applied systemically or topically was similar to that of steroids in reducing clinical signs of trauma, but MSH efficacy in maintaining BAB integrity surpassed that of steroids. We suggest that the melanocortins might be a useful anti-inflammatory agents in ocular trauma.

Effects of Tetramethylpyrazine on Prostaglandin E 2- and Prostaglandin E 2 Receptor Agonist-induced Disruption of Blood-Aqueous Barrier in Pigmented Rabbits

Purpose: To evaluate the effect of tetramethylpyrazine on the elevation of aqueous flare and intraocular pressure (IOP) induced by prostaglandin (PG) E 2 and PGE 2 receptor (EP) agonists. Methods: PGE 2 or EP agonists (11-deoxy PGE 1, EP 2 agonist; 17-phenyl trinor PGE 2, EP 1 and EP 3 agonist; or sulprostone, EP 1 and EP 3 agonist), 25 μg/mL, were transcorneally administered to pigmented rabbits. Animals were pretreated with tetramethylpyrazine intravenously (10 or 30 mg/kg) or topically (0.1% solution). Aqueous flare was measured using a laser flare-cell meter, and the intensity was expressed as the area under the curve (AUC). Intraocular pressure was measured using a noncontact tonometer. Results: After administration of PGE 2, aqueous flare and IOP increased and then gradually decreased. The AUC of eyes pretreated with tetramethylpyrazine, 10 or 30 mg/kg, intravenously, or topical 0.1% solution, was significantly smaller than that of the controls. The mean Δ IOP of eyes pretreated with tetramethylpyrazine, 30 mg/kg intravenously, was significantly lower than that of the controls. After administration of 11-deoxy PGE 1, aqueous flare increased and then gradually decreased. 17-phenyl trinor PGE 2 and sulprostone did not disrupt the blood-aqueous barrier. The AUC of eyes pretreated with tetramethylpyrazine, 10 or 30 mg/kg, intravenously, before 11-deoxy PGE 1 application was significantly smaller than that of the controls. Conclusion: The results indicated that tetramethylpyrazine inhibited PGE 2- or 11-deoxy PGE 1-induced elevation of aqueous flare and IOP.

Disruption of the Blood-Aqueous Barrier following Retinal Laser Photocoagulation and Cryopexy in Pigmented Rabbits

Disruption of the blood-aqueous barrier (BAB) induced by retinal photocoagulation and cryopexy in pigmented rabbits was evaluated by laser flare photometry. A significant increase in flare values after retinal photocoagulation was measured from the 1st postoperative day, with values returning to baseline levels by day 7. Cryopexy induced consistently high flare values for 14 days. Intravitreal injection of interleukin (IL) 1, IL-6 and prostaglandin (PG) E₂ induced a significant increase in flare values. Following these treatments, introduction of a PG synthetase inhibitor can partially ameliorate BAB disruption. IL-1, IL-6 and PGE₂ may be involved in BAB disruption following retinal photocoagulation and cryopexy.

Blood-Aqueous Barrier Disruptionin Expe rimental Anterior Segment Ischemia in Rabbit Eyes

The blood-aqueous barrier (BAB) in experimentally induced anterior segment ischemia (ASI) following strabismus or retinal detachment surgery in pigmented rabbits was evaluated by laser flare photometry. Four simultaneous rectus tenotomies produced a significantly higher flare value on the 1st postoperative day. Obstruction of one or two vortex veins produced significantly high flare values on the 1st and 3rd postoperative days. Scleral buckling with interference of one vortex vein produced a higher flare value than that with buckling alone. Interference of three vortex veins by diathermy and the encircling procedure produced serious ASI. Disruption of BAB in ASI can be detected quantitatively with laser flare photometry. Introduction of prostaglandin synthetase inhibitor resulted in a significant reduction of flare values following surgery. Prostaglandin synthetase inhibitor can partly ameliorate BAB disruption.

Inhibitory Effect of Nilvadipine on Disruption of Blood-Aqueous Barrier Induced by Prostaglandin E2 Application in Pigmented Rabbits: A Morphologic Study

The purpose of the present study is to investigate the morphologic sites of breakdown in eyes pretreated with nilvadipine (a calcium channel blocker) that has been shown to inhibit the acute rise of aqueous flare induced by prostaglandin E₂ (PGE₂). Nilvadipine (100 µg/kg body weight) was injected intravenously in pigmented rabbits. Thirty minutes later, vehicle or PGE₂ (10, 50 or 250 µg/ml) was applied on the cornea by use of a glass cylinder. Forty-five minutes later, the animals received horseradish peroxidase (HRP) intravenously and the eyes were enucleated. Distribution of HRP in the anterior segments was observed by electron microscopy. Without nilvadipine pretreatment, HRP was seen in the intercellular space of nonpigmented cells of the eyes treated with 50 µg/ml PGE₂ and in the iris stroma of the eyes treated with 250 µg/ml PGE₂. With nilvadipine pretreatment, HRP was not observed in these sites. Our results indicate that nilvadipine suppresses disruption of the different sites of the blood-aqueous barrier.

Postoperative inflammation after clear corneal and sclerocorneal incisions

Purpose: To compare two standard small incision techniques for cataract surgery—clear corneal incision and sclerocorneal incision—with regard to postoperative disturbance of the blood-aqueous barrier (BAB).Setting: Department of Ophthalmology, University of Vienna, Austria.Methods: This prospective comparative study comprised 108 eyes with senile cataract. A clear corneal tunnel incision was made in 53 eyes and a sclerocorneal incision with tunnel preparation in 55. All other surgical procedures and postoperative medication were standardized. Postoperative BAB disruption was measured with a laser flare-cell meter (Kowa FC 1000) in an undilated pupil on 1, 3, 7, 14, 28, 60, and 90 days postoperatively. The values were compared using a two-sided t-est.Results: In both groups, flare and cell values were highest on the first postoperative day. They gradually declined but without recovery of preoperative flare values on day 28. At no time was there a noticeable between-group difference in mean cell and flare values except for flare at day 14 (P = .04).Conclusion: Postoperative trauma, measured by the BAB disturbance, was equally low after clear corneal and sclerocorneal incisions.

Use of Laser Flare Photometry to Assess and Monitor Inflammation in Uveitis

Laser flare photometry (LFP) is a new quantitative method for the evaluation of aqueous flare, making flare the only inflammatory parameter that can be evaluated precisely and objectively. The aim of this study was to characterize the inflammatory pattern of acute human leukocyte antigen-B27 (HLA-B27)-related anterior uveitis and to determine further clinical use and limitations of LFP in posterior inflammation. In the first part of the study, 78 episodes of HLA-B27-related acute anterior uveitis were analyzed to determine mean pretreatment (initial) flare, mean flare evolution, need for additional periocular steroids, and mean duration of an episode. In the second part of the study, the use of LFP was further tested in posterior inflammation, first by analyzing the predictive value of a subclinical LFP-detected flare increase for disease recrudescence in posterior scleritis, and then by exploring clinical applications for LFP in posterior uveitis, where LFP was essential either in the establishment of a diagnosis or in guiding therapeutic decisions. Mean initial flare in HLA-B27-related acute anterior uveitis was 160 +/- 22 photons/msec, and mean duration of an episode was 18.5 +/- 15 days. A 50% and 90% flare reduction occurred after 2 and 8 days, respectively. In posterior scleritis, LFP was accurate in monitoring response to systemic steroid therapy and a small flare increase was predictive for disease recrudescence in five of six cases (predictive value 0.83, sensitivity 100%). In posterior uveitis, LFP was sensitive to monitor systemic treatments and to establish a diagnosis in unclear cases by measuring the effect of a selective therapy (therapeutic trial) on the flare level. In acute anterior HLA-B27-associated uveitis, LFP represented a potential improvement in management by allowing precise adjustment of therapy. In uveitis of the posterior segment, our data confirm the validity of LFP to monitor response and adjust systemic therapy and to detect disease recurrence in patients with a sufficient pretreatment level of associated blood-aqueous barrier disruption (flare).

Effect of 3.0 mm tunnel and 6.0 mm corneoscleral incisions on the blood-aqueous barrier

Purpose: To study of the effect of silicone intraocular lens (IOL) implantation using a 3.0 mm tunnel incision with that of implantation though a 6.0 mm corneoscleral incision after phacoemulsification in human eyes.Setting: Department of Ophthalmology, University of Köln, Germany.Methods: In a prospective, randomized clinical study, 50 patients with senile cataract had phacoemulsification and IOL implantation through a 3.0 mm tunnel or a 6.0 mm corneoscleral incision. To assess blood-aqueous barrier (BAB) disruption, preoperative and postoperative sodium fluorescein concentrations in the anterior chamber were measured with the Fluorotron Master II. Diclofenac sodium 0.1% was applied to the operative eyes five times a day for 5 days. The contralateral eyes served as controls.Results: There was no significant between-group difference in sodium fluorescein concentrations in the 5 days after surgery.Conclusion: The findings underline our clinical impression that BAB disruption 5 days after surgery does not differ significantly with the type and length of scleral incision used for IOL implantation.