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Biomedical subjects

Christos Haritoglou

Publications and source records attributed to Christos Haritoglou.

At least 37 records · Page 2Linked to original sources
PubMed2005

Staining of the internal limiting membrane with intravitreal triamcinolone acetonide.

PURPOSE: To evaluate the use of triamcinolone acetonide to stain the internal limiting membrane (ILM) during vitreoretinal surgery. METHODS: A prospective clinical interventional case series study was performed, including 16 patients who underwent pars plana vitrectomy. Seven patients had proliferative diabetic retinopathy with macular edema. Seven patients had epiretinal membranes. One patient had a retinal detachment with a cystoid macular edema and proliferative vitreoretinopathy. One patient had a pseudophakic cystoid macular edema. After vitrectomy, 2 mL triamcinolone acetonide suspension was injected into the vitreous cavity. The ILM was peeled, as it was evidenced by the particles of triamcinolone that adhered to its surface. The ultrastructure of tissue harvested during surgery was analyzed using transmission electron microscopy in selected cases to confirm the presence or absence of ILM. RESULTS: After the injection of triamcinolone, the visualization of the vitreous base and hyaloid was excellent in all patients. The particles of triamcinolone deposited on the retinal surface enabled the ILM to be stained. Once removed, the ILM was clearly distinguishable, floating in the vitreous cavity with particles of triamcinolone adhering to its surface. Ultrastructural analysis of tissue collected during vitrectomy confirmed that the removed tissue represented ILM. CONCLUSION: We observed that triamcinolone acetonide can be useful in staining the internal limiting membrane, thus greatly facilitating the retinal ILM peeling. The absence of particles of triamcinolone on the underlying retina enables the area where the ILM has already been removed to be identified.

Aged↗
PubMed2005

Histology of the vitreoretinal interface after indocyanine green staining of the ILM, with illumination using a halogen and xenon light source.

PURPOSE: To assess the histology of the retinal surface after staining of the inner limiting membrane (ILM) with indocyanine green (ICG) followed by illumination with halogen or xenon light sources in human donor and porcine eyes. METHODS: Ten eyes of six human donors and six porcine eyes were used in the study. In human donor eyes, the postmortem time varied between 7 and 38 hours, and porcine eyes were evaluated 9 hours after death. In all eyes, the vitreous was removed, and a few drops of 0.5% ICG were poured over the trephined posterior pole and carefully washed out after a period of 1 minute, with balanced salt solution. Then the stained retina was illuminated for 3 minutes with different light sources: a halogen light source of 145-W power or a xenon light source of 50-W power. Adjacent, unstained retina of each eye served as a control to assess postmortem artifacts. In two human and two porcine eyes ICG was applied without illumination. Retinal specimens were evaluated by light and electron microscopy. RESULTS: In human eyes, severe disorganization of the innermost retina and ILM loss were observed after ICG application with subsequent illumination with the halogen light source. After illumination with the xenon light source, there was only slight vacuolization of the innermost retina, with mostly intact Muller cells. The ILM remained in situ in relation to the retinal surface. Intact cellular architecture was found in all specimens after ICG staining without subsequent illumination and control specimens of unstained retina. In porcine eyes, no impact attributable to the light source or ICG alone was noted in this experimental setting. CONCLUSIONS: These findings suggest that adverse effects of ICG at the retinal surface may depend on the light source used during vitrectomy and correlate with the emission spectrum of the different light sources. In addition, care should be taken when comparing results obtained in human eyes and porcine eyes.

Adolescent↗
PubMed2005

An evaluation of novel vital dyes for intraocular surgery.

PURPOSE: To evaluate systematically the staining characteristics and safety of potential new dyes for intraocular surgery. METHODS: Six dyes were included in the investigation: light green SF (LGSF) yellowish, E68, bromophenol blue (BPB), Chicago blue (CB), rhodamine 6G, rhodulinblau-basic 3 (RDB-B3). All dyes were dissolved and diluted in a balanced saline saline solution. The light-absorbing properties of each dye were measured at a concentration of 0.05% between 200 and 1000 nm. Staining characteristics were examined by staining lens capsule tissue and epiretinal membranes (ERMs), removed intraoperatively, with dye concentrations of 1.0%, 0.5%, 0.2%, and 0.05%. Enucleated porcine eyes (postmortem time, 9 hours) were also stained. Dye-related toxicity was evaluated by a colorimetric test (MTT) measuring the inhibition of retinal pigment epithelium (RPE) cell proliferation (ARPE-19 and primary human RPE cells, passages 3-6). Cell viability was also quantified based on a two-color fluorescence cell-viability assay. Dyes were investigated in concentrations of 0.2% and 0.02%. RESULTS: All dyes investigated in this study stained human lens capsules, removed intraoperatively; ERMs, peeled during macular pucker surgery; and enucleated porcine eyes, depending on the concentration applied. The long-wavelength absorption maximum of the dyes was within the range of 527 to 655 nm at concentrations of 0.05%. Rhodamine G6 and RDB-B3 showed adverse effects on ARPE-19 cell proliferation at a concentration of 0.2% and were excluded from further investigation in primary RPE cells. The remaining four dyes showed no toxic effect on ARPE-19 and primary RPE cell proliferation at concentrations of 0.2% and 0.02%. Cell viability was affected by LGSF yellowish (0.2%) and CB (0.2% and 0.02%). Two dyes (E68 and BPB) showed no relevant toxicity in vitro. CONCLUSIONS: The systematic evaluation of dyes for intraocular use seems mandatory. In this study four dyes were identified with effective staining characteristics, with two of these dyes having no detectable toxic effect on RPE cells in vitro.

Acridine Orange↗
PubMed2004

Histopathological abnormalities in ocular blood vessels of CADASIL patients.

PURPOSE: To assess histopathological findings in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). DESIGN: Case reports and histopathological evaluation of enucleated eyes. METHODS: Four eyes from two CADASIL patients were enucleated at autopsy and prepared for histopathological analysis using light and electron microscopy. RESULTS: Thickening of arterial walls with fibrosis, eosinophilic Periodic acid Schiff-positive basement membrane material and loss of vascular smooth muscle cells (VSMC) in the central retinal artery and its branches, the leptomeninges, the ocular adnexa, and the optic disk were observed. On electron microscopy, numerous deposits of granular, osmiophilic material in arterial walls as well as VSMC and pericyte degeneration were noted. In contrast to retinal vessels, the choroid was not affected. CONCLUSION: Our findings suggest a differential involvement of small blood vessels in CADASIL, depending on the angioarchitecture and support autopsy data of nervous tissue describing that loss of VSMCs is most pronounced in tissues depending on blood-tissue barriers.

Bruch Membrane↗
PubMed2004

Functional outcome after trypan blue-assisted vitrectomy for macular pucker: a prospective, randomized, comparative trial.

PURPOSE: To evaluate functional outcome after the intraoperative application of 0.06% trypan blue during vitrectomy for macular pucker. DESIGN: Prospective, randomized, comparative study. METHODS: Forty-three eyes of 43 consecutive patients, 30 women and 13 men, were incorporated in the study. Patients were randomized into two groups: group 1 (n = 22) with trypan blue (0.06%) staining, and group 2 (n = 21) without trypan blue staining. Functional outcome (best-corrected visual acuity, Goldmann perimetry) was evaluated 1 day before surgery, at 6 weeks, and at intervals of 3, 6, and 12 or more months postoperatively. Only patients with an idiopathic macular pucker were included. In all patients, a standard three-port pars plana vitrectomy with peeling of an epiretinal membrane (ERM) and the internal limiting membrane was performed. No other modification of the surgical procedure, except the use of trypan blue was made between the two groups. RESULTS: Mean age was 68.9 years in group 1 (with trypan blue) and 69.4 in group 2 (without trypan blue). Median best-corrected visual acuity was 20/63 in both groups (range, 20/200-20/40; P >.5) before surgery. Mean follow-up time was 5.8 months in group 1 and 5.3 months in group 2. After surgery, median visual acuity had increased to 20/40 in both groups (range, 20/500 to 20/20 in group 1 and 20/100 to 20/20 in group 2; P <.001 for both groups). The difference between both groups was not statistically significant (P >.5). An improvement of visual acuity (gain of 2 or more lines) was seen in 16 patients of both groups. No postoperative visual field defects were noted. CONCLUSIONS: Trypan blue-assisted vitrectomy for macular pucker leads to good functional results with no dye-related adverse effects after short follow-up. Trypan blue might be especially applicable in cases in which the borders of the ERM are difficult to define. Hypothetical advantages, such as fewer recurrences of ERMs after trypan blue staining, will have to be evaluated during further follow-up of patients.

Aged↗
PubMed2004

Histology of the vitreoretinal interface after staining of the internal limiting membrane using glucose 5% diluted indocyanine and infracyanine green.

PURPOSE: To evaluate the effect of indocyanine green (ICG) diluted with glucose 5% on the human retina in an experimental setting in postmortem eyes and during surgery for macular hole formation. DESIGN: Histopathological evaluation. METHODS: Possible adverse effects of two different solutions of 0.05% ICG (Pulsion, Munich, Germany; and Infracyanine, Laboratoire SERB, Paris, France) diluted with glucose 5% were evaluated in four eyes of two donors. In one eye of each donor, the ICG-stained macula was illuminated with 380 to 760 nm using the light source of a commonly used vitrectomy machine. In the other eye, ICG was applied to the macula without illumination. The retinal specimens were evaluated using light- and electron microscopy. Additionally, the ultrastructure of the internal limiting membrane (ILM) of four eyes that underwent ICG-assisted vitrectomy for macular hole formation was examined. RESULTS: In the postmortem study, both solutions of ICG caused significant morphologic alterations of the inner retina after light exposure. There was disorganization of the inner retina and complete loss of ILM after application of the dye and illumination. In contrast, no abnormalities were found after application of the dye without illumination and in unstained control specimens. No differences were noted between the two ICG products. Specimens of the ILM harvested during vitrectomy revealed cellular elements adjacent to the retinal side of the ILM. CONCLUSIONS: Staining of the ILM using ICG diluted in glucose 5% followed by illumination might induce an adverse effect on the inner retina and may result in an alteration of the cleavage plane from the ILM to the innermost retinal layers.

Adult↗
PubMed2004

[Presumed ocular histoplasmosis syndrome (POHS) in a non-endemic area].

BACKGROUND: POHS is a chorioretinal disease rarely occurring in non-endemic areas. METHODS: We present the case of a 35-year old male patient with symptoms of dry eyes, but subjectively no other ocular complaints. However, visual acuity of the right eye was 20/20, but only 20/200 in the left eye. RESULTS: On fundoscopic examination both eyes showed alterations consistent with all four typical features of presumed ocular histoplasmosis syndrome. In both eyes in the mid-periphery punched-out chorioretinal spots were found, an extensive peripapillary atrophy and peripheral linear chorioretinal streaks were seen. Moreover, in the left eye an atrophic macular scar existed, presumably due to subretinal neovascularisation. The macula of the right eye was normal, serology testing for Histoplasma capsulatum negative. CONCLUSIONS: As the patient had never travelled to endemic areas such as the USA but exhibited all features of POHS, the case shows that POHS may also occur in European, non-endemic areas. This further supports the theory that other factors play a role in the etiopathology of this syndrome.

Adult↗
PubMed2004

Trypan blue in macular pucker surgery: an evaluation of histology and functional outcome.

PURPOSE: To evaluate possible adverse effects of trypan blue on the ultrastructure of the human retina, to report on functional outcome of macular pucker surgery with and without the use of trypan blue, and to evaluate the ultrastructure of tissue harvested during surgery. DESIGN: Experimental study and prospective matched-pair analysis of two consecutive, interventional case series. METHODS: Possible adverse effects on the ultrastructure of the human retina by trypan blue were evaluated in three donor eyes in an experimental study using trypan blue in concentrations of 0.02%, 0.15%, and 0.25%. The retinas were histologically evaluated. In the clinical study, the functional outcome (visual acuity, Goldmann perimetry) of 10 eyes of 10 consecutive patients with intraoperative use of trypan blue (0.15%) was analyzed (group 1) and compared with the functional outcome in a matched group of patients (preoperative visual acuity, pre- and postoperative lens status) who had undergone vitrectomy without trypan blue assistance (group 2). Only patients with an idiopathic macular pucker were included. Epiretinal tissue of all eyes was harvested and prepared for ultrastructural analysis using light and electron microscopy. RESULTS: In the postmortem study, no significant alterations of the inner retina suggesting adverse effects of trypan blue concentrations of 0.02% were observed. In contrast, a disorganization of the innermost retina and an absence of the internal limiting membrane (ILM) was seen after the application of undiluted 0.15% and 0.25% trypan blue. In the clinical study, the median best-corrected visual acuity was 20/50 in both groups (range, 20/200-20/40) before surgery. Mean age was 70 years in group 1 (with trypan blue) and 69 years in group 2 (without trypan blue). Mean follow-up time was 4 months in group 1 and 5.6 months in group 2. Postoperatively, median visual acuity had increased to 20/32 (range, 20/100-20/25; Wilcoxon test P = 0.01) in group 1 and to 20/40 (range, 20/100-20/25; P = 0.09) in group 2. The difference between the two groups was not statistically significant (P = 0.4). Four of 10 patients without and 7 of 10 patients with trypan blue staining experienced an improvement of visual acuity (gain of 2 lines or more). No postoperative visual field defects were noted in either group. Histologic analysis of tissue harvested intraoperatively revealed the regular picture of undisturbed fibrocellular membranes. In some specimens, a layer of interspersed collagen was noted between epiretinal cells and the ILM, suggesting two different morphologic types of macular pucker. In a few sections, areas of cellular elements were detected adjacent to the retinal surface of the ILM. CONCLUSION: Trypan blue in a concentration of 0.02% is not associated with morphologic alterations of the inner retinal layers in our postmortem study. After application of 0.15% and 0.25% trypan blue solutions, a disorganization of the inner retinal layers was observed; the ILM was absent. We did not find any adverse effects of an intraocular trypan blue concentration of 0.02% on functional status. Our study further indicates that the functional results of surgery with and without the use of trypan blue are comparable. As the question of toxicity of a dye can not be answered by morphological observations alone, further experimental studies will be needed.

Adult↗
PubMed2003

Functional outcome of macular hole surgery with and without indocyanine green-assisted peeling of the internal limiting membrane.

PURPOSE: To describe the impact of indocyanine green (ICG) staining of the internal limiting membrane (ILM) on the functional outcome of anatomically successful macular hole surgery by comparing consecutive patient series with and without ILM staining. METHODS: Eighteen consecutive patients who had undergone ICG-assisted vitrectomy (0.05%) for idiopathic macular hole were retrospectively analysed (visual acuity, gain in lines, Goldmann perimetry) and compared with two consecutive series of patients who had undergone macular hole surgery without the use of ICG immediately before (n=22) and after (n=17) the introduction of ICG in our institution. The osmolarity of the ICG solution applied was 275 mosmol, pH was 7.5. RESULTS: Although there was no statistically significant difference in duration of preoperative symptoms (P>0.3) and preoperative visual acuity (P>0.5), the functional outcome in patients after ICG-assisted vitrectomy was significantly lower (P<0.001 for visual acuity). The incidence of visual field defects was 50% (9/18) in patients after ICG application. CONCLUSION: Our findings suggest potential damage to the neurosensory retina in association with the intraoperative administration of the ICG solution. Whether this is caused by toxic effects of the dye itself, mechanical trauma to the retina or other mechanisms remains unknown.

Aged↗
PubMed2003

The effect of indocyanine-green on functional outcome of macular pucker surgery.

PURPOSE: To compare functional results after surgery for macular pucker either with or without indocyanine-green staining of the internal limiting membrane (ILM) and to evaluate the ultrastructure of the tissue removed. DESIGN: Retrospective analysis of two successive, consecutive, interventional case series. METHODS: Functional outcome (visual acuity, Goldmann perimetry) of 48 eyes of 48 consecutive patients with (group 1, n = 20) or without (group 2, n = 28) intraoperative use of indocyanine-green (ICG) was retrospectively analyzed. For statistical analysis, best-corrected visual acuity measured at the last presentation was considered. Only patients with an idiopathic macular pucker were included. Surgery consisted of three-port pars plana vitrectomy, and removal of epiretinal tissue and the ILM in a second step. Commercially available ICG with a concentration of.05% and an osmolarity of 275 mOsm was used to stain the ILM. The surgical technique used for both groups was identical, except the use of ICG. Epiretinal tissue of all eyes was harvested and prepared for ultrastructural analysis using light and electron microscopy. RESULTS: Follow-up time was 8.5 months in group 1 and 5.4 months in group 2. Whereas patients operated on without ICG experienced a significant improvement of median best-corrected visual acuity from 20/63 (range, 20/400 to 20/32) preoperatively to 20/40 (range, 20/200 to 20/25) postoperatively (P < .001), median best-corrected visual acuity remained 20/63 before (range, 20/200 to 20/63) and after (range, 20/400 to 20/20) (P > .9) ICG-assisted peeling. There was a statistically significant difference (P = .013) in best-corrected postoperative visual acuity of patients with and without the use of ICG. An improvement of vision was noted in 86% of patients without and 55% of patients with ICG-assisted surgery. Thirty-five percent of patients after ICG application presented with a deterioration of visual acuity. Furthermore, we observed large visual field defects in 7 of 20 patients after ILM staining. No visual field defects were noted after conventional peeling. Histologic analysis revealed clear differences between the two groups concerning the amount of cellular elements adjacent to the retinal surface of the ILM: There was more cellular debris visible in specimens after ICG application during surgery. Additionally, in contrast to surgery without ILM staining, epiretinal cells had ruptured and lost their cellular integrity after ICG-assisted vitrectomy. CONCLUSIONS: Indocyanine green-assisted surgery for macular pucker might have an adverse effect on functional outcome. Although there were obvious differences in the ultrastructure of tissue removed during surgery, our observations cannot be explained by histologic analysis alone. Other, so far unknown mechanisms of action must be considered.

Adult↗