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Objectives: Oxygen saturation in retinal vessels can be measured by spectrometry. However, there are no studies on the influence of different camera chips on these measurements. The presented study reports the effect of two different camera chips ("1-CCD" vs. "3-CCD") on the spectrometric measurements in the same patients., Methods: 61 eyes of 61 patients were included in this study. The study was approved by the local ethics commission. Patients were separated in 3 groups: the first group contained healthy volunteers, the second group patients with diabetes mellitus but without previous laser treatment, the third group included patients with diabetes mellitus and previous laser coagulation treatment. The oxygen saturation was calculated from the difference between wavelengths on and right next to the retinal vessel. This methodology uses the different absorption spectra of oxy- and deoxyhaemoglobin., Results: All 3 groups demonstrated valid outcomes of the retinal oxygen saturation in arterial and venous vessels. No significant differences we found in the arterial-venous oxygen difference between the two different camera chips (group 1 p = 0.063, group 2 p = 0.204, group 3 p = 0.059)., Conclusion: As no significant differences could be found between the two camera chips, the less expensive system should be used if the spectrometric measurement of oxygen saturation is added to an analysis system already established on the market.

VEGF expression and signalling are deregulated in diabetic retinopathy. Cellular processes like migration and proliferation as well as control of the permeability of the endothelium by VEGF are regulated as a consequence of its binding to the VEGF receptor 2. Proteins forming tight junctions between microvascular endothelial cells of the retina are delocated to the cytoplasm after treatment with VEGF(165), likely leading to the breakdown of the blood-retina barrier. VEGF-inhibitors such as a VEGF-aptamer (modified RNA-oligonucleotide; pegaptanib) or specific antibodies/antibody fragments (bevacizumab, ranibzumab) which directly interfere with the interaction of VEGF with its receptors are considered to be promising novel therapeutics to treat diabetic retinopathy and age-related macular degeneration. In vitro studies using microvascular endothelial cells will help to clarify the mechanisms of action of VEGF and its inhibitors. In particular, the influence of VEGF isoforms and the inhibitor ranibizumab on the proliferation and migration of bovine retinal microvascular endothelial cells was studied, as well as the rearrangement of tight-junction proteins after treatment of the cells with VEGF(165) and specific inhibitors. In addition to a review of recent publications in the field, primary data from our own studies are presented in this article.

Background: Disturbances in the microcirculation are a source of retinal diabetic alterations. Comprehensive studies of blood flow parameters have been performed, but it is not known how ageing, duration of diabetes, blood sugar, glycolysed haemoglobin and elevated systemic blood pressure act in the early stages of diabetic retinopathy., Material and Methods: The arterial and venous oxygen saturation (aOS, vOS) were measured with a Jena Ophthalmo Spectrometer in 28 healthy subjects (NP) (30.3 +/- 13.1 years), 31 Type I diabetics (T I) (42.2 +/- 12.9 years), and in 25 Type II diabetics (T II) (58.9 +/- 6.9 years), suffering form mild or moderate non-proliferative diabetic retinopathy, before, during breathing of 100 % oxygen for 6 minutes, and after respiration of air during 10 minutes., Results: Before oxygen breathing, the venous oxygen saturation in diabetics increased with age. During breathing of 100 % oxygen, the vOS increased considerably by 20 % in all groups. The arterio-venous difference of oxygen saturation was decreased with age in diabetics, but there was no dependence on age in normals. In Type II diabetics, the vOS before oxygen breathing was increased with HbA1c. There was also a positive correlation between vOS and blood pressure before oxygen breathing., Conclusion: Healthy subjects and diabetics in the early stages of diabetic retinopathy exhibit comparable changes of oxygen saturation during breathing of 100 % oxygen. Measurements of venous OS are most evident. First differences were detectable between diabetics and normals in the normalisation after oxygen respiration.

Background: Oxidative metabolites and different cytokines are believed to be involved in the pathogenesis of (proliferative) diabetic retinopathy. It was the aim of this study to analyze vitreous body and proliferations of diabetic patients for oxidative metabolites and VEGF und to correlate these values to the retinal coagulation status., Patients and Methods: The study was performed in 208 patients vitrectomized for diabetic retinopathy (Type I: n = 114, Type II: n = 94). Grouping of patients was performed according to retinal coagulations status: (1) no or minimal preoperative coagulation [mean coagulation area, CA: 156 mm2], (2) coagulation (scatter laser coagulation und/oder cryopexy) < 3 months before surgery [CA: 589 mm2]. (3) coagulation > 3 months before surgery [CA: 546 mm2]. In the vitreous body and, if present, in the fibrovascular proliferations (Type I: n = 83; Type II: n = 73) the level of lipid peroxides (LPO, measured with two methods) and VEGF was determined., Results: In the vitreous body LPO in group 1 were significantly (P < 0.01 (Type I und II)) higher as compared to other groups. In group 3 LPO were significantly lower as compared to group 2 (P < 0.01 (Typ I) and P < 0.05 (Typ II)). Similar results were observed in the proliferations. In Type I patients VEGF values were significantly (P < 0.01 for group 1 vs. 2 and groups 1/2 vs. 3) reduced following coagulation and coagulation + 3 months. In Type II patients only group 3 was significantly (P < 0.01) different from group 1. In proliferations groups 2 and 3 were significantly different from group 1 (P < 0.05 for Typ I and Type II patients)., Conclusions: The time course of the values leads to the conclusion that oxidative metabolites are able to directly modulate growth activity and to exert this effect via induction of VEGF. This hypothesis has to be confirmed in vitro and by means of a prospective study.

Background: Complete detachment of the posterior vitreous cortex is an important aim in the treatment of proliferative diabetic vitreoretinopathy (PDVR). Today a posterior vitreous detachment (PVD) can only be achieved during vitrectomy. A randomized pilot study was started to evaluate wether intravitreally injected TPA is sufficient to induce a PVD in diabetic eyes., Patients and Methods: Eight weeks prior to vitrectomy because of proliferative diabetic vitreoretinopathy (non-clearing haemorrhage, fibrovascular proliferations) 20 eyes which had an attached vitreous received a cryopexy of the peripheral retina. In 11 eyes that had been selected at random 10 micrograms of recombinant tissue plasminogen activator were injected midvitreally 24 hrs later. A newly formed PVD was assessed by means of biomicroscopy or ultrasound., Results: A newly formed partial (n = 3) or complete (n = 7) PVD was found in 10 of 11 TPA-treated eyes versus one partial detached vitreous in the control group. In 3 younger patients PVD developed exclusively after TPA-injection. We did not observe severe changes of the ERG, decrease of visual acuity, severe new vitreous haemorrhages or opacities of the lens. In 3 eyes (2 eyes of the control group) a circumscribed retinal detachment developed during the follow-up period., Conclusions: The described technique can be used in diabetics without severe side effects. It facilitates the removal of the vitreous cortex and may be a valuable adjunct to the surgical management of PDVR. Unlike other proteases TPA is available for clinical use through recombinant DNA technology which allows standardized enzymatic activities, steril and non-infectious conditions.

Gingiva biopsy samples from healthy individuals and from diabetics with different forms of periodontal disease were incubated in the Warburg apparatus for 2 hours. Considerable reduction in oxygen consumption and glucose uptake was found in each type of periodontal disease, the most marked reduction being stated in case of parodontopathia dystrophica. The extent of the metabolic disturbance as well as the appearence of periodontal disease correlated with the duration of diabetes on the one hand with the frequency and severity of diabetic retinopathy on the other hand.

For elucidation of the pathogenesis of the lipoidic depostis due to diabetic retinopathy, 40 patients (44 eyes) were submitted to fluorescence angiography in intervals of 4-6 months; the follow-up covered 1-3 years, the average time being 1.75 years. In 43 of 44 cases, disturbances of the permeability of retinal blood vessels were found, their extent correlating with the size of the exudate foci. An increased perfound, thier extent correlating with the size of the exudate foci. An increased permeation of the dye was closely connected with an increased exudation, and a decreased vascular permeability was connected with a regression of lipoidic deposits.

Changes in the plasma transcortin level were studied in patients with primary glaucoma, glaucoma and diabetes, diabetes mellitus compared with a control croup. It was found that the plasma transcortin level of the patients with or without glaucoma was significantly higher than that of the control values. Moreover, the analysis of the dissociation constant of transcortincorticosterone complex revealed that it is greater in patients with primary glaucoma than could be expected by the dilution ratio. Further studies are required to understand the mechanism of the changes occurring in plasma transcortin level in glaucoma.