Cyclosporin
A in
highly risk perforating keratoplasties.
Cyclosporin
A in
highly risk perforating keratoplasties.
Clinical examination of patients
with early glaucoma by means of
unconventional methods.
Solving workers:
| Leading worker: | Prof. MUDr. Eva VLKOVÁ, CSc. |
| Co-workers: | Consultant MUDr. Václav Bartl |
| MUDr. Zuzana Hlinomazová | |
| MUDr. Hana Došková | |
| MUDr. Daniea Vysloužilová |
The project substance
Although corneal keratoplasty belongs to the most successful tissue transplantations, immunological response is a cause of 50 % rejections of the graft in highly risk keratoplasties, particularly in vascularized leukomas. The risk of rejection is greatest in early post-operative period. Contemporary therapy is based on steroids administered generally and locally and it fails in most cases.
The project aims at finding out the effects of systemic and local application of Cyclosporin A (CsA) on surviving highly risk discs, especially after a burn with lye. Systemic immunosuppression by a new local therapy with Cyclosporin A and its combination with steroids is a way for reducing the immunological response of the disc.
Key words
Risk perforating keratoplasty, vascularized cornea, graft rejection, immunosuppressive agents, cyclosporin.
The subject of solving
The effects of independently systemic, local and combined immunosppressive therapy with CsA, potentiated by steroid therapy for highly risk perforating keratoplasties.
The project description (aim, present state in foreign countries and in the Czech Republic, methodology)
The problem of the therapy for highly risk perforating keratoplasties (vascularized leukomas, both early and late rejection of graft) has been the topic of these days throughout the world, because these are serious therapeutical, social as well as economical concerns.
Recently corticosteroids have been used routinely in the therapy for rejections of corneal grafts. However, this treatment is not always effective, sometimes serious side-effects (diabetes mellitus, hypertension, glaucoma) can appear. These facts have become the subject of looking for other alternatives.
The application of immunosuppressive agents gives a certain hope in the therapy for infaust corneal transplantations. The first experimental and clinical foreign trials have been directed only to solving partial problems in small studies without a complex approach. The project aims at establishing the effects of immunosuppressor Cyclosporin A (Consupren Galena) on the treatment of risk transplantations of the cornea.
The subject of the project is Cyclosporin applied in an isolated form systematically, locally (in patients inable of systemic therapy) and in combination of local and systemic applications, always potentiated by steroid local as well as systemic therapy.
The methodology of applying immunosuppressive substances combined with steroid treatment for highly risk keratoplasties has been already introduced at our clinic. Preliminary results from a small set of patients have shown positive effects of that treatment. Present personal, spacial and apparatus equipment of the clinic corresponds with the demanding character of the project.
Complex studies about these problems have existed neither in the Czech Republic nor in foreign literature.
Solving workers:
| Leading worker: | MUDr. Zuzana Hlinomazová |
| Co-workers: | Prof. MUDr. Eva Vlková, CSc. |
| MUDr. Jitka Svačinová | |
| MUDr. Monika Procházková | |
| Ing. Zdeněk Míča |
The project substance
The diagnostics of pre-clinical forms of glaucoma with the open chamber angle is very difficult. Besides conventional examination methods, this problem will be also studied using electrophysiological methods of examinations: P-ERG (pattern electroretinogram) and P-VEP (pattern evoked potentials). Furthermore, Doppler ultrasonography will serve for studying the circulatory hemodynamics of the eye.
The examinations will be supplemented with the morphometry of the optic nerve papilla and with establishing contrast sensitivity.
The examination methods mentioned above will be evaluated in dependence on changes within the visual field and thus pre-clinical forms of the disease should be revelaed selectively.
Key words
Early glaucoma, P-ERG, P-VEP, perimetry, Doppler ultrasound, tonometry.
The subject of solving
Giving greater precision to glaucoma diagnostics, electrophysilogical and ultrasonographic examinations supplemented with morphometry of the optic nerve papilla, and establishing contrast sensitivity.
The project description (aim, present state in foreign countries and in the Czech Republic, methodology)
Introduction and present state of problems
The problem of diagnosing glaucoma with open chamber angle is serious, especially in patients with initial stage of the disease because insufficiently treated glaucoma is one of the most frequent causes of blindness.
The disease is most often diagnosed as an advanced disorder by means of traditional examination methods, such as establishing visual acuity, biomicroscopy of the anterior and posterior segments of the eye, finding out the value of intraocular pressure by means of aplanation or contact-free tonometry supplemented with the examination of visual field, gonioscopy of the chamber angle, electrotonography and recently even by establishing contrast sensitivity.
As shown in reports from present foreign and Czech literature, electrophysiological examination methods by means of reverse structural stimuli have been used in early diagnostics, especially in the pre-clinical stage of the disease, both at recording electric response from the central area of the retina (Pattern ERG) and at recording visually provoked responses (Pattern VEP) from the visual pathway as far as the region of the primary optic centre. Present literature gives 30 - 40 % positive results.
Perimetry occupies unreplaceable position in the diagnostics of early glaucoma. Initial pathological changes, which could not be identified by previous methods, can be revealed due to more perfect examination of visual field using modified colour stimulation.
Studying extensive problems, neither morphometry of the optic nerve papilla performed recently by establishing C/D ration can be omitted.
Recently, even establishing contrast sensitivity of the retina is of great importance for the diagnostics of glaucoma with the open angle.
Pathogenesis of glaucoma of open angle has not been solved explicitly. Circulatory dynamics has been shown to play an important role in pathogenesis and its changes revealed in early stages can contribute to early diagnostics of glaucoma. Ultrasound doppler recording is a non-invasive method allowing the examination of vascular supply within the orbit. Triplex ultrasound recording (B pattern colour Doppler and pulse Doppler) enables to study the blood flow in the arteria ophthalmica, arteria centralis retinae and arteriae ciliares posteriores breves.
The project aim - working hypothesis
As seen from the facts mentioned above, the abtained knowledge is not unified and the problem has not been solved in a complex form. Examining methods diagnose already passed disease. Therefore the aim of our project is to solve the problem of early pre-clinical diagnostic of glaucoma in a complex form, by means of unconventional examining methods that can give us a new view of glaucoma disease. The konwledge obtained will be given into reciprocal correlation and thus we will attempt at giving greater precision to the diagnostics of glaucoma especially to its initial stages.
Expected results
On the base of studying these problems, the diagnostics of glaucoma of open angle will be more accurate and extensive. New views of this diagnostic problem will improve the registration and therapy of patients and will have direct influence on economical effects on the treatment. Early diagnostics will be undoubtedly of great meaning for social and economical conditions of patients.
Methodology
The following examination methods will be applied at studying the followed-up patients:
A) Electrophysiological examining methods: Pattern ERG that obtains responses from the central region of retina (ganglial cells). At the same time, even Pattern VEP will be examined from the visual pathway which can also give positive results in patients with glaucoma.
B) Perimetry: for examining visual field we plan to utilize both statical and kinetic perimetry and to extend this method by "blue-yellow" stimulation that could provide better information about the initial pathological changes in the visual field.
C) Morphometry of the optic nerve papilla: establishing the C/D ratio by means of routine of laser ophthalmoscope with a supplementing photo of the optic nerve papilla.
D) Establishing contrast sensitivity by means of CSV-1000 apparatus.
E) Ultrasound Doppler examination: our study will be oriented to the examination of blood-vessels supplying the optic disc (arteria ophthalmica, arteria centralis retinae, arteria ciliares posteriores breves). The quantification of circulation will be evaluated by calculating a few indices, namely resistance index, pulsation index and ratio of systolic and diastolic rate of flow. This part of study aims at judging each index and establishing their limit values. Triplex recording will be carried out in cooperation with the Clinic of Radiodiagnostics using ALT HDI 3000, the apparatus of the 4th generation, that enables automatic calculation of all the indices.
The data obtaining and proposal of statistical processing
The data obtained, expressed in most cases in the form of numerical parameters, will be evaluated statistically, their reciprocal statistical significance will be established. The established values will be compared with a control set. The data will be also correlated reciprocally between individual methods. The project is planned for the period of 3 years. Each year, 20 patients will be examined with numerically matching control group.
