798 resultados para Intraocular lenses


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Hydrogels are used in a variety of applications in daily life, such as super absorbers, contact lenses and in drug delivery. Functional hydrogels that allow the incorporation of additional functionalities have enormous potential for future development. The properties of such hydrogels can be diversified by introducing responsiveness to external stimuli. These crosslinked polymers are known to respond to changes in temperature, pH and pressure, as well as chemical and electrical stimuli, magnetic fields and irradiation. From this responsive behavior possible applications arise in many fields like drug delivery, tissue engineering, purification and implementation as actuators, biosensors or for medical coatings. However, their interaction with biomaterial and way of functioning are yet not fully understood. Therefore, thorough investigations regarding their optical, mechanical and chemical nature have to be conducted. A UV-crosslinkable polymer, consisting of N-isopropylacrylamide, methacrylic acid and the UV-crosslinker 4-benzoylphenyl methacrylate was synthesized. Its composition, determined by a comprehensive NMR study, is equivalent to the composition of the monomer mixture. The chemical characteristics were preserved during the subsequently formation of hydrogel films by photo-crosslinking as proved by XPS. For the optical characterization, e.g. the degree of swelling of very thin films, the spectroscopy of coupled long range surface plasmons is introduced. Thicker films, able to guide light waves were analyzed with combined surface plasmon and optical waveguide mode spectroscopy (SPR/OWS). The evaluation of the data was facilitated by the reverse Wentzel-Kramers-Brillouin (WKB) approximation. The meshsize and proper motion of the surface anchored hydrogels were investigated by fluorescence correlation spectroscopy (FCS), micro photon correlation spectroscopy (µPCS) and SPR/OWS. The studied gels exhibit a meshsize that allowed for the diffusion of small biomolecules inside their network. For future enhancement of probing diffusants, a dye that enables FRET in FCS was immobilized in the gel and the diffusion of gold-nanoparticles embedded in the polymer solution was studied by PCS. These properties can be conveniently tuned by the crosslinking density, which depends on the irradiation dose. Additionally, protocols and components for polymer analogous reactions based on active ester chemistry of the hydrogel were developed. Based on these syntheses and investigations, the hydrogel films are applied in the fields of medical coatings as well as in biosensing as matrix and biomimetic cushion. Their non-adhesive properties were proved in cell experiments, SPR/OWS and ToF-SIMS studies. The functionality and non-fouling property of the prepared hydrogels allowed for adaption to the needs of the respective application.

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In this work, we have considered the theme of landscape in the poetry of Andrea Zanzotto, Philippe Jaccottet and Seamus Heaney within the perspective of a fragmentation of the aesthetics of nature. To that end, the most advanced theories of aesthetics applied to nature, such as environmental Aesthetics and Aesthetik der Natur (also known as ökologische Aesthetik) have been taken into account. The philosophical perspective of Paolo D’Angelo, insights from geography (in particular from the works of Franco Farinelli) and from ecology (considering the contributions of Gilles Clément to this discipline) have also been useful. We have argued that the poetic experiences of Zanzotto, Jaccottet and Heaney follow a similar path, each starting from the fusion between the poetic subject and landscape to reach a two-way relationship between them. In this interpretation, the concept of landscape has been considered, according to Michel Collot’s theory of pensée-paysage, as a phenomenon. The poetic texts have been analysed under the lenses of linguistic, stylistic and rhetorical approaches, consistent with the idea that every text must be studied within its context, as every poetic experience is constituted of three elements: the poetic subject, his language and his world, the latest being shaped by and shaping the subject’s position and the perspectives related to it: that is his discourse to the world and in this world.

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Das Glaukom ist, nach dem Katarakt, die zweithäufigste Ursache für Erblindungen weltweit mit Milionen von Betroffenen, die von dieser zunächst weitgehend symptomfreien neurodegenerativen Erkrankung heimgesucht werden. Die Möglichkeiten auf dem Feld der Diagnose beschränken sich bislang weitestgehend auf die Messung des Augeninnendrucks und der Beurteilung des Augenhintergrundes durch einen erfahrenen Augenarzt. Eine labordiagnostische Prophylaxe ist bis heute nicht verfügbar, die Zahl unerkannter Erkrankungen dementsprechend hoch. Hierdurch geht wertvolle Zeit verloren, die man für eine effektive Therapie nutzen könnte.rnBezüglich der Pathogenese des Glaukoms geht man heute von mehreren, miteinander wechselwirkenden Pathomechanismen aus, zu denen neben mechanischen Einflüssen durch einen erhöhten IOD auch Hypoxie, verminderte Neutrophinversorgung, Exzitotoxizität, oxidativer Stress und eine Beteiligung autoimmuner Prozesse gezählt werden. Unabhängig vom Pathomechanismus folgt stets die Etablierung umfangreicher degenerativer Prozesse im Sehnervenkopf, den retinalen Ganglienzellen und den Axonen des Sehnerven, die letztlich im irreversiblen Untergang dieser Neuronen münden. Diese pathologischen Prozesse im ZNS hinterlassen auf Proteomebene Spuren, die mithilfe moderner massenspektrometrischer Methoden in Kombination mit multivariaten statistischen Methoden detektierbar und als sogenannte Biomarker-Kandidaten mit definiertem Molekulargewicht darstellbar sind. In dieser Arbeit wurde ein „Workflow“ entwickelt, der es ermöglicht, diese Biomarker-Kandidaten im Blutserum und in der Tränenflüssigkeit in einfachen, reproduzierbaren Schritten zu identifizieren und zu charakterisieren. Abweichend von der etablierten Methotik der Bottom-Up-Proteomics musste hierfür eine Methode entsprechend einer Top-Down-Philosophie entwickelt werden, die es erlaubt, die Spuren des Glaukoms im Proteom zu detektieren und zu charakterisieren.rnDies erfolgte in dieser Arbeit durch sowohl massenspektroskopischen Methoden wie SELDI-TOF® und MALDI-Tof-Tof als auch durch Bead-, Gel- und Flüssigkeits-chromatographisch-basierte Separations und Fraktionierungstechniken.rnDie erfolgreiche Kombination dieser Methoden führte zu Identifikationen einer ganzen Reihe von Biomarker-Kandidaten. Unter den identifizierten Proteinen, die bezüglich ihres korrespondierenden SELDI-Peaks im Massenbereich von Biomarker-Kandidaten liegen, finden sich Zytokine und Effektormoleküle der angeborernen Immunität, stressinduzierbare Kinasen, Faktoren, die zum Schutz der Telomeren dienen, Proliferationsmarker, neuronale Antigene und Transportproteine. Darüber hinaus wurden Komponenten identifiziert, die an der neuronalen Neutrophinversorgung beteiligt sind, neuronale Rezeptoren und Antigene, Komponenten des Komplementsystems und des MHC-I-Komplexes. All diese identifizierten Proteine sind bezüglich ihrer Funktion und möglichen Rolle innerhalb der Pathogenese des Glaukoms detailliert beschrieben und charakterisiert. Dies erlaubt einen umfassenden Einblick in alle Pathomechanismen, denen nach heutigem Kenntnisstand, eine Rolle an der Pathogenese des Glaukoms unterstellt wird.rn

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Hintergrund: Die antimetabolitgestützte Trabekulektomie stellt seit längeren denrnGoldstandard bei medikamentös nicht ausreichend therapierbaren Glaukomen dar. Kurz- und mittelfristige Erfolge wurden durch viele Studien bestätigt. Allerdings unterliegen diese sehr unterschiedlichen Erfolgsdefinitionen. Eine strikte Druckkontrolle ≤ 15 mm Hg ohne zusätzliche medikamentöse Therapie erscheint sinnvoll einen risikofreien Therapieerfolg zu bewerten. Es existieren nur wenige Langzeitstudien mit diesem Erfolgskriterium. Die durchgeführte Studie soll einen Eindruck der ophthalmologischen Versorgung trabekulektomierter Patienten an der Universitätsaugenklinik Mainz über einen bewusst langen Zeitraum bieten. Patienten und Methoden: In diese retrospektiven Studie wurden alle Patienten, die aufgrund einer fortgeschrittenen Glaukomerkrankung in den Jahren 1996, 2001 oder 2006 eine Trabekulektomie erhielten, aufgenommen. Von den 723 Augen der 664 Patienten dieser Jahrgänge konnten 447 (61,8%) nachverfolgt werden. Die Zusammensetzung der Patienten war mit anderen Studien vergleichbar. 28% konnten mindestens 7 Jahre, 10% sogar 10 Jahre nachverfolgt werden. Esrnwurde untersucht, ob ein signifikanter Zusammenhang zwischen dem ophthalomologisch-internistischem Entlassstatus (Visus, Tensio, Gesichtsfeld,rnGlaukomtyp, Voroperationen, Medikation, Vorerkrankungen, Art der Operation) undrnder erstrebten Kontrolle des Intraokulardruckes besteht. Ergebnisse: Die mittlere Nachbeobachtungszeit betrug 4,3 ± 3,4 Jahre. Nach 1, 3,rn5, 7 und 10 Jahren wiesen 217 (82,1%) (p < 0,001), 133 (67,7%) (p < 0,001), 70rn(50%) (p < 0,001), 59 (47,7%) (p = 0,056) und 16 (38,1%) (p = 0,06) Augen Intraokulardrücke ≤ 15 mm Hg ohne zusätzliche Antiglaukomatosa auf. Nichtrnstatistisch signifikant waren die 7- und 10-Jahresergebnisse. Mit Hilfe von Antiglaukomatosa waren es insgesamt, 225 (85,1%), 156 (79,7%), 87 (62,5%), 93 (75%) und 23 (54,7%) (alle p < 0,001). Die mediane Überlebenszeit für IOD ≤ 15 mm Hg ohne Medikation betrug 7,4 Jahre ± 5 Monate. Druckobergrenzen von ≤ 18 bzw. 21 mm Hg erfüllten bis zu 20% mehr Patienten. Der mittlere Visus von 0,32 ± 6 Stufen blieb nach einem mittleren postoperativen Abfall auf 0,25 ± 5 Stufen in den Folgeuntersuchungen stabil. Er zeigte ab dem 3-Jahresintervall keine statistisch signifikante Verschlechterung zum präoperativen Visus. 5,8 Jahre ± 80 Tage betrug die mediane Überlebenszeit für ein stabiles Gesichtsfeld. Gesichtsfelddaten, MD und PSD zeigten keine statistisch signifikante Verschlechterung (p > 0,05). Risikofaktoren für ein Scheitern der Operation waren Patientenalter (RR = 1,01, KI: 0,95 - 1,34, p = 0,043), arterielle Hypertonie (RR = 1,87, KI: 1,21-2,9, p = 0,005) und männliches Geschlecht (RR = 1,24; KI: 1,07 – 1,43; p = 0,004). Komplikationen waren passagere okuläre Hypotonien an 85 (19%), Fistulation an 46(10,2%), Aderhautschwellung an 29 (6,4%) –abhebung an 14 (3,1%), retinale Amotio an 9 (2%), hypotone Makulopathie an 5 (1,1%) und Hypertonien an 70 (15,6%) Augen. 150 (33,5%) Augen erhielten einen Folgeeingriff, 117 (26%) eine Phakoemulsifikation, 149 (33%) eine Fadenlockerung, 122 (27%) 5-FU-Injektionen, 42 (9,4%) eine Fadennachlegung, 33 (7,4%) ein Needling, 26 (5,8%) eine Zyklophotokoagulation, 19 (4,3%) eine Re-TE und 9 (2%) sonstige chirurgische Revisionen. Schlussfolgerung: Die Kontrolle des Augeninnendruckes ≤ 15 mm Hg ohne zusätzliche Medikation erreichten viele Patienten über einen langen Nachbeobachtungszeitraum. Die Häufigkeit der Komplikationen oder nötiger Folgeeingriffe war meist niedriger als in vergleichbaren Studien. Selbst Patienten mit hohem Risikoprofil hatten gute Ergebnisse. Aufgrund mangelnder Gesichtsfelddaten fanden sich keine Hinweise auf statistisch relevantes Fortschreiten des Glaukoms zur angestrebten medikationsfreien Druckkontrolle. Weitere Studien für einen Untersuchungszeitraum von 10 Jahren mit gleichen Erfolgskriterien wie in der vorliegenden Arbeit mit genauer Analyse der Gesichtsfelddaten wären wünschenswert, um zu belegen, dass die guten Langzeitergebnisse nach Trabekulektomie an der Universitätsaugenklinik Mainz auch eine Glaukomprogredienz dauerhaft verhindern. Damit stellt die an der Universitätsaugenklinik Mainz durchgeführte antimetabolitgestützte Trabekulektomie und deren postoperative Nachbetreuung an einer repräsentativen Population eine sichere und komplikationsarme Methode dar.

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This work considers the reconstruction of strong gravitational lenses from their observed effects on the light distribution of background sources. After reviewing the formalism of gravitational lensing and the most common and relevant lens models, new analytical results on the elliptical power law lens are presented, including new expressions for the deflection, potential, shear and magnification, which naturally lead to a fast numerical scheme for practical calculation. The main part of the thesis investigates lens reconstruction with extended sources by means of the forward reconstruction method, in which the lenses and sources are given by parametric models. The numerical realities of the problem make it necessary to find targeted optimisations for the forward method, in order to make it feasible for general applications to modern, high resolution images. The result of these optimisations is presented in the \textsc{Lensed} algorithm. Subsequently, a number of tests for general forward reconstruction methods are created to decouple the influence of sourced from lens reconstructions, in order to objectively demonstrate the constraining power of the reconstruction. The final chapters on lens reconstruction contain two sample applications of the forward method. One is the analysis of images from a strong lensing survey. Such surveys today contain $\sim 100$ strong lenses, and much larger sample sizes are expected in the future, making it necessary to quickly and reliably analyse catalogues of lenses with a fixed model. The second application deals with the opposite situation of a single observation that is to be confronted with different lens models, where the forward method allows for natural model-building. This is demonstrated using an example reconstruction of the ``Cosmic Horseshoe''. An appendix presents an independent work on the use of weak gravitational lensing to investigate theories of modified gravity which exhibit screening in the non-linear regime of structure formation.

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The optical quality of the human eye mainly depends on the refractive performance of the cornea. The shape of the cornea is a mechanical balance between intraocular pressure and tissue intrinsic stiffness. Several surgical procedures in ophthalmology alter the biomechanics of the cornea to provoke local or global curvature changes for vision correction. Legitimated by the large number of surgical interventions performed every day, the demand for a deeper understanding of corneal biomechanics is rising to improve the safety of procedures and medical devices. The aim of our work is to propose a numerical model of corneal biomechanics, based on the stromal microstructure. Our novel anisotropic constitutive material law features a probabilistic weighting approach to model collagen fiber distribution as observed on human cornea by Xray scattering analysis (Aghamohammadzadeh et. al., Structure, February 2004). Furthermore, collagen cross-linking was explicitly included in the strain energy function. Results showed that the proposed model is able to successfully reproduce both inflation and extensiometry experimental data (Elsheikh et. al., Curr Eye Res, 2007; Elsheikh et. al., Exp Eye Res, May 2008). In addition, the mechanical properties calculated for patients of different age groups (Group A: 65-79 years; Group B: 80-95 years) demonstrate an increased collagen cross-linking, and a decrease in collagen fiber elasticity from younger to older specimen. These findings correspond to what is known about maturing fibrous biological tissue. Since the presented model can handle different loading situations and includes the anisotropic distribution of collagen fibers, it has the potential to simulate clinical procedures involving nonsymmetrical tissue interventions. In the future, such mechanical model can be used to improve surgical planning and the design of next generation ophthalmic devices.

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It has been shown that the pressure-to-cornea index (PCI), which estimates the relative effects of intraocular pressure (IOP) and central corneal thickness (CCT), may differentiate between glaucoma and non-glaucoma states. The authors investigated the utility of the pressure-cornea-vascular index (PCVI) in predicting field-progression in patients with normal tension glaucoma (NTG).

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A new simple method for two-dimensional determination of optical density of macular pigment xanthophyll (ODx) in clinical routine is based on a single blue-reflection fundus image. Individual different vignetting is corrected by a shading function. For its construction, nodes are automatically found in structureless image regions. The influence of stray light in elderly crystalline lenses is compensated by a correction function that depends on age. The reproducibility of parameters in a one-wavelength reflection method determined for three subjects (47, 61, and 78 years old) was: maxODx = 6.3%, meanODx = 4.6%, volume = 6%, and area = 6% already before stray-light correction. ODx was comparable in pseudophakic and in an eye with a crystalline lens of the same 11 subjects after stray-light correction. Significant correlation in ODx was found between the one-wavelength reflection method and the two-wavelength autofluorescence method for pseudophakic and cataract eyes of 19 patients suffering from dry age-related macular degeneration (AMD) (R(2) = 0.855). In pseudophakic eyes, maxODx was significantly lower for dry AMD (n = 45) (ODx = 0.491±0.102 ODU) than in eyes with healthy fundus (n = 22) (ODx = 0.615±0.103 ODU) (p = 0.000033). Also in eyes with crystalline lens, maxODx was lower in AMD (n = 125) (ODx = 0.610±0.093 ODU) than in healthy subjects (n = 45) (ODx = 0.674±0.098 ODU) (p = 0.00019). No dependence on age was found in the pseudophakic eyes both of healthy subjects and AMD patients.

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Wheatstone’s stereoscope placed two mirrors on either side that were mounted at a right angle in order to view the two dissimilar drawings presented (Hankins 148). There are two identical monocular tubes that allow each eye to view the images (Hankins 148). Each eye views the image it was intended to see. The two eyes see slightly different images through this binocular vision (Hankins 148). The combination of the two images creates this illusion of depth and solidarity through their superimposition (Hankins 154). In order to view these images, the eyes were covered from all external light (Clay 152). The stereoscope was first seen as a philosophical toy along with other inventions such as the zoetrope, providing entertainment as well as scientific insight (Hankins 148). The stereoscope above is more similar to the “Holmes Stereoscope”, which transformed Wheatstone’s stereoscope into a handheld version that could be put on a stand (Hawkins 155). He replaced the retina of the eye with a sensitive plate; therefore, the lenses acted as the eyes (Silverman 738). In the video, an embellishment adorns the bottom of the stand that holds up the binocular lens and the images. The lenses are in a wooden frame that has an attached stand that holds the slides of images. There also is a knob on the side of the device that can adjust the lens on the two monocular tubes (Bokander 485).

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A biunial magic lantern is a wooden box with two lenses, one on top of the other. The lenses have shutters and slots to insert glass slides. The light source is placed inside the box and the images are projected through either of the two lenses. It works in the same way as traditional magic lanterns, but allows for dissolving images and special effects.

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With the United States‘ entry into the Second World War, the word ?censorship? was seen largely as antithetical to, rather than a necessary counterpart to, victory among Americans. People did not want to be censored in their writing, photographs or speech,but it proved to be necessary even before the war began, in order to protect government secrets and the people on the home-front from scenes that were too disturbing. Even before the war had officially begun, there were problems with censorship among journalists and newspapers. The initial response of outrage in reference to censorship in the United States was common among journalists, newspapers, magazines, and radio news; nevertheless, there was a necessity for censorship among Americans, on the home frontand the front lines, and it would be tolerated throughout the war to ensure that enemies of America did not gain access to information that would assist in a defeat of the United States in the Second World War. The research I have conducted has dealt with the censorship of combat photography during World War II, in conjunction with the ethics that were in play at the time that affected the censors. Through exploring the work of three combat photographers — Tony Vaccaro, James R. Stephens and Charles E. Sumners — I wasable to effectively construct an explanatory ethical history of these three men. Research on the censorship and effects it had on the United States brought me to three distinctareas of censorship and ethics that would be explored: (1) the restrictions and limitations enforced by the Office of Censorship, (2) a general overview of war and photography as it influenced the soldiers and their families on the home-front, (3) and the combat photographers and personal and military censorship that influenced their work. Although their work was censored both by the military and the government, these men saw the war in a different light that remained with them long after the battles and war had ceased.Using the narratives of Tony Vaccaro, Charles E. Sumners and James R. Stephens as means for more in depth research, this thesis strives to create lenses through which to view the history and ethics of censorship that shaped combat photography during the Second World War and the images to which we refer as representative of that war today.

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The progress of wet age-related macular degeneration can now be controlled by intravitreal drug injection. This approach requires repeated injections, which could be avoided by delivering the drug to the retina. Intraocular implants are a promising solution for drug delivery near the retina. Currently, their accurate placement is challenging, and they can only be removed after a vitrectomy. In this paper, we introduce an approach for minimally invasive retinal drug delivery using magnetic intraocular inserts. We briefly discuss the electromagnetic-control system for magnetic implants and then focus on evaluating their ability to move in the vitreous humor. The mobility of magnetic intraocular implants is estimated in vitro with synthesized vitreous humors, and ex vivo with experiments on cadaver porcine eyes. Preliminary results show that with such magnetic implants a vitrectomy can be avoided.

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Numerical simulations of eye globes often rely on topographies that have been measured in vivo using devices such as the Pentacam or OCT. The topographies, which represent the form of the already stressed eye under the existing intraocular pressure, introduce approximations in the analysis. The accuracy of the simulations could be improved if either the stress state of the eye under the effect of intraocular pressure is determined, or the stress-free form of the eye estimated prior to conducting the analysis. This study reviews earlier attempts to address this problem and assesses the performance of an iterative technique proposed by Pandolfi and Holzapfel [1], which is both simple to implement and promises high accuracy in estimating the eye's stress-free form. A parametric study has been conducted and demonstrated reliance of the error level on the level of flexibility of the eye model, especially in the cornea region. However, in all cases considered 3-4 analysis iterations were sufficient to produce a stress-free form with average errors in node location <10(-6)mm and a maximal error <10(-4)mm. This error level, which is similar to what has been achieved with other methods and orders of magnitude lower than the accuracy of current clinical topography systems, justifies the use of the technique as a pre-processing step in ocular numerical simulations.

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It is increasingly recognised that chronically activated glia contribute to the pathology of various neurodegenerative diseases, including glaucoma. One means by which this can occur is through the release of neurotoxic, proinflammatory factors. In the current study, we therefore investigated the spatio-temporal patterns of expression of three such cytokines, IL-1β, TNFα and IL-6, in a validated rat model of experimental glaucoma. First, only weak evidence was found for increased expression of IL-1β and TNFα following induction of ocular hypertension. Second, and much more striking, was that robust evidence was uncovered showing IL-6 to be synthesised by injured retinal ganglion cells following elevation of intraocular pressure and transported in an orthograde fashion along the nerve, accumulating at sites of axonal disruption in the optic nerve head. Verification that IL-6 represents a novel marker of disrupted axonal transport in this model was obtained by performing double labelling immunofluorescence with recognised markers of fast axonal transport. The stimulus for IL-6 synthesis and axonal transport during experimental glaucoma arose from axonal injury rather than ocular hypertension, as the response was identical after optic nerve crush and bilateral occlusion of the carotid arteries, each of which is independent of elevated intraocular pressure. Moreover, the response of IL-6 was not a generalised feature of the gp130 family of cytokines, as it was not mimicked by another family member, ciliary neurotrophic factor. Finally, further study suggested that IL-6 may be an early part of the endogenous regenerative response as the cytokine colocalised with growth-associated membrane phosphoprotein-43 in some putative regenerating axons, and potently stimulated neuritogenesis in retinal ganglion cells in culture, an effect that was additive to that of ciliary neurotrophic factor. These data comprise clear evidence that IL-6 is actively involved in the attempt of injured retinal ganglion cells to regenerate their axons.

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The maintenance of vision, through prevention and attenuation of neuronal injury in glaucoma, forms the basis of current clinical practice. Currently, the reduction of intraocular pressure is the only proven method to achieve these goals. Although this strategy enjoys considerable success, some patients progress to blindness; hence, additional management options are highly desirable. Several terms describing treatment modalities of neuronal diseases with potential applicability to glaucoma are used in the literature, including neuroprotection, neurorecovery, neurorescue and neuroregeneration. These phenomena have not been defined within a coherent framework. Here, we suggest a set of definitions, postulates and principles to form a foundation for the successful translation of novel glaucoma therapies from the laboratory to the clinic.