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Biomedical subjects

C Zetterström

Publications and source records attributed to C Zetterström.

At least 19 recordsLinked to original sources
PubMed2004

The paracrine role played by interleukin-1 alpha in the testis.

Interleukin-1alpha (IL-1alpha) plays an important role(s) in the regulation of immune and inflammatory responses. The testis is an immunologically privileged organ and the variety of effects exerted by IL-1alpha on this organ have yet to be explored in detail. The aim of the present review is to describe our current view of the paracrine role played by IL-1alpha in testicular physiology. Testicular IL-1alpha is expressed during development, primarily in Sertoli cells, appearing in rats for the first time 20 days after birth. This cytokine is microheterogeneous, consisting of three molecular species with molecular weights of 45, 24 and 17 KDa. The 17 KDa form represents mature IL-1alpha, while the 24-KDa IL-1alpha has been shown by our research group to be an alternately spliced form of the 45-KDa pro-IL-1alpha. IL-1alpha was observed to stimulate the proliferation of immature Sertoli cells with higher efficacy than FSH. IL-1alpha was also found to exert mitogenic effects both on isolated peritubular cells and germ cells. Furthermore, isoforms of IL-1alpha were seen to stimulate basal testosterone production in immature Leydig cells, but not in the corresponding adult cells. This effect involved induction of the steroidogenic acute regulatory (StAR) protein and positively regulation by p38 MAPK. Recently, we have observed positive interactions between IL-1alpha and hormones of the GH/IGF-I system that lead to enhanced androgen production by the Leydig cell. In conclusion, our findings suggest that isoforms of IL-1alpha may serve as paracrine mediators, alone or in concert with other factors, that support proper testicular cell functioning and, thereby, reproduction and fertility.

Animals↗
PubMed2002

Effects of dexamethasone, diclofenac, or placebo on the inflammatory response after cataract surgery.

AIM: To compare the inflammatory response after phacoemulsification and intraocular lens (IOL) implantation using postoperative treatment with dexamethasone, diclofenac, or placebo. METHODS: A prospective, randomised, controlled double masked study including 180 patients enrolled for cataract surgery. The patients were 64-85 years old and had no eye disease other than cataract. After phacoemulsification and IOL implantation the patients were randomised to topical treatment with dexamethasone phosphate 0.1% (group I), diclofenac sodium 0.1% (group II), or placebo (saline 0.9%) (group III). The drops were administered four times daily during the first week and twice daily during the second, third, and fourth weeks. The inflammatory reaction in the anterior chamber was measured with laser flare photometry preoperatively and 1, 3, and 8 days, 2 and 4 weeks, 2 and 6 months, and 1, 2, and 4 years postoperatively. Inflammatory symptoms were registered. Biomicroscopy and visual acuity determinations were performed. The rate of Nd:YAG laser posterior capsulotomies after 2 and 4 years was determined. RESULTS: After 3 and 8 days (p <0.0001), 2 weeks (p <0.0001), and 1 month (p = 0.0013) median flare was highest in group III. There were no significant differences between group I and II. Inflammatory symptoms and striate keratopathy were more common in group III. CONCLUSION: Dexamethasone and diclofenac were equally effective in reducing postoperative inflammation after phacoemulsification and IOL implantation in eyes with no other disease than cataract. Both substances were more effective than placebo.

Aged↗
PubMed2001

Intraocular lens designed for the newborn infant eye.

PURPOSE: To evaluate the effects of an intraocular lens (IOL) designed for small eyes after clear lens extraction in an animal model. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Clear lens extraction was performed in both eyes in 19 3-week-old rabbits. In 1 randomly selected eye of each rabbit, a small IOL with long haptics was implanted. Axial length, corneal thickness, corneal diameter, and intraocular pressure were measured preoperatively and every month for 6 months postoperatively. Six months after surgery, the wet mass of the after-cataract was determined. RESULTS: The IOL remained well centered in all eyes. Four animals developed severe glaucoma in 5 eyes (3 aphakic and 2 pseudophakic) soon after surgery and were excluded. In the 15 animals completing the study, signs of glaucoma evolved in 7 animals (5 aphakic and 4 pseudophakic eyes). In aphakic eyes, significant amounts of after-cataract (median 250 mg) developed in all 15 surviving animals. In pseudophakic eyes, small amounts of after-cataract (median 30 mg) were present. During the first 2 months after surgery, ocular growth was less in pseudophakic eyes than in aphakic eyes. CONCLUSIONS: Results indicate that implantation of a down-sized IOL with long haptics in small eyes is safe. Considerable less after-cataract was found in eyes with the IOL than in aphakic control eyes.

Animals↗
PubMed2000

After-cataract and secondary glaucoma in the aphakic infant rabbit.

PURPOSE: To study the association between after-cataract and secondary glaucoma after lensectomy and 5-fluorouracil treatment in an experimental infant rabbit model. SETTING: St Erik Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Lensectomy was performed in both eyes of 16 3-week-old rabbits. One randomly selected eye in each rabbit was injected with 2.5 mg of 5-fluorouracil (5-FU) at surgery and 5.0 mg the day after surgery to reduce the formation of after-cataract. Axial length, corneal thickness, corneal diameter, and intraocular pressure were measured preoperatively and 4 times during the 6 months following surgery. Six months after surgery, the wet weight of the after-cataract was determined. RESULTS: In 16 aphakic eyes treated with 5-FU, no or a minimal amount (<0.001 g) of after-cataract developed. None of the eyes showed signs of secondary glaucoma. Of 16 aphakic eyes not treated with 5-FU, 10 developed considerable amounts of after-cataract (>0.10 g); 8 of these developed glaucoma. The other 6 eyes had no or minimal after-cataract and did not develop secondary glaucoma. The relationship between after-cataract and secondary glaucoma was statistically significant. CONCLUSION: A significant relationship between the amount of after-cataract and the development of secondary glaucoma was found in aphakic infant rabbit eyes.

Animals↗
PubMed2000

The effect of phenylephrine on pain and flare intensity in eyes with uveitis.

PURPOSE: To investigate the influence of protein concentration in the anterior chamber, measured by laser flare meter, on pain sensation after phenylephrine instillation in patients with iridocyclitis. METHODS: Twenty-five consecutive patients with iridocyclitis were included. Patients with cataract, exfoliation syndrome, diabetes mellitus, glaucoma or any other previous ocular diseases or ocular surgery were excluded. Patients were divided into two groups: Group 1--without fibrinoid reaction (FR) in the anterior chamber (18 patients), and Group 2--with FR (7 patients). Protein concentration in the anterior chamber was measured with laser flare meter (FC 500, Kowa Co., Japan). Pupil size was measured by Alcon Tilo Scale, and pain sensation was estimated by Visual Analogue Scale (VAS, Kabi Pharmacia). All measurements were done before and 1 hour after topical instillation of 10% phenylephrine hydrochloride into the subconjunctival sac of the inflamed eyes. RESULTS: Eyes with iridocyclitis and fibrinoid reaction (FR) have a higher flare intensity compared to those without FR (p<0.05). Pupil size was significantly increased after phenylephrine instillation in both study groups (Wilcoxon test, p<0.05). The VAS pain and flare intensity were significantly decreased in group without FR after phenylephrine instillation (Group 1) compared to values before treatment (Wilcoxon test, p<0.05). In eyes with FR (Group 2), no significant influence of phenylephrine instillation was found on VAS pain and flare intensity. CONCLUSIONS: After phenylephrine instillation, flare intensity and pain were significantly decreased only in eyes with iridocyclitis and without FR. The decreasing level of flare intensity, and paralysis of the pupil after phenylephrine instillation seem to alleviate pain in those eyes.

Adult↗
PubMed2000

Cataract extraction and intraocular lens implantation in children with uveitis.

AIM: To evaluate the long term results of cataract surgery with intraocular lens implantation (IOL) in children with uveitis. METHODS: The study included 10 eyes in seven children (age 3.5-10 years, mean 6.5 years). The cataract surgery included capsulorhexis of the anterior and the posterior capsule, anterior vitrectomy in some eyes, and implantation of a heparin surface modified (HSM) poly(methyl methacrylate) (PMMA) IOL into the capsular bag. RESULTS: Follow up periods ranged from 1 to 5 years. Best corrected visual acuity after surgery reached 20/50-20/20 in all but two eyes. Opacities or membranes requiring reoperation developed in seven eyes. Glaucoma developed in three eyes after the cataract operation. CONCLUSION: These results suggest that implantation of a HSM PMMA IOL is an alternative to correct aphakia also in children with uveitis.

Anticoagulants↗
PubMed1999

Sulcus fixation without capsular support in children.

PURPOSE: To evaluate long-term follow-up in eyes of children who had sulcus fixation of an intraocular lens (IOL) without capsular support. SETTING: St. Eriks Eye Hospital/Karolinska Institute, Stockholm, Sweden. METHODS: This retrospective study included 21 eyes of 13 children. Seven eyes had Marfan's syndrome, 7 essential lens dislocation, 2 perforation with lens injury, and 5 spherophakia. The IOL implantation was primary in 16 eyes and secondary in 5 eyes. Lensectomy was performed with a limbal approach. An IOL with holes in the haptics was sutured in the sulcus, with the knots buried in the scleral bed. RESULTS: Mean patient age was 5.8 years +/- 2.6 (SD). Follow-up ranged from 9 to 33 months. No complications occurred during surgery. In all cases after IOL implantation, best corrected visual acuity was equal to or better than preoperatively. After surgery, no opacification of the visual axis, secondary glaucoma, or retinal complication was recorded. Posterior synechia formation occurred in 4 eyes, and 4 had cells on the IOL surface in 2 eyes, the IOL optic subluxated into the anterior chamber with the haptics in place. Both cases were successfully treated with pilocarpine 4%. CONCLUSION: Our results suggest that sulcus fixation of an IOL without capsular support is an option to correct aphakia in children.

Aphakia, Postcataract↗
PubMed1999

Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system. RESULTS: No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P < .05, Mann-Whitney). In addition, progression of PCO from 1 year to 2 years after surgery was significantly less in diabetic groups with different stages of diabetic retinopathy than in the control group (P < or = .05, Kruskal-Wallis analysis of variance and multiple comparisons). CONCLUSION: The rate of PCO after phacoemulsification was statistically significantly lower in patients with diabetes mellitus than in those without diabetes.

Aged↗
PubMed1999

Complications after early surgery for congenital cataracts.

PURPOSE: To study the type and frequency of complications requiring additional surgery in infants operated on for congenital cataract before 12 months of age. METHODS: The medical records of 57 infants who underwent surgery for unilateral and bilateral congenital cataracts during a five-year-period were reviewed retrospectively. The follow-up period ranged from 9 to 70 months with a mean of 37 months. Cataract extraction was performed on 83 eyes. RESULTS: Thirty-eight operations for after-cataracts were performed on 32 out of 83 eyes. Fourteen vitrectomies were made on 11 eyes because of pupillary block glaucoma. Glaucoma requiring trabeculectomy developed in eight eyes 2 to 14 months after cataract extraction. This type of glaucoma occurred almost exclusively in eyes operated on during the first two months of life. CONCLUSION: Complications requiring additional surgery are very common in infants operated on for congenital cataracts during the first year of life. Glaucoma requiring trabeculectomy developed particularly in infants who had their cataract extraction very early. Glaucoma development was not more common in infants operated on for after-cataract.

Cataract↗
PubMed1999

Visual outcome after phacoemulsification and IOL implantation in diabetic patients.

AIMS: To follow visual acuity (VA) and progression of diabetic retinopathy (DR) after phacoemulsification in diabetic patients with different stages of DR and controls. METHODS: This prospective study included 27 diabetic patients with no or mild to moderate non-proliferative DR; 25 patients with moderate to severe non-proliferative, or proliferative DR; and 22 non-diabetic controls. All patients underwent uncomplicated, phacoemulsification surgery, with implantation of a heparin-surface modified (HSM) poly(methylmethacrylate) (PMMA) intraocular lens (IOL) into the capsular bag. Colour fundus photographs and fluorescein angiograms (FA) were taken at 1 week (baseline), 3 months, and 1 year postoperatively to determine stability or progression of DR. RESULTS: The VA of 46 diabetic eyes (88%), was improved 1 year after surgery and only six eyes (12%) were unchanged or worse. 41 diabetic eyes (79%) achieved a VA of 0.5 or better and 11 eyes (21%) had a final VA lower than 0.5. Significantly lower final corrected VA was found 1 year after surgery in eyes with advanced DR (median 0.5; range 0.1-1.0) compared with controls (1.0; 0.1-1.0) and eyes with no or mild to moderate DR (1.0; 0.1-1.0). Eyes with mild to moderate DR and clinically significant macular oedema (CSMO) 1 week postoperatively had a lower final VA than those without CSMO. Angiographic cystoid macular oedema (CMO) was detected with FA in 15% of all diabetic eyes 1 week postoperatively. 41 eyes (79%) showed no change or improvement of the retinal status 1 year after cataract surgery. Progression was found in 11 eyes (21%), mainly in eyes with mild to moderate DR and moderate to severe DR. Eyes with an indication for laser photocoagulation at baseline showed a significantly higher rate of progression of DR after surgery than those without indication for laser treatment. CONCLUSION: The final visual outcome was improved in the majority of diabetic eyes. Eyes with CSMO at the time of surgery had the worst prognosis regarding postoperative VA.

Aged↗
PubMed1998

Aqueous flare intensity after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To prospectively compare the postoperative blood-aqueous barrier breakdown induced by phacoemulsification and implantation of a heparin-surface-modified poly(methyl methacrylate) intraocular lens in the capsular bag in eyes with different stages of diabetic retinopathy (DR) and a control group. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Aqueous flare intensity was measured preoperatively and 1 day, 1 week, and 3 months postoperatively in 21 nondiabetic control patients (Group 1), 20 diabetic patients with no or mild-moderate nonproliferative DR (Group 2), and 19 diabetic patients with advanced DR (moderate-severe, severe nonproliferative, and proliferative DR) who were divided into groups: without clinically significant macular edema (CSME), 7 eyes (Group 3), and with CSME, 12 eyes (Group 4). RESULTS: Before surgery, flare intensity in Group 4 was significantly higher than in Groups 1 and 2 (P < .05). Surgical trauma increased flare values 1 day postoperatively in all groups. One week after surgery, Groups 1 and 4 had flare intensity significantly higher than preoperatively (P < .05). Recovery of flare occurred 3 months postoperatively in all groups except Group 2, in which it occurred 1 week after surgery. One day postoperatively, only Group 4 had significantly higher flare than Group 1 (P < .05). One week and 3 months after surgery, Group 4 had significantly higher flare intensity than Groups 1 and 2 (P < .05). The duration of phacoemulsification in Groups 2 and 4 was significantly longer than in Group 1 (P < .05). Operating time was significantly longer than in Group 1 only in Group 4 (P < .05). CONCLUSION: Eyes with advanced stages of DR and with CSME had the highest flare intensity after cataract surgery.

Aged↗
PubMed1998

Phacoemulsification and lens implantation in rabbit eyes: capsular bag versus ciliary sulcus implantation and 4.0 versus 7.0 mm capsulorhexis.

PURPOSE: To compare the effects of intraocular lens (IOL) implantation in the capsular bag versus the ciliary sulcus and of a 4.0 versus 7.0 mm continuous curvilinear capsulorhexis (CCC) on postoperative inflammation and after-cataract formation. SETTING: St. Erik's Eye Hospital, Karolinska Institute, Stockholm, Sweden. METHODS: Trial 1 comprised 40 rabbits that had CCC, endocapsular phacoemulsification, and a poly(methyl methacrylate) IOL implanted in the capsular bag in one eye and the ciliary sulcus in the fellow eye. In Trial 2, 40 rabbits had a 4.0 mm CCC in one eye and a 7.0 mm CCC in the fellow eye followed by phacoemulsification and IOL implantation in the capsular bag. White blood cell (WBC) counts and prostaglandin E2 (PGE2) concentrations in aqueous humor were determined at 1, 3, 7(8), 28, and 56 days postoperatively. Wet mass of the dissected after-cataract was measured at day 56. In Trial 1, wet mass of the iris-ciliary body was measured at each observation. RESULTS: In Trial 1, WBC counts at day 1 were higher with a sulcus-fixated IOL (P = .05). The median wet mass of the dissected after-cataract was 108.5 mg in eyes with a sulcus-fixated IOL and 62.5 mg in eyes with a capsule-fixated IOL (P = .01). In Trial 2, WBC counts at day 8 were significantly higher in eyes with a 7.0 mm CCC than in those with a 4.0 mm CCC (P < .05). There was no significant difference in the amount of after-cataract. CONCLUSIONS: The results indicate that IOL implantation in the capsular bag causes less inflammation and after-cataract formation than sulcus fixation and that using a large CCC does not affect the total amount of after-cataract but may enhance the inflammatory response.

Animals↗
PubMed1998

Posterior continuous curvilinear capsulorhexis and postoperative inflammation.

PURPOSE: To evaluate the influence of posterior continuous curvilinear capsulorhexis (PCCC) on inflammation after phacoemulsification and implantation of a foldable silicone intraocular lens (IOL) in the capsular bag. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: Fifty patients were enrolled in this prospective, randomized study. Eyes with diabetes mellitus, glaucoma, uveitis, exfoliation syndrome, other previous ocular diseases, or an axial length greater than 26.0 mm were excluded. One group comprised 25 eyes of 25 patients (median age 76 years) in which phacoemulsification and implantation of a silicone IOL in the capsular bag were performed. The other group consisted of 25 eyes of 25 patients (median age 77 years) who received the same surgical procedure in addition to PCCC. The aqueous protein concentration was measured using a laser flare meter (FC 500, Kowa Co.) preoperatively and 1 day, 1 week, and 1 and 3 months after surgery. RESULTS: Surgical trauma significantly increased aqueous flare values 1 day, 1 week, and 1 month after surgery in both groups (P < .05). Three months postoperatively, flare values in both groups were not different from preoperative values. No difference between the 2 groups was found in flare intensity measurements or in best corrected visual acuity before and after uneventful surgery. The incidence of postoperative clinical cystoid macular edema was 8% (2 eyes) in the control group and 4% (1 eye) in the group with PCCC. CONCLUSION: Postoperative flare intensity after phacoemulsification with PCCC and implantation of a foldable silicone IOL was not significantly different than postoperative flare measurements in a control group.

Aged↗
PubMed1998

The effect of phenylephrine and pilocarpine on pupil size and aqueous flare intensity in patients with diabetes mellitus.

PURPOSE: The aqueous flare intensity and pupillary size were studied before and after instillation of 10% phenylephrine and 4% pilocarpine in eyes with diabetes mellitus (DM). METHODS: Twenty-three patients with DM type I were compared with 30 age-matched controls, and 25 patients with DM type II were compared with 30 age-matched controls. Patients with DM were divided into two groups: 1) with mild-moderate nonproliferative diabetic retinopathy (NPDR), and 2) with advanced diabetic retinopathy (DR) which includes moderate-severe, severe NPDR and proliferative DR. The aqueous flare intensity and the horizontal diameter of the pupil were measured before and 60 minutes after topical instillation of 10% phenylephrine and 60 min after topical administration of 4% pilocarpine. RESULTS: Degree of induced mydriasis after phenylephrine instillation was not significantly different between diabetic groups and controls. Significantly less pronounced miosis was observed after stimulation of cholinergic receptors by pilocarpine in eyes with mild-moderate NPDR with DM type II and in eyes with advanced DR with DM type I and type II when compared to controls (p<0.05). Phenylephrine decreased flare intensity in all groups without a significant difference between groups. Pilocarpine instillation increased flare intensity in all groups as compared to flare intensity before any treatment. Also, a significantly smaller increase in flare intensity in eyes with advanced retinopathy in both DM type I and type II was found when compared to controls (p<0.05). CONCLUSION: Pharmacological response to cholinergic stimulation on pupil size and flare intensity is weaker in advanced stages of DR.

Administration, Topical↗
PubMed1998

Randomized study of the blood-aqueous barrier reaction after phacoemulsification and extracapsular cataract extraction.

PURPOSE: To compare the blood-aqueous barrier (BAB) breakdown after endocapsular phacoemulsification and extracapsular cataract extraction (ECCE). METHODS: Forty-two patients (64-82 years) enrolled for cataract surgery were randomly assigned to phacoemulsification (group I) or ECCE (group II). Patients with pseudoexfoliation syndrome, small pupils, glaucoma, uveitis, dark brown irides, diabetes, treatment with eye drops or anti-inflammatory drugs were excluded. In group I the patients were operated with continuous curvilinear capsulorhexis (CCC), phacoemulsification and implantation of a poly-(methyl methacrylate) (PMMA) intraocular lens (IOL) through a 5.2 mm self-sealing incision. In group II linear capsulotomy, nucleus expression and PMMA IOL implantation through a large incision (10-11 mm) were performed. The incision was sutured. Before surgery and three days and three months after surgery postoperative inflammation and BAB reaction were measured by laser flare photometry and anterior chamber fluorophotometry after intravenous administration of fluorescein. The BAB diffusion coefficient was calculated. Laser flare photometry was performed also after one and two years. RESULTS: According to fluorophotometry, ECCE induced significantly more postoperative BAB breakdown than did phacoemulsification at three days (p=0.00016) and three months (p=0.00829). Laser flare photometry showed more inflammation in the ECCE group than in the phacoemulsification group at three days postoperatively (p=0.00005). CONCLUSIONS: This study suggests that cataract surgery performed with a small, self-sealing incision, CCC and phacoemulsification induces a reduced surgical trauma with less BAB breakdown compared to ECCE using a large sutured incision, linear capsulotomy and nucleus expression.

Aged↗