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Biomedical subjects

S Crafoord

Publications and source records attributed to S Crafoord.

15 recordsLinked to original sources
PubMed2001

Experimental transplantation of autologous iris pigment epithelial cells to the subretinal space.

PURPOSE: To investigate the cellular morphology in the subretinal space following transplantation of iris pigment epithelial (IPE) cells from the same eye. METHODS: Following an iridectomy, fresh IPE cells were prepared and no culturing performed. After pars plana vitrectomy, a suspension of autologous IPE cells was injected into the subretinal space in 37 rabbits. The grafts were monitored by ophthalmoscopy and colour fundus photography. Rabbits were sacrificed at 1, 2, 3 and 6 months, respectively, and the eyes examined with light and electron microscopy. RESULTS: The grafted area retained the same configuration over 6 months but then appeared less pigmented. At 1-3 months, the IPE formed one or more contiguous layers on top of native RPE. At 6 months, cells compatible with grafted IPE were present in the subretinal space, often forming monolayer-like chains integrating with the native RPE. Depigmented cells of presumed IPE origin were seen and frequently in association with abundant melanin granules located in the apical portion of adjacent RPE cells. In such areas, large macrophage-like cells were observed. CONCLUSION: Transplanted IPE cells survived for up to 6 months in the subretinal space. Our observations suggest a scenario of remodelling of the cellular layers in the subretinal space over time where grafted IPE cells formed a compound layer with the native RPE. Transplantation of autologous IPE cells may have a potential as a treatment modality in selected cases of age-related macular degeneration.

Animals↗
PubMed2001

The Swedish national survey of surgical excision for submacular choroidal neovascularization (CNV).

PURPOSE: To compare the visual outcome after surgical removal of subfoveal choroidal neovascularization (CNV) in patients younger and older than 50 years of age. METHODS: Patient records from all Swedish centers performing submacular CNV surgery were reviewed and 90 patients treated between 1992-1999 with a follow-up of 6 months or more were included. The results obtained in 49 patients aged 51-89 years (median=72 years) with neovascular disease caused by age-related macular degeneration (AMD) were compared with the outcome of 41 patients aged 6-49 years (median=36 years) with CNV secondary to non-AMD causes. The main outcome measure was the improvement or deterioration in visual acuity (standardized in logMAR units) at 6 months following surgery. Secondary endpoints were recurrent CNV and surgical complications. RESULTS: The level of preoperative visual acuity was not significantly different between younger patients with CNV associated with non-AMD and older patients with visual loss due to AMD (p=0.069). However, visual acuity at 6 months after surgery was better (p=0.0042) in younger patients (median improvement=0.19 logMAR) than in older patients (median improvement=0.0 log MAR). Marked visual improvement (>1 log MAR unit) was seen in 29% of non-AMD patients <50 years compared to 0% in the AMD group >50 years. CONCLUSION: Surgical removal of submacular CNV does not appear to improve visual acuity in patients > 50 years of age. However, it may be beneficial for younger patients where a substantial improvement of visual acuity is seen in a subset of these patients. Further studies are required to assess the long-term outcome.

Adolescent↗
PubMed2000

Cellular migration into neural retina following implantation of melanin granules in the subretinal space.

BACKGROUND: In some retinal diseases and following transplantation of retinal pigment epithelium (RPE), melanin granules are liberated to the subretinal space. Our aim was to investigate the cellular response to implanted extracellular melanin. METHODS: After pars plana vitrectomy, 17 albino rabbits received a suspension of melanin granules in the subretinal space. Postoperative examination included ophthalmoscopy, color fundus photography, histology using monoclonal antibodies identifying RPE cells (AE1/3), macrophages (RAM 11), B-lymphocytes (CD20) and T-lymphocytes (CD45), and electron microscopy. The follow-up time was 2 weeks, 4 weeks and 6 months. RESULTS: On fundus photographs, the layer of melanin showed focal attenuation with lighter areas at 6 months. Melanin granules were phagocytosed by RPE cells and macrophages at 2 weeks, as identified by monoclonal antibodies. In areas where an abundance of melanin was present, multilayers of macrophages were seen associated with considerable photoreceptor damage. Pigment-laden cells invaded the neural retina. The cellular infiltration of the retina was focal, and when it involved the outer nuclear layer the photoreceptor damage was severe. Electron microscopy demonstrated the presence of melanosomes intracellularly in Müller glia. The process of phagocytosis and removal of melanin granules from the subretinal space was slow and not completed at 6 months. CONCLUSION: Our experiments show that implantation of melanin granules in the subretinal space of albino rabbits may induce a considerable phagocytic cellular response featuring the host's RPE, macrophages and glial cells. The migration of pigment-laden cells into the neural retina was associated with focal photoreceptor damage.

Animals↗
PubMed2000

Cyclosporine treatment of RPE allografts in the rabbit subretinal space.

PURPOSE: To determine the effects of systemic cyclosporine A (CsA) on the survival of retinal pigment epithelial (RPE) allografts in the subretinal space in an animal model using atraumatic transplantation surgery. METHODS: Following pars plana vitrectomy, an RPE cell suspension from brown rabbits was injected with a glass micropipette into the subretinal space of 39 albino rabbits. For immunosuppression, 22 rabbits were given an injection of CsA, 20 mg daily intramuscularly, 17 rabbits with RPE grafts were controls. The grafts were monitored by biomicroscopy, color fundus photography, and fluorescein angiography. Rabbits were sacrificed at 1, 3 and 6 months, respectively, and the eyes processed for light and electron microscopy including immunohistochemistry. RESULTS: After three months, the transplanted RPE cells, in both the CsA group and the controls, formed a monolayer in the subretinal space. Although a few macrophages were encountered, there was no massive cellular infiltration and the photoreceptor layer was well preserved. After six months, however, there was a disruption of grafted RPE cells in both groups, characterized by dispersion of melanin pigment in the subretinal space, and invasion of macrophages with focal photoreceptor damage but no infiltration of lymphocytes in the retina or choroid. No significant differences between the CsA treated and the control eyes were discernible. CONCLUSION: Although the subretinal space has been considered an immunologically privileged site, we found that the survival of RPE allografts was limited. CsA did not prevent RPE allograft destruction in the subretinal space. The transplant seems to be disrupted either by immunological mechanisms that are not inhibited by CsA, or by nonimmunologic events.

Animals↗
PubMed1999

Long-term outcome of RPE allografts to the subretinal space of rabbits.

PURPOSE: To determine the long-term RPE allograft survival in the subretinal space using suspensions of RPE cells and atraumatic transplantation surgery. METHODS: Nineteen albino rabbits were transplanted with suspensions of pigmented RPE cells from brown rabbits. Following pars plana vitrectomy, the RPE cell suspension was injected through a small retinotomy using a glass micropipette into the subretinal space under microscopic control. No immunosuppression was used. The eyes were monitored by biomicroscopy, color fundus photography, and fluorescein angiography. Rabbits were sacrificed at 1, 3 and 6 months, respectively, and the eyes processed for light and electron microscopy, using monoclonal antibodies for identifying macrophages. RESULTS: Transplanted RPE cells were present in the subretinal space in all eyes at 6 months. There was no fluorescein leakage. Generally, the RPE allograft formed a monolayer, but focal fragmentation and disruption with dispersion of melanin pigment occurred. Foci of multilayers of cells in the subretinal space, containing large macrophages, were associated with adjacent photoreceptor damage. There was no infiltration of lymphocytes but macrophages and glial cells were contiguous to the transplant. Cells harboring intracytoplasmatic melanin pigment were observed in the neural retina. CONCLUSION: Transplantation of RPE cell suspensions to the subretinal space generally forms a monolayer that persists at 6 months. However, in areas of multilayers of RPE cells and macrophages, graft failure occurs in combination with adjacent photoreceptor damage. Graft failure is not associated with the infiltration of lymphocytes, but other mechanisms seem to occur.

Animals↗
PubMed1998

Tackling the "dropped nucleus".

PURPOSE: To summarize and analyse the results of our experience in treating patients with a "dropped nucleus". METHODS: The case records of nineteen patients who underwent surgery for a "dropped nucleus" at the Ophthalmology Departments of Sahlgren's University Hospital, Gothenburg, and Orebro Medical Centre, Orebro, Sweden during 1994 were retrospectively reviewed to determine the mode of treatment used and the results of surgery. The frequency of this complication was also calculated for Sweden as a whole with the help of the National Cataract Register. RESULTS: The lens was successfully removed in all eyes. No retinal breaks or detachments were present at vitrectomy or follow-up. One eye was lost to panophthalmitis 11 days after the vitrectomy; the remaining 18 eyes showed a favourable outcome. CONCLUSION: The loss of a crystalline lens to the vitreous during cataract surgery is a severe complication. We recommend that an experienced vitreoretinal surgeon should be consulted at an early stage.

Aged↗
PubMed1997

Long-term results of macular pucker surgery.

PURPOSE: Macular pucker patients were re-examined 16-90 months after surgery (mean 72 months) to evaluate visual acuity, metamorphopsia, and complications, with particular reference to cataract development. Surgery had been performed on 48 eyes in 46 patients, 31 eyes having a primary, and 17 eyes a secondary macular pucker. RESULTS: At the 6-month control 65% of the eyes with a primary macular pucker and 35% of the eyes with a secondary macular pucker exhibited an improved visual acuity defined as doubling or more of the visual angle. At the last control 57% of the primary group and 33% of the secondary group had a visual acuity which still exceeded the preoperative value. At the final examination a cataract progression was observed in 22/28 (79%) of the primary group and 8/14 (57%) of the secondary group. In the primary group 11% and in the secondary group 36% of the eyes suffered a retinal detachment. All cases were successfully treated and none were followed by visual deterioration. CONCLUSION: The improvement in visual quality after macular pucker surgery appears to be long-standing, if not permanent, especially in primary cases. In those eyes in which a decrease in visual acuity is observed, the most frequent cause is cataract development.

Cataract↗
PubMed1995

The use of perfluorocarbon liquids in vitreoretinal surgery.

Two perfluorocarbon liquids (perfluoro-n-octane and perfluorodecaline) were evaluated as technical aids in vitreoretinal surgery in 42 patients. Perfluorocarbon liquids were found to stabilize the retina and simplify removal of repiretinal membranes, which in many cases permitted the subsequent use of an expanding gas instead of silicone oil at the conclusion of the operation. The infusion of a perfluorocarbon liquids allowed the drainage of subretinal fluid through peripheral retinal breaks obviating the need for a retinotomy in most cases. No difference could be observed between the two types of perfluorocarbon liquids, and there were no adverse effects associated with their use. The retina was centrally attached in 32 eyes (76%) at 3-10 months follow-up.

Adolescent↗
PubMed1994

Severe retinopathy of prematurity in infants from the southern regions of Sweden.

We studied children born in 1986-1989 with severe retinopathy of prematurity (ROP) defined as stage 3 "plus" or more. Sixteen children from the southern and central areas of Sweden were identified and 15 of these were referred to Orebro Medical Center Hospital for surgical treatment of ROP. The incidence of severe ROP was estimated as 0.8 per 10,000 newborns per year. All children were born before 29 weeks' gestation and weighed less than 1310 g; they also needed ventilatory support for a long time. The overall neonatal morbidity was high. A model for eye examination in premature newborns is suggested.

Female↗
PubMed1993

Follow-up of 15 children with severe ROP 1987-1989.

Between 1987-89 fifteen premature infants with severe retinopathy of prematurity (ROP), at the age of ten months or less, were admitted as outpatients to the Department of Ophthalmology at the Orebro Medical Center Hospital. Initial examination of the infants showed that 6 eyes had stage 3+, 3 eyes had stage 4B and 21 eyes had stage 5 ROP. All 15 infants were born at gestational week 24-28 (mean value 26) and had a birth weight between 600 and 1310 g (mean 907 g). For stage 3+ cryotherapy was performed. For stage 4B and 5 buckling procedure and vitreous surgery was performed in an attempt to re-attach the retina. The children were followed 2-5.5 years. Postoperatively, the retinas of all eyes in stage 3+ and 4B were attached. Four retinas out of seventeen stage 5 eyes were later found to be centrally re-attached. One eye with stage 3+ and four eyes with stage 5 were not treated at all. At follow-up of stage 3+ and 4B, visual acuity was measurable in all eyes; in stage 5 only two out of four eyes with anatomically reattached retinas had perception of light.

Child, Preschool↗
PubMed1993

Healon GV in posterior segment surgery.

Healon, a viscoelastic preparation of Sodium hyaluronate, has been reported effective in posterior segment surgery for dissection of epiretinal membranes, i.e. proliferative diabetic retinopathy and macular pucker. A more viscous substance might be more effective for this kind of surgery. Therefore, a new Sodium hyaluronate preparation Healon GV with a ten times greater viscosity at rest than Healon, was tested in an open clinical study. Twenty-four patients of both sexes and not younger than 18 years were enrolled. The follow-up time was three months. The main indications for using Healon GV were: to separate membranes from the retina, to stop bleeding and to reposition a detached retina. 0.2-0.5 ml of Healon GV was injected through a 27 gauge bent cannula and at close of surgery irrigated out of the eye. Postoperatively the patients were monitored concerning intraocular pressure, vitreous clarity, anterior chamber flare and visual acuity. Healon GV was found to make the surgical procedure simpler and safer. No inflammatory reaction and no increase of IOP was observed.

Adult↗
PubMed1992

Healon Yellow as a surgical tool in maneuvering intraocular tissues.

Tinted sodium hyaluronate (Healon Yellow) was used during posterior segment surgery mainly for the dissection of epiretinal membranes in cases of proliferative diabetic retinopathy and macular pucker. The yellow color facilitated injecting the viscoelastic substance under the membranes and simplified its removal at the end of surgery.

Diabetic Retinopathy↗
PubMed1987

A new technique of treating rhegmatogenous retinal detachment using the Q-switched Nd:YAG laser.

In eyes with retinal detachment and a horseshoe break, vitreous traction on the retina has been relieved by severing the flap of the break with the aid of the Q-switched Nd:YAG laser. The retina often flattens in eyes with shallow retinal detachment after this treatment; the breaks then can be sealed off with argon laser. In cases of retinal detachment treated with expanding gas, fewer recurrences were observed when vitreous traction had been relieved by Nd:YAG laser treatment.

Argon↗
PubMed1986

Sealing of retinal breaks with metal tacks. Evaluation of a new procedure in retinal re-attachment surgery.

Metal retinal tacks were used in 18 patients with complicated retinal detachments, such as giant tears (3 cases), severe proliferative vitreoretinopathy (PVR) (7 eyes) and diabetic traction and rhegmatogenous detachment (8 cases). All eyes had undergone vitreous microsurgery, including excision or segmentation of epiretinal membranes, fluid-air (SF6) or silicone oil exchange. Retinal breaks and the cut edges of retinotomies and retinectomies were successfully sealed by metal tacks. Retinal re-attachment was achieved in 9 cases and partial re-attachment in another 5 eyes (follow-up 3-6 months). Retinal tears in diabetic macular detachment associated with extensive epiretinal fibrovascular membranes were also successfully sealed despite persisting traction. Our first experience indicates that the closing of retinal breaks with metal tacks is a major step forward in retinal re-attachment surgery.

Adolescent↗