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To compare the efficacy and safety of ultrathin Descemet stripping (automated) endothelial keratoplasty (UT-DS(A)EK) versus Descemet membrane endothelial keratoplasty (DMEK) for the treatment of Fuchs endothelial dystrophy (FED) and bullous keratopathy (BK).Systematic review and meta-analysis.Literature containing DMEK and UT-DSAEK were searched in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, LILACS, and through manual reference searching. Studies were included that measured the outcome of interventions-including best corrected visual acuity (BCVA), endothelial cell density (ECD), and postoperative complications, especially graft detachment with the need of re-bubbling, graft rejection, graft failure, and postoperative elevated intraocular pressure (IOP)-in patients with FED and BK. Included outcomes were pooled as standardized mean differences (SMD) or risk ratios (RR) using random effects models. Inter-study heterogeneity was assessed using the Q-test and ISeven (of 163) studies met all the inclusion and exclusion criteria. Meta-analysis showed a significantly better BCVA 12 months postoperatively, but an increased re-bubbling rate in eyes after DMEK compared with eyes after UT-DS(A)EK (BCVA: SMD = 0.50 [95% CI 0.27-0.74] and re-bubbling rate: RR = 0.33 [95% CI 0.16-0.67]). All other parameters did not differ significantly between both interventions, although estimates were imprecise (graft failure: RR = 0.65 [95% CI 0.18-2.30], graft rejection: RR = 1.40 [95% CI 0.27-7.30], and postoperative intraocular pressure elevation: RR = 1.14 [95% CI 0.60-2.18]). Postoperative SMDs of ECD could not be evaluated due to significant heterogeneity between studies.Although the improvement in BCVA was higher after UT-DS(A)EK than after conventional DS(A)EK, the BCVA after DMEK was still superior. The complication rates were comparable for both procedures, except for the higher rate of re-bubbling after DMEK.

Purpose To evaluate the outcome of Descemet Membrane Endothelial Keratoplasty (DMEK) in eyes with pre-existing glaucoma. Design In this retrospective, observational case series we included data of 150 consecutive DMEKs in eyes with pre-existing glaucoma of 150 patients after excluding data of the second treated eye of each patient and of re-DMEKs during follow-up. Cumulative incidences of IOP elevation (IOP > 21 mmHg or ≥ 10 mmHg increase in IOP from preoperative value), post-DMEK glaucoma (need of an additional intervention due to worsening of the IOP), graft rejection, and graft failure rate were analyzed using Kaplan–Meier survival analysis. COX regression analysis was used to evaluate independent risk factors. Results The 36-month cumulative incidence of IOP elevation was 53.5% [95 CI 43.5–63.5%] and of post-DMEK glaucoma 36.3% [95 CI 26.3–46.3%]. Graft rejection occurred with a 36-month cumulative incidence of 9.2% [CI 95% 2.3–16.1]. None of the analyzed risk factors increased the risk for the development of graft rejection. The 36-month cumulative incidence of graft failure was 16.6% [CI 95% 8.4–24.8]. Independent risk factors for graft failure were the indication for DMEK “status after graft failure” (n = 16) compared to Fuchs’ dystrophy (n = 74) (p = 0.045, HR 8.511 [CI 95% 1.054–68.756]) and pre-existing filtrating surgery via glaucoma drainage device (GDD) (n = 10) compared to no surgery/iridectomy (n = 109) (p = 0.014, HR 6.273 [CI 95% 1.456–27.031]). Conclusion The risks of postoperative complications (IOP elevation, post-DMEK glaucoma, graft rejection, and graft failure) in patients with pre-existing glaucoma are high. In particular, pre-existing filtrating surgery via GDD implantation—but not trabeculectomy—and DMEK after graft failure increase the risk of graft failure.

ZusammenfassungBlepharitis ist eine häufige entzündliche Erkrankung der Augenlider einschließlich des Lidrandes, die bei Erwachsenen und Kindern auftreten und schwere Symptome hervorrufen haben kann. Je nach anatomischer Lokalisation kann die Blepharitis in anteriore und posteriore Formen eingeteilt werden. Die Pathogenese der chronischen Blepharitis ist noch nicht vollständig geklärt, es wird jedoch ein multifaktorielles Krankheitsgeschehen vermutet. Die Erkrankung stellt eine therapeutische Herausforderung dar.

Blepharitis represents a frequent inflammatory condition of the lids including the lid margin, which can be apparent in adults and children. Chronic blepharitis is therapeutically challenging. According to the anatomic localization, blepharitis can be graded in anterior and posterior forms. Blepharitis can lead to severe symptoms and complications, mainly dry eye disease, corneal complications and defective lid position. The pathogenesis of chronic blepharitis is not fully understood so far, however, multifactorial disease proceedings are supposed, which include systemic diseases (mainly dermatological disorders), habitual bacteria and infections. In all these processes inflammatory changes are the common final path.Therapeutic strategies include topical and systemic therapies, however evidence levels are generally low and patients are often resistant to therapy. Basic therapeutic measures are warm compresses, lid hygiene and lubricants. Topical anti-inflammatory drugs comprise corticosteroids and ciclosporin A. Topical and systemic antibiotics are commonly used. Systemic intake of omega-3 fatty acids is often recommended due to its anti-inflammatory potential.

PURPOSE To study the change in contrast sensitivities in eyes with Fuchs endothelial dystrophy and bullous keratopathy after Descemet membrane endothelial keratoplasty (DMEK). METHODS In this prospective study, 50 pseudophakic eyes of 50 patients who received DMEK surgery at the Charite-Universitatsmedizin Berlin were included. Visual acuity; contrast sensitivity using OPTEC 6500 at spatial frequencies of 1.5, 3, 6, 12, and 18 cycles/degree in photopic and mesopic light with and without glare; central corneal thickness (CCT); and anterior and posterior corneal aberrations were measured preoperatively and at 3 and 12 months postoperatively. RESULTS Best-corrected visual acuity (preoperative 0.67 ± 0.46 and after 12 months 0.19 ± 0.16 LogMAR, P < 0.001) and photopic and mesopic contrast sensitivities with and without glare improved significantly, whereas CCT decreased significantly (preoperative 677 ± 114 μm, after 12 months 527 ± 29 μm, P < 0.001). Preoperative CCT correlates significantly with preoperative photopic contrast sensitivity (correlation coefficient -0.462, P = 0.002), and postoperative total anterior aberrations correlates with postoperative photopic contrast sensitivity (correlation coefficient -0.361, P = 0.006). CONCLUSIONS Photopic and mesopic contrast sensitivities, especially with glare, are impaired in patients with Fuchs endothelial dystrophy and bullous keratopathy. The extent of the corneal thickening seems to mainly influence the contrast sensitivity preoperatively. DMEK surgery improves the contrast sensitivity significantly. However, higher postoperative anterior corneal aberrations limit the postoperative contrast sensitivities.

Purpose/Aim of the study: Graft detachment after DMEK can be treated easily with an additional air injection – re-bubbling. The aim of our study was to investigate the effect of a re-bubbling on th...

Unfolding and attachment of the posterior donor lamella may be the most challenging part in Descemet membrane endothelial keratoplasty (DMEK) procedure. We investigated the correlation of the difficulty degrees of this step to the postoperative clinical outcome 6 years after surgery. One hundred sixty-nine consecutive DMEKs between September 2012 and August 2013 at the Charite–University Medicine Berlin were graded prospectively into 4 groups according to their grade of difficulty in unfolding and attachment of the graft lamella. Postoperative visual acuity, endothelial cell density, and rate of graft failure were measured after 1 year, after 2 years, and after 6 years and analyzed according to their grading group. Visual acuity improved significantly in all groups and did not differ significantly between the grading groups at any time point postoperatively. There was a significant decrease of endothelial cell density in all groups with a significantly higher endothelial cell loss in group IV compared with the other groups within the first 24 months after surgery. The graft failure rate was significantly higher in eyes graded III and IV than in groups I and II (p = 0.012). Although the endothelial cell loss and the graft failure rate increase significantly with a more difficult graft unfolding and attachment, DMEK surgery is a promising procedure with a good long-term postoperative outcome. A direct manipulation of the graft lamella for unfolding and centering by cannula or forceps should be avoided if possible to reduce the risk of an increased endothelial cell loss and a higher graft failure rate. NCT02020044

To report the efficacy of systemic anti-TNF agents in Mooren's ulcer.Retrospective, consecutive case series.We report on clinical characteristics and outcome of five patients with Mooren's ulcer with anti-TNF treatment.During a mean follow-up of 30 months, relief of symptoms and arrest of corneal melting were observed in all eyes. Systemic corticosteroid treatment could be discontinued or reduced to threshold levels. No patient experienced adverse effects on bDMARDs.Our results suggest that bDMARDs are effective in Mooren's ulcer unresponsive to conventional treatment. This is in line with accumulating evidence in the current literature. Therefore, more targeted immunomodulatory approaches might be an effective first-line therapy in the future.

Purpose To evaluate the outcome of phacoemulsification in patients with chronic ocular Graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplantation (aHSCT). Methods Retrospective, observational multicenter study from 1507 oGVHD patients. From the patient files, data were collected including best-corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer’s test I, tear film break-up time (TFBUT), corneal fluorescein staining score, postoperative complications, and pre- and post-operative topical therapy. Results Seventy-three patients underwent cataract surgery in 104 eyes. In n = 84 eyes, the oGVHD NIH grade was documented; 12% (n = 12) of analyzed eyes were staged oGVHD NIH grade 1, 31% (n = 32) NIH 2 and 39% (n = 41) NIH 3. The mean BCVA improved in 82% of the eyes (n = 86 eyes). BCVA significantly increased from 0.7 ± 0.5 to 0.4 ± 0.4 LogMAR after surgery independent from oGVHD severity. The mean IOP decreased from 14 ± 4 to 13 ± 4 mmHg after surgery. Visual acuity was moderately correlated to the pre-operative degree of corneal staining (Pearson p = 0.26, p = 0.002, Cohen’s effect size f = 0.29). The visual acuity decreased by 0.078 LogMar units (95% CI = 0.027–0.141) with each increase of corneal staining by one grade (p = 0.05). After surgery, corneal epitheliopathy increased significantly in 42% (n = 44) of the eyes. Postoperative complications included corneal perforation (n = 6, 6%), cystoid macular edema (n = 4, 4%), and endophthalmitis (n = 1, 1%). Conclusion Phacoemulsification in patients with chronic oGVHD significantly improves visual acuity, but is associated with an increased risk of complications in particular corneal epitheliopathy and corneal perforations.

Chronic graft-versus-host disease (GVHD) can be associated with significant morbidity, in part because of nonreversible fibrosis, which impacts physical functioning (eye, skin, lung manifestations) and mortality (lung, gastrointestinal manifestations). Progress in preventing severe morbidity and mortality associated with chronic GVHD is limited by a complex and incompletely understood disease biology and a lack of prognostic biomarkers. Likewise, treatment advances for highly morbid manifestations remain hindered by the absence of effective organ-specific approaches targeting “irreversible” fibrotic sequelae and difficulties in conducting clinical trials in a heterogeneous disease with small patient numbers. The purpose of this document is to identify current gaps, to outline a roadmap of research goals for highly morbid forms of chronic GVHD including advanced skin sclerosis, fasciitis, lung, ocular and gastrointestinal involvement, and to propose strategies for effective trial design. The working group made the following recommendations: (1) Phenotype chronic GVHD clinically and biologically in future cohorts, to describe the incidence, prognostic factors, mechanisms of organ damage, and clinical evolution of highly morbid conditions including long-term effects in children ; (2) Conduct longitudinal multicenter studies with common definitions and research sample collections ; (3) Develop new approaches for early identification and treatment of highly morbid forms of chronic GVHD, especially biologically targeted treatments, with a special focus on fibrotic changes ; and (4) Establish primary endpoints for clinical trials addressing each highly morbid manifestation in relationship to the time point of intervention (early versus late). Alternative endpoints, such as lack of progression and improvement in physical functioning or quality of life, may be suitable for clinical trials in patients with highly morbid manifestations. Finally, new approaches for objective response assessment and exploration of novel trial designs for small populations are required.

Corneal nerves are responsible for the reception of pain, temperature, and touch and are an important component of homeostasis of the ocular surface. When the corneal innervation is reduced, degenerative changes can be manifested as neurotrophic keratopathy (NK). In a stage-dependent course, corneal epithelial alterations and ulcers may occur, even leading to perforation. The cause of NK is predominantly damage to the trigeminal nerve, which can be caused by infections (especially herpesviruses), metabolic diseases (such as diabetes mellitus) and by surgical procedures. The diagnosis of NK requires a detailed medical and ocular history, assessment of corneal sensitivity, and a complete ocular examination. The treatment of NK is oriented to the clinical severity and aims to restore the integrity of the ocular surface in order to prevent further disease progression.

Zusammenfassung Hintergrund Bei der Graft-versus-Host Disease (GvHD) kommt es zu einer Abstoßung des Empfängerkörpers nach allogener Blutstammzelltransplantation (aBSZT). Hierbei werden akute von chronischen Formen unterschieden. Circa 40 – 80% der Patienten, bei denen eine chronische GvHD diagnostiziert wurde, entwickeln eine okuläre GvHD. Für diese ist es wichtig, einen einfachen Zugang zu multidisziplinärer Versorgung zu erhalten. Um Entwicklungen in den Versorgungsstrukturen zu erfragen, führten wir eine Umfrage durch. Methoden Von der Arbeitsgruppe okuläre GvHD der Sektion Kornea wurde die „Umfrage zur okulären GvHD 2016“ erstellt und an alle Universitäts- und Schwerpunktkliniken in Deutschland versendet. Ausgewertet wurden die Antworten sowie Veränderungen zu einer Umfrage 2014, um so Rückschlüsse auf die Entwicklung der Versorgungsstrukturen zuzulassen. Neben den Fragen aus dem Jahr 2014 zur Anzahl von BSZT und Untersuchungshäufigkeit und -setting wurden Fragen zur Verordnung von Ciclosporin- und autologen Serumaugentropfen aufgenommen. Zudem wurde die Frage nach der Untersuchungshäufigkeit unterteilt, um diese auch bei Kindern zu erfassen. Ergebnisse Von 30 antwortenden Kliniken hatten 22 auch an der 1. Umfrage teilgenommen. Den Angaben nach wurden im Jahr 2016 ca. 1860 aBSZT in den assoziierten Zentren der befragten Kliniken durchgeführt. Dies entspricht etwas mehr als der Hälfte der 2016 insgesamt transplantierten Patienten. Jährlich wurden zwischen 2 und 250 Patienten augenärztlich pro Klinik untersucht. Acht Kliniken bieten hierfür eine gesonderte Sprechstunde an. In fast allen der teilnehmenden Kliniken werden Ciclosporin-Augentropfen verordnet. Circa ⅔ der Krankenhäuser stellen autologe Serumaugentropfen her, 7 beziehen diese aus externen Quellen. Insgesamt wurden 2016 ca. 125 – 140 Kinder untersucht. Schlussfolgerungen Aufgrund der schweren Verläufe der okulären GvHD mit gravierenden Beeinträchtigungen der Patienten und drohenden Erblindungen wäre der Ausbau von Spezialsprechstunden mit Bindung von Expertise in örtlicher Nähe zu jedem Transplantationszentrum zu empfehlen. Hier sind vor allem Augenärztinnen und Augenärzte gefragt, sich an der Versorgung zu beteiligen, um die Lebensqualität nach aBSZT zu verbessern. Zusammenfassend gehen wir weiterhin von einer Unterversorgung der okulären GvHD in Deutschland aus, wobei jedoch Anzeichen für eine Verbesserung der Situation bestehen.

Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres.The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany.Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated.All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 - 5 times daily) and tapering (2 - 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days.Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.Heutzutage bleibt die perforierende Keratoplastik (pKP) immer komplizierteren Ausgangssituationen vorbehalten. Die Komorbiditäten bergen oft Risiken, welche die Überlebensrate der perforierend operierten Transplantate limitieren. Die häufigste Ursache für das Versagen eines Hornhauttransplantates ist die endotheliale Immunreaktion. Die Fadenentfernung nach pKP ist als Risikofaktor für eine Abstoßung bekannt. Dennoch existiert keine evidenzbasierte Empfehlung zur Prophylaxe der Abstoßung im Rahmen der Fadenentfernung. Daher wurde eine Umfrage an 7 deutschen Keratoplastikzentren zu diesem Thema durchgeführt.Ziel der Studie ist die Dokumentation der Variabilität der medikamentösen Nachsorge nach Fadenentfernung in Deutschland.Aus dem Deutschen Keratoplastikregister wurden die 7 Zentren mit den größten Operationszahlen für perforierende Eingriffe ausgewählt und mit einem halboffenen Fragebogen angeschrieben. Die Zentren hatten in 2018 durchschnittlich jeweils 140 pKP durchgeführt. Der Rücklauf betrug 100%. Zur deskriptiven Auswertung wurde eine Tabelle erstellt.Alle Zentren wenden im Standardfall die doppelt fortlaufende Kreuzstichnaht nach Hoffmann an und führen eine Abstoßungsprophylaxe mit topischen Steroiden nach Fadenentfernung durch. Unterschiede zeigen sich hinsichtlich der Intensität (1 – 5 × tgl.) und Ausschleichdauer (2 – 20 Wochen) der topischen Steroidtherapie nach Fadenentfernung. Zwei Zentren wenden zusätzlich kurzfristig systemisches Steroid an.Die Nachbehandlung der Fadenentfernung nach pKP ist aktuell wenig standardisiert und nicht evidenzbasiert. Alle befragten Zentren indizieren eine medikamentöse Nachbehandlung nach Fadenentfernung. Es ist davon auszugehen, dass die jeweiligen Regimes unterschiedlich günstige Kosten-Nutzen-Eigenschaften aufweisen. Angesichts der Diversität ist eine systematische Untersuchung der Ergebnisse angezeigt, um ein optimiertes Schema für alle Patienten zu entwickeln.

Wir berichten uber eine 27-jahrige Patientin mit aplastischer Anamie, die eine beidseitige Ziliarkorperschwellung mit Sekundarglaukom und „myopic shift“ wahrend der Therapie mit systemischem Ciclosporin entwickelte. Durch topische Therapie mit Atropin und Prednisolon sowie Umstellung der systemischen Therapie von Ciclosporin auf Tacrolimus kam es zu einem kompletten Ruckgang des Befundes. Eine infektiose Ursache konnte nicht festgestellt werden. Wir vermuten, dass die Ziliarkorperschwellung im vorliegenden Fall durch Ciclosporin verursacht wurde, welches bekanntermasen die mikrovaskulare Gefasstruktur schadigt.

Corneal nerves are responsible for the reception of pain, temperature, and touch and are an important component of homeostasis of the ocular surface. When the corneal innervation is reduced, degenerative changes can be manifested as neurotrophic keratopathy (NK). In a stage-dependent course, corneal epithelial alterations and ulcers may occur, even leading to perforation. The cause of NK is predominantly damage to the trigeminal nerve, which can be caused by infections (especially herpesviruses), metabolic diseases (such as diabetes mellitus) and by surgical procedures. The diagnosis of NK requires a detailed medical and ocular history, assessment of corneal sensitivity, and a complete ocular examination. The treatment of NK is oriented to the clinical severity and aims to restore the integrity of the ocular surface in order to prevent further disease progression.

graft-versus-host disease (GvHD) is a common complication after allogeneic haematopoietic stem cell transplantation (allo-SCT) and causes immunological rejection of host tissues, which can occur both acute or chronically. Approximately 40 - 80% of patients with the diagnosis of chronic GvHD (cGvHD) also develop ocular GvHD. For these patients, immediate and uncomplicated access to interdisciplinary patient-centred care is important. We performed this survey to improve understanding of the structure of patient-centred care in Germany.The GvHD working party of the Cornea Section of the German Society of Ophthalmology sent the "Survey of ocular GvHD 2016" to all university and specialised hospitals in Germany. We evaluated the data and compared the information with survey results from 2014, in order to draw conclusions about the structure and process of patient-centred care in ocular GvHD. Besides the questions from 2014 on the numbers of allo-SCT, frequency of examinations, etc. there were additional questions on the prescription of ciclosporin and autologous serum eye drops. The question on frequency examination was further expanded to include examinations of paediatric patients.Of 30 participating hospitals, 22 had already taken part in the first survey. According to the information they provided, approx. 1860 allo-SCTs were performed in the transplantation units of the participating eye hospitals in 2016. This was more than half of the transplantations performed in Germany. Ophthalmologists examined between 2 and 250 Patients per year per centre. Eight clinics provide a specialised outpatient clinic for ocular GvHD. Nearly all the participating clinics prescribe ciclosporin eye drops. About ⅔ provide autologous serum eye drops, seven obtain them from external sources. Overall approx. 125 - 140 children were examined in 2016.Due to the potential severity of ocular GvHD with immobilisation of the patients and the imminent loss of sight, further improvements in eye care are required. For example, offers such as special consultations, with expertise located close to any transplantation unit are recommended. This requires in particular ophthalmologists to participate in the patient care to enhance quality of life after allo-SCT. In summary, we conclude that the present structures are not sufficient to treat all patients suffering from ocular GvHD in Germany, but the situation has evidently improved.Bei der Graft-versus-Host Disease (GvHD) kommt es zu einer Abstoßung des Empfängerkörpers nach allogener Blutstammzelltransplantation (aBSZT). Hierbei werden akute von chronischen Formen unterschieden. Circa 40 – 80% der Patienten, bei denen eine chronische GvHD diagnostiziert wurde, entwickeln eine okuläre GvHD. Für diese ist es wichtig, einen einfachen Zugang zu multidisziplinärer Versorgung zu erhalten. Um Entwicklungen in den Versorgungsstrukturen zu erfragen, führten wir eine Umfrage durch.Von der Arbeitsgruppe okuläre GvHD der Sektion Kornea wurde die „Umfrage zur okulären GvHD 2016“ erstellt und an alle Universitäts- und Schwerpunktkliniken in Deutschland versendet. Ausgewertet wurden die Antworten sowie Veränderungen zu einer Umfrage 2014, um so Rückschlüsse auf die Entwicklung der Versorgungsstrukturen zuzulassen. Neben den Fragen aus dem Jahr 2014 zur Anzahl von BSZT und Untersuchungshäufigkeit und -setting wurden Fragen zur Verordnung von Ciclosporin- und autologen Serumaugentropfen aufgenommen. Zudem wurde die Frage nach der Untersuchungshäufigkeit unterteilt, um diese auch bei Kindern zu erfassen.Von 30 antwortenden Kliniken hatten 22 auch an der 1. Umfrage teilgenommen. Den Angaben nach wurden im Jahr 2016 ca. 1860 aBSZT in den assoziierten Zentren der befragten Kliniken durchgeführt. Dies entspricht etwas mehr als der Hälfte der 2016 insgesamt transplantierten Patienten. Jährlich wurden zwischen 2 und 250 Patienten augenärztlich pro Klinik untersucht. Acht Kliniken bieten hierfür eine gesonderte Sprechstunde an. In fast allen der teilnehmenden Kliniken werden Ciclosporin-Augentropfen verordnet. Circa ⅔ der Krankenhäuser stellen autologe Serumaugentropfen her, 7 beziehen diese aus externen Quellen. Insgesamt wurden 2016 ca. 125 – 140 Kinder untersucht.Aufgrund der schweren Verläufe der okulären GvHD mit gravierenden Beeinträchtigungen der Patienten und drohenden Erblindungen wäre der Ausbau von Spezialsprechstunden mit Bindung von Expertise in örtlicher Nähe zu jedem Transplantationszentrum zu empfehlen. Hier sind vor allem Augenärztinnen und Augenärzte gefragt, sich an der Versorgung zu beteiligen, um die Lebensqualität nach aBSZT zu verbessern. Zusammenfassend gehen wir weiterhin von einer Unterversorgung der okulären GvHD in Deutschland aus, wobei jedoch Anzeichen für eine Verbesserung der Situation bestehen.

Die okulare Hypotonie ist eine Folge einer fehlenden Produktion oder eines Verlusts von Kammerwasser. Intraokulare Entzundungen, Medikamente oder eine proliferative Vitreoretinopathie (PVR) mit Uberwachsung des Ziliarkorpers konnen zu einer Sekretionsminderung des Kammerwassers fuhren. Bei der Hypotonie durch Kammerwasserverlust unterscheidet man externe Grunde – wie Z. n. (fistulierender) Chirurgie oder Traumata – von internen Ursachen, wie Zyklodialysespalten oder Netzhautablosungen. In diesem Ubersichtsartikel wird die kausale Therapie der okularen Hypotonie aus der Sicht der Netzhaut- und Glaskorperchirurgie diskutiert: Ziliarkorperrefixation, Entfernung von Ziliarkorpermembranen, PVR-Chirurgie, die Wahl der Tamponade sowie Moglichkeiten und Grenzen des Irisdiaphragmas im Vergleich zu pharmakologischen Ansatzen.

Falldarstellung Eine 69-jahrige, immunkompetente Patientin stellte sich mit einem seit 1 Monat bestehenden kontaktlinsenassoziierten, therapieresistenten Hornhautulkus am linken Auge vor. Bei Erstvorstellung bestand ein bestkorrigierter Fernvisus am linken Auge von 0,2. Im Bereich der Hornhaut zeigte sich eine Keratitis mit zentralem Ulkus. Es wurde ein Hornhautscraping durchgefuhrt und die Patientin mit antibiotischen Augentropfen stationar behandelt. Die Polymerasekettenreaktion (PCR) war negativ, die Kultur steril nach 48 h. Im Laufe des stationaren Aufenthaltes zeigte sich eine Befundbesserung mit Visusanstieg auf 0,4 und Abheilung des Ulkus, sodass wir die Patientin bei stabilem Befund entliesen.

Hintergrund Ziel der vorgestellten Umfrage war es, die aktuelle Situation der Assistenzarztinnen und -arzte in der Ophthalmologie zu beschreiben und ihre Vorstellungen und Ziele zu erfassen. Die Beschreibung der Ist-Situation soll zur Identifizierung von Problembereichen und Entwicklung von bedarfsorientierten Verbesserungsansatzen beitragen.

Background Patients with initially low visual acuity were excluded from the therapy approval studies for retinal vein occlusion. But up to 28 % of patients presenting with central retinal vein occlusion have a baseline BCVA of less than 34 ETDRS letters (0.1). The purpose of our study was to assess visual acuity and central retinal thickness in patients suffering from central retinal vein occlusion and low visual acuity (

Hintergrund: Bei der Behandlung der Chorioretinopathia centralis serosa (CRCS) gibt es derzeit verschiedene Therapiestrategien. Die Laserkoagulation von, in der Fluoreszenzangiographie sichtbaren Quellpunkten ist eine Möglichkeit der Behandlung, in der Regel bei Patienten, bei denen sich weder [zum vollständigen Text gelangen Sie über die oben angegebene URL], 29. Jahrestagung der Retinologischen Gesellschaft

Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life.The German/Austrian/Swiss Consensus Conference on Clinical Practice in cGVHD aimed to summarize the currently available evidence for diagnosis and (topical) treatment and to summarize different treatment modalities of ocular cGVHD. The presented consensus was based on a review of published evidence and a survey on the current clinical practice including transplant centers from Germany, Austria, and Switzerland.Ocular cGVHD often affects the lacrimal glands, the conjunctiva, the lids (including meibomian glands), and the cornea but can also involve other parts of the eye such as the sclera. Up to now, there have been no pathognomonic diagnostic features identified. The main therapeutic aim in the management of ocular cGVHD is the treatment of inflammation and dryness to relieve patients' symptoms and to maintain ocular integrity and function. Therapy should be chosen in the context of the patient's overall condition, systemic immunosuppressive therapy, symptoms, ocular surface integrity, and inflammatory activity. The consensus conference proposed new grading criteria and diagnostic recommendations for general monitoring of patients with graft-versus-host-disease for use in clinical practice.The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge. Topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocular cGVHD. Further clinical trials are necessary to elucidate risk factors for eye manifestation, complications, and visual loss and to evaluate staging criteria and diagnostic and therapeutic measures for ocular cGVHD.

The purpose of the study was to validate a recently proposed new grading system for ocular manifestations of chronic graft-versus-host disease (cGVHD). Diagnosis of cGVHD was based on the NIH consensus criteria. In addition, a grading scale was applied, which has been developed by the German-Austrian-Swiss Consensus Conference on Clinical Practice in cGVHD. Sixty-six patients (male n = 46, female n = 20, mean age 48 years) with ocular cGVHD were included. Application of the proposed Consensus Conference grading revealed inflammatory activity in all patients with mild (33 %), moderate (44 %), or severe inflammation (23 %). Clinical scoring by the NIH scoring system showed that 6 % of patients had mild symptoms; 59 % of patients had moderate dry eye symptoms partially affecting activities of daily living, without vision impairment; and 35 % of patients had severe dry eye symptoms significantly affecting daily activities. Clinical characterization and grading by the Consensus Conference grading scale revealed that ocular cGVHD (1) frequently leads to severe ocular surface disease based on impaired function of the lacrimal glands and involvement of cornea, conjunctiva, and lids; (2) is mostly associated with ongoing inflammatory activity; (3) often leads to functional impairment and reduced quality of life; and (4) is associated with an increased risk for severe, sight-threatening complications.

Background: We report a 35-year-old female patient with cerebral manifestations of chronic graft-versus-host disease (cGvHD) and putative retinal involvement after allogeneic peripheral blood stem cell transplantation (alloHSCT). Patient and Methods: The patient experienced recurrent episodes of fever and encephalitic signs 7 months after alloHSCT during taper of immunosuppression (IS). Results: Cerebral magnetic resonance imaging (MRI) showed non-gadolinium-enhancing confluent periventricular lesions and cerebrospinal fluid inflammation. After exclusion of infectious causes, treatment with steroids and antiepileptics improved cognitive deficits. Steroid reduction provoked a relapse responding to IS. 2 years later, she complained of right-sided blurred vision and floaters; both eyes showed whitish circumscribed retinal infiltrations, cellular infiltration of the vitreous and mild bilateral optic disc edema. Oncological and neurological work-up ruled out infectious diseases and other GvHD manifestations. Symptoms and signs resolved under continued systemic IS, leaving pigmented retinal scars. After IS withdrawal, classical cutaneous cGvHD developed, resolving on systemic IS. 94 months after transplantation, she is doing well. Conclusion: To our knowledge, this is the first observation of retinal involvement of cerebral cGvHD manifestations with retinal infiltrations documented in the absence of other causes and in parallel to periventricular lesions in cerebral MRI. Based on bone marrow histology, we discuss a small vessel pathophysiology of cGvHD.

Purpose Human amniotic membrane has been widely used as substrate for ex vivo expansion and transplantation of limbal epithelial cells. To further clarify its suitability as a surrogate niche for limbal stem cells and progenitor cells, we analyzed the composition of the amniotic epithelial basement membrane, with special focus on the expression of limbus-specific matrix components. Methods Cryosections of corneoscleral specimens obtained from 10 human donor eyes and of 6 amniotic membrane specimens obtained at cesarean section were stained by indirect immunofluorescence using a broad panel of antibodies against basement membrane components. Results Both amniotic and limbal epithelial basement membranes showed positive immunoreactivity for collagen type IV α1, α2, α5, and α6 chains; collagens type VII, XV, XVI, XVII, and XVIII; laminin α3, β1, β2, β3, γ1, and γ2 chains; laminin-111 and laminin-332; nidogen-1 and nidogen-2; fibronectin; fibulin-2; fibrillin-2; perlecan; and agrin. Both types of basement membrane were negative for collagen type IV α3 and α4 chains, collagen type V, and laminin α4 chain. Limbal basement membrane components, which were not detected in amniotic membrane, included laminin α1, α2, α5, and γ3 chains; BM40/SPARC; tenascin-C; matrilin-2; endostatin; and collagen type XVIII. Conclusions Despite extensive similarities in basement membrane composition between amniotic and corneolimbal epithelia, the lack of limbus-specific environmental factors argues against the potential of denuded amniotic membrane as a surrogate niche for limbal stem cells but supports its suitability as a substrate to promote the formation of a well-differentiated stratified corneal epithelial equivalent for tissue engineering strategies.

Isolated orbital relapse of multiple myeloma in a patient with severe chronic GVHD after allogeneic hematopoietic SCT

Definiton of hematopoietic recovery Neutrophil recovery: absolute neutrophil count (ANC) of ≥0.5 × 109/L for three consecutive laboratory values obtained on different days with the first day defined as date of recovery Autologous: day +10 to +14 Allogeneic: day +10 to +day 14 (PB SCT); day + 16 to +day 22 (BMT) Platelet recovery: platelet count >20 × 109/L for three consecutive laboratory values obtained on different days and with no platelet transfusions in the previous seven days; the first day defined as date of recovery