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Purpose: Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. Methods: In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. Results: Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan–Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. Conclusion: The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical characteristics of fall-related ocular trauma in patients over 90 years of age. Methods: Retrospective, medical record reviews. Patients over the age of 90 years treated in a tertiary center with fall-related ocular trauma were included in the study. Results: Fifty consecutive patients (fifty eyes) were analyzed. The mean age was 93.6 ± 1.8 years and 41 patients (82%) were female. The most common site of the injuries was orbital fracture (18 patients, 36%), accompanied with open globe rupture (OGR) in three patients, and globe contusion in two patients. Seventeen patients (34%) presented with OGR. Ocular trauma score in those patients was category 1 in 10 patients (58.8%) and category 2 in the others. Conjunctival hemorrhage and/or periocular contusion was seen in 14 patients (28%) and globe contusion in six patients (12%). At the presentation, the mean best corrected visual acuity (BCVA) was 2.82 ± 0.24 logMAR in patients with OGR and 1.98 ± 0.81 logMAR in six patients with globe contusion. Three of the patients with OGR had a final vision of 20/200 or better whereas the remaining patients had hand movements or less. The most common risk factors were female gender (82%) and use of antihypertensive drugs (46%). Conclusion: Patients with OGR had a poor visual outcome despite the early treatment. It is important to raise public awareness about of the poor prognosis of ocular injuries due to falls in the elderly population in order to establish preventive measures. [ABSTRACT FROM AUTHOR]

Purpose: Optic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M). Methods: A retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively. Results: The mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0–12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4–1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0–1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559–1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110–344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1–144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period. Conclusion: Our study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether compulsory face masking in public life changes the incidence or pattern of post-injection endophthalmitis (PIE). Patients and methods: All injections of bevacizumab, ranibizumab, aflibercept, dexamethasone or triamcinolone between 01/01/2015 and 12/31/2021 at the University Eye Clinic of Tuebingen were included in this retrospective analysis. The injection procedure itself was unchanged since 2015 and included the use of a sterile drape covering the head up to the shoulders which prevents airflow toward the eye. Furthermore, all staff wore a face mask and gloves at all times. The two study periods were defined by the introduction of a compulsory face masking rule in public life (01/01/2015 until 04/27/2020 vs. 04/28/2020 until 12/31/2021). Results: A total of 83,543 injections were performed in the tertiary eye clinic, associated with a total of 20 PIE (0.024%, 1/4177 injections). Of these, thirteen PIE were documented during the pre-pandemic period (0.021%, 1/4773 injections) and seven PIE during the pandemic period (0.033%, 1/3071 injections). No significant difference in PIE risk was observed (p = 0.49), and there was no case of oral flora associated PIE. Conclusion: Although some potential confounders (wearing time, skin flora) could not be considered, there was no clear signal that the introduction of compulsory face masking in public life did alter the risk for PIE in our patient population. Three and six months after PIE, no difference in visual acuity was detectable between the two study periods. [ABSTRACT FROM AUTHOR]

Purpose: To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)). Methods: Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density. Results: Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002;.63 to.23 logMAR; group 2, p <.001; 1.15 to.87 logMAR) with a group difference in favor of group 1 (p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p <.001; group 2, p =.045) and paired t-tests (group 1, p <.001; group 2, p =.003). Complications were less common, and graft longevity was superior in group 1. Conclusion: Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required. [ABSTRACT FROM AUTHOR]

Purpose: Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study's aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed. Methods: A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups. Results: This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3–1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2–1.8). The post-treatment decrease in group 1 was a median equal to − 0.6 versus − 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups. Conclusion: For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to construct a new retinal tack design with high retention forces to prevent spontaneous disentanglement in cases of complicated retinal surgery. Methods: Six new forms for the peak of a retinal tack were developed using computer-aided design (CAD); then a prototype was produced for each model. Finally, standardised design testing was conducted using human (ex vivo) sclera by logging 15 consecutive measurements for each model. Results: Seven different models underwent pull-out testing (six new models and the original tack model), but two tack models (Model 4, Model 5) failed to penetrate the human tissue. The highest pull-out forces (median) were measured for Model 3, followed by Model 6, Model 2 and Model 1. The original Heimann tack (Model H) was found to have the lowest retention forces. Conclusion: The different tack designs altered the penetration and holding forces. The retention forces of the proposed peak design led to a significant increase in the retention forces that were more than twice as high as those in the original Heimann Model. [ABSTRACT FROM AUTHOR]

Purpose: Retidyne™ is a new lutein-based dye for internal limiting membrane staining. It uses the intrinsic staining characteristics of lutein which is already known to act as an antioxidant and blue-light filter in the human retina. We investigated retinal tolerance to different staining times measured by the electroretinogram (ERG) of an isolated and perfused retina whole mount. Methods: For functionality, testing bovine retinas were prepared and perfused with an oxygen saturated standard solution and the ERG was recorded until stable b-wave amplitudes were reached. Then the perfusion was stopped and Retidyne™ was applied directly onto the retinal surface for exposure times of 60 or 120 s. After restarting the perfusion with standard solution, the ERG amplitudes were monitored for 75 min. To investigate the effects on photoreceptor function alone, 1 mM asparate was added to block b-waves. Results: For an exposure time of 60 s amplitudes of a- and b-waves remained stable throughout the experiment. Exposure times of 120 s caused an initial drop of amplitudes that reached statistical significance only for a-waves (a, − 21%, p = 0.047; b, − 14%, p = 0.052). This effect was only seen during the first minutes of the washout and the ERG recovered completely. Conclusions: In the model of isolated and perfused bovine retina, Retidyne™ showed a good safety profile for common intraoperatively used staining times. An initial toxic effect regarding the transient drop of amplitudes cannot be ruled out but the effect might also be explained by the partial blockage of the flashlight due to a more intense staining effect at the beginning of the washout. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to present a feasibility study to evaluate and compare a self-constructed, digital-based tangent scale using the Harms tangent screen test for the examination of patients’ strabismus angles.Methods: The documented strabismus angles of 10 patients were measured at nine gaze-positions and compared using the Harms tangent screen test (Harms Screen) and a self-constructed digital screen test (Digital Screen). The primary outcome is the difference in the measured angles between both methods. Secondary outcomes include the duration of the examinations and the diagnostic conclusion based on the results of the measurements.Results: The datasets from 10 of 13 patients were used for comparisons (median age 52 years; females 5; males 5). All measurements showed a mean of 1.77° (SD 2.95°) in horizontal deviations and 1.11° (SD 2.23°) in vertical deviations. The two methods showed differences (> 5°) in 12 cases (13.3%) for horizontal angle measurements and in four cases (4.4%) for vertical angle measurements. The median examination time was 238 s (range 60-430 s) for the Harms Screen and 150 s (range 120-600 s) for the Digital Screen tests. The diagnostic conclusions were identical for both methods.Conclusions: The feasibility of the experimental digital setup in principle is shown. Despite some deviations in the measured strabismus angles, the resulting diagnosis of the paresis was identical. The new method showed a reduction of examination time. [ABSTRACT FROM AUTHOR]

Background: Melphalan, as a treatment for retinoblastoma, has been applied intra-arterially by catheterisation of the ophthalmic artery or intravitreally, aiming to reduce systemic side effects of intravenous drug therapy. This study evaluates retinal toxicity of different melphalan concentrations measured by electroretinogram (ERG) in an isolated and perfused retinal whole mount culture. Methods: For functional testing, bovine retinas were prepared and perfused with an oxygen-saturated standard solution and the ERG was recorded until stable b-wave or a-wave amplitudes were reached. Thereafter, retinae were exposed to 80, 160 and 320 μg/ml of melphalan for 30 min. After exposure, a washout was performed thrice for 5 min each and the ERG amplitude recovery was monitored for 60 min. To investigate the effects on photoreceptor function, 1-mM asparate was added to suppress the b-wave and obtain isolated a-waves. Results: While no toxic effects for a concentration of 80 μg/ml were observed, both b- and a-waves were significantly reduced after application of 160 (b-wave 43.8 %, p = 0.03; a-wave 28.2 %, p = 0.04) and 320 μg/ml (b-wave 20.0 %, p = 0.04; a-wave 35.8 %, p = 0.02). For 320 μg/ml, this reduction remained significant at the end of the washout (b-wave 40.0 % p = 0.02; a-wave 26.4 %, p = 0.02). Conclusions: Epiretinal or intraretinal concentrations of 80-μg/ml melphalan do not cause toxic effects in this in vitro model. Concentrations higher than 160 μg/ml should be avoided. [ABSTRACT FROM AUTHOR]

Purpose: Tempol (4-hydroxy-2,2,6,6-tetramethylpiperidinyl-1-oxyl) is a membrane-permeable superoxide dismutase and potentially neuroprotective substance. This study evaluates the retinal tolerance of 0.5 mM, 1 mM, 2 mM, and 5 mM tempol measured by the electroretinogram (ERG) of an isolated and perfused retina whole mount. Methods: For functionality testing, bovine retinas were prepared and perfused with an oxygen-saturated standard solution, and the ERG was recorded until stable b-wave amplitudes were reached. Tempol concentrations of 0.5 mM, 1 mM, 2 mM, and 5 mM were tested for 45 minutes. To investigate the effects on photoreceptor function, 1 mM aspartate was added to suppress the b-wave and obtain isolated a-waves. ERG amplitudes were monitored for 100 minutes. Results: While no toxic effects for concentrations of 0.5 mM and 1 mM tempol could be detected, concentrations of 2 mM tempol and higher caused statistically significant negative effects on the b-wave amplitude (−38 %, p = 0.02 for 2 mM; −54 %, p = 0.02 for 5 mM). The a-wave amplitude remained stable even at higher concentrations. Conclusions: Although the photoreceptors seem to have a tolerance to high concentrations of tempol, higher intravitreal concentrations than 1 mM should be considered critical. [ABSTRACT FROM AUTHOR]

Background: Congenital anterior staphyloma is a rare, complex malformation syndrome of the anterior segment. Only a few reports on associated systemic malformations have been published. We herein present a rare manifestation of congenital anterior staphyloma (CAS) combined with amniotic band disruption syndrome (ABS). Patient and methods: Shortly after birth, a massive enlargement of the left eye was observed in a female child. Furthermore, an extensive bilateral congenital cleft lip and cleft alveolar ridge with oblique facial cleft extending into the left medial canthal region, coloboma(s) of the left eyelids, extensive adhesions between lids and eye bulb, as well as circumferential grooves, clubfeet, and terminal transverse defects in both hands and feet were present. Due to severe progression of eye bulb protrusion with thinning of the sclera, enucleation of the left eye was performed at the age of 3 years in order to prevent complications including perforation of the globe and with the aim of improving cosmetic aspects. Results: Histopathological examination of the enucleated eye disclosed findings typical of congenital anterior staphyloma, including massive corneal staphylomatic deformation with superficial vascularization and elapsed corneoscleral margin, destruction of Bowman's layer, absence of Descemet's layer, corneal endothelium, and angle structures. The lens was only partially formed, and had mainly dissolved. The neural retina appeared normal. The optic nerve disc revealed a pronounced excavation. Facial clefts, lid colobomas, congenital constriction bands, and amputation of distal limbs match ABS. This malformation complex develops in early pregnancy, probably prior to 35 days post conception. Conclusion: This is the first report on an association of these two rare complex congenital malformations, congenital anterior staphyloma and amniotic band syndrome. The anterior staphyloma was unilateral, and related to facial clefts and lid coloboma in the area adjacent to the anterior staphyloma. Furthermore, the systemic deformities are clearly due to the amniotic bands, and the timing of the development of both complex malformations seems to be similar. All findings suggest that the presence of amniotic bands is a causative factor for all observed abnormalities including anterior staphyloma. [ABSTRACT FROM AUTHOR]

Background: Dyes such as brilliant blue (BBG) are used during vitreoretinal surgery to visualize anatomical structures. By adding deuterium oxide (D2O), surgeons have tried to create a dye mixture heavier than water to facilitate staining of the inner limiting membrane (ILM) without prior fluid-air exchange. This study investigated the effect of 0.4 ml BBG (Fluoron, Ulm, Germany) mixed with 0.13 ml/ml D2O and D2O on retinal function of a pseudo in vivo model using bovine and human whole mount cultures. Methods: Bovine and human retinas were superfused, and the electroretinogram (ERG) was recorded. BBG with 0.13 ml/ml D2O and D2O were applied epiretinally, different staining periods (10, 30, 60 and 120 s) were tested, and ERG recovery was monitored. 1 mM aspartate was added to the nutrient solution to examine the photoreceptor reaction. Results: Reductions of the a- and b-wave amplitudes were found directly after exposure with BBG with 0.13 ml/ml D2O and with D2O in all test series. These effects on the electroretinogram were rapidly and completely reversible within the recovery time for all exposure times. ERG amplitudes measured after dye application at the end of the washout did not differ significantly from those recorded before staining. Conclusions: The clinically used mixture of BBG/D2O seems to be safe for clinical use. Staining periods of more than 120 seconds were not tested. [ABSTRACT FROM AUTHOR]

Background: During vitreoretinal surgery, vital dyes are used to visualize anatomical structures. Substances with a density higher than water are added to facilitate sedimentation and staining. BBG with 4% PEG (ILM Blue) and BBG with TB and 4% PEG (MBB Dual) are two new dyes. This study evaluates biocompatibility of the new dye solutions, using cell cultures and electrophysiological evaluation. Methods: To determine cytotoxicity of ILM Blue and MBB Dual for 30, 60, 120 and 320 seconds, monolayer cultures of retinal ganglion cells (RGC5) were used. For functionality testing, bovine retinas were isolated and superfused with an oxygen-saturated nutrient solution, and the electroretinogram (ERG) was recorded. The two dye solutions were applied epiretinally for 30, 60 and 120 seconds. ERG recovery was monitored. Results: After staining with ILM Blue, no statistical significant reduction of a- or b-wave amplitudes at the end of the wash-out was recorded. For MBB Dual, only a significant reduction of the a-wave amplitudes after 30 seconds of application at the end of the wash-out was noticed, while no statistically different changes for a- and b-wave amplitudes up to 120 seconds were noted. During the MTT assay, we noted no significant difference in cell viability after 30, 60, 120 and 320 seconds of staining with ILM blue, MBB Dual or 4% PEG in comparison to the control group (DMEM, Triton X-100 0.9% as positive control) after formazan extraction. Conclusions: ILM Blue and MBB Dual seem to be safe for clinical use for a staining period of up to 120 seconds, probably even up to 320 seconds. [ABSTRACT FROM AUTHOR]

Background: During vitreoretinal surgery, vital dyes such as brilliant blue G (BBG) are used to visualize anatomical structures. By adding glucose to a concentration of 5%, many surgeons try to achieve a dye mixture heavier than water to facilitate staining of the ILM without preceding fluid-air exchange. However, the intraocular use of high glucose concentrations is critical. This study investigated the effect of 0.4 ml BBG (Brilliant Peel™ 0.25 mg/ml, Fluoron, Ulm, Germany) mixed with various glucose concentrations on the retina in an pseudo in vivo model Methods: Bovine retinas were isolated and superfused with an oxygen saturated nutrient solution, and the electroretinogram (ERG) was recorded. BBG mixed with 0.05 ml/0.1 ml/0.15 ml glucose 40% was applied epiretinally. ERG recovery was monitored for 75 minutes. 1 mM aspartate was added to the nutrient solution to obtain a-waves. Results: After application of BBG/0.05 ml 40% glucose, a non-significant decrease of the b-wave amplitude was recorded (11.2%). In contrast, higher glucose concentrations showed a significant decrease of the b-wave (23.40% at 0.1 ml glucose, 26% at 0.15 ml glucose). The a-wave amplitudes showed no significant change at the end of the washout for all concentrations. Conclusions: The clinically used mixture of BBG and glucose seems to be safe up to a concentration of 5%. However, higher concentrations of glucose starting from 10% showed strong evidence of a toxic effect on the retinal function and should be avoided. [ABSTRACT FROM AUTHOR]

Acute macular neuroretinopathy (AMNR) is a rare disease entity, the diagnosis of which is frequently complicated by the subtlety of biomicroscopic findings. Two cases of AMNR are presented, in which the diagnosis and follow-up was enabled using the Spectralis® HRA+OCT in the absence of clear biomicroscopic findings. The typical lesions were visualized by hyporeflexion during infrared imaging and faded over time. With spectral domain optical coherence tomography, changes in the outer retina in the affected regions were documented, with no change over time. The broader availability of this technology may enhance the diagnosis and follow-up of AMNR. [ABSTRACT FROM AUTHOR]

To report a case of nonarteritic anterior ischemic optic neuropathy (NA-AION) following intravitreal injection of bevacizumab (Avastin®). Interventional case report with an 18-month follow-up. A 51-year-old male with pseudoxanthoma elasticum presented with NA-AION 2 weeks after treatment with intravitreal of bevazicumab (Avastin®) for choroidal neovascularisation secondary to angioid streaks. Except from a small optic disc without cupping he did not show further risk factors. Risk of NA-AION should be taken into consideration when deciding for intravitreal application of drugs including anti-vascular endothelial growth factors (VEGF) agents like bevacizumab (Avastin®) in the treatment of retinal vascular diseases. [ABSTRACT FROM AUTHOR]

To characterise ocular pigment abnormalities associated with iris atrophy in DBA/2J mice as a model for human pigment dispersion syndrome. Immunohistochemistry, electron and light microscopy were performed to examine the eyes of DBA/2J mice ranging in age from 2.5 to 18 months old. The focus of our study was the description of the ultrastructural modifications in the irides of DBA/2J mice. The DBA/2J mice presented modifications in the melanosomes in all the pigmented parts of the eye, including the retinal pigment epithelial cells and choroidal melanocytes of the ciliary pigment epithelium. The extracellular matrix of the iris stroma disappeared with ageing. Pigmented cells detached from the iris and migrated into the trabecular meshwork exclusively on the anterior iris surface. These cells were identified as macrophages by immunohistochemistry and electron microscopy. There was no evidence that melanocytes or iris pigment epithelial cells migrated into the trabecular meshwork, but they became more and more depigmented. The aqueous outflow was blocked by pigment-laden cells, but not by cellular debris or melanosomes. No substantial amount of extracellular melanosomes was observed. The morphology of melanosomes is aberrant in all pigment cells in the eyes of DBA/2J mice. We conclude that the disease process begins with the transfer of both immature melanosomes from the iris pigment epithelium (IPE) and melanocytes to macrophages, which subsequently migrate into the trabecular meshwork. Accumulating macrophages cause a blockade of the chamber angle. As the disease progresses, the IPE, melanocytes and iris stroma, including blood vessels, disappear, leading to iris atrophy. It is speculated that the loss of these pigment cells is partly caused by reduction of the iris stroma. [ABSTRACT FROM AUTHOR]

Background: In patients with more complex rhegmatogenous retinal detachments (RRD) not complicated by proliferative vitreoretinopathy (PVR), the most appropriate operating method is controversial, and different surgeons use different techniques. The Scleral Buckling Versus Primary Vitrectomy in Rhegmatogenous Retinal Detachments Study (SPR Study) is designed to compare primary vitrectomy and scleral buckling techniques in these patients. Methods: The SPR Study is a multicentre, randomised, controlled clinical trial stratified by lens status. Patients with RRD which is not complicated by PVR grade B or C and which cannot be treated with a single meridional sponge are randomised to either scleral buckling or pars plana vitrectomy as first surgical intervention. Four hundred consecutive patients are to be recruited per subtrial (phakic and aphakic/pseudophakic patients), and followed up for 1 year. The primary endpoint (functional outcome) is the change in visual acuity. Secondary endpoints (anatomical outcome) include postoperative PVR, retinal reattachment and the number of reoperations necessary to achieve retinal reattachment. Twenty-seven institutions (49 surgeons) in six European countries have been recruited for participation in the study. Conclusion: The SPR Study is the first randomised prospective clinical trial to compare scleral buckling and primary vitrectomy in patients with RRD. The results of this study should enable vitreoretinal surgeons to improve the surgical therapy of patients with the more complicated manifestations of RRD. [ABSTRACT FROM AUTHOR]

· Background: To investigate in iris pigment epithelium (IPE) the expression of mRNA for proteins involved in retinol metabolism we used a semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) technique. · Methods: RNA was prepared from freshly isolated bovine IPE and retinal pigment epithelium (RPE) cells and reverse transcribed. The expression of mRNA for cellular retinaldehyde binding protein (CRALBP), p63 (RPE63), the presumed retinal pigment epithelial membrane receptor for retinoids, and 11- cis-dehydrogenase (11cisRDH ) was determined by RT-PCR using specific primers. Semi-quantitative expression data were obtained by using a series of fivefold dilution of each cDNA with a fixed number of PCR cycles. · Results: Bovine IPE and RPE cells express mRNA for CRALBP, 11cisRDH, and RPE63. The mRNA expression for CRALBP and 11cisRDH is high and equal in both cell types. However, RPE63 mRNA expression in IPE cells is relatively low compared with the expression in RPE cells. · Conclusions: The presence of mRNA for CRALBP, RPE63, and 11cisRDH suggests that IPE cells may be able to metabolize retinol. [ABSTRACT FROM AUTHOR]

· Background. The assessment of the cup of the optic disc in follow-up of glaucomatous optic nerve heads depends on the variability of the cup area over time. We examined the variability of topographic measurements depending on scan focus settings and evaluated the long-term fluctuations of the normalised rim/disc area ratio quotient of normal subjects for 1 year. · Methods. Part 1. Evaluation of the influence of scan focus and corneal curvature on the number of pixels per millimetre in one emmetropic volunteer. The scan focus was varied using contact lenses of different refraction. Part 2. HRT examinations of the optic nerve head of five eyes of five volunteers were repeatedly recorded during a 12-month period. The contour line from the first mean topographic image was transferred into the following seven mean topographic images of each subject. · Results. Part 1. The size of pixels depends on the adjusted scan focus for mean corneal curvature radius between 6 and 9 mm. However, after image to image scaling the size of pixels is nearly independent to the scan focus. Part 2. We found the highest variation of normalised rim/disc area ratio for the location of the temporal horizontal sectors, followed by the temporal inferior and the temporal superior sectors. Variation was smallest in the nasal sectors. Mean fluctuation of the normalised rim/disc area ratio quotient of the 95th percentile was 0.09 following image to image scaling compared to 0.16 when using individual image scaling. · Conclusion. Scan focus variation during HRT follow-up examinations can influence optic disc parameters, especially when image to image scaling has not been performed. A confidence area of an individual optic disc could now be calculated. These confidence bands could help to distinguish more easily between progress of glaucomatous optic nerve head damage and physiological intertopographic variation of optic cup measurements. A decrease of more than 43% in the fluctuations of the normalised rim/disc area ratio could be achieved using image to image scaling techniques. For that reason follow-up of glaucomatous optic nerve heads should only be performed using this software application. [ABSTRACT FROM AUTHOR]

· Background: The aim of this prospective study was to ascertain whether external beam irradiation is effective in patients with subretinal neovascularization (SRN) due to age-related macular degeneration (AMD). · Methods: All patients had subfoveal SRN due to AMD as verified by fluoresceinangiography. Two hundred and eighty-seven patient-eyes were treated by external beam irradiation (total dose of 16 Gy in 2-Gy fractions, 5 times a week) from January 1996. The analysis was restricted to those 73 patients with a minimum follow-up of 11 months. Eighteen patients with subfoveal SRN who refused treatment served as control group (CG). 18 patients of the treatment group (TG) were matched for visual acuity, refraction and extent of SRN. The statistical analysis was performed with the unpaired t-test. · Results: The mean age of the CG was 73.9 years (range 66.9–81.3 years) and of the TG 75.6 years (range: 65.7–80.6 years). The median follow-up was 13.5 months (range 11.9–18.4 months) in the CG and 12.9 months (range 11–13.9 months) in the TG. The initial visual acuity (VA) was 20/80 in both groups. After 7 months the follow-up revealed median VA of 20/400 in the CG and 20/160 in the TG ( P=0.0335). The final median VA was 20/400 in both groups, with a range from 20/40 to 20/1000 in the CG and from 20/63 to 20/500 in the TG ( P=0.2433). The SRN doubled in size during this time in both groups. · Conclusion: These results suggest that external beam irradiation applied in 2-Gy fractions 5 times a week slows down the visual loss in exudative AMD for a short time. Nevertheless, the patients’ reading vision could not be saved in the long term. [ABSTRACT FROM AUTHOR]

· Background: We set out to evaluate the growth potential of human iris pigment epithelial (hIPE) cells in vitro, to establish whether these cells acquire the ability to phagocytose rod outer sgments (ROS) and to compare the phagocytic activity of hIPE to that of human retinal pigment epithelial (hRPE) cells. · Methods: hIPE and hRPE cells were isolated and cultured from human donor eyes and surgical specimens and growth characteristics were analyzed. HIPE and hRPE of an eye of a 46-year-old donor were used for the phagocytosis assay. Phagocytosis was evaluated by adding ROS isolated from porcine retina to cultures of hIPE and hRPE, which had been labeled with the pH-sensitive fluorescent dye, carboxy-SNAFL. After 4 h the number of ingested ROS was counted with a light microscope. For each cell type phagosomes in 500 cells were counted. The epithelial characteristics of the cells used in this study were evidenced by their morphology. · Results: Morphologically cultured hIPE are indistinguishable from the hRPE cultured from the same donor eye and show a similar pattern of cytokeratin distribution. Cultured hIPE acquire the ability to phagocytose ROS at a level slightly lower than hRPE; hIPE contained 0.76 phagosomes per cell, hRPE 0.99 phagosomes per cell. · Conclusion: The morphology of hIPE in culture and the acquisition of the phagocytic phenotype indicate that these cells have the ability to differentiate into cells that have characteristics in common with hRPE. The acquisition of phagocytic activity suggests that it is feasible to culture hIPE from surgical iridectomies and that these cultured cells can be transplanted into the subretinal space in individuals with retinal degenerations. [ABSTRACT FROM AUTHOR]