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Purpose: To evaluate the standard of care, in particular the use of topical or subconjunctival interferon- α 2b, in treating ocular surface squamous neoplasia or melanocytic tumours in tertiary eye centres in Germany., Methods: A survey containing 14 questions was sent to 43 tertiary eye centres in Germany. The questions addressed the surgical and medical management of ocular surface squamous neoplasia and melanocytic tumours (primary acquired melanosis and malignant melanoma), as well as the clinical experiences and difficulties in prescribing off-label interferon- α 2b eye drops and subconjunctival injections., Results: Twenty-four tertiary eye centres responded to the survey. Eighty-three percent of centres had used interferon- α 2b in their clinical practice and 25% prescribed it as the first-line cytostatic agent following surgical excision of ocular surface squamous neoplasia, while 10% would do so for melanocytic tumours. Correspondingly, the majority of respondents selected mitomycin C as their first-line agent. Side effects were uncommon with topical interferon- α 2b eye drops but were more frequently reported after subconjunctival interferon- α 2b injections. In total, eight centres had experience with interferon- α 2b injections. The most significant obstacles perceived by ophthalmologists when prescribing interferon- α 2b were its high cost and the reimbursement thereof., Conclusion: Off-label mitomycin C was the preferred adjuvant therapy for epithelial and melanocytic tumours, with interferon- α 2b being the standard second-line option. Interferon- α 2b has predominantly been used to treat ocular surface squamous neoplasia and, to a lesser extent, melanocytic tumours at German tertiary eye centres. Following its market withdrawal, supply shortages of interferon- α 2b are likely to have a profound impact on patient care and their quality of life., Competing Interests: The authors declare that they have no conflict of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Thieme. All rights reserved.)

Background: The aim of the present study was to evaluate the ophthalmologic care in childhood and adolescence of infants born preterm and full-term from the retrospective point of view of their parents., Methodology: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of persons born preterm and full-term between 1969 and 2002 (now aged 18 to 52 years), and asks their parents about the ophthalmologic care received by their children in childhood and adolescence from their retrospective perspective. Participants and their parents were grouped into those with normal gestational age (GA) ≥ 37 (control group), preterm born infants without retinopathy of prematurity (ROP) and gestational age (GA) 33 - 36 (group 2), GA 29 - 32 (group 3), GA ≤ 28 weeks (group 4), and those with ROP without treatment (group 5) and with ROP with treatment (group 6). Parents of participants were interviewed about the ophthalmic care received by their children., Results: In total, data from 57 full-term and 131 preterm infants and their parents were included in the present study. The parents of the participants reported that ophthalmologic examination had taken place until 6 years of age in the respective groups 1 to 6 in 22/57 (38.6%), 33/58 (56.9%), 22/38 (57.9%), 3/6 (50%), 19/21 (90.5%), and 7/8 (87.5%). Overall, between 83% and 100% of parents in the different groups reported that ophthalmologic care had been adequate. A change of ophthalmologist due to dissatisfaction with treatment was reported by a total of 4/57 (7%), 9/58 (15.5%), 8/38 (21.1%), 1/6 (16.7%), 1/21 (4.8%) and 2/8 (25%) in the respective groups., Discussion: The present study demonstrates adequate satisfaction and good treatment regarding ophthalmologic care of former preterm children from the parents' perspective. Especially parents of children with ROP rated the treatment positively., Competing Interests: Norbert Pfeiffer erhält finanzielle Unterstützung und Zuschüsse von Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon und Sanoculis. Alexander K. Schuster erhält Forschungsunterstützung von Allergan, Bayer, Heidelberg Engineering, PlusOptix und Norvartis. Die Autoren erklären, dass sie keinen Interessenkonflikt haben./Norbert Pfeiffer receives financial support and grants from Novartis, Ivantis, Santen, Thea, Boehringer Ingelheim Deutschland GmbH & Co. KG, Alcon, and Sanoculis. Alexander K. Schuster receives research support from Allergan, Bayer, Heidelberg Engineering, PlusOptix, and Norvartis. The authors hereby declare that they have no conflicts of interest., (Thieme. All rights reserved.)

Glaucoma is a group of chronic eye diseases that lead to degeneration of retinal ganglion cells (RGCs) and their axons followed by irreversible loss of vision in the patient. Glaucoma is a disease that initially evolves asymptomatically with the first symptoms appearing only at an advanced stage of this eye disease. For this reason, it is always necessary to develop state-of-the-art technologies and methods for the identification and characterization of new, specific biomarkers for the early diagnosis of glaucoma. Therefore, the analysis of biological fluids, as in this case the tear fluid of patients, represents an attractive source to identify new specific as well as sensitive biomarkers in glaucoma. These biomarkers could be involved in the pathophysiological processes of glaucoma or possibly serve for diagnostic differentiation of various types of glaucoma., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht./The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: 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., Objective: The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany., Methods: 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., Results: 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., Discussion: 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., Competing Interests: The authors declare that they have no conflict of interest./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Endothelial dysfunction has become a strongly discussed factor regarding glaucoma pathogenesis. In addition to peripapillary bleedings as signs of vascular damage, there is a definite correlation between glaucoma and vascular dysregulation syndrome. The aim of this study was to evaluate endothelial cell reaction to moderately elevated hydrostatic pressure and oxidative stress in vitro., Methods: In vitro, primarily dissociated brain microvascular endothelial cells (BMECs) were exposed to moderately elevated hydrostatic pressure (60 and 120 mmHg) in a special pressure chamber. Additionally, cells primarily exposed to pressure, and cells not exposed to pressure, were incubated with low amounts of H 2 O 2 . A live/dead assay was performed to evaluate cell viability. Immunohistochemical staining against actin was used for morphological evaluation., Results: Neither 60 nor 120 mmHg of elevated pressure had a viability changing effect on primary endothelial cells. Secondary, no big morphological changes could be discovered. However, against a low concentration of oxidative stress, BMECs showed high vulnerability. A difference in reaction to cells stressed with high pressure before could not be shown., Conclusion: Direct effects, in terms of higher vulnerability or morphological changes of moderately elevated high pressure on endothelial cells, could not be shown. However, the reaction to low amounts of oxidative stress indicates the involvement of endothelial cells in the pathogenesis of glaucoma and the special role of oxidative stress when referring to endothelial dysfunction in glaucomatous disease., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Glaucoma is characterised by progressive loss of retinal ganglion cells and axons. Experimental research has concentrated on understanding the pathophysiological mechanisms involved in glaucomatous damage. It is still a matter of debate whether neurons or capillaries are primarily damaged by elevated intraocular pressure (IOP). The aim of this study was to detect IOP-induced vascular changes in the vessels of the optic nerve head and the main vessels of the retina in vivo., Methods: Experimental glaucoma was induced in adult Sprague Dawley rats by cauterisation of three episcleral veins of the left eye (n = 3). In vivo, retinal vessel calibre was measured manually using a peripapillary scan with SD-OCT (Heidelberg Engineering) at baseline and after seven weeks of IOP elevation. The animals were then sacrificed and the optic nerve was fixed with 30% glutaraldehyde and cross-sections stained with paraphenylene diamine to mark the vessels. Contralateral eyes served as controls. Pictures were taken and number of vessels, vessel calibre and area were calculated and compared., Results: IOP was significantly elevated (p < 0.001). In optic nerve cross sections, the number of capillaries did not differ significantly between animals with elevated IOP and controls. However, vessel calibre and area were significantly reduced (p < 0.001) in glaucomatous optic nerves. The calibre of the retinal vessels was significantly lowered - by 9.22% (p = 0.021)., Conclusion: Retinal arterioles and optic nerve capillaries respond sensitively to abnormal pressure elevation in vivo, showing high and early vulnerability. The vascular responses may influence secondary neuronal responses, which culminate in the death of ganglion cells and blindness, as occurs in clinical glaucoma., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Patients with monoclonal gammopathy can show paraproteinemic keratopathy (PPK) with an indication to treatment. PPK has to be differentiated from corneal dystrophies, systemic metabolic disorders with corneal involvement, as well as from immunologic and inflammatory corneal diseases., Competing Interests: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Glaucoma is a heterogeneous group of diseases which all share retinal ganglion cell loss leading to a typical optic disc cupping and characteristic visual field defects. Glaucoma is the leading cause of irreversible blindness affecting 8.4 million people. In 2013, 65 million people suffered from glaucoma worldwide and the number will increase to about 112 million in 2040. This review provides an overview about the classification and genetic basics in glaucoma., Competing Interests: Interessenkonflikt: R. Höhn: kein Interessenkonflikt. N. Pfeiffer: Santen, Thea, Novartis, Isarna, Medscape, Ivantis, Alcon, Bayer, Kowa, Novaliq, Aeri, MedEdicus, Sanoculis., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Individual health services (ihs) have gained importance in the German health-care system. This article describes the economic impact and the daily practice of individual health services from the perspective of ophthalmologists., Methods: An online survey to examine the role of individual health services in ophthalmology was sent to the members of the German Ophthalmological Society (DOG) and the Professional Association of Ophthalmologists in Germany (BVA). 1,361 ophthalmologists (one fifth of all ophthalmologists in Germany) responded to the poll., Results: 87.5 % of the ophthalmologists agree that the quality of ophthalmic care could suffer if the necessary individual health services were not performed. 78.9 % consider individual health services to be financially feasible for the patient. 65.6 % responded to be hardly able to survive economically without individual health services. For approximately half of the ophthalmologists, individual health services represent more than 10 % of their overall income. 57.5 % wish to abolish individual health services and to extend the service catalogue of the statutory health insurances., Discussion: In contrast to official reports about the benefit from individual health services, the ophthalmologists do see a medical need for individual health services. Obviously there is a discrepancy in the perspective between health insurers and ophthalmologists., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Morbus Morbihan is a rare complication of rosacea, consisting of a persistent lymphoedema of the upper part of the face. It has typically a chronic course, unspecific histopathological findings and an extreme refractoriness to therapy., Patients and Methods: Between February 2008 and January 2010, 5 patients with Morbus Morbihan were observed at the Department of Ophthalmology of the University Medical Centre Mainz. In the present cohort study, we describe the clinical, laboratory and histological findings that led to the diagnosis. The course of the affection and the results of different therapeutic options are also reported., Results: Each patient underwent a complete ophthalmological examination, as well as general and dermatological consultations. All patients showed facial skin alterations typical for rosacea. 4 out of 5 subjects underwent a lid biopsy to confirm the diagnosis of Morbus Morbihan, one patient refused it. Initial treatment consisted of various systemic and local medical therapies, however, with poor success. One patient had intravenous therapy with corticosteroids elsewhere with no effect. We treated 3 cases with intralesional triamcinolone injections with good results. 2 patients underwent upper lid blepharoplasty. Results of surgery remained stable also due to manual lymph drainage and intralesional injections of triamcinolon. No complications or side effects were seen in patients treated with triamcinolone., Conclusions: Morbus Morbihan can be diagnosed only after excluding other conditions leading to chronic lid swelling. In our series, good results were achieved with intralesional injection of triamcinolone. Surgery also led to relevant improvements for a long period (13 months), with some adjuvant therapy. The treatment of chronic eyelid oedema associated with rosacea remains a challenge for the ophthalmologist and the oculoplastic surgeon., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: We have made a comparison of clinical evaluation, Heidelberg-Retina-Tomograph (HRT) and Nerve Fiber Analyzer (GDx) in diagnosing glaucoma., Materials and Methods: One eye of 38 glaucoma patients and 26 non-glaucoma patients was examined with HRT and GDx. Assignment of the patients into the two groups by clinical evaluation was performed on the basis of visual field and optic disc results. As classification criterion for glaucoma/non-glaucoma by means of the instruments we employed the statistical classification of the HRT and "the number" of the GDx. Statistical analysis was performed with Cohen's kappa and McNemar tests. Additionally, ROC curves for evaluation of the sensitivity and specificity of the glaucoma classification are demonstrated for HRT and GDx., Results: Agreement between clinical evaluation and HRT was moderate (Cohen's kappa = 0.43), there was no significant over- or underdiagnosis by HRT (p = 0.48). Agreement between clinical evaluation and GDx (diagnosis of glaucoma when "the number" > 50) was bad (Cohen's kappa = 0.27) with a significant overdiagnosis by GDx compared to clinical evaluation (p < 0.05). Agreement between clinical evaluation and GDx (diagnosis of glaucoma when "the number" > 40) was better (Cohen's kappa = 0.54), there was no significant over- or underdiagnosis by GDx (p = 0.79). ROC curves for glaucoma classification showed no difference between HRT and GDx (area under the curve: HRT = 0.8, GDx = 0.78)., Conclusions: Because of the only moderate agreement between clinical evaluation on the one hand and HRT and GDx classification on the other hand for the discrimination between glaucoma and non-glaucoma, the clinician should not completely rely on the instrument-derived glaucoma classification.

Background: Significance of retrobulbar irradiation in patients suffering form Graves' ophthalmopathy, though established since almost one century, is subject of scientific debate. The present study investigated the effect of retrobulbar irradiation using a standardized protocol focussing on long term results., Patients and Methods: Between 1981 and 1997, 104 patients treated by retrobulbar irradiation (10 to 20 Gray) due to Graves' disease. Twenty-nine of these underwent irradiation as sole treatment (mean follow-up 57 months), while in the remaining 75, it was combined with a systemic steroid treatment (mean follow-up 40 months). Patients were evaluated regarding proptosis, intraocular pressure, lid signs, motility as well as subjective assessment of double vision and retrobulbar pain., Results: While proptosis remained unchanged, lid signs, chemosis and intraocular pressure showed slight and statistically significant improvement. However, these findings were considered to be clinically insignificant. Retrobulbar pain was improved in 75 % of patients. 25 % of patients showed improved motility, 75 % remained stable, and in none of them was there a deterioration of ductions. Results proved stable even in long-term follow-up. 25 % per cent of patients underwent a surgical procedure one year after radiotherapy., Conclusions: In our series, we could not demonstrate an additional benefit of systemic steroids when combined with retrobulbar irradiation. Up to sixteen years after treatment, no treatment-related adverse reaction was seen. We found a remarkable improvement in ocular motility. This holds even more true in comparison to the natural course of the condition. Retrobulbar irradiation seems to shorten the duration of the disease, thus allowing earlier performance of eventual rehabilitative surgery.

Aim: Object of this study was to compare the near visual acuity between eyes with monofocal intraocular lens (MONO) and myopic target refraction in comparison with eyes after refractive multifocal intraocular lens (MIOL) implantation and emmetropic to slight hyperopic target refraction., Patients and Method: 89 eyes of 83 patients underwent cataract surgery, in 49 eyes a MONO (SI-40NB, Allergan) was implanted, in 40 eyes a refractive MIOL (SA-40N, Allergan). At day 2 after surgery and after 5 months the uncorrected near visual acuity, the near visual aculty with distance correction and with an addition of +3 diopters (D) were determined. The refractive outcome targeted in case of MIOL implantation was emmetropia to slight hyperopia and myopia for the MONO subjects. The eyes with MONO were classified in 4 categories depending on their postoperative refractive error (spherical equivalent, SE): category 1 with SE +1 to > 0 D, category 2 with SE 0 to > -1 D, category 3 with SE -1 to > -2 D and category 4 with a SE -2 to > -3 D., Results: We found a statistically significant better uncorrected near visual acuity in eyes with MIOL than in MONO subjects for category 1-3. In category 4 there was no statistically significant difference between MONO and MIOL. With best distance correction near visual acuity in MIOL was statistically significant better than in all 4 MONO categories. After adding 3 D, there was no statistically significant difference between the groups., Conclusion: Even in case of a myopic target refraction near visual acuity in eyes of the MONO group was statistically significant worse than in the eyes of the MIOL group. Only in case of postoperative SE of < or = -2 D eyes of the MONO group had a near visual acuity similar to the eyes of the MIOL group. This advantage is accomplished with a decrease in the uncorrected distance visual acuity.

An essential aspect in the cooperation of clinic and biometry consists in designing of studies, e.g. during the preparation of grant applications or for review by official drug surveillance institutions. A central aspect in study planning is the design-adequate and well-documented prediction of sample size, which should be recommended for any intended study. Based on several examples for sample size planning in study designs, which are of common relevance for ophthalmology, guidelines are derived to enable clinical researchers to perform sample size planning on their own. The latter can be based on the various available software packages for sample size prediction.

Background: Resistance to activated protein C (APC) is the most common hereditary defect in patients with venous thrombosis. There are conflicting reports on the prevalence of APC resistance in patients with arterial thrombosis, e.g. coronary arteries, compared to the APC resistance prevalence among the normal population. The prevalence of APC resistance in branch retinal artery occlusion (BRAO) and central retinal artery occlusion (CRAO) is unknown., Patients and Methods: 29 consecutive patients with arterial retinal occlusions (BRAO, n = 12; CRAO, n = 17) were included in this prospective study over a 23-months-period. We searched for APC resistance, protein C or S deficiencies, as well as for acquired vascular risk factors. Factor-V-deficient plasma and genetic analysis with a PCR method were employed for APC resistance determination. Protein C and protein S activity were determined with functional tests., Results: APC resistance was found in 3 of 29 patients (10.3%). Two of these patients had BRAO and one patient CRAO. Comparing this prevalence to the APC resistance prevalence within the normal population (9%), the difference was not statistically significant. 27 patients (93.1%) had one or more vascular risk factors (arterial hypertension = 19 [65.5%], hyperlipidaemia = 14 [48.2%], smoking = 7 [24.1%], diabetes mellitus = 5 [17.2%], carotid artery stenosis = 5 [17.2%])., Conclusions: We could not find an increased prevalence of APC resistance in patients with CRAO or BRAO when compared to the normal population.

Background: The pH-values of artificial tears have not been examined up to now., Materials and Methods: The pH-values of 20 commercially available artificial tears were determined., Results: pH-values measured from 4.82 to 8.39. One sixth showed pH-values above physiological values., Conclusion: A remarkable proportion of commercially available artificial tears deviate from the physiological range of the pH. It does not seem advisable to apply those in eyes with damaged anterior segments.

Background: Neodymium:YAG laser capsulotomy frequently damages the intraocular lens (IOL). This damage, mainly caused by acoustic shock wave and thermal conduction, results in opacities in the IOL, which may cause glare or image degradation. Because of the introduction of new IOL materials in cataract surgery, investigation of YAG laser resistance of these IOL materials seems to be necessary., Materials and Methods: A total of 17 standard IOLs of different types and classes of materials were tested as follows: Class I: Acrylate a) PMMA, compression molding, b) PMMA, compression molding, heparin-surface modified, c) acrylate/methacrylate copolymer; Class II: Silicone: a) Polydimethylsiloxane, b) Polydimethyldiphenylsiloxane; Class III: Hydrogel: a) poly-hydroxyethylmethacrylate (poly-HEMA), b) polyacrylate-hydrogel; Class IV: Thermoset polymer: methylmethacrylate, hydroxyethylmethacrylate, ethylene glycol dimethacrylate. Each IOL was placed in a rectangular transparent acrylic test chamber filled with balanced salt solution and subjected to irradiation from a Q-switched Nd:YAG laser. The laser beam was focused on the posterior surface and inside of the IOLs. The optic of the IOL was divided into four target zones and each zone was subjected to 40 bursts inside the lens and 40 bursts on the posterior surface of the lens. Laser power settings were: 1.1 mJ, 1.1 mJ with 0.4 mm defocus, 2.1 mJ and 4 mJ and one burst was applied (wave length 1064 nm, fundamental mode, duration 7 +/- 2 nanoseconds, spot size 15 microns in air). Following exposure, each lens was examined by light microscopy for the interior damage and by scanning electron microscopy for the posterior surface damage. For quantitative analysis, the extent of each superficial damage was evaluated by an image analysis system using at least original magnification x 1400., Results: Each IOL material demonstrated specific morphologic damage patterns. Intralenticular damage: Class I: cracks with radiating fractures with smaller extent in group Ic; Class II: blistered snowball-like inclusions; Class III: localized small holes, exception: IIIb: with very short radiating fractures; Class IV: stellar pits with short radiating fractures. For silicone superficial posterior damage sites a splash crater pattern with irregular melted edges was observed, while acrylate damage sites demonstrated a melted or stellate crater pattern with slightly raised edges. The silicone, poly-HEMA and the acrylic IOLs containing HEMA presented highest YAG laser resistance with the smallest amount of posterior damage in comparison to PMMA-IOLs. There was no marked increase in damage size in these IOL materials with higher energy exposure in this set-up., Conclusion: For each material consistent and characteristic specific morphologic damage patterns were observed. Foldable optic materials were more resistant against Nd:YAG-laser photodisruption than rigid optic materials. Individual laser strategies for each IOL-material and design should be deducted.

Background: Silicone oil is increasingly used as an intravitreal tamponade in severe forms of vitreoretinal disorders, also in pseudophakic eyes. In some patients silicone oil was observed to be adherent to the intraocular implant., Material and Methods: To investigate the interaction of silicone oil with IOL-materials and the influence of lipoproteins of the serum on this interaction we used the following in vitro experimental set-up: Sterile IOLs of different IOL-materials (e.g. PMMA, silicone, hydrogel) and surface-modifications (e.g. Pharmacia 809P and 809C, Soflex LI41U, Alcon AcrySof M60BM, Allergan SI-30NB, SI-40NB, Chiron adatomed 90D, C10 and C31UB, MemoryLens U940A, Corneal ISHEMA 66, Storz H60M) were stored in vitro together with silicone oil (1000 centistokes) with and without a fresh serum solution at 37 degrees Celsius. This combination was rotated slowly and mixed thoroughly three times a day. After 3 and 6 months and a standardized special preparation in an ultrasound bath and air treatment, the IOLs were examined by light microscopy followed by scanning electron microscopy., Results: Silicone oil strongly adhered to holes and to the IOL surface especially in silicone and PMMA IOLs. Highly hydrophylic IOLs-like the heparin-surface-modified and hydrogel IOL-cleared from silicone oil relatively early. This effect was more pronounced in the group with lipid-/serum solution than without. In some silicone IOLs silicone oil was strongly adherent to the lens and it was nearly impossible to wash off the oil even when using an alcoholic solution. One silicone IOL lost its haptics in the serum-oil-IOL-mixture, another lost small particles from the IOL surface., Conclusion: Silicone oil is more adherent to hydrophobic IOLs than to hydrophylic IOLs. Lipoproteins of the serum play an important role in facilitating an effect of silicone oil on IOL materials. We recommend highly hydrophylic especially surface-modified IOLs for lens implantation following vitreoretinal silicone oil surgery. Implantation of silicone IOLs in vitreoretinal high risk eyes should be avoided.

Background: Endophthalmitis is a serious complication after cataract surgery., Patients and Methods: Therefore, a retrospective study was performed by reviewing patient-records of all cases of end-ophthalmitis after catract surgery that were treated at the department of ophthalmology of the University Hospital in Mainz between January 1986 and December 1995., Results: 44 eyes were treated for endophthalmitis. Of those, 38 had been referred. In 15 eyes cataract surgery was performed on an outpatient basis. In 20 cases the onset of end-ophthalmitis occurred within the first postoperative week. We isolated staphylococcus epidermidis (14), staphylococcus aureus (4), other gram-positive microorganisms (15), gram-negative bacteria (2) and candida (1). As risk factors we found a wound dehiscence (14), an intraoperative loss of vitreous (11), diabetes (11), skin-diseases like rosacea or neurodermatitis (6). In 36 cases a vitrectomy was performed. After a mean follow-up of 25 +/- 22 months 26 patients had a visual acuity of 0.05 or better., Conclusion: Gram-positive bacteria showed to be the most common causetive microorganisms. In a third of all cases the sample demonstrated no growth. More than 80% of the eyes were treated by vitrectomy. About 60% of the patients obtained a visual acuity of 0.05 or better.

Background: Pattern-induced flicker-colors are subjective colors produced by rotating disks with black-and-white arcs. Changing the direction of rotation results in a different color. Small variations in the temporal sequence (phase differences) of the black-and-white pattern cause the colors to vary and can be perceived as color differences., Patients and Methods: We investigated the thresholds for such phase differences in healthy (n = 11) and in glaucomatous (n = 19) eyes. Acuity and color vision were tested and in patients static visual field perimetry (Octopus G1) was carried out. The disks used for producing the pattern-induced flicker-colors were viewed from a distance of 2 m and had a luminance of 35 cd/m2. The phase difference thresholds were determined using a double staircase procedure., Results: In glaucomatous eyes the thresholds were significantly higher (33.9 +/- 4.8 for clockwise rotation) than in normal eyes (18.2 +/- 1.4), p < 0.005 and this was the case for anticlockwise as well as clockwise rotation. The difference between the two groups remained significant (p < 0.025) when the data for glaucomatous eyes was corrected for acuity losses., Conclusions: In the glaucomatous eyes the increase in phase difference threshold was correlated with raised visual field MD (r = 0.87 for clockwise rotation). The higher thresholds in glaucomatous eyes point to a loss in blue-yellow-sensitive, parvocellular retinal ganglion cells, which play an important part in the perception of pattern-induced flicker-colors. Pattern-induced flicker-colors are a new method for the clinical investigation of retinal function in the center of the visual field and have the advantage that fixation is unnecessary and the yellow filter properties of the refractive media and the macula are of no importance.

This paper reviews publications in the field of glaucoma research from 1991 and 1992. The role of elevated intraocular pressure (IOP) is redefined. Raised IOP is not the only, but probably the most important risk factor in the development of glaucomatous optic nerve damage. The IOP threshold of 20-22 mm Hg may be too high for many patients to avoid progressive damage. Early surgical treatment is more successful than medical or laser treatment and is gaining importance. New techniques have made trabeculectomy safer. In patients with poor surgical prognosis antimetabolites such as 5-fluorouracil or mitomycin C may improve results considerably. However, these treatments need to be defined in their side effects as far as long-term results are concerned. Lasersclerostomy ab interno and ab externo minimize surgical trauma and promise better results in eyes with previous surgery. Contact-cyclo-photocoagulation renders results comparable to cyclo-cryo-coagulation with less perioperative side-effects. However, long-term results must be obtained before it can replace the older technique. Medical treatment on the step to clinical introduction (in Germany) are apraclonidine with less side effects than clonidin, topical carbonic anhydrase inhibitors (dorzolamide) and possibly prostaglandin F2alpha-ester such as PhXA34. Galenic modifications are gelrite, a heteropolymer and betaxolol suspension. Which patients with ocular hypertension to treat and which not to treat still is a therapeutic dilemma. Methods such as colour contrast, investigation of scotopic low-contrast vision and the pattern-electroretinogram promise earlier detection of glaucomatous damage than conventional computer perimetry or morphological methods.

The effect on the intraocular pressure of patients with primary open-angle glaucoma of a combination of timolol 0.5% with epinephrine 0.5% plus guanethidine 3% was studied and compared with the effects of timolol alone, of epinephrine 0.5% plus guanethidine 3%, and of other glaucoma drugs. The combination of timolol 0.5% with epinephrine 0.5% plus guanethidine 3% had a stronger effect on intraocular pressure (reduction 10.9 +/- 1.1 mm Hg) than epinephrine 0.5% plus guanethidine 3% (7.6 +/- 0.9 mm Hg) or timolol alone (5.8 +/- 1.1 mm Hg) or other glaucoma drugs. However, when the three substances are administered in combination therapy may show an addition of both pressure-lowering and side effects.