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Background: Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone., Patients and Methods: In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded., Results: No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to > 35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed., Conclusions: In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.

Background: Globe injuries frequently are the cause of permanent loss of visual function. Especially ruptures of the globe have a 50 times lower chance of achieving a final visual acuity better than 20/200 as compared to contusions of the globe. Besides injury to the retina and choroids, injury of the iris-lens diaphragm plays an important role for visual rehabilitation (10% iris defects and 1% aniridia after blunt trauma). Against this background the surgical results after implantation of aniridia intraocular lenses were investigated., Patients and Methods: Eleven patients (41.9+/-19.6 years of age) after globe injury (three ruptures of the globe, eight penetrating injuries with trauma of the iris) were implanted with an aniridia IOL., Results: The implantation of an aniridia IOL was performed on average 1.0+/-0.6 years (range: 0.4-2.3 years) after the primary injury. In ten eyes an aniridia IOL model HMK ANI 2 (Ophtec/Polytech) was implanted and in one eye an aniridia IOL model 67 (Morcher). Most patients were very satisfied with the results achieved (average corrected visual acuity 0.48; 0.05-1.0). Of the operated eyes, 63% reached a visual acuity > or = 0.4. All patients noticed a significant reduction in glare disability as compared to the preoperative condition. The incidence of secondary glaucoma remained unchanged after the secondary implantation. One patient demonstrated retinal detachment 3 months after receiving the secondary implant, which was successfully treated with vitrectomy and gas tamponade., Conclusions: The implantation of aniridia IOLs seems to be a beneficial therapeutic option in post-traumatic eyes with partial or complete aniridia and aphakia with good visual recovery. During the postoperative follow-up special attention must be paid to sufficient regulation of intraocular pressure and to the retinal situation.

Background: After simple excision without additional surgical measures, pterygiums demonstrate high recurrence rates. According to the literature, recurrences may occur in up to 83% after simple excision compared to 5-21% after excision combined with conjunctival autografts. An alternative to the free conjunctival graft is the sliding conjunctival graft., Methods: The data of 50 patients operated over a period of 8 years were evaluated retrospectively. The long-term results after pterygium excision with free conjunctival graft vs sliding conjunctival flap were compared with data extracted from the literature., Results: The average follow-up was 23 months. During this period, 18.5% of 27 operated eyes with free conjunctival grafts developed a recurrence of pterygium. After excision with sliding conjunctival grafts only 6.9% of 29 operated and examined eyes developed recurrences., Conclusion: In the present study pterygium excision combined with sliding conjunctival graft was a simplified surgical technique with a lower recurrence rate compared to the free conjunctival graft.

Background: The risk of postoperative immune reaction/transplant rejection is increased in the presence of distinct risk factors. In these situations, the use of established immunosuppressive agents (steroids, cyclosporin) is indicated. However, immune reactions can occur despite this therapy. Basiliximab is a monoclonal antibody with a high specific binding affinity to the IL-2 receptor of activated T-cells. After renal transplantation, the combination therapy with basiliximab and cyclosporin reduces the risk of acute rejection by 30% against placebo. The aim of this study was to investigate the effect of complementary immune suppression with the IL-2 synthesis inhibitor cyclosporin and the IL-2 receptor antagonist basiliximab on the incidence of transplant rejection after high-risk keratoplasty., Patients and Methods: In an open pilot study, seven patients with high-risk keratoplasty were treated with basiliximab perioperatively and cyclosporin postoperatively. All patients had penetrating keratoplasty with a non-HLA-matched corneal graft., Results: Seven patients were operated on from 12/98 through 12/99 with a corneal transplant diameter between 7.1 and 9.5 mm. Risk factors included extensive corneal neovascularization in all patients (indications for surgery: 4 cases with corneal scars after herpetic disease, 2 cases with conditions after alkali burns, 1 case with corneal ulceration after thermal burn). During the follow-up of 14-25 months, no immune reaction has occurred, and all transplants are clear. The mean visual acuity increased from 0.04 to 0.41 postoperatively., Discussion: The preliminary data on a combination therapy with basiliximab and cyclosporin are promising. For further evaluation a prospective multicenter study is planned.

The internet offers charge-free access to electronic online databases and thus has revolutionized the handling of information. Today's challenge is the rational management of the large amount of attainable data. This overview presents the various databases--particularly databases for online Medline search--and basic knowledge for effective and successful search strategies. There are numerous important advantages of online access to literature databases: availability at any time and any place in the world, easy handling due to the user-friendly surface of the World Wide Web, capability of linking directly to the private database. Clinicians, scientists, and ophthalmologists in private practice can equally profit from the advantages of fast, easy, and charge-free online-search in medical literature databases. Literature search should thus be an important tool to obtain the latest scientific knowledge for every physician.

Background: Central vein pressure depends on intracranial pressure (ICP). Baurmann in 1925 therefore recommended measuring central vein pressure to determine ICP, but the accuracy of this method has not yet been verified. To test the method we measured venous outflow pressure (VOP) by noninvasive ophthalmodynamometry (ODM)., Methods and Materials: We studied 31 patients with suspected increased ICP. ICP was recorded continuously for a minimum of 24 h by intraventricular catheters, and ODM was performed during ICP measurement. The findings were compared with the results of conventional invasive ICP measurement., Results: Pressure in the central retinal vein was highly correlated with ICP., Conclusion: Measuring VOP by ODM seems to be a reliable method for noninvasive recording of ICP. It is a useful screening test in all cases of presumed ICP elevation.

Background: Penetrating keratoplasty in cases of perforated corneal ulcers is a technical challenge. The loss of anterior chamber volume during trephination causes irregularities of surgical margins and carries the risk of trauma to iris and crystalline lens. The highly viscous substance Healon 5 allows a deep anterior chamber to be maintained even in cases of rather large perforations., Case Report: A 34-year-old man presented with acutely perforated ulcer on the transplant-host interface. Perforating minikeratoplasty (diameter 4.5 mm) including the corneal limbus had been performed 3 years previously because of a perforated ulcer after pterygium surgery. Corneal melting extending to the visual axis required a large-diameter transplant (8.0 mm), partially including the former transplant. Before trephination the anterior chamber was restored with Healon 5. Despite the fairly large perforation site we did not note any anterior chamber shallowing during trephination. Hardly any bleeding occurred perioperatively, although deep and superficial neovascularizations in the former transplant were cut. The postoperative course was uneventful with no rise in intraocular pressure. After 4 weeks, postoperative pinhole visual acuity with the preoperative correction (1.5 dpt. cyl.) was 0.7, with a topographic astigmatism of 6.5 dpt., Conclusion: In the case presented here, a regular recipient wound bed as a prerequisite for a relatively low postoperative astigmatism was created by the use of Healon 5 for anterior chamber stabilization during trephination.

In a retrospective study of the records of 64 patients with AIDS and cytomegalovirus (CMV) retinitis, 47 patients were evaluated regarding the effectiveness of initial virustatic therapy, and 41 patients regarding the anatomical and functional long-term development (maintenance therapy, rate and intervals of recurrences, complications, adverse drug reactions, time of survival, and visual outcome). The average survival time of 45 treated patients was 226 days (31-717 days). More than 90% responded to initial therapy with ganciclovir or foscarnet. Forty-four percent remained free of recurrences until they died (for up to 15 months); 56% had 1 to 4 recurrences, altogether 35 episodes, of which 14 occurred after withdrawal of therapy. Recurrences were treated with high-dose reinduction therapy with good or partial response in more than 80% of cases. Nine patients showed "smouldering retinitis" at a late stage. Two out of 45 patients became blind shortly after diagnosis despite therapy; both showed a course mimicking acute retinal necrosis syndrome with histologically proven CMV disease. None of the 43 patients on maintenance therapy for up to 2 years became blind in both eyes. Only 2 out of 43 patients had a poor visual outcome < 40/100 in the better eye at a late disease stage. Of 60 affected eyes, 11 showed retinal detachment, 14 eyes developed optic atrophy and 12 eyes became blind. Our retrospective study shows that consistent maintenance therapy of patients with CMV retinitis prevents severe deterioration of visual acuity in most cases even in long disease courses and thus maintains quality of life.