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Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. This review presents the sequence of events due to complicated persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction, VMT; macular hole, MH; epiretinal membrane). Pathologic aspects, clinical features, diagnostic implications, and current management strategies are described. Observation, pharmacologic vitreolysis with Ocriplasmin, and surgical treatment are positioned as treatment options for different diseases., Competing Interests: Die Autorin gibt an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Mandatory screening performed by an experience ophthalmologist remains the most important pillar in the management of retinopathy of prematurity (ROP). The current gold standard for treatment of proliferative ROP is still panretinal laser photocoagulation, depending on severity, in combination with vitreoretinal surgery if necessary. The first case series of off-label intravitreal anti-VEGF treatment are encouraging. In addition to intravitreal anti-VEGF therapy, other treatment concepts such as supplementation with IGF-1 or omega-3 fatty acids also represent interesting pharmacological approaches to the management of ROP. However, larger controlled trials are required to validate the benefits and safety of these systemic treatment approaches.

This review highlights recent advances in clinical research on the therapy for retinopathy of prematurity (ROP). This disease is still important, because improvements in neonatal intensive care during the last years have increased the survival of the most immature newborns, but have not diminished the ROP frequency. Laser treatment at the optimal time for advanced ROP mostly prevents blindness. This paper describes the classification, current German screening criteria and the modern concept of ROP pathophysiology. The therapeutic treatment strategies and the treatment results, as well the possible promising future therapy with anti-VEGF (bevacizumab) is discussed., ((c) Georg Thieme Verlag KG Stuttgart-New York.)

These revised guidelines replace the previous guidelines on the screening of preterm infants for retinopathy of prematurity (ROP) that were published in 1999. Recently published research provided the impetus for this revision. These guidelines propose the following criteria for an efficient screening programme for the early detection and treatment of ROP in Germany: Inclusion criteria for ROP screening: All preterm infants with a gestational age of less than 32 weeks (if gestational age is unknown; of <1500 g birth weight) should be examined. In addition, all preterm infants with 32-36 weeks gestational age are included if postnatal oxygen was supplemented for more than 3 days. The first examination should be performed within the 5(th) week of postnatal age (day 36-42), but not prior to 31 weeks gestational age. Indications for laser photocoagulation: in Zone I: 1. any stage with "plus disease", 2. stage 3 without "plus disease." In Zone II: stage 3 with extraretinal proliferations in 5 continuous or 8 cumulative clock hours in combination with "plus-disease". In certain cases an earlier treatment may be indicated.

Purpose: The aim of this study was to analyse the results of retinopathy of prematurity (ROP) screening, stage of disease and time of treatment from one tertiary care centre., Patients and Methods: Between 1991 and 2001, 666 infants with a gestational age (GA) < 33 weeks or birth weight (BW) less than < 1501 g were examined. Coagulation treatment was performed in accordance with the Cryo-ROP study, after reaching the threshold. All infants were followed-up until a stable retinal situation was reached., Results: Mean GA of the 666 infants was 28.5 +/- 2.3 weeks. Mean BW was 1180 +/- 372 g. During the years of screening, the GA and BW significantly decreased, but no significant change in the yearly incidence of ROP was detected. 460 (69.1 %) of the infants did not develop any stage of ROP. Maximum stage of ROP in the worse eye was stage one in 51 (7.6 %) infants, stage two in 59 (8.9 %) infants and stage three below threshold in 62 (9.3 %) infants. 34 (5.1 %) infants were treated with coagulation treatment. Mean time of treatment was 36.5 weeks postmenstrual age, or 10.7 weeks postnatal age. Postnatal age showed a better correlation to treatment time than postmenstrual age. No infant was treated before seven weeks of life and not before 32 weeks postmenstrual age., Conclusion: In spite of the increasing survival of children with lower GA and BW the incidence of ROP has not increased, and the incidence of ROP in our centre appears to be comparable to other international studies. In contrast to the Cryo-ROP study, treatment time correlates better to postnatal age than to postmenstrual age. All infants who underwent treatment were detected at an appropriate time using German screening guidelines.

Purpose: To analyze and compare the anatomical and functional outcome following cryotherapy or laser therapy for ROP., Methods: Between April 1991 and February 2002, 127 eyes with ROP (65 patients) were treated after threshold ROP was reached. Ten additional eyes with zone I disease were treated with prethreshold. All patients were followed up until a stable retinal situation occurred., Results: An "unfavorable outcome," as described in the Cryo ROP study, occurred in 1 of 91 (1%) eyes with laser treatment and in 3 of 46 (6.5%) eyes with cryotherapy. Temporal dragging of vessels was noticed in 6 of 91 eyes (6.6%) with laser treatment vs 7 of 46 eyes (15.2%) with cryotherapy, respectively. Visual acuity > or =20/25 was achieved in 39.2% in eyes with laser therapy and in 17.6% with cryotherapy (p<0.05)., Conclusion: A strict screening protocol and treatment at onset of threshold disease results in an excellent anatomical and functional outcome. The results of laser therapy were superior over cryotherapy, indicating that laser treatment is the therapy of choice.

This review summarizes the knowledge and highlights recent advances in clinical research of retinopathy of prematurity (ROP). This disease is still important, because improvements in neonatal intensive care during the last years have increased the survival of the most immature newborns, but did not diminish the ROP frequency. Ophthalmologic screening and, if applicable, laser treatment at the optimal time for advanced ROP prevents blindness in most cases. The history, classification and the modern concepts of ROP pathophysiology are described. The results of various multicenter treatment trials are summarized. The current German screening guidelines are discussed with the guidelines of other nations. The therapeutic treatment strategies and the treatment results are discussed. The ophthalmologic disorders of former preterm infants, as higher rates of amblyopia, strabismus, and refractive error, are mentioned. Possible future therapies, e. g. anti-angiogenic factors are discussed.

Background: The purpose of this study is to evaluate late retinal complications in former preterm infants with regressed stages of acute retinopathy of prematurity (ROP)., Patients and Methods: Between 1995 and 2002 a consecutive series of 15 patients (16 eyes) with loss in visual acuity were examined. Gestational age was < 32 weeks, birth weight < 1500 g. The reason for visual disturbances was: RD (n = 14), vitreous haemorrhage (n = 3) and posterior vitreous detachment (n = 1)., Results: Two eyes recovered spontaneously. Surgery was performed in 14/16 eyes, with a pars plana vitrectomy (n = 14), or buckling procedure (n = 2). Four eyes with a severe form of regressed ROP needed multiple procedures for reattachment At last follow-up in 13/14 (93.0 %) eyes the retina was completely attached. Visual acuity ranged from light projection to 20/25., Conclusions: Former premature patients with vitreoretinal changes due to regressed ROP may develop vitreous traction and subsequent late-onset retinal detachment. Surgery with primary vitrectomy technique in eyes with retinal detachment can remove the vitreoretinal adhesions and is an effective treatment technique. In eyes without retinal detachment the natural course can be awaited.

Background: Coats disease is a retinal vasculopathy of unknown cause. Untreated cases usually lead to an exudative retinal detachment and rubeosis iridis with secondary glaucoma. Photocoagulation and/or cryotherapy are generally the first interventions in treating the disease. Pars plana vitrectomy may be indicated in cases of vitreous hemorrhage or retinal detachment., Methods: We performed pars plana vitrectomy in 9 eyes with Coats disease between 1992 and 1999. A retinal detachment was present in 3 cases, and three showed a vitreous hemorrhage. In two cases surgery was indicated because of paramacular localization of the pathological vessels with associated exudations., Results: The two cases with paramacular involvement showed improvement in visual acuity of eight lines. In the remaining cases visual acuity remained within two lines compared to the initial visual acuity. All eyes except one could be saved., Conclusion: Pars plana vitrectomy is a useful option in treating advanced Coats disease, especially in cases associated with vitreous hemorrhage or retinal traction.

Purpose: Analysis of a consecutive series of patients suffering from hereditary macular dystrophies., Patients and Methods: Between 1991 and 1997, 136 patients underwent clinical and electrophysiologic examinations (Ganzfeld ERG, EOG or multifocal ERG)., Results: The time of first examination was similar to the onset of clinical signs in most patients. In half of the patients onset was not before 40 years of age. In younger patients, Stargardt disease, X-linked retinoschisis and Best disease were the most frequent disorders. In patients aged 40 year and older, pattern dystrophies and central areolar choroidal dystrophy were more frequent. In 41 cases (30.2%) a specific diagnosis could not be made. Color vision and multifocal ERG were abnormal in all patients examined. Ganzfeld ERG was important for the diagnosis of X-linked retinoschisis, as was the EOG for Best disease., Conclusions: Hereditary macular dystrophies are a heterogeneous group of disorders. In several cases a definite diagnosis could not be made. Pattern dystrophies are the most frequent hereditary macular dystrophies in patients older than 40 years of age.

Septo-optic dysplasia (or de Morsier syndrome) is a congenital disorder characterised by anomalies in cerebral midline structures, optic nerve hypoplasia, and hormonal deficiencies. Diagnosis should be made early, due to the possibility of treating the hormonal disturbances. We describe here a case with decreased visual acuity, one-sided hemianopia, nystagmus und agenesis of the septum pellucidum and discuss the heterogeneous appearance of this syndrome. There are two theories regarding its pathogenesis. The first postulates simultaneous damage to both cerebral structures and optic nerve development around the 6th week of gestation, while the other favours secondary degeneration of optic nerve fibres due to a cerebral lesion.

Purpose: To analyze the value of electrophysiologic testing according to standards of the International Society for Clinical Electrophysiology of Vision (ISCEV) in infants less than 10 years of age., Patients and Methods: In 64 infants less than 10 years, the results from of age electroretinograms (n = 47), visual evoked potentials (n = 30), or electro-oculograms (n = 1) were recorded. Twenty-nine infants were less than 6 years of age, and 17 infants were less than 3 years of age. Indications for examination were unexplained visual loss in 54 infants and familial hereditary retinal dystrophies in ten infants. Sedation with chloral hydrate was performed in seven children., Results: In 40/64 infants (62%), the results of electrophysiologic examination were pathologic. In 29 infants visual loss was due to retinochoroidal dystrophies, and in 11 infants it was due to disturbances in the optic pathway. In 7/64, infants the suspected retinochoroidal dystrophy could be excluded. Therefore electrophysiologic testing was diagnostically accurate in 47/64 (73%) of cases., Conclusion: Electrophysiologic testing according to TSCEV standards can be reliably performed in infants less than 10 years of age. When the indication for electrophysiologic testing is made following meticulous ophthalmologic examination, diagnostic accuracy is given in at least 73% of cases.

Purpose: Evaluation of different and partially contradictory guidelines for screening for retinopathy of prematurity published in Germany., Patients: The data on 1219 preterm infants examined in Bern (n = 900) and Berlin (n = 319) were analyzed. A total of 680 preterm infants (56%) had a birth weight below 1500 g. The remaining infants were examined because oxygen had to be supplied or surgery done before or around the estimated delivery time., Results: Stage 3 retinopathy was found in 88/1219 (7.2%) preterm infants. Only 5/88 infants weighed more than 1500 g at birth. Three of these infants had a birth weight below 2000 g and needed supplemental oxygen for a prolonged period of time. The other 2 infants had birth weights of more than 2000 g and were severely ill. Of 1219 preterm infants, 37 (3%) developed threshold retinopathy (according to the criteria of the multicenter trial); 35/37 infants weighed less than 1230 g at birth. The remaining 2 children (1650 g and 2185 g birth weight) were severely ill., Conclusions: Preterm infants should be screened for retinopathy of prematurity: (1) if the birth weight is below 1500 g; (2) if the birth weight is below 2000 g and oxygen supply was necessary for more than 30 days; (3) if infants are very sick or must undergo multiple surgery before term. The first examination should be scheduled for the 6th week postnatal and not before 31 weeks postmenstrual age.

We analyzed retrospectively 239 consecutive patients who had undergone reoperation for repeat retinal detachment; 441 repeat operations were performed. The average follow-up was 2.1 years, and on average we noted 1.8 retinal redetachments per patient. At the last follow-up examination in 173 eyes (72.4%), the retina was reattached; 10.5% of the eyes had a partially detached retina and in 15.9% the retina was again completely detached. Enucleation was necessary in 3 eyes (1.2%). Visual improvement occurred in 45% of the eyes with reattachment of the retina. When the first retinal detachment occurred, 74 eyes were aphakic. Compared to the other 165 eyes there was no difference in anatomic or visual outcome. Aphakic eyes needed fewer additional reoperations (39%) compared to the phakic group (50%, p less than 0.01). One important reason for the surgery being unsuccessful was poor placement of the scleral buckle. In both groups equatorial placement of the scleral buckle led to anatomical success in more than 50%. The eyes in the aphakic group required more vitrectomies (47%) compared to the phakic eyes (34%, p less than 0.01).