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For more than 100 years keratotomy has been in the focus of ophthalmology as a treatment option for correction of astigmatism. Femtosecond laser technology provides a new level of precision, standardization and control as well as completely new options, such as purely intrastromal incisions.The current literature is summarized with respect to femtosecond laser-assisted astigmatic keratotomy (FSAK) in combination with cataract surgery, where less astigmatic correction is necessary as well as after corneal surgery, such as perforating keratoplasty, where higher astigmatic errors need to be corrected.The FSAK provides a safe treatment option for both scenarios although larger studies with longer follow-up are needed to improve currently available nomograms.

Radiation Retinopathy is a progressive chronic disease triggered by ionising radiation and is characterised by vascular endothelial damage that can lead to macular edema, optic disc edema and proliferative retinopathy. We discuss a case of a patient with radiation retinopathy and optic disc edema who we treated with a combination of intravitreal bevacizumab and dexamethasone. After 3 injections of bevacizumab, and one of dexamethasone, the patient experienced a resolution of optic disc edema and a marked increase of his visual acuity and remained stable throughout the follow-up period.Die Strahlenretinopathie ist eine chronische, fortschreitende Erkrankung, die durch die Wirkung ionisierender Strahlung verursacht wird. Häufig ist die Ursache einer Strahlenretinopathie die Behandlung eines intra- oder periokulären Tumors.Ein pseudophaker Patient stellte sich im August 2016 mit einer seit ca. 1 Woche bestehenden Visusverschlechterung des linken Auges in unserer Klinik vor. In der Patientengeschichte war eine Protonenbestrahlung des linken Auges vor 3 Jahren bei Aderhautmelanom bekannt. Es zeigte sich ein Makulaödem mit Exsudatbildung und Papillenödem. Wir stellten die Diagnose einer Strahlenoptiko- und -retinopathie. Es erfolgten intravitreale Injektionen mit Dexamethason (OzurdexDie Kombination aus intravitrealer Gabe von Steroiden und Anti-VEGF erwies sich in diesem Fall als effektive Behandlungsmodalität bei iatrogen induzierter Strahlenoptikopathie und -retinopathie. Weitere Studien sind zur Ermittlung des Stellenwerts der kombinierten Therapie notwendig.

Kurzsichtigkeit galt lange als im Wesentlichen genetisch prädeterminiert. Die schnelle Zunahme der Myopieprävalenz in den industrialisierten Staaten widerspricht dieser Annahme. Auch neuere Studien unterstützen die Hypothese, dass die Kurzsichtigkeit hauptsächlich durch Umweltfaktoren[zum vollständigen Text gelangen Sie über die oben angegebene URL], 178. Versammlung des Vereins Rheinisch-Westfälischer Augenärzte

Intraocular pressure (IOD) is the most important risk factor for the occurrence and progression of glaucoma because it is the only measurable risk factor. There is a positive connection between IOD and both systolic and diastolic blood pressure. The clinical relevance is, however, limited because the moderate alterations in IOD are less than the known measurement error and daily physiological oscillation.

The Gutenberg Health Study (GHS) is a prospective, single center, population-based cohort study. It is an interdisciplinary project for investigation of ocular, cardiovascular, psychosomatic and immune diseases in the population of the City of Mainz and the district of Mainz-Bingen in central Germany. The main goals of the ophthalmological branch of GHS are determination of the prevalence and incidence of major ocular risk factors and diseases, exploring the genetic determinants and assessing complex interdisciplinary associations. The study cohort includes 15,010 participants aged between 35 and 74 years at the time of inclusion. After completing the baseline investigations the 5-year follow-up of the whole study cohort started in April 2012. The GHS is the most extensive data set of major ophthalmological conditions and risk factors in Germany and will help researchers in understanding complex medical associations.

Hintergrund: Der Zusammenhang zwischen Augeninnendruck (IOD) und dem Blutdruck ist gut belegt, auch wenn die klinische Relevanz nicht überbewertet werden darf. Kontrovers wird jedoch der Einfluss blutdrucksenkender Medikamente auf den Augeninnendruck diskutiert. Wir führten eine Analyse zur[for full text, please go to the a.m. URL], 86. Versammlung der Vereinigung Rhein-Mainischer Augenärzte

A 48-year-old man presented with a vascular anomaly of the iris in the left eye. Slit-lamp microscopy revealed dilated and tortuous vessels of the iris between 12 and 4 o'clock. Fluorescein angiography confirmed a diagnosis of arteriovenous (AV) malformation of the iris. The vessel originated at the iris base, passed to the pupillary margin and returned to the base. Such AV-malformations of the iris are very rare, benign vascular anomalies that have to be distinguished from other, potentially malignant pathologies of the iris (e. g. tortuous vessels in iris melanoma).

Hintergrund: Tumornekrosefaktor α (TNF) ist ein proinflammatorisches Zytokin, das von Makrophagen und den T-Zellen produziert wird und eine wichtige Rolle bei der Apoptose und bei entzündlichen Prozessen spielt. Ziel dieser Studie war es, die relative Glaskörper-Konzentration des TNF[for full text, please go to the a.m. URL], 25. Jahrestagung der Retinologischen Gesellschaft

The aim of this study was to evaluate the long-term results of transpupillary thermotherapy (TTT) for small malignant choroidal melanomas.In the time period 1/1998 to 10/1999 in a prospective non-randomised analysis 26 eyes with small malignant melanomas (located posterior to the equator with base ≤ 12 and thickness ≤ 4.5 mm) were primary treated with the TTT standard protocol (follow-up over a time span of at least 10 years).Thirteen women and thirteen men (mean age: 64 years) underwent TTT. The mean preoperative tumour thickness was 2.45 mm (0.8 - 4.5 mm). Ten years postoperatively tumour regression without recurrence after 1.4 treatment sessions (mean) was achieved in 16 / 26 eyes, primary regression followed by tumour regrowth in 6 / 26 eyes, and primary failure of tumour regression in 4 / 26 eyes. Two patients died on liver metastasis. Ocular complications (with preference in posterior tumours after multiple TTT sessions) were observed in 14 eyes: macular pucker in 8, macular oedema in 6, choroidal neovascularisation in 4 and posterior synechia with iris atrophy in one eye.Choroidal melanomas treated with TTT as a stand-alone procedure need a close monitoring since these tumours developed a significant rate of local recurrences and ocular side-effects in the long run.

Retinal vein occlusions are a common vascular disease of the eye. Ophthalmological diagnostic procedures and imaging are important for the prognosis of the disease, as are the systemic work-up and therapy. Besides routine ophthalmic tests (visual acuity, slit lamp examination, funduscopy) a work-up for glaucoma such as intraocular pressure, visual field or 24 h IOP profile is useful as a diagnostic procedure. Furthermore, new diagnostic and imaging tests such as central corneal thickness and optic nerve head imaging by Heidelberg retina tomography or optical coherence tomography (OCT) should be considered for glaucoma evaluation. Optical coherence tomography also plays a major role in treatment monitoring of macular edema secondary to retinal vein occlusions. Fluorescein angiography is well established and can provide information with regard to size and extent of the occlusion, degree of ischemia, areas of non-perfusion and neovascularization, as well as macular edema.

Hintergrund: Ziel der Studie war der Vergleich von Wirksamkeit und Sicherheit zwischen intravitrealem Ranibizumab, Laserkoagulation und einer Kombination aus beidem bei chronischem Makulaödem nach Venenastverschluss (VAV) der Netzhaut. Methoden: In diese prospektive, randomisierte Multicenterstudie[for full text, please go to the a.m. URL], 24. Jahrestagung der Retinologischen Gesellschaft

Ziel: Evaluation der Verteilung des Augeninnendruckes (IOD) in einer populationsbasierten Erwachsenenbevölkerung sowie seine Korrelationen mit okulären Parametern und kardiovaskulären Risikofaktoren. Methodik: Die Gutenberg Health Study ist eine prospektive, populationsbasierte Beobachtungsstudie[for full text, please go to the a.m. URL], Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi)

Hintergrund: Derzeit gibt es zahlreiche Papier-Zeitschriften mit dem Fokus auf Erkrankungen der Netzhaut und des Glaskörpers. Gleichzeitig präsentieren vielen Operateure ihre neue OP-Techniken und technologische Erneuerungen in Form von Videoclips auf Kongressen. Jedoch existierte bisher kein[for full text, please go to the a.m. URL], 23. Jahrestagung der Retinologischen Gesellschaft

Hintergrund: Sowohl diee parazentrale Laserkoagulation als auch die intravitreale Injektion von Anti-VEGF-Substanzen scheinen bei der Therapie des Makulaödems nach Venenastverschluss (VAV) effektiv zu sein. In dieser Studie wurde die Effektivität dieser zwei Therapieoptionen miteinander verglichen.[for full text, please go to the a.m. URL], 23. Jahrestagung der Retinologischen Gesellschaft

The value of measuring the critical fusion frequency (CFF) as part of ophthalmological diagnostics is examined. The relevant literature on changes of the CFF concomitant with refraction errors, media opacity, age-related macular degeneration, glaucoma and various other opticopathies is discussed regarding the relevance of CFF for the differential diagnosis. Various methods and instruments for measuring the CFF are presented. The CFF is a complex function of the visual system and changes in CFF cannot be ascribed to a specific level of signal transduction. However, measurement of the CFF is a valuable test in the clinical routine to estimate potential visual acuity in the presence of media opacity and to screen for lesions of the optic nerve. Reduction of CFF in an eye that otherwise appears normal may prompt the ophthalmologist to initiate further examination facilitating diagnosis of specific conditions, such as optic neuritis, before visual acuity is reduced. Measuring the CFF is technically simple, inexpensive and fast and can be delegated to medical personnel. Measurement of the CFF should be an integral component of routine ophthalmological examinations.

Hintergrund: Mit der Ranibizumab for Branch Retinal Vein Occlusion Associated Macular Edema Study (R.A.B.A.M.E.S.) wird derzeit bei Patienten mit Venenastverschluß und chronischem Makulaödem die Wirksamkeit einer intravitrealen anti-VEGF Therapie mit dem therapeutischen Effekt der Laserkoagulationsbehandlung[for full text, please go to the a.m. URL], 83. Versammlung der Vereinigung Rhein-Mainischer Augenärzte

A corneal penetration secondary to inflammation or chronic trophic disease is an emergency situation in ophthalmology. The ocular globe is instable and there is a significant risk of an endophthalmitis. A corneal graft for a tectonic transplantation may not be available in many cases. The prognosis of an emergency corneal transplantation is relatively poor. We report the results of multilayer amniotic membrane transplantation as initial therapy for penetrating corneal ulcers.In 13 eyes with penetrating corneal ulcers an initial therapy with multilayer amniotic membrane was performed. All patients (11 men, 2 women; age 52-90 years; mean 71.7 years) were given therapeutic contact lenses as well as systemic and local antibiotics. We investigated the postoperative course with regard to stabilisation of the cornea and deepening of the anterior chamber.The anterior chamber was reestablished in 8 of 13 patients (62%) after an average of 5.25 days (range, 1-15) using multi-layer amniotic membrane transplantation.Our data show that an initial treatment of penetrating corneal ulcers with multilayer amniotic membrane is reasonable. With this procedure the surgeon gains sufficient time for obtain a corneal graft for a possible penetrating corneal transplantation.

To investigate the efficacy of intravitreous bevacizumab and sulphur hexafluoride (SF(6)) for treating submacular hemorrhage secondary to age-related macular degeneration (ARMD).Ten eyes of 10 patients (mean age 78.4 years, +/-6.5) with recent (range 1-4 weeks, median 1.0, mean 1.5) subfoveal hemorrhage secondary to ARMD were included in this study. The size of the subretinal hemorrhage ranged from 0.85 to 21.7 mm(2) (median 6.6 mm(2), mean 9.5 mm(2), +/-8.12). All patients received combined intravitreous injections of 1.25 mg bevacizumab and 0.3 ml SF(6). Follow-up visits were done 4 weeks after treatment. Depending on the ophthalmologic findings, further treatment with antivascular endothelial growth factor (anti-VEGF) injections was planned.Visual acuity improved three or more Snellen lines in six eyes (60%), remained stable in three (30%), and worsened by three or more lines in one eye (10%). Overall, displacement of blood was achieved in eight eyes (80%). In the following months, nine eyes received further injections with VEGF inhibitors. The Wilcoxon paired sample test revealed significant improvement of visual acuity in our patients (p=0.05).Our findings suggest that combined intravitreous injections of bevacizumab and SF(6) have the potential to improve visual outcome in patients with subretinal hemorrhage secondary to ARMD. However, further treatment of the underlying choroidal neovascularization is mandatory.

Bisher wurde über verschiedene Ansätze zur chirurgischen Therapie submakulärer Blutungen bei feuchter altersbedingter Makuladegeneration berichtet. Kleinere Blutungen können mittels intravitrealen Injektionen von SF6-Gas ggf. mit rTPA disloziert werden. Eine Therapieoption bei größeren[for full text, please go to the a.m. URL], 22. Internationaler Kongress der Deutschen Ophthalmochirurgen

Hintergrund und Ziel: Unsere Studie untersucht den Einfluss unterschiedlicher Injektionstechniken auf den Anstieg des Augeninnendrucks nach einer intravitrealen Applikation von 0,05 ml Ranibizumab (Lucentis®) zur Behandlung der exsudativen altersbedingten Makuladegeneration (AMD). Methoden: [for full text, please go to the a.m. URL], 22. Internationaler Kongress der Deutschen Ophthalmochirurgen

Hintergrund: Die operative Behandlung bei persistierendem Makulaforamen oder Rezidiv einer epiretinalen Gliose bleibt eine therapeutische Herausforderung. Jüngere Studien weisen darauf hin, daß schweres Silikonöl in solchen Fällen eine sinnvolle Alternative zur herkömmlichen[for full text, please go to the a.m. URL], 22. Jahrestagung der Retinologischen Gesellschaft

To date, the surgical plan for the removal of epiretinal membranes is mainly adapted to the intraoperative situation. In the current study, we sought to investigate whether the surgical removal of macular pucker can be facilitated by the preoperative assessment of topographic features using high-definition optical coherence tomography (HD-OCT).In a consecutive case series, 20 eyes of 20 patients with macular pucker underwent full ophthalmological evaluation including high-definition optical coherence tomography (Cirrus, Carl Zeiss Meditec) prior to a three-port-pars plana vitrectomy with peel of the epiretinal membrane (ERM). Furthermore, we documented the intraoperative course.Thirteen eyes (65 %) exhibited multiple foci of retinal contraction as detected by HD-OCT. In these eyes, surgical removal of the ERM was facilitated by using HD-OCT images. In contrast, eyes with flat membranes showed a strong adhesion to the retinal surface.Our findings suggest that preoperative assessment of topographic features using high-definition optical coherence tomography has the potential to improve surgical strategies in eyes with macular pucker.

Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a degenerative disease of the peripheral retina and choroid in the elderly. Although PEHCR is often seen by clinicians, this entity is underrepresented in the ophthalmological literature. This may be due to inconsistent naming.We present the clinical, ultrasonographic and angiographic findings of 11 eyes of 8 patients who were diagnosed with PECHR in our department between January 2006 and June 2008. In addition, we report the intra- and postoperative course of three eyes that have been vitrectomised because of a vitreous haemorrhage associated with PEHCR.The mean age of the patients is 83.5 years (range: 75 - 95). The mean follow-up is 11 months (range: 0 to 20). The clinical and angiographic signs were dependent on the stage of the disease and may be seen as small asymptomatic peripheral subretinal bleeding and exudation. In advanced stages, vitreous haemorrhage and exudative retinal detachment may be observed. The temporal periphery of the fundus appears to be more often affected than other locations. Three patients were affected bilaterally. Vitreous haemorrhage was the reason for presentation in three eyes (27 %) that were treated successfully by vitrectomy.Peripheral exudative hemorrhagic chorioretinopathy should be considered in the differential diagnosis of vitreous haemorrhage and peripheral subretinal tumors in the elderly.

Einleitung: Die RABAMES-Studie untersucht und vergleicht die funktionellen und anatomischen Resultate von intravitreal appliziertem Ranibizumab und fokaler Argonlasertherapie zur Behandlung des chronischen Makulaödems nach Venenastverschluß. Methode: Es handelt sich um eine prospektive,[for full text, please go to the a.m. URL], 22. Internationaler Kongress der Deutschen Ophthalmochirurgen

Arteriovenous dissection (AVD) is a surgical maneuver to separate the retinal artery and vein at the crossing site in patients with branch retinal vein occlusion (BRVO). The published studies showed an evidence level 3. AVD seems to be maintainable in patients with recent onset of BRVO and decimal visual acuityor =0.4.

During the past years refractive surgical procedures and particularly laser IN SITU keratomileusis (LASIK) have become established by clinical and experimental studies and are performed worldwide in a high number. This paper provides a survey of the published posterior segment complications of LASIK that may occur albeit very rarely. Additionally, current clinical and experimental hypotheses regarding the pathogenesis of those complications are discussed. Currently a cause-effect relationship between LASIK and reported posterior segment complications has not been proven although a very high number of LASIK procedures have been performed worldwide.

Photodynamic therapy (PDT) and surgical macular translocation are concurrent treatment options for exudative age-related macular degeneration (ARMD). PDT is currently favoured because of positive study results and the non-invasive technique. We report a case of macular translocation with 360 degrees retinotomy after unsuccessful previous PDT for treatment of ARMD.PDT with verteporfin was performed in the left eye of a 79-year-old patient with exudative ARMD and predominantly classic juxtafoveal choroidal neovascularisation (CNV). Because of continuing visual loss and deteriorating angiographic signs three months after PDT, a surgical macular translocation with 360 degrees retinotomy was performed successfully. During the surgery increased adhesion between the CNV and the retina was observed in contrast to patients without previous PDT. In a second step three months later, counter-rotation of the ocular globe was achieved by muscle surgery and the silicone oil was removed in the same session. The best spectacle corrected visual acuity improved from 0.1 before the surgery to 0.4 nine months thereafter (six Snellen lines). No CNV recurrence was observed. Patient satisfaction with the surgery outcome is high.Macular translocation may be considered in cases of continuing deterioration after a previous PDT for treatment of exudative ARMD. Possible complications must be discussed with the patient. Intraoperatively, increased adhesion of CNV to the retina was observed, which might increase the risk of inadvertent damage to the retina during surgery.

The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications of LASIK for the treatment of hyperopia and hyperopic astigmatism using a scanning spot excimer laser.A total of 64 consecutive LASIK operations (37 patients, mean age 41 years, range 22-68 years) have been evaluated. The Hansatome microkeratome producing a superior hinge (flap diameter 9.5 mm) and a scanning spot excimer laser with an optical zone of 6.0 mm were used. Examinations were performed preoperatively, after 1 day, 7 days, 1 month, 4 and 12 months.One year after the primary procedure only 1 eye lost 2 or more lines of best-corrected visual acuity, 91% were within +/-1 line and 4 eyes gained 2 lines. Of these eyes 50 (86%) reached an uncorrected visual acuity ofor=0.5, 32 (55%)or=0.8, 16 (28%)or=1.0, 24 eyes (41%) needed a refractive correction of +/-0.5 D, 44 eyes (76%) of +/-1.0 D and 55 eyes (95%) of +/-2.0 D. The mean spherical equivalent after 1 year was +0.17+/-0.85 D.LASIK is suitable for the correction of hyperopia (up to a maximum of +5 D) and for hyperopic astigmatism (up to a maximum of -5 D). However, results were better in lower hyperopia (up to +3 D) than in the moderate hyperopia. The refractive results showed overall a good stability during the 12-month study period, but higher regression occurred in a few cases.

During recent years refractive surgical procedures have been increasingly used to correct refractive errors. Exact saving and assessment of pre-, intra- and postoperative results for scientific evaluation are desired and are necessary for quality management. The purpose of this investigation was to evaluate the database program Datagraph med (version 2.5) which has been developed for data processing and assessment in refractive surgery.Pre-, intra- and postoperative data of 169 eyes treated with different refractive surgical methods (laser in situ keratomileusis, photorefractive keratectomy, laser thermal keratoplasty, phacic IOL) were collected, entered in the database and then evaluated by the above-mentioned program (with a follow-up of up to 12 months). The exactness of the Datagraph results was compared by means of manual recalculation.Datagraph med was able to precisely process the patient data and save them in a database. Statistics and graphs presented by Datagraph were as data has been entered. Furthermore all standard graphs requested by the international consensus for evaluation of refractive surgical data (stability, predictability, efficacy, safety and complications) could be imaged.Datagraph med is a helpful and precisely functioning program for processing and evaluation of refractive surgical data. It can be used for both scientific studies and for quality control. A continuous development and improvement of the program as well as the addition of statistical functions will be necessary due to the on-going progress in refractive surgery.