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PURPOSE To assess the effect of an internal limiting membrane flap (IF) in macular hole surgery on the best-corrected visual acuity (BCVA) and integrity of the ellipsoid zone (EZ) and external limiting membrane. METHODS Patients were included who had successful surgery for macular hole

To introduce an ETDRS grid-based classification for macula involving retinal detachment (MIRD) with or without center (foveal) involvement and to identify biomarkers in preoperative optical coherence tomography (OCT) associated with a favorable postoperative functional outcome in eyes with center involving retinal detachment (CIRD). One hundred and two eyes of 102 consecutive patients (f/m: 35/67) with primary rhegmatogenous retinal detachment, preoperative evidence of MIRD (perifoveal involvement of ≤ 6.0 mm), and successful retinal surgery were included in this retrospective cohort study. Eyes were assigned to 5 grades of MIRD (G1–G5), based on the extent of detachment in the ETDRS grid. Eyes with a detached foveal status (CIRD) were assigned to G4 or G5. In CIRD, the following OCT biomarkers were quantified and correlated with mean BCVA (logMAR) at 3 months postsurgery, using univariate and multivariable regression models: grade of detachment, extent of intraretinal edema, height of foveal detachment, subretinal folds, and epiretinal membrane. Forty-one of 102 eyes (40.2%) presented with an attached foveal status, defined as either outer (G1: 11.8%) or inner (G2: 18.6%) macular involvement or fovea-threatening MIRD (G3: 9.8%). Sixty-one eyes (59.8%) showed CIRD (G4 or G5). Eyes with CIRD had significantly worse postoperative BCVA than eyes without foveal involvement (0.355 logMAR vs. 0.138 logMAR, ppp=0.072) and 52.4% of eyes with G5 (ppp

Purpose To investigate morphological and functional outcomes of the inverted internal limiting membrane (I-ILM) flap technique in large (≥ 400 μm) idiopathic full-thickness macular holes (FTMH) over a follow-up period of 12 months. Methods In this retrospective study, 55 eyes of 54 consecutive patients were enrolled. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT, Heidelberg, Spectralis) were performed preoperatively as well as 1, 3, 6, 9, and 12 months postoperatively. Special focus was put on the reintegration of outer retinal layers and the different ILM flap appearances. Results FTMH closure rate was 100% (55/55). BCVA significantly improved over the follow-up period of 12 months from 0.98 ± 0.38 LogMAR preoperatively to 0.42 ± 0.33 LogMAR at 12 months postoperatively (p Conclusion Our study highlights the favorable morphological and functional outcomes of the I-ILM flap technique in the short as well as in the long term. While complete ELM restoration revealed to be an important factor for improvement in BCVA, the different postoperative ILM flap appearances seem not to be related to BCVA.

Subretinal injection is a delicate and complex microsurgery. The main surgical difficulties come from the surgeon's hand tremor, dexterous motion, and insufficient visual feedback. In order to begin addressing these challenges, this article presents a robot system for subretinal insertion integrated with intraoperative optical coherence tomography (OCT). The surgical workflow using this system consists of two main parts. The first part is the manual robot control, which aims the target before approaching the retinal surface, while considering the remote center of motion (RCM) constraint. When the injection area has been located precisely, needle is inserted into retina. To ensure surgical safety, needle insertion depth is estimated using OCT images on a continuous basis. A soft RCM control method is designed and integrated for the controller of our hybrid parallel–serial surgical robot. Safety and accuracy performance evaluation with a 15-ms control loop shows that the worst-case RCM deviation error is within 1 mm. Experimental results demonstrated that the proposed system has the ability to improve surgical outcomes by surgeons overcoming their physical limitations in order to enable a better dexterous motion, and furthermore enhancing their visual feedback for a better intraocular perception.

The treatment options for patients with metastatic melanoma (MM) have been dramatically expanded in recent years with the approval of new drugs. The MEK (mitogen-acitvated protein kinase kinase) and BRAF (serine/threonine-protein kinase B-Raf coding gene) inhibitor combination therapy is currently part of the standard of care for stage IIIC/IV of BRAF mutant melanoma. The MEK inhibitor-associated retinopathy (MEKAR) is observed in patients with MM who are treated (or have been treated) with such a combination therapy. This article reports the case of a 72-year-old male patient, who suffered from such a pathological condition under treatment with binimetinib in combination with nivolumab. This case study illustrates the importance of interdisciplinary collaboration in the treatment of MM patients.Die Behandlungsmöglichkeiten für Patienten mit metastasierendem Melanom (MM) wurden in den letzten Jahren mit der Zulassung von neuen Medikamenten dramatisch erweitert. Die MEK(mitogen-aktivierte Proteinkinase-Kinasen)- und BRAF(Serin/Threonin-Kinase B-Raf kodierendes Gen)-Hemmer-Kombinationstherapie gehört aktuell zum Versorgungsstandard für das Stadium IIIC/IV des BRAF-mutierten Melanoms. MEKAR (MEK-Inhibitor-assoziierte Retinopathie) werden bei Patienten mit metastasierendem Melanom beobachtet, die mit einer solchen Kombinationstherapie behandelt werden bzw. wurden. Wir berichten über den Fall eines 72-jährigen Patienten, der eine solche Pathologie unter der Therapie mit Binimetinib in Kombination mit Nivolumab erlitt. Diese Kasuistik verdeutlicht die Wichtigkeit einer interdisziplinären Zusammenarbeit bei der Behandlung von MM-Patienten.

The purpose of this study was to assess the repeatability and reproducibility of measuring the minimum linear diameter (MLD) of macular holes (MHs) using horizontal linear and radial scan modes in optical coherence tomography (OCT). Patients with concurrent sets of radial and horizontal linear OCT volume scans were included. The MLD was measured twice in both scan modes by six raters of three different experience levels (groups). Outcome measures were the reliability and repeatability of MLD measurements. Fifty patients were included. Mean MLD was 317.21(±170.63) µm in horizontal linear and 364.52 (±161.71) µm in radial mode, a difference of 47.31 (±26.48) µm (p &lt, 0.001). In the radial scan mode, MLD was identified within 15° of the horizontal meridian in 27% and within 15° of the vertical meridian in 26.7%, with the remainder (46.3%) in oblique meridians. The intra-group coefficients of repeatability (CR) for horizontal linear mode were 23 µm, 33 µm and 45 µm, and for radial mode 25 µm, 44 µm and 57 µm for groups 1, 2 and 3, respectively. The inter-group CR, taking group 1 as reference standard for groups 2 and 3, were 74 µm and 71 µm for the linear mode, and 62 µm and 78 µm for radial mode. The radial mode provides good repeatability and reliability for measurement of MLD. In a majority of cases the MLD does not lie in the horizontal meridian and would be underestimated using a horizontal OCT mode.

Purpose The purpose of this study was to develop methods to model the external limiting membrane (ELM) and ellipsoid zone (EZ) within the elevated cuff surrounding a macular hole (MH) to determine if the predicted size of the defect in these layers after virtual flattening was associated with the actual postoperative defect and best-corrected visual acuity (BCVA). Methods Patients were included who had undergone successful MH surgery. The defects in the ELM and EZ after virtual flattening were modeled using in-house software. Main outcomes were postoperative defects in ELM and EZ at 2 months and BCVA at 12 months. Results Fifty-eight patients were included. BCVA improved from 0.87 (0.31) logMAR pre-operatively to 0.26 (0.21) at 12 months (P < 0.001). For both the ELM and EZ, the predicted virtually flattened pre-operative defects were associated with the actual postoperative defects at 2 months (R2 = 0.33, P < 0.01 and R2 = 0.50, P < 0.01, respectively). There was a significant association of BCVA at 12 months (adjusted R2 = 0.85) with the pre-operative modeled area of the defect in the ELM (P < 0.01) and to a lesser extent with the defect in the EZ (P < 0.01) and base of the MH (P < 0.01). Conclusions Virtually flattening of the pre-operative defect in the ELM provides important predictive information of visual acuity. Incorporation of tools into commercially available optical coherence tomography (OCT) devices to facilitate such measurements would provide the clinician with important prognostic information. Translational Relevance We have developed methodology that can potentially be used to predict the postoperative state of the outer retinal layers and the associated visual outcome in patients undergoing surgery for MH.

Machine learning and especially deep learning techniques are dominating medical image and data analysis. This article reviews machine learning approaches proposed for diagnosing ophthalmic diseases during the last four years. Three diseases are addressed in this survey, namely diabetic retinopathy, age-related macular degeneration, and glaucoma. The review covers over 60 publications and 25 public datasets and challenges related to the detection, grading, and lesion segmentation of the three considered diseases. Each section provides a summary of the public datasets and challenges related to each pathology and the current methods that have been applied to the problem. Furthermore, the recent machine learning approaches used for retinal vessels segmentation, and methods of retinal layers and fluid segmentation are reviewed. Two main imaging modalities are considered in this survey, namely color fundus imaging, and optical coherence tomography. Machine learning approaches that use eye measurements and visual field data for glaucoma detection are also included in the survey. Finally, the authors provide their views, expectations and the limitations of the future of these techniques in the clinical practice.

Ophthalmic microsurgery is known to be a challenging operation, which requires very precise and dexterous manipulation. Image guided robot-assisted surgery (RAS) is a promising solution that brings significant improvements in outcomes and reduces the physical limitations of human surgeons. However, this technology must be further developed before it can be routinely used in clinics. One of the problems is the lack of proper calibration between the robotic manipulator and appropriate imaging device. In this work, we developed a flexible framework for hand-eye calibration of an ophthalmic robot with a microscope-integrated Optical Coherence Tomography (MIOCT) without any markers. The proposed method consists of three main steps: a) we estimate the OCT calibration parameters; b) with micro-scale displacements controlled by the robot, we detect and segment the needle tip in 3D-OCT volume; c) we find the transformation between the coordinate system of the OCT camera and the coordinate system of the robot. We verified the capability of our framework in ex-vivo pig eye experiments and compared the results with a reference method (marker-based). In all experiments, our method showed a small difference from the marker based method, with a mean calibration error of 9.2 $\mu$m and 7.0 $\mu$m, respectively. Additionally, the noise test shows the robustness of the proposed method., Comment: *The first two authors contributed equally to this paper. Accepted by IEEE Robotics and Automation Letters (RA-L), 2018

To investigate safety of accelerated corneal crosslinking during the first postoperative month. In this retrospective study, 76 eyes of 60 patients with verified progressive keratectasia were enrolled in this study and followed for 1 month after accelerated CXL (18 mW/cm2 for 5 min, radiant exposure 5.4 J/cm2) (A-CXL(5*18)). Preoperatively, objective refraction, slit lamp inspection, and corneal tomography were performed. Early postoperative slit lamp examinations were performed on days 1 and 4. At 1 month, objective refraction, slit lamp inspection, and corneal tomography were performed. Gender distribution was m:f = 55:21, OD:OS was 40:36, and the average age was 26.5 ± 8.6 years at surgery. Only 71 of the 76 eyes completed the 1-month follow-up, indicating a dropout rate of 6.6%. In 7.0% (n = 5), sterile infiltrates were observed; 5.6% of eyes (n = 4) showed delayed epithelial healing (> 4 days) in 2.8% (n = 2); an infection occurred and in 1 eye (1.4%), a stromal scar was detected; no other complications, neither a loss of two or more Snellen lines at 1 month postoperatively, were observed. As a risk factor for sterile infiltrates, thin preoperative pachymetry could be identified (p = 0.027). This study revealed no difference in early postoperative safety between CXL using 18 mW/cm2 and standard corneal CXL. Thinner preoperative pachymetry could be identified predicting a higher rate of postoperative sterile infiltrates.

PurposeThe purpose of this study was to determine a cutoff for progression of idiopathic full-thickness macular hole (MH) size.MethodsRetrospective analysis of consecutive patients waiting 4 weeks for MH surgery. Two observers performed 3 repeat sets of MH size measurements on optical coherence tomography (OCT) high-density radial scans taken at first presentation and 4 weeks later before surgery. Primary outcome was the definition of a cutoff for true enlargement of MH size versus measurement error. Secondary outcomes were risk factors for change in minimum linear diameter (MLD) size and best-corrected visual acuity (BCVA).ResultsFifty-one patients were included with a mean MH size of 334 µm (±179 µm; range 39 to 793 µm). The cutoff for an increase in MLD size calculated as the outer confidence limit for the 99.73% limits of agreement was 31 µm. This was independent of MH size. Using this cutoff, MLD size increased in 9/34 (26.5%) of patients without and in 14 of 17 (82.4%) of patients with vitreomacular traction (VMT; P < 0.001). Mean BCVA deteriorated in patients in whom the MH had progressed from 0.62 (±0.23) logMAR to 0.82 (±0.29; P < 0.001), whereas there was no significant change in BCVA in patients without MH progression (P = 0.25). In 31% (16/51) of patients, classification of their MHs (small ≤250 µm, medium 251-400 µm, and large >400 µm) changed over the 4-week period.ConclusionsUsing a cutoff discriminates change from measurement error. A significant proportion of MHs progressed by 4 weeks, particularly in the presence of VMT.Translational relevanceThe established cutoff enables clinicians to differentiate true MH enlargement from measurement error.

ZusammenfassungArterielle Gefäßverschlüsse sollten als Notfall bewertet werden und sind als okuläres Analogon zum zerebralen Apoplex zu sehen. Sie besitzen dieselben arteriosklerotischen Risikofaktoren, die auch bei Herz-, Kreislauf- und zerebrovaskulären Erkrankungen ursächlich sind, weshalb eine intensive interdisziplinäre Abklärung erforderlich ist, um mögliche Komorbiditäten rechtzeitig zu erkennen und gegebenenfalls zu behandeln. Die derzeitigen Therapiemöglichkeiten eines akuten arteriellen Gefäßverschlusses sind in ihrer Effizienz hinsichtlich Visusverbesserung sehr limitiert. Verfahren zur systemischen Lyse können in der Routineversorgung aufgrund ihres deutlich erhöhten Nebenwirkungsprofils nicht empfohlen werden. Hinzu kommt ein begrenztes Zeitfenster von bis zu 6 Stunden nach Symptombeginn (Retinatoleranzzeit), in dem nach Studienlage eine Intervention überhaupt nur sinnvoll zu sein scheint. Dagegen haben die neuen Therapiemöglichkeiten retinaler Venenverschlüsse, insbesondere durch die intravitreale operative Medikamentenapplikation, zu deutlichen Visusverbesserungen geführt. Die Wirksamkeit und Effizienz der einzelnen Anti-VEGF-Medikamente ist nach aktueller Studienlage vergleichbar. Alternativ kann auch der Einsatz von Steroiden erwogen werden, wobei hierbei das Nebenwirkungsprofil sorgfältig abgewogen werden sollte. Des Weiteren kann ergänzend und gerade beim Vorliegen von retinalen Ischämien die periphere Photolaserkoagulation einen visusstabilisierenden Effekt haben und die Ausbildung von Neovaskularisationen verhindern. Es wird angenommen, dass die Kombination aus IVOM- und Lasertherapie einen symbiotischen Effekt haben könnte.

Zusammenfassung Hintergrund Die hochauflösende optische Kohärenztomografie (OCT) ermöglicht eine kontrastreiche Bildgebung von Mikrostrukturen, die mit konventioneller Bildgebung nicht so detailliert darstellbar waren. Wir berichten über unsere Erfahrungen beim Einsatz der intraoperativen OCT (iOCT) in der vitreoretinalen Chirurgie. Methoden 110 Patienten mit vitreoretinalen Erkrankungen (Makulaforamen, epiretinale Membranen, vitreomakulärem Traktionssyndrom, Ablatio und Glaskörperblutung) wurden unter Visualisierung mit dem im Mikroskop integrierten iOCT-Gerät operiert. Ergebnisse Das iOCT liefert durch die Integration von Mikroskop und SD-OCT eine sofortige Visualisierung der „Region of Interest“ (ROI). Der Operateur erhält neben dem Mikroskopbild die intraoperative Darstellung aller Netzhautschichten, des Glaskörpers sowie der Instrument-Gewebe-Interaktion in Echtzeit und kann diese intraoperativ sofort verfügbare Information für die chirurgische Strategie nutzen. Schlussfolgerung Bisher ist das iOCT nur als Standmikroskop erhältlich, es besitzt keine Messfunktion, keine Tracking-Funktion, und die Metallinstrumente verdecken den Scan. Künftig könnten transparente Instrumente, Tracking-Funktionen, ein Autofokus sowie eine noch bessere Auflösung eine optimierte, lückenlose, hochauflösende intraoperative OCT-Diagnostik in Echtzeit erlauben.

This paper introduces an optimized input device workflow to control an eye surgical robot in a simulated vitreoretinal environment. The input device is a joystick with four Degrees of Freedom (DOF) that controls a six DOFs robot. This aim is achieved through a segmentation plan for an eye surgeon. In this study, the different surgical phases are defined while each phase includes their specific number of DOFs. The segmentation plan is divided into four surgical phases: Phase I: Approach with three DOFs; Phase II: Introduction with three DOFs; Phase III: Aim with 3+1 DOFs; and Phase IV: Injection with one DOF. Taking these phases into consideration, an eye surgical robot with six DOFs could be controlled through a joystick with only four DOFs intuitively. In this work we show that reducing the number of DOFs will decrease the complexity of the surgery with a robotic platform.

Subretinal injection is known to be a complicated task for ophthalmologists to perform, the main sources of difficulties are the fine anatomy of the retina, insufficient visual feedback, and high surgical precision. Image guided robot-assisted surgery is one of the promising solutions that bring significant surgical enhancement in treatment outcome and reduces the physical limitations of human surgeons. In this paper, we demonstrate a robust framework for needle detection and localization in subretinal injection using microscope-integrated Optical Coherence Tomography (MI-OCT) based on deep learning. The proposed method consists of two main steps: a) the preprocessing of OCT volumetric images; b) needle localization in the processed images. The first step is to coarsely localize the needle position based on the needle information above the retinal surface and crop the original image into a small region of interest (ROI). Afterward, the cropped small image is fed into a well trained network for detection and localization of the needle segment. The entire framework is extensively validated in ex-vivo pig eye experiments with robotic subretinal injection. The results show that the proposed method can localize the needle accurately with a confidence of 99.2%.

Background: To assess functional and morphological outcomes in patients with chronic recurrent neovascular age-related macular degeneration (nAMD) previously treated with ranibizumab, who were either switched from ranibizumab to aflibercept or received further ranibizumab injections. Methods: Retrospective analysis of eyes with recurrent nAMD previously treated with ranibizumab. On recurrence of the macular oedema, patients had received either 3 injections of aflibercept (2.0 mg) or ranibizumab (0.5 mg) at 4 week intervals. Patients were examined before the first injection and four weeks after the last injection. The main outcome measures included change in visual acuity (VA) in logMAR, subfoveal central retinal thickness (CRT), subretinal fluid (SRF) and height of pigment epithelial detachment (PED height), as well as the maximum height of macular subretinal fluid (SRF max) and of macular pigment epithelial detachment (PED height max) in spectral-domain optical coherence tomography (OCT). Changes in VA and OCT were compared between the two groups to investigate differences in the therapeutic effects of aflibercept and ranibizumab. Results: 60 eyes of 55 patients were included. The aflibercept group (n = 30) and the ranibizumab group (n = 30) showed no statistically significant differences in mean age (p = 0.813), number of prior injections of ranibizumab (p = 0.127) or time since last injection (p = 0.523). Mean VA logMAR improved in both groups, though only in the ranibizumab group was the difference significant (0.50 ± 0.33 to 0.44 ± 0.29 logMAR; p = 0.013; Table 1). CRT decreased in the aflibercept (p = 0.133) and ranibizumab groups (p = 0.043). PED height was reduced in both groups (aflibercept p = 0.068; ranibizumab p = 0.241). SRF, SRF max and PED height max showed statistically significant decreases in both groups. Comparison of the aflibercept and the ranibizumab groups showed no statistically significant differences between the two groups in change in VA logMAR (p = 0.680), CRT (p = 0.882), SRF (p = 0.871), PED height (p = 0.524), SRF max (p = 0.940) or PED height max (p = 0.762). Conclusions: Aflibercept and ranibizumab were similarly effective in improving visual acuity and morphological parameters of patients with recurrent nAMD after four months. There were no statistically significant differences in the therapeutic effects of the two drugs.

BACKGROUND AND OBJECTIVE: To describe optical coherence tomography angiography (OCTA) findings in patients with acute central serous chorioretinopathy (CSC) compared to conventional imaging methods. PATIENTS AND METHODS: A consecutive series of 11 eyes from 10 healthy patients with acute CSC were included and underwent fluorescein angiography (FA), indocyanine green angiography (ICGA), OCT, fundus autofluorescence (FAF), and OCTA. Obtained OCTA images were evaluated for the presence of serous detachments of the neurosensory retina, leakage points, or other altered findings and compared to conventional imaging devices. RESULTS: In four out of 11 eyes, it was possible to detect detached retina adjacent to the leakage point in OCTA images, compared with four of 11 eyes using FA, five of 11 eyes using ICGA, 11 of 11 eyes using SD-OCT, and four of 11 eyes using FAF. In five out of 11 eyes, irregular flow patterns were observed on OCTA images through the choriocapillaris. OCTA images could not identify leakage points in any of the included eyes, compared with 11 out of 11 eyes on FA, five out of 11 eyes on ICGA, eight out of 11 eyes on SD-OCT, and zero out of 11 eyes on FAF. CONCLUSION: OCTA images of the superficial and deep retinal plexus, outer retina, and choriocapillaris did not reveal altered flow patterns directly associated with the leakage point in acute CSC. However, OCTA was able to visualize altered choroidal flow in some of the included eyes. [ Ophthalmic Surg Lasers Imaging Retina . 2016;47:322–327.]

Aim To describe retinal findings of various imaging modalities in acute retinal ischemia. Methods Fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), OCT-angiography (OCT-A) and fundus autofluorescence (FAF) images of 13 patients (mean age 64y, range 28-86y) with acute retinal ischemia were evaluated. Six suffered from branch arterial occlusion, 2 had a central retinal artery occlusion, 2 had a combined arteriovenous occlusions, 1 patient had a retrobulbar arterial compression by an orbital haemangioma and 2 patients showed an ocular ischemic syndrome. Results All patients showed increased reflectivity and thickening of the ischemic retinal tissue. In 10 out of 13 patients SD-OCT revealed an additional highly reflective band located within or above the outer plexiform layer. Morphological characteristics were a decreasing intensity with distance from the fovea, partially segmental occurrence and manifestation limited in time. OCT-A showed a loss of flow signal in the superficial and deep capillary plexus at the affected areas. Reduced flow signal was detected underneath the regions with retinal edema. FAF showed areas of altered signal intensity at the posterior pole. The regions of decreased FAF signal corresponded to peri-venous regions. Conclusion Multimodal imaging modalities in retinal ischemia yield characteristic findings and valuable diagnostic information. Conventional OCT identifies hyperreflectivity and thickening and a mid-retinal hyperreflective band is frequently observed. OCT-A examination reveals demarcation of the ischemic retinal area on the vascular level. FAF shows decreased fluorescence signal in areas of retinal edema often corresponding to peri-venous regions.

BACKGROUND AND OBJECTIVE: To correlate subfoveal choriocapillaris (CC) flow density with age using spectral-domain optical coherence tomography angiography (SD-OCTA). PATIENTS AND METHODS: One hundred eighty-three eyes of 94 subjects (66 female, 28 male) were enrolled. Included were healthy subjects between the ages of 21 and 82 years without any history of vitreoretinal disease. Measurements were obtained with software from the OCT device. Significance was defined as a P value of less than .05. RESULTS: The mean age was 43.43 years ± 17.63 years. Correlation between decreasing CC flow density and increasing age was significant ( P < .001), with a mean yearly flow decrease of 0.026%. Subfoveal choroidal thickness decreased with advancing age; however, this did not reach a level of significance ( P = .069). CONCLUSION: There is a significantly negative correlation between CC flow density and advancing age in healthy subjects, analyzing direct extracted in-built software values from a commercial SD-OCTA device. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:302–308.]

Die Patienten entwickelten primar eine Visusminderung ein- bzw. beidseitig bei angiographisch und klinisch diagnostiziertem Papillenodem. Bei unauffalliger neurologischer und internistischer Abklarung bestatigte eine Serologie letztlich den Verdacht auf eine Papillitis bei akuter Syphilis. Eine Papillitis mit Visusminderung kann Symptom einer Syphilis sein. Man sollte hier nicht nur an die bekannte plakoide Chorioretinitis bei Lues denken. Eine ausfuhrliche Anamnese und diagnostische Masnahmen sind zur Ursachenfindung unerlasslich. Zielfuhrend sind meist auch das relativ junge Alter der Patienten, das mannliche Geschlecht, sexuelle Orientierung sowie fehlende klassische Risikofaktoren fur eine anteriore ischamische Optikusneuropathie (AION) oder neurologische Ursachen fur eine randunscharfe geschwollene Papille wie eine intrakranielle Raumforderung (Stauungspapille).

BACKGROUND AND OBJECTIVE: To investigate choriocapillary blood flow in myopic eyes using optical coherence tomography angiography. PATIENTS AND METHODS: Seventy-eight myopic and 79 age-matched healthy eyes were included in this study, with myopia defined as a spherical equivalent refraction (SER) between −1 diopters (D) and −6 D. Quantitative measurements of the choriocapillaris were obtained using the Avanti RTVue XR with AngioVue. Choroidal thickness (CT) was assessed using the single-line enhanced high-definition scan of the same device. RESULTS: CT correlated positively with SER ( P = .017) and negatively with bulbus axial length (AL) ( P = .180). Subfoveal choriocapillary blood flow did not show any significant correlation with any of the parameters SER, AL, or CT ( P = .798, P = .269, and P = .820, respectively). The mean flow signal of the myopic group did not differ significantly from the mean flow signal of the emmetropic control group ( P = .266). CONCLUSION: Choriocapillary blood flow seems to retain a constant level with increasing physiological myopia. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:e133–e139.]

The standard measure for the assessment of functional vision in the central retina is best corrected visual acuity (VA). Our aim was to investigate whether it is an advantage to include tests for functional changes in the near retinal periphery to monitor treatment effects in patients receiving multiple injections of anti-vascular endothelial growth factor (anti-VEGF) agents for advanced exudative age-related macular degeneration (AMD).Prospective pilot study.Our cohort consisted of 24 patients with exudative AMD (mean age ± SD: 77.46 ± 7.82 years) treated at an ophthalmology clinic.We compared data from standard functional measurements, VA-near, and contrast sensitivity (CS), with results from the macular mapping test (MMT) at 10% and 100% contrast. Measurements of retinal thickness by optical coherence tomography (OCT) were used to document the morphologic efficacy of the anti-VEGF agent. Tests were performed at baseline and 4 weeks after 3 monthly ranibizumab injections.All 4 functional tests yielded successes (equal or better visual performance after treatment) in 79.2% to 83.3% of cases. Including test locations in the near periphery yielded the highest success rate in the MMT at 10% contrast. Values for VA-near and CS also improved in a majority of cases. OCT measurements of retinal thickness indicated that the agent was effective in the fovea and near periphery.Our findings indicate that using the MMT adds information about functional changes in the near periphery of the retina and allows more sensitive assessment of treatment effects or disease progression without the high expense of other techniques.

AIM: To evaluate and compare structural optical coherence tomography (OCT)-based parameters, such as Bruch’s membrane opening-minimum rim width (BMO-MRW), and retinal nerve fiber layer (RNFL) thickness in glaucoma patients with visual field (VF) defects, and to correlate both to mean deviation (MD) values of obtained standard achromatic perimetry (SAP) examinations. METHODS: Patients with glaucoma and glaucomatous VF defects were enrolled in this prospective study and compared to age-matched healthy individuals. All study participants underwent a full ophthalmic examination and VF testing with SAP. Peripapillary RNFL thickness and BMO-MRW were acquired with SD-OCT. Correlation analyses between obtained global functional and global as well as sectorial structural parameters were calculated. RESULTS: A consecutive series of 30 glaucomatous right eyes of 30 patients were included and compared to 36 healthy right eyes of 36 individuals in the control group. Global MD of values correlated significantly with global RNFL (Pearson corr. coeff: 0.632, P=0.001) and global BMO-MRW (Pearson corr. coeff: 0.746, P4 diopters) within the glaucoma group (n=6) revealed a tendency for higher correlations between MD and BMO-MRW than MD and RNFL measurements. CONCLUSION: In a clinical setting, RNFL thickness and BMO-MRW correlate similarly with global VF sensitivity in glaucoma patients with BMO-MRW showing higher correlations in myopic glaucoma patients.

Purpose: To examine the biocompatibility of Siluron Xtra® (Fluoron, Ulm, Germany), a silicone oil used as a vitreous substitute in vitreo-retinal surgery on porcine retinal tissue in vitro. Methods: Retinal tissue of 37 porcine eyes was immediately prepared post mortem and placed into Minucell perfusion systems (Minucell, Bad Abbach, Germany) to be perfused with liquid culture medium over a period of 4-8 days. 23 retinal tissue samples including retinal pigment epithelium (RPE) were covered by silicone oil (group 1) during the perfusion and compared to a control group of 7 samples (group 2) without silicone oil. Group 3 included 7 single RPE tissues without retinal tissue layer in direct contact with silicone oil, thus imitating a retinal tear, during the perfusion. The morphology of the retina and RPE was examined by light microscopy and stained with immunohistochemical markers to determine Muller cell damage in the retina with Glial fibrillary acidic protein (GFAP) and proliferation in the RPE with Ki67. Results: Ki67 staining showed significantly less proliferation in the tissue covered by silicone oil (group 1) compared to the control samples in group 2 (p=0.001). Direct contact of silicone oil and RPE (group 3) showed no significant increase in proliferation compared to the controls (p=1). GFAP staining also did not show any significant Muller cell damage related to Siluron Xtra® (p=0.9). No structural changes in the retinal tissue were observed related to silicone oil by HE staining. Conclusion: The results of our in vitro examination verified good structural biocompatibility of silicone oil (Siluron Xtra®) on porcine retina and RPE in vitro. Furthermore, silicone oil may exert a protective layer preventing proliferation on retinal tissue. Further examination of other silicone oils and alternative vitreous substitutes, such as gas and water are necessary to determine the protective advantage of Siluron Xtra® on retinal tissue proliferation.

Purpose To assess efficacy and safety of intravitreal ranibizumab 0.5 mg plus laser (COMBI) versus laser monotherapy (LASER) in patients with visual impairment due to diabetic macular oedema (DME) in either nonproliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) and to analyse the relevance of inner versus outer retinal thickness. Methods In this double‐masked, multicentre phase IIIb study, patients (N = 128) were randomized (2:1) to receive COMBI (n = 85) versus LASER (n = 43). Patients received four initial monthly injections of ranibizumab 0.5 mg (COMBI) or sham (LASER) followed by pro re nata (PRN) injections. In both groups, patients received laser at baseline and additional laser at 3 monthly intervals, as needed. The study was started in 2010 and was prematurely terminated due to approval of ranibizumab for DME. Results The least squares (LS) mean change in mean best‐corrected visual acuity (BCVA) from baseline to month 12 was higher in the COMBI (6.5) versus LASER (2.3) group (LS mean difference: 4.2 [95% CI 0.9; 7.4] letters, p = 0.01, primary end‐point). There was also a tendency in the same direction for the subgroup of 26 patients with PDR (LS mean difference 14.7, p = 0.11). Mean central retinal thickness decreased by 107.3 μm in the COMBI group and by 80.3 μm in the LASER group from baseline to month 12 (p = 0.28). Ranibizumab was well tolerated. Conclusion This study showed that ranibizumab plus laser is a valuable treatment option for the management of DME. Patients with DME in PDR might also benefit from combined therapy compared to laser alone.

Objective: To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). Methods: This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. Results: After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. Conclusion: In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.

Presented here are two cases of patients with unclear visual loss. A diagnostic assessment with spectral domain optical coherence tomography (Sd-OCT), fluorescein angiography (FLA) and blood analyses was performed due to vitreous clouding. Characteristic FLA findings for papillitis and vasculitis and as yet undescribed morphological Sd-OCT changes in the photoreceptor layer and in the pigment epithelium were found. During the treatment of the diagnosed lues these changes were resolved. The Sd-OCT technique seems to be a useful and effective diagnostic tool for uveitis diagnostics.

To evaluate the safety, efficacy, predictability and stability of laser in situ keratomileusis (LASIK) with a 1000-Hz scanning spot excimer laser (Concept System 1000; WaveLight GmbH, Erlangen, Germany).LASIK was performed on twenty eyes with myopia or myopic astigmatism (mean spherical equivalent refraction: -3.97±1.72 dioptres (D); mean cylinder: -0.84±0.77 D) using a microkeratome for flap creation and the Concept System 1000 for photoablation. Patients were examined preoperatively as well as 1, 3 and 6 months after the treatment. Manifest sphere and cylinder, uncorrected (UCDVA) and best corrected (BCDVA) distance visual acuity, corneal topography and pachymetry were analysed.We observed no adverse events that might have been associated with the use of a repetition rate of 1000 Hz. All eyes maintained or had improved BCDVA at 6 months after treatment when compared to preoperative values. Six months after LASIK, UCDVA was 20/20 or better in 85% and 20/25 or better in 100% of the eyes. The spherical equivalent refraction was within ±0.50 D in 95% of the eyes at 6 months after surgery. The refraction stayed stable over time; 95% of the eyes changed

Vasoproliferative retinal tumors are benign tumors of unknown origin often accompanied by vitreoretinal inflammation. A 21-year-old female patient presented with acute reduced unilateral visual acuity. A solid yellow vascularized lesion was present in the inferior temporal retina accompanied by localized retinal detachment and accumulation of hard exudations. The only finding was an increased Bartonella henselae titer. Persistence of uveitis and blurred vision led to therapy for Bartonella henselae with macrolide antibiotics and successful tumor regression was achieved by cryotherapy.

We present the case of an 11-year-old girl with continuously progressive loss of vision. Fundoscopy revealed a picture consistent with Stargardt's disease and fundus flavimaculatus. This article provides a short overview of differential diagnoses worth considering in children and adolescents who present with a similar picture. After our initial workup, genetic chip analysis of the ABCA4 gene was performed, which yielded a heterozygous mutation. Because a second mutation could likely have been on a part of the gene not screened by chip analysis, and in light of the striking picture, a clinical diagnosis of Stargardt's disease was made.

PURPOSE: The accuracy of intraocular lens (IOL) calculation is limited by the variation of the measurement of corneal power, axial length, anterior chamber depth, and effective postoperative lens position. Therefore, IOL predictability is limited. The aim of this study was to evaluate the performance of the novel light adjustable lens (LAL, Calhoun Vision). METHODS: Ten eyes with cataracts (seven patients) were included. After standard phacoemulsification, the LAL was implanted. Two to 3 weeks after surgery, all IOL adjustments had been completed. Preoperatively, pre-adjustment, pre-lock-in, and 1 month post-lock-in, a full ophthalmic examination including objective (autorefraction) and subjective refraction (ie, manifest uncorrected visual acuity [UCVA] and manifest best spectacle-corrected visual acuity [BSCVA]) and topography were performed. RESULTS: All cataract surgeries were performed with no complications. Two weeks after surgery, the mean refraction was +0.78±0.79 diopters (D). After adjustment and lock-in, the refraction was −0.07±0.21 D. In 4 of 10 eyes, second adjustments were necessary. One month after surgery, all patients were within ±0.50 D of the intended refraction. Preoperatively, the cylinder was 0.88±0.77 D, but was reduced after adjustments to 0.15±0.20 D. Mean UCVA was 1.02, and all eyes gained at least two lines on the Snellen visual acuity test (ie, BSCVA) after surgery. CONCLUSIONS: The LAL is a new IOL with the ability to correct up to 2.00 D of sphere and cylinder after implantation. Our first clinical results are promising and indicate effective safety and stability. [ J Refract Surg . 2010;26:314–320.]

Systemic hypotension exacerbates the progression of normal pressure glaucoma. We present a female patient with glaucomatous disc changes in the setting of inconspicuous tonometry. Failure of the adrenal gland, thyroid and pancreatic islet cells (Schmidt-Carpenter syndrome) likely formed the basis of the ocular pathology. This clinical constellation provided the chance to influence disease progression by raising the nocturnal blood pressure in addition to lowering intraocular pressure.

Retinal vessel responses to flickering light are different in various systemic and ocular diseases and can be improved after successful therapy. We investigated retinal vessel response to flickering light in age-related macular degeneration (AMD) patients before and after treatment with a single intravitreal bevacizumab (Avastin(®) ) injection.In 10 patients with exudative AMD [age: median (1.quartile; 3.quartile) 76.0 (73.5; 80.0) years], retinal vessel reactions were examined by Dynamic Vessel Analyser (DVA) before and 3 months after a single intravitreal application of bevacizumab (1.25 mg). A baseline measurement was followed by three consecutive monochromatic flicker stimulations (530-600 nm, 12.5 Hz, 20 seconds). Temporal retinal vessel reaction was analysed and compared with the reaction in healthy controls.Mean arterial dilation at the end of flicker was not different in all groups. For veins this parameter amounted to: pre-treatment, 2.6 (1.7; 3.9)%; post-treatment, 2.9 (2.4; 4.0)%; control, 4.3 (3.2; 5.7)%; significant: pre-treatment - control (Dunnett's procedure, p0.05). Maximal dilation occurred in arteries at: pre-treatment, 17.5 (14.8; 32.5) seconds; post-treatment, 18.0 (16.6; 30.6) seconds; control, 14.5 (10.8; 17.3) seconds. Both AMD groups were slower (p0.05): in veins at 17.0 (14.5; 20.0) seconds, 12.8 (8.6; 14.8) seconds and 18.5 (17.1; 19.9) seconds, respectively; significant post-treatment - control (p0.05). In the post-treatment AMD group arterial constriction after stimulation occurred more slowly compared with the control group (p0.05).Dynamic retinal arterial and venous reactions to flickering light are altered in AMD compared with controls. Three months after a single injection of a vascular endothelial growth factor inhibitor, the investigated retinal dynamic vascular parameters were not altered in our study.

A 74-year-old man presented with persistent metamorphopsias of the right eye 2 weeks after intravitreal injection of bevacizumab to treat choroidal neovascularization due to exudative age-related macular degeneration. The diagnosis reached was retinochoroiditis as an occult manifestation of sarcoidosis, possibly resulting from an intravitreal injection of bevacizumab. The patient received a prescription for 100 mg Ultralan to be taken daily for 3 days and then tapered in 3 day steps. During the further course no deterioration of the condition was observed.

We present the case of a 40-year-old female patient with sudden onset of anisocoria and unilateral ptosis of the left eye. With the exception of several previous episodes of nausea and vomiting, mild headache and tiredness, combined with the early death of the patient's mother following aortic rupture, patient history and clinical condition showed no pathological findings. Following indicative findings on duplex sonography, a dissection of the left internal carotid artery from its origin to its distal section was detected on CT angiography of the brain vessels and the diagnosis of Horner syndrome due to internal carotid artery dissection was made. Since this condition is associated with serious embolic complications, prompt treatment following diagnosis is of utmost importance. Our patient was treated conservatively using PTT (partial thromboplastin time)-effective heparinisation. Regular checks including kidney ultrasound, blood pressure measurement, imaging and continuous therapy with acetylsalicylic acid are recommended.

Purpose: Intravitreal injections are used extensively to treat retinal diseases. Performing an intravitreal injection increases intraocular volume by the amount of fluid brought into the eye. Whether this influences intraocular pressure (IOP) was investigated here. Methods: A biomechanical model relying on 3-dimensional elasticity theory was developed to determine the short-term effect of volume changes on IOP. We calculated the effect for intravitreal injections of 0.1 ml in myopic, emmetropic and hyperopic eyes. Our calculations were compared with IOP measurements obtained immediately after intravitreal injection of 4 mg triamcinolone in 0.1 ml solution (IVTA) in 22 patients. Shortly after the measurement had been taken, IOP was reduced by paracentesis. Results: Immediately after IVTA, measured IOP was elevated by a mean of 40.6 ± 12.1 mmHg compared with initial pressure (p

During excimer laser photoablation keratocyte cell death is induced in the retroablation area. Afterwards this area is repopulated by keratocyte mitosis and migration from the adjacent stroma. The aim of this study was to investigate keratocyte density in the retroablation area and in the posterior stroma during the first year after LASEK for the correction of myopia.In a prospective study LASEK surgery was performed in 17 eyes of 10 consecutive patients for the correction of myopia (-2.25 D to -9.0 D, mean -5.0 D). Confocal microscopy (Nidek Confoscan 2) was performed before surgery and 1 month, 3 months, 6 months and 12 months after LASEK. Keratocyte density was assessed in the anterior retroablation area at depths of 5 mum and 25 mum and in the posterior stroma at distances of 5 mum and 100 mum from the corneal endothelium and compared with the corresponding area before surgery.Keratocyte density was statistically significant reduced in the retroablation area at all timepoints after LASEK. At a depth of 5 mum, cell densities were decreased by 64%, 47%, 43%, and 28% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. At a depth of 25 mum, cell densities were decreased by 51%, 32%, 28%, and 18% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. In the posterior stroma no significant change in keratocyte density was observed at any time after LASEK.Keratocyte density in the anterior retroablation area recovers during the first year after LASEK for the correction of myopia, but does not go back to preoperative values.

Histologisch entspricht die Sekundarkatarakt („posterior capsule opacification“ [PCO]) regenerativem Gewebe aus transformierten Linsenepithelzellen („lens epithelial cells“ [LEC]) und Extrazellularmatrix. In dieser Studie wurde der Einfluss ionisierender Strahlen auf proliferierende LEC in vitro untersucht. Jeweils vier bzw. 14 Linsen aus Schweinebulbi wurden mit Elektronen der Energie 6 MeV mit je 8, 10, 12 und 20 Gy bestrahlt. 1–2 h nach Radiatio wurde der Linsenkern durch Kapsulorrhexis und Hydrodissektion aus der Linsenkapsel extrahiert. Nach Fixation der Linsenkapsel in einer speziellen Halterung wurde taglich die Proliferation residueller LEC bei zwolffacher Vergroserung untersucht und photographisch dokumentiert. Der Versuch galt als beendet, wenn die Linsenkapsel durch konfluierende Zellproliferate vollstandig getrubt war. Eine Radiatio mit Elektronen verzogert signifikant die Entwicklung einer PCO im Dosisbereich von 8–12 Gy in vitro. Ab 20 Gy induziert sie eine vollstandige Inhibition der PCO. Zur Inhibition einer PCO in vitro ist eine Einzeldosis von mindestens 20 Gy erforderlich. Das hier angewandte Modell erlaubt eine optimale Untersuchung der PCO-Genese unter verschiedenen auseren Einflussen und eignet sich gut fur radiobiologische Fragestellungen.

Hintergrund Bei der medikamentosen Therapie vieler Erkrankungen der Augenoberflache ist ein konstanter Wirkstoffspiegel uber eine langere Zeit erforderlich. Dies ist durch konventionelle Augentropfen haufig nicht gewahrleistet. Aus diesem Grund wurde in Form eines Kalzium-Alginat-Insertes mit Hydroxyethylcellulose (HEC)-Zusatz ein neuartiges System mit kontrollierter Freisetzung zur Applikation in den Bindehautsack entwickelt. Ziel der Studie war die Untersuchung der Vertraglichkeit dieses Insertes.

Purpose: To investigate newly designed, elliptical ELSA (excimer laser subepithelial ablation) instruments for the treatment of astigmatism. Setting: University Eye Clinic Regensburg, Regensburg, Germany, and the Rayne Institute, Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom. Methods: The new ELSA instrument set consists of an elliptical microtrephine (11.0 mm × 8.0 mm) with a 70 μm calibrated blade and an elliptical alcohol cone (11.5 mm × 8.5 mm). With this instrument set, ELSA (the laser-assisted subepithelial keratectomy [LASEK] described by Camellin) was performed in 34 astigmatic eyes. The cylindrical correction was between 1.00 diopters (D) and 3.50 D and the spherical correction, between −0.75 D and −8.75 D. In all eyes, the follow-up was 6 months. The postoperative refractive outcome was analyzed using Alpins vector analysis. Results: Excimer laser subepithelial ablation was performed without intraoperative complications in all eyes. At 6 months, the mean spherical correction was −0.04 D ± 0.27 (SD) (range +0.75 to −0.75 D) and the mean cylindrical correction, 0.27 ± 0.23 D (range 0 to 0.75 D). The mean index of success was 0.18 ± 0.15. Conclusions: With the elliptical instruments, ELSA was an effective and safe surgical procedure for astigmatism.

Purpose To evaluate the vitality of epithelial cells after various exposure times to 20% ethanol and epithelial flap preparation in laser-assisted subepithelial keratectomy (LASEK) using the trypan blue dye test Setting University Eye Clinic Regensburg, Regensburg, Germany, and the Rayne Institute, Department of Ophthalmology, St. Thomas’ Hospital, London, United Kingdom. Methods Five human cadaver eyes were exposed to 20% ethanol for 15, 30, 45, 60, and 120 seconds, respectively. After an epithelial flap (as in LASEK) was prepared, the flap was deliberately cut off. The flaps were soaked in a trypan blue 0.1% solution at 37°C. After 3 washes with phosphate-buffered saline (PBS), the specimens were reincubated for 30 minutes in culture medium containing 10% fetal calf serum at 37°C. After an additional wash with PBS, the cells were observed with a standard inverted light microscope. Results After 15- and 30-second exposure to 20% ethanol, most epithelial cells were vital. This changed substantially after 45 seconds, when vital and dead cells were approximately equal. Longer exposure times (60 seconds and 120 seconds) showed predominantly dead epithelial cells. Conclusions Exposure to 20% ethanol should be 20 to 30 seconds as the number of vital epithelial cells rapidly decreased after that. Vitality of the epithelial flap is probably a crucial factor in the dampened wound response in LASEK compared to that in photorefractive keratectomy.

Purpose To develop a test based on the individual expression of collagen type IV synthesis in corneal epithelial cells to identify patients who have the potential for significant corneal haze after myopic photorefractive keratectomy (PRK). Setting Department of Ophthalmology and the Institute of Microbiology, University of Regensburg, Germany. Methods The individual synthesis of collagen type IV α3 mRNA was quantitatively measured in corneal epithelial cells of 34 eye (34 patients) with myopia ranging from −1.5 to −10.0 diopters (D) by a polymerase chain reaction (PCR) test. The corneal epithelial cells were collected before the PRK procedure. Collagen type IV α3 mRNA levels were correlated to postoperative haze and regression at 12 months. Results In all samples, collagen type IV α3 mRNA was detected; the mean was 1.47 (range 0.11 to 6.42). There was a correlation between haze and the amount of collagen type IV α3 mRNA; that is, eyes with haze had more collagen IV expression. In contrast, no correlation was observed between regression and the amount of collagen type IV α3 mRNA. Conclusions The results show that collagen type IV α3 is an important factor in the development of corneal haze after PRK. Based on a quantitative PCR test, the individual collagen IV mRNA concentration in corneal epithelial cells could be measured. Further development could establish a screening test by which eyes with pronounced synthesis of collagen IV could be identified as being at high risk for haze after PRK.

BACKGROUND Laser epithelial keratomileusis (LASEK) is a new surgical procedure to treat myopia. An epithelial flap is created after the exposure to 20 % alcohol and following the laser ablation the epithelium is repositioned to its original location. The advantage of LASEK is that the ablated corneal surface is covered by a full thickness epithelium immediately after surgery. It is hypothesised that this epithelial coverage inhibits the wound healing response of the cornea. However, this concept will only work if the epithelial cells are still vital after the exposure to alcohol. MATERIAL AND METHODS The vitality of the corneal epithelial cells was investigated in 6 human cadaver eyes after the exposure to 20 % alcohol over 15 to 60 s. The vitality of the corneal epithelial cells was assessed by soaking the specimen in a 0.1 % trypan blue solution and incubated at 37 degrees C for 2 min. After a wash with BSS the specimen were re-incubated at 37 degrees C for 30 min in culture medium. After one more wash with BSS the cells were observed with a standard light microscope. Cells which retained the blue colour would be dead and vital cells would appear clear. Light microscopy and transmission electron microscopy was used to detect morphological changes. RESULTS Mainly vital corneal epithelial cells were seen for an alcohol exposure time of up to 30 s. In particular the basal epithelial cells appeared alive. With a exposition time of 60 s most cells were dead. CONCLUSION In LASEK the exposure time of 20 % alcohol is between 20 and 30 s. Based on our results we can conclude that after such exposure time most cells are alive, which is essential for the postoperative wound healing response.

BACKGROUND Laser epithelial keratomileusis (LASEK) is a new keratorefractive surgical procedure to treat myopia and possibly other refractive errors, which combines the advantages while eliminating the disadvantages of both PRK (pain, corneal haze) and LASIK (flap complications, interface complications). Our results with LASEK are very promising and because this technique is currently not very popular in Germany we here with introduce the surgical technique and our first clinical results. PATIENTS AND METHODS We treated 24 eyes (18 patients) by LASEK. The preoperative myopia was between - 1.50 and - 6.00 D with an astigmatism less than 1.00 D. Surgery starts with an incision in the epithelium by using a special microtrephine. After the application of 20 % ethanol for 20 seconds a hinged epithelial flap is created and the laser ablation performed with a Keracor 117 excimer laser. Finally, the epithelial flap is repositioned and secured using a bandage contact lens and artificial tears for 3 days. RESULTS In all eyes the creation of the epithelial flap and its repositioning presented no problems. None of the eyes showed any postoperative epithelial instability. However, one eye lost the contact lens and the epithelial flap during the first postoperative day. Postoperatively, none of the patients complained of significant pain; however, the contact lens caused some foreign body sensation. After 3 months all eyes were within +/- 1.0 D and 20/24 eyes (84 %) within +/- 0.50 D of emmetropia (spherical equivalent). None of the eyes showed significant haze. CONCLUSIONS Although, the number of treated eyes is small and the postoperative follow-up is short LASEK seems to be an effective and safe procedure for the treatment of myopia.

Das Neuroleptikum Pipamperon wird zur psychomotorischen Dampfung eingesetzt. Seine Wirkung beruht auf der Blockade von Dopaminrezeptoren im mesolimbischen System, wodurch die der Erkrankung zugrunde liegende pathologisch gesteigerte Dopaminausschuttung gedrosselt wird. Dopamin ist aber auch Teil der Signaltransduktion des visuellen Systems. Visusminderung, abweichende Farbwahrnehmung, Skotome und elektrophysiologische Veranderungen wurden als unerwunschte Wirkung antidopaminerger Medikamente, bisher jedoch noch nicht nach Pipamperon-Therapie, beobachtet. Wir stellen den Fall einer jungen Patientin vor, die nach Pipamperon-Anwendung unter einer passageren, einseitigen Visusminderung litt.

Hintergrund. Die konventionelle Behandlung des Zentralarterienverschlusses (ZAV) fuhrt in der Regel zu unbefriedigenden Ergebnissen. Eine invasive Therapiemoglichkeit stellt die selektive intraarterielle Fibrinolyse (IF) der A. ophthalmica dar. Zur Nutzen-Risiko-Abwagung beider Verfahren analysierten wir retrospektiv die Akten von 62 Patienten mit ZAV. Weiterhin wurde das Risikospektrum fur einen ZAV untersucht. Material und Methode. Krankenakten uber einen Zeitraum von 5 Jahren wurden ausgewertet und Patienten nach IF (n=17) und nach konventioneller Therapie (Drucksenkung, rheologische Masnahmen; n=45) hinsichtlich des Visus verglichen. Ausschlusskriterien fur die IF waren: Eintreffen spater als 8 h nach dem Verschlussereignis, medizinische Kontraindikationen wie Blutungsneigung, vorangegangene Operationen und hohes Alter (≥85 Jahre). Die IF wurde mit Urokinase (n=7) oder tPA (n=10) durchgefuhrt. Ergebnisse. Bei 22 von 62 Patienten (35%) wurde eine IF erwogen, wobei in funf Fallen aufgrund einer Gefasstenose darauf verzichtet werden musste, so dass insgesamt 17 Patienten eine IF erhielten. Bei 40 Patienten (65%) wurde primar keine IF aufgrund von Ausschlusskriterien angestrebt. Diese waren wie folgt: 47% (19/40) trafen spater als 8 h nach dem Verschlussereignis ein, 17% (7/40) stimmten der IF nicht zu, 15% (6/40) wiesen medizinische Kontraindikationen auf, 13% (5/40) waren uber 85 Jahre. Bei 8% (3/40) wurde ein IF nicht in Erwagung gezogen, da ein zilioretinales Gefas mit noch gutem Visus vorlag oder sich wahrend der Untersuchung ein spontaner Visusanstieg ergab. Vier von 17 Patienten mit IF zeigten eine Visusverbesserung um mindestens zwei Zeilen, 12/17 hatten keine Veranderung, und 1/17 wies eine Verschlechterung um mindestens zwei Zeilen auf. Von den konservativ behandelten Patienten erreichten 16/45 eine Visusverbesserung um mindestens zwei Zeilen, bei 29/45 ergab sich keine Visusanderung. Bei drei Patienten mit IF musste aufgrund einer akuten Halbseitensymptomatik die Therapie abgebrochen werden. Haufigster Risikofaktor fur den ZAV war der systemische Hypertonus bei 32% aller Patienten gefolgt vom Nikotinabusus (16%). Schlussfolgerung. Insgesamt zeigte sich, dass ein Grosteil der Patienten mit ZAV fur eine eventuelle IF als Therapie der Wahl zu spat die Klinik erreicht. Bezogen auf den Visus ergab sich jedoch statistisch kein Unterschied zwischen IF und konventioneller Behandlung. Aufgrund des Komplikationsrisikos bei der IF sollte eine prospektive Studie den Stellenwert der IF festlegen. Konsequente Blutdruckeinstellung ist als notwendige Prophylaxe gegen einen ZAV anzusehen.

Background Autoenucleation is the worst form of self-mutilation of the eye. Patients affected are mostly those with psychosis and delusions, but such acts can also happen under the influence of drugs, alcohol, solvents and seldom with organic illnesses. Often, these patients are known to be autoaggressive and suicidal. Patients We present two psychiatric patients who autoenucleated one eye and injured the other. A 41-year-old patient with known organic epilepsy based on a temporal-lobe-hemangioma and psychosis with delusions autoenucleated his right eye and lacerated the conjunctiva of the other, following imperative voices. A 50-year-old female suffered from a long-standing paranoid schizophrenia and religious delusions, and autoaggressive acts with resulting amaurosis of the right eye and several suicidal attempts had preceded the autoenucleation of the left eye. Discussion After the completion of the autoaggressive act the patients experience relief, but often the autoaggresive or suicidal impulses persist or recur. A close cooperation between ophthalmologists and psychiatrist in these patients is imperative.