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Purpose: To assess the efficacy and safety of systemic interferon alpha-2a (IFN) for refractory pseudophakic cystoid macular edema (PCME).Methods: Retrospective observational study. The primary outcome was the decrease of central retinal thickness (CRT). Secondary endpoints were the improvement of best-corrected visual acuity (BCVA) and the assessment of IFN-related side effects.Results: Twenty-four eyes of 20 patients were included. The median CRT was 513 µm (range 220-980 µm) at baseline and decreased to 190 µm (range 140-520 µm) at the last follow-up visit (p < 0.001). Reduction of CRT greater than 100 µm was observed in 22 eyes (92%). The median BCVA (logMAR) increased statistically significant from 0.5 (range 0.2-1.5) at baseline to 0.3 (0-0.8) at the last follow-up (p < 0.001). The BCVA improved in 18 eyes (75%) and remained stable in five eyes (21%). No severe treatment-related side effects occurred.Conclusion: IFN is a very effective agent for treatment of refractory PCME.

BACKGROUND This study investigated the effect of donor-dependent factors on contamination rates of conjunctival swabs of human donor eyes. MATERIAL AND METHODS From July 2015 to September 2017 a total of 1008 conjunctival swabs from 504 consecutive human donor eyes were analyzed. Cross-tabulation, chi-squared tests, and Fisher's exact tests were used to evaluate the effect of donor-dependent factors on contamination rates of conjunctival swabs. RESULTS The mean conjunctival swabs contamination rate was 28.4%. Donors with the diagnosis of carcinoma or metastases were associated with an increased conjunctival swab contamination rate [odds ratio (OR)=1.8, 95% confidence interval (CI)=1.2-2.6, p=0.007; OR=1.7, 95% CI=1.1-2.6, p=0.016; respectively]. However, the age, sex, diagnosis of diabetes mellitus, and donors who received chemotherapy did not significantly increase the conjunctival swab contamination risk. CONCLUSIONS Donors with the diagnosis of a carcinoma or metastases seemed to be predisposed to increased conjunctival swab contamination risk.

Purpose To better assess clinical trajectories of patients with or without ocular comorbidity after Descemet membrane endothelial keratoplasty. Background: To report on the outcomes of eyes with differing starting conditions following surgery. Design: Retrospective study at a University Eye Hospital. Participants: 361 eyes separated into group 1 (n=229; eyes with endothelial disease only) and group 2 (n=132; eyes with additional ocular comorbid conditions, such as herpetic eye disease 18/132 (13.6%), glaucoma 16/132 (12.1%), dry age-related macular degeneration 14/132 (10.6%), epiretinal membranes 10/132 (7.6%), and wet age-related macular degeneration 9/132 (6.8%)). Methods Consecutive eyes that underwent Descemet membrane endothelial keratoplasty over a follow-up period of up to 7 years at a tertiary referral center were reviewed. Main outcome measures were best-corrected visual acuity, postoperative complications, graft survival, central corneal thickness, and endothelial cell density. Results Postoperative best-corrected visual acuity at year 1 improved in both groups significantly (Wilcoxon signed rank test: group 1, p =.002; .63 to .23 logMAR; group 2, p p =.009, Mann-Whitney-Wilcoxon). A decrease of the endothelial cell density and central corneal thickness was noted at postoperative year 1 for both groups (paired t-tests (group 1, p p =.045) and paired t-tests (group 1, p p =.003). Complications were less common, and graft longevity was superior in group 1. Conclusion Eyes with different starting conditions might experience a visual improvement and benefit from surgery. Descemet membrane endothelial keratoplasty is a valid treatment for endothelial disorders in manifold of eyes. Further long-term studies are required.

Inherited retinal dystrophies (IRD) have been studied since their recognition by Franz Donders and Albrecht von Graefe. It nevertheless took 100 years for a causal therapy to take shape in the form of gene therapy: The approval of Voretigen Neparvovec (VN) for the treatment of hereditary retinal dystrophies due to RPE65 mutations was thus a significant milestone – for the era of personalised medicine in general and ophthalmology in particular. The clinical management around gene therapy applications is complex and requires the cooperation of various experts as a multidisciplinary team. This article describes the requirements, challenges, approaches, and open questions regarding the surgical aspects of gene therapy for retinal dystrophies. The first part outlines the standard surgical treatment. Based on this standard, alternative approaches are indicated for each individual step and their value discussed. Knowledge gaps are defined and in the outlook we speculate on future developments.

Purpose To describe intraocular clouding of silicone oil in the absence of emulsification. Methods Retrospective observational case series of patients who received silicone oil injections and developed silicone oil discoloration without emulsification after pars plana vitrectomy. Clinical examinations and physicochemical analyses were performed to find out the common cause for the opaque oil. Results Thirteen patients developed silicone oil discoloration after pars plana vitrectomy. It could be traced down that all patients had received silicone oil from one respective production batch. The silicone oil was removed as soon as possible after the changes were detected (range, 8-16 weeks). Gas chromatography flame ionization detector (GC-FIC), size exclusion chromatography (SEC) and high performance liquid chromatography (HPLC) analysis showed the absence of small molecular weight compounds in the opaque lot. Thermogravimetric analysis (TGA) revealed the opaque lot was more temperature stable. During the follow-ups, no obvious retinal toxicity could be observed and best recorded visual acuity improved considerably in twelve patients and was only limited by the underlying retinal pathology. Conclusion This is the first report on opacification of intraocular silicone oil without emulsification. This discoloration of silicone oil may disturb vision and prevent proper fundus examination, however, seems to be a non-toxic phenomenon without serious long-term consequences.

Background/aimsVoretigene neparvovec (VN) is the first and only subretinal gene therapy approved by the Food and Drug Administration and European Medicines Agency. Real-world application has started in 2018 in patients with vision impairment due to biallelic retinal pigment epithelium (RPE) 65 mutation-associated inherited retinal degenerations. Herein, we evaluated the development of retinal atrophy within in a single-centre patient cohort treated with VN.Methods13 eyes of eight patients treated with VN were retrospectively analysed for areas of retinal atrophy over a period of 6–24 months following surgery. Ultrawide field images were used to measure the area of atrophy. Fundus autofluorescence imaging is presented as an instrument for early detection of signs of retinal atrophy in these patients.ResultsAtrophic changes beyond the retinotomy site were observed in all eyes. Areas of atrophy developed within the area of detachment (bleb) in all eight patients and outside the bleb in three patients. Changes in autofluorescence preceded the development of retinal atrophy and were already evident 2 weeks after surgery in the majority of patients. The areas of atrophy increase with time and progression continued over year 1. Functional outcomes remained stable (VA, FST, visual field).ConclusionSubretinal injection of VN can lead to RPE atrophy with consequent photoreceptor loss in and outside of the bleb area. Fundus autofluorescence is an important tool to monitor atrophic changes in patients after gene therapy. Interestingly, while areas of atrophy also included central areas, the functional benefits of the treatment did not appear to be affected and remained stable.

Background To compare and assess the efficacy of three surgical methods for the treatment of acute submacular hemorrhage (ASH): pneumatic displacement with C2F6, in combination with intravitreal injection of bevacizumab and rtPA, pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and subretinal injection of recombinant tissue plasminogen activator (rtPA), pars plana vitrectomy (PPV) with intravitreal injection of gas (C2F6), bevacizumab and intravitreal injection of recombinant tissue plasminogen activator (rtPA). Methods The study included 85 patients with ASH. In the group without PPV (A), patients were treated with intravitreal injection of C2F6, bevacizumab and rtPA. In the second and third group, patients underwent a PPV, intravitreal injection of bevacizumab, pneumatic displacement with C2F6 and a subretinal (B) or intravitreal (C) injection of recombinant tissue plasminogen activator (rt PA). Results In group A, mean BCVA increased from preop logMAR 1.41 to 1.05, in group B from 1.46 to 1.28 and in group C from 1.63 to 1.33. In group A, CFT changed from 764 ± 340 μm at time point 0 to 246 ± 153 μm at time point 1, in group B from 987 ± 441 μm to 294 ± 166 μm and in group C from 642 ± 322 μm to 418 ± 364 μm. Patients had an average of 5 injections after surgery. Conclusion Our study demonstrates that the three methods are equally effective in improving the morphology and the BCVA of patients with ASH.

Purpose: To examine corneal tissue for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) positivity regarding implications for tissue procurement, processing, corneal transplantation, and ocular surgery on healthy patients. We performed quantitative reverse transcription-polymerase chain reaction qRT-PCR-testing for SARS-CoV-2 RNA on corneal stroma and endothelium, bulbar conjunctiva, conjunctival fluid swabs, anterior chamber fluid, and corneal epithelium of coronavirus disease 2019 (COVID-19) postmortem donors. Methods: Included in this study were 10 bulbi of 5 COVID-19 patients who died because of respiratory insufficiency. Informed consent and institutional review board approval was obtained before this study (241/2020BO2). SARS-CoV-2 was detected by using a pharyngeal swab and bronchoalveolar lavage. Tissue procurement and tissue preparation were performed with personal protective equipment (PPE) and the necessary protective measures. qRT-PCR-testing was performed for each of the abovementioned tissues and intraocular fluids. Results: The qRT-PCRs yielded no viral RNA in the following ocular tissues and intraocular fluid: corneal stroma and endothelium, bulbar-limbal conjunctiva, conjunctival fluid swabs, anterior chamber fluid, and corneal epithelium. Conclusions: In this study, no SARS-CoV-2-RNA was detected in conjunctiva, anterior chamber fluid, and corneal tissues (endothelium, stroma, and epithelium) of COVID-19 donors. This implicates that the risk for SARS-CoV-2 infection using corneal or conjunctival tissue is very low. However, further studies on a higher number of COVID-19 patients are necessary to confirm these results. This might be of high importance for donor tissue procurement, processing, and corneal transplantation.

This work presents a quick clinical protocol for dark-adapted chromatic (DAC) perimetry as well as a novel clinical tool, scotopic chromatic pupil campimetry (CPC). The goal of the study was to explore the applicability of these methods in a clinical setting, their test-retest repeatability, and the congruence of the results. Local rod sensitivity was assessed at 36 locations within 30° eccentricity of the visual field in 15 healthy subjects (mean age 43 ± 16 years; 7 females and 8 males) with DAC perimetry (red and cyan stimuli) and CPC 2 times in repeated measurements. The duration of individual measurements was 370 ± 5 s for CPC and 366 ± 62 s for DAC perimetry. The intraclass correlation (ICC) coefficient was 0.53 for DAC perimetry cyan stimuli, 0.67 for red stimuli, and 0.93 for CPC. However, the spatial resolution of CPC was substantially smaller than in DAC perimetry. We did not find a correlation of DAC perimetry and CPC measurements on the global or the local level. In comparison to DAC perimetry, CPC shows a superior intervisit repeatability in detecting functional changes in the rod population in an objective way with lower spatial resolution. Our results also indicate that these 2 methods measure the rod function in different ways and could thus constitute complementary scotopic functional diagnostics.

Purpose To assess the developments in contrast sensitivity, color vision, and subjective perception after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy (FECD). Methods Included in this study were pseudophakic, unilateral DMEK patients with bilateral FECD having a follow-up period of 6 months (n = 23). The mean age at surgery was 70 years (range: 52-81 years). Pseudophakic eyes without history of other ocular pathology or surgery served as a control (n = 10). Pelli-Robson contrast sensitivity and Panel-D15 color vision tests were used. Best-corrected visual acuity, modified visual functioning questionnaire-25, central corneal thickness, and endothelial cell density were assessed. We visualized the subjective impression of patients with bilateral FECD after unilateral DMEK in a subgroup using Photoshop CS6. Results Contrast sensitivity improved significantly from 1.35 ± 0.26 to 1.64 ± 0.17 (P = 0.002; control eyes: 1.92 ± 0.09). No difference in the color vision error score was observed for preoperative and postoperative eyes (P = 0.063). The best-corrected visual acuity improved significantly after surgery (P = 0.001). The average values in the Logarithm of the Minimum Angle of Resolution were 0.59 ± 0.42 preoperatively and 0.1 ± 0.10 postoperatively (control eyes: 0.01 ± 0.03). Examinations revealed a decrease of the central corneal thickness and endothelial cell density after surgery (P = 0.001; P = 0.001, respectively). Scores in the general and the driving questionnaire were significantly higher after surgery (P = 0.001; P = 0.005, respectively). Conclusions This study showed significant improvement in subjective patient satisfaction and contrast sensitivity. Spontaneous subjective color vision improvement might be explained by significantly improved contrast sensitivity. Contrast sensitivity might be considered as a parameter in preoperative decision-making and evaluation of surgical outcome.

Between 2005 and 2016, over 30,000 cochlear implants were implanted in Germany, while the number of retinal implants remained less than 1% of this number. The two types of retina implants that reached the market did not survive economically. The present review article discusses the impact and future of electronic retina implants in ophthalmology.Während zwischen 2005 und 2016 mehr als 30 000 Cochleaimplantate in Deutschland implantiert wurden, wurden nur weniger als 1% vergleichbarer Eingriffe an der Retina durchgeführt. Die beiden für den Markt zugelassenen Implantattypen haben wirtschaftlich nicht überleben können. Die vorliegende Arbeit diskutiert die Bedeutung und die Zukunft elektronischer Retinaimplantate für die Augenheilkunde.

ZusammenfassungIn einer retrospektiven Analyse klinischer Daten wurden die Häufigkeit und der zeitliche Verlauf von Revisionsoperationen aufgrund einer (Re-)Ablatio retinae bei Patienten untersucht, bei denen 2005, 2010 und 2015 in unserer Klinik mittels Vitrektomie das in den Glaskörperraum eingebrachte Silikonöl erstmals wieder komplett entfernt wurde. Insgesamt wurden die klinischen Daten von 512 Patienten (1,7 : 1 – Männer : Frauen) über einen Nachbeobachtungszeitraum von 1 Jahr bis 11 Jahren ausgewertet. Geschlechtsspezifisch fanden sich mit 15,4 : 14,4% – Männer : Frauen keine auffälligen Unterschiede in der Häufigkeit für das Auftreten einer (Wieder-)Ablösung der Netzhaut. Während das Alter der eingeschlossenen Patienten beider Geschlechter ähnlich war (Frauen: 61,9 Jahre; Männer: 58,1 Jahre), lag das Alter der Frauen, die revidiert werden mussten, deutlich über demjenigen der Männer (67,1 vs. 52,9 Jahre). Insgesamt wurden 77/512 Patienten (15%) wegen einer (erneuten) Netzhautablösung nach vollständiger Silikonölentfernung revidiert. In den ersten 90 postoperativen Tagen betraf dies 58 (75%) der 77 Patienten, im 1. postoperativen Jahr 69 (89%) der 77 Patienten. Die exemplarische Berechnung der Kaplan-Meier-Analyse für das Jahr 2010 bestätigte die Häufigkeit von 75% an Revisionsoperationen in den ersten 90 Tagen nach der Silikonölentfernung. Patienten im Vorfeld einer geplanten Silikonölendotamponade sollten hinsichtlich der Risikoverlagerung einer Netzhautablösung auf den Zeitraum nach der Silikonölentfernung aufgeklärt und auch hinsichtlich des zeitlichen Risikoprofils und der notwendigen engeren Kontrollintervalle innerhalb der ersten 90 Tage nach der Silikonölentfernung beraten werden.

ZusammenfassungIn der retrospektiven Datenanalyse wurde untersucht, ob bei Patienten, bei denen 2002, 2005, 2010, 2014 – 2016 in unserer Klinik mittels Vitrektomie erstmalig das im Glaskörperraum befindliche Silikonöl komplett entfernt wurde, eine Abhängigkeit der Nachblutungswahrscheinlichkeit von der Narkoseart festzustellen ist, und ob sich die Häufigkeit der Nachblutung im untersuchten Zeitverlauf veränderte. Als Nachblutung wurde dabei eine Blutung gewertet, wenn diese postoperativ innerhalb von 2 Wochen neu aufgetreten war und eine Revision mittels erneuter Vitrektomie zur Konsequenz hatte. Insgesamt traten über alle untersuchten Jahre bei 939 Operationen 9 revisionsbedürftige Nachblutungen auf. Obwohl die Anzahl an Intubationsnarkosen (355) geringer als die Anzahl an Operationen in lokaler Anästhesie (584) war, trat die Mehrzahl der Nachblutungen (6) unter Intubationsnarkose auf. Dieser Unterschied entsprach einem Trend (p = 0,089) zu einer geringeren Nachblutungsrate bei lokaler Betäubung, was den Operateur darin bestärken kann, die Silikonölentfernung in Lokalanästhesie durchzuführen. Im Zeitverlauf kam es zu einem Rückgang der Nachblutungen. In den Jahren 2002, 2005 und 2010 traten insgesamt 7 Nachblutungen auf, in den Jahren 2014 – 2016 lediglich 2 Nachblutungen. Neben einem höheren Anteil an Operationen in Lokalanästhesie könnte der Rückgang der Nachblutungshäufigkeit auf eine „sanftere Extubation“, das Aufkommen der trokargeführten Operationstechnik zur Silikonölentfernung und den Einsatz der Anti-VEGF-Therapie und damit einer Veränderung des Spektrums der mit Silikonöltamponade behandelten Grunderkrankungen zurückzuführen sein.

BACKGROUND The goal of this study was to investigate numbers, indications, surgical techniques, and experiences of amniotic membrane transplantation at the University Eye Hospital Tubingen over the last 16 years. MATERIAL AND METHODS Data from all amniotic membrane transplantations from January 2001 to December 2016 were retrospectively analyzed. Data was accessed from the electronic database and the annual reports of the Eye Bank at the University Eye Hospital Tubingen. RESULTS A total of 771 amniotic membrane transplantations were performed between 2001 and 2016 at the University Eye Hospital Tubingen. The mean number of amniotic membrane transplantations was 48 per year (range: 7-81). Overall, the mean number of amniotic membrane transplantations more than doubled, from 31 amniotic membrane transplantations per year during the first 8-year period to 66 amniotic membrane transplantations per year during the second 8-year period (p

This multicenter, open-label study aimed to determine the safety and functional outcome of a high-addition segmented refractive bifocal intraocular lens (IOL) in late inactive age-related macular degeneration (AMD). Twenty eyes of 20 patients were enrolled and followed until 12 months after the intervention. Patients underwent cataract surgery with implantation of a LS-313 MF80 segmented refractive bifocal intraocular lens with a near addition of +8.0 D (Teleon Surgical Vertriebs GmbH, Berlin, Germany). The main outcome measures were distance corrected near visual acuity (DCNVA) and safety as determined by intra- and post-operative complications. Secondary outcomes included distance corrected visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), the need for magnification to read newspaper, preferred reading distance, speed and performance (logRAD), as well as patient satisfaction. Mean DCNVA improved from 0.95 (±0.19) to 0.74 (±0.35) logMAR, until 6 months after surgery, P 2 lines of CDVA between 6 and 12 months, in another case, the study IOL was exchanged for a monofocal one due to dysphotopsia and decreased CDVA. Implantation of a segmented refractive bifocal IOL with +8.0 D addition improves near and distance vision in patients with late AMD and has a satisfactory safety profile.

Purpose Electronic retinal implants restore some visual perception in patients blind from retinitis pigmentosa. Eye movements cause mechanical stress in intraorbital power supply cables leading to cable breaks. By using computer tomography (CT) scans at the extreme positions of the four cardinal gaze directions, this study determined in vivo, which of three surgical routing techniques results in minimal bending radius variation and favors durability. Methods Nine patients received the first-generation subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) in one eye. Three techniques for intraorbital cable routing were used (straight cable route (A), parabulbar loop (B), and encircling band (C)), each in three patients. All patients underwent computer tomography of the orbital region. The bending radius of the intraorbital cable was measured with the DICOM viewer Osirix v4.1.2 (Pixmeo SARL, Bernex, Switzerland) and served as indicator for mechanical stress. Results Average bending radius variation was 87% for method A, 11% for method B, and 16% for method C. Methods A and B (P = 0.005) and methods A and C (P = 0.007) differed significantly, while method B and C showed no statistical difference (P = 0.07). Conclusions Compared to straight routes, arcuated cable routes significantly reduce cable movement and bending. Due to an easier surgical procedure, a parabulbar loop is the preferred method to minimize bending radius variation and prolong survival time of electronic subretinal implants. Translational Relevance CT analysis of cable bending of implanted medical devices allows to determine which surgical routing technique favors durability in vivo.

BACKGROUND AND OBJECTIVE: The aim of this study was to assess changes in retinal structure and thickness after subretinal implantation of the Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany). PATIENTS AND METHODS: Spectral-domain optical coherence tomography (SD-OCT) imaging was performed to assess the structure and thickness of the retina anterior to the microphotodiode array preoperatively, within 6 weeks and 6 months ± 1 month after implantation. Thickness measurements were performed using the distance tool of the built-in software. Three thickness measurements were performed in each of the four quadrants of the retina on the microchip within 6 weeks and 6 months ± 1 month after implantation. RESULTS: The mean ± standard deviation change in retinal thickness from within 6 weeks to 6 months ± 1 month after implantation in all four quadrants combined was 24 μm ± 68 μm. None of the tested variables (location, time, or their interaction) had a statistically significant effect on the mean retinal thickness ( P = .961, P = .131, and P = .182, respectively; n = 19). CONCLUSION: The authors report on qualitative and quantitative findings in retinal structure in 27 patients after subretinal implantation of the Retina Implant Alpha IMS using OCT technology. No significant changes of retinal thickness could be observed in a period of 6 months after surgery. With more patients receiving subretinal implants and with advanced OCT technology, the data set will be extended to study possible changes in retinal structure in finer detail. [ Ophthalmic Surg Lasers Imaging Retina . 2017;48:993–999.]

BACKGROUND The purpose of this study was to assess the effect of an organ transplantation scandal on the rate of corneal donations and organ donors at the University Hospital Tübingen. MATERIAL AND METHODS Data from all hospital deaths from January 2012 to December 2013 were analyzed retrospectively. Each deceased patient was considered as a potential corneal donor. The corneal donor procurement was handled by an ophthalmic resident on a full-time basis with standard used unchanged set of procedures. Each patient who died due to cerebral complications was considered as a potential organ donor. During the two-year period, a German transplantation scandal occurred at the end of 2012 and received worldwide attention. The rates of corneal donation and organ donation in 2012 and 2013 were examined and evaluated. RESULTS Among the 1685 deceased patients, approval for corneal donation was received in 220 cases (13.1%): 124 cases (15.0%) in 2012 and 96 cases (11.2%) in 2013. This corresponds to a decline of 23%. The leading causes of nonfulfillment of corneal donations were refusal to donation: 401 cases (48.4%) in 2012 and 445 cases (52.0%) in 2013; and medical contraindications: 201 cases (24.2%) in 2012 and 212 cases (24.8%) in 2013. During the two-year period, consent for organ donation was obtained in 25 cases (1.5%): 15 cases (1.8%) in 2012 and 10 cases (1.2%) in 2013. The number of realized organ donors was 20 cases (1.2%): 12 cases (1.4%) in 2012 and 8 cases (0.9%) in 2013. This corresponds to a decline of 33%. CONCLUSIONS After a transplantation scandal, the number of realized corneal donors and realized organ donors decreased significantly. It seems that increasing professional performance is very important to gaining trust inside and outside the hospital and improving corneal and organ donation rate.

Zusammenfassung Eine Reihe von Netzhauterkrankungen hat bekannte genetische Ursachen, die prinzipiell durch Gentherapie behandelt werden können. Diese Übersicht stellt das Prinzip und die Besonderheiten der okulären Gentherapie dar, fasst den aktuellen Stand der Forschung bis hin zur klinischen Anwendung zusammen und gibt einen Ausblick auf aktuelle Entwicklungen der Gentherapie am Auge.

Purpose To evaluate the motility of the eye in patients with the RETINA IMPLANT Alpha AMS. Methods Eye motility was determined in eight gaze directions in ten blind retinitis pigmentosa patients, who had received the RETINA IMPLANT Alpha AMS, before implantation of the subretinal implant and at six time-points up to one year after. Results The analysis of eye motility showed a restriction in the upgaze and gaze to the temporal side directly after surgery in eight of the nine patients included. The degree of motility restriction decreased continuously with recovery during the observation time. One year after surgery, eye motility was still restricted in the majority of patients, especially in the upgaze to the temporal side at 20° (five of seven patients). Conclusion Retinal implants with intraorbital parts (e.g. connecting cables) caused restriction in the temporal and superior viewing directions in the majority of patients. Although this restriction might be cosmetically visible, this limitation in eye motility has no effects on the monocular vision and the implant's efficacy for daily use.

IMPORTANCE: Choroideremia (CHM) is a rare, degenerative, genetic retinal disorder resulting from mutation of the CHM gene, leading to an absence of functional ras-associated binding escort protein 1 (REP1). There is currently no approved treatment for CHM. OBJECTIVE: To assess the safety and efficacy of retinal gene therapy with an adeno-associated virus vector (AAV2) designed to deliver a functional version of the CHM gene (AAV2-REP1) for treatment of patients with choroideremia. DESIGN, SETTING, AND PARTICIPANTS: Tübingen Choroideremia Gene Therapy (THOR) was a single-center, phase 2, open-label randomized clinical trial. Data were collected from January 11, 2016, to February 26, 2018. Twenty-four–month data are reported for 6 men with a molecularly confirmed diagnosis of CHM. Intention-to-treat analysis was used. INTERVENTIONS: Patients received AAV2-REP1 by a single, 0.1-mL subretinal injection of 10(11) genome particles during vitrectomy into 1 eye randomly assigned to receive treatment. MAIN OUTCOMES AND MEASURES: Primary end point was change in best-corrected visual acuity (BCVA) on the Early Treatment Diabetic Retinopathy Study chart from baseline to month 24 in the treated eye vs the control eye. Secondary end points included microperimetry variables, change in fundus autofluorescence, and spectral-domain optical coherence tomographic evaluations from baseline to month 24 in the treated eye vs the control eye. RESULTS: On enrollment, the mean (SD) age of the 6 men included in the study was 54.9 (4.1) years. The mean (SD) BCVA score was 60.3 (13.4) (approximately 20/63 Snellen equivalent) in the study eyes and 69.3 (20.6) (approximately 20/40 Snellen equivalent) in the control eyes. At 24 months, the BCVA change was 3.7 (7.5) in the treated eyes and 0.0 (5.1) in the control eyes (difference, 3.7; 95% CI, −7.2 to 14.5; P = .43). Mean change in retinal sensitivity was 10.3 (5.5) dB in the treated eyes and 9.7 (4.9) dB in the control eyes (difference, 0.6; 95% CI, −10.2 to 11.4; P = .74). A total of 28 adverse events were reported; all were consistent with the surgical procedure (eg, conjunctival hyperemia, foreign body sensation), and none were regarded as severe. CONCLUSIONS AND RELEVANCE: Among 6 participants, gene therapy with AAV2-REP1 was associated with maintenance or improvement of visual acuity, although no significant difference was found from control eyes. All safety issues were associated with the surgical procedure and none were judged severe. Continued investigations could more precisely define the efficacy and safety of gene therapy with AAV2-REP1 in CHM. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02671539

Ex vivo organ cultures represent unique research models, as they combine the advantages of cell cultures with those of animal models. Being able to mimic in vivo situations through the use of organ cultures provides an excellent opportunity to investigate cellular processes, molecular pathways and cell–cell interactions, as well as structural and synaptic organisation. Human and animal organ cultures are now well established and comprise sensitive, easy-to-manipulate experimental systems that raise minimal ethical concerns. The eye, in particular, is a very complex organ that is not easy to reproduce in vitro. However, a lot of research has been dedicated to the development of suitable ocular organ cultures. This review covers the various ex vivo retinal organ culture systems available for use in ophthalmology research and compares them with commonly used animal models. In particular, bovine and porcine retinal organ culture systems are described, because the size, anatomy, physiology and vessel morphology of bovine and porcine eyes are similar to the human eye in an undisputed way, thus making them good models. In addition, these animals are widely used by the food industry and the eyes are considered surplus material. A short overview of murine, rat, rabbit, cat, canine and simian retinal organ cultures is also provided.

Purpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols were conducted. Data were pooled for analysis.Participants: Patients (n = 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography.Methods: Patients were randomized in a 1:1:1 ratio to study treatment with DEX implant 0.7 mg, DEX implant 0.35 mg, or sham procedure and followed for 3 years (or 39 months for patients treated at month 36) at ≤40 scheduled visits. Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug Administration was achievement of ≥15-letter improvement in BCVA from baseline at study end. Safety measures included adverse events and intraocular pressure (IOP).Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX implant 0.35 mg, and sham, respectively. The percentage of patients with ≥15-letter improvement in BCVA from baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham (12.0%; P ≤ 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (−111.6 μm) and DEX implant 0.35 mg (−107.9 μm) than sham (−41.9 μm; P < 0.001). Rates of cataract-related adverse events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%) in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in BCVA. The safety profile was acceptable and consistent with previous reports.

BACKGROUND This study aimed to investigate factors limiting corneal donation at the University Hospital Tübingen. MATERIAL AND METHODS We retrospectively studied all hospital deaths from January 2012 to December 2015, considering each deceased patient as a potential corneal donor. During this period an ophthalmic resident managed corneal donor procurement on a full-time basis. Various factors limiting corneal donation were examined. RESULTS Among the 3412 deaths, 2937 (86.1%) displayed nonfulfillment of corneal donation. Consent for corneal donation was obtained in 475 cases (13.9%). The mean annual corneal donation rate was 13.9 donors per 100 deaths (range: 11.2-17.8). The leading causes of nonfulfillment of corneal donations were refusal to donate (49.8%, 1698 cases) and medical contraindications (23.6%, 805 cases). After next-of-kin interview of 2173 potential donors (109 potential donors were excluded because of logistical problems), willingness to participate in corneal donation was present in 475 cases (21.9%), whereas in 1698 cases (78.1%) corneal donation was refused. CONCLUSIONS Our study showed refusal to donate is the most important factor limiting corneal donation. It seems that increasing the knowledge of people about corneal donation through public education and media are necessary to address the corneal shortage.

Purpose To investigate the incidence and risk factors of pupillary block caused by an air bubble in the anterior chamber in the early postoperative period after Descemet membrane endothelial keratoplasty (DMEK). Methods A retrospective review was conducted in 306 eyes that underwent DMEK from September 2009 through October 2014 at the Tubingen Eye Hospital. Intraocular pressure (IOP) elevation was defined as a spike above 30 mm Hg. In the first 190 eyes, an intraoperative peripheral iridectomy was performed at the 12-o'clock position and in the other 116 eyes at the 6-o'clock position. If possible, reasons for IOP elevation were identified. For all eyes, preoperative and postoperative slit-lamp examinations and IOP measurements were performed. Results Overall, 30 eyes (9.8%) showed a postoperative IOP elevation within the first postoperative day. The incidence of IOP elevation was 13.9% (5/36) in the triple DMEK group, and 2 of 5 phakic eyes (40%) developed an air bubble-induced IOP elevation. All eyes presented with a de novo IOP elevation, associated in 25 patients with pupillary block from air anterior to iris and in 5 patients with angle closure from air migration posterior to the iris. All of them had an iridectomy at the 12-o'clock position. Conclusions A postoperative pupillary block with IOP elevation caused by the residual intraoperative air bubble may be an important complication that could be avoided by close and frequent observations, especially in the first postoperative hours and by an inferior peripheral iridectomy and an air bubble with a volume of ≤80% of the anterior chamber.

Purpose A proof of principle study showed that the TheraMon®-microsensor can reliably measure wearing times of glasses and occlusion patches while having no discomfort for the bearer. The goal of this study was to identify specific temperature profiles in a larger patient group wearing the microsensor with an occlusion patch on the eye, the forehead or in the trouser pocket. Methods Temperature measurements with microsensors were performed at the orbital rim of the eye, at the forehead and in a trousers pocket of 20 healthy adults. The temperature measurements were analysed comparing the three locations using a repeated-measures anova with a 0.050 two-sided significance level. Results There was no significant temperature difference in wearing the microsensors at the orbital rim compared to forehead (p = 0.507). A significant difference could be detected if the microsensors had been in trousers pockets as compared to being positioned at orbital rim/forehead (p = 0.001). The study participants reported easy handling and comfortable wearing. Conclusion This study demonstrates for the first time that TheraMon®-microsensors are fully operational in monitoring occlusion therapy in a larger group of patients (20 adult study participants). Because of the microsensor's ease of handling further studies in a larger group of children is recommended.

Purpose To report anatomical and functional outcome of 20-gauge versus 25-gauge primary pars plana vitrectomy for management of complex rhegmatogenous retinal detachment in pseudophakic eyes. Methods Prospective single-centre randomized comparative pilot trial. Fifty patients with retinal detachment (RD) not complicated by proliferative vitreoretinopathy grade B or C, who cannot be treated with a single meridional sponge, were randomized (1:1) from November 2006 to January 2010 to either 20-gauge or 25-gauge vitrectomy as first surgical intervention and followed up over a 12-month period, evaluating change in best-corrected visual acuity, anatomical success and intraocular pressure dysregulation. Results Mean visual acuity improved by 0.88 (SD 0.67) from 1.22 logMAR (SD 0.63) to 0.34 logMAR (SD 0.31) in the 20-gauge group and by 0.53 (SD 0.91) from 0.86 logMAR (SD 0.73) to 0.34 logMAR (SD 0.46) in the 25-gauge group. Final anatomical success rate was 100% and primary success rate was 69% at 6 months of follow-up. In the 20-gauge group, the retina was attached after one single procedure in 18 eyes (72%) and in 21 eyes (84%) of the 25-gauge group. Two patients in the 25-gauge group had hypotony at the first postoperative day which normalized within 6 weeks. Conclusion In our series, transconjunctival sutureless 25-gauge and 20-gauge vitrectomy showed comparable results in pseudophakic RD not suitable for single sponge surgery with respect to visual outcome and retinal reattachment. Postoperative hypotony does not seem to be a significant problem of transconjunctival sutureless vitrectomy.

Purpose Posttraumatic partial or total iris defects often cause significant debilitating glare, photophobia, decreased vision and cosmetic problems. Currently, the best cosmetic results can be obtained with a customized silicone iris prosthesis. However, little is known about the functional results and the rate of complication if this type of iris prosthesis is implanted into severely traumatized eyes. The aim of this study is to analyse the functional and cosmetic outcomes as well as complications after Artificial Iris implantation. Methods A consecutive series of 34 patients who received a customized silicone iris prosthesis after severe globe injury with total or sub-total iris loss was analysed retrospectively. Additionally, patients were interviewed regarding change in subjective complaints. Results Median follow-up was 24 months (range 12.0–48.8). Mean visual acuity prior to Artificial Iris implantation was 1.1 logMAR (range 0.3–2.6). Five patients (15%) had pre-existing glaucoma and eight patients (24%) had pre-existing hypotony. Visual acuity 12 months after surgery was 1.4 logMAR (range 0.2–2.6). Complications included newly diagnosed glaucoma in three eyes (9%) and hypotony in three eyes (9%), persisting intraocular inflammation or macular oedema in seven patients (21%), and corneal endothelial decompensation requiring corneal transplantation in six patients (18%). Patients’ satisfaction increased by reducing glare and enhanced cosmetic appearance. Conclusion The customized silicone iris prosthesis is an individualized treatment approach with appealing cosmetic results. Therefore, especially traumatized eyes with highly different posttraumatic conditions could benefit. However, in some patients, the implantation of this device may cause an increase of intraocular pressure, corneal endothelial decompensation or persisting inflammation.

Electronic implants are able to restore some visual function in blind patients with hereditary retinal degenerations. Subretinal visual implants, such as the CE-approved Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany), sense light through the eye's optics and subsequently stimulate retinal bipolar cells via ∼1500 independent pixels to project visual signals to the brain. Because these devices are directly implanted beneath the fovea, they potentially harness the full benefit of eye movements to scan scenes and fixate objects. However, so far, the oculomotor behavior of patients using subretinal implants has not been characterized. Here, we tracked eye movements in two blind patients seeing with a subretinal implant, and we compared them to those of three healthy controls. We presented bright geometric shapes on a dark background, and we asked the patients to report seeing them or not. We found that once the patients visually localized the shapes, they fixated well and exhibited classic oculomotor fixational patterns, including the generation of microsaccades and ocular drifts. Further, we found that a reduced frequency of saccades and microsaccades was correlated with loss of visibility. Last, but not least, gaze location corresponded to the location of the stimulus, and shape and size aspects of the viewed stimulus were reflected by the direction and size of saccades. Our results pave the way for future use of eye tracking in subretinal implant patients, not only to understand their oculomotor behavior, but also to design oculomotor training strategies that can help improve their quality of life.

Purpose To evaluate the status of ocular donor tissues of a COVID-19 postmortem donor. Methods SARS-CoV-2 was detected via a pharyngeal swab and broncho-alveolar lavage in the COVID-19 suspect. Postmortem tissue procurement and preparation were performed with personal protective equipment (PPE) and the necessary protective measures. qRT-PCR-testing was performed for the following ocular tissues and fluids: conjunctival fluid swabs, bulbar conjunctiva, corneal epithelium, corneal stroma, corneal endothelium, anterior chamber fluid, lens, iris, vitreous, retina, uvea, sclera, and optic nerve. Informed consent and Institutional Review Board approval was obtained prior to this study (196/2020BO2; Date of approval: 03/26/2020; Ethics Committee of the University of Tuebingen). Results In all ocular tissue and fluid samples no SARS-CoV-2 RNA was detected via qRT-PCR of the confirmed COVID-19 postmortem donor. Conclusions and Importance Late-stage COVID-19 patients might not harbor an ocular reservoir of SARS-CoV-2. The risk of transmitting SARS-CoV-2 via ocular tissues and fluids might be low. This may bear future implications for patient management in ophthalmological practice, surgery and transplantation.

Importance Achromatopsia linked to variations in theCNGA3gene is associated with day blindness, poor visual acuity, photophobia, and involuntary eye movements owing to lack of cone photoreceptor function. No treatment is currently available. Objective To assess safety and vision outcomes of supplemental gene therapy with adeno-associated virus (AAV) encodingCNGA3(AAV8.CNGA3) in patients withCNGA3-linked achromatopsia. Design, Setting, and Participants This open-label, exploratory nonrandomized controlled trial tested safety and vision outcomes of gene therapy vector AAV8.CNGA3 administered by subretinal injection at a single center. Nine patients (3 per dose group) with a clinical diagnosis of achromatopsia and confirmed biallelic disease-linked variants inCNGA3were enrolled between November 5, 2015, and September 22, 2016. Data analysis was performed from June 6, 2017, to March 12, 2018. Intervention Patients received a single unilateral injection of 1.0 × 1010, 5.0 × 1010, or 1.0 × 1011total vector genomes of AAV8.CNGA3 and were followed up for a period of 12 months (November 11, 2015, to October 10, 2017). Main Outcomes and Measures Safety as the primary end point was assessed by clinical examination of ocular inflammation. Systemic safety was assessed by vital signs, routine clinical chemistry testing, and full and differential blood cell counts. Secondary outcomes were change in visual function from baseline in terms of spatial and temporal resolution and chromatic, luminance, and contrast sensitivity throughout a period of 12 months after treatment. Results Nine patients (mean [SD] age, 39.6 [11.9] years; age range, 24-59 years; 8 [89%] male) were included in the study. Baseline visual acuity letter score (approximate Snellen equivalent) ranged from 34 (20/200) to 49 (20/100), whereas baseline contrast sensitivity log scores ranged from 0.1 to 0.9. All 9 patients underwent surgery and subretinal injection of AAV8.CNGA3 without complications. No substantial safety problems were observed during the 12-month follow-up period. Despite the congenital deprivation of cone photoreceptor–mediated vision in achromatopsia, all 9 treated eyes demonstrated some level of improvement in secondary end points regarding cone function, including mean change in visual acuity of 2.9 letters (95% CI, 1.65-4.13;P = .006, 2-sidedttest paired samples). Contrast sensitivity improved by a mean of 0.33 log (95% CI, 0.14-0.51 log;P = .003, 2-sidedttest paired samples). Conclusions and Relevance Subretinal gene therapy with AAV8.CNGA3 was not associated with substantial safety problems and was associated with cone photoreceptor activation in adult patients, as reflected by visual acuity and contrast sensitivity gains. Trial Registration ClinicalTrials.gov Identifier:NCT02610582

Patient: Female, 33-year-old Final Diagnosis: Conjunctival squamous cell carcinoma Symptoms: Tumorous lesion on the nasal bulbar conjunctiva • red eye Medication: — Clinical Procedure: The conjunctival tumor was excised. The histopathological diagnosis suggested a conjunctival squamous cell carcinoma. A treatment with topical MMC was admistered Specialty: Ophthalmology Objective: Rare disease Background: Conjunctival squamous cell carcinoma is the most common non-pigmented malignancy of the ocular surface. This report illustrates the clinical management of squamous cell carcinoma of the conjunctiva. Case Report: A 33-year-old female was referred to our eye hospital with a tumorous lesion on the nasal bulbar conjunctiva of the right eye. A topical therapy with antibiotic and corticosteroid eye drops did not change the lesion. The conjunctival tumor was widely resected. The histopathological diagnosis suggested a squamous cell carcinoma. After resection, a treatment with topical mitomycin C (MMC) 0.02% eye drops were started 4 times daily for 14 days. Two cycles of treatment were done with a 2-week interval during which only artificial tears eye drops were administered. At the 12-month follow-up, there was no sign of recurrence. Conclusions: This case illustrates the effective and successful clinical management of squamous cell carcinoma of the conjunctiva with excision and postoperative treatment with MMC 0.02% eye drops.

In a retrospective analysis of the clinical data, the frequency and timing of revision surgery due to retinal (re-)detachment was studied in patients undergoing complete silicone oil removal surgery for the first time, in 2005, 2010 and 2015. Overall, the clinical data from 512 patients (1.7 : 1 - men : women) were evaluated over a follow-up period of 1 year to 11 years. The gender ratio was 15.4 : 14.4% - men : women; there were no clear gender differences in the incidence of retinal (re-)detachments. A total of 77/512 patients (15%) were reviewed for retinal detachment after complete silicone oil removal. During the first 90 postoperative days, this affected 58 (75%) of the 77 patients, and during the first postoperative year, 69 (89%) of the 77 patients. The Kaplan-Meier-analysis for 2010 confirmed that 75% of the revision surgeries were performed in the first 90 days after silicone oil removal. Patients prior to scheduled silicone oil tamponade should be advised on the shift in the risk profile for retinal (re-)detachment during the period after silicone oil removal and on necessary narrow control intervals within the first 90 days of silicone oil removal.In einer retrospektiven Analyse klinischer Daten wurden die Häufigkeit und der zeitliche Verlauf von Revisionsoperationen aufgrund einer (Re-)Ablatio retinae bei Patienten untersucht, bei denen 2005, 2010 und 2015 in unserer Klinik mittels Vitrektomie das in den Glaskörperraum eingebrachte Silikonöl erstmals wieder komplett entfernt wurde. Insgesamt wurden die klinischen Daten von 512 Patienten (1,7 : 1 – Männer : Frauen) über einen Nachbeobachtungszeitraum von 1 Jahr bis 11 Jahren ausgewertet. Geschlechtsspezifisch fanden sich mit 15,4 : 14,4% – Männer : Frauen keine auffälligen Unterschiede in der Häufigkeit für das Auftreten einer (Wieder-)Ablösung der Netzhaut. Während das Alter der eingeschlossenen Patienten beider Geschlechter ähnlich war (Frauen: 61,9 Jahre; Männer: 58,1 Jahre), lag das Alter der Frauen, die revidiert werden mussten, deutlich über demjenigen der Männer (67,1 vs. 52,9 Jahre). Insgesamt wurden 77/512 Patienten (15%) wegen einer (erneuten) Netzhautablösung nach vollständiger Silikonölentfernung revidiert. In den ersten 90 postoperativen Tagen betraf dies 58 (75%) der 77 Patienten, im 1. postoperativen Jahr 69 (89%) der 77 Patienten. Die exemplarische Berechnung der Kaplan-Meier-Analyse für das Jahr 2010 bestätigte die Häufigkeit von 75% an Revisionsoperationen in den ersten 90 Tagen nach der Silikonölentfernung. Patienten im Vorfeld einer geplanten Silikonölendotamponade sollten hinsichtlich der Risikoverlagerung einer Netzhautablösung auf den Zeitraum nach der Silikonölentfernung aufgeklärt und auch hinsichtlich des zeitlichen Risikoprofils und der notwendigen engeren Kontrollintervalle innerhalb der ersten 90 Tage nach der Silikonölentfernung beraten werden.

Background/aimsThe aim of this study was to investigate a change in visual acuity and contrast sensitivity (CS) during high altitude exposure in healthy subjects due to the effects of hypobaric hypoxia. This study is related to the Tübingen High Altitude Ophthalmology study.MethodsVisual acuity and Weber CS were tested monocularly using the Freiburger Visual Acuity and Contrast Test under standardised conditions in 14 healthy subjects at high altitude at the Capanna Margherita (4559 m, Italy) and compared with baseline measurements in Tübingen (341 m, Germany). Intraindividual differences between baseline and follow-up examinations were calculated by multivariate analysis of variance for repeated measures. Clinical parameters of peripheral oxygen saturation (SpO2) and heart rate (HR) as well as scores for acute mountain sickness (AMS) were correlated to psychophysical tests by Pearson’s correlation coefficient.ResultsA significant decrease in CS with a mean effect size of −0.13 logCS was found for Weber CS (day 1=−0.16±0.22, p=0.01; day 2=−0.10±0.2, p=0.049; day 3=−0.12±0.19, p=0.03) at high altitude compared with baseline. Visual acuity remained unchanged. Decreased CS correlated with SpO2 (r=0.53, p=0.046) but not with HR (r=− 0.16, p=0.59) and occurred irrespective of AMS at high altitude.ConclusionHigh altitude exposure leads to decreased CS. Changes occur independent of AMS. This finding is of clinical importance to trekkers and mountaineers exposed to high altitude as visual processing in particular under mesopic conditions at dusk and dawn is altered. Furthermore, it provides novel insight into hypoxia related changes in CS function.

AimTo evaluate and correlate mean light sensitivity thresholds (MLST) in patients with congenital stationary night-blindness (CSNB) in comparison with healthy subjects using microperimetry (MP1).MethodsEleven patients with CSNB and 13 healthy subjects were compared. In all subjects, static threshold perimetry was performed using MP1 evaluating the central 6 mm of the retina. This central retinal area was divided into three rings through using the ETDRS grid algorithm with an innermost (1 mm), inner (3 mm) and outer ring (6 mm). The MLSTs were acquired in nine sectors of the ETDRS grid. A comparison of MLST was performed between both groups using a t-test (significance level pResultsA significant reduction of MLST in the fovea (innermost ring, 1 mm) was observed for patients with CSNB (7.2±3.90 dB) in comparison to healthy subjects (19.7±0.75; pConclusionsExamination of macular retinal sensitivity intensity using MP1 revealed for the first time a significant reduction of MLST within the central 6 mm of the retina in patients with CSNB compared with healthy subjects. This finding supports MP1 as an additional diagnostic tool when examining patients with retinal dysfunctions such as CSNB.

In this retrospective data analysis, it was examined whether the mode of anesthesia influenced postoperative haemorrhage in patients with first time complete silicone oil removal in 2002, 2005, 2010, 2014 - 2016 in our clinic and if there was a change in frequency over time. Haemorrhage was defined as a postoperative haemorrhage within 2 weeks after the operation and which led to revision vitrectomy. In all, there were 939 operations and 9 cases of postoperative surgery requiring revision in the analysed years. Even though the number of patients with intubation anesthesia (355) was smaller than the number with local anesthesia (584), the majority of patients with postoperative haemorrhage had been given intubation anesthesia (6). This difference corresponds to a trend (p = 0.089) towards a lower rate of postoperative haemorrhage with local anesthesia, which could encourage the surgeon to perform silicone oil removal under local anaesthesia. Over the course of time, there was a decline in postoperative haemorrhage. In 2002, 2005 and 2010 there were 7 cases of postoperative haemorrhage, but only 2 in the years 2014 - 2016. Aside from the higher proportion of operations under local anaesthesia, the decline in the frequency of postoperative haemorrhage may be attributed to "smoother extubation", the emergence of trocar-guided surgical procedure and the use of anti-VEGF therapy - all leading to a change in the spectrum of illnesses treated by silicone oil instillation.In der retrospektiven Datenanalyse wurde untersucht, ob bei Patienten, bei denen 2002, 2005, 2010, 2014 – 2016 in unserer Klinik mittels Vitrektomie erstmalig das im Glaskörperraum befindliche Silikonöl komplett entfernt wurde, eine Abhängigkeit der Nachblutungswahrscheinlichkeit von der Narkoseart festzustellen ist, und ob sich die Häufigkeit der Nachblutung im untersuchten Zeitverlauf veränderte. Als Nachblutung wurde dabei eine Blutung gewertet, wenn diese postoperativ innerhalb von 2 Wochen neu aufgetreten war und eine Revision mittels erneuter Vitrektomie zur Konsequenz hatte. Insgesamt traten über alle untersuchten Jahre bei 939 Operationen 9 revisionsbedürftige Nachblutungen auf. Obwohl die Anzahl an Intubationsnarkosen (355) geringer als die Anzahl an Operationen in lokaler Anästhesie (584) war, trat die Mehrzahl der Nachblutungen (6) unter Intubationsnarkose auf. Dieser Unterschied entsprach einem Trend (p = 0,089) zu einer geringeren Nachblutungsrate bei lokaler Betäubung, was den Operateur darin bestärken kann, die Silikonölentfernung in Lokalanästhesie durchzuführen. Im Zeitverlauf kam es zu einem Rückgang der Nachblutungen. In den Jahren 2002, 2005 und 2010 traten insgesamt 7 Nachblutungen auf, in den Jahren 2014 – 2016 lediglich 2 Nachblutungen. Neben einem höheren Anteil an Operationen in Lokalanästhesie könnte der Rückgang der Nachblutungshäufigkeit auf eine „sanftere Extubation“, das Aufkommen der trokargeführten Operationstechnik zur Silikonölentfernung und den Einsatz der Anti-VEGF-Therapie und damit einer Veränderung des Spektrums der mit Silikonöltamponade behandelten Grunderkrankungen zurückzuführen sein.

Purpose of review The purpose of this review is to provide an update on the efforts to restore vision through subretinal implants in patients with degenerative retinal diseases. In addition to the current technique and its latest improvements, it will focus on the surgical technique of implantation as well as explantation and reimplantation. Recent findings The durability of the current subretinal implant RETINA IMPLANT Alpha AMS has increased substantially compared with the predecessor model RETINA IMPLANT Alpha IMS. According to validated examinations in the laboratory, a median lifetime of 4.7 years will be reached in clinical use; in similar examinations, the previous model has reached only 8 months. Visual function has slightly increased. The surgical technique for subretinal implants is complex and demanding for ophthalmic surgeons, as it is multifaceted and combines novel surgical steps in areas, which are not commonly entered such as the suprachoroidal and the subretinal space. The surgical approach for implantation has matured considerably and has led to successful implantation in 64 patient cases. Surgical challenges are now mainly encountered with the exact subfoveal positioning of the device. The explantation procedure is relatively straight-forward because the implant can be withdrawn in a reverse direction along the already existent subretinal path. Reimplantations, however, are more challenging because some degree of scar tissue may exist along the path of the chip and around the scleral trapdoor. Nevertheless, reimplantations have now been carried out successfully in four patients. Summary The new RETINA IMPLANT Alpha AMS shows significantly improved durability compared with the predecessor model RETINA IMPLANT Alpha IMS. The subretinal implant offers excellent visual results but requires experienced surgeons. Explantation of devices is straight-forward, and reimplantations are challenging but have been successful in four patients.

Background/aimsThe study aims to investigate changes in the optic nerve sheath diameter (ONSD) at high altitude and to assess correlation to optic disc oedema (ODE) and acute mountain sickness (AMS). This investigation is part of the Tübingen High Altitude Ophthalmology study.MethodsFourteen volunteers ascended to 4559 m for 4 days before returning to low altitude. Ultrasonography of ONSD, quantification of optic disc parameters using a scanning laser ophthalmoscope and fluorescein angiography were performed at 341 m and at high altitude. Pearson’s coefficient was used to correlate changes in ONSD with the optic disc and AMS. Assessment of AMS was performed using the Lake Louise (LL) and AMS-cerebral (AMS-C) scores of the Environmental Symptom Questionnaire-III. All volunteers were clinically monitored for heart rate (HR) and oxygen saturation (SpO2).ResultsThe mean ONSD at high altitude (4.6±0.3 mm, p2 (r=0.11, p=0.72) and HR (r=0.22, p=0.44). Increased ONSD did not correlate with altered key stereometric parameters of the optic disc describing ODE at high altitude (r0.5).ConclusionHigh-altitude exposure leads to marked oedema formation of the optic nerve independent of AMS. Increased ONSD and ODE reflect hypoxia-driven oedema formation of the optic nerve at high altitude, providing important pathophysiological insight into high-altitude illness development and for future research.

To assess the influence of donor, environment, and logistical factors on the results of virological testing of blood samples from cornea donors. Data from 670 consecutive cornea donors were analyzed retrospectively. Logistic regression analysis was used to assess the influence of different factors on the results of virological testing of blood samples from cornea donors. The mean annual rate of donors with serology-reactive or not evaluable result was 14.8% (99 of 670) (range 11.9%–16.9%). The cause of donor death by cancer increased the risk of serology-reactive or not evaluable result (P = .0300). Prolonged time between death and post mortem blood removal was associated with a higher rate of serology-reactive or not evaluable result (P

Purpose Retinal prosthetic devices have been developed to partially restore very low vision in legally blind patients with end-stage hereditary retinal dystrophies. Subretinal implants, unlike epiretinal implants, are not fixated by a tack. The aim of this study was to assess and analyse possible changes over time in the subretinal position of the RETINA IMPLANT Alpha IMS and Alpha AMS (ClinicalTrials.gov NCT01024803). Methods Imaging studies were performed on fundus photographs using GIMP (Version 2.8.14). Postoperative photographs of the implanted eye were scaled and aligned. Landmarks were chosen and distances between landmarks were measured to then calculate the displacement of the microchip using a transformation matrix for rotational and translational movements. Analyses were performed using MATLAB 8.6 (The MathWorks Inc., Natick, MA). Results Of the 27 datasets with the Alpha IMS device, 12 (44%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 15 (56%), displacement occurred. The mean ± SD displacement in those 15 eyes was 0.66 ± 0.35 mm (range, 0.24-1.67 mm). Of the eight datasets with the Alpha AMS device, 1 (13%) remained stable without displacement of the microchip relative to the optic disc and the major blood vessels, whereas in 7 (87%), displacement occurred. The mean ± SD displacement in those seven eyes was 0.66 ± 0.26 mm (range, 0.32-0.97 mm). Calculated from all eyes (including those in which no displacement occurred), the mean displacement was 0.36 mm in the IMS cohort, and 0.58 mm in the AMS cohort, however, the difference was not statistically significant (p = 0.17). Conclusions We have shown that the position of the subretinal implant changes in the majority of the cases after implantation. While the overall mean displacement of the chip was not significantly different in either of the cohorts, the maximum displacement was smaller in the Alpha AMS cohort.

Vitreoretinal diffuse large B-cell lymphoma is a rare disorder, occurring as primary ocular disease or as secondary involvement by primary central nervous system lymphoma. It is usually diagnosed by cytologic, immunocytochemical, and molecular examination of vitreous aspirates. However, distinguishing vitreoretinal diffuse large B-cell lymphoma from uveitis remains difficult, and clonality analysis may be either unsuccessful or misleading. Diffuse large B-cell lymphoma arising in immune-privileged sites (eg, the central nervous system) shows a high frequency of MYD88 mutations. Therefore, we retrospectively assessed the frequency of MYD88 mutations in vitreoretinal lymphoma (VRL) and their diagnostic potential in 75 vitrectomy samples of 69 patients, and validated our results in a separate cohort (n = 21). MYD88 mutations were identified in 20 of 29 (69%) clinically, histologically, and molecularly confirmed VRL, including 6 cases of the test cohort initially diagnosed as reactive (3/6) or suspicious (3/6) for lymphoma. MYD88 mutations, especially L265P, are very frequent in VRL and their detection significantly improves the diagnostic yield of vitrectomy specimens.

A subretinal visual implant (Alpha IMS, Retina Implant AG, Reutlingen, Germany) was implanted in 29 blind participants with outer retinal degeneration in an international multicenter clinical trial. Primary efficacy endpoints of the study protocol were a significant improvement of activities of daily living and mobility to be assessed by activities of daily living tasks, recognition tasks, mobility, or a combination thereof. Secondary efficacy endpoints were a significant improvement of visual acuity/light perception and/or object recognition (clinicaltrials.gov, NCT01024803).During up to 12months observation time twenty-one participants (72%) reached the primary endpoints, of which thirteen participants (45%) reported restoration of visual function which they use in daily life. Additionally, detection, localization, and identification of objects were significantly better with the implant power switched on in the first 3months.Twenty-five participants (86%) reached the secondary endpoints. Measurable grating acuity was up to 3.3 cycles per degree, visual acuities using standardized Landolt C-rings were 20/2000, 20/2000, 20/606 and 20/546. Maximal correct motion perception ranged from 3 to 35 degrees per second. These results show that subretinal implants can restore very-low-vision or low vision in blind (light perception or less) patients with end-stage hereditary retinal degenerations.