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Zusammenfassung Hintergrund Das Ziel der vorliegenden Studie war die Beschreibung der augenärztlichen Versorgung in der Kindheit und Jugend früh- und reifgeborener Personen aus der retrospektiven Sicht der Eltern. Patienten, Material und Methoden Die Gutenberg Prematurity Eye Study (GPES) ist eine retrospektive Kohortenstudie mit einer prospektiven augenärztlichen Untersuchung von früh- und reifgeborenen Personen, die zwischen 1969 und 2002 geboren wurden (aktuelles Alter 18 bis 52 Jahre). Sie schließt eine Befragung von deren Eltern zur augenärztlichen Versorgung ihrer Kinder in der Kindheit und Jugend aus der Retrospektive ein. Die Teilnehmenden und deren Eltern wurden in Personen mit normalem Gestationsalter (GA) ≥ 37 (Kontrollgruppe), Frühgeborene ohne ROP (Retinopathy of Prematurity) mit GA 33 – 36 (Gruppe 2), GA 29 – 32 (Gruppe 3), GA ≤ 28 Wochen (Gruppe 4) und solche mit ROP ohne Behandlung (Gruppe 5) und mit ROP mit Behandlung (Gruppe 6) gruppiert. Die Eltern der Teilnehmenden wurden zur augenärztlichen Versorgung und zur Zufriedenheit damit befragt. Ergebnisse Insgesamt wurden die Daten von 57 reifgeborenen und 131 frühgeborenen Kindern und deren Eltern in die vorliegende Studie eingeschlossen. Die Eltern der Teilnehmenden gaben an, dass eine augenärztliche Untersuchung bis zum 6. Lebensjahr in den jeweiligen Gruppen 1 bis 6 bei 22/57 (38,6%), 33/58 (56,9%), 22/38 (57,9%), 3/6 (50%), 19/21 (90,5%) und 7/8 (87,5%) stattgefunden habe. Insgesamt gaben 83 – 100% der Eltern in den verschiedenen Gruppen an, dass die augenärztliche Betreuung gut gewesen sei. Einen Augenarztwechsel aufgrund von Behandlungsunzufriedenheit berichteten insgesamt 4/57 (7%), 9/58 (15,5%), 8/38 (21,1%), 1/6 (16,7%), 1/21 (4,8%) und 2/8 (25%) in den jeweiligen Gruppen. Schlussfolgerung Die vorliegende Studie zeigt eine gute Behandlungszufriedenheit hinsichtlich der augenärztlichen Betreuung von ehemaligen frühgeborenen Personen, insbesondere Eltern von Kindern mit einer ROP bewerteten diese positiv.

This study analyses whether prematurity, retinopathy of prematurity (ROP), and associated factors lead to altered foveal shape in adulthood and whether these alterations are associated with visual acuity.The Gutenberg Prematurity Eye Study is a German cohort study with a prospective ophthalmologic examination (participants aged 18-52 years) of individuals born preterm and full-term that were examined with spectral domain optical coherence tomography. Participants were grouped according to gestational age (GA) and postnatal ROP status. Multivariable linear regression analyses for foveolar retinal thickness, foveal hypoplasia, and posterior vitreous status were performed.A total of 755 eyes of 414 preterm and full-term individuals were included (aged 28.6 ± 8.6 years, 233 female individuals). Central foveal retinal thickness increased as GA decreased. The prevalence of foveal hypoplasia was 2% (control group), 9% (GA 33-36), 18% (GA 29-32), 48% (GA ≤28), 50% (ROP without treatment), and 82% of eyes (with ROP requiring treatment). In multivariable analyses, central foveal thickness was independently associated with GA and advanced stages of ROP requiring treatment while foveal hypoplasia was only associated with GA. Posterior vitreous was more frequently visible as partially detached in full-term than in preterm individuals. Lower distant-corrected visual acuity correlated with increased foveolar thickness (rho = 0.08; P = 0.03) and with foveal hypoplasia (rho = 0.15, P0.001).Our findings indicate that there are fetal origins affecting foveal shape, resulting in foveal hypoplasia potentially affecting the visual acuity in adulthood.

Background/Aims: This study investigated whether there are changes in corneal surface regularity and corneal thickness in adults born small, appropriate, or large for gestational age at term. Methods: This retrospective cohort study involved prospective Scheimpflug imaging of the cornea (Pentacam®) to compare the corneal thickness and aberrations between adults classified as small for gestational age (SGA), normal birth weight (BW), and large for gestational age (LGA). Multivariable linear regression was applied to analyze associations with gestational age, BW percentile, placental insufficiency, preeclampsia, and breastfeeding. Results: In total, 448 eyes of 261 individuals born full term (aged 29.9 ± 9.5 years, 140 females) were examined, including 29 severe SGA (BW < 3rd percentile), 32 moderate SGA (BW between 3rd and 90th and 97th percentile), and 33 severe LGA (BW > 97th percentile). There were no differences between groups in the corneal aberrations of the total cornea as well as of the corneal front surface, except for higher-order aberrations in the front of the cornea (p = 0.032). There was an association between the increased total root mean square of higher-order aberrations and lower birth weight percentile (p = 0.004), with increased higher-order aberrations correlating with lower visual acuity and spherical equivalent. Conclusion: Restricted prenatal growth is associated with increased higher-order aberrations in adulthood.

Objectives This study investigated the effects of prematurity and ROP on visual acuity and VRQoL in adults (18–52 years). Methods The Gutenberg Prematurity Eye Study is a retrospective cohort study with a prospective ophthalmologic examination. Preterm and full-term participants at an age from 18 to 52 years were included. Distant corrected visual acuity (DCVA) and VRQoL were assessed in participants (892 eyes of 450 individuals aged 28.6 ± 8.6 years, 251 females) grouped into full-term controls (gestational age [GA] at birth ≥37 weeks), preterm participants without ROP and GA 33–36 weeks (group 2), GA 29–32 weeks (group 3), GA ≤ 28 weeks (group 4), non-treated ROP (group 5) and treated ROP (group 6). Main outcome measures were distant corrected visual acuity (DCVA), VRQoL and prevalence of amblyopia. Results The DCVA of the better eye correlated (p Conclusion Participants with postnatal ROP and its treatment showed decreased visual acuity and VRQol in adulthood, with amblyopia occurring more frequently in more preterm participants with ROP.

Achim Fieß,1 Marilena Brandt,1 Eva Mildenberger,2 Michael Siegfried Urschitz,3 Felix Mathias Wagner,1 Stephanie Desiree Grabitz,1 Esther Maria Hoffmann,1 Norbert Pfeiffer,1 Alexander Konrad Schuster1 1Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; 2Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; 3Division of Pediatric Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyCorrespondence: Achim Fieß, Department of Ophthalmology, Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany, Tel +49-6131-17-5150, Fax +49-6131-17-8495, Email Achim.fiess@gmail.comPurpose: Prenatal growth restriction is associated with impaired neurodevelopment in childhood. This study investigated the effects of being born small for gestational age (SGA) on peripapillary retinal nerve fiber layer (pRNFL) thickness in adults born at term.Methods: A retrospective cohort study was conducted with a prospective ophthalmologic examination of participants born at full-term (gestational age ≥ 37 weeks) between 1969 and 2002. All participants were examined with spectral-domain optical coherence tomography and grouped according to their birth weight in correlation to gestational age as former moderate (birth weight (BW) percentile 3rd to < 10th) and severe SGA (< 3rd percentile), normal (10th-90th percentile, AGA), and moderately (> 90th to 97th percentile) and severely (> 97th percentile) large for gestational age (LGA) adults (18 to 52 years).Results: Overall, 547 eyes of 285 individuals (age 29.9± 9.4 years, 151 females) born at term were included. Multivariable regression analyses revealed a strong association between a lower global pRNFL thickness in the severe SGA (B=− 8.99 [95%-CI: − 12.68; − 5.30] μm; p< 0.001) and in the moderate SGA groups (B=− 6.40 [95%-CI: − 10.29; − 2.50] μm; p=0.001) compared to the reference AGA group.Conclusion: Our results indicate that restricted fetal growth affects neurologic tissue development of the optic nerve head, particularly in individuals born severely SGA at term. This indicates that fetal growth restriction may exert disturbances in the development of neurologic tissue, which persists in adulthood.Keywords: birth weight, small for gestational age, large for gestational age, peripapillary retinal nerve fiber layer, optic nerve head, epidemiology

Prematurity and the presence of retinopathy of prematurity (ROP) increase the risk for the occurrence of amblyogenic risk factors in childhood and adolescence.The aim of the present study was to evaluate ocular morbidities and the ophthalmological care of former preterm and full-term persons in adulthood.The Gutenberg prematurity eye study (GPES) is a retrospective cohort study with a prospective ophthalmological examination of individuals formerly born preterm and full term between 1969 and 2002 (now aged 18-52 years). All participants underwent a detailed ophthalmological examination and were asked about the frequency of ophthalmological care. Participants were grouped into those with normal gestational age (GA) ≥ 37 weeks (control group), preterm individuals without ROP and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤ 28 weeks (group 4), and those with ROP without treatment (group 5) and with ROP with treatment (group 6). All participants were asked if they had an ophthalmological examination within the last 12 months.In total, data from 140 term and 310 preterm adults were included in the present study. Strabismus was present in 2.1 % (3/140), 6.6 % (9/137), 17.4 % (16/92), 11.1 % (2/18), 27.1 % (13/48) and 60 % (9/15) in groups 1-6, respectively. The proportion of subjects with an ophthalmological examination within the last 12 months was highest in the groups of extremely preterm persons with and without ROP compared with the control group. Overall, 33.3 % (1/3) of the term and 57.1 % (28/49) of the preterm subjects with strabismus and 0 % (0/3) of the term and 46.9 % (15/32) of the preterm individuals with amblyopia had an ophthalmological examination within the past 12 months.Extremely preterm adults with and without postnatal ROP showed the highest rate of eye diseases as well as the highest rate of ophthalmological check-ups within the last 12 months. This suggests that extremely preterm adults particularly with the occurrence of postnatal ROP perceive more frequent ophthalmological check-ups throughout their lives.HINTERGRUND: Frühgeburtlichkeit und das Auftreten der Frühgeborenenretinopathie (ROP) erhöhen das Risiko für das Auftreten von amblyogenen Risikofaktoren in der Kindheit und Jugend.Das Ziel der vorliegenden Studie war die Beschreibung der augenärztlichen Versorgung und der Augenerkrankungen ehemaliger früh- und reifgeborener Personen im Erwachsenenalter.Die Gutenberg Prematurity Eye Study (GPES) ist eine retrospektive Kohortenstudie mit einer prospektiven augenärztlichen Untersuchung von ehemaligen früh- und reifgeborenen Personen, geboren zwischen 1969 und 2002 (aktuelles Alter 18 bis 52 Jahre). Alle Teilnehmenden wurden hinsichtlich amblyogener Parameter wie z. B. dem Vorliegen eines Strabismus und von Refraktionsfehlern untersucht. Die Teilnehmenden wurden gruppiert in Personen mit normalem Gestationsalter (GA) ≥ 37 (Kontrollgruppe), Frühgeborene ohne ROP mit GA 33–36 (Gruppe 2), GA 29–32 (Gruppe 3), GA ≤ 28 Wochen (Gruppe 4) und solche mit ROP ohne Behandlung (Gruppe 5) und mit ROP mit Behandlung (Gruppe 6). Es wurde von allen Teilnehmenden erhoben, wie oft sie innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung gewesen sind.Insgesamt wurden die Daten von 140 reifgeborenen und 310 frühgeborenen Erwachsenen in die vorliegende Studie eingeschlossen. Ein Strabismus lag bei 2,1 % (3/140), 6,6 % (9/137), 17,4 % (16/92), 11,1 % (2/18), 27,1 % (13/48) und 60 % (9/15) in den jeweiligen Gruppen 1 bis 6 vor. Der Anteil an Probanden mit augenärztlicher Untersuchung innerhalb der letzten 12 Monate war in den Gruppen der extrem Frühgeborenen mit und ohne ROP im Vergleich zur Kontrollgruppe am höchsten. Insgesamt waren 33,3 % (1/3) der Reifgeborenen und 57,1 % (28/49) der Frühgeborenen mit Strabismus und 0 % (0/3) der Reifgeborenen und 46,9 % (15/32) der Frühgeborenen mit Amblyopie innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung.Extrem frühgeborene Personen mit und ohne postnatale ROP zeigten die höchste Rate an Augenerkrankungen sowie die höchste Rate an augenärztlichen Kontrolluntersuchungen innerhalb der letzten 12 Monate. Dies deutet darauf hin, dass extrem frühgeborene Personen insbesondere mit postnataler ROP insgesamt lebenslang häufigere augenärztliche Kontrolluntersuchungen wahrnehmen.

To evaluate the long-term effects of different degrees of prematurity, retinopathy of prematurity (ROP) and associated perinatal factors on refractive error, accommodation and lens opacification development in adults born preterm aged 18-52 years.The Gutenberg Prematurity Eye Study (GPES) investigated adults born preterm and full-term at 18-52 years in Germany to assess refractive error, accommodation amplitude and lens opacification. The participants were grouped into normal gestational age (GA) ≥37 weeks (control group), preterm participants without ROP and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤28 weeks (group 4) and those with ROP without (group 5) or with treatment (group 6). Main outcome measures were refractive error, anisometropia, accommodation amplitude and lens opacification.In total, 856 eyes of 433 preterm and full-term individuals (aged 28.4 +/− 8.6 years, 242 females) were included. A myopic refractive error of6 diopter was observed in 4% (11/278), 2.7% (7/264), 1.2% (2/174), 5.6% (2/36), 10.5% (8/78) and 26.9% (7/26) of eyes and anisometropia ≥2 diopter in 2.9% (4/139), 2.3% (3/132), 3.5% (3/87), 11.1% (2/18), 9.5% (4/44) and 38.5% (5/13) of participants in the respective groups. Spherical equivalent did not differ between participants without postnatal ROP born moderately, very and extremely preterm compared to the full-term control group. ROP treatment was associated with lower accommodation and more lens opacifications.Retinopathy of prematurity treatment using cryocoagulation and laser coagulation increases refractive error associated with increased lens opacifications and reduced accommodation. Preterm delivery has little effect on absolute refractive error but is associated with anisometropia in adulthood.

This study investigated whether prematurity and associated factors or prenatal growth restriction have long-term effects on the peripapillary retinal nerve fiber layer (pRNFL) in adulthood.Retrospective cohort study.The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. Selected individuals born term and preterm (age 18-52 years) were examined with spectral-domain optical coherence tomography (SD-OCT) in adulthood, and perinatal medical charts were reviewed. The pRNFL thickness was measured using SD-OCT. Univariate and multivariable linear regression analyses were conducted to investigate associations between pRNFL and gestational age (GA; categorical), birth weight percentile (categorical), retinopathy of prematurity (ROP) occurrence, and treatment and other perinatal parameters with adjustment for age, sex, and spherical equivalent.In total, 766 eyes of 406 preterm and full-term individuals were included (mean age 28.4 ± 8.6 years, 228 females). After adjustment for age, sex, and spherical equivalent, global pRNFL thinning was associated with moderate (GA = 33-36 wk, β = -4.68, P.001), very (GA = 29-32 wk, β = -5.72, P.001), and extreme (GA ≤ 28 wk, β = -8.69, P.001) prematurity but not with low birth weight percentile (25th percentile, P = .9) and ROP occurrence (P = .9) in multivariable analysis. ROP treatment was associated with increased pRNFL in the temporal sector (P = .002). Maternal smoking during pregnancy showed an association with pRNFL thinning (P = .07).Our data indicate that the more preterm individuals are born the more pRNFL thinning occurs, whereas prenatal growth restriction and postnatal occurrence of ROP show less effects on pRNFL thickness. Furthermore, individuals with severe ROP with treatment but not lower ROP stages without treatment showed an increased temporal pRNFL thickness.

Purpose This study investigates the prevalence of manifest strabismus and its subtypes in adulthood and analyzes the risk factors and its impact on vision-related quality of life (VRQoL). Design The Gutenberg Health Study (GHS) is a population-based, observational cohort study. A cross-sectional analysis of the baseline examination was conducted. Participants Participants aged 35 to 74 years were included (n = 15 010). Methods All participants were examined with a comprehensive ophthalmologic and general examination including the Hirschberg corneal reflex test to detect manifest strabismus. The following risk factors were analyzed: age, sex, socioeconomic status, birth weight, maternal age at birth, anisometropia, astigmatism, spherical equivalent, low visual acuity in the worse seeing eye (≥1.3 logMAR), and cardiovascular factors, and included in multivariable logistic regression analysis. Lifetime period prevalence and point prevalence of manifest strabismus were computed, and VRQoL was compared between participants with and without strabismus. Main Outcome Measure Strabismus prevalence. Results A total of 14 700 participants (age, 55.0±11.1 years; 49.5% were female) were included in this analysis. The weighted prevalence of ever having strabismus was 2.9% (2.6%–3.2%), and the point prevalence for concomitant strabismus was 2.5% (2.3%–2.8%). Esotropia was twice as frequent as exotropia, and 2 participants had paralytic strabismus. Concomitant strabismus was associated with age 65 to 69 years (odds ratio [OR], 0.13 [0.05–0.39], P 1.0 diopters [D]: OR, 3.61 [2.32–5.62], P 2.0 D: OR, 6.93 [4.23–11.35], P Conclusions Strabismus is a frequent chronic eye condition that is associated with a lower VRQoL. Individuals with anisometropia, astigmatism, and hyperopia are more likely to have strabismus. In addition, low visual acuity in the worse eye was linked to strabismus prevalence.

Zusammenfassung Hintergrund Frühgeburtlichkeit und das Auftreten der Frühgeborenenretinopathie (ROP) erhöhen das Risiko für das Auftreten von amblyogenen Risikofaktoren in der Kindheit und Jugend. Ziel der Arbeit Das Ziel der vorliegenden Studie war die Beschreibung der augenärztlichen Versorgung und der Augenerkrankungen ehemaliger früh- und reifgeborener Personen im Erwachsenenalter. Material und Methoden Die Gutenberg Prematurity Eye Study (GPES) ist eine retrospektive Kohortenstudie mit einer prospektiven augenärztlichen Untersuchung von ehemaligen früh- und reifgeborenen Personen, geboren zwischen 1969 und 2002 (aktuelles Alter 18 bis 52 Jahre). Alle Teilnehmenden wurden hinsichtlich amblyogener Parameter wie z. B. dem Vorliegen eines Strabismus und von Refraktionsfehlern untersucht. Die Teilnehmenden wurden gruppiert in Personen mit normalem Gestationsalter (GA) ≥ 37 (Kontrollgruppe), Frühgeborene ohne ROP mit GA 33–36 (Gruppe 2), GA 29–32 (Gruppe 3), GA ≤ 28 Wochen (Gruppe 4) und solche mit ROP ohne Behandlung (Gruppe 5) und mit ROP mit Behandlung (Gruppe 6). Es wurde von allen Teilnehmenden erhoben, wie oft sie innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung gewesen sind. Ergebnisse Insgesamt wurden die Daten von 140 reifgeborenen und 310 frühgeborenen Erwachsenen in die vorliegende Studie eingeschlossen. Ein Strabismus lag bei 2,1 % (3/140), 6,6 % (9/137), 17,4 % (16/92), 11,1 % (2/18), 27,1 % (13/48) und 60 % (9/15) in den jeweiligen Gruppen 1 bis 6 vor. Der Anteil an Probanden mit augenärztlicher Untersuchung innerhalb der letzten 12 Monate war in den Gruppen der extrem Frühgeborenen mit und ohne ROP im Vergleich zur Kontrollgruppe am höchsten. Insgesamt waren 33,3 % (1/3) der Reifgeborenen und 57,1 % (28/49) der Frühgeborenen mit Strabismus und 0 % (0/3) der Reifgeborenen und 46,9 % (15/32) der Frühgeborenen mit Amblyopie innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung. Diskussion Extrem frühgeborene Personen mit und ohne postnatale ROP zeigten die höchste Rate an Augenerkrankungen sowie die höchste Rate an augenärztlichen Kontrolluntersuchungen innerhalb der letzten 12 Monate. Dies deutet darauf hin, dass extrem frühgeborene Personen insbesondere mit postnataler ROP insgesamt lebenslang häufigere augenärztliche Kontrolluntersuchungen wahrnehmen.

Prematurity and retinopathy of prematurity (ROP) are associated with altered corneal shape and reduced visual acuity in childhood, but their long-term effects on corneal shape in later life are still unclear. This study evaluated whether prematurity and related perinatal factors are associated with corneal aberrations in adulthood.The Gutenberg Prematurity Eye Study (GPES) is a cohort study using Scheimpflug imaging of the cornea. Associations were assessed between corneal Zernike aberrations and gestational age (GA), birth weight (BW), BW percentile, ROP occurrence, ROP treatment and other perinatal factors using univariate and multivariable linear regression analyses.This study involved 444 eyes of 256 individuals born preterm (aged 28.1 ± 8.4 years, 146 females) and 231 eyes of 132 individuals born full-term (aged 29.8 ± 8.9 years, 77 females). Multivariable analyses revealed an association between corneal higher-order aberrations and lower birth weight percentile (B = -0.001, p 0.001) as well as ROP treatment (B = 0.120, p = 0.03). Corneal lower-order aberrations were also associated with lower birth weight percentile (B = -0.004; p = 0.001) and ROP treatment (B = 0.838, p = 0.01) but not with ROP occurrence. Increased corneal aberrations were correlated with lower visual acuity and the spherical equivalent refractive error.Perinatal factors, particularly low birth weight percentile and ROP treatment lead to a more irregular corneal shape in adulthood, thereby reducing optical image quality and potentially contributing to reduced visual acuity and altered refractive error.

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (

This study aimed to investigate associations of prematurity and associated factors with optic disc morphology in adulthood as long-term effects.Retrospective cohort study.The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of adults (age 18-52 years) in Germany. In every participant, photography of optic discs was performed with a nonmydriatic fundus camera, and optic disc measurements were done manually. The vertical cup-to-disc ratio (VCDR), optic disc area, and torted and tilted discs were assessed and exploratively compared between individuals with retinopathy of prematurity (ROP) with treatment, an ROP group without treatment and groups of individuals of different gestational ages (GAs) without ROP (GA ≤ 28 weeks, GA 29-32 weeks, GA 33-36 weeks, and GA ≥ 37 weeks [control group]).The present analysis included 743 eyes of 393 individuals born preterm and full-term (aged 28.4 ± 8.6 years, 223 females). The VCDR was significantly larger in subjects with a GA ≤28 weeks without ROP compared to the full-term control group (GA ≥37 weeks) (P = .002). Subjects with ROP without treatment also had a larger VCDR (P = .001), whereas those with ROP treatment showed a smaller VCDR than the full-term control group (P = .02). In addition, individuals with ROP treatment were more likely to have a torted disc than the full-term control group (P = .006).The present study provides evidence that individuals born extremely preterm have increased VCDR in adulthood. Furthermore, these results indicate that fetal origins affect optic disc morphology until adulthood, which might predispose the affected individual to degenerative optic nerve head diseases or being incorrectly diagnosed to glaucoma.

Low birth weight (BW) is associated with altered ocular geometry such as a steeper corneal shape in adulthood. However, it is unclear whether low birth weight affects corneal thickness development in the center or periphery in adulthood which may contribute to ocular disease. The purpose of this study was to investigate corneal thickness in former low birth weight individuals in adulthood. Methods: The German Gutenberg Health Study is a prospective, population-based study in which every participant (age range 40–80 years) was measured with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany). BW was collected by self-reports. The relationship between birth weight and corneal thickness at different locations were assessed. Linear regression models were carried out including uni- and multivariable analyses with adjustment for age, sex, mean corneal radius, and white-to-white distance. Main outcome measures were corneal thickness at the apex, at the pupil center, and at the corneal periphery. Results: Overall, 5657 participants were successfully measured (3019 females, aged 56.0 ± 10.3 years). In multivariable analyses a lower BW was associated with a thinner corneal thickness at the apex (B = 1.71 µm/500 g, p &lt, 0.001) and at the pupil (B = 1.69 µm/500 g, p &lt, 0.001). These effects diminished towards the corneal periphery resulting in no differences in the perilimbal regions. Conclusion: The present study provides evidence that lower birth weight goes along with corneal thickness alterations even into adult ages of 40 to 80 years. Thinner measurements of the cornea were particularly found in the corneal center and diminished in the periphery. This indicates that there may be fetal origins affecting corneal thickness development particularly in the corneal center.

The present study investigated the long-lasting effect of prematurity, prenatal growth restriction, and associated factors on foveal and peripapillary choroidal thickness in adulthood.The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination in Germany. Foveal and peripapillary choroidal thicknesses were measured at different sectors using spectral-domain optical coherence tomography. Multivariable linear regression analyses were performed to determine associations among gestational age, birth weight percentile, retinopathy of prematurity (ROP) occurrence and treatment, and other perinatal factors, such as maternal smoking and others with foveal and global peripapillary choroidal thickness.A total of 735 eyes of 408 study participants were included (age = 28.4 ± 8.6 years, 229 women). Multivariable regression analyses revealed that foveal choroidal thinning was associated with maternal smoking during pregnancy (B = -38.1, 95% confidence interval [CI] = -65.5 to -10.7, P = 0.006), whereas other perinatal factors revealed no association. Global peripapillary choroidal thinning showed a trend to a lower birth weight percentile (B = 0.22, 95% CI = -0.01 to 0.45, P = 0.057). No correlation was observed between foveal and peripapillary choroidal thicknesses with visual acuity.This study indicates that maternal cigarette smoking during pregnancy has adverse long-lasting effects on choroidal development in the fovea and low birth weight percentile as a surrogate marker for adverse perinatal growth might be linked with peripapillary choroidal thinning whereas prematurity showed no long-term effects.Altered choroidal layer development caused by perinatal influence factors might be a risk factor for reduced visual function and predispose affected individuals to eye diseases in later life.

Ein 10 Monate alter Saugling wird vom Notarzt in unsere Klinik gebracht. Das Kind ist bewusstlos und intubiert. Angeblich ist es vom Sofa auf den Boden gefallen. Jedoch lassen die Angaben des Vaters Zweifel aufkommen.

Low birth weight (BW) is associated with increased corneal aberrations in childhood and alterations of corneal geometry in adulthood. Increased corneal aberrations may be a factor contributing to decreased visual function in former low BW newborns in later life. Hence, the aim of this study was to analyze the long-term effect of low BW on corneal aberrations in adulthood.In the German population-based Gutenberg Health Study (GHS) participants (age: 40-80 years) were examined with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany). The relationship between self-reported BW and the different types of corneal aberrations was analyzed using linear regression analysis as uni- and multivariable analysis with adjustment for potential confounders. The main outcome measures were corneal aberrations defined as astigmatism (ZOverall, 5,628 participants were included in this analysis (3,004 women, aged 56.0 +/- 10.3 years). In a multivariable analysis lower BW was associated with decreased horizontal trefoil (B = 0.004 [0.001; 0.006] µm/500 g; p=.008); higher spherical aberrations (B=-0.006 [-0.008;-0.003] µm/500 g; p.001), higher RMS (B=-0.028 [-0.042;-0.014] µm/500 g; p.001), increased HOA (B=-0.007 [-0.010;-0.003] µm/500 g; p.001) and increased LOA (B=-0.027 [-0.041;-0.013] µm/500 g; p.001). No association was observed between birth weight and the other types of corneal aberrations in multivariable model.Our results indicate an association between BW and spherical aberration in adults aged 40 to 80 years. This indicates that low BW may have an association with an altered corneal shape development which may affect optical image quality and, hence, visual function.

Purpose: This study investigates the relationship between diabetic retinopathy (DR) and birth weight (BW) in diabetic subjects sampled from the general population. Methods: The Gutenberg Health Study (GHS) is a population-based, observational cohort study in participants aged from 35 to 74 years. Criteria for diabetes diagnosis were HbA1c ≥6.5% at study entry, a doctor-diagnosis of diabetes, or diabetes medication. The presence of DR was determined by evaluating fundus photographs. BW was assessed by self-reports. GHS participants were divided into three different BW groups (low: 4000 g). Logistic regression analysis was conducted as uni- and multivariable analysis with adjustment for age and sex. Effect mediators were separately investigated. Results: A total of 1,124 GHS participants (7.5% of the cohort) had diabetes at study entry. Of these, 402 subjects (35.8%) had gradable fundus photographs, reported BW data and were included into this study. Overall, 91/402 subjects (23%) had DR. With regard to BW groups, DR was descriptively more frequent in subjects with low (28.1% [95%-CI: 14.4–47.0%; n = 32]) and high BW (30.8% [95%- CI: 19.1–45.3%; n = 52]) compared to normal BW (20.8% [95%-CI: 16.5–25.7%; n = 318]). Both high and low BW were associated with DR in multivariable analysis (high: OR = 1.68, p = .037; low: OR = 1.81, p = .05). The BW effect was mediated by duration of diabetes in both BW groups and by arterial hypertension in the low BW group. Conclusion: Low and high BW in persons with diabetes is related to higher risk of diabetic retinopathy. Longer duration of diabetes and higher prevalence of arterial hypertension are factors in these subjects explaining the elevated risk.

Purpose To investigate the retinal nerve fiber layer profile measured by optical coherence tomography and its relation to refractive error and axial length. Methods The Gutenberg Health Study is a population-based study in Mainz, Germany. At the five-year follow-up examination, participants underwent optical coherence tomography, objective refraction and biometry. Peripapillary retinal nerve fiber layer (pRNFL) was segmented using proprietary software. The pRNFL profiles were compared between different refraction groups and the angle between the maxima, i.e., the peaks of pRNFL thickness in the upper and lower hemisphere (angle between the maxima of pRNFL thickness [AMR]) was computed. Multivariable linear regression analysis was carried out to determine associations of pRNFL profile (AMR) including age, sex, optic disc size, and axial length in model 1 and spherical equivalent in model 2. Results A total of 5387 participants were included. AMR was 145.3° ± 23.4° in right eyes and 151.8° ± 26.7° in left eyes and the pRNFL profile was significant different in the upper hemisphere. The AMR decreased with increasing axial length by −5.86°/mm (95% confidence interval [CI]: [−6.44; −5.29], P < 0.001), female sex (−7.61°; 95% CI: [−8.71; −6.51], P < 0.001) and increased with higher age (0.08°/year; 95% CI: [0.03; 0.14], P = 0.002) and larger optic disc size (2.29°/mm2; 95% CI: [1.18; 3.41], P < 0.001). In phakic eyes, AMR increased with hyperopic refractive error by 2.60°/diopters (dpt) (95% CI: [2.33; 2.88], P < 0.001). Conclusions The pRNFL profiles are related to individual ocular and systemic parameters. Translational Relevance Biometric parameters should be considered when pRNFL profiles are interpreted in diagnostics, i.e., in glaucoma.

Purpose The purpose of this study was to investigate the association between intraocular pressure (IOP) and ocular geometry. Methods The Gutenberg Health Study is a population-based cohort study in Mainz, Germany. Study participants underwent a comprehensive ophthalmologic examination including noncontact tonometry, objective refraction, optical biometry, and Scheimpflug imaging of the anterior segment at the first 5-year follow-up examination (in 2012–2017). Multivariable linear regression analysis was carried out to determine associations of IOP and geometric parameter of the human phakic eye, namely central corneal thickness (CCT), corneal curvature, anterior chamber depth (ACD), lens thickness, and axial length. In addition, the relationship of IOP and the anterior chamber angle (ACA) width was analyzed. Results There were 6640 participants with phakia (age 57.3 ± 10.2 years, 49.1% women) that were included in this cross-sectional analysis. Mean IOP was 14.8 ± 2.9 mm Hg in the right eyes and 14.9 ± 2.9 mm Hg in the left eyes. IOP increased with higher CCT, greater posterior segment length, higher age (all P < 0.001), thicker lens (P = 0.003), and female sex (P = 0.05), whereas the ACD was not associated with higher IOP. The IOP increased with a narrower ACA in univariable analysis (P < 0.001), but not in adjusted analysis in subjects with an open angle. Conclusions IOP values are related to ocular geometry, as shown in this population-based study on Caucasian subjects. Thus, knowledge of the architecture of the eye is an important factor when measuring IOP. Longitudinal evaluation will analyze whether some of these parameters are also risk factors for the development of glaucoma.

Background Limited data exist collating most of the associated factors for strabismus in one analysis. The aim of this study was to assess the prevalence of strabismus and to analyse associated factors in former preterm and full-term infants. Methods In this cross-sectional study, 239 former preterm infants with gestational age (GA) ≤ 32 weeks and 264 former full-term born infants with GA ≥ 37 weeks underwent detailed ophthalmologic examination in the age of 4–10 years and perinatal data assessment for risk factor analysis. Ophthalmologic examinations included cover testing, best corrected visual acuity, cycloplegic objective refraction, slit lamp as well as fundus examinations. For association analysis with strabismus, the following data was collected and included in multivariable analysis: sex, age at examination, anisometropia, myopic and hyperopic refractive error (≥ 3 dioptres), astigmatism, birth weight percentile, gestational age, retinopathy of prematurity occurrence, maternal age at childbirth, mother smoking, breastfeeding

Purpose Low birth weight (BW) is associated with alterations of foveal shape development in childhood—leading to an increased retinal thickness of the fovea. The aim of the present study was to assess whether BW has a long-term effect on foveal retinal thickness (RT) and is still present in adulthood. Methods In the German population-based Gutenberg Health Study (GHS), participants were examined with spectral-domain optical coherence tomography. The association between self-reported BW and RT in the foveolar and perifoveal locations was assessed. Multivariable linear regression analyses with adjustment for potential confounders and grading of foveal hypoplasia were performed. Results Overall, RT measurements and self-reported BW were available for 2,539 participants (1300 female, mean age 54.5 ± 9.7 years). The absolute foveolar RT was 239.6 ± 25.8 µm, 232.2 ± 20.1 µm and 234.8 ± 21.0 µm, respectively, in the low (4000 g) BW groups (P < 0.001). After adjustment for confounders, an association was observed between lower BW and increased foveolar thickness (B = –0.35 [95% confidence interval {CI}: –0.49; –0.20] µm/100 g; P < 0.001), whereas only a weak association with RT was observed with the nasal (P = 0.010), temporal (P = 0.011), and inferior (P = 0.021) quadrants in the 1 mm distance, with no association in the 2 mm distance to the fovea. Foveal hypoplasia grade 1 was more frequent in the low BW group (6.8%) compared to the normal (0.9%) and high BW group (1.2%). Conclusions This study provides evidence of an association between lower BW and increased foveolar thickness and foveal hypoplasia, indicating that prenatal growth may affect macular morphology, which in turn may persist until adulthood and predispose to retinal disease later in life.

Zusammenfassung Hintergrund Ziele der vorliegenden Untersuchung waren die Evaluation ophthalmologischer Nachsorgeuntersuchungen ehemaliger früh- und reifgeborener Kinder im Alter von 4 bis 10 Jahren und der Vergleich mit den deutschen Leitlinien. Methodik In der prospektiven Wiesbaden Prematurity Study (WPS) wurden 503 Kinder, davon 239 Frühgeborene (FG) mit Gestationsalter (GA) ≤ 32 Wochen und 264 Reifgeborene (RG) mit GA ≥ 37 Wochen (Kontrollgruppe) im Alter von 4 bis 10 Jahren inklusive Refraktionsmessung und orthoptischem Status untersucht. Anisometropie war definiert als Refraktionsunterschied von ≥ 1 dpt sphärischem Äquivalent. Die Eltern wurden zusätzlich gefragt, ob nach der Entlassung aus dem Krankenhaus eine augenärztliche Untersuchung stattgefunden habe und wie oft eine solche innerhalb der letzten 12 Monate durchgeführt wurde. Ergebnis Insgesamt zeigten sich ein Strabismus bzw. eine Anisometropie bei 18 bzw. 10% aller FG- und 2 bzw. 5% aller RG-Kinder. Von den 4 bis 6 Jahre alten FG waren 65% und von den 4 bis 6 Jahre alten RG 42% innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung (p = 0,002). Bei 15% aller Kinder mit Strabismus war innerhalb der letzten 12 Monate keine augenärztliche Untersuchung erfolgt. Die Eltern von 3 frühgeborenen Kindern berichteten nach der Entlassung aus dem Krankenhaus, nie bei einer augenärztlichen Kontrolluntersuchung gewesen zu sein. Schlussfolgerung Zwei Drittel der ehemaligen FG nahmen nach Aussage der Eltern im Alter von 4 bis 6 Jahren innerhalb der letzten 12 Monate an einer augenärztlichen Kontrolluntersuchung teil, was in den Leitlinien für die Versorgung ehemaliger frühgeborener Kinder empfohlen wird. Hier zeigt sich noch Verbesserungspotenzial, um diese Risikopopulation, insbesondere für Strabismus und Amblyopie, bestmöglich zu versorgen.

To analyse macular retinal and choroidal layer thickness in former preterm and full-term infants and to assess associated perinatal influence factors and functional correlation. This prospective controlled, cross-sectional, hospital-based study in a tertiary center of maximum care examined former preterm infants with a gestational age (GA) ≤ 32 weeks and full-term neonates currently aged 4 to 10 years. We investigated data from 397 infants, analysing total foveal retinal thickness and six distinct macular retinal layer and choroidal layer measurements via spectral-domain optical coherence tomography. Multivariable linear regression analysis was performed to investigate associations of layer thickness with GA and retinopathy of prematurity (ROP). Total retinal thickness in the fovea was thicker in former preterm infants with GA ≤ 28 weeks and in those with GA between 29–32 weeks compared to full-term infants independently of ROP. Occurrence of ROP was also associated with increased foveal thickness. Ganglion cell layer together with inner plexiform layer (GCL+IPL) was thinner in infants with GA ≤ 28 weeks than in full-term infants at 1000 and 2000μm distance from the fovea, but no association with ROP was present. Similar results were found for the photoreceptor layer. Total foveal retinal thickness was associated with low visual function. This study identified low gestational age and ROP occurrence as main determinants for foveal thickening. Furthermore, thinned GCL+IPL measurements were associated with lower gestational age. This study highlights the prognostic value of these maturity parameters influencing retinal morphology, which may affect visual function.

This study analyzed whether low birth weight is linked to prevalence and incidence of age-related maculopathy (AMD) in adulthood.The Gutenberg Health Study (GHS) is a population-based, observational cohort study in Germany. GHS participants at an age from 35 to 74 years were included. An ophthalmologic examination with fundus photography was carried out. Fundus photographs were graded according to the Rotterdam Grading Scheme for AMD at baseline and at the 5-year follow-up examination. Participants were divided into three different birth weight groups (low:2500 g; normal: 2500-4000 g; and high:4000 g). Poisson regression analysis with adjustment for several confounders was used to assess associations between birth weight and AMD prevalence (overall, early, late AMD) and 5-year cumulative incidence.Overall, 6492 participants were included (3538 female, aged 50.7 ± 10.4 years). Prevalence of total AMD was highest in the low birth weight group (11.2%; 40/358) compared to the normal birth weight group (6.5%; 346/5328) and the high birth weight group (8.4%; 68/806). Low birth weight was associated with overall AMD prevalence (prevalence ratio [PR] = 1.54, P = 0.006), and in particular with early AMD prevalence (PR = 1.52; P = 0.01). No association was observed between low birth weight and cumulative 5-year incidence of AMD.Our analyses indicate that low birth weight may lead to higher prevalence of retinal diseases in later life, as we observed for AMD. Our results are limited due to missing data and loss to follow-up, but may be a first hint that AMD has one of its origins in early life.

IMPORTANCE: Low birth weight is associated with altered ocular organ development in childhood, including the morphology of the eye. However, no population-based data exist about this association in adulthood. OBJECTIVE: To evaluate whether low birth weight has a long-term association with anterior segment anatomy and axial length in adulthood. DESIGN, SETTING, AND PARTICIPANTS: The Gutenberg Health Study is a population-based, observational cohort study in Germany. All participants underwent ocular biometry. Among the participants with follow-up and self-reported birth weight available, associations were assessed between low birth weight and anterior segment anatomy and axial length using multivariable linear regression analysis with adjustment for age and sex. In patients with phakia, anterior chamber depth and lens thickness were also examined. Data for this study were collected from April 27, 2012, through April 28, 2017, and analyzed from January through April 2018. EXPOSURES: Low birth weight. MAIN OUTCOMES AND MEASURES: Corneal curvature, central corneal thickness, white-to-white distance, anterior chamber depth, lens thickness, and axial length. RESULTS: Overall, 11 294 eyes of 7120 participants were included (52.4% female; mean [SD] age, 56.2 [10.3] years). Most of the participants were white (98.6%). After adjustment for age and sex, an association was found between a lower birth weight and steeper corneal curvature (β = 0.005 mm/100 g; 95% CI, 0.005-0.006 mm/100 g; P

PurposeLow birth weight (BW) is linked to impaired organ development in childhood, including altered ocular morphological and functional development. The aim of this study was to evaluate whether low BW has long-term effects on visual acuity and refraction in adulthood.MethodsThe Gutenberg Health Study is a population-based, observational cohort study in Germany, including 15 010 participants aged between 35 and 74 years. These participants were divided into three different BW groups (low: 4000 g). Best-corrected visual acuity and objective refraction were examined. We used multivariable linear regression models with adjustment for age, sex, socioeconomic status and self-reported glaucoma, age-related macular degeneration, corneal disease and cataract to assess associations between BW and the main outcome measures, best-corrected visual acuity, spherical equivalent and astigmatism.ResultsOverall, 8369 participants reported their BW. In a multivariable analysis, an association for low BW with spherical equivalent (B=−0.28 per dioptre, P=0.005) and best-corrected visual acuity (B=0.02 logarithm of the minimum angle of resolution, P=0.006) compared with normal BW was observed. For participants with high BW, an association was observed with spherical equivalent (B=0.29 per dioptre, PConclusionsOur data demonstrated that low BW is linked to visual acuity and refractive long-term outcomes long after childhood. Individuals with low BW are more likely to have lower visual acuity and a higher myopic refractive error in adulthood. Adults with high BW are more likely to have a more hyperopic refractive error.

Die vorliegende Kasuistik beschreibt den sehr seltenen Fall eines Candida-Linsenabszesses bei einem Fruhgeborenen (Gestationsalter 24 Wochen). Direkt nach der Geburt war es zu einer Candida-Sepsis gekommen, die mit systemischer antimykotischer Therapie erfolgreich behandelt wurde. Die aktuelle Vorstellung im Alter von 6 Monaten erfolgte aufgrund einer weislichen Veranderung im Bereich der Pupille bei unauffalligem Allgemeinzustand. Die Narkoseuntersuchung ergab eine grauliche Pupillarmembran und dahinter weisliches Material in einer gequollenen Linse. Es erfolgte die Lensektomie. Der posteriore Glaskorper sowie der Fundus waren unauffallig. Mikrobiologisch wurde Candida albicans nachgewiesen. Bei Fruhgeborenen mit noch existenter Tunica vasculosa lentis kann es zu einer Keimverschleppung in die Linse kommen, die nach Ruckbildung der Tunica einer systemischen Therapie nicht zugangig ist und erst zeitversetzt klinisch in Form einer Abszessbildung manifest werden kann.

The purpose of this investigation was to analyse the ophthalmic follow-up care of former pre-term and full-term born infants aged 4 to 10 years in the clinical practice and the comparison to the recommendations of the national ophthalmic guidelines.For the prospective Wiesbaden Prematurity Study (WPS), 503 infants were examined: 239 former pre-term infants (PT) with gestational age (GA) ≤ 32 weeks and 264 former full-term born infants (FT) with a GA ≥ 37 weeks aged 4 to 10 years. Ophthalmic examination was performed including refractive measurements and orthoptic examination. Anisometropia was defined as a difference of ≥ 1 D spherical equivalent. Data was assessed if an ophthalmological examination was performed after hospital discharge, and how many times the ophthalmologist was contacted within the last 12 months.Overall, strabismus and anisometropia were present in 18 and 10% of all PT, and in 2 and 5% of all FT infants, respectively. In infants aged 4 to 6 years, 65% of all former PT and 42% of all former FT had ophthalmological contacts within the last year (p = 0.002). 15% of the pre-term infants with strabismus did not have an ophthalmological examination within the last year. The parents of three former pre-term infants reported that they never had an ophthalmologic examination after hospital discharge.Two-thirds of the former pre-term infants participated in a screening examination at the age of 4 to 6 years in the last year according to their parents, which is recommended by the guidelines for the care of former pre-term infants. There is still room for improvement to provide best ophthalmological care for this vulnerable population that have high risk for strabismus and amblyopia.Ziele der vorliegenden Untersuchung waren die Evaluation ophthalmologischer Nachsorgeuntersuchungen ehemaliger früh- und reifgeborener Kinder im Alter von 4 bis 10 Jahren und der Vergleich mit den deutschen Leitlinien.In der prospektiven Wiesbaden Prematurity Study (WPS) wurden 503 Kinder, davon 239 Frühgeborene (FG) mit Gestationsalter (GA) ≤ 32 Wochen und 264 Reifgeborene (RG) mit GA ≥ 37 Wochen (Kontrollgruppe) im Alter von 4 bis 10 Jahren inklusive Refraktionsmessung und orthoptischem Status untersucht. Anisometropie war definiert als Refraktionsunterschied von ≥ 1 dpt sphärischem Äquivalent. Die Eltern wurden zusätzlich gefragt, ob nach der Entlassung aus dem Krankenhaus eine augenärztliche Untersuchung stattgefunden habe und wie oft eine solche innerhalb der letzten 12 Monate durchgeführt wurde.Insgesamt zeigten sich ein Strabismus bzw. eine Anisometropie bei 18 bzw. 10% aller FG- und 2 bzw. 5% aller RG-Kinder. Von den 4 bis 6 Jahre alten FG waren 65% und von den 4 bis 6 Jahre alten RG 42% innerhalb der letzten 12 Monate bei einer augenärztlichen Untersuchung (p = 0,002). Bei 15% aller Kinder mit Strabismus war innerhalb der letzten 12 Monate keine augenärztliche Untersuchung erfolgt. Die Eltern von 3 frühgeborenen Kindern berichteten nach der Entlassung aus dem Krankenhaus, nie bei einer augenärztlichen Kontrolluntersuchung gewesen zu sein.Zwei Drittel der ehemaligen FG nahmen nach Aussage der Eltern im Alter von 4 bis 6 Jahren innerhalb der letzten 12 Monate an einer augenärztlichen Kontrolluntersuchung teil, was in den Leitlinien für die Versorgung ehemaliger frühgeborener Kinder empfohlen wird. Hier zeigt sich noch Verbesserungspotenzial, um diese Risikopopulation, insbesondere für Strabismus und Amblyopie, bestmöglich zu versorgen.

The purpose is to describe the outcome of trabeculectomy with transscleral cyclophotocoagulation (TSCPC) as an initial intervention for secondary childhood glaucoma in Northern Tanzania.A retrospective, consecutive case series was analyzed of all children with secondary childhood glaucoma who underwent initial trabeculectomy or TSCPC between 2000 and 2013 at a referral eye unit in Northern Tanzania. Retrospective data were collected on causes of glaucoma, intraocular pressure (IOP), visual acuity, complications, and subsequent interventions. Outcomes were evaluated using Kaplan-Meier survival analysis and compared with Cox regression analysis. The main outcome measure was failure (IOP21 mm Hg).Thirty-six eyes of 27 children (male, 21; median age, 9 y; range, 0.3 to 15 y) with secondary childhood glaucoma underwent trabeculectomy (19 eyes, 53%) or TSCPC (17 eyes, 47%). Causes included ocular trauma (13, 36%), previous cataract surgery (12, 33%), congenital aniridia (5, 14%), Sturge-Weber syndrome (2, 6%), steroid-induced glaucoma (2, 6%), uveitis (1, 3%), and unspecified leucoma (1, 3%). After 12 months, success was achieved in 48% after trabeculectomy and 18% after TSCPC, with visual acuity remaining unchanged in 11 of 14 (79%) and 4 of 5 eyes (80%), respectively. One third of the children did not return for follow-up after 1 year. Distance to the hospital (100 km) was a significant risk factor for trabeculectomy failure (P=0.031).A high proportion of secondary childhood glaucoma in Northern Tanzania was caused by trauma and previous cataract surgery. Trabeculectomy was associated with better IOP control but also a higher complication rate. The ability to maintain visual function was comparable after both interventions. Failure was associated with a journey to the eye hospital (100 km) possibly leading to late presentation with advanced disease and erratic follow-up.

PURPOSE. The aim of the study was to investigate peripapillary choroidal thickness in former preterm and full-term infants with spectral-domain optical coherence tomography (SD-OCT). METHODS. Subanalysis of infants with successful peripapillary choroidal thickness measurements of a prospective, controlled, cross-sectional, hospital-based study in a tertiary center of maximum care. The study examined 503 infants aged 4 to 10 years at the time of examination. Infants were divided into different groups: group 1 born with gestational age (GA) >= 37 weeks, group 2 born with GA between 29 and 32 weeks without ROP (retinopathy of prematurity), group 3 born with GA

Einleitung: Die Sarkoidose kann hinsichtlich ophthalmologischer und allgemeiner Symptomatik eine grose Bandbreite aufweisen. Dabei sind die fruhzeitige Diagnosestellung und Therapie fur die Visusprognose von entscheidender Bedeutung. Deshalb werden im Folgenden 3 besondere Falle mit okularer Symptomatik bei Sarkoidose vorgestellt. Methodik: Drei Fallberichte. Ergebnisse: Wir beschreiben 3 Falle mit Panuveitis bei unterschiedlicher Anamnese und entsprechend differenter Verdachtsdiagnose. Ein 14-jahriger Junge litt initial an einer therapieresistenten Sinusitis, gefolgt von einer Panuveitis mit ausgepragtem chorioretinalen Befallsmuster. Weiterhin bestanden eine Fazialisparese, eine Parotisschwellung, Fieber sowie eine Verschlechterung des Allgemeinzustands. Die histologische Aufarbeitung der Conchotomie ergab eine granulomatose Entzundung mit nicht verkasenden Granulomen. Eine 66-jahrige Patientin stellte sich mit der Verdachtsdiagnose eines paraneoplastischen Syndroms bei Z. n. Sigmakarzinom vor. Es imponierte eine ausgepragte Uveitis mit uberwiegend anteriorem Reizzustand. Zunachst karzinomverdachtige Herde im Thorax-CT ergaben die Diagnose einer Sarkoidose. Ein 51-jahriger Patient war allgemeinanamnestisch gesund. Er beschrieb eine langsam progrediente Abnahme der Sehscharfe, welche sowohl durch eine Vitritis als auch vor allem durch ein ausgepragtes Makulaodem erklart war. Im Rahmen der Ursachenabklarung zeigte sich eine bihilare Lymphadenopathie im Rontgen-Thorax. Diskussion: Bei allen Patienten konnte nach zunachst anders lautender Verdachtsdiagnose eine Sarkoidose gesichert werden, wobei es sich bei Fall 1 um ein Heerfordt-Syndrom als Sonderform der Sarkoidose handelte. Unter systemischer Prednisolontherapie kam es bei allen 3 Patienten zu einer deutlichen Befundbesserung. Die beschriebenen Falle demonstrieren die Bandbreite des ophthalmologischen Befallsmusters der Sarkoidose, deren fruhzeitige Diagnosestellung und Therapie von entscheidender Bedeutung fur die Prognose sind.

Purpose The aim of the study was to investigate peripapillary retinal nerve fibre layer thickness (RNFLT) in former preterm infants and full-term neonates using spectral-domain optical coherence tomography (SD-OCT). Methods The prospective, controlled, cross-sectional, hospital-based study in a tertiary centre with maximum care examined 503 infants with a former gestational age (GA) of ≥37 and ≤32 weeks now aged between 4 and 10 years. In total, we analysed 432 participants with successful circular peripapillary RNFLT OCT measurements. Main outcome measures were RNFLT correlations to GA, birth weight, occurrence of retinopathy of prematurity (ROP), perinatal adverse events as well as functional correlation. Results Global RNFLT was thinner in infants with GA ≤28 weeks compared with infants with GA between 29 and 32 weeks (p=0.024), and to full-term neonates (p=0.007) independent of the occurrence of ROP. Multivariable analysis revealed that RNFLT was positively associated with higher birth weight and GA. Furthermore, a decrease of RNFLT was related to reduced visual function in all peripapillary sectors. Conclusions The main factors for retinal nerve fibre layer thinning are low birth weight and low GA. In addition, decreased RNFLT was associated with reduced visual function. This demonstrates that preterm infants are at high risk for peripapillary RNFL damage associated with reduced visual function.

Purpose To compare corneal aberrations in former preterm infants to that of full-term infants. Methods A prospective cross-sectional study was carried out measuring the corneal shape with Scheimpflug imaging in former preterm infants of gestational age (GA) ≤32 weeks and full-term infants with GA ≥37 weeks now being aged between 4 to 10 years. The main outcome measures were corneal aberrations including astigmatism (Zernike: Z2-2; Z22), coma (Z3-1; Z31), trefoil (Z3-3; Z33), spherical aberration (Z40) and root-mean square of higher-order aberrations (RMS HOA). Multivariable analysis was performed to assess independent associations of gestational age groups and of retinopathy of prematurity (ROP) occurrence with corneal aberrations adjusting for sex and age at examination. Results A total of 259 former full-term and 226 preterm infants with a mean age of 7.2 ± 2.0 years were included in this study. Statistical analysis revealed an association of extreme prematurity (GA ≤28 weeks) with higher-order and lower-order aberrations of the total cornea. Vertical coma was higher in extreme prematurity (P < 0.001), due to the shape of the anterior corneal surface, while there was no association with trefoil and spherical aberration. ROP was not associated with higher-order aberrations when adjusted for gestational age group. Conclusions This study demonstrated that specific corneal aberrations were associated with extreme prematurity rather than with ROP occurrence.

Aim To evaluate goniotomy, trabeculotomy, transscleral cyclophotocoagulation (TSCPC) and trabeculectomy as initial procedures in children with primary childhood glaucoma from Northern Tanzania. Methods A retrospective analysis of consecutive interventions for primary childhood glaucoma from 2000 to 2013 was conducted at the Kilimanjaro Christian Medical Centre. Success was defined as postoperative intraocular pressure (IOP) below 22 mmHg. Success rates, IOP, visual acuity (VA), subsequent interventions and potential risk factors for failure were reported for the respective interventions. Results The study included 116 eyes of 70 children (age 4.6±5.9 years) with primary childhood glaucoma; 46 (65.7%) children were male. The preoperative IOP was 33.1±10.2 mmHg, the preoperative cup/disc (CD) ratio 0.71±0.3 and the corneal diameter 13.3±1.4 mm. As a primary intervention, 61 (52.6%) eyes underwent goniotomy, 10 (8.6%) eyes trabeculotomy, 12 (10.3%) TSCPC and 33 (28.4%) trabeculectomy. Follow-up data after 12 months were available for 63 (54.3%) eyes. Success rates at 12 months were 38% (goniotomy), 30% (trabeculotomy), 17% (TSCPC) and 64% (trabeculectomy). All interventions achieved a statistically significant IOP reduction at 3, 6 and 12 months, except for trabeculotomy after 6 months and TSCPC at all time points. Postoperative endophthalmitis occurred in one child treated with trabeculectomy. VA in 82% of all eyes was maintained or had improved after 12 months. Conclusions Based on the success rates of this retrospective analysis, goniotomy or trabeculotomy for younger and trabeculectomy for older children can be recommended in our setting to reduce IOP. Late presentation in combination with advanced glaucomatous damage as well as erratic postoperative follow-up and treatment were likely factors that compromised overall success rates. More efforts are necessary to detect the blinding disease earlier and improve adherence to follow-up.

This case report describes an extremely rare Candida lens abscess in a premature infant (gestational age 24 weeks at birth).After birth the infant suffered from Candida sepsis which was successfully treated with an antifungal medication. The patient was referred at the age of 6 months because of greyish alterations in the pupils but an absence of other symptoms. The examination with the patient under general anesthesia revealed a grey pupillary membrane and behind it a whitish swollen lens. A lensectomy was performed. The vitreous body was inconspicuous. Candida albicans was identified microbiologically.In preterm infants dissemination of pathogens into the lens through the vascular coat of the lens is possible, which after regression of the coat is no longer accessible to systemic treatment and may thus be manifested as delayed abscess formation.

Introduction This case report presents for the first time an acute systemic allergic reaction to corticosteroids in a patient with ocular toxoplasmosis after treatment with intravenous cortisone, and discusses alternative treatments. Case presentation We present the case of a 57-year-old Caucasian woman with an anaphylactic reaction after intravenous injection of prednisolone-21-hydrogensuccinate (Solu-Decortin® H) given for the treatment of toxoplasmosis-associated chorioretinitis. Immediately after the injection, she developed an acute erythema of the legs and abdomen, angioedema, hypotension (blood pressure 80/40mmHg), tachycardia (heart rate 140/minute), hyperthermia (38.8°C), and respiratory distress. Allergological examinations showed a positive skin-prick test to prednisolone and methylprednisolone. In addition, an oral exposure test with dexamethasone (Fortecortin®) and betamethasone (Celestamine®) was conducted to find alternative corticosteroids for future treatments. After oral application, no local or systemic reactions were observed for these two substances. Conclusions This case report demonstrates that systemic allergic reactions are possible in patients with uveitis or other inflammatory ophthalmological conditions treated with intravenous corticosteroids. Intravenous administration of cortisone, for example, in the treatment of ocular toxoplasmosis, should always be conducted with caution because of a possible allergic reaction. For patients who react to a particular steroid, it is necessary to undergo allergological testing to confirm that the compound in question is indeed allergenic, and to identify other corticosteroids that are safe for future anti-inflammatory treatments.

Background The goal of this study was to investigate the visual outcome of acute central retinal artery occlusion (CRAO) after current standard therapy with and without paracentesis. In addition, we investigated whether there was a dependence of the resulting visual acuity on the time between first symptoms and implementation of paracentesis. Finally, we analysed risk factors for CRAO. Methods We performed a retrospective analysis of data from patients with CRAO who received standard in-patient therapy with and without paracentesis at the Dr. Horst Schmidt Clinics in Wiesbaden, Germany between 2000 and 2012. The primary endpoint was the change of visual acuity 3 days after the initiation of intervention. Results Data from 74 patients with CRAO were included in the study. Fifteen patients were treated conservatively and 59 patients received additional paracentesis. Clinically significant improvement of BCVA (logMAR ≥ 0.3) after 3 days was observed in 26.7% of patients without paracentesis, 36.4% of patients with paracentesis within 6 hours, 20% of patients with paracentesis within 7–24 hours, and 23.1% of patients with paracentesis more than 24 hours after the onset of symptoms. There was no significant difference in the outcome between patients with (BCVA 1.9 ± 0.31) and without paracentesis (BCVA 1.75 ± 0.32) (p = 0.9), nor among the groups with paracentesis (p = 0.8). One patient suffered a lens injury due to the paracentesis, with subsequent need for cataract surgery. Conclusions There was no added gain in visual acuity by performing a paracentesis, independent of the time elapsed between first symptoms and the implementation of paracentesis. In the absence of any tangible effectiveness of paracentesis and the inherent risks of paracentesis such as intraocular infection and injury, paracentesis does not appear to be warranted as a treatment of CRAO.