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Es soll untersucht werden, wie sich die Versorgung von Patienten mit Netzhautablosung im Laufe der letzten 15 Jahre verandert hat. Die Akten aller 5101 Patienten, die sich zwischen Januar 2005 und Marz 2020 wegen einer rhegmatogenen Netzhautablosung an einem tertiaren retinologischen Zentrum zur Operation vorstellten, wurden retrospektiv ausgewertet. Die Zahl der Ablatiooperationen ist im Laufe dieser 15 Jahre kontinuierlich von ca. 150 auf ca. 600 pro Jahr gestiegen. Dabei lag die Zahl der Netzhautablosungen in den Sommermonaten ca. 20 % uber der Anzahl in den Wintermonaten. Die anatomischen Ergebnisse am Wochenende im Notdienst unterschieden sich nicht wesentlich von den wochentags im Routineprogramm erzielten. Der relative Anteil einer Buckelchirurgie ging von uber 60 % erheblich bis auf 5 % zuruck. Zu Beginn des untersuchten Zeitraums wurde bei den meisten primaren Vitrektomien eine Zusatzcerclage gelegt, hierauf wurde jedoch in den letzten Jahren fast vollstandig verzichtet, ohne dass dabei eine Verschlechterung der Erfolgsraten beobachtet werden konnte. Eine primare Silikontamponade wurde zunehmend seltener gewahlt. Betrachtet man die Erfolgsraten der letzten 15 Jahre, lasst sich ein leichter Trend zu besseren Ergebnissen erkennen. Die Behandlungsstrategien der Netzhautablosung haben sich in den letzten Jahren erheblich gewandelt: Weniger Buckelchirurgie, mehr Vitrektomien, weniger Zusatzcerclagen, seltener primare Silikontamponade. Es zeigte sich ein leichter Trend zu besseren anatomischen Erfolgsraten.

Purpose To investigate the learning curve of vitreoretinal (VR) surgeons beginning training in retinal detachment (RD) surgery. Methods The files of all consecutive patients undergoing VR surgery for uncomplicated RD between Jan 2005 und Mar 2020 were retrospectively reviewed. Successful outcome was defined as no retinal redetachment within 3 months after surgery. Results Ten surgeons started their VR career during this period. Together, these 10 surgeons performed 3786 RD operations (mean 379; median 251; range 71–1053). Primary success rate after one operation was 90% (3420 of 3786). When starting to operate retinal detachments, VR surgeons had a primary success rate of about 80%. Redetachment rates steadily decreased and stabilized at just under 10% after about 200 operations. Beginners needed more than twice the time for the procedure compared to experienced surgeons. The individual learning curves varied widely. In our series, female surgeons seem to have a faster learning curve. Conclusion RD surgery performed by VR surgeons in training had acceptable results. With increasing experience, success rates continuously improve reaching stable levels after approximately 200 operations. The training of VR surgeons requires considerable resources.

The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15 years.Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed.The number of retinal detachment surgeries over the past 15 years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed a slight trend towards improved results over the past 15 years.The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. A slight trend towards better anatomical success rates could be observed.EINLEITUNG: Es soll untersucht werden, wie sich die Versorgung von Patienten mit Netzhautablösung im Laufe der letzten 15 Jahre verändert hat.Die Akten aller 5101 Patienten, die sich zwischen Januar 2005 und März 2020 wegen einer rhegmatogenen Netzhautablösung an einem tertiären retinologischen Zentrum zur Operation vorstellten, wurden retrospektiv ausgewertet.Die Zahl der Ablatiooperationen ist im Laufe dieser 15 Jahre kontinuierlich von ca. 150 auf ca. 600 pro Jahr gestiegen. Dabei lag die Zahl der Netzhautablösungen in den Sommermonaten ca. 20 % über der Anzahl in den Wintermonaten. Die anatomischen Ergebnisse am Wochenende im Notdienst unterschieden sich nicht wesentlich von den wochentags im Routineprogramm erzielten. Der relative Anteil einer Buckelchirurgie ging von über 60 % erheblich bis auf 5 % zurück. Zu Beginn des untersuchten Zeitraums wurde bei den meisten primären Vitrektomien eine Zusatzcerclage gelegt, hierauf wurde jedoch in den letzten Jahren fast vollständig verzichtet, ohne dass dabei eine Verschlechterung der Erfolgsraten beobachtet werden konnte. Eine primäre Silikontamponade wurde zunehmend seltener gewählt. Betrachtet man die Erfolgsraten der letzten 15 Jahre, lässt sich ein leichter Trend zu besseren Ergebnissen erkennen.Die Behandlungsstrategien der Netzhautablösung haben sich in den letzten Jahren erheblich gewandelt: Weniger Buckelchirurgie, mehr Vitrektomien, weniger Zusatzcerclagen, seltener primäre Silikontamponade. Es zeigte sich ein leichter Trend zu besseren anatomischen Erfolgsraten.

Introduction The prospective, non-interventional OCEAN study examined the use of intravitreal ranibizumab injections for the treatment of diabetic macular oedema (DME) in a real-world setting in Germany. Methods Adults with DME receiving ≥ 1 ranibizumab (0.5 mg) injections were recruited by 250 ophthalmologists. Best-corrected visual acuity (VA) testing, imaging and treatments were performed according to the investigators’ routine practice and documented over 24 months. Results The full analysis set included 1226 participants. Mean baseline VA was 60.6 [95% CI: 59.7; 61.5] Early Treatment Diabetic Retinopathy Study letters. VA improved by ≥ 15 letters in 21.5% and 23.5% of the participants at 12 months and 24 months, respectively. They received a mean number of 4.42 [95% CI: 4.30; 4.54] injections in the first year and 5.52 [95% CI: 5.32; 5.73] injections over 24 months, which was markedly lower than in clinical trials. Only 33.4% of the participants received an upload with four initial monthly injections as recommended by the German ophthalmologic societies. Time-to-event analyses that account for missing data inherent to a non-interventional study design demonstrated that participants receiving ≥ 7 injections in the first year had a faster response, but the duration of the response was shorter compared to the subgroups receiving 1–3 and 4–6 injections. Serious adverse events were reported for 143/1250 (11.4%) participants in the safety population. Conclusion Under-treatment is a major problem of DME anti- vascular endothelial growth factor therapy under real life conditions. Despite fewer injections given compared to randomised controlled trials with a consequently reduced overall mean visual gain, a profound functional improvement (≥ 15 letters) was achieved over 2 years in 23.5% of eyes with DME. Trial Registration Number NCT02194803, ClinicalTrials.gov. Funding Novartis Pharma GmbH, Nuremberg, Germany. Electronic supplementary material The online version of this article (10.1007/s13300-018-0513-2) contains supplementary material, which is available to authorized users.

To classify and characterize AMN lesions with SD-OCT during a follow-up as long as 5 years. Retrospective study of 14 patients (18 eyes) with special focus on SD-OCT. We measured thickness of inner nuclear layer (INL), outer retinal layer (ONL), and hyperreflective band at baseline and during follow-up. AMN lesions were classified as type 1 and type 2. Of 14 patients (six males, eight females, mean age 29.7 years), three patients (four eyes) had type 1 and nine (12 eyes) had type 2. Two patients did not meet the criteria for AMN type 1 or 2 and were therefore classified as new subtype of AMN. In all patients, statistically significant thinning of ONL and INL was observable. Mean ONL of all patients was 90.2 ± 7.81 and 72.3 ± 15.64 μm (p

Currently, for non-exudative age-related macular degeneration (AMD), therapy is not possible-in contrast to the exudative form. Many patients hope for a preventive effect and a slower progression of the disease from the dietary supplements on the market. The substances contained in them are supposed to reduce the oxidative environment in the outer retina and, thereby, slow down the cell damage and the progression of AMD. The Age-Related Eye Disease Studies (AREDS) examined certain supplements for their effectiveness in reducing the risk of AMD progression. They are the only interventional large-scale, prospective, randomized and controlled clinical trials and are repeatedly used as the basis for dietary supplementation in AMD. This article discusses the rationale for the use of certain ingredients of AREDS supplements and critically examines the results of AREDS. Furthermore, the modern term "lifestyle" will be discussed in the context of AMD as a possibility to influence the progression of this disease.Aktuell ist eine Therapie der nicht exsudativen altersabhängigen Makuladegeneration (AMD) – im Gegensatz zu der exsudativen Form – nicht möglich. Eine präventive Wirkung und ein verlangsamtes Fortschreiten der Erkrankung erhoffen sich viele Betroffene von den sich auf dem Markt befindenden Nahrungsergänzungsmitteln. Die darin enthaltenen Stoffe sollen das oxidative Milieu im Bereich der äußeren Netzhaut reduzieren und so den Zellschaden und damit die Progression der AMD verlangsamen. Die ARED-Studien (ARED: Age-Related Eye Disease) untersuchten bestimmte dieser Nahrungsergänzungsmittel auf ihre Wirksamkeit, das Risiko des Fortschreitens der AMD in die Spätformen zu vermindern. Sie sind die einzigen interventionellen groß angelegten, prospektiven, randomisierten und kontrollierten klinischen Studien und werden immer wieder als Basis für die Nahrungsergänzung bei der AMD herangezogen. In diesem Artikel soll die Rationale für die Verwendung bestimmter Inhaltsstoffe der AREDS-Nahrungsergänzungsmittel besprochen und die Ergebnisse der ARED-Studien kritisch beleuchtet werden. Weiterhin soll der moderne Begriff des „Lifestyle“ im Kontext der AMD als weitere Möglichkeit der Einflussnahme jedes Einzelnen auf die Progression der Erkrankung thematisiert und diskutiert werden.

Objective The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic mechanisms, and the measures that offer patients a restitutio ad integrum . Study Design This systematic review adopted a structured protocol to access available publications and followed the PRISMA statement. Results Eighty-nine cases of patients experiencing ocular adverse events after administration of dental local anesthesia have been reported in the literature. Most of the complications manifested as double vision. Only 8% of the complications caused permanent functional damage, either as vision deficit or anisocoria. Complete permanent blindness was not reported. Conclusions Ocular complications as a result of dental local anesthesia may be seen as rare occurrences with usually low intensity. However, visual function may become permanently impaired and serious medical conditions may obscure ocular dysfunction.

BACKGROUND AND PURPOSE Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery (“spot sign”). METHODS In this study we performed a follow-up investigation in 7 patients with CRAO and positive spot sign indicating the embolic cause of the occlusion after a median interval of 17 months (range 11-38 months) using a battery of tests (ocular color-coded sonography, optic coherence tomography [OCT], fundoscopy, amongst others). RESULTS The spot sign persisted in all patients, none had high-grade internal carotid artery stenosis, stroke or transient ischemic attacks. Four patients were completely blind, 3 patients were able to recognize hand movements. OCT demonstrated retinal atrophy, and fundoscopy revealed only minimal arterial perfusion. CONCLUSIONS The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.

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

To assess the long-term outcome of patients with subretinal neovascular membrane (SRNVM) secondary to type 2 idiopathic juxtafoveolar telangiectasia (IJT) receiving intravitreal anti-VEGF (vascular endothelial growth factor) injections. A total of 14 eyes of 12 patients treated with intravitreal anti-VEGF for SRNVM related to type 2 IJT were retrospectively assessed. Nine men and 3 women with a mean age of 66 years (SD 12, range 47–87 years) were diagnosed with IJT-related SRNVM. On average, 6.8 injections (SD 5.5, range 3–18) were given per eye. Ten eyes were treated with ranibizumab, 3 eyes with bevacizumab and 1 eye received both substances. The median follow-up after the last injection was 31 months (IQR: 18, 48). In 6 eyes, BCVA improved by 1–4 lines (mean Δ +2.0 lines), 1 eye remained stable and 7 eyes showed decline of vision by 1–5 lines (mean Δ −2.1 lines). The baseline central foveal thickness was significantly reduced from a mean of 323 (SD 87) to 266 µm (SD 71 µm) at the last follow-up visit (p = 0.001). SRNVM development is a severe complication of type 2 IJT. Since the establishment of intravitreal anti-VEGF treatment laser coagulation and PDT have lost significance. Intravitreal anti-VEGF therapy seems to be safe and effective for the treatment of IJT-related SRNVM. Frequently multiple intravitreal injections are necessary for stabilisation.

The purpose of this article is to describe functional and morphological short-term results in patients with exudative age-related macular degeneration (AMD) of all subtypes, treated with intravitreal bevacizumab versus intravitreal ranibizumab. This was a retrospective case-controlled series of 30 patients treated with intravitreal bevacizumab and 30 patients treated with intravitreal ranibizumab for exudative AMD. All patients received three initial injections every 4 weeks. Best corrected visual acuity (BCVA) as well as greatest linear dimension (GLD) of the CNV in fluorescein angiography and central retinal thickness (CRT) in optical coherence tomography (OCT) were monitored 2–4 months after last injection. BCVA stabilized and slightly increased from logMAR 0.74 to 0.62 in the bevacizumab group, and from logMAR 0.76 to 0.58 in the ranibizumab group (P

To describe functional and morphological long-term follow-up results in patients with idiopathic macular telangiectasia (IMT) treated with intravitreal bevacizumab. Retrospective case series of three consecutive male patients with IMT who were treated with intravitreal bevacizumab injections. Best corrected visual acuity (BCVA) as well as fluorescein angiography (FA) and optical coherence tomography (OCT) were monitored over the period of up to 12 months. Single intravitreal bevacizumab injection resulted in a marked increase in BCVA from 20/50 to 20/20 in the patient with type 1 (aneurysmal) IMT during the first 4 weeks. Late-phase leakage on FA and cystoid macular oedema on OCT decreased significantly. This was sustained over the whole follow-up period of 12 months. In contrast, in the two patients with type 2 (perifoveal) IMT, leakage on FA decreased likewise, but this was not accompanied by an increase in BCVA despite triple injections. Small cystic changes seen on OCT remained unchanged. Patients with type 1 IMT with pronounced macular oedema on OCT may benefit from intravitreal bevacizumab injections, showing functional as well as morphological improvement, while patients with type 2 IMT with minimal cystic changes on OCT do not show functional improvement despite repeated injections.

Age-related macular degeneration has become the most common cause of visual loss leading to legal blindness in the industrialised world. This progressive disorder of the posterior pole of the eye involves the retinal pigment epithelium, its basal membrane (Bruch's membrane), as well as the choriocapillaris and retina. Multiple factors are thought to be involved, including oxidative damage, retinal pigment epithelium cell lysosomal dysfunction, immunological responses to extracellular matrix proteins and an imbalance between pro- and antiangiogenic cytokines. While little therapeutic options are available for the atrophic form of the disease, several treatment modalities have been developed for the exudative form of age-related macular degeneration. The first therapeutic interventions consisted in laser photocoagulation of choroidal neovascular membranes in the 1970s. In the late 1990s, photodynamic therapy with the photosensitiser verteporfin was the first step towards a more specific therapy, allowing tr...

To describe optical coherence tomography (OCT) findings in patients with juxtafoveal retinal telangiectasis (JRT). Fourteen consecutive patients (28 eyes) with JRT (12 patients with JRT type II, one with JRT type I and one with JRT type III) were examined using fluorescein angiography (FA) and OCT. Despite prominent leakage in FA, macular oedema was absent in all 26 eyes with type II JRT. In contrast to that, in patients with type I and type III JRT, cystoid macular oedema was evident. In 14 of 28 eyes (all with type II JRT), a single foveal cyst was found in OCT. It varied significantly in size and was associated with visual acuity decrease. An intraretinal hyperreflective lesion was seen in eight of 28 eyes and flattening of the fovea in three eyes. Foveal cyst, absent macular oedema, intraretinal hyperreflective lesions and foveal flattening were the most common OCT findings in patients with JRT type II. These may represent progressive loss of retinal tissue, possibly due to Muller cells degeneration, and provide additional diagnostic criteria for JRT.

The aim of this study was to elucidate cellular mechanisms involved in ceramide-induced apoptosis and its attenuation by hepatocyte growth factor (HGF). Human retinal pigmented epithelial cells (RPE) incubated with C2 ceramide accumulated reactive oxygen species (ROS) in mitochondria and underwent apoptosis in a dose-dependent manner. Ceramide-treated cells showed increased caspase-3 activation and an increase in mitochondrial membrane permeability transition (MPT). Low doses of H2O2 (100 μM) alone induced negligible apoptosis; however, ceramide-induced apoptosis was significantly enhanced by co-incubation with H2O2 (100 μM). Furthermore, ceramide treatment significantly decreased catalase enzymatic activity and protein expression. HGF pretreatment (20 ng/ml) significantly inhibited ceramide-induced apoptosis and reduced the accumulation of ROS, the activation of caspase-3, and the increase in MPT and prevented the reduction in catalase activity and expression. Together, the data suggest that ceramide induces apoptosis in RPE cells by increasing ROS production, MPT, and caspase-3 activation. The ceramide effect is potentiated by H2O2 and associated with a reduction in catalase activity, suggesting that catalase plays a central role in regulating this apoptotic response. The ability of HGF to attenuate these effects demonstrates its effectiveness as an antioxidant growth factor.

Purpose To evaluate intravitreal aflibercept for treatment of macular edema secondary to central retinal vein occlusion (CRVO). Design Randomized, double-masked, phase 3 study. Methods A total of 177 patients with macular edema secondary to CRVO were randomized to receive 2 mg intravitreal aflibercept (n = 106) or sham (n = 71) every 4 weeks for 20 weeks. From weeks 24 to 48, patients were monitored every 4 weeks; the former group received intravitreal aflibercept as needed (PRN), and the sham group received sham. From weeks 52 to 76, patients were monitored every 8 weeks, and both groups received intravitreal aflibercept PRN. The primary endpoint (proportion of patients who gained ≥15 letters) was at week 24. This study reports exploratory outcomes at week 76. Results The proportion of patients who gained ≥15 letters in the intravitreal aflibercept and sham groups was 60.2% vs 22.1% at week 24 (patients discontinued before week 24 were considered nonresponders; P P P .001). Mean μm change from baseline central retinal thickness was −448.6 vs −169.3 at week 24 ( P P P = .1122). Over 76 weeks, the most common ocular serious adverse event in the intravitreal aflibercept group was macular edema (3.8%). Conclusions The visual and anatomic improvements seen after fixed, monthly dosing at week 24 were largely maintained when treatment intervals were extended. Patients with macular edema following CRVO benefited from early treatment with intravitreal aflibercept.

Central retinal artery occlusion (CRAO) is most often indirectly diagnosed by lack of retinal perfusion. Direct embolus characterization may help to understand the natural course and low response to treatment. In a previous study we identified a hyperechoic signal within the optic nerve and in the central retinal artery ("spot sign").In this study we performed a follow-up investigation in 7 patients with CRAO and positive spot sign indicating the embolic cause of the occlusion after a median interval of 17 months (range 11-38 months) using a battery of tests (ocular color-coded sonography, optic coherence tomography [OCT], fundoscopy, amongst others).The spot sign persisted in all patients, none had high-grade internal carotid artery stenosis, stroke or transient ischemic attacks. Four patients were completely blind, 3 patients were able to recognize hand movements. OCT demonstrated retinal atrophy, and fundoscopy revealed only minimal arterial perfusion.The hyperechoic spot sign may be an important predictive prognostic marker for persistent loss of vision. Its persistence may indicate calcified or cholesterol emboli and may explain the low therapeutic success rate to thrombolysis. Further studies on their origin and significance in atherosclerotic disease are warranted.

We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p

Color-coded duplex sonography is a well established non-invasive method for vascular and parenchymal examination in a wide range of neurological disorders including stroke, cerebral venous thrombosis and degenerative diseases, amongst others. Considering development, cell types and vascular structures as well as pathology and pathophysiology, high similarities and interactions exist between the central nervous system (CNS) and the eye.

Vertebrobasilar ischaemia is a rare life-threatening complication in giant cell arteritis (GCA). We report three patients with bilateral vertebral artery occlusion. Neurovascular imaging, including CT-angiography, MR-angiography and colour-coded duplex sonography revealed flow reversal in the basilar artery as well as inflammation of the vertebral vessel wall. The first patient died from massive brainstem infarction, the other two patients survived the initial inflammatory phase of GCA. No stroke recurrence at 12 months’ follow-up on warfarin and steroid treatment was observed. Bilateral distal vertebral artery occlusion and retrograde basilar artery flow persisted. Outcome in these patients is dependant on potent immunosuppression, concurrent atherosclerotic steno-occlusive disease and presence and/or rapid development of sufficient collateral pathways into the vertebrobasilar circulation. The identification of patients with high risk of ischaemia due to compromised vertebrobasilar flow may be important to select adjunct treatment to immunosuppression, such as anticoagulation in GCA.

Retinal angiomatous proliferation (RAP) is a variant of exudative age-related macular degeneration with particularly bad prognosis. The purpose of this work is to describe the long-term functional and morphological outcome of patients treated with intravitreal bevacizumab and ranibizumab. Retrospective case series of 16 eyes treated with bevacizumab and 19 eyes treated with ranibizumab. All patients received initially three intravitreal injections of bevacizumab (1.25 mg/0.05 ml) or ranibizumab (0.5 mg/0.05 ml) every 4 weeks. Follow-up ranged from 1 to 7 months after the third injection. Complete ophthalmologic examination including best-corrected visual acuity (VA), optical coherence tomography, fluorescein angiography, and in selected cases, indocyanine green angiography was performed. Triple intravitreal injections resulted in improvement of VA in bevacizumab-treated as well as in ranibizumab-treated patients; logarithm of the minimal angle of resolution (logMAR) 0.84 before treatment and 0.67 at month 9, and logMAR 0.75 before treatment and 0.59 at month 9, respectively. Central macular thickness (CMT) in the bevacizumab group improved from 363.67 ± 47.4 μm at baseline to 328 ± 49.77 μm at month 6 (p = 0.03) and 301 ± 129.69 at month 9 (p = 0.35). CMT in the ranibizumab group improved from 545.62 ± 167.39 μm at baseline to 395.88 ± 169.37 μm at month 6 and 411.83 ± 212.41 μm at month 9 (p = 0.03, p = 0.05, respectively). Patients with RAP might benefit from both intravitreal bevacizumab and ranibizumab treatments with stabilization of VA over a longer period of time. Close follow-up should nevertheless be performed in this special subgroup because of the high recurrence rate.

In patients with exudative age-related macular degeneration (AMD), intravitreal anti-vascular endothelial growth factor (VEGF) therapy can lead to stabilization and even improvement of visual acuity in the treated eye, as proven by multiple studies. Some case reports, however, also suspect an effect in the untreated fellow eye.Prospective case series of 26 patients treated with intravitreal ranibizumab injections in both eyes because of bilateral exudative AMD. In all patients, central retinal thickness (CRT) was measured by optical coherence tomography (OCT) in both eyes: before first treatment of the first eye, as well as 2 weeks later, just before first treatment of the second eye.While mean CRT was significantly reduced in the treated first eye 2 weeks after intravitreal injection from 369.46 microm (+ or - 170.88) to 275.04 microm (+ or - 113.04), P = 0.0005, mean CRT in the untreated fellow eye increased significantly: from 349.08 microm (+ or - 118.93) to 403.46 microm (+ or - 173.14) 2 weeks later, P = 0.017.A therapeutic effect of ranibizumab in the untreated fellow eye could not be demonstrated. Overall, mean CRT in the untreated eye increased as would be expected for the normal course of this disease.

Retinal arterial macroaneurysms (MA) are a rare pathology, often associated with old age, arterial hypertension, artherosclerosis, and retinal vein occlusions. Here, we present two unusual cases of MA in patients with arterial hypertension, that displayed small vascular networks at the site of the MA on angiography. Resulting exudative changes and the networks themselves regressed after laser treatment, and visual acuity improved. Those vascular networks might represent collateral vessels forming as a rare sequel after spontaneous occlusion of the MA.

Retinal pigment epithelial (RPE)-rips in age-related macular degeneration (AMD)-associated pigment epithelial detachment (PED) occur in the natural course of the disease but also after therapy (e.g. laser photocoagulation, photodynamic therapy), possibly triggered by the specific therapy. We report here on four patients that received intravitreal bevacizumab (Avastin) for AMD-associated vascularised PED and developed RPE-rips during the follow-up.The case reports of four consecutive patients that developed RPE-rips after intravitreal injection of bevacizumab at 1 mg/0.1 ml were reviewed.The RPE-rips occurred in all patients between 1 week and 1 month following intravitreal injection. Two of the four patients improved in vision despite the rip, but 3 months after the initial intervention, three patients suffered deterioration in visual acuity and had to be re-injected.Improvement in visual acuity may occur following intravitreal bevacizumab despite RPE-rips, but the patients need close follow-up and eventual re-treatment in the case of deterioration.

To investigate the role of neutrophils in the development of laser induced experimental choroidal neovascularization (CNV).CNV was induced by laser photocoagulation in adult male C57BL/6J mice. Neutrophil infiltration was evaluated by histology and confocal immunohistology. The expression of neutrophil chemotactic chemokines in the regions of laser injury was determined by quantitative real-time PCR. Animals were treated with NIMP-R14, an anti-murine neutrophil monoclonal antibody (mAb), intraperitoneally to deplete neutrophils. The specific neutrophil depletion was confirmed by flow cytometry. The CNV responses were compared between neutropenic and untreated control mice on the basis of fluorescein angiography (FA), CNV lesion volume and lesion histology, and vascular endothelial growth factor (VEGF) expression by ELISA. Expression of VEGF and Angiopoietin-1 and Angiopoietin-2 protein by murine neutrophils was evaluated by confocal immunohistochemistry.Neutrophils infiltrated the sites of laser injury as early as day 1 after laser treatment and peaked at day 3. The neutrophil infiltration correlated with enhanced mRNA expression of neutrophil chemotactic chemokines MIP-2 and KC in the lesions. Administration of NIMP-R14 mAb specifically depleted neutrophils. Analysis of FA, CNV volume, and lesion histology, all demonstrated a moderate decrease in the CNV response in neutropenic mice compared to control mice (p0.01). The reduction in the CNV response in neutropenic mice was associated with decreased VEGF protein levels in the ocular posterior segment. Murine neutrophils contained VEGF and Angiopoietin-1 and Angiopoietin-2 proteins.Neutrophil invasion was part of early inflammatory responses during laser induced CNV. Neutrophil depletion correlated with reduced CNV responses and decreased VEGF protein expression. These data suggest that neutrophils promoted the early development of CNV possibly via secretion of angiogenic growth factors.

Platelet activation results in formation of filopodia and cell spreading by extension of lamellae. Moesin is a member of the ezrin/radixin/moesin (ERM) family of proteins, which localize in cell extensions like filopodia and function as cross-linkers between the actin cytoskeleton and the plasma membrane. Here we investigated whether the adhesion molecule PECAM-1 (CD31) is a membrane-binding partner for moesin in platelets. Our data show that moesin co-immunoprecipitated with PECAM-1 in lysates from thrombin-stimulated, but not resting platelets. Furthermore, PECAM-1 co-localized with moesin at the cell periphery and in filopodia of glass-activated platelets. Our observations suggest that moesin may play a role in platelet adhesion, linking PECAM-1 with the actin cytoskeleton.

Introduction: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. Case report: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. Conclusion: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.