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Retinoblastoma (RB) management has evolved over the last three decades. Goals of modern RB treatment are first to protect life and prevent metastatic disease, then preservation of the globe and useful vision. With modern treatment protocols and early disease detection success rates can reach up to 100% of disease-free-globe and eye preservation. Treatment of advanced cases remains complex, requiring aggressive chemotherapy or/and external beam radiation. Treatment protocols are extremely diverse and dependent on local resources thus success rates are variable. Here we review narratively current treatment protocols and failure rates based on a PubMed search using keywords of retinoblastoma, retinoblastoma seed, retinoblastoma treatment, enucleation.

Purpose We report visual and anatomical outcomes of chronic postoperative macular edema treated with a fluocinolone acetonide intravitreal implant. Method Retrospective study of chronic, post-surgical CME treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed over 24 months. The need for IOP lowering treatment, top-up therapy during follow-up, and complications were also assessed. Results We analyzed 16 consecutive eyes of 16 patients with chronic, post-surgical CME treated with fluocinolone acetonide intravitreal implant. Surgical indications included cataract surgery, vitrectomy plus membrane peeling and combined phaco-vitrectomy. Baseline mean BRVA of 0.8 ± 0.65 logMAR improved to 0.60 ± 0.4 logMAR ( p = 0.02) at 12 months and to 0.7 ± 0.5 logMAR ( p = 0.32) at 24 months. At month 12, BRVA improved in 11 eyes, stabilized in 4 eyes, and decreased in 1 eye. At month 24, VA remained improved in 5 eyes, remained stabilized in 5 eyes, and decreased in 1 eye. Mean CRT decreased from 524 ± 132 μm at baseline to 389 μm at month 3, 347 μm at month 6, 355 ± 106 μm ( p = 0.0003) at month 12, and 313 ± 83 μm ( p = 0.0001) at month 24. At 12 months, CRT improved in 13 eyes and remained unchanged in 2 eyes. At 24 months, CRT improved further in 8 eyes, and stabilized in 3 eyes. Increased IOP (≥21 mmHg) was observed only in 4 eyes, all successfully managed with topical medication. No further side effects were observed in any patient. Conclusion Visual and anatomic improvements were achieved by a single fluocinolone acetonide implant with few side effects up to 24 months in CME eyes with a long and heavy prior treatment history.

Intravitreal injection treatment for the management of macular edema as an expression of increased capillary permeability and leakage constitute the mainstay of treatment in retinal vein occlusion. In contrast to diabetic retinopathy or neovascular age-related macular degeneration, permanent and complete functional and morphological restoration can be achieved, as retinal vein occlusions are usually associated with risk factors, but do not represent the manifestation form of an underlying systemic or degenerative chronic disorder; however, successful long-term management of retinal vein occlusion -associated macular edema usually requires intensive and also long-term continued treatment with vascular endothelial growth factor (VEGF) inhibitors or with a less favorable side effect profile, dexamethasone. A functional treatment success can be maintained over the long term by both pro re nata (PRN) or treat and extend (TE) regimens. In contrast, according to the currently available data, the combination of anti-VEGF administration and grid laser treatment has no additional benefit compared to monotherapy. In patients with recalcitrant macular edema, switching to another intravitreal agent may be considered during the course of treatment, although a true therapeutic benefit with respect to the development of visual acuity has not yet been proven. The current review summarizes the relevant aspects in the management of RVO-associated macular edema and provides the foundations for the application of successful treatment strategies.Intravitreale Injektionstherapien zur Behandlung des Makulaödems als Ausdruck von Schrankenstörungen stellen den zentralen Ansatz in der Therapie venöser retinaler Gefäßverschlüsse dar. Im Gegensatz zur diabetischen Retinopathie oder der neovaskulären altersbedingten Makuladegeneration kann dabei eine dauerhafte, vollständige funktionelle und morphologische Wiederherstellung erreicht werden, da venöse retinale Gefäßverschlüsse in der Regel zwar mit Risikofaktoren assoziiert sind, jedoch nicht als Manifestationsform einer systemischen oder degenerativen Grunderkrankung einen zwangsläufig chronischen Charakter aufweisen. Eine dauerhaft erfolgreiche Therapie des RVO(„retinal vein occlusion“)-assoziierten Makulaödems setzt allerdings eine möglichst intensive und mitunter langfristig fortgesetzte Behandlung mit VEGF(„vascular endothelial growth factor“)-Hemmern oder dem mit einem ungünstigeren Nebenwirkungsspektrum verbundenen Dexamethason voraus. Dabei kann sowohl mit einer PRN(pro re nata)- als auch mit einer TE(„treat and extend“)-Strategie ein funktioneller Behandlungserfolg langfristig aufrechterhalten werden. Hingegen ergibt die Kombination der Anti-VEGF-Gabe mit einer Laserkoagulation nach aktueller Datenlage keinen zusätzlichen therapeutischen Nutzen im Vergleich zur Monotherapie. In therapierefraktären Fällen kann im Verlauf ein Medikamentenwechsel in Erwägung gezogen werden, wenngleich ein therapeutischer Nutzen hinsichtlich der Visusentwicklung bislang nicht belegt ist. Die vorliegende Übersichtsarbeit fasst die bei der Behandlung des RVO-assoziierten Makulaödems maßgeblichen Aspekte zusammen und vermittelt die Grundlagen zur Anwendung erfolgreicher Therapiestrategien.

Malignant tumors of the eye can be successfully treated with radiotherapy, which, however, can lead to radiogenic side effects in the surrounding healthy tissues. A distinction can be made between two forms of irradiation, external radiotherapy (teletherapy) and brachytherapy with a radiation source close to the tumor. The radiation dose is important for the occurrence of side effects. Acute damage usually results from inflammatory processes initiated at the cellular level. In contrast, late side effects are rather due to the reaction of the tissue with repair and remodeling processes . Acute side effects often resolve completely, especially under corresponding treatment, whereas late side effects tend to be irreversible. The aim of this article is to present risk factors as well as the clinical signs of periocular and ocular radiogenic side effects for the relevant tissue structures of the eye in a narrative review to facilitate ophthalmologic follow-up and, if necessary, treatment measures for these patients during everyday practice.Insbesondere maligne Tumoren des Auges können gut durch eine Strahlentherapie behandelt werden, was aber auch zu radiogenen Nebenwirkungen im umliegenden, gesunden Gewebe führen kann. Man unterscheidet grob zwischen 2 Bestrahlungsformen, der externen Strahlentherapie (Teletherapie) und der Brachytherapie mit einer tumornahen Strahlenquelle. Entscheidend für das Auftreten von Nebenwirkungen am gesunden Gewebe ist hierbei v. a. die Strahlendosis. Akute Nebenwirkungen resultieren meist aus Entzündungsprozessen, die auf zellulärer Ebene angestoßen werden. Dahingegen sind späte Nebenwirkungen eher auf die Reaktion des Gewebes in Form von Reparatur- und Umbauprozessen nach ionisierenden Verletzungen zurückzuführen. Akute Nebenwirkungen bilden sich, besonders unter Therapie, häufig zurück, während späte Nebenwirkungen häufig irreversibel sind. Ziel des Beitrags ist es, in Form eines narrativen Reviews die Risikofaktoren sowie die klinischen Zeichen der periokulären und okulären radiogenen Nebenwirkungen für die relevanten Gewebestrukturen am Auge darzustellen, um die augenärztliche Nachsorge sowie ggf. therapeutische Maßnahmen bei diesen Patient:innen im Praxisalltag zu erleichtern.

Radiation maculopathy and radiation-induced macular edema are common, sight-threatening complications after radiotherapy, especially that used for uveal melanoma. While many treatment and preventive strategies have been proposed, management of these conditions is still challenging. Initially, treatments were based on the use of retinal laser, but the outcomes were poor. Subsequently, management has shifted toward injection of intravitreal antivascular endothelial growth factor or corticosteroids. We reviewed current clinical evidence, which mostly relies on small sample-sized and retrospective studies, for the management of radiation maculopathy and, in particular, radiation-induced macular edema. At present, the first-line approach is usually intravitreal antivascular endothelial growth factor. Intravitreal dexamethasone implantation may be an option for those with suboptimal response or contraindications to antivascular endothelial growth factor agents. Possible preventive treatments that require future study are intravitreal bevacizumab and ranibizumab, peripheral laser photocoagulation, and subtenon triamcinolone acetonide.

Das Stevens-Johnson-Syndrom (SJS) und die toxisch epidermale Nekrolyse (TEN) sind seltene, schwere und oft lebensbedrohliche Reaktionen der Haut- und der Schleimhaute. Sie werden als eine Krankheitsentitat verschieden schwerer Auspragung angesehen und unter dem Begriff epidermale Nekrolyse zusammengefasst. Es besteht ein hohes Risiko okularer Beteiligung, die ohne eine rasche, adaquate ophthalmologische Behandlung zu langwierigen Augenproblemen bis zur Erblindung fuhren kann. Das akute Auftreten, der unvorhersagbare Verlauf und die stark variierende Manifestation der Komplikationen erfordern einen interdisziplinaren Ansatz. Eine rasche Diagnosestellung und Einleitung einer antiinflammatorischen oberflachenwirksamen Behandlung ist von groser Bedeutung fur das Langzeitergebnis. Dieser Beitrag soll dem Verstandnis dieser Reaktionsformen dienen und so zu einer Verbesserung der visuellen Rehabilitation und Lebensqualitat der Patienten fuhren.

Epiretinale Membranbildungen in Form eines Makula-Puckers zahlen zu den typischen Komplikationen im Rahmen einer proliferativen Vitreoretinopathie (PVR) bei Amotio retinae und haben entscheidenden Einfluss auf das funktionelle Ergebnis nach chirurgischer Therapie. Es erfolgte eine Literaturrecherche uber PubMed. Ein wesentlicher Ansatz der Therapie bei PVR-assoziiertem Makula-Pucker besteht in der Reduktion von Traktionen am hinteren Pol durch moglichst vollstandige Membranentfernung innerhalb der Gefasbogen sowie in einem Peeling der Membrana limitans interna (ILM). Als weitere Option gilt ein primares Peeling der ILM im Rahmen der chirurgischen Versorgung einer Amotio retinae, um das Risiko der Entstehung einer epiretinalen Membranbildung zu reduzieren. Das richtige Timing des chirurgischen Eingriffs kann zu einer erfolgreichen Behandlung beitragen. Aufgrund der besonderen traktiven Eigenschaften sowie der haufig gleichzeitig bestehenden Amotio retinae stellt die chirurgische Therapie des PVR-assoziierten Makula-Puckers eine besondere Herausforderung dar. Wie bei der idiopathischen Form kann durch die Membranresektion eine funktionelle Verbesserung erreicht werden. Fur die Visusprognose ist dabei zudem entscheidend, ob zuvor eine Makulabeteiligung der Amotio retinae vorgelegen hatte.

Bei allgemeinonkologischen Patienten konnen morphologische Veranderungen am Auge zu Sehminderung fuhren, sie konnen aber auch Anzeichen einer lebensbedrohlichen Situation fur den Patienten sein. Ziel war die Darstellung von akuten Situationen am Auge bei onkologischen Patienten. Insbesondere soll der Blick fur ophthalmologische Akutsituationen bei Tumorpatienten gescharft werden. Es handelt sich um eine Literaturrecherche sowie strukturierte Darstellung und Bewertung der Ergebnisse. Immunreaktionen auf nichtokulares Tumorgewebe sowie auf onkologische Systemtherapien konnen zu sehmindernden Entzundungen im Auge fuhren. Klinische Zeichen am Auge, wie z. B. Roth-Flecken an der Retina, weisen auf Leukamie hin und konnen lebensbedrohlich sein. Metastasen am Auge, sei es bei einem bekannten Primarius oder als Erstdiagnose, sind abklarungsbedurftig, da aufgrund der gleichen hamatogenen Streuungswege uber die Karotiden haufig zusatzlich Filiae im zentralen Nervensystem (ZNS) zu finden sind. Nicht selten besteht bei Schwerkranken mit Sepsis eine endogene Endophthalmitis mit Bakterien oder Pilzen – mit meist reduzierter Lebensprognose. Periokulare Hautreaktionen nach Bestrahlung von Augentumoren konnen fur den Patienten beunruhigend sein, heilen allerdings in der Regel von allein ab. Eine ophthalmologische Untersuchung kann einen Sehverlust richtig einordnen und ggf. lebensbedrohliche Situationen entdecken. Entsprechende Therapieeinleitungen oder -unterbrechungen konnen diese akuten Situationen entscharfen. Letztendlich kann auch eine Erklarung von Beschwerden am Auge fur den onkologischen Patienten in seiner angespannten Situation von besonderem Wert sein. Daher ist ein onkologisch erfahrener Augenarzt fur jedes interdisziplinare Tumorteam ein wichtiger Zugewinn.

Accumulation of serous fluid in the suprachoroidal space, known as uveal effusion, and choroidal or suprachoroidal haemorrhage (SCH) following rupture of ciliary blood vessels are considered rare, but serious, events with extremely poor functional prognosis. As a result, uveal effusion, and expulsive suprachoroidal haemorrhage in particular, continue to be considered as more or less fatal complications. However, clinical experience demonstrates that both clinical entities can be managed by conservative as well as surgical strategies, depending on their severity and localisation, with sometimes surprisingly favourable visual outcome. In addition to prognostic factors, timely recognition and prompt, if possible preventive, acute care, as well as carefully considered timing of adequate surgical measures taking advantage of the specific characteristics of the choroidal tissue, are crucial to treatment success. Along with technical advances in the field of vitreoretinal surgery, numerous variants of therapeutic approaches to the treatment of choroidal effusion and suprachoroidal haemorrhage have been proposed to date. This review presents some of the most important surgical techniques and strategies in the field.Die als uveale Effusion bezeichnete Akkumulation von seröser Flüssigkeit im Suprachorioidalraum sowie chorioidale bzw. suprachorioidale Blutungen (SCH) infolge einer Ruptur zilialer Blutgefäße gelten als seltene, aber schwerwiegende Ereignisse, die durch eine äußerst schlechte funktionelle Prognose gekennzeichnet sind. Bis heute werden daher uveale Effusion und insbesondere expulsive suprachorioidale Blutungen als mehr oder weniger fatale Komplikation betrachtet. Die klinische Erfahrung zeigt jedoch, dass beide Krankheitsbilder der Aderhaut in Abhängigkeit von Ausmaß und Lokalisation sowohl einer konservativen als auch chirurgischen Therapie durchaus zugänglich sind, mit teilweise erstaunlichen funktionellen Ergebnissen. Neben prognostischen Faktoren sind dabei vor allem das rechtzeitige Erkennen und die umgehende, nach Möglichkeit präventive Akutversorgung sowie ein sorgfältig abgewogenes Timing adäquater chirurgischer Maßnahmen, das sich die besonderen Eigenschaften des chorioidalen Gewebes zunutze macht, entscheidend für den Therapieerfolg. Mit der Weiterentwicklung der technischen Möglichkeiten der Vitreoretinalchirurgie wurden bis heute zahlreiche Varianten therapeutischer Ansätze zur Behandlung von Aderhauteffusion und Suprachorioidalblutung vorgeschlagen, deren wesentliche Techniken und Strategien in der vorliegenden Arbeit vorgestellt werden.

Durch die vollstandige Integration der SD-OCT (Spectral-Domain-optische Koharenztomographie) in das Operationsmikroskop bietet die intraoperative optische Koharenztomographie (iOCT) die Moglichkeit einer gezielten hochauflosenden Bildgebung in Echtzeit. Der Operateur erhalt neben dem En-Face-Bild eine Live-Darstellung aller Netzhautschichten, des Glaskorpers sowie der Instrument-Gewebe-Interaktion, die fur intraoperative Entscheidungen genutzt werden kann. Im Vergleich zur herkommlichen Operationsmikroskopie ermoglicht die iOCT eine weitaus hohere Prazision vitreoretinalchirurgischer Masnahmen und ist essenzielle Voraussetzung zur Umsetzung Echtzeit-kontrollierter Operationstechniken im Mikrometerbereich.

The progression of the COVID-19 pandemic has caused significant changes in the environment for outpatient and inpatient care in ophthalmology, with limitations on access to medical care but also new observations and challenges. We now describe major developments in recent months and provide an outlook on the expected consequences.PubMed literature search, clinical survey.To date, the course of the COVID-19 pandemic has been characterised by several new but overall rare ocular manifestations, the ophthalmological shared management of COVID-19 patients on intensive care units, and a significant decrease in case numbers, associated with an increase in case severity and relative proportion of emergencies, as a result of delayed presentation of patients and reduced treatment adherence. With the introduction of hygiene measures and infection control procedures, ophthalmic patient care was maintained - including emergencies and urgent treatments. Due to the extensive postponement of elective surgeries, scarce therapeutic and health care professional resources, and the prioritisation of critically ill patients from other specialties, there is a reasonable likelihood that urgent treatments will be delayed as infection rates rise.Outpatient and inpatient care in ophthalmology during the COVID-19 pandemic is primarily accompanied by additional organisational or medical challenges and a decline in case volume. Although to date emergency and urgent ophthalmic treatments have been maintained, long-term persistence of pandemic conditions will require additional strategies to provide continuation of ophthalmic care at the required level.Mit fortschreitender Dauer hat die COVID-19-Pandemie zu einer deutlichen Veränderung der Rahmenbedingungen für die ambulante und stationäre Augenheilkunde mit Einschränkungen bei der medizinischen Versorgung, aber auch neuen Beobachtungen und Herausforderungen geführt. Der vorliegende Beitrag beschreibt wesentliche Entwicklungen der vergangenen Monate und gibt einen Ausblick auf die zu erwartenden Folgen.Literaturrecherche über PubMed, klinische Beobachtungen.Neben neuen, aber insgesamt seltenen okulären Manifestationen sowie der augenärztlichen Mitbetreuung intensivmedizinisch behandelter COVID-19-Patienten wurde im bisherigen Verlauf der COVID-19-Pandemie weltweit vor allem ein Rückgang der Fallzahlen bei gleichzeitigem Anstieg der Fallschwere und des relativen Anteils an Notfällen beobachtet, was u. a. auf eine verzögerte Vorstellung der Patienten und eine niedrigere Therapieadhärenz zurückzuführen ist. Mit der Einführung von Hygienemaßnahmen und Abläufen für den Infektionsschutz konnten sowohl die Notfallversorgung als auch die Durchführung dringlicher Behandlungen aufrechterhalten werden. Aufgrund der umfangreichen Verschiebung elektiver Operationen, knapper personeller und operativer Ressourcen sowie der Priorisierung der Behandlung vitaler Indikationen anderer Fachrichtungen muss bei steigenden Infektionszahlen zunehmend auch mit einer Verzögerung dringlicher Eingriffe gerechnet werden.Die ambulante und stationäre Augenheilkunde während der COVID-19-Pandemie wird vor allem durch zusätzliche organisatorische und medizinische Herausforderungen sowie einen Rückgang der Fallzahlen begleitet. Obwohl ophthalmologische Notfallbehandlungen und dringliche Therapien bis dato gewährleistet werden konnten, würde ein langfristiges Andauern der Pandemiebedingungen zusätzliche Strategien erfordern, um eine Patientenversorgung auf dem erforderlichen Niveau weiterhin zu gewährleisten.

Purpose: To assess the incidence of normal vision following anatomically successful macular hole surgery and associated clinical variables. Methods: Multicentre, retrospective chart review. Preoperative, intraoperative and postoperative clinical data were extracted from electronic medical records from seven European vitreoretinal units. Inclusion criteria were as follows: eyes undergoing primary vitrectomy for idiopathic full-thickness macular hole from January 2015 to January 2018; postoperative macular hole closure confirmed by spectral domain optical coherence tomography (OCT); preoperative pseudophakia or phakic eyes receiving combined cataract surgery; one-year follow-up. The primary outcome was ‘normal vision’ defined as a final best-corrected visual acuity (BCVA) ≥ 20/25. Univariate, multivariate and decision-tree analyses were conducted to evaluate the clinical variables associated with ‘normal vision’. Odds ratios (OR) and confidence intervals (CIs) were calculated. Results: Of 327 eligible cases, 91 (27.8%) achieved ‘normal vision’ at 1year. Multivariate analysis identified variables significantly associated with ‘normal vision’: shorter symptom duration (odds ratio [OR]=1.05; 95% confidence interval [CI]:1.02-1.09; p=0.002), smaller preoperative OCT minimum linear diameter (OR per 100-micron increase=1.65; 95%CI:1.31-2.08; p&nbsp

Subretinal hemorrhage involving the macula is a typical complication in a variety of retinal diseases, whereby age-related macular degeneration (AMD) is by far the leading cause.A literature search was carried out in PubMed.Numerous studies have demonstrated the effectiveness of various approaches to the management of submacular hemorrhage, including intravitreal anti-VEGF treatment, pneumatic displacement supported by fibrinolytic agents or surgical drainage.There is currently no consensus regarding evidence-based standard treatment for macular hemorrhage, although there is a trend towards minimally invasive approaches. Regardless of the choice of the primary treatment approach, the time to treatment and an accompanying intravitreal treatment with VEGF inhibitors are decisive for the functional outcome.HINTERGRUND: Subretinale Blutungen im Bereich der Makula sind eine typische Komplikation verschiedener retinaler Erkrankungen, wobei die exsudative altersbedingte Makuladegeneration (AMD) die bei Weitem häufigste Ursache darstellt.Es erfolgte eine Literaturrecherche über PubMed.Zahlreiche Studien zur Behandlung submakulärer Blutungen zeigen, dass eine erfolgreiche morphologische und funktionelle Behandlung mit unterschiedlichen Ansätzen wie der intravitrealen Gabe von VEGF(„vascular endothelial growth factor“)-Inhibitoren, der durch Fibrinolytika unterstützten pneumatischen Dislokation oder der chirurgischen Drainage möglich ist.Aus den vorliegenden Daten kann bis heute kein genereller evidenzbasierter Therapiestandard abgeleitet werden, wobei sich ein zunehmender Trend zur Anwendung minimal-invasiver Verfahren abzeichnet. Unabhängig von der Wahl des initialen Therapieverfahrens sind eine möglichst frühzeitige Intervention sowie eine begleitende intravitreale Behandlung mit VEGF-Inhibitoren für das funktionelle Ergebnis entscheidend.

Purpose: To investigate the significance of the presence and form of pigment epithelial detachment in the course of central serous chorioretinopathy as well as corticosteroid use as a risk in our patient cohort. Material and methods: Retrospective, single center study of central serous chorioretinopathy patients between January 2013 and January 2019 recording corticosteroid use prior to onset and presence and type of pigment epithelial detachment (flat-irregular, dome-shaped, none) in relationship to disease course. Results: We analyzed 53 eyes of 53 consecutive central serous chorioretinopathy patients treated in our department. Mean patient age was 53 ± 13 years. A flat-irregular pigment epithelial detachment was associated with either chronic or recurrent central serous chorioretinopathy, whereas the absence of a pigment epithelial detachment correlated positively with acute central serous chorioretinopathy (chi-square test, p Conclusion: A small, flat-irregular pigment epithelial detachment could be a marker for chronic or recurrent central serous chorioretinopathy, whereas the absence of pigment epithelial detachment could favor acute central serous chorioretinopathy. Advanced imaging studies may provide more information on the exact characteristics and nature of pigment epithelial detachments. Corticosteroid use as possible disease trigger was not confirmed in this study.

SIGNIFICANCE Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity. PURPOSE This pilot study analyzes the efficacy for treating acute CSCR with combined systemic acetazolamide 250 mg twice a day and nepafenac 0.1% eye drops three times a day in comparison with an untreated control group. It also evaluates the presence a pigment epithelial detachment (PED) as a risk factor for chronic CSCR. METHODS Nineteen consecutive patients (group 1) with new or new onset of recurrent CSCR were treated with oral acetazolamide and nepafenac eye drops for at least 2 months. A control group of 14 patients (group 2) with new or new onset of recurrent CSCR were untreated while under regular observation for 4 months. Primary end points were central macular thickness and best-corrected visual acuity after 4 months. Secondary end points were complete regression of subretinal fluid at 3 months and association of PED at baseline with recurrent or chronic CSCR imaged by optical coherence tomography. RESULTS Group 1 showed significantly faster resolution of subretinal fluid with a mean central macular thickness at 4 months of 271 ± 85 μm compared with 322 ± 79 μm for group 2 (P < .05), but with no functional benefit with a best-corrected visual acuity at 4 months of 0.8 ± 0.2 for group 1 compared with 0.9 ± 0.1 for the control group (P < .05). Patients with a small flat PED were at a higher risk of developing chronic CSCR compared with patients with a dome-shaped or no PED (P < .05). CONCLUSIONS Central serous chorioretinopathy remains a therapeutic challenge. This pilot study shows faster resolution of subretinal fluid with treatment but without functional benefit compared with observation. The presence of small, flat PED was associated with development of chronic CSCR.

Zusammenfassung Fragestellung Die diabetische Retinopathie ist durch eine gestörte retinale Gefäßautoregulation gekennzeichnet mit retinaler Hyperperfusion im Frühstadium und Kapillarausfall mit peripherer Ischämie im Spätstadium. Die initiale retinale Gefäßdilatation deutet auf eine Progression der Erkrankung hin und die anschließende Vasokonstriktion signalisiert einen proliferativen Zustand. In dieser Pilotstudie untersuchen wir den Einfluss des intravitrealen Aflibercepts auf den Durchmesser der retinalen Gefäße bei Patienten mit diabetischem Makulaödem. Methoden Zwölf Augen von 9 Patienten mit diabetischem Makulaödem wurden während der ersten 3 Monate der Behandlung mit Aflibercept untersucht. Es wurden das Kaliber der Netzhautarterien und -venen sowie das zentrale Netzhautarterien- und -venenäquivalent registriert. Das diabetische Makulaödem wurde im Verlauf der Behandlung mit dem Netzhautgefäßkaliber korreliert. Ergebnisse Die Behandlung mit Aflibercept führt zur signifikanten Reduktion des Durchmessers der Netzhautarterien sowie des zentralen Netzhautarterienäquivalents. Die Netzhautvenen zeigten zwar eine Vasokonstriktion, die aber keine Signifikanz erreichte. Es kam zudem zur signifikanten Reduktion des Makulaödems. Diese korrelierte aber nicht mit dem vaskulären Kaliber der Netzhaut. Schlussfolgerung Diese Pilotstudie zeigt zum ersten Mal, dass Aflibercept möglicherweise zur signifikanten Reduktion des retinalen arteriellen Gefäßkalibers führt. Ob diese Reaktion auf die intravitreale Anti-VEGF-Behandlung auch eine Verbesserung der retinalen Gefäßhomöostase widerspiegelt, muss in weiteren Studien verifiziert werden.

Ziel Wir berichten uber eine junge immunkompetente Patientin mit einer parainfektiosen Neuritis nervi optici mit makularem Infiltrat im Rahmen einer Neisseria-meningitidis-B-Meningitis.

Purpose: To assess the efficacy of intravitreal aflibercept in patients suffering from post-radiation macular edema following plaque radiotherapy for choroidal melanoma. Methods: This prospective, interventional case series included patients affected by radiation maculopathy (RM) with macular edema secondary to ruthenium-106 plaque brachytherapy for choroidal melanoma. The effect of intravitreal aflibercept on best-corrected visual acuity (BCVA), central foveal thickness (CFT) detected by spectral domain optical coherence tomography (sd-OCT), and Horgan’s grading scale of RM was evaluated throughout the 24-month follow-up. Intraocular pressure (IOP) and possible complications were also recorded. Results: Nine eyes of 9 patients were included. A mean of 4.4 ± 1.2 injections were given over the 24 months. At the end of follow-up, mean BCVA was significantly improved, from 0.9 ± 0.19 logMAR at baseline to 0.56 ± 0.3 logMAR (P = 0.028), and mean CFT was significantly decreased, from 546 ± 123 μm at baseline to 223 ± 34 μm (P < 0.001). Intravitreal aflibercept lowered baseline maculopathy stage as well. No significant change in IOP values and no complications, such as endophthalmitis, was recorded. Conclusion: Intravitreal aflibercept is an effective treatment for patients with radiation-induced macular edema, allowing functional and anatomical improvements to be achieved with a relatively low number of injections.

The retinal ganglion cells infarcted in central retinal artery occlusion (CRAO) are the somata of the optic nerve axons, part of the central nervous system. Consequently, CRAO with inner retinal infarction is a small vessel stroke, usually with the devastating consequence of severe visual loss in the affected eye. At present, there is no generally accepted, evidence-based therapy of nonarteritic CRAO in contrast to ischemic cerebral stroke that has well-accepted treatment protocols. Widely divergent and controversial therapeutic options for CRAO reflect the desperation of treating physicians and disparate conflicting studies. We examine reasons why treatment of nonarteritic CRAO remains problematic and then suggest a provisional new approach to treatment based on updated understanding of CRAO pathophysiology and analysis of current therapeutic options and their rationales.

Diabetic retinopathy is characterised by impaired retinal vascular autoregulation with signs of early retinal hyperperfusion and subsequent capillary drop out and peripheral ischemia. Initial retinal vascular dilation indicates disease progression and subsequent constriction signals a proliferative state. In this pilot study, we examined the effect of intravitreal aflibercept on retinal vessel diameter in patients with diabetic macular oedema.Twelve eyes of nine treatment-naive patients with diabetic macular oedema were examined during the first three months of treatment with aflibercept. The calibers of retinal arteries and veins and the central retinal arterial and vein equivalent were registered over the course of treatment. The evolution of the diabetic macular oedema was also registered and correlated to the retinal vascular caliber.During treatment, there was a significant reduction in the diameter of retinal arteries as well as in the central retinal arterial equivalent. The calibers of the retinal veins were also reduced, but not significantly. Macular oedema was significantly reduced, which however did not correlate with the vascular caliber changes.This pilot study demonstrates for the first time a possible significant reduction in retinal arterial caliber under aflibercept treatment for diabetic macular oedema. Further studies are needed to verify whether this response to intravitreal anti-VEGF treatment also signifies an improvement in retinal vascular homeostasis.Die diabetische Retinopathie ist durch eine gestörte retinale Gefäßautoregulation gekennzeichnet mit retinaler Hyperperfusion im Frühstadium und Kapillarausfall mit peripherer Ischämie im Spätstadium. Die initiale retinale Gefäßdilatation deutet auf eine Progression der Erkrankung hin und die anschließende Vasokonstriktion signalisiert einen proliferativen Zustand. In dieser Pilotstudie untersuchen wir den Einfluss des intravitrealen Aflibercepts auf den Durchmesser der retinalen Gefäße bei Patienten mit diabetischem Makulaödem.Zwölf Augen von 9 Patienten mit diabetischem Makulaödem wurden während der ersten 3 Monate der Behandlung mit Aflibercept untersucht. Es wurden das Kaliber der Netzhautarterien und -venen sowie das zentrale Netzhautarterien- und -venenäquivalent registriert. Das diabetische Makulaödem wurde im Verlauf der Behandlung mit dem Netzhautgefäßkaliber korreliert.Die Behandlung mit Aflibercept führt zur signifikanten Reduktion des Durchmessers der Netzhautarterien sowie des zentralen Netzhautarterienäquivalents. Die Netzhautvenen zeigten zwar eine Vasokonstriktion, die aber keine Signifikanz erreichte. Es kam zudem zur signifikanten Reduktion des Makulaödems. Diese korrelierte aber nicht mit dem vaskulären Kaliber der Netzhaut.Diese Pilotstudie zeigt zum ersten Mal, dass Aflibercept möglicherweise zur signifikanten Reduktion des retinalen arteriellen Gefäßkalibers führt. Ob diese Reaktion auf die intravitreale Anti-VEGF-Behandlung auch eine Verbesserung der retinalen Gefäßhomöostase widerspiegelt, muss in weiteren Studien verifiziert werden.

Background The critical time from onset of complete occlusion of the central retinal artery (CRA) to functionally significant inner retinal infarction represents a window of opportunity for treatment and also has medical-legal implications, particularly when central retinal artery occlusion (CRAO) complicates therapeutic interventions. Here, we review the evidence for time to infarction from complete CRAO and discuss the implications of our findings. Methods A Medline search was performed using each of the terms “central retinal artery occlusion”, “retinal infarction”, “retinal ischemia”, and “cherry red spot” from 1970 to the present including articles in French and German. All retrieved references as well as their reference lists were screened for relevance. An Internet search using these terms was also performed to look for additional references. Results We find that the experimental evidence showing that inner retinal infarction occurs after 90–240 min of total CRAO, which is the interval generally accepted in the medical literature and practice guidelines, is flawed in important ways. Moreover, the retinal ganglion cells, supplied by the CRA, are part of the central nervous system which undergoes infarction after non-perfusion of 12–15 min or less. Conclusions Retinal infarction is most likely to occur after only 12–15 min of complete CRAO. This helps to explain why therapeutic maneuvers for CRAO are often ineffective. Nevertheless, many CRAOs are incomplete and may benefit from therapy after longer intervals. To try to avoid retinal infarcton from inadvertent ocular compression by a headrest during prone anesthesia, the eyes should be checked at intervals of less than 15′.

Occult globe rupture is a traumatic dehiscence of the sclera at or posterior to the rectus muscle insertions without a visible eye wall defect on slit lamp examination. Occult scleral ruptures are important because they can be difficult to diagnose, but normally require preoperative protection against external pressure to reduce risk of herniation of ocular contents through the rupture and then urgent surgical repair to restore eye wall structural integrity and achieve optimum prognosis. A deeper-than-normal anterior chamber with posteriorly retracted plateau iris seen immediately after acute ocular trauma is virtually pathognomonic of posterior globe dehiscence. Three additional less specific signs are helpful: extensive chemosis that is often hemorrhagic, relative hypotony, and vitreous hemorrhage. Although the diagnosis is normally clinical, made by history of direct severe ocular trauma and careful anterior-segment slit lamp examination, computed tomography and ultrasonography can be helpful when thorough slit lamp examination is not possible. Strong suspicion of occult rupture should engender surgical exploration. Vitreous hemorrhage, vitreous or retinal incarceration, and retinal tears or detachment may necessitate subsequent pars plana vitrectomy or other vitreoretinal surgery. When pars plana vitrectomy is indicated, special precautions are suggested if watertight closure of the globe rupture has not been possible.

The paucity of animal models exhibiting full pathology of diabetic retinopathy (DR) has impeded understanding of the pathogenesis of DR and the development of therapeutic interventions. Here, we investigated whether hyperhexosemic marmosets (Callithrix jacchus) develop characteristic retinal vascular lesions including macular edema (ME), a leading cause of vision loss in DR. Marmosets maintained on 30% galactose (gal)-rich diet for 2 years were monitored for retinal vascular permeability, development of ME, and morphological characteristics including acellular capillaries (AC) and pericyte loss (PL), vessel tortuosity, and capillary basement membrane (BM) thickness. Excess vascular permeability, increased number of AC and PL, vascular BM thickening, and increased vessel tortuosity were observed in the retinas of gal-fed marmosets. Optical coherence tomography (OCT) images revealed significant thickening of the retinal foveal and the juxtafoveal area, and histological analysis showed incipient microaneurysms in retinas of gal-fed marmosets. Findings from this study indicate that hyperhexosemia can trigger retinal vascular changes similar to those seen in human DR including ME and microaneurysms. The striking similarities between the marmoset retina and the human retina, and the exceptionally small size of the monkey, offer significant advantages to this primate model of DR.

Large-vessel giant cell arteritis (GCA) can be a diagnostic dilemma for the eye care provider because it may not involve the typical cranial arteries. When any of its potential ocular complications are diagnosed, it is important to consider this unusual form of GCA.To report an unusual ophthalmic presentation of large-vessel GCA with sequential bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion.A 65-year-old previously healthy woman experienced sequential bilateral anterior ischemic optic neuropathy with branch retinal artery occlusion in the absence of other signs and symptoms suggestive of cranial GCA.Extensive workup, including temporal artery biopsy, failed to demonstrate vascular inflammation suggestive of GCA or vascular abnormalities, such as atheromatous plaques, but coincidentally revealed a breast tumor, which was excised. Positron emission tomography scan was performed revealing distinct hypermetabolism of the thoracic and abdominal aorta consistent with large-vessel GCA, and corticosteroid therapy was initiated.Large-vessel GCA is an underdiagnosed and undertreated type of GCA that does not typically affect the cranial arteries but rather larger proximal aortic branches. When associated with ocular complications, it can be a puzzling diagnostic dilemma for the eye care provider.

Collaboration of the surgical and anesthesia teams for patient positioning is essential to assure patient comfort and safety, preventing systemic and ophthalmic complications. The goals and rationales of positioning for intraocular surgery are discussed including placing the head above the heart, elevating the chin, using a head rest that is sufficiently firm, maximizing anesthesia care team access and minimizing fire risk, and taping the patient's head to the operating table to reduce unexpected movement with intraocular injury.

Positive vitreous pressure occurs during anterior segment intraocular surgery associated with acute hypotony and is characterized by forward displacement of the lens-iris diaphragm with shallowing of the anterior chamber resistant to reformation, repeated iris prolapse, and, in severe cases, zonular rupture and vitreous or lens prolapse that can lead to a cascade of intraoperative complications. Positive vitreous pressure is particularly common during penetrating keratoplasty, conventional nuclear expression cataract extraction, and repair of anterior open-globe injury. Hypotony resulting from aqueous loss leads to elevated vitreous pressure from 3 possible causes: external scleral compression, acute intraocular intumescence, or rarely acutely increased vitreous volume. Understanding the pathophysiology of positive vitreous pressure helps in its prevention and management.

Background: To study the value and safety of aqueous humor polymerase chain reaction (PCR) analysis for Herpes simplex, varicella zoster, cytomegalovirus, Epstein-Barr virus and Toxoplasma gondii in patients with uveitis. Methods: Records of 45 consecutive patients with anterior and posterior uveitis who underwent AC paracentesis with PCR were reviewed. The main outcome measure was frequency of PCR positivity. Secondary outcomes were alteration of treatment, safety of paracentesis, and correlation of keratitic precipitates with PCR positivity, Results: The overall PCR positivity was 48.9 % (22/45). Therapy was changed because of the PCR results in 14/45 patients (37.7 %). One patient experienced a paracentesis related complication (1/45, 2.2 %) without long-term sequelae. Conclusion: Aqueous PCR altered the diagnosis and treatment in over a third of our patients and was relatively safe. Aqueous PCR should be considered for uveitis of atypical clinical appearance, recurrent severe uveitis of uncertain etiology, and therapy refractory cases.

Despite the considerable progress in prevention and treatement options since the first big epidemiologic studies in the 80's, diabetic retinopathy still represents the primary cause of blindness in the working age population. The intensified prevention efforts that took place recentyears did show hopeful results as the incidence of diabetic retinopathy seems to decline. However a still considerable number of patients does not meet metabolic or treatment recommandations. In the aftermath of an ongoing globalisation and growing urbanisation of the society, there is an even bigger need of understanding the disease as well as improving prevention and treatment guidelines.

Affecting primarily the anterior part of the eye, all the structures of ophthalmological body may however be reached in case of drug- induced toxicity: eyelids and the conjunctiva for example in the syndromes of Lyell and Steven-Johnson, cornea with cornea verticillata related to amiodarone, ciliary muscle (accommodation) or pupil related to antidepressants, lens with glucocorticoid-induced cataract, retinal toxicity of anti malarial synthesis or optical neuropathy with ethambutol. Unfortunately often underrated because of their usual benignity, drug side effects affecting the eye yet can be severe. Simple, conscientious and planned monitoring however allowes for a large majority of our patients to minimize the risk of visual function impairment, thus preserving optimal visual function over time.

Accurate characterization of a retinal detachment as traumatic is often difficult, but is important because it may instigate a careful search for occult coexistent traumatic pathology, affect the prognosis and the treatment of both eyes, influence insurance coverage benefits and medical-legal determinations, and is essential for epidemiologic studies. We review the epidemiology and pathophysiology of traumatic retinal detachment, common obstacles to correct diagnosis, diagnostic guidelines, and outline categories of traumatic causal relationships. Because there is no generally accepted definition of traumatic retinal detachment, we offer a practical one. Categorization as traumatic should be based on the particular history and physical examination rather than epidemiologic criteria.