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Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study’s aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed. A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups. This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3–1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2–1.8). The post-treatment decrease in group 1 was a median equal to − 0.6 versus − 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups. For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO.

Zusammenfassung Hintergrund Bei der Behandlung von Glaukompatienten sind die Hauptziele die Bewahrung der Sehfähigkeit und Aufrechterhaltung einer möglichst hohen Lebensqualität bei volkswirtschaftlich akzeptablen Kosten. Daher ist es wichtig, jeden einzelnen Patienten sorgfältig zu evaluieren, um einen individuellen Behandlungsansatz zu erarbeiten. Material/Methoden Basierend auf den aktuellen Erkenntnissen, werden in der Übersicht die Vor- und Nachteile der medikamentösen Glaukomtherapie sowie der gängigen glaukomchirurgischen Methoden zusammengefasst. Die verschiedenen Wirkansätze der neuen minimal-invasiven Verfahren werden erläutert, die derzeit in Deutschland am häufigsten genutzten Verfahren vorgestellt sowie Empfehlungen für Vor- und Nachsorge gegeben. Ergebnisse und Diskussion Seit einigen Jahren stehen außer verschiedenen medikamentösen Tropftherapien und den klassischen operativen Verfahren, auch neue minimal-invasive Therapiealternativen zur Verfügung. Letztere eröffnen die Möglichkeit einer früheren chirurgischen Intervention, besonders für Patienten, die bereits initial oder im Laufe der Therapie für einen medikamentösen Ansatz ungeeignet erscheinen.

Beim Einsatz von glaukomchirurgischen subkonjunktivalen/subtenonalen Ab-interno-Verfahren sind die Selektion der Patienten sowie deren praoperatives Management essenziell zur Verminderung des postoperativen Vernarbungsprozesses des Sickerkissens. Ziel der Arbeit war das Zusammenstellen der Risikofaktoren, die sich ungunstig auf den Vernarbungsprozess auswirken konnen. Literatursuche in PubMed mit Bezug auf den Vernarbungsprozess beim Gelimplantat XEN® (Allergan GmbH, Frankfurt am Main, Deutschland). Ophthalmologische Risikofaktoren fur den konjunktivoskleralen/tenonalen Wundheilungsprozess sind unter anderem das trockene Auge, Allergien, die Verwendung von konservierungsmittelhaltigen Augentropfen sowie vorangegangene Operationen am Auge. Die praoperative Gabe von kunstlichen Tranenersatzmitteln, Kortikosteroiden sowie die grundsatzliche Umstellung auf konservierungsmittelfreie Augentropfen konnen die Normalisierung einer chronisch entzundlich veranderten Bindehaut unterstutzen und somit den Wundheilungsprozess nach dem Eingriff positiv beeinflussen.

Purpose: Investigating the existence of inflammation in the distal outflow system posterior of the Schlemm's canal in primary open-angle glaucoma (POAG).Methods: Scleral biopsies (n = 62) from POAG...

Objective: The role of elevated intraocular pressure (IOP) in the incidence and progression of glaucoma is well known. However, the exact mechanisms of IOP regulation are still unclear. Central IOP control has been suggested, but the autonomic pathway through which it acts is not known. The aim of this study was to investigate if isolated cranial nerve (CN) palsies of the third, fourth and sixth nerves are associated with an IOP difference between the affected and the unaffected eyes. Materials and Methods: This was a retrospective study including patients diagnosed with a third, fourth and sixth nerve palsy at a single tertiary centre. We included only patients with an isolated unilateral palsy. Patients with a history of strabismus, orbital disease or neurosurgical cases were excluded. Results: The charts of 1712 patients were reviewed. Third, fourth and sixth nerve palsies were found in 469 patients, 314 patients and 929 patients, respectively. Of all patients, 190 (10.6%) were eligible for inclusion in the study. A third nerve, fourth nerve or sixth nerve palsy was present in 85 (44.7%), 65 (34.2%) and 40 (21.1%) patients, respectively. The mean IOP of the affected eyes and the unaffected eyes was not statistically significant different: 14.1 ± 3.1 mmHg vs. 14.6 ± 2.7 mmHg in the CN3 group (p=0.087); 13.6 ± 2.6 mmHg vs. 13.7 ± 2.3 mmHg in the CN4 group (p=0.69); and 14.3 ± 2.7 mmHg vs. 14.9 ± 3.3 mmHg in the CN6 group (p=0.089). There was no statistically significant difference between the mean IOP differences of the affected and unaffected eyes among the three groups (p=0.47). Conclusion: Our study demonstrated no difference in IOP between affected and unaffected eyes in patients with an isolated cranial nerve palsy. These findings are the first and important for ophthalmology practice.

Evaluation of treatment efficacy of XEN45 gelstent for glaucoma secondary to Fuchs uveitis syndrome (FUS).This retrospective case series evaluated patients with glaucoma secondary to FUS, who underwent XEN45 implantation. Complete success was defined as IOP lowering of ≥ 20% and cutoff IOP atTwelve eyes of 12 patients were included. Qualified and complete success rates were 50% after one year (n = 10). Qualified success was achieved in 66.6% of patients with 33.3% of patients achieving complete success after two years (n = 6).XEN45 implantation had some success in the treatment of glaucoma secondary to FUS, but needling was frequently necessary to improve outcome.

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

The main goals of glaucoma treatment are to preserve the visual function and maintain as high a quality of life as possible at a cost acceptable to society. Therefore, it is crucial to carefully observe each individual patient in order to determine an individual and personalized treatment approach.This article summarizes the advantages and disadvantages of medicinal glaucoma treatment as well as traditional methods of glaucoma surgery, based on the current state of knowledge. The article explains the various mechanisms of action of new minimally invasive procedures, introduces the methods mostly commonly used in Germany and gives recommendations for preoperative care and postoperative follow-up.In addition to the plethora of medicinal glaucoma treatments and classical surgical procedures, new minimally invasive treatment alternatives have become available in the past few years. The latter are an option for an earlier surgical intervention, especially in naïve or previously treated patients who appear to be unsuitable for medicinal treatment.HINTERGRUND: Bei der Behandlung von Glaukompatienten sind die Hauptziele die Bewahrung der Sehfähigkeit und Aufrechterhaltung einer möglichst hohen Lebensqualität bei volkswirtschaftlich akzeptablen Kosten. Daher ist es wichtig, jeden einzelnen Patienten sorgfältig zu evaluieren, um einen individuellen Behandlungsansatz zu erarbeiten.Basierend auf den aktuellen Erkenntnissen, werden in der Übersicht die Vor- und Nachteile der medikamentösen Glaukomtherapie sowie der gängigen glaukomchirurgischen Methoden zusammengefasst. Die verschiedenen Wirkansätze der neuen minimal-invasiven Verfahren werden erläutert, die derzeit in Deutschland am häufigsten genutzten Verfahren vorgestellt sowie Empfehlungen für Vor- und Nachsorge gegeben.Seit einigen Jahren stehen außer verschiedenen medikamentösen Tropftherapien und den klassischen operativen Verfahren, auch neue minimal-invasive Therapiealternativen zur Verfügung. Letztere eröffnen die Möglichkeit einer früheren chirurgischen Intervention, besonders für Patienten, die bereits initial oder im Laufe der Therapie für einen medikamentösen Ansatz ungeeignet erscheinen.

Purpose To report a new genetic mutation in the COL4A1 gene, which was identified in a baby girl with Peters anomaly (PA), a rare anterior segment mesenchymal dysgenesis, which is characterized by unilateral or bilateral corneal opacities often accompanied by glaucoma, cataract, and systemic malformations and associated with various genetic mutations. Methods Ophthalmologic examination of one baby girl and whole exome sequencing and Sanger sequencing of blood samples of the child and her biological parents were performed. Results Ophthalmologic examination led to the diagnosis of PA type I in the baby girl. Whole exome sequencing and Sanger sequencing identified the de novo mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene in the child, whereas no other putatively causative variants in established genes associated with anterior segment dysgenesis were present. Conclusions PA might be associated with the mutation c.181_189delinsAGGTTTCCG; p.Gly61Arg in the COL4A1 gene. The COL4A1 gene encodes for collagen IVα1, an essential component of basal membranes, and mutations are associated with an increased risk for renal and cerebrovascular disorders and stroke. This should be considered when advising and monitoring patients.

Aim To assess the efficacy and tolerability of mycophenolate sodium (MPS) in the therapy of children with chronic non-infectious uveitis. Methods Retrospective analysis of 23 children with chronic uveitis, treated with MPS, with a follow-up of at least 6 months. The main outcome measures were time to uveitis reactivation and corticosteroid-sparing effect under MPS treatment. The secondary outcome measures were best-corrected visual acuity (BCVA) and treatment-related side effects. Results From 23 patients included in the study, 2 patients had anterior uveitis, 19 had intermediate uveitis and 2 had panuveitis. The probability of reactivation-free survival after MPS initiation was estimated as 65% at both 1 and 2 years. The probability of discontinuing systemic corticosteroids after 1 year of treatment was 39% and after 2 years 51%. The probability to taper corticosteroids to a daily dosage of ≤0.1 mg/kg after 1 and 2 years was 62% and 85%, respectively. BCVA improved or remained stable in 96% of eyes after 1 year of therapy. Treatment-related side effects were found in nine children (rate: 0.17/patient-year). No therapy discontinuation because of side effects was needed. Conclusion Our data suggest that MPS is useful and well tolerated in children with chronic uveitis. MPS seems to be an effective drug for the treatment of chronic non-infectious uveitis of childhood and may be preferred as a first-line steroid-sparing agent in this form of uveitis.

To present the long-term results of ab externo trabeculotomy in the management of glaucoma secondary to chronic uveitis. In this retrospective single-centre case series, medical records of patients with glaucoma secondary to chronic uveitis, who underwent ab externo trabeculotomy, were evaluated. Two definitions of success were used: intraocular pressure (IOP) 6 ≤ IOP ≤ 21 mmHg (success 1) or 6 ≤ IOP ≤ 21 mmHg and at least 25 % reduction from baseline (success 2). Success was complete when no additional medication was required or qualified when additional medication or cycloablative procedures were required to achieve the specific IOP definition. Twenty-two eyes of 18 patients were included. After 3 years, median IOP decreased from 27 mmHg [range 17–43 mmHg, mean 27.5 mmHg, 95 % confidence interval of the mean (CI) 24.5–30.5 mmHg] to 15 mmHg (range 9–19 mmHg, mean 14.5 mmHg, CI 13–16.1 mmHg). Complete and qualified success 1 was 23 and 45 % after 3 years, respectively. For success 2, the rates were 23 and 32 %, respectively. Hyphema was the most common complication, which resolved completely within 1 month after surgery without further intervention. Trabeculotomy ab externo was moderately successful in glaucoma secondary to chronic uveitis after 3 years. No sight-threatening complications were observed during the follow-up period.

To investigate the safety and efficacy of intraoperative conversion of unsuccessful canaloplasty technique into 180-degree metal or 360-degree suture trabeculotomy. In this retrospective observational case series, 35 eyes of 35 patients with open-angle glaucoma (OAG) who had undergone unsuccessful canaloplasty technique and underwent intraoperative conversion were studied. In 17 eyes (group A), the procedure was converted into 180-degree metal trabeculotomy because of unsuccessful circumferential Schlemm’s canal (SC) catheterisation. Group B included 18 eyes that were converted into 360-degree trabeculotomy because of cheese wiring of tension suture through the trabecular meshwork (TM) after successful complete catheterisation of SC. Median preoperative IOP was 22.0 mmHg (range 16–34) in group A, and 22.0 mmHg (range 15–48) in group B. Median IOP was significantly reduced in both groups postoperatively, at the 12-month examination to 15.0 mmHg (range 9–21) representing a reduction of 36 % in group A, and to 14.5 mmHg (range 8-21) representing a reduction of 34 % in group B. Median glaucoma medication number decreased significantly from 4 (range 2–4) and 3 (range 1–4) preoperatively to 2 (range 0–4) and 1 (range 0–3) at 12 months in groups A and B respectively. Hyphema was the commonest complication, with an incidence of 76 % in group A and 78 % in group B. 180-degree metal or 360-degree suture/catheter trabeculotomy are safe and effective surgical backup methods to control IOP in cases of unsuccessful intracanalicular placement of tension suture during canaloplasty surgery.

Background In this study, a conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed micro-invasive suture trabeculotomy (MIST) and its preliminary results are presented. Design Retrospective case-series in a university setting. Participants A total of 31 patients with open-angle glaucoma with history of canaloplasty. Methods A conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed MIST. Main Outcome Measures Mean decrease of intraocular pressure (IOP) and number of pressure-lowering medications. Results Mean decrease of IOP was 11.1 mmHg (standard deviation [SD], 9.9 mmHg) at 6 months, 12.1 mmHg (SD, 10.5 mmHg) at 12 months and 13.5 mmHg (SD, 11.4 mmHg) at 24 months. The average percent lowering of IOP was 36.7% (SD, 32.8%) at 6 months, 41.4% (SD, 35.9%) at 12 months and 44.6% (SD, 37.7%) at 24 months. The number of pressure-lowering medications decreased by 1.1 (SD, 1.3) at month 6, by 1.2 (SD, 1.5) at month 12, and by 1.3 (SD, 1.6) at month 24. Conclusions MIST is a promising approach for the treatment of open-angle glaucoma, which is insufficiently controlled with canaloplasty. The procedure achieved significant and sustained lowering of the intraocular pressure and demonstrated an excellent safety profile. The main advantages of the procedure are: easy to learn, fast to perform, and sparing of the conjunctiva for further filtration surgery, if necessary.

Um die Vergleichbarkeit aller Latanoprost-Praparate bzw. deren Generika zu prufen, wurde die Wirkstoffkonzentration der in Deutschland verfugbaren Praparate getestet. In Europa wird fur einen Bereich von (− 20 bis + 25 %) von einer Bioaquivalenz ausgegangen. Verfugbare Praparate wurden beschafft und erfasst. Die Konzentration von Latanoprost und Benzalkoniumchlorid wurde bei 23 Produkten mittels „high-performance liquid chromatography“ (HPLC) in einem validierten Referenzlabor bestimmt. Auserdem wurden noch das mittlere Tropfenvolumen und der pH der Wirkstoffformulierung getestet. Die Verpackungen wurden erfasst und die Lesbarkeit der Gebrauchsinformationen uberpruft. Alle Produkte enthielten weniger als 50 μg/ml Latanoprost. Die unterschiedlich erniedrigte Wirkstoffmenge (mittlere Abweichung: − 7,39 %, ± 2,8 %) wurde noch von Schwankungen der Tropfenmenge (mittleres Gewicht 0,03 g, ± 0,002 g) uberlagert. Dafur war die Benzalkoniumchlorid-Konzentration zum Teil deutlich hoher (Median Abweichung 5,45 %, min: − 2,5 %, max: 11,5 %). Der pH-Wert des ursprunglichen Originalpraparates und seiner Generika hatte einen Median von 6,78 (min: 6,62, max: 6,81) und unterschied sich somit von einer unkonservierten Latanoprost-Formulierung (pH 7,18). Die beiliegende Gebrauchsinformation der meisten Generika war aufgrund einer zu kleinen Schriftgrose fur Menschen mit reduzierter Sehscharfe nicht lesbar. Fur die Verordnung von Ophthalmologika ist zu berucksichtigen, dass verschiedene Einflussfaktoren zu einer schwankenden Drucksenkung im Ergebnis beitragen konnen. Angesichts einer fehlenden Versorgungsforschung ist unklar, inwieweit sich auch deutliche Unterschiede einer Tropfflasche mit anderem Erscheinungsbild und erhohtem Druckpunkt auf die nicht unproblematische Adharenz von Glaukompatienten auswirken konnen.

Purpose To assess the long-term results and complications of scleral-fixated posterior chamber intraocular lenses (PC IOLs) with the knotless Z-suture technique. Setting University Eye Hospital, Tubingen, Germany. Design Retrospective case series. Methods Records of consecutive patients who had implantation of scleral-fixated PC IOLs with the knotless Z-suture technique with a minimum follow-up of 3 years were reviewed. Results Sixty-six eyes of 62 patients were included. The mean preoperative corrected distance visual acuity (CDVA) was 0.71 logarithm of the minimum angle of resolution (logMAR) ± 0.58 (SD). The mean CDVA was 0.67 ± 0.54 logMAR (P = .257; n = 66) after 3 years, 0.73 ± 0.55 logMAR (P = .399; n = 60) after 5 years, 0.8 ± 0.68 logMAR (P = .348; n = 30) after 8 years, and 1.09 ± 0.76 logMAR (P = .069; n = 13) after 10 years. Failure because of suture breakage was observed in 11 eyes (16.7%) after a mean of 7.5 years. Kaplan-Meier time-to-event analysis showed a 40% failure probability after 10 years. Traumatic aphakia was the only risk factor for failure (odds ratio 4.1; 95% confidence interval, 1.0-18.3; P = .049). Complications included retinal detachment (15%), cystoid macular edema (9%), increased intraocular pressure requiring surgical intervention (7.6%), corneal edema (4.5%), and posterior iris-chafing syndrome with microhyphema (3%). Conclusions Implantation of scleral-fixated PC IOLs using the knotless Z-suture was a safe technique resulting in good visual outcomes. The long-term success of the procedure was dependent on the material properties of the suture.

PURPOSE To evaluate the safety and tolerability of intravitreal ISTH0036, an antisense oligonucleotide selectively targeting transforming growth factor beta 2 (TGF-β2), in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy (TE; glaucoma filtration surgery). METHODS In this prospective phase I trial glaucoma patients scheduled for TE with mitomycin C (MMC) received a single intravitreal injection of ISTH0036 at the end of surgery in escalating total doses of 6.75 μg, 22.5 μg, 67.5 μg or 225 μg, resulting in calculated intraocular ISTH0036 concentrations in the vitreous humor of approximately 0.3 μM, 1 μM, 3 μM or 10 μM after injection, respectively. Outcomes assessed included: type and frequency of adverse events (AEs), intraocular pressure (IOP), numbers of interventions post trabeculectomy, bleb survival, visual acuity, visual field, electroretinogram (ERG), slit lamp biomicroscopy and optic disc assessment. RESULTS In total, 12 patients were treated in the 4 dose groups. Main ocular AEs observed were corneal erosion, corneal epithelium defect, or too high or too low IOP, among others. No AE was reported to be related to ISTH0036. All other safety-related analyses did not reveal any toxicities of concern, either. The mean medicated preoperative IOP at decision time-point for surgery was 27.3 mmHg +/- 12.6 mmHg (SD). Mean IOP (±SD) for dose levels 1, 2, 3, and 4 were at Day 43 9.8 mmHg ± 1.0 mmHg, 11.3 mmHg ± 6.7 mmHg, 5.5 mmHg ± 3.0 mmHg and 7.5 mmHg ± 2.3 mmHg SD; and at Day 85 9.7 mmHg ± 3.3 mmHg, 14.2 mmHg ± 6.5 mmHg, 5.8 mmHg ± 1.8 mmHg and 7.8 mmHg ± 0.6 mmHg, respectively. In contrast to IOP values for dose levels 1 and 2, IOP values for dose levels 3 and 4 persistently remained below 10 mmHg throughout the observation period. CONCLUSION This first-in-human trial demonstrates that intravitreal injection of ISTH0036 at the end of TE is safe. Regarding IOP control, single-dose ISTH0036 administration of 67.5 μg or 225 μg at the time of TE resulted in IOP values persistently < 10 mmHg over the three month postoperative observation period.

To measure the value of augmented reality technology usage to teach the medical students performing binocular indirect ophthalmoscopy.Thirty-seven medical students were randomly assigned to the training of binocular indirect ophthalmoscopy either in the conventional way or with augmented reality ophthalmoscopy (ARO). For testing student's skills, they had to examine a real person using a conventional ophthalmoscopy system and draw the optic disk. They also had to fill out a questionnaire. Subjective and objective evaluations were performed.Thirty-seven students were randomly assigned to two groups. Eighteen students were trained with conventional ophthalmoscopy and 19 students with ARO. The questionnaires showed no differences. Performing an objective analysis, the median ophthalmoscopy training score for the conventional ophthalmoscopy group was 1.2 (range, 0.67-2) and showed a significant difference (P0.0033) to the ARO group (median 2; range, 0.67-2).The study provides evidence that a single ARO training is efficient to improve ophthalmoscopy skills. As the objective analysis showed, the ARO group had a significantly superior performance. Our study also indicates that subjective evaluation of the fundus drawings without systematic analysis is prone to errors.

Glaucoma is one of the sight-threatening complications of Fuchs' uveitis syndrome (FUS) and the most difficult to manage. The goal of this study was to assess the efficacy and safety of cyclophotocoagulation (CPC) in the management of glaucoma secondary to FUS.In a retrospective analysis, the charts of all patients with FUS referred to our clinic from January 2002 to December 2012 were reviewed. In patients with glaucoma or ocular hypertension, controlled eye pressure was defined using two alternative upper limits of 6 ≤ IOP ≤ 21 mmHg and 6 ≤ IOP ≤ 18 mmHg at 1 year follow-up.One hundred and seventy-six patients with FUS were included in this study. Of those, 28 had ocular hypertension (OHT) or glaucoma. Mean maximal intraocular pressure (IOP) of patients with glaucoma/OHT was 40.8 mmHg. Twenty-three patients (82.1 %) had maximal IOP levels of 35 mmHg or higher. Sixteen patients with glaucoma/OHT underwent CPC alone (ten patients) or in combination with other surgical procedures (six patients). After 1 year, control of IOP for both upper limits (6 ≤ IOP ≤ 18 mmHg) and (6 ≤ IOP ≤ 21 mmHg) was achieved in six of ten patients (60 %) who received CPC alone, and in five of six patients (83.3 %) who required additional surgery after CPC. The mean number of cycloablative procedures was 1.3 (range 1-2) in the CPC alone group and 1.2 (range 1-2) in patients for whom CPC was used as adjunct therapy. There was no exacerbation of intraocular inflammation, no postoperative hypotony and no phthisis bulbi in the 16 patients who underwent CPC.CPC is a safe and effective procedure that should be considered if medical treatment has failed to control glaucoma in FUS.

There is a need for cheap and efficacious wound dressings in developing countries. Banana leaves have been described as an excellent, inexpensive, easily available dressing material in tropical countries. As a natural product, banana leaves are heavily contaminated with various pathogens that must be removed before they can be used as wound dressings, but effective sterilization methods that do not affect the beneficial wound-dressing properties of banana leaves have not been described.To study different sterilization methods and determine which can be used on banana leaves without affecting their beneficial wound-dressing properties.We first compared the use of different decontamination techniques to reduce the natural microflora of the leaves and then tested the wound-dressing properties of the leaves in a mouse model of skin transplantation and in postsurgical patients in Uganda, Africa.Steam sterilization proved to be the optimal sterilization technique. Banana leaves displayed wound-dressing properties that equaled those of petroleum jelly gauze dressings and were tested successfully in a clinical setting in postsurgical patients in Uganda, Africa.We found banana leaves to be an excellent alternative wound dressing, combining the desirable properties of modern wound-dressing material with low cost.

To investigate the ophthalmotonic consensual reaction (OCR) in healthy individuals.This was a cohort study of 59 pairs of eyes of patients who underwent cataract surgery in one eye and had no other ocular pathology than cataract. Main outcome measure was change of intraocular pressure (IOP) in the untreated fellow eye. The IOP was measured 1 hour before, 1 hour after, and 1 day after surgery.One hour after surgery, IOP decreased in 24 (41%) operated eyes (group A). In the corresponding untreated fellow eyes (group Af), the mean IOP (±standard deviation [SD]) did not change (14.1 ± 3.0 mmHg preoperatively to 14.2 ± 3.1 mmHg postoperatively, p = 0.8). Only two operated eyes showed unchanged IOP (group B). In 33 (56%) operated eyes, the IOP increased (group C). In the untreated fellow eyes (group Cf), the mean IOP decreased significantly from 15.1 ± 2.9 to 13.7 ± 2.6 mmHg (p = 0.0012). One day after surgery, the mean IOP of group Af decreased significantly from 14.2 ± 3.1 (postoperative IOP) to 12.7 ± 3.2 mmHg (p = 0.007). In group Cf, the mean IOP revealed no changes from 13.7 ± 2.6 to 13.5 ± 2.4 mmHg (p = 0.69).Our results showed some evidence for the existence of the OCR in healthy individuals. Significant IOP elevation in one eye resulted in IOP reduction in the fellow eye. Interestingly, this phenomenon did not exist vice versa.

To report the outcomes of primary transconjunctival 23-gauge (23-G) vitrectomy in the diagnosis and treatment of presumed endogenous fungal endophthalmitis (EFE).Retrospective analysis of patients with EFE who underwent diagnostic transconjunctival 23-G vitrectomy at a tertiary referral center.Nineteen eyes of 15 patients with EFE were included in the study. Four patients had bilateral and 11 patients unilateral disease. Sixteen eyes of 15 patients underwent 23-G vitrectomy to confirm the diagnosis using vitreous culture, polymerase chain reaction, and histopathologic examinations. All affected eyes were treated with intravitreal amphotericin B 5 µg/0.1 mL. Fourteen patients received additional systemic antifungal therapy. Diagnostic 23-G vitrectomy confirmed the diagnosis of EFE in 75% of the eyes (12/16). Candida was found to be a causative agent in 62.5% and Aspergillus in 12.5% of the eyes. Retinal detachment was the most common complication (42% of eyes).EFE can be easily confirmed using primary 23-G vitrectomy.

Purpose.To investigate the agreement between morphometric optic nerve head parameters assessed with the confocal laser ophthalmoscope HRT III and the stereoscopic fundus camera Kowa nonmyd WX3D retrospectively.Methods.Morphometric optic nerve head parameters of 40 eyes of 40 patients with primary open angle glaucoma were analyzed regarding their vertical cup-to-disc-ratio (CDR). Vertical CDR, disc area, cup volume, rim volume, and maximum cup depth were assessed with both devices by one examiner. Mean bias and limits of agreement (95% CI) were obtained using scatter plots and Bland-Altman analysis.Results.Overall vertical CDR comparison between HRT III and Kowa nonmyd WX3D measurements showed a mean difference (limits of agreement) of −0.06 (−0.36 to 0.24). For the CDR < 0.5 group (n=24) mean difference in vertical CDR was −0.14 (−0.34 to 0.06) and for the CDR ≥ 0.5 group (n=16) 0.06 (−0.21 to 0.34).Conclusion.This study showed a good agreement between Kowa nonmyd WX3D and HRT III with regard to widely used optic nerve head parameters in patients with glaucomatous optic neuropathy. However, data from Kowa nonmyd WX3D exhibited the tendency to measure larger CDR values than HRT III in the group with CDR < 0.5 group and lower CDR values in the group with CDR ≥ 0.5.

Die ersten Fallserien beschreiben die Wirksamkeit der VEGF („vascular endothelial growth factor“)-Inhibitoren uber den Zeitraum mehrerer Jahre, wahrend die photodynamische Therapie in der prospektiven VIP-Studie keinen signifikanten Unterschied gegenuber einer Placebobehandlung vorweisen konnte. Obwohl systemische Untersuchungen verschiedener Wiederbehandlungsregime bis heute fehlen, scheint die Gabe einzelner Injektionen nach der facharztlichen Beurteilung der morphologischen Veranderungen haufig schon mit wenigen Applikationen gute Ergebnisse erreichen zu konnen. Die Bedingungen der IVOM (intravitreale operative Medikamenteneingabe)-Therapie durfen nicht einfach von der altersabhangigen Makuladegeneration ubertragen werden. Eine individuelle Betreuung scheint – nicht nur bei Frauen im gebarfahigen Alter – angeraten.

Despite its relatively long history conventional perimetry has preserved its role in (glaucoma) diagnostics by the continuous advancement of technical equipment, examination strategies and new methods for analysis and visualization of progression. A high standardization in execution and evaluation of visual field examination can now be obtained by the increasing use of computer technology. Standardized protocols become increasingly more useful especially in cases of chronic diseases, such as glaucoma where several suitable diagnostic methods must be applied over a long time period. For the assessment of functional deterioration several (numeric) perimetric indices are available in addition to clinical evaluation. The use of fast threshold estimating strategies and locally condensed grids are promising tools for early detection of the functional manifestation or progression of (glaucomatous) loss of visual field. In cases of advanced (glaucomatous) visual field loss, perimetry with (computer generated) moving stimuli (semi-automated kinetic perimetry) allows an efficient, standardized and patient-friendly edge detection of scotoma borders. This method is also very well suited for expert opinions and ability testing. The assessment by morphological or morphometric, hydrodynamic and other functional parameters serve as complementary diagnostic aids or as elementary tools for plausibility control.

Makulopathien mit areolaren oder annularen Defekten im retinalen Pigmentepithel (RPE) lassen an vielfaltige Differenzialdiagnosen denken. Treten derartige Veranderungen im jugendlichen oder fruhen Erwachsenenalter bei gutem Visus auf, ist die genaue Diagnostik und Diagnosesicherung hinsichtlich der Prognose der Erkrankung von besonderer Bedeutung. Wir berichten uber eine 36-jahrige Patientin mit perifoveolaren, areolaren RPE-Defekten beidseits. Beschwerden bestehen in Form von Metamorphopsien bei gutem Visus. Sehstorungen waren initial bereits vor 8 Jahren aufgetreten. Die perifoveolaren RPE-Defekte lassen sich in der Autofluoreszenzphotographie und der OCT darstellen und haben funktionell Defekte in der Perimetrie, Mikroperimetrie und der multifokalen Elektroretinographie zur Folge. Die Beschwerden und der Verlauf stehen im Einklang mit der Diagnose einer Fenestrated-Sheen-Makuladystrophie. Eine Therapie existiert nicht. Diese seltene, autosomal-dominant vererbte Makuladystrophie verlauft haufig asymptomatisch und hat eine gute Visusprognose.

Hintergrund: Die tuberose Sklerose ist eine relativ seltene Erkrankung, die einen sehr schweren Verlauf zeigen kann. Ziel dieser Arbeit ist es, anhand eines klinischen Falls einige der typischen Veranderungen bei der tuberosen Sklerose und deren Relevanz fur den Augenarzt zu zeigen. Zusammenfassung der Befunde: Es wurden eine Untersuchung des Vorderabschnittes, eine Funduskopie, eine Perimetrie und eine Fotodokumentation bei einem 40-jahrigen Patienten durchgefuhrt. Die ophthalmologische Untersuchung zeigte einen Nervenfaserverlaufsausfall in der unteren Gesichtsfeldhalfte sowie ein prominentes, scharfbegrenztes, multinodulares, etwa ⅓ - œ PD groses Hamartom (sog. „Maulbeer-Lasion”) an der oberen temporalen Gefasarkade. Die restlichen interdisziplinaren Untersuchungen ergaben weitere, fur die tuberose Sklerose typische Veranderungen. Fazit: Bei Vorliegen von retinalen Hamartomen ist differenzialdiagnostisch immer an eine tuberose Sklerose zu denken. Weitere typische Augenbefunde sind Gesichts- und Lidangiofibrome, Iris-, Linsen- und Aderhautkolobome, ein Strabismus, eine Poliosis der Wimpern, ein Papillenodem und eine sektorielle Irisdepigmentation. Die Diagnosestellung bei der tuberosen Sklerose ist in den meisten Fallen relativ einfach, erfordert allerdings ein interdisziplinares Denken und Vorgehen. Background: Tuberous sclerosis is a relatively rare disease, but it often takes a progressive and severe course. We wish to demonstrate the typical changes in a patient with tuberous sclerosis and their relevance for the ophthalmologist. Findings: Ophthalmologic evaluation including funduscopy, 30°-perimetry and fundus photography and clinical course of a 40-year-old man are described. We observed an elevated, multinodular, opaque hamartoma resembling mulberries, approximately ⅓ - œ PD large, at the temporal superior arc with corresponding visual field defects. Conclusions: An ophthalmologist should always think of a tuberous sclerosis as a differential diagnosis when confronted with a retinal hamartoma. Other characteristic ophthalmological findings include facial and eyelid angiofibromas, coloboma of the iris, lens and choroid, strabismus, poliosis of the eyelashes, papilloedema and sector iris depigmentation. Clinical diagnosis of tuberous sclerosis is in most cases relatively easy; however, an interdisciplinary cooperation is needed.

In this study, a conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed micro-invasive suture trabeculotomy (MIST) and its preliminary results are presented.Retrospective case-series in a university setting.A total of 31 patients with open-angle glaucoma with history of canaloplasty.A conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed MIST.Mean decrease of intraocular pressure (IOP) and number of pressure-lowering medications.Mean decrease of IOP was 11.1 mmHg (standard deviation [SD], 9.9 mmHg) at 6 months, 12.1 mmHg (SD, 10.5 mmHg) at 12 months and 13.5 mmHg (SD, 11.4 mmHg) at 24 months. The average percent lowering of IOP was 36.7% (SD, 32.8%) at 6 months, 41.4% (SD, 35.9%) at 12 months and 44.6% (SD, 37.7%) at 24 months. The number of pressure-lowering medications decreased by 1.1 (SD, 1.3) at month 6, by 1.2 (SD, 1.5) at month 12, and by 1.3 (SD, 1.6) at month 24.MIST is a promising approach for the treatment of open-angle glaucoma, which is insufficiently controlled with canaloplasty. The procedure achieved significant and sustained lowering of the intraocular pressure and demonstrated an excellent safety profile. The main advantages of the procedure are: easy to learn, fast to perform, and sparing of the conjunctiva for further filtration surgery, if necessary.

Purpose To evaluate a digital high-speed camera combined with digital morphometry software for dynamic measurements of phakic intraocular lens movements to observe kinetic influences, particularly in fast direction changes and at lateral end points. Materials and methods A high-speed camera taking 300 frames per second observed movements of eight iris-claw intraocular lenses and two angle-supported intraocular lenses. Standardized saccades were performed by the patients to trigger mass inertia with lens position changes. Freeze images with maximum deviation were used for digital software-based morphometry analysis with ImageJ. Results Two eyes from each of five patients (median age 32 years, range 28–45 years) without findings other than refractive errors were included. The high-speed images showed sufficient usability for further morphometric processing. In the primary eye position, the median decentrations downward and in a lateral direction were −0.32 mm (range −0.69 to 0.024) and 0.175 mm (range −0.37 to 0.45), respectively. Despite the small sample size of asymptomatic patients, we found a considerable amount of lens dislocation. The median distance amplitude during eye movements was 0.158 mm (range 0.02–0.84). There was a slight positive correlation (r=0.39, P

Aim: To assess the long-term efficacy and tolerability of both derivatives of mycophenolic acid, mycophenolate mofetil (MMF) and mycophenolate sodium (MPS), in the therapy of patients with birdshot chorioretinopathy (BSCR). Methods: Retrospective analysis of 24 patients (48 eyes) with BSCR, treated with MMF or MPS with a follow-up of at least 1 year. The main outcome measures included control of inflammation, steroid-sparing potential and side effects. Secondary outcome measure was the development of retinal function during the therapy measured by best-corrected visual acuity (BCVA), visual field and/or electroretinography (ERG). Results: Twelve patients (50%) were treated with MMF and 12 patients (50%) with MPS. Control of intraocular inflammation, defined as complete lack of clinical and angiographic signs of inflammatory activity, was achieved in 16 of 24 patients (67%). The angiographic signs of activity were significantly reduced during the follow-up (p0.05). In 20 out of 21 patients (95%) who received systemic corticosteroids, the corticosteroids could be tapered to a daily dose of ≤10 mg (rate 0.26/patient-year). Drug-related side effects occurred in 12 patients (50%, rate 0.16/patient-year). In four patients (17%), a therapy switch from MMF to MPS was undertaken due to gastrointestinal discomfort. Conclusions: Derivatives of mycophenolic acid are effective and safe drugs for the treatment of BSCR. In cases with gastrointestinal side effects, a therapy switch from MMF to MPS should be considered.

SummaryBackground Primary cutaneous γ/δ T-cell lymphoma (PCGD-TCL) is aggressive and has a poor prognosis. In contrast, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) of the α/β T-cell receptor phenotype is known to follow an indolent course and have a more favourable prognosis. In the past, PCGD-TCL and SPTCL were often considered to be a manifestation of the same disease, and aggressive systemic polychemotherapy has commonly been the first-line therapy for both. Given the understanding that SPTCL is a separate and less aggressive entity, clinical data exclusively evaluating the efficacy of conservative treatment in SPTCL are needed. Objectives To assess the overall clinical response to systemic corticosteroids in the treatment of SPTCL. Methods This was a retrospective cross-sectional study based on a patient data repository from two tertiary care university hospitals in Zurich (Switzerland) and Tubingen (Germany). The repository spanned 13 years. Results In four of the five patients (80%) with SPTCL, treatment with systemic corticosteroids induced a complete remission. Conclusions Systemic corticosteroids may be an excellent first-line single-agent therapy for SPTCL.

Aim The aim of the study was to assess the long-term efficacy and tolerability of tumour necrosis factor α (TNFα) inhibitors in the therapy of children with refractory antinuclear antibody (ANA)-associated chronic anterior uveitis. Methods Retrospective analysis of 31 children with ANA-associated uveitis, treated with TNFα inhibitors with a follow-up period of at least 2 years. The outcome measures included: control of inflammation, corticosteroid-sparing potential and side effects. Results Twenty-three children (74%) were treated with adalimumab, five children (16%) with infliximab and three children (10%) with etanercept. Control of uveitis, defined as 0 anterior chamber cells while on ≤2 drops/day topical corticosteroids, was achieved in 22 of 31 patients (71%) after 1 year (95% CI 52% to 86%), and in 21 of 29 patients (72%) after 2 years of treatment (95% CI 53% to 87%). Control of uveitis was observed in 18 of 23 children (78%) treated with adalimumab, and in two of five children (40%) treated with infliximab. In all children treated with etanercept, no sufficient inflammatory control was found. Systemic corticosteroids could be discontinued in 71% (12/17 children) and topical corticosteroids in 55% (17/31) of the patients. Treatment-related side effects were found in nine children (29%, rate: 0.10/patient-year). Conclusions Our data show that adalimumab and infliximab have beneficial effects in the therapy of severe ANA-associated anterior uveitis in children.

Purpose: Alagille syndrome is frequently associated with optic disc anomalies. This is the first report of a patient with Alagille syndrome and myelinated retinal nerve fibers. Methods: A 5-year-old female patient was referred to the Centre for Ophthalmology before a liver transplantation. Ocular examinations including slit lamp examination and funduscopy as well as anterior segment and fundus images were performed. Results: We observed myelinated retinal nerve fibers in both eyes of a 5-year-old female patient with Alagille syndrome. Conclusions: A broad spectrum of ocular anomalies is associated with Alagille syndrome. To our knowledge, this is the first reported case of myelinated retinal nerve fibers in a patient with Alagille syndrome.

To analyze the foveal surface using binary image analysis after spectral-domain optical coherence tomography (SD-OCT) following 23-gauge macular surgery in epiretinal membranes (ERM) using either air tamponade (AIR) or balanced salt solution (BSS).One hundred twenty-four eyes (124 patients) with ERM that had undergone membrane peeling with installation of air or BSS were analyzed retrospectively. Ophthalmic examination was performed at baseline and 3 months.The foveal area and surface symmetry, area matched thickness, area matched contour, and best-corrected visual acuity (BCVA). The OCT images were analyzed after binary conversion with ImageJ software.Eighty eyes (80 patients) of 124 screened patients were included (AIR group: 39 patients, BSS group: 41 patients). Median follow-up time was 14 weeks (range, 9-19 weeks). Three months after surgery, the median horizontal area decreased significantly in both groups (p 0.0001). At follow-up, the foveal surface symmetry values for the BSS group (median, 22.73 μm, range, 0-153) were significantly lower than for the AIR group (median, 23.95 μm, range, 0-160.43) (p 0.0001). The area-matched thickness increased significantly in both groups (p 0.001). The AIR group showed a significant increase of the area matched contour for the nasal located measurement-areas N1 (p 0.0003), N2 (p 0.0079), N3 (p 0.007). The BSS group showed a significant increase of the area-matched contour for the measurement areas N1 (p 0.019), N2 (p 0.0014), and N4 (p 0.022). After surgery, median BCVA for both groups increased significantly to 0.3 logMAR.The analysis of early contour changes after ERM surgery was technically possible. Long-term data have to be looked at before the clinical impact of this methodology can be estimated. Although there were no big differences between both groups (AIR vs. BSS), this could change within a longer and more representative follow-up.

To investigate the use of a small gravity- and tilt-compensated, head-fixed sensor with data-logging function to measure compliance and head posture of patients after macular hole surgery based on the recommendation of a face-down position. Main outcome measures were the median inclination, the times with correct or incorrect head position and the acceptance/annoyance of a data-logging device. A small battery-driven electronic sensor device with gravity and tilt compensations was placed within a plastic box and fixed on a patient’s head with a headband. Face-down position data were logged every half second for 24 h after macular hole surgery and were stored on a memory card. Thirteen patients were involved (seven females, six males, median age, 68 years, range, 50–75 years), two cases with early dropout. Ten of 11 datasets could be evaluated showing a complete data record file. The average percentage for face-down >45° was 18 % within 24 h and 17 % in the daytime. The median inclination was −6.7° (min: −89.7° max: 90°). The sensor system was well tolerated and disturbance was rated low by all ten patients. While the patients’ face-down posture considerably varied over time in extent and continuity, the assessment might lead to optimizing the patients’ compliance with the optimal position. Results showed an excellent acceptance of the motion sensor.

Here, we report the case of an incidental finding of lamellar calcification of the falx cerebri in a routine computed tomography scan of the head after an accidental trauma. This lamellar calcification led to the diagnosis of Gorlin-Goltz syndrome (GGS) in the patient and her daughter. Lamellar calcification of the falx cerebri is a pathognomonic feature of GGS. Our case report highlights the importance of a multidisciplinary diagnostic approach to GGS.

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