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Purpose To evaluate the effect of Prism adaptation test (PAT) on the angle of squint in decompensated esophoria (decEPH) and decompensated microesotropia (decMET). Methods In this single-center retrospective study we reviewed the medical records of patients with the diagnosis of decEPH or decMET, aged at least 12 years, who were treated by strabismus surgery for the first time. The maximum Angle of squint (AOS) for far (F) and near (N) fixation and PAT results before surgery, as well as AOS (F) and AOS (N) after surgery and results of binocular function tests were considered. PAT included wearing a prism based on the largest angle for over 60 min. Results 100 patients (mean age 37 ± 17 years) were included in the decEPH group, 82 patients (mean age 30 ± 13 years) in the decMET group. For decEPH, before surgery AOS was 25.5 ± 8.8 pdpt (F) and 23.5 ± 9.8 pdpt (N). During PAT the AOS increased significantly by 2.7 ± 4.3 to 28.2 ± 8.6 pdpt (F) and by 4.9 ± 4.5 to 28.3 ± 9.5 pdpt (N). Altogether, in 82% of decEPH patients AOS (F) and/ or AOS (N) in- or decreased by at least 3 pdpt. For decMET, before surgery AOS was 28.6 ± 10.8 pdpt for far (F) and 30.9 ± 11.8 pdpt for near fixation (N). During PAT the AOS increased significantly by 4.2 ± 5.8 to 32.5 ± 9.5 pdpt (F) and by 3.7 ± 6.1 to 34.4 ± 9.5 pdpt (N). Altogether, in 51% of decMET patients, AOS (F) and/ or AOS (N) increased by at least 10 pdpt, therefore more than 5° which would have been maximally expected from mictrotropia, or decreased by at least 3 pdpt. Conclusions The Prism adaptation test (PAT) showed remarkable changes in AOS in both decEPH and decMET. In patients with decEPH, the preoperative assessment of the “true AOS” under PAT reflects a pivotal requirement for successful strabismus surgery, as 82% had dose relevant angle changes ≥ 3 pdpt. For patients with decMET the preoperative prism adaptation test is especially of diagnostic value, but also 51% of decMET patients had changes in AOS beyond the expected microtropic angle (≥ 10 pdpt) or even a dose relevant angle decrease (≥ 3pdpt).

IntroductionMyopia is a major cause of degenerative eye disease and increases the risk of secondary visual impairment. Mitigating its progression therefore has great potential of clinically relevant benefit as shown by using highly diluted atropine eye drops in children of Asian origin. However, limited evidence is available regarding the efficacy and safety of low-dose atropine therapy in non-Asian populations. Hence, the Low-dose AtropIne for Myopia Control in Children (AIM) study will test the efficacy and safety of 0.02% atropine vs placebo in a German population.Methods and analysisAIM is a national, multicentre, prospective, randomised, placebo-controlled, double-blind trial with two parallel arms. The primary objective is to assess the efficacy of atropine 0.02% eyedrops for myopia control in children of Caucasian origin. The primary outcome is the change in cycloplegic refraction after 1 year of treatment (D/year). Secondary and tertiary outcome measures comprise the change in axial length (mm/year) in children treated with 0.02% atropine compared with placebo, the myopic progression of participants treated with 0.01% compared with 0.02% atropine (D/year and mm/year), and the safety profile of both 0.02% and 0.01% atropine. Furthermore, the myopic progression 1 year after cessation of therapy with 0.02% atropine will be evaluated. Inclusion criteria are an age of 8–12 years and myopia of −1 D to −6 D with an estimated annual myopia progression of ≥0.5 D. After randomisation, patients will receive either atropine 0.02% (arm A) or placebo eye drops (arm B) in the first year of treatment. In the second year, they will continue to receive atropine 0.02% (arm A) or switch to atropine 0.01% (arm B). In the third year, they will switch to placebo (arm A) or continue with atropine 0.01% (arm B). To achieve a statistical power of 80%, the calculated sample size is 300. The trial has started in October 2021 with a planned recruitment period of 18 months.Ethics and disseminationAIM has been approved by the Central Ethics Committee of the University Medical Center Freiburg (21-1106), local ethics committees of each participating centre and the German Federal Institute for Drugs and Medical Devices (61-3910-4044659). It complies with the Declaration of Helsinki, local laws and ICH-GCP. Results and underlying data from this trial will be disseminated through peer-reviewed publications and conference presentations.Trial registration numberNCT03865160.

Die Ophthalmologie 120, 520-528 (2022). doi:10.1007/s00347-022-01753-w, Published by Springer Medizin, Heidelberg

Infantile nystagmus syndrome (INS) denominates early-onset, involuntary oscillatory eye movements with different etiologies. Nystagmus is also one of the symptoms in oculocutaneus albinism (OCA), a heterogeneous disease mainly caused by defects in melanin synthesis or melanosome biogenesis. Dopachrome tautomerase (DCT, also called TYRP2) together with tyrosinase (TYR) and tyrosin-related protein 1 (TYRP1) is one of the key enzymes in melanin synthesis. Although DCT´s role in pigmentation has been proven in different species, until now only mutations in TYR and TYRP1 have been found in patients with OCA. Detailed ophthalmological and orthoptic investigations identified a consanguineous family with two individuals with isolated infantile nystagmus and one family member with subtle signs of albinism. By whole-exome sequencing and segregation analysis, we identified the missense mutation c.176G > T (p.Gly59Val) in DCT in a homozygous state in all three affected family members. We show that this mutation results in incomplete protein maturation and targeting in vitro compatible with a partial or total loss of function. Subsequent screening of a cohort of patients with OCA (n = 85) and INS (n = 25) revealed two heterozygous truncating mutations, namely c.876C > A (p.Tyr292*) and c.1407G > A (p.Trp469*), in an independent patient with OCA. Taken together, our data suggest that mutations in DCT can cause a phenotypic spectrum ranging from isolated infantile nystagmus to oculocutaneous albinism.

Introduction Disease-causing mutations in the protocadherin FAT1 have been recently described both in patients with a glomerulotubular nephropathy and in patients with a syndromic nephropathy. Methods We identified 4 patients with FAT1-associated disease, performed clinical and genetic characterization, and compared our findings to the previously published patients. Patient-derived primary urinary epithelial cells were analyzed by quantitative polymerase chain reaction (qPCR) and immunoblotting to identify possible alterations in Hippo signaling. Results Here we expand the spectrum of FAT1-associated disease with the identification of novel FAT1 mutations in 4 patients from 3 families (homozygous truncating variants in 3, compound heterozygous missense variants in 1 patient). All patients show an ophthalmologic phenotype together with heterogeneous renal phenotypes ranging from normal renal function to early-onset end-stage kidney failure. Molecular analysis of primary urine-derived urinary renal epithelial cells revealed alterations in the Hippo signaling cascade with a decreased phosphorylation of both the core kinase MST and the downstream effector YAP. Consistently, we found a transcriptional upregulation of bona fide YAP target genes. Conclusion A comprehensive review of the here identified patients and those previously published indicates a highly diverse phenotype in patients with missense mutations but a more uniform and better recognizable phenotype in the patients with truncating mutations. Altered Hippo signaling and de-repressed YAP activity might be novel contributing factors to the pathomechanism in FAT1-associated renal disease., Graphical abstract

Purpose This study is a secondary analysis of the IDOSP trial published in the Annals of Surgery 2020. The aim of this study was to examine the influence of stereo acuity on surgical performance in a laparoscopic training parkour with 3D- versus 4 K-2D-display technique. Methods The surgical performance of medical students (MS), non-board-certified surgeons (NBC), and board-certified surgeons (BC) was compared using 3D- versus 4 K-2D-display technique at a training parkour in a randomized cross-over trial. Stereo acuity was tested by TNO and Titmus Stereo tests. Results Eighty-nine participants were included in this sub-trial. The median stereo acuity for all participants, measured with the Titmus test, was 25 s arc, with TNO test 30 s arc. Higher quality stereo vision, measured with the Titmus test, correlated significantly with a reduced parkour time (r = 0.26, p = 0.02) and error (r = 0.21, p = 0.048) with the 3D screen. The TNO test did not correlate significantly with parkour performance. There was no statistically significant correlation between parkour time nor error and stereo acuity using the 4 K system (p > 0.457 respectively). Higher age showed a significant correlation with lower stereo acuity measured with TNO (r = 0.21, p = 0.014), but not with the Titmus test (r = − 0.7, p = 0.39). Seven percent of the group “NBC and BC” showed reduced stereo acuity > 120 s arc with the Titmus test and 3% with the TNO test. Conclusion High-quality stereo vision is of utmost importance for surgical skills using a 3D-display system. This was most obvious for MS and for tasks that place particularly high demands on hand–eye coordination. The Titmus test was more precise than the TNO test to predict the benefit of a 3D monitor system. Experience and fine motor skills could partly compensate for a poorer stereo acuity. Trial registration This trial was registered at clinicaltrials.gov (trial number: NCT03445429, registered February 26, 2018).

Background For some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves’ orbitopathy in which it is already widely used. Methods We reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves’ orbitopathy were excluded. Results From 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3–75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane’s retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1–5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane’s retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered. Conclusions Strabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.

OBJECTIVE To evaluate if "state-of-the-art" 3D- versus 4K-display techniques could influence surgical performance. BACKGROUND High quality minimally invasive surgery is challenging. Therefore excellent vision is crucial. 3D display technique (3D) and 2D-4K technique (4K) are designed to facilitate surgical performance, either due to spatial resolution (3D) or due to very high resolution (4K). METHODS In randomized cross-over trial the surgical performance of medical students (MS), non-board certified surgeons (NBC), and board certified surgeons (BC) was compared using 3D versus 4K display technique at a minimally invasive training Parkour. RESULTS One hundred twenty-eight participants were included (February 2018 through October 2019, 49 MS, 39 NBC, 40 BC). The overall Parkour time (s) 3D versus 4K was 712.5 s ± 17.5 s versus 999.5 s ± 25.1 s (P < 0.001) for all levels of experience. It was (3D vs 4K) for MS (30 tasks) 555.4 s ± 28.9 s versus 858.7 s ± 41.6 s, (P < 0.0001), for NBC (42 tasks) 935.9 s ± 31.5 s versus 1274.1 s ± 45.1 s (P =< 0.001) and for BC (42 task) 646.3 s ± 30.9 s versus 865.7 s ± 43.7 s (P < 0.001). The overall number of mistakes was (3D vs 4K) 10.0 ± 0.5 versus 13.3 ± 0.7 (P < 0.001), for MS 8.9 ± 0.9 versus 13.1 ± 1.1 (P < 0.001), for NBC 12.45 ± 1.0 versus 16.7 ± 1.2 (P < 0.001) and for BC 8.8 ± 1.0 versus 10.0 ± 1.2 (P = 0.18). MS, BC, and NBC showed shorter performance time in 100% of the task with 3D (significantly in 6/7 tasks). For number of mistakes the effect was less pronounced for more experienced surgeons. The National Aeronautics and Space Administration-task load index was lower with 3D. CONCLUSION 3D laparoscopic display technique optimizes surgical performance compared to the 4K technique. Surgeons benefit from the improved visualization regardless of their individual surgical expertise.

Die Pr��valenz der Myopie hat in den letzten Jahrzehnten auch in Europa zugenommen und erreicht in der Altersgruppe der 25- bis 29-J��hrigen ein Niveau von 45���50%. Die sogenannte ���Schulmyopie��� schreitet in der Regel am schnellsten im Alter von 7���12 Jahren voran [zum vollst��ndigen Text gelangen Sie ��ber die oben angegebene URL]

Der Begriff „Nanophthalmus“ bezeichnet einen klinisch kleinen Bulbus, der strukturell normal erscheint. Ein Nanophthalmus geht einher mit einer Hyperopie, kann aber auch mit diversen sekundaren Pathologien assoziiert sein, wie z. B. einem Engwinkelglaukom. Insbesondere die mit einem nanophthalmischen Auge verbundenen perioperativen Risiken erfordern die Auseinandersetzung mit dessen anatomischen Besonderheiten, die sich – trotz struktureller Normalitat – durch das Missverhaltnis der intraokularen Proportionen der verschiedenen intraokularen Gewebsstrukturen ergeben konnen. Hierzu gehoren eine geringe Vorderkammertiefe, eine Skleraverdickung und eine Anomalie der Venenplexus, die zur Ausbildung von Winkelblockglaukomen disponieren. Der daraus resultierenden therapeutischen Herausforderung kann man im nanophthalmischen Auge mit der Iridektomie, der Lentektomie, der Vitrektomie und der Zyklophotokoagulation begegnen. Im Folgenden wird auf die Definition, die Genetik und die klinischen Befunde des Nanophthalmus eingegangen mit dem Schwerpunkt der Komplikation des Glaukoms und dessen Therapie.

Infantile nystagmus syndrome (INS) denominates early-onset, involuntary oscillatory eye movements with different etiologies. Nystagmus is also one of the symptoms in oculocutaneus albinism (OCA), a heterogeneous disease mainly caused by defects in melanin synthesis or melanosome biogenesis. Dopachrome tautomerase (DCT, also called TYRP2) together with tyrosinase (TYR) and tyrosin-related protein 1 (TYRP1) is one of the key enzymes in melanin synthesis. Although DCT´s role in pigmentation has been proven in different species, until now only mutations in TYR and TYRP1 have been found in patients with OCA. Detailed ophthalmological and orthoptic investigations identified a consanguineous family with two individuals with isolated infantile nystagmus and one family member with subtle signs of albinism. By whole-exome sequencing and segregation analysis, we identified the missense mutation c.176G T (p.Gly59Val) in DCT in a homozygous state in all three affected family members. We show that this mutation results in incomplete protein maturation and targeting in vitro compatible with a partial or total loss of function. Subsequent screening of a cohort of patients with OCA (n = 85) and INS (n = 25) revealed two heterozygous truncating mutations, namely c.876C A (p.Tyr292*) and c.1407G A (p.Trp469*), in an independent patient with OCA. Taken together, our data suggest that mutations in DCT can cause a phenotypic spectrum ranging from isolated infantile nystagmus to oculocutaneous albinism.

Background The use of 3D technique compared to high-resolution 2D-4K-display technique has been shown to optimize spatial orientation and surgical performance in laparoscopic surgery. Since women make up an increasing amount of medical students and surgeons, this study was designed to investigate whether one gender has a greater benefit from using a 3D compared to a 4K-display system. Methods In a randomized cross-over trial, the surgical performance of male and female medical students (MS), non-board certified surgeons (NBCS), and board certified surgeons (BCS) was compared using 3D- vs. 4K-display technique at a minimally invasive training parkour with multiple surgical tasks and repetitions. Results 128 participants (56 women, 72 men) were included. Overall parkour time in seconds was 3D vs. 4K for all women 770.7 ± 31.9 vs. 1068.1 ± 50.0 (p p p = 0.005) for all women and 9.6 ± 0.7 vs. 12.2 ± 1.0 (p = 0.001) for all men. The benefit of using a 3D system, measured by the difference in seconds, was for women 297.3 ± 41.8 (27.84%) vs. 225.2 ± 23.3 (25.31%) for men (p = 0.005). This can be confirmed in the MS group with 327.6 ± 65.5 (35.82%) vs. 249.8 ± 33.7 (32.12%), p = 0.041 and in the NBCS group 359 ± 52.4 (28.25%) vs. 198.2 ± 54.2 (18.62%), p = 0.003. There was no significant difference in the BCS group. Conclusion 3D laparoscopic display technique optimizes surgical performance compared to the 2D-4K technique for both women and men. The greatest 3D benefit was found for women with less surgical experience. As a possible result of surgical education, this gender specific difference disappears with higher grade of experience. Using a 3D-vision system could facilitate surgical apprenticeship, especially for women.

To provide an overview of the differential diagnoses of acquired esotropia that occur in the elderly and to facilitate their differentiation in everyday clinical practice.The data of all patients who presented in our outpatient university department for strabology and neuroophthalmology from March 2014 to October 2015 due to esotropia with diplopia with onset after age 50 were evaluated retrospectively. Exclusion criteria were a known strabismus before the age of 50 and/or vertical deviations in the primary position. Anamnestic characteristics, accompanying findings and orthoptic parameters, were analysed.85 patients were included in the study, 42 of them female and 43 male. The following diagnoses were made: abducens nerve palsy (n = 34, 3 of them both sides), esotropia due to myopia magna (n = 12), esotropia with accompanying neurological symptoms (n = 6) and other etiology (n = 5). In 4 cases, the diagnosis was still unclear at the end of the study. In 24 patients, none of the above diagnoses existed and the diagnosis of "sagging eye syndrome" (ETSAG) was made. The abducens nerve palsy typically showed a sudden onset of double vision, slowed abduction saccades and asymmetrical abduction ability. With unilateral abducens nerve palsy, the esotropia increased continuously from the view to the unaffected side through the primary position to the view to the affected side. Patients with ETSAG and myopia-associated esotropia, on the other hand, reported a gradual onset of double vision, showed normal abduction saccades and a slightly reduced abduction ability. The squint angle often increased slightly to both sides. Esotropia with accompanying neurological symptoms was rare and was seen in various underlying diseases.The kind of onset of the double vision, the quality of the saccades, the incomitance pattern and the ability to abduct are important parameters for the etiological assignment of an esotropia in the elderly. The characteristics of the individual diagnoses are described and differential diagnostic aspects are discussed.Diese Studie soll einen Überblick über die im Alter auftretenden Formen der Esotropie geben und deren Differenzierbarkeit im klinischen Alltag erleichtern.Die Daten aller Patienten, die sich von März 2014 bis Oktober 2015 aufgrund einer im Alter von über 50 Jahren neu aufgetretenen Esotropie mit Diplopie in der Ambulanz unseres universitären Schwerpunkts für Strabologie und Neuroophthalmologie vorstellten, wurden retrospektiv ausgewertet. Ausschlusskriterien waren eine bekannte, vor dem 50. Lebensjahr bestehende Schielerkrankung und/oder Vertikalabweichungen in Primärposition. Analysiert wurden anamnestische Charakteristika, Begleitbefunde und orthoptische Parameter.85 Patienten konnten in die Studie eingeschlossen werden, davon 42 weiblich, 43 männlich. Folgende Diagnosen wurden gestellt: Abduzensparese (n = 34, davon 3 beidseits), Esotropie bei Myopia magna (n = 12), Esotropien mit neurologischer Begleitsymptomatik (n = 6), andere Genese (n = 5). In 4 Fällen war die Diagnose zum Ende der Studie noch unklar. Bei 24 Patienten bestand keine der o. g. Diagnosen, es wurde die Diagnose Esotropie im Senium im Sinne eines Sagging-Eye-Syndroms (ETSAG) gestellt. Die Abduzensparesen zeigten typischerweise einen plötzlichen Doppelbildbeginn, verlangsamte Abduktionssakkaden und asymmetrische Abduktionsfähigkeit. Bei einseitigen Abduzensparesen vergrößerte sich die Esotropie kontinuierlich vom Blick zur nicht betroffenen Seite über Primärposition bis zum Blick zur betroffenen Seite. Patienten mit ETSAG und myopieassoziierter Esotropie gaben hingegen einen schleichenden Doppelbildbeginn an, zeigten normale Abduktionssakkaden und eine symmetrisch leicht verminderte Abduktionsfähigkeit. Der Schielwinkel nahm häufig zu beiden Seiten hin geringfügig zu. Eine Esotropie mit neurologischer Begleitsymptomatik war selten und zeigte sich bei unterschiedlichen Grunderkrankungen.Die Art des Doppelbildbeginns, die Qualität der Sakkaden, das Inkomitanzverhalten sowie die Abduktionsfähigkeit sind wegweisende Parameter für die ätiologische Zuordnung einer im Alter aufgetretenen Esotropie. Die Charakteristika der einzelnen Diagnosen werden beschrieben und differenzialdiagnostische Gesichtspunkte diskutiert.

Zusammenfassung Hintergrund Wir berichten über Ergebnisse einer modifizierten Muskeltransposition nach dem Hummelsheim-Prinzip mit und ohne einzeitige M.-rectus-internus-Rücklagerung bei unilateralen Abduzensparesen/-paralysen. Der Einfluss von Paresedauer, Schielwinkelgröße und präoperativer Abduktionsfähigkeit auf die Auswahl und Effektivität der Verfahren wird untersucht. Patienten und Methoden Retrospektiv wurden die Daten von 29 konsekutiven Patienten mit unilateraler Abduzensparese/-paralyse ausgewertet, bei denen im Zeitraum von 2001 – 2012 zur Korrektur des Schielwinkels erstmals eine modifizierte Muskeltransposition nach dem Hummelsheim-Prinzip (HUM: n = 21) oder diese Operation kombiniert mit einer zeitgleichen M.-rectus-internus-Rücklagerung (HUM+I: n = 8) durchgeführt wurde. Die Operationen fanden frühestens 9 Monate nach Paresebeginn statt (HUM: von 9 – 98, Median 19, Mittelwert [MW] 30 Monate; HUM+I: von 12 – 65, Median 25, MW 29 Monate). Ergebnisse Präoperativ betrug der Schielwinkel (Ferne) im Median für die HUM-Gruppe 27,0° (von 20,0 – 45,0; MW 28,1°), für die HUM+I-Gruppe 30,5° (von 21,8 – 50,0; MW 33,4°). Die mediane präoperative Abduktion betrug in der HUM-Gruppe − 1,6 mm vor Mittellinie (von − 8,0 bis + 1,2; MW − 1,8 mm), in der HUM+I-Gruppe − 3,0 mm vor Mittellinie (von − 10,0 bis − 1,0; MW − 4,1 mm). Postoperativ betrug der Schielwinkel (Fernblick) im Median für die HUM-Gruppe 0° (von − 11,3 bis + 20,0; MW 0,1°), für die HUM+I-Gruppe − 2,3° (von − 11,3 bis + 12,0; MW − 2,1°). Die mediane postoperative Abduktion betrug in der HUM-Gruppe 1,0 mm (von 0 bis + 3,0; MW + 1,1 mm), in der HUM+I-Gruppe 1,1 mm (von − 1,2 bis + 3,0; MW + 0,9 mm). Der Effekt der Schielwinkelveränderung war in der HUM-Gruppe im Median 27,0° (von 9,1 – 45,0; MW 28,0°), in der HUM+I-Gruppe 36,8° (von 25,2 – 41,4; MW 35,5°). Die Abduktion verbesserte sich im Median in der HUM-Gruppe um 2,5 mm (von 0 – 11,0; MW + 2,9 mm), in der HUM+I-Gruppe um 4,6 mm (von 2,4 – 8,8; MW + 5,0 mm). Die Effektstärke fiel in der HUM-Gruppe in Abhängigkeit von der Paresedauer ab, während in der HUM+I-Gruppe eine Zunahme der Effektstärke mit längerer Paresedauer zu verzeichnen war. Schlussfolgerung Bei unilateralen Abduzensparalysen steigert die einzeitige M.-rectus-internus-Rücklagerung den Effekt einer Operation nach dem Hummelsheim-Prinzip. Die Paresedauer ist ein relevanter Parameter zur Auswahl eines isolierten oder mit M.-rectus-internus-Rücklagerung kombinierten Eingriffs.

ZusammenfassungIn der Therapie komplizierter Netzhautablösungen kommt dem Silikonöl als intraokularer Tamponade eine wichtige Funktion zu. Es ist durch seine Langzeitwirkung in der Lage, die Wiederanlagerate der Retina nach deren Ablösung zu erhöhen und damit die Visusprognose zu verbessern. Abweichend von diesen Erwartungen werden in den letzten Jahren Fälle von Visusminderungen nach Silikonölchirurgie beobachtet, die irreversibel verlaufen und deren Genese unklar bleibt. Diese Arbeit bezweckt, einen Überblick über die Erkenntnisse, die bisher zu diesem Phänomen existieren, zu geben. Die Hinweise auf solche unglücklichen Verläufe mehren sich derart, dass die Retinologische Gesellschaft mit der Unterstützung des Retinanet (http://retina-net.uni-koeln.de) eine laufende Datensammlung realisiert hat in Zusammenarbeit mit der Augenklinik der Uniklinik Köln. Klinische Daten zu Patienten sollen gesammelt werden, um die Verläufe besser charakterisieren zu können und mögliche Ursachen zu finden. Behandelnde Augenärzte können Fälle unklarer Visusminderungen nach Silikonölchirurgie anonym melden. Eine Kontaktaufnahme hierfür ist über das Zentrum für Klinische Studien der Uniklinik Köln oder über die E-Mail-Adresse augenklinik-silikonoel@uk-koeln.de möglich.

Background Three-dimensional (3D) stereoscopic vision is crucial to perform any kind of manual task. The reduction from real life 3D to virtual two-dimensional (2D) sight is a major challenge in minimally invasive surgery (MIS). A 3D display technique has been shown to reduce operation time and mistakes and to improve the learning curve. Therefore, the use of a3D display technique seems to optimize surgical performance for novice and experienced surgeons. Inspired by consumer electronics, a 4K display technique was recently introduced to MIS. Due to its high resolution and zoom effect, surgeons should benefit from it. The aim of this study is to evaluate if “state-of-the-art” 3D- vs. 4K-display techniques could influence surgical performance. Methods A randomized, cross-over, single-institution, single-blinded trial is designed. It compares the primary outcome parameter “surgical performance”, represented by “performance time ”and “number of mistakes”, using a passive polarizing 3D and a 4K display system (two arms) to perform different tasks in a minimally invasive/laparoscopic training parkour. Secondary outcome parameters are the mental stress load (National Aeronautics and Space Administration (NASA) Task Load Index) and the learning curve. Unexperienced novices (medical students), non-board-certified, and board-certified abdominal surgeons participate in the trial (i.e., level of experience, 3 strata). The parkour consists of seven tasks (for novices, five tasks), which will be repeated three times. The 1st run of the parkour will be performed with the randomized display system, the 2nd run with the other one. After each run, the mental stress load is measured. After completion of the parkour, all participants are evaluated by an ophthalmologist for visual acuity and stereoscopic vision with five tests. Assuming a correlation of 0.5 between measurements per subject, a sample size of 36 per stratum is required to detect a standardized effect of 0.5 (including an additional 5% for a non-parametric approach) with a power of 80% at a two-sided type I error of 5%. Thus, altogether 108 subjects need to be enrolled. Discussion Complex surgical procedures are performed in a minimally invasive/laparoscopic technique. This study should provide some evidence to decide which display technique a surgeon could choose to optimize his performance. Trial registration ClinicalTrials.gov, NCT03445429. Registered on 7 February 2018.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)

The term nanophthalmos refers to a clinically small eye that appears morphologically normal. A nanophthalmos is characterized by hyperopia but can also be associated with various secondary pathologies, such as angle-closure glaucoma. In particular, the perioperative risks associated with a nanophthalmic eye necessitate examination of the anatomical characteristics, which can result from the disproportional size of intraocular tissues despite structural normality. These include a small anterior chamber depth, scleral thickening and anomalies of the vein plexus, which are predisposing factors for the formation of angle-closure glaucoma. The resulting therapeutic challenges in the nanophthalmic eye can be countered with iridectomy, lensectomy, vitrectomy and cyclophotocoagulation. The definition, genetics and clinical findings of nanophthalmos are discussed with a focus on the complication of glaucoma and its treatment.