Search

Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the experience of a group of leading German experts in the field.The current evidence base for the use of rTMS in depression was examined via review of the literature. From the evidence and from clinical experience, recommendations for the use of rTMS in clinical practice were derived. All members of the of the German Society for Brain Stimulation in Psychiatry and all members of the sections Clinical Brain Stimulation and Experimental Brain Stimulation of the German Society for Psychiatry, Psychotherapy, Psychosomatics and Mental Health were invited to participate in a poll on whether they consent with the recommendations.Among rTMS experts, a high consensus rate could be identified for clinical practice concerning the setting and the technical parameters of rTMS treatment in depression, indications and contra-indications, the relation of rTMS to other antidepressive treatment modalities and the frequency and management of side effects.

Background/aimsThe prospective, non-interventional ORCA module of the OCEAN study (Observation of Treatment Patterns with Lucentis in Approved Indications) evaluated the qualiy of spectral domain-optical coherence tomography (SD-OCT) image interpretation and treatment decisions by clinicians in Germany and the impact on visual outcomes over 24 months in patients with neovascular age-related macular degeneration (nAMD).Methods2286 SD-OCT scans of 205 eyes were independently evaluated by clinicians and reading centres (RCs) regarding signs of choroidal neovascularisation (CNV) activity, including presence of intraretinal fluid, subretinal fluid, and/or increase in pigment epithelial detachments. Agreement between clinicians and RCs was calculated. Treatment decisions by clinicians and the impact on treatment outcomes were evaluated.ResultsCNV activity was detected by RCs on 1578 scans (69.0%) and by clinicians on 1392 scans (60.9%), with agreement in 74.9% of cases. Of the 1578 scans with RC detected CNV activity, anti-vascular endothelial growth factor injections were performed by clinicians in only 35.5% (560/1578). In 19.7% of cases (311/1578), lack of treatment was justified by patients request, termination criteria or chronic cystoid spaces without other signs for CNV activity. In 44.8% of cases (707/1578) with RC detected CNV activity, clinicians claimed no treatment was necessary despite having correctly detected CNV activity in about 2/3 of these cases. In 34% of cases with presumed undertreatment, visual acuity declined in the following visit.ConclusionAlthough broad agreement on CNV activity parameters was observed between clinicians and RCs, correct identification of CNV activity did not always lead to the initiation of (re-)treatment. To preserve vision over time, correct interpretation of SD-OCT scans and careful retreatment decisions are required.Trial registration numberNCT02194803.

Objective of surgery The indications for CyPass trimming are based on the standard protocol for endothelial protection of the Department of Ophthalmology at the Dietrich Bonhoeffer Hospital Neubrandenburg. The CyPass stent should be shortened to a maximum reach up to the scleral spur. Indications The indications for CyPass trimming are based on two main criteria: the position of the CyPass in relation to the structures of the anterior chamber angle and the presence of corneal endothelial cell loss. Contraindications There are no contraindications. Surgical technique The operation shown in the video available online is performed with the patient under local anesthesia. The incisions are created individually and depend on the position of the CyPass stent. Through a 1.2 mm corneal paracentesis opposite to the stent, the anterior chamber is filled with a cohesive viscoelastic material and the stent is stabilized with a 20-gauge vitreous forceps and then cut with 20-gauge bent vitreous scissors through another 1.4-1.8 mm paracentesis, 3-4 h away from the stent visualized by gonioscopy. In some cases, surgical goniosynechiolysis in the area of the stent is required. The anterior end of the stent is cut as deep as possible. After aspiration of the viscoelastic material and possibly blood, the anterior chamber is toned with balanced salt solution (BSS) and the paracenteses are hydrated. Corneal suturing is not necessary. Results Up to November 2019 65 CyPass stents in 64 eyes have been trimmed using this method. Iridodialysis occurred in 1 eye, in 12 eyes slight self-limiting bleeding and in 2 eyes an iris defect. Conclusion The procedure shown enables a safe microsurgical shortening of the CyPass stent with few complications. The risk of intraoperative expulsive bleeding or postoperative fistulation is markedly reduced.

Purpose: Monochromatic blue-light fundus autofluorescence has proven to be particularly useful for the detection of optic disc drusen (ODD). The aim of this study was to investigate how accurately novel confocal scanners can detect ODD by means of color fundus and autofluorescence images. Methods: Images were taken in 20 consecutive patients’ eyes with funduscopically visible ODD using the TrueColor Eidon AF (60 × 55°) and the spectral domain Spectralis HRA+OCT (30 × 30°). The features of ODD, including localization, extent, and intensity patterns of autofluorescence were compared and correlated with retinal nerve fiber layer (RNFL) thickness in OCT and perimetry findings. Results: Mean patient age was 46 ± 6 years (6 females, 4 males). The TrueColor Eidon AF enabled accurate localization and extent estimation of the drusen area. Drusen presented as a homogeneous signal. The predilection site of ODD, which was nasally pronounced in >80% of cases, was associated with thinning of the RNFL and corresponding visual field defects. Conclusion: The TrueColor Eidon AF allows reliable detection of superficial ODD in nondilated eyes. Extended observational studies are needed to determine the value of this noninvasive, nonmydriatic procedure in terms of follow-up and progression analyses of ODD.

We surveyed 33 symptomatic faba bean sites in central Germany towards the end of the growing season 2016 to analyse the suspected virus spectrum. All sites displayed plants with characteristic symptoms and had distinct funnel-shaped patches with a severely affected centre. The central core consisted of stunted, prematurely senescent plants. Symptomatic foci were scattered at random over a largely symptomless field. At two exemplary investigation sites we combined ground based yield assessments with remote sensing techniques to describe disease-loss relationships. Based on low altitude true-colour aerial imaging data, symptomatic patches were categorised into: (i) severely affected blackish core region, (ii) yellowish symptomatic periphery, and (iii) a corresponding non-symptomatic reference patch. Serological tests revealed PNYDV (Pea necrotic yellow dwarf virus) together with PEMV (Pea enation mosaic virus) as dominant and equally abundant viruses. However, because PNYDV was significantly more restricted to the focal core than PEMV, we perceived PNYDV to be the causal agent for this apparently new symptom pattern in faba bean. As both viruses are vectored persistently by leguminous aphids, the observed symptom gradient within individual foci mirrored the epidemiological development over time, starting from an initial infection point and expanding towards the periphery via secondary virus spread to successively maturing and less susceptible plants. For each investigation site the segmented symptomatic surface of category (i) was 0.8 and 0.4%, for (ii) 20.5 and 6.4%, respectively. Combining the relative yield level for each symptom category with its respective surface, the overall yield gap at the field scale was extrapolated to 4.1 and 9.2% for grain yield and for 3.9 and 1.2% for crude protein. In the symptomatic core category, TKWs (thousand kernel weights) were halved due to enhanced proportions of shriveled grain. Because PNYDV-related yield decline was determined by the number, relative surface and disease intensity of individual foci, remote sensing techniques can offer valuable options for monitoring, loss assessment and agricultural decision-making.

Das ORCA-Modul der nichtinterventionellen OCEAN-Studie untersucht den Einsatz der bildgebenden Diagnostik in der klinischen Versorgung bei Patienten unter VEGF(„vascular endothelial growth factor“)-Hemmer-Behandlung. In der vorliegenden Arbeit werden zum Zeitpunkt der Basisvisite die Ubereinstimmung zwischen der dokumentierten Diagnose des Behandlers und der Auswertung durch Reading Center sowie Effekte auf den weiteren Verlauf analysiert. Insgesamt wurden 396 Patienten (Alter 75,4 Jahre) eingeschlossen, bei denen die Indikation zur Ranibizumab-Therapie aufgrund eines diabetischen Makulaodems (DMO), einer neovaskularen altersabhangigen Makuladegeneration (nvAMD) oder eines retinalen Venenverschlusses (RVV) durch die Behandler gestellt wurde. Uber 24 Monate erfolgte die systematische Erfassung von Patienten- und Untersuchungsdaten, Behandlungen sowie der Befundung bildgebender Diagnostik durch den Behandler. Zusatzlich erfolgte die Auswertung der Netzhautbildgebung durch 3 Reading Center. Bei 338 von 396 (85,4 %) Studienaugen wurde die Diagnose des Behandlers bei Therapiebeginn von den Reading Centern bestatigt (DMO 87,5 %, nvAMD 82,3 %, RVV 94,9 %). Bei 17 von 58 Augen mit diskrepanter Diagnose bestand zumindest Konsensus hinsichtlich der Indikation zur VEGF-Hemmer-Therapie. Insgesamt umfassten die ermittelten Differenzialdiagnosen eine Vielzahl von unterschiedlichen Netzhauterkrankungen. Augen mit ubereinstimmender Diagnose zeigten im Verlauf von bis zu 3 Monaten einen deutlicheren Visusanstieg (6,4 vs. 2,7 Buchstaben, p = 0,05) und einen starkerer Ruckgang der zentralen Netzhautdicke (−112,3 vs. −24,4 µm, p

Background A major limitation of circulating tumor DNA (ctDNA) for somatic mutation detection has been the low level of ctDNA found in a subset of cancer patients. We investigated whether using a combined isolation of exosomal RNA (exoRNA) and cell-free DNA (cfDNA) could improve blood-based liquid biopsy for EGFR mutation detection in non-small-cell lung cancer (NSCLC) patients. Patients and methods Matched pretreatment tumor and plasma were collected from 84 patients enrolled in TIGER-X (NCT01526928), a phase 1/2 study of rociletinib in mutant EGFR NSCLC patients. The combined isolated exoRNA and cfDNA (exoNA) was analyzed blinded for mutations using a targeted next-generation sequencing panel (EXO1000) and compared with existing data from the same samples using analysis of ctDNA by BEAMing. Results For exoNA, the sensitivity was 98% for detection of activating EGFR mutations and 90% for EGFR T790M. The corresponding sensitivities for ctDNA by BEAMing were 82% for activating mutations and 84% for T790M. In a subgroup of patients with intrathoracic metastatic disease (M0/M1a; n = 21), the sensitivity increased from 26% to 74% for activating mutations (P = 0.003) and from 19% to 31% for T790M (P = 0.5) when using exoNA for detection. Conclusions Combining exoRNA and ctDNA increased the sensitivity for EGFR mutation detection in plasma, with the largest improvement seen in the subgroup of M0/M1a disease patients known to have low levels of ctDNA and poses challenges for mutation detection on ctDNA alone. Clinical Trials NCT01526928

Background/AimsTo analyse the retest reliability of visual field indices and to describe patterns of visual field deficits in mesopic and dark-adapted two-colour fundus-controlled perimetry (FCP) in macular diseases.MethodsSeventy-seven eyes (30 eyes with macular diseases and 47 normal eyes) underwent duplicate mesopic and dark-adapted two-colour FCP (Scotopic Macular Integrity Assessment, CenterVue). Non-weighted (mean defect, loss variance), variability-weighted (mean deviation, pattern standard deviation (PSD)) and graphical (cumulative defect (Bebie) curves) indices were computed. Reproducibility (coefficient of repeatability, CoR) of these indices was assessed. Cluster analysis was carried out to identify patterns of visual field deficits.ResultsThe intrasession reproducibility was lower for the mean defect as compared with the mean deviation (CoR (dB) 2.67 vs 2.57 for mesopic, 1.71 vs 1.45 for dark-adapted cyan, 1.94 vs 1.87 for dark-adapted red testing) and lower for the square-root loss variance as compared with the PSD (CoR (dB) 1.48 vs 1.34, 0.77 vs 0.65, 1.23 vs 1.03). Hierarchical cluster analysis of the indices disclosed six patterns of visual field deficits (approximately unbiased P value>0.95) with varying degrees of global versus focal defect and rod versus cone dysfunction. These were also reflected by the cumulative defect curves.ConclusionFCP with mesopic and dark-adapted two-colour testing allows for reproducible assessment of different types of retinal sensitivity, whereby mean deviation and PSD exhibited the better retest reliability of the tested indices. Distinct patterns of retinal dysfunction can be identified using this setup, reflecting variable degrees of rod and cone dysfunction in different macular diseases. Dark-adapted two-colour FCP provides additional diagnostic information and allows for refined structure–function correlation in macular diseases.

Purpose To compare two generations of Heidelberg SPECTRALIS optical coherence tomography (OCT) technologies (SPECTRALIS OCT1 and OCT2) with regard to time efficiency and image quality of retinal nerve fiber layer (RNFL) thickness and Bruch's membrane opening (BMO) analysis in individuals with glaucoma. Materials and methods In this single center, prospective cohort study, 35 consecutive glaucoma patients (70 eyes) were included. RNFL thickness and BMO-MRW analysis was performed in all patients using the Heidelberg SPECTRALIS OCT1 and the Heidelberg SPECTRALIS OCT2 module. Each patient was imaged three times both with the SPECTRALIS-OCT1 and the SPECTRALIS-OCT2 device. All scans were assessed for further analyzability. Acquisition duration, signal-to-noise ratio (SNR), and the displacement between the initially localized and the redetermined BMO center were extracted from the measurement protocols and statistically compared. Results Mean (cumulative) scan acquisition duration was significantly higher with OCT1 compared with OCT2 (54.80 ± 18.61 seconds vs 20.40 ± 6.61 seconds; p < 0.01). Patient-related comparison showed a lower scan duration with the OCT2 device in all 35 patients. Mean SNR of the OCT1 images was 29.9 dB and 32.3 dB for the OCT2 images. The difference of −2.4 (95% CI: −3.1 to 2) was highly significant (p < 0.001). Mean displacement of the OCT1 images was 42.9 μm and 40.2 μm for the OCT2 images (95% CI: −4.710; p = 0.479). Conclusion With SPECTRALIS OCT2, acquisition time of BMO and RNFL scans is less than half of the acquisition time of SPECTRALIS OCT1. Image quality of OCT2 module is at least equivalent to the image quality of OCT1. How to cite this article Bosche F, Andresen J, et al. Spectralis OCT1 versus OCT2: Time Efficiency and Image Quality of Retinal Nerve Fiber Layer Thickness and Bruch's Membrane Opening Analysis for Glaucoma Patients. J Curr Glaucoma Pract 2019;13(1):16–20.

Die optische Koharenztomographie (OCT) hat im Management von Patienten mit Makula- und Netzhauterkrankungen mittlerweile einen wichtigen Stellenwert eingenommen. Neben vielen Vorteilen dieses nichtinvasiven bildgebenden Verfahrens sind in der zunehmend breiten Anwendung auch Limitationen und Fallstricke zu beachten. Im vorliegenden Beitrag werden mogliche Fehlerquellen in der Durchfuhrung und Interpretation von OCT-Aufnahmen diskutiert. Damit soll ein Beitrag zu einem zielgerichteten und sinnvollen Einsatz im klinischen Alltag geleistet werden.

Bound nuclear systems with two units of strangeness are still poorly known despite their importance for many strong interaction phenomena. Stored antiprotons beams in the GeV range represent an unparalleled factory for various hyperon-antihyperon pairs. Their outstanding large production probability in antiproton collisions will open the floodgates for a series of new studies of systems which contain two or even more units of strangeness at the PANDA experiment at FAIR. For the first time, high resolution gamma-spectroscopy of doubly strange Lambda Lambda-hypernuclei will be performed, thus complementing measurements of ground state decays of Lambda Lambda-hypernuclei at J-PARC or possible decays of particle unstable hypernuclei in heavy ion reactions. High resolution spectroscopy of multistrange Xi(-) -atoms will be feasible and even the production of Omega(-) -atoms will be within reach. The latter might open the door to the vertical bar S vertical bar = 3 world in strangeness nuclear physics, by the study of the hadronic Omega(-) -nucleus interaction. For the first time it will be possible to study the behavior of Xi(+) in nuclear systems under well controlled conditions. (C) 2016 Elsevier B.V. All rights reserved.

Durch rezente technologische Weiterentwicklungen ist es gelungen, die hochauflosende SD-OCT-Bildgebung in den Strahlengang von Operationsmikroskopen zu integrieren. In einem Uberblick werden mogliche Anwendungsbereiche der sog. iOCT („intraoperative optical coherence tomography“) im Rahmen von netzhaut-, glaukom- und hornhautchirurgischen Eingriffen dargestellt. Die Visualisierung mittels SD-OCT kann bei bestimmten Eingriffen die Sicherheit und Qualitat der Operation potentiell verbessern sowie zur operativen Ausbildung beitragen. Bei der Makulachirurgie, Trabekulektomien und lamellierenden Hornhauttransplantationsverfahren kann durch Darstellung von aufgrund Transparenz kaum sichtbarer Strukturen ein Vorteil erzielt werden. Weitere systematische Evaluationen im operativen Einsatz sind erforderlich, um sinnvolle Einsatzbereiche der iOCT naher zu prazisieren.

The ORCA module of the non-interventional OCEAN study investigated the use of retinal imaging diagnostics in the clinical treatment of patients undergoing vascular endothelial growth factor (VEGF) inhibitor treatment as part of routine clinical care. This article analyzes the agreement between the diagnosis documented by the treating ophthalmologist and the evaluation of reading centers at baseline as well as the effect on the response to treatment during the course.A total of 396 patients (age 75.4 years) were enrolled in which ranibizumab treatment was indicated by the treating ophthalmologist due to either diabetic macular edema (DME), neovascular age-related macular degeneration (nvAMD) or retinal venous occlusion (RVO). Over a period of 24 months, patient and examination data, treatments and interpretation of retinal imaging data by the treating ophthalmologist were systematically recorded. Furthermore, retinal imaging data were also evaluated by three reading centers.In 338 out of 396 (85.4%) study eyes, the baseline diagnosis of the treating ophthalmologist was confirmed by the reading centers (DME 87.5%, nvAMD 82.3%, RVO 94.9%). In 17 of the remaining 58 eyes with a discrepant diagnosis, there was at least a consensus with respect to the indications for VEGF inhibitor therapy. The differential diagnoses included a variety of different retinal diseases. During follow-up of up to 3 months, eyes with a consistent diagnosis showed a clear increase in visual acuity (6.4 versus 2.7 letters, p = 0.05) and greater decrease in central retinal thickness (-112.3 versus -24.4 μm, p 0.0001).The initial treatment decision for anti-VEGF therapy with consideration of the differential diagnoses can be challenging. Accurate evaluation of the clinical and imaging findings along with appropriate expertise appear to be important. The observation of superior initial response in eyes with a consensus of the diagnosis at baseline underlines the relevance of an adequate initial assessment for a successful treatment outcome.

Zusammenfassung: Hintergrund: Wir haben gezeigt, dass die makuläre Pigmentdichte (MPD) mit einem modifizierten konfokalen Scanning-Laser-Ophthalmoskop (HRA, Fa. Heidelberg Engineering, Heidelberg, Deutschland) bestimmt werden kann. In dieser Studie untersuchten wir, ob Schwankungen der MPD bei gesunden Probanden im Verlauf eines Jahres auftraten und ob die MPD von wechselnden Ernährungsgewohnheiten abhängig ist. Methode: Die MPD wurde mithilfe von Autofluoreszenzbildern, die mit einem HRA aufgenommen wurden, dargestellt und in einem auf die Fovea zentrierten Messfeld von 2° Durchmesser bei den Probanden im Abstand von 2Monaten innerhalb eines Jahres bestimmt. Ergebnisse: Wir schlossen 30 gesunde Probanden im Alter von 19-34Jahren (Mittel: 23±2Jahre) in die Studie ein. Die mittlere MPD war an Untersuchungszeitpunkt1 0,215±0,056D.U., bei der 2.Untersuchung 0,235±0,051D.U., bei der 3. 0,218±0,055D.U., an Untersuchungszeitpunkt4 0,228±057D.U., bei der 5.Untersuchung 0,225±0,053D.U. und bei der letzten 0,203±0,050D.U.. Die statistische Analyse zeigte keine signifikanten Unterschiede der MPD im Verlauf eines Jahres. Zusammenfassung: Die Studie zeigt, dass bei jungen und gesunden Probanden die MPD keinen jahreszeitlichen und diätetischen Schwankungen unterliegt

Die Pravalenz von Erblindungen im Sinne des Gesetzes konnte durch die Einfuhrung der intravitrealen Anti-VEGF („vascular endothelial growth factor“)-Therapie reduziert werden. Da die Behandlung bedarfsgesteuert u. a. anhand morphologischer Kriterien erfolgt, kommt der bildgebenden Diagnostik ein besonderer Stellenwert zu. Die nichtinterventionelle OCEAN-Studie untersucht die Behandlung mit Ranibizumab im klinischen Alltag. In einer Subgruppe analysiert das ORCA-Modul die Befundung von Spectral-Domain optischer Koharenztomographie (SD-OCT)-Scans durch die behandelnden Arzte. Uber 24 Monate werden die Daten von Patienten mit exsudativer altersabhangiger Makuladegeneration (AMD), einem Makulaodem durch retinalen Venenverschluss oder Diabetes mellitus erfasst, die intravitreale Injektionen mit Ranibizumab erhalten. Informationen uber Untersuchungen, Visus, Behandlungen sowie bildgebende Verfahren werden anhand eines Fragebogens dokumentiert. Durchgefuhrte SD-OCT-Scans, Fluoreszeinangiographien und Fundusfotografien werden unabhangig voneinander durch den Augenarzt des Studienzentrums sowie durch 3 Reading-Center (CIRCL Koln, GRADE Bonn, M3 Munster) befundet. Die automatische Messung der Netzhautdicke durch die Herstellersoftware wird uberpruft und ggf. manuell korrigiert. Es erfolgt eine qualitative Auswertung im Hinblick auf morphologische Kriterien fur eine (Wieder-)Behandlung. Eine sorgfaltige Beurteilung der SD-OCT-Aufnahmen im Verlauf unter einer Anti-VEGF-Therapie bildet die Grundlage fur eine bestmogliche bedarfsorientierte Behandlung. Die Uberprufung der Befunderhebungsqualitat in der taglichen Praxis kann hierbei mogliche Schwachstellen aufzeigen, gezieltes Training ermoglichen und somit die Behandlung der Patienten optimieren.

Purpose To describe the directional kinetics of the spread of geographic atrophy (GA) spread in eyes with age-related macular degeneration and foveal sparing. Design Prospective, noninterventional natural history study: Fundus Autofluorescence Imaging in Age-Related Macular Degeneration (FAM; clinicaltrials.gov identifier, NCT00393692). Subjects Participants of the FAM study exhibiting foveal sparing of GA. Methods Eyes were examined longitudinally with fundus autofluorescence (FAF; excitation wavelength, 488 nm; emission wavelength, >500 nm) and near infrared (NIR) reflectance imaging (Spectralis HRA+OCT or HRA2; Heidelberg Engineering, Heidelberg, Germany). Areas of foveal sparing and GA were measured by 2 independent readers using a semiautomated software tool that allows for combined NIR reflectance and FAF image grading (RegionFinder; Heidelberg Engineering). A linear mixed effect model was used to model GA kinetics over time. Main Outcome Measure Change of GA lesion size over time (central vs. peripheral progression). Results A total of 47 eyes of 36 patients (mean age, 73.8±7.5 years) met the inclusion criteria. Mean follow-up time was 25.2±16.9 months (range, 5.9–74.6 months). Interreader agreement for measurements of GA and foveal-sparing size were 0.995 and 0.946, respectively. Mean area progression of GA toward the periphery was 2.27±0.22 mm 2 /year and 0.25±0.03 mm 2 /year toward the center. Analysis of square root–transformed data revealed a 2.8-fold faster atrophy progression toward the periphery than toward the fovea. Faster atrophy progression toward the fovea correlated with faster progression toward the periphery in presence of marked interindividual differences. Conclusions The results demonstrate a significantly faster centrifugal than centripetal GA spread in eyes with GA and foveal sparing. Although the underlying pathomechanisms for differential GA progression remain unknown, local factors may be operative that protect the foveal retina–retinal pigment epithelial complex. Quantification of directional spread characteristics and modeling may be useful in the design of interventional clinical trials aiming to prolong foveal survival in eyes with GA.

Smartphone-based fundus photography (SBFP) allows for a cheap and mobile fundus examination with the potential to revolutionize eye care especially in low income settings. The purpose of this study was to assess the impact of pupil dilation on image quality in optic nerve head (ONH) imaging and vertical cup-to-disc ratio (vCDR) evaluation with SBFP. Eyes with glaucoma or suspected to have glaucoma were imaged with conventional digital fundus photography (CFP) and SBFP undilated and following dilation, all monoscopically. SBFP was possible in 74% of eyes without dilation and in 98% following dilation. Better image quality on SBFP was achieved with dilation and complete visualization of the optic disc rim was possible in 46% of images without dilation and on 94% of images with dilation. VCDR measurements on images obtained following dilation highly correlated with measurements on CFP (coefficient of correlation r = 0.91, p

PURPOSE To analyze choroidal thickness (CT) in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). METHODS A total of 72 eyes of 72 patients (mean age, 75.97 ± 7.09 years) with GA and 37 eyes of 37 healthy controls (73.89 ± 6.19 years) were examined by confocal scanning laser ophthalmoscopy and enhanced depth imaging (EDI) spectral-domain optical coherence tomography. Choroidal thickness was measured at 25 defined points in horizontal and vertical scans. Geographic atrophy size was determined in fundus autofluorescence (FAF) images and GA subtypes were classified based on abnormal FAF in the perilesional zone. RESULTS In GA, subfoveal CT (fCT) was significantly thinner compared to controls (173.03 ± 90.22 vs. 253.95 ± 69.19 μm, P < 0.001). Analysis of averaged measurements of all 25 points obtained per patient (mCT) revealed similar results (162.07 ± 76.26 vs. 228.00 ± 66.24 μm, P < 0.001). Spatial differences in CT between both groups were largest superior to the fovea. Addressing "diffuse-trickling" (n = 15) and "non-diffuse-trickling" (n = 57) GA independently, fCT was 114.67 ± 43.32 and 188.39 ± 93.26 μm, respectively (P = 0.002), with both groups being significantly thinner than controls (P < 0.001 for "diffuse-trickling" and P < 0.001 for "?non-diffuse-trickling"). Similar results were obtained for mCT, which was 110.21 ± 29.66 μm in "diffuse-trickling," 175.72 ± 79.02 μm in "?non-diffuse-trickling" and 228.00 ± 66.24 μm in controls. Differences were significant with P = 0.002 between both GA groups and P ≤ 0.001 toward controls for each GA group. CONCLUSIONS The results indicate that the choroid in eyes with GA is thinner compared to normal eyes of similar age. Hereby, the extent of thinning is most pronounced in a specific subtype of GA identified by FAF imaging ("diffuse trickling"). Such GA subtype-related differences in choroidal thickness may reflect heterogeneity in the pathogenesis of disease. (ClinicalTrials.gov number, NCT02051998.).

Purpose: To assess the natural disease progression of high myopia in Caucasians considered at risk for the development of myopic choroidal neovascularization (mCNV). Methods: Subjects were recruited in 25 clinical sites between June 2014 and June 2016. Main inclusion criteria included axial length of ≥26 mm, best-corrected visual acuity ≥0.05 decimal equivalent and presence of at least one out of five predefined morphological disease risk criteria. These were (1) subfoveal choroidal thinning < 50 µm, (2) enhanced choroidal curvature length > 6,300 µm, (3) lacquer cracks, (4) patchy atrophy > 5 mm2 and (5) preexisting mCNV in the fellow eye (German Clinical Trial Register DRKS00007761). Results: A total of 150 participants (66% females) with a mean age of 57.2 (±12.7) years (range 21.9–86.2 years) were included. The disease criteria most frequently encountered were choroidal thinning (33.3%) and lacquer cracks (32.7%). Enhanced choroidal curvature length was detected in only 8 subjects and always occurred in combination with other disease criteria. Presence of patchy atrophy was found to be more common in older subjects (p = 0.0012) and also associated with a more severe disease manifestation. Conclusion: The baseline data of this study indicate that enhanced choroidal curvature might be less common in Caucasians than in Asian populations. Further, disease severity in patients with high myopia is relatively high in the presence of patchy atrophy.

Optical coherence tomography (OCT) imaging now plays an important role in the management of macular and retinal diseases. In addition to the many advantages of this noninvasive imaging modality, limitations and pitfalls should be taken into consideration. The aim of this review is to discuss several possible sources of error in the conduct and interpretation of OCT imaging. Ultimately, this article should add to a meaningful and focused use in clinical practice.

Recent improvements in technology have enabled integration of SD-OCT into the optical path of an operating microscope. Here we present an overview of possible applications of iOCT (intraoperative optical coherence tomography) for retinal, glaucoma and corneal surgery. iOCT-based imaging can not only improve safety and quality of the surgery but also the learning curve of the surgeon. The ability to visualize barely visible or transparent structures with iOCT has achieved a significant added value intraoperatively, particularly in macular surgery, trabeculectomy and lamellar keratoplasty. Further, systematic assessment is warranted to define the usefulness of the iOCT more precisely.

This study aims to evaluate and compare central foveal thickness (CFT) changes after cataract surgery between normal and diabetic patients without retinopathy, using optical coherence tomography (OCT).Ninety-eight patients (49 patients with type 2 diabetes and 49 healthy controls, sex- and age-matched) undergoing phacoemulsification in one eye were included. The presence of retinopathy was an exclusion criterion. The OCT examination was performed preoperatively as well as one, three, six and twelve months postoperatively. CFT was evaluated and compared between groups.Preoperative CFT showed no significant difference between the two groups (normals: 205 ± 18 μm vs. diabetics: 202 ± 23 μm, p0.1). Postoperative CFT in diabetics at all time-points of the follow-up period was significantly increased when compared to controls (first month, normals: 215 ± 28 μm vs. diabetics: 262 ± 33 μm, p0.05; third month, normals: 211 ± 19 μm vs. diabetics: 250 ± 27 μm, p0.05; sixth month, normals: 208 ± 12 μm vs. diabetics: 266 ± 13 μm, p0.05; and twelfth month, normals: 209 ± 13 μm vs. diabetics: 280 ± 11 μm, p0.05). The incidence of cystoid macular edema (CME) was 4.0 % and 28.6 % for the control group and the diabetic group, respectively, at the end of the follow-up period (p0.05).Eyes of diabetic patients without retinopathy present higher CFT and a higher incidence of CME after cataract surgery on OCT examination compared to eyes of healthy controls. This may explain the unsatisfactory visual acuity following cataract surgery in these patients.

Advances in retinal imaging technology have largely contributed to the understanding of the natural history, prognostic markers and disease mechanisms of geographic atrophy (GA) due to age-related macular degeneration. There is still no therapy available to halt or slow the disease process. In order to evaluate potential therapeutic effects in interventional trials, there is a need for precise quantification of the GA progression rate. Fundus autofluorescence imaging allows for accurate identification and segmentation of atrophic areas and currently represents the gold standard for evaluating progressive GA enlargement. By means of high-resolution spectral-domain optical coherence tomography, distinct microstructural alterations related to GA can be visualized.

Background Presentation of the current treatment indications for photodynamic therapy (PDT) with verteporfin in the management of different choroidal diseases. Methods A review is given of the standard treatment protocol, the results of published clinical trials and cohort or case-control studies with two clinical examples. Results Monotherapy with PDT for neovascular age-related macular degeneration is no longer a first-line therapy. The reasoning behind combining PDT with an antiangiogenic treatment with anti-vascular endothelial growth factor is to decrease the number of re-treatments. In other diseases of the choroid, such as circumscribed choroidal hemangioma or central serous chorioretinopathy, use of PDT with verteporfin as a monotherapy may prove to be an effective method to improve or stabilize vision in the majority of patients. Conclusions Verteporfin PDT still represents an effective and safe treatment because of its selectivity to the choroid.

Geographic atrophy (GA) as the late stage manifestation of age-related macular degeneration (AMD) is a progressive disease process afflicting the retinal pigment epithelium, choriocapillaris and the outer neurosensory retina. GA represents a complex, multifactorial disease governed by the interdependence of genetic, endogenous and exogenous factors. Diagnosis and monitoring of GA progression is largely based on various retinal imaging modalities. After the breakthrough in the treatment of wet AMD GA represents a large clinical challenge. Recent studies have contributed to a better understanding of the pathophysiological pathways, natural history and predictive markers for progression.

Hyperon production in the threshold region was studied in the reaction pp → K + Λ p using the time-of-flight spectrometer COSY-TOF. Exclusive data, covering the full phase-space, were taken at the three different beam momenta of p beam = 2.95 , 3.20 and 3.30 GeV/c, corresponding to excess energies of e = 204 , 285 and 316 MeV, respectively. Total cross-sections were deduced for the three beam momenta to be 23.9 ± 0.8 ± 2.0 μb , 28.4 ± 1.3 ± 2.2 μb and 35.0 ± 1.3 ± 3.0 μb . Differential observables including Dalitz plots were obtained. The analysis of the Dalitz plots reveals a strong influence of the N ( 1650 ) -resonance at p beam = 2.95 GeV / c , whereas for the higher momenta an increasing relative contribution of the N ( 1710 ) - and/or of the N ( 1720 ) -resonance was observed. In addition, the pΛ-final-state interaction turned out to have a significant influence on the Dalitz plot distribution.

Background We describe the clinical findings and course of cilioretinal artery occlusion (CAO) combined with central retinal vein occlusion (CRVO) in two patients and present a review of the relevant literature. History and signs Case 1: An otherwise healthy 24-year-old woman presented to the emergency unit with a painless visual decrease in her right eye. Fundus examination revealed retinal edema due to CAO in association with signs of venous stasis. Fluorescein angiography (FA) showed a patent cilioretinal artery. Case 2: A heavy smoker, hypertensive, 59-year-old man was referred for sudden visual loss in his left eye. Fundus examination and FA revealed CAO and CRVO. Therapy and outcome No treatment was applied for the first patient. Two weeks after diagnosis, retinal edema had subsided and only the signs of venous stasis were evident. The central scotoma remained unchanged. In the second patient, within the next three months, the development of retinal ischemia led to retinal neovascularization. Panretinal photocoagulation was applied. Visual acuity remained very low (light perception). Conclusions The combination of CAO and CRVO comprises a discrete clinical entity. In both our cases, FA did not show full obstruction of the cilioretinal artery. Even though many hypotheses have been postulated about this entity, it seems that it ensues from the increased intraluminal pressure in the retinal capillaries (due to the CRVO), which exceeds the pressure in the cilioretinal artery. Thus, it is probably a functional obstruction of the cilioretinal artery, although its pathogenesis remains controversial.

This open-label, prospective, small-scale study investigated the benefits of same-day verteporfin and intravitreal ranibizumab in patients with predominantly classic, minimally classic or occult subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration.Patients received verteporfin at baseline and at month 3, if leakage persisted. Ranibizumab (0.5 mg) was given at baseline and months 1, 2 and 3, and thereafter at monthly intervals if required. Same-day ranibizumab was given ≥ 1 hr after verteporfin.Fifteen patients [11 male, four female; mean age 75.5 years (range 54-94 years)] were treated. At day 360, mean visual acuity (VA) had improved by 10.9 letters. An increase of ≥ 15 and ≥ 30 letters (i.e. ≥ 3 and ≥ 6 lines) was observed in seven (47%) patients and one patient (7%), respectively. Mean central retinal thickness (CRT) decreased by 85 μm. At days 7, 14 and 30, CNV perfusion was absent in 14/15 patients. Mean lesion area had reduced from baseline by 23.1% at day 120, 25.5% at day 180 and 23.6% at day 360. There were no visual safety concerns and intraocular pressures remained normal. Only two serious adverse events were recorded over the 12-month period, and neither was considered to be related to treatment.Same-day verteporfin plus ranibizumab improved VA, reduced CRT, prevented CNV perfusion and reduced lesion area safely over 12 months. Further investigation is warranted to confirm whether this combination improves long-term vision and reduces the need for retreatment.

BACKGROUND: This study presents an evaluation of the preoperative and postoperative best corrected visual acuity (BCVA), as well as of the incidence of perioperative and postoperative complications after opacified hydrogel intraocular lens (IOL) exchange. PATIENTS AND METHODS: We exchanged opacified hydrogel IOLs (Hydroview H 60 M, Bausch ; Lomb) in 55 patients (55 eyes). Preoperative and postoperative BCVA were compared. Intraoperative and postoperative complications were recorded. Follow-up period ranged from 3 months to 24 months. RESULTS: Mean BCVA improved significantly from 0.05 preoperatively to 0.4 at 3 months postoperatively and to 0.2 at the end of the follow-up period. Forty patients (72.7 %) reported visual improvement. The procedure was uneventful in 30 eyes (54.5 %) with complete removal of the opacified IOL optics and haptics. Intraoperative complications included partial zonular dehiscence in 10 eyes (18.2 %), en block capsular bag-IOL extraction in 2 eyes (3.6 %), posterior capsule rupture in 2 eyes (3.6 %), hyphema in 3 eyes (5.5 %), retained haptics in 8 eyes (14.5 %). Postoperative complications included corneal decompensation in 5 eyes (9.1 %), cystoid macular edema in 15 eyes (27.3 %), elevated intraocular pressure in 6 eyes (10.9 %), and retinal detachment in 1 eye (1.8 %). CONCLUSIONS: Visual acuity improved after opacified hydrogel IOL exchange, however, coexistent ocular morbidity as well as the appearance of serious postoperative complications may not yield the expected results. For these reasons extensive informed consent is mandatory.

The prevalence of blindness as defined by law could be reduced by the introduction of anti-vascular endothelial growth factor (VEGF) therapy. Because the treatment is governed by patient needs, mostly using morphological criteria, imaging diagnostics are of particular importance. The non-interventional OCEAN study investigates the treatment with ranibizumab in the clinical routine practice. In a subgroup of patients the interpretation of spectral domain optical coherence tomography (SD-OCT) scans by the treating physicians will be analyzed (ORCA module).Over a period of 24 months data from patients with exudative age-related macular degeneration (AMD), macular edema due to retinal vein occlusion or diabetes mellitus, who are receiving intravitreal injections of ranibizumab, will be assessed. Information on examinations, visual acuity, treatment and recordings from imaging techniques will be documented using a questionnaire. The SD-OCT scans, fluorescence angiography and fundus photography will be independently analyzed by the ophthalmologist of the study center and by three reading centers (CIRCL Cologne, GRADE Bonn and M3 Münster). Automated measurements of retinal thickness by the manufacturers' software will be checked and if necessary manually corrected. A qualitative interpretation in terms of morphological criteria for (further) treatment will be performed.A thorough assessment of SD-OCT images during anti-VEGF therapy provides the basis for the best possible needs-oriented treatment regimen. The control of the quality of data from daily routine practice may indicate possible weaknesses allowing explicit training and therefore optimization of patient treatment.

The latest approach to diagnosing glaucoma by high resolution spectral domain optical coherence tomography (SD-OCT) is to assess the minimal rim width (MRW) of the retinal nerve fiber layer (RNFL) at the Bruch's membrane opening (BMO) in the optic disk margin.This study was carried out to evaluate if this new parameter allows a more precise detection of glaucomatous damage to the RNFL.This article presents clinical examples and differences in the measurement methods in glaucoma cases.The main advantage is the automated detection by software allowing precise landmark tracking and coherent follow-up investigations. There seem to be considerable differences between the funduscopically assumed margin and the detection of the margin by the new software. Likewise there is a difference between RNFL measurements taken at the BMO and the peripapillary scan by SD-OCT.Ongoing research should assess the potential of this new parameter for a more precise detection of nerve fiber defects and changes over time compared to other imaging techniques.

Der mobile Kanal bringt durch seine Verfugbarkeit komplett neue Kundenbedurfnisse hervor, begleitet von einer hohen Anspruchs- und Erwartungshaltung. Die dabei vorherrschenden Entwicklungszyklen sind noch um ein Vielfaches schneller als die durch die Verbreitung des Internets ausgelosten Veranderungen. Bestehende Produkte und Services mussen in Richtung der neuen Moglichkeiten und Kundenerwartungen angepasst oder komplett neu definiert werden. Hierzu liefert der Beitrag zahlreiche Beispiele.

To study the incorporation of carbon and nitrogen in different plant fractions, 3-year-old-beech (Fagus sylvatica L.) seedlings were exposed in microcosms to a dual-labelling experiment employing 13 C and 15 N throughout one season. Leaves, stems, coarse and fine roots were harvested 6,12 and 18 weeks after bud break (June to September) and used to isolate acid-detergent fibre lignins (ADF lignin) for the determination of carbon and nitrogen and their isotope ratios. Lignin concentrations were also determined with the thioglycolic acid method. The highest lignin concentrations were found in fine roots. ADF lignins of all tissues analysed, especially those of leaves, also contained significant concentrations of nitrogen. This suggests that lignin-bound proteins constitute an important cell wall fraction and shows that the ADF method is not suitable to determine genuine lignin. ADF lignin should be re-named as ligno-protein fraction. Whole-leaf biomass was composed of 50 to 70% newly assimilated carbon and about 7% newly assimilated nitrogen; net changes in the isotope ratios were not observed during the experimental period. In the other tissues analysed, the fraction of new carbon and nitrogen was initially low and increased significantly during the time-course of the experiment, whereas the total tissue concentrations of carbon remained almost unaffected and nitrogen declined. At the end of the experiment, the whole-tissue biomass and ADF lignins of fine roots contained about 65 and 50% new carbon and about 50 and 40% new nitrogen, respectively. These results indicate that significant metabolic activity was related to the formation of structural biopolymers after leaf growth, especially below-ground and that this activity also led to a substantial binding of nitrogen to structural compounds.

The sequences of the hypervariable region 1 (HV1) of the mitochondrial DNA control region from multiple hair shafts from 10 unrelated individuals were compared to determine the frequency of differences in hairs from one individual. The extraction method described herein showed an average success rate of 67% for all 150 hair shafts tested in HV1. The mtDNA sequences from the hair shafts matched the sequences from the corresponding blood and saliva samples taken from the same donor and no evidence of heteroplasmy was found. The results emphasize the reliability of DNA extraction and mtDNA typing from human hair shafts for forensic purposes.

PURPOSE: To evaluate different therapies for choroidal neovascularization (CNV) due to angioid streaks (AS). METHODS: Studies were identified by a systematic literature search and were included in the analysis based on predefined criteria. Primary outcome measure was change in best-corrected visual acuity (BCVA). RESULTS: Fifty-four relevant studies were identified and included mostly uncontrolled case series. No randomized controlled trials were available. Treatment with vascular endothelial growth factor inhibitors improved or stabilized BCVA in all case series. Photodynamic therapy slowed down disease progression with stabilization or decrease of BCVA. Individual BCVA and follow-up data for each treated eye were reported in >160 cases for both treatments, vascular endothelial growth factor inhibitors and photodynamic therapy. In a pooled analysis of those studies, the difference of mean change in BCVA between both treatment groups was estimated as approximately 6 lines (0.59 logMAR [95% confidence interval, 0.38-0.8; P < 0.0001]). A better baseline BCVA was associated with a better BCVA outcome (P < 0.0001). Laser photocoagulation yielded comparable results as photodynamic therapy but application was mostly restricted to extrafoveal lesions, was complicated by frequent recurrences, and led to more retinal damage with subsequent absolute scotomas. Combination therapies seem to be not superior to monotherapy. CONCLUSION: Intravitreal vascular endothelial growth factor inhibitors are currently the most effective treatment of CNV due to angioid streaks.

Optical coherence tomography (OCT) imaging plays an important role in the management of retinal diseases. However, limitations and pitfalls should be taken into consideration when applying this noninvasive imaging technology. The aim of this review is to discuss several possible sources of error in the conduct and interpretation of OCT imaging.

Purpose Ozurdex, a novel dexamethasone (DEX) implant, is released by a drug delivery system into the vitreous cavity. We analyzed the mechanical release aperture of the novel applicator, obtained real-time recordings using a high-speed camera system and performed kinematic analysis of the DEX application. Design Experimental study. Methods : The application of intravitreal DEX implants (6 mm length, 0.46 mm diameter; 700 μg DEX mass, 0.0012 g total implant mass) was recorded by a high-speed camera (500 frames per second) in water (Group A: n = 7) or vitreous (Group B: n = 7) filled tanks. Kinematic analysis calculated the initial muzzle velocity as well as the impact on the retinal surface at approximately 15 mm of the injected drug delivery system implant in both groups. A series of drug delivery system implant positions was obtained and graphically plotted over time. Results High-speed real-time recordings revealed that the entire movement of the DEX implant lasted between 28 milliseconds and 55 milliseconds in Group A and 1 millisecond and 7 milliseconds in Group B. The implants moved with a mean muzzle velocity of 820 ± 350 mm/s (±SD, range, 326-1,349 mm/s) in Group A and 817 ± 307 mm/s (±SD, range, 373-1,185 mm/s) in Group B. In both groups, the implant gradually decelerated because of drag force. With greater distances, the velocity of the DEX implant decreased exponentially to a complete stop at 13.9 mm to 24.7 mm in Group A and at 6.4 mm to 8.0 mm in Group B. Five DEX implants in Group A reached a total distance of more than 15 mm, and their calculated mean velocity at a retinal impact of 15 mm was 408 ± 145 mm/s (±SD, range, 322-667 mm/s), and the consecutive normalized energy was 0.55 ± 0.44 J/m (±SD). In Group B, none of the DEX implants reached a total distance of 6 mm or more. An accidental application at an angle of 30 grade and consecutively reduced distance of approximately 6 mm may result in a mean velocity of 844 and mean normalized energy of 0.15 J/m (SD ± 0.47) in a water-filled eye. Conclusion The muzzle velocity of DEX implants is approximately 0.8 m/s and decreases exponentially over distance. The drag over time in vitreous is faster than in water. The calculated retinal impact energy does not reach reported damage levels for direct foreign bodies or other projectiles.