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We aimed to test for feasibility of volume-rendered optical coherence tomography angiography (OCTA) as a novel method for assessing/quantifying retinal vasculature during ocular procedures and to explore the potential for intraoperative use. Thirty patients undergoing periocular anaesthesia were enrolled, since published evidence suggests a reduction in ocular blood flow. Retinal perfusion was monitored based on planar OCTA image-derived data provided by a standard quantification algorithm and postprocessed/volume-rendered OCTA data using a custom software script. Overall, imaging procedures were successful, yet imaging artifacts occurred frequently. In interventional eyes, perfusion parameters decreased during anaesthesia. Planar image-derived and volume rendering-derived parameters were correlated. No correlation was found between perfusion parameters and a motion artifact score developed for this study, yet all perfusion parameters correlated with signal strength as displayed by the device. Concluding, volume-rendered OCTA allows for noninvasive three-dimensional retinal vasculature assessment/quantification in challenging surgical settings and appears generally feasible for intraoperative use.

BACKGROUND Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocular pressure and proptosis, which try to estimate the orbital compartment pressure. However, the reliability of these surrogates is unclear. Current techniques for the direct measurement of orbital compartment pressure are widely experimental and impractical in the clinical setting. Our aim was to explore the feasibility of minimally invasive needle manometry for direct measurement of orbital compartment pressure under reproducible conditions in an in vivo model of orbital congestion. We further sought to evaluate intraocular pressure and proptosis as indicators for elevated orbital compartment pressure. METHODS A total of 7 ml of mepivacaine 2% solution was injected into the orbital compartment in 20 patients undergoing cataract surgery under local anesthesia. A commercially available single-use manometer device was inserted between the syringe and the injection needle to measure the orbital compartment pressure for each milliliter of intraorbital volume increment. Additionally, intraocular pressure (subgroup A; n = 10) or axial globe position (subgroup B; n = 10) were measured. RESULTS Needle manometry allowed for rapid and continuous measurement of orbital compartment pressure. Overall mean orbital compartment pressure increased from 2.5 mmHg pre- to 12.8 mmHg post-interventionally. Both, intraocular pressure (Spearman's correlation coefficient rs = 0.637, p < 0.0001) and proptosis (rs = 0.675, p < 0.0001) correlated strongly with the orbital compartment pressure. CONCLUSIONS Needle manometry appears to be a feasible minimally invasive instrument to directly measure orbital compartment pressure, showing promises for a more routine application in managing orbital compartment syndrome. The results further suggest that both elevated intraocular pressure and proptosis are valuable indicators for orbital compartment syndrome.

This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch

Purpose:Intraretinal cystoid spaces are commonly found after surgical peeling of epiretinal membranes. In this study, we explored whether these cysts were associated with ganglion cell loss and thus might be a manifestation of retrograde maculopathy. The latter is a nonvascular edema with a characte

Diagnosis of orbital compartment syndrome is mainly based on clinical findings, such as intraocular pressure and proptosis, which try to estimate the orbital compartment pressure. However, the reliability of these surrogates is unclear. Current techniques for the direct measurement of orbital compartment pressure are widely experimental and impractical in the clinical setting. Our aim was to explore the feasibility of minimally invasive needle manometry for direct measurement of orbital compartment pressure under reproducible conditions in an in vivo model of orbital congestion. We further sought to evaluate intraocular pressure and proptosis as indicators for elevated orbital compartment pressure.A total of 7 ml of mepivacaine 2% solution was injected into the orbital compartment in 20 patients undergoing cataract surgery under local anesthesia. A commercially available single-use manometer device was inserted between the syringe and the injection needle to measure the orbital compartment pressure for each milliliter of intraorbital volume increment. Additionally, intraocular pressure (subgroup A; n = 10) or axial globe position (subgroup B; n = 10) were measured.Needle manometry allowed for rapid and continuous measurement of orbital compartment pressure. Overall mean orbital compartment pressure increased from 2.5 mmHg pre- to 12.8 mmHg post-interventionally. Both, intraocular pressure (Spearman's correlation coefficient rs = 0.637, p0.0001) and proptosis (rs = 0.675, p0.0001) correlated strongly with the orbital compartment pressure.Needle manometry appears to be a feasible minimally invasive instrument to directly measure orbital compartment pressure, showing promises for a more routine application in managing orbital compartment syndrome. The results further suggest that both elevated intraocular pressure and proptosis are valuable indicators for orbital compartment syndrome.

We aimed to evaluate the neuroprotective efficacy of rasagiline in pseudophakic patients who had surgery for macula-off rhegmatogenous retinal detachment (RRD). This was a 6-month, prospective, randomized, double-blind, placebo-controlled pilot study. Patients presenting with acute macula-off RRD were recruited and randomized 1:1 to receive rasagiline 1 mg/day or placebo for 7 days. Best-corrected visual acuity (BCVA) and optical coherence tomography were acquired 1 day before as well as 2 days, 3 weeks, 3 months and 6 months after surgery. We screened 26 patients with RRD whereof 23 were eventually included and randomized. The primary outcome was final BCVA. Secondary outcomes included central retinal thickness (CRT) and adverse events (AE). We evaluated photoreceptor cells (prc) recovery through morphological measurements. The baseline characteristics were comparable between groups. BCVA significantly improved in both groups (letters gained: rasagiline 61.5 ± 18.1 vs placebo 55.3 ± 29.2, p = 0.56), but no significant inter-group difference was found at any visit. CRT was stable 3 weeks after surgery onwards, with no inter-group difference. No treatment-emergent AE occurred. Significant prc restoration was observed from 3 weeks to 6 months after surgery, without inter-group difference at either visit. Ellipsoid zone integrity (β = 0.517, p = 0.008) and foveal bulge (β = 0.387, p = 0.038) were significant predictors of good final BCVA. In conclusion, perioperative oral treatment with rasagiline 1 mg/day for 7 days did not show significant benefits on visual or anatomical outcomes in macula-off RRD patients.

To compare 4 optical coherence tomography-angiography (OCT-A) devices for foveal avascular zone (FAZ) measurements in healthy subjects.The central retinas of 24 eyes of 12 healthy subjects were scanned with 4 different OCT-A devices (Optovue RTVue-XR, Zeiss Cirrus 5000-HD-OCT, a prototype Spectralis OCT2, Heidelberg Engineering, and Topcon DRI-OCT Triton Swept-source OCT). For the Topcon, Zeiss, and Optovue devices, 3-mm and 6-mm scans were performed. The Heidelberg device only provided 4-mm scans. En-face OCT-A images of the superficial and deep capillary plexus of the macular area were generated. The FAZ areas were measured and compared.Twenty-four healthy eyes were included. OCT-A devices showed significant differences in FAZ measurements. The Zeiss OCT-A device measured the smallest values for foveal avascular area (mean 218.7 mmCurrent OCT-A devices provide images that allow such measurements, but values showed significant differences between devices and, for the Optovue instrument, even within scan modes. The data for OCTA measurements cannot be transferred interchangeably between the devices. Therefore, a patient should always be measured with the same device.Vergleich der Messergebnisse von 4 verschiedenen optischen Kohärenztomografie-Angiografie-Geräten (OCT-A-Geräten) bei der Vermessung der Fläche der fovealen avaskulären Zone (FAZ) bei gesunden Probanden.In 24 Augen von 12 gesunden Probanden wurde die zentrale Netzhaut mit 4 verschiedenen OCT-A-Geräten gescannt (Optovue RTVue-XR, Zeiss Cirrus 5000-HD‑OCT, der Prototyp von Spectralis OCT2, Heidelberg Engineering, und Topcon DRI‑OCT Triton Swept-source OCT). Bei den Geräten von Topcon, Zeiss und Optovue wurden Scans mit 3 × 3 mm und 6 × 6 mm Größe durchgeführt. Das Gerät von Heidelberg Engineering ermöglichte Scans im Format 4,3 × 1,5 mm. Die Vermessung der Fläche der FAZ erfolgte in den generierten Scans des superfiziellen Gefäßplexus und wurde zwischen den Geräten verglichen.24 Augen wurden in die Studie eingeschlossen. In den Scans mit verschiedenen Geräten zeigten sich in der Vermessung der FAZ signifikante Abweichungen. Das Zeiss OCT-A-Gerät lieferte den kleinsten Flächenwert (Mean 218,7 mmIn der Vermessung der Fläche der FAZ zeigen gegenwärtige OCT-A-Geräte signifikante Abweichungen. Bei dem Optovue OCT-A-Gerät lassen sich signifikante Abweichungen in den Scans verschiedener Größe nachweisen. Da die Messdaten der verschiedenen Geräte nicht übereinstimmen, sollten Folgeuntersuchungen bei Patienten mit demselben Gerät erfolgen.

Postmortem pathological examinations, animal studies, and anecdotal reports suggest that coronavirus disease 2019 (COVID-19) could potentially affect intraocular tissue. However, published evidence is scarce and conflicting. In our study, we screened 100 eyes of 50 patients hospitalized for COVID-19. Relevant medical and ophthalmological history was assessed as well as symptoms, laboratory results, specific treatments, clinical course, and outcome. Ophthalmic exams including assessment of best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, ocular motility, ophthalmoscopy as well as optical coherence tomography (OCT) of the macula and the optic disc was performed at hospital admission and 29 to 192 days later. Of the 50 patients included, 14 (28%) were female. Median age was 64.5 (range 29–90) years. COVID-19 severity was mild in 15 (30%), severe in 30 (60%), and critical in five cases (10%). At baseline, median BCVA was 0.1 (0–1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) and median IOP was 16 (8–22) mmHg. At follow-up, no relevant changes in BCVA and IOP were documented. No signs of active intraocular inflammation or optic nerve affection were found and OCT findings were widely stable during the observation period. Our findings suggest that COVID-19 does not regularly affect intraocular tissue.

Hintergrund: Das chirurgische Management groser Schielwinkel bei fruhkindlichem Innenschielen und dekompensiertem Mikrostrabismus wird kontrovers gehandhabt. Es scheint ein gewisser Bias gegenuber Operationen an mehr als 2 horizontalen Augenmuskeln aus Angst vor einer Uberkorrektur vorzuliegen. Hauptziel dieser Studie war die motorische und sensorische Beurteilung der horizontalen Dreimuskelchirurgie sowie die Etablierung einer chirurgischen Dosis-Wirkungs-Beziehung. Patienten und Methoden: Retrospektive Kohorten-Studie von 27 Patienten (16 weiblich, 11 mannlich; mittleres Alter 7,9 [J], zwischen 1 und 27 [J]), mit fruhkindlicher Esotropie und dekompensiertem Mikrostrabismus, bei denen zwischen 2005 und 2013 eine Dreimuskelchirurgie (beidseitige Rucklagerung des M. rectus medialis und einseitige Faltung des M. rectus lateralis) zur Korrektur des Schielwinkels durchgefuhrt wurde. Ergebnisse: Der Schielwinkel betrug praoperativ 30,2 [°] (21,9 bis 48,0). Postoperativ zeigte sich eine signifikante Reduktion auf 2,6 [°] (− 16,7 bis 16,7), nach sechs Monaten auf 5,5 [°] (− 14,1 bis 21,9). Eine Dosis-Wirkungsbeziehung von 1,63°/mm lies sich fur die kombinierte Dreimuskelchirurgie ermitteln. Schlussfolgerung: Die horizontale Dreimuskelchirurgie ist zur Korrektur groser Schielwinkel bei fruhkindlicher Esotropie und dekompensiertem Mikrostrabismus gut geeignet. Konsekutive Exotropien stellen eine Raritat dar.

PURPOSE: To compare tunnelled scleral intravitreal injection with straight scleral intravitreal injection concerning short-term intraocular pressure (IOP) changes, occurrence and amount of vitreous reflux, and patient discomfort. METHODS: Sixty patients were randomly allocated to two groups (tunnelled intravitreal injection and straight intravitreal injection). IOP was measured before and directly (

Acta Ophthalmol. 2010: 88: 804–807 Abstract. Purpose: The aim of this study was to estimate the frequency and severity of ocular involvement in paediatric patients with haemolytic uraemic syndrome (HUS). Methods: The study was designed as an institutional, retrospective, observational case series. Charts for all 87 paediatric patients with HUS treated at the University Children’s Hospital Zurich between 1995 and 2007 were reviewed. Patients with ocular involvement were identified and clinical findings presented. Results: Three of 69 examined patients with HUS showed ocular involvement. Ophthalmic findings in two children were consistent with bilateral Purtscher retinopathy, showing multiple haemorrhages, exudations and superficial retinal whitening. The third child presented with bilateral isolated central intraretinal haemorrhages as a milder form of ocular involvement. In one of the children with Purtscher retinopathy, laser photocoagulation was required for bilateral rubeosis irides and development of disc neovascularization. Longterm outcomes in the two severely affected children showed decreased visual acuity caused by partial atrophy of the optic nerves. In the milder case visual acuity was not impaired at any time. Conclusions: A minority of paediatric patients with HUS developed ocular involvement. Acute ocular findings varied in severity from isolated intraretinal haemorrhages to Purtscher-like retinopathy with retinal ischaemia. Longterm complications included the development of neovascularizations and consecutive optic nerve atrophy. Although ocular involvement in HUS seems to be rare, physicians should be aware of this complication because of its possible vision-endangering consequences.

Background/aims: Age-related macular degeneration (AMD) is among the leading causes of severe visual loss in individuals over 60 years old. Retinal changes associated with AMD were previously studied by time-domain optical coherence tomography (OCT). Recently, Fourier-domain OCT (FD-OCT) has been introduced. FD-OCT provides increased scan resolution and scanning speed, and generates three-dimensional (3D) OCT images. The purpose of this study was to demonstrate features of AMD assessed with high-density scanning 3D-FD-OCT (Topcon 3D-OCT1000). Methods: The study was designed as a prospective, observational case series. Five patients with typical morphological changes due to AMD were chosen based on funduscopic findings. Eyes with non-exudative- and exudative AMD were included. 3D-FD-OCT images were obtained, and typical morphological changes associated with AMD were presented. Results: FD-OCT provided detailed 3D-images of retinal structure. In addition, FD-OCT showed improved retinal coverage and image quality. FD-OCT B-scan imaging identified typical retinal changes associated with AMD. In addition, FD-OCT imaging revealed information about the extent and the 3D shape of retinal lesions. Conclusion: 3D-FD-OCT imaging is useful for diagnosing and following patients with AMD. In addition, 3D-FD-OCT provided information about the extent and 3D shape of retinal pathologies and showed improved retinal coverage.

Background. Ranibizumab is approved for treatment of macular edema in eyes with retinal vein occlusion (RVO). Some eyes show low-response to treatment with regard to visual acuity gain (VA) and OCT central retinal thickness (CRT) reduction. The goal of this study was to quantify the percentage of low-responders. Methods. Treatment of naïve eyes with macular edema secondary to RVO was included and monthly VA and CRT were analyzed. Four weeks after the loading phase, and at the end of the study, eyes were grouped into low- and good responders based on predefined criteria. The responder and low-responder groups were then compared at various time points. Results. Forty-three eyes were included. Regarding VA, 27.9% were low-responders after the loading phase and 30.2% at the end of the study. For CRT, 34.9% were low-responders after the loading phase versus 27.9% at the end of the study. 75% of patients that were VA low-responders and 73.3% of CRT low-responders after loading phase remained low-responders at the end of the study. Conclusion. Approximately 30% of patients showed low response to ranibizumab after the loading phase and after 1 year of treatment. Two-thirds of patients that were low-responders after the loading phase remained low-responders after 1 year.

* BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) leads to morphological changes that can interfere with optical coherence tomography retinal thickness measurements. The effects of AMD on two available retinal thickness scan modes were tested. * PATIENTS AND METHODS: Ninety-four scans, equally divided into Radial Line Scans (RLS) and Fast Macula Scans (FMS), of 42 patients with AMD were reviewed. Patients were graded into 4 categories regarding AMD severity. Each scan mode was evaluated for each AMD category. * RESULTS: In dry moderate AMD, 2% of the RLS and 5% of the FMS thickness measurements failed. In dry progressed AMD, the RLS mode performed better (26% failure rate) than the FMS mode (42% failure rate). However, in exudative AMD the FMS mode performed better (6% failure rate) than the RLS mode (28% failure rate). The difference between the RLS and FMS performance in dry progressed AMD compared with exudative AMD was significant (P < .0001). * CONCLUSION: The optical coherence tomography retinal thickness scan modes perform differently, depending on AMD severity. Retinal thickness algorithms with better performance are needed to facilitate measurements in patients with AMD. [Ophthalmic Surg Lasers Imaging 2005;36:310314.1

Objective To investigate whether there is an association between the magnitude of retinal haemodynamic abnormalities in patients with age-related macular degeneration (AMD) and the degree of severity of the AMD. Methods A retinal laser Doppler system (Canon CLBF 100) was used to measure retinal arterial haemodynamic parameters in 25 eyes of 25 patients with AMD and nine eyes of nine age-matched control subjects. Severity of AMD was classified into Mild (n ¼ 11), Moderate (n ¼ 7), or Severe (n ¼ 7). The pulsatility ratio (PR), the pulsatility index (PI), and the resistivity index (RI) were determined. Results PR, PI, and RI in the patients with AMD were each significantly higher than in the control group, and increased monotonically with increasing severity of AMD. However, there were no differences in mean blood velocity, arterial diameter, or blood flow rate among the groups. This suggests that the increased blood flow pulsatility in the retinal arteries of the eyes with AMD is not due to increased distal vascular resistance, but instead is likely due to a loss of compliance in the arterial vasculature leading to the eye. Conclusion Our results suggest that an increasing vascular rigidity in the systemic arterial circulation is directly associated with

PURPOSE Optical coherence tomography (OCT) was used to analyze the thickness of various retinal layers of patients following successful macula-off retinal detachment (RD) repair. METHODS Optical coherence tomography scans of patients after successful macula-off RD repair were reanalyzed with a subsegmentation algorithm to measure various retinal layers. Regression analysis was performed to correlate time after surgery with changes in layer thickness. In addition, patients were divided in two groups. Group 1 had a follow-up period after surgery of up to 7 weeks (range, 21-49 days). In group 2, the follow-up period was >8 weeks (range, 60-438 days). Findings were compared to a group of age-matched healthy controls. RESULTS Correlation analysis showed a significant positive correlation between inner nuclear-outer plexiform layer (INL-OPL) thickness and time after surgery (P=0.0212; r2=0.1551). Similar results were found for the ellipsoid zone-retinal pigment epithelium complex (EZ-RPE) thickness (P=0.005; r2=0.2215). Ganglion cell-inner plexiform layer thickness (GCL-IPL) was negatively correlated with time after surgery (P=0.0064; r2=0.2101). For group comparison, the retinal nerve fiber layer in both groups was thicker compared to controls. The GCL-IPL showed significant thinning in group 2. The outer nuclear layer was significantly thinner in groups 1 and 2 compared to controls. The EZ-RPE complex was significantly thinner in groups 1 and 2 compared to controls. In addition, values in group 1 were significantly thinner than in group 2. CONCLUSIONS Optical coherence tomography retinal layer thickness measurements after successful macular-off RD repair revealed time-dependent thickness changes. Inner nuclear-outer plexiform layer thickness and EZ-RPE thickness was positively correlated with time after surgery. Ganglion cell-inner plexiform layer thickness was negatively correlated with time after surgery.

AIMS To assess the functional and morphological outcome of eyes with neovascular AMD treated with intravitreal ranbizumab following an exit strategy treatment regime. METHODS The Bern treatment regime for neovascular AMD has a fixed injection schedule, even in the non-active stage of the disease. The regimen has been adapted from the PIER study treatment protocol. Eyes with non-active AMD will receive 4 injections in the first year, and 2 injections in the second year of follow-up before treatment stops. Patients that received ranibizumab for treatment and reached the exit criteria were identified, and charts were reviewed to assess functional and morphological outcome. RESULTS Only 2.6% of all patients (15 out of 575 patients) reached the exit criteria. Mean change in best corrected ETDRS visual acuity (VA) was 4.5±16.9 letters when comparing baseline VA to 4 weeks after the last injection (p=0.32). OCT mean foveal thickness was significantly thinner after last treatment (247.9±43.0 µm) compared to baseline (332.5±83.1 µm, p=0.002). The mean total number of ranibizumab injections was 15.6±8.0, and the mean total treatment period was 40.9±18.3 months. Twenty percent of eyes had geographic atrophy present at baseline versus 46.6% at the end of treatment. CONCLUSIONS Even with a fixed treatment regime and a defined treatment exit strategy, only a small percentage of patients reach exit criteria. Retinal thickness has been significantly reduced by repeated intravitreal ranibizumab injections, and geographic atrophy became more frequent.

Background/Aims: To investigate the long-term effects of multiple intravitreal injections (IVTs) of ranibizumab (Lucentis) on intraocular pressure (IOP) in patients with neovascular age-related macular degeneration. Methods: In 320 eyes, IOP measurements were performed at baseline prior to injection and compared with IOP measurements of the last visit. Correlations between mean IOP change and total number of IVTs, visual acuity or patient age were tested. Results: The mean IOP increase was 0.8 ± 3.1 mm Hg (p < 0.0001). Seven eyes showed final IOP values between 22 and 25 mm Hg. The mean follow-up was 22.7 ± 14.1 months. No further correlations between IOP change and number of IVTs, visual acuity or patient age have been found. Conclusions: This study demonstrated a statistically significant IOP increase in patients treated with repeated injections of ranibizumab. However, IOP increase required no glaucoma treatment during the study. Therefore, repeated injections with ranibizumab can be considered safe with regard to long-term IOP changes in patients without ocular hypertension or glaucoma.

Background: The aim of this study was to describe the clinical characteristics and surgical outcome of acquired comitant non-accommodative esotropia without obvious cause in children with an early onset ≤ three years of age. Patients and Methods: 24 consecutive patients (13 females) with acquired comitant non-accommodative esotropia underwent strabismus surgery. Outcome measures included amount of deviation and level of binocularity at last follow-up. Results: An acute onset of strabismus was observed in 83 % of patients. Accompanying features such as diplopia, covering one eye or stumbling were observed in 40 % of the children. Cycloplegic retinoscopy revealed a mild to moderate hypermetropia in all children (mean hypermetropia + 2.2 diopters). 90.5 % of children were aligned within 8 PD of orthotropia. 81 % regained normal stereovision (Lang I/II). Conclusions: All children exhibited the typical features of acute acquired comitant esotropia (AACE) type II (Burian-Franceschetti). Collective characteristics of this form of strabismus are a comitant and relatively large deviation, mild hypermetropia, a potential of normal binocular cooperation and absence of an accommodative component and neurological pathology. Time and suddenness of strabismus onset may be less helpful in defining this entity.

To investigate changes in ocular pulse amplitude (OPA) during a short-term increase in intraocular pressure (IOP) and to assess possible influences of biometrical properties of the eye, including central corneal thickness (CCT) and axial length.In a prospective, single centre study, OPA and IOP as measured by dynamic contour tonometry (DCT) were taken before baseline- and post-OPA (delta) intravitreal injection of 0.05 ml anti-vascular endothelial growth factor agents. Analysis was performed employing linear regression with baseline- and post (delta)-OPA differences as the dependent and post-IOP as well as delta IOP as the independent variable. A multilinear regression analysis with delta OPA as the dependent variable and baseline IOP, post-IOP, CCT and axial length as independent variables was conducted.Forty eyes of 40 patients were included. IOP and OPA increased significantly after injection (IOP mean increase ± SD: 17.83 ± 9.83 mmHg, p0.001; OPA mean increase ± SD: 1.39 ± 1.16 mmHg, p0.001). For every mmHg increase in IOP, the OPA showed a linear increase of 0.05 mmHg (slope 0.05, 95% CI: 0.02-0.09, p = 0.003, r(2) = 0.20). Multiple regression analysis with delta OPA as the dependent variable revealed a partial correlation coefficient of 0.47 (p = 0.003) for post-IOP as the only significant contribution.A clear positive relationship between OPA measurements and IOP levels was shown in a clinical routine setting using DCT focusing on baseline and postinterventional comparisons of OPA values after intravitreal injections in patients with exudative age related macular degeneration. When considering the OPA for diagnostic purposes, we recommend indication of corresponding IOP values.

X-linked retinoschisis (XLRS) is one of the most common causes of macular degeneration in young men. The purpose of this study was to use optical coherence tomography combined with ophthalmoscopy to study the effects of aging on the morphologic changes associated with XLRS.Twenty-five eyes of 17 men with XLRS ranging in age from 3 years to 68 years were studied using ophthalmoscopy and optical coherence tomography. Optical coherence tomography was used to measure macular thickness and to evaluate XLRS-related structural changes. Correlation analyses between the findings and patients' age and visual acuity were performed.Mean visual acuity was 20/100 (range, 20/40 to 20/400). There were no correlations between visual acuity and age or macular thickness. However, there was a significant decrease in macular thickness with age (P0.01). Eyes with posterior vitreous detachment had significantly decreased central foveal thickness (P0.001). Various retinal morphologic changes could be identified by optical coherence tomography, including epiretinal membranes, intraretinal cysts, tissue pillars bridging the schisis cavities, and tissue hyperreflectivity in collapsed XLRS. These findings were significantly correlated with age.Optical coherence tomography revealed various retinal morphologic changes associated with XLRS. These changes were correlated with age but not with visual acuity. Younger patients showed cystic retinal elevation, whereas older patients showed collapsed retinoschisis with retinal thinning.

Background: The aim of this work is to assess the repeatability of spectral-domain-OCT (SD-OCT) retinal nerve fiber layer thickness (RNFL) thickness measurements in a non-glaucoma group and patients with glaucoma and to compare these results to conventional time-domain-OCT (TD-OCT). Methods: In a prospective, comparative, observational case-control study, 50 eyes of 25 non-glaucoma and 22 eyes of 11 patients with primary open angle glaucoma (POAG) were included. SD-OCT and TD-OCT circle scans were centered on the optic disc. In each eye, OCT scans were performed three times by two independent observers. RNFL thickness was measured in four quadrants around the optic disc. In addition, the overall mean RNFL thickness was assessed. Intraclass correlation coefficients (ICC) and coefficients of variation (COV) were calculated. Inter-observer and inter-OCT repeatability was visualized by using Bland-Altman analysis. Results: Intra-observer repeatability for TD- OCT was good with an ICCmean RNFL thickness of 0.939 in non-glaucomas and 0.980 in glaucomatous eyes. For SD-OCT, intra-observer repeatability was higher with an ICC of 0.989 for non-glaucomas and 0.997 for glaucomatous eyes. COVs for TD-OCT ranged from 2.9-7.7% in non-glaucomas and from 6.0-13.3% in glaucoma patients. COVs for SD-OCT ranged from 0.3-1% in non-glaucomas and from 0.9-2.3% in glaucomatous eyes. COVs were influenced by various factors. In the glaucoma group, COVs were significantly higher (p

Purpose: Conventional time-domain optical coherence tomography (OCT) has become an important tool for following dry or exudative age-related macular degeneration (AMD). Fourier-domain three-dimensional (3D) OCT was recently introduced. This study tested the reproducibility of 3D-OCT retinal thickness measurements in patients with dry and exudative AMD. Methods: Ten eyes with dry AMD and 12 eyes with exudative AMD were included in the study. Sets of three OCT 6 × 6-mm raster scans were taken by one operator. Mean retinal thickness was calculated for 36 areas. Coefficients of variation (CoV) were calculated for each patient and area. For analysis, two separate areas (central and peripheral) were defined. Generalized estimating equations (GEEs) were applied to all 36 subfields in order to analyse possible differences in CoV and mean retinal thickness between dry and exudative AMD. Results: Mean retinal thickness values were significantly larger in the central area in exudative AMD (p

Purpose: We report the longterm follow-up of children with optic nerve avulsion (ONA) caused by traumatic events. The remarkable differences in courses and outcomes may elucidate the spectrum of ONA-associated symptoms and injuries. Methods: During the last 15 years, three children with ONA were referred to our department. These cases are presented with special attention to their longterm follow-up. Results: Two patients suffered from complete ONA after head injury. The third patient presented with partial ONA caused by a bicycle accident. Longterm follow-up varied between 7 and 15 years. In the first patient, a pale swollen retina without any visible retinal vasculature was observed early in the course of follow-up. The retina later completely detached. In the second patient, extended fibroglial scarring occurred and an extremely large epiretinal membrane formed and was finally released spontaneously into the vitreous. The third patient developed only mild fibroglial scarring and retinal pigment epithelium hyperplasia. The optic nerve head in this patient came to resemble a morning glory disc. Conclusions: Optic nerve avulsion can adopt different courses and outcomes in different patients. Final visual outcome seems to depend on the degree of visual acuity immediately after injury. Substantial intraocular architecture changes can occur as a result of ONA.

Purpose To evaluate the intraoperative use of handheld Fourier-domain optical coherence tomography (OCT) during Descemet stripping automated endothelial keratoplasty (DSAEK) to assess the donor-host interface. Design Prospective, observational case series. Methods Six patients undergoing DSAEK surgery were included. OCT scans of the cornea were performed intraoperatively after insertion of the donor disc, after instillation of air in the anterior chamber beneath the disc, after vent incisions in the host cornea in each quadrant, following air-fluid exchange at the end of operation, and on day 1 after surgery. The central 3 mm of each cornea was scanned. The broadest gap between donor and host cornea (interface space) was measured. Results Adequate readings could be obtained from all patients without any complications. In 2 patients there was a decrease in the width of the interface space after each surgical step documented by the OCT scans. At the end of their operation, no interface space was detectable. In 2 patients, interface space disappeared after the vent incisions and did not reappear during the further course of the surgery. In further 2 patients the separation between the host and donor was still detectable at the end of the operation. All patients had no detectable interface gap on day 1. Conclusions Handheld anterior segment OCT can be used to assess the host-donor interface in lamellar corneal transplantation surgery. Donor adherence can occur in spite of residual interface space at the end of surgery. Further studies should be conducted to answer the question of which surgical steps are useful in assisting with donor adhesion.

Zusammenfassung: Der Artikel gibt einen Überblick über das Spektrum möglicher Motilitätseinschränkungen und Stellungsanomalien der Augen bei Patienten mit Möbius-Sequenz. Die augenmuskelchirurgischen Behandlungsoptionen werden diskutiert und es wird ein operatives Stufenschema vorgestellt

Joubert syndrome (JS) is an autosomal-recessive inherited complex malformation of the midbrain-hindbrain. It has been associated with ocular and oculomotor abnormalities. The aim of our study was to extend the ophthalmic knowledge in JS and to add new findings.In a retrospective study, 10 consecutive patients, who met the revised diagnostic criteria of JS were included. Mutation analysis was carried out in all the cases. Each patient underwent a comprehensive neuro-ophthalmological examination.Bilateral drusen of the optic disc were found in two patients. Four patients showed bilateral morphological and functional signs of retinal dystrophy (CEP290 mutation in two cases and AHI1 mutation in one case). In nine patients performance during smooth pursuit, saccades, and vestibulo-ocular reflex (VOR) cancellation was poor.To the best of our knowledge, the association of optic disc drusen with JS has not yet been described. In support of the earlier findings, decreased smooth pursuit and VOR cancellation, as well as partial-to-complete oculomotor apraxia seem to be the key oculomotor features of JS. Genotype-phenotype correlations showed the predictive value of CEP290 and AHI1 mutations for retinal involvement.

Purpose The characteristic findings in accidental head injury consist of linear skull fracture, epidural haematoma, localized subdural haematoma, or cortical contusion because of a linear or translational impact force. Retinal haemorrhages have been found, although uncommon, in accidental head trauma. Methods We performed a retrospective study of 24 consecutive cases of children with severe head injuries caused by falls. Inclusion criteria were skull fractures and/or intracranial haemorrhages documented by computerized tomography. All patients underwent a careful ophthalmic examination including dilated indirect fundoscopy within the first 48 h following admission. Results No retinal haemorrhages could be found in patients whose accidents were plausible and physical and imaging findings were compatible with reported histories. Excessive bilateral retinal haemorrhages were found in only three children with the typical signs of shaken baby syndrome. In eight children, trauma had led to orbital roof fractures. Conclusions Retinal haemorrhages were not found in any of the patients with accidental trauma despite the severity of their head injuries. Hence, we add more evidence that there are strong differences between the ocular involvement in accidental translational trauma and those in victims of non-accidental trauma. Fall-related injuries carry a very low risk of retinal haemorrhages.

Purpose To evaluate features of optical coherence tomography (OCT) associated with Shaken Baby syndrome (SBS) in an attempt to gain new insight into the pathophysiology of this phenomenon. Design Institutional prospective observational case series. Methods We report three infants with SBS. Each patient underwent an ophthalmic examination including slit-lamp biomicroscopy, dilated indirect ophthalmoscopy, color fundus photography, and OCT. Results In all infants, numerous bilateral multilayered retinal hemorrhages were present. In one case, bilateral perimacular folds had occurred. OCT confirmed retinal hemorrhages and perimacular folds. Moreover, OCT revealed vitreoretinal traction in all infants and suspected hemorrhagic macular retinoschisis in one case. Based on OCT findings, a hypothesis of vitreoretinal traction development and retinal fold formation is proposed. Conclusions OCT provided valuable additional information about the ocular pathology in patients with SBS. Vitreoretinal membrane formation seen in OCT could support the pathophysiological theory of a direct mechanical effect. OCT revealed preretinal blood accumulation as a cause for localized vitreous detachment and vitreoretinal traction. Furthermore, OCT showed persistent attachment of the vitreous to the internal limiting membrane at the apices of perimacular folds and suggested small hemorrhagic macular retinoschisis in one patient. Perimacular folds and hemorrhagic macular retinoschisis are regarded as highly specific for SBS and indicate poor visual outcome. Thus OCT might be of both diagnostic and prognostic value in SBS.

Purpose To compare the newly developed handheld dynamic contour tonometer (hh-DCT) with the established slit-lamp–mounted DCT (sl-DCT) in terms of agreement for intraocular pressure (IOP) and ocular pulse amplitude (OPA) measurements, intraobserver variability, and tonography effect. Design Evaluation of diagnostic technology. Participants Fifty eyes of 50 healthy volunteers were examined with the hh-DCT and sl-DCT. Methods A paired t test was performed to analyze differences in IOP and OPA readings. Measurements were compared for bias and agreement according to the method of Bland and Altman. Intraclass correlation coefficients (ICCs) were calculated to compare intraobserver variability. A mixed model analysis was performed to assess a possible tonography effect. Main Outcome Measures The differences in IOP and OPA measurements, intraobserver variability, and tonography effect between the hh-DCT and the sl-DCT were examined. Results No statistically significant differences in IOP (sl-DCT−hh-DCT: 0.1±1.43 mmHg, 95% confidence interval [CI], −0.31 to 0.5, P = 0.63) or OPA (sl-DCT−hh-DCT: −0.1±0.52 mmHg, 95% CI, −0.28 to 0.01, P = 0.08) measurements were detected. Bland-Altman analysis revealed a bias of 0.1 with the limits of agreement of IOP measurement differences ranging from −2.71 to +2.90 mmHg. With regard to IOP readings obtained by sl-DCT, hh-DCT overestimated IOPs less than 15.6 mmHg and underestimated IOPs more than 15.6 mmHg. ICCs calculated for IOP readings were 0.87 (95% CI, 0.8–0.92) for hh-DCT and 0.85 (95% CI, 0.78–0.90) for sl-DCT. ICCs for OPA readings were 0.86 (95% CI, 0.79–0.91) for hh-DCT and 0.87 (95% CI, 0.8–0.91) for sl-DCT. Comparing the ICCs revealed no statistically significant difference between the devices with regard to IOP and OPA measurements ( P = 0.53 and P = 0.93, respectively). Mixed model analysis of 3 consecutive IOP measurements revealed a decrease in IOP of 0.5 mmHg after each measurement in both devices, which was not significant between the 2 methods ( P = 0.68). Conclusions IOP and OPA readings obtained by the novel hh-DCT were shown to be strongly concordant with measurements obtained by the sl-DCT device. The hh-DCT may be a valuable alternative to the sl-DCT in clinical practice. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

PURPOSE: Conventional time-domain optical coherence tomography (OCT) has been shown to provide reproducible retinal nerve fiber layer (RNFL) measurements. Recently, high-speed, high-resolution Fourier-domain 3D-OCT has been introduced to improve OCT quality. It can provide 6-mm(2) high-density scans to provide RNFL thickness measurements. The purpose of this study was to test the reproducibility of 3D-OCT RNFL thickness measurements in healthy volunteers. METHODS: Thirty-eight eyes were included in the study. High-density 6-mm(2) 3D scans were registered by two independent operators. RNFL thickness was calculated for eight areas corresponding to the ETDRS areas and for two ring areas. The ETDRS grid was centered on the optic disc. Intraclass correlation coefficients (ICC) and coefficients of variation (COV) were calculated. Interobserver reproducibility was visualized by using Bland-Altman analysis. RESULTS: Intrasession reproducibility was good with a mean ICC of 0.90. The mean COV for operator 1 and 2 was 4.2% and 4%, respectively (range, 1.9%-6.7%). Highest reproducibility was found for the two ring areas and the superior and inferior quadrants. Mean differences in RNFL thickness measurements for ring 1 and 2 between operator 1 and 2 were 0.9 microm (limits of agreement, -11.4 to +9.6 microm) and 0.1 microm (limits of agreement -4.1 to +3.9 microm), respectively. CONCLUSIONS: 3D-OCT RNFL thickness measurements in healthy volunteers showed good intra- and interobserver reproducibility. 3D-OCT provides more RNFL thickness information compared to conventional time-domain OCT measurements and may be useful for the management of glaucoma and other optic neuropathies.

Background/Aims: Conventional time domain optical coherence tomography (OCT) has become an important diagnostic tool to measure retinal thickness in clinical routine. Recently, different models of high-speed, high-resolution frequency domain OCTs have been introduced by various manufacturers. The purpose of this study was to compare 3 commercially available OCT models for retinal thickness measurements in healthy controls. Methods: OCT scans were performed on 28 healthy eyes with the RTVue-100 FD-OCT (Optovue Inc., USA), the Cirrus™ HD-OCT (Carl Zeiss Meditec Inc., USA) and the Stratus OCT 3000 (Carl Zeiss Meditec Inc.). Retinal thickness values were calculated and compared between OCT models. Results: Differences in mean retinal thickness measurements between OCT models were statistically significant. Mean retinal thickness measurement with Cirrus OCT, RTVue OCT and with Stratus OCT was 300, 265 and 257 μm, respectively. Conclusion: Measurements with different OCT models lead to significantly different retinal thickness values.

PURPOSE: To test the reproducibility of retinal thickness measurements in healthy volunteers of a new Frequency-domain optical coherence tomography (OCT) device (Spectralis OCT; Heidelberg Engineering, Heidelberg, Germany). DESIGN: Prospective, observational study. METHODS: Forty-one eyes of 41 healthy subjects were included into the study. Intraobserver reproducibility was tested with 20 x 15 degree raster scans consisting of 37 high-resolution line scans that were repeated three times by one examiner (M.N.M.). Mean retinal thickness was calculated for nine areas corresponding to the Early Treatment Diabetic Retinopathy Study (ETDRS) areas. Coefficients of variation (COV) were calculated. RESULTS: Retinal thickness measurements were highly reproducible for all ETDRS areas. Mean total retinal thickness was 342 +/- 15 microm. Mean foveal thickness was 286 +/- 17 microm. COVs ranged from 0.38% to 0.86%. Lowest COV was found for the temporal outer ETDRS area (area 7; COV, 0.38%). Highest COV was found for the temporal inner ETDRS area (area 3; COV, 0.86%). Mean difference between measurement 1 and 2, measurement 1 and 3, and measurement 2 and 3 for all ETDRS areas was 1.01 microm, 0.98 microm, and 0.99 microm, respectively. CONCLUSION: Spectralis OCT retinal thickness measurements in healthy volunteers showed excellent intraobserver reproducibility with virtually identical results between retinal thickness measurements performed by one operator.

Background: Surgical treatment of myopic strabismus fixus is challenging. Options for its correction range from conventional combined recession-resection surgery to innovative surgical procedures aiming to correct the deviated muscle paths. In this report we review our experience and compare the results of various surgical options for treatment of strabismus fixus. Methods: We report the surgical outcomes of nine adults with acquired strabismus fixus due to myopia with a follow-up of 1year. Patients were enrolled between May 2003 and April 2007 in this retrospective study. The surgical procedure was determined depending on the angle of deviation and extent of motility impairment. A new transposition technique was performed in one patient who had an extreme variant of strabismus fixus. Results: Combined recession-resection surgery was performed in four patients with resulting small-angle esotropia. In patients with both esotropia and hypotropia due to muscle alignment, we performed an additional upward displacement of both horizontal recti muscles combined with a myopexy of the lateral rectus muscle. The results were satisfying; in particular in one patient who had a transposition procedure a significant improvement was achieved. Conclusions: For treatment of myopic strabismus fixus, a graded approach seems advisable. Combined recession-resection surgery yields good results for smaller deviations with mildly impaired motility, additional fixation techniques need to be applied once the horizontal muscle paths are deviated, and in extreme cases, a transposition procedure is required

Age-related macular degeneration (AMD) leads to morphological changes that can interfere with optical coherence tomography retinal thickness measurements. The effects of AMD on two available retinal thickness scan modes were tested.Ninety-four scans, equally divided into Radial Line Scans (RLS) and Fast Macula Scans (FMS), of 42 patients with AMD were reviewed. Patients were graded into 4 categories regarding AMD severity. Each scan mode was evaluated for each AMD category.In dry moderate AMD, 2% of the RLS and 5% of the FMS thickness measurements failed. In dry progressed AMD, the RLS mode performed better (26% failure rate) than the FMS mode (42% failure rate). However, in exudative AMD the FMS mode performed better (6% failure rate) than the RLS mode (28% failure rate). The difference between the RLS and FMS performance in dry progressed AMD compared with exudative AMD was significant (P.0001).The optical coherence tomography retinal thickness scan modes perform differently, depending on AMD severity. Retinal thickness algorithms with better performance are needed to facilitate measurements in patients with AMD.

This study compared SLO microperimetry scotoma size measurements with the sizes of lesions assessed with OCT in the areas of scotoma. SLO microperimetry was performed on eight patients to assess the location and extent of scotoma areas. An SLO microperimetry master image was used to localize the scotoma areas in the real time OCT fundus image and to center OCT cross scans on the areas of scotoma. The sizes of the morphological changes measured by OCT were compared with the scotoma size measurements. In each patient, OCT revealed a morphological change located in the area of scotoma. Scotoma sizes ranged from 465 to 3180 μm horizontally and from 570 to 2550 μm vertically. The corresponding lesion sizes ranged from 461 to 2660 μm horizontally and from 523 to 2282 μm vertically. The average difference between SLO and OCT measurements was 2.4% horizontally and 4.9% vertically. There were significant correlations between horizontal and vertical SLO and OCT measurements (Horizontal: R sq=0.955, P

PURPOSE Fundus autofluorescence (FAF) cannot only be characterized by the intensity or the emission spectrum, but also by its lifetime. As the lifetime of a fluorescent molecule is sensitive to its local microenvironment, this technique may provide more information than fundus autofluorescence imaging. We report here the characteristics and repeatability of FAF lifetime measurements of the human macula using a new fluorescence lifetime imaging ophthalmoscope (FLIO). METHODS A total of 31 healthy phakic subjects were included in this study with an age range from 22 to 61 years. For image acquisition, a fluorescence lifetime ophthalmoscope based on a Heidelberg Engineering Spectralis system was used. Fluorescence lifetime maps of the retina were recorded in a short- (498-560 nm) and a long- (560-720 nm) spectral channel. For quantification of fluorescence lifetimes a standard ETDRS grid was used. RESULTS Mean fluorescence lifetimes were shortest in the fovea, with 208 picoseconds for the short-spectral channel and 239 picoseconds for the long-spectral channel, respectively. Fluorescence lifetimes increased from the central area to the outer ring of the ETDRS grid. The test-retest reliability of FLIO was very high for all ETDRS areas (Spearman's ρ = 0.80 for the short- and 0.97 for the long-spectral channel, P < 0.0001). Fluorescence lifetimes increased with age. CONCLUSIONS The FLIO allows reproducible measurements of fluorescence lifetimes of the macula in healthy subjects. By using a custom-built software, we were able to quantify fluorescence lifetimes within the ETDRS grid. Establishing a clinically accessible standard against which to measure FAF lifetimes within the retina is a prerequisite for future studies in retinal disease.

Zusammenfassung: Die Möbius-Sequenz betrifft nicht nur die Okulomotorik, sondern auch die Augen selbst. Das Sehen der Patienten kann durch das Syndrom erheblich beeinträchtigt sein. Daher bedarf es regelmäßiger augenärztlicher Kontrollen

Objectives To determine the earliest retinal changes associated with Waldenstrom macroglobulinemia (WM) and to ascertain the serum IgM and serum viscosity (SV) levels at which these changes occur. Methods Patients with WM were evaluated using indirect ophthalmoscopy with scleral depression, laser Doppler retinal blood flow measurements, and serum IgM and SV determinations. Hemodynamic findings were compared with those of a group of age-matched controls. A retinopathy severity scale was developed, and the associated IgM and SV values were related to particular morphologic changes. Results A total of 46 patients with WM and 14 age-matched, healthy controls participated in the study. Patients exhibited far-peripheral hemorrhages and venous dilation with increasing SV and IgM values. Central retinal changes were associated with significantly higher SV values. Retinal vessel diameter increased with increasing serum IgM and SV levels. The mean IgM level of patients with the earliest retinal changes was 5442 mg/dL. The mean SV level was 3.1 cP. Conclusions Retinal manifestations of hyperviscosity syndrome occur at lower serum IgM and SV levels than previously reported. Indirect ophthalmoscopy with scleral depression along with retinal vessel diameter measurements are able to detect the earliest hyperviscosity syndrome–related complications and should be considered in the treatment of patients with WM.

PURPOSE This study investigated the influence of disc edema (DE) caused by inflammatory optic neuropathies or retinal vein occlusions on optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness measurements. METHODS OCT RNFL circle scans centered on the optic disc were made for 13 patients with DE (7 with retinal vein occlusions and 6 with inflammatory optic neuropathies) and 13 controls. RNFL thickness was assessed using the OCT normative database. The same circle scans were also used for peripapillary total retinal thickness measurements. The RNFL percentage of total retinal thickness was calculated, normalized (nRNFL%), and averaged separately for affected and unaffected regions of each eye. RESULTS Average RNFL thickness was 122 +/- 23 microm in the DE group, and 91 +/- 8 microm in the control group (P = 0.0001). Mean peripapillary total retinal thickness was 329 +/- 56 microm in the DE group and 255 +/- 12 microm in the control group (P < 0.001). Comparison of the averaged nRNFL% values at measurement locations above the range of the normative database with averaged nRNFL% values at measurement locations within the range of the normative database in the optic neuropathy group showed a significant difference (P = 0.024); however, the same analysis in the retinal vein occlusion group revealed no significant difference. CONCLUSIONS OCT measurements are influenced by DE and show significantly greater thickness values in those patients than in controls. The presence of a significant difference within the averaged nRNFL% values in the optic neuropathy group and the absence of such a difference in the retinal vein occlusion group could be explained by edema primarily affecting the RNFL in optic neuropathy in contrast to what occurs in retinal vein occlusion, where edema affects all retinal layers.

PURPOSE The present study was designed to investigate the effect of intravenously administered sodium lactate on ocular blood flow. METHODS Twelve healthy male volunteers received either sodium lactate (0.6 mol/L) or physiologic saline solution in a randomized, double-masked, two-way crossover study. Sodium lactate or placebo were administered at an infusion speed of 500 and 1000 mL/h for 30 minutes each. Blood flow measurements were performed in the last 10 minutes of the infusion periods. Retinal blood flow was calculated based on the measurement of maximum erythrocyte velocity, assessed with bidirectional laser Doppler velocimetry, and retinal vessel diameter obtained with a retinal vessel analyzer. Choroidal blood flow was assessed with laser Doppler flowmetry and laser interferometric measurement of fundus pulsation amplitude. RESULTS Administration of lactate increased blood lactate concentration from 1.3 +/- 0.4 to 3.9 +/- 0.7 mmol/L (P < 0.001) and to 7.1 +/- 1.4 mmol/L (P < 0.001) at infusion speeds of 500 and 1000 mL/h, respectively. At these blood lactate concentrations, retinal blood flow increased by 15% +/- 20% and by 24% +/- 37% (ANOVA, P = 0.01). Fundus pulsation amplitude increased by 3% +/- 6% and 10% +/- 5% (ANOVA, P = 0.04) at the two plasma lactate concentrations. Subfoveal choroidal blood flow measured with laser Doppler flowmetry tended to increase by 10% +/- 15% and 13% +/- 20% (ANOVA, P = 0.19), but this effect was not significant. Infusion of sodium lactate induced alkalosis in arterial blood taken from the earlobe (7.41 +/- 0.03 at baseline; 7.50 +/- 0.03 during lactate infusion; P = 0.001). CONCLUSIONS The data indicate that intravenously administered sodium lactate increases retinal blood flow. Whether this is related to a cytosolic redox impairment or to other hitherto unidentified mechanism remains to be clarified. Further studies are needed to determine whether lactate plays a role in regulation of choroidal blood flow.

BACKGROUND Treatment of retinopathy of prematurity (ROP) stage 3 plus with bevacizumab is still very controversial. We report the outcome of 6 eyes of 4 premature infants with ROP stage 3 plus disease treated with ranibizumab monotherapy. METHODS Six eyes of 4 premature infants with threshold ROP 3 plus disease in zone II, were treated with one intravitreal injection of 0.03 ml ranibizumab. No prior laser or other intravitreal therapy was done. Fundus examination was performed prior to the intervention and at each follow-up visit. Changes in various mean vital parameters one week post intervention compared to one week pre-intervention were assessed. RESULTS The gestational age (GA) of patient 1, 2, 3, and 4 at birth was 24 5/7, 24 5/7, 24 4/7, and 26 1/7 weeks, respectively. The birth weight was 500 grams, 450 grams, 665 grams, and 745 grams, respectively. The GA at the date of treatment ranged from 34 3/7 to 38 6/7 weeks. In one infant, upper air way infection was observed 2 days post injection of the second eye. Three eyes required paracentesis to reduce the intraocular pressure after injection and to restore central artery perfusion. After six months, all eyes showed complete retinal vascularisation without any signs of disease recurrence. CONCLUSIONS Treatment of ROP 3 plus disease with intravitreal ranibizumab was effective in all cases and should be considered for treatment. One infant developed an upper air way infection suspicious for nasopharyngitis, which might be a possible side effect of ranibizumab. Another frequent complication was intraocular pressure rise after injection. More patients with longer follow-up duration are mandatory to confirm the safety and efficacy of this treatment. TRIAL REGISTRATION NUMBER NCT02164604 ; Date of registration: 13.06.2014.