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Graphical abstract, Highlights • Novel method induces highly reproducible chemical injuries in an ex vivo cornea model. • Initial corneal surface humidity is an important parameter for consistent injury. • The application frequency of the corrosive has a major impact on the extent of injury. • This automated method can provide a consistent baseline for further investigations., Introduction Live-animal-free ocular toxicity models and tests are a necessity in multiple branches of medicine, industry and science. Corneal models with adjustable ranges of injury severities do not exist. In this work, a novel and precise and dose - response method to induce and observe ex vivo corneal chemical burns has been established. Methods The EVEIT (Ex Vivo Eye Irritation Test) is based on an ex vivo corneal organ model for rabbit corneas from food industry. Further, a highly precise three – axis workstation has been employed to apply liquid corrosive, sodium hydroxide (NaOH), droplets in a nanolitre (nL) range onto the corneal surface. Optical Coherence Tomography (OCT) has been used to observe and quantify the elicited changes in the corneal layers. Results The speed and intervals of single nanodroplet application played a crucial role in the extent of the corneal changes. Similar total volumes applied at low frequencies elicited deep and extensive changes in the corneal layers whereas high application frequencies elicited comparatively superficial changes. Increasing NaOH concentrations effected measurably increasing corneal changes. Increasing the volume of applied NaOH also showed an increase in corneal changes. Conclusions OCT imaging proved to be effective in observing, documenting and quantifying the changes in the corneal layers. The ex vivo model, in conjunction with the novel application method was able to induce and display distinctive and consistent correlations between NaOH volume, concentration and elicited corneal changes. This ex vivo ocular chemical burn model provides a consistent in vitro basis for pharmaceutical and toxicological experiments and investigations into corneal chemical burn mechanisms and treatment.

Purpose: High-frequency applied cetalkonium chloride (CAC) and benzalkonium chloride (BAC) 0.02% did not hamper corneal healing in a living rabbit model of induced corneal erosion. In contrast, the...

PURPOSE A malfunction of the corneal endothelium leading to corneal opacity is one of the main causes of impaired vision. Currently, keratoplasty is the one and only donor cornea-dependent treatment, and this calls for alternatives because of the worldwide lack of donor corneas. Recently, the topography of Descemet membrane (DM) has been discovered as a feasible stem cell differentiation tool. With this study, we further confirm this mechanotransductive system by using preinduced Wharton jelly-derived mesenchymal stem cells (WJ-EPCs). METHODS To measure the mechanotransductive potential of Descemet-like topography (DLT), WJ-EPCs were cultivated on collagen imprints with DLT. Changes in the gene and protein expressions of corneal endothelial cells (CECs), typical markers such as zonula occludens (ZO-1), sodium/potassium (Na/K)-ATPase, paired-like homeodomain 2 (PITX2), and collagen 8 (COL-8) were measured. In addition, CEC functionality has been evaluated by measuring the relative potential differences in a 2-compartment system and by measuring corneal transparency in an ex vivo rabbit cornea model. To confirm the activity of WJ-EPCs, rabbit CECs were restless deleted by collagen digestion of a thin layer of rabbit Descemet membrane. RESULTS The proper CEC-typical hexagonal morphology of WJ-EPCs in combination with a significant expression of ZO-1, Na/K-ATPase, PITX2, and COL-8 could be demonstrated. In addition, the WJ-EPCs were able to build up a relative potential difference of 40 mV and to keep corneas clear and transparent. CONCLUSIONS These data indicate that a well-characterized, functional CEC monolayer was developed by using a DLT-mediated mechanotransductive differentiation of WJ-EPCs.

Parvovirus B19 (B19V) is the predominant cardiotropic virus currently found in endomyocardial biopsies (EMBs). However, direct evidence showing a causal relationship between B19V and progression of inflammatory cardiomyopathy are still missing. The aim of this study was to analyze the impact of transcriptionally active cardiotropic B19V infection determined by viral RNA expression upon long-term outcomes in a large cohort of adult patients with non-ischemic cardiomyopathy in a retrospective analysis from a prospective observational cohort. In total, the analyzed study group comprised 871 consecutive B19V-positive patients (mean age 50.0 ± 15.0 years) with non-ischemic cardiomyopathy who underwent EMB. B19V-positivity was ascertained by routine diagnosis of viral genomes in EMBs. Molecular analysis of EMB revealed positive B19V transcriptional activity in n = 165 patients (18.9%). Primary endpoint was all-cause mortality in the overall cohort. The patients were followed up to 60 months. On the Cox regression analysis, B19V transcriptional activity was predictive of a worse prognosis compared to those without actively replicating B19V (p = 0.01). Moreover, multivariable analysis revealed transcriptional active B19V combined with inflammation [hazard ratio 4.013, 95% confidence interval 1.515–10.629 (p = 0.005)] as the strongest predictor of impaired survival even after adjustment for age and baseline LVEF (p = 0.005) and independently of viral load. The study demonstrates for the first time the pathogenic clinical importance of B19V with transcriptional activity in a large cohort of patients. Transcriptionally active B19V infection is an unfavourable prognostic trigger of adverse outcome. Our findings are of high clinical relevance, indicating that advanced diagnostic differentiation of B19V positive patients is of high prognostic importance.

Corneal calcification is a vision-threatening manifestation of calcium containing agents in ocular burn. As we previously reported, our interest was sparked by a particular discrepancy of a case: A patient treated for a non-calcium containing agent in eye burn from exposure to an alkaline mixture of NaOH and KOH, who unexpectedly developed corneal calcification. This current study aims to elucidate whether the 2 min lasting irrigation with a phosphate-buffered saline itself, regardless of rinsing regimen, triggers corneal calcification. The Ex Vivo Eye Irritation Test (EVEIT) system was used on rabbit corneas to replicate the very same phosphate-buffered saline solution the patient was treated with. The rabbit corneas were first burned with 1 M NaOH, rinsed with 4.9% phosphate-buffered saline for 2 min, and were then moisturized with an artificial tear solution for 48 h. All corneas were fluorescein-stained for photo documentation, snap-frozen, lyophilizated, and the electrolyte content was analyzed by Energy-Dispersive X-ray spectroscopy (EDX). The EDX analysis revealed pathological phosphorous in corneal stroma after a single rinsing with phosphate-buffered saline. Ongoing application of artificial tears containing physiological 14.581 mmol Ca2+ /l led to macroscopically visible calcification, but only in areas of induced corneal erosion. Regardless of the rinsing protocol neither 2 or 15 min of eye rinsing with phosphate containing rinsing solutions, we have given proof that corneal calcification is a foreseeable effect of the phosphate-buffered saline rinsing of mechanically epithelial damaged and chemically burnt eyes. Thus, it is crucial to legally restrict the formulations of phosphate-buffered salines in the medical treatment of eye burns, corneal erosions or chemical splashes of the eye.

ZusammenfassungDer demografische Wandel in Deutschland führt zu einer zunehmenden Zahl alter und pflegebedürftiger Personen, die stationär in Pflegeeinrichtungen betreut werden. Zusammen mit der Vergütungspraxis der Krankenkassen für Hausbesuche, auch von Fachärzten, sorgt dies für deutliche Defizite in der augenärztlichen Versorgung. Zur Entlastung des Systems wurde im Rahmen unserer Studie der ACTO-Sehtest getestet. Dieser kann nach einer kurzen Einführung auch von Laien durchgeführt werden. Für unsere Studie haben wir den Lesevisus von 218 Probanden in 4 Altenheimen in Deutschland beurteilt. Das Alter der Probanden lag bei mindestens 60 Jahren. Für die Studie wurden beide Augen einzeln untersucht, wobei eine eventuell vorhandene Lesebrille verwendet werden sollte. Das Pflegepersonal nutzte zur Bestimmung des Lesevisus den ACTO-Sehtest. Dieser stuft ab von 1 – 10, wobei 2 einem Dezimalvisus von 0,8 und 10 einem Dezimalvisus von 0,05 entspricht. Drei Wochen später ermittelte ein Augenarzt mithilfe der Birkhäuser-Lesetafeln ebenfalls den Lesevisus. Der Augenarzt erstellte eine allgemeine Anamnese und eine Anamnese der Augenerkrankungen, weiterhin erfolgte eine Untersuchung mittels Handspaltlampe und eine Funduskopie. Zwei Drittel der Heimbewohner gaben zu Beginn der Studie an, nicht unter Augenerkrankungen zu leiden. Die Untersuchung durch den Augenarzt zeigte jedoch, dass fast die Hälfte der Probanden dringend behandlungsbedürftig war. Der Vergleich der unterschiedlichen Sehtests zeigte, dass die Ergebnisse des ACTO-Lesetests mit den Werten der Birkhäuser-Lesetafel mit einem Korrelationskoeffizienten von r2 = 0,8443 korrelierten. Über den ACTO-Test wurde bei 40% der Probanden ein fehlender Lesevisus (> 7) ermittelt, über die Birkhäuser-Tafeln bei 35% (

Purpose This study was designed to detect CoV-RNA in the tears of polymerase chain reaction (PCR)-confirmed SARS-CoV-2 positive patients. Methods We performed a prospective case series study of hospitalized patients who have been confirmed SARS-CoV-2 positive by oropharyngeal swab within the previous 5 days. Tear samples obtained with a laboratory capillary and oropharyngeal swabs were analyzed by real-time PCR using the Altona SARS-CoV-2 Assay or the Roche SARS-CoV-2 LightMix PCR, depending on the availability. Patient history was documented, and ophthalmoscopy was used to assess for ocular surface disease. Results Of all 18 patients recruited in April 2020, 5 suffered from respiratory failure and were submitted to an intensive care unit. None of our patients had signs of viral conjunctivitis although all patients in intensive care showed chemosis and conjunctival hyperemia because of third-spacing or fluid overload. The presence of coronavirus RNA was confirmed by PCR in 5 of 18 patients (28%) in tears and 72% for oropharyngeal swabs. Conclusions Using a tear fluid sampling technique similar to oropharyngeal lavage presents a higher percentage of SARS-CoV-2 positive tears in contrast to earlier reports that used a conjunctival swab. This does not automatically indicate viral shedding in ocular tissue or contagiousness of tear fluid.

Introduction Since the beginning of the COVID-19 pandemic there has been some debate regarding the risk of transmission through tissue transplantation and tissue banking processes. Aim of the study To analyze the changes that SARS-CoV-2 has caused regarding the harvesting of corneal donor tissue and eye bank activities in Germany. Methods A questionnaire was provided to 26 eye banks in Germany, consisting of questions about adaptations made in the screening of potential donors and the harvesting of corneal tissue following the pandemic spread of SARS-CoV-2. Results Eighteen eye banks actively reduced recruitment of donors and two banks ceased all activity. Additional diagnostic screening was performed in eight banks, using conjunctival swabs and/or nasopharyngeal swabs. In six eye banks, additional protective measures, such as FFP2 masks and/or facial shields, were implemented. Overall, a mean reduction in the number of obtained donor tissues of 17% was observed. Discussion Conjunctival and/or nasopharyngeal swabs of donors have been implemented by a minority. Reasons for not performing additional tests may be moderate sensitivity and lack of validation for postmortem use of RT-PCR testing. Also, the hazard of SARS-CoV-2 entering the corneal donor pool with subsequent transmission might be perceived as theoretical. Face shields provide a sufficient barrier against splash and splatter contamination but may be insufficient against aerosols. Additional face masks would provide support against aerosols, but it remains debatable if corneal harvesting can be considered an aerosol-producing procedure. In the future we expect to see changes in current guidelines because of a surge in scientific activities to improve our understanding of the risks involved with cornea donation in the COVID-19 pandemic, and because current practice may reduce the availability of donor corneas due to new exclusion criteria while the demand remains unchanged.

Purpose This study analyzes the efficiency of different vitrectomy systems and compares single with double-bladed cutters. Methods The systems EVA™ (DORC), Constellation® Vision System (ALCON), megaTRON S4HPS (Geuder) and Stellaris® PC (Bausch and Lomb) were used. We chose 20G and 23G probes, since not all systems had switched to a smaller G at the time the study was conducted in 2016. Cut rates were varied in increments of 1000 cuts/min from 500 cpm to the system’s maximum and vacuum pressures were varied in increments of 100 mmHg, from 100 to 600 mmHg up to the individual system’s maximum. In this study water, egg white, Pluronic®−F127 gel and isolated porcine vitreous were used as models of human vitreous. The vitrectomy efficiency was calculated from the aspirated mass (g) within 30 s. The aperture of the different vitrectomy probes was filmed with a high-speed camera. Results The area under the curve analysis showed differences in efficiency between vitrectomy systems. For water, a reverse relationship between the aspirated mass and cut rate was shown. By contrast, for most systems aspirated egg white and porcine vitreous showed a non-linear increase or decrease for 4000 cpm and above. For all vitreous surrogates, EVA™’s double-bladed probe aspirated significantly (p Conclusion We can demonstrate differences in the efficiency of vitrectomy depending on the vitrectomy system used. Double-bladed probes were more efficient and probably safer than single-bladed probes.

Snakes belonging to the genus Naja (Elapid family), also known as "spitting cobras", can spit venom towards the eyes of the predator as a defensive strategy, causing painful and potentially blinding ocular envenoming. Venom ophthalmia is characterized by pain, hyperemia, blepharitis, blepharospasm and corneal erosions. Elapid venom ophthalmia is not well documented and no specific treatment exists. Furthermore, accidental ejection of venom by non-spitting vipers, as Bothrops, also occurs. The Ex vivo Eye Irritation Test model (EVEIT) has enabled important progress in the knowledge of chemical ocular burns. Considering the lack of experimental animal model, we adapted the EVEIT to study venom ophthalmia mechanisms. Ex vivo rabbit corneas were exposed to venoms from spitting (Naja mossambica, Naja nigricollis) and non-spitting (Naja naja, Bothrops jararaca and Bothrops lanceolatus) snakes, and rinsed or not with water. The corneal thickness and the depth of damage were assessed using high-resolution optical coherence tomography (HR-OCT) imaging and histological analysis. All Naja venoms induced significant corneal edema, collagen structure disorganization and epithelial necrosis. Corneas envenomed by African N. mossambica and N. nigricollis venoms were completely opaque. Opacification was not observed in corneas treated with venoms from non-spitting snakes, such as the Asian cobra, N. naja, and the vipers, B. jararaca and B. lanceolatus. Moreover, Bothrops venoms were able to damage the epithelium and cause collagen structure disorganization, but not edema. Immediate water rinsing improved corneal status, though damage and edema could still be observed. In conclusion, the present study shows that the EVEIT model was successfully adapted to set a new experimental ex vivo animal model of ophthalmia, caused by snake venoms, which will enable to explore new therapies for venom ophthalmia.

Purpose: Meibomian gland disease is generally accepted as the leading cause for evaporative dry eye disease (DED). In a previous study, perfluorohexyloctane, a semifluorinated alkane, has been demonstrated to significantly increase tear film breakup time and to reduce corneal fluorescein staining in patients with evaporative DED, thereby vastly reducing dry eye-related symptoms. This study was set up to evaluate perfluorohexyloctane in a larger population of patients with Meibomian gland dysfunction. Methods: Seventy-two patients with Meibomian gland disease and associated dry eye received 1 drop of perfluorohexyloctane 4 times daily during an observational, prospective, multicenter, 6–8-week study. Clinical assessment included best-corrected visual acuity, intraocular pressure, Schirmer test I, tear film breakup time, anterior and posterior blepharitis assessment, number of expressible Meibomian glands, meibum quality and quantity, ocular surface fluorescein staining, lid margin and symptom assessment, and Ocular Surface Disease Index (OSDI©). Results: From the 72 patients recruited, 61 completed the trial per protocol. Nine patients did not apply the medication as recommended and 2 patients were lost to follow-up. Tear film breakup time, corneal and conjunctival fluorescein staining, number of expressible Meibomian glands, and severity of anterior and posterior blepharitis significantly improved after 6–8 weeks of perfluorohexyloctane application. In addition, symptoms improved as demonstrated by a significant decrease of OSDI-values from 37 (±13) to 26 (±16). Conclusions: In concordance with previous findings, 6–8 weeks of topical application of perfluorohexyloctane significantly improves clinical signs of Meibomian gland disease and associated mild to moderate DED.

Ingredients of lubricant eye drops are potentially harmful to the ocular surface. The products Optive, Optive Fusion, Neopt were tested regarding corneal irritability versus Vismed Multi and 0.01% benzalkonium chloride as negative and positive control, respectively. Formulas (30-40μl per hour) were applied hourly in-vitro for six days on rabbit corneas (n=5, per product) cultured in artificial anterior chambers (EVEIT system). Initially, four corneal abrasions (2.4-4.6mm2) were induced. All defects were monitored during drop application by fluorescein stains and photographs. To ensure corneal vitality, glucose and lactate concentrations in artificial anterior chamber fluids were determined photometrically. All products showed a complete corneal healing on day 2. Thereafter, all five Optive-treated corneas developed progressive fluorescein-positive epithelial lesions until day six (24.96μm, ±21.45μm, p 0.5) while Vismed Multi did not adversely affect the corneal integrity. Glucose/lactate concentrations remained unchanged while lubricants were applied. Histology revealed epithelial loss and severe alterations of the superficial stroma for Optive. Optive Fusion displayed a comparable pathology. Neopt did not significantly affect the corneal healing and integrity. This study suggested a cumulative corneal toxicity of Optive and, to a lesser extent, Optive Fusion most likely caused by its oxidative preservative, SOC. Clinical data are needed to clarify the application frequency at which corneal toxicity might occur. Neopt and Vismed Multi did not affect the corneal integrity.

Clinical appearance, grading, and treatment of eye burns are explained. There is a brief and clear instruction how to treat best. The decisions to take, the medical products and drugs to use and the basic knowledge in ophthalmology of eye burns is detailed.

The demographic change in Germany has led to an increasing number of elderly and dependent persons being cared for in nursing homes. Additionally, public health insurance has tried to save money on home visits made by general practitioners and specialists. This has led to significant deficits in ophthalmic care. To relieve the stress on the health care system, we tested the ACTO eye test as part of our study. This test can be performed after a short introduction; even by laypeople. For our study, we assessed the vision of 218 persons, aged 60 or above, in four nursing homes in Germany. Both eyes were examined individually, with reading glasses if required. The nursing staff applied the ACTO eye test for vision testing. The classification of the ACTO test ranges from 1 to 10, where 2 corresponds to a decimal visual acuity of 0.8 and 10 to a decimal visual acuity of 0.05. Three weeks later, an ophthalmologist visited the care homes and employed the Birkhäuser reading boards to determine the visual acuity. The ophthalmologist also did a general medical history and a history of ocular diseases. She also examined the eyes using a handheld slit lamp and did a fundoscopy in miosis. Two-thirds of the residents stated at the beginning of the study that they did not suffer from any eye disease. However, the ophthalmologist's examination showed that nearly half of the subjects needed urgent treatment. The comparison of the different eye tests showed that the results of the ACTO reading test correlated with the results from the Birkhäuser panels with a coefficient of rDer demografische Wandel in Deutschland führt zu einer zunehmenden Zahl alter und pflegebedürftiger Personen, die stationär in Pflegeeinrichtungen betreut werden. Zusammen mit der Vergütungspraxis der Krankenkassen für Hausbesuche, auch von Fachärzten, sorgt dies für deutliche Defizite in der augenärztlichen Versorgung. Zur Entlastung des Systems wurde im Rahmen unserer Studie der ACTO-Sehtest getestet. Dieser kann nach einer kurzen Einführung auch von Laien durchgeführt werden. Für unsere Studie haben wir den Lesevisus von 218 Probanden in 4 Altenheimen in Deutschland beurteilt. Das Alter der Probanden lag bei mindestens 60 Jahren. Für die Studie wurden beide Augen einzeln untersucht, wobei eine eventuell vorhandene Lesebrille verwendet werden sollte. Das Pflegepersonal nutzte zur Bestimmung des Lesevisus den ACTO-Sehtest. Dieser stuft ab von 1 – 10, wobei 2 einem Dezimalvisus von 0,8 und 10 einem Dezimalvisus von 0,05 entspricht. Drei Wochen später ermittelte ein Augenarzt mithilfe der Birkhäuser-Lesetafeln ebenfalls den Lesevisus. Der Augenarzt erstellte eine allgemeine Anamnese und eine Anamnese der Augenerkrankungen, weiterhin erfolgte eine Untersuchung mittels Handspaltlampe und eine Funduskopie. Zwei Drittel der Heimbewohner gaben zu Beginn der Studie an, nicht unter Augenerkrankungen zu leiden. Die Untersuchung durch den Augenarzt zeigte jedoch, dass fast die Hälfte der Probanden dringend behandlungsbedürftig war. Der Vergleich der unterschiedlichen Sehtests zeigte, dass die Ergebnisse des ACTO-Lesetests mit den Werten der Birkhäuser-Lesetafel mit einem Korrelationskoeffizienten von r

Introduction Hydrofluoric acid (HF) is very corrosive and toxic for humans by all routes of exposures. Materials and methods Recent ex vivo studies have been conducted on eye, skin and respiratory track in order to determine the damages induced by HF. For respiratory effects, an experiment was designed to explore HF toxicological doses and effects on MucilAir ™ , a unique 3D Human Airway Epithelia reconstructed in vitro . Review of current available literature on clinical data was also performed. Results For inhalation exposure, up to 1.5 mM HF, no toxic effect was detected. From 7.5 mM, damage to epithelia were observed but could be repaired 7 days after exposure. 75 mM HF and above caused severe non reversible damage to epithelia. Ex Vivo Eye Irritation Test (EVEIT) combined with OCT allowed to characterise HF ocular burn with a complete diffusion into the cornea within 240 s for a 2.5% concentration. Ex Vivo study on human skin explants showed a diffusion in full skin within 5 min after a 70% HF exposure. Decontamination on both eye/skin ex vivo models with water alone or with calcium gluconate limited the diffusion but did not prevent all damages, whereas decontamination with an hypertonic amphoteric exposure such Hexafluorine solution avoided the diffusion and damages. This result is in agreement with the analysis of the clinical results of the literature. Conclusion Experimental models can help to understand chemical damages from HF exposures and design management based on new tools and devices in order to provide immediate and efficient decontamination to protect exposed workers.

Purpose To evaluate the impact of lubricant eyedrops on the corneal healing process and corneal toxicity. Methods Optive® and Cationorm® were tested regarding corneal irritability against Vismed Multi® and 0.01% benzalkonium chloride as negative and positive control, respectively. Formulas were applied on rabbit corneas (n = 5) cultured on artificial anterior chambers (EVEIT system) hourly over 3 days. Initially, 4 corneal abrasions (2–5.4 mm2) were induced. All defects were monitored during drug application by fluorescein stains and photographs. To ensure corneal vitality, glucose and lactate concentrations were determined photometrically in artificial anterior chamber fluids. Corneal fluorescein sodium permeability was tested as an indicator of the corneal barrier function. Results Optive® and Vismed Multi® showed a complete corneal healing on day 2. In one cornea (Optive®), erosion reoccurred on day 3. Erosion sizes of Cationorm®-treated corneas increased significantly from 12.20 mm2 to a subtotal erosion of 51.89 mm2 on day 3. Histology revealed epithelial loss and severe alterations of the superficial stroma for Cationorm®. Glucose and lactate concentrations did not change after application of Optive® and Vismed Multi®. In contrast, Cationorm®- and BAC-treated corneas showed a significant increase in lactate concentrations. Conclusions Vismed Multi® application resulted in rapid corneal healing. Whether the toxicity seen for Optive® in one cornea is a valid result should be examined further. Cationorm® showed considerable corneal toxicity that could be caused by its additive, cetalkonium chloride. Otherwise, the electrostatic properties of Cationorm® led to a drug film on the area of epithelial loss that could hinder epithelial cell migration and adhesion in order to heal the lesion.

Microbacterium species (formerly CDC [Centers for Disease Control and Prevention] coryneform group A-4 and A-5 bacteria) are widely distributed in the environment and rarely cause infections in humans. We present a case of endophthalmitis due to Microbacterium species that occurred after accidental trauma and review the literature on microbacterium infections. If the infected tissue or medical device is removed and antimicrobial therapy (preferably with beta-lactams or glycopeptides) is instituted, the prognosis is usually favorable for patients with microbacterium infections.

Background Although corneal transplant surgery in avascular normal risk eyes is becoming even more minimally invasive and successful, treatment options for difficult to treat patients with high risk eyes are still limited. In these cases HLA typed allogeneic transplants and artificial corneas (keratoprostheses) can be used. Methods This article combines a review of the literature in PubMed and own clinical experiences on the use of artificial corneas in high risk eyes. Osteo-odontokeratoprosthesis (OOKP), Boston Kpro, Miro Cornea® and KeraKlear® corneas were used as clinical keratoprostheses. Results Worldwide, the most experience exists for the use of Boston Kpro and OOKP in high risk eyes. Miro Cornea® and KeraKlear® are new procedures where only preliminary results are available and further evaluation is necessary. The longest experience and best anatomical long-term results have been achieved with OOKPs. Comparable cohorts are available for the Boston Kpro. The function of all keratoprostheses is threatened by secondary glaucoma. Implantation of the KeraKlear® prosthesis remains difficult. The Miro Cornea® shows an initially stable integration behavior. Conclusion Keratoprostheses, such as the Boston Kpro and OOKP are valid treatment options for eyes which are not open to therapy with allogeneic corneal transplantation. Modern implants such as KeraKlear® prosthesis and Miro Cornea® need further prospective clinical evaluation.

The optical coherence tomography (OCT) is a non-invasive imaging technique, which recently has found important clinical micrometer applications. It allows noncontact and non-invasive cross-section imaging of the tissues with a depth resolution of about 10 µm. Similar to high-frequency ultrasound, the OCT shows real-time cross-sectional images of the tissue structures and tissue layers in a depth of a few millimeters. The OCT has evolved to an indispensable tool in ophthalmic diagnosis. An emerging application is the intraoperative use of OCT (iOCT). We developed the first commercially available device for the OCT, a universal OCT-Camera, which can be attached to the camera port of the different surgical microscopes. The OCT-Camera is completely integrated into the surgical procedure by enabling the OCT imaging before, during, and after microsurgery without interruption. The individual steps and the outcome of the surgical procedures, such as transplantation of the thin membranes or micro implants, are visualized in real time. The easy handling and first clinical applications of the iOCT were successfully demonstrated.

Es besteht eine gewisse Unsicherheit in der Ophthalmologie uber die Qualitat und spektrale Durchlassigkeit von sog. Blaufilter-Intraokularlinsen (IOL). Die verschiedenen Produkte erscheinen dem Operateur verschieden stark gefarbt. Die Diskussionen um medizinische Auswirkungen hangen aber entscheidend von der realen Transmission der Intraokularlinsen ab. Diese Frage zu objektivieren dient unsere Studie an verschiedenen derzeit erhaltlichen Intraokularlinsen mit Blaufilter-Charakteristik. Unterschiede in der Brechkraft wurden ebenso berucksichtigt wie messtechnische Differenzen auf der Basis von geometrischen Uberlegungen. Das Ergebnis belegt, dass es grose Unterschiede in der Transmission von Licht durch verschiedene Blaufilter-IOL gibt. Diese werden in der Publikation detailliert dargestellt.

Chemical burns of the eye are becoming rare due to improvements in occupational protection. Effective decontamination is the foundation for good clinical results of this ophthalmological emergency. The toxicological aspect focuses on classifying the specific toxicity of a chemical substance by evaluating the degree of eye irritation and eye burns. Chemical substances are classified into defined risk levels by specific tests. The traditional ophthalmological approach is based on the clinical presentation of eye burns as a result of contact with a specific toxic substance. In an integral approach it is shown that substance-specific characteristics, such as concentration and specific reactivity as well as individual features, such as mode and duration of exposition have an influence on the clinical appearance of the tissue damage. The decontamination is dependent on the mode of action and the effectiveness of the decontamination solution. Amphoteric substances have the best effectiveness for decontamination of the eye due to their specific characteristics.

Nach VEGF-Injektionen sind monatliche Kontrollen durch den betreuenden Augenarzt erforderlich, um einen erneuten Visusabfall zeitnah zu erkennen. Dieses Zeitintervall ist fur viele altere AMD-Patienten nicht einhaltbar. Vielfach stosen die Praxen an ihre logistischen Grenzen; die Vergutung der zusatzlichen arztlichen Leistung ist unzureichend. Vor diesem Hintergrund entstand der ACTO-Selbsttest. Bei dieser Screeningmethode kann der Patient seine Leseleistung selbst uberprufen, um Veranderungen der Sehkraft – auserhalb der Routinekontrollen beim Augenarzt – aufzudecken. Der papiergestutzte ACTO-Selbsttest besteht aus einer in Dezimalschritten abgestuften Sehtesttafel und einem Amsler-Gitternetz mit 6 „Ja-Nein“-Fragen sowie einer Anleitung. Der Patient fuhrt den Selbsttest an beiden Augen getrennt durch und ubertragt die Ergebnisse in eine Tabelle. Das „Aktion Augenlicht“ Service Center begleitet die Untersuchungen telefonisch, motiviert den Patienten und vereinbart bei stabilem Testergebnis neue Kontrolltermine. Fallt das Ergebnis schlechter aus oder besteht der Verdacht auf eine Visusminderung, erfolgt umgehend eine Terminvereinbarung beim betreuenden Augenarzt. Zwischen den Lesestufen des ACTO-Selbsttests und der dezimalen Sehscharfe in die Ferne besteht eine gute Korrelation (r2=0,9). Insgesamt wurden 1444 Patienten telefonisch begleitet, 745 von ihnen nahmen an dem regelmasigen Kontrollprogramm teil. Insgesamt kam es zu 3003 Kontakten. In 137 Fallen wurde der Augenarzt uber ein verschlechtertes Ergebnis beim ACTO-Selbsttest informiert und eine umgehende augenarztliche Uberprufung vereinbart. 699 Patienten wurden als sog. „dropouts“ nicht weiter verfolgt. Die Grunde dafur waren in 39% der Falle ein Visusabfall unterhalb der Grenzen des ACTO-Selbsttests, bei 29% eine gleichzeitige monatliche augenarztliche Kontrolle und bei 32% eine – trotz anfanglicher schriftlicher Einwilligung – nicht mehr gewunschte Betreuung. Im Verlauf der Erhaltungsphase kam es bei rund 18% der AMD-Patienten zu einer Verschlechterung der ACTO-Selbsttest-Ergebnisse. Durch den monatlich durchgefuhrten ACTO-Selbsttest kann, in Kombination mit der telefonischen Unterstutzung, eine erneute Leseminderung zeitnah erkannt und augenarztlich als echte Visusminderung bestatigt werden. Der Selbsttest ersetzt dabei nicht die qualifizierte Funduskopie des Augenarztes. Allerdings erhohen die monatlich durchgefuhrten Selbsttests – bei gleichzeitig wenigeren Arztkontakten – die Sicherheit bei der Erkennung eines Rezidivs. Gleichzeitig kann dadurch die fruhzeitige augenarztliche Intervention bei Visusveranderungen verbessert werden.

Between February 1992 and March 1994, reconstruction of the fornices in 17 patients with extensive symblephara or lid fusion after most severe eye burns was performed with nasal mucosa from the inferior conchae as graft material. The time between accident and transplantation ranged from 2-64 months. All patients were followed for 6 to 31 months. Reconstruction of the fornices was achieved in 13 patients. Postoperative Schirmer-tests revealed markedly improved results. Impression cytology showed a persistence of goblet-cells and an excess of mucus. We have subsequently performed keratoplasties in 5 of these patients and are planning penetrating keratoplasties in a further 8 cases. In 4 patients, partial symblepharon formation recurred within 2-3 months after transplantation of nasal mucosa. The main advantage of nasal mucosa over buccal or labial mucosa may be the transplantation of intraepithelial goblet cells, leading to an improvement and stabilisation of the tear film.

The prediction of side-effects is a key issue in the REACH initiative on chemicals, in the production of cosmetics and in the preclinical testing of drugs. A new ex vivo test for repeated substance application is presented, that is able to identify corrosive and irritant effects on the eye by using crucial endpoints, such as cellular and morphological damage, and healing characteristics. The test is intended to replace the Draize eye test and to improve the preclinical testing of drugs and chemicals that are likely to come into direct contact with the cornea. The Ex Vivo Eye Irritation Test (EVEIT) is a self-healing system, involving living corneas obtained from abattoir rabbit eyes. The corneas are cultured in a similar way to the method used during the transplantation of corneal grafts. The corneas are exposed to multiple small, mechanical abrasions, and then test substances are repeatedly dropped onto the centres of the corneas. The test substances applied in this study were citrate-buffered hyaluronate eye drops and an artificial tear replacement, with increasing concentrations of up to 0.1% benzalkonium chloride. A dose-dependent inhibition of recovery and impairment of the lactate production mechanism in the cornea was observed with benzalkonium chloride treatment.

Ocular hypotony secondary to proliferative vitreoretinopathy-related retinal detachment, trauma or inflammation is difficult to treat. Besides endotamponades such as silicone oil, vitreous implants such as iris diaphragms or balloons have been developed to stabilize the eye and to prevent phthisis of the globe. Vitreous implants tested thus far exhibit a seam at the attachment site of the hemispheres, or micropores. This manuscript reports the development of a seamless silicone balloon implant without micropores, which can be filled with silicone oil and surface-modified to improve its biocompatibility. Developed for intraocular placement in the management of chronic hypotony and phthisis prevention, it may also be suitable for tamponading retinal detachments. Silicone was used as the basic structure for the fabrication of a seamless balloon-shaped intraocular implant, which was coated by employing a six-arm star-shaped (sP) macromer of a copolymer of 80 % ethylene oxide (EO) and 20 % propylene oxide (PO) with conjugated functional terminal isocyanate groups, NCO-sP(EO-stat-PO), with and without heparin. Three variants of implants, which differ in their surfaces, were manufactured: uncoated silicone, NCO-sP (EO-stat-PO) coated silicone and heparin-NCO-sP (EO-stat-PO) coated silicone implants. To exert a tamponade effect, the implant was filled with silicone oil and its properties were studied. Seamless thin balloon implants made of silicone, which are considered biocompatible and intrinsically resistant to biological attacks in vivo, could be fabricated in different sizes. The silicone oil-filled implant can mimic the mechanism of buoyant force and high surface tension of silicone oil, which is the only long-term vitreous substitute currently available. The silicone oil-filled implant can also mimic the natural vitreous body by occupying the entire posterior segment. The intraocular silicone implant as an alternative long-term treatment of chronic ocular hypotony might offer a new option for clinical ophthalmological practice. In vivo studies need to be performed to collect more data on the implant’s long-term mechanical and optical properties, as well as long-term biocompatibility.

Ocular irritation testing is a common requirement for the classification, labelling and packaging of chemicals (substances and mixtures). The in vivo Draize rabbit eye test (OECD Test Guideline 405) is considered to be the regulatory reference method for the classification of chemicals according to their potential to induce eye injury. In the Draize test, chemicals are applied to rabbit eyes in vivo, and changes are monitored over time. If no damage is observed, the chemical is not categorised. Otherwise, the classification depends on the severity and reversibility of the damage. Alternative test methods have to be designed to match the classifications from the in vivo reference method. However, observation of damage reversibility is usually not possible in vitro. Within the present study, a new organotypic method based on rabbit corneas obtained from food production is demonstrated to close this gap. The Ex Vivo Eye Irritation Test (EVEIT) retains the full biochemical activity of the corneal epithelium, epithelial stem cells and endothelium. This permits the in-depth analysis of ocular chemical trauma beyond that achievable by using established in vitro methods. In particular, the EVEIT is the first test to permit the direct monitoring of recovery of all corneal layers after damage. To develop a prediction model for the EVEIT that is comparable to the GHS system, 37 reference chemicals were analysed. The experimental data were used to derive a three-level potency ranking of eye irritation and corrosion that best fits the GHS categorisation. In vivo data available in the literature were used for comparison. When compared with GHS classification predictions, the overall accuracy of the three-level potency ranking was 78%. The classification of chemicals as irritating versus non-irritating resulted in 96% sensitivity, 91% specificity and 95% accuracy.

Purpose To evaluate the impact of antiglaucoma drugs on the corneal healing process and corneal toxicity. Materials and methods Four eye drops to treat glaucoma--Xalatan (latanoprost 50 μg/mL; Pfizer), Monoprost (latanoprost 50 μg/mL; Thea Pharma), Taflotan Sine (tafluprost 15 μg/mL; Santen Pharmaceutical Co.), Travatan (travoprost 40 μg/mL; Alcon), and 0.02% benzalkonium chloride (BAC) solution and HyloComod (1 mg/mL sodium hyaluronate; Ursapharm) as positive and negative control were tested regarding corneal irritability and effect on corneal healing. Formulas were tested over 3 days and administered 6 times daily on rabbit corneas cultured on an artificial anterior chamber (the Ex Vivo Eye Irritation Test system). Initially, 4 corneal abrasions (2.5 to 5.7 mm2) were applied. All defects were monitored during drug application by fluorescein stains and photographs. Glucose/lactate concentrations were monitored for corneal metabolic activity evaluation. Results For Xalatan and BAC, the corneal erosion size increased from 14.65 to 66.57 mm2 and 14.80 to 87.26 mm2. Travatan and Taflotan Sine did not interfere with corneal healing. Monoprost delayed corneal healing. For Xalatan and BAC, histology showed severe alteration of the superficial cornea. An increase in anterior chamber lactate concentration indicates corneal toxicity for Xalatan, BAC, and Monoprost. Conclusions Corneal toxicity of Xalatan is most probably caused by BAC. Monoprost delays corneal healing, which is not well understood. The Monoprost effects could be caused by its additive, macrogolglycerolhydroxystearate 40. This excipient is a known skin irritant, and its concentration is relatively elevated in Monoprost, 50 mg/mL, compared with its active ingredient, latanoprost (0.05 mg/mL).

Little is known about how the osmolarity of ophthalmic formulations affects the ocular surface. Because hyperosmolar eye drops could be therapeutic for treating corneal edema, this article presents an ex vivo model of corneal edema for testing ophthalmic drugs based on their osmolarity. The respective osmolarity of common eye drops found in the German market is also analyzed here.For modeling corneal edema, an Ex Vivo Eye Irritation Test was used to simulate an ocular anterior chamber with a physiological corneal barrier. To induce corneal edema, the anterior chamber was supplied with a hypoosmolar medium (148 mOsm/L) for 24 hours. Preserved and preservative-free 5% sodium chloride (hyperosmolar Omnisorb and Ocusalin 5% UD) were used for 1 hour, on 5 corneas each, to test their efficiency to reduce corneal edema in this model. Corneal thickness was determined by optical coherence tomography. Osmolarity of 87 common eye drops was measured by freezing point osmometry.Ex vivo, the tested hypoosmolar condition induced corneal edema from 450 μm (±50 μm) at baseline to 851 μm (±94 μm, P0.0001). Omnisorb and Ocusalin 5% UD significantly reduced the corneal thickness by 279 μm (±28 μm, P0.001) for Omnisorb and 258 μm (±29 μm, P0.001) for Ocusalin 5% UD. Forty-three (49%) of the tested products had an osmolarity below and 44 (51%) above the physiological tear osmolarity of 289 mOsm/L. Osmolarity values of less than 200 mOsm/L were found in lubricant drops. The highest osmolarity was detected in Omnisorb (1955 mOsm/L).The Ex Vivo Eye Irritation Test has proven to be a reliable novel model of corneal edema for evaluating osmotic eye drops. Osmolarity measurements revealed a wide range from hypotonic to hypertonic formulations for commonly marketed ophthalmic drugs.

Purpose Chemical burns with calcium containing corrosives as well as irrigation with phosphate buffer solutions after eye burns bear the risk of corneal calcification. The aim of this study was to evaluate the correlation between the occurrence of corneal calcification after chemical injuries and the usage of phosphate buffer containing local therapeutics. Methods We reviewed the data of 179 patients who have been treated in the University Eye Clinic Aachen, Germany, between 1941 and 2000. Only when the corrosive did not contain calcium and when the initial irrigating solution did not contain phosphate buffer, respectively, were patients included in the study. The cases were analyse, if the patient was treated with phosphate buffer containing eye drops/ointment during the first 7 days of hospitalization or as an out-patient, and if corneal calcification was visible by slit-lamp examination during the follow-up. Statistical analysis was performed using Fischer's exact test. Results 152 eyes were included. From 63 eyes treated with phosphate buffer containing eye drops, 31 eyes (49%) developed corneal calcification. From 89 eyes treated without phosphate buffer containing eye drops, only 23 eyes (26%) developed corneal calcification. The two-sided p-value of Fischer's exact test is 0.0036. Conclusion During follow-up after chemical eye burns, eye drops containing phosphate buffer double the risk of corneal calcification. We recommend avoiding these agents in order to prevent the burned cornea from additional opacity. Substances containing phosphate buffer are listed in this article.

Purpose: To evaluate the effects of hypo-osmolar tap water and isotonic saline solution on the intracameral pH, intraocular pressure and histological changes in alkali burned rabbit eyes. Methods: Four groups of four rabbit corneas each were burned with 2 N sodium hydroxide, and then rinsed with 0.5 l or 1.5 l of saline solution or tap water, respectively. Changes in pH were monitored with an intracameral microelectrode. Intraocular pressure (IOP) was monitored by a transducer placed in the vitreous cavity. After enucleation, histology was performed. Results: The pH increased after 1.5 min following alkali application. Irrigation with different solutions affected the maximum pH levels reached. Following the tap water rinse, the maximum rise was significantly lower than after the saline solution rinse. The maximum rise following rinsing with 1.5 l of tap water showed a significant delay. The increase in IOP was 23 ± 10 mmHg without differences between the groups; the original pressure was recovered after 18 ± 9 min. Histology of the eyes revealed a significant oedema in all corneas. Other ocular structures appeared unchanged. Conclusions: The hypo-osmolarity of tap water led to remarkable corneal oedema. Enlargement of the diffusion barrier and intracorneal dilution inhibit elevated intracameral pH levels. The difference in maximum pH levels reached may influence the degree of subsequent intraocular structure injury. Therefore, the use of iso-osmolar saline solution proves to be less efficacious than tap water as an irrigation agent for ocular burns.

The clinical pattern of corneal calcification has been considered to be a part of chronic eye diseases, such as uveitis, severe glaucoma, keratitis and eye burns. Since, in some cases of eye burns, we have found corneal calcifications to be related to the initial calciferous caustic agents and to the use of phosphate-buffer-containing fluids, we have reviewed our files of clinical eye burns for the incidence and appearance of corneal calcification.A total of 176 burnt eyes of 98 patients suffering from severe eye burns were retrospectively reviewed. The following data set was acquired: the type of caustic agent, the time of the burns, the delay and type of immediate treatment and the time and type of first aid, the subsequent medication, the clinical grading and the later results.Calciferous burning agents and corneal calcification are correlated (P0.01). Initial single rinsing with phosphate does not produce corneal calcification (P=0.134). There is evidence that corneal calcifications are correlated with chronically administered phosphate-buffered eye drops (P0.005).Eye burns followed by calcifications follow two different major patterns: the corrosive substance contained calcium or the continued therapy was applied with phosphate-buffered eye drops. We present case reports of three different types of eye burns and later therapy resulting in corneal calcification. Corneal calcifications are presumably related to longer-lasting phosphate application. One suspicious mechanism is the low content of calcium ion stabilizing proteins such as hyaluronate or fetuin in treatments for severe eye burns. The exceeding of the solubility product of Ca(2+) and PO(4) (-) results in the precipitation of calcium phosphates. In cases of chronic corneal disturbance, we recommend the elimination of phosphate-buffered medications to prevent corneal calcification.

Purpose: Proliferation control in adult retinal pigment epithelial (ARPE) cells is an essential factor in the clinical management of proliferative vitreoretinopathy (PVR). Factors which inhibit PVR and which are without toxic potential are therefore of interest in controlling proliferation. The aim of the present study was to gain insight into a possible function of high intraocular ascorbic acid levels as a physiological modulator of proliferation. Methods: Adult retinal pigment epithelial cells were incubated in vitro with increasing concentrations of ascorbic acid (0.5–4 mmol, pH 7.4). Cell proliferation was assayed by the bromide-deoxy-uridine (BrdU) assay. The culture medium (CM) containing ascorbic acid was replaced with normal CM and the recovery of proliferation was measured after 24 hours. In order to be able to distinguish between proliferation inhibition, apoptosis, necrosis and recovery of proliferation, we performed TUNEL assays and fluorescence analysis cell-counter (FAC) analysis. Results: Ascorbic acid significantly inhibits ARPE cell proliferation if it is present in concentrations above 2 mmol. Proliferation resumed in all ARPE cell cultures after pre-incubation with ascorbic acid, indicating that direct toxicity of ascorbic acid is a negligible factor. The time-point and extent of recovery in proliferation was dependent on the initial ascorbic acid concentration. Fluorescence-labelled cell counts on apoptosis markers (FAC) data showed some induction of apoptosis and necrosis after incubation with 4 mmol ascorbic acid. Conclusions: Ascorbic acid has a dose-dependent influence on the proliferation of vital ARPE cells. This possibly reflects the role of ascorbic acid at a physiological level within the vitreous cavity in preventing proliferative vitreoretinopathy (PVR). These findings may stimulate the development of new strategies in the clinical treatment of PVR.

Die Augenspulung ist nach Augenveratzungen eine anerkannte Erste-Hilfe-Masnahme. Hierbei soll das atzende Agens entfernt, verdunnt und am besten auch neutralisiert werden. Im Vergleich zu den herkommlichen schon lange klinisch angewendeten Augenspulmedien (Wasser, NaCl 0,9%, Ringer-Lactat und Phosphatpuffer) soll hier die relativ neue Substanz Previn® in Bezug auf Vertraglichkeit und Wirksamkeit gestestet werden. Die erste Studie (I) befasst sich mit dem Unschadlichkeitsnachweis von Previn® an 10 gesunden Probanden nach Spulung mit 500 ml im Vergleich zur Augenspulung mit Phosphatpuffer, die mithilfe von konfokaler- und Spaltlampenmikroskopie ausgewertet wurde. In einem zweiten Ansatz (II) wurde a) die Pufferkapazitat unterschiedlicher Augenspullosungen in vitro und b) ihre unterschiedliche Wirkung auf Hornhautoberflachen- und Vorderkammer-pH bei Kaninchen nach 30 s Veratzung mit 1 N NaOH getestet. (I) Es konnten keine negativen Auswirkungen von Previn® auf das gesunde menschliche Auge gefunden werden. Es besteht in der Vertraglichkeit kein Unterschied zwischen Previn® und Phosphatpuffer. (IIa) Pufferkapazitatsmessungen in vitro ergaben eine etwas bessere Pufferkapazitat fur Previn® im Vergleich zu Phosphatpuffer oder Ringer-Lactat sowohl im sauren als auch im basischen Bereich. (IIb) Die In-vivo-Messungen ergaben einen vergleichbaren Puffereffekt von Previn® und Phosphatpuffer. Die o. g. Studien haben gezeigt, dass Previn® im Vergleich zu den herkommlichen Spulmedien vertraglich ist und in der Pufferkapazitat eine vergleichbare Wirkung hat wie Phosphatpuffer. Phosphatpuffer und Previn® sollten nur in der Erste-Hilfe Therapie und nicht zur prolongierten Augenspulung verwendet werden.

Hintergrund. Bei einem partiellen oder vollstandigen Verlust des Irisdiaphragmas fuhrt eine Silikonoltamponade haufig zu einer Keratopathie. Kunstliche Irisdiaphragmata konnen eine solche Komplikation vermeiden.Bei hypotonen Augen ist dabei wegen der unzureichenden Kammerwasserzirkulation ein geschlossenes Diaphragma notwendig. Methoden. In dieser retrospektiven Studie wurden die Verlaufe von 41 Patienten (41 Augen) untersucht, die im Zeitraum von 1996–2000 nach Silikonolchirurgie mit einem geschlossenen Irisdiaphragma versorgt wurden.Alle 41 Augen waren aphak. Die haufigsten Diagnosen waren Trauma (22 Augen, 54%), PVR-Amotio (12 Augen, 29%), schwere Uveitis (4 Augen, 10%) und schwere proliferative diabetische Retinopathie (3 Augen, 7%).Die Nachbeobachtungszeit betragt im Mittel 12 Monate. Ergebnisse. Bei 25 Augen (61%) wurde das Silikonol hinter dem Diaphragma zuruckgehalten. Bei 14 Augen (34%) kam es zu einer Abflachung der Vorderkammer.Bei 2 Augen war,wegen der getrubten Hornhautsituation, eine Beurteilung des Silikonolstands nicht moglich.Eine Verschlechterung der Hornhautsituation insgesamt sah man bei 11 Augen (27%).Als Langzeitkomplikationen zeigten sich eine weiterhin bestehende Hypotonie (≤5 mm Hg) bei 29 Augen (71%),Fibrinreaktion bei 13 Augen (32%) bis hin zur Ausbildung von Fibrinmembranen (9 Augen, 22%).Der Visus blieb bei 39 Augen (95%) stabil, verbesserte sich bei keinem Patienten und verschlechterte sich in 2 Fallen (5%). Schlussfolgerung. Trotz aller Komplikationen stellt das kunstliche Irisdiaphragma einen Fortschritt zum Erhalt schwersttraumatisierter Augen dar,wenngleich eine persistierende Hypotonie bei 29 Augen (71%) fortbesteht. Ein Silikonol-Hornhautendothel-Kontakt wird in 25 Augen (61%) im Beobachtungszeitraum verhindert. Es trat keine Phthsis bulbi oder Enukleation ein. Die Entwicklung einer verbesserten Abdichtung am Ubergang des Irisdiaphragmas zur Bulbuswand ist wunschenswert.

Background To report on our clinical experience with autologous platelet concentrate and indocyanine green(ICG)-assisted internal limiting membrane (ILM) peeling in macular hole surgery. Patients and methods Standard 3-port vitrectomy was performed in 107 eyes of 101 patients (m: f = 27 : 74; mean age 60 +/- 9, range 30 - 80 years) with idiopathic macular hole stages II - IV. After fluid/air exchange, autologous platelet concentrate was applied (1.9 +/- 0,1 x 10(8) thrombocytes). ILM peeling, which was preceded by ICG staining in 19 eyes, was performed in 34 patients. Results After one procedure, anatomic success (hole closure) could be achieved in 85 % (n = 68), 75 % (n = 27) and 100 % (n = 3) of the eyes with stage II, III and IV holes, respectively. The mean visual acuity improved by 1 line. The overall initial closure rate of 82 % could be further enhanced to 96 % with a second procedure. In eyes pretreated with ICG, an initial rate of hole closure in 94 % and an improvement of visual acuity by 2 lines was observed. Conclusion Autologous platelet concentrate appears to be a safe and reliable adjunct to improve the anatomical outcome of conventional macular hole surgery. Functional results can be further enhanced by ICG-assisted ILM peeling

An amphoteric rinse used in the emergency treatment of a serious ocular burn Max Gerard a,∗, Harold Merle b,1, Frederick Chiambaretta c,2, Daniele Rigal c,3, Norbert Schrage d a Service d’Ophtalmologie, Centre Hospitalier de Cayenne, Rue des Flamboyants, 97300 Cayenne, Guyane Francaise, France b Service d’Ophtalmologie, Centre Hospitalier Universitaire de Fort de France, Hopital Pierre Zobda Quitman, BP 632, 97261 Fort de France Cedex, France c Service d’Ophtalmologie, Centre Hospitalier Universitaire de Clermont Ferrand, Hopital Gabriel Montpied, Rue Montalembert, BP 69, 63003 Clermont Ferrand Cedex, France d Labor der Augenklinik RWTH, PauwelsstraBe 30, D-52057 Aachen, France

Background. Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of the ILM is an obstacle for successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. Patients and methods. Eighteen eyes with macular holes stages 2–4 were included. Intraoperatively, the ILM was stained with three drops of 1:9-diluted ICG. After 1 min incubation, the vitreous cavity was rinsed with Ringer's lactate solution, and the ILM was peeled. Autologous thrombocytes were applied to the macular hole and the eye was endotamponaded with 20% SF-6 gas. Preoperatively, 6 weeks postoperatively, and in 3-month intervals thereafter, visual acuity, fundus photographs, scanning laser ophthalmoscope imaging, and Humphrey 24–2 static perimetry was performed. Results. Intraoperatively, the ILM could be nicely visualized by ICG, which allowed easier and less traumatic peeling. At 6 weeks follow-up, visual acuity had improved in 14 of 18 patients, and the macular hole was closed 6 weeks after surgery. Scanning laser imaging revealed a strong signal. During prolonged follow-up, visual acuity declined due to cataract formation. Conclusion. ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We observed no negative effects on retinal function, but patients should be followed.

Chemical and thermal eye burns account for a small but significant fraction of ocular trauma. The speed at which initial irrigation of the eye begins, has the greatest influence on the prognosis and outcome of eye burns. Water is commonly recommended as an irrigation fluid. However, water is hypotonic to the corneal stroma. The osmolarity gradient causes an increased water influx into the cornea and the invasion of the corrosive substance into deeper corneal structures. We therefore recommend higher osmolarities for the initial rinsing to mobilize water and the dissolved corrosives out of the burnt tissue. Universal systems such as amphoteric solutions, which have an unspecific binding with bases and acids, provide a convenient solution for emergency neutralisation. Both conservative anti-inflammatory therapy and early surgical intervention are important to reduce the inflammatory response of the burnt tissue. In most severe eye burns, tenonplasty re-establishes the conjunctival surface and limbal vascularity and prevents anterior segment necrosis.

PURPOSE: To report the use of perfluorohexyloctane, a liquid semifluorinated alkane that is heavier than water, as an internal tamponade agent in surgery for complicated retinal detachments. DESIGN: A consecutive interventional case series from three study centers. METHODS: In 23 consecutive eyes (23 patients, 19 men and four women, mean ± standard deviation (SD) age of 58.5 years ± 16.1) perfluorohexyloctane was used for long-term internal tamponade. Included were eyes with complicated retinal detachment involving the lower two quadrants of the fundus. Excluded were patients with diseases in the fellow eye or severe systemic disease. A pars plana vitrectomy was performed, including membrane peeling and retinotomy where necessary. RESULTS: The mean duration for perfluorohexyloctane being left in situ was 76 days (SD 37.64) (range, 35–202 days). Four weeks following the removal of perfluorohexyloctane 19 of the 23 patients had total reattachment of the retina; three eyes had a recurrence of retinal detachment. One patient was lost to follow-up. The mean follow-up after perfluorohexyloctane removal was 97 days (range, 48 to 169 days). Cataract formation or progression was noted in nine of the 10 eyes. There were two cases with high intraocular pressures. Dispersion into small droplets was observed as early as 3 days postoperatively in three of the 23 patients. At least 12 of the 23 patients had an obvious dispersion by the time of perfluorohexyloctane removal. There was no sign of optic atrophy, retinal necrosis, or retinal vascular occlusion. CONCLUSION: Perfluorohexyloctane was tolerated as a long-term internal tamponade agent without obvious signs of damage to the retina or optic disk. Of all the complications noted, the most common was that of dispersion of the perfluorohexyloctane bubble into droplets.

In Deutschland stellen 27 Hornhautbanken die Versorgung mit menschlichem Gewebe fur die Transplantation der Hornhaut des Auges und der Amnionmembran sicher. Die Sektion fur Gewebetransplantation und Biotechnologie der Deutschen Ophthalmologischen Gesellschaft erfasst die Aktivitaten jahrlich mittels Fragebogen; 21 Hornhautbanken sendeten den Fragebogen beantwortet zuruck. Im Jahr 2009 wurden von 21 Hornhautbanken insgesamt 4818 Hornhauttransplantate konserviert; 57% erfullten die Qualitatskriterien fur eine Hornhauttransplantation. Diese Quote ist etwas hoher als der europaische Durchschnittswert. Zusatzlich wurden 1257 Amniontransplantate zu Transplantationszwecken freigegeben. Die deutschen Hornhautbanken stellen sich aktuell den regulatorischen Hurden des novellierten Transplantationsgesetzes bzw. der Transplantationsgesetz-Gewebeverordnung. Ein sehr aktuelles Problem stellt dabei die sog. 24-h-Regel fur postmortale Blutentnahmen nach europaischem Recht dar mit der Folge einer deutlichen Reduzierung des Spenderpools.