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BACKGROUND In accordance with worldwide data, the Robert Koch Institute (RKI) has reported a constant increase of syphilis cases in Germany over the past decade. METHODS We analysed the data of all patients, referred to a Department of Ophthalmology in a tertiary referral centre in Dusseldorf, Germany between 2008 and 2019, who were tested for syphilis. The epidemiologic, demographic, clinical, diagnostic and therapeutic data were retrieved from the records and evaluated in a retrospective, descriptive, non-comparative study. RESULTS Syphilis serology was positive in 32/1840 (1.7%) patients, and was evenly distributed over this period. 26 (81.3%) were male, 19 (59.4%) belonged to a risk group. Ocular syphilis was the primary diagnosis for 29 patients (90.6%). The most frequent manifestation was uveitis (n = 20, 62.5%). By the end of therapy, 19 patients (59.4%) had an improved visual acuity. CONCLUSION The incidence of ocular syphilis cases has remained stable over the last decade.

Climate change is also an increasingly important issue in the healthcare system. Due to its anatomical and physiological nature, the eye is directly exposed to environmental influences and changes in a special way.The current literature is used to illustrate the effects of climate-induced changes and the respective influences on the eye. A PubMed search (cut-off date 3 October 2021) using the search terms "climate change" or "planetary health" or "global health" and in each case "ophthalmology" or "eye" or "ocular" was used to determine the development of the number of publications between 2011 and 2021.Measurable effects of climate change are already evident in a wide variety of ophthalmological fields. The significance of this topic, for instance, is reflected in a relatively constant increase in the number of publications and an almost tenfold increase in the number of publications per year from 2011 to 2021.The impact of climate change on eye diseases and on the field of ophthalmology is multifaceted and could be expected to intensify in the coming years. Therefore, the interrelationships need to be further investigated in future studies, preferably on a large scale.HINTERGRUND UND ZIELE: Auch im Gesundheitswesen gewinnt der Klimawandel zunehmend an Bedeutung. Das Auge ist aufgrund seiner anatomischen und physiologischen Beschaffenheit Umwelteinflüssen und -veränderungen in besonderer Weise direkt ausgesetzt.Anhand aktueller Literatur werden die Auswirkungen klimabedingter Veränderungen und die jeweiligen Einflüsse auf das Auge dargestellt. In einer PubMed-Suche (Stichtag 03.10.2021) mit den Suchworten „Climate change“ oder „Planetary Health“ oder „Global Health“ und jeweils „Ophthalmology“ oder „Eye“ oder „ocular“ wurde der Verlauf der Publikationszahlen zwischen 2011 und 2021 ermittelt.Bereits jetzt zeigen sich in verschiedensten Bereichen der Augenheilkunde messbare Folgen des Klimawandels. Unter anderem drückt sich der Stellenwert dieses Themas in relativ konstant steigenden Publikationszahlen und einer annähernden Verzehnfachung der jährlichen Publikationen von 2011 bis 2021 aus.Der Einfluss des Klimawandels auf Augenerkrankungen und die Augenheilkunde ist vielfältig und könnte sich absehbar in den nächsten Jahren weiter verstärken. Die Zusammenhänge müssen deshalb in zukünftigen, möglichst groß angelegten Studien weiter untersucht werden.

In 1999 the global initiative "Vision 2020 - The Right to Sight" was established by the World Health Organization (WHO), the International Agency for the Prevention of Blindness (IAPB) and several non-governmental organizations (NGOs) with the goal of reducing avoidable blindness. Based on this initiative, the working group "International Ophthalmology" of the German Ophthalmological Society (DOG), which was established in 1994, was converted into a DOG section with the same name in 2004 and represents one of the core components of the DOG;however, even before there were a number of established partnerships of German and African eye hospitals. The first cooperation of this kind was the partnership between the Department of Ophthalmology, Ludwig-Maximilians University Munich and the University of Nairobi, Kenya, which was founded in 1978. As a result of this cooperation, the Department of Ophthalmology in Nairobi has evolved into one of the major centers of ophthalmological training and ophthalmic care in East Africa. Since then a number of similar cooperation projects between several hospitals and numerous further projects (e. g. in Myanmar) have been implemented and some of these are presented in this manuscript.

Table S1. Prevalence by age and sex, alternative validation strategy, 2010, AOK data. Table S2. Incidence rate by age and sex, alternative validation strategy, 2011–2013, AOK data. Table S3. Results of the complete Cox-regression model, risk of incidence of POAG, 2011-2013, AOK data. Table S4. Results of the complete Cox-regression model, risk of incidence of POAG, alternative validation strategy, 2011-2013, AOK data. Table S5. Results of the complete Cox-regression model, risk of incidence of POAG, persons with diabetes excluded, 2011–2013, AOK data. Table S6. Results of the complete Cox-regression model, risk of incidence of POAG, persons with (prior or later) primary angle-closure glaucoma (H40.2) and secondary glaucoma (H40.3–6) excluded, 2011–2013, AOK data. (DOCX 1680 kb)

The biomechanics of accommodation are of particular interest in terms of the causes of presbyopia and the function of intraocular lenses.The aim of the present article is to model the mechanism of accommodation in detail.The state of the art of applying biomechanical models to accommodation is presented, which enables the accommodation process to be understood.The established models, which are based on the Helmholtz theory, can explain the accommodation process in a plausible manner. These models thereby also enable further investigations on the genesis of presbyopia as well as on the development of accommodative intraocular lenses and implants. However, measurements are always necessary to compare the simulation results with reality, and to provide input and material data as well as geometric dimensions of components of the eye.

In 1999 the global initiative "Vision 2020 - The Right to Sight" was established by the World Health Organization (WHO), the International Agency for the Prevention of Blindness (IAPB) and several non-governmental organizations (NGOs) with the goal of reducing avoidable blindness. Based on this initiative, the working group "International Ophthalmology" of the German Ophthalmological Society (DOG), which was established in 1994, was converted into a DOG section with the same name in 2004 and represents one of the core components of the DOG; however, even before there were a number of established partnerships of German and African eye hospitals. The first cooperation of this kind was the partnership between the Department of Ophthalmology, Ludwig-Maximilians University Munich and the University of Nairobi, Kenya, which was founded in 1978. As a result of this cooperation, the Department of Ophthalmology in Nairobi has evolved into one of the major centers of ophthalmological training and ophthalmic care in East Africa. Since then a number of similar cooperation projects between several hospitals and numerous further projects (e. g. in Myanmar) have been implemented and some of these are presented in this manuscript.

Background While randomized controlled trials (RCTs) are based on strict inclusion/exclusion criteria, non-interventional studies (NISs) might provide additional information to guide management in patients more representative to the real-world setting. The aim of this study was to compare baseline characteristics of patients receiving intravitreal treatment in the NIS OCEAN with those from published RCTs. Methods The ongoing OCEAN study enrolled patients treated with ranibizumab for neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DME) or branch/central retinal vein occlusion (B/CRVO). Baseline patient characteristics were compared by indication within the OCEAN cohort. Furthermore, the characteristics were set in reference to those of published RCTs in the same indications. Confidence intervals (CIs) were calculated and assessed for statistically significant differences as indicated by non-overlapping CIs. Results Patient characteristics in the NIS OCEAN were evaluated for 3,614 patients with nAMD, 1,211 with DME, 204 with BRVO and 121 with CRVO. Between these groups, significant differences in mean age, gender distributions, and mean baseline VA were seen, reflecting known differences between the indications. Compared to the patient characteristics of published RCTs (trials selected by literature search: nAMD: 13 RCTs, DME: 9, RVO: 5), the OCEAN patients’ mean age was significantly higher in every indication. The gender distributions across the trials were comparable, with only few differences between OCEAN and the RCTs. Regarding the mean baseline VA, notable differences were found in nAMD and in DME, with VA significantly higher in some RCTs and lower in others. Conclusions The described differences underline the complementarity of NISs and RCTs. OCEAN covers a broader spectrum and more variability of patients than do RCTs. As baseline values may have impact on the treatment response (ceiling effect), there is an ongoing need for research in all patient subgroups. Country-specific assessments of patient populations can better reflect the real-world situation. NISs can deliver insights that RCTs may not, as NISs can include non-typical patients, patients with comorbidities, a broader age spectrum and patients of various disease stages. Trial registration The NIS OCEAN was registered on www.clinicaltrials.gov (identifier: NCT02194803). Electronic supplementary material The online version of this article (doi:10.1186/s12886-017-0401-y) contains supplementary material, which is available to authorized users.

Table of confidence intervals for baseline demographic characteristics (age, gender, time since diagnosis, baseline visual acuity) in the indication diabetic macular oedema: results for the OCEAN study and for selected randomized controlled trials. (DOCX 20Â kb)

Table of confidence intervals for baseline demographic characteristics of OCEAN patients, by indication. (DOCX 14Â kb)

Table of confidence intervals for baseline demographic characteristics (age, gender, time since diagnosis, baseline visual acuity) in the indication neovascular age-related macular degeneration: results for the OCEAN study and for selected randomized controlled trials. (DOCX 25Â kb)

Table of confidence intervals for additional baseline demographic parameters (BMI, diabetes type, HbA1c) in the indication diabetic macular oedema: results for the OCEAN study and for selected randomized controlled trials. (DOCX 18Â kb)

Table of selected randomized controlled trials for comparison to OCEAN, by indication. (DOCX 15Â kb)

Table of confidence intervals for baseline demographic characteristics (age, gender, time since diagnosis, baseline visual acuity) in the indications branch and central retinal vein occlusion: results for the OCEAN study and for selected randomized controlled trials. (DOCX 20Â kb)

Table of confidence intervals for medical history parameters in the indication neovascular age-related macular degeneration: results for the OCEAN study and for those selected randomized controlled trials for which comparable data were available. (DOCX 15Â kb)

Zytologische und histologische Methoden sind vergleichsweise selten eingesetzte, aber wichtige Hilfsmittel bei der Diagnostik von Erkrankungen der Bindehaut und Hornhaut. Die Impressionszytologie bzw. mit Bürsten gewonnene zytologische Abstriche der Konjunktiva sind einfach durchzuführen, kostengünstig und effizient. Als nicht invasive Verfahren stellen sie nur geringe Anforderungen an die Patientencompliance und das manuelle Geschick des Untersuchers. Sie können rasch in Tropfanästhesie durchgeführt und bei Bedarf problemlos wiederholt werden. Ein weiteres Mittel stellt die histologische Untersuchung dar, die im Regelfall zwar eine lokale Betäubung und Exzision erfordert, aber auch eine höhere diagnostische Aussagekraft besitzt.

BACKGROUND When pars plana vitrectomy is performed, the sizes of the sclerotomy cannula vary between 20 and 23 gauge. We examined the morphology of the scleral tunnels by ultrasound biomicroscopy additionally taking into account the incision angle. MATERIAL AND METHODS In each of 16 enucleated porcine eyes three 20 or 23 gauge sclerotomies with varying angles between 30 and 90° to the horizontal level were performed. The vertical 20 gauge sclerotomies were additionally sealed by 7.0 vicryl cross-stitching. The resulting scleral channels were analysed by 3-D ultrasound biomicroscopy. RESULTS The sclerotomies were echographically detectable in all cases. Analysis revealed that the sutured straight 20 gauge tunnels were hyporeflective in only some parts while the other incisions showed continuous hyporeflectivity along the complete channel in many cases. The smaller the instruments used and the flatter the scleral angles chosen, the smaller were the measured widths of the incision tunnels. CONCLUSION Imaging sclerotomies ex vivo by ultrasound biomicroscopy is reliably reproducible. In the echographic pictures straight 20 gauge incisions appeared to be safely sealed by the sutures while the nonsealed tunnels often showed continuous patency. By choosing small instruments and flat incision angles the width of the resulting scleral channels can be reduced.

Vascular malformations of the orbit present special diagnostic and therapeutic challenges for the ophthalmologist. The haemodynamic characteristics and localisation of these lesions play a key role for therapy planning. Thorough clinical and radiological examinations are indispensable for patient counselling. Any decision for surgical intervention should be made on an individual basis after careful consideration of the intra- and postoperative risks. An interdisciplinary approach by an experienced team of radiologists, interventional radiologists, maxillofacial surgeons and ophthalmologists is in many cases necessary in order to achieve an optimal therapeutic result.

BACKGROUND: The aim of this study was to identify the clinical presentation of idiopathic non-specific orbital inflammations (NSI) in relation to the anatomic pattern of involvement in the orbit and to evaluate the treatment options. PATIENTS AND METHODS: 35 cases of patients with NSI were retrospectively reviewed. In all cases the diagnosis was confirmed by biopsy of the lesion. 10 patients exhibited a severe amount of fibrosis in biopsy specimens in terms of an idiopathic sclerosing non-specific orbital inflammation (SNSI). The patients were treated with corticosteroids, radiotherapy or surgery (en-block excision or orbital decompression/debulking). Follow-up data were available for 27 / 35 patients for a period of 2 to 24 months after initial diagnosis. RESULTS: The anatomic pattern of involvement was anterior in 7 / 35, intraconal in 5 / 35, diffuse in 1 / 35, apical in 2 / 35, and lacrimal in 20 / 35 patients. 16 patients with NSI were initially treated with systemic corticosteroids. 12 / 16 patients had a complete regression of symptoms, 1 / 16 patients had partial regression and 3 / 16 patients had no improvement. 4 patients with SNSI were initially treated with systemic corticosteroids. 3 / 4 patients with SNSI had no improvement under steroid therapy. 1 patient with SNSI received no treatment and no progression was observed on follow-up. 7 patients (3 with NSI and 4 with SNSI) were treated surgically. In 5 / 7 (2 with NSI and 3 with SNSI) surgical therapy was the initial treatment due to well-circumscribed lesions in orbital imaging, whereas in 2 / 7 orbital decompression with debulking was performed after failure of systemic corticosteroids. 5 / 7 patients had a complete resolution of symptoms, whereas 2 / 7 had a partial resolution with persistent postoperative diplopia. 3 patients were treated with radiotherapy. In 2 / 3 previous steroid therapy was unsuccessful in controlling the disease. 2 / 3 of these patients had complete regression and 1 / 3 partial regression of symptoms. CONCLUSIONS: Classification of NSI according to their anatomic pattern of involvement provides a useful framework for the clinical evaluation of these patients. Systemic steroids should be the first-line therapy in cases with NSI. However, if severe fibrosis in terms of SNSI is present, corticosteroid therapy is very likely to fail, so that surgical therapy should be considered early, especially in cases of relatively well-circumscribed lesions.

Bei der Revitrektomie persistierender Makulaforamina wird haufig Silikonol fur die Endotamponade eingesetzt. Im postoperativen Verlauf besteht eine Unsicherheit, ob das Makulaforamen tatsachlich verschlossen ist. Die bisher verfugbaren Time-Domain-Gerate (Stratus-OCT und Vorlaufer, Carl Zeiss Meditec AG) ermoglichen nur in Ausnahmefallen eine Darstellung der Makula unter Silikonolendotamponade. Es gibt Anhaltspunkte dafur, dass die neuen hochauflosenden Fourier-Domain-Gerate (z. B. Cirrus-OCT) eine wesentlich zuverlassigere Darstellung unter diesen Untersuchungsbedingungen erlauben. Zehn Augen von 10 Patienten, bei denen wegen einer Persistenz des Makulaforamens nach Vitrektomie mit Gasendotamponade eine Reoperation mit Silikonolendotamponade durchgefuhrt worden war, wurden mit Hilfe des Cirrus-OCT (Carl Zeiss Meditec AG) untersucht. Voraussetzung fur die Untersuchung waren ausreichend klare optische Medien. Es wurde die Morphologie des Makulaforamens analysiert. Diese Morphologie unter Silikonol wurde mit dem Befund nach Silikonolentfernung verglichen. Funf Augen zeigten unter Silikonoltamponade einen Verschluss des Makulaforamens mit Netzhautgewebe im Zentrum der Fovea. Bei 3 Augen fand sich im Zentrum unter der Netzhaut eine flache Zyste. Bei den 5 anderen Augen war eine persistierende durchgreifende Foramenkontur zu erkennen. Nach Olentfernung blieb bei allen 5 Augen mit vorhandener fovealer Kontur das Makulaforamen verschlossen. Bei den 5 Augen mit persistierender Foramenkontur hoben sich die Foramenrander in 4 Fallen progredient ab, bei 1 Auge mit stumpfwinkligem Ansatz der Foramenrander am Pigmentepithel blieb das Foramen weitgehend stabil. Diese Pilotuntersuchung legt nahe, dass die Morphologie eines Makulaforamens unter Silikonolendotamponade einen Ruckschluss auf die Prognose nach Olentfernung erlaubt. Dies kann die Entscheidung zur Olentfernung und ggf. adjuvanten Masnahmen beeinflussen. Die genaue Analyse unter Oltamponade ist erst mit dem hochauflosenden Fourier-Domain-OCT moglich geworden.

Wir stellen 2 Falle der Peters-Anomalie (ein Peters-Plus-Syndrom und eine Maximalvariante) mit abnormal dicker Hornhaut und kornealem Staphylom vor. Die bei der perforierenden Keratoplastik entnommenen Hornhautscheibchen zeigten histologisch eine deutliche Dickenzunahme, die sich als vermehrte Bindegewebseinlagerung im Stroma im Sinne eines Keloids darstellte. Beide Augen zeigten die charakteristischen Veranderungen einer Peters-Anomalie mit Hornhauttrubung, Anhaftung der Linsen- und Irisvorderflache an der Hornhautruckflache, fehlendem Endothel, Descemet und Bowman-Schicht. Eine Peters-Anomalie mit einer intrakornealen Keloidbildung und einer kongenitalen Staphylombildung der Hornhaut stellt eine extrem seltene Fehlbildung dar.

Eine Verbesserung der optischen Detektion flachenhafter Urothelkarzinome ist potentiell von klinischem Interesse, wenn sie eine bessere Erkennung zu biopsierender Areale erlaubt. Wir untersuchten dazu in einer Pilotstudie die Anwendung hochauflosender optischer Systeme mit zellularer Lasermikroskopie, welche die Beurteilung einzelner Zellen im Epithelverband erlaubt. Ex-vivo-Praparate von radikal zystektomierten Patienten wurden mit einer eigens entwickelten Methode der konfokalen Laserscanningmikroskopie (Wellenlange 670 nm) untersucht, wobei oberflachenparallele optische Schnitte (Kantenlange 200×200 µm) bis zu einer Gewebetiefe von 120 µm aufgenommen wurden. Ausgewahlte Datensatze wurden mittels AMIRA dreidimensional rekonstruiert. Insgesamt 35 Ex-vivo-Praparate von 20 Patienten wurden konfokal-mikroskopisch untersucht und die Befunde mit denen der histologischen Schnittpraparate verglichen. In allen Fallen konnten makroskopisch tumorbefallene Bezirke lasermikroskopisch aufgrund deutlich erkennbarer zellularer Atypien eindeutig identifiziert werden. Zusatzliche Befunde waren vielfach eine subepithelial nachweisbare Hypervaskularisation in tumortragenden Bereichen. Bei flachenhaften Karzinomen (CIS) konnten diese in vielen Fallen ebenfalls mittels der Streulichtmikroskopie eindeutig identifiziert werden. Die konfokale Streulichtmikroskopie erlaubt eine Visualisierung und Analyse einzelner Zellen und ihrer Atypien bezuglich der Kernstruktur, die weit uber die normalen zystoskopischen Beurteilungsmoglichkeiten hinausgeht. Die entwickelte Methode liefert eine Basis fur weitere Untersuchungen mit der potentiellen Moglichkeit einer endoskopischen In-vivo-Bildgebung.

Background Malignant melanoma of the conjunctiva is a rare tumour. Early disease stages may be difficult to distinguish from benign lesions such as pigmented nevi or primary acquired melanosis. We describe the therapeutic procedure and histological findings in two patients and review the epidemiology and pathogenesis of malignant conjunctival melanoma. Two female patients (84 and 85 years old, respectively) presented with a pigmented tumor close to the limbus with surrounding conjunctival pigmentation and involvement of the cornea. Results Following complete excision of the tumour, conjunctival malignant melanoma arising from primary acquired melanosis was diagnosed histologically. Subsequent treatment with mitomycin C eye drops was initiated. There was no recurrence of the tumor within the follow-up period (24 and 6 months). Discussion Patients with primary acquired melanosis need to be reviewed on a regular basis to detect malignant transformation at an early stage.

Between 1983 and 1987 the authors studied 64 patients with dilated episcleral vessels and open-angle glaucoma. Elevated episcleral venous pressure was found to be the cause of the increased intraocular pressure. Clinically, the cause of elevation of venous pressure included spontaneous carotid cavernous fistulas, Sturge-Weber syndrome, orbital tumors, endocrine exophthalmos, anterior scleritis and idiopathic cases. A variety of pathophysiological mechanisms causing elevated episcleral venous pressure were found. The clinical course and complications associated with elevated episcleral venous pressure are discussed.

Background Confocal laser scanning microscopy enables the visualization of the anterior regions of the oropharynx mucosa. The specific aim of this investigation was to evaluate whether this in vivo tool supplies essential information for the surgeon prior to operation or not. Patients and methods The laser scanning microscope HRT II and Rostock Cornea Module were used in this in vivo study. To obtain comparable images, the specifications of this tool used for all investigations were maintained (63 x water immersion objective lens). The investigations were performed on 9 patients with tongue cancer with primary tumor site and stage I (AJCC) and on 12 patients with head and neck cancer who underwent radiochemotherapy (RCT). Data from 21 patients were compared to those of healthy subjects. Results The following parameters can be detected using LSM: nuclear density, nuclear size, nucleus/cytoplasm relation, number of nuclei, regularity of cell layers, morphology of cells of a cell layer, and occurrence of cellular junctions. In regard to these parameters, dysplastic and cancerous lesions reveal significant differences compared to healthy tissue of the oropharynx. After RCT several epithelial changes were found, such as keratosis, mild dysplasia, increased vascularization and more cell edema and necrosis. Conclusions Consistent differences exist between LSM findings of healthy subjects and those of patients with dysplastic, keratotic and cancerous lesions. Both strong hyperplasia and leukoplakia prevent a visualization of the basement cell layer in the oropharynx. The combination of LSM technology and endoscopy and following further investigations are needed for evaluation of LSM technology in the field of otorhinolaryngology.

BACKGROUND: To evaluate mucosal changes of the true vocal cord, e. g. leukoplakia, microlaryngoscopy is needed to obtain tissue for histopathologic investigation. But there is a discrepancy between the amount of representative tissue necessary for pathology and the postoperative voice function. Thus, a diagnostic procedure that enables the surgeon to differentiate inflammation from dysplasia and carcinoma in situ intra-operatively is urgently needed. We are now reporting on our results using laser scanning microscopy to visualize larynx epithelia. METHODS: The laser scanning microscope used in this ex vivo study is a combination of the Heidelberg Retina Tomograph HRTII and the Rostock Cornea Module. A 63 × water immersion objective lens was used for imaging. PATIENTS: Seven larynx preparations of patients (age 54 to 62 years) with a T4 larynx carcinoma who underwent laryngectomy between 2003 and 2006 were examined. RESULTS: Areas of epithelia of the true vocal cord of macroscopically normal appearance supplied images of healthy, but also inflamed laryngeal epithelia. The corresponding histopathologic sections prepared horizontally confirmed the regularity and homogeneity of the mucosa. The different layers of the lamina propria can be separated. In contrast to healthy and inflamed laryngeal mucosa, dysplasia, precancerous lesions and carcinoma-atypical cells were visible. In the latter entity a loss of cellular junctions characterized by lack of visualization of the cell membrane was apparent. CONCLUSIONS: LSM supplies information of healthy, inflamed, but also pre-malignant and malignant mucosa changes of the larynx. The pilot study shows that both hyperkeratosis and extensive hyperplasia confine the visualization of the basement cell layer. Research projects have been initiated with the objective to develop a rigid endoscope with integrated LSM technology.

Hintergrund Durch die gezielte Formanpassung der Hornhaut an die Ruckflache einer Orthokeratologie-Kontaktlinse kann wahrend der Schlafphase eine Anderung der kornealen Brechkraft bis zu –4,5 dpt erreicht werden. Es wird angenommen, dass das Tragen der OrthoK-Linsen eine Abflachung der zentralen Hornhaut bewirkt, wahrend sich in der Hornhautperipherie eine Dickenzunahme einstellt. Das Ziel dieser Untersuchung bestand darin, die Veranderung der Gesamthornhautdicke sowie der Hornhautepitheldicke im Hornhautzentrum und in der mittleren Hornhautperipherie mit dem Laser-Scanning-Mikroskop zu analysieren, die durch das Tragen der OrthoK-Linsen induziert wird.

Additive manufacturing and 3D printing create new paths for the design and manufacturing of implants. Technologies with high resolution are required for the development of microstructured eye implants. In the present study, we demonstrate how these technologies can be used during the design development and manufacturing of a multifocal diffractive aspheric intraocular lens.Multiphoton polymerisation (MPP) is used to manufacture a diffractive relief with resolution in the sub-micrometer range. The relief is applied to the moulded body of a refractive lens, forming a trifocal lens. Propagation of light behind the lens is visualised in water with fluorescein.Multifocal lenses were successfully manufactured with this approach. The optical design with three foci is confirmed by the light propagation images. The images even clearly demonstrate the impact of the refractive and diffractive elements and may provide information on artefacts and aberrations.Multiphoton polymerisation is an interesting tool for the flexible manufacturing of complex multifocal lenses. With future technological progress in 3D printing with MPP, this is a promising method for on-demand manufacturing of patient individual intraocular lenses.

Glaucoma is the leading cause of irreversible blindness worldwide. In therapeutically refractory cases, alloplastic glaucoma drainage devices (GDD) are being increasingly used to decrease intraocular pressure. Current devices are mainly limited by fibrotic encapsulation and postoperative hypotension. Preliminary studies have described the development of a glaucoma microstent to control aqueous humour drainage from the anterior chamber into the suprachoroidal space. One focus of these studies was on the design of a micro-mechanical valve placed in the anterior chamber to inhibit postoperative hypotension. The present report describes the coupled analysis of fluid-structure interaction (FSI) as basis for future improvements in the design micro-mechanical valves.FSI analysis was carried out with ANSYS 14.5 software. Solid and fluid geometry were combined in a model, and the corresponding material properties of silicone (Silastic Rx-50) and water at room temperature were assigned. The meshing of the solid and fluid domains was carried out in accordance with the results of a convergence study with tetrahedron elements. Structural and fluid mechanical boundary conditions completed the model. The FSI analysis takes into account geometric non-linearity and adaptive remeshing to consider changing geometry.A valve opening pressure of 3.26 mmHg was derived from the FSI analysis and correlates well with the results of preliminary experimental fluid mechanical studies. Flow resistance was calculated from non-linear pressure-flow characteristics as 8.5 × 10(-3) mmHg/µl · min(-1) and 2.7 × 10(-3) mmHg/µl · min(-1), respectively before and after valve opening pressure is exceeded. FSI analysis indicated leakage flow before valve opening, which is due to the simplified model geometry.The presented bidirectional coupled FSI analysis is a powerful tool for the development of new designs of micro-mechanical valves for GDD and may help to minimise the time and cost expended on manufacturing and testing prototypes. Further optimisation of the FSI model is expected to ensure further convergence between the simulation and the results of experimental investigations.

Die zytomorphologische Beurteilung des Oberflachenepithels der Konjunktiva ist bei verschiedenen Augenerkrankungen ein wesentlicher Bestandteil der klinischen Stufendiagnostik. Voraussetzung dafur ist bislang die minimal-invasive Materialentnahme und labortechnische Probenaufbereitung. Fur eine zeitnahe direkte In-vivo-Darstellung kornealer Strukturen wird seit geraumer Zeit die konfokale Laser-Scanning-Mikroskopie mit dem Rostocker Laser-Scanning-Mikroskop (RLSM) erfolgreich eingesetzt. Mit einer vergleichenden Untersuchung des normalen Bindehautepithels zwischen der Lichtmikroskopie und der konfokalen RLSM sollen wesentliche Vorraussetzungen fur eine In-vivo-Evaluierung des konjunktivalen Epithels geschaffen werden. Fur den intraindividuellen Vergleich wurden 110 impressionszytologische Flachenpraparate von 23 augengesunden Probanden analysiert. Die vergleichende Mustererkennung erfolgte nach Herstellung eines flachenhaften, direkten Kontaktes zwischen der Augenoberflache und der planen Vorderflache des RLSM. Anhand der Verteilung der Reflektoren (helle Bildpunkte) lassen sich bereits in der In-vivo-Diagnostik wichtige morphologische Strukturen des Epithels (Zellkern, Zytoplasma, Kern-Plasma-Relation) differenzieren. Anhand von Form und Grose sind sekretorische Zellen mit dem RLSM zu erfassen. Hochreflektive, helle Bildpunkte stellen kontrastreich die Zellwandung der Becherzellen bzw. breite Intrazellularraume dar. Mit dem RLSM gelingt die In-vivo-Untersuchung wesentlicher anatomisch-morphologischer Strukturen des Bindehautepithels. Im Hell-Dunkel-Erkennungsmuster der Becherzellen imponieren Unterschiede, welche auf die Sekretzusammensetzung oder den Funktionszustand (Hypo- oder Hypersekretion) Hinweise geben konnten.

High-resolution biometry of the anterior ocular segment is now becoming more and more important against a background of refractive surgery and the evaluation of potentially accommodative lens replacement materials. The aim of this study was a systematic investigation of the currently available non-contact methods for measuring the anterior chamber depth (ACD).The ACDs of 50 phakic eyes of 27 patients aged between 19 and 59 years were measured with the IOL-Master (Zeiss), the AC-Master (Zeiss), the Pentacam (Oculus) and slit-lamp pachymetry by Jaeger (Haag-Streit).The median anterior chamber depth in the investigated eyes was 3.63 mm for the IOL-Master (minimum 2.88 mm, maximum 4.22 mm), 3.802 mm for the AC-Master (2.816 mm-4.373 mm), 3.915 mm for the Pentacam (minimum 2.994 mm, maximum 4.614 mm) and 3.75 mm for Jaeger (2.887 mm-4.29 mm). With a probability of error of alpha=0.05 there were no significant differences concerning the ACD between the methods of Jaeger and AC-Master, Jaeger and IOL-Master, or Pentacam and AC-Master (Wilcoxon and Wilcox). The intra-individual variability was +/-5.4 microm for AC-Master, +/-12.7 microm for Pentacam, +/-24.5 microm for IOL-Master and +/-41.2 microm for Jaeger. The maximum method-dependent difference in ACD determination was 285 microm.All the methods allow non-contact biometry, but the results might differ due to measuring principles inherent to the system, experience of the examiner and compliance of the patient. Partial coherence interferometry with the AC-Master offers the advantage of measurement exactly along the optical axis with the highest reproducibility and patient compliance.

Varicella zoster virus (VZV) causes varicella (chickenpox), remains dormant in dorsal root and cranial nerve ganglia and can be reactivated as a consequence of declining VZV-specific cellular immunity leading to herpes zoster (shingles). Patients older than 50 years of age affected by herpes zoster may suffer a significant decrease of quality of life. These patients and immunocompromised individuals are at increased risks for severe complications, involving the eye, the peripheral and the central nervous system (prolonged pain, postherpetic neuralgia). Such complications occur with and without cutaneous symptoms. The German Dermatology Society (DDG) has released guidelines in order to guarantee updated management to anyone affected by herpes zoster. Diagnosis is primarily clinical. The gold standard of laboratory diagnosis comprises PCR and direct identification of VZV in cell cultures. Detection of IgM- and IgA-anti VZV antibodies may be helpful in immunocompromised patients. Therapy has become very effective in the last years. Systemic antiviral therapy is able to shorten the healing process of acute herpes zoster, to prevent or to alleviate pain and other acute and chronic complications, particularly, when given within 48 h to a maximum of 72 h after onset of the rash. Systemic antiviral therapy is urgently indicated in patients beyond the age of 50 years and in patients at any age with herpes zoster in the head and neck area, especially in patients with zoster ophthalmicus. Further urgent indications are severe herpes zoster on the trunk and on the extremities, herpes zoster in immunosuppressed patients and in patients with severe atopic dermatitis and severe ekzema. Only relative indications for antiviral therapy exist in patients younger than 50 years with zoster on the trunk and on the extremities. In Germany acyclovir, valacyclovir, famciclovir and brivudin are approved for the systemic antiviral treatment of herpes zoster. These compounds are all well tolerated by the patients and do not differ with regard to efficacy and safety. Brivudin has a markedly higher anti-VZV potency than oral acyclovir, valacyclovir and famciclovir and thus offers a simpler dosing regimen. It must be given only once daily during 7 days in comparison to three and five times dosing per day of valacyclovir, famciclovir and acyclovir, respectively. Brivudin is an antiviral agent with no nephrotoxic properties, which is an advantage when compared to acyclovir. The most important aim of therapy of herpes zoster is to achieve painlessness. Appropriately dosed analgesics in combination with a neuroactive agent (i.e. amitriptylin) are very helpful when given together with antiviral therapy. The additive therapy with corticosteroids may shorten the degree and duration of acute zoster pain, but has no essential effect on the development of postherpetic neuralgia, which is a very difficult condition to treat. Thus early presentation to a pain therapist is recommended in specific cases.

Factors that are predictive for the outcome of medical or surgical therapy to anatomic success are desirable. Clinical tools such as optical coherence tomography and autofluorescence provide to demonstrate early morphological alterations. The value in identifying subclinical pathologies that affects the macula may help to understand better the natural course. The examination results of these tools may be useful for the correlation with post-treatment visual acuity to better predict the eventual visual function.

Hintergrund. Die Phakoemulsifikation der Linse kann eine zentrale Hornhautveranderung zur Folge haben. Ziel unserer Studie war die Quantifizierung der durch den Eingriff induzierten Volumenanderung der zentralen Hornhaut. Patienten und Methode. Zur Volumenbestimmung wurde das Hornhauttopographiesystem Orbscan® herangezogen. Die Erfassung des Volumens eines zentralen Hornhautbezirkes von 3 mm Durchmesser erfolgte praoperativ, 6 h und 24 h postoperativ bei 55 Patienten an 56 Augen nach einer Phakoemulsifikation mit Kunstlinsenimplantation. Als Viskoelastikum wurde Healon verwandt. Ergebnisse. Das durchschnittliche praoperative Hornhautvolumen im zentralen 3 mm Hornhautdurchmesser betrug 4,64 mm3. Die 1. Messung ca. 6 h nach der Operation ergab ein mittleres Hornhautvolumen von 5,36 mm3, 24 h postoperativ einen durchschnittlichen Wert von 5,05 mm3. Das Hornhautvolumen erhohte sich demnach um 0,72 mm3 bis 6 h postoperativ, um dann im Verlauf von 24 h um 0,31 mm3 wieder abzunehmen. Schlussfolgerung. Es konnte gezeigt werden, dass die Untersuchung mittels Orbscan® eine gute, nichtinvasive Methode zur Hornhautvolumenbestimmung ist. Diese Methode konnte sich in Bezug auf die Endothelfunktion der Kornea als neues Qualitatskriterium der Kataraktchirurgie erweisen.

BACKGROUND Sufficient and regular wetting of the cornea with a normal preocular tear film is an essential requirement for the accurate visual functioning of the eye. Multiple factors may cause tear film instability. Measuring the break-up time of the preocular tear film is a necessary, clinically reliable means for evaluating tear film stability. We designed a new instrument to observe the preocular tear film at high magnification which can contribute to the in vivo imaging of the physiological and pathophysiological dynamics of the tear film and its break-up phenomena. MATERIALS AND METHODS To image the tear film phenomena at sufficient magnification (x200) we used a confocal laser scanning microscope. Modification of an additional adaptor allows the tear film to be imaged at high magnification. This study evaluated the dynamics and microarchitecture of the break-up phenomena in the preocular tear film of normal patients and patients with "dry eye". RESULTS Laser scanning microscopy allows high magnification imaging of the preocular tear film and evaluation of a number of break-up mechanisms. The dynamics and structure of the tear film was analyzed and documented. Based on our observations we formulate a new hypothesis on the break-up mechanism of the preocular tear film caused by alterations in the epithelial surface, for example, an elevation or tear film microparticle. By evaluating video sequences in the fluorescence and reflection modus of the laser scanning ophthalmoscope we also found early thinning of the aqueous layer simultaneously with an intact lipid layer covering the aqueous layer. CONCLUSION Additional criteria result from using high-magnification microscopy, for example, laser scanning microscopy. This method reveals more microstructures of the corneal surface and the preocular tear film. The morphological representation of break-up phenomena leads to a better understanding of the underlying mechanisms and can be used for further investigations. Confocal laser scanning microscopy supplements the examination facilities and can be used in addition to slit lamp microscopy and to diagnose "dry eye".

A search for a standard model Higgs boson decaying into a pair of tau leptons is performed using events recorded by the CMS experiment at the LHC in 2011 and 2012. The dataset corresponds to an integrated luminosity of 4.9 fb(-1) at a centre-of-mass energy of 7 TeV and 19.7 fb(-1) at 8 TeV. Each tau lepton decays hadronically or leptonically to an electron or a muon, leading to six different final states for the tau-lepton pair, all considered in this analysis. An excess of events is observed over the expected background contributions, with a local significance larger than 3 standard deviations for m (H) values between 115 and 130 GeV. The best fit of the observed H -> tau tau signal cross section times branching fraction for m(H) = 125 GeV is 0.78 +/- 0.27 times the standard model expectation. These observations constitute evidence for the 125 GeV Higgs boson decaying to a pair of tau leptons.

Prof. v. Zehender entstammt einer sehr alten Schweizer Familie und wurde am 21. Mai 1819 in Bremen geboren. Er studierte Medizin in Gottingen, Jena, Prag, Paris und Wien. In dieser Zeit entstand eine lebenslange Freundschaft zu Albrecht v. Graefe (1828–1870). 1856 ubernahm er die facharztliche Betreuung des Erbherzogs Georg v. Mecklenburg-Strelitz und brachte das „Correspondenzblatt fur Arzte im Grosherzoglichen Mecklenburg-Strelitz“ heraus. Ein Kongress 1857 in Heidelberg unter seiner Mitwirkung fuhrte letztlich zur Grundung der „Heidelberger Ophthalmologischen Gesellschaft“, aus der 1920 die „Deutsche Ophthalmologische Gesellschaft“ hervorging. 1863 erschien die 1. Ausgabe der „Klinischen Monatsblatter fur Augenheilkunde“ als Periodika, deren Deckblatt seinen Namen als Begrunder der Zeitschrift fuhrte. Nach dem Tod des Erbherzogs Georg und einer Professur in seiner Heimatstadt Bern nahm er 1866 einen Ruf an die Universitat Rostock als Honorarprofessor an. Ab 1869 wirkte er als ordentlicher Professor an der Klinik mit Lehrstuhl. Hier gelang ihm die Entwicklung seiner binokularen Cornea-Loupe, mit ihrer Spaltbeleuchtung, Vorbild fur alle spateren derartigen Entwicklungen fur Diagnostik und schlieslich der Mirkochirurgie. Nach gescheiterten Bemuhungen um den Bau einer eigenen Klinik legte er noch 1889 demonstrativ und endgultig sein Lehramt nieder, ging nach Munchen und widmete sich der Redaktion der „Klinischen Monatsblatter fur Augenheilkunde“. 1907 zog er mit seiner Frau uber Eutin nach Warnemunde. Dort wurde er mit 98 Jahren Nestor der Welt-Augenarzte und starb am 19. 12. 1916.

In previous studies Doppler sonography was proven to the useful for diagnostics and follow-up of malignant melanomas of the choroid.To evaluate the correlation between Doppler sonographical findings and the histological tumor vascularization, we examined five eyes of five patients with malignant melanoma of the choroid before enucleation with an ATL Ultramark-8 Duplex scanner and compared these results with computerized planimetry of histological tumor vascularization after immunohistochemical staining of vascular endothelium with anti-factor-VIII antibodies.We found no definite correlation of flow velocities with histological parameters of tumor vascularization. The tendency was for a decrease in maximum flow velocities as histological vascularization increased.Due to (1) the usual lack of sensitivity parameters of the used Duplex device for the clinical user and (2) the unpredictable branching pattern within a melanoma resulting in an unknown angle of incidence of the Doppler beam, we conclude that the quantitative results of Doppler sonography require cautious interpretation. Nevertheless, presence or absence of Doppler shifts is a valuable parameter for the follow-up of irradiated tumors.

Counterfeit drugs are often ineffective and are considered a problem with an immense risk potential especially in the treatment of infectious diseases. Emerging and developing countries are particularly affected. Little is known about the extent of counterfeit antibiotic drugs used in eye care. In the present study we investigated antibiotic eye drops purchased in two African countries with respect to the active substance and its concentration in the sample.A total of 33 antibiotic eye drops purchased in Kenya and the Democratic Republic of Congo were tested. The bottles were labeled to contain one of the following substances: the quinolones ciprofloxacin, levofloxacin and ofloxacin and the aminoglycosides gentamicin and tobramycin. Imported quality products as well as cheaper generic drugs were tested. Fluoroquinolones were determined by high pressure liquid chromatography (HPLC) and quantified by fluorescence measurement and aminoglycosides were tested by using a fluorescence polarization immunoassay.All samples were found to contain the declared drug. Nine samples (27%) showed an under-concentration by 10% or less and ten (30%) showed an increased concentration of 10% or more than indicated on the label. 75% of the original drugs but only 12% of the generic drugs had measured concentrations within the standard advisory ranges of ± 5% from the nominal value.Our results provide no evidence for significant criminal counterfeiting of eye drops in the studied countries. The frequent deviation from the stated concentration in the generic samples is cause for concern and justifies further investigation.

The aim of this clinical study was to demonstrate the practicability of self-measured intraocular pressure and to evaluate the reliability by comparing the data with those obtained by Goldmann applanation tonometry (GAT).A total of 40 patients aged between 44 and 82 years with glaucoma were introduced to the handling of the tonometer. The self-measurements were done for 1-3 days following the medical measurement by GAT. The data were saved as "correct" or in the case of wrong handling as "false". The impressions of the patients were obtained by a questionnaire.A total number of 191 single measurements were registered by the Icare ONE and of these there were 97 (50.8%) signed "false". Of the patients 45% reached a maximum difference of ±5 mmHg between GAT and self-measurement in every single measurement. In the subgroup of under 60-year-old patients 70% reached this result. There were no indications of a systematic error. Of the probands 60% considered the handling of the Icare ONE as difficult. Nevertheless, 80% could imagine using the self-tonometer at home.The differences between the self-measurements and the GAT were highly fluctuating in some cases. In the group of patients younger than 60 years the agreement was better, so problems with the handling of the Icare ONE may be an important factor. However, the acceptance in the patients tested was high and continuous pressure measurements at home could be reasonable. Advancements in the handling and reliability are needed to improve clinical application of the measured values.