Search

Background /Objectives To compare two suturing techniques in patients undergoing upper eyelid blepharoplasty by using the FACE-Q™ Eye Module questionnaire to assess patient-reported outcomes and by blinded Likert-scale gradings of two experienced surgeons. Methods 90 patients undergoing bilateral blepharoplasty were randomly assigned to a suturing technique (running cutaneous or subcuticular closure) using Prolene 6.0. Patients completed the FACE-Q eye module questionnaire before surgery and 7 days and 3 months after surgery. Further, two trained oculoplastic surgeons assessed the outcome. FACE-Q ratings were RASCH-transformed, and linear models were fitted for appraisal and satisfaction results. Intraclass correlation coefficient (ICC) was calculated to assess the surgeons’ rating agreement. Results There was no statistically significantly difference in patients’ FACE-Q self-assessments regarding satisfaction with eyes and appraisal of upper eyelids between the two suturing techniques investigated, both 7 days and 3 months after blepharoplasty. The more content the patient at baseline, the less the increase in satisfaction after 3 months. There was good agreement between blinded graders in outcome assessment expressed by an ICC of 0.86. Dry-eye symptoms increased after surgery, independent of the suturing technique, patient age or sex. Conclusion In conclusion, this study shows that post operative patient satisfaction is independent of suturing technique, but depends on baseline FACE-Q reports. These findings are valuable in patient communication and selection and are in line with observer-based assessments. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Summary Background The aim of this study was to profile patients with simple and complex congenital nasolacrimal duct obstruction (CNLDO) and to determine the success rates of interventions at a third-level referral center. Methods In this retrospective and comparative study, medical records of patients with CNLDO were reviewed. Demographic data, types of CNLDO, surgical approach, type of silicone intubation, as well as outcome were recorded up to 3 months after the intervention. Obstruction location was identified by probing and irrigation following the American Academy of Ophthalmology (AAO) approach. Success rates were calculated for treatment approach and age group. Results Based on the outcome of 130 eyes with CNLDO, the overall success rate was 96%. The mean age of patients was 2.5 ± 2.2 months; 73% of cases were simple and 27% were complex CNLDO. Five children had to undergo reoperation; consequently, there was a lower success rate in the complex CNLDO (91%) than in the simple CNLDO subgroup (97%). There was a male predominance (61.5%), which was also present in the simple and complex CNLDO subgroups. The most frequent type of CNLDO was complete nasolacrimal duct obstruction (NLDO, 55.4%), followed by partial (17.7%) and bony NLDO (11.5%). In 87% of eyes, initial probing was performed followed by dacryocystorhinostomy (10%). Mono- or bi-canalicular lacrimal drainage system intubation was used in 86% of eyes. Conclusion The AAO-based diagnostic approach followed by an individualized treatment regimen yielded excellent success rates of 96% in unselected patients with CNLDO. These success rates were independent of patient age or gender.

Lasionen des N. ophthalmicus fuhren zu neurotropher Keratopathie. Die bisherige Therapie war rein symptomatisch und fuhrte nicht zur Verbesserung der Hornhautsensibilitat. Eine rezent publizierte Operationsmethode ermoglicht eine Reinnervation der asensiblen Hornhaut durch Nervenfasern des kontralateralen N. supratrochlearis oder N. supraorbitalis uber ein autologes Nerventransplantat. Wir beschreiben den ersten Fallbericht eines osterreichischen Patienten mit neurotropher Keratopathie, dessen Hornhaut im Rahmen einer interdisziplinaren Kooperation erfolgreich reinnerviert wurde. Es wird der Fallbericht eines 59-jahrigen Patienten mit vollstandiger Asensibilitat der linken Hornhaut nach Herpeskeratitis beschrieben. Bei dem Patienten wurde die Hornhaut durch Spendernerven des rechten N. supratrochlearis reinnerviert. Es wurde ein autologes Nerventransplantat eingebracht, welches End-zu-Seit an den N. supratrochlearis koaptiert wurde. Auf der Empfangerseite wurden die einzelnen Faszikel subkonjunktival, perilimbal angenaht. Der Patient wurde mit einer temporaren Tarsorrhaphie versorgt. Sechs Monate postoperativ zeigte sich bei der Cochet-Bonnet-Asthesiometrie ein Anstieg der Sensibilitat im temporalen Bereich der Hornhaut, sodass nun eine limbale Stammzelltransplantation sowie eine Keratoplastik geplant werden konnen. Die Wiederherstellung der Hornhautinnervation ermoglicht eine kausale Therapie der neurotrophen Keratopathie. In dieser interdisziplinaren Kasuistik wird der erste osterreichische Fall beschrieben.

Purpose To correlate the area of geographic atrophy (GA) and residual foveal sparing (FS), and to identify the minimum FS and maximum GA area allowing sufficient visual acuity (VA) for daily tasks. Design Prospective cohort study. Methods Thirty-six eyes of 25 patients with GA and FS were followed for 18 months using spectral-domain optical coherence tomography and VA tests. Volume scans were imported into software enabling grading of areas in B-scans and computing of planimetric measurements in complete volume scans. Correlation of areas 1 (complete atrophy), 2 (FS in the central millimeter), and 3 (FS in the central 3 mm) with each other and with best-corrected VA (BCVA) were evaluated. Results Baseline means of areas 1, 2, and 3 were 6.15 mm 2 , 0.49 mm 2 , and 3.08 mm 2 , respectively. At 1 year, area 1 increased by a mean of 1.33 mm 2 , while areas 2 and 3 were decreased by 0.12 mm 2 and 0.65 mm 2 , respectively. From baseline to 18 months and from visit to visit, all areas and BCVA changed progressively ( P 2 ; area 2: ≥0.48 mm 2 ; and area 3: ≥3.28 mm 2 ). Conclusion GA and FS changed inversely over time. In general, FS highly correlated with BCVA, while GA progression correlated with the central 3-mm FS regression, but not with BCVA. A threshold in GA and FS area could be determined for BCVA necessary for daily activity.

Purpose To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO). Methods Forty eyes of 40 consecutive patients with macular oedema (ME) due to branch and central retinal vein occlusion (BRVO/CRVO) were treated with an intravitreal dexamethasone implant (Ozurdex®) at baseline and evaluated until month 6. Retreatment was performed in case of recurrent ME earliest 4 months after the baseline treatment. Aqueous humour samples were taken at baseline, months 1, 3, 6 and at the time of each retreatment. Concentrations of 29 different cytokines were measured by Luminex® bead assays. The control group comprised healthy patients undergoing cataract surgery. Results At baseline concentrations of interleukin (IL)-8, angiopoietin (ANG)-2 and intercellular adhesion molecule (ICAM)-1 were highly elevated in patients with CRVO compared with controls (p = 0.006; p = 0.02; p = 0.03). Vascular endothelial growth factor (VEGF) concentrations were upregulated in patients with BRVO and CRVO (p = 0.003; p = 0.001). Retreatment with a dexamethasone implant was necessary after 4 months in 14/8 (BRVO/CRVO) patients, 5 months in 5/3 patients and 6 months in one patient (BRVO). After the initial treatment, macrophage chemo-attractant protein (MCP)-1 and IL17-E concentrations decreased in BRVO (p

Das Basalzellkarzimon (BCC) gehort zu den haufigsten Tumoren in der periorbitalen Region. Aufgrund lokal fortgeschrittener und metastasierender BCC Falle ruckte eine neue Therapieform ins Zentrum klinischer Forschung. Die Entdeckung des Hedgehog Signalwegs fuhrte zu einem neuen Therapieansatz. Vismodegib, ein Hedgehog Signalweg Inhibitor, wird oral verabreicht und fur die Behandlung lokal fortgeschrittener und metastasierender BCC eingesetzt. Bemerkenswerte Tumorruckbildungen sind zu beobachten.

Die Evaluation funktioneller Blepharoplastikoperationen der Oberlider durch Objektivierung und Vergleich der superioren und temporalen Gesichtsfeldeinschrankung pra- und postoperativ, die Korrelation zwischen subjektiven Patientenangaben und objektivierbaren, postoperativen Gesichtsfeldanderungen sowie die Untersuchung des Einflusses von periorbitalen Strukturen auf das Gesichtsfeld. Die Daten von insgesamt 19 Patienten wurden miteinander verglichen. Alle Patienten wurden pra- sowie postoperativ mit einem Goldmann-Perimeter untersucht, zusatzlich wurden postoperative Fotografien und eine Fragebogenuntersuchung durchgefuhrt. Die Untersuchung ergab am superioren Gesichtsfeld eine signifikante Verbesserung, wohingegen am temporalen Gesichtsfeld keine signifikante Verbesserung erzielt werden konnte. Die OCH-Winkel zeigten auf der linken Seite einen Mittelwert von 65,1 (± 8,7) Grad und auf der rechten 65,3 (± 9,5) Grad, es konnten aber keine signifikanten Zusammenhange zwischen dem Winkel und den pra- sowie postoperativen superioren Gesichtsfeldern gefunden werden. Die Patientenangaben waren zum Grosteil vom objektivierbaren Ergebnis der Operation unabhangig. Die funktionelle Blepharoplastikoperation der Oberlider zeigte unabhangig vom Geschlecht am superioren Gesichtsfeld eine hohe Wirksamkeit. Fur das temporale Gesichtsfeld war jedoch die Wirksamkeit gering.

Die altersbedingte Makuladegeneration (AMD) und insbesondere deren neovaskulare Form (nAMD) ist aufgrund ihres in der Regel progredienten Verlaufs die haufigste Ursache fur Erblindung im Alter von uber 60 Jahren. Zur Verlaufsbeobachtung der nAMD wird heute vermehrt die optische Koharenztomographie (OCT) eingesetzt. Dabei ist bisher jedoch oft unklar, welche Parameter fur die funktionelle Prognose tatsachlich relevant sind. Ziel dieser Studie war es deshalb, relevante prognostische Faktoren der nAMD zu identifizieren und mit Visusveranderungen wahrend der ersten fur den Visusverlauf besonders wichtigen 3 Monate einer antiangiogenen Therapie zu korrelieren. In die Studie wurden 17 konsekutive Patienten mit nAMD aufgenommen, die sich einer Therapie mit dem Antikorperfragment Ranibizumab (Lucentis) unterzogen. Die Bildgebung erfolgte mittels eines Stratus- und eines hochauflosenden Cirrus-OCT-Systems. Verschiedene Parameter, darunter das Volumen der subretinalen Flussigkeit und die Hohe der serosen Netzhautabhebung in der Fovea, wurden in Hinblick auf ihren prognostischen Aussagewert fur den Visus analysiert. Der Ausgangsvisus war ein prognostisch wichtiger Faktor, der mit dem Visus nach Studienende signifikant korrelierte. Die im OCT gemessene Netzhautdicke (ZMM) korrelierte zwar mit dem Visus zum Untersuchungszeitpunkt, nicht aber mit dem Visus nach Studienende. Es fand sich aber eine deutliche Korrelation zwischen dem subretinalen Flussigkeitsvolumen (SRFV), das bisher nicht mit automatischen Analysen erfasst werden kann, und dem Visus nach 4 und 12 Wochen. Dabei war die Gesamtmenge der subretinalen Flussigkeit entscheidend fur die Funktion. In dieser Studie gelang es, den Faktor „subretinales Volumen“ als wichtigen prognostischen Parameter fur die nAMD zu bestatigen. Ferner konnte gezeigt werden, dass die Prasenz von subretinaler Flussigkeit Ursache fur eine haufig reversible Visusbeeintrachtigung zu sein scheint. Die Ergebnisse scheinen die Hypothese, dass die subretinale Flussigkeit als Marker fur die exsudative Aktivitat der Lasion wichtig ist, aber nicht direkt durch eine Abhebung der Netzhaut zu einer irreversiblen Schadigung der Netzhautfunktion fuhren muss, zu bestatigen.

Problemstellung Der Verlust eines Chromosoms 3 in uvealen Melanomen gilt in der Literatur als ein prognostisch ungunstiger Faktor. In der vorliegenden Studie wurden die Veranderungen des Chromosoms 3 bei uvealen Melanomen untersucht.

Purpose: To evaluate the reproducibility of a new colour test, using the Chromatometer CM3. Methods: Twenty healthy subjects were recruited at the Department of Ophthalmology, at the Medical University of Vienna. A total of 40 eyes were tested. Both eyes were tested separately with the Chromatometer CM3. The colour test was repeated after several days. Each time, best-corrected visual acuity was tested using Snellen charts, and colour perception was tested using the Chromatometer CM3. Results: The Chromatometer CM3 showed reproducible results between the two tests at almost every luminosity level. All 4 green-red measurements and 2 blue-yellow brightness measurements showed reproducible results between the first and second tests. Conclusion: The Chromatometer CM3 seems to be an appropriate method to detect changes in colour perception, although the red-green comparison appeared to be more precise than the blue-yellow comparison.

To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs).Prospective, randomized, investigator-masked, controlled clinical study.Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively.At month 3, mean BCVA improved to a eight-letter gain in each study group (P0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups).The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.

PURPOSE: To investigate the potential role of optical density ratios (ODRs) obtained from subretinal fluid analysis in exudative macular disease and to identify the predictive role of ODRs under therapy in comparison to conventional morphometric measurements (CMMs). METHODS: Fifteen patients with neovascular age-related macular degeneration (nAMD) and 15 with acute central serous chorioretinopathy (CSC) were included in this prospective comparative and interventional case series. High-definition optical coherence tomography (SD-OCT) was performed according to a standardized protocol. nAMD patients received a standard treatment consisting of three monthly doses of intravitreous ranibizumab. Best corrected visual acuity (BCVA) was assessed at baseline (BSL) and weeks 2, 4, and 12. SD-OCT parameters were compared between CSC and nAMD at baseline. Predictive factors for functional recovery under ranibizumab treatment were identified in patients with nAMD. RESULTS: ODR showed highly significant differences between CSC and nAMD, whereas it was not possible to differentiate between these diseases on the basis of CMM. During follow-up, CMM correlated with BCVA at BSL only, whereas ODR showed a significant correlation with BCVA at week 4 and 12 during antiangiogenic therapy. CONCLUSIONS: Results suggest that CMM may correlate with BCVA at BSL, but has limited predictive value regarding recovery of visual function. Most interesting, ODR correlated with BCVA under therapy and was the only parameter that was pathognomic for nAMD in contrast to CSC in this study. ODR may reflect the status of the blood-retina barrier and may be used for pathophysiologic differentiation and prognostic purposes in exudative macular disease.