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Thioredoxin (Trx) family proteins are key players in redox signaling. Here, we have analyzed glutaredoxin (Grx) 1 and Grx2 in age-related macular degeneration (AMD) and in retinal pigment epithelial (ARPE-19) cells. We hypothesized that these redoxins regulate cellular functions and signaling circuits such as cell proliferation, Wnt signaling and VEGF release that have been correlated to the pathophysiology of AMD. ARPE-19 cells were transfected with specific siRNAs to silence the expression of Grx1 and Grx2 and were analyzed for proliferation/viability, migration capacity, β-catenin activation, and VEGF release. An active site-mutated C-X-X-S Grx1 was utilized to trap interacting proteins present in ARPE-19 cell extracts. In both, AMD retinas and in ARPE-19 cells incubated under hypoxia/reoxygenation conditions, Grx1 showed an increased nuclear localization. Grx1-silenced ARPE-19 cells showed a significantly reduced proliferation and migration rate. Our trapping approach showed that Grx1 interacts with β-catenin in a dithiol-disulfide exchange reaction. Knock-down of Grx1 led to a reduction in both total and active β-catenin levels. These findings add redox control to the regulatory mechanisms of β-catenin signaling in the retinal pigment epithelium and open the door to novel therapeutic approaches in AMD that is currently treated with VEGF-inhibitors.

Persisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure. Twelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach. The mean duration of the MH prior to SR-fluid application was 17 months (6–96 months). The mean age of the patients at the time of surgery was 72 years (54–88). The mean preoperative aperture diameter of the opening was 1212 μm (239–4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01–0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02–0.5). The application of SR-fluid was not associated with major intraoperative adverse effects. Remaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow-up depending on stage of diabetic eye disease are summarized.

Low-temperature district heating and cooling networks, operated at water temperatures below 20 °C, substitute fossil-based heating systems with environmental heat or waste heat from industrial processes and additionally provide a source of direct cooling during the warmer months. These networks have the potential to reduce carbon emissions and are a key future technology in the strategy to combat climate change. However, large initial investments limit the diffusion of such networks. A large fraction of those investments, apart from trenching, goes to piping. Piping costs are highly dependent on pipe diameter, material and pressure rating. In this work, we focus on reducing costs by reducing the pressure in the system; thus allowing a reduced pressure rating. To reduce the maximum pressure in a hydraulic system, we present a novel technique based on alternating the connection of the expansion vessel. We explain our concept in a lab experiment and subsequently apply our method to the large-scale network at ETH Zurich, Switzerland. At ETH Zurich, we predict a pressure reduction of 8% from 6 to 5.5 bar. Lowering the pressure increases the economic viability and may thus promote the market dissemination of low-temperature district heating and cooling networks.

The fourth generation of district heating is an established expression for new features and configurations. This generation’s overarching goal is to develop heating concepts for smart energy systems contributing to the net-zero carbon emission society by substituting older district heating generations, originally developed for fossil fuels. The evolving technology generation has to consider the future challenges of lower heat demands, increased cooling demands, and integration of renewable and recycled thermal sources. Driven by these challenges, the district heating and cooling community is fast growing and very dynamic in its innovation. This trend can be observed in the development of cold networks for both heating and cooling. Several new systems in Europe, North America, and Asia have applied newly developed heating and cooling network configurations. It is essential to consolidate these novel technical solutions into the entire family of fourth generation at this stage of development to efficiently and effectively deploy and expand district heating and cooling solutions. This paper exemplary discusses ambiguous terms to demonstrate the shortfall of not having a broad and internationally accepted vocabulary. The conclusion gives suggestions for harmonising expressions, terms, and definitions introduced and used during the last years. An interactive vocabulary will facilitate innovation and a common language.

Thermal district networks are effective solutions to substitute fossil fuels with renewable energy sources for heating and cooling. Moreover, thermal networking of buildings allows energy efficiency to be further increased. The waste heat from cooling can be reused for heating in thermal district systems. Because of bidirectional energy flows between prosumers, thermal networks require new hydraulic concepts. In this work, we present a novel network topology for simultaneous heating and cooling: the reservoir network. The reservoir network is robust in operation due to hydraulic decoupling of transfer stations, integrates heat sources and heat sinks at various temperature levels and is flexible in terms of network expansion. We used Modelica simulations to compare the new single-pipe reservoir network to a basecase double-pipe network, taking yearly demand profiles of different building types for heating and cooling. The electric energy consumed by the heat pumps and circulations pumps differs between the reservoir and base case networks by less than 1%. However, if the reservoir network is operated with constant instead of variable mass flow rate, the total electrical consumption can increase by 48% compared to the base case. As with any other network topology, the design and control of such networks is crucial to achieving energy efficient operation. Investment costs for piping and trenching depend on the district layout and dimensioning of the network. If a ring layout is applied in a district, the reservoir network with its single-pipe configuration is more economical than other topologies. For a linear layout, the piping costs are slightly higher for the reservoir network than for the base case because of larger pipe diameters.

In this study we present a method for the assessment of the economic potential of deep energy retrofit packages for a national building stock, based on three main economic assessment approaches: 1) full investment cost and energy savings (approach FULL), 2) an approach only considering the cost of energy efficiency improvement and the related energy savings (approach IMPROVEMENT) and 3) an approach which is in line with the IMPROVEMENT approach but additionally assigns a residual value to each building element (approach DEPRECIATION). These three economic assessment approaches allow to assess the cost-effectiveness of large-scale retrofit packages according to different strategies, i.e. profit-oriented in the case of FULL, retrofitting only at end of lifetime in the case of IMPROVEMENT and pursuing a balance between environmental/energy and economic aspects in the case of DEPRECIATION. A case study for Switzerland shows that deep energy retrofit packages offer a technical energy saving potential of 55–86% and a technical greenhouse gas abatement potential of 50% to 80% (compared to current levels). The different approaches result in economic energy saving potentials of 3% (FULL), 14% (DEPRECIATION) and 50% (IMPROVEMENT). The respective marginal levelized costs for reaching a 50% reduction in final energy demand amount to 120 CHF/MWh (FULL), 40 CHF/MWh (DEPRECIATION) and 1 CHF/MWh (IMPROVEMENT). The results show an economic greenhouse gas saving potential of 1% (FULL), 13% (DEPRECIATION) and 65% (IMPROVEMENT) with respective marginal levelized costs for a 50% reduction of 350 CHF/t CO2eq., 90 CHF/t CO2eq. and −40 CHF/t CO2eq. The findings indicate that, without subsidies or with rather low subsidies, large-scale deep energy retrofit is economically viable only if it is part of the regular refurbishment cycle (IMPROVEMENT approach). Since full alignment with regular refurbishment cycle is not practically possible across the building stock, policy design is recommended to rather follow the DEPRECIATION approach according to which a subsidy of 40 CHF/MWhsaved (or 90 CHF/ t CO2, avoided) would be needed in order to achieve a 50% final energy and greenhouse gas emission reduction in the building stock.

Formation of retinal folds is a serious and possibly underreported complication of vitrectomy with intraocular gas for retinal detachment. Certain risk factors are associated with this complication. Presentation of our own cases with retinal folds after retinal detachment surgery and review of the relevant literature. Spontaneous resolution of a retinal fold without surgical intervention with excellent visual outcome was observed in a patient operated with vitrectomy and intraocular gas for retinal detachment. In another case surgical intervention with repeat vitrectomy and macular detachment followed by intraocular gas resulted in complete resolution of a retinal fold with excellent visual outcome. Retinal fold formation after vitrectomy for superior bullous retinal detachments running through the fovea can be managed both conservatively and surgically. Treatment decision is made on an individual basis depending on patient symptoms. Knowledge of the risk factors for fold formation and postoperative posturing after retinal detachment surgery is very important in order to avoid this complication.

Pharmacologic vitreolysis with ocriplasmin has emerged as a new option for the treatment of symptomatic vitreomacular traction syndrome (VMT). Not all cases of VMT require therapy. Knowledge of the natural history of VMT is essential for patient counselling and for deciding between observation and treatment. Ocriplasmin treatment for VMT may provide very good results if used with the correct candidates. On the other hand, observation might be the best option in cases of VMT with high chances of spontaneous resolution. The purpose of this review is to report on the natural course of VMT based on the current literature, present briefly the author’s experience with the use of ocriplasmin in cases of VMT, and provide practical hints for the implementation of this treatment modality in the clinical setting.

To determine functional and anatomical outcomes of pars plana vitrectomy for persistent full-thickness macular hole (MH) after intravitreal injection of ocriplasmin.This is a multicenter retrospective interventional study of 37 eyes of 37 patients who underwent pars plana vitrectomy with internal limiting membrane peeling for persistent MH after ocriplasmin treatment between December 2013 and December 2015 and comparison with 35 eyes of 35 patients who were offered ocriplasmin injection but underwent pars plana vitrectomy alone without pharmacologic vitreolysis before surgery. In addition, 24 matched pairs (MH diameter at baseline ±5 µm) were analyzed. Clinical data such as visual acuity, intraoperative characteristics, and spectral domain optical coherence tomography images were reviewed. Main outcome measures were visual acuity and MH closure rate.After a mean follow-up period of 9 months, postoperative mean visual acuity showed no significant differences between ocriplasmin-treated eyes (logarithm of minimum angle of resolution 0.37 ± 0.26, Snellen 20/47) and eyes without ocriplasmin treatment (logarithm of minimum angle of resolution 0.39 ± 0.25; Snellen 20/49) (P0.9). After ocriplasmin injection, mean MH diameter enlarged from 217 ± 102 µm to 384 ± 239 µm (P0.001). Matched-pair analysis revealed no difference in gain of visual acuity between the first visit and the last follow-up (P = 0.29). Macular hole closure was observed in similar proportion in ocriplasmin-treated eyes (97%) and vitrectomy-only eyes (94%) (P0.5).Eyes with persistent MH after ocriplasmin injection showed significant visual improvement after pars plana vitrectomy. Matched-pair analysis revealed no statistical differences in functional and anatomical postoperative results comparing with eyes of similar MH diameter that proceeded directly to surgery without ocriplasmin pretreatment.

Ein 41-jahriger Patient stellte sich mit langsam progredientem Visusabfall vor. Der Visus lag bei 0,4 beidseits. Ophthalmoskopisch zeigte sich eine temporale Papillenblasse symmetrisch an beiden Augen. Eine entsprechend reduzierte Nervenfaserschichtdicke im temporalen und temporal-unteren Segment beidseits konnte mittels optischer Koharenztomographie nachgewiesen werden. Die kraniale Magnetresonanztomographie und die Laborbefunde waren normal. Die molekulare Diagnostik bestatigte den klinischen Verdacht auf eine autosomal-dominante Optikusatrophie. Papillomakulare Bundeldefekte beider Augen kombiniert mit langsam progredienter Sehverschlechterung sind ein typischer Befund fur die autosomal-dominante Optikusatrophie (Typ Kjer), fur welche eine genetische Diagnostik verfugbar ist.

Zusammenfassung Hintergrund Durch die Einführung der Pars plana Vitrektomie ist eine Vielzahl von vitreoretinalen Erkrankungen behandelbar geworden. Kontinuierliche Verbesserungen der Geräte, Instrumente und zusätzliche Hilfsmittel sowie neue Techniken kennzeichnen den enormen Fortschritt der vitreoretinalen Chirurgie. Methoden In einer Literaturübersicht werden die Operationstechniken verschiedenster vitreoretinaler Eingriffe analysiert. Sofern aufgrund aktueller Entwicklungen verschiedene Optionen in der Operationstechnik bestehen, werden Experten auf dem Gebiet der vitreoretinalen Chirurgie über ihre Erfahrung und ihre Empfehlung befragt. Ergebnisse Die 20 Gauge Pars plana Vitrektomie wurde größtenteils durch die Verwendung von Trokaren (23, 25 und 27 Gauge) mit entsprechenden Instrumenten mit kleinerem Durchmesser abgelöst. Die Pars plana Vitrektomie ist nahtlos möglich, trotzdem kann es notwendig sein, eine zusätzliche Sicherung der Wunde mit einer Naht durchzuführen, um Leckage und Hypotonie zu vermeiden. Die Visualisierung des Glaskörpers erfolgt zunehmend mit Triamcinolon, epiretinale Gliosen und die Membrana limitans interna werden routinemäßig mit Vitalfarbstoffen dargestellt. Bei der Operationstechnik beim Makulaforamen und bei der Ablatio retinae zeigen sich sowohl bei aktuellen Publikationen als auch unter den Experten Variationen. Schlussfolgerungen Die Pars plana Vitrektomie hat sich aufgrund der Weiterentwicklung speziell im Bereich der Trokar Systeme, Vitrektome, der Weitwinkel-Beobachtungssysteme sowie dank neuer Techniken zu einer essentiellen OP-Methode für ein weites Indikationsspektrum entwickelt. Dies ist die Basis der Behandlung verschiedenster vitreoretinaler Erkrankungen mit immer weniger Operationstrauma, weniger intraoperativen und postoperativen Komplikationen und gutem Therapieerfolg. Unterschiedliche Operationsvarianten, neue Techniken und die Weiterentwicklung der Geräte und Instrumente sind die Basis für einen auch zukünftigen Fortschritt der Pars plana Vitrektomie.

This article presents the case study Uettligen, a village in a smaller urban community in the periphery of Berne, Switzerland. The case study applies a previously developed general energy concept methodology [1,2] and explores the possibility to apply and adapt such a methodology to a small urban community. The article discusses challenges that smaller urban communities may face in the application of such an energy concept methodology and whether such a methodology may be applied more broadly and in a standardised way to small urban, peri-urban or rural communities. The authors also analyse required data input and tools to effectively and efficiently develop and apply such energy concepts. The article concludes with recommendations to small urban, peri-urban or rural communities on how to develop and implement energy concepts that serve their needs and provides an outlook on how these concepts may further be developed and tailored to these communities.

To assess the efficacy of intravitreally injected tissue plasminogen activator (t-PA, Alteplase [Actilyse®]) to induce posterior vitreous detachment (PVD) in eyes with recent onset of retinal vein occlusion (RVO). Retrospective patient chart analysis. Nine eyes were included thereof 4 eyes (44%) with central (CRVO) and 5 eyes (56%) with branch RVO (BRVO). One week after injection none of the eyes treated showed PVD formation. After 12 months one patient (17%) developed partial PVD and two patients (33%) demonstrated complete PVD. All eyes developing (partial) PVD after one year suffered from BRVO. Mean best corrected visual acuity (BCVA) increased from 0.35 to 0.45 after one week (p = 0.401) and further to 1.0 after 12 months (p = 0.042). There was an overall significant gain in mean BCVA development after 12 months (p = 0.015). Mean central retinal thickness decreased from 572 to 485 µm after one week (p = 0.374) and further to 299 µm after 12 months (p = 0.345). There was an overall significant decrease in CRT development from injection until month 12 (p = 0.030). Intravitreally injected Actilyse® might have the potential to induce PVD in eyes with recent onset of RVO and might favorably impact standard treatment regimens. A prospective and randomized clinical trial is needed to prove this hypothesis.

PURPOSE To evaluate the impact of the vitreoretinal interface architecture, in specific the angle between the posterior vitreous cortex and the internal limiting membrane, on vitreomacular traction (VMT) resolution in eyes treated with intravitreally injected ocriplasmin (Jetrea). METHODS Retrospective, multicenter cohort study and exploratory data analysis. Spectral domain optical coherence tomography assessments were performed before scheduled ocriplasmin injections. General (age and sex) as well as ocular variables (lens status, presence of epiretinal membrane formations, horizontal diameter of VMT, central retinal thickness, and in particular various prespecified angles between the posterior vitreous cortex and internal limiting membrane) were analyzed to evaluate their impact on successful VMT resolution. RESULTS Fifty-nine eyes of 59 patients were included. Univariate analysis of age (odds ratio [OR]: 0.881; 95% CI: [0.812-0.955]; P = 0.0022) and lens status (OR: 11.03; 95% CI: [2.23-54.57]; P = 0.0033) had a significant impact on successful VMT resolution, whereas sex (OR: 0.668; 95% CI: [0.126-2.065]; P = 0.4906), epiretinal membrane formation (OR: 0.581; 95% CI: [0.168-2.006]; P = 0.3903), horizontal diameter of VMT (OR: 0.99930; 95% CI: [0.99825-1.00035]; P = 0.1886), and central retinal thickness (OR: 0.9985; 95% CI: [0.9934-1.00436]; P = 0.56) failed. The angle at 500 μm apart from the fovea centralis, irrespective if measured nasally (OR: 1.135; 95% CI: [1.013-1.272]; P = 0.0289) or temporally (OR: 1.099; 95% CI: [1.001-1.208]; P = 0.0485), showed a significant correlation with VMT resolution. CONCLUSION The angle between the posterior vitreous cortex and the internal limiting membrane 500 μm apart from the fovea centralis correlates with VMT resolution and may be a clinically useful marker for selection of patients to be treated with ocriplasmin. This observation needs to be proven in a prospective confirmatory investigation.

Abstract: Background: Paclitaxel is a member of the taxane family used for cancer therapy. Ovarian cancer is treated with Paclitaxel in first- and in second- line therapy. Cystoid macular edema without fluorescein leakage is a rare side effect of Paclitaxel treatment. Case presentation: We report the case of a 59-year-old female with ovarian cancer treated with paclitaxel. The patient received 21 cycles of adjuvant chemotherapy and was presented with bilateral gradual vision loss due to macular edema after paclitaxel treatment. Optical coherence tomography revealed a bilateral cystoid macular edema. Fluorescence angiography demonstrated the unusual finding of non-leakage in the late phases of the angiogram. Microperimetric findings of both eyes confirmed the visual deficits. After cessation of the paclitaxel therapy, vision, OCT and microperimetric findings returned to normal. Also, color vision testing demonstrated no persistent defect after therapy cessation. Conclusion: Paclitaxel induced bilateral maculopathy is a rare side effect of chemotherapy. Cessation of the Paclitaxel drug therapy leads to complete functional and anatomical resolution of drug induced side effects. Vision, microperimetric defects, color perception as also anatomical defects detected by OCT change to normal after drug cessation. Taxane induced bilateral maculopathy is a rare disease which should be known by ophthalmologists as also oncologists. Paclitaxel therapy must be counseled to report any vision problems during the treatment period because early recognition of a rare non leaking CME can facilitate appropriate intervention to reverse visual compromise and minimize any potential long-term ophthalmologic sequelae.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow-up depending on stage of diabetic eye disease are summarized.

To assess the effect of intravitreal dexamethasone implant (Ozurdex) for the treatment of macular edema secondary to retinal vein occlusion (RVO) resistant to repeated intravitreal ranibizumab injection. Retrospective review of 11 patients (11 eyes) with ranibizumab-resistant macular edema secondary to RVO. Macular edema was considered refractory to ranibizumab if no change of the pattern of macular fluid on optical coherence tomography and no change of best-corrected visual acuity (BCVA) was observed after at least three consecutive monthly injections, excluding the loading dose. A single Ozurdex injection was performed and BCVA and central foveal thickness (CFT) were reviewed 2, 3, and 6 months after treatment. Mean BCVA improved significantly from 0.51 logarithm of the minimal angle of resolution (log MAR) at baseline to 0.3 log MAR (p = 0.03) at 2 months and 0.29 log MAR (p = 0.003) at 3 months. There was no significant difference in the BCVA between baseline at 6 months (p = 0.62). Mean CFT reduced significantly from 538 µm at baseline to 281 µm at 2 months (p = 0.00003), 281 µm at 3 months (p = 0.00003), and 445 µm at 6 months (p = 0.03). Treatment with Ozurdex results in improvement of BCVA and reduction of CFT in patients with ranibizumab refractory macular edema due to RVO at 3 months. However, it seems that the visual acuity gain may not last up to 6 months, so that a re-injection before this time point could be considered.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow up depending on stage of diabetic eye disease are summarized.

To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.

A 24-year-old patient with Friedreich's ataxia presented with advanced visual loss due to optic nerve atrophy. After interdisciplinary consultation and after obtaining informed consent, an off-label therapy with the N-methyl-D-aspartate (NMDA) antagonist memantine was initiated. In a 1-year follow-up no further loss of the nerve fiber layer could be detected by optical coherence tomography (OCT) and visual acuity remained stable. Despite the limitations of this single and time limited case observational study, memantine should be discussed as an option for treatment of acute optic nerve atrophy in Friedreich's ataxia.

To compare the anatomical and visual outcomes of 20 gauge (g) pars plana vitrectomy (PPV) with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling and 23 g PPV with brilliant blue G (BBG)-assisted ILM peeling for idiopathic epiretinal membrane (ERM). 38 eyes of 38 patients with idiopathic ERM were included. They were divided in two groups: group 1 (18 eyes) underwent 20 g PPV with ICG-assisted ILM peeling and group 2 (20 eyes) 23 g PPV with BBG-assisted ILM peeling. Postoperative best-corrected visual acuity (BCVA) and central macular thickness (CMT) were compared. Average BCVA in group 1 improved significantly from 0.60 logarithm of the minimal angle of resolution (log MAR) at baseline to 0.3 log MAR postoperatively. Average BCVA in group 2 improved significantly from 0.60 log MAR at baseline to 0.3 log MAR postoperatively. Mean CMT reduced significantly from 473 to 375 μm in group 1 and from 486 to 396 μm in group 2. There were no significant differences in the BCVA and CMT between the groups. Both surgical methods appeared to be safe and provided similar anatomical and visual outcomes.

Das dargestellte Fallbeispiel zeigt, dass ein orbitales Emphysem mit Exophthalmus eine seltene Komplikation einer transkonjunktivalen Pars-plana-Vitrektomie sein kann. Durch engmaschige Kontrollen der Patientensymptome, der Augenmotilitat, des Augendrucks und des Fundus konnte eine Optikuskompression oder Perfusionsstorung der durch die Orbita ziehenden Gefase ausgeschlossen werden. Innerhalb weniger Tagen zeigte sich eine spontane und folgenlose Ruckbildung des Exophthalmus.

Eine 31-jahrige Patientin stellte sich mit einer milden Keratitis am linken Auge vor. Das Tragen von regelmasig mit Leitungswasser gereinigten Tageskontaktlinsen und perineurale Infiltrate lenkten den klinischen Verdacht auf eine Infektion mit Akanthamoben. Eine durch Epithelabrasio gewonnene Probe auf Akanthamoben bestatigte den klinischen Verdacht. Obwohl die Behandlung aufgrund einer schlechten Medikamentenvertraglichkeit auf eine niedrig dosierte Monotherapie mit Propamidin reduziert war, heilte die Keratitis nach 13 Monaten konsequenter Therapie fast ohne Narbenbildung aus.

In daily practice, vitreomacular traction (VMT) is described by the horizontal diameter of its attachment site implying a regular round shape of VMT. We investigated the deviation from this circular area of vitreous traction in patients with VMT. A retrospective analysis of optical coherence tomography (OCT) scans was performed. The area of vitreomacular attachment was determined using six radial OCT scans (Ameasured). The assumed circular area of traction was calculated based on measuring the maximal horizontal diameter for comparison (Acircular). Thirty-seven eyes of 37 patients with pure VMT were included. Patients’ mean age was 72.8 ± 8.2 years. Mean horizontal VMT diameter was 400.8 ± 230.5 μm (median 361 μm; range 44–991 μm). While there was no difference between mean areas of traction for Acircular and Ameasured (P = 0.93), the individual difference (|Acircular − Ameasured|) was 0.042 (± 0.044) mm2 in mean or relative 73.0% (± 135.8%). A difference of ≥ 30% of Ameasured to Acircular was found in 16 eyes (43.2%) and ≥ 100% in 7 eyes (18.9%), respectively. Vitreous attachment sites possess an irregular non-circular shape in a significant number of eyes with VMT. Consequently, the area of traction appears inaccurately described by its horizontal VMT diameter alone. As the area of traction is important for therapeutic recommendation, our results emphasize the need for a more precise description of the area of traction in eyes with VMT.

Ziel der vorliegenden Studie war es, verschiedene intravitreale Fibrinolyseparameter zu analysieren und zwischen Augen mit retinalem Zentralvenenverschluss (ZVV), retinalem Venenastverschluss (VAV) und einer Kontrollgruppe zu vergleichen. Die gefundenen Aktivitaten und Konzentrationen wurden mit der intravitrealen VEGF („vascular endothelial growth factor“)-Konzentration als Zeichen der Schwere der vorliegenden Blut-Retina-Schranken (BRS)-Storung korreliert. Aus 14 Augen mit ZVV, 22 Augen mit VAV sowie 11 Kontrollaugen wurden Proben aus dem zentralen Glaskorper entnommen und auf die Aktivitaten bzw. Konzentrationen an Plasminogen, Plasmin-α2-Antiplasmin (PAP) und VEGF untersucht. Die intravitrealen Aktivitaten/Konzentrationen lagen in der ZVV-/VAV-/Kontrollgruppe bei 2,07 ± 1,87 %/1,24 ± 1,12 %/0,38 ± 0,63 % fur funktionelles Plasminogen, bei 8,14 ± 7,07 ng/ml/6,96 ± 4,8 ng/ml/9,74 ± 10,98 ng/ml fur PAP und bei 1269 ± 1318 pg/ml/528 ± 543 pg/ml/105 ± 116 pg/ml fur VEGF. Es zeigten sich signifikante Unterschiede in Bezug auf die intravitreale Plasminogenaktivitat und VEGF-Konzentration zwischen den 3 Gruppen (jeweils p

Hintergrund Ziel der vorliegenden Studie war es zu evaluieren, ob der Anheftungsstatus der hinteren Glaskorpergrenzschicht (PVC) an der Lamina limitans interna (ILM) der neurosensorischen Netzhaut einen Einfluss auf die Entstehung von retinalen Zentralvenen- (ZVV) oder Venenastverschlussen (VAV) hat.

Low-temperature thermal networks enable simultaneous heating and cooling of buildings and reduce CO2 emissions by substituting fossil fuels by environmental heat sources. In this work, we compare two different network topologies, the traditional lowtemperature network (TLTN) and the new reservoir low-temperature network (RLTN). We show that the volume flow in the RLTN can be adjusted to increase the efficiency of heat pumps and to reduce hydraulic power losses in the supply lines without compromising heat demands., + ID der Publikation: hslu_60968 + Art des Beitrages: Wissenschaftliche Medien + Jahrgang: 1343 + Sprache: Deutsch + Letzte Aktualisierung: 2019-12-03 14:14:29

Purpose: To detect intravitreal functional plasminogen in vitreous samples of patients with recent onset of central retinal vein occlusion (CRVO) and to demonstrate significantly higher intravitreal plasminogen in CRVO patients in comparison to controls. Methods: Prospective clinical case series of 13 consecutive patients with recent onset of CRVO scheduled for core pars plana vitrectomy and 10 consecutive patients undergoing standard pars plana vitrectomy for routine macular surgery or vitreal floater removal. In all 23 cases, vitreous taps were extracted from the central vitreous body, and plasminogen was functionally determined in a new ultrasensitive p-nitroanilide reaction after activation with streptokinase (100% of normal, %N = functional plasminogen in pooled normal citrated plasma). Results: Plasminogen was detected in all analyzed samples (n = 23), and mean plasminogen was revealed to be 1.33 ± 1.73% (mean ± SD), with a range of 0.03-7.8%N. Patients with recent onset of CRVO exhibited significantly higher intravitreal plasminogen (2.19 ± 1.89%N) in comparison to controls (0.20 ± 0.21%N; p < 0.001, Mann-Whitney U test). Conclusion: Due to significantly increased intravitreal plasminogen in patients with recent onset of CRVO, intravitreally administered tissue plasminogen activator might be an option to induce posterior vitreous detachment (enzymatic vitreolysis) in CRVO patients.

To evaluate the agreement and predictability of ocriplasmin treatment effects among retinal experts (raters) by assessment of retinal imaging data of eyes treated for vitreomacular traction in nine different centers in Germany and Austria. Retrospective cohort study. Combined confocal near-infrared scanning laser ophthalmoscopy and spectral-domain optical coherence tomography images (Spectralis® device, Heidelberg Engineering GmbH, Germany) from 136 eyes of 135 subjects were reviewed by 14 raters using an internet-based grading database and a standardized questionnaire. In addition to the images taken within 2 days prior to treatment, age, gender, and lens status were disclosed to the raters. Treatment success was defined as a complete cleavage of the posterior vitreous cortex at day 28±5. Main outcome was the agreement and predictability among raters for assessment of treatment success. Raters generally accepted starting ocriplasmin treatment (chance for treatment success ≥ 1%) in 22.4 to 69.1% (median 53.2%) of eyes (moderate intra- and interrater agreements with kappa-values of 0.6 and 0.48). The likelihood for a high potential treatment success (equal or higher than 25%) was judged by the raters in 43.4% to 86.0% (median 62.6%) of eyes (moderate intra- and fair interrater agreements with kappa-values of 0.56 and 0.22). Allocating eyes for high potential treatment success overall increased the odds by 3.07, with odds ratios of single raters up to 4.06 to 6.16. These results underscore the importance of training health care providers in the evaluation of retinal imaging data and also to define characteristic morphological features better in the presence of vitreoretinal interface diseases. The better results of single raters in the predictability of treatment success by the allocation of eyes in the high-potential group indicates the high relevance of the meticulous analysis of retinal images.

Diabetes mellitus can cause diabetic retinopathy, diabetic macular edema, optic neuropathy, cataract or dysfunction of the eye muscles. The incidence of these defects correlates with disease duration and quality of metabolic control. Recommendations of the Austrian Diabetes Association for diagnosis, therapeutic procedures and requirements for adequate follow up depending on stage of diabetic eye disease are summarized.

Purpose. To objectively detect true posterior vitreous cortex (PVC) adhesion status using a commercially available swept-source OCT device (DRI OCT-1, Atlantis©). Material and Methods. Case report, review of the literature, and methodical discussion of concepts to improve OCT-guided PVC imaging. Results. Standard OCT imaging misdiagnosed PVC adhesion status as totally detached in this case report when using a horizontal 6 mm scan only. Contrariwise imaging the same eye with a 12 mm horizontal scan, partial posterior vitreous detachment (PVD) and the presence of a bursa premacularis were clearly discernible. Besides a broader scan, specific scan patterns, highest resolution, and contrast sensitivity, an anterior-to-posterior adjusted scan through the entire vitreous as well as the detection of characteristic undulating aftermovements might enhance the capability of OCT imaging to detect true PVC adhesion status. Conclusions. Further developments are needed to address these issues and to establish OCT recordings as the standard and objective method of choice in PVC adhesion status imaging.

Pseudophakic cystoid macular oedema is still a relevant clinical disease entity although major progress in modern cataract surgery has been made within the last decades. The relevance is attributed to the large number of cases that are performed each year. Even after uneventful surgery, a pseudophakic cystoid macular oedema can develop and may lead to severe and lasting visual impairments. In respect to the pathophysiology, four consecutive steps have to be considered: (i) surgical procedure-related induction and release of various inflammation mediators into the anterior chamber; (ii) removal of the physiological lens barrier between the anterior and posterior segments of the eye, leading consecutively to an increase in diffusion rate in either direction; (iii) local action of the inflammation mediators towards the macular area; and (iv) increased vitreoretinal traction due to the anteriorly oriented drive of the vitreous. To prevent the development of a pseudophakic cystoid macular oedema, systemic and ocular pathologies should be treated consequently prior to surgery. Furthermore, an individual risk profile of each patient needs to be evaluated to define the best pre- and postsurgical medical treatment. A less traumatic surgical approach can help to prevent macular oedema development additionally. The diagnosis is made by performing biomicroscopy, fluorescence angiography and optical coherence tomography as well as by evaluating the patients' major complaints. Standard operation procedures or recommended guidelines by the specialised eye associations to prevent and treat pseudophakic cystoid macular oedema are not available up to date. A synopsis of recommendations in the literature suggests a step-wise treatment regimen, including topical medical treatment on the one hand and a surgical approach on the other hand as well as a combination of both, if needed. Topical medical treatment options include the use of non-steroidal, corticosteroid and/or carbonic anhydrase inhibitor eye drops. Surgical interventions include pars plana vitrectomy.

Purpose: To evaluate the posterior vitreous adhesion status in patients with a history of central or branch retinal vein occlusion and to compare the results with the natural time-course of posterior vitreous detachment in healthy age-related controls. Methods: A retrospective chart review in terms of the posterior vitreous adhesion status was performed in 132 patients (133 eyes) with a history of a central (CRVO) or branch (BRVO) retinal vein occlusion. All patients underwent vitrectomy. Based on the operation reports, the vitreous adhesion status was classified as attached, partially detached or completely detached. The results were compared to the natural time-course of posterior vitreous detachment development in healthy age-related controls. Results: Eighty-one eyes met the inclusion and exclusion criteria. Fifty-two eyes (64%) had a history of CRVO and 29 eyes (36%) a history of BRVO, respectively. In the CRVO group, the posterior vitreous was attached in 47 eyes (90%) and completely detached in five eyes (10%). In the BRVO group, the posterior vitreous was attached in 27 eyes (93%), partially detached in 1 eye (3%) and completely detached in another eye (3%). A subdivision into age classes and a comparison with healthy age-related controls [data by Weber-Krause & Eckardt (1997) Ophthalmologe, 94, 619–623] showed in patients between 65 and 69 years of age an attached posterior vitreous cortex in 72% in healthy eyes, in 100% in CRVO (p = 0.109) and in 89% in BRVO (p = 0.440), in patients between 70 and 79 years of age an attached posterior vitreous cortex in 56% in healthy eyes, in 86% in CRVO (p = 0.010) and in 100% in BRVO (p = 0.038) and in patients between 80 and 89 years of age an attached posterior vitreous cortex in 43% in healthy eyes, in 100% in CRVO (p = 0.191) and in 67% in BRVO (p = 0.582) (Fisher’s exact t-test). Conclusion: In patients with a history of CRVO or BRVO, the posterior vitreous cortex stays attached more frequently in all age groups in comparison with the healthy age-related controls.

An intact blood-retina barrier (BRB) ensures the homeostatic regulation of the retinal environment by preventing proteins and enzymes to pass from the blood stream into the retinal tissue as well as the vitreous cavity ('nonleaky eyes'). Nevertheless, thrombin is needed within the eye to avoid bleeding events. It might, furthermore, play an essential role in preventing BRB breakdown ('leaky eyes'). Until today, the intraocular thrombin activity as well as the source of the latter has not been investigated. The present work was conducted to evaluate whether intravitreal thrombin activity is present in eyes without BRB breakdown. Therefore, 16 vitreal taps were harvested at the beginning of a standard 23-gauge three-port pars plana vitrectomy. These 200 μl undiluted vitreous samples were instantly stabilized by 1 + 1 mixture with 5% human albumin, followed by 1 + 1 mixture of such an aliquot with 2.5 mol/l arginine, pH 8.6, and frozen at -20°C. After thawing at 23°C, thrombin activity was analyzed chromogenically in the presence of arginine protection against unspecific cleavage of the chromogenic substrate. Intravitreal thrombin was detected in all 16 analyzed samples and thrombin activity exhibited to be 1.5 ± 1.0 mIU/ml (mean value ± SD; range: 0.2-3.25 mIU/ml). Thus, our investigation is the first successful quantification of the physiologic intraocular activity of thrombin. Further studies will evaluate intravitreal thrombin activities in eyes with BRB breakdown and compare those results with the physiologic activities demonstrated herein. Standardized intraocular thrombin activity might be a new diagnostic parameter in ophthalmology.

Age-related macular degeneration (AMD) is the main cause of severe visual decease in elderly people in the industrialised countries. AMD is a multifactorial disease with only limited therapeutic options before anti-VEGF treatment was introduced. In spite of all the progress no long-term healing is possible. Actually, the vitreous is being investigated as a possible co-factor in the pathogenesis of AMD. Numerous authors demonstrated a higher incidence of vitreoretinal adhesion in exudative AMD by considering age, genetic and environmental factors. The essential question is whether the therapeutic release of vitreoretinal adhesion could affect the development and progress of AMD. Up to now only case reports and case series have demonstrated a positive effect on disease progress. An ongoing multicentre, prospective, comparative, randomised, double-blind clinical trial with enzymatic vitreolysis is now evaluting the effect of vitreoretinal release on the progress of AMD. The results are necessary to evaluate whether vitreoretinal release is a therapeutic option for the future.