[Neovascular Glaucomas - Pathogenesis, Diagnosis, Treatment and Prophylaxis]. / Neovaskularisationsglaukome ­ Pathogenese, Diagnose, Therapie und Prophylaxe.

Neovascular glaucoma (NVG) is a severe potentially blinding disease, which represents one of the most common types of secondary glaucomas. The majority of cases are caused by ischemic retinal conditions such as diabetic retinopathy, central retinal vein occlusion or ocular ischemic syndrome. If appropriately diagnosed and treated, ideally the development of NVG can be prevented. Since treatment gets increasingly challenging as the disease progresses, early diagnosis is of utmost importance. In this review pathogenesis, diagnosis, treatment and prophylaxis are discussed extensively. A focus is put on the consecutive stages through which the disease progresses and how to diagnose and differentiate them. Ultimately a stage adapted therapy approach is detailed, consisting of the three blocks: 1. treatment of the underlying disease/retinal ischemia, 2. adjunctive medical therapy (anti-VEGF) and 3. therapy of the elevated intraocular pressure.

[Secondary open-angle glaucoma: uveitic secondary glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, tumor-related glaucoma and glaucoma due to elevated episcleral venous pressure]. / Sekundäre Offenwinkelglaukome: uveitische Sekundärglaukome, Steroidglaukom, posttraumatische/postoperative Glaukome, tumorbedingte Glaukome und Glaukome im Rahmen eines erhöhten episkleralen Venendrucks.

Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure (IOP). In contrast to primary open-angle glaucoma in many cases besides IOP reduction a causal treatment is possible. This article is the second part of a review of the more frequently encountered forms of secondary open-angle glaucoma. Uveitic glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, glaucoma due to intraocular tumors and caused by elevated episcleral venous pressure are covered. The underlying pathophysiological mechanisms, characteristic clinical findings and treatment options are discussed.

[Secondary open-angle glaucoma: pseudoexfoliative glaucoma, pigmentary glaucoma and neovascular glaucoma]. / Sekundäre Offenwinkelglaukome: Pseudoexfoliationsglaukom, Pigmentglaukom und Neovaskularisationsglaukom.

Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure. This article is the first part of a review of the more common forms of secondary open-angle glaucomas. The pathogenesis, characteristic clinical findings and treatment of pseudoexfoliative glaucoma, pigmentary glaucoma and neovascular glaucoma are discussed. An emphasis is placed on the differences in treatment compared to primary open-angle glaucoma and prophylactic treatment approaches are explained where possible.

Secondary Glaucoma in the Context of Retinal Disease. / Sekundärglaukome im Rahmen retinaler Erkrankungen.

A variety of retinal diseases can lead to the development of glaucoma. The most common type of these secondary glaucomas is neovascular glaucoma (NVG), which constitutes the main subject of this review. NVG is a severe condition with a poor prognosis. Treatment becomes increasingly challenging as the disease progresses. Thus emphasis is put on early diagnosis and therapy adapted to the disease stage. The review also covers other less frequent secondary glaucomas, such as glaucomas due to intraocular tumours or associated with retinal detachment (Schwartz-Matsuo syndrome) as well as late onset open-angle glaucomas after uncomplicated vitrectomy.

[Laser Trabeculoplasty in Modern Glaucoma Therapy - a Review]. / Die Lasertrabekuloplastik in der modernen Glaukomtherapie ­ ein Überblick.

BACKGROUND: Laser trabeculoplasty (LTP) is a well established treatment modality in the management of chronic open angle glaucoma. Nonetheless there is much variation in practice. METHODS: A literature search in the PubMed database was conducted and the most important evidence-based results were summarised. RESULTS: Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are safe and effective treatment modalities, achieving an IOP reduction of 20 - 30%. Similar success rates have been reported for both procedures. A 50% rate of failure occurs after 2 - 5 years. Repeat-ALT is associated with a lower IOP decrease and a shorter duration of treatment effect. Repetition of SLT after initial SLT seems to be associated with loss of efficiency as well. SLT has been shown to be successful after initial ALT, whereas there are no data on ALT after initial SLT. For advanced glaucoma on maximum medical therapy, low success rates have been reported with regard to additional interventions. CONCLUSION: LTP is a good option for initial and adjunctive treatment. In advanced glaucoma on maximum medical therapy, low target pressures are needed, and filtering surgery has to be considered.

Spectral Domain Optical Coherence Tomography Allows the Unification of Clinical Decision Making for the Evaluation of Choroidal Neovascularization Activity.

PURPOSE: This prospective observational clinical study investigated the benefits of spectral domain optical coherence tomography for specialists and residents in the management of neovascular age-related macular degeneration (AMD). PROCEDURES: The study involved 49 eyes of 44 patients. Patients were advised to present for reevaluation 4 weeks after the administration of the loading dose of vascular endothelial growth factor (VEGF)-inhibitors (3 intravitreal injections every 4 weeks after diagnosis). They were examined by residents (3-4 years' experience in ophthalmology) and specialists (> 5 years' experience). Each examiner evaluated the clinical situation and the spectral domain optical coherence tomography (SD-OCT) scan. After each evaluation, the examiners independently stated if further anti-VEGF treatment was recommended. The "true outcome" was defined as the specialist decision based on clinical evaluation and SD-OCT. RESULTS: Specialists and residents did not significantly differ in their accuracy in deciding on the correct treatment (p = 0.705 and p = 1), with or without the aid of SD-OCT. Both groups benefited from using SD-OCT to support their recommendations (p = 0.001 and p = 0.0002) and achieved a similar level of accuracy (p = 1 for difference). CONCLUSIONS: Residents benefited more than specialists by using SD-OCT to substantiate their recommendation on how to manage exudative AMD after the administration of the loading dose.

A novel multiplex detection array revealed systemic complement activation in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is one of the most common tumors within the oral cavity. Early diagnosis and prognosis tools are urgently needed. This study aimed to investigate the activation of the complement system in OSCC patients as potential biomarker. Therefore, an innovative complement activation array was developed. Characterized antibodies detecting the complement activation specific epitopes C3a, C5a and sC5b-9 along with control antibodies were implemented into a suspension bead array. Human serum from a healthy (n = 46) and OSCC patient (n = 57) cohort were used to investigate the role of complement activation in oral tumor progression. The novel multiplex assay detected C3a, C5a and sC5b-9 from a minimal sample volume of human tears, aqueous humor and blood samples. Limits of detection were 0.04 ng/mL for C3a, 0.03 ng/mL for C5a and 18.9 ng/mL for sC5b-9, respectively. Biological cut-off levels guaranteed specific detections from serum. The mean serum concentration of a healthy control cohort was 680 ng/mL C3a, 70 ng/mL C5a and 2247 ng/mL sC5b-9, respectively. The assay showed an intra-assay precision of 2.9-6.4% and an inter-assay precision of 9.2-18.2%. Increased systemic C5a (p < 0.0001) and sC5b-9 (p = 0.01) concentrations in OSCC patients were determined using the validated multiplex complement assay. Higher C5a concentrations correlated with tumor differentiation and OSCC extension state. Systemic sC5b-9 determination provided a novel biomarker for infiltrating tumor growth and C3a levels were associated with local tumor spreading. Our study suggests that systemic complement activation levels in OSCC patients may be useful to assess disease progression.

Effect of an aspheric intraocular lens on the ocular wave-front adjusted for pupil size and capsulorhexis size.

PURPOSE: To compare the ocular wave-front of eyes with silicone Intraocular lens (IOLs) with aspheric and spherical optics after cataract surgery, taking into account the patient's pupil size under reading conditions and after pupil dilatation. METHODS: In this institutional prospective, randomized, controlled, patient and examiner masked, bilateral trial with intra-individual comparison, 60 eyes of 30 patients with bilateral age-related cataract were included. Each patient received a spherical IOL (CeeOn Edge, 911A, AMO, Santa Ana, CA, USA) in one eye and an aspheric IOL (Tecnis, Z9000, AMO) in the contra-lateral eye. Exclusion criteria were other ocular pathologies, capsular changes or zonular weakness. The main outcome variable was spherical aberration of the ocular wave-front under mesopic pupil conditions measured 2 years after surgery. Additional outcome variables were visual acuity and photopic and mesopic contrast sensitivity. RESULTS: There was no significant difference in visual acuity between the two IOL types under physiological pupil conditions and also not after pupil dilation. However, spherical aberrations were significantly lower with the aspheric IOL (SA: spherical 0.38 µm, SD: 0.11 µm; aspheric 0.10 µm, SD: 0.13 µm; p < 0.01), and there was a significant difference in contrast sensitivity at 12 cycles/degree. CONCLUSIONS: This is the first randomized and masked trial on visual function and ocular wave-front after implantation with this silicone aspheric IOL, taking the patients' own pupil size into account. The effect on visual function was detectable for mesopic contrast sensitivity, but there was no difference in visual acuity. The SA was found to be significantly lower under physiological pupil conditions as well as when recalculated for the rhexis size and under pharmacological dilatation.