[Effect of Morphological and Functional Parameters on Ocular Pulse Amplitudes: An Analysis in Ocular Hypertension and Different Types of Glaucoma]. / Der Einfluss von morphologischen und funktionellen Parametern auf die okuläre Pulsamplitude: eine Analyse bei verschiedenen Glaukomformen und okulärer Hypertension.

Background and Purpose: Ocular blood flow imbalance and the loss of autoregulation are widely believed to be important factors in the pathogenesis of glaucoma. The purpose of this study was to investigate the impact of morphometric and functional changes on ocular pulse amplitude (OPA) in normal tension glaucoma (NTG), primary open-angle glaucoma (POAG), pseudoexfoliation-glaucoma (PEX) and ocular hypertension (OHT). Patients and Methods: This prospective study included 172 patients with manifest glaucoma and OHT. All patients were examined with dynamic contour tonometry (DCT), Goldmann applanation tonometry (GAT), Heidelberg retina tomography II (HRT), and Octopus visual field analysis (program 30II). In order to identify potential determinants of OPA, a generalised linear model (GLM) analysis was defined. As effect sizes, we included gender as a factor and intraocular pressure (measured by DCT [IOP]), optic disc area, cup area, mean deviation (MD), central corneal thickness (CCT), cup-disc ratio (CDR), and patient age as covariates. Results: Mean OPA was lower in patients with NTG than in other groups. In the generalised linear model in the entire population, a larger OPA was associated with a larger IOP and female gender. In the NTG group, we did not identify effect sizes, whereas, in the OHT group, IOP (measured with DCT) and MD, in the POAG group IOP (measured with DCT) and gender and in the PEX group MD and gender showed a positive effect on OPA. Conclusions: In this study, we showed that in the NTG group neither demographic nor morphological or functional factors affected OPA. However, in the OHT and POAG groups, OPA was influenced by IOP (measured with DCT), in the OHT and PEX group by MD and in the POAG and PEX groups by gender.

[Comparison of pars plana vitrectomy with ILM peeling and intravitreal triamcinolone in diffuse diabetic macular oedema]. / Pars-plana-Vitrektomie mit ILM-Peeling versus intravitreale Triamcinolon-Injektion bei diffusem diabetischem Makulaödem.

BACKGROUND: Visual outcome and anatomic results in patients with diffuse diabetic macular oedema (DDME) were evaluated after vitrectomy with internal limiting membrane (ILM) peeling versus intravitreal triamcinolone acetonide (TA). MATERIALS AND METHODS: A prospective, non-randomised pilot study included 41 eyes (35 patients) with clinically significant DDME. In 24 eyes (group A) we performed pars plana vitrectomy with ILM peeling. Seventeen eyes (group B) received an injection of 10 mg TA. Best corrected visual acuity and central macular thickness (measured with OCT) were determined preoperatively as well as 1 and 4 months postoperatively. RESULTS: In group A, OCT showed a macular thickness of 403 +/- 142 microm preoperatively. Best corrected visual acuity was 0.24 +/- 0.18. One month after surgery, macular thickness decreased to 311 +/- 62 microm (p = 0.06 ns) and visual acuity was 0.17 +/- 0.14 (ns). Four months after surgery, macular thickness remained significantly lower compared with preoperative values, at 307 +/- 161 microm (p = 0.012). There was a tendency towards a higher visual acuity of 0.30 +/- 0.26 (p = 0.32 ns). Before TA injection, macular thickness in group B was 551 +/- 180 microm and visual acuity was 0.19 +/- 0.14. One month after TA, macular thickness decreased to 242 +/- 82 (p = 0.001) microm while visual acuity increased to 0.31 +/- 0.21 (p = 0.005). At 4 months follow-up, group B showed recurrence of macular oedema. Compared with the preoperative findings macular thickness was significantly lower (368 +/- 159 microm; p = 0,001). Best corrected visual acuity after 4 months was 0.27 +/- 0.17 and did not differ significantly from the preoperative visual acuity (p = 0.033 ns). CONCLUSIONS: Intravitreal TA as a single treatment reduces the extent of DDME within a short time after surgery. These promising results may not be stable during long-term follow-up, necessitating in many cases a re-injection of TA. Macular oedema reduction after vitrectomy with ILM peeling, however, remains stable for more than 4 months and, therefore, offers more permanent results. However, none of these treatments facilitated a significant visual acuity restoration 4 months postoperatively.

[Floppy eyelid syndrome : A frequently underdiagnosed entity of interdisciplinary importance]. / Floppy-Eyelid-Syndrom : Ein häufig unterdiagnostiziertes Krankheitsbild mit interdisziplinärer Bedeutung.

Clinically, the floppy eyelid syndrome is a frequent but underdiagnosed condition. This clinical phenotype is characterized by an extreme laxity of the eyelid, which is enlarged and has a rubber-like structure in combination with a pronounced hyperelastic tarsus. When looking down, minimal vertical tension can trigger spontaneous eversion of the upper eyelid leading to chronic papillary conjunctivitis. This syndrome usually affects older, adipose men who also suffer from sleep apnea and metabolic syndrome. Due to the resistance of chronic papillary conjunctivitis to conservative treatment, surgical treatment is often necessary; however, due to the frequent association between floppy eyelid syndrome, sleep apnea and metabolic syndrome a collaborative interdisciplinary approach is necessary.

[Does acetylsalicylic acid have a negative influence on photodynamic therapy?]. / Wirkt sich Acetylsalicylsäure negativ auf die photodynamische Therapie aus?

BACKGROUND: Non-thermal photodynamic therapy (PDT) is presently being used for the treatment of certain forms of age-related macular degeneration (AMD). This therapy results in selective occlusion of newly growing vessels. Due to this effectiveness of PDT the question came up whether inhibitors of platelet aggregation have an influence on PDT. PATIENTS AND METHODS: Our retrospective study included 60 patients with mainly classic subfoveal choroidal neovascularizations (CNV) due to AMD. All patients were treated by PDT. Thirty patients took acetylsalicylic acid (aspirin) because of their general disease before and during treatment. In the control group none of the patients took acetylsalicylic acid. RESULTS: Best corrected visual acuity and measured dimension of the choroidal neovascularization showed before beginning PDT no statistically significant difference (visual acuity p=0.676; dimension of CNV p=0.678). Also no significant difference existed between visual acuity (p=0.412; p=0.226; p=0.969) and CNV (p=0.871; p=0.245; p=0.323) at the follow-up examination. CONCLUSION: Our study has shown that acetylsalicylic acid does not have any effect on PDT treatment.

[Cataract development after electrical injury]. / Kataraktentwicklung nach Stromverletzung.

Cataract development is one of the most common complications of ocular electrical injury. Our patient reported an electrical injury of his face 13 years ago that affected both eyes. Since that time he noticed progressive visual impairment of both eyes. At the time of first presentation in 2014, slit lamp examination showed characteristic opacities within the anterior and posterior subcapsular area of the lens. Cataract surgery led to full recovery of visual acuity.

[Visual acuity and astigmatism after keratoplasty. Differences between the guided trephine system and motor trephine]. / Visus und Astigmatismus nach Keratoplastik. Unterschiede zwischen geführtem Trepansystem und Motortrepan.

BACKGROUND: The purpose of this study was to assess the differences in postoperative visual acuity, astigmatism, and selected postoperative complications between a guided trephine system (GTS) and motor trephine after penetrating keratoplasty. PATIENTS AND METHODS: In this retrospective analysis 74 patients who had undergone penetrating keratoplasty either by GTS (n = 53) or by motor trephine (Motortrepan) (n = 21) were included. Both patient groups included in this analysis were selected to ensure a homogeneous distribution of preoperative parameters to the greatest possible extent. However, some significant differences in patient selection between the two groups could not be avoided. Patients in the motor trephine group were older (mean age 68.4 years vs 56.4 years; p < 0.01) and had Fuchs' endothelial dystrophy more often (47.6 % vs 26.4 %) and significantly less keratoconus (14.3 % vs 32.1 %). RESULTS: No significant differences regarding visual acuity outcomes could be found between GTS and Motortrepan. In both patient groups there were no differences in the amount of preoperative astigmatism (1.36 vs. 2.0 dpt., p = 0.39). However, at the time of final corneal suture removal (2.23 vs. 3.5 dpt., p = 0.03) and at a postoperative control 1 year after final suture removal (2.29 vs. 3.85 dpt., p = 0.005) the amount of astigmatism in the motor trephine group was found to be significantly higher. CONCLUSION: In summary penetrating kerastoplasty using the motor trephine was found to result in significantly higher postoperative astigmatism than those performed with the GTS.

[Follicular conjunctivitis of unknown origin]. / Follikuläre Konjunktivitis unklarer Genese.

A 40-year-old female chemical laboratory assistant presented at our clinic with chronic conjunctivitis of 4 years' standing. We initially misdiagnosed her symptoms as giant papillary conjunctivitis. Topical treatment failed to produce an improvement and a biopsy was performed. Histopathological analysis showed bilateral follicular lymphoma, a subtype of the B-cell non-Hodgkin lymphoma. The patient was referred for radiotherapy. At follow-up 18 months later the patient was symptom-free.

[Experimental corneal imaging and corneal surgery with non-amplified femtosecond laser pulses]. / Experimentelle Hornhautbildgebung und Hornhautchirurgie mit nicht verstärkten Femtosekundenlaserpulsen.

BACKGROUND: Non-amplified femtosecond laser was used to induce multiphoton effects for corneal tissue imaging and for tissue ablation. MATERIAL AND METHODS: A non-amplified titanium-sapphire laser was coupled to a laser scanning microscope in order to examine human and porcine cornea. Tissue was subjected to imaging and lesions were created using identical optical pathways at pulse energies below 2 nJ. RESULTS: Cellular components and the extracellular matrix were selectively imaged by applying autofluorescence and second harmonic generation at submicron resolution. Intrastromal linear scanning at higher power resulted in luminescent plasma along the scanning line. Lesion width decreased with increasing tissue depth and increased with increasing laser power at the target. Light microscopy showed intact stromal tissue around the area of the lesion. CONCLUSIONS: High-resolution images as well as high precision tissue lesions were created in the cornea using low energy femtosecond laser pulses. Easy switching between tissue imaging and ablation seems to be suitable for diagnostic and therapeutic applications.

[Sudden papilledema of unclear origin]. / Plötzliches Papillenödem unklarer Genese.

A 44-year-old patient with a known history of Crohn's disease come to our clinic with unilateral vision impairment, orbital pain, and papillary swelling. The patient was treated with methylprednisolone for 5 days. Differential diagnosis excluded ischemic, inflammatory, and tumor-related causes of the papillary swelling, which was more likely to be due to papillitis associated with the known presence of Crohn's disease. Under steroid treatment visual acuity increased from 0.1 to 0.5, and an evident improvement of the ophthalmological and neurological findings was observed. Papillitis in conjunction with Crohn's disease is a rare cause of papillary swelling and should be taken into consideration during differential diagnosis. The disorder responds to steroid therapy but does not avoid irreversible damage.

[Intraocular hyperintense structure in MRI in a female patient with vertigo]. / Intraokulare hyperintense Struktur in der MRT bei einer Patientin mit Schwindel.

We present the case of a 77-year-old female patient who complained of dizziness. Consequently, a magnetic resonance imaging (MRI) examination was performed to rule out an intracranial tumor. The examination revealed an intraocular structure with signal hyperintensity in the left eye. The patient was referred to our clinic to screen for an intraocular tumor. Ophthalmological findings together with the medical history unmasked the "tumor" as residual perfluorodecaline vesicles.