[Clinical aspects, diagnostics and differential diagnostics of uveitis for rheumatologists]. / Klinik, Diagnostik und Differenzialdiagnostik der Uveitis für Rheumatologen.

This review article presents the different forms of uveitis and their clinical manifestations. The exact type and localization of the ocular inflammation is crucial for the probability of the underlying rheumatological disease and thus for a correct differential diagnosis. In this first part, in addition to the anatomy of the eye, the different forms of uveitis including the associated nomenclature, typical symptoms, diagnostics and possible complications are presented. In a following second part ("Association of the different forms of uveitis with inflammatory rheumatic diseases and their treatment"), the associations with rheumatological and other systemic diseases are explained and highlighted from an ophthalmological and rheumatological perspective.

[Association of the different forms of uveitis with inflammatory rheumatic diseases and their treatment]. / Assoziation der verschiedenen Uveitisformen mit entzündlich rheumatischen Erkrankungen und ihre Therapie.

The etiology of uveitis greatly varies worldwide, whereby in industrial nations noninfectious causes occur relatively more frequently. In Germany, 44% of all cases of uveitis are due to systemic diseases. In rheumatology, uveitis or other kinds of ocular inflammation, such as scleritis or retinal vasculitis, most commonly occur in spondylarthritis, vasculitis and sarcoidosis. Vice versa, ophthalmologists often ask rheumatologists about an underlying rheumatic disease in patients with uveitis. It is of utmost importance to differentiate between the different forms of uveitis. This review article presents the associations with inflammatory rheumatic diseases as well as treatment options from the point of view of both ophthalmologists and rheumatologists.

[Efficiency and Therapy Safety of Fractionated Cyclophotocoagulation with up to Ten Laser Spots for Advanced Primary Open-Angle and Pseudoexfoliation Glaucoma]. / Effektivität und Therapiesicherheit der fraktionierten Zyklophotokoagulation mit bis zu 10 Herden für fortgeschrittene primäre Offenwinkel- und Pseudoexfoliationsglaukome.

BACKGROUND: Various procedures are available for the treatment of advanced glaucoma. We examined the efficacy and safety of fractionated cyclophotocoagulation (CPC) with up to ten laser spots for advanced primary open-angle glaucoma (POAG) and pseudoexfoliation (PEX) glaucoma treated with maximal topical therapy or eye-drop intolerance. MATERIAL UND METHODS: This retrospective study evaluated data from 297 eyes with advanced POAG and PEX glaucoma which received 10 applications of CPC between February 2012 and June 2017. Intraocular pressure (IOP), number of topical eye drops and postoperative complications were evaluated. Data were collected preoperatively, four weeks postoperatively, and at the last documented contact (six months postoperative visit). The paired Wilcoxon rank sum test was used to analyse the changes. RESULTS: The IOP for open-angle glaucoma decreased from 16.66 ± 4.36 mmHg preoperatively to 13.87 ± 3.59 mmHg at the last visit (6 months postoperative visit; p < 0.05). The IOP for the PEX glaucoma decreased significantly from 20.76 ± 9.55 mmHg preoperatively to 15.50 ± 5.93 mmHg at the last visit (p < 0.003). The number of hypotensive agents in the POAG was 2.51 ± 1.00 preoperatively and at the last visit 2.27 ± 1.03. In PEX glaucoma, the number of hypotensive agents was 2.46 ± 1.07 preoperatively and at the last visit 1.88 ± 0.97. Treatment-related complications occurred in three eyes - two cases of postoperative macular oedema, which were treated well with systemic steroids, and one case of pretreated anterior chamber irritation with hyphema, which was also treated with topical steroids. CONCLUSION: In our group of patients, the mild CPC performed by us with a maximum of 10 applications (vs. the conventional 20 - 30 applications) produced a good reduction of intraocular pressure, as well as a reduction in topical medication, with a low complication rate.

In vivo Histology of the Cornea - from the "Rostock Cornea Module" to the "Rostock Electronic Slit Lamp" - a Clinical "Proof of Concept" Study. / In-vivo-Histologie der Hornhaut ­ vom "Rostocker Cornea Modul" zur "Rostocker Elektronischen Spaltlampe" ­ eine klinische "Proof-of-Concept"-Studie.

INTRODUCTION: Confocal in vivo microscopy is an established method in ophthalmology research. As it requires contact coupling and calibration of the instruments is suboptimal, this method has been only rarely used in clinical routine work. As a result of close collaboration between physicists, information scientists and ophthalmologists, confocal laser scanning microscopy (CLSM) of the eye has been developed in recent years and a prototype can now be used in patients. The present study evaluates possible clinical uses of this method. MATERIAL AND METHODS: The essential innovations in CLSM are (1) a newly designed coupling element with superficial adaptation to corneal curvature and (2) the use of a dual computerised piezo drive for rapid and precise focusing. In post-processing and after elastic imaging registration of the individual images parallel to the surface, it is also possible to produce sagittal sections resembling a split lamp and with resolution in the micrometer range. The concept was tested on enucleated pig bulbi and tested on normal volunteers and selected patients with diseases of the cornea. RESULTS: Simultaneous imaging in planes parallel to the surface and in sagittal planes provided additional information that can help us to understand the processes of wound healing in all substructures of the cornea and the role of immune competent cells. Possible clinical uses were demonstrated in a volunteer with healthy eyes and several groups of patients (keratoconus after CXL, recurrent keratitis, status after PRK). These show that this new approach can be used in morphological studies at cellular level in any desired and appropriate test plane. CONCLUSIONS: It could be shown that this new concept of CLSM can be used clinically. It can provide valuable and novel information to both preclinical researchers and to ophthalmologists interested in corneal disease, e.g. density of Langerhans cells and epithelial stratification in ocular surface diseases.

[Association of the different forms of uveitis with inflammatory rheumatic diseases and their treatment]. / Assoziation der verschiedenen Uveitisformen mit entzündlich rheumatischen Erkrankungen und ihre Therapie.

The etiology of uveitis greatly varies worldwide, whereby in industrial nations noninfectious causes occur relatively more frequently. In Germany, 44% of all cases of uveitis are due to systemic diseases. In rheumatology, uveitis or other kinds of ocular inflammation, such as scleritis or retinal vasculitis, most commonly occur in spondylarthritis, vasculitis and sarcoidosis. Vice versa, ophthalmologists often ask rheumatologists about an underlying rheumatic disease in patients with uveitis. It is of utmost importance to differentiate between the different forms of uveitis. This review article presents the associations with inflammatory rheumatic diseases as well as treatment options from the point of view of both ophthalmologists and rheumatologists.

[Congenital nasolacrimal duct obstruction : A real-life study from the first symptoms to the results of surgical treatment]. / Konnatale Tränenwegsstenose : Eine Real-Life-Datenstudie von den ersten Symptomen bis zum Ergebnis der operativen Sanierung.

OBJECTIVE: The optimal timing for surgery of congenital nasolacrimal duct obstruction (CNLDO) is controversially discussed . An aspect that has not yet been studied in this context is the path from first symptoms to the initial diagnosis and surgical treatment with respect to social factors and burden of suffering. The aim of this study was a real-life analysis of the entire course of the disease. METHODS: Monocentric, retrospective study evaluating children with CNLDO (n = 147) who underwent surgery. The minimum follow-up was 3 months (26 ± 14 months). The patient information was collected by telephone using a questionnaire especially created for this purpose. The famelial suffering was measured on a scale of 1-5. RESULTS: Data were collected from 118 parents with a mean follow-up of 26 months. First symptoms occurred at a median age of 1 month. The diagnosis was confirmed through a pediatrician/ophthalmologist after a median of 6 months. An assignment to a referral center for surgical treatment was performed a median of 18 months after the first presentation. The average age of the patients at the time of surgery was 23 months. Surgery before the age of 13 months showed a 100% success rate. The average age of those who needed revision surgery was 27 months (±12 months). The familial suffering was measured as 4.1 points before surgery and 1.3 after surgery. CONCLUSION: This study is the first real-life study, which illustrates the path of CNLDO from the first symptoms to rehabilitation, including influential social factors. Early surgery significantly shortens the suffering of both patients and parents. Considering the low operative risks and excellent success rate of operative treatment, an early consultation at a surgical department is recommended.

Morphological characterization of the human corneal epithelium by in vivo confocal laser scanning microscopy.

BACKGROUND: Regarding the growing interest and importance of understanding the cellular changes of the cornea in diseases, a quantitative cellular characterization of the epithelium is becoming increasingly important. Towards this, the latest research offers considerable improvements in imaging of the cornea by confocal laser scanning microscopy (CLSM). This study presents a pipeline to generate normative morphological data of epithelial cell layers of healthy human corneas. METHODS: 3D in vivo CLSM was performed on the eyes of volunteers (n=25) with a Heidelberg Retina Tomograph II equipped with an in-house modified version of the Rostock Cornea Module implementing two dedicated piezo actuators and a concave contact cap. Image data were acquired with nearly isotropic voxel resolution. After image registration, stacks of en-face sections were used to generate full-thickness volume data sets of the epithelium. Beyond that, an image analysis algorithm quantified en-face sections of epithelial cells regarding the depth-dependent mean of cell density, area, diameter, aggregation (Clark and Evans index of aggregation), neighbor count and polygonality. RESULTS: Imaging and cell segmentation were successfully performed in all subjects. Thereby intermediated cells were efficiently recognized by the segmentation algorithm while efficiency for superficial and basal cells was reduced. Morphological parameters showed an increased mean cell density, decreased mean cell area and mean diameter from anterior to posterior (5,197.02 to 8,190.39 cells/mm2; 160.51 to 90.29 µm2; 15.9 to 12.3 µm respectively). Aggregation gradually increased from anterior to posterior ranging from 1.45 to 1.53. Average neighbor count increased from 5.50 to a maximum of 5.66 followed by a gradual decrease to 5.45 within the normalized depth from anterior to posterior. Polygonality gradually decreased ranging from 4.93 to 4.64 sides of cells. The neighbor count and polygonality parameters exhibited profound depth-dependent changes. CONCLUSIONS: This in vivo study demonstrates the successful implementation of a CLSM-based imaging pipeline for cellular characterization of the human corneal epithelium. The dedicated hardware in combination with an adapted image registration method to correct the remaining motion-induced image distortions followed by a dedicated algorithm to calculate characteristic quantities of different epithelial cell layers enabled the generation of normative data. Further significant effort is necessary to improve the algorithm for superficial and basal cell segmentation.

Intraoperative optical coherence tomography measurements of aphakic eyes to predict postoperative position of 2 intraocular lens designs.

PURPOSE: To evaluate intraoperative anterior chamber depth (ACD) measurements of the aphakic eye to predict the postoperative ACD and compare 2 intraocular lens (IOL) designs. SETTING: Hanusch Hospital, Vienna, Austria. DESIGN: Prospective study. METHODS: In this prospective study, patients scheduled for cataract surgery received a plate-haptic IOL (Asphina, Carl Zeiss Meditec AG) or an open-loop haptic IOL (ZCB00, Johnson & Johnson). Preoperatively, optical biometry (IOLMaster 700, CZM, or Lenstar, Haag-Streit) was performed. Intraoperatively, a prototype setup was used to perform time-domain OCT scans of the anterior eye segment (Visante connected to OPMI Lumera 200, both CZM). The intraoperative ACD was measured and used to predict the postoperative IOL position. Optical biometry and subjective refraction and autorefraction (RM 8800, Topcon) were performed 2 months postoperatively. RESULTS: The study comprised 203 eyes of 203 patients. A partial least-square regression model for ACD generated 2 months postoperatively showed that the predictive power of the intraoperative ACD (0.48) was highest followed by the axial eye length (0.45) and then the preoperatively measured ACD (0.30). These findings were confirmed in a bootstrapping model. Regression models combining the preoperative ACD and intraoperative ACD resulted in further significant improvement. CONCLUSIONS: Intraoperative ACD measurements predicted the postoperative position of open-loop IOLs and plate-haptic IOLs better than preoperative ACD measurements. Combining preoperative and intraoperative ACD measurements further improved the prediction.

Comparability of anterior chamber depth measurements with partial coherence interferometry and optical low-coherence reflectometry in pseudophakic eyes.

PURPOSE: To assess whether anterior chamber depth (ACD) measurements in pseudophakic eyes obtained with partial coherence interferometry (PCI) and optical low-coherence reflectometry (OLCR) devices can be used interchangeably. SETTING: Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria. DESIGN: Prospective case series. METHODS: The ACD measurements in 1 eye of each pseudophakic patient were performed with the PCI-based ACMaster device and the OLCR-based Lenstar LS900 device at least 1 day postoperatively. RESULTS: The study comprised 65 eyes of 65 patients with a mean age of 71.7 years ± 9.0 (SD) (range 39 to 91 years). In 15 eyes, no valid ACD readings could be obtained with the OLCR device. No obvious reason for these measurement failures was identified; however, tear-film alterations shortly after surgery were suspected. No significant difference in the mean ACD in the remaining 50 eyes was found between PCI measurements (5019 ± 660 µm; range 4008 to 6181 µm) and OLCR measurements (5015 ± 663 µm; range 4017 to 6163 µm) (P = .06). Three (6%) of 50 measurements were not within the 95% limits of agreement in the Bland-Altman analysis. CONCLUSIONS: Pseudophakic ACD measurements with the PCI and OLCR devices can be used interchangeably. The OLCR device proved to be more user-friendly and faster; however, in a substantial number of eyes, no usable values were obtainable. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.