[Microsurgical Treatment of Canalicular Stenosis: Long-Term Follow-Up]. / Verlauf von Kanalikulusstenosen nach mikroskopischer Kanalikuluschirurgie.

PURPOSE: Studies about the indication and the functional prognosis of microsurgical treatment of canalicular stenosis (CR) are rare. In this study we determined the cause, recurrence and success rates of CR and compared our results with the results in the literature. METHODS: We retrospectively reviewed the medical records of 22 patients who required a microsurgical treatment of canalicular stenosis (CR) from 2009 to 2011. We systematically evaluated the medical data and asked the patients about the recent symptoms via telephone questionnaire. RESULTS: 22 patients were included (73 % women; 27 % men; age: 52.8 ± 19.9 years), 12 (55 %) patients had already had operations. The mean postoperative follow-up was 45 ± 9.2 months. The patients were followed for a minimum of 30 months. The success rate was 58 %. CONCLUSION: In some cases like long localised canalicular stenosis and especially after traumatic lacerations of the lacrimal canaliculi, a microsurgical treatment of canalicular stenosis is required. The aim of this procedure is to restore the lacrimal mucosa continuity so that a spontaneous lacrimal drainage is possible. The success rate of CR in our study was 58 %.

[Impact of age on success rate of lacrimal duct irrigation with silicone tube intubation in connatal lacrimal duct stenosis]. / Einfluss des Operationszeitpunktes auf den langfristigen Erfolg von Tränenwegsoperationen mit Schlauchintubation bei kindlicher Tränenwegsstenose.

BACKGROUND: Irrigation of the lacrimal duct with silicone tube intubation (TWS/S) remains the preferred treatment in persisting connatal lacrimal duct stenosis (kTWS). The timepoint of operation is however discussed controversely. On the one hand, it is recommended to wait for spontaneous opening of the lacrimal duct within the first year of life, on the other hand a later operation may trigger inflammatory changes within the lacrimal duct system influencing the success rate of the operation negatively. The aim of this study was to analyze the best time point of operation regarding the long-term success rate of the operation. PATIENTS/MATERIALS AND METHODS: 411 lacrimal ducts of 316 children with kTWS between 0 and 48 months of age (164 male, 156 female), who had undergone TWS with S because of kTWS at a tertiary eye care centre between 2007-2011 were included in this study. The children were divided into 6 groups of age (0-6, 7-12, 13-18, 19-24, 24-36, > 36 months) at the time of operation. The operative success was retrospectively evaluated after 36 months. The groups were compared and differences in late success rate analyzed statistically. RESULTS: The average success of operation of TWS/S in kTWS was 89 % (366 of 411 lacrimal ducts). The success rate of operation differed between the groups. If operated at the age of 0-6 months the operation was successful in 94 %, at the age 7-12 months in 91 %, between 13-18 months in 90.5 %, from 19-24 months in 88 %, and from 25-36 months in only 84.5 %. The success rate was therewith at the age of 25-36 months significantly lower than at the age of 0-6 months (p < 0.05). CONCLUSION: TWS/S in kTWS has overall a very high rate of success. The success of the operation decreases however in correlation with age at time of operation and shows with > 25 months significantly poorer results than at 0-6 months. The choice of the best time point for operation merits further investigation.

[Microbiological analysis in contact lens-associated keratits]. / Bakterielles Spektrum der kontaktlinsenassoziierten Keratitis.

INTRODUCTION: More than 125 million (2 %) people worldwide wear contact lenses (CL). 0.011 - 0.2 % of the wearers develop keratitis per year. The aim of this study was to explore and analyse the spectrum of germs in different microbiological analysis techniques to optimize the strategy of antiobiotic therapy. PATIENTS AND METHODS: A retrospective study about 65 eyes with CL induced keratitis or corneal ulceration who were treated in our hospital between 2005 - 2010. We analysed and compared the development of best-corrected visual acuity (BCVA) under single and combined antibiotic therapy and microbiological analysis of conjunctiva (CS) and CL and CL-container swabs (CLS). RESULTS: Of the patients 96.9 % were soft contact lenses wearers. 48.8 % had microbiological findings in the CS, 81.3 % in CLS. 19.6 % (n = 9) coagulase-negative Stapyhlococcus and 17.3 (n = 8) Pseudomonas species were found. Different spectra of germs in CS and CLS were found. Gram-positive bacteria in CS (54.5 %) were dominant, whereas Gram-negative bacteria were dominant in CLS. No significant difference of mean BCVA changes between single (0.09 ± 0.2) and double (0.14 ± 0.29) topical antibiotic therapy (p = 0.16) were seen, but significant differences between the groups of "gentamicin & ofloxacin" (0.2 ± 0.2) and "moxifloxacin & tobramycin" (0.1 ± 0.43) (p < 0.05) were found. No significant differences of BCVA change between patients with positive (0.12 ± 0.23) and negative (0.20 ± 0.37) microbiological results of conjunctival swabs were observed (p = 0.5). CONCLUSIONS: A strong association between keratitis among wearers of soft lenses and typical spectra of germs was found. Different microbiological findings in different swabs, a lack of findings in around 51.2 % of CS combined with the comparable clinical outcomes between sterile and "microbial" disease means the findings from CS are less important. No differences in development of BCVA between single and double antibiotical therapy were found. There was a better outcome of BCVA with ofloxacin with gentamicin compared to newer generation agents. To improve current treatment strategies in future we recommend increasing the microbiological analysis of CL and CL containers.

[Fasanella-Servat procedure for the surgical treatment of acquired ptosis of the upper eyelid]. / Das Fasanella-Servat-Verfahren zur Therapie der erworbenen Ptosis.

PURPOSE: The oculoplastic surgeon may choose between several surgical procedures to treat ptosis of the eyelid. One such potential therapeutic option is the Fasanella-Servat procedure. The purpose of our study was to evaluate the postoperative outcome of the Fasanella-Servat procedure in patients with ptosis of the eyelid with regard to objective and subjective criteria. METHODS: The postoperative success of 20 patients (23 eyelids), 11 female and 9 male, with acquired ptosis of the upper eyelid who underwent the Fasanella-Servat procedure between 1995 and 2004 in an eye tertiary care centre, was evaluated. With regard to the type of ptosis, the pre- and postoperative opening of the eyelid, the levator function, and the symmetry between both eyes were analysed statistically. The patients' subjective satisfaction with the functional and cosmetic postoperative outcome was evaluated by means of a nominal questionnaire (scale 1 - 5). The intraoperatively removed tissue was analysed histopathologically for accessory lacrimal glands or levator muscle. RESULTS: The mean preoperative opening of the eyelid was 7.1 mm (min. 4 mm, max. 10 mm) with a mean levator function of 12.6 mm. Postoperatively, the opening of the eyelid improved significantly to 9.3 mm (min. 7 mm; max. 14 mm), while the levator function remained stable. The preoperative asymmetry between both eyes was significantly decreased. 90 % of the patients were satisfied with the cosmetic and functional results. There were no early and late postoperative complications. No side effects were recorded following treatment. The intraoperatively removed tissue showed no evidence of tissue of accessory lacrimal gland or levator muscle. CONCLUSIONS: The Fasanella-Servat procedure remains an effective procedure in treating mild ptosis with few complications and good cosmetic and functional results.

[Factors influencing the long-term success of lacrimal duct surgery and the prognostic value of dacryocystography]. / Einflussfaktoren auf den langfristigen Erfolg von Tränenwegsoperationen und der prognostische Wert der Dakryozystografie.

BACKGROUND: Irrigation of the lacrimal duct with silicone tube intubation, endoscopic microdrill dacryoplasty and external dacryocystorhinostomy (DCR) are commonly used in lacrimal duct surgery. Dacryocystography (DCG) is one of the standard procedures in preoperative imaging. This study evaluates the influence of individual parameters and the prognostic meaning of preoperative DCG on the success rates after lacrimal duct surgery, in order to predict more precisely the long-term outcome after different operative paradigms. MATERIALS AND METHODS: 145 patients (mean age 60 years; 32 % male) with lacrimal stenosis, who underwent lacrimal duct surgery in the University Eye Hospital Münster during 2002 were included in this retrospective study. Individual parameters (age, gender, preoperative duration of symptoms, lacrimal sac area and operative procedures) were recorded. The lacrimal sac area of each patient was calculated from preoperative DCG imaging. The individual parameters and the prognostic relevance of preoperative DCG were statistically analysed with regards to the long-term success rate after different surgical procedures. Criteria for success were an asymptomatic patient and a successful probing and irrigation of the lacrimal duct system at follow-up at 24 to 36 months after lacrimal duct surgery. RESULTS: With a mean success rate of 79 %, DCR was most effective regarding long-term outcome. Particularly in elderly patients DCG was superior to minimal-invasive procedures. The mean area of the lacrimal sac, calculated from DCG imaging, was 18 mm (2). There was a significant correlation (p = 0.001) between the area of the lacrimal sac and long-term success of DCR. CONCLUSION: Endoscopic microdrill dacryoplasty and DCR have the most successful options in the treatment of lacrimal stenosis. DCG was the most effective procedure in elderly patients. An enlargred lacrimal sac proved to be a positive prognostic factor for the long-term success of DCR.

[Bacteriology of occluded nasolacrimal ducts in infants]. / Bakterielles Keimspektrum bei kindlichen Tränenwegsstenosen.

BACKGROUND: Connatal lacrimal duct stenosis (cLDO) commonly causes purulent bacterial dacyrocystitis. The recommended treatment of choice is up to the sixth month of life a conservative antimicrobiological therapy. After the sixth month lacrimal duct irrigation with silicone tube intubation remains the gold standard. Our purpose was to analyse the current bacterial spectrum in cLDO and to compile a bacterial resistogram in order to specify antimicrobiological therapy. METHODS: 66 samples from the lacrimal duct of 6- to 16-month-old children (41 female, 25 male) were obtained by collecting the refluxing liquids with cotton wool swabs after irrigation of the lacrimal drainage system with sterile saline during lacrimal duct surgery. Cultures were incubated aerobically and anaerobically and the infectious agents were isolated. Sensitivity testing was performed for each isolate, testing 8 different commonly used local antibiotics. Data were statistically analysed using SPSS. RESULTS: Cultures were positive in cLDO in 97 %, showing co-colonisation in 87 % with up to five bacterial strains. Gram-positive bacteria were seen in 72 % of the isolates in cLDO with Streptococcus pneumoniae (31 %) being the most abundant strain, followed by Staphylococcus aureus (13 %) and S. epidermidis (13 %). In 85 % of the samples at least one Gram-negative rod was present, most often Branhamella (12 %), followed by Haemophilus influenzae (11 %). Sensitivity testing revealed chloramphenicol, fusidic acid and ciprofloxacin/levofloxacin to be the most effective drugs in cLDO, whereas erythromycin and gentamycin turned out to be insufficient in treating cLDO. CONCLUSION: Bacterial colonisation plays a crucial role in cLDO, showing a positive culture in 97 % with frequent co-colonisation of several bacterial strains (often in combination with at least one Gram-negative strain). The sampling of a microbiological probe of the lacrimal duct is recommended at least in therapy-refractory cases. Current bacteria in cLDO can be effectively treated with chloramphenicol, fusidic acid and ciprofloxacin. The commonly used antibiotics erythromycin and gentamicin are inappropriate as monotherapeutics.

[Ophthalmological symptoms as key findings in neurosyphilis--diagnosis and therapy]. / Ophthalmologische Symptomatik als Schlüsselbefund der Neurosyphilis--Diagnose und Therapie.

BACKGROUND: The incidence of neurosyphilis, one of the late manifestations of syphilis, is reemerging. Affection of the eye is often associated with the disease. It may present with various clinical symptoms, leading to diagnostic difficulties. In cases of early diagnosis and adequate treatment the prognosis of the disease is good. PURPOSE: The purposes of this study are 1. to analyse clinical manifestations of patients with neurosyphilis on ophthalmological symptoms and 2. to demonstrate the course of the disease and the visual outcome in patients with optic nerve affection in neurosyphilis treated with standard therapy (penicillin G) or adjunct steroids. METHODS: We performed 1. a retrospective analysis of all 23 patients who were treated for neurosyphilis between 2000-2008 at this centre and 2. evaluated a case series of 4 patients with optic nerve affection in neurosyphilis who were treated with penicillin and adjunct methylprednisolone. RESULTS: 91% of the patients with neurosyphilis showed ocular affection in various presentations. The optic nerve was affected in 78%. In 43% ocular symptoms were the exclusive sign of the neurosyphilis. In all patients who were treated with penicillin, visual acuity improved. Adjunct treatment with methylprednisolone resulted in complete visual recovery in two cases. CONCLUSION: Ocular symptoms serve as the key diagnostic findings in neurosyphilis. Treatment of choice is penicillin G. Adjunct treatment with methylprednisolone may improve the visual outcome in patients with optic nerve involvement.

[Long-term results of iridocyclectomy for iris tumours]. / Langzeitergebnisse nach Iridozyklektomie bei Iristumoren.

BACKGROUND: The aim of this study was to evaluate the long-term survival rate and functional results after iridocyclectomy. PATIENTS AND METHOD: Between 1980 and 2002 39 patients (26 female and 13 male) ranging in age from 20 to 79 years (median m = 58 years) underwent iridocyclectomy for a tumour of periphery iris by means of a lamellar technique or by trepanating. Follow-up time ranged from 3 months to 24 years (m = 11.2 years). RESULTS: In 21 cases (54 %) there was a malignant tumour including 20 melanomas (mostly spindle-cell and mixed-cell melanomas) and one filiae of a bronchial carcinoma. There was a variety of histopathological entities in the 18 benign lesions (46 %). Naevi were the most frequent. The outcome was satisfactory: 57 % of the patients kept a visual acuity of > 0.5. Three eyes had to be enucleated. The rate of recurrence was 10 % (4 cases). The Kaplan-Meyer estimate for the 10-year-survival of the patients with a malignant iris tumour was 77 %. Two patients died of metastic melanoma following spindle-cell and mixed-cell melanoma. CONCLUSION: The long-term functional results after Iridocyclectomy are good, whereas complications and recurrences are rare. The 10-year-survival is high. Over a long period iridocyclectomy is a recommendable surgical procedure for removal of progredient tumours of the anterior uvea.

Decelerated neurodegeneration after intravitreal injection of α-synuclein antibodies in a glaucoma animal model.

Although elevated intraocular pressure (IOP) remains the major risk factor in glaucoma, neurodegenerative processes continue despite effective IOP lowering. Altered α-synuclein antibody (Abs) levels have been reported to play a crucial role. This study aimed at identifying whether α-synuclein Abs are capable to decelerate neuronal decay while providing insights into proteomic changes. Four groups of Sprague Dawley rats received episcleral vein occlusion: (1) CTRL, no intravitreal injection, n = 6, (2) CTRL IgG, intravitreal injection of unspecific IgG, n = 5, (3) Buffer, intravitreal injection of buffer, n = 6, (4), α-synuclein Ab, intravitreal injection of α-synuclein Ab, n = 5. IOP and retinal nerve fiber layer thickness (RNFLT) were monitored and immunohistochemistry, microarray and proteomic analysis were performed. RNFLT was reduced in CTRL, CTRL IgG and Buffer group (all p < 0.01) and α-synuclein Ab group (p = 0.17). Axon and RGC density showed an increased neurodegeneration in CTRL, CTRL IgG and Buffer group (all p < 0.01) and increased neuronal survival in α-synuclein Ab group (p = 0.38 and 0.06, respectively) compared with fellow eyes. Proteomic analysis revealed alterations of cofilin 1 and superoxide dismutase 1 expression. This data indicate that α-synuclein Ab might indirectly modulate the actin cytoskeleton organization and negatively regulate apoptotic processes via cofilin 1 and superoxide dismutase 1.

[Optic disc swelling : A compilation of relevant differential diagnoses]. / Differenzialdiagnose der Papillenschwellung : Wichtige Differenzialdiagnosen im Überblick.

Optic disc oedema describes blurred optic disc margins. It describes an unspecific clinical sign with various possible underlying causal mechanisms. The correct diagnosis and the detection of the underlying disease is however of special clinical importance. This article summarizes the most important differential diagnoses and gives advice to find the correct diagnosis.

Long-Term Outcomes of External Dacryocystorhinostomy in the Age of Transcanalicular Microendoscopic Techniques.

Purpose. This study aimed to evaluate long-term results of external dacryocystorhinostomy (DCR) at a tertiary eye care center specializing in lacrimal duct surgery in Germany. Methods. The medical records of 1010 patients with acquired nasolacrimal duct obstruction (NLDO), who had undergone lacrimal duct surgery at a tertiary eye care center, were reviewed. Only adult patients who had undergone external DCR were included. The evaluation included the following parameters: age, gender, duration of symptoms, patient satisfaction, previous dacryocystitis, complication rates, and surgical outcome. Results. 154 eyes of 146 patients (14.5%) could be included in the study. The average age was 64.1 ± 29.7 years. 66.4% of patients were females and 33.6% were males. Acute or chronic dacryocystitis was found in 81 patients (55.5%). Overall, 82.8% of patients had full resolution of symptoms. The success rate of external DCR for patients with previous episodes of dacryocystitis was 82.7% compared to 83.4% for patients without dacryocystitis in their medical history. Conclusion. In cases in which transcanalicular microendoscopic techniques are contraindicated (e.g., after dacryocystitis) or in complex cases where microendoscopic procedures have failed (revision surgery), external DCR is still the surgical treatment of choice with very good postoperative success.

[Concomitant cellular reactions in optic nerve siderosis existing for 30 years]. / Zelluläre Begleitreaktionen bei seit 30 Jahren bestehender Siderosis N. optici.

Metal foreign bodies located in the optic nerve are a rare clinical picture and sooner or later often associated with vision loss. We report on a patient who had a foreign body in the optic nerve for 30 years. Histochemical analysis of the optic nerve after the requisite enucleation with complete functional loss of the eye revealed amazing results. Even 30 years after entry of the foreign body into the optic nerve neuronal structures with organized axons surrounded by cytoblasts, glial cells, and immunocompetent cells still remoined. These findings hold out hope and may serve as the starting point for regenerative medicine to potentially restore neuronal function.