[Outcome and complications after trabeculectomy depending on the preoperative intraocular pressure]. / Sechs-Monats-Verlauf nach Trabekulektomie in Abhängigkeit vom Ausgangsdruck.

PURPOSE: Trabeculectomy is a frequently used surgical procedure in open-angle glaucomas. The present study analyses the outcome and complications after trabeculectomy or re-trabeculectomy depending on the preoperative intraocular pressure (IOP) < 30 mmHg and ≥ 30 mmHg. METHODS: One hundred and eighteen patients were included in this retrospective study. Primary ocular outcomes were the postoperative IOP at discharge and postoperative complications such as choroidal detachment and flattening of the anterior chamber. The necessity of postoperative interventions such as needle revisions, viscoelastic injections or surgical revision was documented. RESULTS: In this survey 118 patients (68 men, 50 women) were included (age [arithmetic mean] 68.3 ± 12.1 years). The postoperative follow-up period was 6-9 months. In 60 patients the preoperative IOP was < 30 mmHg, in 58 patients ≥ 30 mmHg. Postoperative complications were flattening of the anterior chamber (< 2 corneal thickness) in 11 patients (9.3 %) and temporary choroidal detachment in 20 patients (16.9 %). On the day of discharge the mean IOP was 9.8 mmHg. Hence the IOP was on average reduced by 17 mmHg (SD 11.2 mmHg). Postoperative interventions were necessary in 28 patients (23.7 %). Seventeen (14.4 %) developed tenon cysts which were treated by needle revision of the bleb. Nine patients (7.6 %) underwent a viscoelastic injection for persistent hypotony and 10 patients underwent bleb revision (8.5 %). CONCLUSIONS: This study does not show statistically significant differences depending on preoperative IOP in temporary choroidal detachment and postoperative interventions. A postoperative flattening of the anterior chamber was found statistically significantly more often in patients with higher preoperative IOP.

[Awareness for glaucoma in the general population]. / Bewusstsein für eine Glaukomerkrankung in der Bevölkerung.

BACKGROUND: Glaucoma is not a rare entity but because very few symptoms occur and visual field defects are frequently first recognized at a late stage, a large proportion of glaucoma diseases remain undetected. The aim of this study was to identify the proportion of undiagnosed glaucoma in German population-based cohort studies and to contextualize them in the context of the literature. MATERIAL AND METHODS: The prevalence of glaucoma in the Gutenberg Health Study (GHS) and the age-related investigations on health of the University of Regensburg (AugUR) was evaluated based on visual field examinations and optic disc color photography according to the ISGEO criteria. Furthermore, the self-reported glaucoma diagnoses were collected and the proportion of undiagnosed glaucoma was determined. RESULTS: The proportion of undiagnosed glaucoma was 55% in the GHS, and 53% in the AugUR study. The results correlate with results from previous studies from other countries in which the proportion of unrecognized glaucoma ranged from 33% to 78%. In the GHS and the AugUR study the proportion of undiagnosed glaucoma was higher in younger age groups and in women. DISCUSSION: Roughly every second case of glaucoma is undetected. As the symptoms are often nonspecific or take a long time to appear, there is a risk of advanced glaucomatous visual field defects or blindness due to a lack of glaucoma awareness. Studies have shown that a systematic screening can halve this risk.

[Management of childhood glaucoma associated with Sturge-Weber syndrome]. / Management kindlicher Glaukome bei Sturge-Weber-Syndrom.

PURPOSE: Sturge-Weber syndrome is a rare congenital disorder consisting of cutaneous, leptomeningeal and ocular vascular malformations. Glaucoma occurs in 30-70 % of patients. Treatment is challenging due to a high risk of severe complications such as expulsive haemorrhage, massive choroidal effusion and serous retinal detachment. Ocular findings and the occurrence of complications under different treatment modalities have been reviewed. METHODS: A retrospective analysis of a case series of 5 children (5 eyes/mean age 5.6 years) with secondary glaucoma associated with Sturge-Weber syndrome was undertaken. Ocular findings, treatment modalities, intraocular pressure and complications were assessed. RESULTS: Facial port-wine nevus, i.e., nevus flammeus and dilated episcleral vessels were present in all cases. Diffuse choroidal haemangiomas were seen in four eyes. Glaucoma surgery was performed in 4 children, one child was treated with antiglaucomatous medication alone. Reversible uveal effusion and subluxation of the lens appeared postoperatively in one eye, persistent serous retinal detachment occurred 3 years after surgery in another eye (with an intraocular pressure of 10 mmHg). Both complications were found in eyes with diffuse choroidal haemangioma. CONCLUSION: Management of glaucoma associated with Sturge-Weber syndrome is difficult and controversial. Medical treatment often does not decrease intraocular pressure sufficiently. When planning surgical intervention an increased risk of severe complications has to be considered, especially in the presence of diffuse choroidal haemangioma.

[Anti-VEGF-therapy of fibrovascular and serous-vascularized pigment epithelial detachment in neovascular AMD : A retrospective five-year-analysis]. / Anti-VEGF-Therapie bei fibrovaskulärer und serös-vaskularisierter Pigmentepithelabhebung bei neovaskulärer AMD : Eine retrospektive Fünf-Jahres-Analyse.

BACKGROUND: Neovascular age-related macular degeneration (nAMD) is the most frequent cause of pigment epithelial detachment (PED). In the clinical routine the treatment of fibrovascular PED (fPED) and serous vascularized PED (svPED) with intravitreal vascular endothelial growth factor (VEGF) inhibitors has a restricted prognosis. OBJECTIVE: There are limited data on the long-term outcome of PED under anti-VEGF therapy. Therefore, this study recorded the course of treated PEDs in nAMD eyes over a period of 5 years. METHODS: All eyes with fPED or svPED that underwent anti-VEGF medication between 2006 and 2015 were retrospectively analyzed regarding the clinical course and the morphology seen on optical coherence tomography (OCT). The inclusion criteria were the detection of a PED on OCT, the angiographic verification of nAMD, a documented clinical history over 5 years and a good image quality. RESULTS: A total of 23 eyes from 22 patients met the inclusion criteria. After 5 years a significant deterioration of visual acuity (VA) was seen in all eyes (p = 0.007) and in the subgroup of cases with fPED (p = 0.045). In the eyes with svPED the decline of VA was not significant (p = 0.097). In the collective study group a statistically significant reduction of PED height (p = 0.006) and an increase of PED diameter was measured (p = 0.002). In the subgroup analysis the decrease of PED height and increase of PED diameter were significant for cases with svPED (p = 0.004, p = 0.013, respectively) but were not statistically significant for fPED eyes (height: p = 0.616; diameter: p = 0.097). In 17 (74%) eyes fibrosis or atrophy were seen on the final assessment of OCT images. DISCUSSION: After 5 years of anti-VEGF therapy for nAMD-associated PED the VA declined in half of the eyes and the OCT showed an unfavorable morphology in 3/4 of the cases. The average number of visits and injections was distinctly lower than in clinical trials and other real-life analyses. In summary, we observed an undertreatment with a worse functional and anatomical outcome in our clinical routine compared to other studies.

[Glaucoma due to elevated episcleral venous pressure]. / Glaukome durch erhöhten episkleralen Venendruck.

BACKGROUND: Glaucoma due to elevated episcleral venous pressure is a rare and difficult to treat form of secondary open angle glaucoma. OBJECTIVE: The pathophysiology, clinical findings, differential diagnosis and treatment options are discussed. Radius-Maumenee syndrome, Sturge-Weber syndrome and carotid-cavernous sinus fistulas are covered in particular. MATERIAL AND METHODS: A literature search was conducted in the PubMed database. RESULTS: In the course of the diagnostics potentially severe diseases, such as carotid-cavernous sinus fistulas have to be ruled out. Treatment is based on the therapy of the underlying disease. Anti-glaucomatous medicinal treatment is often insufficient. In the case of surgery the increased risk for severe complications has to be taken into account. A variety of different surgical approaches have been reported in a number of small case series. CONCLUSION: Glaucoma due to elevated episcleral venous pressure can be idiopathic or secondary to another underlying disease. Although rare it should always be considered in the differential diagnosis. Treatment is challenging because of an increased risk for severe complications.

[Eclipse retinopathy : A case series after the partial solar eclipse on 20 March 2015]. / Retinopathia solaris : Eine Fallserie nach der Sonnenfinsternis am 20.3.2015.

BACKGROUND: Solar retinopathy refers to damage to the central macula caused by exposure to intense solar radiation, most frequently observed after a solar eclipse. OBJECTIVE: Description of the morphological changes in spectral domain optical coherence tomography (SD-OCT) and the clinical course in patients with acute solar retinopathy. MATERIAL AND METHODS: The study included a retrospective analysis of 12 eyes from 7 patients with solar retinopathy after the partial solar eclipse on 20 March 2015. Best corrected visual acuity, fundus changes and SD-OCT findings were analyzed. Out of the 7 patients 5 underwent treatment with 1 mg prednisolone per kg body weight. RESULTS: The average age of the patients was 30.1±13.1 years. Best corrected visual acuity was 0.65 at initial presentation. In the acute stage all affected eyes showed a small yellowish lesion in the centre of the fovea in the fundoscopic examination. In SD-OCT the continuity of all layers in the foveola appeared disrupted. In the follow-up examination these changes were partially resolved. After 2 months SD-OCT revealed a small defect of the ellipsoid zone. In one patient the defect could not be shown due to slightly excentric imaging sections. Best corrected visual acuity increased to 0.97. CONCLUSION: The SD-OCT is an appropriate tool to determine the exact localization of the site of damage and for follow-up examination in solar retinopathy. In the acute phase it shows a disruption of the continuity of all layers in the foveola. Despite good recovery of visual acuity a small central defect of the ellipsoid zone remains in the long term.

[Preoperative therapy switch before glaucoma filtration surgery : Influence of the systemic antiglaucomatous and local antiphlogistic therapy on the intraocular pressure]. / Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie : Einfluss der systemischen augendrucksenkenden sowie der lokalen antiphlogistischen Therapie auf den Augendruck.

BACKGROUND: The preoperative switch from local to systemic antiglaucomatous therapy and the additional application of local antiphlogistic drugs represents an important component of perioperative wound healing modulation within the framework of glaucoma filtration surgery. OBJECTIVE: The aim of the present study was to compare the intraocular pressure (IOP) under a maximum local and oral antiglaucomatous therapy with or without additional application of local steroids. METHODS: A retrospective clinical analysis of 121 consecutive patients who underwent primary trabeculectomy for open-angle glaucoma in 2013 and who attended the outpatient clinic at least 3 weeks before surgery was carried out. The patients were set on preoperative therapy as follows: continuation of the maximum local antiglaucomatous therapy (with or without local dexamethasone 1 mg/ml 3 times daily) or administration of 750 mg acetazolamide orally per day (with or without local steroids). RESULTS: The switch to oral antiglaucomatous therapy led to a mean IOP rise of 3.14 mm Hg which was short of statistical significance (p = 0.052). The additional administration of local steroids did not significantly influence the IOP (p = 0.218). Some patients with oral acetazolamide therapy and local steroid application showed large increases in IOP up to 30 mm Hg. CONCLUSION: The mean IOP rise of 3.14 mm Hg 3 weeks after replacement of antiglaucomatous eye drops by acetazolamide was short of missing statistical significance and seems to be clinically negligible for this relatively short period. The advantages of a lower postoperative fibrotic activity have to be weighed up against this change in IOP. Surprisingly, the effect of administration of local steroids for 3 weeks was minor compared to the effect of the switch from local to oral antiglaucomatous medication. Individual major IOP increases under the preoperative therapy change should be taken into consideration.

[Clinical evaluation of the optic disc in glaucoma]. / Klinische Papillenbeurteilung bei Glaukom.

BACKGROUND: Glaucoma is defined as a progressive neuropathy of the optic nerve, characterized by specific changes of the optic disc, parapapillary region, and retinal nerve fiber layer. OBJECTIVES: Characteristic glaucomatous changes of the optic disc, parapapillary region, and retinal nerve fiber layer are discussed and their ophthalmoscopic examination is described. MATERIALS AND METHODS: A literature search in the PubMed database was conducted. RESULTS: A systematic step-by-step approach to a qualitative and quantitative ophthalmoscopic evaluation of the optic disc regarding glaucomatous damage is presented. CONCLUSION: A systematic, clinical, qualitative, and quantitative assessment of the optic disc can be performed with little effort and forms the basis for diagnosis and treatment of glaucoma.