Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis. / Transkutane (externe) Dakryozystorhinostomie mit Rekonstruktion des Ductus nasolacrimalis.

BACKGROUND: Dacryocystorhinostomy (DCR) is regarded as the gold standard for the treatment of chronic dacryocystitis (CDC). Different modifications of the surgical procedure have been developed over the years. METHODS: Patients with CDC due to postsaccal lacrimal stenosis and under treatment with DCR have been included in this retrospective study. Two groups of different surgical procedures were analysed: firstly DCR without reconstruction of the ductus nasolacrimalis (DNL, group 1) and secondly patients with reopening the DNL (group 2). Criteria for success were absence of permanent epiphora, absence of inflammation of the lacrimal sac (functional success), and no recurrent surgery with free patency of the lacrimal duct (anatomical success). This was obtained by questionnaire after a follow-up of at least 12 months. The impact of gender, ectasia of the lacrimal sac, dacryoliths, and prior lacrimal surgeries was analysed. RESULTS: Overall, 248 surgeries were enrolled in this trial. Mean age in group 1 was 68 years (range: 22 to 92 years) and gender ratio was 3.2 to 1 (female : male). In that group, 68 operations could be followed up. In group 2, 62 operations on patients of a mean age of 63 years (range: 24 to 89 years) and a gender ratio of 2.9 to 1 (female : male) were observed. Complete success occurred in 75.0% in group 1 and 75.8% in group 2. Recurrent operations were necessary in one case of group 2 (1.6%) and 4 cases of group 1 (5.9%). Gender (group 1 p = 1; group 2 p = 0.115; between groups p = 0.511), ectasia of the lacrimal sac (group 1 p = 0.877; group 2 p = 0.674; between groups p = 0.878), dacryolith (group 1 p = 1; group 2 p = 0.465; between groups p = 1), and prior lacrimal surgery (group 1 p = 0.092; group 2 p = 0.051; between groups p = 0.520) did not influence the success rates in each group or between groups. Significantly more dacryoliths were found during operations of group 2 (p = 0.010). CONCLUSION: Reconstruction of the DNL during DCR is a possible and easy modification, with a slightly better success rate in curing CDC. Intraoperatively, dacryoliths might not be apparent remain in the deeper parts of the lacrimal ducts. Therefore, these segments should be inspected during surgery.

PORES OF THE INTERNAL LIMITING MEMBRANE: A Common Finding in Vitreomaculopathies.

PURPOSE: To describe presence and distribution of pores of the inner limiting membrane (ILM) in eyes with vitreomaculopathies. METHODS: Inner limiting membrane specimens were harvested from 117 eyes of 117 patients during vitrectomy with membrane peeling from eyes with vitreomacular traction syndrome, idiopathic and secondary epiretinal gliosis, and idiopathic full-thickness macular hole. All specimens were processed as flat-mounts for immunocytochemistry and examined by phase-contrast, interference, and fluorescence microscopy. Demographic and clinical data were correlated. RESULTS: Inner limiting membrane pores were found in all vitreomaculopathies. They were identified in 47 (40.2%) of 117 eyes being most evident with antilaminin. In eyes with full-thickness macular hole >400 µ m, pores were seen in more than half of all eyes. They occur as numerous and uniformly distributed defects of the flat-mounted ILM with a mean diameter of 9.5 ± 2.4 µ m. Edges of ILM pores are round with an irregular contour and no specific cellular pattern. Pores were distinguished from retinal vessel thinning and iatrogenic artefacts. CONCLUSION: Contrary to previous reports, ILM pores are a common finding in vitreomaculopathies easily visible with antilaminin staining. Further studies are needed to clarify whether their presence correlates with differences in disease progression or imaging before and after vitrectomy with ILM peeling.

Which competencies should be fostered in education for sustainable development at higher education institutions? Findings from the evaluation of the study programs at the University of Bern, Switzerland.

A relatively broad consolidated consensus has emerged among experts regarding the competencies that should be fostered through an education for sustainable development at the higher education level. However, there is little empirical support to aid in answering the question of which competencies should be promoted from the perspective of students and graduates. This was the main purpose for analyzing the corresponding results of the evaluation of the study programs in sustainable development at the University of Bern. In a standardized survey, students (N = 124), graduates (N = 121), and the supervisors of internships (N = 37) were asked, among other questions, how important they consider the fostering of the respective 13 competencies during their studies and for their professional activities. Overall, the results confirm the view of experts: the study programs should be designed for a comprehensive empowerment with respect of responsible and self-motivated participation in meeting the challenges of sustainable development. Even the students are of the opinion that competency-oriented education is important and that not only the acquisition, respectively the imparting of knowledge is relevant. Regarding the estimation of the promotion of competencies in the study program, the three groups agree that the competencies "Interconnected, foresighted, and thinking approaches in system-dynamic contexts" and "Recognizing on one's own perspective on a situation and problem, empathizing with other perspectives, and taking these into account when solving problems" are the most important. For the professional field, the competency "Communicating in a comprehensive and target group-oriented manner" is rated most important by all three groups. However, it must be noted that there are also differences between the varying perspectives of the students, graduates, and internship supervisors. The results indicate opportunities for improvement that can also be considered as recommendations in the further development of inter- and transdisciplinary sustainability-oriented study programs. Furthermore, lecturers should, especially regarding a multidisciplinary team, coordinate and communize the development of competencies across the different educational elements. Students should be well informed regarding how the various educational elements, i.e., teaching/learning arrangements and assessments, are intended to contribute to the overall development of competency. Finally, in order to ensure that lecturers align respective learning outcomes, as well as teaching/learning arrangements and assessments in their educational elements, there will need to be a greater focus on competency development across a program of study.

Allogeneic Limbal Transplants Integrate into the Corneal Surface and Lead to an Improved Visual Acuity.

Limbal stem cell deficiency (LSCD) severely impairs vision and can lead to blindness. LSCD causes include chemical burns, infections, multiple previous operations and congenital malformations. Allogeneic limbal transplantation is a procedure for treating LSCD where prepared limbal tissue is attached using a double running suture during allogeneic penetrating keratoplasty (PKP). A total of 22 patients underwent ALT surgery between February 2019 and June 2022 at the University Hospital Halle (Saale). Regular follow-up was performed postoperatively every three months and included visual acuity testing, pressure measurement, slit lamp microscopic examination, fundoscopy, corneal topography and anterior segment optical coherence tomography (AS-OCT). The mean patient age was 69.5 years, and the mean follow-up was 19 months. All included patients had LSCD and multiple previous surgeries. Patient LSCD etiology was 59% infectious and 41% traumatic. ALTs integrated into corneal surfaces in all patients, demonstrated on AS-OCT. Since most patients initially received allogeneic limbal transplants, none of the operated eyes had surgical complications. Overall, visual acuity improved postoperatively from an initial 2.06 to 1.44 logarithm of the minimum angle of resolution (logMAR). Allogeneic limbal transplantation can be used to treat LSCD and its integration into the surrounding corneal tissue can be observed on AS-OCT.

How can Quality of Life be Achieved in a Sustainable Way? Perceptions of Swiss Rural Inhabitants.

Rural regions in Europe are often structurally weaker than urban areas and are subject to strong socio-economic development. At the same time, they offer opportunities for a high quality of life and sustainability. The key question of this article is how quality of life in high-income countries can be achieved more sustainably. Little is known about the perception of the rural population itself on the reconciling of high quality of life with sustainability. Thus, based on a concept of sustainable quality of life, qualitative interviews with 90 rural residents were conducted to ask them which factors benefit sustainable quality of life. In the perception of the interview participants, a change in attitudes and values would be a starting point for shaping many other areas to enhance sustainable quality of life; social and legal norms should provide reference points for individuals and economic actors; infrastructure should support individuals in their ecological behaviour; and the economy should serve the common good. We derive four strands of recommendations for decision-makers from these results: the enhancement of education on applicable environmental behaviours, equal access to renewable energies and local productions and services.

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency.

PURPOSE: Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse. METHODS: We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. RESULTS: All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average. CONCLUSION: The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.

Impact of the transcription factor IRF8 on limbal epithelial progenitor cells in a mouse model.

The limbus of the eye is the location of the corneal epithelial stem cell niche. These cells are necessary for continuous renewal of the corneal epithelium. In the case of limbal stem cell deficiency, these cells are damaged, and the whole cornea becomes opaque. It is important to be able to identify stem cells that could be applied for new therapeutic strategies. There are various known markers to characterize these cells, including p63, Nanog, oct4 and FGFR2. However, none of these markers are exclusively expressed in these stem cells (they are also expressed in transient amplified cells). It seems likely that a combination of stem cell markers will be necessary for corneal stem cell identification. The aim of this study was to detect IRF8 in limbal epithelial stem cells and to determine its function. In a mouse model, IRF8 could be detected in limbal and basal epithelial cells of the cornea by histological and immunohistological staining of wild-type mouse eyes. Furthermore, the limbus of the eye was significantly smaller in IRF8-knockout mice than in wild-type mice, and the expression of Nanog was lower in IRF8-knockout mice. This suggests that IRF8 has an influence on the maintenance of stem cell properties in the limbus, possibly by affecting the expression of Nanog. Furthermore, IRF8 has an impact on E-cadherin and N-cadherin expression in the mouse eye.

Relation between riding pleasure and vehicle dynamics - Results from a motorcycle field test.

Powered two-wheelers are a common means of transport all over the world. In several countries, primary motorcycles with high displacement involve another purpose, namely motorcycling is a leisure activity. Motorcycles are used as tools of transport pleasure as opposed to being purely used for individual commuting purposes. The aim of the current study involves investigating the relation between experienced riding pleasure and riding behavior in a field test. Specifically, N = 12 motorcyclists between 21 and 66 years of age were observed while riding for approximately 8 h on public roads. The measurement setup included a logger for vehicle dynamics and vehicle handling data, GNSS data, video data, and subjective measures recorded as audio comments at predefined points of interest along the round course. A comprehensive dataset with more than 6000 km of motorcycling was gathered. The results indicate that parameters of lateral vehicle behavior, such as the maximum lean angle, reflected riding pleasure. Interestingly, this is applicable for curvy sections as well as straight roads. High ratings of riding pleasure correlated with riding in snaky lines as a type of self-stimulation on straight sections. Longitudinal vehicle dynamics, such as the range of accelerations, tend to increase with the riding pleasure in curves. Hence, the effects are smaller than those for lateral vehicle behavior and not visible on straight sections. Generally, curvy sections on rural roads produce higher pleasure than straight roads. On a global level, riding pleasure increases during the first few hours of riding and subsequently decreases with respect to the time on task. The results are discussed in the context of studies on driving pleasure from the automotive sector and more fundamental psychological theories that explain pleasure as a physiological stimulation or flow. Several individuals ride motorcycles to experience pleasure. A better understanding of rider behavior in these situations can aid in deriving proper assistance and to provide individual support to a rider, thereby increasing riding pleasure as well as safety.

Reporting of Safety Events during Anti-VEGF Treatment: Pharmacovigilance in a Noninterventional Trial.

AIM: The prospective, noninterventional OCEAN study assessed the safety of intravitreal ranibizumab injections for treatment of neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion under real-world conditions in Germany. METHODS: Adults receiving ≥1 ranibizumab (0.5 mg) injections were recruited by 369 ophthalmologists and followed for 24 months. Information on adverse events (AEs) was reported by the treating physician or detected by the data management team. Collected information included observed AE, AE start and end date, intensity, causal relationship, outcome, severity, suspected drug, and actions taken. RESULTS: 2,687 AEs were reported for 1,176 of the 5,781 patients who had received a total of 32,621 injections: 27.4% nonserious AEs, 30.3% serious AEs, 27.3% nonserious adverse drug reactions (ADRs), and 15.0% serious ADRs. Most patients reported no AEs (79.7%) or only 1 AE (10.3%). AEs were most commonly reported in the Medical Dictionary for Regulatory Activities (MedDRA) System Organ Class (SOC) Eye disorders (9.4% of patients) and General disorders and administration site conditions (5.8%). The most frequent AEs by MedDRA preferred term (PT) were visual acuity reduced (3.5% of patients), intraocular pressure increased (2.5%), and drug ineffective (2.1%). AEs occurred most frequently after 3 or 4 injections (1,129 of 2,687 AEs). The proportion of AEs in the SOC Eye disorders decreased slightly with increasing number of injections, from 39.8% of events after 1 or 2 injections to 29.1% after 5 or more injections. Rates of the most frequently reported PTs did not show any consistent increase with increasing number of injections. A decrease in overall AE rates was observed over the study course. CONCLUSIONS: The results did not raise any new safety concerns for ranibizumab. The findings allow conclusions to be drawn on how pharmacovigilance data can be collected even more effectively in real-world studies to facilitate discussion on benefit-risk ratio.

EXPERIENCE WITH OCRIPLASMIN IN PATIENTS WITH VITREOMACULAR TRACTION SYNDROME: A RETROSPECTIVE STUDY OF 10 PATIENTS.

PURPOSE: To assess the efficacy of ocriplasmin in patients with vitreomacular traction (VMT) syndrome <1,500 µm with or without a full-thickness macular holes of <400 µm. METHODS: In this study, a retrospective analysis of 10 eyes of 10 patients with VMT who were treated with ocriplasmin between December 2014 and January 2016 was performed. Ocriplasmin 0.125 mg was injected only once in all cases. Outcome measures included the detachment of VMT, best-corrected visual acuity, the evaluation of optical coherence tomography, including the closure of full-thickness macular holes, and the reduction of macular edema (if present) and the decrease of metamorphopsia if present. RESULTS: Ten patients (7 women and 3 men) with an average age of 75.1 years (range, 63-84 years) were treated with ocriplasmin with a follow-up period of 8 weeks. All patients were treated for VMT syndrome, and 5 patients (50.0%) showed an additional macular hole. An absolute detachment of VMT was seen in 3 patients (30.0%) and partially in 4 patients (40.0%). In three of the five patients, a complete closure of the full-thickness macular holes was seen. The two other patients needed an additional pars plana vitrectomy as a result of the persistent macular hole. An improvement of visual acuity was seen in 6 out of 10 patients (60.0%), a reduction of macular edema in 8 out of 9 patients (88.9%), and a decrease of metamorphopsia in 6 out of 7 patients (85.7%). CONCLUSION: In this retrospective analysis, the treatment with ocriplasmin showed a resolution of VMT in 7 of 10 patients (70.0%) after a follow-up period of 8 weeks.

Temperature determination of superheated water vapor by rotational-vibrational Raman spectroscopy.

We present a novel non-invasive laser-based tool for tracer-free spatially resolved temperature measurement in superheated water vapor at atmospheric pressure. The technique exploits the temperature sensitivity of the rotational-vibrational Raman spectrum of the v1 stretching vibration. This Letter demonstrates the Raman sensor, its application to a steam gasification reactor, and four methods to analyze the Raman spectra in order to obtain the temperature: an equal intensity point approach, a pseudo-isosbestic point approach, and two approaches based on the reconstruction of the Raman band by Gaussian/Lorentzian profiles. The evaluated water vapor temperatures inside a reactor for plasma-assisted gasification are compared to data acquired by supercontinuum absorption spectroscopy.

High frequency of secondary, but not primary ocular manifestations of inflammatory bowel disease in patients treated at a tertiary care center.

OBJECTIVE: Ocular manifestations of inflammatory bowel disease (IBD) are relevant complications of IBD. Only a few prospective studies are available on the characteristics of these manifestations. The aim of this study was to characterize the frequency of eye disease in patients with IBD, including primary and secondary ocular manifestations of IBD, and to identify patients who may need specialized ophthalmologic care. PATIENTS AND METHODS: In a prospective observational study, patients with IBD were examined for ocular symptoms in comparison with control participants without IBD. All patients with IBD underwent a thorough ophthalmologic examination (including slit-lamp, tonometry, tear breakup time, Schirmer's test, and coherence tomography). The results were analyzed with respect to sociodemographic and disease-related characteristics. RESULTS: A total of 61 patients (33 women, 39 Crohn's disease, 22 ulcerative colitis, age 43.3±12.9 years, disease duration 12.4±9.3 years) were included. Ophthalmologic symptoms were reported by 53 patients (86.9%, most frequently deterioration of vision 42.6%, foreign body sensation 36.1%) compared with 60.6% in healthy controls (P=0.001). A clinically relevant, previously undetected ophthalmologic diagnosis was identified in 56 patients (91.8% - dry eye syndrome 75.4%, cataract 67.2%, blepharitis 45.9%, fundus hypertonicus 14.8%, other 16.4%). CONCLUSION: Although primary ocular manifestations of IBD are rare in intensively treated patients, the high frequency of unrecognized secondary manifestations should give reason to refer especially patients with longstanding or complicated IBD to an eye specialist - irrespective of ocular symptoms.

Methods of fixation of intraocular lenses according to the anatomical structures in trauma eyes.

Ocular trauma can lead to severe visual impairment and morbidity, depending on the anatomical structures affected. The main causes of ocular trauma include foreign bodies, impact by an object, falls, and chemicals. Most ocular traumas occur in children or young male adults. A meticulous slit lamp examination is crucial for assessing all anatomical structures. Trauma to the crystalline lens can result in dislocation, an intralenticular foreign body, cataract, fragmentation, and capsular breach. An intraocular lens (IOL) can endure subluxation or luxation under the conjunctiva, into the anterior chamber or the vitreous, or can be extruded. The surgical approach depends on the condition and morphology of the lens and the anatomical structures surrounding it. If there is capsular bag support, a secondary IOL can be placed in the sulcus using remnants of the damaged capsule. If there is no capsular bag support, a secondary IOL can be fixated to the anterior chamber angle, to the iris, or to the sclera. A detailed history of injury cannot always be obtained in trauma settings. Proper education, supervision, and certified safety eye protectors could prevent up to 90% of ocular injuries. Lens trauma can be treated with various surgical procedures and fixation techniques, which nevertheless require advanced surgical skills owing to the fine anatomical structure of the anterior segment. A careful surgical strategy should be established for a globe reconstruction after trauma with secondary lens implantation. Clin. Anat. 31:6-15, 2018. © 2017 Wiley Periodicals, Inc.

Intravitreal Anti-Vascular Endothelial Growth Factor for Macular Edema due to Complex Retinal Arterial Macroaneurysms.

INTRODUCTION: Complex retinal arterial macroaneurysms (RAM) are often accompanied by hemorrhage and/or affect the macula. We evaluated the effect of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy using ranibizumab or aflibercept with or without laser photocoagulation in the treatment of macular edema due to RAM. METHODS: A case report of two patients with secondary macular edema caused by RAM is presented. The first case was a 76-year-old female treated with two 0.5-mg injections of ranibizumab and additional focal laser photocoagulation. This patient presented a solely intraretinal exudation. The second patient was a 96-year-old female, who received one 2.0-mg injection of aflibercept. She showed sub- and intraretinal edema. We documented the clinical courses of these patients based on fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography. Patients were followed-up for 12 months. RESULTS: Patients were treated successfully using anti-VEGF therapy (ranibizumab or aflibercept) with or without laser photocoagulation. In both cases, we observed a complete regression of the macular edema and an increase in visual acuity. CONCLUSION: RAM can manifest with heterogeneous findings. Intravitreal anti-VEGF therapy with or without laser photocoagulation may be an effective treatment option in cases of macular edema due to RAM. Aflibercept and ranibizumab seem to be a potent anti-VEGF therapy for RAM. Individualized patient care is needed.

Anatomic landmarks in lacrimal surgery from an ophthalmologist's point of view: Clinical findings of external dacryocystorhinostomy and dacryoendoscopy.

Epiphora is a common clinical symptom of nasolacrimal duct obstruction. However, it is present in several pathologies and can lead to decreased quality of life for patients. A careful clinical examination including a detailed patient's history and diagnostic tests such as the fluorescein dye disappearance test and diagnostic syringing of the lacrimal duct are essential. Depending on the time of presentation (congenital, primary, or secondary acquired), grade (subtotal or total) and location of the stenosis, different surgical approaches can be considered. These are subdivided into minimally invasive (transcanalicular) and anastomosing (dacryocystorhinostomy) procedures. Furthermore, the anatomical landmarks and the site of surgical intervention differentiate the surgical techniques into endoscopic or transcutaneous. Modern intubation techniques offer a large spectrum of therapeutic possibilities enabling patient care to be customized and individualized. Knowledge of the topographical anatomy is crucial for achieving greater success and a lower complication rate. Clin. Anat. 30:1034-1042, 2017. © 2017 Wiley Periodicals, Inc.

A Case Series of Dacryoendoscopy in Childhood: A Diagnostic and Therapeutic Alternative for Complex Congenital Nasolacrimal Duct Obstruction Even in the First Year of Life.

INTRODUCTION: Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infancy. Spontaneous resolution occurs in the majority of the cases by 1 year of age. Nevertheless, obstruction has a negative impact on the outcome of conservative or surgical therapy, especially in cases of complex CNLDO. When the condition persists beyond several months, early intervention with dacryoendoscopy (DE) around the age of 1 year could yield good results. The objective of the study is to analyze the success rate and effectiveness of early DE for complex CNLDO in the first year of life. METHODS: A retrospective, non-comparative case series is presented. DE was performed under general anesthesia in patients between the age of 1 and 12 months with severe recurrent acute or chronic dacryocystitis. The medical histories, intraoperative and postoperative results after 3 months as well as via parents' interviews were analyzed to investigate the success rate. RESULTS: A total of 18 consecutive DE in 16 patients between the age of 1 and 12 months (mean 7.3 ± 3.4 months) were studied. Nine lacrimal ducts were diagnosed with persistent chronic dacryocystitis refractory to probing/syringing. The remaining 9 presented recurrent acute dacryocystitis. Diagnostic DE was performed in 18 cases. A therapeutic DE was conducted in 15 lacrimal ducts (83.3%) with simultaneous correction of the associated stenosiswith the tip of the endoscope. A visual controlled opening of the stenosis was impossible in 3 cases due to a too narrow presaccal anatomy (n = 1), an osseous duct stenosis (n = 1), and a bulging membrane of Hasner into the inferior nasal meatus (n = 1). Postoperative findings were classified into four categories: poor, fair, good and excellent. Good results were documented in 16.7% (n = 3) and excellent results in 77.7% (n = 14). The bony obstruction was treated with dacryocystorhinostomy. A minimum follow-up of 3 months was considered for final clinical analysis. Ten patients' parents (12 surgeries) were interviewed by telephone (mean follow-up 24.8 months). No recurrence of stenosis and no further postoperative complications were observed. CONCLUSION: DE is a diagnostic and therapeutic option for complex CNLDO in patients before the age of 1 year. The outcome of DE in the 3 months follow-up is highly indicative of positive final results in terms of patency of the lacrimal duct.

Nd:YAG Laser Hyaloidotomy for the Treatment of Acute Subhyaloid Hemorrhage: A Comparison of Two Cases.

INTRODUCTION: Subhyaloid hemorrhage, whether spontaneous or in the context of a Valsalva maneuver, can lead to an acute decrease in vision when located in the premacular region. Nd:YAG laser hyaloidotomy (NYLH) is a minimally invasive treatment option. METHODS: We examined two different clinical courses based on two case reports of NYLH. One case report described a 52-year-old female patient who presented with a painless decrease of vision to 20/200. The fundoscopy verified a subhyaloid premacular hemorrhage. The precipitating event for the hemorrhage could not be determined, and a NYLH was performed 5 days after the event. The other patient was a 48-year-old man who suffered an acute visual decrease (hand motion) after developing a migraine with vomiting. Fundoscopy showed a dense subhyaloid premacular hemorrhage. NYLH was performed 1 day after the hemorrhage. These clinical courses were documented based on fundus photographs, ultrasounds, and spectral-domain optical coherence tomography (SD-OCT). RESULTS: In both cases, there was an effect with approximately 2.2 mJ of laser energy. In the female patient, we observed a gradual but constant increase in vision. After 4 weeks, her vision improved to 20/20. In the male patient, the vision increased to 25/20 1 day after treatment. However, his vision returned to hand motion as he developed a diffuse vitreous opacification. Because of delayed reabsorption, vitrectomy was considered. Since the optical axis was clear with good vision, we decided against this surgery. Complete reabsorption took more than 3 months. CONCLUSION: After NYLH for subhyaloid hemorrhage, pronounced vitreous body opacification could develop despite a rapid increase in vision, and requires close monitoring by the surgeon. Fundus photography and SD-OCT are suitable means for clinical course evaluations.

Topographic Findings of the Porcine Cornea.

The porcine eye is often used as an ex vivo animal model in ophthalmological research. It is well suited for investigations concerning refractive surgery; however, corneal topography data are scarce. This study investigated the corneal topography and pachymetry of the porcine eye to provide further reproducible data. We evaluated freshly enucleated porcine eyes (n = 16) by performing computerized corneal topographies (Orbscan® IIz, Bausch and Lomb, Rochester, NY, USA). We assessed the steepest and flattest keratometric powers (K1 and K2, units in diopters (D)), astigmatism (D), white-to-white (WTW) diameter (mm), thinnest point pachymetry (µm), anterior and posterior best-fit sphere (BFS) (D), refractive power of the anterior and posterior curvatures, and total refractive power of the cornea (D). The mean keratometric powers were 39.6 ± 0.89 D (K1) and 38.5 ± 0.92 D (K2), and the mean astigmatism was 1.1 ± 0.78 D. The mean WTW diameter was 13.81 ± 0.83 mm, and the mean corneal thickness was 832.6 ± 40.18 µm. The BFSs were 38.14 ± 0.73 D (anterior) and 42.56 ± 1.15 D (posterior), and the mean refractive powers were 43.27 ± 1.08 D (anterior) and -5.15 ± 0.20 D (posterior); therefore, the mean of the total refractive power was 38.16 ± 1.00 D. The topography and pachymetry of the porcine cornea showed a specific configuration differing from the human cornea. When using animal ex vivo models such as porcine corneas for experimental corneal surgery, findings such as these should be considered.

Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula.

INTRODUCTION: This case report presents the pressure-lowering effect of transluminal fistula occlusion in a patient suffering from secondary glaucoma due to carotid cavernous fistula (CCF). CASE REPORT: A 76-year-old Caucasian woman presented with dilated epibulbar vessels with elevated intraocular pressure (IOP, >30 mmHg) as well as glaucomatous excavations of the optic disc in both eyes. Cerebral digital subtraction angiography revealed a CCF with bilateral orbital communication. Preoperative diurnal pressure profiling showed an average IOP of 25.8 mmHg (right eye) and 26.6 mmHg (left eye). Transluminal intervention and fistula occlusion led to a decrease in IOP of about 9 mmHg. A post-operative oculomotor nerve palsy regressed spontaneously. CONCLUSION: Secondary glaucoma due to CCF might be affected by fistula occlusion. Therefore, it should be considered before any surgical glaucoma interventions are performed. Diurnal pressure profiling is an effective tool for monitoring therapeutic success.