[Traumatic Lacrimal Duct Stenosis: Demographics and Success Rate of Surgical Procedures for Secondary Treatment]. / Traumatische Tränenwegsstenosen: Epidemiologie und Erfolgsraten nach sekundärer operativer Intervention.

BACKGROUND: Traumatic lacrimal duct stenosis can be the result of sharp trauma of the eyelid, indirect trauma or surgery in the nasoorbital region, as well as burns, chemotherapy and radiation of the facial region. The aim of the study is to present the demographics, patient satisfaction, and course of different surgical procedures for secondary treatment of traumatic lacrimal duct stenosis. METHODS: We retrospectively reviewed the medical records of 50 patients who required surgery for traumatic lacrimal duct stenosis from 2009 to 2011 at the University Eye Hospital in Muenster. The evaluation included the following criteria: age, sex, duration of symptoms, complication rate and the rate of recurrence. We systematically evaluated the medical data and asked the patients about the recent symptoms via telephone questionnaire. RESULTS: 60 eyes of 50 patients were included (18 women; 32 men; age: 51.8 ± 17.1 years); 34 eyes (56.7 %) had already had operations of the lacrimal system. The success rate was 58.1 %. The mean postoperative follow-up was 52.3 ± 10.7 months. In 11 cases (18.3 %), a dakryocystorhinostomy (DCR) was necessary. CONCLUSION: Traumatic lacrimal stenosis is more common in men, and has a poorer prognosis than lacrimal duct stenosis from other causes.

[Effect of Hypericin on the Function of the Neuroretina: An Electroretinographic Study]. / Einfluss von Hypericin auf die isolierte pigmentepithelfreie Netzhaut: Eine elektroretinografische Untersuchung.

BACKGROUND: Hypericin is an important component of the Saint John's wort (Hypericum perforatum). It is assumed to inhibit intracellular signalling cascades, which contribute to neoangiogenesis. The phototoxic effect of hypericin on the retina was investigated in human retinal pigment epithelium (RPE); hypericin induces oxidative stress and has also been described to be an inhibitor of Ca(2+) influx channel in cultured RPE cells. The aim of our study is to evaluate the effect of hypericine on the function of the neuroretina. METHODS: Isolated bovine retinas were perfused with an oxygen saturated nutrient solution (1 mL/min). We exposed the retina to a flashlight of 6.3 mlx every 5 min. The electroretinogram (ERG) was recorded as a transretinal potential using Ag/AgCl electrodes. ERGs were monitored before, during and after hypericin exposure. RESULTS: In three independent experiments we investigated the effect of hypericin on the amplitude of the b-wave. In our experiments we observed a significant reduction of the amplitude of the b-wave to 87.1 ± 3.5 % (p = 0.02). This reduction was in all our experiments partially reversible. After hypericin wash-out the b-wave amplitude did not recover completely and did not return to the initial value (91.0 ± 5.1 %; not significant). We did not observe a significant effect of hypericin on the implicit time of the b-wave. CONCLUSION: This study shows for the first time that hypericin influences retinal signal transduction, suggesting that hypericin impairs not only the RPE, but also affects retinal signalling and function.

[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 %.

[Alterations of intraocular pressure in comparison of self- and external-administered topical antiglaucomatosa during diurnal intraocular pressure measurements]. / Vergleichende Analyse intraokularer Druckwerte zwischen Fremd- und Eigenapplikation topischer Antiglaukomatosa bei stationärem Tagestensioprofil.

BACKGROUND: The correct self-administration of topical antiglaucomatous eye drops is important for the success of glaucoma treatment. Individual impairment, like increased age, decreased visual acuity, impaired visual-field perception or the frequency of drug appliance may influence a correct application technique and the patients compliance and therewith intraocular pressure (IOP). The aim of this study was to explore alterations of IOP due to self versus external administration (by trained medical personnel) of topical antiglaucomatous eye drops due to impairing factors. MATERIAL AND METHODS: A prospective analysis was undertaken of 123 patients with primary chronic open-angle glaucoma receiving a diurnal intraocular pressure (DIP) measurement over 72 hours at our department. During the first 24 hours, the application of topical eye drops was self-administered by patients (SA), while the application of eye drops within the following 48 hours was performed by trained medical personnel (EA). Alterations of mean intraocular pressure (MIP) and diurnal fluctuations (DF) between EA and SA were analysed with regard to initial IOP, restrictions of visual field perception, visual acuity, age, general health status and frequency of daily eye drop administration. RESULTS: Overall comparable MIP in SA and EA was seen. 19.2-43.9 % of the patients with an initial IOP ≥ 11 mmHg showed beneficial effects of EA with lowering of IOP under 15.5 mmHg. 27.6 % of the patients showed lowering of DF < 5 mmHg due to EA. EA influenced DF beneficially in cases of poor visual acuity (≤ 0.1, - 0.8 mmHg) and frequent drop administration (- 0.75 mmHg). CONCLUSIONS: Subpopulations of investigated patients showed lowering of MIP due to EA, although EA showed no MIP lowering effects in comparison with SA in general. Glaucoma-impaired patients show decreased DF by EA. Particularly beneficial influences to DF by EA were observed due to impaired visual acuity and frequent drop administration. We recommend a 72-hour DIP to evaluate individual parameters influencing the success of topical glaucomatous treatment. The benefit of EA in patients with certain impairments should be the subject of further investigations.

Skin metastases in metastatic uveal melanoma: GNAQ/GNA11 mutational analysis as a valuable tool.

BACKGROUND: Uveal melanomas represent 3.1% of all melanomas, with a high potential of metastatic disease of up to 50%, where the median survival time is 6 months. Though liver metastases dominate as the primary site for metastasis, the existence of primary skin metastases is still under discussion but has been reported in only a few studies. OBJECTIVES: We present two cases in which patients with a known history of uveal melanoma developed melanoma skin metastases. METHODS: Mutational analysis was performed to clarify the origin of the metastases (uvea or skin). RESULTS: The analyses revealed GNA11 mutations, which are typical for uveal melanoma. These cases strongly suggest the skin to be the primary site of uveal melanoma. CONCLUSIONS: Knowledge about the mutational status of uveal melanomas opens the opportunity for future targeted therapies that directly interact with the mutation and its activated signal cascades. First trials in uveal melanoma have shown promising results with MEK inhibitors.

[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.

Topographic protein profiling of the age-related proteome in the retinal pigment epithelium of Callithrix jacchus with respect to macular degeneration.

In the retinal pigment epithelium (RPE) several factors within the macular compared to peripheral regions cause differences in physiological aging. The molecular mechanisms during aging in the context of topography are not well known. The proteome of RPE of different aged macular-bearing primates Callithrix jacchus was thus analysed with ion mobility mass spectrometry. Macular and periphery of neonate RPE were well differentiated from aged tissues as demonstrated by principal component analysis. This finding was mainly due to proteins involved in major developmental processes and the visual cycle. The distinction of adult from senile tissue and macular from periphery was more subtle. The hypotheses of inflammation increasing with age was supported. High expression levels of proteins related to oxidative stress (e.g., cathepsin B) and chaperones (e.g., HSP90) were detected in aged RPE as confirmed by Western blot and immunohistochemical analysis. Decreased levels of proteins participating in angiostatic properties (e.g., thrombospondin 1) and the integrity of tissue basement membranes with age (e.g., nidogen 1) were in agreement with neovascularization. This study presents targets for further investigations of the mechanisms of the aging process with the aim to elucidate predictive factors for the conversion of physiological aging into pathological conditions. SIGNIFICANCE: The current study characterized the different protein profiles of the retinal pigment epithelium (RPE) of the macula-bearing, non-human primate Callithrix jacchus during life-time. In addition, the subproteomes of macular and peripheral RPE were investigated. Differently expressed proteins described developmental processes in neonate tissue and destructive mechanisms in aged samples. Insights into the physiological aging process of the RPE and its conversion into pathophysiological conditions were gained. They assist in designing therapeutical approaches to counteract age-related diseases of the retina.

[Multimodal diagnostic of CSNB1 with NYX gene mutation]. / Stufendiagnostik einer CSNB1 mit NYX-Genmutation.

This article presents the case of a young male patient with complete congenital stationary night blindness (CSNB1). The informative value of the general medical history and clinical findings for the diagnosis was impaired due to language barriers and low compliance. Full-field electroretinography and optical coherence tomography help to define particular hereditary retinal dystrophies. Molecular genetic analysis by next generation sequencing as a part of multimodal diagnostics finally uncovered a rare, causal missense mutation in the nyctalopin (NYX) gene.

[Role of the aging visual system in glaucoma]. / Rolle des alternden visuellen Systems bei Glaukomen.

BACKGROUND: Glaucoma is the second leading cause of blindness worldwide and is usually diagnosed in higher age groups. The goal was to survey how patient age influences the development of glaucoma. MATERIALS AND METHODS: A web-based search on aging of the visual system and its influence on glaucoma was performed and the most important results are summarized. RESULTS: The prevalence of glaucoma rises with age. Aging processes of the trabecular meshwork and the uveoscleral outflow pathway lead to a rise in the intraocular pressure. Chronically elevated intraocular pressure leads to remodelling of the lamina cribrosa and narrowing of its pores through which ganglion cell axons leave the eye. Age-dependent glia cell, mitochondria and immune system alterations are discussed to influence glaucoma. Patient age and further age-related nonophthalmological systemic diseases also influence adherence and persistence to the prescribed therapy. CONCLUSIONS: Aging is an important risk factor for developing glaucoma and is a main factor which influences therapy and course of the disease. At this point in time it remains unclear to which extent additional factors determine the development of glaucoma.

[Clinical, morphological and molecular biological characteristics of the aging eye]. / Klinische, morphologische und molekularbiologische Charakteristika des alternden Auges.

BACKGROUND: The physiological aging of the eye is associated with loss of visual function. Age-related changes of the eye can result in ophthalmological diseases. The aim of this article is to display morphological, histological and molecular biological alterations of the aging eye. MATERIAL AND METHODS: A web-based search and review of the literature for aging of the visual system including cornea, lens, vitreous humor, retina, retinal pigment epithelium (RPE), choroidea and optic nerve were carried out. The most important results related to morphological, histological and molecular biological changes are summarized. RESULTS: Age-related, morphological alterations can be found in preretinal structures, e. g. cornea, lens and vitreous humor, as well as neuronal structures, such as the retina. In addition to negligible clinical signs of the aging eye, there are clinically relevant changes which can develop into pathological ophthalmological diseases. These transitions from age-related alterations to relevant ophthalmological diseases, e. g. age-related macular degeneration and glaucoma are continuous. CONCLUSION: An understanding of aging could provide predictive factors to detect the conversion of physiological aging into pathological conditions. The derivation of physiological markers or new approaches to detection and treatment of disease-related entities associated with the risk factor aging are desirable. Translational approaches in clinical and basic science are necessary to provide new therapeutic options for relevant ophthalmological diseases in the future.

[Successful treatment of Fusarium-associated keratitis with multiresistant pathogen and multimorbid patient]. / Erfolgreiche Therapie einer Fusarium-assoziierten Keratitis bei multiresistentem Erreger und multimorbidem Patienten.

A 75-year-old man (not a contact lens wearer) presented with Fusarium-associated hypopyon keratitis. After several weeks of empirical and subsequently targeted antimycotic treatment, no considerable improvement was observed. However, after sclerokeratoplasty (11.2 × 11.2 mm) combined with prolonged antimycotic therapy a good local result with relapse-free long-term follow-up was achieved.