The time course of spontaneous closure of idiopathic full-thickness macular holes.

PURPOSE: Spontaneous closure of idiopathic full-thickness macular holes (iFTMH) has been reported regularly. However, little is known about its probability and timeline. METHODS: In this retrospective study all consecutive patients who presented between August 2008 and August 2019 were screened for the presence of a macular hole and only iFTMHs were included. The primary outcome measure was the spontaneous closure of the iFTMH. RESULTS: Of 1256 eyes with macular holes, 338 fulfilled the inclusion criteria. Spontaneous closure of the iFTMH was detected in 31 eyes (9.2%) with a median time of 44 days after diagnosis. Eyes exhibiting spontaneous closure demonstrated a higher baseline best-corrected visual-acuity (BCVA) and smaller iFTMH diameter (p < 0.0001 and p < 0.0001, respectively). The mean BCVA improved from 0.4 logMAR (SD ± 0.21) to 0.29 logMAR (SD ± 0.20) after spontaneous closure (p = 0.031). The iFTMH diameter was positively correlated with the time to spontaneous closure (Pearson-r = 0.37, p = 0.0377). Spontaneously closed iFTMHs reopened in 16% (n = 5) of cases, with a median of 136 days after closure. A logistic regression model showed the hole diameter was associated with spontaneous closure (odds-Ratio 0.97, 95%CI [0.96, 0.98]). The Kaplan-Meier-Curve revealed that approximately 25% of small-iFTMH (n = 124) and 55% of iFTMH with a diameter < 150µm (n = 48) closed spontaneously within two months. CONCLUSION: The established gold-standard for the treatment of iFTMHs is macular surgery. However, the potential for spontaneous closure of small iFTMHs must be acknowledged. Therefore, if surgical treatment is delayed in individual cases, close observation is recommended.

Introducing a customized low-cost macular buckle.

PURPOSE: To demonstrate a novel surgical technique that is a low-cost alternative to commercial implants for macular buckling in high myopia. METHODS: A silicon encircling band serves as the anchor. A second silicon circling band is employed, with a 10mm silicon strip to widen the posterior scleral indentation. This band is inserted posteriorly the lateral and inferior rectus muscles and pushed behind the globe, orienting it in a superior-temporal to inferio-nasal position with the silicone strip directly under the macula. For better visualization, the placement of the macular buckle is done under the microscope. RESULTS: The placement of the macular buckle led to reattachment of the central retina in treated patients during long-term follow-up. This technique eliminates the need for detaching a rectus muscle. Visual acuity remained stable throughout the follow-up period. CONCLUSION: This customized macular buckle technique can improve the anatomical outcome in patients with central retinal detachment due to high myopia.

A Comparative Analysis of Traumatic Retinal Detachment After Open and Closed Globe Injuries in Children.

PURPOSE: Pediatric traumatic retinal detachment (RD) resulting from open globe (OGI) or closed globe injuries (CGI) presents unique challenges due to complexity often resulting in lifelong sequelae. This study compares pediatric traumatic RD outcomes and prognostic factors following OGI and CGI. METHODS: A retrospective analysis reviewed 47 cases of pediatric traumatic RD cases (age <18 years) undergoing retinal detachment surgery between 2002 and 2021. Among them, 25 cases were caused by CGI and 22 cases by OGI. Demographics, retinal detachment characteristics, surgical procedures, anatomical and functional results were assessed. Predictive factors for visual outcomes were investigated. RESULTS: In the CGI group, mean (± standard deviation) age was 11 ± 4 years, and 10 ± 5 years in the OGI group. CGI traumatic RD had significantly better preoperative (CGI: logMAR 1.39 ± 0.19 (mean ± standard error); OGI: logMAR 2.12 ± 0.20) and follow-up (CGI: logMAR 0.94 ± 0.19; OGI: logMAR 1.85 ± 0.20) best corrected visual acuity (BCVA) (p<0.05). Initial BCVA improvement was observed in CGI only. In multivariable analysis, prognostic factors for favorable BCVA outcomes included higher preoperative BCVA, older age and absence of proliferative vitreoretinopathy (p<0.05). CONCLUSION: Visual prognosis for pediatric traumatic RD remains limited, favoring CGI cases compared to OGI. Baseline BCVA emerged as major determinant of final visual acuity. Tailored management approaches can optimize treatment results.

Full-field Scotopic Threshold Improvement after Voretigene Neparvovec-rzyl Treatment Correlates with Chorioretinal Atrophy.

PURPOSE: To analyze demographic and ophthalmic data in patients with and without chorioretinal atrophy after voretigene neparvovec-rzyl (VN) to identify possible causes for this phenomenon. DESIGN: Retrospective cohort study with longitudinal follow-up. PARTICIPANTS: A total of 71 eyes of 38 patients aged 2 to 44 years with RPE65-mediated retinal dystrophy treated with VN across 2 large gene therapy centers in the United States and Germany. METHODS: Patients treated with VN who developed atrophy were compared with those who did not. MAIN OUTCOME MEASURES: Gender, age, surgical center, spherical equivalent refraction, best-corrected visual acuity (BCVA), baseline full-field scotopic threshold testing (FST), and posttreatment change in FST. RESULTS: A total of 20 eyes of 12 patients developed atrophy after treatment with VN (28% of all eyes). There was no significant difference in gender, age, surgical center, or spherical equivalent refraction between the atrophy group and the no atrophy group. However, patients between school age and young adulthood were predominantly affected, whereas the youngest and the oldest patients did not develop atrophy. Baseline BCVA was better in patients who developed atrophy than those who did not (P = 0.006). The postoperative improvement in FST at 1 month was significantly higher in the atrophy group than in the no atrophy group (P = 0.0005), and this difference remained statistically significant at 1 year (P = 0.0001). There was no correlation to baseline FST, to inflammation, or to which eye was treated first. CONCLUSIONS: The degree of FST improvement after VN appears to be strongly correlated with the development of VN-related chorioretinal atrophy. This finding raises the possibility that atrophy may develop as a toxic or metabolic sequela of vector-mediated RPE65 expression. In light of the expanding number of retinal gene therapy clinical trials, this complication warrants further study because it may not be limited to VN. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Long-term outcomes of autologous platelet treatment for optic disc pit maculopathy.

PURPOSE: Optic disc pits (ODPs) are rare congenital cavitary abnormalities of the optic nerve head, which can lead to serous macular detachments. The aim of this study was to evaluate the long-term efficacy of pars plana vitrectomy (PPV) combined with autologous platelet concentrate (APC) for the treatment of optic disc pit maculopathy (ODP-M). METHODS: A retrospective analysis was performed on eleven eyes of ten patients with ODP-M, who received PPV combined with APC. Nine eyes operated primary, four of which had a repeat surgery also with injection of APC and two eyes underwent a rescue surgery, after they have been operated in another eye center without APC. Morphological and functional results were the main outcome parameters, determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA), respectively. RESULTS: The mean duration of visual loss before surgery was 4.7 ± 3.89 months (range 0-12 months). The mean BCVA increased significantly from 0.82 ± 0.33 logMAR (range 0.4-1.3) preoperatively to 0.51 ± 0.36 logMAR (range 0-1.2) at the last examination (p = 0.0022). A significant morphological improvement was also noticed with decrease of the mean foveal thickness from 935.82 ± 248.48 µm (range 559-1400 µm) preoperatively to 226.45 ± 76.09 µm (range 110-344 µm) at the final examination (p < 0.0001). The patients were followed-up for a mean 65.36 ± 48.81 months (range 1-144 months). Two eyes developed postoperatively a retinal detachment. Cataract surgery was performed in 5 eyes during the follow-up period. CONCLUSION: Our study demonstrated that PPV with APC can improve functional and morphological outcomes, both as a primary and a rescue therapy, without any recurrence over a long follow-up period. To the best of our knowledge, this was the longest observation period regarding the use of APC in treatment of ODP-M.

Intravitreal 5-Fluorouracil and Heparin to Prevent Proliferative Vitreoretinopathy: Results from a Randomized Clinical Trial.

PURPOSE: Proliferative vitreoretinopathy (PVR) is the major cause for surgical failure after primary rhegmatogenous retinal detachment (RRD). So far, no therapy has been proven to prevent PVR. Promising results for 5-fluorouracil (5-FU) and low-molecular weight heparin (LMWH) in high-risk eyes have been reported previously. The objective of this trial was to examine the effect of adjuvant intravitreal therapy with 5-FU and LMWH compared with placebo on incidence of PVR in high-risk patients with primary RRD. DESIGN: Randomized, double-blind, controlled, multicenter, interventional trial with 1 interim analysis. PARTICIPANTS: Patients with RRD who were considered to be at high risk for PVR were included. Risk of PVR was assessed by noninvasive aqueous flare measurement using laser flare photometry. METHODS: Patients were randomized 1:1 to verum (200 mg/ml 5-FU and 5 IU/ml dalteparin) and placebo (balanced salt solution) intravitreally applied during routine pars plana vitrectomy. MAIN OUTCOME MEASURES: Primary end point was the development of PVR grade CP (full-thickness retinal folds or subretinal strands in clock hours located posterior to equator) 1 or higher within 12 weeks after surgery. For grading, an end point committee assessed fundus photographs. Secondary end points included best-corrected visual acuity and redetachment rate. A group sequential design with 1 interim analysis was applied using the O'Brien and Fleming boundaries. Proliferative vitreoretinopathy grade CP incidence was compared using a Mantel-Haenszel test stratified by surgeon. RESULTS: A total of 325 patients in 13 German trial sites had been randomized (verum, n = 163; placebo, n = 162). In study eyes, mean laser flare was 31 ± 26 pc/ms. No significant difference was found in PVR rate. Primary analysis in the modified intention-to-treat population results were: verum 28% vs. placebo 23% (including not assessable cases as failures); odds ratio [OR], 1.25; 95% confidence interval [CI], 0.76-2.08; P = 0.77. Those in the per-protocol population were: 12% vs. 12%; OR, 1.05; 95% CI, 0.47-2.34; P = 0.47. None of the secondary end points showed any significant difference between treatment groups. During the study period, no relevant safety risks were identified. CONCLUSIONS: Rate of PVR did not differ between adjuvant therapy with 5-FU and LMWH and placebo treatment in eyes with RRD.

Results of different strategies to manage complicated retinal re-detachment.

PURPOSE: Complicated retinal re-detachment with inferior proliferative vitreoretinopathy (PVR) remains a challenge. This study's aim was to compare vitrectomy with conventional silicon oil (CSO) combined with an encircling band (EB) and vitrectomy with heavy silicon oil (HSO) alone to treat retinal re-detachment through inferior PVR, where standard procedures have already failed. METHODS: A retrospective analysis was done on patients with inferior complex re-detachment with secondary PVR after primary surgery, who received pars plana vitrectomy (PPV) with CSO combined with EB (group 1) or PPV alone with HSO (group 2) between December 2006 and August 2017. The primary endpoint was retinal reattachment, and the secondary endpoint was visual acuity (VA) change and complications in both groups. RESULTS: This study included 119 eyes. Total single surgery anatomical success (SSAS) was 64%, with 80% (52/65) achieved in group 1 and 44.5% (24/54) in group 2 (p < 0.0001). The total final anatomical success (FAS) rate was 79% (94/119). In group 1, FAS was 91% (59/65) compared with 65% (35/54) in group 2 (p = 0.003). The pretreatment VA of group 1 had a median of 1.4 logMAR (95% CI 0.3-1.8), and group 2 showed a median of 1.4 logMAR (95% CI 0.2-1.8). The post-treatment decrease in group 1 was a median equal to - 0.6 versus - 0.1 for group 2 (p = 0.0001). Serious complications were similar in both groups. CONCLUSION: For complicated retinal re-detachment through inferior PVR, the combination of PPV with EB may lead to better anatomical (SSAS, FAS) and functional success compared with PPV alone with HSO.

Analysis of retinal detachment resulted from post-operative endophthalmitis treated with 23G pars Plana Vitrectomy.

BACKGROUND: To evaluate the rate, risk factors, functional outcome and prognosis in eyes with retinal detachment after post-operative endophthalmitis treated with 23G Pars Plana Vitrectomy. METHODS: Electronic patient files from 2009 until 2018 were screened for the presence of an endophthalmitis. Included were 116 eyes of 116 patients. This population was evaluated for the rate of retinal detachment after 23G Pars Plana Vitrectomy for endophthalmitis following cataract surgery or intravitreal injection. The main outcome measures were retinal detachment and visual acuity. RESULTS: The reasons for endophthalmitis were previous cataract surgery in 78 patients and following intravitreal injection in 38 patients. The first clinical evidence of endophthalmitis was present in median 5 days after the triggering intervention. Twenty-five eyes (21.55%) developed a retinal detachment an average of 25 days after endophthalmitis. RD is significantly associated with preoperative visual acuity (p = 0.001). CONCLUSIONS: We emphasize the prognostic role of preoperative visual acuity in RD development of the endophthalmitis treated with 23G Pars Plana Vitrectomy.

Surgical Aspects in Gene Therapy for Inherited Retinal Diseases. / Chirurgische Aspekte der Gentherapie von Netzhautdystrophien.

Inherited retinal dystrophies (IRD) have been studied since their recognition by Franz Donders and Albrecht von Graefe. It nevertheless took 100 years for a causal therapy to take shape in the form of gene therapy: The approval of Voretigen Neparvovec (VN) for the treatment of hereditary retinal dystrophies due to RPE65 mutations was thus a significant milestone - for the era of personalised medicine in general and ophthalmology in particular. The clinical management around gene therapy applications is complex and requires the cooperation of various experts as a multidisciplinary team. This article describes the requirements, challenges, approaches, and open questions regarding the surgical aspects of gene therapy for retinal dystrophies. The first part outlines the standard surgical treatment. Based on this standard, alternative approaches are indicated for each individual step and their value discussed. Knowledge gaps are defined and in the outlook we speculate on future developments.

PROSPECTIVE RANDOMIZED TRIAL ASSESSING THE IMPACT OF FEEDBACK MECHANISMS ON PATIENT POSITIONING.

PURPOSE: To investigate the use of a head-fixed feedback sensor to improve good positioning times after macular hole or retinal detachment surgery. The instructional methods, macular hole closure rates, and questionnaire responses were also evaluated. METHODS: After randomization, sensor devices with different feedback types (none/acoustic/vibration) were fixed on the patients' heads. Two positioning recommendations (verbal/illustrated) were used. The posturing data were logged every 500 ms for 24 hours. RESULTS: Forty-eight data sets (24 per group) were evaluated. Using sensory feedback, the median time for face-down positioning after macular hole surgery (Group 1) was significantly boosted from 463 minutes (range: 61-1,168) to 1,257 minutes (range: 1,024-1,327). The side positioning time after retinal detachment surgery (Group 2) increased from a median of 1,032 minutes (range: 520-1,165) to 1,284 minutes (range: 1,231-1,437). The night-time alarm records were reduced; however, the instructional methods exhibited no noteworthy effects. The questionnaires indicated positive acceptance of the sensors. CONCLUSION: Sensory feedback may help in cases where face-down or side positioning is recommended. These constant reminders were superior to verbal or written reminders; however, further studies are required to assess the clinical impact of sensory feedback on patient positioning.

Predictive factors for functional improvement following intravitreal bevacizumab injections after central retinal vein occlusion.

PURPOSE: Vision loss in central retinal vein occlusion (CRVO) is mostly caused by macular edema (ME) and can be treated with intravitreal bevacizumab injections. The goal of this study was to identify predictive factors for improvement in visual acuity. METHODS: Three hundred and sixteen eyes of six centres having received intravitreal bevacizumab for ME due to CRVO were enrolled in this multicentre, retrospective, interventional case series. The follow-up time was 24 to 48 weeks. Investigated patient characteristics were pretreatment, duration of CRVO prior to the first injection, initial best-corrected visual acuity (BCVA), baseline central retinal thickness as measured by optical coherence tomography, gender, eye, age, comorbidity with glaucoma, systemic hypertension, or diabetes mellitus. RESULTS: Multiple regression analysis confirmed the following baseline predictive factors for an increase in visual acuity: low BCVA (p < 0.001), high CRT (p < 0.02), and treatment naïve patients (p = 0.03). None of the other investigated patient characteristics could be identified as prognostic factors for increase in visual acuity (p > 0.1). CONCLUSIONS: Intravitreal injections of bevacizumab in a routine clinical setting effectively improved and stabilized BCVA in CRVO. Our large multicenter study identified initial BCVA, baseline CRT, and pre-treatment as prognostic factors for visual improvement.

[Healthcare Research into Anti-VEGF Therapy: Selection and Methodological Precautions]. / Versorgungsforschung der Anti-VEGF-Therapie: Selektion und methodische Besonderheiten.

Health care research has emerged as an approach to assess and improve quality of care and patient outcomes in the real world. It also has the potential to reduce healthcare costs by providing evidence to guide healthcare decisions.Randomised controlled trials (RCTs) theoretically offer the ideal study design to support treatment decisions. In RCTs, randomisation (formal chance) determines treatment allocation, which prevents selection bias from distorting the parameters of anti-VEGF treatment effects. Despite this advantage, only a minority of patients qualify for inclusion in neovascular age-related macular degeneration or diabetic macular oedema trials, which limits the validity of the results to the whole patient population seen in clinical practice. The evidence base for anti-VEGF is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials. RCTs often do not address other knowledge gaps, including treatment delay, comparisons for less frequent types of CNV, monitoring of rare or late toxicity events or systemic safety.Observational studies, or studies in which treatment allocation occurs independently of investigators' choice or randomisation, can complement RCTs by providing data that is more relevant to the circumstances under which intravitreal therapy is routinely practiced. However, it is important to be aware of the strengths and limitations of such observational study designs, in order to optimise the design as well as the analytic techniques. Selection bias and loss-to-follow-up cause make comprehensive interpretation and careful analysis necessary. Future reports should focus on time-to-event analysis, as this is much less prone to loss-to-follow-up and improves adherence of (functionally) one-eyed or good responders. Observational studies and pragmatic trials can test new hypotheses and possible license extensions. The bearing of RCT findings on day-to-day practice can then be assessed. The data can be interpreted in a more meaningful manner by practicing clinicians if evidence is integrated from a variety of different study designs and methodologies.

Long-term results of ab externo trabeculotomy for glaucoma secondary to chronic uveitis.

PURPOSE: To present the long-term results of ab externo trabeculotomy in the management of glaucoma secondary to chronic uveitis. METHODS: In this retrospective single-centre case series, medical records of patients with glaucoma secondary to chronic uveitis, who underwent ab externo trabeculotomy, were evaluated. Two definitions of success were used: intraocular pressure (IOP) 6 ≤ IOP ≤ 21 mmHg (success 1) or 6 ≤ IOP ≤ 21 mmHg and at least 25 % reduction from baseline (success 2). Success was complete when no additional medication was required or qualified when additional medication or cycloablative procedures were required to achieve the specific IOP definition. RESULTS: Twenty-two eyes of 18 patients were included. After 3 years, median IOP decreased from 27 mmHg [range 17-43 mmHg, mean 27.5 mmHg, 95 % confidence interval of the mean (CI) 24.5-30.5 mmHg] to 15 mmHg (range 9-19 mmHg, mean 14.5 mmHg, CI 13-16.1 mmHg). Complete and qualified success 1 was 23 and 45 % after 3 years, respectively. For success 2, the rates were 23 and 32 %, respectively. Hyphema was the most common complication, which resolved completely within 1 month after surgery without further intervention. CONCLUSION: Trabeculotomy ab externo was moderately successful in glaucoma secondary to chronic uveitis after 3 years. No sight-threatening complications were observed during the follow-up period.

Exit strategies in canaloplasty: intraoperative conversion into 180-degree trabeculotomy or 360-degree trabeculotomy in cases of unsuccessful catheterisation of Schlemm's canal: influence of degree of canal cleavage.

PURPOSE: To investigate the safety and efficacy of intraoperative conversion of unsuccessful canaloplasty technique into 180-degree metal or 360-degree suture trabeculotomy. METHODS: In this retrospective observational case series, 35 eyes of 35 patients with open-angle glaucoma (OAG) who had undergone unsuccessful canaloplasty technique and underwent intraoperative conversion were studied. In 17 eyes (group A), the procedure was converted into 180-degree metal trabeculotomy because of unsuccessful circumferential Schlemm's canal (SC) catheterisation. Group B included 18 eyes that were converted into 360-degree trabeculotomy because of cheese wiring of tension suture through the trabecular meshwork (TM) after successful complete catheterisation of SC. RESULTS: Median preoperative IOP was 22.0 mmHg (range 16-34) in group A, and 22.0 mmHg (range 15-48) in group B. Median IOP was significantly reduced in both groups postoperatively, at the 12-month examination to 15.0 mmHg (range 9-21) representing a reduction of 36 % in group A, and to 14.5 mmHg (range 8-21) representing a reduction of 34 % in group B. Median glaucoma medication number decreased significantly from 4 (range 2-4) and 3 (range 1-4) preoperatively to 2 (range 0-4) and 1 (range 0-3) at 12 months in groups A and B respectively. Hyphema was the commonest complication, with an incidence of 76 % in group A and 78 % in group B. CONCLUSION: 180-degree metal or 360-degree suture/catheter trabeculotomy are safe and effective surgical backup methods to control IOP in cases of unsuccessful intracanalicular placement of tension suture during canaloplasty surgery.

Micro-invasive suture trabeculotomy after canaloplasty: preliminary results.

BACKGROUND: In this study, a conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed micro-invasive suture trabeculotomy (MIST) and its preliminary results are presented. DESIGN: Retrospective case-series in a university setting. PARTICIPANTS: A total of 31 patients with open-angle glaucoma with history of canaloplasty. METHODS: A conjunctival-sparing ab interno approach for circumferential trabeculotomy, termed MIST. MAIN OUTCOME MEASURES: Mean decrease of intraocular pressure (IOP) and number of pressure-lowering medications. RESULTS: Mean decrease of IOP was 11.1 mmHg (standard deviation [SD], 9.9 mmHg) at 6 months, 12.1 mmHg (SD, 10.5 mmHg) at 12 months and 13.5 mmHg (SD, 11.4 mmHg) at 24 months. The average percent lowering of IOP was 36.7% (SD, 32.8%) at 6 months, 41.4% (SD, 35.9%) at 12 months and 44.6% (SD, 37.7%) at 24 months. The number of pressure-lowering medications decreased by 1.1 (SD, 1.3) at month 6, by 1.2 (SD, 1.5) at month 12, and by 1.3 (SD, 1.6) at month 24. CONCLUSIONS: MIST is a promising approach for the treatment of open-angle glaucoma, which is insufficiently controlled with canaloplasty. The procedure achieved significant and sustained lowering of the intraocular pressure and demonstrated an excellent safety profile. The main advantages of the procedure are: easy to learn, fast to perform, and sparing of the conjunctiva for further filtration surgery, if necessary.

Early postoperative changes of the foveal surface in epiretinal membranes: comparison of 23-gauge macular surgery with air vs. balanced salt solution.

OBJECTIVE: To analyze the foveal surface using binary image analysis after spectral-domain optical coherence tomography (SD-OCT) following 23-gauge macular surgery in epiretinal membranes (ERM) using either air tamponade (AIR) or balanced salt solution (BSS). METHODS: One hundred twenty-four eyes (124 patients) with ERM that had undergone membrane peeling with installation of air or BSS were analyzed retrospectively. Ophthalmic examination was performed at baseline and 3 months. OUTCOME MEASURES: The foveal area and surface symmetry, area matched thickness, area matched contour, and best-corrected visual acuity (BCVA). The OCT images were analyzed after binary conversion with ImageJ software. RESULTS: Eighty eyes (80 patients) of 124 screened patients were included (AIR group: 39 patients, BSS group: 41 patients). Median follow-up time was 14 weeks (range, 9-19 weeks). Three months after surgery, the median horizontal area decreased significantly in both groups (p < 0.0001). At follow-up, the foveal surface symmetry values for the BSS group (median, 22.73 µm, range, 0-153) were significantly lower than for the AIR group (median, 23.95 µm, range, 0-160.43) (p < 0.0001). The area-matched thickness increased significantly in both groups (p < 0.001). The AIR group showed a significant increase of the area matched contour for the nasal located measurement-areas N1 (p < 0.0003), N2 (p < 0.0079), N3 (p < 0.007). The BSS group showed a significant increase of the area-matched contour for the measurement areas N1 (p < 0.019), N2 (p < 0.0014), and N4 (p < 0.022). After surgery, median BCVA for both groups increased significantly to 0.3 logMAR. CONCLUSIONS: The analysis of early contour changes after ERM surgery was technically possible. Long-term data have to be looked at before the clinical impact of this methodology can be estimated. Although there were no big differences between both groups (AIR vs. BSS), this could change within a longer and more representative follow-up.

Restoring vision after cat bite: a case report on successful diagnostic and therapeutic regimen for Capnocytophaga endophthalmitis.

BACKGROUND: Capnocytophaga is a bacterium frequently found in the oral flora of dogs and cats (e.g. Capnocytophaga canimorsus) and humans (e.g. Capnocytophaga gingivalis). Among Capnocytophaga related ocular infections, fulminant endophthalmitis is a rare but sight-threatening clinical manifestation. CASE PRESENTATION: A 35-year-old previously healthy patient presented after a cat bite into the left upper and lower eyelid and nasal part of the conjunctiva of the left eye. At initial consultation, the corrected visual acuity was 0.8 in decimal scale and a detailed clinical examination revealed no evidence of ocular penetration. However, daily follow-up examinations under local therapy revealed a progressive intraocular inflammation, therefore the decision was made to perform a diagnostic vitrectomy with intravitreal and systemic antibiotic treatment. Capnocytophaga felis was detected as the cause of endophthalmitis and the initiated treatment resulted in quick morphological and functional recovery of the left eye. After surgery of secondary cataract, visual acuity improved from hand motion preoperatively to 1.0 postoperatively. CONCLUSIONS: Early recognition as well as prompt and effective treatment of animal bite associated endophthalmitis is essential for good visual recovery and functional outcome. Furthermore, this case highlights the importance of daily follow-up examinations, even in the absence of signs of ocular penetration and intraocular inflammation, to enable prompt and effective treatment initiation. Given the negative results in bacterial culture, we additionally emphasize the value of sequencing-based microbiological diagnostics in unclear cases.