[Pediatric acute dacryocystitis due to frontoethmoidal mucocele]. / Akute Dakryozystitis im Kindesalter bei frontoethmoidaler Mukozele.

BACKGROUND: Pediatric acute dacryocystitis typically develops due to persistence of Hasner's membrane. Pediatric paranasal mucoceles are rare entities. In contrast, chronic dacryocystitis in cases of congenital dacryostenosis is one of the most frequent pediatric ophthalmologic issues. METHODS: The case report of a 10-year-old girl suffering acute dacryocystitis is presented. RESULTS: The area around the left lacrimal sac showed a painful swelling with edema and hyperemia. Systemic and local antibiotic therapy resulted in only slight improvement. Dacryoendoscopy detected acute dacryocystitis with significant stenosis of the nasolacrimal duct. The nasolacrimal duct was widened dacryoendoscopically and autostable bicanalicular nasolacrimal intubation was performed. Nevertheless, the lacrimal ducts were blocked subtotally and a widening of the ethmoid on the left side was shown by rhinoscopy. Magnetic resonance imaging confirmed a frontoethmoidal mucocele which was treated by marsupialization. During the 24-month follow-up there was no recurrence of acute dacryocystitis. There were no signs of sinusitis. CONCLUSION: Paranasal mucoceles, e. g., ethmoidal mucoceles, can compress the lacrimal pathways and cause acute lacrimal inflammation in childhood. Paranasal mucoceles should thus be excluded in cases of unclear masses in the lacrimal region.

Electrochemotherapy with bleomycin and cisplatin enhances cytotoxicity in primary and metastatic uveal melanoma cell lines in vitro.

Electrochemotherapy (ECT) enhances responsiveness to cytotoxic drugs in numerous cell lines in vitro. Clinically ECT is widely applied for skin tumor ablation and has shown efficacy in treating non-resectable colorectal liver metastases. There is limited experience of ECT for ocular tumor therapy. We investigated the cytotoxic effect of bleomycin and cisplatin in combination with electroporation on chemoresistant human uveal melanoma (UM) cell lines in vitro. Four UM cell lines (Mel 270, 92-1, OMM-1, OMM-2.5) were treated with electroporation (pulse amplitude 300-1000 V/cm, 8-80 pulses, 100 µs, 5 Hz) and increasing concentrations of bleomycin and cisplatin (0-7.5 µg/ml). Cell survival was analyzed by MTT viability assay after 36 hours. UM cell lines were resistant to both bleomycin and cisplatin. In combination with electro- poration, the effects of bleomycin and cisplatin were increased 8-70 fold and 3-15 fold, respectively, in all UM cell lines. At the lowest concentration of bleomycin tested (1 µg/ml), viability was maximally reduced in all UM cell lines by ≥69% with electroporation conditions of 750 V/cm and 20 pulses. All UM cell lines were more resistant to cisplatin; however, electro- poration of 1000 V/cm and 8 pulses resulted in similar reductions in cell viability of 92-1, Mel270 with 2.5 µg/ml cisplatin, OMM2-5 cells with 5 µg/ml cisplatin and OMM1 cells with 1 µg/ml cisplatin. In vitro ECT with bleomycin or cisplatin is more effective than the highest concentration of the antineoplastic drug or electroporation alone, opening new perspectives in primary and metastatic UM treatment.

Anatomy-based DMEK Wetlab in Homburg/Saar: Novel aspects of donor preparation and host maneuvers to teach descemet membrane endothelial keratoplasty.

Use of Descemet Membrane Endothelial Keratoplasty (DMEK) has been limited because of problems with donor preparation, i.e. tearing of the Descemet membrane and difficulties in unfolding the Endothelium-Descemet-Membrane-Layer (EDML) in the anterior chamber (AC). The purpose of this work was to describe a novel approach to teaching anatomy-based donor and recipient preparation in a DMEK-Wetlab. We teach successful mono-manual donor preparation of human corneas in organ culture not suitable for transplantation, including peripheral markers for orientation. We also teach safe recipient preparation in a freshly-enucleated pig eye in organ culture preservation medium for atraumatic introduction of the EDML roll into the AC, reliable orientation of the EDML during surgery, and stepwise unfolding within the AC. Twenty-two candidates in the 1. Homburg Cornea Curriculum HCC 2015 who practiced both preparations using three human donor corneas and three pig eyes assessed the procedure as follows: (1) overall grade of the Wetlab 1.4 (median 1, range 1 to 2 - on a scale from 1 (excellent) to 6 (terrible); (2) most participants and tutors stated that the Wetlab is most effective for colleagues who have some previous experience with corneal microsurgery. Our novel anatomy-based approach to simulating donor preparation and graft implantation for DMEK seems to meet the expectations and requirements of colleagues with previous experience in corneal microsurgery and will help to reduce the rate of complications for incipient DMEK surgeons in the future. Clin. Anat. 31:16-27, 2018. © 2017 Wiley Periodicals, Inc.

[PKP for Keratoconus - From Hand/Motor Trephine to Excimer Laser and Back to Femtosecond Laser]. / Perforierende Keratoplastik bei fortgeschrittenem Keratokonus - vom Hand-/Motortrepan hinauf zum Excimerlaser und zurück zum Femtosekundenlaser.

For patients with keratoconus, rigid gas-permeable contact lenses are the first line correction method and allow good visual acuity for quite some time. In severe stages of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no longer tolerated. If there are contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis. In patients with advanced keratoconus - especially after corneal hydrops due to rupture of Descemet's membrane - penetrating keratoplasty (PKP) is still the first line surgical method. Non-contact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and for patients with repeat grafts due to "keratoconus recurrences" due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually, depending on corneal size ("as large as possible - as small as necessary"). Limbal centration is preferred intraoperatively, due to optical displacement of the pupil. During the last 10 years, femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach. Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces "vertical tilt" and "horizontal torsion" of the graft in the recipient bed, and thus results in significantly less "all-sutures-out" keratometric astigmatism (2.8 vs. 5.7 D), more regular topography (surface regularity index [SRI] 0.80 vs. 1.0) and better visual acuity (0.80 vs. 0.60), in comparison to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. However, the refractive outcome of femtosecond laser keratoplasty resembles that with motor trephine. In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination, with intraoperative disadvantages and high postoperative astigmatism.

[Endogenous Candida endophthalmitis]. / Endogene Candida-Endophthalmitis.

Endogenous Candida endophthalmitis is a rare but vision-threatening disease. In most cases, endogenous endophthalmitis caused by Candida species has a better prognosis than endogenous endophthalmitis caused by other fungal species or bacteria but the prognosis still depends heavily on the time required for diagnosis and subsequent treatment as well as the initial visual acuity. Suggestions for treatment algorithms have already been made in the past but binding guidelines in ophthalmology only exist sporadically due to the rarity of the disease. This review discusses the current knowledge on endogenous Candida endophthalmitis and draws conclusions from the current study situation.

[Endogenous Candida endophthalmitis: diagnostics and treatment options based on case studies]. / Endogene Candida-Endophthalmitis: Diagnostik und Therapieoptionen anhand von Fallbeispielen.

BACKGROUND: Endogenous Candida endophthalmitis is an emergency that can threaten vision and the eye as a whole organ but also the life of the patient due to its systemic cause. MATERIAL AND METHOD: Retrospective case evaluation of the University Hospital for Ophthalmology Halle (Saale) and the Eye Clinic of the Ernst von Bergmann Hospital Potsdam from 2017-2022. (Age, gender, side involvement, underlying diseases, symptoms, preoperative and postoperative visual acuity, diagnostics, treatment and complications). The standardized procedures for endogenous Candida endophthalmitis are explained, the data are compared with the literature and treatment suggestions are presented. RESULTS: 8 patients with 14 eyes were treated for endogenous Candida endophthalmitis. Of the patients 2 were women and 6 were men. The overall average age was 70.25 years (53-82 years), 6 patients had bilateral eye involvement and 2 patients were affected on one side. All patients had several serious immunocompromising underlying diseases that were the cause of the candidemia. All patients underwent a pars plana vitrectomy (ppV) on the affected eyes except for one male patient who did not obtain permission for anesthesia. In addition to systemic treatment with antimycotics, voriconazole was routinely administered intravitreally during ppV. The patients received further intravitreal doses of voriconazole based on the findings. Vitreous body samples were taken from all patients during the ppV and detection of Candida albicans was possible in all cases. As part of the local perioperative treatment 1 patient received parabulbar administration of a triamcinolone depot in both eyes, 7 patients received a dexamethasone depot in 11 eyes and all 8 patients received findings-oriented local treatment with prednisolone acetate eye drops. visual acuity increased from preoperatively 1.2 logMar to 1.0 logMar. Postoperative retinal detachment did not occur and there were no serious perioperative complications. 2 patients died from one of the underlying diseases after 3 and 25 months, respectively. CONCLUSION: Despite an increasing number of case series, there are still no uniform guidelines for ophthalmologists in Germany. There is agreement regarding systemic treatment and the intravitreal administration of antifungal agents. The role of ppV has not yet been clearly defined and the question of the adjuvant use of steroids (systemic and/or local) has also not been conclusively clarified.

[Calculation of pseudophakic toric intraocular lenses]. / Berechnung pseudophaker torischer Intraokularlinsen.

BACKGROUND: A high corneal astigmatism limits the attainable visual acuity and the ability of correction with spectacles or contact lenses. The astigmatism can also be an impairment for visual rehabilitation, especially after penetrating keratoplasty. A pseudohakic toric intraocular lens (T-IOL) can correct high corneal astigmatism during cataract surgery. For the calculation of the correct power for the T-IOL several additional factors need to be considered, which are less relevant for spherical IOL calculation. METHODS: With the matrix-based vergence transformation an elegant paraxial calculation scheme is available for calculating the optical system "pseudophakic eye" as a closed system. The basic elements of this method are explained in detail along with some clinical examples. The Java-based software JToricIOL is provided online to support comprehension of the examples and to enable readers to make their own calculations for teaching and experimental purposes. The examples mentioned in this article have been calculated with JToricIOL. CONCLUSIONS: Toric intraocular lenses are an essential tool for correcting high corneal astigmatism if cataract surgery is needed. For preoperative calculation of the lens power and axis, the matrix method provides a qualified tool for precise calculations. The software JToricIOL enables surgeons and students to reproduce the examples in this paper and to experiment with their own calculations.

[Contact free in-vivo imaging of cornea and anterior chamber of the human eye - a qualitative comparison of imaging techniques]. / Kontaktlose In-vivo-Bildgebung der Hornhaut und Vorderkammer des menschlichen Auges - ein qualitativer Vergleich zweier Bildgebungsmodalitäten in der Praxis.

For the contactless diagnosis of the human cornea and anterior chamber in clinical routine, two systems have been established besides the slit lamp: the Scheimpflug camera and optical coherence tomography (OCT). A short introduction into these imaging methods is provided along with a comparison with respect to imaging quality and the visibility of relevant ocular structures. We present different examples from special clinical diagnostics such as keratoconus, condition after keratoplasty or tumours in ocular tissue.

[Calculation of phakic intraocular lenses]. / Berechnung phaker Intraokularlinsen.

BACKGROUND: A high corneal astigmatism is a major limitation for the attainable visual acuity with spectacle or contact lens correction. In addition, people with higher ametropia may feel discomfort while wearing contact lenses or spectacles which leads to the desire for a permanent correction. Phakic intraocular lenses provide correction possibilities of higher spherocylindrical ametropies beyond those of corneal refractive surgery. METHODS: For the calculation of toric phakic lenses the matrix formalism for calculation of toric pseudophakic implants is applied. The methods are presented and explained using clinically relevant data examples. A Java-based program JPhakicIOL was used for calculation of the examples and is provided online for teaching and experimental purposes. CONCLUSIONS: Phakic IOLs can be calculated using a matrix scheme similar to the one used for toric pseudophakic implants. With the Java programme JPhakicIOL we provide a software tool to assist ophthalmologists in understanding and performing the phakic IOL calculation.

[Accuracy of IOL power prediction in cataract surgery after penetrating keratoplasty--retrospective study of 72 eyes]. / Treffsicherheit der Kunstlinsenberechnung bei Katarakt-Operation nach perforierender Keratoplastik--retrospektive Studie an 72 Augen.

BACKGROUND: In concomitant cataract surgery and penetrating keratoplasty (PKP), the sequential procedure is supposed to have a higher accuracy in calculation of the intraocular lens (IOL) power compared to the triple procedure. The purpose of this study was to evaluate the refractive results of cataract surgery in patients after PKP. MATERIALS AND METHODS: Our retrospective study included 72 operations on 65 patients. In 35 eyes (group 1, G 1), all corneal sutures had been removed before cataract surgery (median time interval after PKP 3.1 years), while in 37 eyes (group 2, G 2) corneal sutures were in place but removed intra- or postoperatively (median time interval after PKP 1.5 years). Mean age of the patients (65 / 67 years), mean target refraction (-1.8 diopters, D), and mean follow-up interval (2.9 / 3.4 years) were comparable in G1 / G2. Pre- and postoperatively refraction, keratometry, and best corrected visual acuity were recorded. Main outcome measures included the deviation of the spherical equivalent of the real refraction from the target refraction after cataract surgery. RESULTS: In G1 / G2 median visual acuity increased from preoperatively 0.2 / 0.15 to 0.6 / 0.5 after a follow-up period of 3 years on average. Mean deviation from target refraction was -0.3 ± 2.2 (-4.95 to + 3.15) D in G 1 and -0.4 ± 3.0 (-7.3 to + 7.25) D in G 2. After cataract surgery, the steepening of the cornea on average was significantly less in G 1 (0.5 ± 1.6 D) than it was in G 2 (3.3 ± 2.1 D; p = 0.003). CONCLUSIONS: Although the mean deviation from target refraction is minimal after cataract surgery following PKP, our results indicate a high level of variability. If corneal sutures have been completely removed before biometry, the accuracy of the IOL power calculation seems to be better.

[Long-term follow-ups of patients with glaucoma with digital planimetry]. / Digitale Planimetrie zur Langzeitverlaufskontrolle bei stabilen und progredienten Glaukomen.

BACKGROUND: The purpose of this study was to investigate whether digital planimetry is appropriate for quantification of neuroretinal rim loss in patients with glaucoma, with and without progression. PATIENTS AND METHODS: The optic discs of 44 patients, whose illness had been well documented with photographs over a period of at least eight years were divided in a progression group and an unchanged group with regard to glaucoma. After this evaluation we measured each disc by digital planimetry and correlated the results. The researcher conducting the measurements was unaware of the patients' date of examination and the diagnosis. RESULTS: While the neuroretinal rim decreased by only 0.06 A+/- 0.15 mm(2) on average in the group of patients without glaucoma, the average decrease was 0.30 A+/- 0.27 mm(2) in the group with progression. This corresponds to a yearly decrease on average of merely 0.0043 A+/- 0.011 mm(2) (0.25%/a) in the group without progression and one of 0.0228 A+/- 0.025 mm(2) (1.9%/a) in the group with progression. Mean neuroretinal rim loss was 0.25% per year in the group without progression of glaucoma, and 1.9% per year in the group with progression. This annual difference is significant. (p = 0.003). The average observation time in the morphologically better group was on average significantly shorter (12.3 years compared to 14.5 years). CONCLUSION: Digital planimetry was able to determine if a morphological progression was found in a clinical examination or if a glaucoma showed no signs of worsening. So we can use this method of digital planimetry of optic discs to examine and re-examine older and more recent photographs to always get the best results of a possible progression of glaucoma.

[High myopia in vitrectomized eyes : Contraindication for minimally invasive glaucoma surgery implant?] / Hohe Myopie bei vitrektomiertem Auge : Kontraindikation für minimal-invasive glaukomchirurgische Implantate?

Minimally invasive glaucoma surgery (MIGS) implants, such as XEN® gel stent are additional procedures in glaucoma treatment, which were designed to reduce the postoperative risk of severe hypotony and further complications. Until now the contraindications for every implant have not yet been identified. This case report describes the disastrous follow-up after implantation of a XEN® gel stent in the only high myopic eye of a patient. Despite elaborate subsequent interventions massive choroidal hemorrhage occurred with loss of the remaining visual field and total loss of visual acuity. The ocular pressure could be stabilized only after explantation of the XEN® gel stent. Patients with high myopia and the associated thin sclera, vitrectomized eyes and previous treatment with mitomycin C should be selected very carefully for XEN® gel stent. If these criteria are present the XEN® gel stent should be avoided whenever possible.

[Recurrent choroidal detachment in a patient undergoing hormone therapy for prostate cancer]. / Rezidivierende Aderhautamotio bei einem Patienten mit hormonell therapiertem Prostatakarzinom.

An 85-year-old male patient receiving hormone therapy for prostate cancer and secondary open-angle pseudoexfoliation glaucoma developed peripheral choroidal detachment in both eyes. The patient had been admitted to the eye hospital for clarification of a vascular occlusion in the left eye. Cerebral magnetic resonance imaging could exclude metastases and a cerebral space-occupying lesion as the cause of the ocular findings. The local antiglaucomatous treatment was interrupted and as a result the intraocular pressure normalized and the choroidal detachment receded completely. Patients with prostate cancer who receive hormone therapy should also undergo regular ophthalmological screening including funduscopy and measurment of intraocular pressure.

[Tyrosine kinase inhibitor-associated choroidopathy]. / Tyrosinkinaseinhibitor-assoziierte Choroidopathie.

A 66-year-old male patient presented to the ophthalmology department with bilateral blurred vision, which had persisted for 1 week. Due to a pulmonary melanoma metastasis, the patient received a combination treatment with dabrafenib and trametinib. At the first presentation visual acuity was 1.2 on the right and 1.0 on the left. A normotensive intraocular pressure was measured in both eyes. Fundoscopy showed bilateral white, areolar alterations in the choroid and choroid folds and in the left eye a bullous choroidal detachment. Bilateral neurosensory detachment and subretinal fluid were found in optical coherence tomography (OCT). After reduction of the local treatment for pressure reduction and under local and systemic anti-inflammatory treatment, the choroidal swelling was progressive, the visual acuity dropped to 0.5 in the right and to 0.1 in the left eye. A significant regression of the findings occurred only after pausing the treatment with trametinib. Visual acuity rose to 1.0 (left) and 0.8 (right). The OCT showed a dry macula on the right and a small amount of residual subretinal fluid in the left eye.

[When the "lantern goes out"-maximum surgery pays off in the case of severe eye trauma]. / Wenn die "Laterne ausgeht" ­ Maximalchirurgie lohnt sich bei schwerstem Augentrauma.

Trauma surgeons are often confronted with severe complex eyeball injuries. The primary wound treatment and internal reconstruction are carried out depending on the surgical experience. The following case report describes a patient with severe eyeball rupture, from the preoperative findings up to the current status 1 year after the injury. After the initial severe trauma and complex primary reconstruction with subsequent pole to pole surgery in the irritation-free interval, a good functional and cosmetic result was achieved. Even after severe eyeball injuries the best possible primary reconstruction should be strived for. Secondary corrections are possible in irritation-free periods and can help the patient to achieve functional and cosmetic rehabilitation.

[Ocular injuries from fireworks in the past 11 years : Evaluation of the University Hospital and Polyclinic for Ophthalmology Halle]. / Feuerwerksverletzungen am Auge in den letzten 11 Jahren : Eine Auswertung der Universitätsklinik und Poliklinik für Augenheilkunde Halle.

PURPOSE: Every year around New Year's Eve severe eye injuries are caused by fireworks. There is a large variety ranging from slight superficial injuries to very severe trauma necessitating extensive and sometimes repeated surgical treatment. As a consequence the patients not only suffer from functional or cosmetic impairments but also from socioeconomic problems, such as reduced capacity to work and inability to work. All firework-related eye injuries treated at the University Hospital Halle from 2008 to 2018 were retrospectively and systematically analyzed. MATERIAL AND METHODS: The patients were analyzed with respect to age, gender, injury distribution, type of injury, circumstances, form of treatment, consequences and duration of inability to work. RESULTS: From the turn of the year 2008/2009 to the turn of the year 2018/2019 a total of 144 eyes from 116 patients were treated at the ophthalmology department of the University Hospital Halle. The injuries involved 80 male patients (69%) and 36 female patients (31%), among them 44 children (38%) aged under 18 years, 81 right and 63 left eyes. In 28 patients both eyes were affected. Of the patients 44% handled the fireworks themselves and 56% were bystanders. Injuries were mostly caused by bangers (37%) and rockets (24%). Of the patients 37 had to be hospitalized, 14 eyes needed immediate surgical treatment, 2 eyes needed surgery later on in irritation-free intervals and 12 eyes needed repeated surgery. The duration of inability to work was on average 21.6 days, 2 eyes went blind because of the fireworks-related injury and 29% of the patients had visual impairments of which 43% were classified as severe impairments. CONCLUSION: Fireworks-related injuries are preventable injuries. As in most cases children, young adults and bystanders are affected by fireworks injuries, prophylactic and educational programs are urgently needed and legal regulations are necessary.

[The German keratomycosis registry : Initial results of a multicenter survey]. / Das Deutsche Pilz-Keratitis-Register : Erste Ergebnisse einer multizentrischen Erhebung.

BACKGROUND AND PURPOSE: Mycotic keratitis is a serious but relatively rare disease. No targeted data collection in Germany existed until the foundation of the German Pilz-Keratitis Register in 2015. PATIENTS AND METHODS: The inclusion of retrospective and prospective patients was carried out. INCLUSION CRITERIA: diagnosis confirmed by the polymerase chain reaction (PCR), culture, histology or confocal microscopy (IVCM). Collected parameters: date of symptom onset, date and method of diagnosis, risk factors, visual acuity and findings at admission and at follow-up, conservative and surgical treatment. RESULTS: By January 2018, a total of 102 eyes from the years 2000-2017 were reported from 16 centers (64.3% female, mean age 52 years, range 18-95 years). The initial diagnosis was made correctly in only 20.6% of cases. The mean time to correct diagnosis was 31.7 ±â€¯46.9 (0-296) days. The diagnosis was confirmed in cultures in 74.5%, histologically in 30.4%, by PCR in 38.2% and IVCM in 27.4%. Fungal species identified were: 36.7% Fusarium spp., 35.8% Candida spp., 6.4% Aspergillus spp. and 21.1% other. The most important risk factor was the use of contact lenses. The most commonly used antifungal agent was voriconazole (64.7%) followed by amphotericin B (37.2%). Penetrating keratoplasty was performed in 65.7% of the cases and 8.8% of the affected eyes had to be enucleated. The visual acuity of the entire study population increased from the initial 0.16 ±â€¯0.25 (0.001-1.0) decimal to 0.28 ±â€¯0.34 (0-1.0) decimal. CONCLUSION: The correct diagnosis of fungal keratitis is often significantly delayed. The treatment can be very difficult and keratoplasty is often necessary. In order to gain a better understanding of this disease, to recognize previously unknown risk factors and, if necessary, a change in the spectrum of pathogens and to identify approaches to treatment optimization, the fungal keratitis registry will be continued.

[Severe open globe injury. New treatment concepts]. / Schwere Bulbus eröffnende Augenverletzungen. Aktuelle Behandlungskonzepte.

In spite of the technical progress in vitreoretinal surgery, the anatomical and functional results of severe ocular injuries involving the posterior segment are still discouraging. Perforating injuries and ruptures that extend posterior to the muscle insertions have the worst outcomes. When the secondary intervention is usually performed between days 7 and 14 post trauma, it is not unlikely that a severe proliferative vitreoretinopathy has already occurred. With a new concept--to act rather than to react to alterations secondary to severe posterior segment trauma--the functional results of these injuries may be further improved, according to various studies. The internal reconstruction is in part performed together with the primary wound closure, or, alternatively, within 100 h after the trauma. This idea is currently being further evaluated in a prospective multicenter multinational study conducted by the World Eye Injury Register.

[Management of a ruptured globe]. / Management der Bulbusruptur.

Globe rupture is one of the most severe open globe injuries, permanently impairing visual acuity or leading to blindness. The risk of globe rupture is increased after previous intraocular surgery (27-fold), in myopia, older age, females, and after sudden falls. The differentiation between an occult globe rupture and severe ocular contusion may be complicated by pronounced subconjunctival hemorrhage with conjunctival swelling. In case of doubt, a rupture of the eyeball should be ruled out after a severe blunt ocular trauma. Limbal and scleral exploration after 360 degrees peritomy leads to the correct diagnosis. Immediate and watertight wound closure is essential to avoid expulsive choroidal hemorrhage, persisting ocular hypotony or epithelial ingrowth. Delayed wound closure raises the risk of posttraumatic endophthalmitis. Early vitrectomy may prevent tractional retinal detachment in case of retinal injury with vitreal bleeding. Silicone oil instillation stabilizes the central retina after open globe injury; scleral buckling is controversial.