ADVERSE EVENTS OF THE ARGUS II RETINAL PROSTHESIS: Incidence, Causes, and Best Practices for Managing and Preventing Conjunctival Erosion.

PURPOSE: To analyze and provide an overview of the incidence, management, and prevention of conjunctival erosion in Argus II clinical trial subjects and postapproval patients. METHODS: This retrospective analysis followed the results of 274 patients treated with the Argus II Retinal Prosthesis System between June 2007 and November 2017, including 30 subjects from the US and European clinical trials, and 244 patients in the postapproval phase. Results were gathered for incidence of a serious adverse event, incidence of conjunctival erosion, occurrence sites, rates of erosion, and erosion timing. RESULTS: Overall, 60% of subjects in the clinical trial subjects versus 83% of patients in the postapproval phase did not experience device- or surgery-related serious adverse events. In the postapproval phase, conjunctival erosion had an incidence rate of 6.2% over 5 years and 11 months. In 55% of conjunctival erosion cases, erosion occurred in the inferotemporal quadrant, 25% in the superotemporal quadrant, and 20% in both. Sixty percent of the erosion events occurred in the first 15 months after implantation, and 85% within the first 2.5 years. CONCLUSION: Reducing occurrence of conjunctival erosion in patients with the Argus II Retinal Prosthesis requires identification and minimization of risk factors before and during implantation. Implementing inverted sutures at the implant tabs, use of graft material at these locations as well as Mersilene rather than nylon sutures, and accurate Tenon's and conjunctiva closure are recommended for consideration in all patients.

A Case of a Bilateral Cicatricial Upper Eyelid Entropion After Hematopoietic Stem Cell Transplantation in Mucopolysaccharidosis Type I.

Minor eyelid abnormalities are commonly encountered in mucopolysaccharidosis, but only rarely leading to a clinically relevant situation. The authors report a clinical case of severe bilateral cicatricial entropion of the upper eyelids, leading to recurrent conjunctival infections, corneal erosion, persistent epiphora, and a major decline in life quality in a 7-year-old boy with mucopolysaccharidosis type I who underwent hematopoietic stem cell transplantation at 1.6 years old. A bilateral anterior lamellar repositioning including eyelid split and cryoepilation was performed to correct bilateral upper eyelid entropium and trichiasis. Three months after the surgical intervention, the patient showed a persistent regular eyelid position with only mild recurrent right-sided lateral upper eyelid entropion. A significant reduction in conjunctival infections and epiphora with complete discontinuation of topical therapy was achieved. Although mucopolysaccaridosis is associated with eyelid abnormalities, the authors conclude that the described case is most likely due to chronic graft versus host disease.

Scheduled versus Pro Re Nata Dosing in the VIEW Trials.

PURPOSE: To analyze visual acuity (VA) outcomes before and after preplanned treatment regimen change in the VIEW studies at week 52 (W52). DESIGN: Multiple post hoc analyses for retrospectively defined subgroups in 2 multicenter, multinational, double-masked trials. PARTICIPANTS: Two thousand four hundred fifty-seven neovascular age-related macular degeneration (AMD) patients. METHODS: Patients were randomized to treatment with 0.5 mg ranibizumab given monthly, a 0.5-mg or 2-mg intravitreal aflibercept injection given monthly, or 2 mg intravitreal aflibercept given every other month, after 3 initial monthly doses, up to W52. From W52 through W96, patients received their original dosing assignment using a capped pro re nata (PRN) regimen, with defined retreatment criteria based on VA and morphologic signs of disease activity and mandatory dosing at least every 12 weeks. MAIN OUTCOME MEASURES: Best-corrected VA (BCVA) and optical coherence tomography assessments were mandatory at all visits from baseline to W96. Outcomes were changes in BCVA and central retinal thickness. Outcomes were evaluated in all patients who completed 2 years of the VIEW studies using the last observation carried forward method for missing data at interim visits. RESULTS: After W52, approximately 20% of patients lost 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters or more across all treatment arms with PRN treatment. Patients who met the retreatment criterion of loss of 5 ETDRS letters or more in the first quarter of the PRN dosing phase did not recover; mean final VA loss across the 4 study arms was -4.4 to -5.8 letters. Outcomes of these patients up to W52 were indistinguishable from those of the overall population. There were no differences between groups in serious ocular adverse events or Anti-Platelet Trialists' Collaboration arterial thromboembolic events through W96. CONCLUSIONS: These analyses suggest that there are subgroups of patients for whom VA outcomes in the second year of the VIEW studies were less stable than in the first year and for whom W52 seems to be an important inflection point. Although alternate reasons specific to the nature of the underlying AMD cannot be fully excluded, the switch in treatment regimen at W52 is a plausible explanation.

Postoperative refractive error after phacovitrectomy for epiretinal membrane with and without macular oedema.

PURPOSE: This study was initiated to investigate whether the presence of macular oedema influenced intraocular lens (IOL) power calculation in eyes with epiretinal membrane. METHODS: The files of patients undergoing combined phacoemulsification were retrospectively reviewed. Two groups were defined according to presence of macular oedema. The main outcome measure was the IOL power prediction error (PE). Secondary outcome measures were the correlation between preoperative macular thickness, absolute change of macular thickness and dioptric shift. The mean postoperative PE achieved with the Haigis formula was compared with the PE that would have been obtained had the SRKII and HofferQ formulas been used. RESULTS: We investigated 47 eyes of 47 consecutive patients. Regardless of the IOL formula used, the PE was on average higher in eyes without macula oedema (group 1). The myopic dioptric shift was dependent on preoperative macular thickness and absolute change of macular thickness. This association was more markedly pronounced in group 1. CONCLUSIONS: Increased retinal thickness is the main cause for underestimation of the cornea-photoreceptor layer distance, and therefore could contribute to inaccuracy in IOL power calculations. The current results show that a myopic shift tends to be less pronounced in cases where a macula oedema is present. Eyes with pure traction have less predictable refractive results in terms of higher PE and dioptric shift.

Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury.

This prospective trial was designed to evaluate the incidence of Terson syndrome in patients suffering from subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury and whether consequences necessarily derive from the intraocular hemorrhage itself. Two ophthalmologic examinations were performed to identify patients with Terson syndrome. Data on initial Glasgow Coma Scale, Hunt and Hess and Fisher grades, aneurysm site and diameter, and volume of hemorrhage in intracerebral hemorrhage patients were correlated to the location and course of Terson syndrome. Follow-up was performed after 3 months, including clinical and ophthalmologic investigations. The data showed that 16 of 83 subarachnoid hemorrhage patients (19.3%), 2 of 22 intracerebral hemorrhage patients (9.1%), and 1 of 32 traumatic brain injury patients (3.1%) suffered from Terson syndrome. Low Glasgow Coma Scale (p = 0.002), high Hunt and Hess grade (p < 0.001), and high Fisher grade (p = 0.002) were found to be associated with a higher incidence of Terson syndrome. The neurological outcome in subarachnoid hemorrhage patients suffering from Terson syndrome was worse compared with that of subarachnoid hemorrhage patients without Terson syndrome (p = 0.005), and vitrectomy was performed in seven eyes of six patients due to poor visual acuity. Terson syndrome is underestimated in patients with subarachnoid hemorrhage and a rare pathology in intracerebral hemorrhage as well as in traumatic brain injury patients. Spontaneous regression of the intraocular hemorrhage may be seen, but in half of the patients, vitrectomy is necessary to prevent permanent visual deterioration.

Wikipedia--challenges and new horizons in enhancing medical education.

BACKGROUND: Wikipedia gains growing attention as a provider of health information. This study aimed to investigate the use, relevance and challenges of Wikipedia among medical students. METHODS: An online questionnaire was made accessible to students at five medical universities in Germany, Austria, and Norway. Besides demographical data, the questions covered the role of Wikipedia in the academic life of medical students. The questionnaire investigated if the students had ever found erroneous medical entries and whether they corrected these. RESULTS: A frequent use of Wikipedia in general is statistically significant correlated with a frequent use in medical studies (p < 0.001). Information retrieved from Wikipedia is predominantly critically appraised either by comparing it to profound knowledge (79%) and/or to specific literature (75%). Despite most (97%) respondents disclosed that they already had found false information in Wikipedia, recognized errors were seldomly corrected (~20%). CONCLUSIONS: The information retrieved from Wikipedia is critically appraised. However, we found shortcomings in handling erroneous entries. We argue for professional responsibility among medical students in dealing with this dynamic resource. Moreover, we encourage medical schools to supplement information to Wikipedia to further benefit from the vast possibilities of this platform.

Terson's syndrome--rate and surgical approach in patients with subarachnoid hemorrhage: a prospective interdisciplinary study.

OBJECTIVES: To analyze the need for surgical intervention in Terson's syndrome (TS) and the rate of TS, as well as the effect of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling, complications, correlations between TS and sex, and the influence of the severity of subarachnoid hemorrhage (SAH) expressed by Glasgow Coma Scale (GCS) score and Hunt and Hess grade on the occurrence of TS. DESIGN: Prospective, uncontrolled, interdisciplinary study. PARTICIPANTS: A total of 102 patients with SAH over a period of 24 months. METHODS: Patients were examined on days 1 and 14. A PPV was indicated in cases of nonresorbing vitreous hemorrhage (VH). Peeling of the ILM was performed with the help of ILM-BLUE (DORC, Zuidland, The Netherlands) using end-gripping ILM forceps. MAIN OUTCOME MEASURES: Effect of PPV on visual acuity (VA) and timing of intervention in cases of nonresorbing VH. RESULTS: The rate of TS was 19.6% (20/102). The mean age of the patients was 52.1 ± 11.8 years. Patients presenting with an initial GCS of less than 8 or with high Hunt and Hess grades were more affected by TS. Eight (9 eyes) of the 20 patients with TS (40% of the patients with TS) underwent a PPV for nonclearing vitreous bleeding. In 4 patients (4 eyes; 20% of patients with TS), ILM peeling was considered necessary because of sub-ILM bleeding. The mean interval between SAH and PPV was 4.4 months (range, 3-5 months). Postoperative follow-up was 6.4 months. Visual acuity improved in all patients. Best-corrected VAs at first and at last presentations were 2.2 and 0.0625 logarithm of the minimum angle of resolution (logMAR), respectively. For patients who underwent ILM peeling, these values were 1.725 and 0.05 logMAR, respectively. CONCLUSIONS: Pars plana vitrectomy and ILM peeling have beneficial effects on the visual rehabilitation of patients with nonclearing VH after TS. We did not identify any safety concerns after PPV in our patients with dense nonclearing hemorrhage that persisted for more than 3 months.

Laser in situ keratomileusis for astigmatism ≤ 0.75 diopter combined with low myopia: a retrospective data analysis.

BACKGROUND: This study examined the refractive and visual outcome of wavefront-optimized laser in situ keratomileusis (LASIK) in eyes with low myopia and compound myopic astigmatism ≤ 0.75 diopter (D). METHODS: 153 eyes from 153 consecutive myopic patients (74 male, 79 female; mean age at surgery 40.4 ± 10.4 years) who had a preoperative refractive cylinder ≤ 0.75 D and a manifest sphere between -0.25 D and -2.75 D, and who had completed 4-month follow-up. Three subgroups defined by the magnitude of preoperative manifest refractive cylinder (0.25, 0.50, and 0.75 D) were formed. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and postoperatively. The astigmatic changes achieved were determined using the Alpins vector analysis. RESULTS: After 4 months (120.0 ± 27.6 days) of follow-up, a mean uncorrected distant visual acuity of 0.07 ± 0.11 logMAR and a mean manifest refraction spherical equivalent of -0.06 ± 0.56 D were found. There was no statistically significant difference in efficacy and safety between the preoperative cylinder groups. Astigmatic overcorrection for preoperative cylinder of ≤ 0.50 D was suggested by the correction index, the magnitude of error, the index of success, and the flattening index. CONCLUSIONS: Low myopic eyes with a preoperative cylinder of ≤ 0.50 D were significantly overcorrected with regard to cylinder correction when combined with low myopic LASIK. Accordingly, we are cautious in recommending full astigmatic correction for eyes with low myopia and manifest cylinder of ≤ 0.50 D.

Do air pressure and wind speed influence the outcome of myopic laser refractive surgery? Results from the Hamburg Weather Study.

Laser in situ keratomileusis (LASIK) is one of the dominant procedures for the surgical correction of refractive errors. Meteorotropic reaction has been described regarding the field of ophthalmology. This study was thus initiated to assess the impact of air pressure and wind speed on the refractive and visual outcome of LASIK in myopic eyes. Our study comprised 1,052 eyes of 1,052 consecutive myopic patients (419 males, 633 females; mean age at surgery 35.0 ± 9.0 years) with mean preoperative refractive spherical equivalent (SE) of -3.88 ± 1.85 diopters (D). Two subgroups were defined, which had undergone surgery either during meteorological winter or summer. Manifest refraction, uncorrected and corrected visual acuity were assessed pre- and post-operatively. We applied robust regression analysis with efficiency index (EI), safety index, and postoperative SE (D) as dependent variables. At the 1-month (33.0 ± 5.0 days) follow-up, the mean postoperative SE was -0.18 ± 0.44 D. Bivariate comparisons showed that statistically significant better EI was related to days with low to moderate air-pressure. This was confirmed by robust regression analysis. Moderate to high wind speed was related to more appropriate postoperative SE. No change by more than one line on logMar scale was obtained. Although being statistically significant, there is no clinically relevant difference in outcome of LASIK, which demonstrates its highly standardized quality. Prospective, longitudinal studies are warranted to address meteorotropic reactions through evaluating individual risk profiles.

LASIK versus photorefractive keratectomy for high myopic (> 3 diopter) astigmatism.

PURPOSE: To compare the efficacy, safety, predictability, and vector analysis indices of LASIK and photorefractive keratectomy (PRK) for correction of high cylinder of greater than 3 diopters (D) in myopic eyes. METHODS: The efficacy, safety, and predictability of LASIK or PRK performed in 114 consecutive randomly selected myopic eyes with an astigmatism of greater than 3 D were retrospectively analyzed at the 2- to 6-month follow-up visits. Vector analysis of the cylindrical correction was compared between the treatment groups. RESULTS: A total of 57 eyes receiving PRK and 57 eyes receiving LASIK of 114 refractive surgery candidates were enrolled in the study. No statistically significant difference in efficacy [efficacy index = 0.76 (±0.32) for PRK vs 0.74 (±0.19) for LASIK (P = .82)], safety [safety index = 1.10 (±0.26) for PRK vs 1.01 (±0.17) for LASIK (P = .121)], or predictability [achieved astigmatism < 1 D in 39% of PRK- and 54% of LASIK-treated eyes, and < 2 D in 88% of PRK- and 89% of LASIK-treated eyes (P = .218)] was demonstrated. Using Alpins vector analysis, the surgically induced astigmatism and difference vector were not significantly different between the surgery methods, whereas the correction index showed a slight and significant advantage of LASIK over PRK (1.25 for PRK and 1.06 for LASIK, P < .001). CONCLUSIONS: LASIK and PRK are comparably safe, effective, and predictable procedures for excimer laser correction of high astigmatism of greater than 3 D in myopic eyes. Predictability of the correction of the cylindrical component is lower than that of the spherical equivalent.

Depression, anxiety, and disturbed sleep in glaucoma.

Although it has been suggested that glaucoma is associated with circadian misalignment, sleep disorder, anxiety, and depression, these comorbid conditions have not received much attention. This study provides evidence for a significantly higher prevalence of depression, trait anxiety, and sleep disturbances in patients with progressed glaucoma, as compared with glaucoma patients with no or minor visual field defects (VFD). Logistic-regression analyses suggest that severe VFD constitute a significant predictor of depression, trait-anxiety, and sleep disturbance. Results indicate the necessity of regular screening and psychochronobiological treatment in glaucoma patients.

Subjective pain, visual recovery and visual quality after LASIK, EpiLASIK (flap off) and APRK - a consecutive, non-randomized study.

INTRODUCTION: Laser in situ keratomileusis (LASIK) is superior to surface ablation techniques (SAT) such as alcohol photorefractive keratectomy (APRK) or Epi-LASIK (EpiK) in terms of visual recovery and postoperative pain. This study compares subjective symptoms and visual recovery of two different SATs with LASIK. MATERIALS AND METHODS: One hundred and twenty seven patients were operated using one of the three techniques. Patients filled out a questionnaire describing symptoms assessing subjective visual recovery on a linear scale from 'not functioning' to 'full visual function' and pain on a linear scale from 'no pain' to 'severe daily pain'. Subjective symptoms such as halos, double vision, low night vision, reduced contrast and dry eyes were also evaluated. RESULTS: Visual recovery was faster and discomfort symptoms less pronounced with the LASIK than with surface ablation procedures. More pain was reported after APRK than after EpiK (flap-off technique) in the early postoperative period, with a maximum of pain on postoperative days 3-4. Subjective visual recovery showed no statistically significant difference between the two surface ablation procedures. Halos, double vision, low night vision, reduced contrast and dry eyes were more extensively reported by the EpiK than the APRK group and were less pronounced in the LASIK than in the SAT group. DISCUSSION AND CONCLUSIONS: Our study does not uniformly support the previously published favourable results of EpiK compared to APRK with regard to subjective recovery of vision and postoperative pain.

The effect of reactive oxygen species on the myogenic tone of rat ophthalmic arteries with and without endothelium.

BACKGROUND: Reactive oxygen species (ROS) play an important role in the pathogenesis of various ocular diseases. ROS can induce vasodilation or vasoconstriction depending on the species, the tested vessel bed, and the condition of the vessel. This study investigates the effect of different dosages of ROS on the tone of rat ophthalmic arteries. METHODS: Freshly dissected rat ophthalmic arteries were pressurized in a perfusion setup in steps of 10 mmHg to 180 mmHg in three consecutive cycles. The first cycle was run under mostly physiological conditions, the second cycle was run after ROS treatment, and the third cycle as passive dilation after all Ca(2+) was removed from the solution. ROS-induced dilation or constriction was calculated in relation to the passive dilation. All experiments were performed with or without endothelium. RESULTS: For vessels with endothelium, dilation in control experiments was 20.0 ± 0.1%; after 5 s of ROS dilation was 74.4 ± 0.6%, and after 20 s 87.4 ± 0.3%. ANOVA revealed significant differences between these groups (P = 0.048). For vessels without endothelium, a slight dilation was seen in control experiments (14.5 ± 0.4%), which was also present after 5 s of ROS treatment (15.4 ± 0.4%). Treatment with ROS for 20 s led to a constriction of the vessel preparations (-16.6 ± 0.5%; P = 0.831). CONCLUSIONS: ROS led to a vasodilation in vessels with endothelium that was not seen in vessels without endothelium. Endothelial function seems to determine the effect of ROS on the vessel tone in isolated rat ophthalmic arteries.

Accuracy of wavefront aberrometer refraction vs manifest refraction in cataract patients: impact of age, ametropia and visual function.

BACKGROUND: To evaluate accuracy of WASCA wavefront aberrometry (WA) refraction in comparison to manifest refraction (MR) in an older population awaiting cataract surgery. METHODS: Prospectively, refractive errors of 130 eyes were determined by WA and MR. Mean age was 65.9 (SD 11.81), corrected distance visual acuity (CDVA) averaged 0.20 logMar (SD 0.57), mean manifest sphere was 0.23 dioptres (D, SD 3.39) and manifest astigmatism amounted to -1.25 D (SD 1.21). For further analysis, refractive values were transformed into power vector components: spherical equivalent (SE), Jackson cross cylinder at 0° and 45° (J0 and J45). The 'limits of agreement' approach, regression analysis, correlation analysis, and ANOVA were applied and additionally compared to 28 healthy eyes (mean VA -0.1 logMAR) of a group of young subjects (mean age 33.9). RESULTS: SE measures in myopia correlated highly between WA and MR (r = 0.917, p < .001). In hyperopia this correlation was moderately high (r = 0.800, p < .001). For all subjects, correlations between WA and MR for J0 and J45 were r = 0.742 (p < .001) and r = 0.760 (p < .001) respectively. WA measurements revealed larger agreement ranges with increasing myopia and astigmatism. Controlled for possible confounding variables of age, VA, and refractive state, no statistically significant effects were found. Across nearly all conditions, WA measured significantly higher myopic and astigmatic values than MR. Most effects were replicated in the reference group. CONCLUSIONS: WA refraction can provide valuable information in previously under-researched conditions such as reduced VA (cataract-related), advanced age, and hyperopia. However, loss of optical media transparency will inherently reduce accuracy of WA. Further studies are needed to define cut-off values for automated wavefront quality grading and intra-operative application of WA in refractive surgery.

Mesopic pupil size in a refractive surgery population (13,959 eyes).

PURPOSE: To evaluate factors that may affect mesopic pupil size in refractive surgery candidates. METHODS: Medical records of 13,959 eyes of 13,959 refractive surgery candidates were reviewed, and one eye per subject was selected randomly for statistical analysis. Detailed ophthalmological examination data were obtained from medical records. Preoperative measurements included uncorrected distance visual acuity, corrected distance visual acuity, manifest and cycloplegic refraction, topography, slit lamp examination, and funduscopy. Mesopic pupil size measurements were performed with Colvard pupillometer. Relationship between mesopic pupil size and age, gender, refractive state, average keratometry, and pachymetry (thinnest point) were analyzed by means of ANOVA (+ANCOVA) and multivariate regression analyses. RESULTS: Overall mesopic pupil size was 6.45 ± 0.82 mm, and mean age was 36.07 years. Mesopic pupil size was 5.96 ± 0.8 mm in hyperopic astigmatism, 6.36 ± 0.83 mm in high astigmatism, and 6.51 ± 0.8 mm in myopic astigmatism. The difference in mesopic pupil size between all refractive subgroups was statistically significant (p < 0.001). Age revealed the strongest correlation (r = -0.405, p < 0.001) with mesopic pupil size. Spherical equivalent showed a moderate correlation (r = -0.136), whereas keratometry (r = -0.064) and pachymetry (r = -0.057) had a weak correlation with mesopic pupil size. No statistically significant difference in mesopic pupil size was noted regarding gender and ocular side. The sum of all analyzed factors (age, refractive state, keratometry, and pachymetry) can only predict the expected pupil size in <20% (R = 0.179, p < 0.001). CONCLUSIONS: Our analysis confirmed that age and refractive state are determinative factors on mesopic pupil size. Average keratometry and minimal pachymetry exhibited a statistically significant, but clinically insignificant, impact on mesopic pupil size.

SU5416 induces premature senescence in endothelial progenitor cells from patients with age-related macular degeneration.

PURPOSE: We recently demonstrated increased frequency and growth potential of late outgrowth endothelial progenitor cells (OECs) in patients with neovascular age-related macular degeneration (nvAMD). This study investigated the effects of short- and long-term in vitro inhibition of vascular endothelial growth factor (VEGF) Receptor-2 (VEGFR-2) signaling by SU5416 and other inhibitors of the VEGF signaling pathway in OECs. METHODS: OECs, from the peripheral blood of patients with nvAMD, and human umbilical vein endothelial cells were grown in the presence of SU5416, other VEGFR-2 tyrosine kinase inhibitors (TKIs), and inhibitors of phosphatidylinositol 3'-Kinase (PI3K)/protein kinase B (Akt) and protein kinase C (PKC) in complete angiogenic medium. Apotosis was assessed after 48 h using the fluorescein isothiocyanate Annexin V method. Cell counts were performed for 10 days, and features of senescence were analyzed using senescence-associated ß-galactosidase staining, the telomeric repeat amplification protocol for telomerase activity, Southern blot analysis for mean telomere length, flow cytometric analysis for cell-cycle arrest, and western blot for p53 and p21. Control OECs, cells treated for 7 days with inhibitors, as well as naturally senescent OECs were analyzed for expression of different endothelial antigens, including VEGFR-2 and the receptor for stromal cell-derived factor 1, chemokine receptor 4 (CXCR-4). Migration in vitro to VEGF and stromal cell-derived factor 1 of OECs was assessed. RESULTS: SU5416, other VEGFR-2 TKIs, and inhibitors of PI3K, Akt, and PKC induced apoptosis, inhibited long-term proliferation, reduced telomerase activity, and induced premature senescence and cell-cycle arrest in OECs as well as in human umbilical vein endothelial cells. Naturally senescent cells and cells rendered senescent by VEGFR-2 TKIs had reduced VEGFR-2 and CXCR-4 expression and demonstrated reduced migratory ability to VEGF. CONCLUSIONS: This study demonstrates apoptosis upon short-term inhibition and inhibition of long-term survival of OECs from patients with nvAMD by SU5416, presumably via PI3K/Akt and/or PKC-mediated reduction in telomerase activity and subsequent induction of premature senescence, which is accompanied by impaired endothelial activity. Therefore, induction of premature senescence in endothelial cells may represent a potential therapeutic target in nvAMD.

Superficial keratectomy, PTK, and mitomycin C as a combined treatment option for Salzmann's nodular degeneration: a follow-up of eight eyes.

PURPOSE: To analyze the treatment outcomes (safety and efficacy) of manual superficial keratectomy, phototherapeutic keratectomy (PTK), and intraoperative application of mitomycin C (MMC) for Salzmann nodular degeneration (SND). METHODS: In this retrospective study, we analyzed the records of eight eyes of five patients with Salzmann nodular degeneration (SND) who were treated between December 2006 and May 2008 at the University Eye Clinic Hamburg, Eppendorf, Germany. This case study includes data previously published within a single case report. Patients were followed-up pre- and postoperatively by slit-lamp biomicroscopy, digital photography, and corneal topography. All of the eight eyes were followed-up for at least 12 months, whereas in four eyes, follow-up was done for more than 24 months. PTK was performed with a 193-nm Ar-F excimer laser (Allegretto 200; WaveLight AG, Erlangen, Germany) within a 7-mm optical zone. Mitomycin C 0.02% was applied after PTK for 30 s. Postoperatively, a therapeutic contact lens was administered until corneal epithelial healing, which occurred usually at the forth postoperative day. Then local steroid therapy (prednisolone 1%) eye drops fours times per day was given for the following 4 weeks. RESULTS: Mean BCVA preoperatively was 0.61 logMAR (i.e., 20/80 Snellen equivalent or 0.25 decimal). There was a significant increase of BCVA by average of four reading lines (far distance) up to ten reading lines (p < 0.001). Mean BCVA postoperatively was 0.2 logMAR (i.e., 20/32 Snellen equivalent or 0.63 decimal). Treatment of SND led to a dramatic reduction of hyperopia (myopic shift) corresponding to a marked increase of best-corrected visual acuity (BCVA). Preoperatively documented hyperopic progression was stopped and refraction remained stable during the follow-up period in all eyes. Corneal topography showed regular astigmatism. During follow-up after treatment, the corneas appeared clear on slit-lamp examination. CONCLUSIONS: Our follow-up and the small treatment numbers are not sufficient to finally prove the superiority of the combined treatment modality (superficial keratectomy, PTK, and MMC) for SND, but the results of our study are promising. Longer follow-up and a larger cohort are warranted for proving MMC to be an effective, successful, and safe method in the armamentarium for treating and preventing Salzmann degeneration.

Radial optic neurotomy in central retinal vein occlusion does not influence ocular hemodynamics.

PURPOSE: radial optic neurotomy (RON) is used for the treatment of central retinal vein occlusion. Its effects on visual acuity differ substantially between patients. Our study aims to evaluate if RON has an impact on ocular microcirculation and if analysis of ocular microcirculation might serve as a predictor for surgical success. PROCEDURES: a complete ophthalmologic examination including color Doppler imaging of the retrobulbar vessels was performed before and 2-4 months after RON in 12 patients. RESULTS: mean visual acuity was 0.09 ± 0.03 prior to and 0.24 ± 0.12 after RON. Visual acuity improved in 7 (+3.5 ± 0.9 lines), was stable in 3 (± 0 lines) and worsened in 2 cases (-6 and -2 lines). Doppler parameters were not affected by RON, and no correlations between visual acuity and perfusion parameters were found. CONCLUSIONS: Our data indicate that RON does not influence ocular microcirculation. None of the assessed hemodynamic parameters appears to be a predictor for surgical success.

Progress in the development of vision prostheses.

Degenerative retinal diseases like retinitis pigmentosa and age-related macular degeneration are among the most common causes of blindness worldwide. Electronic visual prostheses represent a potential therapeutic option of increasing importance in otherwise incurably impaired patients. Based on extensive animal experiments, several devices are now being tested in clinical trials. According to the placement of the electrodes, possible stimulation sites are located subretinally, epiretinally, along the optic nerve or cortically. Anatomical, physiological and pathophysiological aspects must be considered in development and clinical application. To provide an appropriate retinal substitute, the optimal integration and adaptation of the prosthesis into the highly complex system of the visual pathway is important. This article aims to summarize the relevant studies and provides an overview of the current status of developments and challenges that still need to be mastered.