[Infection-associated Acute Posterior Multifocal Placoid Pigment Epitheliopathy]. / Infektassoziierte akute posteriore multifokale plakoide Pigmentepitheliopathie.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare inflammatory chorioretinopathy, which mainly affects young light-skinned, myopic adults between 20 and 30 years of age. The exact aetiology of APMPPE is unknown. Some patients report a viral or flu-like illness preceding the onset of APMPPE symptoms. This condition is usually bilateral and self-limiting with a good overall prognosis. Visual loss is sudden, but usually temporary. Relapses are very rare. Foveal involvement may lead to a worse visual prognosis. There is no current consensus on treatment. A wait-and-see approach with monitoring at short intervals is often sufficient. Based on a case example from our clinic we will demonstrate symptoms, diagnostic work-up and treatment options.

[One-year results of small incision lenticule extraction (SMILE) in myopia]. / Ein-Jahres-Ergebnisse bei Small-Incision-Lentikel-Extraktion (SMILE) zur Myopiekorrektur.

BACKGROUND: This clinical trial is focused on the 12-month results of a new method for refractive correction in myopia, called "small incision lenticule extraction" (SMILE). PATIENTS AND METHODS: In a prospective study 91 eyes were treated with the new refractive procedure and the results were published after 6 months. A lenticule of intrastromal corneal tissue is cut utilising the Carl Zeiss Meditec AG (Jena, Germany) VisuMax femtosecond laser system. Thereafter, this lenticule is manually removed without lifting a flap. 55 eyes of 33 patients volunteered for a 12-month follow-up. UCVA and BSCVA after 12 months, objective and manifest refraction as well as slit-lamp examination and late side effects were documented. RESULTS: 55 eyes of 33 patients were re-examined in this study 12 months after surgery. The spherical equivalent before surgery was - 4.66 (± 1.75) D; after 12 months - 0.11 (± 0.42) D was manifest. No significant change was observed compared to the 6-month control. Starting with UCVA of 0.1 (± 0.06) before surgery. UCVA was 1.02 (± 0.3) after 12 months. One eye lost more than two lines. All other patients did not have any late side effects. CONCLUSION: The one-year results of this new procedure are encouraging. Especially stability of the correction of myopia and myopic astigmatism with the SMILE procedure is very good.

[Study on the time course of macular pigment density measurement in patients with a macular hole--clinical course and impact of surgery]. / Untersuchungen zum zeitlichen Verlauf der Makulapigmentdichte bei Patienten mit idiopathischem Makulaforamen--klinischer Verlauf und Einfluss der Operation.

BACKGROUND: In a prospective clinical study we examined the course of the optical density of the macular pigment (MPOD) in patients with idiopathic macular holes before and after pars-plana vitrectomy. PATIENTS AND METHODS: Of the 26 patients four had macular holes stage 1, six patients had stage 2 or stage 4 holes and ten people had a macular hole stage 3. The surgical procedure consisted always of a standard 3-port pars plana vitrectomy (PPV) with colouring assisted peeling of the internal limiting membrane. The optical density of macular pigment was determined by the 1-wavelength reflection method before pars plana vitrectomy and after macular hole closure. RESULTS: The macular hole was completely closed in 25 of 26 eyes (96.15 %). This anatomical success is also the basis for a postoperative improvement in the retinal function. In the case of macular holes from stages 3 and 4 the surgery achieved an increase in visual acuity and an increase of the optical density of the the macular pigment. In patients with macular holes stage 2 the visual acuity and the optical density of the macular pigment were reduced after vitrectomy. In the case of stage 1 holes the visual acuity and the volume of macular pigment also were reduced after the operation. DISCUSSION: In the group of stage 4 macular holes there was a significant increase in maximum optical density and volume of macular pigment after successful surgical hole closure, so the functional profit of PPV is very high in these patients. Even in the case of macular holes of stage 3 the PPV effected a functional improvement in the sense of an increase of the optical density of macular pigment. The increase in volume proved to be significant. For macular holes stage 2 the vitrectomy as a therapy option is generally recognised but PPV does not effect positively the height of the optical density of macular pigment. In these patients both the maximum optical density as well as the volume of macular pigment were reduced in the therapeutic course. Whether surgical intervention is indicated in stage 1 is still controversial. Taking into account the development of MPOD the profit from surgery for the patients is very low. This led to a decrease in volume of macular pigment and only a slight increase in maximum optical density after pars plana vitrectomy.

[Objective measurement of macular optical density]. / Möglichkeiten der objektiven Messung der optischen Dichte der Makula.

Determination of the optical density of the macular pigment may be used for an assessment of the efficacy of oral lutein supplementation in patients with dry AMD. Beside subjective methods like heterochrome flicker photometry, objective methods like the 2-wavelength auto-fluorescence method and the 1-wavelength reflection method are in clinical use today. Both methods show comparable results. For a long-term assessment of the efficacy of oral lutein supplementation, different parameters like mean and maximal optical density as well as the integral over optical density on all pixels ("volume") should be used. The parameter volume often increases also in cases in which other parameters do not change anymore. The 1-wavelength reflection method is used for the newly initiated LUTEGA study. This study will investigate the long-term effects of a fixed lutein/omega-3-fatty acid combination on the optical density in patients with dry AMD.

[Corneal ulcers in systemic autoimmunologic diseases]. / Hornhautulzera bei systemischen Autoimmunerkrankungen.

BACKGROUND: Keratolysis is a rare severe complication following systemic autoimmunologic diseases. Despite of complex therapeutic treatments, the prognosis is very poor. PATIENTS: Ten eyes from seven patients with corneal ulcers were reported (age 45 - 73 years, mean 63 years; 6 women, 1 man). The corneal ulcer was perforated in 7 eyes. Five patients suffered from rheumatoid arthritis, and one patient developed a Sjögren's syndrome. Besides, one patient had shown both autoimmunologic diseases. After clinical attendance, visual acuity in the eyes with nonperforated ulcers was between 0.1 and 0.4, and in the eyes with perforated ulcers between light perception and 0.2. RESULTS: In 7 eyes with perforated corneal ulcers an emergency tectonic conjunctival plasty and, 1 - 2 days later, a keratoplasty had been performed. Postoperatively, local therapies had been initiated with antibiotic and immunosuppressive eyedrops as well as with conventional drops for dry-eye symptoms. Because of the autoimmunologic diseases of the patients, a systemic immunosuppressive therapy had been arranged. Follow-up period had been between 4 weeks and 3,5 years (mean 16 months). In the three eyes with nonperforated ulcers which received an antibiotic and immunosuppressive treatment, visual acuity was found at 1 / 20 and 0.4. However, in spite of stabilized findings in the 5 eyes with perforated ulcers, the visual acuity was in this case only between light perception and 0.05. One patient with a perforated ulcer and one patient with a recurrent corneal perforation after keratoplasty refused further operative procedures. Finally, both eyes had to undergo evisceration. CONCLUSIONS: Despite of intensive local and systemic immunosuppressive as well as operative therapies, corneal ulcers associated with autoimmunologic diseases (rheumatoid arthritis, Sjögren's syndrome) may cause a marked decrease of visual acuity or the loss of an eye. With regard to the healthy eye, an immunosuppressive therapy for life is most important.

[Haemoglobin oxygenation of retinal vessels in branch retinal artery occlusions over time and correlation with clinical outcome]. / Nichtinvasive Messung der Sauerstoffsättigung retinaler Gefäße bei retinalen Astarterienverschlüssen unter Therapie.

OBJECTIVE: Purpose of these study was the evaluation of a new method for the measurement of haemoglobin oxygenation in retinal vessels. Patients with branch retinal artery occlusion have been measured before and after a rheological therapy. METHODS: The haemoglobin oxygenation in retinal vessels was measured by the "oxygen module" (Imedos GmbH, Jena, Germany) which uses a special filter (transmission at 548 and 610 nm, band width 10 nm) in the illumination path of a fundus camera. Fundus images were acquired by a colour CCD camera and specific software was used for vessel tracking and calculation of their haemoglobin oxygen saturation. 11 patients with branch retinal artery occlusions, average age 63.4 ± 11.7 years were investigated at time of diagnosis and at the 5th day of a rheological and intraocular pressure reduction therapy. RESULTS: 10 out of 11 patients have shown an increase of haemoglobin oxygenation over time (on average from 73 ± 16 % to 87 ± 11 %). This increase was statistically significant (p < 0.05, Wilcoxon test). Non-affected retinal areas have also shown an increase of haemoglobin oxygenation. The visual acuity improved by one line. This increase in visual acuity was, however, not statistically significant. CONCLUSIONS: We observed an increase of the arterial haemoglobin oxygenation. One possible reason of the improvement of the haemoglobin oxygenation by the therapy may be an increase of the rheological properties of the blood. All patients showed an increase or at least a stabilisation of their visual acuity. Retinal vessel oximetry might be used as an additional parameter in the follow-up of retinal artery occlusion.

[Femtosecond lenticule extraction (FLEx) - Results after 12 months in myopic astigmatism]. / Femtosekunden-Lentikel-Extraktion (FLEx) - Ergebnisse nach 12 Monaten bei myopen Astigmatismus.

BACKGROUND: This clinical trial is focussed on the 12-month results of a new method for refractive correction, femtosecond lenticule extraction (FLEx). PATIENTS AND METHODS: In a prospective 6-month study 108 eyes were treated in Erfurt and Marburg. Both a flap and a lenticule of intrastromal corneal tissue were simultaneously cut utilising the Carl Zeiss Meditec AG (Jena, Germany) VisuMax femtosecond laser system. Thereafter, the lenticule was manually removed and the flap repositioned. 31 patients all treated in Erfurt volunteered for a 12-month follow-up. UCVA and BSCVA after 12 months, objective and manifest refraction as well as slit-lamp examination and late side effects were documented. RESULTS: 62 eyes of 31 patients were examined in this study. The spherical equivalent before surgery was -4.81 (± 1.16) D; after 12 months -0.15 (± 0.46) D were manifest. No significant change was observed after the 6 months control. Starting with UCVA of 0.12 (± 0.09) before surgery UCVA was 1.10 (± 0.26) after 12 months. In one patient corneal ectasia was diagnosed. All other patients did not have any late side effects. CONCLUSION: The stability of the correction of myopic astigmatism with the FLEx procedure is very good. The fact that one patient presented with a corneal ectasia demonstrates that one general problem of refractive corneal surgery persists with this new fs technology.

[Fusarium keratitis]. / Fusarium-Keratitis.

The case of a previously healthy 48-year-old patient (not a contact lens wearer) with a Fusarium keratitis is reported. He had developed a deep corneal ulcer with total stromal infiltration (Fusarium ssp.). An intensive topical and systemic antiinfectious medication was initiated, along with some procedures (keratoplasty, rinsing of the anterior chamber). However, the infection progressed (endophthalmitis), and an enucleation was necessary. Despite modern drug therapy and surgical intervention, fungal keratitis can cause an enucleation.

Anterior segment optical coherence tomography for evaluation of changes in anterior chamber angle and depth after intraocular lens implantation in eyes with glaucoma.

PURPOSE: To examine anterior chamber depth (ACD) and anterior chamber angle (ACA) in patients with glaucoma after cataract extraction with an anterior optical coherence tomography (OCT) system. METHODS: A new commercially available 1310 nm infrared light anterior segment OCT system was used for anterior chamber evaluation. Sixty patients (n=20 with primary open angle glaucoma [POAG], n=20 with angle closure glaucoma [ACG], and n=20 with no known glaucoma as control group) with a mean age of 68.8+/-13.9 years undergoing cataract surgery were enrolled. RESULTS: Before cataract surgery, ACD and ACA of the ACG group were significantly lower compared to the POAG and control groups (ACD p<0.005; ACA p<0.005). After cataract extraction, ACD and ACA increased significantly in the ACG group (3.1+/-0.4 mm vs 1.8+/-0.2 mm, p<0.005 and 32.3 degrees +/-7.7 degrees vs 16.0 degrees +/-4.7 degrees , p<0.005). In the POAG and control groups, ACD and ACA also increased postoperatively, but not as much as in the ACG group. After cataract extraction, IOP decreased significantly in the glaucoma groups (ACG: 15.6+/-6.1 vs 18.6+/-5.7 mm Hg, p=0.008; POAG: 16.2+/-3.4 vs 20.7+/-8.0 mmHg, p=0.02) and was almost the same in all three groups after surgery (control group after surgery: 15.2+/-2.8 mmHg). CONCLUSIONS: Both ACD and ACA increased significantly after cataract extraction and IOL implantation. IOP reduction after surgery was higher in the glaucoma groups compared to the control group.

Selenium and zinc in patients with acute and chronic uveitis.

Patients with chronic inflammation often show decreased serum levels of trace elements. This study aimed to investigate serum levels of selenium and zinc in patients with uveitis. Twenty-four patients (13 female, 11 male) with a mean age of 40.6 +/- 15.5 yr were included in this study. According to their underlying disease, they were divided into acute (n = 13) or chronic (n = 11) uveitis. Selenium and zinc determination was performed by atomic absorption spectroscopy in EDTA blood samples. Patients with acute or first-time uveitis showed selenium and zinc concentrations within the normal range. In contrast to this, patients with chronic recurrent uveitis tend to result in decreased selenium and zinc levels. Especially selenium showed a remarkable reduction in serum concentration below the normal range. Furthermore, there was a tendency to decreased trace element concentrations with increasing age. A sex dependency could not been found. Especially patients with chronic, recurring uveitis show remarkable decreased selenium concentration in the EDTA-blood. Further studies should investigate possible positive effects of therapeutic selenium and zinc supplementation in patients with chronic, recurrent uveitis.

[The aging lens--new concepts for lens aging]. / "The aging lens"--neue Konzepte zum Alterungsprozess der Linse.

Epidemiological changes within the next decades will lead to an increase in the world population and to life expectancy. These changes will in turn lead to an increase in age correlated lens opacities and cataracts. Intensive research on cataract formation therefore becomes more and more important for socioeconomic reasons. In addition to the known risk factors, increased attention is currently being paid to oxidative processes. Typically, changes in the old lens are caused by the failure of protective systems and an accumulation of metabolic end-products and their influence on light transmission. Advanced glycation end-products and their potential inhibition seem to play a key role.

Increased content of zinc and iron in human cataractous lenses.

The purpose of the study was to examine the zinc and iron content of human lenses in different types of cataract and to investigate the possible influence of diabetes on the zinc and iron content of the lens. Iron and zinc of 57 human lenses (28 corticonuclear cataracts and 29 mature cataracts with a mean age of 70.6 +/- 16.1 and 74.7 +/- 11.1 yr, 41 nondiabetics and 16 diabetics) were determined by atomic absorption spectroscopy. The zinc content of human lenses was significantly increased in mature cataracts compared to corticonuclear cataracts (0.51 +/- 0.33 vs 0.32 +/- 0.20 micromol/g dry mass, p=0.012). The iron content of mature cataracts was also higher than in corticonuclear cataracts (0.11 +/- 0.09 vs 0.07 +/- 0.05 micromol/g dry mass, p=0.071). Furthermore, a significant increase of the lens zinc content could be observed with increasing lens coloration (light brown 0.33 +/- 0.17 vs dark brown 0.52 +/- 0.35 micromol/g dry mass, p=0.032). Diabetic patients seem to have both increased zinc and iron contents in the lens compared to nondiabetic subjects (zinc: 0.45 +/- 0.42 vs 0.40 +/- 0.22 micromol/g dry mass; iron: 0.12 +/- 0.10 vs 0.08 +/- 0.05 micromol/g dry mass). These data suggest a possible influence of the lens zinc and iron content on the development of lens opacification. Especially advanced forms of cataract and dark brown colored lenses show significantly increased zinc and iron content.

[Pattern laser trabeculoplasty and argon laser trabeculoplasty for treatment of glaucoma]. / Pattern-Laser-Trabekuloplastik und Argon-Laser-Trabekuloplastik zur Glaukombehandlung.

INTRODUCTION: Argon laser trabeculoplasty (ALT) and pattern laser trabeculoplasty (PLT) are two laser surgery methods for treatment of open angle glaucoma and the effect in reducing intraocular pressure (IOP) of these methods was compared in a retrospective study. METHODS: The IOP, the best corrected visual acuity (BCVA) and the eye drop glaucoma medication used by patients who were treated by ALT or PLT in this clinic between January 2011 and December 2012 were compiled and evaluated. RESULTS: An ALT was carried out on 22 eyes from 22 patients (13 right and 9 left eyes in patients with an average age of 71.1 ± 1.5 years, 7 men and 15 women) and a significant average reduction of IOP from 18.6 ± 0.9 to 15.3 ± 0.7 mmHg (p < 0.001) was observed an average of 8.2 ± 0.8 weeks after ALT. The number of dropped glaucoma medications per eye (p = 0.19) and the mean BCVA both remained constant (p = 0.15). A PLT was carried out on 20 eyes from 20 patients (12 right and 8 left eyes in patients with an average age of 69.9 ± 2.6 years, 10 men and 10 women) and a significant average reduction of IOP from 20.2 ± 1.1 to 15.6 ± 0.8 mmHg (p < 0.001) was observed an average of 8.3 ± 0.6 weeks after PLT. The number of dropped glaucoma medications per eye (p = 0.08) and the mean BCVA both remained constant (p = 0.59). The difference in the reduction of IOP between the ALT and PLT groups was not significant (p=0.26). CONCLUSION: Both PLT and ALT are effective methods for treatment of open angle glaucoma and lead to similar significant reductions in IOP.

Influence of seasonal sunlight intensity and iris color on the anti-VEGF therapy for neovascular age-related macular degeneration.

PURPOSE: To investigate the influence of seasonal light intensity and patients' iris color on the visual recovery after anti-vascular endothelial growth factor (VEGF) therapy with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD). METHODS: The visual acuity of 555 eyes (529 patients) with neovascular AMD was evaluated after intravitreal injections of either ranibizumab or bevacizumab in respect to global radiation intensity and iris color. RESULTS: The functional results during anti-VEGF therapy revealed a seasonal oscillation with a negative correlation between visual recovery and global radiation intensity (R(2)=-0.756, P=0.004). Although the influence of the sunlight intensity on the visual recovery was significant after the first injection, this effect vanished within the continuous course of treatment. Regarding the improvement of functional recovery depending on iris color, dark-colored eyes (16.0%) gained 8.5 ± 10.0 letters after the first injection and 9.9 ± 12.8 letters after the second injection, compared with 3.4 ± 8.6 letters and 4.4 ± 11.0 letters in light-colored eyes (84.0%), respectively (P=0.005 and P=0.019). CONCLUSIONS: Our results indicate that seasonal sunlight intensity and iris color might influence the visual recovery of neovascular AMD patients undergoing anti-VEGF therapy. Our findings may be used as suggestions to refine individual anti-VEGF therapy regimens, especially in patients with light-colored eyes.

[Monochromatic aberration in accommodation. Dynamic wavefront analysis]. / Aberrationen höherer Ordnung bei Akkommodation. Dynamische Wellenfrontmessung.

BACKGROUND: Monochromatic aberrations may influence the visual acuity of the eye. They are not stable and can be affected by different factors. The subject of the following paper is the dynamic investigation of the changes in wavefront aberration with accommodation. METHOD: Dynamic measurement of higher and lower order aberrations was performed with a WASCA Wavefront Analyzer (Carl-Zeiss-Meditec) and a specially constructed target device for aligning objects in far and near distances on 25 subjects aged from 15 to 27 years old. RESULTS: Wavefront aberrations showed some significant changes in accommodation. In addition to the characteristic sphere reaction accompanying miosis and changes in horizontal prism (Z(1) (1)) in the sense of a convergence movement of the eyeball also occurred. Furthermore defocus rose (Z(2) (0)) and astigmatism (Z(2) (-2)) changed. In higher-order aberrations a decrease in coma-like Zernike polynomials (Z(3) (-1), Z(3) (1)) was found. The most obvious change appeared in spherical aberration (Z(4) (0)) which increased and changed from positive to negative. In addition the secondary astigmatism (Z(4) (-2)) and quadrafoil (Z(4) (4)) rise also increased. The total root mean square (RMS), as well as the higher-order aberrations (RMS-HO) significantly increased in accommodation which is associated with a theoretical reduction of visual acuity. An analysis of the influence of pupil size on aberrations showed significant increases in defocus, spherical aberration, quadrafoil, RMS and RMS HO by increasing pupil diameter. By accommodation-associated miosis, the growing aberrations are partially compensated by focusing on near objects. Temporal analysis of the accommodation process with dynamic wavefront analysis revealed significant delays in pupil response and changing of prism in relation to the sphere reaction. In accommodation to near objects a discrete time ahead of third order aberrations in relation to the sphere response was found. CONCLUSION: Using dynamic wavefront measurement achieved a sequential analysis of aberrations during accommodation. Significant changes in the lower and higher-order aberrations could be detected. These are additionally varied by the associated pupillary response. Moreover, the synchronicity of wave front reaction in the accommodation process was proven.