[Microstructural retinal changes after pharmacological vitreolysis with ocriplasmin-an SD-OCT supported analysis]. / Mikrostrukturelle retinale Veränderungen nach pharmakologischer Vitreolyse mit Ocriplasmin ­ eine SD-OCT-gestützte Analyse.

PURPOSE: Ocriplasmin (Jetrea®) is a therapeutic option for patients with focal vitreomacular traction (VMT) with or without small full thickness macular holes (FTMH) < 400 µm. Retinal alterations after injection with ocriplasmin have been described. The purpose of this essay was to determine Ocriplasmin-associated side-effects and changes in the retinal microstructure. METHODS: We included 70 patients with ocriplasmin treatment in our study. On all patients SD-OCT (spectral-domain optical coherence tomography) scans were performed prior to injection with Ocriplasmin. If present, adverse events were registered. The OCT scans were then evaluated taking the following into account: macular hole (MH) size, macular edema, subretinal fluid (SRF), changes in the ellipsoid zone (EZ) and the external limiting membrane (ELM). RESULTS: Twenty of the 70 examined patients showed a preoperative FTMH. One week after ocriplasmin IVI (intravitreal injection) 8 of the 20 FTMHs were already closed. Overall 12 patients showed a FTMH closure and 4 patients developed a FTMH after ocriplasmin IVI. Twelve of the 24 MH (macular hole) patients still required an operative closure of the FTMH. We noticed a resolution of the VMT on 51 patients. Three patients developed a retinal detachment. Furthermore, after ocriplasmin IVI we detected changes in the EZ and ELM on 8 patients. CONCLUSIONS: Ocriplasmin is a substantial minimal invasive option in the therapy of VMT with or without small FTMH. Nevertheless, there seem to be some specific ocriplasmin-associated risks, although usually transient. Severe complications like retinal detachment are rare but exist. Therefore, every indication of ocriplasmin should be considered carefully.

[Maculopathy with optic nerve pits : Morphological criteria in SD-OCT]. / Makulopathie bei Grubenpapille : Morphologische Kriterien im SD-OCT.

PURPOSE: Optic pit is a congenital anomaly with malformation similar to coloboma of the optic disc. The cause of optic pit maculopathy is controversial. We used high resolution OCT to investigate changes in the vitreoretinal and vitreopapillary transition within optic pit eyes. METHODS: The vitreoretinal and vitreo-papillary transition of 12 eyes was accurately analyzed using SD-OCT. We registered the following criteria: liquefaction of prepapillary vitreous, papillary vitreous traction, discontinuity within the hyaloid cortex and communication spaces between pit and retinal edema. RESULTS: Communication gaps between pit and retinal edema were identified in 8 eyes. 4 eyes had a papillary vitreous traction. 4 showed a discontinuity in the hyaloid cortex. 2 of the 12 patients showed no maculopathy in SD-OCT. Those patients had an adjacent papillary vitreous without prepapillary liquefaction. However all eyes showed vitreous liquefaction at some stage premacullary or prepapillary. CONCLUSION: Yet the cause of optic pit maculopathy is not clearly understood. High resolution OCT imaging provides a very detailed assessment of the vitreoretinal transition prepapillary and premacullary, however with limited penetration depth and analyzation of deeper lying structures. Our observations suggest that prepapillary liquefaction and pressure gradients within cerebrospinal and intraokular pressure could be key factors.

[Fluorescein, indocyanine green and optical coherence tomography angiography in patients with native exudative age-related macular degeneration]. / Fluoreszein­, Indocyaningrün- und optische Kohärenztomographie-Angiographie bei Patienten mit nativer exsudativer altersabhängiger Makuladegeneration.

INTRODUCTION: The newly developed optical coherence tomography angiography (OCT-A) has provided new means to depict the vascular plexus in neovascular age-related macular degeneration (nAMD). If these images are to be used as a basis for therapeutic decisions, it is of vital importance to classify choroidal neovascularization (CNV) as either classical or occult. This study aimed at comparing the findings in OCT-A imaging of CNV with the traditional multimodal imaging through fluorescein angiography (FLA) and indocyanine green angiography (ICGA). METHODS: For this investigation 13 eyes from 13 patients with CNV on the basis of untreated nAMD were studied using FLA, ICGA, spectral domain OCT and OCT-A. All CNV were classified on the basis of SD-OCT and OCT-A images by two independent raters. Thereafter FLA and ICGA images were analyzed to set the gold standard for the classification and the ratings were compared to the previous SD-OCT and OCT-A results. RESULTS: 88% of eyes were correctly classified as either classical or occult CNV on the basis of SD-OCT and OCT-A images. Based on the CNV subgroups, 93% of classical CNV were identified using OCT-A images. In contrast occult CNV was correctly classified in 83% of patients. The interrater agreement was 77%. In general it was noted that the more the retina was pathologically altered, e. g. by edema or vascular pigment epithelium detachment, the harder it became to correctly classify the CNV. DISCUSSION: These results show that OCT-A can be used as an interesting addition in the diagnosis of CNV in nAMD. All CNV could be visualized using OCT-A and especially classical CNV could be clearly recognized in most cases. In contrast occult CNV could be identified in slightly fewer cases.

[Von Hippel-Lindau disease : OCTA findings in retinal hemangioma]. / Von Hippel-Lindau-Syndrom : OCT-A Befund bei retinalen Hämangiomen.

The case report of a 35-year-old woman suffering from Hippel-Lindau syndrome (VHL) with retinal hemangiomas is presented. The patient developed macular edema with loss of vision and metamorphopsia. Laser treatment of hemangiomas improved the clinical picture. Hemangiomas were visualized using fluorescein angiography and optical coherence angiography. To our knowledge we describe retinal hemangiomas in VHL disease with the optical coherence tomographical angiography (OCTA) for the first time. CONCLUSION: OCTA is suitable as a new non-invasive method to visualize retinal hemangioma without intravenous contrast agent.

[OCT angiography findings in acute posterior multifocal placoid pigment epitheliopathy (APMPPE)]. / OCT-Angiographie-Befund bei akuter posteriorer multifokaler plakoider Pigment epitheliopathie (APMPPE).

This article reports the case of a 32-year-old female patient who presented with severe spasmodically occurring retrobulbar pain, headaches and light sensitivity. The neurological examination confirmed cephalalgia but no evidence of other neurological symptoms was found. Ophthalmoscopy revealed yellowish patchy lightened spots in the middle periphery. Fluorescein angiography (FLA) and indocyanine green angiography (ICGA) revealed findings typical for acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Hypofluorescent areas visible using ICGA in the early and late phases showed corresponding hypoperfused areas by optical coherence tomography angiography (OCT-A). To the best of our knowledge this is the first description of these findings in OCT-A.

Evaluation of a new three-dimensional magnetic imaging system for use during colonoscopy.

BACKGROUND AND STUDY AIMS: A prototype magnetic imaging system (Scope Guide, Olympus Optical Co., Ltd.) provides a new facility for continuous viewing on a monitor of the position of the colonoscope during examination, without exposing patients or medical staff to radiation. The aim of this prospective study was to compare this magnetic imaging system with routine colonoscopy, including fluoroscopy. The study parameters were the detection of loops, the location of the endoscope tip at defined positions, the insertion time, and the premedication rate. MATERIALS AND METHODS: In the first part of the study, 133 consecutive patients were examined - 64 using an integrated three-dimensional colonoscope and 69 with the three-dimensional probe inserted into the biopsy channel of a routine video colonoscope. Fluoroscopy was used in all investigations for comparison at defined anatomical points and loops, and pathological findings and defined anatomic structures were documented using a laser printer both for three-dimensional colonoscopy and fluoroscopy. In the second part of the study, 25 further patients underwent colonoscopy with a modified prototype, now exclusively using the integrated three-dimensional colonoscope. RESULTS: The total time for insertion and the premedication rate did not differ from those of routine colonoscopies with fluoroscopy available. Precise detection of loops was observed in the first study in 79 - 100 % of cases in comparison with fluoroscopy. Precise localization of the endoscopic tip improved from 30 % in the first part of the study to 80 % in part 2. CONCLUSION: Using magnetic three-dimensional imaging systems, the position of the colonoscope, the detection and observation of loops during straightening, and localization of pathological findings can be accurately achieved. Modification of the prototype led to satisfactory improvement in all parameters tested.

[Removing adenomas reduces colon carcinoma risk up to 90%. Effective cancer prevention with the endoscope]. / Adenomentfernung reduziert Kolonkarzinom--Risiko um bis zu 90%. Effektive Krebsprävention mit dem Endoskop.

Endoscopic polypectomy is considered the method of choice for the diagnosis and treatment of colorectal polyps. 70-80% of all colorectal polyps are adenomas, which are precursors of colorectal carcinoma. The endoscopic detection and rigorous removal of colorectal polyps is an effective means of preventing colorectal carcinoma, since the incidence of the latter can be reduced by 90%. If technically possible, a snare should be used to remove all polyps larger than 5 mm in diameter. Tiny polyps may be removed with forceps. The removed polyp must be send for histological work-up and the results obtained used to plan the further steps or post-polypectomy surveillance. In defined cases (removal with adequate clearance, well-differentiated carcinoma, low risk situation), endoscopic polypectomy of adenomas with invasive carcinoma (pT1 carcinoma) is now the only treatment needed. Further surgical resection is not necessary. Surveillance is as for surgically removed colorectal carcinoma.

[Ultrasound controlled fine needle cytology and fine needle histology in circumscribed pancreatic processes]. / Ultraschallgezielte Feinnadelzytologie und Feinnadelhistologie bei umschriebenen Pankreasprozessen.

Using a biopsy transducer 171 fine-needle punctures of focal pancreatic processes were done in 158 patients. The final diagnosis was made in the first group by surgical operation or autopsy, in the second by the further clinical course. The sensitivity of the cytological examination alone was 78% in the first group and 90% in the second. The histological examination alone had a sensitivity of 79% to 100%. Combining both ways of examination according to defined criteria the sensitivity in the first group was 84% and in the second 100%. The specificity was 100% for both. The complications were 2.9%. Of these 5 cases one pancreatitis had to be operated. There were no lethal complications. To optimize the sensitivity and specificity of the ultrasound guided fine needle puncture technique we want to recommend the following points: A biopsy transducer or puncture-aid must be available. The fine needle technique only should be done under the prerequisite of a high frequency of punctures and a high constancy in the relation between puncturer and pathologist. To receive representative material it can be necessary to make several needle passes during one session. Material for cytological und histological examination should always be taken simultaneously.