Ophthalmologic Care of Former Preterm and Full-Term Infants during Their Childhood and Adolescence - A Retrospective View of Their Parents. / Augenärztliche Versorgung früh- und reifgeborener Personen in deren Kindheit und Jugend ­ eine retrospektive Sicht der Eltern.

BACKGROUND: The aim of the present study was to evaluate the ophthalmologic care in childhood and adolescence of infants born preterm and full-term from the retrospective point of view of their parents. METHODOLOGY: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of persons born preterm and full-term between 1969 and 2002 (now aged 18 to 52 years), and asks their parents about the ophthalmologic care received by their children in childhood and adolescence from their retrospective perspective. Participants and their parents were grouped into those with normal gestational age (GA) ≥ 37 (control group), preterm born infants without retinopathy of prematurity (ROP) and gestational age (GA) 33 - 36 (group 2), GA 29 - 32 (group 3), GA ≤ 28 weeks (group 4), and those with ROP without treatment (group 5) and with ROP with treatment (group 6). Parents of participants were interviewed about the ophthalmic care received by their children. RESULTS: In total, data from 57 full-term and 131 preterm infants and their parents were included in the present study. The parents of the participants reported that ophthalmologic examination had taken place until 6 years of age in the respective groups 1 to 6 in 22/57 (38.6%), 33/58 (56.9%), 22/38 (57.9%), 3/6 (50%), 19/21 (90.5%), and 7/8 (87.5%). Overall, between 83% and 100% of parents in the different groups reported that ophthalmologic care had been adequate. A change of ophthalmologist due to dissatisfaction with treatment was reported by a total of 4/57 (7%), 9/58 (15.5%), 8/38 (21.1%), 1/6 (16.7%), 1/21 (4.8%) and 2/8 (25%) in the respective groups. DISCUSSION: The present study demonstrates adequate satisfaction and good treatment regarding ophthalmologic care of former preterm children from the parents' perspective. Especially parents of children with ROP rated the treatment positively.

Prevalence of strabismus and risk factors in adults born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Eye study.

AIM: The purpose of this study was to assess the prevalence of strabismus and nystagmus and to analyse associated factors in preterm and full-term infants in adulthood. METHODS: The Gutenberg Prematurity Eye Study is a retrospective cohort study with a prospective ophthalmological examination of participants born preterm and full-term (aged 18-52 years). Perinatal data were carefully assessed for risk factors and comprehensive ophthalmological examinations were conducted. The association between strabismus and nystagmus was assessed by analysing 16 different perinatal and actual risk factors in multivariable analysis. Participants were grouped into full-term controls (gestational age (GA) at birth ≥37 weeks), preterm participants without retinopathy of prematurity (ROP) and GA 33-36 weeks (group 2), GA 29-32 weeks (group 3), GA ≤28 weeks (group 4), non-treated ROP (group 5) and treated ROP (group 6). RESULTS: In total, 892 eyes of 450 preterm and full-term individuals (mean age: 28.6 years, SD: ± 8.6 years, 251 females) were included. Strabismus was observed in 2.1% (3/140), 6.6% (9/137), 17.4% (16/92), 11.1% (2/18), 27.1% (13/48) and 60% (9/15) of participants and nystagmus in 0.7% (1/140), 1.5% (2/137), 4.3% (4/92), 5.6% (1/18), 10.4% (5/48) and 26.7% (4/15) of participants in the respective groups. In the multivariable regression model, strabismus was associated with GA (OR=0.90; p=0.046), anisometropia ≥1.5 diopter (OR=3.87; p=0.003), hypermetropia ≥2 diopter (OR=9.89; p<0.001) and astigmatism ≥1.5 diopter (OR=2.73; p=0.017). Esotropia was more frequent than exotropia and hypermetropia/hypometropia. Most strabismus cases occurred within the first 10 years of life. The strongest predictor associated with nystagmus was perinatal adverse events (OR=15.8; p=0.002). CONCLUSION: Low GA and refraction of the eye are independent risk factors for strabismus, which typically occurs in the first 10 years of life. Perinatal adverse events are the most important factors for the presence of nystagmus in adulthood.

Effect of contact lenses on the protein composition in tear film: a ProteinChip study.

BACKGROUND: The aim of this study was to analyze and compare the effects of rigid gas permeable and soft contact lenses on the protein composition in the tear film of contact lens wearers. METHODS: Wearers of soft contact lenses (CL_S, n = 13) and rigid gas permeable contact lenses (CL_H, n = 13) were recruited for this study. Thirteen non-contact lens wearers were also included as the control. Tears were collected using Schirmer strips and frozen until use. The tears were eluted and analyzed on ProteinChips SELDI-TOF (surface-enhanced laser desorption and ionization in time of flight mass spectrometry; Bio-Rad, USA) with different chromatographic surfaces (cationic and anionic exchanger and reversed phase surface). The SELDI spectra were analyzed by multivariate statistical analysis and artificial neural networks in order to find a biomarker panel which differentiates best between the groups. In order to identify protein/peptide peaks from SELDI spectra which showed a significant difference between groups, fractionated tear samples were analyzed using MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). For validation of biomarkers, we used an antibody microarray approach. RESULTS: Complex patterns of tear proteins and peptides were detected in the control group and in both contact lens groups. The tear protein composition in both wearers of rigid gas permeable (CL_H) and soft contact lenses (CL_S) differed significantly from protein composition in non-contact lens wearers (p < 0.01). The identification of biomarkers revealed an increase of Protein S100 A8 in the group of wearers of soft contact lenses (CL_S) and a decrease of a main tear protein, lysozyme, in both contact lens groups. The identified biomarker cystatin was upregulated in the group of rigid gas permeable lens wearers (CL_H), whereas the protein intensity of secretoglobin was significantly reduced in this group. Using the microarray approach, detected alterations could be confirmed. CONCLUSIONS: Contact lens wear alters the protein profiles in a complex manner. This study demonstrates that significant changes can be found in wearers of soft contact lenses (CL_S) and rigid gas permeable contact lenses (CL_H). Some biomarker intensities are significantly altered only in the group of rigid gas permeable lens wearers (CL_H).

Anterior ischemic optic neuropathy due to abdominal hemorrhage after laparotomy for uterine myoma.

INTRODUCTION: This retrospective observational case report describes a very rare but dreadful ocular complication due to severe blood loss in association with a major surgical procedure. It is the first time that this complication is reported in gynecological surgery. CASE REPORT: A previously healthy 41-year-old woman underwent hysterectomy because of large uterine myomas. Postoperatively, she was found to be severely anemic (hemoglobin 7.2 g/dl), but refused blood transfusion. Thirty-six hours after the first operation, relaparotomy was performed with extraction of a 1.5 l blood clot from the abdominal cavity. When she woke up from general anesthesia, the woman complained of visual loss in her left eye. At the time of visual loss, the hemoglobin level was 5.2 g/dl and the patient agreed to infusion of packed red blood cells. Ophthalmic examination revealed in the left eye an anterior ischemic optic neuropathy (AION). The optic disk was small, swollen and hyperemic (visual acuity at 8/10 with a superior altitudinal visual field defect). The right eye also had a small optic disk with a small cup (disk at risk), but no functional impairment. Despite blood transfusion, the left eye did not show any recovery and the optic disk had a pale appearance when examined after 3 years. CONCLUSION: Development of AION in this case was due to severe blood loss accompanied by head-down surgery in an eye with so-called "disk at risk". Meticulous management of perioperative systemic hypotension and early correction of anemia may reduce the risk of perioperative visual loss.

Is buckle surgery still the state of the art for retinal detachments due to retinal dialysis?

PURPOSE: Retinal dialysis is a frequent cause of retinal detachment in infants and young adults. The authors report long-term results obtained with conventional detachment surgery in a large consecutive series. METHODS: Fifty-two eyes of 50 patients with retinal detachment due to dialysis underwent a segmental buckling procedure between January 1990 and December 1998. Patient characteristics and surgical results at 1 year of follow-up were evaluated. In 2007, 40 eyes from these groups were reexamined for long-term results (follow-up: 9 to 17 years; median: 13.4 years). RESULTS: The mean age of the patients was 12.8 years (range = 6 to 28 years). Preferred locations of the dialyses were inferotemporal (72%) and superonasal (16%). The macula was detached in 82%. At 1 year of follow-up, the retina was completely reattached after one surgical procedure in 87% and after two procedures in 97%. Long-term follow-up of 40 of 52 eyes revealed no retinal redetachment, but additional surgeries had been performed. Visual acuity improved in 70% of the eyes, but only 40% reattained reading vision due to the high rate of macula-off retinal detachment preoperatively. CONCLUSION: Scleral buckling for retinal detachment due to dialysis yields good results, even in the long term, and remains the treatment of choice for these usually young patients despite the increasing popularity of primary vitrectomy.

Capsule measuring ring to predict capsular bag diameter and follow its course after foldable intraocular lens implantation.

PURPOSE: To evaluate the extent of capsular bag shrinkage after cataract surgery with intraocular lens (IOL) implantation and develop a regression formula to predict postoperative capsular bag size. SETTING: Eye Hospital, Johannes Gutenberg-University, Mainz, Germany. METHODS: The axial length (AL), anterior chamber depth, and corneal radius in 58 eyes were measured preoperatively. Cataract surgery was by phacoemulsification followed by implantation of a 3-piece, acrylic, posterior chamber IOL. The capsular bag diameter and anterior capsulorhexis were measured intraoperatively and 1 day and 1, 3, and 6 months postoperatively using a Koch capsule measuring ring (HumanOptics). RESULTS: The mean capsular bag size was 10.53 mm intraoperatively, 10.31 mm at 1 day, 9.62 mm at 1 month, 9.07 mm at 3 months, and 9.01 mm at 6 months. The mean capsular bag shrinkage over the entire postoperative period was 14.8% (P<.001). Of the parameters studied, only AL had a positive correlation with capsule shrinkage. The correlation was moderate but statistically significant (P =.001). CONCLUSIONS: A correlation was found between capsular bag shrinkage and AL. Using preoperative biometric data, a regression formula of moderate validity was determined to predict capsular bag shrinkage.

Late postoperative opacification of MemoryLens hydrophilic acrylic intraocular lenses: case series and review.

PURPOSE: To report clinical and spectrographic analyses of 2 explanted hydrophilic acrylic intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, Salt Lake City, Utah, USA, and Johannes Gutenberg-University, Department of Ophthalmology, Mainz, Germany. METHODS: We report 6 cases of opacification of MemoryLens IOLs (Ciba Vision) that occurred approximately 2 years after implantation. The anterior and posterior surfaces of the IOLs had a white, frosted appearance, and the IOLs' interior looked brown, similar to the appearance of a brunescent cataract. Two of the IOLs were explanted because of a significant decrease in visual acuity. The IOLs were sent for further clinicopathologic analysis including scanning electron microscopy and energy dispersive x-ray spectroscopy (EDX). RESULTS: Microscopic analysis revealed multiple, fine, granular deposits of various sizes on the surface of the lens optics. The EDX analysis showed the presence of calcium within the deposits. CONCLUSIONS: Our cases show that hydrophilic acrylic IOLs can opacify even years after implantation. Analysis of the explanted IOLs revealed calcification.

Intravitreal ranibizumab treatment of retinal angiomatous proliferation.

PURPOSE: To determine the efficacy of intravitreal injections of ranibizumab in the treatment of retinal angiomatous proliferation (RAP) in neovascular age-related macular degeneration. METHODS: Retrospective, consecutive case series of 26 eyes (26 patients) treated with intravitreal injections of 0.5 mg ranibizumab for RAP. Patients received intravitreal injections at monthly intervals during upload phase for a 3-month period. RESULTS: Mean visual acuity before treatment was 0.75 ± 0.38logMAR (mean ± SD, n = 26). In the upload phase, mean visual acuity improved 4 weeks after the initial injection to 0.6 ± 0.37logMAR (n = 26) and to 0.53 ± 0.34logMAR (n = 26) 4 weeks after the third monthly intravitreal injection of ranibizumab. The mean optical coherence tomography (OCT) central foveal thickness reduced from 345 ± 55 µm at baseline to 215 ± 87 µm at 3 months. In the maintenance phase, mean visual acuity after 6 months was 0.66 ± 0.38logMAR (n = 12) and 0.7 ± 0.37logMAR after 9 months (n = 6). The mean OCT central foveal thickness was 259 ± 59 µm (n = 13) at 6 months and 280 ± 127 µm (n = 6) at nine-month follow-up. CONCLUSION: Intravitreal ranibizumab resulted in an improvement of visual acuity 4 weeks after the first injection but was more pronounced after 3 months. A reduction in leakage and OCT central foveal thickness was seen 3 months after the commencement of treatment.

[Retrospective analysis of ruthenium-106 brachytherapy for small and medium-sized malignant melanoma of the posterior choroid]. / Retrospektive Analyse der Ruthenium-106-Brachytherapie bei kleinen bis mittelgrossen malignen Melanomen der posterioren Aderhaut.

BACKGROUND: Transpupillary thermotherapy is a new and most promising treatment modality for up to medium-sized choroidal melanoma at the posterior pole. We analysed the results of conventional ruthenium-106 brachytherapy in these special tumour subgroup. PATIENTS AND METHODS: Results of ruthenium-106 brachytherapy (radioactive dose to the tumour apex 150 Gy) in a series of 52 eyes with primary malignant choroidal melanoma (posterior to the equator, thickness

[Prospective nonrandomised analysis of "Sandwich Therapy" for malignant melanoma of the choroid]. / Prospektive nicht randomisierte Analyse der "Sandwich-Therapie" beim malignen Melanom der Aderhaut.

BACKGROUND: To evaluate the effectiveness of transpupillary thermotherapy (TTT) as an adjunct to ruthenium brachytherapy for treatment of choroidal melanoma with reduced radioactive dose. PATIENTS AND METHODS: In a prospective nonrandomised analysis 15 eyes with primary malignant melanoma of the choroid (posterior to the equator, thickness