[Analysis of Anti-VEGF Intravitreal Injection Treatment in Clinical Practice]. / Analyse der Durchführung der intravitrealen operativen Medikamenteneingabe im klinischen Alltag.

BACKGROUND: As AMD patients are very often administered intravitreal operative drugs (IVOM), the relevant procedure in ophthalmological institutes was examined in the present project: A questionnaire was used to collect data on structures, criteria and time expended in the treatment in single or small practices, clinics and (university) departments of ophthalmology. 42 facilities participated in the main study. RESULTS: The patient is usually given an appointment within two weeks of the first contact. If the patient has AMD requiring treatment, the first IVOM is administered within up to two weeks. This often lasts no longer than three hours. The follow-ups after the injection cycle may last up to one hour. If the findings are stable, there is normally a new follow-up after four weeks. The criterion for retreatment is always given as SD-OCT, followed by vision and funduscopy. The next appointment for injection is normally within one week. In diagnostic testing, angiography is almost as important as SD-OCT, funduscopy and vision, but is rarely used as a criterion for retreatment. The main differences in the organisation of the treatment plan are in the time course of the first IVOM and the follow-ups after the injection cycle. In this respect, practice clinics and individual or group practices may be quicker than departments of ophthalmology. One third of the surveyed facilities stated that they cooperated in diagnostic testing. These cooperating facilities repeat many investigations, both in diagnostic testing and in follow-ups. CONCLUSION: Bearing in mind that IVOM patients have a special interest in timely treatment, it would be desirable to shorten the waiting times, both for injection appointments and during treatment. Cooperation between the different service providers is sensible if this shortens the treatment pathways and relieve the patient and ophthalmologist. Moreover, both groups could benefit from standard and efficient treatment pathways, as these simplify patient care, increase the patient's satisfaction with the treatment and therefore tend to increase compliance.

Keratopathy following pars plana vitrectomy with silicone oil filling.

Out of 196 aphakic and 4 phakic eyes with silicone oil in the anterior chamber (all vitrectomized, postoperative follow-up 6 months to 5 years) we found 83 eyes (42%) with keratopathy. They present clinically and histologically as calcific band keratopathy (55 eyes) or diffuse bullous corneal edema (28 eyes). Time of onset, course and frequency in correlation to preoperative diagnosis are analyzed. Pathogenesis, prevention and therapy of keratopathy are discussed.

[Diabetic retinopathy. Pathophysiology and therapy of hypoxia-induced inflammation]. / Diabetische Retinopathie. Pathophysiologie und Therapie einer hypoxieinduzierten Entzündung.

Diabetic retinopathy is the most common chronic microvascular complication associated with diabetes mellitus. The development of diabetic retinopathy is a consequence of metabolic dysregulation. Hyperglycemia is a critical factor which is involved in basement membrane thickening, loss of pericytes and endothelial cells, and retinal capillary nonperfusion. We review the molecular basis of diabetic retinopathy and maculopathy and elaborate the role of growth factors and cytokines in the development of diabetic vascular alterations, their specific influence on the cellular interaction between retinal endothelial cells and pericytes, and the role of intravascular blood components.

[Early vitrectomy with primary silicone oil injection in very severely injured eyes]. / Früh-Vitrektomie mit primärer Silikonölinjektion bei schwerstverletzten Augen.

Performing early vitrectomy with primary silicone oil filling in 11 severely injured eyes (large or multiple intraocular foreign bodies, double perforations, ruptures - all with vitreous hemorrhage and retinal detachment), the authors succeeded in treating the posterior segment trauma with adequate hemostasis in ten cases. During postoperative follow-up of between 12 and 39 months there were no recurrences of hemorrhage. Primary retinal reattachment was achieved in seven eyes. A traction detachment due to proliferative vitreoretinopathy developed in three eyes at a relatively late stage (6-19 months postoperatively): reoperation was successful in two cases. With regard to functional results, six eyes had a visual acuity of between 1/25 and 0.6, and in four it was in the range between perception of light projection and hand movements. There were three cases with keratopathy encouraged by aniridia or hypotonia. One eye with emulsification of the silicone oil developed a secondary glaucoma which responded to topical treatment. In three cases the silicone oil was removed without complications. In one eye there was an expulsive choroidal hemorrhage which could not be managed intraoperatively and which led to phthisis and amaurosis postoperatively.

[Perforating eye injuries with multiple intraocular foreign bodies following military maneuver accidents]. / Perforierende Augenverletzungen mit multiplen intraokularen Fremdkörpern nach Manöverunfällen.

Nine patients sustained massive ocular injuries mostly bilateral, caused by practice ammunition fragments during military maneuvers. The injuries consisted of severe contusion and perforation damage to the cornea, traumatic cataract, vitreous hemorrhage, and multiple small intraocular foreign bodies frequently impacting on or penetrating the retina. Extraction of the foreign bodies was difficult, usually because they could not be localized preoperatively, because of optical problems due to corneal opacifications and frequent hemorrhages, and because of a lack of posterior vitreous detachment. Nevertheless, in the 15 eyes which underwent secondary surgery travel vision (1/35 to 0.2) was achieved in three and good visual acuity (0.3 to 1.0) in eight. Only four eyes ended up with practical blindness (LP to hand movements) due to retinal traction detachments with proliferative vitreoretinopathy.

[Problems in pneumatic retinopexy]. / Probleme der pneumatischen Retinopexie.

Fifty-four phakic eyes with selected rhegmatogenous retinal detachment (one retinal tear or a circumscribed group of tears in the upper two-thirds of the fundus, no sign of PVR) were treated by pneumatic retinopexy (transconjunctival cryopexy, intraocular gas injection with appropriate postoperative head positioning). After postoperative follow-up of six months or more primary reattachment of the retina was found in 27 patients (50%). In 12 eyes (22%) there was insufficient relief of traction, so that the detachment persisted (seven eyes) or recurred (five eyes). New retinal tears developed in 12 eyes (22%) between three days and six months postoperatively. This was probably due to interaction of the gas bubble with the vitreous base, an incompletely detached posterior vitreous border, or intravitreal condensations. Three eyes (6%) developed PVR. Other complications were vitreous hemorrhage (one eye) and subretinal gas bubble (one eye). The higher rate of complications, including the development of new tears, as compared to episcleral buckling procedures is discussed. In the authors's view appropriate experience on the part of the retinal surgeon and a level of intraoperative asepsis adequate for intraocular procedures are of major importance.

Pars plana vitrectomy and silicone oil injection in proliferative diabetic retinopathy.

A retrospective study is reported on 106 eyes with proliferative diabetic retinopathy, treated by vitrectomy and silicone oil injection. Indications were traction detachment in 91 eyes and nonclearing rebleeding in 15 eyes; 31 eyes had previously had vitrectomy. Anatomical success was obtained at the end surgery in 91 eyes, and after a minimum follow-up of 6 months in 68 eyes (64%). Functional results were as follows: satisfactory visual acuity (0.5-0.05) in 23 eyes (22%), ambulatory vision (0.03-CF) in 14 eyes (13%), HM-LP in 54 eyes (51%), and NLP in 15 eyes (14%). The functional results are limited by recurrent detachments due to characteristic reproliferations under the silicone bubble or by ischemic diabetic angiopathy in the attached retina. A positive effect of silicone oil is demonstrated in the reduction of preexisting or postoperatively new iris neovascularization and in preventing postoperative rebleeding.

[Keratopathy following vitrectomy with silicone oil injection]. / Keratopathie nach Vitrektomie mit Silikonölinjektion.

We present a retrospective study on keratopathy following vitrectomy and injection of SF96 silicone oil (viscosity 1000 centipoise, n = 232 eyes) and the purified OP 1000 silicone oil (viscosity 1000 centipoise, n = 129 eyes). In cases with aniridia, with closed inferior basal iridectomy (IBI) or without IBI, keratopathy was found in 74 of the 166 eyes (45%) injected with silicone SF96 and in 14 of the 30 eyes (47%) injected with silicone OP 1000. An intact IBI reduced the incidence of keratopathy to 0% (SF96, 0/45 eyes) or 6% (OP1000, 5/88 eyes) when the anterior chamber was free of silicone. When silicone oil was in contact with the corneal endothelium (due to periretinal reproliferation, hypotony, overfilling or droplet formation), there was corneal decompensation in 66% (SF96, 14/21 eyes) or 55% (OP1000, 6/11 eyes). The keratopathy presents as calcified band keratopathy or diffuse bullous corneal edema as in "endothelial decompensation." These variations in keratopathy are in agreement with the following basic diagnoses: 77% (43/56 eyes) of trauma patients (n = 130) develop calcified band keratopathy, and 47% (24/51 eyes) of patients with idiopathic proliferative vitreoretinopathy (n = 182) present with diffuse bullous corneal edema.

[Postmortem endoscopic diagnosis]. / Postmortale endoskopische Diagnostik.

The use of endoscopical methods augments the macroscopical diagnosis in autopsies. Cavities and sinuses which are hardly accessible may be inspected and photographically documented as well without damage of the anatomical context. In terms of forensic autopsies the endoscopical technique is mostly recommended for the inspection of the fundus of the eye, the external auditory meatus up to the tympanic membrane, the naso- and laryngopharynx. Pathological and traumatical changes can be valued at once in situ. Forensic evidence of postmortal endoscopical findings is exemplified.