[Functional Results 3 Months after Implantation of an "Extended Range of Vision" Intraocular Lens]. / Funktionelle Ergebnisse 3 Monate nach Implantation einer "Extended-Range-of-Vision"-Intraokularlinse.

PURPOSE: Evaluation of the visual and refractive results 3 months after implantation of a diffractive extended range of vision (ERV) intraocular lens (IOL) during cataract surgery. METHODS: In a prospective multicentre study, patients with a calculated postoperative corneal astigmatism of ≤ 1.5 D received a diffractive ERV IOL (TECNIS Symfony, model ZXR00, Abbott Medical Optics, USA) during cataract surgery. After 3 months, the monocular and binocular corrected and uncorrected far, intermediate and near visual acuity, as well as refraction, were evaluated. RESULTS: 18 patients (36 eyes) with a mean age of 63.34 ± 4.6 years underwent bilateral cataract surgery. After 3 months, the binocular uncorrected distance visual acuity (UDVA) of logMAR was - 0.05 ± 0.11 and the corrected distance visual acuity (CDVA) of logMAR - 0.14 ± 0.05. Binocular uncorrected intermediate (UIVA) and near visual acuity (UNVA) were logMAR - 0.09 ± 0.02 and 0.19 ± 0.09, respectively. A target refraction of ± 0.75 D was reached by 89 % of the patients. CONCLUSION: Implantation of an extended range of vision intraocular lens offers an effective way for visual rehabilitation at far and intermediate distances. Near vision is still in a functional range.

[Half-Dose Verteporfin Photodynamic Therapy (hdPDT) in the Treatment of Central Serous Chorioretinopathy]. / Photodynamische Therapie mit halber Verteporfin-Dosis zur Behandlung der Chorioretinopathia Centralis Serosa.

BACKGROUND: To estimate the efficacy and safety profile of half-dose photodynamic therapy (hdPDT) for treating central serous chorioretinopathy (CSC). PATIENTS AND METHODS: An interventional, retrospective case series of patients with CSC (symptoms ≧ 3 months) receiving half-dose PDT (3 mg/m2 verteporfin). The ophthalmic examination at baseline and at 8 and 16 weeks after treatment included slit-lamp biomicroscopy, indirect ophthalmoscopy, measurement of intraocular pressure (IOP), ETDRS best-corrected visual acuity (BCVA), Amsler grid screening and contrast visual acuity (CVA). Fluorescein angiography (FA), autofluorescence (FAF) and optical coherence tomography (OCT) were measured at each visit. Central macular thickness (CMT) was measured automatically. RESULTS: 12 eyes of 12 patients (10 male and 2 female patients; mean age 46.6 ± 7.91 years) were included in this study. Anatomical resolution was obtained in 10 eyes (83.4 %) at week 16, but 2 eyes (16.6 %) exhibited persistent SRD throughout the follow-up period. Baseline CMT decreased from initially 330.1 µm ± 131.3 to 205.6 µm ± 97.6 (p = 0.034) at week 8 and to 220.3 µm ± 120.1 (p = 0.05) at week 16. Visual acuity (number of total letters read) significantly improved from initially 82.8 ± 11.5 to 86.8 ± 13.9 at week 8 and 91.3 ± 13.8 at week 16 (p = 0.012). Contrast visual acuity (calculated decimal visual acuity) significantly improved from initially 0.14 ± 0.09 to 0.38 ± 0.28 (p = 0.002) at week 16. After therapy, no significant changes in RPE could be detected with FAF and no ocular adverse events were observed. CONCLUSION: PDT with half-dose verteporfin resulted in reduced leakage in FA, enhanced visual acuity and resolution of subretinal fluid in OCT in patients with CSC, with no detected side effects of treatment.

[Functional Results One Year after Implantation of a Bitoric, Trifocal Intraocular Lens]. / Funktionelle Ergebnisse 1 Jahr nach Implantation einer bitorischen, trifokalen Intraokularlinse.

PURPOSE: An evaluation of the visual and refractive results was undertaken one year after implantation of a trifocal diffractive toric intraocular lens (IOL) during cataract surgery. METHODS: In a prospective study patients with a calculated postoperative corneal astigmatism of ≥ 0.75 D received a diffractive trifocal toric IOL (AT LISA tri toric 939MP, Carl Zeiss Meditech, Jena, Germany) during cataract surgery. One year postoperatively the near, intermediate and distance visual acuity, corrected and uncorrected vision as well as refraction were evaluated. RESULTS: 20 patients (40 eyes) with a median age of 59 ± 11 years of which 15 were female underwent bilateral cataract surgery. One year postoperatively a binocular uncorrected distance visual acuity (UDVA) of 0.10 logMAR ± 0.11 and a corrected distance visual acuity (CDVA) of 0.00 logMAR ± 0.08 could be found. Binocular intermediate visual acuity (UIVA) and near visual acuity (UNVA) were 0.00 logMAR ± 0.05 and 0.09 logMAR ± 0.07, respectively. 100 % of patients were between ± 1.0 D from target refraction. Even 1 year after surgery no patient had an IOL rotation greater than 5°. CONCLUSION: The implantation of a trifocal toric intraocular lens offers an effective way for visual rehabilitation in near, intermediate and far distances with a good rotational stability of the IOL platform.

[Primary vitrectomy with peeling of the internal limiting membrane under decaline: a promising surgical maneuver for treatment of total and subtotal retinal detachment]. / Primäre Vitrektomie mit Membrana-limitans-interna-Peeling unter Decalin: Ein Erfolg versprechendes chirurgisches Manöver zur Behandlung von totalen und subtotalen Amotiones.

OBJECTIVE OF SURGERY: The aim of the surgical treatment of retinal detachment is retinal reattachment especially of the central portion for the best possible regeneration of functional visual outcome. INDICATIONS: Total and subtotal retinal detachments in combination with macular involvement were investigated. SURGICAL TECHNIQUE: After complete 20 or 23-gauge pars plana vitrectomy (ppV) the internal limiting membrane (ILM) was stained with Brilliant Blue for 30 s. The detached and more mobile central retina was weighted and stabilized with decaline so that the raised ILM could be carefully peeled away under the decaline level. Removal of residual decaline was followed by drainage of subretinal fluids through the retinal foramen and fluid-air exchange. To prevent renewed detachment circular laser coagulation was performed under air and followed by tamponade with silicone oil or SF6 gas depending on the status of the retina. RESULTS: The surgical intervention could be successfully performed in all selected patients with a primary reattachment rate of 100 %. In the 12-month follow-up period no renewed detachment or formation of a secondary epiretinal membrane was observed. The postoperative visual acuity (VA) showed a statistically significant increase (p < 0.0001) in the Wilcoxon test for paired samples. CONCLUSION: Primary vitrectomy with ILM peeling under decaline is a promising but ambitious surgical intervention for the treatment of incomplete and complete retinal detachment with and without proliferative vitreoretinopathy.

[Reliability and safety of intravitreal Ozurdex injections. The ZERO study]. / Zuverlässigkeit und Sicherheit von intravitrealen Ozurdex-Injektionen. Die ZERO-Studie.

BACKGROUND: Since July 2010 Ozurdex® is approved in Germany for treatment of macular edema from retinal vein occlusion (RVO). The objective of this observational study was a systemic summary and analysis of clinical experience regarding complications and side effects of intravitreal administration of dexamethasone. PATIENTS AND METHODS: In a retrospective, multicenter study conducted at 10 centers, 342 eyes with RVO were treated with intravitreal dexamethasone (Ozurdex®, Allergan). After treatment the patients were followed-up over a period of 8 months and intraoperative, perioperative and postoperative complications, such as elevated intraocular pressure and dislocation of implants were systematically recorded. RESULTS: No infections, endophthalmitis, perioperative hypotension, intraoperative lens injuries or retinal detachment occurred. Elevated intraocular pressure was the most common complication accounting for nearly 20 %. In 9 % of patients the intraocular pressure increased by more than 10 mmHg compared to baseline and in 6 patients to > 35 mmHg. In cases of known glaucoma intraocular pressure elevation was not significantly more frequent compared to non-glaucoma patients. In four cases a progression of lens opacity led to phacoemulsification and two implant dislocations in the anterior chamber required surgical repositioning in the vitreous cavity. In two cases a postinterventional macular hole was observed. CONCLUSIONS: In the clinical routine Ozurdex treatment has proven to be a therapy method with minimal side effects. In Ozurdex administration intraocular pressure elevation was observed as the most common side effect; however, this generally did not require surgical intervention. Caution is advised in patients with an anterior chamber lens and iridectomy. Macular holes as a rare complication might result from vitreous traction during the administration process. In summary, even in the clinical routine application of Ozurdex the complication rate was not higher than in registration studies.

[Choroidal tumor with exsudative retinal detachment?]. / Aderhauttumor mit exsudativer Amotio retinae?

We present the case of a 41-year-old female patient with acute onset of nyctalopia, xanthopsia and impairment of visual field. The ophthalmologic examination revealed peripheral choroidal elevation with accompanying retinal detachment. Due to the the presence of a nanophthalmic eye without any evidence of inflammation or malignant growth, the diagnosis uveal effusion syndrome could be made.

[Combined intravitreal injection of bevacizumab and SF6 gas for treatment of submacular hemorrhage secondary to age-related macular degeneration]. / Kombinierte intravitreale Injektion von Bevacizumab und SF(6)-Gas bei AMD-assoziierter, submakulärer Hämorrhagie.

OBJECTIVE: To investigate the efficacy of intravitreous bevacizumab and sulphur hexafluoride (SF(6)) for treating submacular hemorrhage secondary to age-related macular degeneration (ARMD). METHODS: Ten eyes of 10 patients (mean age 78.4 years, +/-6.5) with recent (range 1-4 weeks, median 1.0, mean 1.5) subfoveal hemorrhage secondary to ARMD were included in this study. The size of the subretinal hemorrhage ranged from 0.85 to 21.7 mm(2) (median 6.6 mm(2), mean 9.5 mm(2), +/-8.12). All patients received combined intravitreous injections of 1.25 mg bevacizumab and 0.3 ml SF(6). Follow-up visits were done 4 weeks after treatment. Depending on the ophthalmologic findings, further treatment with antivascular endothelial growth factor (anti-VEGF) injections was planned. RESULTS: Visual acuity improved three or more Snellen lines in six eyes (60%), remained stable in three (30%), and worsened by three or more lines in one eye (10%). Overall, displacement of blood was achieved in eight eyes (80%). In the following months, nine eyes received further injections with VEGF inhibitors. The Wilcoxon paired sample test revealed significant improvement of visual acuity in our patients (p=0.05). CONCLUSIONS: Our findings suggest that combined intravitreous injections of bevacizumab and SF(6) have the potential to improve visual outcome in patients with subretinal hemorrhage secondary to ARMD. However, further treatment of the underlying choroidal neovascularization is mandatory.

[Preoperative assessment of topographic features in macular pucker using high-definition optical coherence tomography]. / Präoperative Diagnostik topografischer Merkmale bei epiretinaler Gliose mittels hochauflösender optischer Kohärenztomografie.

BACKGROUND: To date, the surgical plan for the removal of epiretinal membranes is mainly adapted to the intraoperative situation. In the current study, we sought to investigate whether the surgical removal of macular pucker can be facilitated by the preoperative assessment of topographic features using high-definition optical coherence tomography (HD-OCT). PATIENTS AND METHODS: In a consecutive case series, 20 eyes of 20 patients with macular pucker underwent full ophthalmological evaluation including high-definition optical coherence tomography (Cirrus, Carl Zeiss Meditec) prior to a three-port-pars plana vitrectomy with peel of the epiretinal membrane (ERM). Furthermore, we documented the intraoperative course. RESULTS: Thirteen eyes (65 %) exhibited multiple foci of retinal contraction as detected by HD-OCT. In these eyes, surgical removal of the ERM was facilitated by using HD-OCT images. In contrast, eyes with flat membranes showed a strong adhesion to the retinal surface. CONCLUSION: Our findings suggest that preoperative assessment of topographic features using high-definition optical coherence tomography has the potential to improve surgical strategies in eyes with macular pucker.

[Peripheral exudative haemorrhagic chorioretinopathy: clinical and angiographic findings]. / Periphere, exsudative hämorrhagische Chorioretinopathie: Klinische und angiografische Befunde.

BACKGROUND: Peripheral exudative haemorrhagic chorioretinopathy (PEHCR) is a degenerative disease of the peripheral retina and choroid in the elderly. Although PEHCR is often seen by clinicians, this entity is underrepresented in the ophthalmological literature. This may be due to inconsistent naming. PATIENTS: We present the clinical, ultrasonographic and angiographic findings of 11 eyes of 8 patients who were diagnosed with PECHR in our department between January 2006 and June 2008. In addition, we report the intra- and postoperative course of three eyes that have been vitrectomised because of a vitreous haemorrhage associated with PEHCR. RESULTS: The mean age of the patients is 83.5 years (range: 75 - 95). The mean follow-up is 11 months (range: 0 to 20). The clinical and angiographic signs were dependent on the stage of the disease and may be seen as small asymptomatic peripheral subretinal bleeding and exudation. In advanced stages, vitreous haemorrhage and exudative retinal detachment may be observed. The temporal periphery of the fundus appears to be more often affected than other locations. Three patients were affected bilaterally. Vitreous haemorrhage was the reason for presentation in three eyes (27 %) that were treated successfully by vitrectomy. CONCLUSIONS: Peripheral exudative hemorrhagic chorioretinopathy should be considered in the differential diagnosis of vitreous haemorrhage and peripheral subretinal tumors in the elderly.

Screening library evolution through automation of solution preparation.

The quality of the compound library is a critical success factor in every high-throughput screening campaign. Screening solutions have to be prepared with a high level of process control to ensure the correct identity and initial concentration of each compound. However, even under optimized storage conditions, a certain level of degradation in solution cannot be avoided. Therefore, regular quality control and eventual removal of solutions from the screening deck is necessary. Because solution preparation, especially the weighing of compounds, is a tedious and often manual task, a regular resolubilization of compounds is difficult to achieve. By complete automation of the solution preparation, the authors have laid the foundation for a life cycle management of screening solutions. They demonstrate how a combination of quality and process control leads to a continuous improvement of the screening library. In presenting an automation concept, they show how a series of innovative process optimizations led to a high-performance system that achieves full industrialization of solution preparation.

Procurement of dermal graft from the suprapubic or inguinal fold region with primary linear closure.

OBJECTIVE: To report on two cosmetically advantageous sites for the harvesting of dermal grafts. The traditional method of dermal graft harvest using a dermatome may leave an unsightly defect. MATERIALS AND METHODS: Thirty-eight dermal grafts were harvested from either the inguinal fold or the suprapubic region. A freehand harvesting technique was used. The patients were all female and were having concurrent temporomandibular joint procedures. The donor sites were monitored for cosmetic result, patient satisfaction, and complications. RESULTS: All donor site wounds were determined to be cosmetically acceptable. The scars were well placed in anatomic skin folds. One complication, a seroma, was reported. CONCLUSIONS: Freehand graft harvest with primary closure provides an acceptable defect. The use of this technique in anatomically advantageous areas successfully conceals the resultant scar for heightened cosmesis.

Blastomycosis of the skull base.

Blastomycosis is usually considered a pulmonary or cutaneous disease. A patient with blastomycosis of the infratemporal fossa temporal bone and sinuses without pulmonary disease is presented. Extensive skull base involvement required surgical debridement for relief of pain, and long-term systemic antifungal therapy. The literature is reviewed and discussed.

Tisseel, a two component fibrin tissue sealant system: report of a trial involving anticoagulated dental patients.

There have been attempts since the early years of this century to produce a biocompatible, biodegradable tissue glue to aid in hemostasis and lessen the need for conventional sutures. In the early 1970s, Matras et al developed a glue to anastomose the severed ends of peripheral nerves, and which was the precursor of the product tested in this trial. Since that time, the product has gained wide acceptance in Europe, with applications in microvascular anastomosis, hemostasis of soft tissue defects, bone sealing and dural sealing.