[Chamber Angle Assessment in Clinical Practice - A Comparison between Optical Coherence Tomography and Gonioscopy]. / Kammerwinkelbeurteilung im klinischen Alltag - ein Vergleich zwischen der optischen Kohärenztomografie und der Gonioskopie.

BACKGROUND: In glaucoma the structures of the anterior chamber are important for classification, therapy, progression and prognosis. In this context anterior segment optical coherence tomography (AS-OCT) gains more relevance. This study compares AS-OCT with gonioscopy in diagnostic performance of chamber angle (CA) assessment. PATIENTS AND METHODS: 104 consecutive subjects with glaucoma underwent AS-OCT imaging using the Visante OCT. RESULTS were compared to gonioscopic grading from patient history using the Shaffer system. In addition, anterior chamber depth (ACD) assessment using slitlamp examination was evaluated as a prognostic factor for chamber angle width (CAW) and verified by AS-OCT measurement. RESULTS: Average CAW was 29° (AS-OCT). 17 % of the CAs that were "wide" in gonioscopy (variance 5-55°), showed a "narrow" CA in AS-OCT. 35 % of the CAs that were "narrow" in gonioscopy (variance 0-39°) showed a "wide" CA in AS-OCT. ACD assessment using slitlamp examination is a good predictor for CAW. In this context the technique provides equal informative value as gonioscopy. In cases of "wide" ACDs it is even superior. The critical ACD for an increased risk of angle closure is 2.4 mm. Concerning the critical ACD (< 2.4 mm) the technique gave the possibility to estimate, whether the patients were in the crucial range or not. Average ACD was 2.7 mm (AS-OCT). A strong correlation (correlation coefficient 0.83) between ACD and CAW was observed. Variation of 1 mm in the ACD leads to a change of 18.9° in the CAW. All patients with angle closure glaucoma were below this threshold and 74 % of patients with critical ACD had "narrow" (AS-OCT) CAs. CONCLUSION: In the case of routine clinical practice with inexperienced residents or circumstances that make gonioscopy difficult or impossible, optical coherence tomography is an effective alternative to the gold standard and is to some extent even superior.

[Basic in vitro studies on VEGF inhibition with aflibercept: similarities and differences to other VEGF-binding therapeutic proteins]. / Grundlegende In-vitro-Untersuchungen zur VEGF-Inhibition mit Aflibercept: Gemeinsamkeiten und Unterschiede zu anderen VEGF-bindenden therapeutischen Proteinen.

Patients suffering from various retinal diseases benefit from therapies directed against the vascular endothelial growth factor (VEGF). Aflibercept (Eylea) is another VEGF-binding protein available for intravitreal injection, in addition to the antibody bevacizumab (Avastin) and the F(ab) fragment ranibizumab (Lucentis). Aflibercept's distinct structure and broader binding specificity may have clinically relevant consequences, which is supported by basic in vitro studies and observations in animal eyes. All pathological processes involving neovascularisation are driven by the dominant action of VEGF, but other factors including placenta growth factor (PlGF), a mitogenic protein for retinal endothelial cells, potentially modulate its effects. Aflibercept is an inhibitor of both VEGF and PlGF and therefore may have superior therapeutic effects in some cases. However, whether or not aflibercept's broader binding specificity or different affinities for the different VEGF-binding proteins to VEGF result in substantially diverse therapeutic efficiencies has not yet been clarified. In vitro studies confirm that aflibercept efficiently prevents or normalises VEGF-stimulation of retinal cells and disturbance of their barrier function. These experiments also show that aflibercept is taken up by important retinal cell types and affects their normal function, i.e., migration of endothelial cells and phagocytosis of pigment epithelial cells. In accordance with a role of the Fc domains of aflibercept and bevacizumab, substantial amounts of both proteins are internalised, whereas only a small portion of ranibizumab enters the cells. Internalisation and storage by ocular cells, also observed in vivo after intravitreal injection into eyes of monkeys, may result in not yet recognised side effects during long-term treatment of patients with certain VEGF-binding proteins.

[Ophthalmopathology in everyday clinical routine]. / Ophthalmopathologie im klinischen Einsatz.

This article is intended to take up the cudgels on behalf of ophthalmopathology. To achieve this it is required to shed a light on ophthalmopathology in everyday clinical routine and to emphasise its relevance in today's world. Furthermore, it is intended to show how ophthalmopathology (unconsciously in part) has an impact on our actions. An ophthalmopathologist thinks differently, diagnoses differently and operates differently! Therefore ophthalmopathology should be a cornerstone not only in patient care but also in research and education.

[Treatment of diabetic macular oedema with the VEGF inhibitors ranibizumab and bevacizumab: conclusions from basic in vitro studies]. / Therapie des diabetischen Makulaödems mit den VEGF-Inhibitoren Ranibizumab und Bevacizumab: Schlüsse aus grundlegenden In-vitro-Untersuchungen.

Diabetic macular oedema (DMO) which may occur at all stages of diabetic retinopathy (DR) is a severe vision-threatening complication. In most cases, laser treatment does not improve visual acuity. Therefore research in ophthalmology focuses on the improvement of the prognosis of DMO patients with a drug-based DMO therapy. Vascular endothelial growth factor (VEGF) is considered the most important therapeutic target because this growth factor also is the most potent permeability factor affecting the inner retinal barrier formed by endothelial cells (ECs). Compared to its angiogenic stimulation of proliferation and migration of ECs, effects of VEGF on permeability have not been studied in all details. In vitro investigations on the behaviour of primary or immortalised retinal endothelial cells confirmed the key role of VEGF in the regulation of the permeability of the inner retinal barrier. Despite the presence of a variety of other factors found to be elevated in DR, a VEGF-disrupted barrier can be completely restored with the VEGF-inhibiting ranibizumab (Lucentis®) and bevacizumab (Avastin®) when applied at clinically achievable concentrations. The antibody bevacizumab, but not the antibody fragment ranibizumab, accumulates in both retinal EC and pigment epithelial cells during prolonged treatment. This observation might be relevant because patients are often treated for several years and additional long-term side effects may be recognised in the future.

[Demodex folliculorum: diagnosis and therapy today]. / Demodex folliculorum: Diagnostik und Therapie im klinischen Alltag.

Demodex folliculorum is an ectoparasite found in eye lashes. A Demodex-associated blepharoconjunctivitis is common. Demodex are diagnosed via microscopy in a drop of oil after epilation of a few eye lashes. You can often watch the mites in movement under the microscope. Treatment includes lid hygiene and metronidazole gel 1-2 %. The treatment often improves the symptoms of the patient. Demodex folliculorum is often found in patients with persistent blepharoconjunctivitis. Every ophthalmologist should have a microscope to find the mites. Then you will be able to treat the patients in an early stage.