Originalbeiträge (Originals). Altered microvascular density in patients with anorexia nervosa ­ an optical coherence tomography angiography (OCTA) pilot study.

OBJECTIVES: To investigate macular and peripapillary vascular density (VD) in patients with anorexia nervosa (AN) compared to healthy controls. Methods:Whole face scans of the superficial and deep macular layers and whole face and peripapillary scans of the radial peripapillary capillaries (RPC) were obtained using optical coherence tomography angiography (OCTA, AngioVueR, Optovue) in ten patients with AN and ten age-matched controls.The primary objective was to determine whether there was a difference between the vessel density (VD) in the above areas in AN and controls. P-values ≤ 0.0125 were considered statistically significant. Results: VD in the superficialmacular en-face OCTA image was significantly lower in the study group compared to the control group. Neither the deepmacula nor the radial peripapillary capillary (RPC) in the whole-face image nor the RPC-peripapillary imaging appeared to be significantly different. Conclusion: Patients with AN showed reduced VD in the superficialmacular layers compared to healthy controls, which can be discussed as a consequence of the malnutrition. OCTA could be a useful non- invasive tool to detect reduced peripheral blood supply to show vascular changes that occur before ocular symptoms.

Comparison of the iStent Inject® versus the iStent Inject® W-Both in Combination with Cataract Surgery-In Open-Angle Glaucoma.

We compare the short- and mid-term postoperative outcomes of the iStent inject® with its successor, the iStent inject® W. A retrospective monocentric study was performed to compare the iStent inject® used for cataract surgery with the iStent inject® W, also used for cataract surgery. The primary study endpoint was intraocular pressure (IOP) reduction six months after surgery. Six-month follow-up results were available for 35 eyes from 27 patients in the iStent inject® group and for 32 eyes from 25 patients in the iStent inject® W group. IOP reduction at six months post surgery was significantly greater in the iStent inject® W group (-2.2 mmHg [iStent inject® W] vs. -0.06 mmHg [iStent inject®], p = 0.037). There was a statistically greater decrease in glaucoma medication administration at six months in the iStent inject® group than in the iStent inject® W group (-1.28 agents vs. -0.62 agents, p = 0.007). These findings support the hypothesis that the superior positioning of the iStent inject® W (due to its larger base diameter) compared to the iStent Inject® leads to greater IOP reduction. Because of the short follow-up period, small study cohort, and differences in the number of glaucoma patients, the study results must be interpreted carefully.

[Münster standard: modified Paul® implantation in a condition following Preserflo® MicroShunt implantation. Video article]. / Münsteraner Standard: modifizierte PAUL®-Implantation bei Zustand nach PreserFlo® MicroShunt-Implantation. Videobeitrag.

OBJECTIVE OF SURGERY: The aim of this surgical technique is the modified placement of a Paul® implant (Fa. Advanced Ophthalmic Innovations, Singapur) in eyes after failure of Preserflo® MicroShunt (Fa. Santen, Osaka, Japan) implantation for the best possible adjustment of the intraocular pressure. INDICATIONS: The technique presented here is intended for patients suffering from more complex glaucomas, which were unsuccessfully previously treated with a Preserflo® Microshunt (Santen Inc.). SURGICAL TECHNIQUE: The special feature of the Münster standard is the choice of the surgical field and the waiver of a further tunnel placement. The patients receive a Paul® implant in the same quadrant as the previously inserted Preserflo® MicroShunt implant (superior temporal). The latter is explanted after preparation of the conjunctiva and priming of the Paul® implant with a Prolene 6.0 suture and fixation of the plate. In order to carry out the implantation of the Paul® tube through the existing 25-gauge tunnel, the latter is dilated laterally with an iris spatula under positioning of the anterior chamber. A surgical video, which is available online, shows the surgical technique in detail. ADVANTAGES OF THE MüNSTER STANDARD: The superior temporal surgical access promises easier handling. The fact that there is no need for a new tunnel effectively saves surgery time and is expected to reduce endothelial cell loss as only one tube remains in place in comparison to two anterior chamber tubes.

Nasolacrimal intubation in transcanalicular endoscopic dacryoplasty: a long-term follow-up study.

Nowadays, transcanalicular endoscopic dacryoplasty represents the majority of lacrimal duct surgery procedures performed in adults in specialised centers. However, there are still hardly any data available regarding the intra- and postoperative care, particularly regarding the duration of silicone tube intubation (STI). Our aim was to evaluate the relation between tube duration and recurrence of symptoms in patients who underwent transcanalicular microdrill dacryoplasty (MDP) in a long-term setting. Medical records of 576 adult patients after MDP were retrospectively reviewed. A total of 256 eyes of 191 patients could be included. The median follow-up time was 7.83 [7.08; 9.25] years. In 57.0% of the cases there was still full resolution of symptoms at the time of the survey. The median duration of the STI was 6 [3.00; 6:00] months. When distinguishing between a tube duration < 3 months and ≥ 3 months there was a significant difference in the long-term success rate (< 3 months: 38%; ≥ 3 months: 61%; p = 0.011). In conclusion, an early removal of the STI (< 3 months) after transcanalicular MDP seems to be associated with a higher incidence of recurrence of symptoms. This should be considered in the intra- and postoperative care of patients following this minimally invasive first-step procedure.

The Hippo pathway component Wwc2 is a key regulator of embryonic development and angiogenesis in mice.

The WW-and-C2-domain-containing (WWC) protein family is involved in the regulation of cell differentiation, cell proliferation, and organ growth control. As upstream components of the Hippo signaling pathway, WWC proteins activate the Large tumor suppressor (LATS) kinase that in turn phosphorylates Yes-associated protein (YAP) and its paralog Transcriptional coactivator-with-PDZ-binding motif (TAZ) preventing their nuclear import and transcriptional activity. Inhibition of WWC expression leads to downregulation of the Hippo pathway, increased expression of YAP/TAZ target genes and enhanced organ growth. In mice, a ubiquitous Wwc1 knockout (KO) induces a mild neurological phenotype with no impact on embryogenesis or organ growth. In contrast, we could show here that ubiquitous deletion of Wwc2 in mice leads to early embryonic lethality. Wwc2 KO embryos display growth retardation, a disturbed placenta development, impaired vascularization, and finally embryonic death. A whole-transcriptome analysis of embryos lacking Wwc2 revealed a massive deregulation of gene expression with impact on cell fate determination, cell metabolism, and angiogenesis. Consequently, a perinatal, endothelial-specific Wwc2 KO in mice led to disturbed vessel formation and vascular hypersprouting in the retina. In summary, our data elucidate a novel role for Wwc2 as a key regulator in early embryonic development and sprouting angiogenesis in mice.

Altered microvascular density in patients with systemic lupus erythematosus treated with hydroxychloroquine-an optical coherence tomography angiography study.

PURPOSE: To evaluate the retinal microvascular density using optical coherence tomography angiography (OCTA) in patients with systemic lupus erythematosus (SLE) treated with hydroxychloroquine (HCQ). METHODS: Nineteen eyes of 19 patients with SLE (study group) without HCQ retinopathy and 19 eyes of 19 healthy subjects (control group) were included in this study. The study group was divided into patients using HCQ for > 5 years (high-risk group) and < 5 years (low-risk group). The VD data of the 3 × 3 mm OCT angiogram of the superficial capillary plexus (SCP) and the choriocapillaris (VD-CC), the foveal avascular zone (FAZ) area and the central retinal thickness (CRT) were extracted and analyzed. RESULTS: VD in the en face SCP was significantly reduced in the high-risk group and the low-risk group compared with that in the control group (p < 0.001, p = 0.001) and in the high-risk group compared with the low-risk group (p = 0.007). Correlation analysis between the cumulative dose of HCQ and the VD of the study group revealed a negative correlation, but no statistical significance (p = 0.074). However, a significant positive correlation was observed for the low-risk group (p = 0.035). In patients with SLE, VD-CC was lower (p = 0.042) and the FAZ area larger (p = 0.019). CRT showed no difference between the groups (p = 0.183). CONCLUSION: In this study, SLE patients showed a reduced VD in both groups. In patients treated with HCQ < 5 years, HCQ might have a protective effect on retinal microvasculature. Analysis of retinal microvascular density using OCTA could be useful in the diagnosis and monitoring of vascular alteration in patients with SLE.

Results of Resorbable and Running Sutured Amniotic Multilayers in Sterile Deep Corneal Ulcers and Perforations.

PURPOSE: To present the results of a modified surgical technique for secure tightening and fixation of multilayer amniotic membranes (AMs) in sterile deep or perforating corneal ulcers. METHODS: We retrospectively analyzed the data of patients suffering from corneal ulcers who had been treated between February 2016 and June 2018 with running and resorbable sutures to fixate multilayer AMs. The parameters analyzed were gender, age, etiology of corneal ulcer, ulcer diameter, corneal thickness (CST) before and after the microsurgical procedure as measured with optical coherence tomography, number of inlays, repeat surgical procedures, follow-up duration in months, and rate of success (defined as a stable anterior chamber with improved CST, a negative Seidel test, and no need for any microsurgical keratoplasty during the first 6 months after treatment). The results were statistically evaluated using the Wilcoxon test. A P-value ≤0.05 was considered to show a statistically significant difference. RESULTS: The CST increased significantly after AM transplantation (from 206.26 ± 114.93 µm at baseline to 454.70 ± 244.08 µm at 1-3 months; P < 0.001). Repeat multilayer transplantation was required in 7 of the 23 patients included (30.4%), in 6 of whom the treated eye was stable at month 6. In 2 of the 23 patients, perforating keratoplasty became necessary. One patient also demanded such a procedure to improve his visual acuity. The success rate was 91.3% (n = 21). CONCLUSIONS: Running resorbable suture fixation of multilayer AMs proved to be an efficient means for the treatment of noninfectious deep or small perforating corneal ulcers.

Optical coherence tomography angiography-derived flow density: a review of the influencing factors.

Research interest in the possibility of quantifying macular and optic nerve head perfusion through optical coherence tomography angiography (OCTA) is rapidly advancing. Numerous scientific trials have furthered our understanding of the capabilities and the limitations of this novel technology, while applying OCTA to various ocular pathologies. In recent years, different parameters such as age, gender, intraocular pressure, spherical equivalent, physical activity, systemic diseases, and medication have been shown to have a significant impact on quantitative OCTA metrics. Since OCTA is likely to remain a "hot topic" in the near future, it is crucial to be aware of influencing factors in order to ensure correct interpretation of imaging results. This article reviews the factors currently known to influence flow density (FD) as measured by OCTA in healthy eyes.

Distribution of macular ganglion cell layer thickness in foveal hypoplasia: A new diagnostic criterion for ocular albinism.

BACKGROUND/AIMS: To analyse the distribution of macular ganglion cell layer thickness (GCLT) in patients with foveal hypoplasia (FH) with or without albinism to obtain new insights into visual pathway anomalies in albinos. METHODS: Patients with FH who presented at our institution between 2013 and 2018 were retrospectively drawn for analysis. Mean GCLT was calculated after automated segmentation of spectral domain-optical coherence tomography (SD-OCT) scans. Patients with FH due to albinism (n = 13, termed 'albinism FH') or other kinds (n = 10, termed 'non-albinism FH') were compared with control subjects (n = 15). The areas: fovea (central), parafovea (nasal I, temporal I) and perifovea (nasal II, temporal II) along the horizontal meridian were of particular interest. Primary endpoints of this study were the ratios (GCLT-I- and GCLT-II-Quotient) between the GCLT measured in the temporal I or II and nasal I or II areas. RESULTS: There was a significant difference between the GCLT-I-Quotient of healthy controls and albinism FH (p<0.001), as well as between non-albinism FH and albinism FH (p = 0.004). GCLT-II-Quotient showed significant differences between healthy controls and albinism FH (p<0.001) and between non-albinism FH and albinism FH (p = 0.006). The best measure for distinguishing between non-albinism FH and albinism FH was the calculation of GCLT-II-Quotient (area temporal II divided by area nasal II), indicating albinism at a cut-off of <0.7169. The estimated specificity and sensitivity for this cut-off were 84.6% and 100.0%, respectively. The estimated area under the curve (AUC) was 0.892 [95%CI: 0.743-1.000, p = 0.002]. CONCLUSION: Macular GCLT-distribution showed a characteristic temporal to central shift in patients with FH due to albinism. Calculation of the GCLT-II-Quotient at a cut-off of <0.7169 presents a new diagnostic criterion for identification of ocular albinism.

Influence of mydriasis on optical coherence tomography angiography imaging in patients with age-related macular degeneration.

PURPOSE: To evaluate the effect of topical mydriatic eye drops on optical coherence tomography angiography (OCTA) parameters in patients with age-related macular degeneration (AMD). METHODS: 27 eyes of 27 patients suffering from AMD were included in this cross-sectional study. Patients with ≥-4.5 diopters spherical equivalent, corneal opacities or dense cataract preventing high-quality imaging were excluded. Whole-en-face scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the central 3x3mm foveal region as well as whole-en-face and peripapillary scans of the radial peripapillary capillaries (RPC) were generated using OCTA (AngioVue®, Optovue). Imaging was first conducted with patients' eyes in miosis, then in mydriasis after instillation of a dilating eye drop (0.5% tropicamide, 2.5% phenylephrine-HCl). Main outcome measures were flow density (FD), foveal avascular zone (FAZ), signal strength index (SSI) and motion artifact score (MAS). RESULTS: Our results reveal that in AMD patients there is no significant difference between FD measurements taken in miosis and those taken in mydriasis around the SCP (p = 0.198), DCP (p = 0.458), RPC whole-en-face (p = 0.275) and RPC peripapillary (p = 0.503). Measurements taken in these two states appear to be equivalent for assessment of FD (90%CI within ± 0.05). No significant difference was found either in the area of the FAZ (p = 0.338) or in the SSI (p = 0.371) before and after the instillation of tropicamide/phenylephrine. MAS was significantly lower after the application of mydriatic eye drops (p = 0.003). CONCLUSIONS: Our findings reveal that neither measurements of FD nor measurements of the FAZ area changed significantly in AMD patients after the application of tropicamide/phenylephrine. Since MAS improved significantly in dilation, mydriatic examination is recommended. Nevertheless, a comparison of OCTA metrics from images taken with different pupil states (miosis versus mydriasis) is valid for clinical trials.

Attitudes and Knowledge Regarding Postmortem Cornea Donation among Young and Elderly People in Germany: Sufficient for Decision Making?

OBJECTIVES: To evaluate the knowledge of and attitudes toward postmortem cornea donation in living young and elderly potential donors in a German city. METHOD: High-school students and seniors participated in a nonrandomized prospective survey focusing on willingness to donate corneas postmortem and factors that might influence underlying specific attitudes. Statistical analysis was descriptive and included logistic regression. RESULTS: The survey showed that 73.3% of the high-school students and 41.6% of the seniors, 53.2% of whom had already signed an advanced medical directive, felt insufficiently informed about donation. High-school students were significantly less willing to donate their corneas postmortem (p < 0.001), and fewer of them possessed a donor card (p < 0.001). High-school students specified the internet as their favored source of information about donation in 82.7% of cases, while the family physician was the first preference for 47.8% of the seniors. CONCLUSIONS: The willingness to donate and the proportion of donor card ownership were significantly lower in the high-school students than among the seniors, corresponding to their respective knowledge in matters of donation. Young people should be systematically informed about cornea donation at school, as soon as they reach the legal minimum age for donation, and primary-care physicians should provide relevant information to every new patient to aid their decision making concerning postmortem cornea donation.