[Postoperative endophthalmitis-a review of literature]. / Postoperative Endophthalmitis im Spiegel der Literatur.

Postoperative endophthalmitis is one of the most feared complications for ophthalmologists, and the number of infections after intraocular procedures have been increasing. Nonetheless, a prompt intervention can result in the recovery of vision. In the past, endophthalmitis after cataract surgery was accountable for the majority of cases but is becoming less frequent due to the progress of surgical techniques and demographic developments with a steadily increasing number of intravitreal injections. In this article, the different forms of postoperative endophthalmitis are assessed in terms of pathophysiology and their specific characteristics depending on their etiology.

[Evaluation of a virtual reality simulator for learning direct ophthalmoscopy in student teaching]. / Evaluierung eines VR-Simulators zum Erlernen der direkten Ophthalmoskopie in der studentischen Lehre.

BACKGROUND: The use of direct ophthalmoscopy in non-ophthalmological specialties seems to be decreasing in the clinical routine. This could be due to a lack of training and thus an uncertain assessment. OBJECTIVE: The aim of this study was to evaluate the effectiveness and acceptance of learning direct ophthalmoscopy on a simulator in comparison to the classical teaching method among students. MATERIAL AND METHODS: Within the framework of the student block internship for ophthalmology, a total of 34 students took part in the project. The first group received classical training, the second group received simulator training. The learning success was assessed by an objective structured clinical examination (OSCE). RESULTS: The simulator training group showed a significantly higher points score in individual disciplines. The subjects in the classical group achieved a learning success in the OSCE of 78%. In the simulator-based group a higher score of 91% was achieved with a lower scatter in all subdisciplines. DISCUSSION: The patient and instructor-independent availability of the teaching materials, a reduction of light exposure for patients and test subjects, as well as a standardized and controlled mediation of physiological and pathological findings can be emphasized as advantages of the tested simulator. CONCLUSION: The simulator-based training for learning direct funduscopy is effective. The virtual reality simulator evaluated in this project can improve the training of students and residents.

[Heavy liquids as intraoperative instrument in retinal surgery]. / Schwere Flüssigkeiten als intraoperatives Instrument in der Netzhautchirurgie.

The introduction of perfluorocarbon liquids (PFCL) resuled in a significant change in vitreoretinal surgery. Even complicated retinal detachments could be treated reliably and successfully. The combination of vitrectomy with the use of PFCL was one of the decisive factors for the continuing success of pars plana vitrectomy (ppV) in addition to technical refinements. The PFCLs have become an established part of vitreoretinal surgery due to their wide range of application and the positive intraoperative influence. When applied correctly and intelligently, PFCL can serve as the third hand of a retinal surgeon. Contrary to the widespread scepticism, the currently discussed toxicity of PFCL is negligible for short-term use.

[Suprachoroidal Hydrogel Buckle - a New Minimal-Invasive Technique in Treatment of Rhegmatogenous Retinal Detachment]. / Suprachoroidale Hydrogelplombe ­ eine neue minimalinvasive Technik zur Behandlung der rhegmatogenen Netzhautablösung.

The suprachoroidal hydrogel buckle is a new, simple and safe procedure for the treatment of rhegmatogenous retinal detachment. This technique combines the advantages of modern vitrectomy and classic buckling surgery. Placing the suprachoroidal buckle is possible as a stand-alone procedure or in addition to vitrectomy. The cross-linked hyaluronic acid seems to be the ideal agent for the suprachoroidal buckle with a buckling effect over 8 weeks. We need further investigations with long-term results.

[Importance of vitrectomy in endophthalmitis : How immediate vitrectomy can restore visual acuity]. / Stellenwert der Vitrektomie bei Endophthalmitis : Wie eine prompte Vitrektomie den Visus wiederherstellen kann.

This article presents a case of endophthalmitis after intravitreal injection with bevacizumab (Avastin®) in a patient suffering from exudative age-related macular degeneration (AMD). Within 1h after diagnosis the patient underwent vitrectomy with intravitreal injection of antibiotics combined with corticosteroids and 4 weeks after the endophthalmitis the visual acuity increased to 0.5. This case report demonstrates that an immediate vitrectomy combining intravitreal injection of medication can lead to a good visual outcome even in the case of severe endophthalmitis.

[Steroid implant in treatment of sympathetic ophthalmia : Intravitreal implant of dexamethasone in cystoid macular edema in the context of sympathetic ophthalmia]. / Steroidimplantat bei sympathischer Ophthalmie : Intravitreales Dexamethason-Implantat bei zystoidem Makulaödem im Rahmen einer sympathischen Ophthalmie.

We present the case of a 39-year-old female patient with cystoid macular edema of the left eye in the context of sympathetic ophthalmia. The right eye underwent several surgical interventions of both cornea and retina after ocular trauma and was enucleated after first clinical signs compatible with sympathetic ophthalmia and after exclusion of other infectious/non-infectious etiologies. The patient was treated with parabulbar triamcinolone injections and intravitreal injections of a dexamethasone slow-release implant with a good clinical course with respect to the macular edema. A steroid response did not occur over the treatment period of more than 12 months.

[Suprachoroidal hydrogel buckling]. / Suprachoroidale Hydrogelplombe.

Suprachoroidal hydrogel buckling is a simple and safe procedure for the treatment of rhegmatogenous retinal detachment. The advantages of modern vitrectomy and classical buckling surgery are combined in this surgical approach. Suprachoroidal buckling can be performed as a stand-alone procedure or in addition to vitrectomy. Cross-linked hyaluronic acid with a resorption time of up to 8 weeks is a suitable agent for this technique. Further studies will help to establish suprachoroidal buckling as a surgical procedure for treatment of retinal detachment.

[Novel vitreous body replacement with hydrogel?] / Neuer Glaskörperersatz mit Hydrogel?

Although the surgical treatment of rhegmatogenous retinal detachment has advanced, there still is a significant risk of redetachment and a slow visual rehabilitation due to the use of endotamponades. Hydrophobic tamponades act via a buoyancy vector causing an accumulation of proinflammatory cytokines opposite the buoyancy vector. So far, the use of hydrophilic endotamponades is very promising because they represent a possible solution for the abovementioned problems of surgical ablation. This article presents the current developments in this field.

[Aging and age-related changes of the vitreous body]. / Gesunder Glaskörper und seine Alterung.

BACKGROUND AND PURPOSE: The vitreous body is the largest component of the eye. It is a colorless, gelatinous, highly hydrated matrix that fills the posterior segment of the eye between the lens, the ciliary body and the retina. Changes in vitreal structure that occur with aging, such as vitreous liquefaction and fiber aggregation (vitreous syneresis) are important in the pathogenesis of many vitreoretinal diseases. During senescence, the vitreous volume is reduced, the vitreous body collapses and the vitreal fibers are continuously thickened, become more tortuous and surrounded by liquefied vitreous. This sequence of age-related changes results from a progressive reorganization of the hyaluronic acid and collagen molecular networks. RESULTS AND DISCUSSION: Although the vitreous body may at first glance appear to be a redundant tissue than can be removed and almost normal ocular function will still be maintained, the vitreous body and the vitreoretinal interface have a crucial influence on the physiology and pathophysiology of the eye. Age-related liquefaction and vitrous syneresis play an essential pathogenetic role in the development of posterior vitreous detachment, retinal breaks and retinal detachment.

[The diagnostic risk of overlooking temporal arteritis]. / Vom Risiko, die Diagnose einer Arteriitis temporalis zu versäumen.

We report two cases of atypical temporal arteritis. A 73-year-old woman with typical internal (diabetes, hypertony, hypercholesterinemia) and ophthomological (optic disc drusen) risk factors for N-AION reported with an acute unilateral decrease in vision. General symptoms, laboratory analysis and biopsy led to the diagnosis of temporal arteritis and iv steroids were administered. An 83-year-old male patient reported with a sudden unilateral decrease in vision, but did not complain about general symptoms. Laboratory analysis revealed no signs for temporal arteritis, therefore the patient was referred to his internal specialist for evaluation of internal risk factors for N-AION. A few days later the patient reported with a unilateral decrease in vision of the partner eye. This time blood analysis was suggestive of temporal arteritis although no general symptoms were reported. Diagnosis was supported by a biopsy of the temporal artery and steroids were administered. These two cases teach us how dangerously easy temporal arteritis can be overlooked and that we have to take even the slightest hint for temporal arteritis seriously and initiate treatment as early as possible.

[Stereometric parameters of the optic disc. Comparison between a simultaneous non-mydriatic stereoscopic fundus camera (KOWA WX 3D) and the Heidelberg scanning laser ophthalmoscope (HRT IIII)]. / Stereometrische Parameter der Papillentopographie. Vergleich einer simultan-stereoskopischen Non-Mydriasis-Funduskamera (KOWA WX 3D) mit dem Heidelberg Retina Tomograph (HRT III).

BACKGROUND: The Heidelberg retina tomograph (HRTIII, Heidelberg Engineering, Germany) in conjunction with the Moorfields regression analysis (MRA) allows monitoring for the progression of early damage to the optic nerve suspicious of early stage glaucoma. The confocal scanning laser ophthalmoscope provides clinicians with an objective and reproducible analysis of morphological parameters of the optic disc. Margins of the optic disc are approximated with a contour line to calculate the stereometric parameters leading to interobserver and intraobserver variability of the MRA. New devices enabling 3D fundus photography might be an alternative to the established HRT. It was the goal of this study to compare the methods by assessing the differences in the topographic parameters obtained by the HRT and the Kowa nonmyd WX 3D (2D/3D non-mydriatic retinal camera, Kowa, Japan) in a representative sample. METHODS: This retrospective study included 45 eyes of normal patients, 40 eyes of patients with macropapillae and 45 eyes of glaucoma patients. Each patient underwent an HRT examination and fundus photography with the Kowa nonmyd WX 3D on the same day. Excluded from the study were eyes with hazy media (cornea, lens, vitreous) or refractive anomalies higher than >4 dpt or astigmatisms >2 dpt. Eyes with previous refractive surgery history or other retinal diseases affecting the optic nerve were also excluded from the study. Bland-Altman plots were used for statistical evaluation. Distribution of parameters was described by 95% confidence intervals (CI). RESULTS: In normal eyes (n=45) a mean difference in the disc area of 0.33 mm(2) was found (95 % confidence interval CI: 0.22-0.43), in the cup-disc ratio (CDR) of 0.02 (95% CI: -0.06-0.14), in the cup volume of 0.03 mm(3) (95% CI: -0.04-0.01), in the rim volume of 0.04 mm(3) (95%-CI: -0.04-0.13) and in the maximum cup depth of 0.28 mm (95 %-CI: 0.34-0.23). All differences, except for the rim volume, were statistically significant (p<0.05). Patients exhibiting a macropapilla (n=40) displayed a mean difference of 0.03 mm(2) (95 % CI: -0.18-0.11) for the disc area, a difference in CDR of 0.09 (95% CI: -0.05-0.13), a difference in maximum cup depth of 0.28 mm (95% CI: 0.23-0.34) and a cup volume of 0.14 mm(3) (95%-CI: 0.10-0.18). In addition, there were no significant differences in rim volume (difference: -0.02 mm(3), 95% CI: -0.07-0.12) or in disc area. In glaucomatous eyes (n=45), the mean difference for cup area was 0.33 mm(2) (95% CI: 0.22-0.43), an area of 0.09 mm(2) (95% CI: 0.06-0.13) for the CDR, -0.03 mm(3) (95 % CI: -0.09-0.02) for the cup volume and 0.08 mm(3) (95% CI: 0.03-0.13) for the rim volume. Mean maximum cup depth difference was 0.25 mm (95% CI: 0.20-0.31). Mean differences in CDR, maximum cup depth and cup area were all statistically significant. The mean differences did not exceed the interobserver and intraobserver variability found in HRT measurements of other studies. CONCLUSIONS: To the best of our knowledge this study is the first comparing optic disc parameters of HRT and 3D photography. Mean differences in stereometric parameters did not exceed the known interobserver and intraobserver variability. The combination of non-mydriatic fundus photography and optic disc analysis is a very attractive and time-saving method. However, before progression of early glaucoma can be monitored or suspected glaucoma can be appraised over longer time periods, further studies are needed to clarify test and retest variability.

The effects of ranibizumab (Lucentis) on retinal function in isolated perfused vertebrate retina.

BACKGROUND: Intraocular ranibizumab (Lucentis, Novartis, Basel Switzerland) is the primary choice in the treatment of neovascular age-related macular degeneration (AMD). Vascular endothelial growth factor (VEGF) is known to be a survival factor for neuronal cells. Therefore, blockage of all VEGF isoforms by ranibizumab could induce retinal dysfunction. METHODS: Using isolated bovine retinas, the electroretinogram (ERG) was recorded as a transretinal potential using Ag/AgCl electrodes, while the retinas were perfused with an oxygen preincubated nutrient solution. For 45 min, ranibizumab was applied at a concentration of 0.2 mg/ml and alternatively the solvent carrier without the active agent. The ERG was monitored before, during and after exposure. RESULTS: The concentration of 0.2 mg/ml ranibizumab induced a non-significant b-wave reduction of 22.32% after exposure (p = 0.13). For the a-wave amplitude only a reduction of 4% was detected (p = 0.18). The solvent carrier induced no significant reduction of the a- and b-wave amplitudes (p = 0.30 and p = 0.979, respectively). CONCLUSION: In the ex vivo model, the isolated perfused vertebrate retina, ranibizumab has been proven to be a safe compound at the concentrations applied. The stability of the ERG-amplitudes rules out a considerable retinal dysfunction after an injection of up to 1 mg ranibizumab.