[E-PTFE Membrane for the Management of Perforated Corneal Ulcer]. / E-PTFE Membran für die Behandlung von perforiertem Hornhautulkus.

Purpose: To present the surgical management of perforated corneal ulcer using PRECLUDE® Pericardial Membrane, composed of expanded polytetrafluoroethylene (e-PTFE; GORE-TEX®), as an alternative surgical procedure in patients at high risk of graft rejections and to evaluate side effects for a prolonged period. Patients and Methods: The study included all patients who were admitted to our department and underwent surgical repair of perforated corneal ulcer with the e-PTFE membrane between 2010 and 2015. In total, 8 patients (8 eyes) were enrolled. Medical records of all patients were retrospectively reviewed. The operation was performed under peribulbar anaesthesia. Non-absorbable, microporous, watertight 0.1 mm thick e-PTFE membrane was used to close the corneal ulcer. The membrane was cut to overlap the defect adequately and to achieve the desired tissue attachment without preparing the conjunctiva or superficial trephination of the cornea. The membrane was fixed to the healthy cornea with several non-absorbable sutures (Prolene® 10.0), in order to achieve the proper stress without wrinkling. Results: Five of 8 patients were treated for systemic immunological diseases. Sjögren's syndrome was diagnosed in 2 patients, granulomatosis with polyangiitis in one, vasculitis with a history of previous sclerokeratitis in one and systemic lupus erythematosus in one. In 2 patients, corneal perforation was observed as a complication of corneal infection and in one patient as a late complication of a severe chemical burn. Corneal perforations were successfully covered with e-PTFE membrane in all patients. E-PTFE membrane was well tolerated in all patients and the eye was always preserved. After 3 to 4 months, the membrane was removed in 7 patients. The underlying cornea was thin, firm, stable and vascularised. In one patient with Sjögren's syndrome, the e-PTFE membrane is still in place. Conclusion: Surgical management of perforated corneal ulcer using E-PTFE membrane may be the method of choice for eye preservation or for delayed corneal transplantation. Our results confirmed that the procedure is safe and effective, especially in high risk patients. After removing the membrane, penetrating keratoplasty can be performed as a definitive treatment in all eyes where an improvement in visual acuity is expected.

[Diagnostic methods in the clinical evaluation of iridocorneal endothelial syndrome]. / Diagnostische Methoden bei der klinischen Untersuchung des iridokornealen endothelialen Syndroms.

BACKGROUND: This article presents a patient with iridocorneal endothelial (ICE) syndome. CASE REPORT: A 35-year-old man presented with unilateral slightly decreased visual acuity. Examination by slit-lamp biomicroscopy of the affected eye revealed alterations to the corneal endothelial layer, which had a silver-grey and hammered appearance. Corectopia with the pupil drawn towards an area with peripheral anterior synechiae could be gonioscopically detected. In vivo confocal microscopy of the cornea revealed alterations of the corneal endothelial layers of the affected eye, namely epithelization of the endothelium with pleomorphic epithelioid cells of irregular size and shape, indistinct borders and hyperreflective nuclei. CONCLUSION: In vivo confocal microscopy of the cornea is a sensitive diagnostic method for the rapid and early diagnosis of ICE syndrome.

[Clinical Findings in Patients with Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION) Under 50 Years of Age]. / Klinische Befunde bei Patienten mit nicht arteriitischer anteriorer ischämischer Optikusneuropathie (NAION) unter 50 Jahren.

BACKGROUND: The aim of our study was to determine the prevalence of NA-AION patients younger than 50 years among all our NA-AION patients and to compare clinical findings between young and elderly NA-AION patients. METHODS: This was a retrospective review of complete ophthalmic examinations, including fluorescein angiography and visual field testing, performed on all patients with the first attack of acute NA-AION admitted to our department during the period of ten years (2004 to 2013). Of 120 NA-AION patients, 10 (8.3 %) were under 50 years of age. RESULTS: The majority of these were men: 8 of 10 (80 %). The average best corrected visual acuity on admission was 0.34 (fingers counted up to 1.0) and on discharge 0.53 (fingers counted up to 1.0). Of 10 eyes, 6 were emmetropic and 4 hyperopic, from + 0.50 D to + 2.0 D. Aside from the clinical picture of AION, other ophthalmological findings were normal. In fluorescein angiography, typical changes for ischaemic optic neuropathy were observed in all patients. In a majority of patients, an inferior altitudinal visual field defect was found. As regards systemic risk factors, hyperlipidaemia was observed in 7, arterial hypertension in 3, diabetes mellitus without diabetic retinopathy in 3, and ischaemic heart disease in 1 of 10 patients. One patient was treated for rheumatoid arthritis without signs of vasculitis. In 3 patients, more than one systemic risk factor was observed. Two of our patients had no systemic risk factors except moderate hyperopia. Bilateral manifestation was observed only in one patient 8 months after the first attack. None of the patients experienced recurrent attacks. CONCLUSION: The prevalence of younger patients in our study was lower than in previous studies. The reason could be the better medical prevention in our region. Our study confirmed that even in young NA-AION patients, moderate hyperopia could be a predisposing factor. Our study did not confirm the differences between young and elderly NA-AION patients as observed in previous studies. During a period of 10 years, we did not observe recurrences, high risk of other eye involvement or severe vision loss in our young patients compared to the elderly.

[Characteristics of traumatic versus spontaneous wound dehiscence after penetrating keratoplasty]. / Merkmale von traumatischen und spontanen Wunddehiszenzen nach perforierender Keratoplastik.

BACKGROUND AND PURPOSE: After penetrating keratoplasty (PK) patients remain at risk for wound dehiscence at the graft-host junction even years after surgery. The aim of our study was, firstly, to assess the site-specific characteristics between traumatic and spontaneous wound dehiscence at the graft-host junction and, secondly, to determine the incidence of traumatic and spontaneous wound dehiscence. METHODS: The medical records of all 243 patients who underwent a penetrating keratoplasty from 1 March 1996 to 1 March 2012 were retrospectively reviewed. During a 16-year period 9 eyes showed signs of open wound dehiscence after blunt ocular trauma and 7 eyes spontaneously after suture removal. RESULTS: Over the 16-year period, the incidence of traumatic wound dehiscence was 3.7 % (9 of patients), whereas the incidence of spontaneous wound dehiscence after suture removal was 2.9 % (7 of 243 patients). In traumatic cases the graft dehiscence occurred in 88.9 % (8 of 9 patients) in the nasal part, predominantly in the inferior nasal part. In one case (11.1 %), only the temporal part was affected. The average extent of wound dehiscence for traumatic cases was 96° of the total wound circumference in the nasal part, and only 30° of the circumference in the temporal part. Spontaneous dehiscence after suture removal mainly occurred at temporal site in 71.4 % (5 of 7 eyes), mostly temporal inferior. Only in one case was the nasal part affected (14.3 %). The average extent of wound dehiscence in spontaneous cases was 54° of the total circumference in the temporal part and 21° in the nasal part. The total average extent of dehiscence was significantly larger in traumatic cases, 126° (one third) for traumatic and 75° (one fifth) of the wound circumference for spontaneous cases. All of the re-sutured grafts retained clarity, except for 3 eyes among the traumatic cases. CONCLUSION: The difference between both groups was significant regarding the localisation, the extent and the clarity of the re-sutured grafts. The nasal inferior part was the most affected area in traumatic cases probably as a result of indirect, contrecoup injuries, and the temporal part in spontaneous wound dehiscence probably due to direct minor forces.

[Cataract surgery in nanophthalmic eyes]. / Phakoemulsifikation bei nanophthalmischen Augen.

PURPOSE: The aim of this study was to determine the prevalence of nanophthalmos among cataract patients and to evaluate intraoperative and postoperative complications in nanophthalmic eyes. PATIENTS AND METHODS: Medical and operating records of all 3287 patients who had undergone clear cornea phacoemulsification cataract surgery with foldable acrylic IOL implantation during a period of two years (January 2009 to December 2010) were retrospectively reviewed. Nanophthalmos was diagnosed according to a shorter axial length than 20 mm, a shallow anterior chamber, hyperopia and scleral thickness greater than 1.7 mm as determined by echography. Before surgery all patients received an intravenous 20 % mannitol solution. RESULTS: From 3287 eyes, six eyes of four patients were identified as nanophthalmic with an axial length below 20 mm and a scleral thickness greater than 1.7 mm. The prevalence of nanophthalmos was 0.18 %. The average hyperopia was + 7.87 D (+ 6.0 to + 9.50). The mean axial length was 19.58 mm (18.94 to 20.00). The mean biometry calculation was 33.16 D (31.5 to 36.0). In all cases no complications were observed during the surgery. In two eyes a mild iritis was observed one day after surgery. During a follow-up of 3 months no further complications occurred. CONCLUSIONS: Surgical manipulation in a narrow and crowded anterior chamber in nanophthalmic eyes with increased vitreous pressure is always a challenge and must be performed by an experienced surgeon. Preoperative examination of scleral thickness and preoperative administration of hyper-osmotic solution for reduction of vitreous pressure are very important to prevent unexpected complications. There was no need for a prophylactic surgical procedure in our patients.

Influence of cataract surgery on macular thickness--a 3-month follow-up.

This prospective follow-up study evaluated the longer term changes to macular thickness and volume following cataract surgery. The study included 23 patients (23 eyes) who underwent ambulatory cataract surgery with phacoemulsification and intraocular lens implantation, followed by a scheduled optical coherence tomography measurement of macular thickness and volume after 3 months. Results were compared with preoperative data and measurements taken at 1 month after surgery, which were recorded in a previous study. A comparison of preoperative macular thickness values with those at 3 months after surgery demonstrated that the latter values remained greater in all macular regions except the superior outer macula, and that the differences were significant in the fovea, nasal inner macula and inferior outer macula. When macular thickness at 3 months after surgery was compared with that measured at 1 month, decreases were observed in all perifoveal areas, suggesting the reversible nature of cataract surgery-related macular thickness changes.

[Slovenia's contribution to research in ophthalmology (1991 - 2009)]. / Beitrag Sloweniens zur Forschung in der Ophthalmologie (1991 - 2009).

OBJECTIVE: The purpose of our study was to evaluate Slovenia's contribution to research in ophthalmology over a period of 18 years (1991 - 2009) including not only ophthalmologists but also other researchers. The aim of the study was to determine the relative contribution, quantitatively and qualitatively, to research in ophthalmology and to determine the trend over the period. The first authors as well as their institutes were evaluated. METHODS: A bibliometric analysis was performed using the database of the Institute for Scientific Information (ISI) 2007 report. All articles published in the top 45 ophthalmology journals listed in the ISI 2007 report were analysed. RESULTS: A total of 187 170 articles have been published in these journals in the given period of time. Slovenia's ophthalmologists and other researchers published 75 articles or 0.040 % of all publications. The articles were published in 21 of the 45 listed journals. Two were excluded from the study because they were only abstracts. In 8 articles the first author was not a Slovenian ophthalmologist. At the end, 65 articles remained in the study. 22 different Slovenian ophthalmologists were found as first author among these journals. Comparing ophthalmologists and other researchers, ophthalmologists produced 57 from 65 articles or 87.69 %. 13 from 22 ophthalmologists had published only one paper, accounting for 22.8 % (13 of 57) of total first authors. There were 47 articles with one or more co-authors (82.5 %) and 10 papers with a single author, which represent 17.5 % of total papers. There was only one first author who issued more than 10 articles (13 from 57 or 22.8 %). All the contribution came from two university clinical centres, Ljubljana (27 articles or 47.37 %) and Maribor (30 articles or 52.63 %). Three authors contributed to 45.6 % of all papers. Two-thirds of articles were published in English and one-third in German language. CONCLUSIONS: Although the number of articles published by Slovenia's ophthalmologists is increasing over the last 8 years there is a need to increase the quality and quantity of clinical research in ophthalmology and to involve more ophthalmologists in research work to support these trends.

[Ocular symptoms as the initial signs of Wegener's granulomatosis]. / Augensymptome als Initialzeichen von Wegener-Granulomatose.

OBJECTIVE: Wegener's granulomatosis (WG) is a systemic, necrotising, granulomatous vasculitis of unknown aetiology. Ocular involvement is present in up to 60 %. The aim of our study was firstly to evaluate the presence of ophthalmic manifestations as the first sign of WG in patients without obvious systemic manifestations of WG, and secondly to evaluate the clinical manifestation of ocular symptoms as the initial signs of WG. METHODS: The medical records of all patients with a diagnosis of WG examined at the Department of Rheumatology and Immunology during the 5-year period from January 2003 to January 2008 were reviewed. Initial manifestation of WG, initial ocular presentation, biopsy results, laboratory testing results, treatment and the final outcome were determined. Only patients in whom WG was not diagnosed at the time of the ocular symptoms were included in the study. RESULTS: Fifteen patients diagnosed with WG were identified. Six patients (40 %) developed no ocular symptoms before and after WG was diagnosed. Two patients (13.3 %) had a systemic disease first and subsequently developed ocular symptoms. Seven patients (46.7 %) had ocular symptoms as the first signs of WG (necrotising sclerokeratitis in two patients, peripheral ulcerative keratitis in two patients, non-granulomatous uveitis in one patient, anterior necrotising sclerokeratitis and nodular posterior scleritis with serous retinal detachment in one patient, severe retinal and chorioidal vascular occlusions with ischaemic optic disc neuropathy and complete visual loss in one patient). CONCLUSIONS: In nearly 50 % of patients with WG, ocular symptoms were observed as the initial signs before WG was diagnosed. The initial symptoms may be obscure and may vary from one patient to another. Knowledge of the ocular initial symptoms of WG is very important and can contribute to a better prognosis and prevention of visual loss.

[Hyperopia as a risk factor in patients with non-arteritic anterior ischaemic optic neuropathy]. / Weitsichtigkeit als Risikofaktor für Patienten mit nicht arteritischer anteriorer ischämischer Optikusneuropathie.

BACKGROUND: The aim of this study was to review the refractive errors of non-arteritic anterior ischaemic optic neuropathy (NAION) patients, especially with regard to hyperopia as an additional risk for NAION. PATIENTS AND METHODS: The medical records of detailed ophthalmic examinations of 45 patients with acute NAION who were admitted to our department between January 1, 2002 and January 1, 2007 were reviewed retrospectively. Refractive errors were measured with an autorefractometer. The spherical equivalent (sum of sphere and cylinder) was used as a measure of refractive error. RESULTS: The majority of eyes (32 of 45) were hyperopic (71.1 %) The average degree of hyperopia was + 1.86 D. Six of 45 patients (13.3 %) were myopic. The average degree of myopia was -0.87 D. CONCLUSION: Our results suggest that hyperopia could be a predisposing factor for NAION. Since there is no reliable and effective treatment for NAION, measures to avoid ischaemic optic neuropathy have priority. Patients with moderate hyperopia should receive a detailed eye examination with emphasis placed on recognition and management of other possible risk factors to minimise the risk for NAION. Prevention of possible risk factors is the only way to avoid this severe complication and to prevent the involvement of the fellow eye.

[Information system in ophthalmology]. / Ophthalmologisches Informationssystem.

BACKGROUND: Rapid advances in digital imaging technology that characterised the early part of the 21 (st) century have caused modern hospital information systems (HIS) to face a big challenge. One of the key goals of their reorganisation is integration based on open standards in order to achieve optimal interoperability. METHODS: At the Department of Ophthalmology of the University Clinical Centre Maribor, we have set up an intranet integrating a variety of diagnostic procedures into a single network. All workstations are connected to a dedicated data server, which represents the core of the network. The system is compatible with the DICOM (Digital Imaging and Communications in Medicine) standard and ready for future integration with hospital information systems over the HL 7 (Health Level 7) protocol. RESULTS: With the integration of different systems we have achieved the availability of all administrative, clinical and photo documentation for each patient on every workstation. This kind of system enables numerous connections within different diagnostic units and workstations, which is most distinctive during the diagnostic work-up of complex clinical cases. CONCLUSIONS: At our department integration of different diagnostic units into one ophthalmology information system proved to be a helpful tool regarding patient care during diagnostic and therapeutic procedures and at the same time represents a reduction of burdens for the medical staff.

[Systemic endothelial dysfunction in patients with pseudoexfoliation syndrome]. / Systemische Endotheldysfunktion bei Patienten mit Pseudoexfoliationssyndrom.

BACKGROUND: Recent studies have shown that pseudoexfoliation syndrome (PEX) is not limited to the anterior segment of the eye, but also affects different structures, such as blood vessels, heart, liver and lungs. Vascular endothelial dysfunction is associated with an increased cardiovascular risk. The purpose of our study was to evaluate endothelial function of the brachial artery in patients with PEX. PATIENTS/MATERIALS AND METHODS: We prospectively examined 21 patients with PEX and 21 age- and sex-matched individuals in a control group. Brachial artery endothelial function was assessed by the response to flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) using high resolution ultrasound. Dilation was expressed as the percent change in diameter relative to the baseline diameter. RESULTS: Patients with PEX had significantly lower FMD (1.9-2.8 versus 4.1-3.3 in the control group, p = 0.02). NMD in PEX patients was lower than in the control group (10.1-5.1 versus 10.8-5.8 in the control group, p < 0.69), but the difference was not statistically significant. CONCLUSIONS: Our study showed a statistically significant association between PEX and systemic vascular endothelial dysfunction. Larger clinical studies are needed to prove the higher cardiovascular risk in PEX patients.

[Optical coherence tomography findings in hemodialysis patients]. / Optische Kohärenztomografie bei hämodialysierten Patienten.

BACKGROUND: The aim of the present prospective study was to compare retinal thickness between normal healthy subjects and chronic renal failure patients treated with maintenance hemodialysis (HD) as well as to determine whether there was any correlation between age and duration of HD treatment. PATIENTS AND METHODS: A total of 24 eyes of 12 HD patients and 32 eyes of 16 controls underwent optical coherence tomographic scanning (OCT) in the central disc of 6000 mum in diameter. RESULTS: The mean retinal thickness was measured in the inner temporal, superior, nasal and inferior quadrants. There was a highly significant difference in the inner quadrants between controls and HD patients (p < 0.005). The mean retinal thickness was also measured in all outer quadrants. The differences between HD patients and controls were highly significant (p < 0.005). The average reduction in retinal thickness in HD patients compared to the controls in the inner quadrants was 7.9% or 22 microm (279.0 in controls, 257.0 in HD patients) and 7.3% or 17.7 microm in the outer quadrants (244.5 in controls, 226.8 in HD patients). The average reduction in all quadrants was 7.7% or 20.1 microm (262 in controls, 241.9 in HD patients). The differences between HD patients and controls were highly significant in all quadrants (p < 0.001). No differences in foveal thickness between controls and HD patients were found. The reduction of retinal thickness was correlated with the age of HD patients, but not with the duration of HD treatment. CONCLUSION: OCT revealed a significant reduction of retinal thickness in HD patients. The reduction was significant in all quadrants and was correlated to the age of HD patients. No differences in foveal retinal thickness were found.

[Traumatic wound dehiscence following penetrating keratoplasty]. / Traumatische Wunddehiszenz nach perforierender Keratoplastik.

BACKGROUND AND PURPOSE: Blunt ocular trauma to a corneal transplanted eye represents a higher risk for wound rupture at the donor-recipient interface. We have evaluated the causes, clinical characteristics, treatment and outcome, particularly the graft's clarity, in patients with traumatic wound dehiscence after penetrating keratoplasty. METHODS: Between March 1996 and April 2006, over a period of 10 years, 4 patients who had previously undergone successful penetrating keratoplasty and subsequently sustained traumatic wound dehiscence were treated at our department. All eyes underwent primary wound closure with interrupted 10-0 nylon sutures. RESULTS: Over the 10-year period, the incidence of traumatic wound dehiscence in which penetrating keratoplasty was performed was 2.35 % (4 of 170 patients). The ages of our patients at the time of injury were 6, 76, 78 and 39 years. The interval between penetrating keratoplasty and trauma varied from 12 through 16 and 17 to 30 months. All corneal dehiscences occurred at the graft-host junction. All dehiscences were at the temporal-superior quadrant (4 of 4 eyes) and at superior-nasal and temporal quadrants in 3 of 4 eyes. Two eyes that were pseudophakic had lost their implants and required anterior vitrectomy. In one of these patients (a 76-year-old women) delayed-onset expulsive choroidal haemorrhage occurred at the end of surgical repair. Visual outcome was correlated with the force of trauma, previous eye conditions and complications during surgery. All of the resutured grafts retained clarity. CONCLUSION: Traumatic wound dehiscence is a serious and not uncommon complication following penetrating keratoplasty. Despite severe trauma, graft transparency was achieved in all cases and there was no need for regrafting.

[Changing indications for penetrating keratoplasty over a 20-year period, 1985-2004]. / Veränderungen der Indikationen für die perforierende Keratoplastik über 20 Jahre, 1985-2004.

BACKGROUND: The aim of the study was to determine the changing indications for penetrating keratoplasty (PK) over the 20 years from 1.1.1985 through 31.12.2004 at our Ophthalmology Department as well as to identify additional surgical interventions. PATIENTS AND METHODS: Medical records of all 268 patients (290 eyes) who underwent PK at our Ophthalmology Department Teaching Hospital Maribor over the 20-year period (1985-2004) were reviewed retrospectively. All PK were divided into two groups: the first group comprised 121 eyes operated in the first 10 years (1985-1994) and the second one comprised those operated in the last 10 years (1995-2004). RESULTS: During the period of 20 years (1984-2004), the most common indication for PK was aphakic/pseudophakic bullous keratopathy (23.1 %). Keratoconus was the second most common indication for PK (21.7 %), followed by corneal scars (21.4 %). In the first 10 years of the study (1985 to 1994) the most common indications were corneal scars (28.9 %), keratoconus (22.3 %) and corneal dystrophy (19.8 %). Over the second 10 years (1995 to 2004) the three most common indications were bullous keratopathy (29 %), keratoconus (21.3 %) and corneal scars (16.9 %). There was a dramatic increase in the number of PK for failed corneal transplants, from 3.3 % in the first to 12.4 % in the second period (+ 275.8 %) and for bullous keratopathy (+ 94.6 %) as well as a decrease for corneal scarring (-41.5 %) and corneal dystrophy (-40.4 %). Additional surgical interventions increased from 21.5 % in the first 10 years to 28.4 % (+ 32.1 %) in the second 10 years. CONCLUSIONS: Bullous keratopathy was the leading indication for PK during the last 10 years (1994-2005). Keratoconus was the second leading indication in both 10 year periods. Regrafting showed a significant increasing trend in the last 10 years.

[Predictive factors of successful selective laser trabeculoplasty in open-angle glaucoma]. / Die Vorhersagefaktoren einer erfolgreichen selektiven Lasertrabekuloplastik bei Offenwinkelglaukom.

BACKGROUND: The aim of this study was to determine factors that predict successful selective laser trabeculoplasty (SLT) in open-angle glaucoma (OAG). PATIENTS AND METHODS: In 122 eyes suffering from OAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66, 72, 78 and 84 months thereafter. Success was defined as an IOP reduction exceeding 20 % of the pretreatment IOP. Correlations between successful SLT and baseline IOP, age, sex, hypertension, diabetes mellitus, family history of glaucoma, previous anterior segment surgery, the grade of trabecular meshwork pigmentation, laser energy used, and local antiglaucoma therapy were determined. RESULTS: The mean follow-up time was 43.4 months (SD: 25.6). The mean pretreatment IOP was 22.5 mmHg (SD: 2.8). The success rate after 12 months determined from the Kaplan-Meier survival analysis was 88 %, after 24 months 79 %, after 36 months 67 %, after 48 months 58 %, after 60 months 49 % and after 84 months 48 %. We found statistically significant negative correlation betweens successful SLT and the grade of trabecular meshwork pigmentation (r = -0.234; p = 0.01), diabetes mellitus (r = -0.223; p = 0.014). We found no statistically significant correlations between successful SLT and baseline IOP, age, sex, hypertension, family history of glaucoma, previous anterior segment surgery, laser energy used, local antiglaucoma therapy. CONCLUSION: SLT success in OAG with a mean follow-up time of 43.4 months was significantly predicted by the lower grade of trabecular meshwork pigmentation and the absence of diabetes mellitus.

[Changes of retinal light sensitivity after YAG-laser capsulotomy]. / Veränderungen der Lichtunterschiedsempfindlichkeit (LUE) der Netzhaut nach der YAG-Laser-Kapsulotomie.

BACKGROUND: The aim of this prospective study was firstly to investigate the changes of retinal light sensitivity of the central visual field in patients with posterior capsule opacification (PCO) after YAG-laser capsulotomy and secondly to determine the correlation between changes in retinal light sensitivity and patient's age and the diameter of posterior laser capsulotomy. PATIENTS AND METHODS: Our study includes 25 eyes (25 patients) with PCO after phacoemulsification and intraocular lens implantation. In all patients YAG-laser capsulotomy was performed. In all patients, a threshold visual field analysis was carried out with the C 30 - 2 programme of the automated Humphrey Field Analyzer before and one month after the procedure. RESULTS: In all patients a significant improvement of visual acuity was observed one month after capsulotomy (p = 0,00003). One month after YAG-laser treatment, a significant improvement of retinal light sensitivity in the central visual field was also observed. The average MD (mean deviation) before the procedure was - 6.05 db (+/- 3.2, max. - 11.7, min. + 2.17) and after the procedure - 3.61 db (+/- 3.7, max. - 10.87, min. + 0.71). Before laser capsulotomy obvious areas of reduced retinal sensitivity in 19 of 25 eyes (76 %) were found with MD p values of less than 5 %. One month after the procedure the MD p values were less than 5 % only in 8 eyes (32 %). The improvement in MD was statistically significant (p = 0,0002). No correlation was established between the improvement of retinal light sensitivity and patient's age or the size of the capsulotomy. CONCLUSIONS: Our study shows that the improvement of retinal light sensitivity is significant after YAG-laser capsulotomy and not depends on patient age or capsulotomy size.

[Repair of an extensive corneoscleral perforation in a case of ocular rosacea with a keratoplasty]. / Behandlung einer umfangreichen Korneoskleraperforation bei okulärer Rosacea mit der Keratoplastik.

BACKGROUND: A 58-year-old female patient with rosacea and a 7year history of eye trouble presented with a spontaneous corneoscleral perforation of the left eye. METHODS: The persisting ocular hypotonia with retinal folds made a closure of the leakage area necessary. Covering with a corneal transplant was chosen from among several possibilities available for the repair of eye-surface defects. The involved parts of the sclera and cornea were removed in a diameter of 7 mm. RESULTS AND CONCLUSIONS: The almost 6-year postoperative course with virtually no problems confirmed the keratoplasty as being effective therapy also in the case of perforation in rosacea scleroperikeratitis.

[Long-term follow-up of selective laser trabeculoplasty in primary open-angle glaucoma]. / Langfristige Nachbeobachtung der selektiven Lasertrabekuloplastik bei primärem Offenwinkelglaukom.

BACKGROUND: Our aim was to investigate the outcomes of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study. PATIENTS AND METHODS: In 90 eyes suffering from POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60, 66 and 72 months after. A failure was defined as an IOP reduction of less than 20 % of the pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged. RESULTS: The mean follow-up time was 41.2 months (SD 20.0). The mean pretreatment IOP was 22.4 mmHg (SD 2.3). At one month of follow-up, the mean IOP reduction was 5.0 mmHg (SD 2.3) or 22.3 % and at 6 months 5.2 mmHg (SD 2.4) or 23.2 %. At 12 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.4) or 24.0 % and at 24 months 5.8 mmHg (SD 2.3) or 25.5 %. At 36 months of follow-up, the mean IOP reduction was 5.7 mmHg (SD 2.1) or 25.1 % and at 48 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 1.9) or 23.1 %. At 60 months of follow-up, the mean IOP reduction was 5.2 mmHg (SD 2.0) or 22.6 % and at the end of 72 months of follow-up, the mean IOP reduction was 5.4 mmHg (SD 2.3) or 22.8 %. The success rate after 12 months determined by Kaplan-Meier survival analysis was 94 %, after 24 months 85 %, after 36 months 74 %, after 48 months 68 % and after 72 months 59 %. CONCLUSION: SLT is an effective procedure offering an additional therapy option for the treatment of POAG, but the effect diminishes over time.

[Pseudomonas-keratoconjunctivitis in a contact lens wearer, the therapy and keratoplasty á chaud]. / Pseudomonas--Keratokonjunktivitis bei einer Kontaktlinsenträgerin, Therapie und Keratoplastik á chaud.

BACKGROUND: Eye infections in contact lens wearers can cause severe complications. Especially dangerous is Pseudomonas aeruginosa. PATIENT: A 18-year-old patient who received her first soft contact lens from a optician two years ago without an ophthalmological examination, will be presented. At the time of an excursion to Paris in August 2004 she suffered from a purulent secretion on her right eye. In a pharmacy she bought medicinal herbal eye drops first. Then after three days a physician prescribed her Tobramycin eye drops 4 times per day and Chloramphenicol ointment at bedtime. At that time the visual acuity (VA) of the infected eye was already very bad. Two days later we performed the first ophthalmological examination at our Ophthalmological Department. RESULTS: The clinical finding was typical for a Pseudomonas infection: mucopurulent secretion, corneal ring abscess with stromal necrosis and hypopyon. The VA was only light perception. Immediately, a topical and systemic antibiotic therapy was prescribed (grade III by W. Behrens-Baumann). A conjunctival smear was sterile. For the microbiological examination the corneal scraping, the contact lens and storing solution were also taken and Pseudomonas aeruginosa and Klebsiella spp. were isolated. One month after the first presentation of the patient at our Department we performed a keratoplasty á chaud (diameter 8.0 mm). 1 year later the corneal graft is clear and the VA is 0.6 - 0.7 cc. CONCLUSIONS: The contact lens fitting lies worldwide in different hands and could be done by an ophthalmologist, an optometrist or an optician. The changes of the cornea and conjunctiva made by contact lenses can have different causes. Especially dangerous are metabolic-hypoxic corneal changes and infections. Therefore, an ophthalmological check-up, particularly after contact lens fitting done by an non-physician, is very important and necessary.

[The outcome of phacoemulsification in eyes after filtering glaucoma surgery]. / Ergebnisse nach Phakoemulsifikation in Augen nach filtrierender Glaukomoperation.

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.