[Vitreomacular interface and posterior vitreomacular adhesion in exudative age-related macular degeneration (AMD): an OCT-based comparative study]. / Vitreomakuläre Grenzfläche und posteriore vitreomakuläre Adhäsion bei exsudativer altersabhängiger Makuladegeneration (AMD): Eine OCT-basierte Vergleichsstudie.

PURPOSE: The aim of this study was to evaluate posterior vitreomacular adhesion as a risk factor for choroidal neovascularisation (CNV) in age-related macular degeneration (AMD). The vitreoretinal interface was examined using spectralis optical coherence tomography (Spectralis-OCT, Heidelberg Engineering). PATIENTS AND METHODS: In a retrospective observational case series 375 consecutive eyes of 375 patients (age 51-90 years) were examined with spectralis OCT and fluorescein angiography (Spectralis-HRA, Heidelberg Engineering). Vitreomacular adhesion was defined when a posterior hyaloid line attached to the inner retinal surface was seen in OCT. In 202 patients with exudative AMD the incidence of posterior vitreomacular adhesion was compared to 173 control eyes (72 with non-exudative AMD and 101 eyes without retinal alterations). RESULTS: We found posterior vitreomacular adhesions in 151 patients (40.27 %). In the control group 53 patients (30.6 %) showed vitreomacular adhesions compared to 98 patients (48.5 %) with exudative AMD. The difference was statistically significant (p = 0.001). The location of vitreomacular adhesion was observed over the area of the CNV in 87 patients (88 %) with exudative AMD. CONCLUSIONS: Spectralis OCT allows a detailed examination of the vitreomacular interface. The frequency of posterior vitreomacular adhesion is significantly increased in eyes with CNV in AMD. Chronic vitreomacular traction may be a risk factor for the development of exudative AMD.

[Comparison of the aesthetic outcome and complication rate of reconstructive surgical procedures of the eyelid after basalioma excision]. / Vergleich rekonstruktiver Operationsverfahren des Lides. Ästhetische Ergebnisse und Komplikationsrate nach Basaliomexzision.

BACKGROUND: The therapy of choice of the basalcellcarcinoma is the surgical removal often combined with soft-tissue reconstruction. Aim of this study was to evaluate the subjective aesthetic outcome and the complication rate in consequence of the chosen surgical procedure. METHOD: 57 patients formerly treated by surgery enclosing free grafts, Hughes flaps, interpolated flaps or primary wound closures were included. The patients were examined to evaluate possible surgery derived complications. Furthermore the aesthetic outcome was assessed by a questionnaire. RESULTS: After an interpolated flap nearly 30% of the patients were without any complications and after a Hughes flap 21.4%. In contrast 43.8% of the patients after primary wound closure showed any complications and even 57% of the patients treated with a free graft. Concerning the aesthetic outcome 92.3% of the patients undergoing an interpolated flap were subjective satisfied or even very satisfied with their aesthetic outcome. CONCLUSION: Regarding the complication rate the free graft and the primary wound closure seem to be superior. On the contrary the interpolated flap demonstrated a considerable better estimated aesthetic outcome.

[Early emulsification of silicone oil (2000 cs) in minimally invasive transconjunctival vitreoretinal surgery]. / Frühe Emulsifikation des 2000er-Silikonöls nach minimalinvasiver transkonjunktivaler vitreoretinaler Chirurgie.

BACKGROUND: The highly purified polydimethylsiloxane (PDMS) with a viscosity of 5000 centistokes (cs) is the preferred silicone oil endotamponade in vitreoretinal surgery (20 gauge) and shows high stability. In contrast in transconjunctival minimally invasive surgery (23 gauge) the application of 5000 cs. silicone oil shows substantial disadvantages because of time-consuming and difficult application procedure due to the small lumen of the used surgical equipment. Consequently silicone oils with lower viscosity like the 2000 cs silicone oil are being increasingly used in transconjunctival surgery. PATIENTS: We present two cases of early emulsification of the 2000 cs silicone oil (Siluron 2000 ©, Fluoron, Neu-Ulm, Germany) consisting of highly purified PDMS in the course of minimally invasive transconjunctival vitreoretinal surgery. In both cases 23 gauge vitrectomy with application of 2000 cs silicone oil was performed without any complication. The first case is a 34-year-old female with proliferative diabetic retinopathy who had already experienced several vitreoretinal operations. The present indication for vitrectomy was a persistent macular hole and vitreous haemorrhage. The second case is a 55-year-old pseudophakic patient with a retinal detachment after vitrectomy with gas endotamponade following rhegmatogenous retinal detachment. RESULTS: In the first case emulsification of silicone oil was seen on the second postoperative day. In the second case emulsification was discovered two weeks postoperatively. In both cases high intraocular pressure did not occur. CONCLUSION: With emerging performance of minimally invasive vitrectomy techniques the use of silicone oil with low viscosity in patients with conceivable endurance of the endotamponade appears to be beneficial. Up to now 10 patients have undergone 23 gauge vitrectomy with application of 2000 cs silicone oil without any complications in our clinic. In contrast, two cases demonstrated early emulsification of the 2000 cs silicone oil. To the best of our knowledge this complication has not been described before.

[Vasoproliferative retinal tumours]. / Vasoproliferative retinale Tumoren.

Vasoproliferative retinal tumors are benign tumors of unknown origin often accompanied by vitreoretinal inflammation. A 21-year-old female patient presented with acute reduced unilateral visual acuity. A solid yellow vascularized lesion was present in the inferior temporal retina accompanied by localized retinal detachment and accumulation of hard exudations. The only finding was an increased Bartonella henselae titer. Persistence of uveitis and blurred vision led to therapy for Bartonella henselae with macrolide antibiotics and successful tumor regression was achieved by cryotherapy.

[Definition of the success of the surgical treatment of palpebral tumours with respect to quality of life]. / Definition des Operationserfolgs von Lidtumoren im Hinblick auf Lebensqualität.

BACKGROUND: The NEI-VFQ-25 (National Eye Institute Visual Function Questionnaire) was extended by several questions taking account of aesthetic and cosmetic aspects in addition to the mere visual function aspects. This amended questionnaire, named NEI-VQF +, was used to evaluate the perceived overall success of various surgical - including reconstructive - measures taken in the case of palpebral tumours. MATERIALS AND METHODS: The NEI-VFQ + was presented to a group of 73 patients (average age 71 years) after surgical treatment of malignant palpebral tumours (basal cell carcinoma, squamous cell carcinoma, melanoma). The surgical treatment included different types of surgical techniques for eyelid resection and reconstruction performed between 2005 and 2008. The questions were asked after at least three and at most 56 months of post-operative observation. They covered the perceived success of the surgical treatment with respect to general quality of life, in particular concerning personal problems relating to behavioural as well as social changes caused by functional or aesthetic deficiencies resulting from the treatment. RESULTS: The ratings given by the vast majority of patients, when linked to particular treatment regimes, reflect the subjectively superior importance of the aesthetic outcome in comparison to probable health risks, such as, e. g., rate of relapse or metastasis. CONCLUSIONS: The overall success of a particular surgical intervention to treat a malignant palpebral tumour depends not only on the expected minimisation of future health problems, including decreased visual function, but appears to depend strongly on the personal expectations of individual patients with respect to the aesthetic outcome. Therefore in the case of a malignant palpebral tumour, it should be envisaged to plan a treatment strategy not only on the basis of the objective needs and limitations as seen by the surgeon, but also involving the patient's concern with all his/her expectations and fears in order to build up more mutual trust and to get a result that is satisfactory for the surgeon as well as for the patient.

[Overload damage to the Achilles tendon: the importance of vascularization and angiogenesis]. / Uberlastungsschäden der Achillessehne: Die Bedeutung von Blutgefässversorgung und Angiogenese.

In the Achilles tendon, degenerative changes mostly occur in regions that are hypo- or avascular. Angiogenesis is mediated by angiogenic factors and recent studies have shown that vascular endothelial growth factor (VEGF) is highly expressed in degenerative Achilles tendons, whereas VEGF expression is nearly completely downregulated in healthy tendons. VEGF expression in tendon fibroblasts is regulated by the transcription factor hypoxia inducible factor 1 (HIF-1). Several factors are able to upregulate VEGF expression in tenocytes: hypoxia, inflammatory cytokines and mechanical load. Angiogenesis plays an important role in the tendinotic process. The neovessels are accompanied by small glutamate positive neural structures. This finding suggests that angiogenesis plays an important role in the pain experienced during the degenerative tendon disease. On the other hand, there is some evidence that HIF-1/VEGF induced angiogenesis has an effect on the material properties of the tendinotic tendon tissue. Since VEGF has the potential to stimulate the expression of matrix metalloproteinases and inhibits the expression of tissue inhibitors of matrix metalloproteinases (TIMP) in various cell types this cytokine might play a significant role in the pathogenetic processes during degenerative tendon disease. These experimental findings are in accordance with clinical results which show that eccentric training leads to a regression of neovessels and decrease of pain. Another strategy is the local administration of a sclerosing agent (Polidocanol) to destroy neovessles. Preliminary results show that both strategies are effective in reducing vascular density and pain.