[Preservative-free glaucoma treatment : Selection of the correct treatment in 1 min]. / Unkonservierte Glaukomtherapie : Wahl der richtigen Therapie in 1 min.

BACKGROUND: The presence of preservatives in topical glaucoma treatments may impact ocular surface function and structure. For treatment to be effective, side effects need to be minimized, in order to promote compliance and allow continuation of therapy. Therefore, in daily clinical practice, it needs to be decided on an individual basis whether a preservative-free treatment is required. OBJECTIVE: This study aimed to develop a questionnaire which helps to quickly and easily identify patients who require preservative-free treatment. MATERIALS AND METHODS: A questionnaire was prepared to collect relevant clinical findings needed to make a therapeutic decision (preservative-free required? Yes/No). Moreover, a rating scheme was developed to enable efficient final assessment of the collected data. To check their practicability in daily clinical practice, both instruments were tested in 11 ophthalmological centers in Germany. RESULTS: The questionnaire and rating scheme were easy to use, integrated efficiently into everyday routine, and performed in about 1 min. Data of 1150 glaucoma patients were collected and preservative-free eyedrops recommended for 586 (51 %). Parameters most frequently associated with such a recommendation were a reduced tear film break-up time of < 10 s (87.5 %) or marked corneal staining (65.5 %). CONCLUSION: The presented approach helps to decide within 1 min, in daily clinical practice, whether preservative-free glaucoma threatment should be recommended. Individualized therapy decisions can thus be made, allowing goal-oriented use of preservative-free antiglaucomatosa. This might help to promote compliance and lead to reduced progression of glaucoma.

[External trabeculecomy (ETE): an alternative? A retrospective comparison with goniotrepanation]. / Externe Trabekulektomie (ETE): Eine Alternative? Eine retrospektive Studie zur Goniotrepanation.

PURPOSE: The purpose of this retrospective study is to compare the results of deep sclerectomy versus trabeculectomy for IOP reduction and the respective complication rates. METHODS: 199 patients were treated by deep sclerectomy and 80 patients by trabeculectomy between 2000 and 2005. Retrospective results for IOP reduction, visual acuity, success, complication and re-operation rates were evaluated. RESULTS: After deep sclerectomy the IOP dropped from 20.8 mmHg (+/- 6.5) to 23.8 % after 1 year, upon trabeculectomy from 27.7 mmHg (+/- 9.4) to 46.4 %. Visual acuity decreased only slightly. The success rate after a follow-up of 62.3 months (no re-operation or local post-operative treatment) was 36.7 % on treatment by deep sclerectomy compared with 56.3 % by trabeculectomy after a follow-up of 43.6 months. After 15.2 months a mean of 21.6 % of our patients who were treated by deep sclerectomy needed a re-operation, in the trabeculectomy group after 3.9 months this was the case in 17.5 %. One year after treatment by deep sclerectomy 37.2 % and after trabeculectomy 18.8 % of our patients needed glaucoma eye drops for additional local treatment. CONCLUSIONS: Both treatments (deep sclerectomy and trabeculectomy) achieve a target IOP below 18 mmHg after one year. Deep sclerectomy is in special cases an efficient alternative to trabeculectomy with the right indication (for less IOP lowering or high-risk eyes).

[Recurrent corneal erosion. Different treatment options with the excimer laser with emphasis on aggressive PTK]. / Rezidivierende Erosio corneae. Behandlungsstrategien mit dem Excimerlaser unter besonderer Berücksichtigung der aggressiven PTK.

Recurrent corneal erosions in both traumatic and basal membrane dystrophy-associated conditions seem to show a similar pathogenesis for abnormal adhesion between corneal epithelium and stroma. The purpose of each conservative or surgical treatment is fast healing without any infections or recurrences. This paper compares the different excimer laser treatment options with emphasis on the so-called aggressive PTK. A total of 50 eyes of 50 patients with recurrent corneal erosions after mechanical trauma or with epithelial basement membrane dystrophy were treated with aggressive PTK after the second or third recurrence. Aggressive PTK was performed with an ablation of 10-15 microm. After the mean follow-up time of 41.8 months, a recurrence rate of 6% without a change of visual acuity and a hyperopic shift of +0.74 D were observed. The earliest recurrent erosion showed up after 33 and the latest after 65 months. In comparison to other forms of PTK such as transepithelial or conventional subepithelial PTK, aggressive PTK showed the lowest recurrence rate reported for a long-term follow-up.