[Effect of low-dose PDT on perfusion of the choriocapillaris in cCSCR : An OCT-angiography-based study]. / Effekt der "low-dose PDT" auf die choriokapilläre Perfusion bei cCRCS : Eine OCT-Angiographie-gestützte Studie.

BACKGROUND: In patients with chronic central serous chorioretinopathy (cCSCR) it is assumed that low-dose photodynamic therapy (PDT) induces short-term hypoperfusion of the choriocapillaris, which leads to long-term choroidal vascular remodeling and subsequent reduction of vascular hyperpermeability and leakage; however, it remains unclear whether the hypoperfusion completely returns to normal. The main aim of the retrospective study was to analyze the choroidal flow signal after treatment with low-dose PDT by optical coherence tomography-angiography (OCT­A). PATIENTS AND METHODS: In this study 16 eyes with a total of 19 treated areas were included. Aside from visual acuity and metamorphopsia checks, all patients underwent enhanced depth imaging-OCT (EDI-OCT) and OCT­A in the areas treated with low-dose PDT. In the present study, the flow signal in the choriocapillaris and choroidal thickness were measured retrospectively both in the PDT-treated area and in a non-treated reference area located in close proximity with similar eccentricity to the center of the fovea. RESULTS: The study found a mean reduction of 33% (p < 0.001) of the choroidal flow signal in the treated area compared to the reference area and an average decrease in choroidal thickness of 71 µm (p = 0.001). In the long term 7 out of 10 patients suffered from metamorphopsia despite the low-dose PDT; however, visual acuity was improved in almost half of the patients by the treatment. CONCLUSION: Using OCT­A it could be shown that at the choriocapillaris level, hypoperfusion persists in spite of low-dose PDT. Thus, the choroidal vascular remodeling is not able to completely compensate for the hypoperfusion induced by thrombosis.

[Large macular hole-Always a poor prognosis?] / Großes Makulaforamen ­ immer eine schlechte Prognose?

BACKGROUND: Age, preoperative visual acuity and macular hole size have been reported to be prognostic markers for the postoperative outcome in patients with full thickness macular holes (FTMH). OBJECTIVE: A retrospective observational clinical study was performed in order to compare the postoperative course after conventional internal limiting membrane peeling (c-ILM) and inverted flap ILM peeling (i-ILM). Patients with i­ILM peeling had preoperatively a significantly larger macular hole MATERIAL AND METHODS: In this study 45 consecutive patients with a full thickness macular hole (FTMH) were divided into two groups (c-ILM vs. i ILM) and evaluated with respect to the postoperative best corrected visual acuity (BCVA) and retinal morphology. Using spectral domain optical coherence tomography (SD-OCT) the integrity of the outer retinal layers, external limiting membrane (ELM), ellipsoid zone (EZ) and outer photoreceptor outer segments (OS) were analyzed postoperatively for at least 6 months. RESULTS: The preoperative aperture in the i­ILM group was significantly larger (i-ILM = 408.4 µm, SD = 157.5 µm; c­ILM = 287.4 µm, SD = 104.9 µm; p = 0.01). The preoperative BCVA and postoperative BCVA after 1 month were significantly better in the group with c­ILM peeling (p = 0.03 and p = 0.001). The postoperative BCVA after at least 6 months showed no significant difference between the two groups (p = 0.24). The ELM was the first of the outer retinal layers to show postoperative recovery in both groups. CONCLUSION: Using the i­ILM peeling technique in this consecutive series it seemed to be possible to achieve a similar postoperative visual outcome in patients with a large FTMH as for patients with a smaller FTMH operated on with the c­ILM peeling technique.

[Microstructural retinal changes after pharmacological vitreolysis with ocriplasmin-an SD-OCT supported analysis]. / Mikrostrukturelle retinale Veränderungen nach pharmakologischer Vitreolyse mit Ocriplasmin ­ eine SD-OCT-gestützte Analyse.

PURPOSE: Ocriplasmin (Jetrea®) is a therapeutic option for patients with focal vitreomacular traction (VMT) with or without small full thickness macular holes (FTMH) < 400 µm. Retinal alterations after injection with ocriplasmin have been described. The purpose of this essay was to determine Ocriplasmin-associated side-effects and changes in the retinal microstructure. METHODS: We included 70 patients with ocriplasmin treatment in our study. On all patients SD-OCT (spectral-domain optical coherence tomography) scans were performed prior to injection with Ocriplasmin. If present, adverse events were registered. The OCT scans were then evaluated taking the following into account: macular hole (MH) size, macular edema, subretinal fluid (SRF), changes in the ellipsoid zone (EZ) and the external limiting membrane (ELM). RESULTS: Twenty of the 70 examined patients showed a preoperative FTMH. One week after ocriplasmin IVI (intravitreal injection) 8 of the 20 FTMHs were already closed. Overall 12 patients showed a FTMH closure and 4 patients developed a FTMH after ocriplasmin IVI. Twelve of the 24 MH (macular hole) patients still required an operative closure of the FTMH. We noticed a resolution of the VMT on 51 patients. Three patients developed a retinal detachment. Furthermore, after ocriplasmin IVI we detected changes in the EZ and ELM on 8 patients. CONCLUSIONS: Ocriplasmin is a substantial minimal invasive option in the therapy of VMT with or without small FTMH. Nevertheless, there seem to be some specific ocriplasmin-associated risks, although usually transient. Severe complications like retinal detachment are rare but exist. Therefore, every indication of ocriplasmin should be considered carefully.

[Real-time optical coherence tomography-assisted high-precision vitreoretinal surgery in the clinical routine]. / Echtzeit-optische Kohärenztomographie-assistierte Hochpräzisionsvitreoretinalchirurgie in der klinischen Routine.

The complete integration of spectral domain optical coherence tomography (SD-OCT) into an operating microscope now enables targeted, high-resolution imaging-guided vitreoretinal surgery. This provides real-time visualization of retinal layers, vitreous body and instrument-tissue interactions, which can be used for intraoperative decision making. Compared to conventional surgical microscopes, intraoperative OCT enables a greatly enhanced precision of vitreoretinal surgical maneuvers and is an essential prerequisite for the implementation of real-time guided surgical techniques at the micrometer level.

[Diagnostic criteria: OCT angiography for retinal angiomatous proliferation (RAP lesions, type 3 neovascularization)]. / Diagnostische Kriterien: OCT­Angiographie bei retinalen angiomatösen Proliferationen (RAP­Läsionen, Typ­3-Neovaskularisationen).

BACKGROUND: Multimodal imaging of retinal angiomatous proliferation (RAP) lesions (type 3 neovascularization) and the diagnostic significance of optical coherence tomography angiography (OCT-A). MATERIAL AND METHODS: Confirmation of the diagnosis in six case reports with fundus photography, optical coherence tomography (OCT), fluorescein angiography (FLA), indocyanine green angiography (ICGA) and optical coherence tomography angiography (OCT­A). RESULTS AND CONCLUSION: The use of OCT­A is helpful for the diagnosis and follow-up examinations of RAP lesions (type 3 neovascularization). It enables the detailed visualization of intraretinal and choroidal microcirculation. Furthermore, it is possible to evaluate the progression, classify the stages and comprehend the treatment strategy.

[Intraoperative optical coherence tomography in explorative vitrectomy in patients with vitreous haemorrhage-a case series]. / Intraoperative optische Kohärenztomographie bei explorativer Vitrektomie an Patienten mit Glaskörperblutung ­ eine Fallserie.

BACKGROUND: High-resolution spectral domain optical coherence tomography (SD-OCT) is a gold standard technique for diagnosis, management and monitoring of patients with vitreoretinal diseases. Preoperative diagnostics for evaluation of intraocular and retinal status in patients with vitreous haemorrhage are limited, thus final therapeutic decisions can only be made during explorative vitrectomy. We evaluated the use of intraoperative SD-OCT (iSD-OCT) as a real-time additional diagnostic tool during explorative vitrectomy in patients with vitreous haemorrhage. METHODS: We report on 9 patients (11 eyes) with vitreous haemorrhage. Preoperative ultrasound was performed to evaluate intraocular status. Subsequently, an explorative 23G pars plana vitrectomy was performed under visualisation with the OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) equipped with a fully integrated iSD-OCT device (Rescan 700, Carl Zeiss Meditec, Jena, Germany) as a real-time diagnostic tool. RESULTS: In all patients, intraoperative iSD-OCT allowed real-time evaluation of the preretinal, intraretinal and subretinal structures in addition to the intraoperative en face image. The further surgical strategy, i. e. necessity for peeling of epiretinal membranes (ERM) or of the inner limiting membrane (ILM), application of intravitreal medication and selection of the appropriate tamponade, was based on and optimised according to the iSD-OCT images. CONCLUSION: Intraoperative iSD-OCT is highly useful as an additional intraoperative diagnostic tool in patients with vitreous haemorrhage. In addition to the en face microscope image, it facilitates intraoperative real-time diagnosis and aids therapeutic decision-making during surgery.

[Vitrectomy and iOCT-assisted inverted ILM flap technique in patients with full thickness macular holes]. / Vitrektomie mit iOCT-assistierter invertierter ILM-Flap-Technik bei großen Makulaforamina.

BACKGROUND: In large full thickness macular holes (FTMH) the closure rate after vitrectomy and conventional internal limiting membrane (ILM) peeling is less than 90%. The aim of this study was to examine the visual acuity and anatomical success rate with high-resolution optical coherence tomography (OCT) after transconjunctival sutureless 23-gauge pars plana vitrectomy as well as intraoperative OCT (iOCT) and Brilliant Peel (BP)-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMHs. METHOD: In this retrospective study 25 eyes of 25 consecutive patients with large FTMH were treated by 23-G vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique followed by gas tamponade. In all patients best corrected visual acuity (BCVA) and the maximum diameter, base and height of the FTMH as well as intraretinal alterations were measured preoperatively using high-resolution spectral domain OCT (SD-OCT, Spectralis, Heidelberg Engineering, Germany). The BCVA was measured after 1, 3, and 6 months. Additionally, the closure rate and the microstructural integrity of the outer retinal layers, e.g. external limiting membrane (ELM), ellipsoid zone und photoreceptor outer segment (OS) were registered in the SD-OCT and correlated with the results of BCVA after macular hole surgery. RESULTS: In all surgical procedures with the inverted ILM flap technique the application of iOCT enabled a good visualization and a controlled positioning of the ILM flaps. At baseline mean BCVA was 0.2 (0.7 logMAR) and improved significantly after 1, 3 und 6 months to 0.4 (0.4 logMAR), 0.5 (0.3 logMAR) and 0.63 (0.2 logMAR), respectively. The closure rate of the FTMHs was 100%. Microstructural integrity of the outer retinal layers was evaluated semiquantitatively and showed good correlation with BCVA. CONCLUSION: Vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMH is a very controlled and safe microsurgical strategy and shows good functional and anatomical results. The morphology of the FTMH, the ILM flap and the position of the inverted ILM flap under air was well visualized by IOCT. The microstructural integrity of the outer retinal layers is displayed in detail on SD-OCT and represents an important predictive parameter for BCVA after macular hole surgery.

[Optical coherence tomography in eyes with senile retinoschisis : SD-OCT versus ultrasound examinations and assessment of the vitreoretinal interface]. / Optische Kohärenztomographie bei seniler Retinoschisis : SD-OCT versus Ultraschalluntersuchung und Analyse des vitreoretinalen Übergangs.

BACKGROUND: In addition to ocular ultrasonography (US), spectral domain optical coherence tomography (SD-OCT) is available in order to diagnose senile retinoschisis (sRS). SD-OCT also allows for classification of posterior vitreous detachment (PVD) in healthy eyes. OBJECTIVES: Reevaluation of the value and additional benefit of both imaging procedures. SD-OCT-based evaluation of PVD stages in sRS patients. MATERIALS AND METHODS: Diagnostic results of 33 eyes in 26 patients with clinical suspicion of sRS were retrospectively analysed. All patients received a SD-OCT and a 10 MHz US examination of the region of interest (RoI). In 32 eyes the PVD stage was classified by SD-OCT using the description by Uchino et al. The vitreous position in peripheral SD-OCT scans with sRS was reviewed. RESULTS: SD-OCT confirmed sRS in 29 eyes. US examination identified sRS in 26 eyes. In 11 eyes, the examination results of the two methods differed. In 7 eyes sRS was identified by SD-OCT but not by US examination. US examination confirmed sRS in 4 eyes for which SD-OCT scans were not useful. Most cases of sRS were detected in temporal located retinal lesions. There was no significant difference between the results of both imaging procedures regarding the RoI (p = 0.64). SD-OCT provided additional information in 27 eyes. Four eyes did not present PVD. Early and intermediate stages of PVD were detected in 9 eyes, while 19 eyes showed complete PVD. In most cases, the vitreous could not be identified in the SD-OCT scans of the periphery. CONCLUSIONS: In clinical practice, neither SD-OCT nor US ensure an explicit finding of sRS in each eye with sRS. However, both methods positively complement one another and together they improve image-based diagnosis. All stages of PVD may be found in eyes with sRS. The contribution of the vitreous to the pathogenesis of sRS remains uncertain.

[Fluorescein, indocyanine green and optical coherence tomography angiography in patients with native exudative age-related macular degeneration]. / Fluoreszein­, Indocyaningrün- und optische Kohärenztomographie-Angiographie bei Patienten mit nativer exsudativer altersabhängiger Makuladegeneration.

INTRODUCTION: The newly developed optical coherence tomography angiography (OCT-A) has provided new means to depict the vascular plexus in neovascular age-related macular degeneration (nAMD). If these images are to be used as a basis for therapeutic decisions, it is of vital importance to classify choroidal neovascularization (CNV) as either classical or occult. This study aimed at comparing the findings in OCT-A imaging of CNV with the traditional multimodal imaging through fluorescein angiography (FLA) and indocyanine green angiography (ICGA). METHODS: For this investigation 13 eyes from 13 patients with CNV on the basis of untreated nAMD were studied using FLA, ICGA, spectral domain OCT and OCT-A. All CNV were classified on the basis of SD-OCT and OCT-A images by two independent raters. Thereafter FLA and ICGA images were analyzed to set the gold standard for the classification and the ratings were compared to the previous SD-OCT and OCT-A results. RESULTS: 88% of eyes were correctly classified as either classical or occult CNV on the basis of SD-OCT and OCT-A images. Based on the CNV subgroups, 93% of classical CNV were identified using OCT-A images. In contrast occult CNV was correctly classified in 83% of patients. The interrater agreement was 77%. In general it was noted that the more the retina was pathologically altered, e. g. by edema or vascular pigment epithelium detachment, the harder it became to correctly classify the CNV. DISCUSSION: These results show that OCT-A can be used as an interesting addition in the diagnosis of CNV in nAMD. All CNV could be visualized using OCT-A and especially classical CNV could be clearly recognized in most cases. In contrast occult CNV could be identified in slightly fewer cases.

[Morphology of the vitreoretinal interface in fellow eyes of patients with full thickness macular holes]. / Morphologie des vitreoretinalen Übergangs am Partnerauge bei Patienten mit durchgreifendem Makulaforamen.

PURPOSE: We performed a retrospective, observational clinical study to evaluate the vitreoretinal interface (VRI) in fellow eyes of patients with full thickness macular holes (FTMH) based on spectral domain optical coherence tomography (SD-OCT) examinations. METHODS: The VRI in fellow eyes of 38 patients with idiopathic FTMH, 6 of which had concomitant vitreomacular traction (VMT) and the VRI of 32 patients with FTMH with complete resolution of VMT were examined by SD-OCT for the presence of vitreomacular adhesion (VMA), VMT and the formation of FTMH, lamellar macular holes (LMH), macular pseudoholes (MPH) or epiretinal membranes (ERM). Patients underwent complete ophthalmic evaluation, including SD-OCT at baseline and follow-up visits. To classify the morphology of the VRI, we used the international vitreomacular traction study classification system by Duker et al. (Ophthalmology 2013), evaluating the baseline SD-OCT data for significant classification parameters, including size of VMA, macular thickness and volume and structural changes of retinal layers. RESULTS: Of the 38 eyes with FTMH, 2 (5.3%) fellow eyes also showed evidence of FTMH, 5 (13.2%) had isolated VMT while 5 (13.2%) showed formation of ERM, of which 2 demonstrated MPH. In 5 patients (13.2%) showing evidence of VMA and 17 patients (44.7%) with an unremarkable VRI, 22 fellow eyes (57.9%) showed no pathological morphology. Altogether, 16 fellow eyes (42.1%) of patients with FTMH showed pathological changes of the vitreoretinal interface. CONCLUSION: This high-resolution SD-OCT-based retrospective study showed that fellow eyes of patients with VMT or FTMH were at increased risk of demonstrating pathological changes in the morphology of the VRI.

[Maculopathy with optic nerve pits : Morphological criteria in SD-OCT]. / Makulopathie bei Grubenpapille : Morphologische Kriterien im SD-OCT.

PURPOSE: Optic pit is a congenital anomaly with malformation similar to coloboma of the optic disc. The cause of optic pit maculopathy is controversial. We used high resolution OCT to investigate changes in the vitreoretinal and vitreopapillary transition within optic pit eyes. METHODS: The vitreoretinal and vitreo-papillary transition of 12 eyes was accurately analyzed using SD-OCT. We registered the following criteria: liquefaction of prepapillary vitreous, papillary vitreous traction, discontinuity within the hyaloid cortex and communication spaces between pit and retinal edema. RESULTS: Communication gaps between pit and retinal edema were identified in 8 eyes. 4 eyes had a papillary vitreous traction. 4 showed a discontinuity in the hyaloid cortex. 2 of the 12 patients showed no maculopathy in SD-OCT. Those patients had an adjacent papillary vitreous without prepapillary liquefaction. However all eyes showed vitreous liquefaction at some stage premacullary or prepapillary. CONCLUSION: Yet the cause of optic pit maculopathy is not clearly understood. High resolution OCT imaging provides a very detailed assessment of the vitreoretinal transition prepapillary and premacullary, however with limited penetration depth and analyzation of deeper lying structures. Our observations suggest that prepapillary liquefaction and pressure gradients within cerebrospinal and intraokular pressure could be key factors.

[Von Hippel-Lindau disease : OCTA findings in retinal hemangioma]. / Von Hippel-Lindau-Syndrom : OCT-A Befund bei retinalen Hämangiomen.

The case report of a 35-year-old woman suffering from Hippel-Lindau syndrome (VHL) with retinal hemangiomas is presented. The patient developed macular edema with loss of vision and metamorphopsia. Laser treatment of hemangiomas improved the clinical picture. Hemangiomas were visualized using fluorescein angiography and optical coherence angiography. To our knowledge we describe retinal hemangiomas in VHL disease with the optical coherence tomographical angiography (OCTA) for the first time. CONCLUSION: OCTA is suitable as a new non-invasive method to visualize retinal hemangioma without intravenous contrast agent.

[Vitreous metastasis of malignant cutaneous melanoma during treatment with ipilimumab]. / Glaskörpermetastase eines malignen Melanoms der Haut unter Ipilimumab.

An isolated metastasis of the vitreous body from a malignant cutaneous melanoma without involvement of the choroid is an extremely rare occurrence. We report on the case of a 59-year-old female patient who presented with a vitreous body metastasis during systemic treatment with the anti-cytotoxic T lymphocyte-associated antigen (anti-CTLA 4) antibody ipilimumab. This case report underlines the diagnostic difficulties in such cases and points out the risk of metastasis in immune-privileged sites under systemic immunotherapy.

[OCT angiography findings in acute posterior multifocal placoid pigment epitheliopathy (APMPPE)]. / OCT-Angiographie-Befund bei akuter posteriorer multifokaler plakoider Pigment epitheliopathie (APMPPE).

This article reports the case of a 32-year-old female patient who presented with severe spasmodically occurring retrobulbar pain, headaches and light sensitivity. The neurological examination confirmed cephalalgia but no evidence of other neurological symptoms was found. Ophthalmoscopy revealed yellowish patchy lightened spots in the middle periphery. Fluorescein angiography (FLA) and indocyanine green angiography (ICGA) revealed findings typical for acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Hypofluorescent areas visible using ICGA in the early and late phases showed corresponding hypoperfused areas by optical coherence tomography angiography (OCT-A). To the best of our knowledge this is the first description of these findings in OCT-A.

[Pharmaological vitreolysis with ocriplasmin as a treatment option for symptomatic focal vitreomacular traction with or without macular holes (≤400 µm) compared to tranconjunctival vitrectomy]. / Pharmakologische Vitreolyse mit Ocriplasmin als Behandlungsoption bei symptomatischer fokaler vitreomakulärer Traktion mit oder ohne Makulaforamen (≤400 µm) im Vergleich zur transkonjunktivalen Vitrektomie.

BACKGROUND: To evaluate the resolution rate in patients with symptomatic vitreomacular traction (VMT) ≤ 1500 µm with or without macular holes ≤ 400 µm after therapy with intravitreal ocriplasmin (Jetrea®) injections in a clinical setting in comparison to transconjunctival vitrectomy. MATERIALS AND METHODS: We examined 21 eyes of 21 consecutive patients with vitreomacular traction with or without macular holes who underwent intravitreal injection of 0.1 ml ocriplasmin and we retrospectively reviewed 18 eyes of 18 patients with VMT with or without FTMH who underwent 23-gauge vitrectomy. RESULTS: Vitreomacular traction resolved in 15 of 21 eyes treated with ocriplasmin after 6 month (71 %) compared to 100 % of eyes treated by vitrectomy. Of the 5 eyes that initially presented FTMH with VMT in the ocriplasmin group, 2 were closed 1 month after ocriplasmin treatment. The remaining 3 had vitrectomy and closed thereafter. Best corrected visual acuity was 0.38 ± 0.23 LogMAR at baseline, improving to 0.34 ± 0.24 LogMAR at 6 months after ocriplasmin treatment. Best corrected visual acuity in the vitrectomy group improved from 0.55 ± 0.29 LogMAR before operation to 0.53 ± 0.51 LogMAR 6 months postoperatively. Foveal thickness was 355.95 ± 114.53 µm at baseline, reducing to 277.77 ± 40.26 µm at 6 months after ocriplasmin treatment. Foveal thickness of eyes that underwent vitrectomy was 494.61 ± 126.02 µm at baseline, decreasing to 330.2 ± 88.85 µm 6 months postoperatively. CONCLUSION: When traction is ≤ 1500 µm, enzymatic vitreolysis with ocriplasmin is a therapeutic option. In the presence of VMT >1500 µm or ERM, surgical treatment with vitrectomy is associated with better outcomes. In small macular holes with VMT and in the absence of ERM, enzymatic vitreolysis with ocriplasmin is an option. In cases of holes >400 µm, or in the absence of evident VMT, or in the presence of ERM, vitrectomy is the first choice.

[Functional and Morphological Microstructural Changes in SD-OCT in Long-Term Treatment for Neovascular AMD with Ranibizumab - Monotherapy Versus Combination Therapy with PDT]. / Funktionelle und morphologische mikrostrukturelle Veränderungen in der SD-OCT bei der Langzeitbehandlung der neovaskulären AMD mit Ranibizumab-Monotherapie versus Kombinationstherapie mit PDT.

Background: Intravitreal anti-VEGF therapy is the gold standard in the treatment of neovascular age-related macular degeneration (nAMD). In recent literature, the benefit of additional photodynamic therapy (PDT) has been debated. The aim of our study was to compare the functional and structural effects of long-term combination therapy with PDT plus ranibizumab with monotherapy with ranibizumab. Material and Methods: In a retrospective study, patients suffering from nAMD were followed up for at least 42 months. Patients were assigned to group A (monotherapy with ranibizumab according to pro re nata [PRN]) or group B (combination therapy with one-time PDT plus ranibizumab according to PRN). The best-corrected visual acuity (BVCA) was evaluated at the starting and end points, together with central retinal thickness (CRT), maximal retinal thickness (MRT) and the maximal diameter of the base of the subretinal plaque in spectral-domain optical coherence tomography (SD-OCT), at the first measurement and at the end point. Results: Group A consisted of 21 eyes (17 patients) and group B consisted of 12 eyes (11 patients). The average follow-up from starting to end point was 64 months and 47 months, from the first measurement of SD-OCT to the end point. Within this period, patients in group A received 19 ± 14 intravitreal injections, and patients in group B received 22 ± 10 intravitreal injections. BCVA at the starting point was 0.31 ± 0.26 in group A and 0.31 ± 0.17 in group B. At the end point, BCVA in group A was 0.29 ± 0.25 (p = 0.405), and in group B 0.25 ± 0.20 (p = 0.142). CRT decreased in group A by 72 ± 178 µm (p = 0.024) and group B by 28 ± 98 (p = 0.1335). MRT decreased in group A by 25 ± 135 µm (p = 0.166) and in group B by 2 ± 118 µm (p = 0.421). The base of the subretinal plaque increased in group A by 32 ± 1468 µm (p = 0.242) and in group B by 748 ± 1024 (p = 0.025). Conclusion: In a long-term follow-up of 5.3 years, patients with nAMD in both groups exhibited good stabilisation of visual acuity. In both groups, retinal thickness decreased and the base of the subretinal plaque increased. With respect to SD-OCT morphological criteria, patients in group A (monotherapy) responded slightly better to therapy than patients in group B (combination group).

[Comparison of Functional and Morphological Outcome after Aflibercept or Ranibizumab in Chronic Recurrent Neovascular Age-Related Macular Degeneration]. / Aflibercept vs. Ranibizumab ­ funktionelle und morphologische Ergebnisse bei mit Ranibizumab vorbehandelter, chronisch-rezidivierender neovaskulärer altersabhängiger Makuladegeneration.

Background: To assess functional and morphological outcomes in patients with chronic recurrent neovascular age-related macular degeneration (nAMD) previously treated with ranibizumab, who were either switched from ranibizumab to aflibercept or received further ranibizumab injections. Methods: Retrospective analysis of eyes with recurrent nAMD previously treated with ranibizumab. On recurrence of the macular oedema, patients had received either 3 injections of aflibercept (2.0 mg) or ranibizumab (0.5 mg) at 4 week intervals. Patients were examined before the first injection and four weeks after the last injection. The main outcome measures included change in visual acuity (VA) in logMAR, subfoveal central retinal thickness (CRT), subretinal fluid (SRF) and height of pigment epithelial detachment (PED height), as well as the maximum height of macular subretinal fluid (SRF max) and of macular pigment epithelial detachment (PED height max) in spectral-domain optical coherence tomography (OCT). Changes in VA and OCT were compared between the two groups to investigate differences in the therapeutic effects of aflibercept and ranibizumab. Results: 60 eyes of 55 patients were included. The aflibercept group (n = 30) and the ranibizumab group (n = 30) showed no statistically significant differences in mean age (p = 0.813), number of prior injections of ranibizumab (p = 0.127) or time since last injection (p = 0.523). Mean VA logMAR improved in both groups, though only in the ranibizumab group was the difference significant (0.50 ± 0.33 to 0.44 ± 0.29 logMAR; p = 0.013; Table 1). CRT decreased in the aflibercept (p = 0.133) and ranibizumab groups (p = 0.043). PED height was reduced in both groups (aflibercept p = 0.068; ranibizumab p = 0.241). SRF, SRF max and PED height max showed statistically significant decreases in both groups. Comparison of the aflibercept and the ranibizumab groups showed no statistically significant differences between the two groups in change in VA logMAR (p = 0.680), CRT (p = 0.882), SRF (p = 0.871), PED height (p = 0.524), SRF max (p = 0.940) or PED height max (p = 0.762). Conclusions: Aflibercept and ranibizumab were similarly effective in improving visual acuity and morphological parameters of patients with recurrent nAMD after four months. There were no statistically significant differences in the therapeutic effects of the two drugs.

[Localization of scotomas in AMD by reading test : Random series of words in standardized format]. / Lokalisation von Skotomen mittels Lesetest bei AMD : Willkürliche Wortserien in standardisiertem Format.

BACKGROUND: Reading performance that can be measured by reading tests depends on whether reading material with or without contextual continuity is used. OBJECTIVE: The goal of this study was to create a German version of the SKread test and to evaluate it in a clinical setting. MATERIAL AND METHODS: The evaluation of the SKread test was first performed on two groups of visually healthy subjects of different ages: a junior group of 25 persons with ages between 20 and 30 years (mean = 25.84 years, SD ± 2.41 years) and a senior group of 25 persons with ages between 51 and 84 years (mean = 62.40 ± 8.46 years). The same measurements were also performed on a group of 18 patients with age-related macular degeneration (AMD) with ages between 75 and 95 years (mean = 81.89 ± 5.48 years). The reading performance was also measured using Radner charts. RESULTS: Using reading material without syntactic continuity considerably slowed down the reading speed and increased the error rate. Median reading rates of 11.53 characters/s (CPS) for the junior group and 8.96 CPS for the senior group were clearly lower than those for the Radner charts (22.02 CPS and 18.48 CPS, respectively). In the AMD patients, a statistical analysis of the error rates showed a highly significant difference between the Radner charts and the SKread test (p = 0.00014). Furthermore, by analyzing the errors made in the SKread test information could be obtained about the position of central scotomas. The test-retest reliability of the SKread was very good. CONCLUSION: Information about the position of a central scotoma can be acquired by using the SKread test and an analysis of reading errors, which can augment effective clinical monitoring in AMD and subsequent visual rehabilitation.

[Therapeutic Options in Vitreomacular Traction With or Without a Macular Hole]. / Therapie der vitreomakulären Traktion mit und ohne Makulaforamen.

Treatment is usually indicated for symptomatic vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) and without spontaneous resolution. Ultrastructural parameters are evaluated by SD-OCT, in order to classify the vitreoretinal interface and to estimate the success rate of treatment. The resolution rate after therapy with intravitreal Jetrea® (Ocriplasmin) is high (up to 70 %) in patients with symptomatic focal vitreomacular traction (≤ 1500 µm) with or without a macular hole (≤ 250 µm) and with no epiretinal membrane (ERM), but depends on the exact baseline analysis. All other patients with idiopathic traction retinopathy should be treated by minimal invasive pars plana vitrectomy (MIVI). Vitreoretinal surgery effectively removes traction and gives a high closure rate of a full thickness macular hole (FTMH, 90 to 100 %). It is now a very safe procedure with few side effects. Despite a low risk profile (cataract, retinal tear etc.) the indication for surgery needs to take the safety profile into account. Therefore vitrectomy is only indicated in symptomatic patients complaining of blurred vision, VA reduction and metamorphopsia. Vitrectomy is also indicated in patients whose treatment by pharmacologic vitreolysis has failed.