[Bilateral multifocal pigment epithelial detachments associated with inhaled corticosteroids]. / Bilaterale multifokale Pigmentepithelabhebungen in Assoziation mit inhalativen Kortikosteroiden.

A 37-year-old male patient presented with metamorphopsia and unilateral visual impairment with the presence of hundreds of bilateral avascular retinal pigment epithelial detachments (PEDs). The patient suffered from allergic bronchial asthma which was treated with inhaled corticosteroids. Cessation of corticosteroid treatment resulted in flattening of larger PEDs and subsequent transition to atrophic areas over time while smaller PEDs persisted and spread peripherally over an observation period of 14½ years.

[Opacification of a hydrophilic acrylic intraocular lens after DMEK : A material analysis]. / Eintrübung einer hydrophilen Acryl-Intraokularlinse nach DMEK : Eine Materialanalyse.

OBJECTIVE: Calcification of a hydrophilic intraocular lens (IOL) is a rare complication. We report on the analysis of an opacified IOL, which was explanted 2 years after Descemet membrane endothelial keratoplasty (DMEK), using light and scanning electron microscopy, X­ray spectroscopy and investigations on the optical bench. METHODS: In October 2012 a patient with pseudophakic keratopathy and Fuchs endothelial dystrophy underwent DMEK with double rebubbling. Due to primary graft failure the patient underwent penetrating keratoplasty in January 2013. The initial postoperative visual acuity was 0.2. Increasing opacification of the IOL lowered visual acuity down to hand movement, so that in November 2014 the patient underwent IOL replacement. The explanted IOL was first natively examined with an Olympus BX50 light microscope. In addition, image quality was determined on the optical bench. Subsequently, the explanted IOL was divided into two and one half was stained with Alizarin red and von Kossa and examined by light microscopy and the other half was analyzed by scanning electron microscopy. The composition of the deposits was examined by X­ray spectroscopy. RESULTS: The macroscopic view showed opacification of the IOL only in the central area of the lens where contact between the IOL and the gas bubble had taken place. Light and scanning electron microscopy revealed numerous fine granular, crystal-like deposits under the anterior IOL surface, which were linearly arranged parallel to the surface. Using energy dispersive X­ray spectroscopy the deposits were shown to be composed of calcium phosphate. No deposits were detected on the posterior surface. CONCLUSION: The cause of the opacification of hydrophilic IOL is not clearly understood; however, the injection of gas/air into the anterior chamber during DMEK appears to increase the risk of IOL opacification by changing the lens surface or by alterations to the blood-aqueous humor barrier. Granular deposits under the anterior IOL surface can cause such a strong decrease in visual acuity that IOL exchange becomes neccessary.

[BOON (Bonn ophthalmology online network). Concept of an integrative databank for monitoring patients under intravitreal therapy]. / BOON (Bonn Ophthalmology Online Network). Konzept einer integrativen Datenbank zum Monitoring von Patienten unter intravitrealer Therapie.

BACKGROUND: Previous studies have proven that long-lasting success in the therapy of neovascular age-related macular degeneration (AMD) and other neovascular retinal diseases depends on monthly follow-up examinations to assess visual acuity and retinal morphology. MATERIALS AND METHODS: The interactive database Bonn ophthalmology online network (BOON) offers a platform for patient monitoring, increasing control reliability and providing a tool for permanent communication between treating centers and referring ophthalmologists. The BOON data-based project started in 2009 at the department of ophthalmology at Bonn University and ten referring ophthalmology practices. It was programmed to communicate diagnostic findings, images and patient appointments online. In order to react promptly the system gave immediate notice if patients had missed a follow-up appointment or the condition had worsened. Patients were recruited in 2009 and 2010 and were followed for 1 year. Each patient had an electronic master file with several registers in which, besides personal data, precise diagnostic findings, imaging and reports were quickly and easily entered by means of detailed check box and drop-down menus. Each follow-up was registered and an alert email was sent to the referring physician in cases of missed appointments or disease progression. RESULTS AND CONCLUSIONS: The BOON database supports the requirements for a fast and detailed communication between treating and referring physicians in the treatment of patients with AMD as well as other retinal diseases. It was programmed to support data exchange and monthly control visits and thus a better patient management. Results will show whether this helps to enhance long-term treatment success in neovascular diseases.