Risk factors for and management of anterior chamber intravitreal dexamethasone implant migration.

BACKGROUND: This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®). METHODS: A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber dexamethasone implant migrations were identified, as well as the reasons for the anterior chamber migration. The surgical histories were obtained and comprehensive ophthalmic examinations were conducted for all of the eyes. Cross-tabulations, chi-squared tests, and Fisher's exact tests were used to assess the influences of different factors on the anterior chamber implant migrations. RESULTS: Overall, 4 eyes of four patients (0.63%) showed anterior chamber implant migrations. All four of the eyes were pseudophakic, and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008). The vitrectomized pseudophakic eyes, in contrast to the nonvitrectomized pseudophakic eyes, were significantly associated with an increased risk of anterior chamber implant migration (P = 0.009). CONCLUSIONS: The anterior chamber migration of an intravitreal dexamethasone implant is a serious complication. To minimize the risk of permanent corneal edema, immediate removal of the implant with a 20-gauge alligator forceps over a 2.75-mm long clear corneal tunnel is important. Those patients with insufficient zonular support, defects, or missing posterior capsular membranes and vitrectomy histories present a high risk of anterior chamber dexamethasone implant migration.

Transfer characteristics of subretinal visual implants: corneally recorded implant responses.

PURPOSE: The subretinal Alpha IMS visual implant is a CE-approved medical device for restoration of visual functions in blind patients with end-stage outer retina degeneration. We present a method to test the function of the implant objectively in vivo using standard electroretinographic equipment and to assess the devices' parameter range for an optimal perception. METHODS: Subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) consists of 1500 photodiode-amplifier-electrode units and is implanted surgically into the subretinal space in blind retinitis pigmentosa patients. The voltages that regulate the amplifiers' sensitivity (V gl) and gain (V bias), related to the perception of contrast and brightness, respectively, are adjusted manually on a handheld power supply device. Corneally recorded implant responses (CRIR) to full-field illumination with long duration flashes in various implant settings for brightness gain (V bias) and amplifiers' sensitivity (V gl) are measured using electroretinographic setup with a Ganzfeld bowl in a protocol of increasing stimulus luminances up to 1000 cd/m2. RESULTS: CRIRs are a meaningful tool for assessing the transfer characteristic curves of the electronic implant in vivo monitoring the implants' voltage output as a function of log luminance in a sigmoidal shape. Changing the amplifiers' sensitivity (V gl) shifts the curve left or right along the log luminance axis. Adjustment of the gain (V bias) changes the maximal output. Contrast perception is only possible within the luminance range of the increasing slope of the function. CONCLUSIONS: The technical function of subretinal visual implants can be measured objectively using a standard electroretinographic setup. CRIRs help the patient to optimise the perception by adjusting the gain and luminance range of the device and are a useful tool for clinicians to objectively assess the function of subretinal visual implants in vivo.

Factors that influence the suitability of human organ-cultured corneas.

PURPOSE: The purpose was to assess the influence of donor and storage factors on the suitability of organ-cultured corneas for transplantation. METHODS: Data from 1340 donor corneas stored between 2009 and 2015 were analyzed retrospectively. Logistic regression analysis was used to assess the influence of different factors on the suitability of grafts for transplantation. RESULTS: Forty-one percent (553/1340) of corneas were discarded. The leading causes were medical contraindication (20.2 %) and poor endothelial quality (19.3 %). Donor age influenced suitability for transplantation significantly. Corneas from donors aged 80 years and older were more likely to be discarded because of endothelial insufficiency (P < 0.0001). The cause of donor death including infection and multiple organ dsyfunction syndrom (MODS) increased the risk of bacterial or fungal contamination during organ culture (P = 0.007 and P = 0.014, respectively). Prolonged time between death and enucleation was associated with an increased risk of unsuitability for transplantation (P < 0.0001). The amount of time between death and corneoscleral disc excision and duration of storage influenced the suitability for transplantation (P = 0.0007 and P < 0.0001, respectively). CONCLUSION: Donor age, cause of death, storage time, death to enucleation and death to disc excision times influenced transplantation suitability. The percentage of discarded corneas may be reduced by shortening storage time, death to enucleation, and death to corneoscleral disc excision times. Setting a maximum donor age could reduce the percentage of discarded corneas. However, as long as there is a lack of donor corneas, we do not recommend any donor age limit.

Causes that influence the detachment rate after Descemet membrane endothelial keratoplasty.

PURPOSE: To investigate Descemet graft (DG) detachment rate after Descemet membrane endothelial keratoplasty (DMEK) in relation to DG position. METHODS: A total of 175 consecutive pseudophakic eyes that underwent DMEK (175 eyes for Fuchs endothelial dystrophy) from September 2009 through February 2014 at the Tübingen Eye Hospital DG position were studied retrospectively by surgical video at the end of an operation. A group of 45 eyes showed a decentration of the DG with a stromal gap of ≥1.5 mm over at least 3 clock hours between the descematorhexis edge and the DG. DG detachment was documented at a mean follow-up of 13.9 ± 3.7 months after surgery. DG detachment was defined as a detachment of 20 % or more of the DG surface area. Various donor characteristics and patient characteristics were analyzed. RESULTS: The best spectacle-corrected visual acuity (BCVA) in the group of eyes with central well-positioned DG differed significantly from those of eyes with decentered DG. The preoperative BCVA in the central well-positioned DG group was 0.63 ± 0.40 logMAR, and in the decentered DG group 0.91 ± 0.51 logMAR (P < 0.001). The postoperative BCVA in the group of eyes with central well-positioned DG was 0.12 ± 0.11 logMAR, and in the group with decentered DG 0.23 ± 0.29 logMAR (P < 0.001). Endothelial cell density and patient characteristics such as age, gender, and intraocular pressure did not differ significantly between the two groups. The group of eyes with central well-positioned DG showed DG detachment in 12 %; the group with decentered DG findings had DG detachment in 87 % (P < 0.001) at the 12 month follow up. CONCLUSION: The present findings demonstrate the importance of central well-positioned DG and the relation of disease severity. Central well-positioned DG may reduce the incidence of DG detachment. Overlapping of the donor DG and the host Descemet membrane seems to be responsible for DG detachment. One possible way to enhance graft adhesion could be a larger descematorhexis, which avoids an overlapping. The second possible way could be not waiting too long for surgery to reduce disease severity.

The influence of axial length on confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography size measurements: a pilot study.

PURPOSE: To investigate the influence of axial length on SD-OCT and cSLO size measurements from the Heidelberg Spectralis. METHODS: In this pilot study, eight emmetropic pseudophakic eyes with subretinal visual implant were selected. The axial length was measured in three short (<22.5 mm), three medium (22.51-25.50 mm) and two long (>25.52 mm) eyes. The known size of subretinal implant sensor field (2800 × 2800 µm) was measured on 15 images per eye with cSLO and SD-OCT. RESULTS: The mean axial length was 20.8 ± 0.8 mm in short eyes, 23.3 ± 0.4 mm in medium eyes, and 26.3 ± 0.5 mm in long eyes respectively. We found in short eyes, in medium eyes and in long eyes a mean value of sensor field size measurements from cSLO of 3327 ± 9 µm, 2800 ± 9 µm and 2589 ± 12 µm and from SD-OCT of 3328 ± 9 µm, 2800 ± 12 µm and 2585 ± 19 µm respectively. The size measurements decreased in SD-OCT and cSLO measurements with longer axial lengths significantly (p < 0.0001). CONCLUSION: The present findings demonstrate accuracy of the scaling in cSLO and SD-OCT measurements of the Heidelberg Spectralis for emmetropic medium eyes. The size measurements from SD-OCT to those from cSLO were approximately equal. Caution is recommended when comparing the measured values of short and long eyes with the normative database of the instrument. Further studies with larger sample sizes are needed to confirm findings.

[Using intracameral cefuroxime reduces postoperative endophthalmitis rate: 5 years experience at the University Eye Hospital Tübingen]. / Reduktion der postoperativen Endophthalmitisrate durch intrakamerale Cerfuroximgabe: Ergebnisse aus 5 Jahren Erfahrungen an der Universitäts-Augenklinik Tübingen.

BACKGROUND: Cataract surgery is the most commonly performed surgical procedure in developed countries. The annual number of cataract surgeries in Germany is about 600,000. Acute postoperative endophthalmitis is a very severe and the most dreaded complication of cataract surgery. Various operative and non-operative measures have been suggested to prevent this serious complication. The European Society of Cataract & Refractive Surgeons (ESCRS) study of intracameral cefuroxime was the first prospective, randomised and partially placebo-controlled clinical trial showing the efficacy of antibiotic prophylaxis to prevent endophthalmitis in 2007. The aim of this retrospective study is to investigate a possible reduction of intracameral cefuroxime to prevent postoperative endophthalmitis at the University Eye Hospital Tübingen. PATIENTS AND METHODS: During the period from January 2002 to August 2013, 2 time periods were determined based on the adoption of intracameral cefuroxime injections after cataract surgery. From January 2002 to May 2009 patients received at the end of cataract surgery a subconjunctival administration of 50 mg of mezlocillin and postoperative antibiotic eye drops (gentamicin) without intracameral injection. From June 2009 to August 2013, patients received an intracameral injection of cefuroxime while antibiotic drops (moxifloxacin) were used too. The rates of postoperative infectious endophthalmitis during these 2 periods were calculated. RESULTS: 31 cases of endophthalmitis occurred in 31,386 cataract surgeries. The overall cumulative incidence was 0.99 per 1000 patients. The incidence in the first period without intracameral cefuroxime injection was 1.38 (95 % confidence interval [CI]: 1.03-1.72) per 1000 patients and in the second period 0.44 (95 % CI: 0.34-0.54) per 1000 patients (p < 0.001). CONCLUSION: Intracameral injection of cefuroxime reduces the rate of postoperative infectious endophthalmitis in cataract surgery significantly.

[The utilization of ophthalmological emergency departments is on the rise : 14-year results from a German tertiary university outpatient department]. / Die Inanspruchnahme ophthalmologischer Notaufnahmen nimmt zu : 14-Jahres-Ergebnisse aus einer großen deutschen Hochschulambulanz.

BACKGROUND: The increasing congestion in emergency departments of all specialties is one of the most pressing challenges of our time. OBJECTIVE: The aim of this study is to make a well-founded contribution to the development of emergency case numbers in the tertiary sector (specialist clinics) of German ophthalmology. From this, the need to develop new control and triage mechanisms for ophthalmology can be derived. MATERIAL AND METHODS: Retrospectively, > 140,000 emergency treatment cases at the University Eye Hospital Tübingen in the period from 1 January 2010 to 31 December 2023 were analyzed. Sub-analyses were conducted to quantify the impact of the COVID-19 pandemic and differences between weekend and weekday visits. In addition, a questionnaire survey on the referral status of emergency consultations at off-peak times and at weekends was conducted in 2022. RESULTS: The number of emergency consultations more than doubled between 2010 and 2023 and more than tripled at weekends. The peak load, which is relevant for guaranteeing treatment, has increased to the same extent. In the long term, a shift in emergency treatment from core to off-peak times can be observed, particularly at weekends. The majority of consultations (up to 87%) take place without a referral from a doctor. In 2023, the treatment figures returned to the level before the start of the COVID-19 pandemic. DISCUSSION: The emergency outpatient clinic at the University Eye Hospital is increasingly exposed to a double burden: providing treatment for emergency cases with specialist referrals and at the same time acting as a catchment basin for general emergencies. New control and triage mechanisms are urgently needed to ensure good care in the long term.

Characterisation of novel uveal melanoma cell lines under serum-free conditions.

BACKGROUND: The establishment of long-term uveal melanoma (UM) cell lines is difficult. However, studying living cells and their behaviour in the presence of other cells and the extracellular matrix is important in terms of understanding tumour biology and malignant behaviour. We have established three UM cell lines and report a first characterisation of these cell lines. METHODS: Three established UM cell lines (UMT2, UMT26 and UMT33) were analysed according to their morphologic characteristics, melanocytic differentiation, adhesion on different extracellular matrices and proliferative activity. Copy number changes of chromosomes 1, 3, 6 and 8 were studied by multiplex ligation-dependent probe amplification (MLPA). Oncogenic mutations in UM involving exons 4 and 5 of GNAQ and GNA11, respectively, were analysed by sequencing. RESULTS: All cell lines grew in suspension. UMT2 cells were homogeneous, UMT26 and UMT33 cells heterogeneous with regard to cell size and pigmentation. All UM cell lines revealed a melanocytic differentiation. UMT2 and 33 adhered on various extracellular matrices, while UMT26 only adhered to basal membrane extract (BME). This difference corresponded to the different expression of various integrins. Ki67 was expressed by 89% of UMT2 and 95% of UMT33 cells, which thus were in a proliferative stage, while only 2% of UMT26 cells revealed immunostaining for this proliferation marker. The doubling time of UMT2 was 3 days, 12 days for UMT33, and circa 3-4 months for UMT26. MLPA revealed disomy 3 in UMT2 and monosomy 3 in UMT33. The same point mutation was found in UMT2, 26 and 33, in exon 5 of GNA11 at codon 209 (p.Q209L). CONCLUSIONS: The establishment of UM cell lines under serum-free conditions is possible. Characterisation of UMT2, 26, and 33 revealed obvious differences in cytomorphology, melanocytic differentiation, adhesion on extracellular matrices, and proliferative activity. UMT2, 26 and 33 showed the same oncogenic mutation in exon 5 of GNA11.

Dulbecco's Modified Eagle Medium is neuroprotective when compared to standard vitrectomy irrigation solution.

PURPOSE: Several iatrogenic risk factors during pars plana vitrectomy (PPV) could cause damage to the retina. One mechanism is excitotoxicity. Therefore, neuroprotective irrigation solutions would be desirable. METHODS: Retinal ganglion cells (RGC-5) and retinal whole mounts were incubated in standard irrigation solution (SIS) and Dulbecco's Modified Eagle Medium (DMEM). Cell viability, cell amount, cell survival and caspase 3/7 activity were measured by MTS-Test, crystal-violet staining, Annexin-V/PI flow cytometry and caspase 3/7 activity assay, respectively. The morphology and the function of retinal whole mounts were analysed by Live/Dead(TM) staining and by the b-wave and a-wave of the electroretinogram (ERG). RESULTS: Under excitotoxic conditions (10 mM and 12 mM glutamate) RGC-5 cells incubated in SIS showed a statistically significant reduction in cell viability, cell amount, cell survival and caspase 3/7 activity compared to DMEM. Furthermore, the incubation of retinal whole mounts in DMEM resulted in a significant decrease of cell death under excitotoxic (250 µM glutamate) and standard conditions compared to SIS. ERG b-wave recordings revealed good functional preservation of retinal whole mounts in DMEM, but loss in SIS. CONCLUSION: DMEM seems to support retinal cells very well and to be strongly protective against excitotoxicity. Therefore, DMEM may be considered as possible neuroprotective irrigation solution for PPV.

[Primary vitrectomy for rhegmatogenous retinal detachment without use of heavy liquids]. / Primäre Vitrektomie bei rhegmatogener Ablatio ohne Verwendung von schweren Flüssigkeiten.

PURPOSE: The purpose of this study was to analyse the outcome of vitrectomy for rhegmatogenous retinal detachment without intraoperative use of heavy perfluorocarbon liquids (PFCL). MATERIAL AND METHODS: All patients who had undergone vitrectomy with a PFCL-free approach during 4/2001-3/2008 by one single surgeon were recruited retrospectively from the electronic database and their data analysed. RESULTS: A total of 79 patients (42 pseudophakic, 37 phakic) with unilateral surgery were included in the study. The median follow-up was 20.5 months (minimum 3, maximum 133). Median preoperative best-corrected visual acuity was 0.5 logMAR (minimum 0, maximum 2.5) as compared to a postoperative median of 0.45 logMAR (minimum - 0.2, maximum 1.3). The primary anatomic success rate (portion of patients not requiring further retinal surgery, including macular pucker or macular hole surgery) was 70 % for the phakic group, 71 % for the pseudophakic group, and 71 % for all cases. The redetachment rate was 19 % for all cases. The final reattachment rate was 100 %. Complications requiring a repeat surgical intervention occurred in 23 cases, including 7 patients (9 %) with proliferative vitreoretinopathy, and 4 patients (5 %) with macular pucker and macular hole each. CONCLUSION: Even though this surgical procedure avoids possible disadvantages of retained intraocular PFCL and may be more cost-effective, the potential benefits do not outweigh the reduced primary anatomic success rate. The authors therefore recommend this approach in selected cases only.

[Improvement of power and illumination source of the indirect binocular ophthalmoscope designed by Foerster]. / Optimierung von Strom- und Beleuchtungsquelle des indirekten binokularen Brillenophthalmoskops nach Foerster.

BACKGROUND: Since 1982, the indirect binocular ophthalmoscope designed by Foerster has been in use in ophthalmology. The option to implement a new illumination technique using a light-emitting diode (LED) and a new power source should be evaluated in terms of technical feasibility and patient safety. METHODS: The cooling element was redesigned to accommodate the new LED electronics and their components, including an option for a variable brightness control. A more compact rechargeable battery was utilized with variable fixation at the headband or elsewhere. Photometric measurements of light intensity and the operating time were planned. Furthermore, a review of the new lighting technology in terms of EN ISO 15004-2 and EN ISO 10943 was necessary. RESULTS: Technical adjustments to accommodate the LED inside the cooling element could be realised. The power source was a modern rechargeable lithium-ion battery with variable fixation. The luminous intensity of the LED is superior to that of the halogen lamp and the operating time was increased to 520 minutes. The required limits according to DIN EN ISO 15004-2 for ophthalmic devices were met by our measurements. CONCLUSION: The optimisation of the indirect binocular ophthalmoscope brings improvements in illumination intensity and operating time. A conversion for models already in use is possible. A certified appraisal for compliance with the appropriate standards is the next step.

[Development and first results of fast and cost-effective examination methods for an ophthalmological screening within the National Cohort]. / Entwicklung und erste Anwendungserfahrungen einer schnellen und kostengünstigen ophthalmologischen Untersuchung für die Nationale Kohorte.

BACKGROUND: For an implemented ophthalmological screening within a German long-term cohort study (National Cohort) simple and effective methods for an examination of visual acuity and for non-mydriatic retina photografies should be evaluated. Furthermore standard operating-procedures (SOP) should be developed. METHODS: In the years 2011 and 2012 pinhole visual acuity measurements and automated retina photographies (DRS, CenterVue S. p. a., Padua, Italy) were made at three different epidemiological study centers within Germany. Furthermore, anterior segment images were taken by the camera. Standard operating procedures (SOP) regarding the ophthalmological screening were developed and evaluated within the study. The main question was whether it is possible to implement the screening methods within the National Cohort. Further main outcomes were quality and interpretability of the taken images. RESULTS: 457 subjects (914 eyes) were examined within the investigation. Median VA was 0.8 for right and left eyes (p > 0.42). Image quality of the photographies was good in 491 cases (54 %), fair in 239 cases (26 %) and bad in 179 cases (20 %). The usability of the images was without limitations in 686 cases (75 %), limited in 152 cases (17 %) and not given in 71 cases (8 %). Increasing age of the subjects was slightly correlated with decreasing image quality (r = 0.26) and decreasing image usability (r = 0.2). Anterior segment photographies were usable in 176 eyes (56 %). CONCLUSION: The developed screening method fulfilled the specifications of the National Cohort. The used pinhole visual acuity examination was fast and cheap. Image quality and usability of the retina photographies could be improved with prolonged pupil recovery times. The quality of the anterior segment images could not fulfill the expectations and were taken out of the further examinations of the ophthalmological screening. The written SOP showed good acceptance within the investigators' daily routine. The ophthalmological screening within the National Cohort generates information (e. g., pathologies of the vessels or of the retina) which are useful not only from an ophthalmological point of view.

[Chronic central serous chorioretinopathy (cCSC): differential diagnosis to choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD)]. / Chronische RCS (chronic Central Serous Chorioretinopathy cCSC) als Differenzialdiagnose der feuchten, altersbedingten Makuladegeneration (AMD).

Central neurosensory detachments (NSD) with time-dependent height constitute a disease called central serous chorioretinopathy (CSC), if not arising from uveitis, choroidal neovascularisations (CNV) or leaking retinal vessels. In 10 % of these patients, CSC develops into a chronic disease with recurrent NSD, atrophy of photoreceptors and severe drop in visual acuity. This review article summarises recent progress in understanding this disease and its appearance in funduscopy, FLA, ICG, OCT, autofluorescence as well as its progress, therapy and possible development into secondary CNV. The provided examples illustrate the progression of acute CSC into chronic CSC and with CNV over years. The different appearance of polypoidal choroidal vasculopathy (PCV) in ICG and some of the signs of atypical chronic CSC are discussed. To distinguish between cCSC and wet AMD--both exhibiting leakage in FLA--typical signs are helpful, e.g., "gravitational tracks", retinal precipitates and missing drusen. However, in small lesions, it may be difficult or almost impossible to ensure the correct diagnosis of the underlying disease. The same holds for occult and classic secondary CNV in cCSC vs. CNV in AMD, where photodynamic therapy (PDT) can be successful only in cCSC-CNV and in cCSC without CNV. Corticosteroids often lead to further impairment, even in cases of atypical cCSC, when frequently misdiagnosed as uveitis. As a duration of NSD of more than 4 months is suspected to induce an impairment of photoreceptors, regular examinations are necessary not only in chronic CSC but also after acute CSC (as this form can develop into chronic CSC), while effective therapies are available to resolve the NSD (PDT, anti-VEGF).

[Clinical results after Descemet membrane endothelial keratoplasty]. / Klinische Ergebnisse nach Descemet-Membran-Endothelzelltransplantation.

BACKGROUND: Diseases of the endothelial cell layer represent a common indication for perforating keratoplasty. In recent years posterior lamellar keratoplasty techniques have undergone a revival. The latest and most promising advancement is the isolated transplantation of Descemet's membrane (DM) with the endothelial layer - also known as Descemet's membrane endothelial keratoplasty (DMEK). This study was conducted to evaluate the clinical results of our DMEK patients and to assess the perioperative management. PATIENTS AND METHODS: 70 patients (75 eyes) with endothelial cell decompensation (50 eyes with Fuchs endothelial dystrophy and 25 eyes with bullous keratopathy) had undergone DMEK surgery at the Tübingen Eye Clinic. Visual acuity, refractive error, intraocular pressure, slit lamp examination, pachymetry and endothelial cell density were considered and re-examined at intervals of 1, 2 and 4 weeks postoperatively with further 3 monthly follow-ups. RESULTS: The mean age of the 45 female and 25 male patients at time of surgery was 73 years (36 to 91 years). The mean follow-up period was 12.1 months. One patient received an autologous and 4 patients a triple procedure. The mean preoperative LogMAR visual acuity was 0.87 ± 0.41. After 1 week a LogMAR visual acuity of 0.82 ± 0.4 was observed (p = 0.544). At the final examination the LogMAR visual acuity was 0.32 ± 0.35 (p < 0.001, a highly significant result as compared to the preoperative value). The most common and important complication was the dislocation of the transplant which was seen in 23 eyes (31 %). The use of intracameral air pressurisation re-appositioned most transplants. Complications such as highly elevated intraocular pressure, epithelial inclusions or endophthalmitis were not noted in any patient. CONCLUSIONS: DMEK surgery lead to a significant visual rehabilitation in a majority of patients in a relatively short postoperative period. It may be considered as a gold standard to treat isolated endothelial diseases as has been implicated by other studies. Thus, the safety and efficiency of this new type of posterior lamellar keratoplasty technique has been confirmed.

[Precut technique for Descemet's membrane endothelial keratoplasty, preparation and storage in organ culture]. / Precut Verfahren für Descemet-Membran-Endothelzelltransplantation, Präparation und Aufbewahrung in Kultur.

BACKGROUND: The preparation of the Descemet's membrane (DM) with the endothelial cell layer may be performed directly prior to surgery or as a precut tissue procedure. The purpose of the current study was the evaluation of the preparation technique and the tissue culture of 10 days regarding potential endothelial cell loss. MATERIALS AND METHODS: Ten corneoscleral rims with an average age of 64.3 years were dissected to obtain 8.5 mm in diameter endothelial-DM complexes, which subsequently were organ cultured for 10 days. The endothelial cell density (ECD) was assessed during the cell culture period at days 1., 4., 7. and 10. In addition, time of preparation and transplant morphology were evaluated. RESULTS: The DM with the endothelial cell layer could successfully be dissected from all corneoscleral rims. The average preparation time was 8.3 min. The average ECD count was 2183 ± 77 cells/mm2 prior to, 2094 ± 110 cells/ mm2 at day 1, 2078 ± 134 cells/mm2 at day 4, 1977 ± 107 cells/mm2 at day 7 and 1898 ± 170 cells/mm2 at day 10 after preparation, respectively. Endothelial cell loss was 4.1 %, 4.8 %, 9.4 % and 13.1 % after preparation, respectively. None of the transplants exhibited large, centrally-located cell deficits. CONCLUSION: The isolated storage of DM with the endothelial layer, without any stromal remnants, showed gratifying results under storage conditions in organ culture with a moderate ECD decrease. Hence, the implementation of a precut DMEK is conceivable.

[Histological and ultrastructural analysis of the Descemet's membrane after descemetorhexis in DMEK surgery]. / Histologische und ultrastrukturelle Untersuchung der Descemet-Membran nach Descemetorhexis bei der DMEK- Operation.

BACKGROUND: In order to obtain an optimal visual outcome in the isolated transplantation of Descemet's membrane (DM) with the endothelial cell layer, a regular interface between the receiver cornea and the graft is important for the prognosis. The purpose of this histological and ultrastructural study was to investigate how precise the descemetorhexis works using the Sinskey hook and whether the precision of DM removal depends on the clinical and pathological diagnosis of the underlying corneal endothelial disease. PATIENTS AND METHODS: 22 DM specimens of 22 patients obtained after descemetorhexis in DMEK using a Sinskey hook were examined using histological analyses and transmission electron microscopy for the presence of residual stroma, thickness of the DM, endothelial cell count, and presence of guttae. 17 patients had a Fuchs corneal dystrophy, 5 pseudophakic bullous keratopathy. RESULTS: Light and electron microscopy showed no evidence of adherent stroma in all 22 specimes after descemetorhexis independent of the different underlying endothelial pathological abnormalities. The mean total thickness of the DM was 20.58 ± 4.23 µm in patients with Fuchs endothelial dystrophy and 21.31 ± 5.41 µm in patients with bullous keratopathy. There was no significant difference between both pathological abnormalities. The anterior banded layer measured a mean of 3.04 ± 0.40 µm and 3.25 ± 0.22 µm thick; the posterior non-banded layer 17. 63 ± 4.07 µm and 17.60 ± 5.0 µm thick in each case of Fuchs corneal dystrophy and pseudophakic bullous keratopathy. There was no significant difference between the two diseases. CONCLUSIONS: Descemetorhexis allows a selective removal of the DM without adherent stroma in different underlying endothelial pathological abnormalities and in different variability of disease expression.

[Preservative-free triamcinolone versus purified triamcinolone preparations]. / Primär konservierungsmittelfreies Triamcinolon im Vergleich zu aufgereinigten Triamcinolonpräparaten.

BACKGROUND: Intravitreal injections of triamcinolone are not only an important therapeutic tool for a variety of vitreo-retinal disorders, but can also be employed for visualisation of the vitreous during pars plana vitrectomy. Triesence® is a preservative-free triamcinolone suspension that has been approved for visualisation during vitrectomy via intravitreal administration and as intravitreal therapy for certain rare ocular diseases. However, the differences between Triesence® and purified (and thus also preservative-free) triamcinolones such as Volon A® or Kenalog® are not well specified, although the manufacturer of Triesence® advertises the product as "specifically formulated for the eye". METHODS: The publicly available FDA application material and information provided by the manufacturer for Triesence®, Kenalog® and Volon A® were analysed with respect to the differences between Triesence® and older triamcinolone preparations. RESULTS: According to the publicly available FDA documents the approval of Triesence mainly was based on studies that have been conducted with the older triamcinolone preparations Kenalog® or purified Volon A®. Apart from the absence of preservative the differences between Triesence® and the "older" triamcinolone preparation seem marginal. Published experimental or clinical studies in respect to the possible advantages of Triesence® compared to Kenalog® or Volon A® are lacking. Triesence® has been approved for sympathetic ophthalmia, temporal arteriitis, uveitis unresponsive to topical corticosteroids and for enhancing tissue visualisation during vitrectomy. Recently, the manufacturer of Kenalog® added a warning label ("not for intraocular use") on each vial of Kenalog®. The motifs for this re-labelling of Kenalog® remain unclear. CONCLUSION: Apart from the intraoperative use during vitrectomy Triesence® has only been approved for sympathetic ophthalmia, temporal arteriitis, and ocular conditions unresponsive to topical steroids. Consequently, the use of Triesence® like the older triamcinolone preparations (Kenalog® or Volon A®) for diabetic macular oedema, for Irivine-Gass syndrome, for neovascular AMD or after retinal vein occlusion is off-label.

[Clinical results after cataract surgery in patients with Behçet's disease]. / Ergebnisse nach Kataraktchirurgie bei Patienten mit Behçet-Erkrankung.

BACKGROUND: Behçet's disease is a systemic vasculitis disorder of unknown aetiology. Ocular involvement, especially with vasculitis, is detected in up to 80 % of the cases. Anterior segment involvement such as cataract is also seen in the follow-up of patients who are then treated surgically. In this study, we aimed to analyze the outcomes of cataract surgery in patients with Behçet's disease retrospectively. PATIENTS AND METHODS: The records of 9 patients (12 eyes) with Behçet's disease who underwent phacoemulsification with IOL implantation in 11 eyes and extracapsular cataract extraction (ECCE) with IOL implantation in one eye between June 2001 and September 2009 were evaluated retrospectively. The visual outcome and complications were analysed. RESULTS: The mean follow-up was 33.8 months (range 3 to 88 months). The mean preoperative LogMAR BCVA was 1.15 ± 0.53 (95 % CI: 0.81 - 1.49) and increased to 0.36 ± 0.32 (95 % CI: 0.15 - 0.56) at last medical visit (p < 0.001). The most frequent postoperative complication was posterior capsular opacification, which developed in 2 eyes (17 %). Other complications were mild fibrinous reaction in 1 eye (8 %). CONCLUSIONS: The outcomes of cataract surgery in patients with Behçet's disease were satisfactory. The great majority of the patients regained and retained a good visual outcome and had fewer postoperative complications.