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Introduction: The aim of the study was to investigate the changes in the treatment of patients with retinal detachment over the past 15 years., Method: Files of all 5101 patients hospitalized for retinal detachment surgery between January 2005 and March 2020 were retrospectively analyzed., Results: The number of retinal detachment surgeries over the past 15 years increased continually from 150 to 600 per annum. During the summer months an increased incidence of retinal detachment of approximately 20% could be observed compared to the winter months. Anatomical success rates of emergency surgery carried out at weekends were not lower than those of scheduled routine procedures performed during the week. The relative proportion of buckle surgery decreased significantly from more than 60% down to 5% between 2005 and 2019. While initially an additional encircling buckle was employed in most cases of primary vitrectomy, this technique has almost completely disappeared in recent years without a deterioration of success rates. Liquid silicone tamponade was applied less frequently over the years. The overall anatomical success rates showed a slight trend towards improved results over the past 15 years., Conclusion: The strategies for surgical repair of retinal detachment have changed considerably in recent years: less buckle surgery, more vitrectomy, less add-on encircling buckles and less silicone tamponade. A slight trend towards better anatomical success rates could be observed., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Neovascular age-related macular degeneration (nAMD) is the most frequent cause of pigment epithelial detachment (PED). In the clinical routine the treatment of fibrovascular PED (fPED) and serous vascularized PED (svPED) with intravitreal vascular endothelial growth factor (VEGF) inhibitors has a restricted prognosis., Objective: There are limited data on the long-term outcome of PED under anti-VEGF therapy. Therefore, this study recorded the course of treated PEDs in nAMD eyes over a period of 5 years., Methods: All eyes with fPED or svPED that underwent anti-VEGF medication between 2006 and 2015 were retrospectively analyzed regarding the clinical course and the morphology seen on optical coherence tomography (OCT). The inclusion criteria were the detection of a PED on OCT, the angiographic verification of nAMD, a documented clinical history over 5 years and a good image quality., Results: A total of 23 eyes from 22 patients met the inclusion criteria. After 5 years a significant deterioration of visual acuity (VA) was seen in all eyes (p = 0.007) and in the subgroup of cases with fPED (p = 0.045). In the eyes with svPED the decline of VA was not significant (p = 0.097). In the collective study group a statistically significant reduction of PED height (p = 0.006) and an increase of PED diameter was measured (p = 0.002). In the subgroup analysis the decrease of PED height and increase of PED diameter were significant for cases with svPED (p = 0.004, p = 0.013, respectively) but were not statistically significant for fPED eyes (height: p = 0.616; diameter: p = 0.097). In 17 (74%) eyes fibrosis or atrophy were seen on the final assessment of OCT images., Discussion: After 5 years of anti-VEGF therapy for nAMD-associated PED the VA declined in half of the eyes and the OCT showed an unfavorable morphology in 3/4 of the cases. The average number of visits and injections was distinctly lower than in clinical trials and other real-life analyses. In summary, we observed an undertreatment with a worse functional and anatomical outcome in our clinical routine compared to other studies., (© 2020. Der/die Autor(en).)

A 2.5-month-old boy and a 2-month-old girl were admitted to a pediatric intensive care unit with impaired consciousness. Both infants had subdural hemorrhages. Because of presumed non-accidental head injury (NAHI) funduscopy was performed, which revealed unilateral hemorrhage in both children. After intensive differential diagnostics NAHI was suspected in both cases and a forensic medical examination was initiated. This case series is important because it shows that unilateral retinal bleeding does not exclude NAHI.

Background: There is no consensus about the best method for pterygium excision. Variable recurrence rates have been reported in the literature depending on the surgical technique., Objective: To evaluate the postoperative outcome after pterygium excision depending on the preoperative extent of the pterygium and the surgical method., Material and Methods: A total of 109 patients (72 men, 37 women) who underwent 109 pterygium surgeries were retrospectively analyzed. In 87 cases postoperative data over a 5-year follow-up period were available. Besides recording the preoperative extent of the pterygium the functional outcome was analyzed and recurrence rates of the various techniques by simple excision with primary conjunctival closure (SE), conjunctival autograft (BHT) and amniotic membrane transplantation (AMT) were compared., Results: Overall, recurrence was noted in 21 %. The recurrence rate of SE was 20 %. After BHT fewer recurrences (11 %) were seen than after AMT (39 %). After the intraoperative use of mitomycin C (MMC) more recurrences (31 %) occurred than without the use of MMC (17%). In 45 % of the cases delayed recurrence occurred after the first postoperative year., Conclusion: In our opinion the method of SE is not obsolete. Good results can be achieved with SE in pterygia with a small extent. The lowest recurrence rate was seen after BHT; therefore, BHT is the method of choice in general and especially for larger pterygia. The higher recurrence rate after intraoperative use of MMC is probably caused by selection bias. Regular follow-up examinations are required beyond the first postoperative year for timely detection of delayed recurrence.

Background: The preoperative switch from local to systemic antiglaucomatous therapy and the additional application of local antiphlogistic drugs represents an important component of perioperative wound healing modulation within the framework of glaucoma filtration surgery., Objective: The aim of the present study was to compare the intraocular pressure (IOP) under a maximum local and oral antiglaucomatous therapy with or without additional application of local steroids., Methods: A retrospective clinical analysis of 121 consecutive patients who underwent primary trabeculectomy for open-angle glaucoma in 2013 and who attended the outpatient clinic at least 3 weeks before surgery was carried out. The patients were set on preoperative therapy as follows: continuation of the maximum local antiglaucomatous therapy (with or without local dexamethasone 1 mg/ml 3 times daily) or administration of 750 mg acetazolamide orally per day (with or without local steroids)., Results: The switch to oral antiglaucomatous therapy led to a mean IOP rise of 3.14 mm Hg which was short of statistical significance (p = 0.052). The additional administration of local steroids did not significantly influence the IOP (p = 0.218). Some patients with oral acetazolamide therapy and local steroid application showed large increases in IOP up to 30 mm Hg., Conclusion: The mean IOP rise of 3.14 mm Hg 3 weeks after replacement of antiglaucomatous eye drops by acetazolamide was short of missing statistical significance and seems to be clinically negligible for this relatively short period. The advantages of a lower postoperative fibrotic activity have to be weighed up against this change in IOP. Surprisingly, the effect of administration of local steroids for 3 weeks was minor compared to the effect of the switch from local to oral antiglaucomatous medication. Individual major IOP increases under the preoperative therapy change should be taken into consideration.

A prematurely born male infant (24+5 gestational weeks, birth weight 485 g) was diagnosed with bilateral aggressive posterior retinopathy of prematurity (AP-ROP) in zone I. After obtaining informed written consent from the parents, one eye was treated with diode laser photocoagulation and the other eye with 0.25 mg intravitreal ranibizumab. Laser photocoagulation was found to be an effective tool for fast regression of AP-ROP; however, medium-term evaluation showed poor macular formation and peripheral retinal detachment. The intravitreal injection led to a slower but better control of the AP-ROP and central foveal reflexes showed better anatomical outcome.

When IOP is increased by the suction cup method, refraction changes will occur, depending on the shape of the cup and the height of the IOP increase. Similar refraction changes were simulated in six healthy volunteers by employing spherical and cylindrical glasses during pattern-reversal visual evoked cortical potential (VECP) with various check sizes and amount of contrast. While the pattern-reversal VECP latencies were not influenced, the amplitudes were reduced considerably. By using contact lenses and a suitably shaped suction cup, refraction changes could be compensated for. In 22 healthy volunteers pattern-reversal VECPs were derived with and without the application of contact lenses with artificially raised IOP. A comparison showed that the amplitudes differed significantly. Without contact lenses a negative pressure of more than 40 mmHg resulted in a drop in the amplitudes with a plateau formed between 80 and 120 mmHg. With compensation by contact lenses the amplitudes are found to be unaltered or even slightly increased until a negative pressure of 120 mmHg is reached in the suction cup, after which they drop. Plotting the pattern-reversal VECP amplitudes (obtained with refraction changes being compensated for by contact lenses) against ciliary perfusion pressure, one finds the characteristic curve described by Ulrich et al., suggesting an autoregulative capacity between 15 and 20 mmHg in healthy persons. The latencies, which remain uninfluenced by refraction changes, are also not altered within an IOP increase of 15-20 mmHg.

Oculo-pression tonometry (OPT) was introduced in 1984 as a clinical method of examining ocular hydrodynamics. The method involves measuring intraocular pressure (IOP) by applanation tonometry performed before, during and after application of a pressure load that disturbs the dynamic balance between aqueous production and aqueous outflow. From the IOP before (P0) and immediately after (Pr0) the 8-min pressure load period, the outflow facility C(u) can be calculated: [formula: see text] The examinations performed so far have shown that (1) reduced outflow facility can be detected by OPT with a high degree of reliability, and (2) reduced outflow facility is always preceded by the development of glaucoma damage to the optic nerve head. A prospective study has shown that in the group of patients with reduced outflow facility but without glaucoma damage, 73% developed glaucoma damage with typical changes of the papilla and visual field within 3-7 years after the first examination.

To study the haemodynamics of the peripapillary choroid, perfusion pressure videoangiography (PVA) was performed in six healthy subjects and in seven patients with primary open-angle glaucoma (poag). In healthy subjects the peripapillary part of the choroid starts filling at distinctly lower ocular perfusion pressures than other parts of the choroid. The mean difference in perfusion pressure between peripapillary and perimacular filling was 13.6 mmHg in the six healthy subjects. A different filling pattern of the choroid was found in the seven glaucoma patients. The mean difference in perfusion pressure between the beginning of peripapillary and the beginning of perimacular perfusion of the choroid was found to be as small as 1.9 mmHg. That the filling of the peripapillary choroid observed by PVA in healthy subjects is found to start at lower perfusion pressures than in the other parts is explained by autoregulative dilatation of the peripapillary choroidal arterioles resulting from artificially raised intraocular pressure during the PVA examination. In the poag patients the peripapillary choroidal arterioles were dilated either insufficiently or not at all. The following conclusions are drawn: (1) The peripapillary choroid of healthy persons shows effective autoregulation securing the blood supply to the prelaminar part of the optic nerve. (2) In poag the peripapillary choroid has lost the capability of effective autoregulation.