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Background: In recent years, an increasing number of surgical microscopes fitted with an OCT module (intraoperative OCT, iOCT) have become available, providing high-resolution images of the surgical site in real time. While a 2018 survey at our hospital showed that iOCT delivered an additional intraoperative benefit in only 2.4% of all operations, considering that the manufacturer had since revised the hardware and software, we conducted a second user evaluation of this technology., Material and Methods: Prospective monocentric analysis of the application and user-friendliness of an EnFocus Ultra-Deep OCT (Leica Microsystems) over a period of 25 (2018) and 20 working days (2021). A standardized questionnaire was used to assess the surgeons' use of iOCT and its influence on the surgical course., Results: 118 operations were performed over a 25-day period in 2018 and 92 operations were performed over a 20-day period in 2021. In 2018, iOCT was used in 24.6% and in 2021 in 48.9% of all surgeries, with iOCT proving to be "critical" to the surgical course in 2.4% and 3.3% of cases, respectively, as assessed by the surgeons in both years. These were operations in which the intraocular view was limited, e.g., with decompensated cornea, vitreous hemorrhage, or after previous surgery, e.g., after penetrating keratoplasty., Conclusion: Further development of the user interface led to an improvement in usability, and the iOCT was used significantly more often. In both years, the iOCT proved to be critical for the course of the surgery in a comparably small number of operations, especially those involving complex situations., Competing Interests: GG: Leica Microsystems, die anderen Autoren und Autorinnen geben keine Interessenkonflikte an./GG: Leica Microsystems, the other authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

In the case of thermal or caustic burns of the ocular surface, loss of limbal epithelial stem cells leads to compromised self-renewal of the corneal epithelium. This results in permanent loss of vision. In these situations, transplantation of cultured limbal epithelial cells on an amniotic membrane or fibrin gel as substrate (Holoclar®) can help to regenerate the corneal surface. The required cells are obtained from the healthy partner eye, if available. Adult stem cells from other parts of the body potentially serve as alternative cell sources: hair follicles, oral mucosa, mesenchymal stromal cells, or induced pluripotent stem cells (originally, e.g., skin fibroblasts). The reprogramming of such cells can be achieved with the help of transcription factors. In addition, work is being done on biosynthetic or synthetic matrices, which not only serve as substrate material for the transplantation but also support the functional properties of these cells (self-renewal, corneal epithelial-typical phenotype)., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: The demands on conjunctival replacement tissues are high: they need to be elastic, clinically compatible, surgically feasible and support goblet cell growth., Objective: This article provides an overview of currently applied conjunctival replacement tissues and those under investigation., Method: Current publications on clinically applied conjunctival replacement tissues and substrates which are the subject of scientific research and those already tested in animal models are presented and discussed., Results: Replacement tissues in clinical use are autologous and allogenic conjunctiva, nasal and oral mucous membranes, amniotic membrane and decellularized tissues. Autologous conjunctiva shows good results but is not suitable for large defects due to limited availability. In these cases autologous nasal and oral mucous membranes can be used; however, success is limited in cases of autoimmune diseases. Amniotic membranes are frequently applied clinically but goblet cell growth is limited. Different decellularized tissues are used clinically and goblet cell growth was found in vivo. Robust comparative studies are not yet available. Biological matrices such as fibrin, collagen, elastin, gelatin or hyaluronate and synthetic tissues from the group of polyesters are being investigated in the laboratory and in animal models. These studies show good epithelialization and goblet cell growth in vivo., Conclusion: Transplantation of conjunctiva, nasal and oral mucous membranes and amniotic membranes show satisfactory clinical results but exhibit individual weaknesses. Further studies in animal models and clinical settings are required to further evaluate the benefits of other matrices, such as cell-free tissues or other biological and synthetic matrices., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: In recent years, great progress has been made in intraoperative imaging using optical coherence tomography (iOCT). There are now several commercially available iOCT systems that allow high-resolution imaging of all structures of the eye without interrupting surgery. This real-time visualisation can provide additional information to conventional surgical microscopy, but is relatively expensive. The aim of our study was to find out how often OCT integrated into the surgical microscope is used by trained surgeons, or to what extent they consider that iOCT is relevant for intraoperative procedures., Patients and Methods: A prospective monocentric analysis was conducted of the field of application and user-friendliness of the EnFocus Ultra-Deep OCT (Leica Microsystems), a mobile device combination of surgical microscope and OCT. The use and benefit were investigated of iOCT, which was not mandatory. Standardised documentation and evaluation using a questionnaire was performed by the respective surgeon (n = 5) immediately after surgery., Results: Over a period of 25 working days, 118 procedures were performed in the operating theatre equipped with the microscope-OCT combination. The iOCT was used in 24.6% of the 118 procedures performed. iOCT was regarded as crucial to the intraoperative procedure in 3 of the 29 patients. In one patient, it was possible to check graft orientation during a DMEK operation in a very opaque cornea and, in the second patient, to visualise the correct positioning of an iris diaphragm in the capsular bag. In the third patient, the risk of developing a pseudoforamen was assessed, and this led to the decision not to perform a full gliosis peel., Conclusion: Experienced surgeons in a university eye hospital with a full surgical spectrum considered that intraoperative OCT was decisive for the course of surgery in only a few selected surgical situations, e.g. in case of limited corneal transparency. The impact of the use of iOCT on post-operative outcome quality still needs to be evaluated by larger prospective studies. On the basis of this survey, the cost-benefit ratio is still unclear., Competing Interests: The authors declare that they have no conflict of interest./Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Interessenkonflikt: Die Autoren bestätigen, dass kein Interessenkonflikt vorliegt.

Background: An elevated intraocular pressure remains the main risk factor for the development and progression of glaucoma but other factors such as fluctuations of the intraocular pressure, the blood pressure, and the ocular perfusion pressure are gaining in importance. The influence of the anti-glaucomatous therapies on these parameters is barely investigated. This study investigates 1) a correlation between the fluctuations of the intraocular pressure, the blood pressure and the ocular perfusion pressure with the severity of the glaucoma damage and 2) if these parameters can be influenced by different anti-glaucomatous therapies., Material and Methods: Data from 121 glaucoma patients who had been hospitalised for 24-hour measurements of the intraocular pressure and blood pressure between 2003 and 2012 were analysed retrospectively. The patients were divided into groups by the severity of the glaucoma damage and by their anti-glaucomatous therapy. Mean values for the intraocular pressure, the blood pressure and the ocular perfusion pressure were calculated and correlated with the individual groups. The statistical analysis was performed with SPSS21.0 using Kruskal-Wallis and Mann-Whitney U tests for the comparison of the groups. RESULTS with p < 0.05 were considered statistically significant., Results: The severity of the glaucoma damage correlated significantly with higher mean values of the intraocular pressure and its fluctuations, as well as with a nocturnal decrease of the blood pressure and low mean values of the ocular perfusion pressure (p < 0.0001). The anti-glaucomatous therapy decreased the intraocular pressure to normal values. A monotherapy with carboanhydrase inhibitors correlated with the lowest fluctuations of the ocular perfusion pressure while a quadri-therapy was associated with higher values of the intraocular pressure and its fluctuations. The anti-glaucomatous therapy did not show an association with the blood pressure or the ocular perfusion pressure., Conclusion: Glaucoma is negatively influenced by high intraocular pressure, nocturnal blood pressure decreases and ocular perfusion pressure fluctuations. A monotherapy with carboanhydrase inhibitors seems to be sufficient to decrease fluctuations of the intraocular pressure. Patients with a quadri-therapy should be monitored regularly as they present high values of intraocular pressure and its fluctuations. A hospitalisation of the patients with 24-hour measurements of the intraocular pressure and blood pressure provides information needed to improve the therapy or decide about surgical interventions., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Irrigation of the lacrimal duct with silicone tube intubation, endoscopic microdrill dacryoplasty and external dacryocystorhinostomy (DCR) are commonly used in lacrimal duct surgery. Dacryocystography (DCG) is one of the standard procedures in preoperative imaging. This study evaluates the influence of individual parameters and the prognostic meaning of preoperative DCG on the success rates after lacrimal duct surgery, in order to predict more precisely the long-term outcome after different operative paradigms., Materials and Methods: 145 patients (mean age 60 years; 32 % male) with lacrimal stenosis, who underwent lacrimal duct surgery in the University Eye Hospital Münster during 2002 were included in this retrospective study. Individual parameters (age, gender, preoperative duration of symptoms, lacrimal sac area and operative procedures) were recorded. The lacrimal sac area of each patient was calculated from preoperative DCG imaging. The individual parameters and the prognostic relevance of preoperative DCG were statistically analysed with regards to the long-term success rate after different surgical procedures. Criteria for success were an asymptomatic patient and a successful probing and irrigation of the lacrimal duct system at follow-up at 24 to 36 months after lacrimal duct surgery., Results: With a mean success rate of 79 %, DCR was most effective regarding long-term outcome. Particularly in elderly patients DCG was superior to minimal-invasive procedures. The mean area of the lacrimal sac, calculated from DCG imaging, was 18 mm (2). There was a significant correlation (p = 0.001) between the area of the lacrimal sac and long-term success of DCR., Conclusion: Endoscopic microdrill dacryoplasty and DCR have the most successful options in the treatment of lacrimal stenosis. DCG was the most effective procedure in elderly patients. An enlargred lacrimal sac proved to be a positive prognostic factor for the long-term success of DCR., ((c) Georg Thieme Verlag KG Stuttgart New York.)