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Purpose Innovative laser speckle flowgraphy (LSFG) enables noninvasive evaluation of retinal microcirculation and the usefulness has been reported in the field of ophthalmology. LSFG has allowed us to measure the real time changes of retinal blood flow without pupillary dilatations and contrast media. Herein, we investigated the change of retinal blood flow in normal pregnant women during gestation using LSFG. Methods A prospective cohort study was conducted in 53 pregnant women who visited our institution between January, 2013 and July, 2014. Finally, a total of 41 participants without any obstetric complications were available for evaluation. Retinal blood flow was measured with LSFG in a total of 4 times during pregnancy (T1. 11-13 weeks, T2. 19-21 weeks, T3. 28-30 weeks, T4. 34-36 weeks) and mean blur rate (MBR), blowout score (BOS), flow acceleration index (FAI), and resistive index (RI) are analyzed from these measurements. Relations between LSFG parameters and mean arterial blood pressure (MAP) are determined throughout pregnancy. Results MBR showed no significant changes throughout pregnancy. BOS showed a tendency to increase in the 3rd trimester. FAI values showed a slight increase from the 1st to 2nd trimester while a significant decrease was noted in the 3rd trimester. RI exhibited no changes between the 1st and 2nd trimesters, values decreased significantly after the 3rd trimester. MAP was positively correlated with BOS, and negatively correlated with FAI and RI. Conclusion The present study clearly demonstrated that profiles of LSFG parameters demonstrated a decrease of resistance in retinal blood vessels. These changes in indices provide a highly sensitive reflection of physiological changes in vascular resistance due to pregnancy. Thus, LSFG may be useful, as a non-invasive, diagnostic tool to detect pregnancy related disorders such as preeclampsia.

Purpose Normally, Vogt-Koyanagi-Harada (VKH) disease has a good prognosis with adequate treatment. However, VKH disease recurs more frequently if diagnosis is delayed or treatment is inadequate. As soon as VKH disease recurs, inflammation is harder to control and the prognosis worsens. Our objective was to study predictors of recurrence in patients with VKH disease. Design Retrospective case series. Participants Forty-one eyes of 41 patients (25 women, 16 men) were included in this study. Patients with recurrent attacks of inflammation were classified as recurrent, whereas patients needing only steroid treatment, without any recurrent attacks, were classified as nonrecurrent. Methods Descriptive and bivariate analyses were used to characterize disease and outcomes. A blood-flow analysis was performed with laser speckle flowgraphy on days 0, 14, 30, and 60. Choroidal thickness was measured with swept-source OCT, using a 12-radial scan protocol, on the same day as mean blur rate (MBR) measurement. Flare in the anterior chamber also was measured on the same day, using a flare cell meter. Main Outcome Measures Prevalence of each type of disease pattern and flare, MBR, and thickness of the choroidal layers. Results The recurrent group initially had lower visual acuity (VA) and higher flare than the nonrecurrent group, but these parameters improved over time and were similar in the groups on days 14, 30, and 60. However, on these days, MBR was significantly lower in the recurrent group than in the nonrecurrent group. Choroidal thickness was not significantly different in the 2 groups at any time point. Conclusions We found that patients with recurrent VKH disease had lower VA, higher initial flare number, and a lower response of MBR to treatment than patients with nonrecurrent VKH disease. Thus, VA and flare number during the initial phase, as well as the MBR response to treatment, may be useful in determining the prognosis for VKH disease and choosing therapeutic options.

It has been suggested that local and systemic oxidative stress levels are causal risk factors for glaucoma.To evaluate the effect of age on the role of systemic oxidative stress in open-angle glaucoma (OAG).This study included 502 eyes of 251 Japanese patients with OAG. Systemic oxidative stress was assessed with skin autofluorescence (SAF), an indicator of advanced glycogen end products. We selected the youngest and oldest patients by quartile (≤58 and ≥74 years old, respectively) and determined the univariate correlation between SAF and mean deviation (MD) of the visual field in both eyes of each group. We also investigated the association between SAF and glaucoma in the youngest group with a logistic regression analysis.The younger subjects with OAG with high SAF had significantly lower better-eye MD than the younger subjects with normal SAF (p0.01), but the older subjects had similar better-eye MD regardless of SAF level. Furthermore, SAF was negatively correlated with MD in the youngest subjects (better eye: r=-0.35, p0.01, worse eye: r=-0.28, p=0.02), but not in the older subjects. Finally, mixed-effects regression analysis showed that SAF contributed to the MD in the younger patients with OAG (p=0.01).We found that the relationship between systemic oxidative stress and visual field loss was strongest in relatively young patients with OAG, suggesting that the potential benefit of antioxidant therapies to combat systemic oxidative stress might be dependent on the age of the patient.

Purpose To investigate the influence of various risk factors on thinning of the lamina cribrosa (LC), as measured with swept-source optical coherence tomography (SS-OCT; Topcon). Methods This retrospective study comprised 150 eyes of 150 patients: 22 normal subjects, 28 preperimetric glaucoma (PPG) patients, and 100 open-angle glaucoma patients. Average LC thickness was determined in a 3 x 3 mm cube scan of the optic disc, over which a 4 x 4 grid of 16 points was superimposed (interpoint distance: 175 μm), centered on the circular Bruch’s membrane opening. The borders of the LC were defined as the visible limits of the LC pores. The correlation of LC thickness with Humphrey field analyzer-measured mean deviation (MD; SITA standard 24–2), circumpapillary retinal nerve fiber layer thickness (cpRNFLT), the vertical cup-to-disc (C/D) ratio, and tissue mean blur rate (MBR) was determined with Spearman's rank correlation coefficient. The relationship of LC thickness with age, axial length, intraocular pressure (IOP), MD, the vertical C/D ratio, central corneal thickness (CCT), and tissue MBR was determined with multiple regression analysis. Average LC thickness and the correlation between LC thickness and MD were compared in patients with the glaucomatous enlargement (GE) optic disc type and those with non-GE disc types, as classified with Nicolela’s method. Results We found that average LC thickness in the 16 grid points was significantly associated with overall LC thickness (r = 0.77, P < 0.001). The measurement time for this area was 12.4 ± 2.4 minutes. Average LC thickness in this area had a correlation coefficient of 0.57 with cpRNFLT (P < 0.001) and 0.46 (P < 0.001) with MD. Average LC thickness differed significantly between the groups (normal: 268 ± 23 μm, PPG: 248 ± 13 μm, OAG: 233 ± 20 μm). Multiple regression analysis showed that MD (β = 0.29, P = 0.013), vertical C/D ratio (β = -0.25, P = 0.020) and tissue MBR (β = 0.20, P = 0.034) were independent variables significantly affecting LC thickness, but age, axial length, IOP, and CCT were not. LC thickness was significantly lower in the GE patients (233.9 ± 17.3 μm) than the non-GE patients (243.6 ± 19.5 μm, P = 0.040). The correlation coefficient between MD and LC thickness was 0.58 (P < 0.001) in the GE patients and 0.39 (P = 0.013) in the non-GE patients. Conclusion Cupping formation and tissue blood flow were independently correlated to LC thinning. Glaucoma patients with the GE disc type, who predominantly have large cupping, had lower LC thickness even with similar glaucoma severity.

Zielsetzung: Untersuchung der strukturellen, visuellen und refraktiven Ergebnisse der intravitrealen Injektion von Aflibercept in Monotherapie bei Patienten mit Frühgeborenenretinopathie (retinopathy of prematurity; ROP) vom Typ 1 mit hohem Risiko und unterhalb der Therapieschwelle. Aufbau: Prospektive, nichtrandomisierte, interventionelle Fallserien-Studie. Patienten und Methoden: Patienten mit Hochrisiko-Prethreshold-Typ-1-ROP wurden mit 1 mg/0,025 ml Aflibercept intravitreal behandelt. Die betrachteten primären Endpunkte waren ein ungünstiger struktureller Verlauf, ungünstiger visueller Verlauf und ungünstiger refraktiver Verlauf. Die sekundären Endpunkte waren ausbleibende Rezidivierung, okulare und systemische Nebenwirkungen. Ergebnisse: In die Studie wurden 26 Augen aufgenommen; alle hatten eine Nachbeobachtung von 1 Jahr abgeschlossen. Das mittlere Geburtsgewicht betrug 991 ± 266 g (Bereich 875-1105 g); das mittlere Gestationsalter bei Entbindung betrug 26,33 ± 2,1 Wochen (Bereich 24-30 Wochen); bei 9 Augen wurde die ROP als Stadium 2+, Zone I eingestuft, bei 14 Augen lag Stadium 3+ in Zone II vor und bei 3 Augen Stadium 3 in Zone I. 25 Augen (96,2%) zeigten einen günstigen strukturellen und 21 (80,1%) einen günstigen visuellen Verlauf; die Fehlsichtigkeit lag nach 1 Jahr im Median bei 0,75 dpt (Bereich -9,5 bis +4). Schlussfolgerungen: Die intravitreale Injektion von Aflibercept als Monotherapie ist eine einfache, sichere und wirksame Therapieoption bei Hochrisiko-Prethreshold-ROP vom Typ 1. Eine weitere, multizentrische Studie mit längerem Nachbeobachtungszeitraum ist erforderlich. Übersetzung aus Salman AG, Said AM: Structural, visual and refractive outcomes of intravitreal aflibercept injection in high-risk prethreshold type 1 retinopathy of prematurity. Ophthalmic Res 2015;53:15-20 (DOI: 10.1159/000364809)

Purpose To use laser speckle flowgraphy (LSFG) to assess blood flow (BF) in the optic nerve head (ONH) tissue and choroid during elevated intraocular pressure (IOP). Methods This prospective study included 20 eyes of 20 healthy volunteers. The testing protocol had a baseline phase, two elevated IOP phases (+10 and +20 mm Hg), and a recovery phase. IOP was elevated by pushing against the eyelid with a novel tubular device attached to the LSFG apparatus. Measurement parameters in each phase included: LSFG-derived mean blur rate (MBR) and flow acceleration index (FAI); systemic parameters, and IOP. The % change against baseline was calculated for each phase. The protocol was repeated five times to calculate the coefficient of variation (CV) for % change MBR and to determine the effect of mydriasis on % change MBR. We compared % change MBR and FAI and evaluated the relationship between % change ocular perfusion pressure (OPP) and MBR in the choroid and ONH tissue. Results The % change MBR was highly reproducible (CV: 6.1-8.7%) and not affected by mydriasis (P = 0.57-0.96). The % change MBR and FAI were higher in the ONH tissue than choroid during IOP elevation (P = 0.04). The % change OPP and MBR showed positive linear correlations and two-segmental linear correlations in the choroid and ONH tissue, respectively (P < 0.01). Conclusion Hemodynamics during IOP elevation differ in the choroid and ONH tissue. LSFG enables highly reproducible assessment of the dynamic autoregulation of ocular BF in the ONH tissue.

To assess the visual outcome and complications of 25-G transconjunctival sutureless vitrectomy (25G-TSV) for rhegmatogenous retinal detachments. Retrospective, consecutive, interventional case series of 84 eyes of 84 consecutive patients with RRD who underwent 25G-TSV. All surgeries were performed by a single surgeon at a single centre. The initial and final reattachment rates were 95.2 and 100%, respectively. The mean visual acuity improved from 0.78 logarithm of the minimum angle of resolution (logMAR) units to 0.17 logMAR units at the final examination (P

Purpose: To investigate the relationship between vitreous levels of cytokines, including interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF), and visual prognosis after pars plana vitrectomy (PPV) with arteriovenous sheathotomy in patients with branch retinal vein occlusion (BRVO) associated with macular oedema. Methods: We studied 60 patients with logMAR visual acuity (VA) scores of

Retinal diseases related to ischemia, such as diabetic retinopathy, are the main cause of blindness worldwide. However, the pathogenesis of these diseases remains unclear, as does the time course of associated changes in ocular blood flow. Laser speckle flowgraphy (LSFG), which uses the laser speckle phenomenon to detect and quantify ocular circulation, is a promising candidate for a noninvasive method to measure ocular blood flow in living eyes. A recently developed LSFG measurement parameter, mean blur rate (MBR), can serve as a quantitative and reproducible index of retinal blood cell velocity. Mean blur rate can be used in the study of retinal diseases to evaluate microcirculation in the retinal vessels, choroid, and optic nerve head. In addition to overall MBR (MA), LSFG measurements of optic nerve head microcirculation can be divided into vessel-area MBR (MV) and tissue-area MBR (MT). Absolute values for MT have been shown to be linearly correlated with capillary blood flow, regardless of fundus pigmentation. Recently, there has been an increasing number of reports on the clinical applications of LSFG in retinal disease.

Background Natural killer cell tumors can be broadly divided by origin into mature-cell and progenitor-cell types. The invasion of nasal-origin natural killer cells into the ophthalmologic field is sometimes observed in patients, but primary ocular natural killer cell tumors are a rare occurrence. Case presentation A 66 year-old woman without any systemic disease presented with blurred vision due to a severe vitreous opacity in the right eye. Flow cytometric analysis of the vitreous fluid suggested a natural killer cell tumor. Moreover, cytologic examination of vitreal and retinal specimens revealed the infiltration of a natural killer cell tumor, while PCR and immunocytochemistry revealed Epstein-Barr virus infection. The results of a gene rearrangement analysis were positive for IGH, while TCR beta chains were all negative. We examined the patient with whole-body magnetic resonance imaging and positron emission tomography, and performed a bone marrow examination. These examinations returned no abnormal results. Conclusion Thorough analysis of vitreal samples is essential when performing vitrectomies for vitreous opacities of unknown cause. Flow cytometric, cytologic, and PCR analysis of vitreal and retinal samples may reveal the presence and cause of severe illness.

Purpose To evaluate the optic nerve head (ONH) microcirculation in autosomal dominant optic atrophy (ADOA) patients. Methods This study comprised 22 eyes of 12 ADOA patients, diagnosed according to clinical findings including family history and the presence of mutations in the OPA1 gene. Twenty-four normal eyes of 24 age-matched subjects, with either the right or left eye randomly selected for use, served as controls. Circumpapillary retinal nerve fibre layer thickness (cpRNFLT) and mean blur rate (MBR) in the ONH were determined with optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG), respectively. For each ONH quadrant (superior, temporal, inferior and nasal), the MBR and cpRNFLT ratio was also calculated by dividing tissue MBR in that quadrant by tissue MBR in the entire ONH and by dividing cpRNFLT in that quadrant by cpRNFLT in the entire ONH respectively. Results Mean blur rate (MBR) in all quadrants was significantly lower in the ADOA patients than in the controls (p

The retinal ganglion cells (RGCs) are the main source of therapeutic targets for neuroprotective glaucoma treatment, and evaluating RGCs is key for effective glaucoma care. Thus, we developed a minimally invasive, quick, real-time method to evaluate RGC death in mice. In this article we describe the details of our method, report new results obtained from C57BL/6J mice, and report that our method was usable in wild type (WT) and knockout (KO) mice lacking an RGC-death-suppressing gene. It used a non-invasive confocal scanning laser ophthalmoscope (cSLO) and a low molecular weight, photo-switching, cell-impermeant, fluorescent nucleic acid dyeing compound, SYTOX orange (SO). The RGCs were retrogradely labeled with Fluorogold (FG), the optic nerve was crushed (ONC), and SO was injected into the vitreous. After ten minutes, RGC death was visualized with cSLO in vivo. The retinas were then extracted and flat mounted for histological observation. SO-labeled RGCs were counted in vivo and FG-labeled RGCs were counted in retinal flat mounts. The time course of RGC death was examined in Calpastatin KO mice and wild type (WT) mice. Our in vivo imaging method revealed that SO-positive dead RGCs were mainly present from 4 to 6 days after ONC, and the peak of RGC death was after 5 days. Moreover, the number of SO-positive dead RGCs after 5 days differed significantly in the Calpastatin KO mice and the WT mice. Counting FG-labeled RGCs in isolated retinas confirmed these results. Thus, real-time imaging with SO was able to quickly quantify ONC-induced RGC death. This technique may aid research into RGC death and the development of new neuroprotective therapies for glaucoma.

The aim of the study is to determine the relationship between post-trabeculectomy bleb structure evaluated using anterior segment optical coherence tomography (AS-OCT) and postoperative intraocular pressure (IOP).Rretrospective is showed for the design of this study.There are twenty-seven eyes of 27 trabeculectomy patients.We drew contour lines for the bleb and cleft on 8-radius-scanned AS-OCT images, and determined correlations of AS-OCT measurements to postoperative IOP at 6 months.The parameter used in this study is an anterior segment optical coherence tomography measurements of bleb structure, including cleft volume, wall volume, and the brightness of the bleb wall.We found significant correlations between postoperative IOP at 6 months and cleft volume at 3 and 6 months (r = -0.56, P = 0.007 and r = -0.82, P 0.001), bleb wall volume at 6 months (r = -0.48, P = 0.042), bleb vertical brightness at 3 and 6 months (r = 0.73, P 0.001 and r = 0.49, P = 0.040), and bleb horizontal brightness at 1 week, 2 weeks, 3 months and 6 months (r = 0.49, P = 0.016, r = 0.65, P 0.001, r = 0.52, P = 0.013 and r = 0.71, P = 0.001). A stepwise multiple regression analysis of bleb structural measurements made ≤2 weeks postoperatively showed that the strongest independent factor indicating postoperative IOP at 6 months was bleb horizontal brightness at 2 weeks (β = 0.50, P = 0.006).Early postoperative AS-OCT measurements of blebs, especially horizontal brightness of the bleb wall, were associated with postoperative IOP at 6 months. AS-OCT measurements of blebs may be useful predictors of trabeculectomy outcomes.

Purpose: To determine whether trypan blue (TB) is toxic to cultured human retinal pigment epithelial (ARPE-19) cells, and whether hypothermia can protect ARPE-19 cells against TB toxicity. Methods: ARPE-19 cells were cultured and exposed to balanced salt solution as a control, while other cells were exposed to 0.05, 0.2, and 0.5% TB dye at 37 and 4°C for 5 and 30 min. The percentage of ARPE-19 cells that survived was determined by resazurin 1 day after the exposure. Results: A statistically significant decrease in the percentage of ARPE-19 cells surviving was found after exposure to 0.2 and 0.5% TB at any temperature or for any exposure duration (p < 0.01). The percentage of RPE cells surviving at 0.05% was not significantly different from that of controls except for a 30-min exposure at 37°C. The percentage of cells surviving at 4°C for a 5-min exposure to 0.5% TB and a 30-min exposure to 0.2 and 0.5% was significantly higher than that at 37°C under each condition (p < 0.01 for all). Conclusions: These results indicate that TB is toxic to human RPE cells, and the toxicity is dose- and exposure duration-dependent. Exposing the cells at 4°C had a protective effect against higher concentrations or longer exposure durations of TB compared to exposure at 37°C.

Proliferative diabetic retinopathy (PDR) is a leading cause of visual loss in adults in industrialized countries. PDR patients with light perception (LP) or hand movement (HM) acuity due to severe vitreous hemorrhage require vitreous surgery. The purpose of this study was to determine whether the visual acuity of PDR patients with LP or HM can be graded into finer steps with the Low Vision Evaluator (LoVE). In addition, we determined whether the LoVE results are correlated with the amplitude of the electroretinogram (ERG), the presence of retinal detachment (RD), or postoperative visual prognosis. The LoVE instrument is a subjective device that measures the thresholds for light stimulus and is equipped with a pair of goggles with white light-emitting diodes as the stimulus. We measured the LoVE thresholds of 19 PDR patients, whose fundi could not be observed due to vitreous hemorrhage and whose visual acuity was LP or HM. The 13 patients with HM vision had LoVE thresholds that ranged from 25.0 and 40.0 dB, and the 6 patients with LP vision had LoVE thresholds that ranged from 20.0 and 40.0 dB. The LoVE thresholds of 9 patients with RD were significantly lower than those of 10 patients without RD (p < 0.001). The LoVE thresholds were correlated with the amplitude of the a- and b-waves of the ERG and the postoperative best-corrected visual acuity (BCVA) (a-wave: r = 0.70, p < 0.001; b-wave: r = 0.71, p < 0.001; postoperative BCVA: r = 0.46, p < 0.05). These results indicate that the LoVE is capable of grading the visual function of PDR patients with conventional LP and HM vision into finer steps. Thus, the LoVE is an invaluable device in predicting the postoperative visual acuity of patients with vitreous hemorrhage.

There was no device to grade visual function in patients with retinitis pigmentosa (RP). We have therefore developed an instrument capable of measuring and quantifying the visual capabilities, and here present the results from patients with RP. In total, 118 eyes of 59 patients, 26 men and 33 women, with RP were studied. Seven eyes had hand movement (HM) and eight had light perception (LP) vision, and the others had better visual acuity. The Low Vision Evaluator (LoVE) consists of a pair of goggles with white, light-emitting diodes as the stimulus, a control box, an on-off button to signal the detection of the stimulus, and a printer for permanent records. There are 15 luminance levels of stimuli (combination of 5 intensities and 3 durations). The stimuli are delivered in a random sequence with an audio signal presented 0.3 seconds prior to the light stimulus. Each eye was tested separately, and each stimulus magnitude (intensity x duration) was presented 3 times for a total of 27 stimuli per eye. With 6 catch trials (audio signal without a light stimulus), a total of 60 trials were examined in a full examination. The conventional visual acuity and kinetic visual fields were determined. 59 patients had different visual acuities that ranged from no light perception (NLP) to 1.5 vision, and visual field sizes that ranged from 0.0001 to 3.96 steradians. The visual acuity and visual field size were significantly correlated with the LoVE score (r=0.58 and 0.64, respectively; p

We report a case of branch retinal artery occlusion (BRAO) in a patient with iron-deficiency anemia. Various ophthalmological and laboratory studies were performed. A 32-year-old man had a sudden decrease of vision in his left eye to counting fingers at 30 cm two days ago. The left fundus showed a cherry-red spot and milky-white edema, except for the upper temporal region of the macula, and an optic disc malformation. Fluorescein angiography revealed leakage from the disc and a slightly delayed filling time in the left eye but an arterial filling defect was not noted. The differential diagnosis in this young patient includes polycythemia, hypercoagulopathy, coagulation abnormalities, trauma, hypertension, and autoimmune diseases such as systemic lupus erythematosus. Laboratory examinations revealed no abnormalities except for iron-deficiency anemia. The patient was treated with stellate ganglion block, hyperbaric oxygen, and ferrous sulfate. His visual acuity never recovered to better than 0.08. He had a coincidental rectal carcinoid and the tumor was excised surgically. No metastasis was observed. BRAO can be a complication of anemic retinopathy and can lead to severe visual loss without early medication.

To characterize the ophthalmological features and clinical course of an autosomal dominant cone–rod dystrophy (CORD2) in a Japanese family with an Arg41Trp mutation in the CRX gene. Mutation screening by direct sequencing was performed on 42 patients with cone–rod dystrophy. The clinical features of the patients were characterized by the visual acuity and by the findings of slit-lamp biomicroscopy, electroretinography, fluorescein angiography, and kinetic visual field testing. An Arg41Trp mutation in the CRX gene was identified in three members from three generations of one family with cone–rod dystrophy. Fundus examination demonstrated that the retinal dystrophy worsened with increasing age. A heterozygous Arg41Trp mutation in the CRX gene can produce cone–rod dystrophy in Japanese patients. Clinical examination of patients of different ages demonstrated that there was a rapid progressive worsening of the disease with increasing age.

Purpose To investigate the site specificity of visual field changes in eyes with normotensive preperimetric glaucoma (PPG), and to determine factors influencing visual field progression. Methods This prospective study comprised 84 eyes of 84 normotensive PPG patients followed for at least 16 months. Optic nerve head (ONH) blood flow was assessed with tissue-area mean blur rate (MBRT), derived from laser speckle flowgraphy. Total deviation (TD) was measured in each sector of the Garway-Heath map to evaluate the site specificity of visual field loss. Subjects with a TD slope in the first quartile were classified as progressive, and other subjects as nonprogressive. Linear and multiple regression analyses were performed to determine factors affecting visual field progression. Results TD in the superior sector significantly decreased in the subjects overall during the follow-up periods (-0.48 ± 1.92 dB/y, P = 0.025). Linear regression analysis showed that basal MBRT-inferior was correlated significantly with TD-superior slope (r = 0.332, P = 0.002). Furthermore, basal MBRT was significantly lower in this sector in the progressive than the nonprogressive group (P = 0.010). Multiple linear regression analysis revealed that basal MBRT-inferior was the only predictive factor for TD-superior slope (β = 0.329, P = 0.005). Conclusions These findings suggest that superior-sector visual field progression is most common in normotensive PPG eyes, and that reduced basal ONH blood flow is associated with visual field progression. Translational relevance These findings provide new insight into the involvement of ONH blood flow impairment in glaucoma pathogenesis, and demonstrate the importance of assessing ONH blood flow to determine visual field progression in normotensive PPG.

We demonstrate a prototype system of polarization-sensitive optical coherence tomography (PS-OCT) designed for clinical studies of the anterior eye segment imaging. The system can measure Jones matrices of the sample with depth-multiplexing of two orthogonal incident polarizations and polarization-sensitive detection. An optical clock is generated using a quadrature modulator and a logical circuit to double the clock frequency. Systematic artifacts in measured Jones matrices are theoretically analyzed and numerically compensated using signals at the surface of the sample. Local retardation images of filtering blebs after trabeculectomy show improved visualization of subconjunctival tissue, sclera, and scar tissue of the bleb wall in the anterior eye segment.

Purpose. To determine the correlation of reduced retinal thickness in the central papillomacular bundle (CPB) to central visual function, including central retinal sensitivity and visual acuity, in glaucoma patients.Methods. This study enrolled 50 eyes of 50 patients with open-angle glaucoma who were carefully screened for comorbid conditions that can cause decreased central visual function, such as cataracts or macular diseases. We used a novel CPB analysis comprising a program for optical coherence tomography that measured RNFL thickness and GCC thickness in the CPB and divided lengthwise into three parts (upper, middle, and lower CPB). The relationship of these parameters, including conventional macular thickness, to visual field sensitivity in four central standard automated perimetry points (the central four thresholds) and BCVA was analyzed.Results. The two parameters most highly correlated with central four thresholds were macular GCCT and macular RNFLT. The two parameters most highly correlated with BCVA were middle CPB (mid-CPB) GCCT and mid-CPB RNFLT. A multiple regression analysis revealed that mid-CPB GCCT was an independent factor impacting central retinal thresholds and BCVA.Conclusions. Our results suggest that mid-CPB RNFLT and GCCT, parameters of a novel papillomacular bundle analysis, are candidate biomarkers of decreased central visual function in glaucomatous eyes.

PURPOSE To report on the effectiveness and safety of an ophthalmic piezoelectric actuator-driven pulsed water jet (ADPJ) system adapted for intraocular use. METHODS First, we determined the highest ADPJ flow rate that did not cause an unsafe rise in intraoperative intraocular pressure (IOP) in rabbits (n = 4). Next, we determined the most effective ADPJ frequency (in hertz) at that flow rate. Finally, we visualized the ADPJ stream, measured its pressure, and determined the minimum voltage and distance between the ADPJ needle and retinal veins to induce intravenous displacement of the blood column (DBC) through massage of the outer retinal vessels (n = 3) while not causing retinal tearing or hemorrhage. RESULTS We found that a 0.05 mL/min ADPJ flow rate caused IOP to rise above 40 mm Hg after 1 minute, but that at 0.025 mL/min, IOP stayed below 40 mm Hg even after 3 minutes. Moreover, we found that a 0.025 mL/min ADPJ stream was stable at a pulse frequency of 10 Hz and that at this flow rate/frequency the ADPJ pressure was closely correlated with the applied voltage (P < 0.001, r2 = 0.9991). The minimum voltage and distance to achieve intravenous DBC without causing retinal tearing or hemorrhage were 40 V and 0.5 mm, respectively. CONCLUSIONS With an appropriate flow rate and surgical time, ADPJ successfully induced massage of the retinal vessels and intravenous DBC while maintaining safe IOP and not causing retinal complications. TRANSLATIONAL RELEVANCE The ADPJ system has promise as a safe and minimally invasive instrument for the intraocular surgical treatment of human retinal vascular diseases.

Giant retinal tears (GRTs; ≥ 90°) are rare and difficult to treat successfully for even experienced vitreous surgeons. Using microincision vitrectomy surgery (MIVS) to treat GRTs has been an important advancement. Here we describe the surgical technique and its complications.Initially, the eye is carefully vitrectomized with MIVS using a modern wide-viewing system and chandelier illumination. Perfluorocarbon liquid (PFCL) is then gently injected. After endophotocoagulation, the PFCL is exchanged for silicone oil (SO) for a 2-week course of intraocular tamponade. Complete retinal reattachment and visual recovery are achieved after the SO is removed.Postoperative complications in the retina include macular pucker, subretinal PFCL, retinal folds, cystoid macular edema, and redetachment due to proliferative vitreoretinopathy. All complications can be resolved with medication or surgery.The techniques for MIVS offer a feasible new approach for treating eyes with GRTs. In combination with intraoperative use of PFCL and a 2-week course of SO tamponade, MIVS is highly recommended to all vitreous surgeons seeking an excellent rate of reattachment.

Background It is difficult to identify glaucoma in myopic eyes because the configuration of the optic disc varies; yet it is important clinically. Here, we used laser speckle flowgraphy (LSFG) to measure mean blur rate (MBR), representing optic disc microcirculation, and assessed its ability to identify glaucoma in eyes with myopic optic discs. Methods 129 eyes (normal disc: 21 eyes; myopic disc: 108 eyes) were enrolled. The eyes were classified as normal or mildly, moderately, or severely glaucomatous with standard automated perimetry (SAP). We determined the relationship between optic nerve head (ONH) MBR, measured with LSFG, mean deviation (MD), measured with SAP, and circumpapillary retinal nerve fiber layer thickness (cpRNFLT), measured with optical coherence tomography (OCT). Results ONH MBR and cpRNFLT decreased significantly with the severity of glaucoma. MBR was significantly correlated with cpRNFLT and MD (r =0.65 and r =0.63, respectively). A multiple regression analysis revealed that MBR and cpRNFLT were independent factors indicating glaucoma severity. A logistic regression analysis revealed that MBR and cpRNFLT were also independent factors indicating the presence of glaucoma. In a receiver operating characteristic (ROC) analysis, MBR and cpRNFLT could both differentiate between normal and glaucomatous eyes (MBR area under the ROC curve: 0.86, with a cut-off score of 24.0 AU). Conclusion These results suggest that in addition to cpRNFLT, non-invasive and objective LSFG measurements of MBR may enable the identification of glaucoma and the classification of its severity in eyes with myopic optic discs.

Fumihiko Nitta,1 Hiroshi Kunikata,1,2 Naoko Aizawa,1 Kazuko Omodaka,1 Yukihiro Shiga,1 Masayuki Yasuda,1 Toru Nakazawa1–31Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan; 2Department of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan; 3Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanBackground: This study evaluated the effect of intravitreal injection of bevacizumab (IVB) on macular edema associated with diabetic retinopathy (DME) or branch retinal vein occlusion (BRVOME) using laser speckle flowgraphy.Methods: A comparative interventional study of25eyes from22patients with macular edema (DME group:12eyes; BRVOME group:13eyes) who underwent IVB. Mean blur rate (MBR) was measured in the retinal artery, retinal vein, optic nerve head (ONH), and choroid before and after IVB. Results: In the BRVOME group, there was no significant change in MBR in the retinal artery, retinal vein or ONH, but choroidal MBR decreased significantly (P=0.04). In the DME group, the MBR in the retinal artery, retinal vein, ONH, and choroid decreased significantly (P=0.02, P=0.04, P

Aqueous humor (AH) is one of the body fluids in the eye, which is known to be related with various ocular diseases, but the complete RNAs characteristic of the AH in patients is not yet known. The aim of this study was, with a microarray analysis, to reveal the disease-related extracellular miRNAs profiles in individual patients AH. 100 μl of AH was collected by anterior chamber paracentesis from 10 glaucoma, 5 cataract, and 5 epiretinal membrane patients. The extracted total RNAs were shorter than 200 nt, and their amount was 5.27 ± 0.41 ng in average. Among 530.5 ± 44.6 miRNA types detected in each sample with a microarray detectable 2019 types of matured miRNAs, 172 miRNAs were detected in all 10 glaucoma or control patients. From the glaucoma group, 11 significantly up-regulated and 18 significantly down-regulated miRNAs (P < 0.05 for both) were found to have areas under the curve better than 0.74 in a receiver operating characteristic analysis. They also formed a cluster composed only of glaucoma patients in a hierarchal cluster analysis. AH had a possibility of becoming a source of miRNA that can serve as a biomarker and a therapeutic target.

Importance One month after the Great East Japan Earthquake on March 11, 2011, our clinic was granted free use of the Mission Vision Van, a customized bus airlifted to Japan. This mobile eye clinic made it possible for us to provide ophthalmologic examinations anywhere in the disaster zone in Miyagi Prefecture. Observations This study included 731 patients who received treatment in the eye care van in Miyagi Prefecture between April 15 and May 29, 2011. We examined and cared for patients during 25 visits to 11 emergency districts during 15 clinic days. Of the 914 diagnoses we identified, 358 were refractive disorders (39.2%), which were the most common ocular diseases we observed; others included 155 (17.0%) cataracts, 106 (11.6%) dry eye, and 73 (8.0%) infectious diseases, such as conjunctivitis. Overall, we provided emergency prescriptions for 871 bottles of eyedrops comprising 222 prescriptions (25.5%) for dry eye, 189 (21.7%) for cataracts, and 107 (12.3%) for glaucoma. Conclusions and Relevance A substantial number of patients in the earthquake-damaged areas needed replacements for eyeglasses, contact lenses, and eyedrops. The mobile clinic appears to be a useful way to provide ophthalmologic examinations and support after a disaster.

Laser speckle flowgraphy (LSFG), a new, non-invasive method of measuring the mean blur rate (MBR) of ocular blood flow, allows for the analysis of the pulse waveform of a heartbeat as it changes dynamically. Here, we investigated the relationship between the pulse waveform and clinical parameters, particularly age.Sixty eyes of 60 healthy subjects without diabetes were enrolled from among patients undergoing annual health examinations. LSFG, and its analysis software, were used to determine pulse waveform parameters including MBR, skew, blowout score (BOS), blowout time (BOT), rising rate and falling rate in the optic nerve head (ONH), both specifically in the tissue area and in the ONH overall. Fifteen clinical parameters were also recorded, including age and blood pressure, as well as triglyceride and creatinine levels.Skew, BOT and falling rate had a strong correlation (|r| 0.60) with age, but not with the other clinical parameters. This correlation with age was stronger in the tissue area (BOT: p 0.0001, r = - 0.68; skew: p 0.0001, r = 0.65; falling rate: p 0.0001, r = 0.61) than in the ONH overall (BOT: p 0.0001, r = -0.67; skew: p 0.0001, r = 0.60; falling rate: p 0.0001, r = 0.59). Stepwise multiple regression analysis revealed that tissue area falling rate was an independent factor indicating age, and conversely that age was an independent factor indicating tissue area falling rate.The significant correlation of LSFG-measured tissue area falling rate with age suggests that it may be a new candidate biomarker for age-dependent microcirculation.

Abbreviations PDR proliferative diabetic retinopathy PEDF pigment epithelium-derived factor VEGF vascular endothelial growth factor To the Editor: Intraocular neovascularisation develops in many ischaemic retinal diseases, e.g. diabetic retinopathy, ischaemic retinal vein occlusion and retinopathy of prematurity. The new vessels are fragile and often rupture, leading to vitreous haemorrhage, tractional retinal detachment, neovascular glaucoma and subsequent vision decrease. The formation of new vessels is dependent on a local balance of stimulators and inhibitors of angiogenesis [1]. Among the stimulators, vascular endothelial growth factor (VEGF) has been shown to play a major role in mediating active neovascularisation in patients with diabetic retinopathy [2]. In addition, several studies have shown that the concentration of VEGF in the intraocular fluids was significantly elevated in eyes with proliferative diabetic retinopathy (PDR) [3–5]. On the other hand, pigment epithelium-derived factor (PEDF) is a potent inhibitor of angiogenesis, and lower levels of PEDF have been found in the vitreous of eyes with active diabetic retinopathy [4]. It has also been shown that the vitreous level of endostatin, another inhibitor of angiogenesis, is correlated with the level of VEGF and that endostatin is produced in the fibrovascular membrane of eyes with PDR [5]. Vasohibin-1, a novel angiogenesis inhibitor, is mainly produced in endothelial cells and is induced by stimulation with VEGF or fibroblast growth factor 2. Vasohibin-1 selectively affects endothelial cells and inhibits angiogenesis [6]. We therefore hypothesised that vasohibin-1 is present in the vitreous of eyes with PDR and is associated with the vitreous level of VEGF. To examine this hypothesis, we measured the vitreous levels of vasohibin-1 and VEGF in 49 samples from 46 patients. This study was conducted in accordance with the tenets of the Declaration of Helsinki as revised in 2000 and was carried out with the approval of the Institutional Review Board of Tohoku University. Informed consent was obtained from all patients Diabetologia (2009) 52:359–361 DOI 10.1007/s00125-008-1229-z

Purpose.To assess the association between optic nerve head (ONH) microcirculation, central papillomacular bundle (CPB) structure, and visual function in eyes with treatment naive normal tension glaucoma (NTG).Methods. This study included 40 eyes of 40 patients with NTG and 20 eyes of 20 normal patients. We used laser speckle flowgraphy (LSFG) to measure mean blur rate (MBR) in all eyes and calculated the ratio of MBR in the horizontal quadrants of tissue area ONH (temporal/nasal ratio of MBR in the tissue area: T/N MT). Clinical findings also included retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) in the CPB and macular areas, best-corrected visual acuity (BCVA), mean deviation (MD), and refractive error.Results. T/N MT was correlated with both BCVA and MD. The OCT parameters most highly correlated with T/N MT were macular RNFLT and mid-CPB RNFLT. Furthermore, T/N MT, mid-CPB RNFLT, and macular RNFLT were higher in NTG than in normal eyes. A discrimination analysis revealed that T/N MT and refractive error were independent factors indicating NTG.Conclusions. Our results suggest that T/N MT is a candidate biomarker of NTG. Furthermore, T/N MT reflects visual function, including acuity and sensitivity, and CPB structure.

To evaluate the efficacy of combined 25-gauge microincision vitrectomy surgery, intraocular lens (IOL) implantation, and posterior capsulotomy.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.Comparative case series.The medical records of eyes that had 25-gauge microincision vitrectomy and IOL implantation without posterior capsulotomy (June 2009 to May 2010) or with posterior capsulotomy (June 2010 to May 2011) were reviewed. Outcomes measured were corrected distance visual acuity (CDVA) at 1 and 6 months, the rate of neodymium:YAG (Nd:YAG) laser capsulotomies for postoperative posterior capsule opacification (PCO), and the rate of surgical complications.The records of 343 eyes were reviewed; 136 eyes did not have a posterior capsulotomy, and 207 eyes had a posterior capsulotomy. There was a significant difference in the rate of Nd:YAG capsulotomy between the no-capsulotomy group (18 eyes, 13.2%) and the capsulotomy group (2 eyes, 1.0%) (P.01). The mean CDVA improved postoperatively in both groups (P.01); in 20 patients with postoperative PCO, the mean CDVA improved after Nd:YAG capsulotomy (P.05). Intraoperatively, gas leaked into the anterior chamber in 5 (6.3%) of 79 eyes in the capsulotomy group that required fluid-air exchange.Combined 25-gauge microincision vitrectomy, IOL implantation, and posterior capsulotomy was safe and reduced the need for postoperative Nd:YAG capsulotomy. Posterior capsulotomy should be performed with caution in eyes that are expected to require intraoperative fluid-air exchange.

Hintergrund: Störungen der Riechfunktion sind ein verbreitetes Symptom vieler neurodegenerativer Erkrankungen, und die altersbedingte Makuladegeneration (AMD) ist eine spät einsetzende neurodegenerative Krankheit. Ziel: Vor diesem Hintergrund war das Ziel dieser Studie die Untersuchung der Geruchsfunktion bei Patienten mit AMD. Methoden: Insgesamt wurden 69 Patienten mit AMD und 69 nach Alter und Geschlecht angepasste gesunde Kontrollprobanden eingeschlossen. Nach einer umfassenden augenärztlichen Untersuchung wurden die AMD-Patienten nach Früh- oder Spätstadium der AMD unterteilt. Psychophysische Tests der olfaktorischen Funktion wurden unter Verwendung des validierten Testinstruments Sniffin' Sticks durchgeführt. Ergebnisse: Die Studie wurde mit 138 Probanden durchgeführt; das mittlere Alter betrug 74,3 ± 8,9 Jahre (Bereich 51-89 Jahre). Die aktuelle Untersuchung erbrachte 2 Hauptergebnisse: 1) Die Patienten mit AMD zeigten im Vergleich zu den Kontrollen auch schon in frühen Stadien der AMD vermindertes Riechvermögen, insbesondere bei der Unterscheidung und Erkennung von Gerüchen; in späteren AMD-Stadien war das Riechvermögen hingegen bei sämtlichen Teilaufgaben der Riechtests schlechter. 2) Mit abnehmender Sehschärfe verschlechterte sich bei den AMD-Patienten auch das Riechvermögen. Schlussfolgerung: Diese Studie belegt, dass AMD sich bei allen Riechaufgaben signifikant negativ auswirkte, insbesondere in fortgeschrittenen Krankheitsstadien. Ähnlich wie bei anderen neurodegenerativen Erkrankungen scheinen Geruchsdiskriminierung und -identifizierung stärker zu leiden als die Geruchserkennungsschwelle. Übersetzung aus Kar T, et al: The relationship between age-related macular degeneration and olfactory function. Neurodegener Dis 2015;15:219-224 (DOI: 10.1159/000381216)

Zielsetzung: Das Ziel dieser Studie war die Auswertung der klinischen Ergebnisse und von Aberrationen höherer Ordnung (AHO) nach biaxialer Mikroinzisions-Kataraktchirurgie (B-MICS; 1,4 mm) und Implantation einer neuen asphärischen Intraokularlinse (IOL). Material und Methoden: Insgesamt wurden 157 Augen von 106 Patienten in diese prospektive, monozentrische Studie aufgenommen. Auf die B-MICS (1,4 mm; 26 Augen) folgte die Implantation der asphärischen Mikroinzisionslinse Incise® IOL MJ14T (Bausch & Lomb, Rochester, NY, USA). Bei den Patienten in den Kontrollgruppen wurde entweder eine 1,8-mm- (koaxiale MICS, Akreos MI60, 41 Augen), eine 2,2-mm- (Kleininzisions-Kataraktchirurgie, Tecnis ZCB00, 44 Augen) oder eine 2,2-mm-Koaxial-Phakoemulsifikation (Kleininzisions-Kataraktchirurgie, CT Asphina, 46 Augen) mit Implantation einer asphärischen IOL durchgeführt. Nachfolgend wurden intraoperative und postoperative Komplikationen, der bestkorrigierte Visus, AHO bei einer 5,0-mm-Pupille mittels iTrace-Aberrometer (Tracey Technologies, Houston, TX, USA) sowie der Endothelzell-Verlust analysiert. Der Unterschied zwischen den Gruppen wurde mittels Varianzanalyse ausgewertet. Ergebnisse: In der Incise-Gruppe verbesserte sich der durchschnittliche bestkorrigierte Visus signifikant von 0,4 ± 0,27 logMAR präoperativ auf 0,05 ± 0,07 postoperativ. Der quadratische Mittelwert der Gesamt-AHO in den Augen betrug 0,419 ± 0,191 µm, die sphärische Aberration 0,168 ± 0,072 µm und die Koma 0,213 ± 0,200 µm. Beim bestkorrigierten Visus (p = 0,097), der Gesamt-AHO (p = 0,630) und der Koma (p = 0,193) bestand kein statistisch signifikanter Unterschied zwischen den 4 Gruppen. Schlussfolgerung: Die asphärische Mikroinzisions-IOL wurde sicher durch eine 1,4-mm-Inzision implantiert und lieferte ähnlich gute postoperative Ergebnisse wie die koaxiale 1,8- und 2,2-mm-Phakoemulsifikation. Übersetzung aus von Sonnleithner C, et al: Clinical results and higher-order aberrations after 1.4-mm biaxial cataract surgery and implantation of a new aspheric intraocular lens. Ophthalmic Res 2015;53:8-14 (DOI: 10.1159/000364808)

Der Gehalt des Glaskörpers an vaskulärem endothelialem Wachstumsfaktor (VEGF), löslichem VEGF-Rezeptor 2 (sVEGFR-2), löslichem interzellulärem Adhäsionsmolekül 1 (sICAM-1), Monozyten-chemotaktischem Protein 1 (MCP-1) und Pentraxin 3 (PTX3) wurde bei 36 Patienten mit diabetischem Makulaödem (DMÖ) und 15 Patienten mit Makulaforamen (MF) mittels Enzymimmunoassay (enzyme-linked immunosorbent assay) bestimmt. Die Tyndall-Werte wurden mit einem Laser-Flare-Meter ermittelt und das Makulaödem mittels optischer Kohärenztomografie untersucht. Der Gehalt des Glaskörpers an VEGF, sVEGFR-2, sICAM-1, MCP-1 und PTX3 war bei den Patienten mit DMÖ signifikant höher als bei denen mit MF. Zwischen dem Glaskörper-Gehalt an sVEGFR-2 und den Konzentrationen von sICAM-1, MCP-1 und PTX3 bestand eine signifikante Korrelation. Der Tyndall-Wert korrelierte signifikant mit dem Glaskörper-Gehalt an sVEGFR-2, sICAM-1, MCP-1 und PTX3. Diese Ergebnisse deuten darauf hin, dass Entzündungsfaktoren bei DMÖ-Patienten eine erhöhte Gefäßpermeabilität induzieren und zur Unterbrechung der Blut-Kammerwasser-Schranke führen könnten. Übersetzung aus Noma H, et al: Role of inflammation in diabetic macular edema. Ophthalmologica 2014;232:127-135 (DOI: 10.1159/000364955)

Die Ausbildung des vorderen Segments des Auges ist ein komplizierter Prozess, der zu einem großen Teil von der normalen Entwicklung der Linse abhängt. Trotz intensiver Forschung zur Rolle gut beschriebener Augengene sind viele Ursachen für Anomalien der Linse und des vorderen Segments noch ungeklärt. Die meisten bisher erkannten beteiligten Gene agieren autosomal-dominant. Autosomal-rezessive Ursachen sind weniger gut beschrieben; ihre Diagnose wird bisher erschwert durch technologische Begrenzungen, extreme genetische Heterogenität und mangelndes Wissen über die Biologie des Auges und die Rolle vieler Gene im Genom. Gute Chancen zur Entdeckung extrem seltener autosomal-rezessiver Ursachen für Augenanomalien bietet die Untersuchung blutsverwandter Familien, vor allem mit der leistungsstarken Kombination aus Next-Generation Sequencing und Autozygotie-Kartierung. Nachdem der limitierende Faktor der genetischen Heterogenität ansatzweise überwunden ist, wird zunehmend erkannt, dass es weiterhin eine Herausforderung ist, die genetischen Varianten zu interpretieren und neue Gene mit einem bestimmten Phänotyp in Verbindung zu bringen. Ein erweitertes Verständnis der genetischen und mutationsbezogenen Grundlagen für Anomalien der Linse und des vorderen Segments wird von hohem Wert für unser Verständnis von Augenerkrankungen sein. Ferner wird es uns besser in die Lage versetzen, mutmaßlich krankheitsverursachende Varianten zutreffend zu interpretieren, um so die Patientenversorgung stärker zu personalisieren und lebenslangen Sehverlust bei Kindern zu verhindern. Übersetzung aus Gillespie RL, Lloyd IC, Black GCM: The use of autozygosity mapping and next-generation sequencing in understanding anterior segment defects caused by an abnormal development of the lens. Hum Hered 2014;77:118-137 (DOI: 10.1159/000362599)

Zielsetzung: Dies ist eine prospektive, randomisierte, multizentrische, prüferinitiierte Studie zur Beurteilung der 12-Monats-Wirksamkeit der isovolämischen Hämodilution (IH) in Kombination mit sofortigen versus späteren intravitrealen Injektionen (IVI) von Ranibizumab 0,5 mg bei der Behandlung des Makulaödems auf dem Boden eines frühen zentralen retinalen Venenverschlusses (ZVV). Methoden: Augen mit nicht mehr als 8 Wochen zuvor aufgetretenem Makulaödem infolge eines ZVV erhielten entweder monatliche Ranibizumab-IVI in Kombination mit IH (Gruppe I; n = 28) oder IH allein (Gruppe II; n = 30). Von Monat 2 bis 12 konnten die Patienten in beiden Gruppen monatlich mit intravitrealem Ranibizumab behandelt werden. Die wichtigsten Zielgrößen waren die Zunahme der Sehschärfe und die Veränderung der zentralen Netzhaut-Dicke laut optischer Kohärenztomografie. Ergebnisse: Nach 12 Monaten zeigten die Augen in Gruppe I eine durchschnittliche Verbesserung um +28,1 (±19,3) Buchstaben, verglichen mit +25,2 (±20,9) Buchstaben in Gruppe II (p = 0,326). Diese Ergebnisse wurden mit einer signifikant geringeren Anzahl Injektionen in Gruppe II erreicht. Zudem benötigten 30% der Augen in Gruppe II über die 12-monatige Studiendauer hinweg gar keine Ranibizumab-IVI. Schlussfolgerung: Die Ranibizumab-IVI zusätzlich zur IH erwiesen sich als hochgradig wirksam in Bezug auf die Verbesserung der Sehschärfe und Reduktion des Makulaödems infolge von ZVV. Eine initiale IH bei frühem ZVV könnte eine erste Therapieoption bei Patienten sein, die gegenüber IVI Vorbehalte haben. Übersetzung aus Kreutzer TC, et al: Intravitreal ranibizumab versus isovolemic hemodilution in the treatment of macular edema secondary to central retinal vein occlusion: twelve-month results of a prospective, randomized, multicenter trial. Ophthalmologica 2015;233:8-17 (DOI: 10.1159/000369566)

Ziele: Untersuchung des Zusammenhangs zwischen Sehbehinderung und sturzbedingten Hüftfrakturen und Bestimmung der Ätiologie der Sehbehinderung bei einer Population älterer Patienten mit Hüftfrakturen. Methoden: In einer Fall-Kontroll-Studie wurden 96 Patienten mit diagnostizierter Hüftfraktur mit einer zufällig ausgewählten Kontrollgruppe von 103 Patienten ohne Hüftfraktur verglichen. Die Einschlusskriterien für die Fallgruppe waren ein Lebensalter von ≥60 Jahren und eine Hüftfraktur. Die klinische Beurteilung umfasste einen Sehtest und eine augenärztliche Untersuchung. Ergebnisse: 43 Patienten mit Hüftfraktur hatten eine Sehbehinderung, verglichen mit nur 12 Patienten in der Kontrollgruppe. Eine Sehbehinderung stellte einen signifikanten Risikofaktor für eine Hüftfraktur dar (Odds Ratio (OR) 6,15; 95%-Konfidenzintervall (KI) 2,98-12,69). Bei 27 Patienten mit Hüftfraktur lag eine unkorrigierte Fehlsichtigkeit vor; bei den Kontrollprobanden waren es 15 (OR 2,78; 95%-KI 0,92-8,35). Im Hinblick auf dichte Katarakt bestand kein signifikanter Unterschied zwischen den beiden Gruppen (OR 2,28; 95%-KI 0,75-6,93). Bei 14 Hüftfraktur-Patienten lag eine Makuladegeneration vor, im Vergleich zu nur 8 Kontrollpatienten (OR 5,63; 95%-KI 1,57-20,18), und bei 10 Patienten bestand der Verdacht auf Glaukom, verglichen mit nur 5 Kontrollen (OR 10,65; 95%-KI 2,21-51,3). Schlussfolgerung: Das Vorliegen einer Sehbehinderung war bei älteren Menschen signifikant mit einem erhöhten Risiko für Hüftfrakturen assoziiert. Viele verschiedene Ätiologien können auf diese Weise zu Hüftfrakturen beitragen, insbesondere Fehlsichtigkeit, Katarakt, Makuladegeneration und Glaukom. Übersetzung aus Loriaut P, et al: Visual impairment and hip fractures: a case-control study in elderly patients. Ophthalmic Res 2014;52:212-216 (DOI: 10.1159/000362881)

Ziel: Zur Behandlung betroffener Augen von Patienten mit monolateraler Fazialisparese wurde ein einfacher chirurgischer Eingriff für die Korrektur von Ektropium und sichtbarer Sklera vorgenommen. Methoden: 15 Patienten mit Fazialisparese vom Schweregrad IV-VI auf der House-Brackmann-Skala wurden nach unserem chirurgischen Verfahren evaluiert, und die Ergebnisse wurden mit denen verschiedener anderer Verfahren verglichen. Ergebnisse: Wir wendeten eine augenschonende Technik an. Vor diesem Hintergrund war die Dissektion des Musculus orbicularis oculi der wichtigere Verfahrensschritt. Es gelang, nur mit medialen oder lateralen Muskellappen-Nähten das Ektropium und die lateral sichtbare Sklera zu korrigieren. Hier beschreiben wir ausführlich das operative Vorgehen, mit Bilderstrecke und Anleitung. Schlussfolgerung: Die nichtinvasive Chirurgie zeitigte in 100% der Fälle gute klinische Ergebnisse ohne jegliche Risiken oder nachfolgende Rückfälle. Übersetzung aus Di Stadio A: Eyelid lifting for ectropion and scleral show in facial palsy disease. ORL 2014;76:329-335 (DOI: 10.1159/000369623)