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Olga Furashova,1 Joerg Thalwitzer,2 Egbert Matthé3 1Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany; 2Department of Neuroradiology, Klinikum Chemnitz gGmbH, Chemnitz, Germany; 3Department of Ophthalmology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, GermanyCorrespondence: Olga Furashova, Department of Ophthalmology Klinikum Chemnitz gGmbH, Flemmingstrasse 2, Chemnitz, 09116, Germany, Tel +49 371 333 33230, Fax +49 371 333 33223, Email fur.olga@gmail.comPurpose: To report on four cases of central retinal artery occlusion (CRAO) treated with intra-arterial thrombolysis with early onset neovascular glaucoma in the further disease course.Patients and Methods: Retrospective analysis of the medical records of six consecutive patients treated with intra-arterial thrombolysis for CRAO of which four developed neovascular glaucoma.Results: All six patients were diagnosed with acute CRAO and treated with intra-arterial thrombolysis 4.5– 6 hours after symptom onset. The patients had no significant carotid artery stenosis and unremarkable ophthalmic history. No visual improvement could be achieved after treatment. Four to seven weeks after CRAO onset, four of these patients developed severe painful neovascular glaucoma.Conclusion: Early onset of aggressive neovascular glaucoma following intra-arterial thrombolysis for CRAO might be a complication of CRAO itself, still possible association with intra-arterial thrombolysis in our patients should be discussed.Keywords: neovascular glaucoma, retinal artery occlusion, intra-arterial thrombolysis

PURPOSE To compare changes in thickness of separate retinal layers between acute central and branch retinal artery occlusion (RAO) regarding the severity grade of retinal ischemia using spectral-domain optical coherence tomography. METHODS Design: retrospective, observational case-control series. SETTING institutional. PATIENTS 114 patients with acute RAO. Examinations were conducted with spectral-domain optical coherence tomography at the first visit (baseline). OBSERVATIONS RAO was categorized as branch (43 patients) or central RAO (71 patients) clinically. Retinal artery occlusion was categorized into the 3 grades "incomplete," "subtotal," and "total," based on optical coherence tomography findings. Thickness of several retinal layers was evaluated on spectral-domain optical coherence tomography images. Obtained data were compared between the 3 grades and between central and branch RAO. The contralateral eyes were used as controls. MAIN OUTCOME MEASURES thickness of selected retinal layers. RESULTS Thickness of selected inner retinal layers and central foveal thickness increased statistically significant according to the severity grade (healthy = incomplete < subtotal < total). In each severity grade, there was no significant difference in retinal layers' thickness between branch and central RAO, except for central foveal thickness. CONCLUSION Thickness increase of selected retinal layers follows-except for central foveal thickness-the same pattern in central and branch RAO. Retinal layers' thickness increases significantly with the higher ischemia grade in both central and branch RAO.

It has been shown in the literature that the Valsalva manoeuvre influences ocular perfusion by changing intraocular pressure and central retinal venous pressure (CRVP). High-resistance wind instrument (HRWI) playing is a common situation resembling a Valsalva manoeuvre. The aim of this investigation was to explore the influence of amateur trumpet playing on CRVP. The left eyes of 20 healthy non-professional trumpet players (median age 26, range 19–52 years; 17 males, 3 females) were included in this investigation. Subjects, sitting at a slit lamp, were asked to play the tone b’ flat with their own mouthpiece on the same trumpet for at least 30 s with moderate loudness. The following data were obtained: intraocular pressure (IOP) by applanation tonometry before and during playing, CRVP by contact lens dynamometry before and during playing, airway pressure (AirP) using a pressure sensor during playing and blood pressure and heart rate using the common cuff method before and during playing. The results are presented as the medians before vs during playing: a calculated mean ophthalmic artery pressure of 66 vs 72 mmHg, heart rate of 76 vs 82 beats per minute, airway pressure of 0 vs 17 mmHg, IOP 12 vs 13 mmHg and CRVP of 24 vs 55 mmHg (Wilcoxon test: p = 0.00009), respectively. A correlation between the CRVP during playing and the height of the spontaneous CRVP is noted (Spearman rank correlation coefficient: ρ = 0.68). Amateur trumpet playing increases CRVP, airway pressure and IOP. The increase in CRVP is greater than that of the intraocular pressure. The increase in CRVP seems to be more important for retinal perfusion changes during trumpet playing than the increase of IOP. It can be hypothesised that high airway pressure during playing may cause a permanent increase in CRVP, at least in a subgroup of trumpet players.

To investigate the prevalence and predictive value of the foveal crack sign (FCS) in fellow eyes of patients with full-thickness macular holes (FTMH) regarding future macular hole (MH) formation. In a retrospective observational case series, 113 fellow eyes of 113 patients with FTMH have been observed during a mean follow-up time of 21 months. According to baseline SD-OCT images, patients were divided into 4 separate groups: patients with FCS and vitreous adhesion, patients with FCS and vitreous detachment, patients without FCS with vitreous adhesion, patients without FCS with vitreous detachment. Progression rate to MH formation, predictive value of FCS and of vitreous interface status were calculated and compared across the four groups. FCS was observed in 19 of 113 fellow eyes (17%) of patients with FTMH, 10 of them with progression to MH during the mean follow up time of 21 months. 2 other eyes with progression to MH showed no FCS at baseline. Progression rate was shown to be 77% (10 of 13 eyes) in patients with FCS and vitreous adhesion, 0% (none of 6 eyes) in patients with FCS and vitreous detachment, 4% (2 of 48 eyes) in patients without FCS with vitreous adhesion, 0% (none of 46 eyes) in patients without FCS with vitreous detachment. FCS had sensitivity of 83.3% (95% CI 50.9–97.1%) and specificity of 91.1% (95% CI 83.3–95.6%) in predicting MH formation, positive predictive value of FCS was 52.6% (95% CI 29.5–74.8%) and negative predictive value 97.9% (95% CI 91.8–99.6%). Having simultaneously FCS and vitreous adhesion showed 83.3% (95% CI 50.9–97.1%) sensitivity and 97.1% (95% CI 91.1–99.2%) specificity in predicting macular hole formation; positive predictive value was 76.9% (95% CI 46.0–93.8%) and negative predictive value was 98.0% (95% CI 92.4–99.7%). Fellow eyes of patients with FTMH with foveal crack sign are at a very high risk (77%) of FTMH development, as long as posterior vitreous adhesion is present.

Olga Furashova,1 Egbert Matthè2 1Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz 09116, Germany; 2Ophthalmology Department, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, GermanyCorrespondence: Olga FurashovaDepartment of Ophthalmology, Klinikum Chemnitz gGmbH, Flemmingstrasse 2, Chemnitz 09116, GermanyTel +49 371 333 33230Fax +49 371 333 33223Email fur.olga@gmail.comPurpose: To investigate the reflectivity changes of inner retinal layers in acute retinal vein occlusion (RVO) on spectral-domain optical coherence tomography (SD-OCT) and to correlate these values with other known parameters of acute ischemic damage.Patients and Methods: In this retrospective and observational case series, 230 eyes from 115 patients with acute RVO (central or branch) were categorized as ischemic or non-ischemic depending on fluorescein angiography (FA) images at baseline. Thickness and reflectivity of selected retinal layers were measured from SD-OCT images at baseline. Reflectivity values were correlated with other parameters of acute ischemic damage (best-corrected visual acuity (BCVA), retinal thickness, extent of macular edema, ischemic area on fluorescein angiography). The data were compared with contralateral eyes (controls). Prominent middle limiting membrane sign (p-MLM) was also registered.Results: RVO reflectivity values differed significantly in all retinal layers compared to controls (P< 0.001). Ischemic RVO eyes had higher optical intensity values for the innermost retinal layer (IMRL; P=0.008) and inner retinal layer (P=0.019) compared to non-ischemic cases. For all RVO eyes as well as central RVO, severity parameters like BCVA, central and total retinal thickness showed a strong correlation with the IMRL reflectivity. In branch RVO, BCVA remained significantly correlated with the IMRL reflectivity, while the thickness values showed significant correlation only for central foveal thickness in non-ischemic branch RVO type. The p-MLM was seen on OCT in 94% of the ischemic and in 66% of the non-ischemic RVO cases.Conclusion: Acute RVO leads to increased reflectivity of inner retinal layers with significantly higher values in the ischemic vs non-ischemic type. Increased inner retinal layers’ reflectivity correlated significantly with BCVA, retinal thickness of separate retinal layers, as well as ischemic area on FA. Quantitative non-invasive measurement of inner retinal layers’ reflectivity might be used to determine the extent of acute ischemic retinal damage in RVO.Keywords: retinal vein occlusion, optical coherence tomography, retinal layers’ reflectivity, acute retinal ischemia

PURPOSE To investigate hair cortisol concentration (HCC), a biochemical correlate of long-term cortisol output patterns, and its relationship to active central serous chorioretinopathy (CSC). METHODS Twenty-six participants were included in this observational pilot study (11 patients with active CSC and 15 healthy controls). Hair cortisol concentrations (HCCs) were determined from 3 cm hair strands collected near the scalp from patients and controls as an index of cumulative cortisol secretion over the 3-month period prior to hair sampling. RESULTS Patients with CSC exhibited higher HCCs (mean value: 20.14, 95% CI: 14.89-27.16 pg/mg) than healthy controls (mean value: 11.06, 95% CI: 8.63-14.22 pg/mg, p = 0.008). Group differences were not affected by relevant covariates (BMI, smoking status, sex). CONCLUSION Patients with active CSC have increased HCC, supporting the fact that cortisol is a major player in CSC pathogenesis.

Leber’s hereditary optic neuropathy is relatively rare, and no clinical pathognomonic signs exist. We present a rare case of bilateral vision loss of a patient with multiple drug abuse in the history. A 31-year-old man presented with a history of progressive, decreased vision in both eyes for 6 month. On examination, his visual acuity was hand motion in both eyes. Funduscopy demonstrated a temporal pallor of the optic disc. Goldmann visual field perimetry showed a crescent visual field in the right eye and a circular decrease to less than 50 ° in the left eye. Electroretinogram showed a scotopic b-wave amplitude reduction. Optical coherence tomographies, Heidelberg Retina tomography, visual evoked potentials, and magnetic resonance imaging with contrast as well as blood tests were normal. The patient reported to consume various kinds of drugs as well as recreational drug use and alcohol consumption since he was 16 years old. We started a hemodilution therapy, believing the patient suffered from a bilateral, toxic optic neuropathy due to his lifestyle. Laboratory results later on showed Leber’s hereditary optic neuropathy. Leber’s hereditary optic neuropathy is a rare disease without a typical, pathognomonic presentation. Even though the patient gave good reasons for a toxic optic neuropathy, one should never stop to test for other diseases.

Zusammenfassung Hintergrund Bei der vitreomakulären Traktion (VMT) besteht eine abnormal starke Adhärenz zwischen Netzhaut und Glaskörperkortex vorrangig um die Fovea. Es ist eine visusbedrohende Erkrankung mit den klinischen Symptomen Metamorphopsien und Visusreduktion. Seit 2013 ist Ocriplasmin (Jetrea®) zur intravitrealen Behandlung von vitreomakulären Traktionen und auch in Zusammenhang mit einem Makulaforamen (≤ 400 μm) in Deutschland zugelassen. Material/Methoden Alle 23 Augen von 21 Patienten mit persistierender vitreomakulärer Traktion mit und ohne Makulaforamen (MF), die bisher an unserer Klinik mit Ocriplasmin intravitreal behandelt wurden, werteten wir retrospektiv aus. Vor und nach der Behandlung erfolgten die Bestimmung des bestkorrigierten Visus (BCVA), eine ophthalmoskopische Vorderabschnitts- und Fundusuntersuchung, sowie eine SD-OCT-Untersuchung. Als therapeutischer Erfolg wurde die komplette Lösung der VMT bzw. der Verschluss des MF gewertet. Ergebnisse Eine komplette Lösung der VMT erfolgte bei 8 Augen (34,8 %), in 15 Augen (65,2 %) persistierte sie. Zwei der 4 MF waren nach der Behandlung verschlossen mit Normalisierung der anatomischen Strukturen der Netzhaut. Der Visus vor der Ocriplasmin-Injektion betrug im Mittel 0,39 ± 0,25 logMAR mit einem für die Gesamtgruppe leichten, jedoch nicht statistisch signifikanten Abfall auf 0,41 ± 0,24 logMAR (p = 0,613) nach 37,3 ± 22,9 Tagen. Die zentrale Netzhautdicke (CRT) betrug vor der Ocriplasmin-Injektion im Mittel 453,3 ± 172,7 µm mit einer leichten, jedoch für die Gesamtgruppe ebenfalls statistisch nicht signifikanten Abnahme auf 412,0 ± 212 µm (p = 0,124). Schlussfolgerung Ocriplasmin stellt eine medikamentöse Behandlungsoption bei VMT mit und ohne Makulaforamen dar. Unsere Ergebnisse unterstützen eine kritische Indikationsstellung, da signifikante Zusammenhänge bez. einer Patientenselektion ausblieben. Tendenziell korrelierte der Misserfolg mit zipfeliger Adhärenz, höherem Patientenalter sowie ausbleibenden Chromatopsien.

A twelve-year old girl presented herself for a routine ophthalmologic examination in our clinic. Best-corrected visual acuity (BCVA) was 1.0 on both eyes. On funduscopic examination we saw a yellow round structure inferior to the optic nerve head. In optical coherence tomography (OCT) examination the structure showed cupping and opening of the Bruch membrane and retinal pigment epithelium (RPE). Visual field testing revealed an absolute scotoma right in the area were the abnormal coloboma was localized. We diagnosed a pseudo-doubling of the optic disk, which is a rare condition with just a few reports about it in the literature. This finding is harmless and requires no treatment.

Retinale angiomatose Proliferationen (RAP) stellen eine Sonderform der bei exsudativer bzw. „neovaskularer“ altersbedingter Makuladegeneration (nAMD) auftretenden Neovaskularisationen dar. Haufig sind sie mit einem massiven Visusverlust assoziiert. Intravitreales Ranibizumab ist eine haufig angewendete Therapiemethode. Allerdings ist die Effektivitat geringer im Vergleich zu anderen choroidalen Neovaskularisationen. Wir untersuchten die Effektivitat von Ranibizumab im spaten Stadium RAP III mit retinochoroidalen Anastomosen im Vergleich zum Outcome von anderen CNV-Lasionen. Es handelt sich um eine retrospektive Analyse von allen Ranibizumab-behandelten Patienten mit nAMD. Die Patienten wurden unterteilt in Gruppen abhangig vom Lasionstypus in RAP (klinisch identifiziert und selektiert, bewiesen durch Fluoreszenzangiographie) und in CNV-Lasion (identifiziert durch Fluoreszenzangiographie) mit Einteilung in okkult, minimal und uberwiegend klassisch. Der bestkorrigierte Visus (BCVA) wurde vor (zum Zeitpunkt „Diagnose“) und wahrend (erste, zweite, dritte Injektion) der Behandlung erhoben sowie nach der Upload-Phase (1. Kontrollvisite). Vor der ersten Injektion verschlechterte sich der Visus in allen Gruppen (0,73 zu 0,78 logMAR fur alle CNV-Lasionen; 0,95 zu 1,02 logMAR fur RAP). Wahrend der Upload-Phase kam es in der RAP-Gruppe zu keiner weiteren Visusverschlechterung, aber auch zu keiner Verbesserung (1,02 zu 1,03 logMAR), in der anderen Gruppe kam es jedoch zu einem signifikanten Visusanstieg (0,78 zu 0,67 logMAR). Die Behandlung des spaten Stadiums III bei RAP-Lasionen mit Ranibizumab ist effektiv. Stabilisierung des Visus kann erreicht werden – aber im Unterschied zu anderen CNV-Lasionen keine weitere Verbesserung. Daher sollten Patienten mit RAP-Lasionen so fruh wie moglich identifiziert und behandelt werden.

Hintergrund: Die intravitreale Injektion des anti-VEGF-Inhibitors Ranibizumab gilt seit 2007 als Standardtherapie fur die Behandlung der exsudativen AMD. Trotz konsequenter Behandlung mit Ranibizumab kann nicht bei allen Patienten eine vollstandige Befundberuhigung erreicht werden. Seit 2012 steht mit dem rekombinanten Fusionsprotein Aflibercept eine 2. gleichwertige Therapieoption zur Verfugung. Wir untersuchten, ob Patienten, die scheinbar nicht mehr auf Ranibizumab ansprechen, von einem Wechsel auf Aflibercept profitieren. Methoden: In diese retrospektive Studie wurden 83 Augen von 81 Patienten eingeschlossen, bei denen seit Zulassung von Aflibercept 2012 die Indikation zum Therapiewechsel nach therapierefraktarer Ranibizumab-Behandlung gestellt wurde. Einschlusskriterien waren ein Alter ≥ 50 Jahre und mindestens 10 stattgehabte Ranibizumab-IVI (IVI: intravitreale Injektion) am Studienauge vor Therapiewechsel auf Aflibercept. Ausgeschlossen wurden Patienten, die zusatzlich andere schwerwiegende visuslimitierende Erkrankungen aufwiesen. Primare Endpunkte waren die Visusentwicklung und die Beurteilung der zentralen Netzhautdicke (CMT) im OCT. Sekundare Endpunkte waren der prozentuale Anteil Augen, die nach Aflibercept-IVI keine Aktivitat der choroidalen Neovaskularisation (CNV) mehr zeigten und der Anteil der Augen mit Zeilengewinn/-verlust. Die statistische Analyse erfolgte mittels SPSS, wobei ein p

Background Heidenhain variant of Creutzfeldt-Jakob (HvCJD) is a rare disease, patients presenting with loss of visual acuity and a decline in visual fields. Case presentation Two patients with rapid loss of visual acuity and declining visual fields presented with homonymic hemianopsia over several weeks. Cranial MRI showed neither stroke nor other morphological changes explaining the severe visual field defects. Neurological examination revealed no pathologies. However, lumbar puncture showed an increase in total protein in cerebrospinal fluid (CSF). Visual field testing revealed further deterioration during follow-up. Several weeks later, patients’ behaviour changed markedly, exhibiting aggression, declining memory function and physical degeneration. The suspected diagnosis was the Heidenhain variant of Creutzfeld-Jakob disease (HvCJD). CSF analysis showed evidence of PrPSc and 14-3-3 protein. Both patients died within 8 weeks of the CJD diagnosis. Conclusions Loss of visual acuity and a decline in visual fields without corresponding MRI findings and marked changes in behaviour should lead to a diagnosis of HvCJD. Corresponding diagnostic tests should be performed for confirmation. The prognosis for survival is poor and should be immediately communicated to affected patients and their relatives.

The purpose of this study was to investigate the effectiveness of re-switch from intravitreal aflibercept to ranibizumab in patients with exudative age-related macular degeneration.This retrospective case series included 17 eyes of 17 patients who had previously switched from ranibizumab to aflibercept and finally back to ranibizumab. Main outcomes were change of visual acuity (VA) and assessment of central macular thickness (CMT). Secondary outcomes included predictive factors which had a beneficial effect as VA and CMT before re-switch, number of previous injections and gender.The mean VA was 0.64 ± 0.36 logMAR before the switch, and 0.87 ± 0.40 logMAR before the re-switch, and gained with a slight but not significantly improvement up to 0.85 ± 0.58 logMAR after the re-switch (p = 0.896). The average CMT before the switch was 448.6 µm ± 181.5. This decreased to 343.8 µm ± 161.3 after the switch (p = 0.614) to 299.1 µm ± 155.8 at switchback (p = 0.133). Overall, 8 patients (47%) had an improvement of vision, whereas in 5 patients (30%) VA deteriorated. Further analysis of predictive factors revealed a mean improvement of VA in male patients after re-switch, while female patients lost VA, with statistical significance between after the switch and after the re-switch to the benefit of male patients (p = 0.016).A re-switch from aflibercept to ranibizumab may enable improvement in morphological parameters and stabilization of VA in patients with exudative age-related macular degeneration who achieved no more benefit from the initial switch.In der vorliegenden Fallserie sollte die Wirksamkeit einer Therapierückumstellung von intravitrealem Aflibercept auf Ranibizumab bei Patienten mit persistierender Aktivität einer altersbedingten Makuladegeneration untersucht werden.Es wurde eine kleine Patientengruppe (17 Augen von 17 Patienten) untersucht, bei der zuerst eine Therapieumstellung von Ranibizumab auf Aflibercept und schließlich eine Therapierückumstellung auf Ranibizumab erfolgte. Als primäre Endpunkte wurden die Visusentwicklung und Veränderung der zentralen Netzhautdicke im SD-OCT festgelegt. Sekundärer Endpunkt war die Analyse prädiktiver Faktoren mit günstigem Effekt auf die Therapierückumstellung. Hierfür wurden das Geschlecht der Patienten, der Ausgangsvisus und die Netzhautdicke vor Therapierückumstellung sowie die jeweilige Anzahl der Vorinjektionen untersucht.Der durchschnittliche Visus vor Therapieumstellung betrug 0,64 ± 0,36 logMAR, vor Therapierückumstellung 0,87 ± 0,40 logMAR mit einer leichten, jedoch nicht signifikanten Verbesserung auf 0,85 ± 0,58 logMAR nach Therapierückumstellung (p = 0,896). Die zentrale Netzhautdicke vor Therapieumstellung betrug 448,6 ± 181,5 µm. Diese verringerte sich auf 343,8 ± 161,3 µm nach Therapieumstellung (p = 0,614) und knapp nicht statistisch signifikant auf 299,1 ± 155,8 µm nach Therapierückumstellung (p = 0,133). Insgesamt konnte bei 8 Patienten (47%) eine Visusverbesserung erreicht werden, wohingegen bei 5 Patienten (30%) trotz Therapierückumstellung eine progrediente Visusverschlechterung zu beobachten war. Die Analysen der prädiktiven Faktoren ergaben, dass Männer durchschnittlich von einer Therapierückumstellung hinsichtlich der Visusentwicklung profitierten, während diese bei Frauen im Mittel keinen Einfluss auf die progrediente Visusminderung hatte. Hierbei zeigte sich im Vergleich vor und nach Therapierückumstellung ein signifikanter Unterschied (p = 0,016) zugunsten der Männer.Eine Therapierückumstellung von Aflibercept auf Ranibizumab könnte bei Patienten mit persistierender Aktivität einer altersbedingten Makuladegeneration, welche nicht mehr von der Therapieumstellung profitierten, eine Verbesserung der morphologischen Parameter und Visusstabilisierung ermöglichen.

Background: Retinal Angiomatous Proliferations (RAP) is a subgroup of exsudative or “wet” Age-related Macular Degeneration (wAMD) with devastating reduction of visual acuity in later stages. Intravitreal Ranibizumab provides a good therapy, but is considered to be not as effective in this class of neovascularization compared to choroidal neovascularization (CNV). We investigated the efficacy of Ranibizumab in late stage III RAP with retino-choroidal anastomosis compared to the outcome of CNV lesions. Methods: Retrospective analysis of the data of all for wAMD with Ranibizumab treated patients. Patients were divided into groups depending on the lesion type into RAP (identified and selected clinically, proven by fluorescein angiography) and CNV types (identified by fluorescein angiography only) named occult, minimally and predominantly classic groups. Best-corrected visual acuity (BCVA) was obtained before (“diagnosis”), during (1st, 2nd and 3rd injection) and after upload (“1st control”). Results: Before first injection the visual acuity decreased in all groups (0.73 to 0.78 logMAR for all CNV, 0.95 to 1.02 logMAR for RAP). During upload there is no further decline in visual acuity but no improvement as well up to the 1st control visit in the RAP group (1.02 to 1.03 logMAR), but a statistically significant increase in all other groups (0.78 to 0.67 logMAR). Conclusion: Clinically identified late stage III RAP lesions with retino-choroidal anastomosis respond worse to treatment with monthly Ranibizumab than all other lesion types regardless of their severity. Treatment results in stabiliziation of visual acuity, but – in contrast to other forms of CNV – no further improvement. Therefore, patients with this special form need to be identified and treated as early as possible.

PURPOSE The aims of this prospective experimental study were to explore the influence of the Valsalva manoeuvre (VM) on retinal venous pressure (RVP) in human volunteers in a university setting and to establish correlations for RVP with the increase in airway pressure (∆AirP) and in intraocular pressure (∆IOP). METHODS In total, 31 healthy young volunteers (age: 24 ± 1.7 years) were investigated. The instruments used included a dynamic contour tonometer, a contact lens dynamometer (Imedos) and an electronic pressure transducer for measuring airway pressure. The following measurements were successively performed in left eyes: tonometry, dynamometry, repeated simultaneous dynamometry and airway pressure measurement during the VM and tonometry during the VM. The pressures obtained during the VM were determined at 10, 20 and 30 seconds after onset of the VM by linear interpolation. RESULTS The pressures (in mmHg) at baseline and during the VM (median and range with outliers) were as follows: ∆AirP: 10 seconds: 10.0 (7.5); 20 seconds: 12.5 (11.0); and 30 seconds: 11.0 (10.0); and RVP: Start: 17.1 (2.4); 10 seconds: 26.0 (7.5); 20 seconds: 25.0 (6.5); and 30 seconds: 24.0 (6.0). During the VM, the RVP was significantly increased compared with the ∆AirP (p = 0.0017). The IOP during the VM was 13.5 (2.7), and the increase in IOP (∆IOP) was 0.8 (5.6). CONCLUSION During the VM, the RVP was increased compared with the ∆AirP. The increase in RVP (∆RVP) was significantly greater than the ∆IOP. During the VM, the calculated retinal perfusion pressure may be more strongly reduced by the ∆RVP than by the ∆IOP. These properties may influence retinal and optic nerve head pathophysiology.

Hintergrund Mit der intravitrealen Applikation von Ranibizumab (Lucentis®) oder Pegaptanib (Macugen®) stehen effektive Behandlungsmoglichkeiten der exsudativen altersbedingten Makuladegeneration (AMD) zur Verfugung. Aus den Zulassungsstudien scheinen einerseits eine Uberlegenheit von Ranibizumab hinsichtlich der Wirksamkeit, andererseits jedoch mogliche Vorteile fur Pegaptanib hinsichtlich der Sicherheit bezuglich kardiovaskularer Ereignisse hervorzugehen. Ob sich diese beiden Vorteile durch eine Kombinationstherapie beider nutzen lassen, war Gegenstand dieser Untersuchung.

Hintergrund: Für die Behandlung der exsudativen AMD stehen mit Pegaptanib (Macugen®) und Ranibizumab (Lucentis®) zwei effektive Therapiemöglichkeiten zur Verfügung. Die unspezifische Hemmung von auch physiologisch bedeutendem VEGF durch Ranibizumab steht allerdings im Verdacht,[for full text, please go to the a.m. URL], 22. Jahrestagung der Retinologischen Gesellschaft