Search

To describe the progression of pachychoroid neovasculopathy (PNV) into pachychoroid aneurysmal type 1 choroidal neovascularization (PAT1)/polypoidal choroidal vasculopathy (PCV).Retrospective longitudinal cohort study.Patients diagnosed with PNV with a follow-up of ≥2 years.Multimodal imaging, including OCT and fluorescein and indocyanine green angiography, was reviewed for the presence of choroidal neovascularization (CNV), aneurysms within/at the margins of the CNV, and subfoveal choroidal thickness (SFCT).Rate of PNV to PAT1/PCV conversion and risk factors thereof.In total, 37 eyes of 32 patients with PNV with a mean follow-up of 3.3 ± 1.1 years (range, 2.0-5.2) were included in the study. At PNV diagnosis, the mean age was 59.7 ± 8.7 years (range, 38.5-78.0 years) and mean SFCT was 357 ± 92 μm (185-589). During the follow-up, 5 (13.5%) eyes developed aneurysms after a mean 3.4 ± 0.8 years (2.3-4.2), defining PAT1/PCV. The risk of PAT1/PCV conversion was 7.4% at year 3, 13.6% at year 4, and 30.7% at year 5. A mean of 5.2 ± 4.0 to 7.9 ± 3.6 intravitreal anti-VEGF injections were given per year, resulting in a significant reduction of SFCT to 317 ± 104 μm (122-589) (P = 0.0007). The age at diagnosis of PNV was significantly lower in eyes that later went on to develop PAT1/PCV (54.0 ± 5.6 [45.9-60.5] vs. 61.2 ± 8.4 [38.5-78.0] years; P = 0.025). At the end of the follow-up, SFCT had on average decreased by -14.0% ± 17.6% (-55.9% to 23.1%) in the PNV group, whereas it had increased by mean 6.9% ± 4.4% (0.00%-10.8%) in the PAT1/PCV conversion group (P = 0.0025).PNV can develop aneurysms within its type 1 CNV, defining the conversion to PAT1/PCV. In this study, the conversion to PAT1/PCV was seen in 13.5% of eyes, resulting in Kaplan-Meier estimates of risk for conversion of 7.4% at year 3, 13.6% at year 4, and 30.7% at year 5. Younger age at diagnosis of PNV and sustained choroidal thickening despite anti-VEGF therapy might be risk factors for PNV to progress into PAT1/PCV.

To present immunocytochemical characterization of a surgically excised central posterior lens capsule (PLC) that was transplanted to close a secondary refractory full-thickness macular hole (FTMH) as an epiretinal flap. For comparison, tissue of both an unaffected internal limiting membrane and unexposed PLC was processed.Clinical-pathological case report.We report of a 38-year-old patient who underwent pars plana vitrectomy (PPV) with PLC tissue for patching secondary FTMH and silicone oil tamponade after tractional retinal detachment. The PLC was peeled off during a vitrectomy 1 year after positioning. For immunocytochemistry, the removed PLC was prepared as flat mount and showed a positive immunofluorescence of the Müller cells marker glutamine synthetase and for vimentin. The microglia marker IBA and the neuroprotective neurotrophic marker glia cell-derived neurotrophic factor were tested positive too. There was no immunoreactivity of cellular retinaldehyde-binding protein and glial fibrillary acidic protein. In comparison, tissue of a control internal limiting membrane that was obtained during standard FTMH surgery showed few single cells that were likewise positive for glutamine synthetase, glia cell-derived neurotrophic factor, and IBA. The control specimen of unexposed PLC showed rarely cells that were without positive immunostaining for the tested markers.Our analysis revealed positive immunoreactivity of macroglia and microglia cells of the PLC tissue that was used to patch a refractory FTMH. Similar immunostaining of PLC material and internal limiting membrane suggests the PLC transplantation as an alternative treatment option for refractory FTMH.

PURPOSE: To evaluate postoperative subjective quality of vision in patients who underwent Implantable Collamer Lens (ICL) (STAAR Surgical) implantation for correction of myopia and to identify potential predictive parameters. METHODS: In this single-center cross-sectional study, a total of 162 eyes of 81 patients (58 women, 23 men) who underwent ICL implantation were analyzed. The Quality of Vision (QOV) questionnaire was used to assess patient-reported outcomes. Baseline characteristics (eg, age), treatment parameters (eg, surgical corrected refraction), and refractive (eg, residual refraction) and visual (eg, uncorrected distance visual acuity) outcomes were analyzed regarding their effect on QOV. RESULTS: Mean age was 33.3 ± 7.0 years (range: 21 to 51 years) and mean preoperative spherical equivalent was −8.42 ± 2.49 diopters (D) (range: −3.25 to −14.38 D). After a mean postoperative follow-up period of 19 ± 14 months (range: 6 to 54 months), the safety index score was 1.23 ± 0.21 and the efficacy index score was 1.17 ± 0.22. The mean QOV scores were 35.5 ± 11.3, 32.2 ± 11.1, and 23.3 ± 16.1 for frequency, severity, and bothersomeness, respectively. The most frequently experienced symptoms were halos (90.1%) and glare (66.7%). Halos appeared in 66.7% of the patients “occasionally” and 5 of them (6.2%) experienced them “very often.” Only 1 patient (1.2%) classified halos as “very bothersome.” Patients older than 36 years reported visual symptoms more frequently ( P < .05) and showed higher bothersomeness scores ( P = .01). CONCLUSIONS: Halos are the most commonly perceived long-term visual disturbance after myopic ICL implantation with a central hole. Visual symptoms can persist more than 6 months postoperatively, causing only minor disturbances in most cases. Older patients seem more prone to experiencing these symptoms. [ J Refract Surg . 2022;38(5):280–287.]

Purpose To evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction. Methods The database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed. Results In total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 ± 92 vs. PAT1/PCV: 400 ± 83 µm; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 ± 31 vs. 82 ± 46, p p p = 0.04) were significantly more frequent in eyes with PAT1/PCV. Conclusion A relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height (“peaking PED”) exceeding approximately 150 µm, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis.

Background/Objectives. While the exact pathophysiology of pachychoroid disorders remains unclear, scleral changes inducing increased venous outflow resistance are hypothesized to be involved. This work aims to investigate anterior scleral thickness (AST) as a risk factor for central serous chorioretinopathy (CSC) and pachychoroid neovascularization (PNV). Subjects/Methods. Randomized prospective case-control study performed at the Ludwig Maximilians-University, Department of Ophthalmology. 46 eyes of 46 patients were included, with 23 eyes in the CSC/PNV group (9 eyes with PNV) and 23 eyes in the control group. There was no difference in mean age (51.5 ± 8.0 (36 to 65) vs. 47.0 ± 12.9 (30 to 83) years; p = 0.122) or spherical equivalent (0.60 ± 2.23 (-5.5–4.6) vs. -0,93 ± 2.45 (-4.9–5.8); p = 0.441). In all patients, swept source OCT (SS-OCT) with an anterior segment module was used to measure AST. Subfoveal choroidal thickness (SFCT) was assessed using enhanced depth imaging OCT (EDI-OCT). AST and SFCT were then compared to an age and -refraction-matched control group. Results. A significantly higher AST was found in the CSC/PNV as compared to the control group (403.5 ± 68.6 (278 to 619) vs. 362.5 ± 62.6 (218 to 498) µm; p = 0.028). Moreover, the CSC/PNV group showed a higher SFCT (392.8 ± 92.8 (191–523) vs. 330.95 ± 116.5 (167–609) µm, p = 0.004). Conclusions. Compared to age- and refraction-matched controls, patients with CSC and PNV show a significantly thicker anterior sclera. Scleral thickness might contribute to the venous overload hypothesized to induce pachychoroid phenotypes.

The aim of our prospective off-label, interventional clinical trial was to evaluate the efficacy and safety of the fluocinolone-loop-anchoring technique over two years in eyes with iris-lens diaphragm disruption and pseudophakic cystoid macular edema.In 10 eyes, scleral fixation of fluocinolone implant was performed. Main outcome measures were the development of best-corrected visual acuity (BCVA), central retinal thickness over 24 months, and general safety of the procedure.A significant improvement to 0.57 ± 0.38 log MAR (Snellen 20/80) (range 0-1.30) was observed (P = 0.003) at 1 month. Further improvement to 0.45 ± 036 log MAR (Snellen 20/60) was observed until month 18 (P = 0.081). Mean central retinal thickness decreased by 22% from 601.6 ± 235.5 µm to 449.1 ± 128.9 µm at 1 month. In one patient, the implant has to be removed at Month 7 because of elevated intraocular pressure and one patient after globe rupture had a retinal redetachment at Month 4.In this study, we showed that the treatment of recalcitrant pseudophakic cystoid macular edema with scleral fixated fluocinolone implant in eyes with disruption of the iris-lens diaphragm provides good anatomical and functional results with a reasonable safety profile over 24 months in eyes where pseudophakic cystoid macular edema is otherwise difficult to treat and often left untreated.

Introduction: Tumor recurrence in choroidal melanoma has been associated with decreased overall survival due to metastatic spreading. To detect risk factors of local recurrence and side effects, we analyzed tumor planning and treatment parameters in patients with recurrence of choroidal melanoma after treatment with robotic-assisted radiosurgery (CyberKnife). Methods: Six hundred ninety-four patients treated with CyberKnife between 2005 and 2019 were retrospectively reviewed. Age, gender, best-corrected visual acuity, tumor height, and diameter were recorded. Treatment planning and radiation doses were reviewed. Salvage therapy, overall survival, metastasis, and complications were recorded. Results: Seventy-four patients showed local recurrence. Local recurrence occurred after 42.1 months post CyberKnife treatment (mean; range: 5–100 months). Fourteen out of 74 patients (18.9%) died during follow-up. Recurrence treatment included enucleation in 51 patients (68.9%) and radiosurgery in 19 patients (25.7%). Treatment planning without contrast medium MRI, radiation dose of less than 21 Gy, and insufficient margin delineation were identified as risk factors incrementing local control. Discussion: Robotic-assisted radiosurgery (CyberKnife) is a suitable treatment option for large choroidal melanoma up to 12 mm. Patients with significantly better visual acuity received repeat CyberKnife treatment as salvage therapy and showed an eye retention rate of 81%.

Purpose To analyze precision and safety of femtosecond laser-assisted descemetorhexis as well as postoperative corneal wound healing in human ex vivo specimens. Setting Department of Ophthalmology, University Hospital, LMU Munich, Munich, Germany. Design Experimental ex vivo study. Methods Four donor corneas underwent femtosecond laser-assisted descemetorhexis. The descemetorhexis was performed using the LDV Z8 femtosecond laser followed by live/dead staining, phase contrast microscopy and scanning electron microscopy. The descemetorhexis parameters were set using a modified optical coherence tomography image capturing of 8 segments within a focus of 100 μm at the posterior corneal stroma (reversed capsulotomy program). Results Live/dead sample staining analysis demonstrated that the femtosecond laser had minimal impact on the vitality of surrounding endothelial cells. Phase contrast microscopy and scanning electron microscopy evaluation showed that the laser produced precise, clear-cut edges leaving no stromal tissue bridges. Conclusions Femtosecond laser-assisted descemetorhexis could serve as a safe and precise technique with only minimal endothelial cell damage. To minimize stromal damage, further laser energy profile adjustments are necessary to optimize corneal treatment within different stages of corneal tissue swelling.

Achromatopsia (ACHM), also known as rod monochromatism or total color blindness, is an autosomal recessively inherited retinal disorder that affects the cones of the retina, the type of photoreceptors responsible for high-acuity daylight vision. ACHM is caused by pathogenic variants in one of six cone photoreceptor-expressed genes. These mutations result in a functional loss and a slow progressive degeneration of cone photoreceptors. The loss of cone photoreceptor function manifests at birth or early in childhood and results in decreased visual acuity, lack of color discrimination, abnormal intolerance to light (photophobia), and rapid involuntary eye movement (nystagmus). Up to 90% of patients with ACHM carry mutations in CNGA3 or CNGB3, which are the genes encoding the alpha and beta subunits of the cone cyclic nucleotide-gated (CNG) channel, respectively. No authorized therapy for ACHM exists, but research activities have intensified over the past decade and have led to several preclinical gene therapy studies that have shown functional and morphological improvements in animal models of ACHM. These encouraging preclinical data helped advance multiple gene therapy programs for CNGA3- and CNGB3-linked ACHM into the clinical phase. Here, we provide an overview of the genetic and molecular basis of ACHM, summarize the gene therapy-related research activities, and provide an outlook for their clinical application.

Purpose To describe characteristics of the vitreomacular interface (VMI) in traumatic macular holes (TMH) compared to idiopathic macular holes (IMH) using immunofluorescence and electron microscopy, and to correlate with clinical data. Methods For immunocytochemical and ultrastructural analyses, premacular tissue with internal limiting membrane (ILM) and epiretinal membrane (ERM) was harvested during vitrectomy from 5 eyes with TMH and 5 eyes with IMH. All specimens were processed as flat mounts for phase-contrast microscopy, interference and fluorescence microscopy, and transmission electron microscopy (TEM). Primary antibodies were used against microglial and macroglial cells. Clinical data was retrospectively evaluated. Results Surgically excised premacular tissue of eyes with TMH showed a less pronounced positive immunoreactivity for anti-glutamine synthetase, anti-vimentin and anti-IBA1 compared to eyes with IMH. Cell nuclei staining of the flat-mounted specimens as well as TEM presented a lower cell count in eyes with TMH compared to IMH. All detected cells were found on the vitreal side of the ILM. No collagen fibrils were seen in specimens of TMH. According to patients’ age, intraoperative data as well as spectral-domain optical coherence tomography (SD-OCT) analysis revealed an attached posterior vitreous in the majority of TMH cases (60%), whereas all eyes with IMH presented posterior vitreous detachment. Conclusion The vitreomacular interface in TMH and IMH shows significant differences. In TMH, glial cells are a rare finding on the vitreal side of the ILM.

Background: Central retinal artery occlusion ((C)RAO) is known to be associated with stroke and/or atrial fibrillation (AF). Nevertheless, patients often present at the ophthalmologist initially and it is unknown how many of these receive an adequate cardiological/neurological work-up (CWU/NWU), including a 24 h-Holter-ECG. Hypothesis: Hypothesis of this study was that patients with (C)RAO do not undergo CWU on regular basis and that new-onset AF is more often detected in patients with CWU. Methods and results: We performed a retrospective analysis of n = 292 consecutive patients who presented at an ophthalmology department with the diagnosis of (C)RAO during a 3-year period. After excluding patients with known AF, meeting exclusion criteria, inability to comply with the protocol, missed land phoneline, or death during follow-up a total of 174 patients were enrolled; mean follow-up was 20 ± 12 months. The CHA₂DS₂-VASc score of the cohort was 5.3 ± 1.4. Our analysis revealed that only 50.6% of patients received a CWU including a single Holter-ECG after the index-event. In 12.6% cases new-onset AF was diagnosed, while the rate was higher in patients with CWU compared to patients without CWU (18.2 vs. 7.0%; p = 0.26). Evaluation of oral anticoagulation (OAC) therapy showed that only 66% of patients with AF were treated according to guidelines. Conclusion: Only half of patients with (C)RAO underwent CWU. Despite minimal monitoring, rate of new diagnosed AF was high. Our results confirm that (C)RAO identifies a high-risk population for AF. These results illustrate the importance to implement standardized CWU in (C)RAO patients presenting at the ophthalmologist. OA Förderung 2021

Leber congenital amaurosis caused by mutations in the RPE65 gene belongs to the most severe early-onset hereditary childhood retinopathies naturally progressing to legal blindness. The novel gene therapy voretigene neparvovec is the first approved causative treatment option for this devastating eye disease and is specifically designed to treat RPE65-mediated retinal dystrophies. Herein, we present a follow-up of the youngest treated patients in Germany so far, including four pre-school children who received treatment with voretigene neparvovec at a single treatment center between January 2020 and May 2022. All patients underwent pars plana vitrectomy with circumferential peeling of the internal limiting membrane at the injection site and subretinal injection of voretigene neparvovec. Pre- and postoperative diagnostics included imaging (spectral domain optical coherence tomography, fundus autofluorescence, fundus wide-angle imaging), electrophysiologic examination (ERG), retinal light sensitivity measurements (FST) and visual acuity testing. Behavioral changes were assessed using a questionnaire and by observing the children’s vision-guided behavior in different levels of illumination. All children showed marked increase in vision-guided behavior shortly after therapy, as well as marked increase in visual acuity in the postoperative course up to full visual acuity in one child. Two eyes showed partial electrophysiological recovery of an ERG that was undetectable before treatment—a finding that has not been described in humans before.

To compare the efficacy of digital-assisted reference marking for toric implantable collamer lenses (Callisto Eye System) with manual marking technique using a slit lamp markeur.This study included patients that underwent implantation of a toric implantable collamer lens (EVO Visian toric ICL, Staar Surgical). Patients were included if they had a myopia above -3 diopters (D) and regular corneal astigmatism of 0.75 diopters or higher. Between both groups a 1:2 matching regarding similar preoperative level of myopia and astigmatism was performed. Visual and refractive outcomes were evaluated. Vector analysis was performed to evaluate total astigmatic changes.This study comprised 57 eyes of 57 patients with 19 eyes in the digital group and 38 eyes in the manual marking group. Postoperatively there were no statistically significant differences between both groups in UDVA (A digital tracking approach for toric ICL alignment was an efficient and safe method for toric marking with similar results regarding visual and refractive outcomes compared to a conventional corneal marking method. Nevertheless, image-guided surgery helped to streamline the workflow in refractive ICL surgery.

To determine the effect of lockdown on medical care, with the example of ophthalmology.Patients in a period during the first lockdown were compared to a non-lockdown period, with a total of 12 259 patients included in an observational study. Changes in different areas (elective, emergency, inpatients, surgeries) and eye care subspecialties were compared. Emergency patients were analyzed according to severity and urgency. Patients showing hints requiring treatment for urgent cardiovascular diseases were determined. Differences in patients who would have suffered severe vision loss without treatment were identified and the QALY (quality-adjusted life years) loss was determined accordingly. A model to prioritize patient visits after the end of lockdown or in future lockdown scenarios was developed. Data were collected at the University Eye Hospital LMU Munich and patient files were reviewed individually by ophthalmologists.The average patient number decreased by - 59.4% (p 0.001), with a significant loss in all areas (elective, emergency, inpatients, surgeries; p 0.001). There was a decline of - 39.6% for patients at high risk/high severity. Patients with indications of a risk factor of future stroke declined significantly (p = 0.003). QALY loss at the university eye hospital was 171, which was estimated to be 3160 - 24 143 for all of Germany. Working up high losses of outpatients during these 8 weeks of projected lockdown in Germany would take 7 - 23 weeks under normal circumstances, depending on ophthalmologist density. The prioritization model can reduce morbidity by up to 78%.There was marked loss of emergency cases and patients with chronic diseases. Making up for the losses in examinations and treatments will theoretically take weeks to months. To reduce the risk of morbidity, we recommend a prioritization model for rescheduling and future lockdown scenarios.Erfassung der Auswirkungen eines Lockdowns auf die medizinische Versorgung am Beispiel der Augenheilkunde.In einer Beobachtungsstudie wurden Patienten in einem Zeitraum während des ersten Lockdowns mit einem Zeitraum ohne Lockdown verglichen. Hierbei wurden insgesamt 12 259 Patienten eingeschlossen. Es wurden Veränderungen in verschiedenen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen) und augenärztlichen Subspezialitäten verglichen. Notfallpatienten wurden nach Schweregrad und Dringlichkeit analysiert. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf behandlungsbedürftige, dringende kardiovaskuläre Erkrankungen darstellen, wurden ermittelt. Unterschiede von Patienten, die ohne Behandlung einen schweren Sehverlust erlitten hätten, wurden identifiziert und der QALY-Verlust entsprechend ermittelt. Ein Modell zur Priorisierung von Patientenbesuchen nach dem Ende des Lockdowns oder in zukünftigen Lockdownszenarien wurde entwickelt. Die Daten wurden an der Universitätsaugenklinik LMU München erhoben und die Patientenakten einzeln von Augenärzten geprüft.Die durchschnittliche Patientenzahl sank um − 59,4% (p 0,001) mit einem signifikanten Verlust in allen Bereichen (elektive Fälle, Notfälle, stationäre Fälle, Operationen; p 0,001). Bei Patienten mit hohem Risiko/hohem Schweregrad ergab sich ein Rückgang von − 39,6%. Patienten mit ophthalmologischen Erkrankungen, die einen Hinweis auf ein mögliches erhöhtes Risiko für einen zukünftigen Schlaganfall geben, nahmen signifikant ab (p = 0,003). Der QALY-Verlust an der Universitätsaugenklinik betrug 171, geschätzt für Deutschland 3160 – 24 143. Die Aufarbeitung der hohen Verluste an ambulanten Patienten während der 8 Wochen Sperrung würde auf Deutschland hochgerechnet unter normalen Umständen je nach Augenarztdichte 7 – 23 Wochen dauern. Das Priorisierungsmodell kann die Morbidität um bis zu 78% reduzieren.Es kam zu eminenten Verlusten sowohl bei Notfallpatienten als auch bei Patienten mit chronischen Erkrankungen. Das Aufarbeiten der verpassten Untersuchungen und Behandlungen wird theoretisch Wochen bis Monate dauern. Um das Morbiditätsrisiko zu reduzieren, empfehlen wir ein Priorisierungsmodell für die Wiedereinbestellung nach dem Lockdown und künftige Lockdownszenarien.

To evaluate the reliability of spectral-domain optical coherence tomography (SD-OCT; RTVue XR; Optovue, Inc., Fremont, CA, USA) for thickness mapping of the entire cornea (CT), corneal epithelium (ET). and corneal stroma (ST) over a 9-mm zone in healthy eyes. We sought to develop reference values for different age groups and elucidate potential sex- and age-dependent characteristics of corneal sublayer pachymetry maps.Three consecutive SD-OCT scans were obtained in 166 healthy right eyes (mean age = 50 ± 20 years). The thickness maps contain 25 sectors over a 9-mm diameter zone. To test measurement reliability, intraclass correlation coefficients (ICC), coefficients of variation (CoV), and within-subject standard deviations (WSSD) were calculated.CT, ET, and ST ICCs ranged from 0.961 to 0.998, 0.896 to 0.945, and 0.955 to 0.998, respectively. CoV values for CT, ET, and ST ranged between 0.3 and 1.5%, 1.6 and 4.2%, and 0.4 and 1.7%, respectively. WSSD ranged from 6 to 41, 4 to 8, and 7 to 46 µm, respectively. A negative correlation was found between age and ET (p 0.05) but not between age and ST or CT. No gender-related differences in CT, ET, or ST were detected. CoV of CT, ET, and ST measurements showed a positive correlation with age in 28, 64, and 28% of the sectors, respectively.SD-OCT is a rapid and noninvasive technique that provides excellent reliability for corneal sublayer thickness measurements over a 9-mm zone. The reliability of the ET measurement seems to be negatively affected by age. Peripheral CT and global ET thin with age.Die Spectral-Domain optische Kohärenztomografie (SD-OCT) hat in den letzten Jahren zunehmend auch im vorderen Augenabschnitt an Bedeutung gewonnen. Moderne SD-OCT-Geräte (RTVue XR; Optovue, Inc., Fremont, CA, USA) sind in der Lage, Pachymetriekarten der gesamten Kornea (CT), des Korneaepithels (ET) und des Korneastromas (ST) über eine 9-mm-Zone zu bestimmen. Ziele dieser Studie waren, neben einer Überprüfung der Reliabilität des Geräts, sowohl die Bestimmung von Referenzwerten für verschiedene Altersgruppen als auch die Untersuchung möglicher alters- oder geschlechtsabhängiger Merkmale der einzelnen Korneaschichten an gesunden Augen.Es wurden 3 aufeinanderfolgende SD-OCT-Aufnahmen an 166 gesunden rechten Augen (Durchschnittsalter = 50 ± 20 Jahre) angefertigt. Die Pachymetriekarten gliedern sich in 25 Sektoren über eine Fläche mit einem Durchmesser von 9 mm. Um die Reliabilität zu messen, wurden „Intraclass Correlation Coefficients“ (ICC), „Coefficients of Variation“ (CoV) und „Within-subject Standard Deviations“ (WSSD) berechnet.Die ICCs von CT, ET und ST lagen jeweils zwischen 0,961 und 0,998, 0,896 und 0,945 sowie 0,955 und 0,998. Der CoV für CT, ET und ST lag jeweils zwischen 0,3 und 1,5%, 1,6 und 4,2% sowie 0,4 und 1,7%. Die WSSD betrug 6 – 41 µm für die CT, 4 – 8 µm für die ET und 7 – 46 µm für die ST. Die Untersuchungen ergaben eine negative Korrelation zwischen Alter und ET (p 0,05). Für CT und ST konnte keine signifikante Korrelation gezeigt werden. Es wurden keine geschlechtsspezifischen Unterschiede für CT, ET oder ST festgestellt. Der CoV zeigte eine positive Korrelation mit dem Alter der Probanden in bis zu 64% der Sektoren.Die SD-OCT ist eine schnelle, nicht invasive Technik, welche für Messungen der Dicke einzelner Korneaschichten bis zu einer 9-mm-Zone eine exzellente Reliabilität bietet. Allerdings muss beachtet werden, dass die Wiederholbarkeit von Messungen des Epithels mit steigendem Alter sinkt. Ebenfalls altersabhängig wird die periphere Kornea sowie das gesamte Korneaepithel mit der Zeit dünner.

Patienten mit altersbedingter Makuladegeneration leiden oft beidseits an der neovaskularen Form der Erkrankung (nAMD). Die Real-life-Ergebnisse nach Anti-VEGF(antivaskularer endothelialer Wachstumsfaktor)-Therapie sollen zwischen dem zuerst betroffenen (1. Auge) und dem zuletzt betroffenen Auge (2. Auge) verglichen werden. Fur diese retrospektive monozentrische Studie wurden 3217 Augen von 2793 Patienten mit nAMD identifiziert, die von 2006 bis 2014 ≥ 3 Anti-VEGF-Injektionen an der Augenklinik der Universitat Munchen erhalten hatten. Eingeschlossen wurden Patienten mit bilateraler nAMD, wenn 1. und 2. Auge nicht vorbehandelt waren und jeweils eine strikte Adharenz mit kontinuierlicher Nachbeobachtung uber den Zeitraum von mindestens 5 Jahren gegeben war. Verglichen wurden der korrigierte Visus, die Anzahl intravitrealer Injektionen und Visiten sowie die zentrale Makuladicke. Es erfullten 72 Augen von 36 Patienten die Einschlusskriterien. Bei Therapiebeginn der nAMD zeigten die 1. Augen einen signifikant schlechteren mittleren Visus (p

Purpose As the number of intravitreal injections (IVI) increases annually, this study aimed to assess the anatomical and functional outcomes following rhegmatogenous retinal detachment (RRD) surgery for IVI-associated RRD (IVARD). Methods All non-vitrectomized eyes developing IVARD since 2007 in two European vitreoretinal centers (Department of Ophthalmology, LMU Munich, Germany, and Eye Clinic Luigi Sacco, University of Milan, Milan, Italy) were included. Main outcomes were primary and secondary retinal attachment rate after surgery, rate of proliferative vitreoretinopathy (PVR), and final functional result. Ten years of incidence rates per injection were calculated for one center. Results Fifty-two eyes of 52 patients comprised the study. Primary anatomic success rate was 83% (n = 43) and secondary 96% (n = 50). PVR was observed in all uveitic eyes (n = 3), in eyes with postoperative cystoid macular edema (n = 2), and in 8 of 9 eyes that received the dexamethasone implant (DEX). Age, number of prior injections, duration of symptoms, or time between last IVI and RRD did not show any statistically significant differences with regard to presence of PVR or not. Mean BCVA improved in 28 cases, remained stable in 16 cases, and worsened in 8 cases. The RRD incidence rate was statistically significant higher for DEX and ocriplasmin compared with that for anti-VEGF agents. Conclusion The anatomical result after one surgical intervention seems acceptable, but the final visual outcome remains rather poor, because of the underlying macular disease. In our population, injection with DEX is associated with higher IVARD rate, presence and development of PVR, and recurrent RRD in comparison with anti-VEGF agents.

Purpose To investigate the sensitivity of the color vision test by Arden in patients with dysthyroid optic neuropathy (DON) to improve diagnosis. Methods In this observational, retrospective study, we included the medical records of 92 eyes (48 patients) with diagnosis of DON between 2008 and 2019 in order to evaluate the full spectrum of findings from the color vision test by Arden, and to determine potential importance of this test. Thirty-five patients were female, and 13 patients were male. The mean age was 58.0 years (range: 34–79) at the time of the DON diagnosis. Results Forty-one eyes displayed relatively good BCVA with ≤ 0.2 LogMAR. We found a protan value exceeding the threshold of ≥ 8% in 57 eyes (30 patients) at the time of the diagnosis. The sensitivity of protan was 61.9% (95% CI 51.2–71.8%), while that of tritan was a striking 98.9% (95% CI 94.1–99.9%). We discovered one pathological sign, tritan deficiency (based on a threshold of ≥ 8%) consistently in all eyes but one at the time of the diagnosis, regardless of the visual field defects or any changes in best-corrected visual acuity (BCVA). Conclusion We found blue-yellow (tritan) deficiency, to be a sensitive and reliable indicator of dysthyroid optic neuropathy. We conclude that, in cases with suspected DON, a color vision test that can detect tritan deficiency is an essential tool for the adequate assessment, diagnosis, and treatment of DON.

Purpose There is an ongoing controversial debate about the effectiveness of laser treatments in chronic central serous chorioretinopathy (cCSC). We performed a prospective non-randomized interventional study to learn about the effects of a subthreshold laser treatment (Topcon Endpoint Management™, Topcon Healthcare Inc., Tokyo, Japan) in patients with cCSC. Methods Patients with cCSC and a minimum symptom duration of 4 months were included and treated with a standardized laser pattern covering the macular area. Retreatment was performed every 3 months if persistent subretinal fluid was observed. The primary endpoint was resolution of subretinal fluid at 6 months. Further outcome parameters included best corrected visual acuity, microperimetry, central macular and subfoveal choroidal thickness. Results A total of 42 eyes of 39 patients were included. Mean patient age was 48 ± 10.6 years (range 25–67). Mean symptomatic time before inclusion into the study was 134 ± 133.4 weeks (16–518). Before inclusion, 78.6% of the patients had failed to resolve subretinal fluid under mineralocorticoid receptor antagonists and 14.3% had a recurrence after half-dose photodynamic therapy. Complete resolution of subretinal fluid was observed in 42.9% at 6 months and in 53.8% at 12 months after baseline. Central retinal thickness decreased from 398 ± 135 µm to 291 ± 68 µm (p Conclusion The results show that the investigated laser treatment is effective in reducing subretinal fluid and leads to an improvement of functional parameters.

BackgroundTo investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy.MethodsTwenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography.ResultsThere were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60–72), total follow-up was 1.8 ± 0.4 (1–2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269–485) µm. After two years and 13 anti-VEGF injections on average, a mean reduction of -39 ± 10 (-26 to -56) % to final 241 ± 52 (162–327) µm was observed (p 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r=-0.79 ; R2 = 0.63 ; p = 0.00073) and two (r=-0.69; R2 = 0.48 ; p = 0.019). While 85.7 % of PNV eyes exceeded a pachychoroid threshold of ≥ 350 µm at baseline, this figure dropped to 21.4 % at year one and 0 % at year two.ConclusionIn PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a “vanishing pachy-choroid”, and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.

Lamellar macular holes (LMHs) are an entity of a progressive disease in which the efficacy of the therapy of choice, vitrectomy, seems to be reduced. It is unknown whether highly concentrated autologous platelet-rich plasma (PRP) is of value in the therapy of LMHs. The purpose of this study was to gauge the potential of highly concentrated PRP to restore foveal anatomy in LMH surgery.In this interventional case series, eight eyes of eight patients with progressive LMH were included. All patients underwent a 23-gauge pars plana vitrectomy with induction of a posterior vitreous detachment and peeling of tractive epiretinal membranes whenever present. Under air tamponade, 0.1 mL of highly concentrated autologous PRP was applied. Subsequently, a gas or air tamponade was performed. All patients were instructed to rest in the supine position for the first 1 to 2 postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, spectral-domain optical coherence tomography (SD-OCT) and fundus photography were performed prior to and 3 months after surgery.SD-OCT showed closure of the macular defect with restoration of a normal foveal configuration in all (8 of 8) patients 3 months postoperatively. BCVA improved significantly, from 0.28 ± 0.08 to 0.12 ± 0.14 logMAR (Wilcoxon: p = 0.03). Microperimetry remained unchanged (24.13 ± 1.96 vs. 23.7 ± 1.54 dB; p = 0.46). No clinically significant intra- or postoperative complications were observed.The use of highly concentrated PRP enables excellent anatomical and functional outcomes in the surgical therapy of LMH. Further prospective comparative trials are warranted to compare this promising technique with existing surgical strategies.Makulaschichtforamina sind eine progrediente Erkrankung, bei der die Wirksamkeit der Therapie der Wahl, der Vitrektomie, reduziert zu sein scheint. Das Potenzial von hochkonzentriertem autologem Thrombozytenkonzentrat (Platelet-rich Plasma, PRP) in der Therapie von Makulaschichtforamina ist unbekannt. Ziel dieser Studie ist die Beurteilung des Potenzials von hochkonzentriertem autologem Thrombozytenkonzentrat in der chirurgischen Therapie von Makulaschichtforamina.In diese interventionelle Fallserie wurden 8 Augen von 8 Patienten mit progressivem LMH eingeschlossen. Alle Patienten erhielten eine 23-Gauge-Pars-plana-Vitrektomie mit Induktion einer hinteren Glaskörperabhebung und Peeling traktiver epiretinaler Membranen, sofern vorhanden. Unter Lufttamponade wurde 0,1 ml hochkonzentriertes autologes Thrombozytenkonzentrat appliziert. Anschließend wurde eine Gas- oder Lufttamponade eingegeben. Alle Patienten wurden angewiesen, in den ersten 1 – 2 postoperativen Stunden in Rückenlage zu ruhen. Der bestkorrigierte Visus (BCVA), Mikroperimetrie, optische Kohärenztomografie (SD-OCT) und die Fundusfotografie erfolgten präoperativ sowie 3 Monate postoperativ.In der SD-OCT zeigte sich einen Verschluss des Makuladefekts mit Wiederherstellung der normalen fovealen Konfiguration bei allen (8 von 8) Patienten 3 Monate postoperativ. Die bestkorrigierte Sehschärfe verbesserte sich signifikant von 0,28 ± 0,08 auf 0,12 ± 0,14 logMAR (Wilcoxon: p = 0,03). Die Mikroperimetrie blieb stabil (24,13 ± 1,96 vs. 23,7 ± 1,54 dB; p = 0,46). Es wurden keine klinisch signifikanten intra- oder postoperativen Komplikationen beobachtet.Die Verwendung von hochkonzentriertem autologem Thrombozytenkonzentrat ermöglicht hervorragende anatomische und funktionelle Ergebnisse in der chirurgischen Therapie der Makulaschichtforamina. Weitere prospektive Vergleichsstudien sind notwendig, um diese vielversprechende Technik mit bestehenden chirurgischen Strategien zu vergleichen.

Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle ("Yamane") technique.Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 - 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z).Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 - 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = - 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = - 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up.The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.Evaluation der 3 aktuell meistverwendeten Sklerafixationstechniken für Intraokularlinsen (IOL) (1) Prolene-Naht mit Hoffman-Skleratasche, (2) GoreTex-Naht mit 4-Punkt-Aufhängung, (3) nahtlose intrasklerale Fixation mit gekauterten IOL-Haptikenden und Doppelnadeltechnik („Yamane-Technik“).IRB-genehmigte retrospektive klinische Studie an der Augenklinik der Ludwig-Maximilians-Universität (LMU) München. 55 Augen (n = 55) von 51 Patienten wurden eingeschlossen. Bestkorrigierter Fernvisus (BCVA), objektive Refraktion (OR), Hornhauttopografie (CCT), Biometrie, zentrale Makuladicke (CMT) mittels optischer Kohärenztomografie (OCT), Augeninnendruck (IOD), IOL-Typ und IOL-Stärke wurden vor und 3 – 12 Monate nach IOL-Sklerafixation untersucht. Eine statistische Auswertung über Unterschiede präoperativ zu postoperativ wurde mittels eines Wilcoxon-Rangsummentests (z) durchgeführt.Eine Sklerafixation mittels GoreTex-Naht wurde in 14 (25,5%) Augen, mittels Prolene-Naht in 19 (34,5%,) und mittels Yamane-Technik in 22 (40,0%) Augen durchgeführt. Innerhalb der 3 – 12 Monate Beobachtungszeitraum nach Sklerafixation mussten insgesamt 2 × (14,3%) GoreTex-, 3 × (15,8%) Prolene-, 1 × (4,5%) Yamane-Augen refixiert werden. Die Analyse zeigte einen statistisch signifikanten Unterschied bei der BCVA in der gesamten Kohorte (exakter Wilcoxon-Test: z = − 3,202; p = 0,001; n = 55) und in der Yamane-Subgruppe (exakter Wilcoxon-Test: z = − 2,068; p = 0,001; n = 22) im Vergleich zu prä-OP. Die GoreTex- (n = 14) und die Prolene-Subgruppe (n = 19) zeigten keine statistisch signifikanten Unterschiede zu prä-OP. Gruppenübergreifend war kein statistisch signifikanter Unterschied bei IOD, CMT und CCT festzustellen. Es traten keine retinalen Komplikationen auf, weder während der OP noch im Beobachtungszeitraum.Die Anzahl der IOL-Revisionen nimmt zu. Oft bleibt als einzige Option nur eine IOL-Sklerafixation zur visuellen Rehabilitation. Alle 3 untersuchten Sklerafixationsmethoden zeigten ein gutes Sicherheitsprofil ohne statistisch signifikanten Einfluss auf IOD, CMT, CCT, aber eine nennenswerte Revisionsrate. Eine visuelle Rehabilitation des BCVA auf den präoperativen Status (GoreTex [n = 14] und Prolene [n = 19]) bzw. ein statistisch signifikanter Visusanstieg (Gesamtkohorte [n = 55] und Yamane [n = 22]) scheint möglich. Verglichen mit der Irisfixation ist die Sklerafixation chirurgisch komplexer und hat eine steilere Lernkurve für den Chirurgen.

PURPOSE The study was performed to evaluate the refractive and visual outcome of patients with misaligned toric intraocular lenses (IOLs) after operative realignment, with and without back-calculation of the toric axis after implantation of the IOL. DESIGN Institutional, retrospective case-control study. METHODS This is a retrospective case series of 39 patients who underwent a second operation to realign a misaligned toric IOL from August 2013 to December 2019 at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Ideal toric axis was calculated using the back-calculator astigmatismfix.com. RESULTS The study consists of 39 treated eyes (20 [51%] right eyes). The toric IOLs showed a postoperative misalignment of 25.69 ± 26.06°. Postrotational, uncorrected distance visual acuity (UDVA) improved from 0.39 ± 0.29 logMAR to 0.27 ± 0.18 logMAR. Refractive outcome showed a reduction of residual sphere and cylinder. The postoperative UDVA when performing alignment to the preoperative calculated axis (51%) was 0.24 ± 0.16 logMAR with a cylinder of 0.90 ± 0.90 diopter (D). In the group with alignment to a back-calculated axis (49%), the UDVA was 0.32 ± 0.20 logMAR with a cylinder of 0.76 ± 0.72 D. High cylinder power IOLs (≥2 D) showed a higher decrease in residual cylinder when back-calculation was performed than low cylinder power IOLs (

Low energy stereotactic radiotherapy has been proposed for the treatment of neovascular age related macular degeneration. We investigated the in vitro effect of the radiotherapy on pericytes, retinal pigment epithelium and endothelial cells. Primary human retinal pigment epithelium cells, human umbilical vein endothelial cells and human pericytes from Placenta were cultivated. In a pairwise protocol, one plate was irradiated at a dose of 16 Gy, while the second plate served as a non-irradiated control. Thereafter, cells were cultivated either in serum-free (non-permissive) or serum-stimulated (permissive) conditions. A life/dead assay, an XTT and a BrdU assay were performed up to 7 days after irradiation. No cell death occurred at any timepoint in any cell line after treatment nor in the control. Compared to the unirradiated controls, cell viability and metabolic activity were significantly reduced in irradiated cells in the XTT assay, except for non-permissive RPE cells. In the BrdU assay, proliferation was inhibited. While no cell death was detected in vitro, viability and proliferative capacity of all cell lines were significantly reduced. Therefore, it seems that low energy stereotactic radiotherapy inhibits angiogenesis without a direct induction of apoptosis but influencing microvascular function and stability.

Retinal vein occlusion, subdivided into central retinal and branch retinal vein occlusion, is one of the most frequent vascular diseases of the retina. Biomarkers of optical coherence tomography (OCT), OCT-angiography and (ultra-widefield) fluorescein angiography are of exceptional importance in the initial diagnosis and also in the treatment of complications associated with retinal vascular occlusion, particularly macular edema.A systematic literature review was carried out in PubMed with the keywords central retinal vein occlusion, branch retinal vein occlusion, biomarker, OCT, OCT angiography, ultra-widefield fluorescein angiography with prioritization of the most important aspects.Relevant biomarkers in OCT include central retinal thickness (CRT), macular fluid, the integrity of the photoreceptor bands (external limiting membrane and ellipsoid zone), disorganization of retinal inner layers (DRIL), hyperreflective foci, choroidal thickness and signs of ischemia, such as a prominent middle limiting membrane (p-MLM), paracentral acute middle maculopathy (PAMM) as well as hyperreflectivity of inner retinal layers (HIRL). The importance of OCT-angiography lies particularly in the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra-widefield angiography, such as peripheral ischemia (ischemic index) and neovascularízation are essential with respect to treatment decisions for retinal laser.A multitude of simple and complex biomarkers currently enable an effective individualized evaluation of treatment and prognosis in retinal vein occlusion. A shift from invasive to noninvasive biomarkers can be observed.HINTERGRUND: Retinale Venenverschlüsse, subsumiert in Zentralvenen- und Venenastverschluss, gehören zu den häufigsten vaskulären Erkrankungen der Netzhaut. Sowohl bei Erstdiagnose als auch in der Therapie verschlussassoziierter Komplikationen, v. a. des Makulaödems, sind Biomarker der optischen Kohärenztomographie (OCT), OCT-Angiographie und (Ultraweitwinkel‑)Fluoreszeinangiographie von herausragender Bedeutung.Es erfolgte eine systematische Literaturrecherche auf pubmed.gov mit den Keywords „central retinal vein occlusion“, „branch retinal vein occlusion“, „biomarker“, „OCT“, „OCT angiography“, „ultra-widefield fluorescein angiography“ mit Priorisierung der wichtigsten Aspekte zur Umfangsreduktion.Als relevante Biomarker konnten in der OCT Makuladicke („central retinal thickness“ [CRT]), makuläre Flüssigkeit, die Integrität der Photorezeptorbande (Membrana limitans externa [ELM] und „ellipsoid zone“ [EZ]), „disorganization of retinal inner layers“ (DRIL), hyperreflektive Foci, Aderhautdicke sowie Ischämiezeichen wie „prominent middle limiting membrane“ (p-MLM), die „paracentral acute middle maculopathy“ (PAMM) sowie „hyperreflectivity of inner retinal layers“ (HIRL) identifiziert werden. Der Stellenwert der OCT-Angiographie liegt v. a. in der Beurteilung mikrovaskulärer Veränderungen, insbesondere der „vessel density“ im tiefen retinalen Gefäßplexus, der fovealen avaskulären Zone und von Arealen ohne Kapillarperfusion. Bezüglich der Therapieentscheidung zum Netzhautlaser sind Biomarker der Ultraweitwinkelangiographie wie periphere Ischämien („ischemic index“) sowie Neovaskularisationen essenziell.Eine Vielzahl simplerer und komplexer Biomarker ermöglicht heute eine effektive individualisierte Therapie- und Prognoseeinschätzung beim retinalen Venenverschluss. Eine Verschiebung von invasiven zu nichtinvasiven Biomarkern wird beobachtet.

Purpose Amniotic membrane (AM) is a popular treatment for ocular surface diseases due to its wound healing effects. First intraocular implantations showed good anatomical and functional results. Here, three cases of intravitreal AM transplantation and the morphological and functional outcome are described. The reaction to AM was examined by immunostaining and cellular reactions were investigated on retinal cells in-vitro. Methods: Three patients with epiretinal implanted AM during PPV for complicated retinal detachment are presented retrospectively. We investigated the AM-influence in-vitro on RPE cells (ARPE-19), Müller cells (Mio-M1), and retinoblasts (661W). An anti-histone DNA ELISA and live/dead assay for apoptosis, a BrdU ELISA for proliferation and a WST-1 assay for viability were performed. Following AM-removal, tissue-specific cellular responses were evaluated by light microscopy and immunohistochemical staining. Results: Despite severe vitreoretinal disease, good anatomical and functional outcomes were achieved in all three cases. Immunostaining of AM showed no immunological rejection. In-vitro, AM mediates no toxic or proliferating effect on RPE and Müller cells but a neuroprotective effect on differentiated retinoblasts. Conclusion: AM offers possible advantages treating severe vitreoretinal disease. The pathobiological mode of action was elucidated and we could not determine issues regarding rejection reactions and biocompatibility. Further studies are needed to assess clinical potential.

Within the last decade, continuous advances in molecular biological techniques have made it possible to develop causative therapies for inherited retinal disorders (IRDs). Some of the most promising options are gene-specific approaches using adeno-associated virus-based vectors to express a healthy copy of the disease-causing gene in affected cells of a patient. This concept of gene supplementation therapy is already advocated for the treatment of retinal dystrophy in RPE65-linked Leber's congenital amaurosis (LCA) patients. While the concept of gene supplementation therapy can be applied to treat autosomal recessive and X-linked forms of IRD, it is not sufficient for autosomal dominant IRDs, where the pathogenic gene product needs to be removed. Therefore, for autosomal dominant IRDs, alternative approaches that utilize CRISPR/Cas9 or antisense oligonucleotides to edit or deplete the mutant allele or gene product are needed. In recent years, research retinal gene therapy has intensified and promising approaches for various forms of IRD are currently in preclinical and clinical development. This review article provides an overview of current clinical trials for the treatment of IRDs.Stetige Fortschritte in molekularbiologischen und genetischen Techniken ermöglichten es innerhalb der letzten Jahre, die Entwicklung ursächlicher Therapien für erbliche Netzhauterkrankungen (IRD) voranzubringen. Zu den vielversprechendsten Ansätzen gehört die Gensupplementierungstherapie, bei der mittels Adeno-assoziierten Viren (AAV) eine gesunde Kopie des krankheitsverursachenden Gens in die betroffenen Zellen eines Patienten eingeschleust wird. Dieses Therapiekonzept ist bereits bei RPE65-assoziierten Netzhautdystrophien, wie beispielsweise einer Form der Leberʼschen kongenitalen Amaurose (LCA2) als Therapie zugelassen. Während das Konzept der Gensupplementierungstherapie zur Behandlung autosomal-rezessiver und X-chromosomaler Formen von IRD angewendet werden kann, muss bei autosomal-dominanten IRDs, zusätzlich zur Gensupplementation, das pathogene Genprodukt entfernt werden. Daher sind für autosomal-dominante IRDs alternative Ansätze erforderlich, die CRISPR/Cas9- oder Antisense-Oligonukleotide verwenden, um das mutierte Allel oder Genprodukt gezielt zu eliminieren. In den letzten Jahren wurden die Forschungsaktivitäten auf dem Gebiet der retinalen Gentherapie intensiviert und etliche, vielversprechende Ansätze für verschiedene Formen der IRD befinden sich derzeit in der präklinischen und klinischen Entwicklung. Mit diesem Übersichtsartikel möchten wir einen Überblick über aktuelle Studien zur Behandlung von IRDs bieten und einen Ausblick auf zukünftige Entwicklungen geben.

Annemarie Klingenstein,1 Aylin Garip-Kuebler,1 Siegfried Priglinger,1 Christoph Hintschich,1 Ullrich G Mueller-Lisse2 1Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany; 2Department of Radiology, Ludwig-Maximilians-University, Munich, GermanyCorrespondence: Annemarie KlingensteinLudwig-Maximilians-University, Department of Ophthalmology, Klinikum der Universität München, Campus Innenstadt, Mathildenstraße 8, Munich, D-80336, GermanyTel +49 89 44005 3811Fax +49 89 44005 5160Email Annemarie.Klingenstein@med.uni-muenchen.deAim: To detect radiological features that, in addition to clinical findings, may aid in correct differentiation between IgG4-related ophthalmic disease (IgG4-ROD) and ocular adnexal lymphoma (OAL).Methods: In this retrospective, single-center, comparative analysis, we compared cross-sectional imaging findings of 13 consecutive patients with histologically proven IgG4-ROD and a control group of 29 consecutive OAL-patients diagnosed between 10/2014 and 09/2019. Statistical significance was accepted at a p< 0.05 significance level.Results: IgG4-ROD-patients had longer time-to-diagnosis, higher orbital recurrence rates, but smaller lesions compared to OAL-patients (p=0.002; p=0.006 and p=0.006; Mann–Whitney U-test). Frequent cross-sectional imaging findings in both IgG4-ROD-patients and OAL-patients included extraocular muscle enlargement (92% and 93%, respectively; most often in the lateral rectus muscles and the levator-complex), and lacrimal-gland enlargement (85% and 83%, respectively). Other imaging findings comprised infraorbital nerve-involvement (IgG4-ROD, 23%, OAL, 17%) and orbital fat inflammation (IgG4-ROD, 23%, OAL, 28%). Bony infiltration and remodeling, heterogenous contrast-media distribution, and infiltration of the lacrimal system were seen slightly more often in IgG4-ROD (23%, 38%, 15% and 15% versus 17%, 14%, 3% and 7%). However, cross-sectional imaging features did not differ significantly between patient subgroups. Clinical symptoms predominantly occurred unilaterally (IgG4-ROD, 9/13, 69%, OAL, 24/29, 83%), while imaging findings were most often bilateral (IgG4-ROD, 11/13, 85%, OAL, 23/29, 79%, p< 0.001, McNemar test).Conclusion: No morphological cross-sectional imaging sign could reliably distinguish between IgG4-ROD and OAL, leaving histopathology indispensable for definite diagnosis. Yet, importantly, for both IgG4-ROD and OAL, cross-sectional imaging frequently detected bilateral orbital disease when only one eye was clinically affected.Keywords: IgG4, idiopathic orbital inflammation, CT, ocular adnexal lymphoma

To evaluate the effect of IPL (intense pulsed light) treatment in patients with meibomian gland dysfunction (MGD).Clinical data of 25 patients with MGD who underwent IPL treatment at the department of ophthalmology of Ludwig-Maximilians-University between 2016 and 2018 were analyzed. Demographics, clinical history, examination findings (eyelid vascularization, meibomian gland findings, conjunctival redness, tear film break-up time [TFBUT], corneal staining (Oxford grading scale [OGS]), and subjective patients' findings (including ocular surface disease index [OSDI]) were collected from each visit (D1, D15, D45, D75).All included patients underwent three sessions of IPL treatment in both eyes (D1, D15, D45). There was a significant improvement after IPL treatment (D75) in TFBUT (p 0.001), corneal staining (OGS) (p 0.001), conjunctival redness (p 0.001), lid margin edema (p 0.001) and redness (p 0.001), meibum quality (p 0.001), lid margin telangiectasia (p = 0.005), meibomian gland obstruction (p = 0.001), and OSDI score (p = 0.004). Even after the first IPL session, significant improvements in TFBUT (p 0.001), corneal staining (OGS p 0.001), conjunctival redness (p 0.022), lid margin edema (p 0.001) and redness (p 0.016), meibum quality (p = 0.014), and OSDI score (p 0.013) were noted. There were no relevant negative side effects. Subgroup analysis for age, sex, duration or severity of disease, and associated diagnosis of rosacea showed no significant difference in effectiveness.IPL is an effective and safe treatment for patients with MGD, which can be used as a supportive therapeutic option.ZIEL: Beurteilung der Wirkung der IPL-Therapie (IPL: Intensive pulsed Light) bei Patienten mit Meibomdrüsendysfunktion (MDD).Analysiert wurden die Daten von 25 Patienten mit MDD, die zwischen 2016 und 2018 in der Abteilung für Augenheilkunde der LMU mittels IPL behandelt wurden. Demografische Daten, klinische Anamnese sowie Untersuchungsbefunde (Lidrandvaskularisation, Meibomdrüsenbefunde, Bindehautrötung, Tränenfilmaufrisszeit (TFBUT), Hornhautoberflächenfärbung (Oxford Grading Scale [OGS]) und subjektive Symptome (einschließlich des Ocular Surface Disease Index [OSDI]) wurden bei jedem Besuch erhoben (D1, D15, D45, D75).Alle Patienten erhielten eine IPL-Behandlung in 3 Sitzungen an beiden Augen (D1, D15, D45). Am Ende der IPL-Behandlung (D75) zeigte sich eine signifikante Verbesserung von TFBUT (p 0,001), Hornhautoberflächenfärbung (OGS) (p 0,001), Bindehautrötung (p 0,001), Lidrandödem (p 0,001) und Lidrandrötung (p 0,001), Meibumqualität (p 0,001), Lidrandteleangiektasien (p = 0,005), Meibomdrüsenobstruktion (p = 0,001) und OSDI-Score (p = 0,004). Bereits nach der 1. IPL-Sitzung konnte eine signifikante Verbesserung von TFBUT (p = 0,001), Hornhautoberflächenfärbung (OGS p 0,001), Bindehautrötung (p = 0,022), Lidrandödem (p = 0,001) und -rötung (p = 0,016), Meibumqualität (p = 0,014) und OSDI-Score (p = 0,013) festgestellt werden. Es gab keine relevanten negativen Nebenwirkungen. Eine Subgruppenanalyse hinsichtlich Alter, Geschlecht, Dauer oder Schwere der Erkrankung sowie der assoziierten Diagnose der Rosazea zeigte keinen signifikanten Unterschied in der Wirksamkeit.IPL ist eine wirksame und sichere Behandlung für Patienten mit MGD, die als unterstützende therapeutische Option eingesetzt werden kann.

The canonical Wnt/β-catenin signaling pathway has been shown to play a major role during embryonic development and maturation of the central nervous system including the retina. It has a significant impact on retinal vessel formation and maturation, as well as on the establishment of synaptic structures and neuronal function in the central nervous system. Mutations in components of the Wnt/β-catenin signaling cascade may lead to severe retinal diseases, while dysregulation of Wnt signaling can contribute to disease progression. Apart from the angiogenic role of Wnt/β-catenin signaling, research in the last decades leads to the theory of a protective effect of Wnt/β-catenin signaling on damaged neurons. In this review, we focus on the neuroprotective properties of the Wnt/β-catenin pathway as well as its downstream signaling in the retina.

Purpose Long total waiting times (TWT) experienced by patients during a clinic visit have a significant adverse effect on patient’s satisfaction. Our aim was to use big data simulations of a patient scheduling calendar and its effect on TWT in a general ophthalmology clinic. Based on the simulation, we implemented changes to the calendar and verified their effect on TWT in clinical practice. Design and methods For this retrospective simulation study, we generated a discrete event simulation (DES) model based on clinical timepoints of 4.401 visits to our clinic. All data points were exported from our clinical warehouse for further processing. If not available from the electronic health record, manual time measurements of the process were used. Various patient scheduling models were simulated and evaluated based on their reduction of TWT. The most promising model was implemented into clinical practice in 2017. Results During validation of our simulation model, we achieved a high agreement of mean TWT between the real data (229 ± 100 min) and the corresponding simulated data (225 ± 112 min). This indicates a high quality of the simulation model. Following the simulations, a patient scheduling calendar was introduced, which, compared with the old calendar, provided block intervals and extended time windows for patients. The simulated TWT of this model was 153 min. After implementation in clinical practice, TWT per patient in our general ophthalmology clinic has been reduced from 229 ± 100 to 183 ± 89 min. Conclusion By implementing a big data simulation model, we have achieved a cost-neutral reduction of the mean TWT by 21%. Big data simulation enables users to evaluate variations to an existing system before implementation into clinical practice. Various models for improving patient flow or reducing capacity loads can be evaluated cost-effectively.

Nach initial erfolgreicher chirurgischer Versorgung einer Amotio retinae stellt die proliferative Vitreoretinopathie (PVR) die haufigste Ursache fur eine erneute Netzhautablosung dar. Sie hat eine Inzidenz von 5–20 % und ist gekennzeichnet durch epi-, intra- oder subretinale Narbenbildungen, die anspruchsvolle chirurgische Techniken erfordern. Es sollen die wichtigsten 5 Schritte fur eine erfolgreiche Sanierung einer PVR-Amotio erlautert werden. 1. Grundvoraussetzung ist die komplette Entfernung des Glaskorpers, um die Leitschiene fur die Proliferation pathologischer Zellen zu entfernen. 2. Ebenso ist die komplette Entfernung aller traktiven PVR-Membranen notig. Subretinale PVR-Membranen ohne Hinweis auf Traktion konnen belassen werden. 3. Weiterhin wichtig ist die fachgerechte Versorgung der Makula. Da 12 % aller Patienten nach primarer Versorgung einer Amotio retinae eine epiretinale Gliose/„macular pucker“ entwickeln, gehort ein Peeling der ILM v. a. bei der PVR nicht zur Kur, sondern zur Pflicht. 4. Besonders bei der PVR-Amotio wird das erwahnte chirurgische Prozedere durch die Wahl des geeigneten Instrumentariums erleichtert; hierzu gehoren unter anderem Weitwinkeloptiken wie das BIOM („binocular indirect ophthalmomicroscope“), Chandelier-Lichter, Perfluorcarbone (PFCL) und Silikonole. 5. Nicht zuletzt ist das Credo „So viel wie notig, so wenig wie moglich“ von essenzieller Bedeutung, da es sich bei Augen mit PVR meist um voroperierte Befunde handelt und jede weitere chirurgische Masnahme zu nachfolgender Entzundung und einer anhaltenden Stimulation der PVR-Reaktion mit weiterer Schadigung fuhrt. Die Berucksichtigung weniger entscheidender Regeln und Tipps ist Voraussetzung fur eine erfolgreiche Wiederanlage der Netzhaut bei der PVR-Amotio.