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To retrospectively assess the histopathological particularities of explanted CyPass® Micro-Stent of patients with significant loss of endothelial cell density.This is a case series of fourteen eyes from eleven patients who underwent CyPass® Micro-Stent implantation due to mild to moderate glaucoma and who subsequently suffered from loss of endothelial cell density. Therefore, the explantation of the device was necessary. In addition to the retrospective evaluation of the intraocular pressure and the endothelial cell density at the time of implantation and explantation, every surgically removed implant was histologically examined and evaluated.Fourteen eyes of eleven patients were in total analysed. The patients-seven males and four females-had a mean age of 62.9 years. The average time between CyPass implantation and explantation was 3.7 years. Eight patients suffered from primary-open-angle glaucoma (POAG), while two patients had a pseudoexfoliation glaucoma (PXG) and one patient had low-pressure glaucoma. Ten of the patients were already pseudophakic before the CyPass implantation and four patients underwent previously glaucoma interventions. There was a significant reduction in the intraocular pressure from 18.57 ± 5.27 mmHg at the time of implantation to 14.78 ± 3.32 mmHg at the time of explantation (p = 0.037). The average endothelial cell density decreased from 1843.67 ± 421.81 to 932.92 ± 412.86/mmImplants made of polyimides such as the CyPass® Micro-Stent are considered to be biocompatible, but there is no guarantee not to be obliterated or encapsulated. This is the first case series that has detected a foreign body granuloma in multiple eyes after CyPass implantation. However, there is no connection with the type of glaucoma, the extent of previous operations or with the presence of a prolonged postoperative inflammatory reaction.

To present the efficacy and safety of surgical treatment of moderate to advanced stage of open-angle glaucoma using the surgical method of transscleral cyclophotocoagulation with MicroPulse® laser (Iridex, Silicon Valley, California, USA) and to compare these results with those of continuous transscleral cyclophotocoagulation with diode laser. In a prospective observational clinical study 22 patients (30 eyes) with moderate and advanced open-angle glaucoma underwent transscleral cyclophotocoagulation. 15 eyes were treated with transscleral cyclophotocoagulation with MicroPulse® laser with 2500 mW (group A) and 15 eyes with continuous diode laser 810 nm and power between 2000 and 2300 mW (group B). The follow-up period of the study was 12 months. A reduction of the intraocular pressure > 30% was achieved in 53.3% of the group A and in 60% of the group B during the follow-up period of 12 months. A statistically significant decrease of the number of antiglaucoma agents was observed in group A. One eye (6.6%) of group A underwent additional antiglaucoma procedures to achieve target intraocular pressure. The corresponding percentage is 40% in group B. The postoperative inflammatory response was significantly more limited in group A compared to group B. The transscleral cyclophotocoagulation with MicroPulse® diode laser with 2500 mW achieves a similar decrease of the intraocular pressure as cyclophotocoagulation with continuous diode laser for the first postoperative months, but more satisfactory reduction of the number of eye drops as well as more limited postoperative inflammatory response.

The study compares the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) and trabeculectomy in eyes with moderate to advanced open-angle glaucoma.In this prospective study, 300 patients (300 eyes) with moderate to advanced open-angle glaucoma were treated with either PreserFlo MicroShunt or trabeculectomy. The implantation of the PreserFlo MicroShunt was performed in 150 eyes (group A) and trabeculectomy was performed in 150 eyes (group B). The efficacy was evaluated by estimating the absolute and qualified success rates using the Kaplan-Meier survival analysis. Results: During the 12-month follow-up period, 81.33% of eyes in group A and 94% in group B reduced intraocular pressure (IOP)20% without glaucoma eye drops. The average IOP 12 months after surgery was 12.89±3.4 mmHg in group A and 11.39±4.5 mmHg in group B, which was significantly lower than the baseline intraocular pressure (group A: 23.47±8.36 mmHg, p=0.00053; group B: 22.03±5.2 mmHg, p= 0.0006). The number of topical medications administered 12 months after ocular surgery was 0.4±0.8 in group A and 0 in group B, compared to 2.5±1.2 in group A and 2.7±0.9 in group B at baseline (group A: p= 0.00091; group B: p= 0.00072). Ten eyes (6.67%) in group A and four eyes (2.67%) in group B were referred for bleb revision due to bleb fibrosis and consequent acute postoperative rise in IOP. Four eyes of group A and two eyes of group B were treated with transscleral cyclophotocoagulation. Five eyes in group B received re-trabeculectomy because of dysfunction of the primary bleb.PreserFlo MicroShunt reduced the number of antiglaucoma agents compared to baseline, but was inferior to trabeculectomy at reducing IOP after 12 months. Additionally, trabeculectomy produced better absolute success rates after 12 months than PreserFlo MicroShunt in the treatment of moderate to advanced open-angle glaucoma.

To compare the efficacy of transscleral cyclophotocoagulation with MicroPulse® laser (Iridex, Silicon Valley, California, USA) with 3000 mW to Ahmed valve implantation in eyes with advanced stage of primary open-angle glaucoma. In a prospective observational clinical study, 30 patients (30 eyes) with advanced open-angle glaucoma were randomized for either micropulse transscleral cyclophotocoagulation with 3000 mW or Ahmed valve implantation. Fifteen eyes were treated with transscleral cyclophotocoagulation with MicroPulse® laser with 3000 mW (group A) and 15 eyes with Ahmed valve implantation (group B). As inclusion criteria are included the diagnosis of advanced primary open-angle glaucoma, an intraocular pressure above 21 mmHg, cup-to-disk ratio 0.9–1.0, failure to meet the target IOP with either maximal tolerated local medical therapy (2–4 antiglaucoma agents) or systemic therapy (acetazolamide). The follow-up time of the study was 12 months. An absolute success was defined the achievement of IOP between 6 and 15 mmHg and at least 30% reduction of the IOP from baseline under reduced or the same number of antiglaucoma agents after the surgical procedure without following glaucoma surgeries and as qualified success the achievement of IOP between 6 and 18 mmHg and at least 20% reduction of the IOP from baseline regardless of the number of postoperative antiglaucoma agents. The efficacy was evaluated by estimating the absolute success rate and the qualified success rate using the Kaplan–Meier survival analysis. A reduction of the intraocular pressure > 30% was achieved in 33.3% of group A and in 73.3% of group B during the follow-up period of 12 months. A statistically significant decrease in the number of eye drops was observed in both groups (p < 0.01). 53.3% of the eyes of group A underwent additional anti-glaucoma procedures to achieve target intraocular pressure. The number of the local medications that were administered 12 months after the ocular surgery was 2 (± 1.3) in group A and 0.57 (± 0.9) in group B, compared to 3.2 (± 0.78) in group A and 3.33 (± 0.7) in group B administered prior to the surgery (p: 0.016). 8 eyes (53.33%) in group A were referred for additional treatment due to an acute postoperative rise in IOP (5 eyes: mTS-CPC, 1 eye: canaloplasty, 2 eyes: AGV implantation). No further anti-glaucoma procedures were necessary in group B. The Ahmed valve implantation achieves a more efficient decrease of the intraocular pressure as well as of the number of antiglaucoma agents than the transscleral cyclophotocoagulation with MicroPulse® diode laser 3000 mW. Additionally, the Ahmed valve implantation showed better results in terms of absolute and qualified success rates in the treatment of advanced primary open-angle glaucoma.

The coverage of chronic and painful corneal defects with a complete or partial conjunctival flap is a surgical practice that is still applied to advanced stage of keratopathies, which insist despite repeated treatments with a therapeutic contact lens, corneal transplantation or amniotic membrane transplantation.37 cases of refractory corneal defects were treated between January 2006 and December 2019 with conjunctival flap. 27 cases underwent a complete and 10 cases a partial conjunctival flap. The mean age of the patients (n = 37, 23 women and 14 men subjects) was 73 years (23 - 87 years). Unsuccessful efforts of intensive conservative treatment and repetitive surgical procedures for several weeks or even months ended up to the indication of performance of a conjunctival flap. Conjunctival flap was performed using the Gundersen technique. A very thin flap of the upper bulbar conjunctiva is dissected downward towards the limbus without creating buttonholes. When the limbus is reached, the resultant flap is freed and without tension it is pulled over the corneal defect and sutured with nylon sutures placed at the limbus (complete conjunctival flap) or at the stroma of healthy cornea (partial conjunctival flap).This kind of conjunctival flap has low rates of complication. The postoperative follow-up after the partial or complete conjunctival flap was satisfying in 34 cases and showed a good healing process without major complications. Partial conjunctival flap shrinkage was observed in 3 cases, which could be revised in 2 of them. One case underwent enucleation, because of recurrent severe keratopathy.Conjunctival flap is an established surgical procedure that is applied rarely. The more frequent performance of this technique is suggested as it consists the ultima ratio for the treatment of refractory neurotrophic keratitis and non-healing epithelial defects.Partielle oder auch komplette Bindehautdeckungen haben ihre Indikation fast nur noch bei chronischen und schmerzhaften Oberflächenproblemen der Hornhaut, die dauerhaft gelöst werden sollen.Wir berichten über 37 Patienten, 23 Frauen und 14 Männer, mit einem Alter von 23 – 87 Jahren (Mittelwert 73 Jahre), bei denen wir in dem Zeitraum 1/2006 bis 12/2019 27 × eine komplette und 10 × eine partielle Bindehautdeckung durchgeführt haben. Vor der eigentlichen chirurgischen Maßnahme der Bindehautdeckung erfolgt i. d. R. eine wochen- bis monatelange ambulante wie auch stationäre Behandlung der chronischen therapieresistenten Oberflächenveränderungen und auch der Schmerzsymptomatik. Dafür muss ein Bindehautlappen partiell oder komplett möglichst spannungsfrei über die Hornhaut gezogen und dann stromal oder am Limbus verankert werden, bis eine Verwachsung der Subkonjunktiva mit den erkrankten Hornhautarealen erfolgt ist. In der Regel wird heutzutage dafür die Technik nach Gundersen durchgeführt.Insgesamt ist diese Bindehautdeckung komplikationsarm. Bei 34 Patienten waren die postoperativen Verläufe regelrecht. Die partiellen oder auch kompletten Bindehautdeckungen heilten komplikationslos ein. In 3 Fällen wurde eine Bindehautretraktion beobachtet, die in 2 Fällen revidiert werden konnte. In einem Fall musste eine Enukleation vorgenommen werden.Bindehautdeckungen sind eine etablierte, leider zu selten durchgeführte Operationstechnik, die häufiger zur Behandlung einer neurotrophen Keratitis oder bei persistierenden, nicht abheilenden Epitheldefekten zur Anwendung kommen sollte.

Die DMEK („Descemet Membrane Endothelial Keratoplasty“) hat sich in den letzten Jahren als operatives Verfahren auch zur Behandlung von komplizierten Fallen einer Hornhautdekompensation mit bulloser Keratopathie etabliert. In dieser Fallserie wurden 9 Augen von 8 Patienten mit fortgeschrittener Hornhautdekompensation bei Zustand nach multiplen intraokularen Eingriffen mit einer DMEK therapiert. Bei jeweils 1 Auge wurde die DMEK mit einer intravitrealen Gabe von Bevacizumab, mit einem IOL-Austausch, mit einer transskleralen MicroPulse-Zyklophotokoagulation (Iridex, Silicon Valley, Kalifornien, USA) sowie einer intravitrealen Gabe von Bevacizumab und der Deckung einer Skleraperforation mittels Tutopatch® (DMR srl, Italien) und bei 2 Augen mit einer Kurzung des Drainageschlauchs des Ahmed-Valve-Implantats kombiniert. Bei 3 Patienten erfolgte die DMEK als alleiniger operativer Eingriff. Die Beobachtungszeit liegt bei 12 Monaten. Bei 2 von 9 Augen erfolgte bei abgehobener Lamelle und persistierender Hornhautdekompensation trotz wiederholten Rebubblings eine perforierende Keratoplastik mit guten postoperativen Ergebnissen. Eine Visusbesserung konnte bei diesen 2 Augen aufgrund einer vorbestehenden Optikusatrophie nicht erzielt werden, die perforierende Keratoplastik bewirkte jedoch Schmerzfreiheit. Diese 2 Augen wurden von der Datenauswertung der Fallserie ausgeschlossen, sodass die Ergebnisse aus den restlichen 7 Augen generiert wurden. Ein Visusanstieg und Schmerzfreiheit wurden bei allen diesen 7 Augen durch die DMEK innerhalb eines Jahres erreicht. Die Endothelzelldichte der Spenderhornhaut reduzierte sich von 2465 (±147) auf 1295 ± 254 und 1180 ± 197/mm2 (p

In der mikroinvasiven Glaukomchirurgie (MIGS) wurde der CyPass Micro-Stent (Alcon Inc.) in den suprachoroidalen Raum implantiert, um den uveoskleralen Abfluss zu verstarken und somit den Augeninnendruck zu senken. Aufgrund des Verlustes von Hornhautendothelzellen wurde das Implantat im August 2018 vom weltweiten Markt genommen. Drei Jahre nach der CyPass-Implantation wurde bei 6 Patienten (insgesamt 8 Augen) mit fruhem bis masigem primarem Offenwinkelglaukom ein Verlust von Hornhautendothelzellen beobachtet. Bei einem Auge entwickelte sich eine bullose Keratopathie. Bei allen Patienten wurde eine Implantatmigration in der Vorderkammer im Vergleich zur ursprunglichen postoperativen Position festgestellt, wobei mehr als ein Ring des CyPass-Implantats sichtbar war. In allen 8 Fallen erfolgte die Entfernung des CyPass-Implantats. Die lokale Therapie mit kortisonhaltigen Augentropfen in Kombination mit einer 5%igen Natriumchloridlosung verbesserte das chronische Hornhautodem bei einem Patienten nicht. Daher erfolgte eine DMEK („Descemet membrane endothelial keratoplasty“) mit postoperativer Verbesserung des Visus. Bei Patienten mit mehr als einem sichtbaren Ring des CyPass-Implantats und einem lokalisierten Verlust der Hornhautendothelzellen wird die CyPass-Kurzung oder Entfernung empfohlen, damit das Fortschreiten der generalisierten Reduktion der Hornhautendothelzellen und das Auftreten eines therapieresistenten, chronischen Hornhautodems vermieden wird.

Purpose: To compare the performance of two different microcatheter systems, iTrack™ 250A and Glaucolight, in ab externo canaloplasty in three major categories: intraocular pressure reduction, drug therapy reintroduction, and evaluation of viscodilation over distension of the inner wall of Schlemm’s canal. Methods: A total of 56 and 46 eyes from different glaucoma types underwent ab externo canaloplasty using two different microcatheter systems. Group formation was made according to microcatheter system used. Kaplan–Meier test was performed for drug therapy reintroduction in relation to the two microcatheters. Tests of between-subject effects in two-way analysis of variance evaluated the efficacy of the two microcatheters and their features in relation to intraocular pressure reduction. Results: Kaplan–Meier test was not statistically significant (p = 0.20) regardless of microcatheter system. Tests of between-subject effects in relation to intraocular pressure reduction was not statistically different between the two microcatheters (p = 0.26) or between microcatheter and follow-up (p = 0.90). Intraocular pressure reduction in different glaucoma type was statistically significant during the follow-up period and glaucoma types showed different results between them in relation to follow-up (p Conclusion: Both microcatheter systems performed equal in terms of intraocular pressure reduction. Drug therapy reintroduction was not affected by the selection of the two microcatheters. Different types of glaucoma responded different to canaloplasty. Pseudophakic eyes responded better to treatment than phakic eyes, but the microcatheter selection seemed not affect this result.

Background The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms of intraocular pressure (IOP) lowering effect, postoperative complications and additional glaucoma surgery or reintroduction of medical therapy over a 12-month follow-up. Methods In a retrospective cohort study, 602 eyes with primary open angle glaucoma (POAG) were treated with canaloplasty or canaloplasty combined with phacoemulsification. The results were evaluated separately in two main groups; group A canaloplasty (262 eyes) and group B canaloplasty combined with phaco (322 eyes). Each group was then subdivided into three additional groups according to the severity of glaucoma. The criteria for successful treatment were evaluated between three IOP ranges; IOP ≤ 16 mmHg, 18 mmHg and 21 mmHg. Complete success was considered the percentage of eyes reaching target IOP with no medication and partial success with medication. Groups A and B subgroups were compared using the Kaplan Meier test. Mean IOP, reduction of antiglaucoma agents and additional IOP lowering methods were also evaluated. The follow-up time was 12 months. Statistical significance was set at p

To report the efficacy of ab externo canaloplasty by exclusively using only a nonabsorbable suture as a standalone operation or combined with phacoemulsification in terms of mean intraocular pressure (IOP), medication reduction, and intra- and postoperative complication rates as well as additional glaucoma surgery.Forty-eight patients with primary open-angle glaucoma (POAG) and 50 eyes were divided into two groups according to the operation performed (Group A canaloplasty, n = 34 and Group B canaloplasty combined with phaco, n = 16), respectively. The success criteria were evaluated between three IOP ranges: a) IOP ≤ 16 mmHg, b) ≤ 18 mmHg, and c) ≤ 21 mmHg. Complete success was considered the percentage of eyes reaching these goals with no medication and qualified success with or without medication. Groups A and B were compared with the Kaplan-Meier test. Mean IOP and medication reduction as well as additional glaucoma surgery were also evaluated. The follow-up time was 6 months. Statistical importance was given at p 0.05.Fail rate and intraoperative conversion of canaloplasty to other surgery (trabeculotomy due to extensive cheese-wiring) accounted for 12% (6 eyes), while a mandatory usage of the iTrack 250A microcatheter to successfully overcome intracanalicular bridging of the Schlemm's canal accounted for 20% (10 eyes). The most common early postoperative complications in both groups were hyphema, cheese wiring, and transient IOP rising. The mean IOP in Group A reduced from 23.67 ± 6.06 mmHg to 13.35 ± 4.23 mmHg and in Group B, it reduced from 23.55 ± 6.19 mmHg to 12.75 ± 1.5 mmHg at 6 months (p 0.001). Group A's absolute success rates accounted for a) 44%, b) 47.1%, and c) 52.9% in comparison to Group B [a) 50%, b) 50%, and c) 56.3%] at 6 months (p 0.05). Qualified success with or without medication showed no statistical differences between the groups. The mean medication reduction was significantly lower (p 0.001) in both groups (Group A from baseline 3.2 ± 1.23 to 0.95 ± 1.35 and Group B from 3.12 ± 0.88 to 1.12 ± 0.75 at 6 months, respectively). Five eyes (10%) required additional glaucoma surgery.Ab externo canaloplasty by exclusively using only a nonabsorbable suture as a standalone operation or combined with phacoemulsification seems to lower the mean IOP and medication sufficiently. However, they pose a greater surgical challenge and intraoperative complication rate. Additional glaucoma surgery or medication following both procedures may be necessary to achieve an optimal target IOP.Berichterstattung über die Wirksamkeit der Ab-externo-Kanaloplastik durch ausschließliche Verwendung nur einer nicht resorbierbaren Naht als eigenständige Operation oder in Kombination mit einer Phakoemulsifikation in Bezug auf den Mittelwert des Augeninnendrucks und die Reduktion der Antiglaukomatosa, die intra- und postoperativen Komplikationsraten sowie die zusätzliche Glaukomoperation.48 Patienten (50 Augen) mit POAG wurden gemäß der durchgeführten Operation in 2 Gruppen eingeteilt (Gruppe A Kanaloplastik, n = 34, und Gruppe B Kanaloplastik kombiniert mit Phako, n = 16). Die Erfolgskriterien wurden zwischen 3 IOP-Bereichen bewertet: a) IOD ≤ 16 mmHg, b) ≤ 18 mmHg und c) ≤ 21 mmHg. Der vollständige Erfolg wurde als Prozentsatz der Augen angesehen, die diese Zieldrücke ohne Antiglaukomatosa erreichten, und als qualifizierter Erfolg mit oder ohne Antiglaukomatosa. Gruppe A und B wurden mit dem Kaplan-Meier-Test verglichen. Der Mittelwert des Augeninnendrucks und die Reduktion der Antiglaukomatosa sowie eine zusätzliche Glaukomoperation wurden ebenfalls ausgewertet. Die Nachbeobachtungszeit betrug 6 Monate. Die statistische Signifikanz wurde bei p 0,05 angegeben.Die Umstellung der Kanaloplastik auf andere chirurgische Eingriffe (Trabekulotomie aufgrund umfangreichem „cheese wiring“) betrug 12% (6 Augen). Die Verwendung des iTrack 250A-Mikrokatheters zur erfolgreichen Katheterisierung des Kanals und Lösung der intrakanalikulären Vernarbungen des Schlemm-Kanals war bei 20% (10 Augen) erforderlich. Die häufigsten frühen postoperativen Komplikationen in beiden Gruppen waren Hyphema, „cheese wiring“ und vorübergehender Anstieg des Augeninnendrucks. Der Mittelwert des Augeninnendrucks wurde in Gruppe A von 23,67 ± 6,06 auf 13,35 ± 4,23 mmHg and in Gruppe B von 23,55 ± 6,19 auf 12,75 ± 1,5 mmHg nach 6 Monaten reduziert (p 0,001). Die absoluten Erfolgsraten der Gruppe A waren a) 44%, b) 47,1% und c) 52,9% im Vergleich zu denen der Gruppe B a) 50%, b) 50% und c) 56,3% nach 6 Monaten (p 0,05). Qualifizierter Erfolg mit oder ohne Antiglaukomatosa zeigte keine statistischen Unterschiede zwischen den Gruppen. Die mittelwertige Reduktion der Antiglaukomatosa war in beiden Gruppen signifikant niedriger (p 0,001) (Gruppe A von 3,2 ± 1,23 auf 0,95 ± 1,35 und Gruppe B von 3,12 ± 0,88 auf 1,12 ± 0,75 nach 6 Monaten). Fünf Augen (10%) erforderten eine zusätzliche Glaukomoperation.Eine Ab-externo-Kanaloplastik mithilfe einer nicht resorbierbaren Naht als eigenständige Operation oder in Kombination mit einer Phakoemulsifikation kann den mittleren Augeninnendruck und die Antiglaukomatosa ausreichend senken. Diese operative Technik stellt jedoch eine größere chirurgische Herausforderung dar und scheint eine höhere intraoperative Komplikationsrate zu haben. Zusätzliche Glaukomoperationen oder Antiglaukomatosa nach beiden Verfahren können erforderlich sein, falls ein optimaler Zieldruck nicht erreicht ist.

Tectonic eccentric sclerokeratoplasty à chaud is a very complex corneal operation and aims to preserve the eyeball and possibly to improve visual acuity in patients with peripheral corneal ulcerations or perforating corneal trauma.1650 eyes received corneal transplants in our clinic between 2006 and 2019. 14 of these 1650 eyes (0.8%) had a perforated or predescemetal peripheral corneal ulceration and these were treated between 2006 and 2019 with a tectonic eccentric sclerokeratoplasty à chaud. The mean age of the 8 women and 6 men included in this case series was 63 years (22 - 91 years).In the postoperative follow-up period, most complications and reoperations occurred in the first 6 months. Re-ulceration was observed in 2 cases as well as early suture loosening in 12 patients. These 2 cases were treated with a partial conjunctival flap. Additionally, prolonged superficial wound healing process was shown in 12 patients. Therefore 27 amniotic membrane transplantations, 12 suture replacements, and 6 partial conjunctival flaps were performed in total. No re-keratoplasties were required in this case series. All eyes could be stabilised through the sclerokeratoplasty as well as subsequent operations and intensive local or even systemic treatment. After removal of the corneal suture, the best-corrected visual acuity improved only insignificantly to hand movement in 1 case, finger counting in 3 cases, 0.1 in 5 cases, 0.2 in 4 cases and 0.5 in 1 case. Preservation of the eyeball with pain relief was achieved in all 14 eyes.Eccentric sclerokeratoplasty is a very demanding surgical procedure and is extremely rarely performed. The goal is to preserve the eye.Die tektonische exzentrische Sklerokeratoplastik à chaud ist eine sehr aufwendige Hornhautoperation, die auf einen Bulbuserhalt und ggf. zur Visusbesserung bei Fällen mit peripheren Ulzerationen oder perforierenden Verletzungen der Hornhaut zielt.1650 Augen erhielten eine Hornhauttransplantation in den Jahren 2006 bis 2019 in unserer Klinik. Davon wurden 14 Augen (0,8%) mit einer perforierten oder prädescemetalen peripheren Hornhautulzeration mit einer tektonischen exzentrischen Sklerokeratoplastik à chaud behandelt. Das Durchschnittsalter der 8 Frauen und 6 Männer lag bei 63 Jahren (22 – 91 Jahre).Im postoperativen Verlauf traten in den ersten 6 Monaten die meisten Komplikationen und Nachoperationen auf. So zeigte sich bei 2 Patienten an nahezu identischer Stelle eine Re-Ulzeration, die mit einer partiellen exzentrischen Bindehautdeckung behandelt wurde. Frühzeitige Fadenlockerungen wurden bei 12 Patienten und oberflächliche Wundheilungsstörungen bei ebenfalls 12 Patienten beobachtet. Es erfolgte bei 27 Augen eine Amnionmembranaufnähung, bei 12 eine Fadennachlegung, bei 6 eine partielle temporäre Tarsorrhaphie, bei 7 eine lokale Therapie mit Serumaugentropfen und bei 2 eine partielle exzentrische Bindehautdeckung. Eine Re-Keratoplastik war bei keinem Patienten dieser Fallserie erforderlich. Alle Augen konnten durch die Sklerokeratoplastik und die vielen Nachoperationen und die durchaus intensive systemische wie auch lokale Behandlung stabilisiert werden. Nach der Fadenentfernung verbesserte sich der bestkorrigierte Visus nur unwesentlich auf Handbewegung bei 1 Fall, Fingerzählen bei 3 Fällen, 0,1 bei 5 Fällen, 0,2 bei 4 Fällen und 0,5 bei 1 Fall. Eine Bulbuserhaltung mit Schmerzfreiheit wurde bei allen 14 Augen erreicht.Exzentrische Sklerokeratoplastiken sind sehr anspruchsvolle operative Eingriffe und werden extrem selten durchgeführt. Das Ziel ist der Erhalt des Auges.

To demonstrate a novel, alternative endothelium Descemet membrane layer (EDM) orientation method in Descemet membrane endothelial keratoplasty (DMEK) that does not involve prior ink or trepanation marking of the graft, or intraoperative ocular coherence tomography (OCT) guided graft implantation during surgery, thus preventing the occurrence of an upside-down graft implantation that leads with certainty to primary graft failure. From 2017 to early 2020, 500 eyes underwent DMEK operation using the “bubble-tap” technique first described from Dr. Perdikakis in the department of ophthalmology of St.-Johannes- Hospital in Dortmund in Germany. Primary graft failure and re-bubbling results following “bubble-tap” assisted DMEK are presented. Primary graft failure due to upside-down graft implantation was not observed in any patient. Re-bubbling was performed in 4.8% of the eyes. In 1.8% of the cases, a re-DMEK was performed due to a graft failure. The “bubble-tap” technique is a novel, reliable and easy to master orientation method of EDM that enables the surgeon to perform DMEK with safety even in complicated cases with poor visibility in the anterior chamber, while it yields superior or equal results in comparison to other graft marking methods or intraoperative OCT-guided graft implantation.

To compare the efficacy of transscleral cyclophotocoagulation with MicroPulseIn a prospective observational clinical study, 30 patients (30 eyes) with advanced open-angle glaucoma were randomized for either micropulse transscleral cyclophotocoagulation with 3000 mW or Ahmed valve implantation. Fifteen eyes were treated with transscleral cyclophotocoagulation with MicroPulseA reduction of the intraocular pressure30% was achieved in 33.3% of group A and in 73.3% of group B during the follow-up period of 12 months. A statistically significant decrease in the number of eye drops was observed in both groups (p0.01). 53.3% of the eyes of group A underwent additional anti-glaucoma procedures to achieve target intraocular pressure. The number of the local medications that were administered 12 months after the ocular surgery was 2 (± 1.3) in group A and 0.57 (± 0.9) in group B, compared to 3.2 (± 0.78) in group A and 3.33 (± 0.7) in group B administered prior to the surgery (p: 0.016). 8 eyes (53.33%) in group A were referred for additional treatment due to an acute postoperative rise in IOP (5 eyes: mTS-CPC, 1 eye: canaloplasty, 2 eyes: AGV implantation). No further anti-glaucoma procedures were necessary in group B.The Ahmed valve implantation achieves a more efficient decrease of the intraocular pressure as well as of the number of antiglaucoma agents than the transscleral cyclophotocoagulation with MicroPulse

In microinvasive glaucoma surgery (MIGS) the CyPass microstent (Alcon Inc.) was implanted in the suprachoroidal space to increase the uveoscleral outflow, thereby lowering the intraocular pressure. Due to the excessive loss of corneal endothelial cells, the implant was withdrawn from the global market in August 2018.A loss of corneal endothelial cells was observed in 6 patients (8 eyes in total) with early to moderate primary open-angle glaucoma 3 years after CyPass implantation. One eye developed a bullous keratopathy. In all patients an implant migration in the anterior chamber compared to the original postoperative position was detected, with more than one ring of the CyPass implant being visible in the anterior chamber.In all eight cases the CyPass implant was removed. The local therapy with cortisone eye drops in combination with a 5% sodium chloride solution did not improve chronic corneal edema in one patient. Therefore, a Descemet membrane endothelial keratoplasty (DMEK) was performed with postoperative improvement of visual acuity.In patients with more than one visible ring of the CyPass implant in the anterior chamber and subsequent localized loss of corneal endothelial cells, CyPass trimming or removal is recommended to avoid the progression of generalized corneal endothelial cell reduction and the onset of refractory, chronic corneal edema.HINTERGRUND: In der mikroinvasiven Glaukomchirurgie (MIGS) wurde der CyPass Micro-Stent (Alcon Inc.) in den suprachoroidalen Raum implantiert, um den uveoskleralen Abfluss zu verstärken und somit den Augeninnendruck zu senken. Aufgrund des Verlustes von Hornhautendothelzellen wurde das Implantat im August 2018 vom weltweiten Markt genommen.Drei Jahre nach der CyPass-Implantation wurde bei 6 Patienten (insgesamt 8 Augen) mit frühem bis mäßigem primärem Offenwinkelglaukom ein Verlust von Hornhautendothelzellen beobachtet. Bei einem Auge entwickelte sich eine bullöse Keratopathie. Bei allen Patienten wurde eine Implantatmigration in der Vorderkammer im Vergleich zur ursprünglichen postoperativen Position festgestellt, wobei mehr als ein Ring des CyPass-Implantats sichtbar war.In allen 8 Fällen erfolgte die Entfernung des CyPass-Implantats. Die lokale Therapie mit kortisonhaltigen Augentropfen in Kombination mit einer 5%igen Natriumchloridlösung verbesserte das chronische Hornhautödem bei einem Patienten nicht. Daher erfolgte eine DMEK („Descemet membrane endothelial keratoplasty“) mit postoperativer Verbesserung des Visus.Bei Patienten mit mehr als einem sichtbaren Ring des CyPass-Implantats und einem lokalisierten Verlust der Hornhautendothelzellen wird die CyPass-Kürzung oder Entfernung empfohlen, damit das Fortschreiten der generalisierten Reduktion der Hornhautendothelzellen und das Auftreten eines therapieresistenten, chronischen Hornhautödems vermieden wird.

During the last decade Descemet membrane endothelial keratoplasty (DMEK) has been established as a surgical treatment even for complex cases of bullous keratopathy.In a case series 9 eyes from 8 patients with chronic corneal edema caused by multiple intraocular operations underwent DMEK surgery. It was the sole surgical procedure in three eyes. In one case DMEK was combined with an intravitreal injection of bevacizumab, with opacified intraocular lens exchange in a second case, with transscleral cyclophotocoagulation with Iridex micropulse laser (Iridex, Silicon Valley, CA, USA) and intravitreal injection of bevacizumab in a third case and with the Tutopatch® (DMR srl, Italy) coverage of a scleral perforation in a fourth case. Additionally, DMEK was combined with trimming of the Ahmed valve tube length in two cases. The follow-up period was 12 months.Out of 9 eyes 2 showed a persistent partial or total detachment of the graft with concomitant recurrence of bullous keratopathy despite repeated injection of 20% sulfur hexafluoride (SF6) in the anterior chamber. These 2 eyes were treated with penetrating keratoplasty and achieved satisfactory postoperative results including pain relief. Visual acuity did not improve in these 2 eyes due to optic atrophy. Visual acuity and pain improved in the first postoperative month in 7 eyes. Donor endothelial cell density decreased from 2465±147/mmAlthough DMEK is a technically demanding surgical treatment for complicated cases of severe bullous keratopathy, it provides satisfactory results in terms of the improvement of visual acuity, pain relief and a shorter postoperative period.HINTERGRUND: Die DMEK („Descemet Membrane Endothelial Keratoplasty“) hat sich in den letzten Jahren als operatives Verfahren auch zur Behandlung von komplizierten Fällen einer Hornhautdekompensation mit bullöser Keratopathie etabliert.In dieser Fallserie wurden 9 Augen von 8 Patienten mit fortgeschrittener Hornhautdekompensation bei Zustand nach multiplen intraokularen Eingriffen mit einer DMEK therapiert. Bei jeweils 1 Auge wurde die DMEK mit einer intravitrealen Gabe von Bevacizumab, mit einem IOL-Austausch, mit einer transskleralen MicroPulse-Zyklophotokoagulation (Iridex, Silicon Valley, Kalifornien, USA) sowie einer intravitrealen Gabe von Bevacizumab und der Deckung einer Skleraperforation mittels Tutopatch® (DMR srl, Italien) und bei 2 Augen mit einer Kürzung des Drainageschlauchs des Ahmed-Valve-Implantats kombiniert. Bei 3 Patienten erfolgte die DMEK als alleiniger operativer Eingriff. Die Beobachtungszeit liegt bei 12 Monaten.Bei 2 von 9 Augen erfolgte bei abgehobener Lamelle und persistierender Hornhautdekompensation trotz wiederholten Rebubblings eine perforierende Keratoplastik mit guten postoperativen Ergebnissen. Eine Visusbesserung konnte bei diesen 2 Augen aufgrund einer vorbestehenden Optikusatrophie nicht erzielt werden, die perforierende Keratoplastik bewirkte jedoch Schmerzfreiheit. Diese 2 Augen wurden von der Datenauswertung der Fallserie ausgeschlossen, sodass die Ergebnisse aus den restlichen 7 Augen generiert wurden. Ein Visusanstieg und Schmerzfreiheit wurden bei allen diesen 7 Augen durch die DMEK innerhalb eines Jahres erreicht. Die Endothelzelldichte der Spenderhornhaut reduzierte sich von 2465 (±147) auf 1295 ± 254 und 1180 ± 197/mmDie DMEK ist eine technisch anspruchsvolle operative Therapieoption in der Behandlung von komplizierten Fällen einer Hornhautdekompensation mit bullöser Keratopathie, die sich durch zufriedenstellende Visusergebnisse, Schmerzfreiheit und eine verkürzte Heilungsphase auszeichnet.

Purpose: To estimate a risk–benefit ratio by comparing the efficacy of canaloplasty to trabeculectomy exclusively in pseudophakic eyes with primary open angle glaucoma. Patients and methods: One hundred four eyes that underwent ab externo canaloplasty and 136 eyes that underwent trabeculectomy with mitomycin C 0.02% and collagen matrix implantation were retrospectively compared. The efficacy was evaluated by evaluating the absolute success rate (5 ⩽ intraocular pressure ⩽ 15 mmHg) and the qualified success rate (intraocular pressure ⩽15 mmHg) using the Kaplan–Meier survival analysis. A meta-analysis to evaluate the relative risk of both procedures in relation to post-operative interventions was performed. Results: Mean intraocular pressure was significantly lower in both groups. Intraocular pressure decreased by 32.17% in the canaloplasty group and by 55.04% in the trabeculectomy group at 12 months (analysis of variance, p Conclusion: The trabeculectomy group showed better results in terms of absolute success rate. However, canaloplasty may provide a better risk–benefit ratio in terms of qualified success rate, hospitalization time, and required post-operative interventions, since canaloplasty yielded equal or superior results compared to trabeculectomy.

Purpose: To compare the efficacy and safety of PreserFlo (TM) MicroShunt (Santen, Osaka, Japan) combined with phacoemulsification to PreserFlo (TM) MicroShunt as a standalone procedure in eyes with moderate to advanced open-angle glaucoma. Methods: In an observatory, prospective, clinical study, 30 patients (30 eyes) with moderate to advanced angle glaucoma were allocated to either PreserFlo (TM) MicroShunt combined with phacoemulsification (15 eyes; Group A) or PreserFlo (TM) MicroShunt as a standalone procedure (15 eyes; Group B). The follow-up time of the study was 12 months. Results: Average intraocular pressure (IOP) at 12 months was 11.62 +/- 1.6 mmHg in Group A and 13.8 +/- 3.6 mmHg in Group B, which was significantly lower than baseline IOP (Group A: 23.47 +/- 8.99 mmHg, P < 0.001; Group B: 23.4 +/- 8.68 mmHg, P < 0.001). The absolute reduction of IOP within the 12 postoperative months was not significantly different between the two groups (P = 0.056). The number of the topical medications that were administered 12 months after ocular surgery was 0 in Group A and 0.6 +/- 0.8 in Group B, compared to 3.13 +/- 1.02 in Group A (P < 0.001) and 2.4 +/- 1.45 in Group B (P = 0.004) at baseline. Phacoemulsification combined with PreserFlo (TM) MicroShunt significantly reduced the number of antiglaucoma agents after 12 months compared to the standalone procedure (P = 0.026). One eye in Group A was referred for bleb revision due to bleb fibrosis and a consequent acute postoperative rise in IOP. One eye in Group A required transscleral cyclophotocoagulation with MicroPulse (R) laser. One bleb revision was also necessary in Group B at the 4th postoperative week. Endothelial cell density did not significantly change over 12 months in either group (Group A: baseline, 2017.3 +/- 346.8 cells/mm(2); 12 months, 1968.5 +/- 385.6 cells/mm(2); P = 0.38; Group B: baseline, 2134.1 +/- 382.6 cells/mm(2); 12 months, 2094.4 +/- 373.3 cells/mm(2), P = 0.42). The PreserFlo (TM) MicroShunt combined with phacoemulsification produced higher absolute success rates after 12 months in patients with moderate to advanced open-angle glaucoma than the PreserFlo (TM) MicroShunt as standalone procedure (Group A: 80% and Group B: 60%, P = 0.022). Conclusions: In eyes with moderate to advanced open-angle glaucoma, PreserFlo (TM) MicroShunt with or without phacoemulsification is effective in reducing IOP and the number of the antiglaucoma agents with a very small incidence of complications and subsequent glaucoma surgeries. However, adding phacoemulsification to PreserFlo (TM) MicroShunt successfully reduces IOP without the need for ongoing topical medications as are needed after the standalone procedure.

Der Cypass-Microstent (Transcend Medical, Menlo Park, CA, USA) ist ein Implantat aus biokompatiblem Polyamid, das in den suprachoroidalen Raum implantiert wird und den Kammerwasserabfluss uber den uveoskleralen Weg verbessert. In einer retrospektiven klinischen Studie wurden 162 Patienten (220 Augen) mit einem durchschnittlichen Alter von 71,8 (±14,2) Jahren mit mildem bis moderatem Glaukom mit einem Cypass-Implantat behandelt. In der Studie wurden 3 Patientengruppen (Gruppe 1, Gruppe 2 und Gruppe 3) gebildet. Zu der Gruppe 1 gehorten pseudophake Patienten, bei denen eine Cypass-Implantation durchgefuhrt wurde. Die Gruppe 2 bestand aus Patienten, bei denen die Cypass-Implantation kombiniert mit einer Phako/HKL durchgefuhrt wurde. In der Gruppe 3 wurden Patienten eingeschlossen, die mehrere Augenvoroperationen hatten und bei denen eine Cypass-Implantation erfolgte. Die Follow-up-Zeit der Studie betrug 1 Jahr. Der durchschnittliche praoperative intraokulare Druck (IOD) in der Gruppe 1 betrug 20,0 (±8,4) mm Hg und in der Gruppe 2 20,8 (±8,7) mm Hg. Der durchschnittliche IOD fiel in der Gruppe 1 12 Monate postoperativ auf 17,7 (±7,1) mm Hg (prozentuale Drucksenkung: 11,7 %, p

To evaluate the 24-month outcomes following STARflo™ implantation in patients with moderate or advanced open-angle glaucoma. We enrolled 32 patients (40 eyes) with high intraocular pressure (IOP) resistant to topical and systemic medical therapy. After baseline assessments, patients were implanted with STARflo™ implants with the goal of IOP reduction and long-term maintenance. Patients were followed for 24 months. Complete success of implantation was defined as a restoration of normal IOP without topical glaucoma medications, while qualified success was defined as a restoration of normal IOP with implantation and topical glaucoma medications. STARflo™ did not satisfactorily reduce IOP at 24 months. Twenty-eight eyes (70%) had elevated IOP at least once during the 24 months post-implantation period. Five eyes (12.5%) developed corneal decompensation. The average IOP 24 months after the surgery was 13.42 ± 6.03 mmHg and was not significantly different than IOP at 12 months (13.2 ± 5.59 mmHg). Moreover, 45% of treated eyes needed additional glaucoma procedures after 1 year and 2 years to achieve these IOPs. STARflo™ did reduce the average number of topical glaucoma medications from 2.7 pre-implantation to 1.17 at 24 months postoperatively in the rest 55% of the eyes. The STARflo™ implantation did not meet success criteria and so appears to be an ineffective alternative to filtering surgical procedures for patients with treatment-refractory open-angle glaucoma.

Zielsetzung: Das Ologen-Implantat (AeonAstron Europe B.V., Leiden, Niederlande) besteht aus einem biodegradierbaren Kollagen und Glycosaminoglykan und soll eine postoperative Filterkissenvernarbung oder Abkapselung vermeiden. Methode: In einer retrospektiven klinischen Studie wurden 806 mit fortgeschrittenem[zum vollständigen Text gelangen Sie über die oben angegebene URL], 31. Internationaler Kongress der Deutschen Ophthalmochirurgen

The Ologen implant consists of a biodegradable collagen and glycosaminoglycan and is intended to avoid postoperative bleb scarring or encapsulation.In a retrospective clinical study, 806 patients with advanced glaucoma were treated with trabeculectomy combined with mitomycin C0.02% and Ologen implant. The follow-up time of the study was 8 years.A long-term reduction of the intraocular pressure below 16 mmHg was achieved in 92.6% of the patients without glaucoma eye drops in the long-term observation period. The rate of complication was very low during the postoperative period and additional surgical procedures for over-filtration with subsequent choroidal detachment were seen in 6.8% of the patients. A failure of the combined operation with phacoemulsification and implantation of an intraocular lens resulted in revision of the bleb or the application of compressive sutures in 3.35% of patients within 8 years.The Ologen implant was introduced in glaucoma surgery to increase the effectiveness of trabeculectomy and to reduce the complications. Trabeculectomy combined with mitomycin C0.02% and an Ologen implant provides a satisfactory filtering effect without the undesirable effects of postoperative fibrosis.Das Ologen-Implantat (AeonAstron Europe B. V., Leiden, Niederlande) besteht aus einem biodegradierbaren Kollagen und Glycosaminoglykan und soll eine postoperative Filterkissenvernarbung oder Abkapselung vermeiden.In einer retrospektiven klinischen Studie wurden 806 Patienten mit fortgeschrittenem Glaukombefund mit einer Trabekulektomie kombiniert mit Mitomycin C0,02% und einem Ologen-Implantat behandelt. Die Follow-up-Zeit der Studie betrug 8 Jahre.Bei 92,6% der Patienten wurde in der Beobachtungszeit eine dauerhafte Drucksenkung von 16 mmHg ohne das erneute Ansetzen einer drucksenkenden Therapie erreicht. Bei 6,8% der Patienten erfolgten zusätzliche operative Eingriffe bei Überfiltration oder Hypotonie mit Aderhautamotio. Bei der kombinierten Operation mit Phakoemulsifikation und Implantation einer Hinterkammerlinse kam es bei 3,35% der Patienten zur Revision des Filterkissens oder einem erneuten drucksenkenden Eingriff innerhalb von 8 Jahren.Eine Trabekulektomie kombiniert mit Mitomycin C0,02% und einem Ologen-Implantat schafft einen langfristigen filtrierenden Effekt 16 mmHg und eine verringerte postoperative Komplikationsrate.

The STARflo glaucoma implant is a drainage-free system designed for the operative treatment of refractory open-angle glaucoma. The purpose of this study is to investigate the safety and efficacy of the STARflo implant. The results of 12 months follow-up are presented in patients with open-angle glaucoma, PEX–glaucoma, and congenital glaucoma. A prospective study with a total of over 29 patients (36 eyes), in which the suprachoroidal implantation of the STARflo was indicated for long-term intraocular pressure reduction, is still in process and evaluation. The reduction of intraocular pressure was satisfying after 12 months with an average intraocular pressure of 15.0 (± 2.5) mmHg in comparison to 21.08 (± 7.29) mmHg preoperatively. There was a significant 66.7% reduction in local glaucoma drops 12 months postoperatively (p

Low grade endophthalmitis is usually a chronic indolent inflammation that may be misdiagnosed as noninfectious uveitis. Therefore, this form of endophthalmitis is often unsuccessfully treated with corticosteroids. We describe the case of a patient with low grade endophthalmitis caused by Propionibacterium acnes after cataract surgery. This case report presents the difficulties in establishing the diagnosis of this form of endophthalmitis as well as the benefits of a combined operative therapy with pars plana vitrectomy, intravitreal antibiotics and posterior capsulectomy for successful treatment in such cases.

Idiopathic epiretinal membrane (iERM) is very rare in adolescent patients. The pathogenesis remains unclear although the role of hyalocytes is of major importance. The clinical features in young patients are different from those in older patients. We describe a case of iERM in a 15-year-old girl who presented with metamorphopsia of the right eye. This case report presents the basis for the decision for surgical treatment as well as the clinical features at follow-up examination 9 months after surgery.

Backgrounds: To report 2 cases of multidrug-resistant fungal keratitis caused by Fusarium solani. The patients underwent a different conservative and surgical therapy including in both of them a keratoplasty a chaud. Methods and findings: A 21-years-old male and a 26- years-old female patient, who both used soft contact lenses developed corneal infiltrates. In the first case the diagnosis was delayed because multiple microbiological examinations of corneal scrapings were initially negative for fungi. A combined empirical therapy against Acanthamoeba and bacteria resulted in no improvement of the clinical findings. The patient underwent a keratoplasty a chaud and the histopathologic analysis of the corneal button yielded Fusarium solani multiresistant to all antifungal agents. In the second case, Fusarium solani was detected in the initial microbiological examination of the corneal scrapings. Although the fungus was multiresistant to all antifungal agents, an aggressive multiple topical antifungal therapy as well as lyposomal Amphotericin B i.v was applied successfully after the keratoplasty a chaud combined with application of Polyvidon-Iodine on the infected cornea and cryocoagulation circular at limbus. Results: Although a therapy with topical Amphotericin B and systemic lyposomal Amphotericin B was applied by the first case the infection progressed to an endophthalmitis. Unfortunately an enucleation was unavoidable. The multiple conservative antifungal therapy in the second case was successful, and the corneal transplant remained free from new infiltrations. Conclusion: We consider the fast diagnosis of multidrug resistance of great importance. Secondly, a penetrating keratoplasty early on the course of the disease increases the chances of a successful outcome.

Muscle injury induces strong changes in muscle cells and extracellular matrix. Muscle regeneration after injury has similarities to muscle development during embryogenesis and seems to follow the same procedure. The initial phase of muscle repair is characterized by inflammation and degeneration of the damaged tissue. Almost simultaneously, previous quiescent myogenic cells, called satellite cells, are activated, proliferate, differentiate and fuse to form multinucleated myofibers. Other non-muscle stem cells may also take part in this process. Secreted factors, such as hepatocyte growth factor (HGF), fibroblast growth factors (FGFs), transforming growth factor-betas (TGF-betas), insulin-like growth factors (IGFs), tumour necrosis factor alpha (TNFalpha) and others, are released during muscle repair and guide muscle regeneration, however, their exact functions and effects on muscle remodeling remain unknown. Intensive research is currently addressing the regenerative mechanisms which are involved in acute muscle injuries and chronic muscle diseases.

Osteoprotegerin (OPG), a member of the tumor necrosis factor (TNF) receptor superfamily, contributes determinatively to the bone remodeling as well as to the pathogenetic mechanism of bone malignancies and disorders of mineral metabolism. There is additional evidence that OPG can promote cell survival by inhibiting TNF-related apoptosis-inducing ligand (TRAIL)-induced apoptosis. A number of recent in vitro, in vivo and clinical studies have defined the role of the RANK/RANKL/OPG pathway in skeletal and vascular diseases. These works were the milestone of the deep understanding of the mechanism of OPG. This review provides an overview of the potential innovative therapeutic strategies of OPG in metastatic breast and prostate carcinoma, multiple myeloma, postmenopausal osteoporosis, glucocorticoid-induced osteoporosis and rheumatoid arthritis. Special reference is given to the increasing evidence that RANKL and OPG may link the skeletal with the vascular system.

Osteoprotegerin (OPG), member of tumor necrosis factor (TNF) receptor superfamily, has various biological functions including bone remodeling. OPG binds to receptor activator of nuclear factor-kB ligand (RANKL) and prevents osteoclastic bone resorption. Recently, OPG has gained more clinical interest as its role in cancer-mediated bone destruction and the potential of RANKL inhibition could act as a novel treatment in tumor-induced bone disease. OPG protects prostate cancer cells from apoptotic effects of TRAIL and therefore provides tumor cells producing OPG with survival advantages. Additionally, the increased RANKL/OPG ratio in metastatic breast cancer results in severe osteolysis. Thus, bone formation and resorption are the crux of cancer metastasis, resulting in bone pain and pathological fractures. This review provides an overview of the role of OPG in cancer-induced bone disease.