Prevalence of TERT Promoter Mutations in Orbital Solitary Fibrous Tumors.

The orbital manifestation of a solitary fibrous tumor (SFT) is exceptionally rare and poses specific challenges in diagnosis and treatment. Its rather exceptional behavior among all SFTs comprises a high tendency towards local recurrence, but it rarely culminates in metastatic disease. This raises the question of prognostic factors in orbital SFTs (oSFTs). Telomerase reverse transcriptase (TERT)-promoter mutations have previously been linked to an unfavorable prognosis in SFTs of other locations. We analyzed the prevalence of TERT promoter mutations of SFTs in the orbital compartment. We performed a retrospective, descriptive clinico-histopathological analysis of nine cases of oSFTs between the years of 2017 and 2021. A TERT promoter mutation was present in one case, which was classified with intermediate metastatic risk. Local recurrence or progress occurred in six cases after primary resection; no distant metastases were reported. Multimodal imaging repeatedly showed particular morphologic patterns, including tubular vascular structures and ADC reduction. The prevalence of the TERT promoter mutation in oSFT was 11%, which is similar to the prevalence of extra-meningeal SFTs of the head and neck and lower than that in other extra-meningeal compartments. In the present study, the TERT promoter mutation in oSFT manifested in a case with an unfavorable prognosis, comprising aggressive local tumor growth, local recurrence, and eye loss.

Ophthalmological and Interdisciplinary Surgical Approaches to the Orbit. / Ophthalmologische und interdisziplinäre chirurgische Zugänge zur Orbita.

The treatment of orbital masses often requires an interdisciplinary approach. Ophthalmological surgical approaches include the anterior transcutaneous approach for removal of dermoids or taking biopsies. Anterior transconjunctival orbitotomy is suitable for masses of the inferior orbit or the intraconal compartment, but is inappropriate for masses of the orbital apex. The lateral transosseous orbitotomy often fits for masses of the lateral or intraconal compartment, especially for neoplasms of the lacrimal gland e.g. pleomorphic adenoma. Cryoextraction is often the technique of first choice for cavernous haemangiomas of all localisations. Transfrontal approaches are suitable for the resection of tumours of the optic nerve and of the orbital apex.

The Supraorbital Eyebrow Approach in Pediatric Neurosurgery: Perspectives and Challenges of Frontal Keyhole Surgery.

OBJECT: Supraorbital craniotomy via an eyebrow incision provides minimally invasive cosmetically favorable access to both orbital and intracranial pathologies. We describe the indication, surgical technique, and clinical course using this surgical approach in a cohort of patients from a single pediatric neurosurgery unit. METHODS: In a retrospective analysis, we identified all surgical cases between January 2013 and April 2022 who underwent the supraorbital craniotomy via an eyebrow incision. Craniotomy was performed using piezosurgery ultrasonic bone incision. An interdisciplinary team of an orbital surgeon and a neurosurgeon performed the orbital surgeries. Clinical and surgical characteristics, perioperative data, possible complications, or redo surgeries as well as ophthalmologic status were assessed. RESULTS: Clinical data of 37 interventions (cases) in 30 patients (age: 8 ± 6.5 years) were analyzed. The supraorbital craniotomy established access to the cranial, lateral, and central portions of the orbit (n = 11) and ipsilateral fronto-medial portions of the skull base (n = 26). Thirty cases suffered from tumor disease with heterogeneous histopathologic diagnoses, and in 13 cases, adjuvant therapy was required. The mean duration of surgery was 163 ± 95 min, and the mean time of hospital stay was 6.0 ± 2.8 days. In two cases (5.4%), the following complications were observed. One infection treated by puncture and antibiotics and one revision surgery was necessary due to loosening of osteosynthesis material. Postoperative visual function was stable compared to preoperative status after all interventions. After a mean follow-up time of 26 ± 25.9 months for oncologic cases the long term outcome was complete remission in 13, stable disease in 14, progressive disease in 1 and death in 2 patients. CONCLUSION: The supraorbital eyebrow approach is feasible and safe in pediatric neurosurgical cases as a minimally invasive and cosmetic favorable technique and should be considered for intraorbital as well as ipsilateral intracranial lesions adjacent to the skull base. Interdisciplinary cooperation enables a broader spectrum of surgical options in orbital and complex, fronto-basal, skull base pathologies.

Maligne Neoplasien der Orbita.

Malignant masses of the orbit include a large variety of neoplasms of epithelial or mesenchymal origin. The treatment of orbital malignancies is an essential interdisciplinary field of medicine that integrates ENT medicine, facial surgery, plastic surgery, neurosurgery, oncology and radiology.The main symptom of malignant orbital masses is the exophthalmos. A symptom that can help to differentiate a benign from a malignant orbital mass can be the pain. The main diagnostic tool is the MRI including new sequences like DWI and DCE.After presenting symptoms and diagnostic strategies of malignant orbital masses, this article starts with the description of malignant epithelial neoplasms of the lacrimal gland. Furthermore, it describes new insights in orbital lymphomas, followed by the discussion of semimalignant orbital masses. Last but not least the text deals with malignant neoplasms of the skin that can grow secondarily in the orbit. Finally, the manuscript discusses orbital metastases.

Analysis of higher-order aberrations in relation to the clinical outcome of an enhanced monofocal IOL.

PURPOSE: To analyse higher-order aberrations of an enhanced monofocal aspheric intraocular lens (IOL) in relation to the clinical outcome compared to a monofocal aspheric IOL. SETTING: Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Germany. DESIGN: Prospective, monocentric, controlled, non-randomized, two-armed study. METHODS: After phacoemulsification, a total of 30 patients (60 eyes) were bilaterally implanted with either TECNIS Eyhance IOL model ICB00 (Johnson & Johnson Surgical Vision, Inc.) or TECNIS Monofocal 1-Piece IOL model ZCB00 (Johnson & Johnson Surgical Vision, Inc.) in 30 eyes each. Assessments were performed 1 and 3 months after surgery including refraction, uncorrected and best-corrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivities under photopic, mesopic and mesopic conditions with glare, higher-order aberrations (HOAs) at pupil sizes of 5, 4, 3 and 2 mm and patient satisfaction. RESULTS: At 3-month follow-up, measurements of HOAs revealed significant higher negative internal and ocular primary spherical aberrations in the ICB00 group at pupil sizes of 5, 4, 3 and 2 mm. The ICB00 showed significant better results in intermediate and near visual acuity, but no difference in distance visual acuity. No significant difference was found in contrast sensitivities at any condition or spatial frequency. Spectacle independence was significant better without significant higher rates of dysphotopsia in the ICB00 group. CONCLUSIONS: Higher negative spherical aberrations in the ICB00 group at all measured pupil sizes appear to lead to a superior clinical outcome in intermediate and near vision compared to the ZCB00 group without compromising contrast sensitivity or distance visual acuity.

XEN® implantation: an effective strategy to stop glaucoma progression despite prior minimally invasive glaucoma surgery.

PURPOSE: The aim of this study was to evaluate whether XEN® implantation is a reasonable and safe method to lower the intraocular pressure (IOP) and amount of medication for adult primary open-angle glaucoma (POAG) over a 3-year period. The influence of the type of anesthesia, previous glaucoma surgery, and postoperative interventions on the outcome were examined. METHODS: In this retrospective study, 96 eyes were included. XEN® implantation was performed as sole procedure under general (n = 86) or local anesthesia (n = 10). IOP and number of glaucoma medication were assessed preoperatively: day 1, week 6, month 3, 6, 12, 24, and 36. Further outcome parameters were Kaplan-Meier success rates, secondary intervention, and complication rates. RESULTS: IOP decreased from 20.7 ± 5.1 to 12.8 ± 2.5 mmHg at the 36-month follow-up (p < 0.001) and glaucoma therapy was reduced from 3.3 ± 0.8 to 1.2 ± 1.6 (36 months, p < 0.001). Transient postoperative hypotony was documented in 26 eyes (27.1%). General anesthesia resulted in a significant improvement of the survival rate compared to local anesthesia (77% vs. 50%, p = 0.044). Prior iStent inject®, Trabectome®, or SLT laser had no significant impact, such as filter bleb revision. The number of postoperative needlings had a significantly negative influence (p = 0.012). CONCLUSION: XEN® implantation effectively and significantly lowers the IOP and number of glaucoma therapy in POAG in the 36-month follow-up with a favorable profile of side effects and few complications. In case of IOP, general anesthesia has a significant positive influence on the survival rate, whereas prior SLT or MIGS does not have significant impact.

Surgical Management of Pre-Chiasmatic Intraorbital Optic Nerve Gliomas in Children after Loss of Visual Function-Resection from Bulbus to Chiasm.

Optic pathway gliomas in children carry significant morbidity and therapeutic challenges. For the subgroup of pre-chiasmatic gliomas, intraorbital and intradural resection is a curative option after blindness. We present a two-center cohort using different surgical approaches. A retrospective analysis was performed, including 10 children. Mean age at surgery was 6.8 years. Interval between diagnosis and surgery was 1-74 (mean 24 ± 5.5, median 10) months. Indications for surgery were exophthalmos, pain, tumor progression, or a combination. Eight patients underwent an extradural trans-orbital-roof approach to resect the intra-orbital tumor, including the optic canal part plus intradural pre-chiasmatic resection. Gross total resection was achieved in 7/8, and none had a recurrence. One residual behind the bulbus showed progression, treated by chemotherapy. In two patients, a combined supra-orbital mini-craniotomy plus orbital frame osteotomy was used for intraorbital tumor resection + intradural pre-chiasmatic dissection. In these two patients, remnants of the optic nerve within the optic canal remained stable. No patient had a chiasmatic functional affection nor permanent oculomotor deficits. In selected patients, a surgical resection from bulb to chiasm ± removal of optic canal tumor was safe without long-term sequela and with an excellent cosmetic result. Surgery normalizes exophthalmos and provides an effective tumor control.

Visual outcome and optical quality of a wavefront-engineered extended depth-of-focus intraocular lens.

PURPOSE: To evaluate visual performance and optical quality of an extended depth-of-focus intraocular lens (EDoF IOL) compared with a monofocal aspheric IOL. SETTING: Department of Ophthalmology, Charité-Medical University Berlin, Germany. DESIGN: Prospective case series. METHODS: After phacoemulsification, a total of 28 patients (56 eyes) underwent bilateral implantation of either the Mini Well (EDoF IOL) or the Mini 4 (monofocal IOL). Assessments including refraction, distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, glare disability, higher-order aberrations (HOAs), and patient satisfaction were performed at 1 month and 3 months postoperatively. RESULTS: Both study groups comprised 14 patients (28 eyes) each. At 3-month follow-up, the EDoF IOL showed better results in monocular uncorrected intermediate visual acuity (-0.04 vs 0.10 logMAR, P = .000) and in uncorrected near visual acuity (0.13 vs 0.36 logMAR, P = .000), whereas no statistically significant difference was found between groups in monocular uncorrected distance visual acuity (0.04 vs 0.00 logMAR, P = .110). The monocular depth of focus was 0.8 D greater in the Mini Well IOL group. Measurements of internal HOAs revealed a greater negative primary spherical aberration in the EDoF group at pupil sizes of 2.0 to 5.0 mm. At 5.0 mm, total internal HOAs did not differ statistically significantly (0.376 vs 0.340 µm root mean square, P = .068). CONCLUSIONS: The Mini Well IOL provided greater depth of focus with superior outcomes at intermediate and near distances and comparable outcomes at far distance. Although inducing higher amounts of spherical aberration, it showed good results under low lighting conditions with little subjective dysphotopsia.

Selective Laser Trabeculoplasty Versus MIGS: Forgotten Art or First-Step Procedure in Selected Patients with Open-Angle Glaucoma.

INTRODUCTION: To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice. METHODS: A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95-105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome®, NeoMedix, Tustin, USA), and 130 patients received iStent inject® implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan-Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy). RESULTS: In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome® IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject® by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome® and iStent inject® could not demonstrate a significant reduction in glaucoma therapy (Trabectome® p = 0.138, iStent inject® p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome®, 77.6% iStent inject®) and criterion B (74.5% SLT, 48.0% Trabectome®, 56.2% iStent inject®). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome®, 7.0% in iStent inject® and criterion D 3.0% in SLT, 4.3% in Trabectome®, 3.7% in iStent inject® in 3-year follow-up. CONCLUSION: The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité - Universitätsmedizin Berlin, EA4/047/20-retrospectively registered.

Corneal higher-order aberrations after cataract surgery: Manual phacoemulsification versus femtosecond-laser assisted technique.

PURPOSE: To compare and evaluate corneal higher-order aberrations (c-HOA) between conventional manual phacoemulsification (Phaco), femtosecond laser-assisted cataract surgery (FLACS), and femtosecond laser-assisted cataract surgery with astigmatic keratotomy (FSAK). METHODS: In this retrospective single center study, 53 healthy individuals with cataract (73 eyes) underwent phacoemulsification with implantation of an intraocular lens. Three groups were formed: group A, Phaco (n = 27 eyes of 21 patients); group B, FLACS (n = 25 eyes of 15 patients); group C, FSAK (n = 21 eyes of 17 patients). An iTrace aberrometer (Tracey Technologies, Houston, TX, USA) was used to perform aberrometry with a pupil scan size of 5.0 mm. We used ANOVA analysis and the paired sample t-test for statistical analysis. RESULTS: There was no difference in total c-HOA between the groups prior to surgery (F(2,66) = 2.2, p = 0.128), but some evidence for a difference between the groups after surgery (F(2,65) = 3.87, p = 0.025). After surgery, total c-HOA increased in all groups, but the greatest increase occurred FSAK. CONCLUSION: Manual phacoemulsification and femtosecond laser-assisted cataract surgery seem to have less impact on corneal higher-order aberrations than the combination of femtosecond laser-assisted cataract surgery with astigmatic keratotomy.

Firework-inflicted ocular trauma in children and adults in an urban German setting.

PURPOSE: To assess firework-inflicted ocular trauma in the German capital during the week around New Year's Eve with regards to patient characteristics and age, severity of injuries, and their management and outcome. METHODS: A retrospective chart review of all patients presenting to the department of ophthalmology of Charité-University Medicine Berlin during a 7-day period around New Year's Eve in the years 2014-2017 was performed. Patients with ocular complaints and injuries caused by fireworks were included. We recorded demographic data, active role, visual acuity at presentation and at last follow-up, the most pertinent clinical findings, management and outcome with regards to visual acuity, and integrity of the eye. RESULTS: A total of 146 patients with 165 injured eyes were included. Median age at presentation was 23 (4-58) years, and 71.2% were male. Fifty-one patients (34.9%) were less than 18 years old. Ninty-seven patients (66.4%) sustained minor, 34 (23.3%) sustained moderate, and 15 (10.3%) sustained severe injuries. Severe trauma was seen in younger patients (median age: 12, range: 4-58 years) than mild and moderate trauma (median age: 23, range: 4-45 years) and resulted in loss of light perception in two eyes and in a visual acuity of only light perception in three eyes. One eye was enucleated. CONCLUSION: Ocular trauma inflicted by fireworks can have serious consequences for ocular morbidity and visual acuity, especially in severe trauma which affected younger patients. To significantly reduce firework-inflicted trauma, a ban of private fireworks in densely populated areas and in the vicinity of children should be considered.

Comparison of two extended depth of focus intraocular lenses with a monofocal lens: a multi-centre randomised trial.

PURPOSE: The AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL. METHODS: Cataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months. RESULTS: A total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p < 0.0001), while there was no significant difference between Symfony and ASPHINA eyes at 0.1 logMAR and 0.2 logMAR. Both EDOF IOLs were significantly better than the monofocal ASPHINA at all levels for binocular depth of focus (LARA: all p < 0.0001; Symfony: all p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p < 0.0001). Refraction improved in all groups relative to baseline. Contrast sensitivity was higher with the CT ASPHINA 409MP but both EDOF lenses had a better spectacle independence rate. At 6 months, all IOLs were well centred with no cases of tilt. No general safety issues were raised for any of the groups. CONCLUSION: The two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable. TRIAL REGISTRATION: Trial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).

Use of topical anaesthesia and peribulbar anaesthesia in Descemets membrane endothelial keratoplasty.

INTRODUCTION: In instances where peribulbar anaesthesia (PBA) cannot be used, Descemet membrane endothelial keratoplasty (DMEK) surgery can be performed under topical anaesthesia (TA). We evaluated subjective pain and post-operative outcomes of DMEK surgeries performed under PBA and TA. METHODS: Sixty pseudophakic patients without history of ocular comorbidities underwent DMEK surgery under either PBA or TA. PBA was performed with a single injection of 6 mL Prilocaine Hydrochloride 2% in combination with 1500 I.U. hyaluronidase. For TA, patients were given 0.4% Oxybuprocaine eye drops followed by a 2% Lidocain Hydrochloride-Gel and an intraoperative injection of a 2% Lidocaine Hydrochloride solution into the anterior chamber. All surgeries were performed by the same surgeon. Subjective pain was measured using a visual analog scale (VAS). Secondary outcomes (BCVA, duration of surgery, endothelial density, rebubbling rate) were recorded during a follow-up period of 3 months. RESULTS: The mean subjective pain of patients in the PBA group was 1.27 (95% CI 0.87-1.68) and 1.64 (95% CI 1.15-2.21) in the TA group. The mean duration of surgery was 402 s (95% CI 356-448) in the PBA group and 427 s (95% CI 371-483) in the TA group, p = 0.477. No major differences were observed in BCVA, endothelium density and rebubbling rate between the two groups. Anaesthesia-related side effects were more frequent in the PAB group than in the TA group. CONCLUSION: Although levels of subjective pain are lower under PBA than under TA, in selected patients without ocular comorbidities TA can achieve levels of pain acceptable for DMEK surgery.

Iris and Lens Trauma - Iris Reconstruction. / Iris-Linsen-Trauma ­ Irisrekonstruktion.

Iris and lens injuries entail a large spectrum and occur in closed and open globe injuries. Depending on accompanying ocular trauma (e.g. corneal involvement) as well as on the extend of the injuries several different surgical options are available ranging from suturing techniques to special individualized implants. The aim of this article is to present and discuss current treatment options for lens and iris trauma in regards to typical cases.

Outcome of a penetrating keratoplasty in a 3-month-old child with sclerocornea.

Sclerocornea is a rare congenital anomaly with clouding of the peripheral cornea that possibly extends up to the center of the cornea. Characteristically, a clear distinction (limbus) between sclera and cornea is lacking. Early surgical treatment is essential for preventing amblyopia, but penetrating keratoplasty in children carries a relatively high risk of complications. Especially for sclerocornea, penetrating keratoplasty has generally been reported to have a poor surgical outcome and a high risk of complications, including corneoscleral adhesions. Here, we report the 4-year follow-up on a child with sclerocornea, who was successfully operated on at the age of 3 months and had a favorable outcome. Our findings suggest that in some cases, penetrating keratoplasty may be an option to treat sclerocornea in young children.

Assessing full thickness oral mucosal grafting: complications and postoperative outcomes in a broad collective of patients.

BACKGROUND: Conjunctival defects can be repaired with several mucosal tissues. The simplicity of harvesting oral mucosa and its wide availability makes it the preferred graft tissue for all indications requiring mucosal grafting. Through analysing the postsurgical outcomes and rate of revisions, this study explores the suitability of oral mucosa grafts, depending on the initial diagnosis. METHODS: We reviewed all the files of patients with a history of oral mucosal graft surgery, performed at our clinic between 2012 and 2018, focusing on complications and revision rates. RESULTS: In total, we analysed 173 oral mucosa grafts in 131 patients. The most common initial diagnosis was tumour resection, followed by surgical complications, postenucleation socket syndrome, trauma and ocular surface disorders. Complication and revision rates depended highly on the initial diagnosis. Revision rates were highest if the initial diagnosis included ocular surface disorders or chemical trauma. CONCLUSIONS: Oral mucosa grafting (OMG) is the most effective treatment for a wide range of ocular conditions involving conjunctival defects. Conjunctival defects that result from trauma or cicatricial surface diseases seem less suitable for OMG and may benefit from alternative graft tissue or treatment options.

Virus-associated anterior uveitis and secondary glaucoma: Diagnostics, clinical characteristics, and surgical options.

In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time.