[Cell loss in retinal ischemia is associated with increased necroptosis]. / Zellverlust bei retinaler Ischämie ist assoziiert mit vermehrter Nekroptose.

BACKGROUND: Retinal ischemia plays a central pathophysiological role in numerous eye diseases, such as glaucoma. In addition to apoptosis, autophagy, necroptosis and ferroptosis are among the cell death mechanisms of ischemia; however, their role is not clearly understood and controversially discussed. OBJECTIVE: The aim of this study is to gain an improved understanding of the role of alternative cell death mechanisms such as autophagy and necroptosis after retinal ischemia. Based on this, future autophagy-based or necroptosis-based therapeutic approaches could be developed. MATERIAL AND METHODS: Retinal ischemia reperfusion was induced in one eye of 6 to 8­week-old rats by temporarily increasing the intraocular pressure to 140 mm Hg (60 min), followed by reperfusion. The untreated contralateral eye served as a control. Retinas after ischemia and control retinas were examined 7 days after ischemia immunohistochemically with markers for retinal ganglion cells (RGC), astrocytes (GFAP) as well as an autophagy (LAMP1) and a necroptosis marker (RIPK3) (n = 6/group). RESULTS: Ischemia reperfusion resulted in both significant RGC loss (p ≤ 0.001) and a significant increase of astrocyte area (p = 0.026) after 7 days. Interestingly, the number of autophagic LAMP1 positive cells was unchanged 7 days after ischemia (p = 0.272), whereas the number of necroptotic RIPK3 positive cells was significantly increased (p ≤ 0.001). CONCLUSION: Necroptotic processes appear to be activated 7 days after ischemia reperfusion, contributing to retinal cell death and activation of astrocytes. Late autophagic processes are not activated 7 days after ischemia. Necroptosis-associated parameters could therefore be targeted as an early therapeutic approach after ischemia in the future.

On the Current Care Situation and Treatment of Ocular Mucous Membrane Pemphigoid in Germany. / Zur Versorgungssituation und konservativen Therapie des okulären vernarbenden Schleimhautpemphigoids in Deutschland.

BACKGROUND: Ocular involvement in mucous membrane pemphigoid (MMP) is relatively rare, with a prevalence of 25 cases per million population, equating to approx. 2,100 patients throughout Germany. Diagnosis can be difficult - especially in cases of isolated ocular involvement - and treatment can be complex and lengthy. Immunosuppressants or immunomodulatory drugs are often used. Due to the complexity of diagnosis and treatment, MMP patients are usually referred to specialized centers. The aim of this project was to evaluate the current care situation of patients with ocular MMP in Germany. METHODS: A paper-based survey was designed and sent to all university eye clinics and other specialized centers in Germany in April 2020. The survey asked about the existence of a specialized outpatient service, the total annual number of patients with MMP, the annual number of newly diagnosed patients, any interdisciplinary collaboration for diagnostic or therapeutic purposes, as well as the local and systemic therapy used. RESULTS: Of a total of 44 clinics, 28 (64%) responded, reporting a total average of 27 ± 42 (0 - 200) patients and 3.6 ± 2.2 (0 - 10) new cases per year. This corresponds to a total of 741 patients. Only nine (32%) of the responding clinics offer specialized MMP clinics. 93% of the centers collaborate with the local dermatology department. 79% perform serological and histological diagnostics in-house. About half of the centers (n = 16) apply a standardized treatment regime. Systemic glucocorticoids (66.7%) are most commonly used, followed by mycophenolate mofetil and dapsone (57.1%), rituximab (33.3%), azathioprine and cyclophosphamide (28.6%), as well as methotrexate (19.0%). The least frequently used treatment is intravenous immunoglobulin (14.3%). CONCLUSION: This survey of German ophthalmology departments obtained data from about one third of the estimated total cohort of all patients with MMP in Germany. These are presumed to be exclusively patients with at least one ocular involvement. The complex care of these patients is usually provided in collaboration with a dermatologist and with the use of systemic anti-inflammatory medication. Currently, an ophthalmological MMP register is being established to better record the epidemiology and care situation of this rare disease in Germany and to improve it in the long term.

Methods for the study of near, intermediate vision, and accommodation: an overview of subjective and objective approaches.

PURPOSE: To present an overview of contemporary methods and metrics used to measure near vision, intermediate vision, and accommodation. METHODS: A search in PubMed was performed with the following key phrases: near vision, intermediate vision, objective and subjective methods for the measurement of accommodation. For subjective methods, we included only those that are most widely used, had a scientific evidence of its outcomes, and have an easy availability at the doctor's office. For objective methods, we included those aberrometers or autorefractometers that have been proven to give good repeatability and reproducibility in the study of changes in optical power of the eye along the accommodative process. RESULTS: Near vision should be tested at 40 cm and intermediate vision at 63 or 80 cm. Accommodation should be measured with objective methods such as autorefractometers or aberrometers. CONCLUSIONS: The standardization for the measurement of near and intermediate vision, as well as the reading charts, will facilitate the comparison of visual outcomes between studies. Measurement of accommodation should be performed with objective methods as subjective methods tend to overestimate the accommodative power.

Four-year results of a minimally invasive transscleral glaucoma gel stent implantation in a prospective multi-centre study.

IMPORTANCE: The transscleral XEN Glaucoma Gel Microstent (XEN-GGM, Allergan Plc., Parsippany, New Jersey) is implanted by a minimally invasive ab interno technique. BACKGROUND: The present study aims to assess the long-term clinical outcomes in patients after XEN-GGM implantation. DESIGN: This prospective, non-randomized, multi-centred study was conducted in three countries (Austria, Canada and Germany). PARTICIPANTS: Sixty-four consecutive eyes of 64 patients with open angle glaucoma received the XEN-GGM (63 µm) without Mitomycin C. Thirty-five (55%) were solo procedures, and 29 (45%) were combined with cataract surgery. METHODS: Visits were planned at baseline, 6 months, 1, 2, 3 and 4 years postoperatively. MAIN OUTCOME MEASURES: The main outcome measures were mean intraocular pressure (IOP), mean number of IOP lowering medication. Secondary outcome parameters were: visual acuity, visual fields and complete surgical failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) at 4 years, postoperatively. RESULTS: Mean best-medicated baseline IOP was 22.5 ± 4.2 mmHg and decreased significantly to 13.4 ± 3.1 mmHg 4 years postoperatively (-40%, n = 34, P < 0.001). Mean number of IOP lowering medication decreased significantly from 2.4 ± 1.3 preoperatively to 1.2 ± 1.3 (-50%, n = 34, P < 0.001) postoperatively. Visual field mean deviation showed no significant change between preoperative and postoperative examinations. Complete surgical failure rate per year was 10%. CONCLUSIONS AND RELEVANCE: The XEN-GGM resulted in lower IOP and a reduction in medications from baseline over 4 years of follow-up. There was no detectable decrease in visual fields over the study. The surgical failure rate is comparable to other filtration surgeries.

Capsule-Fixated Intraocular Lens Implantation in Small Pupil Cases.

PURPOSE: To describe a new technique for implantation of capsule-fixated intraocular lenses (IOLs) (FEMTIS; Oculentis, Berlin, Germany) in patients with small pupils. METHODS: In 4 eyes with small pupils, an anterior capsule-fixated IOL was implanted into the capsular bag after femtosecond laser treatment. The two large and two small flaps of the IOL were elevated to the front of the iris and the anterior capsule. Finally, the iris was flipped over the flaps to ensure a fixation of the capsule inside of the capsulotomy. RESULTS: In all cases, the implantation of anterior capsule-fixated IOLs was possible. No complications occurred during surgery or within the first months after surgery. CONCLUSIONS: With the described technique, capsulefixated IOLs can be implanted in eyes with small pupil easily and safely. This type of IOL has great potential to improve the refractive outcome by better prediction of the postoperative IOL position and eliminating IOL rotation after cataract surgery. [J Refract Surg. 2017;33(8):568-570.].

Anterior chamber depth in normal subjects by rotating scheimpflug imaging.

PURPOSE: Anterior chamber depth (ACD) is an important preoperative parameter in anterior segment surgery. Several factors are known to influence ACD, including race and geography. Our purpose was to sample data from various countries to characterize differences in ACD worldwide and, if any, assess their level of clinical significance. SETTING: International, multicenter. METHODS: Cross-sectional study. Using the Pentacam Eye Scanner (OCULUS GmbH, Wetzlar, Germany), we analyzed ACD measurements from 1077 eyes of 568 normal adults from nine countries spanning six continents. Differences between countries were assessed by comparison of 95% confidence intervals and by ANOVA. Normative thresholds were constructed at three standard deviations (SD) above and below the mean. RESULTS: Mean ACD was 3.11 mm overall, ranging from 2.91 mm (New Zealand) to 3.24 mm (United States). The ACD among New Zealanders was significantly shallower (P < .0001) than that among Chinese, Egyptians, Germans, Indians, and Americans. The maximum difference in the mean ACDs was 0.33 mm, between New Zealand and the United States. The shallowest 0.15% of normal ACD values occurred below 2.04 mm overall, ranging from 1.69 mm (New Zealand) to 2.42 mm (United States). The deepest 0.15% of normal ACD values occurred above 4.18 mm overall, ranging from 4.03 mm (Saudi Arabia) to 4.35 mm (Brazil). CONCLUSIONS: ACD did not vary significantly in the countries studied, with the notable exception of New Zealand. Surgeons should anticipate a greater likelihood of a shallow ACD when evaluating patients from New Zealand. Clinical examination and direct measurement of ACD are recommended. Finally, deep ACD has limited clinical utility in screening for keratoconus.

[Laser in situ keratomileusis with a flying-spot excimer laser and a carriazo-barraquer microkeratome - outcomes after 6 months]. / Laser-in-situ-Keratomileusis mit einem Flying-Spot-Excimerlaser und dem Mikrokeratom nach Carriazo-Barraquer - Ergebnisse nach 6 Monaten.

PURPOSE: To evaluate safety, efficacy, predictability and refractive stability of LASIK, using a flying-spot excimer laser, 91 eyes were examined during a 6-months follow-up. PATIENTS AND METHODS: Consecutively, 91 eyes were enrolled in the study, each eye previously underwent LASIK with the ESIRIS excimer laser (ESIRIS, supplier: eye-tech-solutions Schwind, Kleinostheim, Germany). 91 myopic eyes (mean preoperative refraction: - 5.4 D, range: - 3 to - 13.3 D, astigmatism: - 1 D, range: 1.3 to 3.5 D) were included. A full ophthalmological examination was performed during the first week, 1, 3 and 6 months postoperatively. RESULTS: 26 % of all eyes achieved an uncorrected visual acuity of 0.8, 35 % of 1.0 and 5 % 1.2 6 months postoperatively. 23 % of the eyes lost 1 line of best spectacle-corrected visual acuity (BSCVA), 25 % gained one or more lines of BSCVA. Refraction of 90 eyes were within +/- 1 D of emmetropia 6 months postoperatively. There was no change in spherical equivalent within the interval of 6 months, all eyes were within +/- 0.5 D. CONCLUSION: LASIK with the ESIRIS excimer laser was an effective and safe option with good stability and predictability within the specified interval.