[Bilateral ciliary body oedema under treatment with ciclosporine]. / Beidseitige Ziliarkörperschwellung unter Therapie mit Ciclosporin.

We present the case of a 27-year-old female patient who developed bilateral ciliary body edema with secondary glaucoma and myopic shift during systemic treatment with cyclosporine for aplastic anemia. After application of topical atropine and prednisolone acetate and conversion from cyclosporine to tacrolimus, the ophthalmologic symptoms resolved completely. Since an infectious etiology was not evident, we hypothesize that ciliary body edema was caused by impairment of microvascular integrity by cyclosporine.

[Ocular Hypotension: How the Retina Surgeon Sees the Causes and Therapeutic Options]. / Okuläre Hypotonie - Ursachen und therapeutische Möglichkeiten aus Sicht des Netzhautchirurgen.

Ocular hypotension is a result of a lack of production or a loss of intraocular fluid. Intraocular inflammation, drugs, or proliferative vitreoretinopathy (PVR) with overgrowth of the ciliary body can result in reduced secretion of intraocular fluid. Loss of intraocular fluid can result from external loss, such as in fistulating surgery or trauma, or internally, e.g. from cyclodialysis clefts or retinal detachment. In this review, we discuss the causal therapy of ocular hypotension: fixation of the ciliary body, removal of ciliary body membranes, surgery for PVR, choice of tamponade, possibilities and limitations of an iris diaphragm, and pharmacological options.

[Prolonged topical natamycin 5 % therapy before and after keratoplasty for Fusarium keratitis]. / Prolongierte topische Natamycin 5 %-Therapie vor und nach Keratoplastik bei Fusarium-Keratitis.

CASE REPORT: A 69-year-old female patient presented with a therapy-resistant corneal ulcer due to contact lenses, which had been present in the left eye for 1 month. The best corrected visual acuity at the first visit was 0.2. Keratitis with a central corneal ulcer was found. A corneal curettage was performed followed by inpatient therapy with antibiotic eye drops. The first PCR result was negative and the microbiological culture was sterile after 48 h. The clinical findings improved during the hospital stay. There was a decrease in the size of the corneal ulcer and an increase of best corrected visual acuity up to 0.4 so that the patient was discharged. COURSE: After 8 weeks the patient presented again with a painful eye and visual decline to 0.1. The left eye showed a fulminant keratitis with corneal abscess so that a second course of therapy was initiated. The PCR of the second corneal curettage was positive for Fusarium. Antifungal therapy with natamycin 5 % eye drops (via the international pharmacy) and systemic antifungal therapy with voriconazole (2 × 200 mg) were initiated. Due to personal circumstances the patient rejected corneal transplantation, therefore, local and systemic antifungal outpatient treatment was continued for another 2 months until keratoplasty à chaud of the left eye could be performed. At this time there was a clear reduction of inflammation but a descemetocele developed. The patient was treated with local and systemic antifungal therapy (under control of liver and kindney parameters in blood) for 3 months postoperatively in addition to administration of local and systemic steroids. DIAGNOSTICS: In cases of therapy-resistant keratitis, a Fusarium keratitis should always be considered. Corneal curettage ahead of therapy is very important. THERAPY: Natamycin 5 % eye drops are the first choice of topical antifungal medication in cases of Fusarium keratitis. Even though intensive local and systemic therapy are performed, patients often require corneal transplantation. Due to a high rate of recurrence a longer local and systemic antifungal therapy is required. CONCLUSION: In the case described here, there was a clear corneal graft without Fusarium recurrence 1 year after surgery and it is presumed the prolonged antifungal therapy before and after surgery was an important factor for this clinical outcome.

[Ocular graft-versus-host disease]. / Okuläre Graft-versus-Host-Disease.

Ocular graft-versus-host disease (GvHD) is predominantly an inflammatory ocular surface disorder after allogeneic hematopoietic stem cell transplantation (HSCT) with increasing incidence. It is not only associated with reduced quality of life because of dry eye syndromes but can also impair visual acuity and lead to blindness due to corneal complications. The GvHD is mostly associated with severe moisturizing disorder of the ocular surface, which is often resistant to therapy and accompanied by chronic inflammation. Corneal complications are an important problem in these patients. An individually adapted multimodal stage-related and interdisciplinary therapy in cooperation with hematologists and oncologists is therefore important for the treatment of patients with ocular GvHD.

[The situation of residents in ophthalmology in Germany: Results of an online survey]. / Situation der Assistenzärztinnen und -ärzte in der Ophthalmologie in Deutschland : Ergebnisse einer Online-Umfrage.

PURPOSE: The main purpose of the present survey was to describe the situation of residents in ophthalmology in Germany, including professional aims and plans for the future. By evaluating the current conditions, potential deficits should be identified which could lead to demand-oriented approaches for improvement. METHODS: The online questionnaire was sent out per e-mail to 1100 German residents. The rate of received answers was 30.1 % (334 completed questionnaires). RESULTS: Of the participants 68 % were female,32 % were male (mean age 31.8 years), one third of the participants had children, 44.6 % worked at university institutions, 54.4 % at non-university institutions and 45.5 % considered themselves as well-trained. Deficits during residency training were seen in the field of neuro-ophthalmology and ophthalmic surgery. The evaluation of the residency in total revealed an overall average grade of 2.9 ("satisfactory"). Of the physicians 35.5 % reported to be actively involved in research projects and 21.9 % reported pursuing an academic career. Almost 50 % of the participant residents aimed to work in a private practice after residency and 15 % aimed to work at an university hospital. CONCLUSION: The present survey revealed representative data because of the acceptable return rate and participating residents from all different educational levels (1st to 5th year). The survey can therefore help to characterize the current situation of residents in ophthalmology in Germany and to develop demand-oriented possibilities for improvement.

[Clinical Signs of Ocular Graft-versus-Host Disease]. / Klinik der okulären Graft-versus-Host Disease.

BACKGROUND: Ocular graft-versus-host disease (GvHD) is mainly an inflammatory ocular surface disorder after allogeneic hematopoetic stem cell transplantation (HSCT) with increasing incidence. METHODS: We present an overview on clinical signs of ocular GvHD. RESULTS: Ocular chronic GvHD representing a severe ocular surface disease is a long-term problem after allogeneic HSCT. It is not only associated with reduced quality of life because of dry eye symptoms but can also impair visual acuity and lead to blindness due to corneal complications. Patients with ocular GvHD are often resistant to therapy because of the severe dry eye disease and persistent inflammatory activity. CONCLUSION: A multimodal and interdisciplinary therapy - in cooperation with the colleagues from haematology and oncology is important for the treatment of patients with ocular GvHD.

[Patient-Centred Care of Ocular Graft-vs-Host Disease in Germany]. / Versorgungsstrukturen der okulären Graft-versus-Host Disease in Deutschland.

BACKGROUND: Ocular GvHD is a severe complication following allogenic blood stem cell transplantation leading to massive reduction in quality of life and ocular pathologies including corneal perforation. Interdisciplinary patient-centred care needs to be performed in specialized ophthalmic centers that provide all diagnostic and therapeutic options, however, only few clinics have the necessary infrastructure. In addition there is a lack of transparency and easily accessible information for the patients regarding ophthalmic care and specialized centres. For this reason the "Ocular GvHD working group" within the Cornea Section of the German Society of Ophthalmology has been founded to evaluate and improve patient-centered care in ocular GvHD within Germany. METHODS: A survey was performed among the members of the Cornea Section of the German Society of Ophthalmology and the Directors of Departments of Ophthalmology in Germany that evaluated the number of annual examinations, presence of specialized GvHD outpatient clinics and eye screenings prior to allogenic blood stem cell transplantation (aBSCT). RESULTS: 25 clinics (19 university hospitals, 6 general hospitals) responded to the survey. In 18 clinics aBSCT are performed. Between 5 and 200 patients after aBSCT are examined per year per clinic. Larger institutions are associated with departments of haemato-oncology and other specialised disciplines to facilitate an interdisciplinary patient care. Three clinics are associated with GvHD competence centres. The major challenge in establishing an appropriate infrastructure for better patient-centered care is the limited or lacking reimbursement by health insurances. CONCLUSIONS: Within Germany only few ophthalmic centres exist that provide state-of-the-art patient-centered care for ocular GvHD. The present structures are not sufficient to treat all patients undergoing aBSCT following existing guidelines. Joint efforts are necessary to establish more and accessible competence centers for ocular GvHD with sufficient personnel and structural resources. In addition, ocular GvHD should be included as a mandatory topic in medical training and transparent and easily accessible information needs to be provided for patients and health-care professionals.

[Combined retinal artery and vein occlusions associated with interferon beta therapy]. / Kombinierter retinaler arteriovenöser Verschluss unter Interferon-ß-Therapie.

Interferon (IFN) beta is commonly used in the treatment of multiple sclerosis. Thromboembolic complications may be associated with this therapy. We describe a case of branch arterial occlusions combined with central vein occlusion in a female patient who had undergone IFN beta therapy for 10 years. Thromboembolic and cardiovascular risk factors responsible for this event were excluded. The appearance of retinal vein and artery occlusions in our patient indicates an association with the long-term use of IFN beta.