[Epi-Bowman Keratectomy: Clinical Evaluation of a New Method of Surface Ablation]. / Epi-Bowman-Keratektomie: klinische Beurteilung einer neuen Variante der Surface Ablation.

PURPOSE: A new device for epithelial abrasion before excimer laser surface ablation or corneal cross-linking (CXL) has recently been introduced (Epi-Clear™, Orca Surgical, Kiryat-Shmona, Israel). We have reviewed the literature on the clinical results, potential benefits and drawbacks of this instrument, compared to other methods of epithelial removal. METHOD: Literature search for "Epi-Bowman Keratectomy", "Epi-clear", and "Epikeratome" yielded 1 peer-review publication, 1 non-peer-review publication, 18 posters and presentations at international conferences (European Society of Cataract and Refractive Surgeons [ESCRS] and American Society of Cataract and Refractive Surgery [ASCRS]) on the use of the Epi-Clear™ device before surface ablation, 2 posters on the use of Epi-Clear before corneal crosslinking and 1 presentation on the experimental use of Epi-Clear for removal of a pterygium. RESULTS: Comparison of laser ablation after epithelial removal with the Epi-Clear device (Epi-Bowman Keratectomy™, EBK™) to other established methods of surface ablation, i.e. alcohol-assisted PRK or PRK with a metallic scraper, EBK, suggests that the results are generally similar. Pain perception, haze formation, and epithelial healing are reported to be better than with conventional surface ablation methods. Studies evaluating the use of the Epi-Clear device before CXL report that the healing time is significantly reduced and that less pain is perceived. CONCLUSION: The Epi-Clear device seems to be a promising new option for epithelial removal before refractive laser ablation, although a convincing explanation for its potential superiority is still missing. In contrast, when the Epi-Clear device is used before CXL, then the Bowman's layer remains intact; this may provide an adequate explanation for the reported benefits of this application. However, currently available studies are of low level of evidence, so that more prospective randomised trials are needed for a robust evaluation of this treatment.

[Early onset of fingolimod-associated macular edema]. / Frühzeitiges Auftreten eines Fingolimod-assoziierten Makulaödems.

BACKGROUND: Fingolimod, a disease-modifying sphingosine 1­phosphate receptor modulator, which was approved in Germany in 2011, decreases the relapse rate and reduces neuroinflammation in patients with relapsing-remitting multiple sclerosis. Macular edema is a well-known ocular side effect of fingolimod therapy. Specific intervals for ophthalmologic check-ups after starting fingolimod and definite treatment schedules for fingolimod-associated macular edema are, however, still lacking. CASE REPORT: We present a case of early fingolimod-associated macular edema in a 45-year-old female patient with relapsing-remitting multiple sclerosis. The patient complained about visual impairment 1 month after the start of fingolimod and visited an eye specialist. Funduscopic examination and imaging diagnostics revealed macular edema in both eyes. The treatment with fingolimod was immediately stopped. For therapy of macular edema topical application of nepafenac and oral acetazolamide were given. During the 6 months of treatment the macular edema completely disappeared and visual function recovered completely. DISCUSSION: At the time of diagnosis, it is fundamentally important to discuss the continuation of fingolimod administration with the attending neurologist and if necessary to discontinue the drug. Regular ophthalmologic check-ups at 4­week intervals over a period of 3 months are meaningful after beginning fingolimod treatment. As before, it is still a key aspect to determine predictive opthalmologic and neurological factors before beginning treatment to evaluate which patients are at risk of fingolimod-associated macular edema.

[Management of suicidal orbital gunshot wounds to the temple]. / Management suizidaler orbitaler Schläfen-Schussverletzungen.

BACKGROUND: Orbital gunshot wounds are rarely found after suicide. A gunshot fired at point blank range into the temple has devastating effects on all intraorbital and neighboring structures. CASE REPORTS: This article reports on two cases of gunshot wounds to the lateral orbit in attempted suicides with different weapons from 2012 and 2013 and treated at the Ruhr University Eye Hospital in Bochum. In both cases treatment was carried out in cooperation with the department of oral and maxillofacial surgery, Ruhr University Hospital, Bochum. In the first case a 7.65 mm gun was used. The patient presented with a double penetration of both orbits with total destruction of both globes and a reconstruction was not possible. The second patient presented with multiple shots to the head from a small caliber gun (5.6 mm) where one bullet entered the right orbit behind the globe. The bullet could be localized using computed tomography (CT) and surgically removed with preservation of the globe and with a postoperative visual acuity of 20/60. CONCLUSION: The preservation of visual function after orbital gunshot wounds depends on both the projectile channel and the characteristics of the gun and bullet. Close collaboration in surgical management between ophthalmologists, maxillofacial surgeons and neurosurgeons in specialized centers is necessary because patients often present with multiple trauma and prompt interdisciplinary treatment is needed.