[Resection of a submacular traction membrane due to significant visual impairment : Case report]. / Resektion einer submakulären Traktionsmembran bei ausgeprägter Visusminderung : Fallbericht.

An 89-year-old female presented with acute visual impairment and large cells in the vitreous cavity of the left eye. The patient was treated for a suspected intraocular lymphoma. In the follow-up a retinal detachment was diagnosed and treated via pars plana vitrectomy. A resection of the subretinal traction membrane following retinectomy was performed. The histological findings did not reveal any indications of a lymphoproliferative process. A ruptured choroidal neovascularization (CNV) with peripheral exudative hemorrhagic chorioretinopathy (PEHCR) and subretinal membrane formation was diagnosed. There were no signs of malignancy. The resection of a subretinal traction membrane poses a challenge for the vitreoretinal surgeon but can provide the possibility of visual improvement.

[Recurrent choroidal detachment in a patient undergoing hormone therapy for prostate cancer]. / Rezidivierende Aderhautamotio bei einem Patienten mit hormonell therapiertem Prostatakarzinom.

An 85-year-old male patient receiving hormone therapy for prostate cancer and secondary open-angle pseudoexfoliation glaucoma developed peripheral choroidal detachment in both eyes. The patient had been admitted to the eye hospital for clarification of a vascular occlusion in the left eye. Cerebral magnetic resonance imaging could exclude metastases and a cerebral space-occupying lesion as the cause of the ocular findings. The local antiglaucomatous treatment was interrupted and as a result the intraocular pressure normalized and the choroidal detachment receded completely. Patients with prostate cancer who receive hormone therapy should also undergo regular ophthalmological screening including funduscopy and measurment of intraocular pressure.

[Tyrosine kinase inhibitor-associated choroidopathy]. / Tyrosinkinaseinhibitor-assoziierte Choroidopathie.

A 66-year-old male patient presented to the ophthalmology department with bilateral blurred vision, which had persisted for 1 week. Due to a pulmonary melanoma metastasis, the patient received a combination treatment with dabrafenib and trametinib. At the first presentation visual acuity was 1.2 on the right and 1.0 on the left. A normotensive intraocular pressure was measured in both eyes. Fundoscopy showed bilateral white, areolar alterations in the choroid and choroid folds and in the left eye a bullous choroidal detachment. Bilateral neurosensory detachment and subretinal fluid were found in optical coherence tomography (OCT). After reduction of the local treatment for pressure reduction and under local and systemic anti-inflammatory treatment, the choroidal swelling was progressive, the visual acuity dropped to 0.5 in the right and to 0.1 in the left eye. A significant regression of the findings occurred only after pausing the treatment with trametinib. Visual acuity rose to 1.0 (left) and 0.8 (right). The OCT showed a dry macula on the right and a small amount of residual subretinal fluid in the left eye.

Electrochemotherapy with bleomycin and cisplatin enhances cytotoxicity in primary and metastatic uveal melanoma cell lines in vitro.

Electrochemotherapy (ECT) enhances responsiveness to cytotoxic drugs in numerous cell lines in vitro. Clinically ECT is widely applied for skin tumor ablation and has shown efficacy in treating non-resectable colorectal liver metastases. There is limited experience of ECT for ocular tumor therapy. We investigated the cytotoxic effect of bleomycin and cisplatin in combination with electroporation on chemoresistant human uveal melanoma (UM) cell lines in vitro. Four UM cell lines (Mel 270, 92-1, OMM-1, OMM-2.5) were treated with electroporation (pulse amplitude 300-1000 V/cm, 8-80 pulses, 100 µs, 5 Hz) and increasing concentrations of bleomycin and cisplatin (0-7.5 µg/ml). Cell survival was analyzed by MTT viability assay after 36 hours. UM cell lines were resistant to both bleomycin and cisplatin. In combination with electro- poration, the effects of bleomycin and cisplatin were increased 8-70 fold and 3-15 fold, respectively, in all UM cell lines. At the lowest concentration of bleomycin tested (1 µg/ml), viability was maximally reduced in all UM cell lines by ≥69% with electroporation conditions of 750 V/cm and 20 pulses. All UM cell lines were more resistant to cisplatin; however, electro- poration of 1000 V/cm and 8 pulses resulted in similar reductions in cell viability of 92-1, Mel270 with 2.5 µg/ml cisplatin, OMM2-5 cells with 5 µg/ml cisplatin and OMM1 cells with 1 µg/ml cisplatin. In vitro ECT with bleomycin or cisplatin is more effective than the highest concentration of the antineoplastic drug or electroporation alone, opening new perspectives in primary and metastatic UM treatment.

[Intravitreal ganciclovir as an additional therapy option in acute retinal necrosis]. / Intravitreales Ganciclovir als additive Therapieoption bei akuter retinaler Nekrose.

Acute retinal necrosis (ARN) is a rare viral inflammatory disease, characterized by uveitis, retinal vasculitis, and necrosis in the late stages. Therapeutic management is based on the clinical findings. The positive outcome in our patient (VA 0.6) indicates that, beside the management of retinal detachment and lens opacification, additional intravitreal injections of 2 mg ganciclovir may achieve better results than systemic/topical antiviral application alone.

[The Effect of Non-Depolarising Muscle Relaxants on Ocular Pulse Amplitude and Intraocular Pressure]. / Beeinflussung der okulären Pulsamplitude und des Intraokulardrucks durch nicht depolarisierende Muskelrelaxanzien.

AIM: In general anaesthesia (GA) for ocular surgery the chosen non-depolarising muscle relaxant has a high influence on the fluctuations of intraocular pressure (IOP) and ocular pulse amplitude (OPA). PATIENTS AND METHODS: In 229 patients, who needed GA for their ophthalmic surgery, OPA and IOP were measured with the dynamic contour tonometer (DCT) before and 5 minutes after intubation. For GA, three groups of non-depolarising muscle relaxants, namely, mivacurium (n = 71), atracurium (n = 91) and rocuronium (n = 67) were used. RESULTS: The IOP decreased by about 4.0 ± 2.3 mmHg using mivacurium in GA, by about 6.1 ± 2.2 mmHg using atracurium and by about 7.4 ± 1.7 mmHg using rocuronium (p < 0.001). The relative decrease of the IOP was 20% for mivacurium, 31% for atracurium and 37% for rocuronium. For mivacurium the OPA decreased from 3.4 ± 1.5 mmHg to 2.2 ± 1.1 mmHg (p < 0.001) in contrast to atracurium (decrease from 3.6 ± 1.5 mmHg to 1.8 ± 0.8 mmHg; p < 0.001) and rocuronium (decrease from 3.1 ± 1.6 mmHg to 1.7 ± 0.9 mmHg; p < 0.001). Mean OPA reduction was lowest with mivacurium (1.3 mmHg) and the highest with atracurium (1.7 mmHg). The mean relative decrease of the OPA was 34% with mivacurium, 46% with atracurium and 43% with rocuronium (p < 0.001). There was no linear correlation between the relative OPA decrease and the relative IOP decrease. CONCLUSION: Risks for ophthalmic surgery may be minimised by avoiding mivacurium in general anaesthesia. Due to its negative effects on IOP and OPA mivacurium does not seem to be suitable for operations with a large opening in the eye such as penetrating keratoplasty and block excision. Rocuronium can be used because it induces a favourised intraoperative decrease of the IOP.

[Immunological graft rejection with Khodadoust line after "Descemet stripping automated endothelial keratoplasty" (DSAEK)]. / Immunreaktion mit Khodadoust-Linie nach ''Descemet stripping automated endothelial keratoplasty'' (DSAEK).

BACKGROUND: Over the past decade endothelial keratoplasty has become the treatment of choice for patients with corneal endothelial dysfunction. METHODS: "Descemet stripping automated endothelial keratoplasty" (DSAEK) is one of the most widespread forms of posterior endothelial keratoplasty. An improvement of visual acuity is achieved more quickly after DSAEK and the reduced amount of transplanted tissue in DSAEK seems to result in fewer instances of immunological graft rejection. PROBLEMS: The clinical signs of immunological graft rejection after DSAEK are not yet well known. Typically, an immunological rejection episode is combined with the presence of corneal edema, Descemet folds and retrocorneal precipitates restricted to the graft but a classical Khodadoust line seems to be rare. RESULTS: The quick response after the combination of high-dose topical and systemic steroid therapy with steroid injection (80 µg fortecortin) in the anterior chamber in our patient confirms the necessity of a prompt and rapid immunosuppression. CONCLUSIONS: Although the risk of graft rejection after DSAEK is rare, the use of immunosuppressants is important in both acute and long-term postoperative care of endothelial corneal transplantation.

[Traumatic macular hole with central retinal detachment and choroidal rupture with ora serrata dialysis]. / Traumatisches Makulaforamen mit zentraler Ablatio retinae und Aderhautruptur mit Oradialyse.

BACKGROUND: Closed ocular trauma is associated with various retinal complications, such as Berlin's edema, peripheral retinal tears, retinal hemorrhage, choroidal rupture, subretinal bleeding and macular holes. Traumatic macular holes (TMH) are rare and surgical intervention is controversial due to possible spontaneous closure. CASE REPORT: The positive development in the patient described here indicates that a pars plana vitrectomy with drainage of subretinal hemorrage combined with peeling of the internal limiting membrane (ILM) for a penetrating traumatic macular hole with choroidal rupture can lead to the restoration of visual acuity. The anti-vascular endothelial growth factor (VEGF) therapy (under silicone oil with avastin 0.02 ml) can successfully lead to limitation of posttraumatic choroidal neovascularization (CNV). CONCLUSIONS: Patients with ocular contusion require extensive long-term ophthalmological follow-up. Furthermore, prevention, education and information is essential to prevent serious injuries.

[Adjuvant anti-VEGF therapy in Coats' disease]. / Anti-VEGF als Adjuvans bei Morbus Coats.

BACKGROUND: Coats' disease is a non-hereditary acquired, usually unilateral eye disorder that predominantly occurs in young males (1/100,000) with the onset of symptoms generally appearing in the first two decades of life. Coats' disease is characterized by telangiectatic changes, blood leaks from the defective vessels with retinal exudation followed in advanced stages by retinal detachment. CASE REPORT: A 14-year-old male patient presented in our department with gradual visual loss in the right eye. Based on the clinical and diagnostic findings Coats' disease was diagnosed. The exudative retinal detachment in the right eye was initially treated with intravitreal bevacizumab injection (B-IVOM) followed by cryocoagulation and combined with a second administration of B-IVOM 2 weeks later. On the grounds of a persistent exudative retinal detachment a new round of cryotherapy was conducted. We proceeded with laser coagulation of the residual Coats areas and with three cycles of B-IVOM therapy. The subretinal and intraretinal exudates regressed over several weeks so that the patient remained symptom-free 22 months after therapy. At the last examination the visual acuity was 0.8 in the right eye. CONCLUSION: The favorable development for our patient demonstrates that adjuvant therapy with intravitreal anti-VEGF injections in addition to laser and cryocoagulation in a case of advanced Coats' disease with exudative retinal tissue damage could lead to the stabilization of the retinal findings and to preservation of good visual acuity.

[Reduction of intraocular pressure and ocular pulse amplitude during general anesthesia]. / Sinken des Augeninnendrucks und der okularen Pulsamplitude während der Intubationsnarkose.

AIM: Measurement of the intraocular pressure (IOP) is an important tool for glaucoma diagnostics in children or patients with impaired cooperation. General anesthesia (GA) may significantly influence the IOP. This study aimed to evaluate the reduction of IOP during GA. PATIENTS AND METHODS: The IOP was measured in 229 patients in a recumbent position in the non-operated eye prior to and 5 min after the beginning of GA with a dynamic contour tonometer (DCT). RESULTS: The average IOP decreased from 19.9 ± 3.7 mmHg prior to GA to 14.1 ± 3.5 mmHg 5 min after beginning GA (p < 0.0001, IOP decrease 30 %). The GA caused a decrease of up to 2 mmHg in 6.1 %, 2-4 mmHg in 18.8 %, 4-6 mmHg in 21.0 %, 6-8 mmHg in 36.6 %, 8-10 mmHg in 13.6 %, 10-12 mmHg in 2.2 % and more than 12 mmHg in 1.7 % of the eyes. The ocular pulse amplitude (OPA) decreased from a mean of 3.4 ± 1.5 mmHg to 1.9 ± 1.0 mmHg (p < 0.0001, OPA decrease 41 %) under GA. CONCLUSION: A significant decrease of IOP (mean 6 mmHg) occurs during GA and under extreme conditions up to 13.8 mmHg. A decrease of OPA of 1.5 mmHg should be taken into consideration for patients under general anesthesia and under extreme conditions up to 7 mmHg.

[Bilateral vascularized disciform corneal scar of herpetic origin in a child]. / Bilaterale vaskularisierte disziforme Hornhautnarbe herpetischer Genese bei einem Kind.

BACKGROUND: Bilateral keratitis is rare and can have various causes. For a good outcome after treatment, the correct diagnosis is decisive. CASE REPORT: A 15-year-old boy presented to our clinic with recurrent keratoconjunctivitis and progressive loss of vision in both eyes since 6 years. The best corrected visual acuity was 0.1 in the right eye and 1/12 in the left eye. Slit-lamp examination verified keratitis disciformis with strongly vascularized corneal stromal scars without conjunctival follicles on both sides. Based on the clinical diagnosis, antiviral treatment was initiated. Best corrected visual acuity 8 weeks later increased to 0.4 in the right eye and 0.8 in the left eye and the corneal edema decreased in both eyes. Due to noncompliance the patient returned with a perforated corneal ulcer of the left eye, where an á chaud penetrating keratoplasty had to be performed. RESULTS: Herpes simplex virus is one of the most common causes of keratitis and has different manifestations. In the treatment of keratitis disciformis the use of topical steroids is mandatory as there is an active immunological process. The use of systemic and local antiviral treatment is necessary at the same time in order to avoid reactivation of viral replication. Bilateral keratitis is relatively frequent in children. CONCLUSION: Herpetic keratitis is now well treatable if the various manifestations of the disease are recognized early and an appropriate therapy is adjusted accordingly.

[Trabeculotomy before the estimated delivery date. Case report of a preterm infant with buphthalamus]. / Trabekulotomie vor dem errechneten Geburtstermin. Falldarstellung eines Frühgeborenen mit Buphthalmus.

Congenital glaucoma is a disease potentially leading to blindness in children. It poses a diagnostic and therapeutic challenge even though new knowledge has been acquired and a sufficient understanding of the pathogenesis has been gained. New discoveries, such as the exact time when Schlemm's canal develops could lead to a prenatal diagnosis and therefore surgical intervention so that other complications including blindness can be avoided. This case report demonstrates that an early prenatal eye screening with ultrasound (after approximately 30 weeks of pregnancy) would be desirable in order to diagnose buphthalmus early and to plan postnatal surgery.