Three Cases of Spontaneous Hyphaema.

Background Spontaneous anterior chamber bleeding is a rare event. We present three photodocumented cases treated in our clinic. History and Findings Three patients sought medical assistance in our clinic because of bleeding inside the eye and/or visual impairment. None of them had a history of trauma or intraocular surgery. Treatment and Outcome Two patients had oral anticoagulation, which was discontinued. These cases were treated with topical steroids. The third patient had no anticoagulation and no topical steroids were used in treatment. Topical intraocular pressure-lowering drugs were administered as needed. In all three cases, the anterior chamber bleeding stopped spontaneously. No intervention was required. Even after resolution of the bleeding, there were no signs of iris abnormalities. Conclusions In cases of spontaneous anterior chamber bleeding without a history of trauma, oral anticoagulation, hypertension and iris abnormalities such as microaneurysm, pseudoexfoliation, iridocyclitis or neovascularisation have to be considered.

[One Year Experience with Quality Control of Cataract Surgery Using an Internet-Based EUREQUO Database]. / Ein Jahr Erfahrung mit der Qualitätssicherung der Kataraktoperation (EUREQUO) an einem öffentlichen Spital.

Purpose Quality control is particularly important in invasive medicine. As cataract surgery is the most frequently performed and most successful ophthalmic surgery, quality control should become mandatory. Patients and Methods Retrospective analysis of all cataract procedures performed in a 12 months period (01. 07. 2014 - 30. 06. 2015) at our hospital, using an internet-based EUREQOU database. This database is easy to use and allows local results to be compared with all participants in Switzerland and elsewhere in Europe. Results During one year, 904 cataract procedures were performed at our hospital. Of these, 892 with complete data were compared to 2918 operations performed in Switzerland and 274,644 in other European countries. Our sample contained more patients with markedly reduced visual acuity (< 0.1; 8.4/4.8/3.5 %; KSW/Switzerland/Europe), more patients with glaucoma (28.1/13.9/7.1 %) and more patients with pseudoexfoliation (22.8/11.5/0.56 %). Despite our training of young ophthalmic surgeons, the rate of capsular complications was as low (0.67/0.34/0.67 %) as in other series. Four to 6 weeks after surgery, the majority of patients achieved a best corrected visual acuity of ≥ 0.8 (79.2 vs. 87.4 % in Europe, not enough data from Switzerland). Biometric prediction error (79.2 % within ± 0.75 D) was within the target range, but in the lower quartile. Conclusions Despite the relatively high number of complex patients in our hospital, quality control reveals that we performed cataract surgery with low complication rates and good results. Although quality control is rapid and easy, only three centres in Switzerland are participating.

[Toric intraocular lenses: a valuable method for correcting corneal astigmatism]. / Torische Intraokularlinsen: Eine nützliche Methode in der Korrektur des kornealen Astigmatismus.

BACKGROUND: The aim of this stud was to assess clinical outcomes after implantation of a hydrophobic toric intraocular lens (IOL) in patients undergoing cataract surgery. PATIENTS AND METHODS: 22 eyes (16 patients) with at least 0.8 diopter (D) of corneal astigmatism having routine cataract surgery were included. After marking the final axis of the IOL, phacoemulsification, implantation and alignment of a toric IOL was performed. Uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (BDVA), manifest refraction, and keratometry were measured 5 to 19 months postoperatively. Individual patient satisfaction was also recorded. The cylinder axis of the toric IOL was determined at a slitlamp examination. RESULTS: The mean UDVA postoperatively was 0.3 logMAR±0.23 (SD) and was 0.3 logMAR or better in 63.6% of eyes. The mean refractive cylinder decreased significantly postoperatively, ranging from -3.3±1.5 D to -1.3±0.7 D. The mean absolute IOL misalignment was 7.5 degrees (range 0 to 21°). The good UDVA resulted in high levels of patient satisfaction. CONCLUSIONS: Implantation of a toric IOL during cataract surgery was an effective and safe method to manage corneal astigmatism in this series of patients.

Retinal venous pressure in the non-affected eye of patients with retinal vein occlusions.

BACKGROUND: To measure the retinal venous pressure (RVP) in both eyes of patients with unilateral central retinal vein occlusions and to compare these values to controls. METHODS: The study included 31 patients with unilateral central retinal vein occlusions (CRVO) and 31 controls who were matched by age, sex, and systemic disease. RVP was measured in all patients bilaterally by means of contact lens ophthalmodynamometry, and the RVP measurements of the affected and unaffected eyes of patients were compared to the RVPs of controls. Ophthalmodynamometry is done by applying an increasing pressure on the eye via a contact lens. The minimum force required to induce a venous pulsation is called ophthalmodynamometric force (ODF). The RVP is defined and calculated as the sum of ODF and intraocular pressure (IOP) [RVP = ODF + IOP]. RESULTS: The RVP group means ± SD were as follows: patient's affected eyes (45.0 ± 11.6 mmHg), patient's unaffected eyes (38.0 ± 11.1 mmHg) ,and (17.7 ± 6.7 mmHg) in the eyes of controls. The values of RVP, even in the patients unaffected eyes, were significantly higher than in the eyes of controls (P < 0.001). CONCLUSIONS: In patients with CRVO, the RVP is increased in both the affected as well as in the unaffected contralateral eye.

Unstable oxygen supply and glaucoma.

The pathogenesis of the glaucomatous optic neuropathy (GON) is an ongoing bone of contention. While the role of intraocular pressure (IOP) is well known, it is also clear that a variety of other factors, particularly those of a vascular nature, are involved as well. In contrast to other eye diseases, it is an unstable oxygen supply, as opposed to chronic hypoxia, that contributes to GON. The major cause of fluctuations in the local oxygen tension is an unstable ocular blood flow (OBF). OBF, in turn, fluctuates if the IOP spikes, blood pressure drops, or OBF autoregulation is defective. The main reason for disturbed autoregulation is a primary vascular dysregulation (PVD), particularly in the context of the so-called Flammer syndrome. Unstable oxygen tension leads to local oxidative stress with many detrimental effects, such as the activation of glial cells, which alters their morphology and gene expression. As a consequence, the local concentrations of nitric oxide and the metalloproteinases increase. The metalloproteinases digest extracellular matrix and thereby contribute to tissue remodelling. The short-lived nitric oxide easily diffuses into the neighbouring neuronal axons, allowing a fusion with the superoxide anion and thereby generating the cell-damaging peroxynitrite. Both this tissue remodelling and damage of the axons contribute to the development and progression of GON.

Vital dyes increase the rigidity of the internal limiting membrane.

PURPOSE: To assess the stiffness of the natural human internal limiting membrane (ILM) and evaluate potential changes of the mechanical properties following staining with brilliant blue (BB) and indocyanine green (ICG). METHODS: Unstained ILM specimens were obtained during ophthalmic surgical procedures. After removal, the specimens were dissected into five parts. Two fragments were stained with BB and ICG, respectively, for 1 min, another two specimens were stained similarly followed by additional subsequent illumination using a standard light source (PENTA LUX x 50, Ophthalmologische Systeme GmbH Fritz Ruck). The fifth part served as an untreated control. All specimens were then analyzed using atomic force microscopy (AFM) in contact mode with a scan rate of 0.6 Hz. Two scan regions of 10 × 10 µm were chosen and stiffness was determined by using AFM in a force spectroscopy mode. The force curves were plotted with a data rate of 5000 Hz. In all specimens both the retinal side and vitreal side were analyzed. RESULTS: Staining resulted in a significant increase in tissue stiffness. An increase was seen both for the vitreal (BB: P<0.001; ICG: P<0.01) and retinal side (BB: P<0.01; ICG: P<0.01), with the retinal side being significantly stiffer in all control and stained samples. Additional illumination after staining did further increase tissue rigidity in most samples but not significantly. CONCLUSIONS: Staining significantly increases the stiffness of the human ILM. This might explain the fact that the stained ILM can be removed more easily and in larger fragments during vitreoretinal surgical procedures compared with unstained ILM.

[Unilateral occlusion of the retinal artery branch and retinal white dots]. / Einseitiger Arterienastverschluss und retinale "white dots".

BACKGROUND: Since the 1990s an increase in the incidence of syphilis has been observed. The classical course of syphilis can be subdivided into three stages. Ocular involvement is particularly possible in stage III. The disease can be efficiently treated by antibiotic therapy. METHODS: We report on the case of a 38-year-old patient who presented with loss of nasal visual field and hazy vision in the left eye which had suddenly appeared 2 weeks previously. The patient had received an intravitreal injection of triamcinolon 6 weeks prior to this for mainly left-sided cystoid macular edema which had been interpreted as the manifestation of hypertensive retinopathy by blood pressures of 200/130. RESULTS: An arterial branch occlusion temporal superior could be detected biomicroscopically as well as multiple sharply defined, whitish-yellow, epiretinal and intraretinal spots and lightly blurred papillary edges. Lues serology revealed very high titers. After 2 weeks of i.v. penicillin G therapy there was a clear regression of the chorioretinal foci but persistence of the reduction in vision and loss of visual field. CONCLUSIONS: Because of the increasing incidence of syphilis it is becoming more important to consider this disease in the differential diagnosis not only for unclear symptom complexes but also in apparently obvious situations.

Macula-off retinal detachment--a matter of time?

BACKGROUND: The aim of this study was to determine the influence of the lag time between macular detachment and surgical intervention on post-operative visual acuity gain in patients with rhegmatogenous macula-off retinal detachment. PATIENTS AND METHODS: We retrospectively evaluated the medical records of 62 consecutive patients having undergone scleral buckling surgery for rhegmatogenous macula-off retinal detachment. The correlation of gender, age, refraction, number of retinal breaks, development of cataract during follow-up, pre-operative visual acuity and timing of surgical intervention with final visual acuity and post-operative visual acuity gain were determined. Mean follow-up time was 12.7 months. RESULTS: A correlation with final visual acuity was found for pre-operative visual acuity and lag between the beginning of symptoms and surgical intervention. A correlation with visual acuity gain was found only for timing of surgical procedure. When divided into subgroups operated after 0, 1-3, 4-6, or 7-9 days, respectively, visual recovery was better the earlier the patients underwent surgical repair. Compared to surgery at day 0, statistical significance was found only for patients operated 4 or more days after the occurrence of symptoms. CONCLUSION: The first three days seem to represent a relatively safe period during which surgery for macula-off retinal detachment may be postponed without compromising the patient's visual prognosis.

Eye disorders in diabetes: potential drug targets.

Diabetes Mellitus (DM) is a serious medical problem that causes long-term systemic complications and considerable associated morbidity. DM can cause retinopathy (DRP), maculopathy, cataract, optic neuropathy, defects of eye muscles. DM is a risk factor for acute infectious conjunctivitis, bacterial keratitis, herpes virus infections and endophtalmitis. Elevated blood glucose induces structural, physiological and hormonal changes which affect retinal capillaries. DRP is recognized by loss of pericyte function and capillary occlusions together leading to breakdown of blood-retinal barrier, edematous changes and proliferation of vessels and fibrous tissue. Depending on stage of DRP, there are different preferable therapeutic approaches applied. In the case of ETDRS, in the area of leakage focal treatment should be performed, while panretinal photocoagulation is applied towards ischemic areas or beginning proliferations. Vitreal haemorrhage followed by fibroproliferative changes or tractional retinal detachment is treated by vitrectomy alone or in combination with ILM peeling. In pathogenesis of DRP, Insulin Growth Factor (IGF-1) can play an important role in production of VEGF (Vascular Endothelial Growth Factor). Hypoxia can up-regulate VEGF expression levels leading to pathologic ocular neovascularisation. An application of intravitreal corticosteroid treatment modulates vascular permeability by suppressing the production of VEGF, reducing both extracellular matrix metalloproteinase activity and basic fibroblast growth factor, decreasing major histocompatibility complex 2 Ag expression levels, and inhibiting activity of inflammatory cells. Clinical effects of treatment using intravitreal corticosteroids are evaluated by reduction of macular thickness and visual improvement. Intravitreal use of Anti-VEGF drugs, Pegaptanib, Ranibizumab and Bevacizumab can modify vasoproliferation, trigger macular edema, and, therefore, influence a prognosis for visual loss.