[Is There Really Agreement between Rebound and Goldmann Applanation Tonometry Methods? Results of a Systematic Review of the Period 01/2005 to 08/2014]. / Wirklich gute Übereinstimmung zwischen Rebound- und Goldmann-Applanationstonometrie? Ergebnisse eines Systematic Review zum Zeitraum 01/2005 bis 08/2014.

BACKGROUND: After its introduction in 2003 the iCare® rebound tonometry has gained wide acceptance, mostly as a result of immediate method comparison trials showing high concordance with the Goldmann applanation tonometry (GAT) as a reference method. The objective of this systemic review was the synopsis of the current literature as a rationale of a concordance evaluation between the iCare® rebound and the Goldmann applanation tonometry methods. METHODS: The PubMed database was searched for Anglo-American and German publications comparing intraindividually the two tonometry methods and having been published during the period 01/2005 to 08/2014. The primary endpoint of the review was the reported IOD deviation [mmHg] between the two devices; for each trial, this primary endpoint was parameterised in terms of the "mean deviation" as well as the "relative frequency [%] of measurements with an intraindividual deviation of ≥ ±â€Š3 mmHg". A total of 33 published method comparison studies concerning the iCare TA01i device were included, 17 of them being published between 01/2009 and 08/2014. The number of analysed eyes ranged between 28 and 445; 17 of the 33 studies reported more than 100 examined eyes. 7 of the 33 studies included only healthy eyes. RESULTS: Only 10 out of the 33 studies reported a mean deviation of more than ± 1.5 mmHg, 7 of these were published between 01/2009 and 08/2014. Only 12 of the 33 studies reported the relative frequency of intraindividual deviations ≥ ±â€Š3 mmHg, 7 of them reporting a frequency > 20 % (with a maximum of 51 %), with higher frequencies being derived from samples showing higher IOD levels according to the GAT reference. CONCLUSION: As concluded from the current literature the iCare® rebound and the Goldmann applanation tonometry methods cannot be considered exchangable.

[Prospective Reliability Trial to Assess Inter and Intra Observer Reliability of Rebound Tonometry in the Eyes of Healthy Probands]. / Prospektive Reproduzierbarkeitsstudie zur Inter- und Intraobserver-Reliabilität der Rebound-Tonometrie an augengesunden Probanden.

PURPOSE: A prospective reliability trial was implemented to estimate the inter- and intraobserver reproducibility of iCare® rebound tonometry in healthy proband eyes. MATERIAL AND METHODS: Three independent observers performed three replicate measurements, respectively, by means of the iCare®PRO rebound tonometry device in 20 eyes of 20 healthy probands. Two of these observers were medical doctors with an at least two years experience in ophthalmological patient care, the third observer was a study nurse with several years practice in applying ophthalmological diagnostic procedures. Each observer's replicate measurements were averaged and then compared by means of a global Friedman test for interobserver bias in the parallel rebound tonometry measurements at the 5 % significance level. In addition, variance component analysis was performed on the overall repeated measurement design to estimate the iCare® reliability coefficient [%] (100 % indicating total reproducibility in absence of any inter or intra observer bias). RESULTS: The respective observers' median average measurements were 15.9 mmHg (interquartile range 15.1 to 17.5 mmHg) and 15.1 mmHg (14.3 to 15.6 mmHg) for the medical doctors, furthermore 16.8 mmHg (14.2 to 18.9 mmHg) for the study nurse; the averaged measurement series showed a significant interobserver bias (Friedman p = 0.006). Variance component analysis revealed an overall iCare® reliability of 35 % (95 % confidence interval 26 to 44 %). CONCLUSION: In this repeated measurement design iCare® rebound tonometry measurements showed significant interobserver bias and thereby notably reduced overall reliability. In particular, the intraindividual measurement profiles showed a gradient towards smaller values during the 9 replicates' series; furthermore the study nurses' measurements showed notably increased variability. As a consequence the routine use of iCare® rebound tonometry must be critically discussed at least when being delegated to less experienced staff.

[How is ophthalmic undersupply demonstrated in socially disadvantaged people? Cross-sectional pilot investigation on the parametrisation of endpoints for patient-centred care research]. / Worin manifestiert sich eine eventuelle augenärztliche Unterversorgung sozial schlechter gestellter Menschen? Pilotstudie zur Wahl versorgungswissenschaftlicher Endpunkte.

BACKGROUND: Many people depend on additional help to maintain their daily needs. In these circumstances preventive medical check-ups are frequently not attended, so that disease development may remain undetected until advanced stages or correctable disorders may not be treated. A fully anonymised cross-sectional study was set up to assess feasibility of parametrisation and to quantify sensitive indicators for screening for possible ophthalmic undersupply in socially disadvantaged people. METHODS: In 2011 a free, voluntary and anonymous ophthalmic examination was offered to attendees of the "Oberhausener Tafel" social project. The visual acuity was checked with adjustment of the objective refractional error via autorefractor, without or with glasses (if available). In addition, an examination of the anterior and posterior segments of the eye was done in miosis. As primary endpoint a corrected visual acuity of > 0.5 combined with a presenting visual acuity ≤ 0.5 on the same eye in at least one eye was considered. A key secondary endpoint was defined as the absolute deviation of at least 1 D in at least one eye between the spherical equivalent measurement of the corrective values of the glasses and the autorefractor readings. The primary intention of this pilot investigation was to assess the feasibility of this endpoint parametrisation and to quantify the corresponding endpoint prevalences. RESULTS: Data of 37 participants could be evaluated, 28 of whom brought their glasses. The best available visual acuity ranged from 0.12 to 1.3 with a median per eye of 0.63. In comparison, the corrected visual acuity per eye was 0.8 (range 0.32-1.0). In 54 % the presenting visual acuity was one- or both-eyed ≤ 0.5, but could be reduced to 30 % (one- or both-eyed) after correction of the objective refractional error. In summary, presenting visual acuity in comparison to corrected visual acuity showed potential for an at least one-eyed improvement for at least two lines in 46 % of the participants. Furthermore, 19 participants showed disorders concerning the anterior or posterior eye segment. CONCLUSION: In the examined population the visual acuity could be improved by two lines in merely 50 % of the participants by adjusting refractive errors. The results indicate the need for discussion on how to lower the threshold for attending preventive ophthalmic examinations.

[Evaluation of possible prognostic factors for the course of visual acuity after intravitreal ttriamconolone acetonide]. / Evaluation möglicher prognostischer Merkmale für den Visusverlauf nach intravitrealer Triamzinoloninjektion.

BACKGROUND: Intrvitreal injections are increasingly applied in the treatment of macular oedema of different origins. So far no clear preoperative prognostic factors are known. This investigation was implemented to quantify the predictive value of preoperative retinal sensitivity assessments by means of microperimetry with regard to the short-term course of visual acuity. METHODS: 42 patients with macular oedema due different ocular diseases (such as diabetic maculopathy, retinal vein occlusion, Irvine Gass syndrome) were examined pre- and postoperatively by means of microperimetry, fixation, optical coherence tomography and fluorescein angiography. Their medical history, treatment to date, visual acuity, central retinal thickness and retinal sensitivity were recorded before and six weeks after intravitreal injection of triamcinolone acetonide. RESULTS: The data from 38 injections could be evaluated; 21 eyes showed an improvement in visual acuity of more than one line. However, statistically significant prognostic factors could not be identified: patients with a visual acuity increase of at least one line showed a median total retinal sensitivity of 8.5 dB (5.0-11.0 dB) versus 8.3 dB (3.6-12.8 dB) in patients with unchanged or decreasing visual acuity (Wilcoxon p = 0.706). The same tendency was observed in retinal thickness with medians of 618 µm (483-689 µm) versus 558 µm (447-621 µm; Wilcoxon p = 0.220). However, a moderate association of the visual outcome with the 6 weeks change in total retinal sensitivity was observed. Patients with visual improvement of at least one line showed a significant sensitivity increase of 1.7 dB in median versus a median decrease of 0.8 dB in patients with stable or worsened visual acuity (sign test p = 0.003 and p = 0.629, respectively). CONCLUSION: The presented data did not reveal statistically significant predictors of the short-term visual outcome after triamzinolone injection by means preoperative microperimetry assessment.

[Additive retrobulbar anesthesia in surgery of retinal detachment with general anesthesia. Reduced postoperative pain and stress response]. / Additive Retrobulbäranästhesie bei Operationen von Netzhautablösungen in Allgemeinanästhesie. Postoperative Schmerzreduktion und Unterdrückung der endogenen Stressantwort.

BACKGROUND: It has recently been shown that the pain occurring after retinal detachment surgery can be reduced by combined general and retrobulbar anesthesia. This study investigated the effect of retrobulbar anesthesia on the intra- and postoperative stress response and on postoperative pain, vigilance, nausea and vomiting. PATIENTS AND METHODS: In this prospective randomized study, 45 patients were enrolled where scleral buckling surgery for retinal detachment had been performed under general anesthesia. Bupivacain 0.5% (4 ml) was injected retrobulbarly in group I (n = 15) before surgery (preoperative) and in group II (n = 15) after surgery (postoperative), group III did not receive retrobulbar anesthesia. At different times during and after surgery, blood pressure, cortisol and glucose levels, time in the recovery unit, vigilance score, nausea and vomiting were measured and the pain score was determined. The dosages of intraoperative opioid analgetics and of postoperative pain medication were documented. RESULTS: Retrobulbar anesthesia reduces postoperative pain. Intra- and postoperative endogenous stress responses in groups I and II were reduced and the plasma levels of cortisol and glucose in group I were lower than in group II. In group I, nausea, dosages of intraoperative opioid analgetics and postoperative pain medication were reduced, the vigilance was increased and time in the recovery unit was shortened. CONCLUSIONS: The data show that combined local and general anesthesia has several advantages over general anesthesia alone, especially when the retrobulbar injection is given before retinal detachment surgery.

[Reuse of instruments for minimal invasive surgery--status and prospects]. / Aufbereitung von Instrumenten der minimal-invasiven Chirurgie--Stand und Perspektiven.

The development of instruments for minimal invasive surgery (MIS) is moving in the direction of the miniaturization of mechanical components, a combination of multiple functions in a single instrument, and the introduction of new techniques, in particular those reducing bleeding and thermal damage when cutting blood vessels. These tendencies have consequences for the reprocessability of the instruments, usually making reprocessing more difficult. In particular cleaning--the removal of contaminations from tiny lumina, joints, etc., is highly demanding. In addition, proof of successful cleaning is difficult, and no standardised method of doing this in practice is currently available. An overview of the problems associated with the reprocessing of instruments for minimal invasive surgery is given, and a numbers of possible solutions are discussed.

Choice of surgical technique in the management of cataract combined with vitreous surgery.

PURPOSE: To compare different methods of lens removal during vitreous surgery. METHODS: We reviewed the data of 37 consecutive eye operations with combined surgery of the lens and vitreous in the Mülheim Eye Hospital between March '93 and September '94. RESULTS: In 14 eyes a pars plana lensectomy was done, in 7 an ECCE (extra capsular cataract extraction), and in 16 phacoemulsification was combined with a regular three-port pars plana vitrectomy. CONCLUSIONS: The choice of procedure was mainly influenced by the hardness of the lens and whether an IOL implant was considered. If no IOL is planned and the lens is soft enough, the best way to remove it is by pars plana lensectomy. If the nucleus seems too hard, phacoemulsification should be performed, because of the risk of releasing the nucleus into the posterior segment. If an IOL is planned, the best method of lens removal is phacoemulsification via a scleral tunnel. In both cases if the nucleus is very hard ECCE should be performed because of the risk of corneal edema.

Vitreous levels of the insulin-like growth factors I and II, and the insulin-like growth factor binding proteins 2 and 3, increase in neovascular eye disease. Studies in nondiabetic and diabetic subjects.

Retinal capillary nonperfusion results in neovascularization of the eye, which is restricted to the retina in less severe cases and progresses to the anterior chamber and the iris angle in the most advanced case, called rubeosis. This angioneogenesis may be induced by the release of retinal growth factors into the vitreous. This study compared levels of the IGF-I and IGF-II, and of the IGF binding protein-2 (IGFBP-2) and IGFBP-3 in vitreous from three groups with different degrees of retinal ischemia, as judged by the extent of neovascularization: a control group without new vessel formation, retinal neovascularization in patients with proliferative diabetic retinopathy, and massive ischemia of various causes resulting in rubeosis. IGF-I and IGFBP-3 were increased 10- and 13-fold in rubeosis (P << 0.01) compared with no ischemia (n = 10), while IGF-II and IGFBP-2 were elevated 2.7- and 4.3-fold (P < 0.01). Within the rubeosis group similar changes were observed independently of the cause of ischemia, which was central vein occlusion, ischemic ophthalmopathy, or intraocular tumor in seven cases and diabetic retinopathy in three samples from two patients. Vitreous from patients with proliferative diabetic retinopathy but without rubeosis (n = 16) contained 2.5- and 2.2-fold elevated levels of IGF-I and of IGFBP-2 (P < 0.05), while IGF-II and IGFBP-3 were increased 1.4- and 1.6-fold, which was not significant. We conclude that: (a) ischemia appears to be a strong stimulus for the local production of IGF-I and -II and of IGFBP-2 and -3 in the eye. (b) Changes in IGF-I and IGFBP-2 in proliferative diabetic retinopathy may be secondary to local ischemia rather than being specific for diabetic retinopathy. (c) IGF-I and IGFBP-3 may play a role in mediating angioneogenesis in the eye.

[Significance of computed tomography in ophthalmologic diagnosis. II. CT of eyeball tumors, orbital tumors, nontumor space-occupying orbital processes and malformations]. / Aussagefähigkeit der Computer-Tomographie in der ophthalmologischen Diagnostik. Teil II: CT bei Bulbustumoren, Orbitatumoren, nicht-tumorösen Raumfordernden Orbita-prozessen und Missbildungen.

CT is valuable to complete ultrasound findings in the evaluation of tumors of the eyeball. Tumoral and nontumoral space-occupying lesions and malformations of the orbit and the exact demarcation of these conditions within the periorbital structures are well demonstrated. In several different pathological conditions the CT appearances are often similar and only sometimes characteristic. Additional clinical data are helpful in giving hints for the diagnostic differentiation of the CT findings.

[The significance of computed tomography in ophthalmologic diagnosis. I: The place of computed tomography, indications, study technics, anatomic representation, computed tomography of eyeball and orbital injuries]. / Aussagefähigkeit der Computertomographie in der Ophthalmologischen Diagnostik. Teil I: Stellenwert der Computertomographie, Indikationen, Untersuchungstechniken, anatomische Darstellung, Computertomographie bei Bulbus- und Orbitatraumen.

CT is recognized today as method of choice for examining pathological conditions of eyeball and orbit. Several techniques of CT examination are needed to attain the most accurate and detailed information about orbital and eyeball lesions. The exact knowledge of the normal anatomic CT feature of orbital structures is necessary. In traumatic lesions of the globe and the orbit foreign bodies, haematomas and fractures of the orbital walls can be proved and localized and traumatic sequelae can be diagnosed.