[Influence of postoperative oral steroid treatment on retinal sensitivity in patients after macular surgery. A randomized, controlled, clinical trial]. / Einfluss postoperativer oraler Steroidgabe auf die retinale Sensitivität bei Patienten nach Makulachirurgie. Eine randomisierte, kontrollierte, klinische Studie.

BACKGROUND: The aim of this study was to evaluate the effect of postoperative systemic steroid treatment on retinal sensitivity in patients with epiretinal membrane (ERM) after successful surgery. PATIENTS AND METHODS: A total of 28 patients with ERM, macular edema and visual loss were included in this study. All patients were treated with combined 23 gauge vitrectomy and peeling of the ERM and inner limiting membrane (ILM). After randomization the first group (n = 14) was treated with postoperative systemic steroids (100 mg prednisolone per day for 5 days) and the second group (n = 14) served as a control group. Follow-up examinations were performed up to 12 months. RESULTS: After 12 months a statistically significant increase in visual acuity with a gain of 17/10 letters in the steroid/control group as well as significant decrease of the central retinal thickness of 107/128 µm could be observed (p < 0.05). In the steroid/control group mean retinal sensitivity increased from 14.0/14.3 dB after 12 months in comparison to 11.7/11.9 dB at baseline examination (p < 0.05). CONCLUSIONS: Postoperative oral steroid treatment does not seem to be beneficial in patients with macular pucker surgery.

New approaches for the treatment of diabetic macular oedema: recommendations by an expert panel.

The current standard therapy for patients with diabetic macular oedema (DME)--focal/grid laser photocoagulation--usually does not improve impaired vision, and many patients lose vision despite laser therapy. Recent approval of ranibizumab by the European Medicines Agency to treat visual impairment due to DME fulfils the previously unmet medical need for a treatment that can improve visual acuity (VA) in these patients. We reviewed 1- and 2-year clinical trial findings for ranibizumab used as treatment for DME to formulate evidence-based treatment recommendations in the context of this new therapy. DME with or without visual impairment should be considered for treatment when it fulfils the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria for clinically significant oedema. For DME with centre involvement and associated vision loss due to DME, monthly ranibizumab monotherapy with treatment interruption and re-initiation based on VA stability is recommended. Laser therapy based on ETDRS guidelines is recommended for other forms of clinically significant DME without centre involvement or when no vision loss has occurred, despite centre involvement. Because these recommendations are based on randomised controlled trials of 1-2 years duration, guidance may need updating as long-term ranibizumab data become available and as additional therapeutic agents are assessed in clinical trials.

Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study.

PURPOSE: To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs). DESIGN: Prospective, randomized, investigator-masked, controlled clinical study. METHODS: Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively. RESULTS: At month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups). CONCLUSION: The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.

[Combination of Intravitreal rTPA, gas and ranibizumab for extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration]. / Kombinierte intravitreale Injektion von rTPA, Gas und Ranibizumab zur Behandlung grossflächiger subfovealer Blutungen bei neovaskulärer altersbedingter Makuladegeneration.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of the combination therapy with intravitreal recombinant tissue plasminogen activator (rTPA), gas and lucentis for patients with extensive subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD). METHODS: In this retrospective clinical study 10 eyes with extensive subfoveal haemorrhages secondary to neovascular AMD were included and treated with intravitreal rTPA (0.05 mL; 0.025 mg/0.1 mL in 0.9% NaCl), 100% sulphur hexafluoride (SF(6)) gas (0.5 mL) and lucentis (0.05 mL, 10 mg/mL) within two weeks after the onset of the subretinal haemorrhage. Retreatments with lucentis were performed at 4-week intervals if there were persistent submacular haemorrhages or signs of active choroideal neovascularisation (CNV). The treatment effect was evaluated using best-corrected visual acuity (VA, Snellen), complete ophthalmic examination, fluorescein angiography (FLA) and optical coherence tomography (OCT). RESULTS: Mean observation period was 6.4 A+/- 3.7 months (range: 3 - 13 months). With regard to VA, in 7 eyes there was an increase in VA (> or = 1 Snellen lines), in 1 eye a stabilisation and in 2 eyes a decrease in VA (> or = 1 Snellen lines). At the end of follow-up time, with regard to VA no significant difference was observed compared to baseline (p = 0.41). In 1 patient an intra-operative transient central arterial occlusion and in another patient a corneal erosion and an increase of intraocular pressure up to 27 mmHg were observed after initial combination treatment. On average there were 1.9 A+/- 1.3 retreatments indicated after initial treatment. CONCLUSION: The combination of rTPA, gas and lucentis is a valuable therapy for extensive subfoveal haemorrhages secondary to neovascular AMD resulting in stabilisation of both VA and morphologic parameters.

Morphological and functional analysis of the loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration.

AIM: To quantify and correlate the morphological and functional effects of the recommended loading regimen with intravitreal ranibizumab in neovascular age-related macular degeneration (AMD). METHODS: In a prospective, interventional clinical trial, 29 consecutive patients (29 eyes) with choroidal neovascularisation secondary to AMD received three initial monthly intravitreal injections of ranibizumab. During this loading regimen, best corrected visual acuity (BCVA) and microperimetry (MP) testing, as well as optical coherence tomography and fluorescein angiography (FA), were performed using a standardised protocol and the results correlated. RESULTS: Significant morphological and functional therapeutic effects were observed as early as 1 week following the first treatment. Throughout the loading-dose period, central retinal thickness, including intraretinal cysts and subretinal fluid, decreased fast and significantly (p<0.01); pigment epithelial detachment resolved less rapidly. The mean leakage area by FA decreased (p<0.01) and retinal function (BCVA and MP) increased significantly (both p<0.01). However, the change in morphology and function was only significant between baseline and week 1. There was no significant additional morphological or functional benefit following the second and third injection. CONCLUSION: The initial administration of intravitreal ranibizumab in neovascular AMD induced a significant effect on intra- and subretinal fluid and visual function; subsequent injections had a less pronounced effect. It remains to be determined whether this loading regimen should be mandatory in all patients or if a single dose regimen would lead to a comparable functional and morphological retinal improvement.

Ranibizumab (Lucentis) in neovascular age-related macular degeneration: evidence from clinical trials.

BACKGROUND: Neovascular age-related macular degeneration (AMD) has a poor prognosis if left untreated, frequently resulting in legal blindness. Ranibizumab is approved for treating neovascular AMD. However, further guidance is needed to assist ophthalmologists in clinical practice to optimise treatment outcomes. METHODS: An international retina expert panel assessed evidence available from prospective, multicentre studies evaluating different ranibizumab treatment schedules (ANCHOR, MARINA, PIER, SAILOR, SUSTAIN and EXCITE) and a literature search to generate evidence-based and consensus recommendations for treatment indication and assessment, retreatment and monitoring. RESULTS: Ranibizumab is indicated for choroidal neovascular lesions with active disease, the clinical parameters of which are outlined. Treatment initiation with three consecutive monthly injections, followed by continued monthly injections, has provided the best visual-acuity outcomes in pivotal clinical trials. If continued monthly injections are not feasible after initiation, a flexible strategy appears viable, with monthly monitoring of lesion activity recommended. Initiation regimens of fewer than three injections have not been assessed. Continuous careful monitoring with flexible retreatment may help avoid vision loss recurring. Standardised biomarkers need to be determined. CONCLUSION: Evidence-based guidelines will help to optimise treatment outcomes with ranibizumab in neovascular AMD.

[Influence of antiangiogenetic therapy on retinal thickness values in age-related macular degeneration]. / Beeinflussung von Netzhautdickenwerten durch antiangiogenetische Therapie bei altersbedingter Makuladegeneration.

BACKGROUND: This study evaluated the impact of antiangiogenetic therapy on differences in central retinal thickness (CRT) as measured with two optical coherence tomography (OCT) systems from the same manufacturer. MATERIAL AND METHODS: Data were obtained from a group of 20 patients with neovascular age-related macular degeneration before and after intravitreal treatment with ranibizumab. Imaging was performed using the Stratus and the high-definition (HD) Cirrus OCT systems. RESULTS: The mean CRT was revealed to be significantly lower as measured by OCT compared with HD-OCT before and after treatment (p<0.002). CRT differences varied more strongly before treatment than after treatment. A higher standard deviation was noted before treatment. The difference in the mean deviation of CRT measurements before and following antiangiogenetic therapy was highly significant. CONCLUSION: This study showed that differences in CRT measurements between different OCT systems were subject not only to technical differences but also to treatment effects of current antiangiogenetic strategies. These effects should be recognized because clinical studies increasingly define OCT parameters as primary or secondary outcome measures.

Characteristics of severe intraocular inflammation following intravitreal injection of bevacizumab (Avastin).

BACKGROUND/AIMS: To report a series of severe intraocular inflammatory events following intravitreal injections of bevacizumab (Avastin). This procedure is performed on a rapidly increasing number worldwide, and rare complications such as intraocular inflammation, endophthalmitis or intraocular haemorrhage are gaining in importance in clinical routine. METHODS: This is a single-centre retrospective interventional case series of eight patients with severe intraocular inflammation after intravitreal injection of bevacizumab at one referral centre consecutively seen out of approximately a total of 2500 injections performed in that time period. Patients who developed severe intraocular inflammation after intravitreal injection were evaluated clinically, including slit-lamp examination, best-corrected Snellen visual acuity (VA), slit-lamp photography, optical coherence tomography and fluorescein angiography prior to the event and during follow-up. RESULTS: Patients noticed a painless drop in VA up to 2 days following the injection. All patients had a marked anterior chamber reaction with increased flare and cells, but no hypopyon. Typical posterior segment findings included vitreous cellular infiltrates of pseudogranulomatous aspect. Due to their initial clinical aspect suspicious of an endophthalmitis, three cases were treated with systemic antibiotics, but the final diagnosis was uveitis. Five cases showed a characteristic pseudogranulomatous vitreous infiltration as seen in vitritis and were treated only topically. CONCLUSIONS: Characteristic features of an inflammation induced by bevacizumab injection include an early onset with painless loss in VA mostly without conjunctival or ciliary injection. Patients respond to systemic or topical cortisone treatment with slow recovery but without permanent damage. Vitreous haemorrhage and infectious endophthalmitis might be differentiated by time course and symptoms.

Management of extensive subfoveal haemorrhage secondary to neovascular age-related macular degeneration.

BACKGROUND: To evaluate the clinical outcomes of subfoveal haemorrhages secondary to neovascular age-related macular degeneration (AMD), which were treated with intravitreal recombinant tissue plasminogen activator (rTPA)/gas and anti-vascular endothelial growth factor (anti-VEGF) drug or with an intravitreal anti-VEGF monotherapy. METHODS: This is a retrospective pilot study. Patients who received intravitreal rTPA/gas and anti-VEGF injections (n=20, bevacizumab or ranibizumab) were included in group A. Patients who refused prone positioning after rTPA/gas injections and were treated with an anti-VEGF monotherapy (bevacizumab) alone were included into group B (n=10). Changes in baseline visual acuity (VA, Snellen), central retinal thickness (CRT) and haemorrhage size were analysed. RESULTS: Mean baseline VA was 0.15+/-0.2 and 0.25+/-0.17 in groups A and B, respectively. At month 4, significant improvement in mean VA was observed in group A (mean difference: +0.1+/-0.14; P=0.003), and a stabilization in group B (mean difference: +0.008+/-0.2; P=0.94). CRT decreased significantly by 70 microm in group A (P=0.001) and by 84 microm in group B (P=0.03). The mean size of subfoveal haemorrhage in groups A and B was 20.2 mm(2) and 19.1 mm(2) at baseline and 0.0 mm(2) and 2.0 mm(2) at month 4, respectively. The anti-VEGF treatment rate was 1.6 in group A and 3.0 in group B. CONCLUSION: In patients with extensive subfoveal haemorrhage secondary to neovascular AMD, the combination therapy of rTPA/pneumatic displacement and anti-VEGF results in mean improvement of VA and stabilization of morphological parameters. If rTPA and pneumatic displacement combination is contraindicated, an anti-VEGF monotherapy may be performed to prevent further visual loss.

Early postoperative recovery of idiopathic macular hole in a young adult.

BACKGROUND: Idiopathic macular holes usually develop in the elderly. We report the case of a spontaneous macular hole in a 23-year-old man. HISTORY AND SIGNS: The patient noticed decreased central vision in his left eye since 5 days without any history of trauma or intraocular inflammation. On examination the best corrected visual acuity was 20/20 in the right eye and 20/50 in the left. Fundus biomicroscopy and OCT showed a full-thickness macular hole. Microperimetry demonstrated a scotoma within the macular hole. THERAPY AND OUTCOME: 2 months later the patient underwent pars plana vitrectomy, ILM-peeling with trypan blue staining and fluid-air exchange followed by face down positioning for 12 h a day for 2 days. On the 4th post-surgical day visual acuity was 20/32 and OCT showed a complete closure of the macular hole. During the further follow-up visual acuity in the left eye improved to 20/20. OCT examination showed a restored foveal depression, and microperimetry demonstrated an increased foveal sensitivity in the area of the previous scotoma. CONCLUSIONS: The aetiology of the macular hole in this patient is unclear. It is most likely an idiopathic macular hole in a young person. Post-surgical follow-up OCTs and microperimetry disclosed an early recovery of the foveal anatomy and function.

[The role of Stratus OCT in anti-VEGF therapy. Qualitative and quantitative assessment of neovascular AMD]. / Die Rolle des Stratus-OCT bei der Anti-VEGF-Therapie : Qualitative und quantitative Beurteilung bei neovaskulärer AMD.

BACKGROUND: The evaluation of OCT3 during anti-VEGF therapy. METHODS: A total of 29 patients with choroidal neovascularization secondary to AMD received 3 intravitreal injections of ranibizumab. OCT examination and visual acuity testing (ETDRS) were performed before therapy onset, after 1 week and after 1, 2 and 3 months. RESULTS: The central retinal thickness (CRT) was assessed correctly by OCT in 128 out of 145 measurements. There was a distinct (84%) but not significant correlation between decrease in central retinal thickness and increase in visual acuity. Incorrect retinal layer segmentation and inadequate CRT measurements were a significant technical limitation. CONCLUSION: During anti-VEGF therapy, OCT allows documentation and quantification of morphologic retinal changes and in most cases also for an estimation of functional improvement.

Early foveal recovery after macular hole surgery.

AIMS: To evaluate morphological and functional recovery after macular hole surgery using pars plana vitrectomy (PPV), inner limiting membrane (ILM) peeling, air-tamponade and short-time limited face-down positioning. DESIGN: Retrospective, interventional, non-comparative consecutive case series. PATIENTS: Thirty eyes in 30 patients (30 eyes) with unilateral full-thickness macular hole (stage II-IV). INTERVENTION: All eyes underwent PPV, ILM peeling and fluid-air exchange followed by postoperative face-down positioning for 2 days. MAIN OUTCOME MEASURES: Best corrected visual acuity, optical coherence tomography (OCT) assessment of macular integrity, and biomicroscopy at days 3 and 7, and months 1, 3, 6 and 12. RESULTS: On postoperative day 3, OCT demonstrated macular hole closure in 28 eyes (93%). One eye required vitrectomy 7 weeks after initial surgery due to retinal detachment. CONCLUSIONS: In the present case series, PPV with Trypan Blue-assisted ILM peeling, short-acting internal tamponade and thus shorter face-down positioning was associated with a 93% macular hole closure rate.

Combination therapy of PDT and triamcinolone in CNV associated with fundus flavimaculatus.

BACKGROUND: Photodynamic therapy (PDT) performed in this rare condition showed promising results according to 3 other case reports. HISTORY AND SIGNS: A 47-year-old female patient with fundus flavimaculatus developed metamorphopsia and minimal vision deterioration (20/25) in her left eye. Fluorescein angiography revealed all signs of classic choroidal neovascularisation (CNV). THERAPY AND OUTCOME: After the first PDT treatment with a spot adapted to the size of the juxtafoveal CNV (1.5 mm) and standard parameters visual acuity (VA) dropped to 20/63, more leakage and progression to subfoveal CNV was observed. 3 months after the second PDT VA was 20/80 and FA revealed persistent leakage. Given the results of the combination treatment in age-related macular degeneration and the poor outcome seen after PDT alone in this case, PDT and intravitreal injection of 4 mg triamcinolone acetonide on the same day was applied. 3, 6 and 9 months after treatment VA stabilised at 20/63 and FA showed confirmed regression of the CNV and, thus, no leakage, but scarring. CONCLUSIONS: To the best of our knowledge this is the first published report of CNV secondary to fundus flavimaculatus in which PDT alone failed to stop leakage and progression of the CNV. However therapy combined with triamcinolone acetonide was successful.

Increased endothelin-1 plasma level in young adults with retinal vascular occlusive diseases.

BACKGROUND: Vascular occlusive diseases are usually seen in the elderly but can occur even in younger patients without arteriosclerosis. We assume a vascular dysregulation as a underlying pathogenetic mechanism. PATIENTS AND METHODS: In a prospective study we analysed the clinical findings of six patients under 55 years of age, three men with retinal vein occlusions and three women with branch retinal arterial obstructions. They were examined for signs of a vascular dysregulation and the endothelin-1 (ET-1) plasma level was measured. RESULTS: In all patients the ET-1 plasma level was markedly elevated. The mean value (3.72 +/- 0.8 pg/ml) was significantly increased compared to normal values for that age (1.52 +/- 0.24 pg/ml; p < 0.001). In all cases an increased tendency for vascular dysregulation could be demonstrated in nailfold capillaroscopy. Furthermore, frequent coldness of the extremities was mentioned by every patient and migraine was mentioned by four patients whereas neither changes of the vessels in carotis and ophthalmica region nor disturbances in the haemostasis and fibrinolysis could be found. CONCLUSIONS: All six patients with vascular occlusive diseases occurring before the age of 55 had a vascular dysregulation and increased ET-1 plasma levels. A relationship between the vascular dysregulation and the vascular occlusive diseases is therefore likely.

Iris transillumination defects in patients with primary open angle glaucoma.

PURPOSE: To examine the incidence and pattern of iris transillumination defects in patients with primary open angle glaucoma (POAG) with and without vascular dysregulation, in comparison to controls. METHODS: We prospectively examined 24 patients with POAG (M/F 10:14; mean age 59 +/- 14, range 21-76 years) and 23 controls (M/F 10:13; mean age 52 +/- 15, range 25-86 years). Vascular dysregulation was presumed if patients had a typical medical history of vasospasm and a pathological result in nailfold capillaroscopy. Iris transillumination defects were visualized by video-taped, digitized diaphanoscopy and assessed by two blinded observers. RESULTS: We found significantly more iris transillumination defects in POAG than in controls (54.2% vs. 8.7%; chi2 = 8.85; df = 1; p = 0.002). The defects in POAG showed a characteristic radially-streaked pattern different from those described, for instance, in pigment dispersion syndrome, pseudoexfoliation syndrome, and acute glaucoma. Glaucoma patients with vascular dysregulation had a tendency to a higher incidence of transillumination defects than non-vasospastic patients, though this finding was not significant. CONCLUSIONS: Patients with POAG have a higher incidence of iris transillumination defects than controls. The underlying mechanisms are not yet clear and call for further investigation.

Multicenter evaluation of tendency-oriented perimetry (TOP) using the G1 grid.

PURPOSE: The G1-TOP program is a short automated perimetric strategy which sub-divides the G1 grid of 59 points into four sub-grids. Each point is tested only once, but each patient's response is used to modify that particular point and the surrounding ones from the remaining sub-grids. This study compared the results of the G1-TOP program with the Standard Bracketing strategy. METHODS: Eleven participating institutions provided data from 213 patients (406 eyes). The main group consisted of 284 glaucomas and 55 glaucoma suspects. Other groups included 31 eyes with neurological disorders, 20 with chorioretinal lesions and 16 normal eyes. Mean age was 62.7 +/- 15.4 (range 14-88) years. All subjects had previous perimetric experience and visual acuity better than 0.5. Examination included G1-Standard Bracketing and G1-TOP testing, in interchangeable order, with the Octopus 1-2-3 perimeter. RESULTS: The correlation coefficient for mean defect (MD) was 0.95. Standard error (YX) for MD, square root of loss variance (LV) and individual thresholds were 1.86 dB, 1.29 dB, and 4.72 dB, respectively. Mean sensitivity values were similar (difference 0.04 +/- 1.87 dB) (p>0.05). Mean duration for G1-TOP was 2.19 +/- 0.26 min, while G1-Standard Bracketing took 11.51 +/- 1.52 min (ratio 1/5.1, or a net reduction of 80.4%). The sensitivity of G1-TOP versus G1-Standard Bracketing was: glaucoma 77.1/78.5, glaucoma suspects 38.2/47.3, neurological disorders 87.1/87.1 and chorioretinal lesions 80.0/85.0. CONCLUSIONS: The G1-TOP program gave very similar results to G1-Standard Bracketing in only 20% of the time required by the standard strategy.

The influence of sex difference in measurements with the Langham Ocular Blood Flow System.

PURPOSE: To assess sex difference and parameters possibly accounting for such a difference in healthy subjects evaluated by means of the Langham Ocular Blood Flow (OBF) System. METHODS: Pulse amplitude of intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) as measured with the Langham OBF System were assessed in 86 healthy men and 69 healthy women. RESULTS: Compared to men, women showed higher POBF (mean +/- SD: 722.6 +/- 152.8 versus 647.8 +/- 164.9 microL/min; P =.0056) and pulse amplitude (mean +/- SD: 2.3 +/- 0.7 versus 2.0 +/- 0.6 mm Hg; P =.0043) values. Sex difference was still significant after correcting for age, refraction, blood pressure, IOP, and pulse rate. Pulse amplitude correlated negatively with pulse rate, and POBF correlated negatively with IOP. Women had higher readings in pulse amplitude and POBF, even after correcting for age, refraction, IOP, blood pressure, and pulse rate. CONCLUSIONS: While using the Langham OBF System, one needs to be aware of sex difference that is independent of other hemodynamic parameters. How the observed difference in POBF is related to ocular blood flow, and how it might influence the preponderance of various ocular diseases in men or women remains to be clarified.

[GRIN (gradient-index) intraocular endoscopy--possibilities and limits--a review]. / GRIN-Endoskopie intraokular--Möglichkeiten und Grenzen--eine Ubersicht.

BACKGROUND: Microendoscope techniques got a more important role in intraocular diagnostic and therapy. The used optical systems are fiberbundle-endoscopes and gradient-index (GRIN)-endoscopes. This study is concerned with the possibilities and limits of GRIN-endoscopes in pig eye models and in clinical use. PATIENTS AND METHODS: Several simulated intraocular techniques (phacoemulsification, implantation of intraocular lenses, vitrektomie, extraction of lost lens parts out of the corpus vitreous, extraction of metal foreign bodies) were done on pig eyes under GRIN-endoscopic control (GRIN-endoscope with diameter of 0.89 mm, Volpi, Switzerland). 3 clinical patients with cornea or lens opacities were examined. RESULTS: The image quality of simulated operations on pig eyes in clear intraocular conditions with a GRIN-endoscope was good. Also the clinical intraocular examinations could be done well, although the additional information were different. The in vivo examinations gave in one case no information (vitreous opacities very tight), in one case a relative information (mild vitreous opacities) and in one case an additional information (vitreous opacities rare). CONCLUSIONS: GRIN-endoscopes could complement the intraocular endoscopic spectrum in selected cases. At clear intraocular conditions good pictures were possible. GRIN-endoscopes could be used in cases where endoillumination is necessary. Then additional visual informations to the illumination are possible. The possibility to get overview images is limited with the actual endoscope probes. Ultrasound examination should be done in all cases with opacities of the anterior parts of the eye to get informations about the conditions inside the eye. Working inside the eye is possible with experience in this technique although a GRIN-endoscope has no stereopsis. Future developments should be done in stereopsis, several endoscope-tips and better handling (footpedal-controlling, autofocus).

Immunosuppressive therapy in serpiginous choroiditis--case report and brief review of the literature.

BACKGROUND: At present there is no consensus regarding the efficacy of the immunosuppressive therapy in serpiginous choroiditis. PATIENT AND METHODS: We describe the case of a patient with a macular serpiginous choroiditis. Despite corticosteroid therapy the choroiditis was progressive and threatened the central vision. Therefore a triple immunosuppressive therapy with prednisone 1 mg/kg body weight/day (mg/kg/d), azathioprine 1.5 mg/kg/d, and low-dose cyclosporine A 4.5 mg/kg/d was introduced. RESULTS: Under this triple immunosuppressive therapy a prompt stabilisation of the chorioretinal process could be observed in fluorescein angiography. After five months of therapy the examination of the visual field shows an impressive recovery. No significant side effects have been noted. CONCLUSIONS: In the literature, until now only six patients with serpiginous choroiditis treated with a triple agent immunosuppressive therapy have been reported. In all cases this regimen seemed to have a positive influence on the disease. Our present observation corroborates the beneficial effect of a triple agent immunosuppressive therapy on the course of serpiginous choroiditis. However, the beneficial effect of such a therapeutic approach needs to be confirmed by further observations.