[Primary ophthalmological diagnosis of Treponema pallidum infection: A case series]. / Primär ophthalmologische Diagnose einer Treponema-pallidum-Infektion: Eine Fallserie.

This report is on five patients (four men and one woman) between the age of 24 and 66 years old who presented with unclear visual impairment in our clinic between 2009 and 2016 for co-evaluation. The clinical picture included intermediate uveitis, chorioretinitis, panuveitis and bilateral spontaneous cystoid macular edema. None of the patients reported systemic or dermatological symptoms. In all five patients, serological testing revealed a Treponema pallidum infection as the reason for ocular inflammation. The ophthalmologist was therefore the first to discover a syphilitic infection. After initiation of appropriate antibiotic therapy, there was improvement in all five patients and an increase in visual acuity.

[Management of paraophthalmic aneurysms : Review of endovascular treatment strategies]. / Management paraophthalmischer Aneurysmen : Übersicht der endovaskulären Behandlungsstrategien.

BACKGROUND: Aneurysms of the cerebral vessels are relatively common and aneurysms of the ophthalmic segment of the internal carotid artery (ICA) represent approximately 10% of intradural aneurysms. ANATOMICAL ASPECTS: The ophthalmic segment of the ICA extends from the origin of the ophthalmic artery to the origin of the posterior communicating artery. Aneurysms can originate from the ophthalmic artery itself or directly from the ICA at a distance from the ophthalmic artery. The various anatomic configurations can alter the risks of treatment. SURGICAL TREATMENT: Surgical treatment of aneurysms of the ophthalmic segment poses unique challenges for the neurosurgeon, given the deep location and complex nearby structures and optic nerve. The necessity to remove the clinoid process can make the operation technically challenging. ENDOVASCULAR TREATMENT: Endovascular treatment of paraophthalmic aneurysms includes coil occlusion, and also stent- or balloon-assisted coil occlusion. More recently, hemodynamically active flow diverter stents improved the treatment results. CONCLUSION: The management of paraophthalmic aneurysms is associated with specific risks. Careful consideration of the available techniques is necessary before each invention. Coil-occlusion remains the first choice for ruptured paraophthalmic aneurysms. For unruptured paraophthalmic aneurysms flow diversion offers improved results. The overall complication rates of these procedures are low; however, cerebral ischemia, intracranial hemorrhage and visual complications must be considered in advance and the patient must be informed of the risks.

High quality entanglement on a chip-based frequency comb.

We report an efficient energy-time entangled photon-pair source based on four-wave mixing in a CMOS-compatible silicon photonics ring resonator. Thanks to suitable optimization, the source shows a large spectral brightness of 400 pairs of entangled photons /s/MHz for 500 µW pump power, compatible with standard telecom dense wavelength division multiplexers. We demonstrate high-purity energy-time entanglement, i.e., free of photonic noise, with near perfect raw visibilities (> 98%) between various channel pairs in the telecom C-band. Such a compact source stands as a path towards more complex quantum photonic circuits dedicated to quantum communication systems.

[Secondary toric intraocular lens implantation in pseudophakic eyes. The add-on IOL system]. / Sekundäre torische Intraokularlinsenimplantation in pseudophake Augen. Das "Add-on"-IOL-System.

The last 2 years have seen the development of toric IOL especially designed for implantation in the ciliary sulcus for correction of corneal astigmatism in pseudophakic eyes. The term 'add-on IOL systems' is becoming more and more widely accepted for the lenses used in this procedure. The main indications for it are regular corneal astigmatism in pseudophakic eyes, for example following perforating keratoplasty, or when corneal scarring is present following trauma or infection. The implantation is a simple atraumatic procedure carried out under topical anaesthesia through a sclerocorneal incision. When the IOL is oriented along the steepest corneal meridian with the aid of corneal topographical monitoring, reliable and lasting correction of even extremely pronounced astigmatism is possible. Although this procedure has proved to be very efficient over a long follow-up period in small patient populations, reports of later adjustment of the rotation of toric add-on IOLs must be tested in further trials, especially in the case of simultaneous implantation of endocapsular IOLs in both eyes. Nonetheless, the possibility of later correction and reversibility of the intervention are further advantages of this lens system. As well as the correction of astigmatism in pseudophakic eyes the add-on IOL system also offers the option of treating pseudophakic eyes with sulcus-fixed multifocal lenses in the context of refractive interventions, e.g. as a secondary procedure.

Bevacizumab for occult subfoveal neovascularization in age-related macular degeneration.

PURPOSE: To report on the treatment of exudative age-related macular degeneration by intravitreal bevacizumab (Avastin). METHODS: A 78-year-old patient experienced a progressive loss of visual acuity in her right eye due to an occult subfoveal neovascular membrane in age-related macular degeneration. She received an intravitreal injection of 1.5 mg bevacizumab. RESULTS: Within 4 weeks after the injection, visual acuity improved from 0.40 to 0.60 with complete resolution of subretinal and intraretinal leakage and edema as shown on optical coherence tomography. Pre-existing metamorphopsias disappeared. Intraocular pressure remained in the normal range. During the follow-up, there were no sings of intraocular inflammation or any other intraocular pathology induced by the intravitreal injection. CONCLUSIONS: Intravitreal bevacizumab may potentially be helpful in the treatment of exudative age-related macular degeneration and may deserve further evaluation.

Cataract surgery under systemic anticoagulant therapy with coumarin.

PURPOSE: To evaluate clinical outcome of cataract surgery under systemic anticoagulant therapy using coumarin. METHODS: This clinical interventional comparative nonrandomized study included 441 patients (441 eyes) consecutively undergoing standard phacoemulsification with clear cornea incision and topical anesthesia. The study group consisted of 21 (4.8%) patients for whom systemic coumarin therapy was continued despite surgery. The control group included 420 patients without anticoagulant coumarin therapy prior to surgery. Study group and control group did not vary significantly in age, preoperative visual acuity, axial length, refractive error, preoperative intraocular pressure, or surgeon. RESULTS: Frequency of intraoperative or postoperative hemorrhages, intraoperative complications such as posterior capsule rupture, postoperative visual acuity, and intraocular pressure did no vary significantly (p>0.30) between study group and control group. CONCLUSIONS: For patients under systemic coumarin therapy, the rate of surgical complications may not markedly be increased compared to patients without coumarin therapy, when standard phacoemulsification with clear cornea incisions is performed with topical anesthesia. Systemic coumarin therapy does not have to be stopped prior to cataract surgery.

Sympathetic ophthalmia in vater association combined with persisting hyperplastic primary vitreous after cyclodestructive procedure.

PURPOSE: To report on the occurrence of histology-proven sympathetic ophthalmia in a patient with VATER association and persisting hyperplastic primary vitreous (PHPV) after a cyclodestructive procedure was performed to treat secondary angle-closure glaucoma. METHODS: The left eye of a 13-year-old boy with VATER association was microphthalmic from birth and had been diagnosed with PHPV at age 1 year. It developed iris neovascularization and secondary angle-closure glaucoma, which was treated by combined cyclocryocoagulation and cyclophotocoagulation. Six weeks later, a bilateral fibrinous iritis developed. Despite intensive topical and systemic steroid treatment, the iritis persisted so that the left blind eye was enucleated. RESULTS: Histology of the enucleated eye showed a marked intraocular inflammation with lymphocytes, epithelioid cells, and multinuclear giant cells grouped around remnants of melanin-bearing cells. CONCLUSIONS: Sympathetic ophthalmia may occur in patients with VATER association and PHPV after a secondary angle-closure glaucoma is treated by a combined cyclocryocoagulation and cyclophotocoagulation.

Sympathetic ophthalmia in vater association combined with persisting hyperplastic primary vitreous after cyclodestructive procedure.

PURPOSE: To report on the occurrence of histology-proven sympathetic ophthalmia in a patient with VATER association and persisting hyperplastic primary vitreous (PHPV) after a cyclodestructive procedure was performed to treat secondary angle-closure glaucoma. METHODS: The left eye of a 13-year-old boy with VATER association was microphthalmic from birth and had been diagnosed with PHPV at age 1 year. It developed iris neovascularization and secondary angle-closure glaucoma, which was treated by combined cyclocryocoagulation and cyclophotocoagulation. Six weeks later, a bilateral fibrinous iritis developed. Despite intensive topical and systemic steroid treatment, the iritis persisted so that the left blind eye was enucleated. RESULTS: Histology of the enucleated eye showed a marked intraocular inflammation with lymphocytes, epithelioid cells, and multinuclear giant cells grouped around remnants of melanin-bearing cells. CONCLUSIONS: Sympathetic ophthalmia may occur in patients with VATER association and PHPV after a secondary angle-closure glaucoma is treated by a combined cyclocryocoagulation and cyclophotocoagulation. (Eur J Ophthalmol 2006; 16: 171-172).

Potential of the 1 CU accommodative intraocular lens.

AIM: To assess the accommodative power of a new foldable monofocal intraocular lens. METHOD: A prospective randomised non-masked clinical interventional study. The study included 40 patients attending the hospital for cataract surgery and who were randomly distributed into a study group receiving a new foldable monofocal intraocular lens with flexible haptics, and a control group receiving a standard foldable intraocular lens. Mean follow up period was 8.51 (SD 1.34) months (range 4-11 months) Standard cataract surgery consisted of clear cornea incision, capsulorrhexis, phacoemulsification, and intraocular lens implantation, with topical anaesthesia. The main outcome measures were preoperative and postoperative visual acuity for near and distance; range of accommodation; change in anterior chamber depth. RESULTS: In the study group compared with the control group, range of accommodation was significantly (p = 0.01) higher (1.01 (SD 0.4) dioptres versus 0.50 (0.11) dioptres) and change in anterior chamber depth was significantly more pronounced (0.82 (0.30) versus 0.40 (0.32), p = 0.01). Both groups did not vary significantly in best corrected vision (0.94 (0.12) versus 0.93 (0.18); p = 0.74). CONCLUSION: During a mean follow up period of 8 months after implantation, the new foldable monofocal intraocular lens with flexible haptics showed an accommodative power of about 1 dioptre, which was significantly higher than the accommodative power of a conventional monofocal flexible intraocular lens. The difference in the accommodative power between the two intraocular lenses was paralleled by a difference in the change of the anterior chamber depth.

Contrast and glare sensitivity after implantation of AcrySof and Human Optics 1CU intraocular lenses.

PURPOSE: To evaluate contrast and glare sensitivity of a newly developed, potentially accommodative intraocular lens. METHODS: The clinical interventional prospective randomized study included 20 patients (23 eyes) undergoing standard phacoemulsification with clear cornea incision in topical anesthesia. In the study group (10 eyes), the 1CU Human Optics intraocular lens (optics diameter 5.5 mm) was implanted. The control group (13 eyes) received the monofocal AcrySof intraocular lens (optics diameter: 6.0 mm). Using a newly developed contrast measuring device, contrast and glare sensitivity were tested 4 weeks after surgery. RESULTS: The study group and control group did not vary significantly in contrast (p=0.38) or glare sensitivity (p=0.52). CONCLUSIONS: The results suggest that the newly developed 1CU Human Optics intraocular lens and the standard AcrySof intraocular lens do not vary significantly in glare and contrast sensitivity.

Effect of triamcinolone acetonide on proliferation of retinal endothelial cells in vitro and in vivo.

AIM: To assess the effect of crystalline triamcinolone acetonide on retinal endothelial cell proliferation in vivo and in vitro. METHODS: For in vitro analysis, a sprouting assay was employed. Bovine retinal endothelial cells were stimulated with basic fibroblast growth factor (bFGF) and incubated with different concentrations of triamcinolone acetonide (0.05 mg/ml to 8 mg/ml). For in vivo analysis, a retinopathy of prematurity (ROP) model was used. 16 C57BL/J6 mice were exposed to 75% oxygen from postnatal day 7 to day 12. On day 12, triamcinolone acetonide was intravitreally injected into one eye ("study eye") and isotonic saline into the contralateral eye ("control eye"). On day 17, the mice were sacrificed and the eyes removed for quantitative analysis of preretinal neovascularisation. Four non-exposed mice served as negative control. RESULTS: The sprouting assay demonstrated a dose dependent inhibition of bovine retinal endothelial cell proliferation from 0.05 mg triamcinolone acetonide/ml (no inhibition) to 3 mg triamcinolone acetonide/ml (complete inhibition). Dosages of more than 2 mg/ml resulted in cytotoxic changes of endothelial cells. The ROP model demonstrated a significantly lower neovascular cell count of 58% in the study group compared to the control group (6.35 (SD 2.1) cells per histological section versus 14.9 (SD 5.3) cells; p<0.005). CONCLUSIONS: Triamcinolone acetonide inhibits bFGF induced proliferation of retinal endothelial cells in vivo and in vitro. These findings contribute to understanding the mode of action and effects of triamcinolone acetonide on retinal neovascularisation.

Treatment of keratoconus by toric foldable intraocular lenses.

PURPOSE: To report on the correction of marked regular corneal astigmatism due to keratoconus by toric intraocular lenses (IOL). SETTING: University eye hospital. METHODS: A 66-year-old woman presented with cataract and unilateral keratoconus (keratometric readings: 50.2/41.3 diopters [D]). She underwent routine cataract surgery with implantation of a foldable posterior chamber toric IOL (refractive power: +10.0 D sphere/+12.0 D cylinder). A 68-year-old surgically aphakic woman presented with peripheral accentuated keratoconus with regular and stable corneal astigmatism (keratometric readings: 39.75/61.5 D). She underwent secondary implantation of a foldable toric IOL (refractive power: -9.0 D sphere/+30.0 D cylinder) into the ciliary sulcus. RESULTS: After a follow-up period of 4 months, visual acuity increased to 0.70 with a correction of +0.75 sphere -2.5 cylinder/84 degrees in Patient 1; after a follow-up period of 6 months, visual acuity increased to 0.60 with a correction of +1.0 -2.0/90 degrees in Patient 2. CONCLUSIONS: Foldable toric silicone IOL may be a surgical option in the management of regular marked corneal astigmatism caused by keratoconus.

Factors influencing visual outcome after penetrating keratoplasty combined with intraocular lens implantation.

PURPOSE: To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. METHODS: This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 +/- 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined t with an exchange of OL, and 23 penetrating keratoplasties combined with a secondary implantation of posterior chamber lens. Mean follow-up was 28.3 +/- 18.7 months (range 3.3-112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and agin in visual acuitvy RESULTS: Mean postoperative visual acuity and mean gain in visual acuity were 0.33 +/- 0.21 (median 0.30) and 0.25 +/- 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129 /135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p < 0.005), reason for keratoplasty (p < 0.005), and diameter of the graft (p = 0.046). ostoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. CONCLUSIONS: The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

Intravitreal triamcinolone acetonide for exudative age related macular degeneration.

AIM: To evaluate the effect of intravitreal triamcinolone acetonide on the visual acuity of patients with exudative age related macular degeneration, to assess the duration of a possible effect, and to evaluate clinical side effects of the treatment. METHODS: The study included 67 patients (71 eyes) who presented with exudative age related macular degeneration of predominantly or total occult type (n = 68) or classic type (n = 3), and who received once, or repeatedly, an intravitreal injection of 25 mg of crystalline triamcinolone acetonide. Mean follow up time was 7.46 (SD 3.54) months (range 3.1-19.57 months). RESULTS: Visual acuity increased significantly (p <0.001) from 0.16 (0.11) to a mean maximum of 0.23 (0.17). Postoperative visual acuity was highest 1-3 months after the injection. 47 (66.2%) eyes gained in maximal visual acuity and 11 (15.5%) eyes lost in visual acuity. Intraocular pressure increased significantly (p <0.001) from 15.1 (3.1) mm Hg at baseline to a maximal value of 23.0 (8.25) mm Hg. At the end of follow up, intraocular pressure again decreased significantly (p<0.001) to 16.8 (4.9) mm Hg. No cases of postoperative infectious endophthalmitis, rhegmatogenous retinal detachment, or proliferative vitreoretinopathy occurred. Owing to a decrease in visual acuity after an initial increase, six patients received a second intravitreal triamcinolone acetonide injection after which visual acuity increased again in three eyes. CONCLUSIONS: Intravitreal injection of 25 mg of crystalline triamcinolone acetonide merits further study for the treatment of exudative age related macular degeneration.