[Intrascleral haptic fixation of intraocular lenses]. / Intrasklerale Haptikfixation von Intraokularlinsen.

Scharioth's intrascleral haptic fixation in cases of no or insufficient capsular support has become a standardized and safe procedure for long-term fixation of intraocular lenses. The surgical technique is explained in detail. The postoperative results have demonstrated a low complication rate and a lack of contraindications for this technique.

Nonpenetrating glaucoma surgery with goniosynechiolysis ab interno: a surgical technique.

PURPOSE: To present a surgical technique for treatment of peripheral anterior synechiae (PAS or goniosynechiae) at the operative field during nonpenetrating glaucoma surgery. METHODS: After usual preparation of a superficial and a deep scleral flap with externalization of the Schlemm's canal and peeling the juxtacanalicular trabecular meshwork, the goniosynechia is transected by a spatula introduced to the anterior chamber through a paracentesis. A Descemet's window provides full visual control at the peripheral cornea at the basis of the superficial scleral flap. RESULTS: With this surgical technique, selective treatment of goniosynechiae is possible exactly at the area where creation of low outflow resistance is intended by the surgeon during nonpenetrating glaucoma surgery. CONCLUSIONS: This technique enables the surgeon to perform nonpenetrating glaucoma surgery even in the presence of peripheral anterior synechiae.

Implications of bevacizumab on vascular endothelial growth factor and endostatin in human choroidal neovascularisation.

AIM: To evaluate the implications of intravitreal bevacizumab on proangiogenic vascular endothelial growth factor (VEGF) with regard to the endogenous angiogenesis inhibitor endostatin in human choroidal neovascularisation (CNV) secondary to age-related macular degeneration. METHODS: Retrospective review of an interventional case series of 48 patients who underwent full macular translocation surgery with removal of CNV. Twenty-five patients were treated with intravitreal bevacizumab injection 1 to 154 days prior to surgery (bevacizumab CNV). Twenty-three CNV without any kind of previous treatment were used as controls (control CNV). CNV were stained for CD34, cytokeratin18, VEGF, endostatin and E-selectin. A "predominance score of VEGF over endostatin" (PS) was defined by the difference between VEGF and endostatin staining scores. RESULTS: Bevacizumab CNV revealed a weaker VEGF expression in endothelial cells (p = 0.0245) but significantly more intense endostatin in retina pigment epithelium (RPE) (p = 0.0001) and stroma (p<0.0001). Consequently, PS was significantly lower in RPE (p = 0.02), vessels (p = 0.03) and stroma (p = 0.0004) in bevacizumab CNV. The intensity of E-selectin expression in bevacizumab CNV was comparable with that in control CNV. CONCLUSIONS: A shift within the angiogenic balance in terms of decreased VEGF predominance over endostatin is detected in human CNV treated with bevacizumab.

Sutureless intrascleral posterior chamber intraocular lens fixation.

We report a technique for sutureless fixation of standard 3-piece posterior chamber intraocular lenses (PC IOLs) in the ciliary sulcus in eyes without capsule support, which we have used in cases of subluxated and luxated cataract and for secondary IOL implantation. Fixation of the haptics in a limbus-parallel scleral tunnel allows exact centration and provides axial stability of the PC IOL to prevent distortion. The technique uses uncomplicated maneuvers for standard 3-piece PC IOL fixation without the need for special haptic architecture or preparation.

[Posterior segment complications of laser in situ keratomileusis (LASIK)--a survey of the literature]. / Hinterabschnittskomplikationen der Laser-in-situ-Keratomileusis (LASIK)--Eine Literaturübersicht.

During the past years refractive surgical procedures and particularly laser IN SITU keratomileusis (LASIK) have become established by clinical and experimental studies and are performed worldwide in a high number. This paper provides a survey of the published posterior segment complications of LASIK that may occur albeit very rarely. Additionally, current clinical and experimental hypotheses regarding the pathogenesis of those complications are discussed. Currently a cause-effect relationship between LASIK and reported posterior segment complications has not been proven although a very high number of LASIK procedures have been performed worldwide.

[Macular translocation after photodynamic therapy: a case report]. / Makula-Translokation nach photodynamischer Therapie: ein Fallbericht.

BACKGROUND: Photodynamic therapy (PDT) and surgical macular translocation are concurrent treatment options for exudative age-related macular degeneration (ARMD). PDT is currently favoured because of positive study results and the non-invasive technique. We report a case of macular translocation with 360 degrees retinotomy after unsuccessful previous PDT for treatment of ARMD. CASE REPORT: PDT with verteporfin was performed in the left eye of a 79-year-old patient with exudative ARMD and predominantly classic juxtafoveal choroidal neovascularisation (CNV). Because of continuing visual loss and deteriorating angiographic signs three months after PDT, a surgical macular translocation with 360 degrees retinotomy was performed successfully. During the surgery increased adhesion between the CNV and the retina was observed in contrast to patients without previous PDT. In a second step three months later, counter-rotation of the ocular globe was achieved by muscle surgery and the silicone oil was removed in the same session. The best spectacle corrected visual acuity improved from 0.1 before the surgery to 0.4 nine months thereafter (six Snellen lines). No CNV recurrence was observed. Patient satisfaction with the surgery outcome is high. CONCLUSIONS: Macular translocation may be considered in cases of continuing deterioration after a previous PDT for treatment of exudative ARMD. Possible complications must be discussed with the patient. Intraoperatively, increased adhesion of CNV to the retina was observed, which might increase the risk of inadvertent damage to the retina during surgery.