[Preoperative management of subconjunctival/sub-Tenon's glaucoma surgery with special consideration of the gel implant (XEN®)]. / Präoperatives Management bei subkonjunktivalen/subtenonalen glaukomchirurgischen Operationen unter besonderer Berücksichtigung des Gelimplantats (XEN®).

BACKGROUND: When using subconjunctival/sub-Tenon's ab interno glaucoma surgical procedures, patient selection and preoperative management are essential to reduce postoperative scarring of the bleb. OBJECTIVE: The aim of this study was to compile a list of risk factors that may have an unfavorable effect on the scarring process. METHOD: A literature search was carried out in PubMed with respect to the scarring process of the gel implant XEN®. RESULTS: Ophthalmological risk factors for conjunctivoscleral/Tenon's wound healing process include dry eye, allergies, use of eye drops containing preservatives and previous eye surgery. CONCLUSION: The preoperative administration of artificial tear substitutes, corticosteroids and the fundamental change to preservative-free eye drops can support the normalization of a chronic inflammatory altered conjunctiva and thus positively influence the wound healing process after surgery.

[Glaucoma treatment in high myopia]. / Glaukombehandlung bei hoher Myopie.

Both high myopia and glaucoma can have devastating effects on the visual function. Diagnostic tests and treatment can be challenging when both diseases are coexistent. This article discusses some of the typical problems in the management of glaucoma in highly myopic patients.

[Secondary diseases in high myopia]. / Sekundärerkrankungen bei hoher Myopie.

BACKGROUND: Eyes with high myopia (axial length ≥ 26.5 mm) do not just have a different size. Due to morphological and structural changes there is a considerably increased risk for many different secondary diseases. OBJECTIVE: Determination of the incidence and mortality in high myopia, discussion of effects and clinical signs, presentation of treatment recommendations and counselling. MATERIAL AND METHODS: A systematic search of the literature was carried out and a discussion on basic principles and epidemiological investigations is presented. RESULTS: Findings due to high myopia are not in a closed state but undergo continuous changes. Choroidal neovascularization (adjusted prevalence 2.5-5%), staphyloma, foveoschisis and peripheral retinal degeneration are examples of problems contributing to the increased rate of visual impairment and blindness related to myopia. High myopia is associated with a clearly increased risk of retinal detachment after lens surgery (hazard ratio 6.1) and particularly more frequently in younger people. The associated primary open-angle glaucoma (odds ratio 2.46) is often recognized too late due to relatively low values of intraocular pressure. CONCLUSION: Understanding of atrophic areas and staphyloma has benefited from recent advances in imaging (e.g. magnetic resonance imaging, optical coherence tomography and wide-field imaging) that complement and explain histological findings. Knowledge of the associated risk profile is of major clinical relevance.

[Revision procedures after canaloplasty]. / Revisionsmöglichkeiten nach Kanaloplastik.

Canaloplasty is a recently introduced non-penetrating surgical technique for glaucoma, which seeks to improve the natural outflow of aqueous humor through Schlemm's canal and the collector channels. Just as in all forms of glaucoma surgery there are a certain number of failures of the procedure and further surgery is often needed to reduce the intraocular pressure in these cases. This article describes some of the revision procedures after canaloplasty.

[Original preparations versus generics--latanoprost: how similar is different?]. / Originalpräparat versus Generika--Latanoprost : Wie gleich ist unterschiedlich?

BACKGROUND: To test the interchangeability of the commercially available (in Germany) latanoprost drugs and their generics respectively, the concentration of the active substance was tested. Guidelines of the European Medicines Agency postulate a sufficient bioequivalence, if the range of the agent is within 80-125% of the original drug. METHODS: All compounds of latanoprost were procured registered. The concentration of latanoprost and benzalkoniumchloride was measured by high-performance liquid chromatography (HPLC) in a validated reference labroratory for 23 generics. In addition, the mean volume of drops and the pH of the formulation were measured. The packaging label and the readability of the enclosed information leaflet were checked. RESULTS: All products contained less than 50 µg/ml latanoprost. The deviating reduction of the active substance (mean: - 7.39%, ± 2.8%) was accompanied by fluctions of the eyedrops' mass (mean: 0.03 g, ± 0.002 g). The concentration of benzalkonium chloride was mostly increased (median: 5.45%, min: - 2.5%, max: 11.5%). The pH of the original drug and the generics (median 6.78, min: 6.62, max: 6.81) was similar to the original drug, but was significantly different from an unpreserved formulation (pH 7.18). Due to type size, the packaging leaflet was illegible for humans with impaired vision. CONCLUSIONS: Before prescribing generics in ophthalmology, different factors have to be considered, which might influence the amount of IOP lowering in effect. In the absence of healthcare research it is still unclear, how different bottle forms of eyedrops--such as appearance (e.g. Cyrillic characters) or pressure point (administration)--reduce the adherence of glaucoma patients.

Systemic corticosteroids for subcutaneous panniculitis-like T-cell lymphoma.

BACKGROUND: Primary cutaneous γ/δ T-cell lymphoma (PCGD-TCL) is aggressive and has a poor prognosis. In contrast, subcutaneous panniculitis-like T-cell lymphoma (SPTCL) of the α/ß T-cell receptor phenotype is known to follow an indolent course and have a more favourable prognosis. In the past, PCGD-TCL and SPTCL were often considered to be a manifestation of the same disease, and aggressive systemic polychemotherapy has commonly been the first-line therapy for both. Given the understanding that SPTCL is a separate and less aggressive entity, clinical data exclusively evaluating the efficacy of conservative treatment in SPTCL are needed. OBJECTIVES: To assess the overall clinical response to systemic corticosteroids in the treatment of SPTCL. METHODS: This was a retrospective cross-sectional study based on a patient data repository from two tertiary care university hospitals in Zürich (Switzerland) and Tübingen (Germany). The repository spanned 13 years. RESULTS: In four of the five patients (80%) with SPTCL, treatment with systemic corticosteroids induced a complete remission. CONCLUSIONS: Systemic corticosteroids may be an excellent first-line single-agent therapy for SPTCL.

[Placido topography combined with optical biometry--first results]. / Placido-Hornhauttopografie kombiniert mit optischer Biometrie - erste Ergebnisse.

INTRODUCTION: Optical biometry for calculation of intraocular lenses (IOL) was introduced by Zeiss with the IOLMaster. A newly developed system combines both video topography and optical coherence biometry (BioTop). This allows not only the conventional calculation of IOLs but also enables the design of customised IOLs based on ray-tracing. This paper presents first results regarding the axial length measurement of the new device compared to the IOLMaster. METHODS: The accuracy of the combination system (BioTop) is proven by a well known reference (20,010 ± 0,004) mm. To compare the new system BioTop with the IOLMaster (two different versions 3 and 5) are used. Measurements are taken at the known reference and at 47 eyes with different stages of cataract. RESULTS: The mean geometrical length for 50 measurements of the known reference was AL = (20.011 ± 0.001) mm. For the standard conditions (5 single measurements) the length results in AL = (20.010 ± 0.001) mm. For the IOLMaster these numbers are: AL = (20.00 ± 0,01) mm for version 3 and AL = (20.02 ± 0.01) mm for version 5 also based on 5 single measurements. The measurable axial lengths for the cataract eyes (43 for IOLMaster and 37 for the BioTop) show a mean difference of - 0.015 mm for the two systems. One outlier was detected. CONCLUSION: The measurements of the know reference showed a high accuracy for all systems. The differences in length measurements on the cataract eyes are clinically not relevant. The combination of topography and optical biometry allows new options for calculations of intraocular lenses.

Incidental finding of lamellar calcification of the falx cerebri leading to the diagnosis of gorlin-goltz syndrome.

Here, we report the case of an incidental finding of lamellar calcification of the falx cerebri in a routine computed tomography scan of the head after an accidental trauma. This lamellar calcification led to the diagnosis of Gorlin-Goltz syndrome (GGS) in the patient and her daughter. Lamellar calcification of the falx cerebri is a pathognomonic feature of GGS. Our case report highlights the importance of a multidisciplinary diagnostic approach to GGS.

[Therapy of myopic choroidal neovascularization]. / Therapie der myopen choroidalen Neovaskularisation.

Recently published studies have shown that myopic choroidal neovascularization (mCNV) is efficiently treated by anti-vascular endothelial growth factor (VEGF) drugs. Within a prospective executive study, photodynamic therapy failed to prove a significant difference over the duration of 2 years. Although a systematic evaluation of different retreatment algorithms still has to be done the administration of single injections depending on specialist assessment of morphological changes, predominantly spectral domain optical coherence tomography (SD-OCT) and fundus, has achieved a marked visual improvement. The experience of treating age-related macular degeneration should not be simply transferred to mCNV and an individual approach, not only for female patients of childbearing age, is necessary.

[Conventional perimetry. Antiquated or indispensable for functional glaucoma diagnostics?]. / Konventionelle Perimetrie. Antiquiert oder unverzichtbar für die funktionelle Glaukomdiagnostik?

Despite its relatively long history conventional perimetry has preserved its role in (glaucoma) diagnostics by the continuous advancement of technical equipment, examination strategies and new methods for analysis and visualization of progression. A high standardization in execution and evaluation of visual field examination can now be obtained by the increasing use of computer technology. Standardized protocols become increasingly more useful especially in cases of chronic diseases, such as glaucoma where several suitable diagnostic methods must be applied over a long time period. For the assessment of functional deterioration several (numeric) perimetric indices are available in addition to clinical evaluation. The use of fast threshold estimating strategies and locally condensed grids are promising tools for early detection of the functional manifestation or progression of (glaucomatous) loss of visual field. In cases of advanced (glaucomatous) visual field loss, perimetry with (computer generated) moving stimuli (semi-automated kinetic perimetry) allows an efficient, standardized and patient-friendly edge detection of scotoma borders. This method is also very well suited for expert opinions and ability testing. The assessment by morphological or morphometric, hydrodynamic and other functional parameters serve as complementary diagnostic aids or as elementary tools for plausibility control.

[Myopic CNV]. / Myope CNV.

Choroidal neovascularisation secondary to pathological myopia is the most common cause of severe visual impairment in myopic patients younger than 50 years old. The typical features of myopic CNV in contrast to age-related macular degeneration as well as the anatomic characteristics have an impact on the parameters of the baseline and follow-up examinations. As the usually small fibrovascular lesions show a rapid progression in the spontaneous course of the disease and lead to irreversible damage to the photoreceptors, prompt initiation of treatment is mandatory. The superior functional results of anti-VEGF drugs provide the reason for the first-line status of this treatment modality. Increasing safety data and consistent results of prospective pilot trials have proved photodynamic therapy to be inferior. There are signs that PRN-based treatment algorithms may allow for less frequent dosing than in other retinal diseases.

[Maculopathy with areolar retinal pigment epithelium defects]. / Makulopathie mit areolären RPE-Defekten.

Maculopathy with areolar or annular defects in the retinal pigment epithelium (RPE) can have manifold differential diagnoses. If such alterations occur in adolescence or early adulthood with good visual acuity, precise diagnostics and confirmation of the diagnosis are of special importance with respect to the prognosis of the disease. We report the case of a 36-year-old female patient with bilateral perifoveolar, areolar retinal pigment epithelium defects. The patient suffered from metamorphopsia with good visual acuity. Visual disturbances had initially begun 8 years previously. Perifoveolar RPE defects can be visualized with autofluorescence photography and optical coherence tomography (OCT) and result in functional defects in perimetry, microperimetry and multifocal electroretinography. The symptoms and course are in accordance with fenestrated sheen macular dystrophy. A therapy does not exist. This rare autosomal-dominant inherited macular dystrophy is often asymptomatic and has a good prognosis for visual acuity.

[Tuberous sclerosis: an interdisciplinary diagnosis]. / Tuberöse Sklerose: eine interdisziplinäre Diagnose.

BACKGROUND: Tuberous sclerosis is a relatively rare disease, but it often takes a progressive and severe course. We wish to demonstrate the typical changes in a patient with tuberous sclerosis and their relevance for the ophthalmologist. FINDINGS: Ophthalmologic evaluation including funduscopy, 30 degree perimetry and fundus photography and clinical course of a 40-year-old man are described. We observed an elevated, multinodular, opaque hamartoma resembling mulberries, approximately (1/3)-(1/2) PD large, at the temporal superior arc with corresponding visual field defects. CONCLUSIONS: An ophthalmologist should always think of a tuberous sclerosis as a differential diagnosis when confronted with a retinal hamartoma. Other characteristic ophthalmological findings include facial and eyelid angiofibromas, coloboma of the iris, lens and choroid, strabismus, poliosis of the eyelashes, papilloedema and sector iris depigmentation. Clinical diagnosis of tuberous sclerosis is in most cases relatively easy; however, an interdisciplinary cooperation is needed.

[Pupillary disorder after use of asthma spray aerosol]. / Pupillenstörung nach Applikation eines Asthmasprays.

A 46-year-old patient was referred as an emergency case to our neuro-ophthalmologic department, because her left pupil was mydriatic and unreactive since the morning of the same day. This pupil did not constrict normally on application of 1 % pilocarpin eye drops. Thus the diagnosis of a medication-induced mydriasis was established. The causative agent proved to be an aerosol, containing ipratropium bromide used for asthma treatment.