[Intravitreal fibrinolysis and retinal vein occlusion]. / Intravitreale Fibrinolyse und retinaler Venenverschluss.

BACKGROUND: The aim of this study was to analyze and compare intravitreal activity and concentrations of different components of the fibrinolytic cascade in eyes with central retinal vein occlusion (CRVO) as well as branch RVO (BRVO) and healthy controls. These results were correlated with corresponding intravitreal vascular endothelial growth factor (VEGF) concentrations as a biomarker for the severity of blood-retina barrier (BRB) breakdown. MATERIAL AND METHODS: Vitreous samples were obtained from 14 eyes with CRVO, 22 eyes with BRVO and 11 controls and the activities and concentrations of plasminogen, plasmin-alpha2-antiplasmin (PAP) and VEGF were analyzed. RESULTS: Intravitreal activities and concentrations in the CRVO, BRVO and control groups were 2.07 ± 1.87%, 1.24 ± 1.12% and 0.38 ± 0.63% for functional plasminogen, 8.14 ± 7.07 ng/ml, 6.96 ± 4.8 ng/ml and 9.74 ± 10.98 ng/ml for PAP while respective results for VEG levels were 1269 ± 1318 pg/ml, 528 ± 543 pg/ml and 105 ± 116 pg/ml, respectively. There were significant differences in intravitreal functional plasminogen and VEGF between the groups analyzed (in each case p < 0.001). Intravitreal functional plasminogen correlated with intravitreal VEGF concentrations (r = 0.478, p = 0.001). No adverse events or serious side effects occurred. CONCLUSION: There were significant differences in intravitreal functional plasminogen and VEGF between eyes with CRVO, BRVO and controls. Intravitreal activity of plasminogen was significantly correlated with the severity of BRB breakdown in RVO affected eyes. The knowledge of intravitreal activities and concentrations of different components of the fibrinolytic cascade could offer new therapeutic strategies in RVO-affected eyes in the future.

[Pseudophakic cystoid macular oedema]. / Das pseudophakiebedingte zystoide Makulaödem.

Pseudophakic cystoid macular oedema is still a relevant clinical disease entity although major progress in modern cataract surgery has been made within the last decades. The relevance is attributed to the large number of cases that are performed each year. Even after uneventful surgery, a pseudophakic cystoid macular oedema can develop and may lead to severe and lasting visual impairments. In respect to the pathophysiology, four consecutive steps have to be considered: (i) surgical procedure-related induction and release of various inflammation mediators into the anterior chamber; (ii) removal of the physiological lens barrier between the anterior and posterior segments of the eye, leading consecutively to an increase in diffusion rate in either direction; (iii) local action of the inflammation mediators towards the macular area; and (iv) increased vitreoretinal traction due to the anteriorly oriented drive of the vitreous. To prevent the development of a pseudophakic cystoid macular oedema, systemic and ocular pathologies should be treated consequently prior to surgery. Furthermore, an individual risk profile of each patient needs to be evaluated to define the best pre- and postsurgical medical treatment. A less traumatic surgical approach can help to prevent macular oedema development additionally. The diagnosis is made by performing biomicroscopy, fluorescence angiography and optical coherence tomography as well as by evaluating the patients' major complaints. Standard operation procedures or recommended guidelines by the specialised eye associations to prevent and treat pseudophakic cystoid macular oedema are not available up to date. A synopsis of recommendations in the literature suggests a step-wise treatment regimen, including topical medical treatment on the one hand and a surgical approach on the other hand as well as a combination of both, if needed. Topical medical treatment options include the use of non-steroidal, corticosteroid and/or carbonic anhydrase inhibitor eye drops. Surgical interventions include pars plana vitrectomy.

[Restricted eyeball with proptosis]. / "Eingemauerter" Bulbus mit Protrusio.

Orbital cellulitis is an acute inflammation of the orbital content with exophthalmos, chemosis, blepharedema, reduction of eyeball motility and generalized illness, occasionally with fever. It is predominantly transmitted from the ENT region and rarely occurs as a complication after a scleral buckling procedure. The patient concerned contracted orbital cellulitis many years after scleral buckling because the cerclage was infected. Alterations to the sclera with atrophy and thinning in the context of myopia were probably favorable factors for development.

[Matched pair analysis: Innex FIXUC vs. NexGen LPS]. / Matched-Pair-Analyse: Innex FIXUC vs. NexGen LPS.

AIM: The aim of the present retrospective matched pair study was to compare the clinical results of patients undergoing total knee arthroplasty (TKA) with 2 different operation strategies: tibia first vs. femur first for ligament balancing and rotational alignment of the femoral component. METHODS: In this study 30 patients underwent TKA with the fixed bearing prosthesis Innex FIXUC between 2003 and 2005. In the same period of time the posterior stabilised prosthesis NexGen LPS was implanted in 123 patients. Out of these, 30 patients were matched to the 30 patients of the Innex group based on the parameters age, gender, height, weight and BMI. All implants were cemented. Clinical examination was rated using UCLA score, Knee Society score, Lequesne score for knees, a visual analogue scale (VAS) for pain and the Feller patellar score. Three patients in the Innex group were lost to follow-up, and 27 matched pairs could finally be analysed. RESULTS: At a mean follow-up of 25 months (Innex) and 3 years (NexGen) statistically significant differences (p < 0.05) with advantages for the NexGen were found in the UCLA activity score (4.9 vs. 5.9, p = 0.013), in part A (knee score) of the Knee Society score (78.9 vs. 91.0, p = 0.002) as well as the total score (153.9 vs. 173.2, p = 0.012), VAS (2.1 vs. 0.6, p = 0.003) and in the Lequesne knee score (5.7 vs. 3.6, p = 0.024). No statistically significant differences (p < 0.05) were found in the function score of the Knee Society score and the patellar score (Feller). CONCLUSION: In the described setting there were functional advantages for the NexGen prosthesis (femur first) at a comparable revision rate. However, satisfactory results with the Innex FIXUC are possible, too.