[Kahook Dual Blade : An instrument for microincisional trabecular meshwork surgery]. / Kahook Dual Blade : Ein Instrument zur mikroinzisionalen Trabekelwerkschirurgie.

The Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA, USA) is a novel goniotomy instrument for opening Schlemm's canal. Performing the procedure is comparable to the Trabectome (Neomedix, Tustin, CA, USA) under gonioscopic control with the major difference that the trabeculectomy is created by a dual blade instead of electroablation. The currently available clinical data are limited to a small number of retrospective studies with ≤1 year of follow-up. Based on these data and in line with the author's personal experience, the Kahook Dual Blade seems comparable to the Trabectome regarding effectiveness as well as intraoperative and postoperative complications, such as intraocular pressure (IOP) elevation and hyphema.

[Does the micropulse laser have an effect on chronic CSC?] / Hat der Mikropulslaser bei chronischer CCS einen Effekt?

INTRODUCTION: Central serous chorioretinopathy (CSC) is the fourth most common cause of vision loss without an evidence-based treatment recommendation. A positive effect of micropulse laser (MPL) treatment has been described in the literature in recent years. This study aimed to reappraise these results in a patient population with chronic CSC. METHODS: Patients suffering from chronic CSC with a source point detectable in fluorescein angiography (longer than 3 months duration and unresponsive to treatment with eplerenone and carbonic anhydrase inhibitors) were identified and included in this prospective and consecutive case study. Patients were controlled with a yellow laser (577 nm) after 6 weeks, 12 weeks and then every 3 months. RESULTS: A total of 28 patients were included (28 eyes). The mean duration of anamnesis was 444 days (90-1412 days) and the mean duration of the observation period after MPL was 257 days (42-909 days). The foveal retinal thickness measured 351.7 ± 82.4 µm before, compared to 253.6 ± 86.48 µm after MPL (mean of all patients over the whole observation period). Visual acuity was 0.33 ± 0.21 logMAR prior to MPL and 0.30 ± 0.22 logMAR posttreatment. Of the patients two underwent a second MPL and three patients underwent photodynamic treatment (PDT) after insufficient clinical improvement and were consequently excluded from the study. CONCLUSION: Retinal thickness in this patient population with chronic CSC was significantly reduced after MPL treatment with no significant changes of visual acuity. No side effects of MPL were observed. Larger studies including control groups are warranted to quantify the effects of MPL further.

[Imaging of the Intrascleral Aqueous Drainage System - New Insights for Glaucoma Surgery Targeting the Trabecular Meshwork]. / Bildgebung der intraskleralen Kammerwasserabflusswege ­ neue Einblicke für die Trabekelwerkschirurgie.

Numerous new techniques in glaucoma surgery target the trabecular meshwork, which is considered to be the main site of aqueous outflow resistance. These approaches rely on a functioning aqueous drainage system distal to the site of surgery. Thus, the intrascleral aqueous outflow tract comprises Schlemm's canal, collector channels and aqueous veins and has become an object of increasing research interest. The intrascleral outflow tract contributes approximately 25-50 % to the total aqueous outflow resistance, but the outflow capacity differs greatly over the segments of the eye. Morphological and functional assessment of the intrascleral outflow tract is challenging, due to its deep scleral location and the complex nature of its small diameter vessel network. In this review, we present novel insights into its morphology and function, based on advances in a variety of imaging modalities, including optical coherence tomography, fluorescence imaging and electron microscopy. Together with clinical data, they support the paradigm of significant sectorial differences in aqueous outflow, which has a direct impact on glaucoma surgery targeting sectors of the trabecular meshwork, such as trabeculectomy ab interno or trabecular meshwork bypass stents. Possible future applications of intrascleral outflow tract imaging are discussed.

[Diaphanoscopy in cyclophotocoagulation]. / Diaphanoskopie bei der Zyklophotokoagulation.

Transscleral cyclophotocoagulation is not usually considered as the first line surgical therapy for glaucoma. However, it still remains an important tool for lowering intraocular pressure in certain patients. It is quick and easy to perform and acts through an alternative physiological approach compared to filtration surgery. As the ciliary body is not directly visible, an empirical distance from the limbus is often used for placement of the laser probe; however, the anatomical structures can be highly variable. Diaphanoscopy provides a very simple and effective way to visualize the ciliary body before or parallel to the cyclophotocoagulation. It helps to direct the laser beam more precisely to the ciliary body and to prevent a false anterior placement of the beams, that carries a great risk of side effects. This article provides an overview on the concept of diaphanoscopy for cyclophotocoagulation.