[One-year results after Cypass implantation]. / 1-Jahres-Ergebnisse nach Cypass-Implantation.

BACKGROUND: The Cypass Microstent (Transcend Medical, Menlo Park, CA, USA) is a biocompatible polyamide implant that is implanted in the suprachoroidal space and improves the flow of the aqueous humour via the uveoscleral pathway. MATERIAL AND METHODS: In a retrospective clinical study 162 patients (220 eyes) with an average age of 71.8 (±14.2) years with a mild to moderate glaucoma were treated with a Cypass implant. In the study three groups of patients (group 1, group 2 and group 3) were formed. Group 1 included patients with pseudophakia who received a Cypass implant, group 2 consisted of patients with a Cypass implant combined with phacoemulsification and implantation of an intraocular lens (Phako/HKL) and group 3 included patients who had had multiple eye surgeries before the Cypass implantation. The follow-up period of the study was 1 year. RESULTS: The mean preoperative intraocular pressure (IOP) in group 1 was 20.0 (±8.4) mm Hg and in group 2 was 20.8 (±8.7) mm Hg. The mean IOP fell to 17.7 (±7.1) mm Hg in group 1 (pressure reduction: 11.7%, p < 0.05) and in group 2 to 18.0 (±7.0) mm Hg (pressure reduction: 13.4%, p > 0.05) 12 months postoperatively. The decrease of IOP in group 3 after 1 year was 11.2%. In 20.5% of the cases (45 eyes), additional operative pressure reducing interventions was performed because the target pressure was not achieved. CONCLUSION: After 1 year patients in group 2 showed a significantly similar reduction in pressure as group 1. Additionally, both groups showed a reduction in the number of locally applied antiglaucoma agents. The reduction of the IOP in group 3 was not significant after 12 months, in contrast to the other two groups.

[Juvenile idiopathic epiretinal membrane]. / Juvenile idiopathische epiretinale Membran.

Idiopathic epiretinal membrane (iERM) is very rare in adolescent patients. The pathogenesis remains unclear although the role of hyalocytes is of major importance. The clinical features in young patients are different from those in older patients. We describe a case of iERM in a 15-year-old girl who presented with metamorphopsia of the right eye. This case report presents the basis for the decision for surgical treatment as well as the clinical features at follow-up examination 9 months after surgery.

[Low grade endophthalmitis caused by P. acnes : Case report]. / Low-grade-Endophthalmitis verursacht durch P. acnes : Eine Kasuistik.

Low grade endophthalmitis is usually a chronic indolent inflammation that may be misdiagnosed as noninfectious uveitis. Therefore, this form of endophthalmitis is often unsuccessfully treated with corticosteroids. We describe the case of a patient with low grade endophthalmitis caused by Propionibacterium acnes after cataract surgery. This case report presents the difficulties in establishing the diagnosis of this form of endophthalmitis as well as the benefits of a combined operative therapy with pars plana vitrectomy, intravitreal antibiotics and posterior capsulectomy for successful treatment in such cases.

Human insulin polymorphism upon ligand binding and pH variation: the case of 4-ethylresorcinol.

This study focuses on the effects of the organic ligand 4-ethylresorcinol on the crystal structure of human insulin using powder X-ray crystallography. For this purpose, systematic crystallization experiments have been conducted in the presence of the organic ligand and zinc ions within the pH range 4.50-8.20, while observing crystallization behaviour around the isoelectric point of insulin. High-throughput crystal screening was performed using a laboratory X-ray diffraction system. The most representative samples were selected for synchrotron X-ray diffraction measurements, which took place at the European Synchrotron Radiation Facility (ESRF) and the Swiss Light Source (SLS). Four different crystalline polymorphs have been identified. Among these, two new phases with monoclinic symmetry have been found, which are targets for the future development of microcrystalline insulin drugs.

Novel crystalline phase and first-order phase transitions of human insulin complexed with two distinct phenol derivatives.

The primary focus of the present work is the study of the effects that two ligands and the crystallization pH have on the crystalline forms of human insulin. For this purpose, human insulin (HI) was co-crystallized with two distinct phenolic derivatives: the organic ligands meta-cresol (m-cresol) and 4-nitrophenol. The formation of polycrystalline precipitates was then followed by means of structural characterization of the individual specimens in terms of unit-cell symmetry and parameters. In both cases, two different polymorphs were identified via X-ray powder diffraction measurements, the first of hexagonal symmetry (R3 space group) at higher pH values and the second of monoclinic symmetry (space group P21) with unit-cell parameters a = 87.4282 (5), b = 70.5020 (3), c = 48.3180 (4) Å, ß = 106.8958 (4)°, the latter of which to our knowledge has never been observed before.

[Surgical treatment of neovascular glaucoma]. / Operative Therapie des Neovaskularisationsglaukoms.

PURPOSE: The neovascular glaucoma is one of the leading causes for an enucleation. The cyclocryocoagulation, the peripheral retinal cryocoagulation and the intravitreal injection of bevacizumab as combined therapy aim at the reduction of the intraocular pressure and of neovascularisation. MATERIALS AND METHODS: This study follows up 135 patients with neovascular glaucoma who underwent the above-mentioned combined therapy consisting of cyclocryocoagulation, peripheral retinal cryocoagulation and intravitreal injection of bevacizumab. RESULTS: The most common causes of neovascular glaucoma in our study are diabetic retinopathy and central retinal vein occlusion. The intraocular pressure was 37.4 mmHg (± 15.8) mmHg preoperatively under maximum antiglaucomatous therapy and was reduced to 19.0 (± 8.5) mmHg direct postoperatively. In the long-term intraocular pressure remained within the normal range in 93.33 % of patients. A successful reduction of the local antiglaucomatous drops of 1.9 substances to 1.7 substances was observed after 3 months. The oral intake of acetazolamide was also statistically significantly reduced. 47.37 % of the patients were normotensive without local therapy and only 3 patients were still on acetazolamide even after 1 year. The most serious complication was a phthisis bulbi in 1.5 % of patients. Overall 98.5 % of patients remained free of pain and maintained visual acuity after the end of the follow-up. CONCLUSION: Long-term pressure regulation and freedom from pain were successfully achieved. For decompensated neovascular glaucoma with poor vision and painful bulb, the combination of retinal cryocoagulation and intravitreal application of bevacizumab is an important therapeutic option.