Alteration of MCP-1 and MMP-9 in Aqueous Humor Is Associated with Secondary Glaucoma in Fuchs Uveitis Syndrome.

PURPOSE: To analyze changes in concentrations of pro- or anti-inflammatory cytokines, chemokines, or metalloproteinases (MMP) in the aqueous humor (AH) in Fuchs uveitis syndrome (FUS) patients with (FUSwG) or without (FUSwoG) secondary glaucoma. METHODS: AH samples were collected from 43 eyes of Caucasian subjects (FUSwoG: n = 11; FUSwG: n = 8; control eyes: n = 24). Concentrations of IL-8, MCP-1, MMP-1,-2,-3,-9, SAA, TGFß-1,-2,-3, and TNF-α were measured by multiplex bead assay analysis. RESULTS: Compared with the control group, levels of IL-8, MCP-1, MMP-3, and MMP-9 in the AH were significantly increased in FUSwG and FUSwoG patients. In contrast to FUSwoG patients, MCP-1 and MMP-9 level were lower in FUSwG, while expression of MMP-2, MMP-3, and TGFß-1 was increased. CONCLUSION: In our experiments, glaucoma in FUS patients was associated with low levels of MCP-1 and MMP-9 in the AH, while expression of MMP-2, MMP-3, and TGFß-1 increased. The alteration in these molecular patterns may contribute to the development of glaucoma in FUS.

[Laser flare photometry for identification of high-risk patients for proliferative vitreoretinopathy]. / Laser Flare Photometrie zur Identifizierung von Hochrisikopatienten für proliferative Vitreoretinopathie.

Proliferative vitreoretinopathy (PVR) is a complication of rhegmatogenous retinal detachment and trauma, which occurs in approximately 10% following vitreoretinal surgery. The visual prognosis for established PVR is poor and so far there is no established conservative treatment for PVR. In the currently recruiting PRIVENT trial the aim is to find a prophylactic treatment possibility for PVR. The PRIVENT study examines the influence of intraoperative adjuvant pharmacotherapy on reducing the incidence of PVR; however, this requires the identification of eyes with increased risk for PVR. Laser flare photometry is a simple method to predict the individual risk for PVR. It is a non-invasive technique that objectifies the Tyndall effect. Various laser flare meter devices are available on the market. In previous studies it could be shown that laser flare photometry can predict the development of PVR in eyes with primary rhegmatogenous retinal detachment with a sensitivity of 80%. The identification of these high-risk eyes for PVR could be the first step towards solving the problem of PVR.

[Vision Loss after Silicone Oil Surgery]. / Visusverlust nach Silikonölchirurgie.

Silicone oil is an intraocular tamponade that is essential for the treatment of complicated retinal detachment. As a long-term tamponade, it improves retinal reattachment and visual outcome. Unexpectedly, surgery with silicone oil tamponade may result in irreversible visual loss of unknown origin. In this report, we provide a general overview of unexplained visual loss after surgery with silicone oil. The frequency of such reports has increased continuously in recent years. The German Retina Society - supported by Retinanet (http://retina-net.uni-koeln.de) - has initiated data collection to gather information about such cases, in cooperation with Cologne University Eye Hospital. Ophthalmologists can provide data about cases of unexplained visual loss anonymously via the "Cologne Clinical Trials Centre" or via augenklinik-silikonoel@uk-koeln.de.

[Watchful waiting as a therapeutic principle for diseases of the vitreoretinal interface]. / "Zuwarten" als therapeutisches Prinzip bei Erkrankungen der vitreoretinalen Grenzfläche.

Elective surgery of the vitreoretinal interface is currently the most common reason for vitrectomy in Germany. The evaluation and correct interpretation of spectral domain optical coherence tomography (SD-OCT) images is of great importance but the indications for vitrectomy in macular surgery should be based more on patient symptoms and not only the OCT findings. Watchful waiting is highlighted as an alternative therapeutic option in individual patients. This article addresses a number of aspects and discrepancies between findings and patients' level of suffering based on binocular symptoms. Postoperative retinal thickening and irregular surface of the macula after peeling operations may still allow excellent function and often require no therapeutic measures. The difficulties in differentiating between cystoid macular edema after cataract operations with simultaneous epiretinal gliosis and gliosis as the cause of macular edema are highlighted.

Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis.

PurposeTo analyze the macular structure in a large series of consecutive patients with different types of uveitis using spectral-domain optical coherence tomography (SD-OCT).Patients and methodsFive hundred eyes of 500 consecutive patients with anterior, intermediate, posterior, and panuveitis underwent standardized macular examination using SD-OCT. Central retinal thickness (CRT), macular volume (MV), and presence of cystoid macular edema (CME), diffuse macular edema (DME), serous retinal detachment (SRD), epiretinal membrane with (ERM+) and without (ERM-) retinal surface wrinkling were determined.ResultsThe anatomic location of inflammation affected significantly CRT and MV (P<0.001, respectively), with the highest values in intermediate and panuveitis. CME was seen in 25% of all uveitic eyes, DME in 11%, SRD in 8%, ERM+ in 18%, and ERM- in 13%. CME was most frequent in intermediate (40%) and panuveitis (36%); DME was most frequent in panuveitis (18%) and posterior uveitis (17%); SRD was most frequent in panuveitis (15%) and posterior uveitis (10%); ERM+ was most frequent in panuveitis (45%) and intermediate uveitis (30%); and ERM- was most frequent in intermediate (14%) and posterior uveitis (15%).ConclusionSD-OCT of the macula is recommended for all uveitis patients. CRT, MV, and the incidence of CME were highest in intermediate and panuveitis.

[Design of the ORCA module in the OCEAN study : Evaluation of SD-OCT results in daily routine practice]. / Design des ORCA-Moduls der OCEAN-Studie : Evaluierung der SD-OCT-Befunderhebung in der täglichen Praxisroutine.

BACKGROUND: The prevalence of blindness as defined by law could be reduced by the introduction of anti-vascular endothelial growth factor (VEGF) therapy. Because the treatment is governed by patient needs, mostly using morphological criteria, imaging diagnostics are of particular importance. The non-interventional OCEAN study investigates the treatment with ranibizumab in the clinical routine practice. In a subgroup of patients the interpretation of spectral domain optical coherence tomography (SD-OCT) scans by the treating physicians will be analyzed (ORCA module). METHODS: Over a period of 24 months data from patients with exudative age-related macular degeneration (AMD), macular edema due to retinal vein occlusion or diabetes mellitus, who are receiving intravitreal injections of ranibizumab, will be assessed. Information on examinations, visual acuity, treatment and recordings from imaging techniques will be documented using a questionnaire. The SD-OCT scans, fluorescence angiography and fundus photography will be independently analyzed by the ophthalmologist of the study center and by three reading centers (CIRCL Cologne, GRADE Bonn and M3 Münster). Automated measurements of retinal thickness by the manufacturers' software will be checked and if necessary manually corrected. A qualitative interpretation in terms of morphological criteria for (further) treatment will be performed. CONCLUSION: A thorough assessment of SD-OCT images during anti-VEGF therapy provides the basis for the best possible needs-oriented treatment regimen. The control of the quality of data from daily routine practice may indicate possible weaknesses allowing explicit training and therefore optimization of patient treatment.

Extramacular drusen are highly associated with age-related macular degeneration, but not with CFH and ARMS2 genotypes.

BACKGROUND: To evaluate the association of extramacular drusen (EMD) with age-related macular degeneration (AMD) and with complement factor H (CFH rs1061170) and age-related maculopathy susceptibility 2 (ARMS2 rs10490924) polymorphisms in individuals with and without AMD. METHODS: In this case-control study, AMD staging was performed in 622 individuals. EMD were defined as ≥10 drusen (including ≥1 intermediate drusen) outside the Early Treatment of Diabetic Retinopathy Study Grid within field 2. Genotype associations for CFH and ARMS2 variants were assessed using logistic regression analysis. RESULTS: EMD (n=213) showed a strong association with AMD (OR=3.85; p=1.66×10(-13)). AMD (n=316) was strongly associated with CFH (p=1.78×10(-7)) and ARMS2 genotypes (p=1.67×10(-8)). After adjustment for AMD, age and gender, EMD were neither associated with CFH (p=0.11) nor with ARMS2 (p=0.45) genotypes. In individuals without AMD, the groups with and without EMD showed no differences regarding both genetic variants. CONCLUSIONS: The strong association between drusen within and outside of the macula suggests a common pathogenesis. However, EMD were not AMD-independently associated with CFH or ARMS2 genotypes. Our results indicate that patients without AMD but with EMD can serve as controls in studies evaluating AMD risk factors. Further studies are required to elucidate the aetiology and clinical relevance of EMD.

[Surgery for age-related macular degeneration. Still an option in the age of pharmacotherapy?]. / Chirurgie der altersbedingten Makuladegeneration--Ist das im Zeitalter der Pharmakotherapie noch eine Option?

This review assesses the relevance of surgical approaches for age-related macular degeneration (AMD) with respect to the pathophysiology of AMD and the current pharmacological possibilities. We discuss the different surgical approaches such as subretinal membrane excision, cell transplantation (IPE and RPE) and transplantation of retina and choroid (PATCH), as well as translocation surgery. Peeling of epiretinal membranes in patients with drusen as well as vitrectomy before epiretinal brachytherapy (VIDEON system) are the final topics. While overall pharmacotherapy has displaced surgical approaches, surgery is worthy of consideration in selected cases. For these patients surgical options need to be maintained in the armamentarium of retinal surgeons.

[Choroidal tumor in a young woman]. / Aderhauttumor bei junger Frau.

A 33-year-old woman presented with unilateral visual impairment since 2 months. A yellowish, prominent lesion was visible in the macula on funduscopy. Spectral domain OCT revealed a choroidal tumor with overlying subretinal fluid and subretinal hyperreflective material. Following a thorough examination including MRI, CT, coloscopy, bone scintigraphy, positron emission tomography and lymph node biopsy, the diagnosis of a choroidal granuloma with systemic sarcoidosis was made. After treatment with systemic steroids over 2 months the choroidal tumor flattened and visual acuity increased from 20/50 to 20/20.

[A 34-year-old patient with retinal vascular abnormality as a coincidental finding]. / 34-jähriger Patient mit auffälligen retinalen Gefäßen als Zufallsbefund.

A young patient presented with recurring blurred vision. Abnormal vessels were found on the retina, which extended as far as the fovea. The diagnosis was congenital vascular malformation in terms of retinal macrovessels.

[Advantages and disadvantages of heavy silicone oil]. / Vor- und Nachteile des schweren Silikonöls.

Heavy silicone oil does not have any evidence-based advantages or disadvantages over conventional silicone oil. It is up to the surgeon to choose the type of tamponade considered to be most suitable for the individual eye. Suitable indications for heavy silicone oil are, for example proliferative vitreoretinopathy (PVR) and risk of PVR in the lower retina. Persistent or complicated macular holes can often be closed with heavy oil but in exchange higher rates of emulsification and cataracts are to be expected. Heavy silicone oils should not remain in the eye for longer than approximately 2 months, therefore, severe ocular trauma and ocular hypotension are not suitable indications. Initial technical difficulties to remove sticky (rare) oil from the retina have now been overcome by using liquid perfluorocarbons.

[Unexplained loss of visual acuity in a 22-year-old woman]. / Unklare Visusminderung bei einer 22-jährigen Patientin.

Developmental disorders of the fovea are almost always accompanied by loss of visual acuity (VA) and are usually associated with different syndromes. We report on a young female patient with an unclear loss in VA, inconspicuous medical history and normal results for funduscopy, electrophysiology and clinical examinations. The presence of fovea plana could be confirmed by spectral-domain optical coherence tomography (OCT).

[Unilateral metamorphopsia of a young woman]. / Einseitiges Verzerrtsehen bei einer jungen Patientin.

A 31 year old woman complained about metamorphopsia on her right eye. Multiple yellowish dots were seen on the retina. The fluorescein angiography showed fluorescein leakage and the indocyanine green angiography showed multiple hypofluorescent areas. The diagnosis of choroidal neovascularization (CNV) due to punctate inner choroidopathy (PIC) was made. Bevacizumab injections and corticosteroid were given as a therapy.

Surgical management of subfoveal choroidal neovascular membranes in age-related macular degeneration by macular relocation: experiences of an early-stopped randomised clinical trial (MARAN Study).

RATIONALE: The MARAN (Macular Relocation in Age-related Neovascular disease) trial was planned to assess the effectiveness of full macular relocation (MR) in patients with neovascular age-related macular degeneration (AMD). DESIGN: Randomised, prospective, controlled clinical trial. METHODS: Patients suffering from visual loss because of AMD were randomised to either surgery or a control group receiving standard treatment (observation or photodynamic therapy (PDT)). The primary end point was the change of visual acuity (VA) (ETDRS) 52 weeks after randomisation compared with initial VA, and secondary end points included reading performance, contrast sensitivity, stability of fixation, eye-specific quality of life, and the absolute number of letters read correctly at 52 weeks compared with initial examination. RESULTS: Owing to early determination, only 28 patients were included in the study. The study did not show a difference between the two groups with respect to the final visual result or any of the secondary outcomes measured. The study was limited by the low recruitment that was, at least in part, attributed to the inherent risks for those patients randomised to the surgical arm of the study as well as to the emerging new treatments for AMD. CONCLUSION: The results of the MARAN trial failed to recruit a sufficient number of patients and a superiority of surgery over observation or PDT in patients with exudative AMD was not shown. There was a trend that the reading function was superior after surgery. In the light of the new pharmacological treatments, surgical options such as MR will be an option for only selected cases.