[Can Anti-VEGF Injections Cause Glaucoma or Ocular Hypertension?] / Können Anti-VEGF-Injektionen Glaukom oder okuläre Hypertension verursachen?

An increasing number of patients receive intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections with a high frequency for the treatment of neovascular macular disease. Since the volume of the vitreous body is temporarily increased by the injection of the substances, a short-term intraocular pressure increase after the introduction of the substance is not uncommon. However, there are more and more reports indicating that multiple injections may lead to a long-term increase in intraocular pressure. This may also be the case in patients without a glaucoma history. In some cases, this pressure increase cannot be adequately treated with local pressure-reducing medication and requires an operative procedure in order to avoid glaucoma damage. This appears to be more common in products dispensed from broken bulk or after administration of bevacizumab. The mechanism leading to inflammation and/or a sustained increase in pressure is unknown. High molecular weight molecules present in the syringe, such as monomer antibodies, aggregated proteins, or silicone oil droplets from the syringe, may lead to inflammation in the trabecular meshwork or displacement thereof and a subsequent increase of the intraocular pressure. Avoiding silicone oil droplets in the syringes would be desirable. Intraocular pressure after intravitreal injections should also be monitored long term after the procedure.

[Possibilities and limitations of eye drops for glaucoma therapy]. / Möglichkeiten und Grenzen der medikamentösen Glaukomtherapie.

BACKGROUND: In Germany, chronic open-angle glaucoma is mostly treated by daily eye drop application. The possibilities and limitations of this form of therapy are presented. Reasons for the change in the selection of the preferred substances over time are also discussed and the limits of local drug therapy are described. OBJECTIVES: What effects can be expected of the available drugs? MATERIALS AND METHODS: The article provides a review of the literature from PubMed and clinical experience. RESULTS: In chronic open-angle glaucoma, eye drops containing a single agent can achieve an intraocular pressure decrease of 15-35 % compared to the initial pressure level. This is dependent on the substance and is achievable when used as directed. Difficulties in administration are often observed in older patients where regular use over extended periods of time is required. In addition, there are limits in the achievable pressure reduction by combining several active ingredients. Novel systems are being developed for future applications. The idea is to achieve a continuous slow release of the active substance by surgical application of a biodegradable carrier. CONCLUSION: A treatment regimen which is individually tailored to the individual patient's needs should be developed by the attending physician and the achievement of the set objectives should be monitored at regular intervals. However, restrictions induced by patients due to inadequate adherence or by the drug due to limited efficacy of the drug have to be considered. Therefore, eye drop therapy in open-angle glaucoma is not always sufficient. It should be supplemented in due time by laser or filtering surgery before the affected patients and their optic nerves suffer advanced glaucomatous damage.

[Possibilities and limitations of glaucoma surgery]. / Möglichkeiten und Grenzen der operativen Glaukomtherapie.

BACKGROUND: Glaucoma is the second leading cause of blindness worldwide and in many cases cannot be adequately controlled with conservative treatment. MATERIALS AND METHODS: Schematic evaluation of various surgical techniques. RESULTS: Trabeculectomy is the gold standard of glaucoma surgery and requires close follow-up care. Novel, minimally invasive procedures are suitable for patients with moderately advanced, uncomplicated stages of the disease, whereas filtrating tube implants or cyclodestructive techniques are required in patients with complex glaucoma. CONCLUSION: Various surgical techniques are available and have their specific indication window for the glaucoma surgeon, depending on the severity, progression, and risk factors of the disease.

[Mastered with statistics: perfect eye drops and ideal screening test : Possibilities and limits of statistical methods for glaucoma]. / Mit Statistik gemeistert: perfekte Augentropfen und idealer Screeningtest : Möglichkeiten und Grenzen statistischer Methoden beim Glaukom.

BACKGROUND: The use and the understanding of statistics are very important for biomedical research and for the clinical practice. This is particularly true for estimation of the possibilities for different diagnostic and therapy options in the field of glaucoma. The apparent complexity and contraintuitiveness of statistics along with a cautious acceptance by many physicians, might be the cause of conscious and unconscious manipulation with data representation and interpretation. OBJECTIVES: Comprehendable clarification of some typical errors in the handling of medical statistical data. MATERIALS AND METHODS: Using two hypothetical examples from glaucoma diagnostics the presentation of the effect of a hypotensive drug and interpretation of the results of a diagnostic test and typical statistical applications and sources of error are analyzed in detail and discussed. RESULTS: Mechanisms of data manipulation and incorrect data interpretation are elucidated. Typical sources of error in the statistical analysis and data presentation are explained. CONCLUSION: The practical examples analyzed demonstrate the need to understand the basics of statistics and to be able to apply them correctly. The lack of basic knowledge or half-knowledge in medical statistics can lead to misunderstandings, confusion and wrong decisions in medical research and also in clinical practice.

[Botulinum toxin injections for senile entropium]. / Botulinumtoxin-Injektionen bei senilem Entropium.

Involutive changes in the collagen and muscular structures of the lower lid in ageing may lead to the formation of senile entropium. Treatment of this condition may be achieved using botulinum toxin injections to the dislocated orbicularis muscle. These injections lead to cessation of the symptoms for a mean of 3.8 months. Repeat injections are possible. Botulinum toxin injections are a viable option for patients who are not amenable to surgical correction of the entropium.

[Ophthalmological alterations at the initial diagnosis of HIV infection]. / Ophthalmologische Veränderungen im Rahmen der Erstdiagnose einer HIV-Infektion.

Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV), is one of the most important infectious causes of death in the twentieth and twenty-first centuries. Ocular manifestations can appear in particular when the CD4 cell count is low. This article presents a case report of a 38-year-old homosexual man in whom HIV microangiopathy retinopathy syndrome (MAPS) was found during the assessment of the initial HIV diagnosis. Typical findings in MAPS are conjunctival and retinal vessel abnormalities, cotton wool spots as well as intraretinal hemorrhages. Loss of vision is a rare complication but MAPS shows an impairment of the immune status and is also associated with a higher mortality.

[Preservative-containing eye drops and adherence in ophthalmological practice]. / Konservierte Augentropfen und Adhärenz in der augenärztlichen Praxis.

Chronic eye diseases, such as glaucoma or dry eye syndrome, require long-term drug application to the eyes. Good adherence is required to achieve the therapeutic goal and patient needs and requirements have to be taken into account. This distinguishes adherence to drug therapy from the former compliance which implies only following medical instructions. Adherence is influenced by socioeconomic, health system-related, disease-related, treatment-related and patient-related factors. It can be measured by tedious procedures, such as electronic monitoring, self-assessment, drop counting and laboratory findings of systemic drug levels. Non-adherence is a growing medical problem worldwide. An increase in adherence means an increased degree of therapeutic safety for the patient and long-term cost savings for the individual as well as society. Non-adherence in chronic diseases, such as glaucoma and dry eye syndrome is increased by eye drops that cause side effects. Often these side effects are caused by agents such as the preservative benzalkonium chloride. To achieve a good adherence preservative-free eye drops are advised.

[Spectral domain OCT in patients with unclear uveitis]. / Spectral-domain-OCT bei unklarer Uveitis.

Presented here are two cases of patients with unclear visual loss. A diagnostic assessment with spectral domain optical coherence tomography (Sd-OCT), fluorescein angiography (FLA) and blood analyses was performed due to vitreous clouding. Characteristic FLA findings for papillitis and vasculitis and as yet undescribed morphological Sd-OCT changes in the photoreceptor layer and in the pigment epithelium were found. During the treatment of the diagnosed lues these changes were resolved. The Sd-OCT technique seems to be a useful and effective diagnostic tool for uveitis diagnostics.

[Spontaneous closure of traumatic macular holes. Two cases]. / Spontanverschluss traumatischer Makulaforamina: Zwei Fälle.

The optimal treatment approach for traumatic macular holes (TMH) is still controversial. We report two cases of spontaneous closure of TMH. In the first patient, closure resulted in an increase in visual acuity from 0.2 to 0.8. In the second case, no increase in visual acuity was detectable despite spontaneous closure of the TMH within a few days after the trauma. This may be explained by an irreversible damage of the photoreceptors and retinal pigment epithelium. In patients with TMH, a waiting approach should be considered because of the possibility of spontaneous closure of TMHs.

[Bilateral loss of vision in an 11-year-old]. / Beidseitiger Visusabfall bei einer 11-Jährigen.

We present the case of an 11-year-old girl with continuously progressive loss of vision. Fundoscopy revealed a picture consistent with Stargardt's disease and fundus flavimaculatus. This article provides a short overview of differential diagnoses worth considering in children and adolescents who present with a similar picture. After our initial workup, genetic chip analysis of the ABCA4 gene was performed, which yielded a heterozygous mutation. Because a second mutation could likely have been on a part of the gene not screened by chip analysis, and in light of the striking picture, a clinical diagnosis of Stargardt's disease was made.

[Optic neuropathy in Schmidt-Carpenter syndrome]. / Optikusneuropathie bei Schmidt-Carpenter-Syndrom.

Systemic hypotension exacerbates the progression of normal pressure glaucoma. We present a female patient with glaucomatous disc changes in the setting of inconspicuous tonometry. Failure of the adrenal gland, thyroid and pancreatic islet cells (Schmidt-Carpenter syndrome) likely formed the basis of the ocular pathology. This clinical constellation provided the chance to influence disease progression by raising the nocturnal blood pressure in addition to lowering intraocular pressure.

[Diffuse stromal corneal opacity and alterations of the hands]. / Diffuse stromale Hornhauttrübungen und Veränderungen der Hände.

Bilateral stromal corneal opacity is a differential diagnostic challenge for ophthalmologists. In this article 2 female patients aged 30 and 36 years old, respectively, with different degrees of expression of stromal diffuse corneal opacity will be presented. Patient 1 was of short stature (114 cm) and patient 2 was 172 cm in size. Both patients exhibited altered joint structures of the hands and feet and diffuse stromal corneal opacity. Furthermore, patient 1 had both mitral and aortal insufficiencies and patient 2 an aorta insufficiency. The stromal diffuse corneal opacity was indicative of Schleie syndrome. For patients with reduced vision a lamellary keratoplasty is to be recommended.

[Ocular motility disorders in a patient with Fabry's disease]. / Augenbewegungsstörungen bei einem Patienten mit Morbus Fabry.

Fabry's disease (FD) is a rare lysosomal storage disorder. Early cerebral manifestations are a major and often life-threatening burden of the disease. We present a 38-year-old male FD patient with a prior history of six different episodes of stroke and newly developing ocular disorders. He presented with nystagmus with different wave forms and directions and blepharospasm as well as cornea verticillata.

[Bilateral recurrent retinal thrombosis in a young man]. / Bilaterale rezidivierende retinale Thrombose bei einem jungen Mann.

A 41-year-old male patient presented with veiled vision which had appeared only a few hours previously. Funduscopy revealed a retinal edema due to venous stasis retinopathy. A previous history was unknown except for an uncorrected arterial hypertension. A retinal vein thrombosis and macula edema developed in the affected eye. An antiphospholipid antibody syndrome was diagnosed which was treated with anticoagulants.

[Temporal oscillations of retinal vessel diameter in healthy volunteers of different age]. / Zeitliche Schwingungen retinaler Gefässdurchmesser bei Gesunden unterschiedlichen Alters. Kreuz- und Autokorrelation für dynamische Gefässanalyse.

PURPOSE: We investigated whether temporal oscillations of the retinal vessel diameter, as measured with the dynamic vessel analyzer (DVA), undergo age-related changes. METHODS: Vessel diameters of retinal arterial and venous segments were examined with the DVA in 28 medically healthy volunteers divided into two age groups of 14 persons each: young subjects (21-32 years) and seniors (52-70 years). Continuous temporal records of vessel diameter were mathematically evaluated and divided into high-frequency (period <1.5 s) and low-frequency (period > or =1.5 s) oscillations. RESULTS: The phase difference between temporal arterial and venous vessel diameter records was higher in the young group [0.6 (0.1, 3.3)] s [median (1st quartile, 3rd quartile)] compared with the seniors [0.1 (-0.4, 0.3) s]. There was a difference in the periodicity in veins between the groups and, in seniors, between the arteries and the veins. CONCLUSIONS: High-frequency oscillations of vessel diameter correspond to the heartbeat. These were expressed more in seniors. Low-frequency oscillations were well expressed in young subjects. Our results show significant age-related alterations in retinal vessel regulation.

[Retrospective investigation of seasonal factors influencing intraocular pressure in glaucoma patients]. / Retrospektive Untersuchung jahreszeitlich bedingter Einflussfaktoren auf den Augeninnendruck therapierter Glaukompatienten.

BACKGROUND: Some studies in the literature claim a significant seasonal variation of intraocular pressure (IOP) due to the influence of various factors. The aim of our study was to examine such influences on IOP in the Caucasian population. PATIENTS AND METHODS: For a period of 12 years, the data of 172 glaucoma patients from the outpatient glaucoma clinic of the Technical University of Munich were retrospectively evaluated. Most patients had been medically treated to lower their IOP. RESULTS: Slight seasonal variations were found, with the months of low sunlight correlating with higher measurements than the months of high sunlight. The statistical significance of seasonal variation shown in other studies could not be confirmed in this study. CONCLUSION: The seasonal variation of IOP was not statistically significant in our population. A reason for this finding could be that the patients were using glaucoma medication.