Ultrastructural analysis of explanted CyPass microstents and correlation with clinical findings.

PURPOSE: The purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure. METHODS: Nine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy. RESULTS: Fibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents. CONCLUSION: Although MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.

[Clinical and sonographic examination findings in patients with carotid-cavernous sinus fistulas]. / Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln.

BACKGROUND: Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit. METHODS: A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit. RESULTS: The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases. CONCLUSION: The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.

[Optical coherence tomography angiography: Value for glaucoma diagnostics]. / Optische Kohärenztomographie-Angiographie: Stellenwert in der Glaukomdiagnostik.

BACKGROUND: Optical coherence tomography angiography (OCTA) is a novel noninvasive method which enables a quantitative evaluation of retinal and optic nerve head (ONH) perfusion. In this article, we discuss the principles of the application of OCTA and give a summary of the knowledge gained by using this method in glaucoma patients. METHODS: This article is based on a selective literature search and the analysis of own data. RESULTS: Quantitative OCTA parameters have a good reproducibility in glaucoma patients. Glaucoma patients show a reduced flow density (FD) in the ONH and in the area of the macula compared with a healthy control group. The FD parameters show a good diagnostic discriminatory power but are not superior to the structural parameters used in routine diagnostics. The reduced FD measured using OCTA correlates with the extent of functional and structural glaucoma damage. CONCLUSION: The OCTA is noninvasive, fast and reproducible. Initial results from studies on glaucoma patients show the high diagnostic potential of this method. The OCTA could become a part of clinical glaucoma management in the future.

[Bilateral posterior persistent hyperplastic primary vitreous]. / Bilateraler posteriorer persistierender hyperplastischer primärer Glaskörper.

Bilateral persistent hyperplastic primary vitreous (PHPV) represents a rare entity of a congential malformation. This casuistic presents for the first time in the German literature the case of a 4-month-old child with bilateral posterior PHPV.

[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report]. / Sinus-cavernosus-Thrombose als seltene Ursache eines Exophthalmus im Kindesalter : Ein Fallbericht.

Complications of acute bacterial sinusitis mostly occur in children and adolescents. In particular, intracranial spread of the infection can lead to severe even fatal courses of the disease. This article is a case report about a 13-year-old boy suffering from left-sided headache, meningismus and exophthalmos as presenting symptoms. Cranial magnetic resonance imaging (MRI) showed merely right-sided sphenoid sinusitis; however, the diffusion-weighted MRI sequence indicated a left-sided cavernous sinus thrombosis, which could be confirmed by computed tomography (CT) angiography. Cerebrospinal fluid diagnostics showed significant leukocytosis confirming secondary meningitis. Finally, exophthalmos was explained by parainfectious cavernous sinus thrombosis and periorbital edema. This case report highlights the importance of extended and specific diagnostic imaging in cases of clinically suspected complications in children and adolescents with sinusitis and the diagnostic significance of diffusion-weighted MRI.

[Sympathetic ophthalmia following repeated pars plana vitrectomy : Clinical findings and spectral domain OCT follow-up]. / Sympathische Ophthalmie nach zweimaliger Pars-plana-Vitrektomie : Klinische Befunde und Spectralis-OCT-Verlauf.

Sympathetic ophthalmia is a rare form of bilateral granulomatous panuveitis, occurring after penetrating trauma. Hitherto, sympathetic ophthalmia after vitrectomy has only occasionally been described in the literature. This case report presents a female patient with sympathetic ophthalmia after repeated pars plana vitrectomy on the basis of clinical findings and follow-up with fluorescein angiography, spectral domain OCT, and histopathology.

[Principles of glaucoma diagnostics with optical coherence tomography]. / Grundlagen der optischen Kohärenztomographie-basierten Glaukomdiagnostik.

BACKGROUND: In recent years many applications of optical coherence tomography (OCT) have led to a better understanding of glaucoma morphology. The clinical routine in the treatment of glaucoma is strongly influenced by the modern diagnostic aspects. METHODS: A selective search of the literature was carried out and the important aspects are presented taking own experiences into account. The measurement principles, diagnostic ability and pitfalls of the three OCT measurement procedures are highlighted. RESULTS: Retinal nerve fiber layer, macula and ganglion cell layer thickness as well as the minimum neuroretinal rim width have facilitated in particular the objective early diagnosis and follow-up measurements. CONCLUSION: For glaucoma, OCT measurements cannot replace the medical expert diagnosis but they represent a valuable decision-making aid for diagnostics and follow-up examinations.

[Structural alterations during the course of glaucoma disease]. / Strukturelle Veränderungen im Verlauf der Glaukomerkrankung.

BACKGROUND: Structural changes in the course of glaucoma disease affect the trabecular meshwork and ciliary body in addition to the optic disc as the primary site of glaucoma damage. OBJECTIVES: Latest results from experimental studies, animal models and measurements in human eyes are presented and discussed. RESULTS: The presenting scenario is complex with age, biochemical and mechanical stress factors leading to subsequent, irreversible tissue change in the trabecular meshwork and cribriform plate of the optic nerve, resulting in neuronal tissue loss. CONCLUSION: Knowledge of these changes will be the key for future glaucoma therapies.

[Successful brachytherapy of a clinically unapparent ciliary body melanoma]. / Erfolgreiche Brachytherapie bei klinisch inapparentem Ziliarkörpermelanom.

We report on a typical case of a ciliary body melanoma in a 59-year-old female, which was only noticed due to nonspecific unilateral vision disorders and which could only be seen in maximal mydriasis via a gonioscopic three-mirror lens. We further discuss tumor monitoring via ultrasound biomicroscopy (UBM) and execution and prognosis of Ru-106 brachytherapy.

[Ultrasound diagnostics in ophthalmology (standardized echography): part 2: diseases of the orbit - ultrasound biomicroscopy diagnostics]. / Ultraschalldiagnostik in der Ophthalmologie (standardisierte Echographie) : Teil 2: Erkrankungen der Orbita - Ultraschallbiomikroskopie-Diagnostik.

Ultrasound diagnostics have been one of the most important noninvasive supplementary diagnostic procedures in ophthalmology for many decades and are indispensable for many intraocular and orbital diseases. When the echography examination and analysis of the echograms obtained are correctly carried out, ultrasound diagnostics are characterized by a high measure of specificity and sensitivity.

[Ultrasound diagnostics in ophthalmology (standardized echography): part 1: principles and diseases of the eyeball]. / Ultraschalldiagnostik in der Ophthalmologie (standardisierte Echographie) : Teil 1: Grundlagen und Erkrankungen des Bulbus.

Ultrasound diagnostics has been one of the most important additional diagnostic non-invasive techniques in ophthalmology for many decades and is essential for many intraocular and orbital diseases. When echographic investigations and analysis of the echograms obtained are correctly carried out, ultrasound diagnostics demonstrates a high degree of specificity and sensitivity.

[Pigment dispersion syndrome and pigmentary glaucoma. Morphometric analysis of the anterior chamber segment with SL-OCT]. / Melanindispersionssyndrom und -glaukom. Morphometrische Analyse des vorderen Augenabschnittes mittels SL-OCT.

BACKGROUND: The purpose of this study was to analyze if anterior chamber parameters are risk factors for the development of pigment dispersion syndrome (PDS) and/or for the conversion to pigmentary glaucoma (PG). PATIENTS AND METHODS: This study included a total of 63 eyes from 35 patients with PDS and PG and 65 eyes from 49 unaffected volunteers as the control group. The following parameters were measured by slit lamp optical coherence tomography (SL-OCT): anterior chamber volume (ACV) and depth (ACD), angle opening distance (AOD) and the trabecular iris space area (TISA) at 500 µm and 750 µm from the scleral spur. Comparisons between the following groups were performed: between the PDS/PG and the control group, between PDS and PG and between male and female patients. RESULTS: The results of ACV, ACD, AOD and TISA were significantly higher in PDS/PG patients when compared to the control group. There were no significant differences between PDS and PG. The gender-specific comparison also showed no significant differences. CONCLUSIONS: Significantly higher anterior chamber parameters are a possible risk factor for development of PDS; however, a higher risk of conversion to PG does not seem to correlate with increased anterior chamber parameters. The parameters of the anterior chamber are apparently not associated with the male predominance of PDS and PG.

[Structural diagnostics of course observation for glaucoma]. / Strukturelle Diagnostik der Verlaufsbeobachtung der Glaukome.

BACKGROUND: Imaging of the structural progression of glaucoma enables measurement of the neuroretinal rim of the optic disc, retinal nerve fibre layer and thickness of the ganglion layer. METHODS: High resolution disc photography, laser scanning tomography, scanning laser polarimetry and optical coherence tomography (OCT) are the current methods of choice to document and measure progression of this chronic degenerative disease. RESULTS: Loss of the neuroretinal rim is only a few mm(2) or mm(3) per year and has to be differentiated from age-related loss which shows less change over the years. The most pronounced loss is temporal both superior and inferior. Thinning of the retinal nerve fibre layer follows the same pattern with significant annual changes of only 6-7 µm. Modern OCT devices deliver measurements of the macula ganglion cell complex which can be even more sensitive than the thickness of the retinal nerve fibre layer. Qualitative criteria for structural progression are papillary hemorrhage, rarification of papillary vessels and specific changes of the retinal pigment epithelium. CONCLUSIONS: Structural loss due to glaucoma can be imaged and measured with different methods in different tissues. The evaluation of significant changes is still the responsibility of the ophthalmologist by taking all findings into account.

[The most important signs of a glaucomatous disc]. / Die wichtigsten ophthalmologischen Papillenveränderungen bei den Glaukomen.

Glaucomatous optic atrophy is the result of both primary and secondary glaucomas leading to functional defects. Loss of axons and ganglion cells leads to a specific atrophy of the optic nerve head. Increased cup size and depth with loss of neuroretinal rim tissue are accompanied by changes of the retinal vessels and juxtapapillary retinal pigment epithelium. Changes of the retinal nerve fibre layer, caused by ganglion cell loss may be earliest signs of glaucomatous atrophy. The marked variability of optic disc size and form may influence the quality of ophthalmoscopic evaluation in extreme variants. Peripapillary haemorrhages and changes of pulsation properties of the retinal venules may give prognostic information for the course of the disease. These signs may be evaluated and even semiquantitatively measured with limited technical effort. They lay the basis for the evaluation of modern imaging and measuring techniques. This article summarises criteria described by Jonas and other authors in the light of modern imaging techniques and adds the latest scientific results.

[Papilledema and echographically detectable retro-orbital dilatation of the sub-arachnoidal space with open fontanelle - six case reports]. / Stauungspapille und echografisch nachweisbare retroorbitale Erweiterung des Subarachnoidalraums bei offener Fontanelle - Sechs Kasuistiken.

This paper analyses the case reports for three children in which a papilledema occurred before the age of one year. Furthermore, an analysis is also given of three further case reports for children aged less than one year in which, in spite of open fontanelle, no papilledema was found, however, a dilatation of the sub-arachnoidal space was demonstrated echographically. Even in children less than one year of age in which an open fontanelle still exists and in whom a neuro-paediatric clarification of internal hydrocepalus is made, in spite of opththalmoscopically inconspicuous findings for the papilla an echography is indispensable for the evaluation of the sub-arachnoidal space. Here, the early recognition of a dilatation of the retro-bulbar sub-arachnoidal space can possibly prevent the occurrence of a consecutive optic atrophy. At the present time, the data available do not allow the recommendation of an upper age limit for an echographic examination.

Influence of atypical retardation pattern on the peripapillary retinal nerve fibre distribution assessed by scanning laser polarimetry and optical coherence tomography.

AIM: To investigate the influence of atypical retardation pattern (ARP) on the distribution of peripapillary retinal nerve fibre layer (RNFL) thickness measured with scanning laser polarimetry in healthy individuals and to compare these results with RNFL thickness from spectral domain optical coherence tomography (OCT) in the same subjects. METHODS: 120 healthy subjects were investigated in this study. All volunteers received detailed ophthalmological examination, GDx variable corneal compensation (VCC) and Spectralis-OCT. The subjects were divided into four subgroups according to their typical scan score (TSS): very typical with TSS=100, typical with 99 ≥ TSS ≥ 91, less typical with 90 ≥ TSS ≥ 81 and atypical with TSS ≤ 80. Deviations from very typical normal values were calculated for 32 sectors for each group. RESULTS: There was a systematic variation of the RNFL thickness deviation around the optic nerve head in the atypical group for the GDxVCC results. The highest percentage deviation of about 96% appeared temporal with decreasing deviation towards the superior and inferior sectors, and nasal sectors exhibited a deviation of 30%. Percentage deviations from very typical RNFL values decreased with increasing TSS. No systematic variation could be found if the RNFL thickness deviation between different TSS-groups was compared with the OCT results. CONCLUSIONS: The ARP has a major impact on the peripapillary RNFL distribution assessed by GDx VCC; thus, the TSS should be included in the standard printout.