[Glaucoma due to elevated episcleral venous pressure]. / Glaukome durch erhöhten episkleralen Venendruck.

BACKGROUND: Glaucoma due to elevated episcleral venous pressure is a rare and difficult to treat form of secondary open angle glaucoma. OBJECTIVE: The pathophysiology, clinical findings, differential diagnosis and treatment options are discussed. Radius-Maumenee syndrome, Sturge-Weber syndrome and carotid-cavernous sinus fistulas are covered in particular. MATERIAL AND METHODS: A literature search was conducted in the PubMed database. RESULTS: In the course of the diagnostics potentially severe diseases, such as carotid-cavernous sinus fistulas have to be ruled out. Treatment is based on the therapy of the underlying disease. Anti-glaucomatous medicinal treatment is often insufficient. In the case of surgery the increased risk for severe complications has to be taken into account. A variety of different surgical approaches have been reported in a number of small case series. CONCLUSION: Glaucoma due to elevated episcleral venous pressure can be idiopathic or secondary to another underlying disease. Although rare it should always be considered in the differential diagnosis. Treatment is challenging because of an increased risk for severe complications.

[Preoperative therapy switch before glaucoma filtration surgery : Influence of the systemic antiglaucomatous and local antiphlogistic therapy on the intraocular pressure]. / Präoperative Therapieumstellung vor filtrierender Glaukomchirurgie : Einfluss der systemischen augendrucksenkenden sowie der lokalen antiphlogistischen Therapie auf den Augendruck.

BACKGROUND: The preoperative switch from local to systemic antiglaucomatous therapy and the additional application of local antiphlogistic drugs represents an important component of perioperative wound healing modulation within the framework of glaucoma filtration surgery. OBJECTIVE: The aim of the present study was to compare the intraocular pressure (IOP) under a maximum local and oral antiglaucomatous therapy with or without additional application of local steroids. METHODS: A retrospective clinical analysis of 121 consecutive patients who underwent primary trabeculectomy for open-angle glaucoma in 2013 and who attended the outpatient clinic at least 3 weeks before surgery was carried out. The patients were set on preoperative therapy as follows: continuation of the maximum local antiglaucomatous therapy (with or without local dexamethasone 1 mg/ml 3 times daily) or administration of 750 mg acetazolamide orally per day (with or without local steroids). RESULTS: The switch to oral antiglaucomatous therapy led to a mean IOP rise of 3.14 mm Hg which was short of statistical significance (p = 0.052). The additional administration of local steroids did not significantly influence the IOP (p = 0.218). Some patients with oral acetazolamide therapy and local steroid application showed large increases in IOP up to 30 mm Hg. CONCLUSION: The mean IOP rise of 3.14 mm Hg 3 weeks after replacement of antiglaucomatous eye drops by acetazolamide was short of missing statistical significance and seems to be clinically negligible for this relatively short period. The advantages of a lower postoperative fibrotic activity have to be weighed up against this change in IOP. Surprisingly, the effect of administration of local steroids for 3 weeks was minor compared to the effect of the switch from local to oral antiglaucomatous medication. Individual major IOP increases under the preoperative therapy change should be taken into consideration.

[Glaucoma-a common disease]. / Volkskrankheit Glaukome.

Glaucoma is the second leading cause of blindness worldwide. The purpose of this paper is to give a review on the epidemiology of the disease, on the importance and the consequences of glaucoma for people regarding their daily life, their ability to work, and quality of life.

[Lymphoepithelial carcinoma of the eye]. / Lymphoepitheliales Karzinom am Auge.

A lymphoepithelial carcinoma of the conjunctiva was excised in an 80-year-old female patient. The otorhinolaryngeal (ENT) examination did not show any abnormalities and nasopharyngeal or systemic metastases were absent. A strictly controlled clinical follow-up of the excision site was scheduled. A lymphoepithelial carcinoma of the eye is very rare and it is classified under the nasopharyngeal carcinomas. The diagnostics and therapy are an interdisciplinary task involving ENT, radiology, pathology and oncology and if the tumor cannot be completely excised, radiotherapy is also included.

[Intracranial hypertension and jugular vein thrombosis]. / Intrakranielle Hypertension und Jugularvenenthrombose.

BACKGROUND: Pseudotumor cerebri is an idiopathic increase in intracranial pressure, which commonly affects obese women of fertile age. The diagnostic criteria according to the guidelines of the German Society for Neurology are increased cerebrospinal fluid (CSF) pressure, symptoms of increased CSF pressure, normal results of CSF examination, no relevant medication and a lack of structural and vascular lesions in magnetic resonance imaging (MRI). CASE REPORT: This article presents the case of a 39-year-old male patient who presented at hospital with visual obscuration and recently occurred double vision. Except for a recently diagnosed thrombosis of the left jugular vein of unknown origin, there was nothing else of note in the medical history. Biomicroscopic examination showed papilledema with hemorrhages and cotton wool spots. The CSF opening pressure was initially > 50 cmH2O. During therapy by lumbar puncture (three times), oral carbonic anhydrase inhibitors and loop diuretics, the abducens nerve palsy and papilledema receded. Anticoagulation therapy (initially with coumarin derivatives, then with low molecular weight heparins) was unsuccessful in eliminating the thrombosis of the jugular vein. Surgical intervention was not recommended by the vascular surgeons. CONCLUSION: This case report demonstrates the unusual combination of (idiopathic) intracranial hypertension and thrombosis of the jugular vein, which occurred spontaneously and without any detectable coagulation disorders.

[Laser treatment or intravitreal VEGF inhibition for aggressive posterior retinopathy of prematurity?]. / Laserbehandlung oder intravitreale VEGF-Inhibition bei aggressiver Frühgeborenenretinopathie?

A prematurely born male infant (24+5 gestational weeks, birth weight 485 g) was diagnosed with bilateral aggressive posterior retinopathy of prematurity (AP-ROP) in zone I. After obtaining informed written consent from the parents, one eye was treated with diode laser photocoagulation and the other eye with 0.25 mg intravitreal ranibizumab. Laser photocoagulation was found to be an effective tool for fast regression of AP-ROP; however, medium-term evaluation showed poor macular formation and peripheral retinal detachment. The intravitreal injection led to a slower but better control of the AP-ROP and central foveal reflexes showed better anatomical outcome.

[Retinal haemorrhages in non-accidental head injury in childhood]. / Retinale Blutungen beim nicht akzidentellen Schädel-Hirn-Trauma im Kindesalter.

Retinal haemorrhages are one of the three cardinal manifestations of the "shaken baby syndrome" or "non-accidental head injury" in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper.

[Outcome and complications after trabeculectomy depending on the preoperative intraocular pressure]. / Sechs-Monats-Verlauf nach Trabekulektomie in Abhängigkeit vom Ausgangsdruck.

PURPOSE: Trabeculectomy is a frequently used surgical procedure in open-angle glaucomas. The present study analyses the outcome and complications after trabeculectomy or re-trabeculectomy depending on the preoperative intraocular pressure (IOP) < 30 mmHg and ≥ 30 mmHg. METHODS: One hundred and eighteen patients were included in this retrospective study. Primary ocular outcomes were the postoperative IOP at discharge and postoperative complications such as choroidal detachment and flattening of the anterior chamber. The necessity of postoperative interventions such as needle revisions, viscoelastic injections or surgical revision was documented. RESULTS: In this survey 118 patients (68 men, 50 women) were included (age [arithmetic mean] 68.3 ± 12.1 years). The postoperative follow-up period was 6-9 months. In 60 patients the preoperative IOP was < 30 mmHg, in 58 patients ≥ 30 mmHg. Postoperative complications were flattening of the anterior chamber (< 2 corneal thickness) in 11 patients (9.3 %) and temporary choroidal detachment in 20 patients (16.9 %). On the day of discharge the mean IOP was 9.8 mmHg. Hence the IOP was on average reduced by 17 mmHg (SD 11.2 mmHg). Postoperative interventions were necessary in 28 patients (23.7 %). Seventeen (14.4 %) developed tenon cysts which were treated by needle revision of the bleb. Nine patients (7.6 %) underwent a viscoelastic injection for persistent hypotony and 10 patients underwent bleb revision (8.5 %). CONCLUSIONS: This study does not show statistically significant differences depending on preoperative IOP in temporary choroidal detachment and postoperative interventions. A postoperative flattening of the anterior chamber was found statistically significantly more often in patients with higher preoperative IOP.

[Acute bilateral loss of vision in posterior reversible encephalopathy syndrome]. / Plötzlicher beidseitiger Visusverlust bei posteriorem reversiblem Enzephalopathiesyndrom.

We describe the case of a patient from the emergency ophthalmic clinic who presented with sudden, bilateral visual loss, headache and dizziness. The magnetic resonance imaging (MRI) showed bilateral parieto-occipital vasogenic edema of the white and grey brain matter consistent with the diagnosis of posterior reversible encephalopathy syndrome (PRES). This is a rare cause of sudden bilateral visual loss which describes a condition with bilateral edema of primarily the white but also the grey matter. The edema is usually detectable with MRI but not always with the less sensitive computed tomography (CT). Further clinical signs may be headache, seizure, nausea, character changes and reduced consciousness. Arterial hypertension, drugs inducing hypertension or drug side effects may cause PRES but sometimes the reason remains unknown. In most cases the symptoms resolve simultaneously with the edema but may also lead to severe complications. In suspected cases of PRES the blood pressure should be measured and a MRI performed, followed by intensive care and treatment of the hypertension, other symptoms and complications.

[Ophthalmological screening for retinopathy of prematurity]. / Augenärztliches Screening bei Frühgeborenen.

Retinopathy of prematurity (ROP) is one of the three leading causes of legal blindness in childhood in developed countries. Adequate screening is one of the most important steps towards successful treatment. During the last decades, international and national guidelines for ROP screening have been continually updated. These guidelines correspond to progress in neonatal care and to a better understanding of the relationship between different neonatal parameters and the risk of developing ROP. The present article surveys ROP classification, the current national and international guidelines and new aspects of ROP screening.

[Management of childhood glaucoma associated with Sturge-Weber syndrome]. / Management kindlicher Glaukome bei Sturge-Weber-Syndrom.

PURPOSE: Sturge-Weber syndrome is a rare congenital disorder consisting of cutaneous, leptomeningeal and ocular vascular malformations. Glaucoma occurs in 30-70 % of patients. Treatment is challenging due to a high risk of severe complications such as expulsive haemorrhage, massive choroidal effusion and serous retinal detachment. Ocular findings and the occurrence of complications under different treatment modalities have been reviewed. METHODS: A retrospective analysis of a case series of 5 children (5 eyes/mean age 5.6 years) with secondary glaucoma associated with Sturge-Weber syndrome was undertaken. Ocular findings, treatment modalities, intraocular pressure and complications were assessed. RESULTS: Facial port-wine nevus, i.e., nevus flammeus and dilated episcleral vessels were present in all cases. Diffuse choroidal haemangiomas were seen in four eyes. Glaucoma surgery was performed in 4 children, one child was treated with antiglaucomatous medication alone. Reversible uveal effusion and subluxation of the lens appeared postoperatively in one eye, persistent serous retinal detachment occurred 3 years after surgery in another eye (with an intraocular pressure of 10 mmHg). Both complications were found in eyes with diffuse choroidal haemangioma. CONCLUSION: Management of glaucoma associated with Sturge-Weber syndrome is difficult and controversial. Medical treatment often does not decrease intraocular pressure sufficiently. When planning surgical intervention an increased risk of severe complications has to be considered, especially in the presence of diffuse choroidal haemangioma.

[VEGF antibodies as therapy for retinopathy of prematurity]. / VEGF-Antikörper in der Therapie der Frühgeborenenretinopathie.

Retinopathy of prematurity (ROP) is one of the three leading causes of legal blindness in childhood in the developed countries. Improved neonatal care has resulted in the increased survival of extremely immature infants at high risk to develop ROP. Current treatment for ROP with laser may prevent blindness by causing involution of pathological vessels and thus inhibit the development of retinal detachment. But this coagulation of the avascular retina is a destructive therapy and does not otherwise ameliorate retinal development. Recent reports have described vascular endothelial growth factor antibodies as therapy for ROP. This article reports our own experience with this new therapy and gives an overview of the recent literature.

[Dry eye syndrome and neurotrophic keratitis in childhood. Causes and therapy]. / Keratoconjunctivitis sicca und neurotrophe Keratopathie im Kindesalter. Ursachen und Therapie.

PURPOSE: The purpose of this review is to enhance the physician's awareness of dry eye syndrome and neurotrophic keratitis in children, to describe the most frequently associated conditions and to discuss the diagnostic and therapeutic options available. METHODS: A literature review of the pathogenesis of dry eye syndrome and neurotrophic keratitis in children was carried out, clinical cases from our pediatric ophthalmology office are presented as well as therapeutic strategies. RESULTS: Diseases of the cornea and ocular surface such as dry eye syndrome, neurotrophic keratitis and corneal ulcers are infrequent in children compared to adults. However, they do occur and should be diagnosed and treated as soon as possible in order to prevent long-term complications and amblyopia. CONCLUSIONS: Inflammatory diseases of the ocular surface can be easily overlooked in children due to the often unknown spectrum of differential diagnoses and the frequently reduced cooperation during examination of young children. Correct and early diagnosis is essential for prevention of long-term complications, e.g. corneal ulceration and scarring.

Diurnal intraocular pressure profiles and progression of chronic open-angle glaucoma.

PURPOSE: To evaluate whether the amplitude of day-and-night intraocular pressure (IOP) profiles influences the rate of progression of chronic open-angle glaucoma. METHODS: The hospital-based clinical observational study included day-and-night profiles of IOP measurements performed on 458 patients (855 eyes) with chronic open-angle glaucoma or ocular hypertension. The 24-h pressure profiles obtained by Goldmann applanation tonometry contained measurements at 0700, noon, 1700, 2100, and midnight. RESULTS: In the whole study population, IOP amplitude was significantly (P<0.001) and positively associated with the mean (r=0.26), minimal (r=-0.23) and maximal (r=0.59) IOP values. Taking the whole study population, glaucoma progression was not associated with the IOP amplitude (P=0.09). After adjustment for age, neuroretinal rim area and the other IOP measurements, age (P<0.001) and neuroretinal rim area (P=0.05) remained as significant predictive factors in the selected Cox model. In the normal-pressure glaucoma group (n=174 eyes), progression was significantly positive associated with the minimal IOP value (P<0.001), the mean of the IOP values (P=0.024), and, less significantly (P=0.037) and negatively, with the pressure profile amplitudes. In the high-pressure glaucoma group (n=681 eyes), rate of glaucoma progression was not associated with the IOP amplitude (P=0.734) or the other IOP parameters. CONCLUSIONS: Taking into account the highly significant associations between the IOP amplitude and the mean, minimal and maximal IOP values suggests that it is the IOP itself, and less the pressure amplitude, which has the main influence on the rate of the glaucoma progression.