[Is there a drug therapy for age-related macular degeneration?--current status and new therapeutic approaches]. / Gibt es eine medikamentöse Therapie der altersbedingten Makuladegeneration?--Derzeitiger Stand und neue therapeutische Ansätze.

Age-related macular degeneration (AMD) is the major cause of legal blindness in society today. In dry AMD age-related changes in Bruch's membrane and RPE result in the accumulation of cell debris with consequent degeneration. In the less common but more aggressive form, wet AMD, hypoxia and inflammation lead to an up-regulation of different growth factors such as VEGF resulting in formation of choroidal neovascularisation. Different therapeutic modalities have evolved to address this problem. Examples are photodynamic therapy to eradicate choroidal neovascularisation (CNV) via a physiochemical reaction or intravitreal application of anti-VEGF agents to stop leakage of fluid from the same CNV. The overall results have been either disappointing or not practical because of the necessity of chronic treatment. The treatment goal continues to evolve to that already realised in oncology which is for a cure. This mandates the investigation of combination strategies. Combination strategies should focus on utilising the differing mechanisms of action on the pathogenesis of the disease all the while minimising the side effects of the individual therapeutic agents.

[Scope and limititions of innovative vitrectomy systems]. / Möglichkeiten und Grenzen der innovativen Vitrektomiesysteme.

PURPOSE: The aim of the present article is to review the methodical and technological development of pars plana vitrectomy. Special attention is drawn to safety, efficiency and functionality of the innovative 25-gauge und 23-gauge vitrectomy systems which are compared to the standard 20-gauge vitrectomy system. This was done based on clinical studies and case reports. METHODS: A literature search was conducted in a cluster of different medical databases (XMedall; XPharmall). Focus of the research was the "development" and "status quo" of pars plana vitrectomy. In particular, clinical studies and case reports dealing with safety and efficiency of 20-, 23- and 25-gauge vitrectomy systems have been evaluated. Only peer-reviewed articles from 1966 until today were investigated. Finally, a descriptive analysis of the relevant studies was made. RESULTS: Both innovative vitrectomy systems are safe and effective and help to reduce operating time. There was no significant difference in postoperative complications following 25-gauge vitrectomy and 20-gauge vitrectomy. 25-gauge instruments, however, show a greater flexibility. For this reason a certain learning curve is required and the range of application is limited. Due to its greater stiffness and larger diameter, the 23-gauge system - while still allowing a transconjunctival access - may overcome the disadvantages of the 25-gauge system. However, the use of silicone oil may lead to leakage of the sclerotomies and thus necessitate additional suturing. CONCLUSION: The use of both innovative vitrectomy systems offers the advantage of a faster and less invasive surgical procedure. However, there are disadvantages which limit the indications for 25-gauge vitrectomy. The 23-gauge vitrectomy may overcome these disadvantages and - due to its wider range of application - may be used instead of conventional 20-gauge vitrectomy in most cases. It may therefore become the new standard for vitrectomy.

Comparison of the original Amsler grid with the modified Amsler grid: result for patients with age-related macular degeneration.

PURPOSE: To compare the sensitivity of the original Amsler grid presenting white lines on a black background with that of the modified standard version of the grid presenting black lines on a white background in the detection of visual disturbances. PATIENTS AND METHODS: One hundred eighty-two patients (182 eyes) with dry and exudative age-related macular degeneration and a history of metamorphopsia were instructed to use an Amsler grid. None of the patients were familiar with an Amsler grid or had used it previously. If the disease was present in both eyes, one eye was chosen as the study eye by randomization. Both grid types were presented and used for documentation of central visual field changes. The sequence of presentation of the respective grid was also chosen by randomization. Original Amsler grid questions were used for grading ("metamorphomas" and "scotomas"). Visual acuity of patients ranged from 0.1 to 0.7. Subgroup analysis was performed based on the visual acuity levels. RESULTS: For the overall study population, the original Amsler grid provided significantly better results than the modified version. Evaluation of data for the different subgroups showed no significant difference between patients with visual acuity ranging from 0.1 to 0.3. For patients with visual acuity of 0.5 or better, the original Amsler grid was significantly more informative and reliable than the modified version. CONCLUSION: For patients with macular diseases, use of the original Amsler grid (white lines on a black background) should be recommended. This is particularly important for patients with visual acuity of 0.5 or better.

[Are Hegar's rods omissible? (author's transl)]. / Sind Hegar-Stifte entbehrlich?

The widening effect of Sulproston 500 microgram IM on the cervix uteri was investigated in a double-blind study conducted in 50 non-pregnant volunteers. In women in the postmenopausal stage who had been given Sulproston, resistance-free widening of the cervix with Hegar's rods was H 8.33 +/- 0.87. Easy passage of the cervix uteri and of the internal os uteri was achieved with Hegar 8.22 +/- 0.66 in the first half of the cycle and with Hegar 8.35 +/- 3.06 in the second half of the cycle. In all three groups, the size of the rods was significantly smaller following intramuscular application of physiological saline solution. The widening effect of PGE2 or PGE2 derivatives on the cervix, which has been known for quite some time in patients with pregnant uterus, applies in equal measure to the non-pregnant cyclic uterus and to the postmenopausal uterus.

PIP: The effects of Sulproston (500 mcg, intramuscular) on cervical dilatation was studied in 50 non-pregnant volunteers. Sulproston, a prostaglandin E2 derivative (chemical name: 16-phenoxy-omega-17,18,19,20-tetranor-PGE2-methylsulfonylamid) was administered to 25 pre- and post-menopausal women; others received intramuscular injections of physiological saline in a double-blind study. Significantly greater cervical dilatation was seen in women receiving sulproston (Hegar sizes 8.22 + or - 0.66 to 8.35 + or - 3.306) than in women receiving the placebo (4.13 + or - 0.99 to 5.33 + or 0.66). The effect of prostaglandin E2 derivatives on cervical dilatation is thus confirmed in non-pregnant as well as pregnant women.