[Postoperative endophthalmitis-a review of literature]. / Postoperative Endophthalmitis im Spiegel der Literatur.

Postoperative endophthalmitis is one of the most feared complications for ophthalmologists, and the number of infections after intraocular procedures have been increasing. Nonetheless, a prompt intervention can result in the recovery of vision. In the past, endophthalmitis after cataract surgery was accountable for the majority of cases but is becoming less frequent due to the progress of surgical techniques and demographic developments with a steadily increasing number of intravitreal injections. In this article, the different forms of postoperative endophthalmitis are assessed in terms of pathophysiology and their specific characteristics depending on their etiology.

[Current value of femtosecond laser-assisted cataract surgery]. / Aktueller Stellenwert der Femtosekundenlaser-assistierten Kataraktchirurgie.

After more than 10 years of experience with the femtosecond laser in cataract surgery, it can be concluded that the safety profile of femtosecond laser-assisted cataract surgery (FLACS) is comparable to that of conventional cataract surgery. This technique offers the possibility to perform incisions with a precision superior to that of any surgeon in the world, based on the connection of preoperative and intraoperative diagnostics. This results in new possibilities to revolutionize the surgical procedure of cataract surgery and to generate new therapeutic approaches for the treatment of cataracts. The combination of keratotomy for correcting astigmatism, intraocular lenses supported by capsulotomy and individually adapted fragmentation patterns is already a component of a personalized cataract surgery.

[Progressive maculopathy despite discontinuation of chloroquine treatment-multimodal imaging and review of the literature]. / Progressive Makulopathie trotz Absetzen der Chloroquin-Therapie ­ Multimodale Bildgebung und Review der Literatur.

This case report presents a pictorially well-documented case with multimodal images of a progression of maculopathy despite discontinuation of chloroquine treatment in a long-term follow-up over 6 years. Additionally, the current detection methods in screening for early recognition of maculopathy and their prognostic significance are reviewed.

[Heavy liquids as intraoperative instrument in retinal surgery]. / Schwere Flüssigkeiten als intraoperatives Instrument in der Netzhautchirurgie.

The introduction of perfluorocarbon liquids (PFCL) resuled in a significant change in vitreoretinal surgery. Even complicated retinal detachments could be treated reliably and successfully. The combination of vitrectomy with the use of PFCL was one of the decisive factors for the continuing success of pars plana vitrectomy (ppV) in addition to technical refinements. The PFCLs have become an established part of vitreoretinal surgery due to their wide range of application and the positive intraoperative influence. When applied correctly and intelligently, PFCL can serve as the third hand of a retinal surgeon. Contrary to the widespread scepticism, the currently discussed toxicity of PFCL is negligible for short-term use.

[LHON-Treatment option despite poor initial visual acuity?] / LHON ­ Behandlungsoption trotz schlechtem Ausgangsvisus?

A case of Leber's hereditary optic neuropathy is reported in order to draw attention to this rare mitochondrial disease in the differential diagnostics and to show current treatment options. In this case despite very poor initial visual acuity and late start of treatment an improvement of visual acuity relevant for the patient could be achieved.

[Suprachoroidal Hydrogel Buckle - a New Minimal-Invasive Technique in Treatment of Rhegmatogenous Retinal Detachment]. / Suprachoroidale Hydrogelplombe ­ eine neue minimalinvasive Technik zur Behandlung der rhegmatogenen Netzhautablösung.

The suprachoroidal hydrogel buckle is a new, simple and safe procedure for the treatment of rhegmatogenous retinal detachment. This technique combines the advantages of modern vitrectomy and classic buckling surgery. Placing the suprachoroidal buckle is possible as a stand-alone procedure or in addition to vitrectomy. The cross-linked hyaluronic acid seems to be the ideal agent for the suprachoroidal buckle with a buckling effect over 8 weeks. We need further investigations with long-term results.

[Suprachoroidal hydrogel buckling]. / Suprachoroidale Hydrogelplombe.

Suprachoroidal hydrogel buckling is a simple and safe procedure for the treatment of rhegmatogenous retinal detachment. The advantages of modern vitrectomy and classical buckling surgery are combined in this surgical approach. Suprachoroidal buckling can be performed as a stand-alone procedure or in addition to vitrectomy. Cross-linked hyaluronic acid with a resorption time of up to 8 weeks is a suitable agent for this technique. Further studies will help to establish suprachoroidal buckling as a surgical procedure for treatment of retinal detachment.

[Novel vitreous body replacement with hydrogel?] / Neuer Glaskörperersatz mit Hydrogel?

Although the surgical treatment of rhegmatogenous retinal detachment has advanced, there still is a significant risk of redetachment and a slow visual rehabilitation due to the use of endotamponades. Hydrophobic tamponades act via a buoyancy vector causing an accumulation of proinflammatory cytokines opposite the buoyancy vector. So far, the use of hydrophilic endotamponades is very promising because they represent a possible solution for the abovementioned problems of surgical ablation. This article presents the current developments in this field.

[Acute monocular loss of vision : Differential diagnostic considerations apart from the internistic etiological clarification]. / Akuter monokularer Visusverlust : Differenzialdiagnostische Überlegung abseits der internistisch-ätiologischen Abklärung.

We report the case of acute painless monocular loss of vision in a 53-year-old man. An interdisciplinary etiological evaluation remained without pathological findings with respect to arterial branch occlusion. A reevaluation of the patient history led to a possible association with the administration of phosphodiesterase type 5 inhibitor (PDE5 inhibitor). A critical review of the literature on PDE5 inhibitor administration with ocular participation was performed.

Efficacy of Vitrectomy Combined with Subretinal rtPA Injection with Gas or Air Tamponade.

Background Functional and anatomical outcome after vitrectomy with rtPA combined with gas or air tamponade. Patients and methods Retrospective analysis of pseudophakic patients treated with subretinal rtPA and gas or air tamponade. The primary endpoint was displacement of haemorrhage six months after surgery. The secondary endpoints were visual acuity (BCVA), haemorrhage diameter (MHD) and central macular thickness (CMT), as measured by SD-OCT. Results 53 of 85 eyes were pseudophakic. 27 of these eyes were treated with air tamponade and 26 with gas tamponade. For patients with air tamponade, the mean BCVA improved from 20/530 to 20/355 (p = 0.01). MHD and CMT decreased from 6386 ± 2281 µm to 3805 ± 2397 µm (p < 0.001) and 895 ± 592 µm to 532 ± 386 µm (p < 0.001), respectively. For patients with gas tamponade, the mean BCVA improved only slightly, from 20/471 to 20/394 (p = 0.17). MHD and CMT exhibited statistically significant decreases from 6759 ± 1773 µm to 3525 ± 1548 µm (p < 0.001) and 1089 ± 587 µm to 537 ± 251 µm (p < 0.001), respectively. Conclusions Vitrectomy with subretinal rtPA injection has strong functional and anatomical effects on submacular haemorrhages with both gas and air tamponade.

[Intramuscular depot steroids : Possible treatment of postsurgical cystoid macula edema with steroid response?] / Intramuskuläres Depot-Steroid : Therapieoption bei postoperativem zystoidem Makulaödem mit Steroidresponse?

We report on a patient with postsurgical cystoid macular edema (CME) after phacoemulsification and multifocal intraocular lens (MIOL) implantation. At first, there was a very good reaction to intravitreal triamcinolone, inducing complete regression of the edema without increasing intraocular pressure (IOP). One year later the patient suffered from retinal detachment and was treated with vitrectomy, laser, and gas tamponade. Afterward, he developed macular pucker with edema. After surgical treatment with pucker peeling and intravitreal triamcinolone, the patient showed a steroid response and an increase IOP. Postoperatively, there was a recurrence of CME. A coincidental administration of a steroid injection intramuscularly by the general practitioner achieved a prompt reduction of the CME without increasing IOP. This case shows that an initially good reaction to triamcinolone without increasing IOP does not rule out a future steroid response, and that a potential treatment option for CME in patients with a known steroid response could consist of intramuscularly injected steroids.

[Artificial vitreous body: Strategies for vitreous body substitutes]. / Künstlicher Glaskörper : Strategien zum Glaskörperersatz.

BACKGROUND: Although numerous advances have been made in technology and techniques of pars plana vitrectomy and tamponades, there are still unsolved issues, such as proliferative vitreoretinopathy (PVR), multiple retinal breaks and persistent hypotonia. All available internal tamponades (e.g, gases, oils and fluorocarbons) are hydrophobic, so they approximate the neurosensory retina to the retinal pigment epithelium due to buoyant force and surface tension. Even though these tamponade materials exhibit various beneficial attributes in the clinical application, the hydrophobic nature has clear disadvantages and compartmentalization and significant incidence of PVR development still occur. RESULTS AND CONCLUSION: An ideal vitreous body substitute should mimic the native human vitreous body, in both form and function. Vitreous body substitutes, such as hydrogels fulfill the biophysical needs in a similar manner to the natural vitreous body by providing an internal tamponade effect through swelling pressure and viscosity. New approaches range from cross-linked semisynthetic to synthetic polymers. These hydrogels have a good biocompatibility, optical clarity, a refractive index and rheological properties that are similar to the natural human vitreous body and are able to act as anti-adhesive and anti-migrative agents and can therefore reduce PVR. Furthermore, hydrogels could also serve as controlled-release drug-delivery systems for anti-proliferative, neuroprotective or nutritive drugs.

[Vitreous body and retinal vein occlusion]. / Glaskörperstatus und retinaler Venenverschluss.

PURPOSE: The aim of this study was to evaluate whether the adhesion status of the posterior vitreous cortex (PVC) towards the internal limiting membrane (ILM) has an impact on the development of retinal vein occlusion (RVO). MATERIAL AND METHODS: In a retrospective analysis the operation protocols of 238 eyes receiving pars plana vitrectomy (ppV) and radial optic neurotomy (RON) for central retinal vein occlusion (CRVO) or ppV in combination with arteriovenous sheathotomy (AVS) for branch retinal vein occlusion (BRVO) were evaluated with respect to the intraoperative status of posterior vitreous body adhesion. The results were compared with age-matched healthy controls. RESULTS: In this study 145 eyes (60.9 %) suffering from CRVO and 93 eyes (39.1 %) diagnosed with BRVO were included. In eyes with CRVO and BRVO the posterior vitreous cortex (PVC) was significantly more often attached (126 eyes, 86.9 % and 89 eyes, 95.7 %, respectively) than completely detached (19 eyes, 13.1 % and 4 eyes, 4.3 %, respectively, in each case p < 0.001). In the age groups between 70 and 79 years as well as between 80 and 89 years the PVC was significantly more often attached in both RVO entities in comparison to age-matched healthy controls (CRVO 70-79 years, p = 0.001 and 80-89 years, p = 0.002 and BRVO 70-79 years, p < 0.001, 80-89 years, p = 0.011). In eyes from the age group between 65 and 69 years (of age) the PVC was not significantly more often attached in comparison to healthy controls (CRVO p = 0.334 and BRVO p = 0.114). CONCLUSION: According to these findings posterior vitreous adhesion is an independent risk factor for the development of retinal vein occlusion among patients aged 70 years or older.

[Secondary intraocular lens implantation using scleral suture fixation]. / Sekundäre Intraokularlinsenimplantation von Sklera-nahtfixierten Intraokularlinsen.

Scleral suture fixation is one of several techniques used for secondary lens implantation in cases of inadequate capsular support for which many variations have been published. A transscleral suture can be accomplished using either an external or internal approach. The lens can be implanted using an injector with large incisions for unfolding lenses or also via small self-sealing incisions. Episcleral fixation of the suture can be accomplished by protecting the knot under scleral flaps, intrascleral rotation of the knot and using sclerocorneal pockets or scleral grooves. The intrascleral Z-suture with five intrascleral passes of the suture is a knotless technique providing several advantages.

[Clinical results after Descemet membrane endothelial keratoplasty]. / Klinische Ergebnisse nach Descemet-Membran-Endothelzelltransplantation.

BACKGROUND: Diseases of the endothelial cell layer represent a common indication for perforating keratoplasty. In recent years posterior lamellar keratoplasty techniques have undergone a revival. The latest and most promising advancement is the isolated transplantation of Descemet's membrane (DM) with the endothelial layer - also known as Descemet's membrane endothelial keratoplasty (DMEK). This study was conducted to evaluate the clinical results of our DMEK patients and to assess the perioperative management. PATIENTS AND METHODS: 70 patients (75 eyes) with endothelial cell decompensation (50 eyes with Fuchs endothelial dystrophy and 25 eyes with bullous keratopathy) had undergone DMEK surgery at the Tübingen Eye Clinic. Visual acuity, refractive error, intraocular pressure, slit lamp examination, pachymetry and endothelial cell density were considered and re-examined at intervals of 1, 2 and 4 weeks postoperatively with further 3 monthly follow-ups. RESULTS: The mean age of the 45 female and 25 male patients at time of surgery was 73 years (36 to 91 years). The mean follow-up period was 12.1 months. One patient received an autologous and 4 patients a triple procedure. The mean preoperative LogMAR visual acuity was 0.87 ± 0.41. After 1 week a LogMAR visual acuity of 0.82 ± 0.4 was observed (p = 0.544). At the final examination the LogMAR visual acuity was 0.32 ± 0.35 (p < 0.001, a highly significant result as compared to the preoperative value). The most common and important complication was the dislocation of the transplant which was seen in 23 eyes (31 %). The use of intracameral air pressurisation re-appositioned most transplants. Complications such as highly elevated intraocular pressure, epithelial inclusions or endophthalmitis were not noted in any patient. CONCLUSIONS: DMEK surgery lead to a significant visual rehabilitation in a majority of patients in a relatively short postoperative period. It may be considered as a gold standard to treat isolated endothelial diseases as has been implicated by other studies. Thus, the safety and efficiency of this new type of posterior lamellar keratoplasty technique has been confirmed.

[Subretinal surgery for massive hemorrhage]. / Subretinale Chirurgie bei Massenblutung.

Subretinal massive hemorrhage due to exsudative age-related macular degeneration remains a challenging field for submacular surgery. While small hemorrhages can be easily displaced by various pneumatic techniques the correct strategy for massive subretinal bleeding is still under debate. This article reviews the different techniques for these severe cases and assesses the visual prognosis and potential complications. In general, invasive techniques for extraction of the neovascular membrane with or without macular translocation or retinal pigment epithelium (RPE) choroidal patch translocation have the potential to achieve visual improvement. However, the risk of severe visual loss due to subsequent complications has to be considered. Far better visual results with a significantly lower complication rate can be achieved by a 2-step strategy using rTPA-assisted dissolution of the hemorrhage and evacuation of the liquefied clot via a small retinotomy.