A.M. Schild

Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients.

Purpose:  To test whether patients aged ≥80 years can safely and successfully apply eyedrops from a single‐use eyedrop container without support, and to compare the results with those of younger patients using single‐use containers and older patients using standard eyedrop bottles.

A Novel Large In-Frame Deletion within the CACNA1F Gene Associates with a Cone-Rod Dystrophy 3-Like Phenotype

Cone-rod dystrophies (CORDs) represent a heterogeneous group of monogenic diseases leading to early impairment of vision. The majority of CORD entities show autosomal modes of inheritance and X-linked traits are comparably rare. So far, three X-chromosomal entities were reported (CORDX1, -X2 and -X3). In this study, we analysed a large family of German origin with solely affected males over three generations showing a CORDX-like phenotype. Due to the heterogeneity of cone-rod dystrophies, we performed a combined linkage and X-exome sequencing approach and identified a novel large intragenic in-frame deletion encompassing exons 18 to 26 within the CACNA1F gene. CACNA1F is described causative for CORDX3 in a single family originating from Finland and alterations in this gene have not yet been reported in other CORDX pedigrees. Our data independently confirm CACNA1F as the causative gene for CORDX3-like phenotypes and detailed clinical characterization of the family expands the knowledge about the phenotypic spectrum of deleterious CACNA1F alterations.

Reboundtonometrie und Applanationstonometrie während einer Narkoseuntersuchung beim kindlichen Glaukom

BACKGROUND A comparison of intraocular pressure (IOP) in cases of infantile glaucoma during general anesthesia was carried out by measurement with the iCare rebound tonometer (RBT) and a handheld applanation tonometer (Perkins). METHODS A total of 45 eyes from pediatric patients with childhood glaucoma were included in this prospective trial. Bland-Altman plots and linear regression were used for statistical analysis. RESULTS In almost two thirds of the eyes the difference between RBT and Perkins was 2 mmHg or less. A systemic bias of 1.96 mmHg and a 95% confidence interval of -3.35 to 7.26 was detected. Linear regression of the Bland-Altman data showed a proportional error (gradient=0.16; r(2)=0.23; p<0.01). CONCLUSIONS The iCare rebound tonometer is useful during general anesthesia in cases of childhood glaucoma. It provides comparable IOP values to applanation tonometry with a tendency to record higher values.

SDOCT Thickness Measurements of Various Retinal Layers in Patients with Autosomal Dominant Optic Atrophy due to OPA1 Mutations

Purpose. To specify thickness values of various retinal layers on macular spectral domain Optical Coherence Tomography (SDOCT) scans in patients with autosomal dominant optic atrophy (ADOA) compared to healthy controls. Methods. SDOCT volume scans of 7 patients with ADOA (OPA-1 mutation) and 14 healthy controls were quantitatively analyzed using manual grading software. Mean thickness values for the ETDRS grid subfields 5–8 were calculated for the spaces neurosensory retina, retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), a combined space of inner plexiform layer/outer plexiform layer/inner nuclear layer (IPL+INL+OPL), and a combined space of outer nuclear layer/photoreceptor layers (ONL+PL). Results. ADOA patients showed statistically significant lower retinal thickness values than controls (P < 0.01). RNFL (P < 0.001) and GCL thicknesses (P < 0.001) were significantly lower in ADOA patients. There was no difference in IPL+INL+OPL and in ONL+PL thickness. Conclusion. Manual subanalysis of macular SDOCT volume scans allowed detailed subanalysis of various retinal layers. Not only RNFL but also GCL thicknesses are reduced in the macular area of ADOA patients whereas subjacent layers are not involved. Together with clinical findings, macular SDOCT helps to identify patients with suspicion for hereditary optic neuropathy before genetic analysis confirms the diagnosis.

Rebound tonometry and applanation tonometry during narcosis investigation of pediatric glaucoma

BACKGROUND A comparison of intraocular pressure (IOP) in cases of infantile glaucoma during general anesthesia was carried out by measurement with the iCare rebound tonometer (RBT) and a handheld applanation tonometer (Perkins). METHODS A total of 45 eyes from pediatric patients with childhood glaucoma were included in this prospective trial. Bland-Altman plots and linear regression were used for statistical analysis. RESULTS In almost two thirds of the eyes the difference between RBT and Perkins was 2 mmHg or less. A systemic bias of 1.96 mmHg and a 95% confidence interval of -3.35 to 7.26 was detected. Linear regression of the Bland-Altman data showed a proportional error (gradient=0.16; r(2)=0.23; p<0.01). CONCLUSIONS The iCare rebound tonometer is useful during general anesthesia in cases of childhood glaucoma. It provides comparable IOP values to applanation tonometry with a tendency to record higher values.

Trabecular meshwork bypass surgery for glaucoma

ZusammenfassungDie trabekuläre Bypasschirurgie hat zum Ziel, eine direkte chirurgische Verbindung von Vorderkammer mit dem Schlemm-Kanal zu erzielen, um dadurch die Abflussleichtigkeit im Glaukomauge zu verbessern. Neben rein mechanischen Verfahren kann der trabekuläre Bypass mittels Laserverfahren, bipolarem Kauter oder durch Mikroimplantate erzielt werden. Aufgrund des niedrigen Risikoprofils ist ein solches Verfahren insbesondere bei der kombinierten Katarakt-Glaukom-Chirurgie sinnvoll. Als alleiniges Verfahren bei Glaukomaugen, die einen niedrigen Zieldruck brauchen, ist allerdings die Trabekulektomie mit Mitomycin C der trabekulären Bypasschirurgie in der Regel deutlich überlegen.AbstractThe outflow facility of the glaucomatous eye can be significantly enhanced by opening Schlemm’s canal to the anterior chamber. Surgical options for this approach include mechanical procedures, laser surgery, microbipolar cauterization and intracanalicular microstents. Especially in the area of combined cataract-glaucoma surgery these procedures are valuable options owing to their limited intraoperative and postoperative risk profiles. However, trabeculectomy with mitomycin C must still be regarded as the superior surgical option for glaucoma, which requires a low target pressure if combined surgery is unnecessary.The outflow facility of the glaucomatous eye can be significantly enhanced by opening Schlemms canal to the anterior chamber. Surgical options for this approach include mechanical procedures, laser surgery, microbipolar cauterization and intracanalicular microstents. Especially in the area of combined cataract-glaucoma surgery these procedures are valuable options owing to their limited intraoperative and postoperative risk profiles. However, trabeculectomy with mitomycin C must still be regarded as the superior surgical option for glaucoma, which requires a low target pressure if combined surgery is unnecessary.

Trabekuläre Bypasschirurgie beim Glaukom

ZusammenfassungDie trabekuläre Bypasschirurgie hat zum Ziel, eine direkte chirurgische Verbindung von Vorderkammer mit dem Schlemm-Kanal zu erzielen, um dadurch die Abflussleichtigkeit im Glaukomauge zu verbessern. Neben rein mechanischen Verfahren kann der trabekuläre Bypass mittels Laserverfahren, bipolarem Kauter oder durch Mikroimplantate erzielt werden. Aufgrund des niedrigen Risikoprofils ist ein solches Verfahren insbesondere bei der kombinierten Katarakt-Glaukom-Chirurgie sinnvoll. Als alleiniges Verfahren bei Glaukomaugen, die einen niedrigen Zieldruck brauchen, ist allerdings die Trabekulektomie mit Mitomycin C der trabekulären Bypasschirurgie in der Regel deutlich überlegen.AbstractThe outflow facility of the glaucomatous eye can be significantly enhanced by opening Schlemm’s canal to the anterior chamber. Surgical options for this approach include mechanical procedures, laser surgery, microbipolar cauterization and intracanalicular microstents. Especially in the area of combined cataract-glaucoma surgery these procedures are valuable options owing to their limited intraoperative and postoperative risk profiles. However, trabeculectomy with mitomycin C must still be regarded as the superior surgical option for glaucoma, which requires a low target pressure if combined surgery is unnecessary.The outflow facility of the glaucomatous eye can be significantly enhanced by opening Schlemms canal to the anterior chamber. Surgical options for this approach include mechanical procedures, laser surgery, microbipolar cauterization and intracanalicular microstents. Especially in the area of combined cataract-glaucoma surgery these procedures are valuable options owing to their limited intraoperative and postoperative risk profiles. However, trabeculectomy with mitomycin C must still be regarded as the superior surgical option for glaucoma, which requires a low target pressure if combined surgery is unnecessary.

Reboundtonometrie und Applanationstonometrie während einer Narkoseuntersuchung beim kindlichen Glaukom@@@Rebound tonometry and applanation tonometry during narcosis investigation of pediatric glaucoma

BACKGROUND A comparison of intraocular pressure (IOP) in cases of infantile glaucoma during general anesthesia was carried out by measurement with the iCare rebound tonometer (RBT) and a handheld applanation tonometer (Perkins). METHODS A total of 45 eyes from pediatric patients with childhood glaucoma were included in this prospective trial. Bland-Altman plots and linear regression were used for statistical analysis. RESULTS In almost two thirds of the eyes the difference between RBT and Perkins was 2 mmHg or less. A systemic bias of 1.96 mmHg and a 95% confidence interval of -3.35 to 7.26 was detected. Linear regression of the Bland-Altman data showed a proportional error (gradient=0.16; r(2)=0.23; p<0.01). CONCLUSIONS The iCare rebound tonometer is useful during general anesthesia in cases of childhood glaucoma. It provides comparable IOP values to applanation tonometry with a tendency to record higher values.

Epithelimplantationszysten – 48 Jahre nach Bulbuspenetration@@@Epithelial downgrowth 48 years after penetrating eye trauma

BACKGROUND Epithelial invasion is a rare but severe complication after penetrating eye trauma or intraocular surgery. Cystic ingrowth can occur even after decades. CASUISTICS A 53-year-old woman developed two epithelial cysts in the left eye 48 years after penetrating trauma with a dart. After primary wound closure the intraocular status remained stable for 48 years before symptoms appeared. Preoperative diagnostics (e.g. ultrasound biomicroscopy) detected the origin of the epithelial downgrowth from an intracorneal cyst. Histology confirmed the clinical suspicion of a cystic epithelial ingrowth. CONCLUSION The latency of our case is the longest reported interval between penetrating eye trauma and appearance of epithelial ingrowth to be described in detail. Ultrasound biomicroscopy is able to detect the origin of epithelial ingrowth.

Epithelial downgrowth 48 years after penetrating eye trauma

BACKGROUND Epithelial invasion is a rare but severe complication after penetrating eye trauma or intraocular surgery. Cystic ingrowth can occur even after decades. CASUISTICS A 53-year-old woman developed two epithelial cysts in the left eye 48 years after penetrating trauma with a dart. After primary wound closure the intraocular status remained stable for 48 years before symptoms appeared. Preoperative diagnostics (e.g. ultrasound biomicroscopy) detected the origin of the epithelial downgrowth from an intracorneal cyst. Histology confirmed the clinical suspicion of a cystic epithelial ingrowth. CONCLUSION The latency of our case is the longest reported interval between penetrating eye trauma and appearance of epithelial ingrowth to be described in detail. Ultrasound biomicroscopy is able to detect the origin of epithelial ingrowth.