M. Maier

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up – The SOLO study

Purpose: To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study.

The introduction of a new robot for assistance in ophthalmic surgery

This paper introduces the design and development of a new robotic system to assist surgeons performing ophthalmic surgeries. The robot itself is very compact and similar to an average human hand in size. Its primary application is intraocular micromanipulation in order to overcome the existing challenges in treatment of diseases like Retinal Vein Occlusion (RVO). The novel hybrid mechanism designed for this robot allows microscale motions and is stable in the presence of vibrations common in operation room (OR). The robotic system can be easily integrated into standard operation rooms and does not require modification of conventional surgical tools. This compact microsurgical system is suitable for mounting on the patients head and thereby, solves the problem of patient motion. The compatibility of the robotic system with a real world surgical setup was evaluated and confirmed in this work.

Endoskopisch kontrollierte Chirurgie mit dem Mikrobohrer und Intubation der Tränenwege

ZusammenfassungHintergrund. Die operative Versorgung der Tränenwege erfolgte traditionell ohne endoskopische Hilfsmittel. Für die Dakryoendoskopie benutzten wir früher eine Zwei-Wege-Sonde mit einem Kanal für das Miniendoskop und einem Spülkanal. Beschrieben wird der Einsatz einer Drei-Wege-Sonde (Vitroptik T®) mit einem Kanal für die Mikrooptik, einem Spülkanal und einem Arbeitskanal für den Mikrobohrer. Methoden. Für die minimal invasive Tränenwegchirurgie setzen wir ein 1,1 mm Drei-Wege-Endoskop (Vitroptik T®) mit einem zusätzlichen Kanal für einen Mikrobohrer ein. Wir berichten über unsere ersten Erfahrungen und die Ergebnisse von 8 Patienten mit Tränenwegstenose, die wir mit dem endoskopischen Mikrobohrer und anschließender Intubation mit einem Silikonschläuchlein behandelten. Ein Patient zeigte eine Restenose nach externer Dakryozystorhinostomie (DCR), 7 Patienten hatten kurzstreckige Stenosen im Ductus nasolacrimalis. Ergebnisse. Die Dakryoendoskopie erlaubt neben der direkten Beurteilung der Schleimhautverhältnisse die Lokalisation von Stenosen und den Nachweis von Konkrementen. Mit dem 3-Kanal-Endoskop (Vitroptik T®) ist eine endoskopisch kontrollierte Chirurgie der ableitenden Tränenwege möglich. 3 Monate nach dem Eingriff zeigten 6 Patienten (75%) eine Durchgängigkeit der ableitenden Tränenwege bei liegendem Silikonschläuchlein. Diese Patienten hatten keine Epiphora mehr. Auch der Patient mit einer Restenose war symptomfrei. Schlussfolgerungen. Die Dakryoendoskopie und die endoskopisch kontrollierte Mikrochirurgie der ableitenden Tränenwege gewährleisten ein atraumatisches Vorgehen und eine minimal invasive Chirurgie. Das Endoskop Vitroptik T® mit dem Mikrobohrer erlaubt die Mikrochirurgie unter endoskopischer Sicht. Mögliche Indikationen für den Mikrobohrer stellen kurzstreckige Stenosen und Restenosen nach externer DCR dar.AbstractPurpose. Operative procedures to manage lacrimal outflow obstruction were made traditionally without endoscopic assistance. For dacryoendoscopy we previously used a 0.5-mm endoscope with a special wash cannula. We now use the microendoscope Vitroptic T for dacryoendoscopy and for endoscopically controlled surgery with a microdrill. Methods. In an attempt to perform microinvasive lacrimal surgery we use a 1.1-mm endoscope (Vitroptik T) with a wash cannula, a channel for the microoptic and a channel for a microdrill. We report on our initial experiences and on the results of eight patients with stenosis of the lacrimal outflow system who were treated with an endoscopic microdrill and silicone tubing. One patient had lacrimal stenosis after external dacryocystorhinostomy (DCR), and seven patients showed punctual stenosis in the nasolacrimal duct. Results. Using the dacryoendoscope (Vitroptic T) we were able to visualize pathologic changes of the lacrimal outflow system. Intraoperative situations during dacryoendoscopy are demonstrated. The Vitroptic T allows dacryoendoscopy and endoscopically controlled surgery of the lacrimal drainage system. Three months after surgery in six patients (75%) the lacrimal outflow system was patent with the silicone tube in place, and these patients had no epiphora. The patient with re-stenosis after external DCR showed patency. Conclusions. Dacryoendoscopy and endoscopic controlled surgery of the lacrimal drainage system enables atraumatic and minimally invasive surgery. The Vitroptik T with the microdrill allows endoscopically controlled microsurgery. Possible indications for the microdrill are punctual stenosis and re-stenosis after external DCR.

Dynamic retinal vessel response to flicker in age-related macular degeneration patients before and after vascular endothelial growth factor inhibitor injection

Purpose:  Retinal vessel responses to flickering light are different in various systemic and ocular diseases and can be improved after successful therapy. We investigated retinal vessel response to flickering light in age‐related macular degeneration (AMD) patients before and after treatment with a single intravitreal bevacizumab (Avastin®) injection.

Changes in the foveal microstructure after intravitreal bevacizumab application in patients with retinal vascular disease

Purpose To investigate changes in the area of the foveal avascular zone (FAZ) in patients with retinal vascular disease. Patients and methods This retrospective, consecutive study examined 53 eyes of 53 patients with macular edema due to branch retinal vein occlusion in 25 patients (47.2%) and nonproliferative diabetic retinopathy in 28 patients (52.8%). The macular edema was treated with an intravitreal injection of 0.05 mL equal to 1.25 mg bevacizumab. Before and 6–8 weeks after the injection, best corrected visual acuity, slit lamp biomicroscopy of the anterior segment and fundus, optical coherence tomography, and fluorescein angiography were conducted. The FAZ was manually circumscribed on early-phase angiography images and the area of the FAZ was measured. Results The preoperative overall mean FAZ area was 0.327 ± 0.126 mm2 (median 0.310 mm2). At the control consultation, the overall mean area was significantly larger (0.422 ± 0.259 mm2; median 0.380 mm2; P < 0.001). In the nonproliferative diabetic retinopathy subpopulation, the mean area was 0.361 ± 0.129 mm2 (median 0.330 mm2) before bevacizumab application and 0.434 mm2 at the follow-up visit (mean increase 0.071 mm2/19.7%). In the branch retinal vein occlusion group, the baseline FAZ area was 0.290 ± 0.115 mm2 and 0.407 ± 0.350 mm2 at follow-up (median 0.330 mm2; mean increase 0.117 mm2/40.3%). No cases of severe operation-associated complications were observed. Conclusion The results confirm the safety of intravitreal bevacizumab injection in patients with macular edema due to nonproliferative diabetic retinopathy and branch retinal vein occlusion. The enlargement of the FAZ could be equivalent to an increase in retinal ischemia. These results may be transient; a potential vascular risk, however, when applying antivascular endothelial growth factor therapy in eyes with preexistent vascular disease must be considered.

Mineralokortikoidrezeptorantagonisten als Therapieoption bei akuter und chronischer Chorioretinopathia centralis serosa

BACKGROUND It is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR. METHODS AND RESULTS Experimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR. CONCLUSION For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.ZusammenfassungHintergrundDie Ätiologie der Chorioretinopathia centralis serosa (CCS) ist nicht abschließend geklärt. Der Zusammenhang zwischen endogenen und exogenen Glukokortikoidkonzentrationen und dem Auftreten einer CCS ist hinreichend bekannt, allerdings wird erst seit Kurzem ein möglicher neuer zugrunde liegender Pathomechanismus diskutiert. Methoden und ErgebnisseUntersuchungen zeigten, dass die Überaktivierung mineralokortikoider Rezeptoren der Choroidea bei der Pathogenese der CCS eine Rolle spielt. Diese Überaktivierung führt über eine intrazelluläre Signalkaskade in der vaskulären Endothelzelle zur Erhöhung der Permeabilität. Die spezifische medikamentöse Blockade mineralokortikoider Rezeptoren war in einer Pilotstudie erfolgreich. Erste Studien und eine eigene Fallserie ergaben einen funktionellen und morphologischen Therapieerfolg mit Mineralokotikoidrezeptorantagonisten. Allerdings handelt es sich bislang um unkontrollierte Beobachtungsstudien, und Spontanbesserungen sind gerade bei akuter CCS nicht auszuschließen.SchlussfolgerungEs sollten daher dringend kontrollierte prospektive klinische Studien erfolgen, da Spironolacton® oder Eplerenon als Therapieansatz insbesondere für Patienten mit einer chronischen CCS ohne Besserungstendenz ein hilfreicher Baustein in der Behandlung sein könnte.AbstractBackgroundIt is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR. Methods and resultsExperimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR. ConclusionFor further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.

Mineralocorticoid receptor antagonists as treatment option for acute and chronic central serous chorioretinopathy

BACKGROUND It is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR. METHODS AND RESULTS Experimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR. CONCLUSION For further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.ZusammenfassungHintergrundDie Ätiologie der Chorioretinopathia centralis serosa (CCS) ist nicht abschließend geklärt. Der Zusammenhang zwischen endogenen und exogenen Glukokortikoidkonzentrationen und dem Auftreten einer CCS ist hinreichend bekannt, allerdings wird erst seit Kurzem ein möglicher neuer zugrunde liegender Pathomechanismus diskutiert. Methoden und ErgebnisseUntersuchungen zeigten, dass die Überaktivierung mineralokortikoider Rezeptoren der Choroidea bei der Pathogenese der CCS eine Rolle spielt. Diese Überaktivierung führt über eine intrazelluläre Signalkaskade in der vaskulären Endothelzelle zur Erhöhung der Permeabilität. Die spezifische medikamentöse Blockade mineralokortikoider Rezeptoren war in einer Pilotstudie erfolgreich. Erste Studien und eine eigene Fallserie ergaben einen funktionellen und morphologischen Therapieerfolg mit Mineralokotikoidrezeptorantagonisten. Allerdings handelt es sich bislang um unkontrollierte Beobachtungsstudien, und Spontanbesserungen sind gerade bei akuter CCS nicht auszuschließen.SchlussfolgerungEs sollten daher dringend kontrollierte prospektive klinische Studien erfolgen, da Spironolacton® oder Eplerenon als Therapieansatz insbesondere für Patienten mit einer chronischen CCS ohne Besserungstendenz ein hilfreicher Baustein in der Behandlung sein könnte.AbstractBackgroundIt is well known that central serous chorioretinopathy (CSCR) is triggered by endogenous and exogenous glucocorticoids but the exact pathomechanism is not completely understood. According to the results of previous studies overactivation of mineralocorticoid receptors may play a decisive role in the pathogenesis of CSCR. Methods and resultsExperimental studies have shown that overactivation of mineralocorticoid receptors in endothelial cells of the choroid induces increased permeability. In a pilot study inhibition of mineralocorticoid receptors was successful in treating CSCR. This article reports about the use of spironolactone in the treatment of CSCR. In this observational case series spectral-domain optical coherence tomographv (SD-OCT) showed either reduction or complete reabsorption of subretinal fluid. In pilot studies and in this case series inhibition of mineralocorticoid receptors as a therapeutic option was effective and safe; however, the efficacy is difficult to distinguish from spontaneous recovery, especially in acute CSCR. ConclusionFor further assessment of this treatment controlled clinical trials are urgently required as this therapy would offer a new approach for patients with chronic CSCR and no tendency towards recovery.

Nine‐month results of intravitreal bevacizumab versus triamcinolone for the treatment of diffuse diabetic macular oedema: a retrospective analysis

Objective:  To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME).

Clinical Results with the Light Adjustable Intraocular Lens After Cataract Surgery

PURPOSE The accuracy of intraocular lens (IOL) calculation is limited by the variation of the measurement of corneal power, axial length, anterior chamber depth, and effective postoperative lens position. Therefore, IOL predictability is limited. The aim of this study was to evaluate the performance of the novel light adjustable lens (LAL, Calhoun Vision). METHODS Ten eyes with cataracts (seven patients) were included. After standard phacoemulsification, the LAL was implanted. Two to 3 weeks after surgery, all IOL adjustments had been completed. Preoperatively, pre-adjustment, pre-lock-in, and 1 month post-lock-in, a full ophthalmic examination including objective (autorefraction) and subjective refraction (ie, manifest uncorrected visual acuity [UCVA] and manifest best spectacle-corrected visual acuity [BSCVA]) and topography were performed. RESULTS All cataract surgeries were performed with no complications. Two weeks after surgery, the mean refraction was +0.78+/-0.79 diopters (D). After adjustment and lock-in, the refraction was -0.07+/-0.21 D. In 4 of 10 eyes, second adjustments were necessary. One month after surgery, all patients were within +/-0.50 D of the intended refraction. Preoperatively, the cylinder was 0.88+/-0.77 D, but was reduced after adjustments to 0.15+/-0.20 D. Mean UCVA was 1.02, and all eyes gained at least two lines on the Snellen visual acuity test (ie, BSCVA) after surgery. CONCLUSIONS The LAL is a new IOL with the ability to correct up to 2.00 D of sphere and cylinder after implantation. Our first clinical results are promising and indicate effective safety and stability.

Photodynamic therapy with verteporfin combined with intravitreal injection of bevacizumab for occult and classic CNV in AMD

PURPOSE The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of ranibizumab (0.5 mg) in occult CNV with recent disease progression and in classic choroidal neovascularization (CNV) due to AMD. METHODS In a pilot study in 28 patients (17 classic, 11 occult CNV) an intravitreal injection of ranibizumab was administered within 12 to 24 hours after standard PDT, followed by 2 injections of ranibizumab after 1 and 2 months. Before as well as 3 and 6 months after treatment visual acuity, OCT examinations (retinal thickness) and fluorescein angiography were performed. RESULTS Mean visual acuity was significantly improved compared to baseline after 3 months (VA baseline 20/80, after 3 months 20/50, and 20/63 after 6 months). We found no choroidal hypoperfusion and no RPE rip. OCT and fluorescein angiography in patients with occult and classic choroidal neovascularisation after the combination therapy showed a reduced retinal thickness (baseline: 307 microm, after 1 month: 210 microm, after 3 months: 228 microm and after 6 months 281 microm) and a reduction of leakage compared to baseline. CONCLUSIONS Photodynamic therapy combined with injection of intravitreal ranibizumab was well tolerated and is effective. We found a stabilisation of VA in 96% of patients. Our short-term results are very promising. Further studies are necessary to show the long-term effect of the PDT and anti-VEGF combination therapy.