key: cord-012518-ncrdwtdg
authors: nan
title: Abstractband DOG 2020
date: 2020-08-24
journal: Ophthalmologe
DOI: 10.1007/s00347-020-01197-0
sha: 
doc_id: 12518
cord_uid: ncrdwtdg

nan

Glaukom S65

Kornea / Konjunktiva S92 Linse S100

Pathologie / Anatomie S102 Plastische Chirurgie, Lider, Orbita S106

Refraktive Chirurgie S112

Retina / RPE / Aderhaut / Glaskörper S151 Sehbahn / Gehirn / Neuro-Ophthalmologie S155 Strabologie / Kinderophthalmologie S159 Trauma S159

Tumoren, Hinterabschnitt S162

Tumoren, Vorderabschnitt und sonstige S166 Uvea, Iris, Pupille, Kammerwinkel S171 Verkehrsophthalmologie S171

Versorgungsforschung, Gesundheitsökonomie und -politik S177

Die Abstracts sind zunächst nach Subspezialitäten sortiert und dann alphabetisch nach Erstautoren.

liegend. Beidseits gingen von der Papille nach nasal ausgeprägte Atrophien und Pigmentepithelverdichtungen im Sinne von Knochenkörperchen aus. In der Fundusautofluoreszenz (FAF) zeigte sich in diesen Bereichen eine ausgeprägt reduzierte FAF, umgeben von einem Saum erhöhter FAF. Die SD-OCT der Makula ergab eine regelrechte foveale Senke und Struktur, die OCT-Analyse der Papille eine normale retinale Nervenfaserschicht. In der kinetischen Perimetrie (OCTOPUS 900, Fa. Haag-Streit Diagnostics, 90° Bereich) stellte sich beidseits ein keilförmiges Skotom der Marke III4 nach temporal superior dar, korrespondierend zu der Lage und Ausdehnung der betroffenen Netzhautareale. Im multifokalen Elektroretinogramm fanden sich normwertige Amplituden. Im photopischen Ganzfeld-Elektroretinogramm (ERG) waren die a-und b-Welle leicht reduziert. Flicker und OPS waren unauffällig. Die skotopischen ERG Antworten waren vor allem in der b-Welle mittelgradig reduziert. Schlussfolgerung: Das Alagille-Syndrom kann zu Pigmentretinopathien mit Gesichtsfelddefekten führen, die einer Retinitis pigmentosa ähneln. Es handelt sich um den ersten beschriebenen Fall eines sektoriellen retinalen Befundes, der sich in bemerkenswerter Weise spiegelsymmetrisch darstellt. 

the first examination no correction of ocular magnification was applied.

In the second examination the previous focus value (of imaging 1) was applied as refraction data in the HEYEX-software to incorporate ocular magnification. The third examination was performed including anterior corneal curvature (as examined with ZEISS IOL Master 700) and objective refraction, the standard parameters in the HEYEX-software for ocular magnification correction. Segmentation of pRNFL, BMO and MRW was conducted with HEYEX-software. Intraclass correlation coefficient (ICC) were computed. Results: Twenty eyes of 12 participants were included in this ongoing study. The mean value of SE was -0. 6 Conclusions: Our preliminary data with small number of eyes showed that measurement of BMO area should incorporate biometric parameters for ocular magnification correction or at least the focus measurement as SE data. In contract, pRNFL and MRW measurements showed high agreement between the three measurements (no correction, using focus as SE data for ocular magnification correction or the standard method). sessed by patient-reported visual functioning together with relevant clinical parameters and visual field (VF) changes over a longer time period. Methods: 43 Patients with glaucomatous optic nerve damage were enrolled in this prospective longitudinal observational study. Assessment of QoL was obtained by patient-reported visual functioning using the Rasch-calibrated Person Estimate Glaucoma Activity Limitation 9 (GAL-9) questionnaire at baseline and after eight years together with best-corrected visual acuity (BCVA), VF data, and many other parameters. Results: BCVA of the better eye changed from logMAR 0,16 ± 0,22 to 0,21 ± 0,14 whereas there was change from 0,27 ± 0,25 to 1,39 ± 1,1 on the worse eye.

Values of GAL-9 changed from -2,39 ± 2,14 to -1,38 ± 2,78, according to a GQL sum score change from 79,17 ± 19,63 to 69,22 ± 27,95 . Mean deviation (MD) of the better eye changed from average -3,99 ± 4,55 to -4,83 ± 5,09 (p = 0,59) while the worse eye changed significantly from -8,86 ± 5,86 to -12,05 ± 8,07 (p = 0,02) . The change in PE-GAL9 showed a highly significant correlation with the MD at follow-up, especially with the worse eye (r = 0,43). The impact of the MD at follow up on QoL could also be well predicted in a regression model. Conclusion: QoL decreases significantly over time in glaucoma patients. Especially the changes of the visual field of the worse eye have a great impact on reported functioning. Careful treatment also of the eye with the worse glaucomatous damage is mandatory. 

Long-term IOP lowering and relationship to early IOP response after a single bimatoprost implant administration in a phase 1/2 study Klabe K. 1*, 2 , Chen M. 3 , Wang K. 3 , Liu J. 3 , Rivas M. 4 Aims: This analysis assessed early IOP response in a subset of patients in which a single administration of bim implant managed IOP for up to 24 months without use of rescue topical medication. Methods: In this prospective, paired-eye phase 1/2 study, bim implant was administered in the study eye; the fellow eye received once-daily topical bimatoprost 0.03 %. Subgroup analysis evaluated early IOP in patients without rescue/implant retreatment in the study eye who remained in the study through month 24 (long-term IOP responders) vs all other patients. Early IOP response was defined as IOP through 12 weeks (average IOP from Day 8 through Week 12) . Associations between early IOP lowering and long-term IOP responder status were explored using logistic regression analysis. Results: Of 75 enrolled patients, the 19 (25 %) long-term IOP responders demonstrated early IOP lowering after bim implant administration, with mean (SEM) IOP through 12 weeks of 15.8 (0.3) mmHg. Patients with rescue/retreatment or early exit (all other pts) had a mean (SEM) IOP through 12 weeks of 18.0 (0.5) mmHg (P < 0.001 vs long-term IOP responders). Baseline mean (SEM) IOPs for long-term IOP responders and all other patients were 23.4 (0.3) and 25. 8 (0.5) (OR 5.886 , >20 % vs ≤20 %). Conclusions: Early response to treatment can potentially be used to predict later response and guide clinical decision-making. The present phase 1/2 study results indicate an association between IOP at early timepoints after bim implant administration and long-term IOP lowering without additional treatment. CMV und RV AU betrifft vorwiegend jüngere und männliche Patienten, während VZV und HSV VAU hauptsächlich in älteren und weiblichen Patienten zu finden ist (p < 0.0001). n = 52 Patienten (19 %) zeigten eine glaukomatöse Schädigung, wovon n = 27 (10 % der Gesamtkohorte) einen glaukomchirurgischen Eingriff bei Progression benötigten. Es zeigte sich eine signifikante Drucksenkung von präoperativ 28,18 ± 9,32 mmHg auf 14,72 ± 6,67 mmHg 2 Jahre postoperativ (p = 0,004). In n = 10 Patienten (37 %, n = 9 MIGS + n = 1 TE) wurde ein zweiter operativer Eingriff notwendig. Schlussfolgerung: Verschiedene Virusentitäten der Uveitis anterior stellen unterschiedliche spezifische Risiken für die Entwicklung eines Glaukoms sowie notwendige Folgeoperationen dar. MIGS kann als Erstbehandlung in individuell ausgewählten Fällen eingesetzt werden. Das passende Verfahren sollte von einem erfahrenen Spezialisten sorgfältig ausgewählt werden. Eine filtrierende Glaukomoperation kann in VAU Patienten zur Augeninnendrucksenkung über einen längeren Zeitraum empfohlen werden.

Intraocular pressure 5 years after repeated anti-VEGF treatment for age-related macular degeneration 38

The paediatric glaucoma diagnosing ability of macular segmentation by optical coherence tomography compared to peripapillary retinal nerve fibre layer thickness Lever M. 1*, 2 , Halfwassen C. 1, 2 , Unterlauft J. D. 3 , Bechrakis N. E. 1, 2 , Manthey A. 1, 2 , Böhm M. 1, 2 1 Universitätsklinikum Essen, Essen, Germany; 2 Achim Wessing Institute for Ophthalmological Diagnosic (AWIO), Essen, Germany; 3 Universitäts-Augenklinik, Leipzig, Germany

Purpose: The decrease of peripapillary retinal nerve fiber layer (pRNFL) and macular layers thickness measured by spectral domain-optical coherence tomography (SD-OCT) is well documented in pediatric glaucoma. However, the diagnostic impact of these measurements in children has rarely been investigated. The aim of this study was to compare these measurements in pediatric glaucoma patients and healthy children to evaluate their respective glaucoma diagnosing ability. Methods: Retrospective observational study including 72 children aged 5-17 years (glaucoma: 19 [26.4 %] , healthy: 53 [73.6 %]) examined with SD-OCT (SPECTRALIS®, Heidelberg Engineering). The thickness of pRNFL sectors and of ETDRS subfields after automated macular segmentation were compared between diseased and healthy control children. The correlation of those measurements with the presence of glaucoma was evaluated using logistic regression. The glaucoma discriminative capacity of single or combined pRNFL and macular areas were calculated using area under the receiver-operating curves (AUC). Results: pRNFL thickness is reduced in glaucoma patients (e. g. total-average-thickness: P < 0.0001). The thickness of the three inner macular layers is reduced in glaucoma patients (e. g., ganglion cell layer [GCL] , outer-inferior subfield: P = 0.0005). pRNFL and macular segments' thickness correlate highly with the presence of glaucoma. Correspondingly, analyzing these parameters revealed a high AUC for the identification of glaucoma (pRNFL: 0.83; GCL: 0.82). Finally, the strongest glaucoma discriminating ability was observed for the combination of selected subfields of all macular segments (AUC 0.96).

The measurement of pRNFL thickness and of selected macular segments showed a high glaucoma discriminative ability. The strongest diagnostic performance, however, was found combining data from all macular segments. Further studies are needed to study more precisely how pRNFL and macular thickness measurements using SD-OCT could improve the diagnostic possibilities in pediatric glaucoma. Pahlitzsch T. 1 , Pahlitzsch M. 2 Methodik: Insgesamt wurden fünfzehn Patienten (Alter: 69,9 ± 7,1 Jahre) mit moderatem bis fortgeschrittenem primären Offenwinkelglaukom (POWG) in die Studie eingeschlossen. Präoperativ, ein Tag und drei Monate postoperativ einer Katarakt-Operation wurden folgende Untersuchungen durchgeführt: Visus, Gesichtsfeldprüfung (Weiß-Weiß-Perimetrie OCTOPUS 900), Augendruckmessung (Goldmann Applanationstonometrie), Bestimmung der Perfusionssituation mit der OCT-Angiographie (CIRRUS HD-OCT 5000), der zentralen kornealen Dicke (Pentacam) und Endothelzelldichte (NIDEK CEM-530) sowie des Flarewerts (KOWA FM 700). Ergebnisse: Postoperativ verbesserte sich der bestkorrigierte Dezimalvisus von 0,57 ± 0,16 auf 0,75 ± 0,11. Es zeigte sich eine Augeninnendruckreduktion von 19,7 ± 2,8 auf 14,0 ± 2,9 mmHg. Eine Abnahme der kornealen Endothelzellzahl von 2502,4 ± 220,2 Zellen/mm 2 auf 2304,3 ± 442,4

As to the optical coherence tomography results, the rate of the ganglion cell complex thinning in patients with PXF was 45.4 % higher than in patients without this syndrome. Conclusions: According to the results of our study, the ganglion cell complex thinning is almost one and a half times higher in patients with openangle glaucoma and pseudoexfoliation syndrome in comparison with the ganglion cell complex thinning in patients with OAG.

Methods: All patients who were admitted in January 2020 to our department for anti-VEGF treatment and were on anti-VEGF therapy (ranibizumab, aflibercept) for 5 years-from January 2015 or before, were included in our study. The retrospective study included 70 patients with nAMD (80 eyes). All the patients with glaucoma, ocular hypertension, myopic or diabetic maculopathy, eye trauma, uveitis were excluded from our study. The diabetes with or without diabetic retinopathy was also an exclusion criterion.

Only the patients with nAMD without any other ophthalmic pathology were involved. Sustained IOP was defined as a rise in IOP above baseline ≥ 6 mmHg and/ or > 21 mmHg on two or more consecutive visits. Untreated eyes were used for control group. Results: The average age of our patients was 82,2 years (ranging from 68 to 96). The majority were women (76,1 %). Except for clinical picture of nAMD other ophthalmological findings were normal. All patients were treated after "treat and extend" regiment receiving intravitreal ranubizimab (Lucentis) or aflibercept (Eylea) injections. Bilateral manifestation was observed in 10 patients (20 eyes). In all eyes a decrease in IOP from baseline was observed after 5 years of therapy with a mean reduction of 0.8 mmHg in treated eyes compared with an average increase of 0.5 mmHg in fellow untreated eyes. The difference was statistically significant. Only in 2,5 % (2 of 80 eyes) IOP elevation of 6 and 7 mmHg was observed. None of the patients in treated group experienced IOP > 21 mmHg. In control group the elevation of 6 or more mmHg or > than 21 mmHg was not observed. Conclusions: Our study revealed that repeated intravitreal anti-VEGF injections during a period of 5 years or more for nAMD in otherwise healthy eyes and subjects are not associated with IOP elevation. We found a significant difference in IOP between treated and untreated eyes with reduction in treated and elevation in untreated eyes. Further studies are necessary to confirm our results.

Purpose: Micro-invasive glaucoma surgery (MIGS) has become an important treatment approach for primary open angle glaucoma, while the long-term efficiency of these procedures remains yet to be substantiated. Recently, we published a protocol for the assessment of aqueous humor outflow in vitro using an in Rostock developed dedicated oculopressor (ROP), which allows analysis of MIGS efficiency. In the present study the performance of an in house developed valve-controlled microstent was evaluated with regard to drainage capacity and effect on intraocular pressure (IOP) using this protocol in rabbits in vivo. Methods: Six months after MIGS draining in the subconjunctival tenon space, aqueous humor outflow was assessed utilizing the ROP protocol in anaesthetized New Zealand White rabbits. A 23G cannula, connected to a scans (Spectralis OCT II, Heidelberg, Germany) in 3 layers: superficial vascular plexus (SVP), intermediate vascular plexus (IVP) , and deep capillary plexus (DCP). The local ethics committee approved the study. Results: Mean macula VD was significantly reduced in SVP (28.91 ± 3.71 vs 32.33 ± 3.04), IVP (19.77 ± 3.54 vs 23.08 ± 2.49), and DCP (20.79 ± 4.29 vs 25.24 ± 2.98) of OHT compared to healthy controls (p < 0.0001). Additionally, mean macula VD of SVP (26.28 ± 5.23), IVP (19.23 ± 3.75), and DCP (21.05 ± 4.60) were significantly reduced in pre-OAG patients compared to controls (p < 0.0001). No significant differences were observed between OHT and pre-OAG patients in IVP, and DCP (p > 0.05), yet SVP differed significantly (p = 0.018). Conclusion: As a significant reduced macula VD was seen in all 3 retinal vascular layers of glaucoma suspects compared to healthy controls, the data of the present study might indicate microvascular changes in the macula region even early in glaucoma pathogenesis.

Vorstellung eines standardisierten Schemas zur Glaukomverlaufskontrolle in der augenärztlichen Praxis Rakitin M. fluid reservoir with buffered saline solution, was injected into the anterior chamber to adjust baseline IOP to 20.0 ± 1.8 mmHg. For IOP-measurements a second 23G cannula, connected to a pressure transducer, was inserted into the anterior chamber. The ROP (weight = 60 g) was positioned on the central cornea and held in place for 4 min. IOP value dynamics were continuously monitored and compared with the contralateral control eye which had not undergone surgical intervention (n = 3, each). Results: Immediately after ROP placement IOP peak values peaked of 44.0 ± 0.9 mmHg for control and 47.6 ± 1.4 mmHg for treated eyes were measured, respectively. IOP of control and MIGS eyes was lowered during the four minutes of oculopression to similar values, 38.2 ± 0.6 mmHg and 38.2 ± 1.1 mmHg, respectively. However, IOP decrease was significantly steeper in MIGS eyes compared to the untreated eyes. Following ROP removal IOP levels were 4.1 ± 3.2 mmHg below adjusted baseline IOP.

The ROP protocol was successfully utilized to evaluate aqueous humor outflow following MIGS in a standardized manner. The faster IOP decrease in treated eyes in comparison to control eyes evidenced in vivo functionality of our proprietary, valve-controlled microstent and its facilitation of aqueous humor outflow six months after implantation. Following this proof-of-principle in vivo study in a rabbit model, further investigations will include use of the ROP protocol with glaucoma patients, before and after MIGS, to assess the contribution of the implanted drainage device to aqueous humor outflow.

In vitro decrease of extracellular matrix deposition by suppression of the TGF-β pathway by a macrolide antibiotic in ocular fibroblasts Sterenczak K. A. 1* , Fuellen G. 2 Purpose: A major complication after fistulating glaucoma surgeries are fibrotic processes causing postoperative decrease in the liquid drain. Accordingly, the prevention of fibrotic processes represents a key aspect in the development of advanced therapeutic surgical concepts. Kitasamycin represents an antibiotic molecule belonging to the group of macrolides and can act as a potential candidate to modulate fibrotic processes. Herein we evaluated the antifibrotic potential of kitasamycin in a TGF-β mediated fibrotic human fibroblast in vitro model system. Methods: Primary ocular fibroblasts from human Tenon capsule (hTF) were isolated, cultivated and kitasamycin was tested for its highest possible non-toxic dose covering a concentration range from 1 to 100 µM. Differentiation of fibroblasts towards myofibroblasts was performed by incubation with 10 ng/ml TGF-β1 for 48 h. Fibroblasts were cultured on coverslips and fixed for immunocytochemical analysis. Immunofluorescence was performed using antibodies against ECM-components (α-smooth muscle actin (SMA), fibronectin). DAPI staining was used for additional nucleic labeling. Protein detection of ECM-components (α-SMA, β-actin, β-tubulin, collagen I and VI, fibronectin, vimentin) was performed by Western Blot. Results: In hTFs exposed to different kitasaymcin concentrations no increase in α-SMA and ECM-component expression was detected. TGF-β1 strongly induced fibrotic marker expression. The addition of kitasamycin inhibited the induced fibrotic marker expression in a concentration dependent manner (up to a highest concentration of 100 µM). Conclusions: Our study demonstrated a dose-dependent expression inhibition of fibrotic marker in TGF-β stimulated hTFs by kitasamycin. These findings demonstrate that kitasamycin impairs the transformation of fibroblasts towards myofibroblasts and the expression of proteins involved in scarring processes. Therefore, kitasamycin is a potential agent for the specific prevention of postoperative scarring processes and fibrosis following glaucoma filtration surgery.

Abstracts pensierte Neovaskularisationsglaukom (NVG) bei gematchen Patienten mit Zentralvenenverschluss (ZVV) und proliferativer diabetischer Retinopathie (PDR) zu vergleichen. Methodik: 83 Patienten wurden mit 23-G-ppV, panretinaler Full-Scatter-Endolaser, transskleraler Zyklophotokoagulation (810-nm-Diodenlaser, 2 W, 2 s, 20 Herde) und intravitrealer Bevacizumab-Eingabe behandelt. Phake Augen wurden kombiniert mit Katarakt Operation versorgt. 12 ZVV Patienten konnten mit 12 PDR Patienten auf IOD gematcht werden mit Coarsened Exact Matching (CEM). Analysiert wurden bestkorrigierter Visus (logMAR), Augeninnendruck (IOD, mmHg), Medi-Score (Anzahl der Glaukom Medikamente) nach 1, 3, 6 und 12 Monaten (M) , visuelle analoge Schmerzskala (VAPS, 0-10), erneute Eingriffe und die Erfolgsrate (IOD ≤21 mmHg oder IOD-Reduktion ≥ 30 %, keine Erblindung). Ergebnisse: 12 ZVV Patienten konnten mit 12 PDR Patienten mit dem präoperativen IOD gematched werden (baseline IOD: 49, 8 ± 8, 5 mmHg, p = 1, 0) . ZVV Patienten (80,9 ± 8,2 J) waren älter als PDR Patienten (67,1 ± 11,3 J) (p = 0,002). Männer waren in beiden Gruppen häufiger betroffen (ZVV 58 %, PDR 75 %). Der Visus zeigte nur in der PDR-Gruppe einen signifikanten Unterschied zwischen baseline (ZVV 2,1 ± 0,4; PDR 1,8 ± 0,8) und 12 M follow up (ZVV 2,0 ± 0,7; PDR 1,0 ± 0,7) (p < 0,002). Der gematchte präoperative IOD sank in beiden Gruppen nach 12 M signifikant (ZVV 13,4 ± 5,6 mmHg; PDR 13,2 ± 5,6 mmHg). Es zeigte sich kein Unterschied diesbezüglich zwischen den beiden Gruppen (p = 0,230). Der Medi-Score sank zwischen baseline (ZVV 4, 3 ± 2, 4; PDR 4, 8 ± 2, 5) und 12 M stärker in der PDR Gruppe (ZVV 2,2 ± 1,6; PDR 1,0 ± 0,5) (p = 0,05). Alle Patienten waren postoperativ schmerzfrei. 10 ZVV und 10 PDR Augen (83,3 %) benötigten keine weiteren stationären Behandlungen. Die Erfolgsrate betrug 83 und 75 % in der ZVV beziehungsweise PDR-Gruppe (p = 0,674). Zusammenfassung: Die kombinierte Operationsstrategie senkte in beiden Gruppen den IOD und kontrollierte die Schmerzen. In der PDR Gruppe verbesserte sich der Visus und sanken die drucksenkenden Medikamente. 75 % der Patienten erfüllten das Erfolgskriterium nach einem Jahr. KGD/IOPstim: 37, 7 ± 5, 2/24, 7 ± 4, . Streubreite der EZM: 3,2 ± 1,8/2,9 ± 1,3, (t-Test: p = 0,36) Intraclass Korrelationskoeffizient (IKK) der EZM: 0,88/0,83. ANOVA der EZM: p = 0,48/0,08. MRVP KGD minus MRVP IOPstim: 13,0 ± 5,6. Verhältnis MRVP KGD/MRVP IOPstim: 1,56 ± 0,31. Schlussfolgerungen: Wie aus dem hohen IKK und dem ANOVA-Ergebnis zu schließen ist, werden mit dem IOPstim und dem KGD gut reproduzierbare Einzelwerte des RVP erhalten, deren Streubreiten sich nur gering unterscheiden. Der IOPstim erscheint somit geeignet für den klinischen Einsatz. Das neue IOPstim Verfahren wurde erst einmal bei Freiwilligen erprobt. Weil bei diesen erwartungsgemäß eine spontane Pulsation der ZV (SVP) vorliegt, musste unter Valsalva-Bedingungen untersucht werden, um die SVP aufzuheben. Diese Bedingung und die unterschiedliche Kraftrichtung bei KGD und IOPstim kommen als Ursache für den Unterschied des MRVP in Frage. Strzalkowska A. Fragestellung: Wir benutzten exact matching, um einen ausgewogenen Vergleich zwischen der ab-Interno-Trabekulektomie (AIT) mit dem Trabektom und der Trabekulektomie (TRAB) mit Mitomycin C (MMC) zu erstellen. Methodik: 96 Patienten, bei denen eine TRAB durchgeführt wurde, wurden mit 5485 AIT Patienten verglichen. Die Patienten wurden anhand des Augeninnendrucks (IOD), der Anzahl der Glaukommedikamente (Medikamente) und der Glaukomarten unter Verwendung von exact matching und nach dem Alter durch nearest-neighbor-matching verglichen. Die Ergebnisse wurden nach 1, 3, 6, 12, 18 und 24 Monaten analysiert. Ergebnis: 165 AIT konnten mit 165 TRAB gematcht werden. Der mittlere präoperative IOD betrug 22,3 ± 5,6 mmHg und die Grundlinienzahl der Glaukommedikamente betrug in beiden Gruppen 2,7 ± 1,1. Nach 24 Monaten sank der IOD in AIT auf 15,8 ± 5,2 mmHg und in TRAB auf 12,4 ± 4,7 mmHg. Der IOD war bei allen weiteren Follow-ups niedriger als der Ausgangswert (p < 0,01) und in TRAB niedriger als der in AIT (p < 0,01). Die Anzahl der Glaukomtropfen sank bei AIT auf 2,1 ± 1,3 und bei TRAB auf 0,2 ± 0,8. Im Vergleich zum Ausgangswert verwendeten die Patienten bei allen Follow-ups weniger Medikamente (p < 0,01) und bei TRAB weniger als bei AIT (p < 0,01). Sekundäre chirurgische Eingriffe (Revisionen oder weitere Glaukom-Operationen) hatten den größten Einfluss auf das Überleben und wurden bei 15 AIT-und 59 TRAB-Patienten notwendig. Schlussfolgerung: AIT und TRAB führten zu einer Verringerung des Augeninnendrucks und der Medikamente, die bei TRAB stärker ausgeprägt war, jedoch auf Kosten von viermal so vielen sekundären Interventionen.

Subgruppenanalyse nach kombinierter Operationsstrategie für das dekompensierte Neovaskularisationsglaukom -eine retrospektive coarsened exact matching Fallserie Strzalkowski P. 1* , Strzalkowska A. 1 , Loewen N. 1 

Uluk Y. 1* , Baulig C. 1 In der Gruppe TS CyA zeigte sich eine IOD-Senkung von präoperativ im Median 19,5 mmHg (q25 10 mmHg/q75 23 mmHg) auf im Median 15 mmHg (q25 11 mmHg/q75 17,5 mmHg) (p = 0,000) nach 12 Monaten. Die drucksenkenden Wirkstoffe konnten im Median von 2 (q25 0/q75 3) auf im Median 0 (q25 0/q75 2) (p = 0,004) reduziert werden. Ein complete success wurde bei 39 % und ein qualified success bei 58 % der Patienten erreicht. Die durchschnittliche prozentuale Drucksenkung lag in beiden Gruppen (TS nativ und TS CyA) bei 22 % nach 12 Monaten. Der Unterschied zwischen den beiden Gruppen war nicht signifikant (p = 1000). Schlussfolgerung: Beide Gruppen zeigten nach TS erwartungsgemäß eine signifikante Senkung des IOD, sowie der drucksenkenden Wirkstoffe. Die Anwendung von topischem CyA in der postoperativen Therapie der TS zeigt keinen Vorteil bezogen auf IOD oder drucksenkende Wirkstoffe. 6-75,9 %) in der Trabekulektomie Gruppe und 58,5 % (95 %-KI: 47,6-69,4 %) in der XEN Gruppe. Es gab keinen signifikanten Unterschied zwischen den beiden Gruppen hinsichtlich des primären Endpunktes ‚kompletter chirurgischer Erfolg' nach einem Jahr (OR = 0,66 [95 %-CI: 0,32-1,34]; p = 0,26). Mittels multivariater logistischer Regressionsanalyse konnte kein Einfluss auf den kompletten chirurgischen Erfolg nach einem Jahr für folgende Faktoren gefunden werden: Geschlecht, Alter, präoperativer IOD oder die Anzahl topischer Medikamentenklassen präoperativ. Nach einem Jahr war die IOD Reduktion (sekundärer Endpunkt) in der Trabekulektomie Gruppe (10,5 ± 9,2 mmHg) signifikant höher verglichen mit der XEN-Gruppe (7,2 ± 8,2 mmHg) (p = 0,003). Schlussfolgerung: XEN-Implantation und Trabekulektomie zeigen ähnliche Erfolgsraten nach einem Jahr bei Patienten mit refraktärem Offenwinkelglaukom, und sind daher chirurgische Optionen für die klinische Routine. Die Trabekulektomie zeigte allerdings eine höhere Drucksenkung im Vergleich zum XEN-Stent. Eine randomisierte klinische Studie fehlt, um einen möglichen Unterschied in den Langzeitergebnissen zwischen den beiden Gruppen zu zeigen. Aim: Glaucoma is a chronic disease that frequently requires long-term treatment with topical ocular hypotensive eyedrops. Dry eye symptoms frequently coexists with glaucoma and may be initiated or exacerbated by topical glaucoma medications. Thealoz Duo® is a novel artificial tear preparation containing two active ingredients: trehalose, a natural alpha-linked disaccharide with high water retention capabilities and sodium hyaluronate, an anionic glycosaminoglycan polysaccharide found in various connective tissue which has lubricant and water-retaining properties. The aim of this study was to evaluate the efficacy of trehalose/hyaluronate tear substitute (Thealoz Duo®) in recovering the tear film changes in glaucoma patients with mild to moderate dry eye symptoms. Methodology and results: The group of glaucoma patients (n = 15, 8 males and 7 females) under topical medical treatment and age-matched controls (n = 15, 7 males and 8 females) were reviewed. The mean age of all patients was (respectively, mean±SD) 56.3 ± 15.9 years, 15 males and 15 females. Age, gender, number of glaucoma medications used, the duration of glaucoma treatment and the presence of dry eye symptoms were recorded. After initial evaluation, patients were instructed to administer Thealoz Duo® with the regimen of one drop/eye/three times daily. Patients were observed in 2 visits: day 0 (baseline) and after one month of treatment (endpoint). Tear film quality was measured using tear break-up time (TBUT) test. Significant changes at endpoint as compared to baseline were found in both groups (p < 0,05). TBUT test results improved in both, glaucoma (7,33 ± 3,90 vs 8,08 ± 3,88 s) and non-glaucoma (8,36 ± 3,66 vs 8,80 ± 3,47 s) patients.

The improvement in tear film quality (measured by TBUT) was shown after application of trehalose/hyaluronate tear substitute for one month in both, glaucoma and control group patients with mild to moderate dry eye symptoms. However, randomized studies are required to truly ascertain the magnitude of their clinical value. Vidinova C. N. 1* , Pravoslava G. 2 1 Military Medical Academy, Sofia, Bulgaria; 2 Eye Clinic Zrenie, Sofia, Bulgaria

Our ability to help patients often depends on technology. OCT is essentially used in the diagnosis and treatment of glaucoma. Understanding the types of artifacts commonly seen is vital in the clinical practice.

Purpose: The purpose of our study is to determine the frequency and distribution of OCT and OCT A errors and imaging artifacts in patients evaluated for glaucoma. To provide examples for the most common mistakes. Methods: In our prospective study 82 patients with primary open-angle Glaucoma were enrolled. They all underwent a complete ophthalmological examination including VA, perimetry and OCT-both SD-OCT (RTVue, examined patients were divided into 2 groups: the main group included 124 workers (248 eyes) who were in direct contact with the petrochemical products; the control group included 243 workers (486 eyes) who were not in direct contact with the petrochemical products. Results: The mean age of workers in the main and control groups was 51.1 ± 0.7 and 49.2 ± 0.6 years, respectively (56.7 % male). The mean work experience of workers in the main and control groups was 22.5 ± 0.9 years and 19.2 ± 0.7 years (p > 0.05). The eye pathology was revealed in 189 (51.5 %) workers of modern petrochemical industry. The prevalence of eye pathology in the main and control groups was 80.6 ± 3.5 % and 36.6 %±3.1, the difference was statistically significant (р < 0,001). The prevalence of different eye pathologies in the both groups were 49.2 ± 4.5 % and 21 ± 2.6 % for the dry eye syndrome, 20.2 ± 3.6 % and 2.5 ± 1.0 %-conjunctival melanosis, 19.4 ± 3.5 % and 4.9 ± 1.4 %-blepharoconjunctivitis, 14.5 ± 3.2 % and 6.2 ± 1.5 %-pingvecula, 14.5 ± 3.2 % and 4.1 ± 1.3 %-conjunctival nevus, 6.2 ± 2.2 % and 1.2 ± 0.7 %-pterygium, 0.8 ± 0.8 % and 0.4 ± 0.4 %-glaucoma. The mean IOP in the main and control groups was 16.1 ± 0.2 mmHg and 16.5 ± 0.1 mmHg, the difference was not statistically significant. Conclusions: Despite the decrease of the harmful factors' influence on the eye due to the use of modern petrochemical industry technologies in Azerbaijan they still could cause occupational diseases of the eye. The prevalence of eye pathology in the workers of modern petrochemical industry with direct contact with the petrochemical products is higher than in workers without direct contact.

Ashikova P. 1* , Oganesyan O. 1 , Khandjan A. 1 , Getadaryan V. 1 , Grdikanyan A. 1 , Oganesyan C. 2 1 The Helmholtz Moscow Institute of Eye Diseases, Moscow, Russian Federation; 2 The Charles University, Prague, Czech Republic Introduction: A pterygium is a pinkish, triangular fibrovascular tissue growth on the cornea, which occurs more often from the medial side. In different countries the frequency (incidence?) of the disease varies from 0.7 to 31 %. Over 100 surgical methods have been offered for the pterygium treatment. However, the rate of recurrence is still relevant and can reach up to 70 %. To decrease the reoccurrence of the pterygium, conjunctival and limbal autografts, amniotic membrane transplantation, beta-irradiation, antimetabolites are used. After any pterygium surgery, there is no Bowman layer in intervention area. The Bowman layer transplantation can restore not only normal anatomy of cornea, but also intercellular interactions (relationships?) as well. This may reduce the frequency of the reoccurrence of the pterygium. Purpose: To describe the feasibility of BL transplantation during pterygium surgery and to study short-term results. Methods: Two female patients 35 and 62 years old with pterygium (stage II) were operated. Decimal uncorrected visual acuity was 1.0. Patients were examined before the surgery, after 1 day, 1 and 3 months after surgery by biomicroscopy, keratotomography, and optical coherence tomography (OCT). Briefly, the surgery technique was following. After the pterygium excision, a simple conjunctival closure was performed. Phototherapeutic keratectomy (PTK) recipient cornea and the stromal surface of BL graft were performed. The BL graft (3.5 and 4.0 mm in diameter) was placed in the postPTK bed. A contact lens was placed on the cornea. Postoperatively corticosteroids and antibiotics were prescribed 3 times per day for 3 weeks. Results: The surgeries and 3 months follow-up were uneventful. The cornea area of intervention are clear, the grafts are in place, and the edges of grafts are fully adapted. The data of visual acuity and central keratometry stay unchanged. According to OCT the grafts thickness are 68 and 73 microns 3 months after surgery.

Clinical efficacy of Cypass microstent with 18 months follow-up Wörn M. 1* , Hohberger B. 1 , Ennen M. 1 , Lämmer R. 1 1 Univ.-Augenklinik, Erlangen, Germany

Propose: Minimal invasive glaucoma surgery (MIGS) offers a good intraocular pressure (IOP) lowering effect and high safety profile. As ab interno approach, the stents enable glaucoma surgery without conjunctival dissection. Cypass microstent (available 04/2017-08/2018) was the only MIGS option, draining the aqueous humor suprachoroidally. It was the aim of the present study to investigate efficacy of Cypass microstent as stand-alone and combined procedure with cataract surgery with a 18 months follow-up. Methods: Eighty-four eyes from 84 open-angle glaucoma (OAG; 45 female, 39 male) patients received stand-alone Cypass microstent implantation (n = 50) or combination with cataract surgery (n = 34). Patients were grouped into cohort 1 with preoperative IOP ≥ 21 mmHg (n = 44) and cohort 2 with preoperative IOP < 21 mmHg (n = 40). Efficacy outcome included change of mean IOP and number of glaucoma medication through 18 months follow-up. Results: Preoperative IOP was 28.25 ± 7.68 mmHg (cohort 1) and 16.37 ± 3.21 mmHg (cohort 2). Mean IOP was significantly decreased after 6 months (14.52 ± 4.91 mmHg; -48.60 %), 12 months (16.47 ± 3.65 mmHg; -41.70 %), and 18 months (18.80 ± 8.08 mmHg; -33.45 %) compared to preoperative IOP for cohort 1 (p < 0.001). Yet, no significant differences were observed for mean IOP after 6 months (15.88 ± 5.49 mmHg, -2.99 %), 12 months (15.48 ± 3.65 mmHg, -5.44 %), and 18 months (15.53 ± 5.67 mmHg, -5.13 %) compared to preoperative IOP in cohort 2 (p > 0.05). Glaucoma medication was significantly reduced in both cohorts after 6 months (cohort 1: p < 0.001, cohort 2: p = 0.002) and 12 months (cohort 1: p < 0.001, cohort 2: p = 0.007) compared to baseline. At the end of the follow-up number of glaucoma medication was significantly decreased in cohort 1 (2.38 ± 1.12 vs 1.82 ± 1.31, p < 0.001) and slightly in cohort 2 (2.27 ± 1.30 vs 1.72 ± 1.31, p = 0.043) compared to preoperative. Surgery procedure of stand-alone implantation or combination with phacoemulsification did not influence outcome of IOP or glaucoma medication (p > 0.05). Conclusion: IOP reduction after Cypass microstent implantation was larger in OAG eyes with higher preoperative IOP than with preoperative IOP< 21 mmHg. Number of locally administered medication was significantly reduced in both cohorts.

Aghayeva F. A. 1* , Ibrahimova S. N. 1 , Kasimov E. M. 1 1 National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan Introduction: The petrochemical industry occupies a leading position among the sectors of the Azerbaijan economy. Thus, health care of the oil industry employees that are exposed to the complex of chemical, physical and psycho-emotional harmful factors is becoming more socially significant. In the 1980s academician Zarifa Aliyeva conducted research on occupational eye diseases in workers of petrochemical industry. Taking into account the use of new modern industry technologies continuation of such type of studies are of great interest.

The aim: of this study was to study the prevalence of eye pathology and intraocular pressure (IOP) in workers of modern petrochemical industry of Azerbaijan. Methods: Analysis of eye condition and IOP was performed in 367 workers (734 eyes) of the oil refinery factory named after Heydar Aliyev. All

First results of a prospective multicentre Phase I/IIa clinical trial on application of purified allogenic ABCB5+ limbal stem cells for treatment of severe limbal stem cell deficiency Auffarth G. 1* , Meller D. 2 , Cursiefen C. 3 , Wasielica-Poslednik J. 4 , Chodosh J. 5 1 Universitäts-Augenklinik Heidelberg, Heidelberg, Germany; 2 Universitäts-Augenklinik Jena, Jena, Germany; 3 Universitäts-Augenklinik Köln, Cologne, Germany; 4 Universitäts-Augenklinik Mainz, Mainz, Germany; 5 Department of Ophthalmology, Harvard University, Boston, United States

Background: Limbal stem cell deficiency (LSCD) is characterized by a loss or deficiency of limbal stem cells (LSCs), which causes a loss of the regeneration potential of the cornea, a loss of the barrier function between conjunctiva and cornea and severely impaired vision up to blindness. Methods: In this study purified LSCs from cadaveric donors were prepared by using the LSC marker ABCB5. The aim of this study is to test this LSCbased ATMP in a first-in-human multicenter phase I/IIa clinical trial to evaluate the safety and efficacy of ascending doses of allogeneic ABCB5 + LSCs for the treatment of LSCD. The LSCs are expected to permanently engraft in the limbal stem cell niche, so that the limbal barrier is restored and a transparent cornea is regenerated.

The study is planned with 16 LSCD patients in 4 ascending dose groups of 4 patients each. The inclusion criteria involve patients with secondary LSCD with vessel penetration of at least 2 quadrants with central cornea involvement. Cells are topically applied on the entire corneal and limbal area following surgical dissection of conjunctival pannus tissue from the corneal surface. To date, 2 patients have been recently treated with the IMP, but as the primary efficacy endpoint is measured after 1 year it is not yet possible to present the primary efficacy endpoints. In preclinical studies, transplantation of ABCB5+ LSCs in mice with induced LSCD led to normal and transparent human corneas without corneal neovascularization. The inclusion criteria involve patients with secondary LSCD with vessel penetration of at least 2 quadrants with central cornea involvement. Cells are topically applied on the entire corneal and limbal area following surgical dissection of conjunctival pannus tissue. To date, 2 patients have been recently treated with the IMP, but as the primary efficacy endpoint is measured after 1 year it is not yet possible to present the primary efficacy endpoints. In preclinical studies, transplantation of ABCB5+ LSCs in mice with induced LSCD led to normal and transparent human corneas without corneal neovascularization. Discussion: ABCB5+ LSCs are a promising new treatment method that could possibly be a permanent cure to patients with LSCD, but before any statistically significant statement about efficacy is possible, more patients need to be treated and the already treated patients need to be observed for a longer period.

Purpose: To assess possible parameters that may affect endothelial cell density (ECD) decrease after Descemet membrane endothelial keratoplasty (DMEK) by comparing eyes in the low versus high quartile of ECD decrease over a follow-up period of four years. Methods: For 351 eyes (275 patients) who underwent DMEK for Fuchs endothelial corneal dystrophy (FECD), donor ECD decrease as compared to preoperative donor ECD was evaluated up to four years after surgery. Eyes with a postoperative ECD decrease in the lower quartile at all available follow-up moments were assigned to Group 1 (n = 51), and those in the upper quartile to Group 2 (n = 42). Multinominal regression was used to assess which covariates were related to the different patterns of ECD decrease (i. e. high versus low ECD decrease). from the retina to the cornea and to increase the in-plane resolution. Furthermore, a piezo actuator is implemented to control the focal plane within the cornea. Measurements on various corneal layers were performed ex vivo on pig and lamb eyes as well as in vivo on human eyes. Results: In general, imaging could be performed at all investigated wavelengths and species. Exemplifying the found imaging patterns, the cell borders and nuclei of the human superficial epithelium are shown, which have a stronger reflectance using the blue or green compared to near-infrared light. At deeper layers, almost all cellular structures (nerves, keratocyte nuclei) are comparable, but the image quality decreases with shorter wavelengths due to scattering (not shown here). Interestingly, although the endothelium is the deepest layer, the cellular structure could only be resolved by the blue or green light and not by the near-infrared light.

Conclusions: Most differences in image quality can be attributed to depthand wavelength-dependent scattering. However, there are also layers that vary in spectral reflectance of certain cellular structures (e. g. endothelium). This demonstrates the importance of choosing the right wavelength for certain target structures. In order to answer the question of the optimal wavelength, various aspects have to be considered: (1) corneal target structures (being a compromise between low scatting and high resolution), (2) light hazard and (3) glaring the patient. The optimal solution would be a multimodal instrument using different wavelengths.

Fallbericht: Interstitielle Keratitis im Rahmen einer Symptomtrias Borgardts K. The Filatov Institute of Eye Diseases and Tissue Therapy NAMS of Ukraine, Odessa, Ukraine; 2 Lviv Regional Clinical Hospital, Lviv, Ukraine

The aim: was to determine the cytological features in conjunctival epithelium in patients with subclinical and manifest hypothyroidism and dry eye Materials and methods: The impression cytology of 29 hypothyroid patients (18 with subclinical, and 11-with manifest) and dry eye was performed. All patients underwent ophthalmological investigation: biomicroscopy with fluorescein test, determination of the ocular surface disease index (OSDI), tear film stability (test Norn) and tear production (Schirmer test I), the LIPCOF test. Cytological material was taken using standart method of impression cytology by contact compression of the bulbar conjunctiva with Millipore filter (Millicell CM). The material was fixed in a mixture of alcohol and ether 1:1 with followed staining with hematotoxillin and eosin. Were analyzed the following signs: state of a layer of epithelial cells (EC), metaplasia, degree of keratinization, type of EC change nuclei, goblet cells density, presence of the inflammatory cells.

In the subclinical hypothyroidism a layer of EC was detected without significant structural changes. A distribution of EC was evenly. The EC were almost the same size without disturbances in intracellular contacts. The cells nuclei were round or oval. The ratio of nucleus to the cytoplasm was 1:2. Changes in EC nucleus due to slight karyopicnosis were rarely observed. Single cells were seen in a state of keratinization. No evidence of epithelial cells metaplasia and inflammatory cells was observed. The Goblet cells density was slightly reduced. Cytological features of the manifest hypothyroidism are more pronounced structural changes in the epithelial layer. In all cases, it was not possible to obtain a single layer of epithelial cells. In the epithelial layer focal epithelial hyperplasia, keratinization of EC, disturbance of intracellular contacts were observed. The nuclei of EC had various shapes, from round to rod-shaped. Karyopicnosis and snow-like dissociation of EC nuclei were observed frequently. The Goblet cells were in a state of degeneration, their density was significantly reduced. Conclusion: Сytological examination of the bulbar konjunctiva of patients with hypothyroidism and dry eye revealed degenerative changes in epithelial and goblet cells of various degrees, which depended on the stage of hypothyroidism. The severity of degenerative changes were more pronounced in patients with manifest hypothyroidism.

El Halabi M. 1* , Seitz B. 1 , Quintin A. 1 , Suffo S. 1 , Flockerzi F. 2 . Further studies showed that stimulation of its activity is involved in this process through promoting both keratocyte transdifferentiation into myofibroblasts and extracellular matrix remodeling. Based on these findings, the purpose of this study was to investigate whether there is an interplay between TRPV1 and another TRP subtype channel such as TRP ankyrin 1 (TRPA1) cold receptor, which is closely related to TRPV1. Methods: An established HCK cell line was used as a cell model for corneal keratocytes. Single cell fluorescence calcium imaging was used to measure the intracellular calcium concentration ([Ca 2+ ] i ). Specifically, the fluorescent dye fura-2/AM was used to measure a fluorescence ratio (f340/f380), which is proportional to [Ca 2+ ] i . Results: The TRPA1 agonist icilin (10 µM) increased the fluorescence ratio f340/f380 from 0.1010 ± 0.0004 to 0.2129 ± 0.0130 (n = 13; p < 0.0001). This increase could be suppressed by the TRPA1 antagonist HC-030031 (10 µM) to 0.1051 ± 0.0008 (n = 51; p < 0.0001). Interestingly, icilin was also able to suppress the CAP-induced increase of f340/f380 from 0.1279 ± 0.0028 (n = 10) to 0.0838 ± 0.0118 (n = 30; p < 0.0398) (both 10 µM). Conclusion: For the first time, our studies show a functional expression of the cold receptor TRPA1 and its interplay with TRPV1 in HCK. Consequently, the use of cold receptor agonists may be an interesting option to modulate stromal scarring through suppressing injury induced intrinsic TRPV1 activity.

Abstracts bilität der Befunde über den Beobachtungszeitraum von derzeit 6 Monaten. Die beschriebene Kohorte wird längsschnittlich weiterverfolgt.

Schayan, F. 1* , Flockerzi E. 1 , Hamon L. 1 , Langenbucher A. 2 (B) , dünnste Pachymetrie (C) und die bestkorrigierte Sehschärfe (D) jeweils in den Ausprägungsstadien 0 bis 4. Alle Werte wurden prä-und 6 Monate postoperativ verglichen. Ergebnisse: Sechs Monate postoperativ zeigte sich eine Verbesserung sowohl des mittleren sc-Visus (logMAR) von 0,8 ± 0,3 auf 0,5 ± 0,3 (p < 0,001) als auch des mittleren cc-Visus (logMAR) von 0,4 ± 0,2 auf 0,3 ± 0,2 (p = 0,09). Hinsichtlich der Refraktion zeigte sich eine Reduktion der Sphäre von -3,0 ± 4,3 Dioptrien (D) auf -0,7 ± 3,4 D (p < 0,001) und des Zylinders von -4,7 ± 2,0 D auf -2,1 ± 3,3 D (p = 0,002 

Gibt es einen Zusammenhang zwischen Geburtsgewicht und Hornhautaberrationen im Erwachsenenalter? Ergebnisse der bevölkerungsbasierten Gutenberg-Gesundheitsstudie (GHS) Fieß A. 1* , Urschitz M. 2 , Nagler M. 3 , Nickels S. 1 , Münzel T. 4 , Wild P. 3 , Beutel M. 5 , Lackner K. J. 6 , Pfeiffer N. 1 Astigmatismus (Z(2,-2); Z(2,2)), Koma (Z(3,-1); Z(3,1)), Trifoil (Z(3,-3); Z(3,3)), sphärische Aberration (Z(4,0)) und Aberrationen höherer Ordnung (HOA) und niederer Ordnung (LOA). Ergebnisse: Insgesamt wurden 5628 Teilnehmer in die vorliegende Analyse einbezogen (3004 Frauen; Alter: 56,0 +/-10,3 Jahren). In der multivariablen Analyse war ein niedriges GG mit höherer sphärischen Aberration (B = -0,006 µm/500 g, 95 %-KI: [-0,008; -0,003]; p < 0,001) und höheren HOA (B = -0,007 [-0,010; -0,003] µm/500 g; p < 0,001) assoziiert. Horizontales Koma (Z(3,1)) zeigte einen möglicherweise schwachen Zusammenhang (B = 0,002 [-0,000; 0,003] µm/500 g; p = 0,051) wohingegen die anderen Aberrationen keinen statistischen Zusammenhang aufwiesen (Astigmatismus (Z(2,-2) P = 0,24; Z(2,2) P = 0,80), Koma (Z(3,-1) P = 0,29), Trifoil (Z(3,-3) P = 0,06; Z(3,3) P = 0,63). Schlussfolgerung: Unsere Ergebnisse zeigen einen Zusammenhang zwischen Geburtsgewicht und sphärischer Aberration bei Erwachsenen im Alter von 40 bis 80 Jahren. Dies deutet darauf hin, dass ein niedriges Geburtsgewicht möglicherweise einen Einfluss auf eine veränderte Entwicklung der Hornhautform haben könnte, was auf die optische Bildqualität Auswirkung haben könnte.

duces involuntary eye movements and avoids compression artifacts, have proven to increase the image quality and 2D/3D reconstruction possibilities in all planes. In this study, we examine the clinical usability of the new system and present findings in patients with specific corneal alterations. Methods: Five patients with brittle corneal syndrome (BCS), mucopolysaccharidosis, small moldering myeloma (SMM), Schnyder corneal dystrophy and keratitis of unknown origin were examined with the HRTII-RCM 2.0 modality. Subsequent, dedicated image alignment procedures and stack quality evaluation were conducted. These results were compared with conventional digital slit lamp examinations as well as anterior segment OCT. Results: The overall investigation time was less than 10 min for each patient. The recorded data was adequate for further analysis in all cases, almost independent of patient compliance. Particular findings worth mentioning were observed in all patients. For example in the patient with BCS, an increased level of stromalhaze, alterations such as the elongation of keratocyte nuclei and clustering of cells at the anterior stroma, and dark bands in the posterior stroma were observed. In the patient with SMM, confocal microscopy visualized diffuse localized deposits throughout the epithelium and stroma. The highly reflective deposits were intracellular as well as extracellular and were present as deep as anterior to Descemet's membrane. This was in line with the slit lamp examination, which showed white dot-like opacities throughout the entire depth of the cornea.

The RCM 2.0 corneal imaging concept enables reliable recordings of expanded in vivo human corneal image stacks, even in patients with limited compliance. This allows optimal imaging plane selection according to individual clinical questions and offers new insights into cellular processes in vivo. The RCM 2.0 enhances the slit lamp imaging concept to a cellular level. 

The influence of TonEBP on lymphatic and electrolytic homeostasis of the cornea Hadrian K. 1*, 2 , Bock F. 1, 2 , Cursiefen C. 1, 2 , Eming S. A. 2, 3 , Hos D. 1 Objectives: Lymphangiogenesis plays an important role in the regulation of various inflammatory processes in the cornea. Furthermore, a positive function of lymphatic vessels in the regulation of corneal edema has recently been demonstrated. In addition to their function as mediators of (lymph)angiogenesis, macrophages have been shown to play a crucial role in the regulation of the salt/water balance in the skin. The mechanism underlying these processes involves the activation of tonicity-responsive enhancer binding protein (TonEBP). TonEBP is an osmosensitive transcription factor and can be induced in macrophages by proinflammatory stimuli. Thus, aim of this work was to characterize the role of macrophagederived TonEBP in the regulation of corneal inflammation and edema. Methods: The role of TonEBP in lymphatic and electrolyte homeostasis was investigated in two different corneal injury models in mice. For this purpose, six to eight weeks old wildtype C57Bl/6N mice and mice with a tamoxifen-inducible TonEBP knockout (UbcC-Cre TonEBP fl/fl) underwent intrastromal suture placement or incision of the central cornea to induce corneal inflammation and/or edema. TonEBP expression was evaluated using immunofluorescence as well as qRT-PCR. Furthermore, the co-expression pattern of TonEBP/F4/80 (macrophages) and TonEBP/ CD45 (leucocytes) in both models was evaluated. In addition, expression of VEGF-C, a main regulator of lymphangiogenesis, was evaluated using qRT-PCR. Results: TonEBP is expressed in both corneal epithelium and stroma. The expression pattern of TonEBP differs in the naïve cornea compared to injured corneas: whereas the majority of TonEBP positive cells in the naïve corneal stroma are fibroblasts, the majority of TonEBP cells in injured corneas are F4/80 as well as CD45 positive. Although the overall expression Schulz A. 2 , Nickels S. 1 , Wild P. 2 , Schmidtmann I. 3 , Münzel T. 4 , Beutel M. 5 , Lackner K. J. 6 , Pfeiffer N Cursiefen C. 3 , Pfeiffer N. 4 , , Viestenz A. 6 , Geerling G. 7 

The treatment of acute hydrops in keratoconus: first results from our centre and a preview of a Germany-wide registry study Händel A. 1* , Siebelmann S. 1 , Hos D. 1 , Matthaei M. 1 , Cursiefen C. 1 , Bachmann B. 1 1 Zentrum für Augenheilkunde -Universitätsklinikum Köln, Köln, Germany

Purpose: The treatment of acute keratoconus varies considerably from conservative to surgical approaches. Thus, aim of this study was to 1) obtain national data on treatment modalities of other centres and 2) compare two surgical treatment options for acute corneal hydrops in keratoconus (mini-Descemet Membrane Endothelial Keratoplasty (mini-DMEK) or predescemetal sutures). Methods: A Germany-wide registry study on acute keratoconus was initiated. In addition, a retrospective analysis of thirteen patients who presented in our clinic with a corneal hydrops treated by mini-DMEK (n = 5, Group 1) or predescemetal sutures (n = 7, Group 2) was conducted. Results: Ten centres agreed to participate in the registry study. In our retrospective analysis, both groups showed reductions in corneal thickness and increased visual acuity after surgical treatment of acute hydrops. In Group 1 (age 32 years (± 7 years)) best corrected visual acuity increased from logMAR 1.88 (± 0.5) before mini-DMEK to 1.02 (± 0.6) 30 days after mini-DMEK (p = 0.037). Corneal thickness significantly decreased from 1230 µm (± 322 µm) preoperatively to 500 µm (± 50 µm) 30 days after mini-DMEK (p = 0.011). Group 2 (age 37 years (± 10 years)) showed a preoperative corneal thickness of 1420 µm (± 297 µm) and a visual acuity of logMAR 1.67 (± 0.9). After surgical treatment using predescemetal suturing, there was a reduction in corneal thickness to 524 µm (± 186 µm) (p = 0.011) and visual acuity increased to logMAR 0.96 (± 0.5) (p = 0.102) respectively after 30 days. There was no relapse of the hydrops and the corneas remained dehydrated to physiological levels. Conclusions: Both techniques, mini-DMEK and predescemetal sutures, are effective treatments for acute hydrops in keratoconus. Mini-DMEK appears to be beneficial in large DM tears. As the treatment of acute keratoconus is different in many centres in Germany, the initiated Germanywide registry study on acute keratoconus will combine the results of many centres and lead to larger case numbers.

Clinical сase early therapeutic deep anterior lamellar keratoplasty following of Pseudomonas corneal ulcers with descemetocele associated with contact lenses wearing. In the future we need to perform further antibody validation for the remaining markers to confirm these findings.

Purpose: The purpose of the study was to analyze mistakes made during surgical treatment for pterygium based on medical records of patients treated at the Corneal Pathology Department of the Filatov Institute. Materials and methods: One hundred and three patients (105 eyes) who had been followed up after surgery for ptergygium stage 3 or 4 during the recent two years were involved in this study. Postoperative complications were observed in 27 eyes (25.7 %) of patients after primary pterygium excision. Results: Some patients seeking care at our institute had undergone 4-5 previous surgeries for pterygium in one eye. Of the surgical complications, there were frequent recurrences with multiple early repeat surgeries (4 to 5 surgeries within a year) with the development of extensive vascular fibrous tissue and decreased vision (10 eyes), corneal ulceration and perforation in bilateral pterygium surgery in patients with concomitant autoimmune disorders (4 cases), and corneal ulceration and perforation due to deep pterygium excision (5 cases).

Conclusion: First, pterygium should be excised with minimal trauma to the limbus and cornea. Special attention should be given to autoimmune disorders, in which a corneal trauma may result in keratomalacia. Second, current medicamentous and surgical techniques should be used to prevent pterygium recurrence. Third, one should not perform bilateral pterygium surgery or repeat pterygium excision early (≤ 6 months) after primary pterygium surgery. Finally, any patient after pterygium excision should be followed by the ophthalmologist to promptly prevent or arrest the recurrence of pterygium. 

In situ donor keratometry in deceased patients as a new screening technique for eye banking? Quintin A. Objective: To evaluate the dynamics of biomechanical properties (corneal hysteresis (CH) and corneal resistance factor (CRF)), topographical corneal thickness changes and corneal densitometry (corneal optical density (COD) in first-time soft contact lenses (SCL) users (3 months) and in longterm SCL wearers (over 3 years). Methods: 20 patients (39 eyes) with low and moderate myopia took part in our trial. Mean age of the participants was 31 ± 5 years. All patients were divided in 2 groups: I group-first-time SCL users (20 eyes), II grouplong-term SCL users (19 eyes). Keratoconic patients were excluded from the study. The participants of both groups underwent corneal pachymetry mapping, corneal densitometry (Pentacam, Oculus) and corneal biomechanical properties evaluation-CH and CRF (ORA, Reichert Technologies). In I group patients were examined before the first time and after 3 months of SCL wear. In the group II the same examinations were held during long-term (over 3 years) SCL wear and after ≥1 week of SCL removal.

The I group showed reduction in central cornea thickness (by 4 mkm) and insignificant decrease of peripheral corneal pachymetry (by 4,35 mkm, p > 0,05) during 3 months of SCL wear. COD reduced by 4 %. CH and CRF were significantly increased compared to baseline by 0,1 and 0,6 mmHg respectively (p < 0,05).

The II group showed reduction in central cornea thickness (by 19,5 mkm) and in peripheral corneal thickness (by 22,5 mkm) during SCL wear. COD increased by 14 %. CH and CRF were significantly decreased by 0,5 and 0,35 mmHg respectively compared to the results after ≥1 week of SCL removal (p < 0,05). Conclusions: Long-term SCL wear can show morphological corneal changes. We observed the same dynamics of corneal pachymetry in both first-time and long-term groups. Increase of CH and CRF as well as COD reduction in the I group can show clinically insignificant water content changes in different corneal layers during first months of SCL wear. Significant CH and CRF decrease with COD increase in long-term SCL users can point at structural and dystrophic corneal changes.

Femtosekundenlaser assistierte Transplantation der Bowman-Lamelle: Laser assistierte Donorpräparation und Empfängerkonditionierung Parlak M. 

Abstracts the cornea (-1.1 D, -1.0 D, -0.9 D; and -0.1 D, -0.5 D, -0.5 D respectively; p > 0.05) did differ between groups. Conclusions: After penetrating keratoplasty (PKP) with both sutures in place, a smaller graft diameter seems to result in a flatter curvature at the anterior surface of the cornea, but does not affect the astigmatism. This information may be indicative for IOL power calculation in relation to graft diameter in a triple PKP procedure, depending of the individual size of the cornea.

Combined "Muraine Sutures" and intracameral air tamponade for the management of corneal hydrops in acute keratoconus Razafimino S. 1* , Daas L. 1 , Quintin A. 1 , Seitz B. 1 1 Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

Purpose: Typically corneal transplantation in case of acute keratoconus with corneal hydrops has to be postponed for 3 to 6 months until the edema has resolved and a stable scar has formed. The purpose of this study was to analyze the short-term clinical outcomes in patients undergoing combined multiple predescemetal interrupted corneal sutures (so-called "Muraine Sutures") with intracameral air tamponade in acute corneal hydrops.

Methods: This retrospective uncontrolled case series enrolled 8 patients with keratoconus who presented with a corneal hydrops of recent onset. All patients underwent combined intracameral air tamponade and 3 to 6 predescemetal 10-0-Nylon sutures placed orthogonally to the axis of the rupture of Descemet's membrane. A prophylactic 6 o' clock iridotomy was preoperatively performed to avoid acute air-bloc intraocular pressure (IOP) elevation. Main outcome measures included pre-and postoperative median pachymetry in the center of the hydrops measured by anterior segment optical coherence tomography Casia 2 (Tomey Corp., Nagoya, Japan) and best-corrected visual acuity (BCVA in logMar).

The median corneal pachymetry decreased significantly (p = 0.02) in all our patients. The median preoperative corneal pachymetry was 1605 µm (range 805-2423 µm), which significantly reduced to 1039 µm (range 573-1395 µm) at day 1 and to 672 µm (range 398-871 µm) 6 weeks after surgery. BCVA improved from 1.5 preoperative to 0.95 log-Mar (p = 0.46) 6 weeks after surgery. BCVA on day 1 was finger counting (1.9 logMar) due to air fill of the anterior chamber. No acute elevation of the IOP occurred. Conclusions: Our results show a rapid reduction of the corneal thickness and non-significant improvement of BCVA after combined intracameral air injection and predescemetal compression sutures. "Muraine sutures" seem to be an effective and safe procedure to reduce corneal swelling in acute corneal hydrops, thus allowing quicker readaptation of contact lenses and earlier corneal transplantation if necessary.

Die Kontaktlinsenanpassung beim Keratokonus -Retrospektive Untersuchung des Verlaufes der Linsenanpassung bei 200 Patienten Richter K. Wir dokumentierten un-measured in situ 5 times repeatedly < 24 h after death using the portable Retinomax K-plus 3 (Bon, Tokyo, Japan). The means of the obtained keratometric readings were compared to the routinely measured 581 donor corneas using a Mann-Whitney U test. The respective values of the whole globes, from which sclerocorneal discs were removed for organ culture in the eye bank, were also compared to those obtained after measuring the same sclerocorneal discs in medium I after 6 ± 4 days using a Wilcoxon signed-rank test.

The mean standard deviation of the five in situ measurements was 1.7 D and 1.0 D for the dioptric power (P) at the steep and flat meridian of the cornea, and 1.0 D for keratometric astigmatism. P at the steep meridian of in situ corneas (44.7 D) remained unchanged after preserving sclerocorneal discs in medium I (43.8 D; p = 0.11). However, P at the flat meridian of in situ measured corneas (41.1 D) increased (p < 0.01) to 42.6 D, whereas keratometric astigmatism (3.6 D) decreased (p < 0.01) to 1.2 D after preservation in medium I. The comparison of the in situ values with the 581 routinely measured different donor corneas in medium II showed no difference in P at the steep meridian (44.6 D; p = 0.34), but again a greater P at the flat meridian (43.1 D; p < 0.01) and a smaller keratometric astigmatism (1.5 D; p < 0.01).

Measuring deceased patients' eyes in situ with the portable Retinomax K-plus 3 could be, in the absence of an anterior segment optical coherence tomograph (AS-OCT), an alternative and moderately reproducible screening technique in the eye bank. In comparison to the AS-OCT, the portable Retinomax K-plus 3 estimates a similar power at the steep meridian of the cornea but seems to underestimate the power at the flat meridian and to overestimate the keratometric astigmatism.

Impact of graft diameter on the relation between sterile donor tomography in the eye bank and graft tomography after penetrating keratoplasty Quintin A. Background and Purpose: Sterile donor tomography in the eye bank can be used to avoid refractive surprises after corneal transplantation. The purpose of this study was to assess the impact of graft diameter on the relation between preoperative donor tomography and postoperative graft tomography after penetrating keratoplasty (PKP). Patients and methods: This retrospective study enrolled 117 eye bank corneal tissues that underwent elective PKP with application of a double-running suture. Donor and recipient trephination were performed using the 193-nm excimer laser (Schwind Amaris 1050RS). Diameters were 7.5 mm (13 %), 8.0 mm (73 %) and 8.5 mm (14 %), with a graft oversize of 0.1 mm. Preoperative measurements, taken through the cell culture flask using the anterior segment optical coherence tomograph Casia 2 (Tomey Corp., Nagoya, Japan), were repeated postoperatively after 5 ± 4 months with all sutures in place. Differences between post-and preoperative values (∆) were compared in function of the graft diameter using a Mann-Whitney U test. Results: The ∆ keratometric power (P) at the steep meridian of the anterior surface of the cornea in the 7.5 mm grafts (-2.9 D) was significantly smaller than that in the 8.0 mm grafts (+0.6 D; p < 0.01) and than that in the 8.5 mm grafts (+1.4 D; p < 0.01). No statistically significant differences occurred for this parameter between the 8.0 mm and the 8.5 mm grafts (p = 0.23). At the flat meridian of the anterior surface of the cornea, ∆ P in the 8.5 mm grafts (-1.0 D) was significantly greater than that in the 8.0 mm grafts (-3.1 D; p = 0.03) and than that in the 7.5 mm grafts (-6.7 D; p < 0.01). No statistically significant differences occurred for this parameter between the 7.5 mm and the 8.0 mm grafts (p = 0.05). Neither ∆ astigmatism (+3. Purpose: To evaluate ocular symptoms in European non-hospitalized patients with severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) and to investigate associations with the demographic data as well as general physical symptoms. Methods: In this prospective, observational study, 108 non-hospitalized patients with polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection not requiring intensive care were asked using a standardized questionnaire regarding disease-associated ocular symptoms, demographic data, and general physical and nasal symptoms. Total Ocular Symptom Score (TOSS) was evaluated during and retrospectively prior to coronavirus disease 19 infection. Associations between TOSS and demographic data as well as general and nasal symptoms were evaluated. Results: 75 out of 108 non-hospitalized patients with COVID-19 infection (69 %) suffered from ocular symptoms mostly including burning sensations, epiphora, and redness, compatible with conjunctivitis. These symptoms occurred in most cases in the first three days of COVID-19 but were rather mild. TOSS was significantly higher during than prior to the COVID-19 infection (p < 0.001). There were no significant associations between TOSS and demographics, general physical and nasal symptoms. Conclusions: Ocular involvement in European non-hospitalized patients with COVID-19 seems to be highly underestimated and needs further attention. Overall, these ocular symptoms including burning sensations, epiphora and redness seem to be mild.

Abstracts Schlussfolgerung: Die Bildqualität der µOCT scheint ausreichend, um durch quantitative Auswertungen diagnostisch relevante Aussagen zur SBP treffen zu können. Aufgrund der variierenden Nervendichte innerhalb der Hornhaut ist die Aufnahmefläche des µOCT von derzeit 1 × 1 mm vorteilhaft, sodass sich zusammen mit der kontaktlosen Anwendung des µOCT ein klinisch erfolgversprechendes Anwendungsfeld ergibt.

Epithelimplantationszyste der Kornea Schölles K. 

The "Knights of the Blind"-Eye Banking and Lions, a successful cooperation since 1952 Scholtz S. 1*, 2 , Auffarth G. 3 , Hellwinkel O. 4 , Kampik D. 5 , Maier P. 6 , Seitz B. 7 , Wegner T. 8 , Krogmann F. 9 , Rosenbaum K. 10 Der prä-zu postoperative ECL in Gruppe 1 betrug 36 % (n = 12) nach 6 Monaten und 37 % nach 12 Monaten (n = 5). In Gruppe 2 lag der ECL bei 44 % (n = 11) nach 6 Monaten, 36 % (n = 9) nach 12 Monaten, 33 % (n = 9) nach 2 Jahren und 27 % (n = 3) nach 3 Jahren. Die postoperative zentrale Hornhautdicke nach 1, 2 und 3 Jahren war in Gruppe 1 im Mittel (± SD) 751 ± 507 µm, 590 ± 174 µm und 552 ± 73 µm beziehungsweise in Gruppe 2621 ± 227 µm, 642 ± 231 µm und 509 ± 43 µm (p = 0923, p = 0309 beziehungsweise p = 0,221). Schlussfolgerung: Unsere Daten legen nahe, dass die DMEK die Sehschärfe bei Patienten mit Endotheldekompensation nach den hier untersuchten Glaukomoperationen, GDD-Implantation und TE, deutlich verbessert. Diese Augen zeigen jedoch ein erhöhtes Risiko zum Transplantatversagen mit Notwendigkeit zur Re-DMEK. Allerdings besteht hierbei kein signifikanter Unterschied zwischen den beiden untersuchten Glaukomoperationen. 

Sinicin E. 1* , Bartram M. 1 Purpose: To compare the efficacy of epi-off customized corneal crosslinking (CXL) with and without supplementary oxygen. Methods: In this prospective study, 40 eyes of 40 patients with documented progressive primary keratoconus were treated either with epi-off customized CXL under a supplementary oxygen environment (O2 > 90 %, n = 20) or with customized CXL under atmospheric oxygen conditions (O2 = 21 %, n = 20) and followed for 1 year. Customized irradiation patterns had an irradiance of 15 mW/cm 2 and radiant exposure levels ranging from 5.4J/cm 2 up to 10J/cm 2 centered on the maximal posterior elevation. Analyzed parameters were Placido topography, Scheimpflug tomography, endothelial cell count, BSCVA and anterior segment OCT.

Results: Kmax showed significant changes after 1 year for both groups with a significantly higher regression in the supplementary oxygen subgroup (-3.5 ± 1.9D vs. -1.3 ± 1.3D). Six out of 19 eyes (32 %) in the supplementary oxygen group showed a flattering of >5D, whereas only 2 out of 19 (11 %) did in the atmospheric oxygen group (p < 0.05). Improvement in BSCVA and reduction in corneal coma were also significantly higher in the supplementary oxygen group, however, sterile infiltrates occurred more frequently, and corneal haze appeared denser. The regularization index (RI) was significantly better in the customized CXL group with supplementary oxygen. Endothelial cell count maintained stable in both groups. Conclusions: Supplementary oxygen enhances the efficacy of epi-off customized CXL with stronger qualitative and quantitative flattening in Kmax and corneal regularization. Substantial flattening rates of more than 5D can be achieved in about 30 % of the treated cases.

Inselspital Bern, Bern, Switzerland; 2 IROC, Zürich, Switzerland

Purpose: To measure the oxygen consumption and concentration during corneal crosslinking (CXL) in different depths and compare different protocols with and without supplementary oxygen. Methods: In de-epithelialized porcine eyes, a femtosecond-laser generated channel was used to place a fiber-probe in corneal depths of 100, 200 and 300 microns to measure the local oxygen concentration. After a 10 min imbibition of 0.1 % riboflavin the corneas were irradiated at 3, 9, 18 and 30 mW/cm2 while the oxygen concentration was continuously measured. To assess the benefit of supplementary oxygen, all experiments were performed under atmospheric (21 % O2) as well as under hyperoxygenic (>95 % O2) conditions. Results: The equilibrium oxygen concentration under atmospheric oxygen conditions at 3 mW/cm2 was 5 % in 100 microns decreasing to 3 % in 200 microns and 0 % at 300 microns. With 9, 18 and 30 mW/cm2 no oxygen was available in 100 microns or deeper. Using a hyperoxygenic environment the oxygen concentration was 44 % using 3 mW/cm2 in 100 microns decreasing to 39 % in 200 microns and 33 % in 300 microns. At 9 mW/cm2 the concentrations were 5 %, 3 % and 1 % in 100, 200 and 300 microns, respectively. Using 18 and 30 mW/cm2 all oxygen was depleted during CXL and no equilibrium was established, however, the time until all oxygen was consumed was longer in the 18 mW/cm2 than in the 30 mW/cm2. Conclusion: Supplementary environmental oxygen increases the stromal oxygen-availability during CXL. In particular at higher irradiances with increased oxygen consumption, supplementary oxygen is beneficial and eliminates the bottleneck of oxygen and, therefore, enhances more crosslinks.

Steindor F. A. 1* , Borgardts K. 1 

The benefits of using the amniotic dry membrane in corneal ulcers Stanila D. M. 1*, 2, 3 , 2, 3 , Stanila A. Epithelial defects of the cornea heal quickly and without incidents. When these defects are not healed in time, defined in the literature in two weeks, they become known as persistent epithelial defects (PED) and sometimes become corneal persistent ulcers. The purpose of this paper is to present using Omnigen refrigerated dry amniotic membrane and Omnilens in corneal ulcers.

We applied Omnigen amniotic membrane and Omnilens contact lens in 15 eyes with corneal ulcers, 8 eyes with neurotrophic keratopathy and 2 were perforated, 2 eyes with Steven-Johnson syndrome, 3 eyes with Mooren ulcer and 2 were perforated, 1 eye with corneal lattice dystrophy and perforation, 1 eye with corneal transplant. We applied the amniotic membrane after rehydration in 10 cases without suture and 5 cases with suture. At the same time we applied the Omnilenz contact lens on ocular surface until membrane was absorbed.

Omnigen is a transportable biological matrix that can be used as a regenerative therapy for corneal ulcers or other diseases of the ocular surface. The application of the membrane has been made according to the existing lesion. The use of the membrane was like Graft with epithelial position up in 3 cases and Patch with epithelial position down in 12 cases. The results were good, obtaining the anatomical reconstruction of the ocular surface. In 3 cases we repeated the membrane application. We must speak about unmet needs in our country regarding the treatment of corneal ulcers with or without perforation. Because we have not a tissue bank we cannot perform corneal transplant and we resort in urgency to amniotransplant for the tectonic purpose. Conclusions: Omnigen's amniotic membrane together with the Omnilenz therapeutic contact lens can be a solution for the treatment of corneal ulcers with perforated or no perforated cornea.

Korneale Aberrationen höherer Ordnung nach superfizieller Keratektomie bei PHSCB Walckling M. Purpose: Implementation of a systematic analytical approach for detection of antigen-presenting cells (APC) in human corneal tissue using FACS. Methods: To implement FACS analysis of APC in the human cornea, we set up a novel protocol for cell harvesting from human corneal tissue. The corneas used were stored in organ culture, they were unsuitable for transplantation and consent for scientific use was available. The harvested cells were analysed by FACS; special attention was paid to the detection of inflammatory and regulatory macrophage populations. Among the live cells, CD14+/CD11b+/CD68+ cells were defined as macrophages. M1 macrophages were defined as cells expressing CD282+/CD86+/ HLA-DR+/CD284+ in addition to the markers mentioned above; while M2 macrophages were defined by their additional expression of CD206+/ CD163+. Subsequently, cell populations were assessed with respect to their response to different stimuli (LPS/IL-10/IL-4 with IL-13) as well as dynamics of APC in organ culture. Results: FACS allowed the identification as well as quantification of innate immune cells in processed human corneal samples. The use of LPS as an innate stimulus led to a down-regulation of CD206 (p > 0.05), a regulatory maker in APC. Co-expression of CD282+ and CD284+ is down-regulated by regulatory interleukins like IL-10 (p < 0.001) and IL4+IL-13 (p < 0.05).

In addition, HLA-DR, as an inflammatory maker, was also down regulated by IL-10 (p < 0.001). A cell loss over time during organ culture of the corneas was observed in both M1 and M2 macrophages (n = 15, p = 0.04).

In the present study we report on the implementation of a FACS protocol for processing and phenotyping human corneal cells. We demonstrate that inflammatory and regulatory macrophage subtypes are present in the cornea and that these cells show a functional response to different interleukins. We also demonstrate for the first time the dynamics of APC cell loss in organ culture. Zwingelberg S. questionnaire. Moreover, diabetes duration, blood sugar levels, and type of therapy for diabetes were assessed. Results: Palpebral demodicosis was twice as common in patients with T2 DM duration more than 10 years as in those with T2 DM duration less than 10 years (p = 0.002). Our meibography study found changes in meibomian glands in 90 % of diabetics with palpebral demodicosis, with the mean meibograde score of 5.0 ± 0.9 points, which indicated a predominance of moderate MGD.

Abstracts skop. Dabei wurde das 3D-System auf das vorhandene Mikroskop angepasst, so dass die Mikroskop-Optik unverändert blieb. In beiden Gruppen wurde entweder eine Femto-Sekunden-Laser-assistierte Kataraktoperation (FLACS) oder eine traditionelle Phakoemulsifikation durchgeführt. Es wurden retrospektiv Komplikationen erfasst und analysiert. Ergebnisse: Der Anteil von FLACS betrug in der 3D Gruppe 17,1 % und in der 2D Gruppe 15,1 %. Eine Kapselruptur trat bei 10 Augen auf (3D: n = 4 (0,4 %), vordere Vitrektomie: n = 3; 2D: n = 6 Fällen (0,6 %), vordere Vitrektomie: n = 5). Ein kurzfristiger Irisprolaps trat bei 3 Augen auf (3D: n = 2, 2D: n = 1). In zwei Augen kam es zu einer Zonulolyse (3D: n = 1, 2D: n = 1). Insgesamt zeigte sich kein statistisch signifikanter Unterschied zwischen den beiden Gruppen (p > 0,5). Schlussfolgerung: In einer großen Serie von 2000 Augen zeigte sich hinsichtlich des Sicherheitsprofils bei Katarakt-Operationen kein signifikanter Unterschied zwischen der 3D und der 2D Chirurgie. Die 3D-Chirurgie ist daher für die Katarakt-OP ohne zusätzliches Risiko einsetzbar. protection of the cornea during cataract PHACO (group 1) and 40 patients with PES who operated without protection (group 2). The average age is 71.8 ± 2.6 years. Visual acuity before surgery 0.02 ± 0.15. In group 1, after capsulorexis was performed using micro-forceps,a soft contact lens (SCL) was inserted into the anterior chamber (AC), and then a viscoprotector was introduced into the AC. The viscoprotector was located between the cornea and the lens and in the AC behind the lens. SCL was removed after surgery at the IOL implantation stage. Results and conclusions: On the 1st day after surgery in 12 (30 %) patients of the 1st group and in 24 patients (60 %) of the 2nd group, diffuse edema of the entire area of the cornea with involvement of the stroma and epithelium was determined, edema of the upper corneal sector with folds of the descemet membrane in 8 patients (20 %) of the 1st group and 15 patients (37.5 %) of the second group. Visual acuity in group 1 on the 1st day after PHACO was also statistically significantly higher than before surgery and in group 2, averaging 0.52 ± 0.02. On the 7th day-0.67 ± 0.05, on the 30th day 0.71 ± 0.04, and this difference was significantly higher than in group 2 (p < 0,05). Visual acuity in the 2nd group of patients on the 1st day after PHACO was 0.34 ± 0.06, on the 7th day-0.46 ± 0.02 and on the 30th day-0.62 ± 0.03. Our results indicate that the use of SCL during PHACO helps to improve the postoperative state of the cornea (to reduce the presence of stromal edema), which reduces the risk of intraoperative damage to the corneal endothelium, accelerates the restoration of corneal transparency, and thereby ensures higher indicators of visual acuity after surgery. Ergebnis: Die vorläufige Auswertung in dieser laufenden Studie ergab eine Wunddehnung von 0,18 mm ± 0,1 mm (von 2,20 ± 0,03 mm vor Implantation auf 2,38 ± 0,09 mm nach der Implantation) in den mit dem Autono-Me-Injektor behandelten Augen und eine Wunddehnung von 0,24 mm ± 0,07 mm (von 2,08 ± 0,08 mm vor Implantation auf 2,31 ± 0,05 mm nach der Implantation) in den mit dem iSert-Injektor behandelten Augen. Die Licht-und Rasterelektronenmikroskopie der Injektorspitzen zeigte folgen- 

Learning Yamane-10 tips for a better start -Videobeitrag Shajari M. 

Comparing the effective lens position and refractive outcome of a novel rhexis-fixated lens to established lens designs Shajari M. 

Benefits and new features of modern international internet database "IOLCon" for updated and optimized IOL constants Scholtz S. pre-and three months postoperatively. Lens constant optimization was performed.

Results: Seventy eyes of 56 subjects were included. ELP for rhexis fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis fixated IOL and both plate-haptic (P = 0.001) and c-loop haptic IOL (P = 0.000). ACD adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P < 0.05). For the rhexis fixated IOL the differences in refraction ranged from +0.04D for the Hill-RBF to +0.096D for Haigis. The other two lenses showed mean differences in refraction between -0.046D for Hill-RBF.

The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.

Usov V. Y. 1* , Kolomiychuk S. G. 1 , Tarik A. T. 1 1

The problem: Age-related cataracts, especially when combined with the development of inflammatory diseases of the cornea-important medical and social problem. Imbalance in the prooxidant-antioxidant eye tissues system is the main reason of the progression of pathological changes in the lens and in the cornea during inflammatory and degenerative diseases of the eye. The aim-to study the relationship between the indicators of the prooxidant-antioxidant system and pathological changes in the lens during the inflammatory process in the cornea. Methodology: Chinchilla breed rabbits with and without modeling bacterial keratitis were modeling a light cataract. The severity of pathological changes in the lens was determined by ophthalmobiomicroscopy. The activity of glutathione peroxidase and catalase, the content of malondialdehyde (MDA) and diene conjugates (DC) were measured in the lens, chamber moisture and tear fluid of rabbits. The total antioxidant activity, the content of MDA and DC were measured in the tear fluid of patients with keratitis with and without age-related cataract. Results: A negative correlation between the indices of lipid peroxidation (MDA and DC) and the antioxidant state rabbit eye tissues with cataract with concomitant keratitis was found. The relationship between the lens state and biochemical parameters was evaluated, with the Spearman correlation coefficient being: negative for glutathione peroxidase (R = -0.82,p < 0.01) and catalase (R = -0.69, p < 0.05), positive for MDA (R = 0.76, p < 0.05) and DC (R = 0.58, p > 0.05). Significant abnormalities in the prooxidant-antioxidant eye tissues system were found to be depended significantly on the severity of pathological changes in the lens of rabbits with light cataracts, especially during the inflammatory process in the cornea. Maximal changes in the prooxidant-antioxidant system in the tear fluid were observed in patients with age-related immature cortical, nuclear and posterior capsular cataracts and visual acuity less than 0.3 with keratitis. Particularly pronounced corneal disorders were observed in patients with cortical and nuclear mature cataracts with visual acuity less than 0.1.

The presence of correlation between the indices of lipid peroxidation products and antioxidant activity indicates the important role of these metabolic disorders in the formation of structural and functional changes in the lens of experimental animals and patients during the inflammatory process in the cornea.

Freiburger Ophthalmopathologie im Wandel der Zeit: 1945-1989 Glegola M. Purpose: To assess a potential relationship between the location of the maximal extent of parapapillary gamma zone and the location of the foveola.

The population-based Beijing Eye Study 2011 consisted of 3468 subjects (mean age: 64.6 ± 9.8 years) who underwent a detailed ophthalmological examination including biometry and fundus photography. Using fundus photographs we measured the angle between the disc-fovea line and the horizontal, and the location and width of parapapillary gamma zone. The present study consisted of 315 individuals with a mean age of 60.0 ± 8.1. years (range: 50-83) and an axial length of 24.1 ± 1.5 mm (range: 21.48,28.68).

The angle between the disc-fovea line and the horizontal increased significantly (i. e., the fovea was located more inferiorly) with increasing width of parapapillary gamma in the inferior sector, and vice versa (Disc-Fovea Angle = 0.004 × Maximal Gamma Zone Width + 11.3; standardized regression coefficient beta: 0.22; P = 0.002). This relationship was independent of axial length (P = 0.24). Conclusions: An inferior location of gamma zone is spatially correlated with a relatively inferior location of the foveola and vice versa. This spatial relationship between location of gamma zone and fovea location supports the notion of Bruch's membrane pushing backward during axial elongation and of a Bruch's membrane opening shift parallel to a change in the fovea location. excessive collagen formation) is considered to be crucial for the congenital glaucoma development as well as for the elaboration of pathogenetically based treatment of this disease.

Peripapillary border tissues of the optic nerve head: Associations with gamma zone and delta zone and potential biomechanical importance

Universität zu Köln, Cologne, Germany; 2 Univ.-Augenklinik, Erlangen, Germany

Purpose: To assess the relationship between the peripapillary border tissue (PBT) of the choroid (PBTC) (Jacoby) and of the peripapillary scleral flange (PBTS) (Elschnig) with the presence and length of parapapillary gamma zone and delta zone. Methods: The histomorphometric investigation included histologic sections of enucleated eyes of Caucasian patients. Using light microscopy, the PBT dimensions were measured.

The study included 85 eyes (age: 62.0 ± 14.1 years) (range: 37-87 years). Mean axial length was 26.7 ± 3.5 mm) (range: 21.0-37.0 mm). The length of PBTC was strongly and positively associated with the length parapapillary gamma zone (P < 0.001; standardized regression coefficient beta: 0.92) and delta zone (P < 0.001, beta: 0.86). In contrast, the length of the PBTS was strongly and negatively associated with gamma zone length (P = 0.009; beta: -0.32) and delta zone length (P < 0.001; beta:-0.54).

The length of the peripapillary border tissues are strongly associated with the width of the parapapillary zones gamma and delta. Since the whole inner ocular shell (choroid, Bruch's membrane, retina) are connected to the outer shell (i. e., sclera) only through the scleral spur anteriorly and through the PBTC posteriorly, the findings may have importance for the physiology and biomechanics of the eye.

Optic disc fovea distance and axial length: highly myopic eyes versus non-highly myopic eyes Purpose: To assess a relationship between the optic disc center-fovea distance and axial length in eyes divided into highly myopic eyes (axial length ≥ 26.5 mm and non-highly myopic eyes. Methods: The population-based Beijing Eye Study 2011 consisted of 3468 subjects (mean age: 64.6 ± 9.8 years) who underwent a detailed ophthalmological examination including biometry and fundus photography. The optic disc center-fovea distance was measured on the fundus photographs. The present study included fundus images of 111 individuals with a mean refractive error of -9.3 ± 3.8 diopters (range:-20.8, +1.75) and an axial length of 26.8 ± 1.9 mm (range: 22.55, 30.88) Results: The disc-fovea distance increased significantly with longer axial length, with a relatively flat slope in the non-highly myopic eyes (Disc-Fovea-Distance = 24.3 × Axial Length (mm)+514) and a steeper slope in the highly myopic group (Disc-Fovea-Distance = 58.7 × Axial Length (mm)-460). The increase in the disc-fovea distance was strongly correlated with an increase in the width of parapapillary gamma zone, while the distance between the peripheral gamma zone border and the fovea was not significantly associated with axial length.

The disc-fovea distance increases slightly with longer axial length in non-highly myopic eyes, and increases more steeply in highly myopic eyes, with a cut-off value of 26.5 mm axial length for the definition of high myopia. The results confirm the notion of Bruch's membrane opening (BMO) shifting to the temporal side in non-highly myopic eyes, leading to the development of parapapillary gamma zone and thus an in- The problem of high risk of blindness and disability in a given population by reason of glaucoma dictated the relevance of this research. Infringement of eye hydrodynamics plays the main role in glaucoma pathogenesis. Purpose of this work was to establish patterns of development and structure of the human eye drainage system in embryogenesis and in postnatal ontogenesis. Methodology: The human iris-corneal angles were studied in 40 embryos from 10 to 70 mm of parietal-coccygeal length (PCL) and on the anatomical preparations of 46 heads. The obtained histological sections of iris-corneal angles were stained with hematoxylin and eosin.

The iris-corneal angle in embryos 21 mm PCL was represented by the accumulation of mesenchymal cells. It began to be identified in embryos 32 mm PCL when the border between the cornea and sclera started to be determined. In embryos 41 mm PCL the iris and ciliary body were shifting posteriorly and the spaces of Schlemm's canal (SC) appeared above the trabecula. On histological sections the transition zone cornea-sclera was located in front of SC. Background: Jones tube surgery-creating a bypass between the caruncular conjunctiva and the nasal cavity using a glass tube drawing tears-is the gold standard for managing epiphora secondary to upper lacrimal outflow obstructions. However, tube extrusion occurred in up to 50 % of the cases.

Recently, the StopLoss Jones tube (SLJT) with an internal silicone flange was reported to reduce the risk for tube extrusion. Besides, tube insertion requires a bony ostium, which might preexist due to previous failed dacryocystorhinostomy (DCR). However, in patients without previous DCR, an external transcutaneous approach is needed for correct tube placement. Purpose: To describe a novel transcaruncular laser-assisted SLJT procedure without any skin incision for the treatment of lacrimal canalicular obstructions.

Methods: Under general anesthesia, sharp scissors were used for a 3-mm caruncular incision and gently advancing dissection in inferomedial direction towards the nasal bone. A laser fiber optic with 300 µm-diameter connected to an 810 µm-wavelength diode laser was inserted into the track and positioned under visual control using nasal endoscopy, so that the aiming beam appeared at the anterior margin of the middle turbinate. Subsequently, laser energy created a bony ostium with a 3-mm diameter, and a specially designed dilator was applied to enlarge the track. After measuring the distance between the caruncle and the nasal mucosa using a sizer, a SLJT of the required length was passed down the guidewire until the silicone flange opened within the nasal cavity. The guidewire was removed, and a suture was passed around the neck of the tube and secured to the caruncular conjunctiva. Results: Twelve consecutive patients (12 eyes) with absolute canalicular dacryostenosis were enrolled. Eleven eyes were surgically successful. In one case the inserted SLJT was too long and had to be replaced by a 2-mm shorter one. In 3 cases, conjunctival scarring, conjunctival granuloma and tube-associated irritation of the ocular surface required conjunctival revision. There were no cases of tube extrusion or sink-in.

Conclusions: This novel technique is a promising strategy for the treatment of lacrimal canalicular obstructions. Advantages include the lack of skin incisions and visible scars, the less risk of bleeding due to the vaporization method, and the reduced risk of tube migration or extrusion due to the StopLoss Jones tube with endonasal silicone flange. Purpose: Currently therapeutic management of patients with Graves' orbitopathy (GO) relies on clinical assessments and MRI scans. However, monitoring of inflammation remains difficult since external inflammatory signs like injection and chemosis do not necessarily represent the orbital disease activity.Therefore, we aimed to evaluate the diagnostic value of FDG-PET/MRI to assess the inflammation of GO patients. Methods: Patients with new onset of GO who were examined in our EU-GOGO tertiary referral center were enrolled in this trial. All patients underwent ophthalmological and orthoptic examinations to evaluate the activity and severity of GO, as well as an 18F-FDG-PET/MRI (Siemens Biograph mMRT). A subset of PET parameters including maximum standardized uptake value (SUVmax), metabolic target volume (MTV), and total lesion glycolysis (TLG) were obtained separately per-eye and per-extraocular eye muscle (EOM). EOM thickness was measured on the coregistered MRI. Subsequently, differences in PET parameters among NOSPECS classes were compared and statistically analysed, as well as tested for correlation with clinical findings. Results: Fourteen GO patients were enrolled and analyzed. Three showed mild, six moderate-to-severe and four sight-threatening GO. Patients with severe GO showed statistically significant higher values for TLG and MTV on the early static images, whereas SUVmax did not differ among groups. PET parameters did not show statistically significant differences on the late acquisition images. PET parameters obtained both from early as well as late static images showed no correlation with EOM thickness. PET parameters obtained from individual EOMs were not correlated with its motility. Discussion: TLG and MTV derived from PEA of early static images appear to be good discriminators for severe vs. mild to moderate GO. Our results suggest that in GO early static acquisition is superior to late static acquisition. As expected PET parameters of individual eye muscles were not correlated with associated eye motility, since fibrosis is responsible and not inflammation is mainly responsible for motility disorders. In conclusion, 18F-FDG-PET/MRI appears to be a promising modality for the assessment of GO severity with the potential to address limitations of the current diagnostic standard procedures. Therefore, its diagnostic value should be subject of further studies on larger collectives. Purpose: Evaluation of the ocular and adnexa pathological signs and the results of their treatment in patients who previously underwent radiation therapy for eyelid skin cancer. Material and methods: The study included 9 patients (3 men, 6 women, mean age 56.3 ± 2.7 years) who previously underwent radiation therapy for eyelid skin cancer. Follow up period from 4 months to 3 years. All patients suffered from lid cosmetic defect, had different grades of cicatricial lagophthalmos and corneal lesions. Lagophthalmos value ranged from 2 to 14 mm (M±m, mm: 7.1 ± 0.37), it was mild-in 1, moderate-in 3, severe-in 5 cases. Cornea was involved in all cases (keratopathy-1, keratoconjunctivitis-2, neurotrophic keratitis-4, corneal ulcer-2 cases). Dry eye diagnosed in all cases. Radiation induced cataract was detected in 5 cases. BCVA varied from 20/200 to 20/20 in 7 patients. Results: All patients underwent medical therapy and one or more surgical steps. Surgical correction of the eyelids position was performed in all cases. The type of surgical intervention depended on the grade of lagophthalmos: fixing of edges of a cartilage of a lower eyelid to the periosteum or canthoplasty, Z-plasty, transposed flaps. In the presence of severe complications of the cornea, the following surgical procedures were performed: transplantation of the amniotic membrane-3, autoconjunctival flap-5 eyes. As a result of the combined treatment, the state of the eye anterior segment has improved in all cases. Cataract extraction with IOL implantation was performed after stabilization of the cornea. Conclusions: Radiation therapy for skin cancer of the eyelids can lead not only to a cosmetic defect, but also to severe dry eye and serious complications of the cornea and adnexa. The optimal combination of medical and surgical treatment can achieve a satisfactory position of the eyelids and stabilization of the ocular surface, which significantly improves the quality of life of patients.

Eine Ptosis als Wegweiser zur Systemerkrankung Neumann C. 

Postoperativer Astigmatismus nach photorefraktiver Keratektomie bei Augen mit rein sphärischer Myopie Ezzeldin M. 1* , Frings A. 2, 3 , Linke S. J. 4, 5 , Steinberg J. 5, 6 Objective: To determine the incidence of tearing in patients after radioiodine therapy (I 131 ), as well as to conduct a correlation analysis of tearing and some clinical and laboratory parameters. Material and methods: A questionnaire survey of 235 patients was conducted (average age 55 ± 12 years, median 57 years) who underwent single (210 cases) or repeated (25 cases, up to 6 times) I 131 therapy in a dose of 1.5 to 6 GBq (average 3,6 ± 0.6 GBq) for thyroid cancer 2 to 61 months ago (average 31 ± 17 months, median 32 months). The severity of tearing was determined in points according to the Munk scale. A statistical analysis was performed, including a Spearman correlation analysis.

The tearing was absent in 123 respondents (58.6 %), the severity of tearing was 1 point according to the Munk scale in 39 cases (18.6 %), 2 points in 19 cases (9.0 %), 3 points in 14 cases (6.7 %), 4 points in 15 cases (7.1 %). A significant correlation was revealed between the severity of tearing and the frequency of I 131 therapy (p < 0.001, R = 0.5). The complaints of significant tearing after a single therapy with radioactive iodine (4 points) were determined in patients for periods of 5 to 46 months. The incidence of significant tearing (4 points) in patients after a single I 131 therapy increased with age (p < 0.001, R = 0.4), as well as with an increase in the effective radiation dose (p < 0.001, R = 0.5). Conclusion: The significant tearing probably caused by a secondary obliteration of the nasolacrimal duct occurs in 7.1 % of cases. The probability of this complication development is dose-dependent and is related to the eines hochviskösen Viskoelastikums im Rahmen der ICL-Implantation beziehungsweise des ICL-Austausches entstehen. Bei Urrets-Zavalia-Syndrom nach ICL-Implantation stellen zwei gegeneinander versetzte Aniridie-Ringe im Kapselsack zur dauerhaften Reduktion der Blendempfindlichkeit eine praktikable Therapieoption dar.

Hamon L. 1* , Flockerzi E. 1 (16) preloaded IOLs (20.0 D-21.0 D) per treatment group were delivered into the anterior chamber of human cadaver eyes through a 2.0 mm (Vivinex) or 2.2 mm (AutonoMe, UltraSert, and iTec) incision size. Corneal incision morphology was evaluated using optical coherence tomography (OCT) and incision sizes were measured using ASICO incision gauges before and after IOL delivery. Differences in mean incision enlargement between delivery devices were evaluated using a paired t-test. Results: AutonoMe (0.29 ± 0.03 mm) and UltraSert (0.29 ± 0.03 mm) had the smallest average incision enlargement compared with iTec (0.31 ± 0.03 mm) and Vivinex (0.36 ± 0.06 mm). Vivinex had the largest corneal incision enlargement and was significantly larger than AutonoMe (p = 0.001), UltraSert (p = 0.001) and iTec (p = 0.002). Representative OCT images of pre-and post-implantation incisions (cross sectional images of cornea) showed more incision gaping, corneal stromal damage and distortion for delivery systems with the largest incision enlargement: Vivinex and iTec.

The new AutonoMe preloaded delivery system protects the corneal incision during IOL implantation and causes smaller incision enlargement and less corneal stromal damage compared to iTec and Vivinex. Further clinical studies are necessary to confirm the effect of incision enlargement on wound healing and post-operative corneal morphology. Lwowski C. M Purpose: To assess the morphological and functional outcome of intravitreal aflibercept following treat and extend regime compared to fixed regime for treatment of eyes with neovascular age-related macular degeneration.

This retrospective study included 128 eyes with primary onset neovascular age-related macular degeneration followed for 12 months. All eyes were treated with 0.5 mg/0.05 mL aflibercept. All eyes received three aflibercept injections monthly as upload phase. Then, we compared two groups of eyes. For group 1, 57 eyes were treated following treat and extend regime. For group 2, 71 eyes were treated following fixed regime (fixed 8-weekly interval). Main outcome measures included: best corrected visual acuity (BCVA), central macular thickness (CMT) and number of injections. Results: BCVA (logMAR) in group 1 vs group 2 was (0.61 ± 0.3 vs 0.72 ± 0.3, p = 0.09) before treatment and (0.48 ± 0.3 vs 0.51 ± 0.3, p = 0.6) after one year of treatment. The visual improvement was (0.10 ± 0.1 vs 0.14 ± 0.1, p = 0.1). CMT in group 1 vs group 2 was (360 ± 106 µm vs 393 ± 108 µm, p = 0.09) before treatment and (284 ± 58 µm vs 290 ± 67 µm, p = 0.5) after one year of treatment. The decrease in CMT was (76 ± 102 µm vs 102 ± 110 µm, p = 0.1). Number of injections/eye in group 1 vs group 2 was (8.8 ± 1.4 vs 7.0 ± 0.0, p = 0.004). In Group 2, six Patients (11 %) were reverted back to monthly treatment as the treatment interval was extended over 8 weeks.

Conclusions: Eyes treated with aflibercept following treat and extend regime had no significant differences regarding BCVA and central macular thickness compared to eyes treated with fixed regime. However, eyes treated following treat and extend regime received a significantly higher number of injections during the first year of treatment. Ergebnis: Bei 11 Augen erfolgte der Revisionseingriff nach primärer Linsenchirurgie (IOL-Gruppe: 10 multifokal, 1 monofokal), bei 11 Augen war eine hornhautchirurgische Operation vorausgegangen (HH-Gruppe: 3 Femto-LASIK, 6 transPRK, 2 LASEK). Die Refraktion betrug präoperativ in der IOL-Gruppe +0,4 ± 1,5 dpt (-2,5 bis +2,25 dpt) im sphärischen Äquivalent (sphÄ), in der HH-Gruppe -0,54 ±0,75 dpt (-2,0 bis +0,5 dpt). Der unkorrigierte Visus (UCVA) lag präoperativ bei 0,53 ± 0,23 (IOL-Gruppe: 0,38 ±0,21 (0,1 bis 0,6), HH-Gruppe: 0,69 ±0,16 (0,4 bis 0,9). In 3 Augen der HH-Gruppe wurde eine wellenfrontgeführte Ablation durchgeführt. 20 von 22 Augen lagen postoperativ im Zielbereich von ± 0,5 dpt. Die UCVA betrug 3 Monate postoperativ im Mittel 0,92 ±0,16 (0,6 bis 1,1) (IOL-Gruppe: 0,82 ±0,16 (0,6 bis 1,0), HH-Gruppe: 0,98 ±0,06 (0,9-1,1). In der Aberrometrie zeigte sich in der IOL-Gruppe eine Zunahme, in der HH-Gruppe eine dezente Abnahme der Aberrationen höherer Ordnung (HOA, bei 6 mm Pupille) (IOL-Gruppe: RMS +0,244 µm, Coma +0,025 µm, Trefoil +0,208 µm, SphAb -0,119 µm; HH-Gruppe: RMS -0,083 µm, Coma -0,028 µm, Trefoil -0,086 µm, SphAb +0,028 µm). In keinem Fall kam es zu postoperativen Komplikationen, und es waren bei subjektiver Patientenzufriedenheit keine weiteren Revisionen notwendig. Schlussfolgerung: Excimer-Laser-gestützte Revisionseingriffe stellen bei residueller Ametropie nach primärer Linsen-oder Hornhautoperation, speziell im refraktiv-chirurgischen Bereich, eine sichere und effektive Therapieoption dar, um dem Patientenwunsch zu entsprechen. Rayamajhi A. 1 Objective: The mechanism of the two-photon absorption by photoreceptors and their visual pigment chromophore isomerization lays the ground for a better understanding of how infrared light (IR) triggers color perception in an unaided eye. The association between retinal disease and expected changes in IR-light sensitivity has yet to be investigated, though. This study aimed to measure and compare scotopic eye sensitivity of healthy and diabetic-retinopathy patients using an IR-light microperimeter. Method: This research was carried out at the Ophthalmology Department of the Heidelberg University Hospital. Among 69 included eyes, 28 were healthy, and 41 were diabetic. All participants underwent a comprehensive eye exam, including visual acuity (VA) and contrast sensitivity tests, optical coherence tomography and slit-lamp examination. The IR threshold was measured following 30-min dark-adaptation with a Goldman II size stimulus and the method of adjustment. To this end, we used the IR-light microperimeter with integrated pulsed laser light (1045 nm) for sensitivity assessment and scanning laser ophthalmoscopy for fundus imaging.

The mean age of the diabetic patients (61.2 ± 12.7 years) and the control group (56.2 ± 15.7 years) was not statistically significant (P = 0.15). The mean logMAR VA of the diabetic patients (0.12 ±0.17) was worse than in the healthy group (-0.04 ±0.08), which was significantly different (P < 0.001). Furthermore, the contrast sensitivity of the diabetic patients was lower than that of the healthy group, especially at 6 and 18 cycles/degree. A statistically significant (P = 0.04) difference was found in the mean retinal thickness between the diabetic patients (300.0 ± 50.0 µm) and the healthy group (277.1 ± 19.5 µm). The mean retinal sensitivity to IR light in the diabetic patients (11.6 ± 2.1 dB) was significantly (P < 0.001) lower than in the healthy group (15.5 ± 1.3 dB). Kharkiv National Medical University, Kharkiv, Ukraine

Background: Nowadays phacoemulsification is a standard in the cataract surgery. However, it is impossible to exclude the negative effect of low-frequency ultrasound, cavitation and thermal energy during surgery. Changes in the posterior segment of the eye after phacoemulsification require clarification.

Aim: was to analyze the changes of the macular morphology and posterior vitreous among patients with unchanged posterior segment of the eye after the phacoemulsification of the cataract with and without posterior capsulorhexis.

Methods: In this prospective study 68 patients with senile cataract and unchanged posterior segment of the eye were included. All patients underwent uncomplicated phacoemulsification. Posterior capsulorhexis was not performed to 42 patients of the first group whereas it was applied to 26 patients of the second group because of the opacification of the posterior capsule of the lens. OCT was performed to all patients preoperatively and postoperatively on the 1st day, the 1st week, and the 1st, the 3rd, and the 6th months.

Results: There were no significant differences in the macular thickness among patients of the first and the second group before the surgery. Significant difference in the macular thickness was detected on the 1st day (p = 0.03), the 1st week (p = 0.02), and the 1st month (p = 0.03). But this difference in both groups became insignificant by the 3rd and 6th month of observation. During the 1st week after the surgery one patient (3.8 %) of the 2nd group manifested cystoid macular edema that was resolved by the 3rd month of the observation. There were no changes of the posterior vitreous among patients of the 1st group. Partial detachment of the posterior hyaloid membrane was observed in 1 patient (3.8 %) of the 2nd group one month after the operation. Three months later partial detachment of the posterior hyaloid membrane was diagnosed in 2 more patients (7.7 %) of the 2nd group. During 6 months of observation partial detachment of the posterior hyaloid membrane did not lead to a significant change in retinal thickness among all 3 patients. Summary: Potentially, posterior capsulorexis during uncomplicated phacoemulsification leads to a more pronounced effect on the vitreous body and macular zone. However, the morphological changes in the posterior segment of the eye in this case are either reversible or do not lead to gross structural changes that could affect visual function within six months of observation. Berlin M. 

Edema-GRADE-DME Study Busch C. Purpose: To evaluate the proportion of functional and anatomical responders and non-responders to the first dexamethasone (DEX) implant in naïve and non-naïve diabetic macular edema (DME); to assess different response patterns; and to propose a grading classification for DME treatment response. Methods: Retrospective, multicenter, observational study. Naïve and nonnaïve DME patients treated with DEX, with visual acuity (VA) ≥ 0.2 log-MAR (≤ 0.8 decimal) and central subfield thickness (CST) of ≥ 300 µm measured on spectral domain optical coherence tomography (SD-OCT). VA and CST were recorded at baseline, month 2 and month 4 after first DEX treatment. Functional and anatomical responses were graded, and different response patterns were analyzed. Results: We included 417 eyes from 388 patients, of which 42 % (175 eyes) were treatment-naïve. Mean baseline VA was 0.63 ± 0.30 logMAR and mean CST was 534.5 ± 144.0 µm. The proportion of very good functional responders (VA gain ≥ 10 letters) after 2 and 4 months was 56 and 57 % for naïve eyes, and 33 and 28 % for non-naïve eyes (naïve vs. non-naïve eyes: p < 0.001). Proportion of functional non-responders (VA gain < 5 letters) after 2 and 4 months were 18 and 16 % for naïve eyes, and 49 and 53 % for non-naïve eyes (naïve vs. non-naïve eyes: p < 0.001). Anatomical non-responders (CST reduction < 10 % or CST increase) at 2 months were rare in both groups (naïve: 4 %, non-naïve: 12 %, p = 0.003). Naïve eyes usually demonstrated an early and stable functional and anatomical improvement, while in non-naïve eyes a persistent non-response pattern was the 223 Visusrelevante prognostische Parameter bei fibrovaskulärer Umwandlung der CNV unter Anti-VEGF-Therapie bei neovaskulärer AMD Book M. Methods: Endothelial cell growth medium (ECGM-MV) and DMEM were supplemented with 5 % fetal bovine serum, endothelial cell growth supplement, 90 µg/ml heparin and 100 nM cortisol, and confluent iBREC were exposed to both cell culture media or mixes thereof for 1-4 d. The cell index (CI) of confluent cells cultivated gold electrodes was continuously determined to evaluate permeability, cell adhesion or cell viability for which the activities of NAD(P)H-dependent oxidoreductases were also measured. We assessed expression and/or subcellular localization of proteins specific for (microvascular) EC and those involved in regulation of paracellular flow and transport. Results: The CI dramatically dropped to 10 % within 6 h after exposure of the cells to DMEM, slowly recovering to normal values over the following 4 days. Expression of tight junction (TJ) protein claudin-5 specific for microvascular EC was significantly lower even after 1d and barely detectable on day 4. In contrast, expression of TJ-protein claudin-1 was higher after 1d, but significantly declined during prolonged cultivation of the cells in DMEM. Adherens junction protein VECadherin was only slightly affected, but expression of caveolin-involved in transcellular transport-was also significantly lower. In accordance, plasma membrane localization of claudin-1 or claudin-5 was reduced and that of VECadherin more diffuse after exposure to DMEM for 3d. The cells then still expressed EC-specific von Willebrand factor although to a lesser extent. Interestingly, the NAD(P)Hdependent oxidoreductases were more active. All changes were observed with iBREC cultivated in mixes of ECGM-MV and DMEM containing at least 50 % DMEM. Conclusion: Cultivating iBREC in DMEM results in a rapid loss of the phenotype and properties typical for microvascular EC. These changes include barrier dysfunction and loss of specific marker proteins. Therefore, observations made with (retinal) EC cultivated in DMEM have to be evaluated with caution. 

Falahat P. 1* , Wintergerst M. W. M. 1 , Holz F. G. 1 , Schaefer C. 2 

Einfluss der WWC-Proteine auf die Gefäßbildung der Netzhaut der Maus Egbring C. 

Non-Adhärenz und Non-Persistenz in der IVOM-Therapie -eine systematische Literaturrecherche Ehlken C. 1* , Ziemssen F. 2 , Eter N. 3 , Lanzl I. 4 , Kaymak H. 5 , Lommatzsch A. 6 

Ex-vivo retinal dystrophy models via blue light induced neurodegeneration Fietz A. 1* , Hurst J. 1 , Leinwetter M. 1 , Schnichels S. 1 1 Universitäts-Augenklinik, Tübingen, Germany

Background: The hallmark of many retinal diseases like age-related macular degeneration (AMD) or retinitis pigmentosa (RP) are neurodegenerative processes in the retina, leading to damaged photoreceptor cells and ultimately blindness. There is strong evidence that photochemical oxidative stress plays a role in AMD and RP pathogenesis as well as in several other eye diseases. Blue light triggers the production of reactive oxygen species (ROS) and might therefore be a promising non-chemical-based inducer of oxidative stress. The aim of this project was to establish a ROS based degeneration model on ex vivo porcine cells and retinae. Methods: Primary porcine retinal cells and organ cultures were exposed to blue light in varying intensities, treatment numbers and periods of time. ROS production was measured and the apoptotic state of the retinal cells and cultures was determined. Furthermore, the degree of degeneration was analyzed via immunhistology, western blot and qRT-PCR. Cell and disease specific, as well as cell death and cellular stress markers were evaluated. Results: Primary RPE and Müller cells were exposed to blue light for 1 h and the ROS-level was determined. Both exhibited significant ROS increase after 6 and 24 h of cultivation (1.3-2-fold). Furthermore, Müller, RPE and dissociated retinal cells were exposed for 2 h and the ROSamount was measured after 6 and 24 h. The strongest ROS-increase was detected after 6 h (2-10-fold), proving that blue light irradiation causes oxidative stress in primary retinal cells. To investigate the effect of blue light on retinal explants, specific markers like PARP-1, HSP70, p53, Caspase 3, and Opsin were analyzed. In blue-light-irradiated retinal explants, a significant increase of PARP-1 and other stress markers was demonstrated, whereas Opsin expression was decreased (2-fold). Conclusion: We successfully established an oxidative stress based disease model with blue-light-induced neurodegeneration. This model can be used to test novel therapeutic approaches for AMD-or RP-treatment exvivo. Due to a similar morphology of the pig eye to the human eye, this setting is close to the human condition. 

The features of vitrectomy and vitreous chamber tamponade in the surgical treatment of severe forms of proliferative diabetic retinopathy Golovin A. 

Germany, the Netherlands and Switzerland. Here, we will focus on the DME subgroup.

The PACIFIC study is a non-interventional, open label, multicentric study aiming to collect real world evidence regarding the use of ranibizumab. 5.014 patients were recruited in 186 sites across Germany (GER), the Netherlands (NL), and Switzerland (CH). We present data of at least 12 months DME treatment with ranibizumab (299 naive and 411 pretreated patients-full analysis set) in a real-life setting, with a focus on treatment outcome, supply and therapy schemes applied.

The percentage of female patients were 40.7 % (GER), 60.0 % (NL) and 31.8 % (CH). The entire population presented with a mean age of 66.4 (GER), 68.1 (NL) and 61.0 (CH) years. In GER most patients were already pretreated (P-T). Mean BCVA at baseline was 62.8 ± 15.8 (GER), 68.3 ± 9.4 (CH) for treatment-naïve (T-N, no patients NL) and 65.9 ± 16.1 (GER) 65.5 ± 12.7 (NL), 78.0 ± 5.4 (CH) letters for P-T patients. After 24 months ranibizumab treatment, 17.5 % more T-N than P-T patients achieved a BCVA gain ≥ 15 letters. Within 12 months T-N patients received an average of 6.2 ± 2.9 (GER), 6.3 ± 6.5 (CH) ranibizumab injections which was comparable to P-T patients ( Markova K. 2 , Rößler B. 3 , Iwersen M. 3 , Michel U. 3 , Beeke E. 4 , Gamael A. 5 , Scheffler M. 6 , ter the lesion. Number and length of regenerating RGC axons in the distal optic nerve stumps were analyzed one month after the lesion. Results: The number of surviving RGCs in retinas treated simultaneously with GDNF and CNTF, GDNF only, or CNTF only was significantly higher than in retinas that received injections of control NSCs at all post-lesion time points. Importantly, the simultaneous administration of both neuroprotective factors rescued RGCs more effectively from injury-induced cell death than the separate administration of either GDNF or CNTF.

Haritoglou C. 1* ,

Conclusions: Data indicate that combinatorial neuroprotective approaches represent a promising strategy to effectively rescue RGCs from lesion-induced cell death even when the treatment is started at a time point when a significant fraction of RGCs is already lost.

Jiang J. 1* 1 Universitätsaugenklinik Freiburg, Freiburg, Germany

Background: Retinopathy of prematurity (ROP) is a major cause of blindness in children. Hyperoxic insults to the premature retina after birth, followed by a hypoxic phase subsequently, lead to neovascularisation. Without timely treatment, retinal detachment ensues. Diode laser photocoagulation is the current gold standard treatment but may not be widely available in developing and middle-income countries, where a surge in the incidence of ROP has been observed. Therefore, trials are ongoing to find time-saving and less invasive alternatives.

Objectives: This literature review aims to discuss potential treatment options explored recently (from 2010 onwards) and to examine how they relate to the pathophysiology of ROP.

Embase and the Cochrane Database of Systematic Reviews (CDSR). Key words such as "Retinopathy of Prematurity", "Anti-VEGF", "IGF-1" and "Beta blockers" were searched using Medical Subject Headings (MESH), free text terms and synonyms. Trials published in English and within the last ten years (2010-2019) were evaluated. Results: Thirty-five trials were relevant to this literature review and generated findings for the use of anti-VEGF, IGF-1, beta blockers, oxygen saturation targets and postnatal nutrition. The largest body of evidence relates to anti-VEGF agents, but their side effect profile and optimal dosages are areas to be addressed before widespread clinical use can be advocated. Other promising interventions include beta blockers and fish oil supplementations, which should be further evaluated in large-scale randomised trials. Discussion: Despite the advantages associated with anti-VEGF therapy, more high-quality studies are required and determination of the safety of this class of drugs is paramount. Up to date guidelines for ophthalmologists in the treatment of ROP are also needed. There is much interest in managing a range of co-morbidities associated with prematurity by means of a single intervention, which has proven to be an ambitious but challenging task. Purpose: To address the need for a reduced treatment burden for the management of neovascular age-related macular degeneration (nAMD), the Port Delivery System with ranibizumab (PDS) was designed as a refillable, indwelling implant providing diffusion-mediated continuous intravitreal delivery of ranibizumab (RBZ).

The Ladder trial (NCT02510794) is evaluating the efficacy and safety of the PDS with 3 RBZ formulations compared with monthly intravitreal RBZ 0.5 mg injections for the treatment of nAMD. The primary study endpoint, defined as time to first required implant refill assessed when the last enrolled patient completed the month 9 visit, has been reached. The phase 3 Archway (NCT03677934) is an ongoing randomized clinical trial directly comparing PDS 100 mg/mL with fixed 24-week refills with intravitreal RBZ 0.5 mg monthly. Results: The Ladder primary analysis population was 220 patients: 59, 62, and 58 patients in the PDS 100, 40, and 10 mg/mL arms, respectively, and 41 patients in the monthly intravitreal RBZ arm. The median time to first refill was 15.0, 13.0, and 8.7 months with 79.8 %, 71.3 %, and 63.5 % patients not meeting implant refill criteria until ≥ 6 months for the PDS 100, 40, and 10 mg/mL arms, respectively. At month 9, mean change in BCVA from baseline was +4.3, -0.5, -3.2, and +3.3 letters for PDS 100, 40, and 10 mg/mL, and monthly intravitreal RBZ arms, respectively. At the time of primary analysis, patients in the PDS 100, 40, and 10 mg/mL arms had received a mean total of 2.4, 2.6, and 3.7 RBZ treatments during a mean time on study of 16.4, 17.0, and 16.9 months, respectively, compared to a mean total of 16.8 RBZ treatments received by patients in the monthly intravitreal RBZ arm during 16.4 month mean time on study. The optimized PDS implant insertion surgery and refill procedures were well tolerated. Case examples from the Ladder study and mechanism of action of continuous delivery will be presented at the meeting. Conclusions: With 80 % of patients not needing an implant refill until ≥ 6 months in the PDS 100 mg/mL arm and comparable efficacy outcomes between PDS 100 mg/mL and monthly intravitreal RBZ treatment, Ladder results support the Archway design of PDS 100 mg/mL with fixed 24-week refills. PDS has the potential to reduce high intravitreal treatment burden and improve patient outcomes in clinical practice. Hintergrund: Beschreibung der klinischen Variabilität in Augen mit Retinitis pigmentosa assoziiert mit pathogenen EYS Genmutationen. Methoden: Neun Patienten (mittleres Alter: 46,2, 29-70 Jahre bei Erstuntersuchung, 4 Frauen) mit zwei pathogenen EYS Genmutation bestätigt durch molekulargenetische Diagnostik wurden klinisch untersucht mit S128 Abstracts these patients. Faricimab is a first-in-class bispecific monoclonal antibody directed against VEGF-A and ANG-2 and designed for intravitreal use. We aimed to assess efficacy and durability of faricimab in patients with DME and nAMD (BOULEVARD and STAIRWAY). Methods: BOULEVARD (NCT02699450) analysed treatment-naïve DME patients receiving intravitreal 1.5 or 6.0 mg faricimab or 0.3 mg ranibizumab (RBZ), and previously anti-VEGF-treated patients 6.0 mg faricimab or 0.3 mg Q4 W for 20 weeks. STAIRWAY (NCT03038880) analysed patients with nAMD treated intravitreal with 6.0 mg faricimab, Q16 W flex or Q12 W after initiation, or with 0.5 mg ranibizumab (RBZ) Q4 W. We here present the results of both phase 2 studies regarding central subfield thickness (CST), diabetic retinopathy severity score, size of choroidal neovascularisation (CNV) lesions and safety signals. Results: CST improved from baseline at week 24 in all DME patients (adj. mean change, microns: 1.5 mg faricimab, -217.1; 6.0 mg faricimab, -225.8; 0.3 mg RBZ, -204.7). 28 %, 39 % and 12 % of DME patients experienced a ≥ 2-step improvement in diabetic retinopathy severity score with 1.5 mg faricimab, 6.0 mg faricimab or 0.3 mg RBZ, respectively. More patients treated with 6.0 mg faricimab maintained disease stability with stable CST during the off-treatment period at both 8 and 12 weeks after the last dose compared to RBZ. 65 % (36/55) of faricimab-treated nAMD patients had no disease activity at week 24. Q16 W flex and Q12 W faricimab-treated nAMD patients showed similar CST and CNV lesion size reductions vs Q4 W RBZ.

In both studies no new or unexpected safety findings were identified. Conclusions: Maintenance of disease stability was improved with faricimab in DME patients, and extended faricimab dosing (Q16 W flex and Q12 W) revealed similar outcomes compared to Q4 W RBZ in nAMD patients. These results support further investigation of the efficacy, safety and durability of response, addressing an important unmet need for treatment options for these patients.

Karzinomassoziierte Retinopathie -zwei Fallberichte Kilic A. Purpose: Multicentre trials have demonstrated the safety and efficacy of the FAc implant in the management of DME over a 3 year period. There are few real-world studies with sufficiently large populations of patients with DME reporting 3 year outcomes. The current study reports the safety and effectiveness findings from the IRISS study Methods: IRISS is a post-authorisation observational open label, registry safety study of the FAc implant in DME, conducted in the United Kingdom, Germany and Portugal. The study was designed to collect the data from 550 patients that had been treated with the FAc implantation according to the European label. The present analysis focused on only those patients (n = 295 patients/n = 343 eyes) completing 3 years of monitoring post-treatment with the FAc implant. Safety was assessed in terms of the occurrence of intra-ocular pressure (IOP) events and their management. Effectiveness was determined from changes best-recorded visual acuity (VA), particularly on the percentage of patients maintaining or achieving 6/12 (20/40 or 70 ETDRS letters) vision. Results: Mean age of the patients was 66.3 ± 10.8 (mean±standard deviation [SD]) years and the duration of DME was 4.95 years. The majority (85.7 %) of eyes treated with the FAc implant were pseudophakic. Mean IOP was 15.6 ± 3.6 mmHg at baseline and remained below 21 mmHg throughout 36 months of follow up, with a small increase from baseline at month 36 (+1.2 mmHg, p = 0.033). Topical IOP-lowering drops were required in 39.9 % of eyes to control elevation in pressure and only 3.2 % (n = 11/343) of eyes requiring IOP-lowering surgery. Mean VA improved/ was maintained in 71 % of eyes at year 3 and 32 % achieved 6/12 vision compared to 18.6 % at baseline. Eyes with a starting VA of 6/12 had no significant change in VA over 3 years. Conclusions: These real-life outcomes confirm the long-term safety and effectiveness of the FAc implant in the treatment of DME after three years of treatment and in a cohort of patients larger than the EU registration trial population. The results from clinical practice show changes in IOP and visual acuity similar to those reported in the pivotal FAME trials. These data also show that when patients with good starting VA (≥70 letters) were treated with the FAc implant, vision was stabilised for the full three years of therapy.

Khoramnia R. 1* , Patel S. 2 , Khanani A. M. 3 , Sahni J. 4 , Sadikhov S. 4 , Basu K. 5 , Grzeschik S. 5 , Szczesny P. 4 Purpose: The importance of VEGF-A inhibition in the treatment of neurovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) has been well demonstrated. Still, real-world response rates are not sufficiently satisfying and treatment burdens are high due to high injection frequencies (Q4 W). Additional simultaneous inhibition of angiopoietin-2 (ANG-2) might improve treatment efficacy and durability in Berlin A. 1 , Radun V. 1 , Reichel C. 1 Augenklinik der LMU München, Munich, Germany; 2 Universität Ulm, Ulm, Germany

Introduction: Foveal alterations in asymptomatic patients can be very challenging in order to facilitate a diagnosis. Methods: A female 21-year-old patient was referred to us by a general ophthalmologist to clarify a foveal lesion, that had been observed in a routine fundus examination of the right eye. In addition to her medical history and a standard clinical examination we performed the following examinations: fundus Imaging, widefield Imaging, Heidelberger autofluorescence, OCT Imaging, fluorescein and ICG angiography.

The patient presented without any medical or ophthalmological history. The vision was 20/20. The clinical examination of the anterior segment of the eye showed no pathological findings. The posterior segment of the right eye showed a circular central lesion of the fovea. In fundus Imaging and widefield Imaging this lesion could be documented. Heidelberger autofluorescence showed no foveal enhancement. In OCT Imaging the retinal layers were normal, however, we observed uncommon dilated choroidal vessels. In fluorescein and ICG angiography the dilatation and central anastomosis of choroidal vessels were clearly documented. Discussion: This is one of the rare examples of an asymptomatic patient who presented with an alterated fovea, which is most likely due to choroidal anastomosis and dilatation.

Bewertung der Eignung des Serum VEGF Spiegels als prognostischer Faktor bei einem Makulaödem bedingt durch einen Venenastverschluss/Zentralvenenverschluss unter Therapie mit Lucentis® (Ranibizumab) Lang M. Purpose: Neuronal ceroid lipofuscinosis (NCL) is a clinically and genetically heterogeneous group of neurodegenerative lysosomal storage disorders of mainly childhood. Characteristic clinical symptoms of this fatal disorder include cognitive decline, mental deterioration, motor impairment, seizures, vision loss as a result of retinal degeneration, and premature death. Enzyme replacement strategies represent promising treatment options for NCL forms caused by dysfunctional lysosomal enzymes. CLN10 disease is caused by mutations in the gene encoding the lysosomal enzyme cathepsin D (CTSD). Here, we analyzed the efficacy of two enzyme replacement strategies to attenuate retinal degeneration in a Ctsd knockout (ko) mouse. Methods: Functional murine CTSD was administered to the Ctsd ko retina prior to the onset of retinal degeneration by intravitreal injections of either a CTSD-overexpressing neural stem cell (NSC) line or CTSD encoding adeno-associated virus (AAV) vectors. The impact of the treatments on accumulation of storage material, reactive astrogliosis and microgliosis, dysregulation of various lysosomal proteins and the loss of different retinal cell types was analyzed at the end-stage of the disease using immunohistochemistry and Western blot analyses. Results: Both treatment strategies resulted in a reduction of storage material and attenuation of reactive microgliosis. Treatments also normalized the dysregulated expression of various lysosomal proteins. However, significant attenuation of retinal degeneration was only observed in animals treated with CTSD-encoding AAV vectors but not in animals that received injections of CTSD-overexpressing NSCs. CTSD levels were significantly higher in AAV-treated than in NSC-treated Ctsd ko retinas. Conclusions: A sustained administration of functional CTSD, either through a cell-or an AAV-based approach, resulted in attenuation of the retinal pathology in an animal model of CLN10 disease, the most severe NCL form. However, delivery of therapeutically relevant amounts of the lysosomal enzyme to the Ctsd ko retina was only achieved through the gene therapy approach, as indicated by a significant rescue of retinal cell types.

BioAdhere -Maßgeschneiderte Bioadhäsiva für epiretinale Netzhautstimulatoren 

Okuläre Beteiligung bei einer systemischen ATTR-Amyloidose mit einer p.V50M Mutation Lubbad A. Verlauf: Im Labor fielen ein Kaliumwert von 2,5 mmol/l, sowie 600.000 Leukozyten mit deutlicher Linksverschiebung auf. Bei V. a. Leukämie erfolgte eine stationäre Aufnahme in der Hämatoonkologie. Mittels zytound molekulargenetischer Analyse wurde die Translokation t(9;22) (q34;q11) mit Nachweis des BCR-ABL Transkriptes ermittelt und die Diagnose einer CML gestellt. Daraufhin wurde die zytoreduktive Therapie (mit Hydroxycarbamid gefolgt von einem Tyrosinkinaseinhibitor) eingeleitet. Unter der Therapie normalisierten sich die Blutwerte und funduskopischen Veränderungen und der Visus stieg beidseits auf 1,2. In der FAG zeigten sich die Tortuositas und Blutungen rückläufig. In der SD-OCT kam es beidseits zum Rückgang des MÖs unter der CML-Therapie. Diskussion: Bei einem ZVV erfolgt die Diagnostik meist ohne Notfallindikation über den Hausarzt. Bei bilateralem Auftreten und jungen Patienten (< 50 Jahre) muss eine Ursachenabklärung durchgeführt werden, da häufig eine systemische Erkrankung assoziiert ist. Die sofortige Blutuntersuchung sowie die hämatoonkologische Therapie sind bei diesen Patienten essentiell. Ein Effekt der systemischen Therapie auf das MÖ sollte für bis zu 6 Wochen nach Symptombeginn abgewartet werden, bevor eine anti-VEGF Therapie begonnen wird. So könnte in manchen Fällen eine Anti-VEGF Therapie eingespart werden. Besteht das MÖ ungeachtet der Purpose: Our increasingly aging society leads to a growing incidence of neurodegenerative diseases. As the pathological mechanisms are inadequately known, the establishment of defined therapies is impeded. Additive gene therapeutic approaches for the increased expression of a protective factor are considered as promising treatment modality. Our approach relies on the genetic modification of retinal pigment epithelial (RPE) cells.

We have already established their transfection to stably overexpress the genes coding for pigment epithelium-derived factor (PEDF) and brainderived neurotrophic factor (BDNF), respectively. Here, we describe the analysis of the neuroprotective function of the transfected RPE cells using a co-culture model. Methods: ARPE-19 cells were transfected with the genes coding for PEDF and BDNF using the non-viral Sleeping Beauty transposon system. PEDF and BDNF gene expression were analyzed via quantitative real-time PCR. PEDF and BDNF secretion were evaluated by immunoblotting and quantified by ELISA. Transfected and non-transfected ARPE-19 cells were cocultured with SH-SY5Y cells, a human neuroblastoma cell line exhibiting neurite outgrowth in the presence of neurotrophic factors. Prior to the co-culture, SH-SY5Y cells were oxidatively stressed with 150 µM H 2 O 2 for 24 h to mimic damaged cells (oxSH-SY5Y). After 48 and 96 h, the neurites were stained with an anti-neuron-specific β-III tubulin antibody and visualized by confocal microscopy. Neurite outgrowth was analyzed using the software Simple Neurite Tracer.

The transfection of ARPE-19 cells resulted in a significant increase in PEDF and BDNF gene expression as well as protein secretion.

First results indicated that BDNF-transfected ARPE-19 (trARPE-19) cells significantly stimulated neurite outgrowth (p < 0.01). The neurite length in trARPE-19/oxSH-SY5Y co-cultures was 1.81-fold extended compared to oxSH-SY5Y cells alone (64.1 ± 2.5 µm vs. 35.5 ± 1.2 µm), whereas nontransfected ARPE-19 cells showed no significant effect on oxSH-SY5Y cells (41.9 ± 1.3 µm). However, for PEDF, no significant neurite elongation was observed until now.

With the establishment of the SH-SY5Y co-culture model, we were able to analyze the neuroprotective function of a cell-based gene therapy. The next steps include the co-cultivation of SH-SY5Y cells with transfected primary pigment epithelial cells and the translation of the method to an ex-vivo retinal organ co-culture model. 

Traumatische Zyklodialyse -von Zyklopexie ab interno bis zur DMEK Martin C. OCT (0, 4, 8, 12, 16, 24, 32, 40, 48 Wochen) auch die Mikroperimetrie (MAIA Mikroperimetrie, 0, 4, 12, 24, 48 Wochen) . Verglichen wurde der Verlauf der Fixationsstabillität (P1) und die Zunahme und Abnahme der retinalen Empfindlichkeit an einzelnen Punkten der Mikroperimetrie. Ergebnisse: Nach 48 Wochen zeigt sich ein Anstieg der Sehschärfe im Mittel von 55, 7 ± 15, 9 auf 63, 9 ± 16, 8 Buchstaben ETDRS (p = 0,005) und eine Abnahme der CRT von 436,3 ± 205,8 µm auf 273,2 ± 152,4 µm (p < 0,001). P1 verbesserte sich von 63,5 ± 28,2 % auf 76, 8 ± 26,8 % (p = 0,019) . Während zu Beginn der Therapie deutlich mehr Punkte eine Verbesserung der retinalen Empfindlichkeit als eine Verschlechterung zeigen (nach 4 Wochen: 19, 1 ± 8, 1 vs. 8, 4 ± 6, 3 (p < 0, 001), Gesamtsumme dB: 90, 4 ± 68, 9 vs. 32, 7 ± 30, 9 (p < 0, 001) ; nach 8 Wochen: 16,2 ± 7,0 vs. 9,8 ± 5,1 (p = 0,005), Gesamtsumme dB: 60,4 ± 48,0 vs. 29,4 ± 18,2 (p = 0,027), sind bei der letzten Visite verbesserte und reduzierte Punkte gleich häufig (12, 5 ± 7, 0 vs. 12, 5 ± 5, 5 (p = 0, 67), Gesamtsumme dB: 55, 8 ± 30, 5, 48, 2 ± 33, 0 (p = 0, 48) . Diskussion: Unsere Ergebnisse zeigen, dass eine Eylea-Therapie mit fixem Schema zu einer kurz-und langfristig signifikanten Verbesserung der Fixationsstabilität sowie der Sensitivität einzelner Bereiche der Mikroperimetrie führt. Es kann also mit einer konsequenten Therapie eine langfristige Verbesserung des Sehens erzielt werden. In all eyes a complete ophthalmic examination, swept source OCT and SS-OCT A was performed. We measured central retinal thickness (CRT), central choroidal thickness (CCT) and the area of the fovea avascular zone in superficial (sFAZ) and deep retina (dFAZ) vessels layer. Results: 38 eyes were included into this retrospective analysis. 24 patients were included into the "observation only group". During the 15 months observation period traction spontaneously released in 5/24 eyes (20 %), and the traction release was statistically significant (p = 0.01). In this group improvement of visual acuity was noted (from 0.5 to 0.7 Snellen). In mul-

Müller P. L. 1*,2 , Treis T. 3 , Pfau M. 2, 4 , Esposti S. D. 1 , Alsaedi A. 1 , Maloca P. 1, 5 , Balaskas K. 1 , Webster A. 1 , Egan C. 1 

Mikroperimetrie bei AMD Patienten während des ersten Jahres fixer Therapie mit Aflibercept (Eylea) Muto E. S. 1* , Dulz S. 1 , Spitzer M. 1 , Wagenfeld L. DRILs at the boundary between the ganglion cell-inner plexiform complex and inner nuclear layer improved in 79/143 eyes (55 %, p = 0.002) one month after DEX treatment. DRILs between the inner nuclear layer and outer plexiform layer improved slightly (p = 0,453).

The occurrence of DRILs at baseline correlate with worse BCVA and CRT at baseline and one month after DEX implantation. Furthermore, an improvement of DRILs could be shown after one month. Therefore, DRIL may serve as a predictive and robust biomarker of visual outcome in uveitic CME treated by DEX injection.

Pauleikhoff L. 1* , Vössing C. 2 , Song F. 2 , Usman M. 2 , Joachimsen L. 1 , Reiff C. M. 1, 3 

Nelis P. 1*,2 , Schmidt C. 3 , Lehmann F. 3 , Ertmer C. 3 , Heßler M. 3 

OCT-based automated vitreous inflammation score: a promising biomarker in dexamethasone implant treated uveitis patients Pohlmann D. 1* , Terheyden J. H. 2 , Berger M. 3 , Ometto G. 4 , Montesano G. 4 , Neuber F. 1 , Langner M. 2 , Wintergerst M. W. M. 2 , Aslam T. 5 , Liu X. 6 , Holz F. G. 2 , Keane P. A. 7 , Crabb D. P. 4 , Denniston A. 6 Purpose: To objectively detect and evaluate vitreous inflammation before and after dexamethasone implant in patients with uveitis by using a recently developed optical coherence tomography (OCT)-based algorithm. Methods: In this multicenter, retrospective, cross-sectional study, 302 eyes of 223 uveitis patients were included. Clinical and OCT data (Spectralis; Heidelberg Engineering Inc) of all patients were collected. The inflammation score was obtained using an available automated OCT-based algorithm. Data of pre and post dexamethasone implantation were compared using a random effects model. Results: Patients with cystoid macular edema in uveitis anterior (n = 18 eyes), intermediate (n = 106 eyes), posterior (n = 153 eyes), and panuveitis (n = 25 eyes) were treated with a dexamethasone implant. The mean of age was 61 years ± 15 years and a range of 22 to 88 years. We registered 277 follow-ups visits at 1 month (up to 2 months after injection) and 265 followup visits at 3 months (>2 months to 4 months). The mean inflammation score at baseline was 0.135, and changed significantly to 0.077 (p < 0.0001) 1-2 months and to 0.079 (p < 0.0001) 3 months after dexamethasone injection. Correlations with clinical ratings of intraocular inflammation are currently evaluated. Conclusion: Automated OCT-based objective quantification of vitreous inflammation captures the expected decrease in vitreous inflammation following intravitreal dexamethasone implant. Thus, the automated OCTbased quantification of vitreous inflammation may be a promising alternative and a potentially relevant biomarker compared to current subjective clinical estimates of vitreous inflammation in uveitis. 

Dunkeladaptation und skotopische Mikroperimetrie bei Patienten mit Sorsby Fundusdystrophie Raming K. 1*, 2 , Hess K. 1, 2 , Pfau M. 1, 3 , Birtel J. 1, 2 , Müller P. L. 4 , Gliem M. 5 , Issa P. C. 6 , Holz F. G. 1, 2 

Vesselness-basiertes KI-Verfahren zur automatischen 3D-Segmentierung der Gefäße in der OCT-Angiographie (OCTA) Rothaus K. 1* , Kuhlmann J. 2 , Faatz H. 1 , Jiang X. 2 , Lommatzsch A. 1, 3 

Longitudinale Struktur-Funktions-Analyse bei intermediärer altersabhängiger Makuladegeneration Saßmannshausen M. 1*, 2 , Zhou J. 1, 3 , Pfau M. 1, 2, 4 , Thiele S. 1, 2 , Fleckenstein M. 5 , Holz F. G. 1, 2 , 

A smart phone app for individual risk assessment for progression of diabetic retinopathy Scholtz S. 1* , Aspelund T. 2 , Einarsson S. 3 , Gudmundsdottir A. 4 , Jonsdottir S. 3 , Steinarsson A. T. 3 , Stefansson E Schultheiss M. 1* , Wenzel D. A. 2 , Kromer R. 1 , Poli S. 3 

Vorstellung der REVISION-Studie zur Therapie des nicht arteritischen Zentralarterienverschlusses Schultheiss M. 1* , Poli S. 2 

In-vitro-Bewertung von Hydrogelen auf Alginat-und Hyaluronsäurebasis als Glaskörperersatz Schulz A. 1*, 2 , Rickmann A. 1, 2 , Wahl S. 1, 2 , Germann A. 3 , Stanzel B. 1, 2, 3 

The pachychoroid disease spectrum-and the need for a uniform classification system 

Purpose: Introduced in 2013, the term pachychoroid has recently generated worldwide interest explaining disorders associated with a thick choroid. The spectrum of pachychoroid disorders includes pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), pachychoroid neovasculopathy (PNV; defined by CNV), and aneurysmal type 1 CNV (AT1). In contrast to these new findings, CNV complicating CSC has already been described in a multitude of publications; and, moreover, polypoidal choroidal vasculopathy (PCV) has long been known to present with a thick choroid. Currently, it is unclear how ophthalmologists implement the old (CSC with CNV, PCV) and new terminology (PNV, AT1).

The online database pubmed.com was searched for the terms "pachychoroid", "PPE", "CSC", "PNV", "PCV", "AT1" and "CNV". Articles published between August 1st 2013 until October 29th 2019 were included. Results: In total, 122 articles containing the term "pachychoroid" were identified. Using the keyword "PPE", 30 articles were found. In the 994 articles on "CSC", only 58 (5.8 %) also contained the keyword "pachychoroid", while 116 (11.7 %) also contained the term "CNV". In contrast, 37 articles were found on "PNV". Only one article referencing "CSC with CNV" and "PNV" as an overlapping disease was found (0.8 %). Reporting the outcomes of anti-VEGF in neovascular non-aneurysmatic pachychoroid disease, 7 articles on "CSC with CNV", and 6 articles on "PNV" were found. In the 669 articles on "PCV", only 37 (5.5 %) also contained the keyword "pachychoroid". In contrast, "AT1" was referred to in 3 articles. Of these, all 3 (100 %) also referenced "PCV". Conclusion: There is a significant amount of overlapping studies reporting similar findings in pachychoroid disease using different names for the disorders involved. Most importantly, this involves the seemingly interchangeable use of the terms "CSC with CNV" and "PNV". To unify the terminology and to spur validating research on the idea that pachychoroid diseases of the macula represent a continuum, we recommend a new classification system as follows:

Rod function rescue after gene therapy with voretigene neparvovec: Time window for intervention? Stingl K. Background: Voretigene neparvovec is a gene therapeutic agent for treatment of retinal degenerations due to bi-allelic mutations in RPE65. RPE65 is part of the phototransduction cycle in the retinal pigment epithelium. The rescue of rods is the short-term therapy effect of voretigene neparvovec. In the long term it should stop the natural course of retinal degeneration leading to blindness. We analysed the prediction value of patient's age for the short-term rod functional rescue by voretigene neparvovec using three readouts of dark adapted retinal function. Methods: Six eyes of four patients (age 16, 21, 24 and 33 years) have been treated with voretigene neparvovec and followed-up for at least 1 month. The dark adapted threshold was assessed by the Full-field Stimulation Threshold (FST) with chromatic stimuli. The local rod function was assessed by Dark Adapted Chromatic Perimetry (DACP) using a new protocol applying 36 test points (cyan and red) in the central 30° visual field. Additionally, the local rod function was also evaluated objectively by scotopic Chromatic Pupil Campimetry (CPC), a novel test of the local rod function based on pupil contraction analysis following local scotopic stimuli inside of the 30° central visual field. All tests have been performed at baseline and one month after the treatment. Results: All three methods indicated no measurable rod function before and showed clear improvement in the two younger subjects, and small or no improvements in the older subjects. FST with blue light improved by up to 40 dB one month after the treatment, the red-blue thresholds difference improved to normal values (25 dB) in the youngest subject. Corresponding to the treated area, DACP showed an improvement of the retinal sensitivity of up to 40 dB. Scotopic CPC in that area improved to up to 30 % of normal values indicating functional rescue of 30 % of rod population in the same area. In the oldest subject, readouts improved only minimally after the therapy. All three readouts at one month after the treatment correlated highly with age: r 2 = 0,84 for FST blue threshold; r 2 = 0,85 for the improvement of DACP hill of vision volume and r 2 = 0,6 for the maximal pupil constriction amplitude in the scotopic CPC. Conclusions: Voretigene neparvovec can restore local rod function, measurable already one month after the treatment. The presented data indicate that the age may be a valid prediction factor for the short term outcome of rod rescue. Medical University of Plovdiv, Plovdiv, Bulgaria

Introduction: Age-related macular degeneration (AMD) is the leading cause of visual impairment in individuals over the age of 55 years worldwide. Wet (exudative, neovascular) AMD represents only about 10 % of all AMD patients, but it is responsible for 90 % of blindness secondary to AMD. Choroidal neovascularization (CNV) is the hallmark of neovascular AMD. According to the localization of CNV by optical coherence tomography (OCT) and OCT-angiography (OCT-A) it may be classified as CNV 1 (under retinal pigment epithelium-RPE), CNV 2 (above RPE), CNV 3-retinal angiomatous proliferation (RAP), and CNV 4 (mixed, CNV 1+CNV 2 subtype). Objectives: Different subtypes of CNV related to AMD were established in randomly selected patient population using OCT-A. Aims: To investigate the frequency distribution and morphological types of the different CNV secondary to wet AMD using OCT-A. Method: A total of 43 eyes (43 consecutive patients, mean age 72 ± 6 years (range 59-87), 53.5 % females) with wet AMD were enrolled in a prospective study. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) using Snellen charts, slit-lamp biomicroscopy, tonometry, fluorescein angiography (FA), and OCT-A (Cirrus HD-OCT, Angioplex, Carl Zeiss Meditec, Dublin, CA). Written informed consent was obtained from all patients. Results: All CNVs were confirmed by FA and OCT-A. In 36 eyes (83.7 %) there was late leakage from an undetermined source on FA and a pathologic vascular complex under RPE on OCT-A correlating with CNV 1. In 2 eyes (4.7 %) there was leakage with a classic pattern on FA and a neovascular membrane into the avascular part of retina on OCT-A suspected for CNV 2. In 5 eyes (11.6 %) we found CNV 4 (mixed CNV). CNV 3 (RAP) was not established in the examined group of patients. Three different morphological subtypes of CNV were visualized-"medusa-like" in 18 eyes (41.8 %), "seafan-like" in 15 eyes (35.0 %), and CNV with indistinct form in the rest 10 eyes (23.2 %).

The results in this study confirmed the higher incidence of CNV 1 against the other CNV subtypes which correlates with the cited frequency in the literature. In addition, "medusa-like" and "seafan-like" CNV present an active subtype, while CNV with an indistinct form-inactive subtype. OCT-A is a reliable and appropriate technique for easily visualizing and localizing different subtypes of CNV in patients with wet AMD.

OCT-A characteristics of neovascular membranes in wet AMDpossible correlation to the prognosis Vidinova C. N. 1* , Dafina A. 1 

A rare case of serous retinal detachment at the posterior pole after high dose intravenous steroids due to renal-graft rejection Wiecha C. Background: Non-adherence (NA) continues to be a major challenge in the real-life treatment with anti-vascular endothelial growth factor. However, there is still a gap of sufficient evidence related to the reasons for NA in patients treated with intravitreal injection therapy (IVT). Furthermore, there is no reliable measure, which can be used in clinical routine to detect potential barriers in time. The aim of this investigation was to develop a questionnaire (Adherence Barriers Questionnaire-IVT: ABQ-IVT), based on an earlier version of the ABQ.

The existing ABQ was discussed in an expert panel and revised according to specifications of IVT. Initially, the ABQ-IVT consisted of 24 items formulated as statements (4-point-Likert-scale ranging from "strongly agree" to "strongly disagree"). The ABQ-IVT was applied in a cross-sectional survey of German patients with neoavascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Evaluation of the questionnaire included an assessment of internal consistency as well as factor analysis. The occurrence of potential barriers in the patient sample investigated was evaluated using descriptive statistics. Results: 234 of 253 patients (92 %) were able to complete the ABQ-IVT. On the basis of the answers given and the analysis of their independence, a possibility was used to condense the questionnaire-without reducing its informative value. The final ABQ-IVT has been reduced within the reliability analysis to 17-items and demonstrated a good internal consistency (Cronbach's alpha = 0.78). Factor analysis showed no evidence for subscales of the questionnaire. Nearly half of the patients (49 %) reported being affected by at least three different barriers. On average, a patient was affected by 3.1 barriers. Most reported barriers were "Challenge due to time commitment of physician visits" (45 % of the patients) followed by "Depression" (29 %), "Travel and opportunity costs" (27 %), and "Burden for family members" (25 %). The prevalence of specific barriers differs by patient characteristics. The items "Cost of treatment" and "Too old for therapy to be worthwhile" were reported more frequently in older patients compared to younger.

The ABQ-IVT is a practical and reliable instrument for identifying patient-specific barriers of adhering to IVT treatment. In practice, it might be useful to assess, whether individual patients are at higher risk of NA due to specific adherence barriers.

Optical coherence tomography angiography in patients with optic nerve head drusen and anterior ischemic optic neuropathystructural and functional analysis Problem: To evaluate the quantitative characteristics of the radial peripapillary capillary (RPC) network in the eyes with anterior ischemic optic neuropathy (AION) in association with optic nerve head drusen (ONHD), and age matched healthy eyes using optical coherence tomography angiography (OCT-A). To determine correlations between RPC density and structural and functional damage of the retinal nerve fiber layer (RNFL). Methodology: 16 eyes (mean 32.3 ± 5.6 years) with AION caused by ONHD (exposed drusen) were enrolled, and also 10 eyes from the same patients with ONHD (buried drusen), but without AION. The control group contained 30 eyes (age matched mean 31.8 ± 2.7 years). Foto fundus, fundus autofluorescence and Goldmann visual field testing were done in all patients. Also peripapillary RNFL and OCT A images were acquired using the Optovue OCT (AngioVue; Optovue). Standard 3.4 mm diameter circular scans were used to record disc parameters and average RNFL in 8 sectors, and 4.5 × 4.5 mm scans of the optic disc were used to record OCT-A RPC density (%) in 8 sectors. Correlations between main outcome parameters (sectoral RPC density and RNFL thickness, disc area size and visual field index) were determined and compared to the control group. Results: Both corresponding RPC and RNFL sectoral parameters were significantly lower in eyes affected by AION than in buried drusen group and control group (P < 0.05). There was no significant difference between these parameters in buried drusen group compared to control group. Sectoral RPC density was strongly correlated with corresponding sectoral RNFL (P < 0.001) and also visual field index (P < 0.01). No significant correlation was found between disc area size and RPC and RNFL damage.

Conclusions: This study shows significant peripapillary microvascular damage in eyes with ONHD and AION correlating with the same sectorial RNFL reduction and visual field defects. The same patients' eyes with ONHD deeply buried without AION and RNFL defects had the same finding of RPC as the age matched control group. Our data suggest that disc area size is not an indicative risk factor for AION associated with ONHD. OCT-A could be a useful method in the analysis of capillary density in patients with ONHD. Introduction: Childhood optic nerve glioma (ONG) is typically a slowgrowing tumor that can lead to blindness. The first six years of life constitute the greatest risk of developing the disease. Treatment of ONG is currently controversial, and involves simple observation, radiation, chemotherapy, and surgical excision.

Objectives: Chemotherapy has emerged as the preferred treatment modality for childhood ONG. However, no study has previously analyzed long-term sequelae of chemotherapeutic treatment in children aged 0-1 years-old compared to older children, which is the objective of this study. Aims: We aim to investigate whether the use of chemotherapy alone in the treatment of childhood optic nerve glioma correlates with different overall survival (OS) patterns in infants as compared to its use in treating older children. Methods: A retrospective, epidemiological analysis of children with optic nerve glioma was conducted on patient data extracted from the Surveillance, Epidemiology, and End Result (SEER) registry. Patients were divided into two groups: group 1 included patients 0-1 years old while group 2 included patients 2-15 years old. Survival analysis was performed in patients treated with chemotherapy only. Results: 580 ONG cases were identified, of which 21 % were in group 1. 457 patients were white. Female:male ratio was 1:1. 

Introduction: Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. CCFs are classified into 4 subtypes based on their communication. These patients may present with signs as conjunctival chemosis, proptosis,exophthalmos, diplopia, ophthalmoplegia, orbital pain etc. Case report: A 70-year-old male patient, presented diplopia and proptosis. His history revealed that he had previously been treated for one month with unspecified drops, after which he was admitted to a local hospital for a month. During that admission, he was given retrobulbar and subconjunctival triamcinolone. The situation with eye improved and he was discharged. An orbital CT scan was performed while in hospital. A few days later, the situation worsened, he developed diplopia, a reddish eye with protrusion. On presentation to our clinical centre, he had BCVA 1.0, was hypermetropic. IOP RE was 14 mmHg and LE 35 mmHg. Slit-lamp and fundus examination of the right eye showed normal findings, while on the left eye, showed episcleral congestion with corkscrew blood vessels, reddish eye, slightly oedema cornea. Fundus showed normal ONH with dilated retinal blood vessels. Both angles were wide open on gonioscopy, RE Schaffer 3, and LE Schaffer 1. The right motility was normal and the left was limited in elevation and abduction (Hesse Lancaster). The optic nerve head and maculae were both normal on OCT. A B scan ultrasound showed a vertical hypoechogenic space just behind the optic nerve in the left orbit. The patient was given timolol 0.5 % 2 ×, brimonidine 2 ×, acetazolamide tablets and tobramycin/dexamethasone drop. He then underwent CT angiography, as MRI was not possible because of a metallic foreign body sustained during the war. CT angiography showed dilated blood vessels crossing over the optic nerve, without much clear detail. The patient was referred to a neurosurgeon and underwent digital subtraction angiography which showed a carotid-cavernous fistula requiring neurosurgical treatment. Brimonidine and tobramycin/dexamethasone drops with acetazolamide tablets were continued while he awaits surgery. The eye is quiet, the proptosis and diplopia have resolved. Conclusion: Many patients with CCF may initially present to an ophthalmologist, who should be able to make a presumptive diagnosis in most cases. An ophthalmologist should properly refer the patient to a neurosurgeon.

LHON-Therapie mit Idebenon -wann beginnen, wie lange therapieren? Eine Langzeitbeobachtung über 14 Jahre Schuart C. O Augenklinik, Universitätsklinikum Dresden, Dresden, Germany Aim: Uveitis is associated with visual impairment and blindness. In Western countries idiopathic inflammation is the most common cause. Nonbiologic treatment for autoimmune/idiopathic uveitis is not based on published strong evidence. This study was to evaluate high-dose intravenous methylprednisolone (IVMP) treatment in patients with juvenile autoimmune/idiopathic uveitis. Method: A retrospective chart review was conducted in two tertiary referral centres to investigate treatment response to IVMP in children and adolescents with autoimmune uveitis between 2003 and 2016. Disease activity, outcomes, and additional treatments were documented at 0, 3 and 6 months after IVMP. Purpose: To evaluate the effect of prism adaptation test (PAT) on the angle of squint as well as eye muscle surgery dosage in decompensated microesotropia (dekMET) and decompensated esophoria (dekEPH). Methods: In this single-centre retrospective study we reviewed the medical records of all patients with the diagnosis of dekMET or dekEPH, aged at least 12 years, who were treated by strabismus surgery for the first time between 2003 and 2019. The maximum angle of squint (AOS), PAT results before surgery, surgical dosing and AOS one day postoperatively were considered. PAT included wearing a prism based on the largest angle for over 60 min. Results: 82 patients (mean age 28 ± 13years) were included in the dekMET group, 100 patients (mean age 37 ± 17years) in the dekEPH group. For dekMET, before surgery AOS was 28.8 ± 10.6 pdpt for far (F), 30.9 ± 11.8 pdpt for near fixation (N). During PAT (30.17 ± 10.47 pdpt), the AOS increased significantly by 4.1 ± 5.7 to 32.5 pdpt (F) and by 3.7 ± 6.1 to 34.4 pdpt (N). Postoperatively, AOS was reduced to 5.3 ± 4.8 pdpt (F) and 5.8 ± 5.7 pdpt (N) . For dekEPH, before surgery AOS was 25.5 ± 8.8 pdpt (F) and 23.5 ± 9.8 pdpt (N). During PAT (25,1 ± 8.6 pdpt), the AOS increased significantly by 2.7 ± 4.3 to 28.2 ± 8.6 pdpt (F) and by 4.9 ± 4.5 to 28.3 ± 9.5 pdpt (N). Postoperatively, AOS was reduced to 3.3 ± 3.5 pdpt (F), and 2.5 ± 4.3 pdpt (N). Before PAT there was a significant distance-near difference (DND) in both groups which differed significantly between both groups: mean DND before PAT: dekMET -2.2 ± 6.4pdpt (AOS(F) lower than (N)), dekEPH +2.0 ± 5.9pdpt (AOS(F) higher than (N)). After PAT there was still a significant DND in the dekMET group, but no longer in the dekEPH group. Considering only eyes with ametropia up to 6 dpt spherical equivalent, the mean dosage applied for combined medial and lateral rectus muscle surgery (referring to the mean of AOS (F) and (N) after PAT) was significantly different between the groups (dekMET 3.18 ± 0.45 pdpt/mm, de-kEPH 2.93 ± 0.42 pdpt/mm). The mean dose-effect was not significantly different (dekMET 2.70 ±0.56 pdpt/mm, dekEPH 2.61 ±0.42 pdpt/mm).

The AOS before PAT in patients with dekMET showed significant DND with greater angle of squint at near fixation, in the dekEPH group the angle of squint was significantly greater at far fixation. After PAT, the difference persisted in dekMET with the near and far angle in-S158 Abstracts 353 ,3 ± 2,5 und die normalgeborenen 9,4 ± 3,2 Jahre alt.

Results: DVD improved significantly (P < 0.05) in the two groups of the study. In group I, the mean vertical deviation improved from 18.21 ± 4.73 prism diopter (PD) preoperatively to 7.82 ± 5.61 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 10.21 ± 3.52 PD and a mean correction of asymmetry of 2.1 ± 1.6 PD. Four patients needed inferior rectus tucking for residual or recurrent manifest DVD. In group II, the mean vertical deviation improved from 17.97 ± 6.89 PD preoperatively to 6.97 ± 5.46 PD 9 months after surgery (P < 0.05), with a mean correction of vertical deviation of 11.34 ± 2.71 PD and a mean correction of asymmetry of 2.5 ± 1.3 PD. Five patients needed inferior rectus retucking for residual manifest DVD. Conclusion: Inferior rectus tucking is as effective as superior rectus recession with posterior fixation sutures for the primary treatment of DVD without inferior oblique overaction. Inferior rectus tucking can also be used effectively for the treatment of residual and recurrent DVD; further studies are recommended in this field.

Do extraocular muscle pulley bands or does retrobulbar fat keep the eye muscles in place, and thereby acts like a pulley?

Simonsz H. J. 1*

Extraocular muscle pulley bands were described by Tenon in 1805 as "faisceaux tendineux", acting as "poulies de renvoi". Sappey described the band's smooth muscle fibers in 1888. In Tenon's, Sappey's, Miller's and Demer's pulley concepts, this connective-tissue band between muscle and bony orbital rim limits vertical shift of a horizontal rectus muscle belly in up-and downgaze caused by the muscle's tendency to follow the shortest path from insertion to origin. It thereby redirects muscle force like a pulley. However, the band's attachment to the muscle moves 20 mm sagittally when looking from 50° left to 50° right, limiting its ability to stabilize the muscle vertically. The band should be elastic to stabilize the muscle vertically while permitting large horizontal eye movements. We measured it after orbital exenteration: It was slack but, once extended, very stiff. In 1984, our research group in Amsterdam compared horizontal-rectusmuscle positions in up-gaze with those in down-gaze using CT and found no vertical shift. In primary gaze the muscle path was curved outwards, indicative of retrobulbar pressure resulting from rectus muscles pulling the eye into the orbit and contained by muscles and connective tissue sheets enveloping retrobulbar fat including the intermuscular membrane. The eye ball is held in place with the retrobulbar pressure. Later, we repeated the CT study in a Crouzon patient whose bony orbital rim was displaced 2 cm posteriorly. The connective tissue band could not attach to bone. Nevertheless, no vertical shift of horizontal rectus muscles occurred when the patient looked up or down. The muscles were kept in place by the retrobulbar fat and its enveloping connective tissue sheets including the intermuscular membrane. This mechanism was simulated in a soft-tissue finite-element model of the orbit, the muscles, the fat and the eye ball moving with 6 degrees of freedom. Although retrobulbar fat was assigned a low elasticity as found in vivo, it not only kept the eye ball in place, but also horizontal rectus muscle bellies in up-and down-gaze and vertical rectus muscle bellies in left-and right-gaze. The force keeping the muscle in place is delivered either by fat, connective tissue and orbital wall, or by the eye. In the former case, overall muscle force is redirected and pulley action occurs. If both force components contribute equally, Listings' Law is implemented naturally. "Faisceaux tendineux" are likely to be check ligaments. Visualisierung von intraokularen Fremdkörpern im vorderen Augenabschnitt mittels infraroter Transillumination (Pilotstudie) Kogan 

The incidence of ocular melanoma in Germany Alfaar A. 1*, 2 , Rehak M. 1 , Saad A. 3 Introduction: Ocular melanoma is the most common ocular malignancy in Adults. Its reported age-adjusted incidence in USA is 5.1 per million. Many European countries have reported incidence and showed an increase from 2 per million in South Europe to more than 8 per million in Northern countries. Our aim is to assess the incidence of Uveal melanoma in Germany between 2009 and 2013. Methods: Data were collected from the German Centre for Cancer Registry Data. We have used the ICD-O-3 topography codes C69.0 to C69.9 and Histology Codes 8720/3 to 8780/3 for mining and reporting the data. The tumors were limited to those with malignant behavior. We have compared the incidence between northern and southern states. German states of Schleswig-Holstein, Hamburg, Lower Saxony, Bremen, North Rhine-Westphalia, Berlin, Brandenburg, Mecklenburg-West Pomerania, and Saxony-Anhalt were grouped as northern while the states of Hessen, Rhineland-Palatinate, Baden-Württemberg, Bavaria, Saarland, Saxony, and Thuringia were grouped as southern states. Results: Our study included 2966 patients diagnosed with melanoma including 2645 patients (89.18 %) with ocular melanoma and 232 with an orbital disease (7.82 %). The diagnosis was histologically confirmed in 73.5 % of the patients, and 3.5 % were registered from death certificates only. The Die RNFL war in allen Quadranten außer dem temporalen signifikant geringer bei Frühgeborenen im Vergleich zu Normalgeborenen. Folgende Parameter der Papille waren signifikant größer bei Frühgeborenen im Vergleich zu Normalgeborenen: die Exkavationsfläche (0,47 ± 0,48 vs. 0,29 ± 0,37 mm 2 , p = 0,036), das Exkavationsvolumen (0,10 ± 0,15 vs. 0,04 ± 0,06 mm 3 , p = 0,012), der Flächenquotient CDR (0,25 ± 0,25 vs. 0,14 ± 0,15, p = 0,009), die horizontale CDR (0,49 ± 0,31 vs. 0,38 ± 0,27, p = 0,041) und die vertikale CDR (0,44 ± 0,29 vs. 0,33 ± 0,24 mm, p = 0,034). Die Randsaumfläche war signifikant dünner bei den Frühgeborenen (1,40 ± 0,62 vs. 1,73 ± 0,56 mm, p = 0,005). Bei den Frühgeborenen zeigte sich eine signifikant positive Korrelation des Geburtsgewichts und des Gestationsalters mit dem superioren Quadranten und der Gesamtdicke der RNFL. Eine negative Korrelation fand sich mit der Exkavationsfläche, dem Exkavationsvolumen und der horizontalen CDR. Frühgeborenenretinopathie hatte keinen Einfluss, die neurologischen Erkrankungen waren hingegen der stärkste prädiktive Faktor für eine dünnere RNFL in allen Quadranten außer dem temporalen. Schlussfolgerung: Aufgrund der dünneren RNFL haben die Papillen bei Frühgeborenen eine dünnere Randsaumfläche und eine größere Exkavation. Insbesondere wird die RNFL durch die neurologischen Begleiterkrankungen negativ beeinflusst. Diese Faktoren sollen berücksichtigt werden, bevor bei einem frühgeborenen Kind die Diagnose eines Glaukoms gestellt wird. Results: According to BETT closed globe eye injury was observed in 72 cases (97.3 %), incl. eye contusion in 70 cases and lamellar corneal injury in 2 cases. In 3 cases (4.0 %) there was open globe injury (with corneal perforating injury and with lens and iris prolapse in one case). Left eye was injuried in 64.5 %, right-35.5 %. The character of the injury and its incidence was the following: corneal erosion-5 cases (6,6 %), corneal edema-1 (1.3 %), retinal edema-10 (13.3 %), eye hypertension-19 (25.0 %), hyphema, accompanied by vitreous hemorrhage-29 cases (38.6 %), vitreous opacity-3 (4.0 %), subretinal hemorrhage-20 (26.6 %). In 6 cases macular hole was observed, in 3 cases-retinal detachment. Iris changes was in 19 cases (incl. aniridia in 1 case). In 16 cases (21.3 %) VA was light perception; in 19 cases (25.3 %)-0,01-0,06; in 20 cases (26.6 %)-0,1-0,5 and in 20 cases (26.6 %)-0,6-1,0. In 24 cases (32.0 %) surgery was necessary and was performed. Conclusion: Bottles of sparkling wine can cause severe ocular trauma due to the high-impact energy. So, there is evident the necessity of educational work and protective measures among population for the prophylaxis of such eye trauma. The real rate of eye injury due to cork of sparkling wine supposed to be much higher. The bottle must be properly handled (although it is not the guarantee for trauma avoidance). It is advisable to avoid the bottle to undue heat and agitation and to direct cork away from the face when opening the bottle. All bottles of sparkling wine must have warning labels. The consumer can reduce the risk of eye trauma by keeping bottles in a cool place and not to shake it before use.

Introduction: Retinoblastoma (RB) is the most common intraocular pediatric malignancy. Many studies have analyzed its epidemiological trends and have shown varying results over the years. Objective: The purpose of our study is to analyze the most recent epidemiological trends of retinoblastoma. Aims: To analyze the epidemiological trends of retinoblastoma during the years 2009 to 2016 Methodology: A retrospective, population-based analysis was conducted on children younger than 5 years of age. Data were extracted from the Surveillance, Epidemiology, and End Results registry from 2009 to 2016. Incidence data from 2001-2008 were accessed for comparative purposes relative to results from the timeframe of our study. All incidence (IR) data were estimated as cases per million. Incidence rate ratios (IRR) were calculated in comparison to the entity with the highest value to determine statistical significance. Results: 571 cases were identified. 52 % were females. The overall IR was 12.6. Incidence rates in male and female subgroups were not statistically different (11.9 and 13.4 per million, respectively [P = 0.17]). IR was highest in black patients (13.9), but was not significantly different from other races; IRR were: non-Hispanic white (0.88, P = 0.35), Asian/Pacific Islander (0.88, P = 0.53), and Hispanic (0.9, P = 0.44). IR was significantly highest in the 1st year of life (29.5) and IRR for presentation at the 2nd, 3rd, 4th, and 5th year of lives were: 0.48 (P < 0.001), 0.44 (P < 0.001), 0.17 (P < 0.001), and 0.06 (P < 0.001), respectively. 69 % of patients presented with unilateral (UL) disease. UL disease incidence was significantly higher than that of bilateral (BL) disease (8.7 and 3.9, respectively P < 0.001 

Epidemiological analysis and comparison of sporadic and inherited Retinoblastoma, 2000-2016 Mikhael S. 1* , Tadrosse A. 2 , Yassa A. 2 , Mikhael M. 2, 3 , Eloy J. A. 2,4,5 1 Lewis (8.8) was significantly higher than that of BL (3.9) [IRR 2.29; P < 0.001]. No change was noted in UL (APC -0.2; P = 0.6) or BL (APC 0.5; P = 0.6) IR from 2000 to 2016. Stratification by sex showed no difference in IR within either UL or BL. In the UL and BL, there was no statistical significance in IR between non-Hispanic white, black, Pacific Islander or Hispanic groups. IR of UL cases were significantly higher than those of BL cases across all races. In the UL, 32 % of cases were diagnosed during the 1st year of life, overall age-adjusted incidence of ocular melanoma was 5 per million. Generally, the incidence of ocular melanoma was higher in males than females consistently across all age groups except the group 45-49 years old. The crude incidence in males reached a peak in the age group 70-74 while the peak appeared between 80-84 in females. About 56 % of the patients were diagnosed at the age of 60 years or older. The choroid was the most common site for intra-ocular melanomas (86.65 %, n = 2292) followed by the ciliary body (12.85 %, n = 340). On the other hand, the conjunctiva was the most common site for orbital tumors (90.95 % of orbital melanomas, n = 211) followed by orbital adnexa (7.76 %, n = 18). Northern states showed higher age-adjusted per/year incidence rates (6.2 per million) in comparison to Southern states (3.9 per million). Conclusion: The incidence of ocular melanoma followed the European rates and patterns. Further studies are required for studying the trends, and the risk factors.

Kiefer T. 1* , Schlüter S. 1 , Bornfeld N. 1 In 20 % der Fälle konnte der Befund mittels einer lokalen Therapie (Brachytherapie, Laser-und oder Kryokoagulation) konsolidiert werden. In 35 % der Fälle konnte der Bulbus mittels IAC, Protonentherapie oder systemischer Chemotherapie erhalten werden. 6 Augen (30 %) mussten im Mittel nach 15 Monaten (0,5-47 Monate) enukleiert werden. Hiervon waren jedoch nur in 2 Fällen die durch IVC behandelten Tumore der Grund der Enukleation. Diskussion: In unserem Patientenkollektiv zeigte sich ein geringfügiges Ansprechen der soliden Tumore oder peripheren Rezidive auf IVC. In vielen Fällen konnte allerdings im weiteren Verlauf nach IVC eine konsolidierende Therapie mit Bulbuserhalt durchgeführt werden. Über die limitierten Therapiemöglichkeiten der IVC bei soliden Tumoren und die potentiell toxischen Nebenwirkungen sind die betroffenen Familien aufzuklären.

Analysis of the epidemiological trends of Retinoblastoma during the years 2009 to 2016 Mikhael S. 1* , Tadrosse A. 2 , Yassa A. 2 , Mikhael M. 2, 3 , Eloy J. A. 2,4,5 1 Lewis Objectives: The expediency of surgical removal of uveal melanoma (UM) after its irradiation by various methods, including Gamma Knife radiosurgery (GKRS), remains debatable. Unresolved questions are the indications and timing for UM resection. Aims: We analyzed the results of eye-conserving treatment of UM after GKRS to determine the indications for UM resection, as well as the optimal timing of surgery. Methods: 68 patients (29 male, 39 female) between 28 and 79 years of age were treated using GKRS with a dose of 60-70 Gy. 37 patients (54.4 %) with large UM (T3N0M0 in 96.7 % of cases) and widespread secondary retinal detachment (SRD) with macula involvement underwent tumor resection after GKRS (transscleral resection-7, endoresection-30). The remaining 31 patients (45.6 %) with medium-sized UM (T2N0M0 in 71 % of cases) and local SRD without macula involvement mainly were treated without surgery. Patients of both groups received local adjuvant therapy (LAT) -angiogenesis inhibitors and triamcinolone. The timing of operations after GKRS ranged from 3 days to 6 months. Last years resection was performed only if there was no effect from LAT for 3-6 months. Follow-up period ranged from 6 to 86 months. Results: In the group with UM resection, enucleation was performed in one patient (2.7 %) due to tumor recurrence 35 months after surgery. 6 in which IR (14.3) was significantly higher than that in the 2nd, 4th and 5th years of life (P = 0.04, <0.001, and <0.001, respectively). In BL, 69 % of cases were diagnosed during the 1st year of life; IR (13.4) was significantly higher than that during the 2nd, 3rd, 4th, and 5th years of life (P < 0.001). The IR of UL cases were significantly higher than that of BL during all other age groups except during the 1st year of life. Mean survival was not statistically different during 2000-2011: 114.5 months (UL) and 116.0 (BL). Survival was also not significantly different between both groups based on race, age and sex. Regression analysis showed that laterality was not a predictor for survival (HR: 1.497; P = 0.479).

The incidence of sporadic cases of retinoblastoma is greater than that of hereditary ones, but similar during the 1st year of life. Incidence is not affected by either sex or race. Incidence during the 1st year of life is higher than that during the 2nd, 4th, and 5th years of life in sporadic cases and higher than all other age groups in inherited ones. Sporadic and inherited cases of Rb share comparable survival patterns.

Einfluss von Papillendosis und bestrahlter Optikuslänge bei Protonentherapie choroidaler Melanome Riechardt A. I. 1* , Stroux A. 2 Mikhael S. 1* , Tadrosse A. 2 , Yassa A. 2 , Mikhael M. 2, 3 , Eloy J. A. 2,4,5 1 Lewis Introduction: Uveal melanoma is the most common intraocular malignancy in adults.

Objectives: The purpose of this study is to analyze epidemiological trends in incidence and survival of uveal melanoma specifically arising from the ciliary body. Aims: To identify epidemiological and survival trends of Ciliary Melanoma. Methods: A retrospective, population-based analysis was conducted using the Surveillance, Epidemiology, and End Results registry from 1973-2008. All incidence (IR) data were estimated in cases/million/year. Incidence rate ratios (IRR) were calculated in comparison to the entity with the highest value to determine statistical significance. Treatment data were available only post year 1998. Results: 743 cases of ciliary melanoma (CM) were identified. Overall IR of CM was 0.92. 98 % of cases were white. IR for the white subgroup (1.08) was significantly higher than that for the black group (0.82) [IRR: 0.038, P < 0.001]. IR was also significantly higher in males (1.04) than in females (0.82) [IRR 0.79, P < 0.00]. Patients aged 61-80 years had an IR of 3.22, which is statistically higher than that of 0-20, 21-40, and 41-60 years intervals [IRR = 0.022 (P < 0.001), 0.09 (P < 0.001), and 0.039 (P < 0.001), respectively], but not the 81-100 years interval (P = 0.22). Average IR during the years 1973-1990 (1.2) was significantly higher than that for the years 1991-2008 (0.68) [IRR = 0.57; P < 0.001]. Annual Percent Change (-3.19 ) over the time frame of the study displays a significant decrease in incidence (P < 0.001). 10-year overall survival (OS) in 1973-83 (63 %) was significantly higher than that in 1996-2006 (54.1 %) [P = 0.048]. 30.6 % of CM cases received radiotherapy treatment and 65.8 % underwent surgery. 10-yr OS in patients with localized malignancy who received only radiotherapy (60.5 %) was similar to that of those who were treated with surgery alone (57.8 %) [P = 0.508]. Conclusion: The incidence of ciliary melanoma is highest in the white, male, and elderly population. Although overall incidence is decreasing, overall survival patterns are declining, which requires further studies to pinpoint the underlying cause. Radiotherapy does not exhibit survival advantage over surgery in the management of localized disease, suggesting that long-term sequelae of radiotherapy can be avoided with tumor excision, while maintaining similar survival rates.

Okkultes Basalzellkarzinom innerhalb einer seborrhoischen Keratose des Augenlids: Ein klinisch-pathologischer Fallbericht Nüßle S. Beutel M. 4 , Schmidtmann I. 5 

Augenzentrum am St Franziskus Hospital

Hautklinik -Experimentelle Dermatologie und Immunologie der Haut

Abteilung für Nephrologie, Immunologie und Osteologie am St. Franziskus Hospital

Schmidtmann I. 10 , Beutel M. 11

Die Konversion eines retinalen Venenverschlusses (RVO) in ein neovaskuläres Glaukom (NVG) ist eine visusbedrohende Komplikation. Unser Ziel war es, die Umwandlungsrate von RVO in NVG innerhalb einer

Klinik für Augenheilkunde/Kath. Krankenhaus Hagen, Hagen, Deutschland Abstracts anzahl über zwei Jahre erreichen. Dabei konnten für 1/3 der Patienten die Injektionsintervalle verlängert werden. Wir halten unser frühes TE-Schema für geeignet

Im Anschluss kam ein 4-Punkte-Evaluationsbogen unter Verwendung von "visual analogue scales" (Bereich: 0-100) zum Einsatz. Sämtliche nachfolgenden Ergebnisse sind als Median/Interquartilsabstand (IQR) dargestellt. Ergebnisse: Im Rahmen dieser Pilotstudie wurden 5 Versuchspersonen im Alter von 21/9 J. untersucht. Die Sehschärfe der untersuchten Augen lag bei 1,7/0,8. Schlussfolgerung: Für deutlich überschwellige Optotypen lagen sowohl die Validität, als auch die Retest-Reliabilität aller Eingabemethoden hoch. Die Untersuchungsdauer war bei sprachlicher Rückmeldung mehr als 1

Untersuchungen mit höherer Fallzahl sind nötig

Lauermann P. 1* , Gebest J. 1 , Pfeiffer S. 2 , Feltgen N. 1 , Hoerauf H. 1 Ausschlusskriterien waren Faktoren, von denen bekannt war, dass sie den IOD beeinflussen, wie z. B. die Kataraktoperation während der Nachsorge, die verlängerte Anwendung von Steroiden, die Kryotherapie und die Silikonöl-Endotamponade. Als primärer Endpunkt wurde die relative Veränderung des IOD (operiertes Auge im Vergleich zum Nachbarauge) [6] [7] [8] [9] [10] [11] [12] Monate nach der Operation definiert. Sekundäre Endpunkte waren die relative Änderung des IOD nach 3-6 und 12-24 Monaten. Mögliche beeinflussende Kofaktoren wurden mittels ANCOVA analysiert. Ergebnisse: Der primäre Endpunkt zeigte keine signifikante IOD-Reduktion des operierten Auges im Vergleich zum Nachbarauge (P = 0,089, n = 84). Allerdings war der IOD des operierten Auges allein nach 6-12 und 12-24 Monaten nach der Operation signifikant reduziert (-0,75 ± 2,80 und -1,22 ± 3,29 mmHg, P = 0,008 bzw. 0,007). Der Augeninnendruck des Nachbarauges war nach 12-24 Monaten ebenfalls signifikant reduziert (-0,75 ± 2,73 mmHg, P = 0,008). In der Subgruppenanalyse war die Größe der Vitrektomie ein signifikant beeinflussender Kofaktor, der zu einem niedrigeren IOD nach 20G im Vergleich zur 23G-Vitrektomie führte (P = 0,04). Zusammenfassung: Die Pars Plana Vitrektomie bewirkte keine signifikante langfristige IOD-Reduktion im Vergleich zum kontralateralen Auge. Wir beobachteten jedoch ein IOD-Senkungspotenzial bei der 20G-Vitrektomie.

Analyse der choriokapillären Flussdichte bei Patienten mit systemischem Lupus erythematodes -eine optische Kohärenztomographie-Angiographie-Studie Leclaire M. D. 1* , Mihailovic N. 1 , Brücher V. C. 1 , Eter N. 1 1 Universitätsaugenklinik Münster, Münster, Deutschland Hintergrund/Ziel: Kollagenosen wie der systemische Lupus Erythematodes (SLE) können Einfluss auf die retinale Durchblutung haben. Immunofluoreszenz-und elektronenmikroskopisch konnten Einlagerungen von Immunkomplexen in der Choroidea von SLE-Patienten demonstriert werden. Ferner zeigten sich Veränderungen der Choriokapillaris bei SLE-Patienten in der konventionellen Kohärenztomographie. Ziel der vorliegenden Studie war die quantitative Analyse der retinalen Flussdichte (FD) gemessen mittels optischer Kohärenztomographie Angiographie (OCT-A) bei Patienten mit SLE unter Hydroxychloroquin (HCQ)-Therapie unter besonderer Berücksichtigung der Choriokapillaris. Methoden: Es erfolgte eine Messung der FD im oberflächlichen und tiefen kapillären Plexus sowie der Choriokapillaris im makulären 3 × 3mm 2 OCT-Angiogramm (RT Vue XRAvanti, Optovue Inc., Fremont, Kalifornien, USA) bei Patienten mit SLE (n = 19) und bei gesunden, alters-und geschlechtskorrelierten Probanden (n = 19). Nur Patienten ohne Hinweis für eine HCQ-induzierte Retinopathie wurden eingeschlossen. Die SLE-Patienten wurden in eine Hochrisiko-(HCQ-Therapiedauer >5 Jahre) und eine Niedrigrisikogruppe (HCQ-Therapiedauer < 5 Jahre) eingeteilt. Korrelationskoeffizienten in Hinblick auf die FD und die kumulative Dosis HCQ wurden berechnet. Ergebnisse: Das mittlere Alter der Patienten lag bei 40,1 ± 11,5 Jahren, das Alter der gesunden Kontrollen bei 38,2 ± 12,6 Jahren (p = 0,63). In beiden inhaltet die Gruppe der W12-Responder alle Patienten, die innerhalb von 12 Wochen auf die Standardtherapie reagiert haben, d. h. dass erstmals kein Makulaödem im OCT entweder zu Visite 3, 4 oder 5 nachweisbar war und bis Visite 5 auch kein Rezidiv dokumentiert war. Insgesamt zählen 17 Patienten (51,5 %) zu den W12-Respondern und 13 Patienten (39,4 %) zu den W12-Non-Respondern und 3 Patienten (9,1 %) sind vor Visite 5 aus der Studie ausgeschieden. Bezüglich des primären Endpunktes sind somit N = 30 Patienten auswertbar. Betrachtet man die Baselinewerte der einzelnen Studienpatienten, so zeigt sich eine deutliche Streuungsbreite. Der Mittelwert liegt bei 226 pg/ml. Insgesamt zeigt die Gruppe der Overall-Responder deutlich niedrigere Serum-VEGF Werte als die Gruppe der Non-Responder. Was auch, berücksichtigt man die Pathophysiologie, zu erwarten war. Schlussfolgerung: Primäres Studienziel war die Frage, ob das erneute Auftreten eines Makulaödems innerhalb von 3 Monaten bzw. eine Erhöhung eines vorbestehenden Makulaödems durch die Bestimmung des Serum VEGF-Wertes vorausgesagt werden könnte. Hierbei konnten keine signifikanten Unterschiede zwischen den Respondern und Non-Respondern in der relativen VEGF Veränderung festgestellt werden.

OCT Veränderungen der neurosensorischen Netzhaut bei zerebraler Mikroangiopathie Langner S. M. 1* , Terheyden J. H. 1 , Geerling C. F. 1 , Kindler C. 2, 3 , Keil V. C. 4 , Turski C. 1 , Turski G. N. 1 , Wintergerst M. W. M. 1 , Holz F. G. 1 , Gabor P. 2, 3 , Finger R. P. 1 1 Universitäts-Augenklinik Bonn, Bonn, Deutschland; 2 Klinik für Neurologie, Universitätsklinikum Bonn, Bonn, Deutschland; 3 Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland; 4 Klinik für Radiologie, Universitätsklinikum Bonn, Bonn, Deutschland Fragestellung: Zerebrale Mikroangiopathien (ZMA) sind ein Risikofaktor für neurodegenerative Erkrankungen. Bei Letzteren wurden bereits retinale Veränderungen in der optischen Kohärenztomographie (OCT) gezeigt, für die ZMA gibt es hierzu bislang jedoch keine Daten. Daher haben wir strukturelle retinale Veränderungen bei Probanden mit ZMA untersucht. Methodik: 62 Probanden wurden rekrutiert. Ausschlusskriterien umfassten ophthalmologische Vorerkrankungen und höhere Myopie (< -6 dpt). Bei allen Probanden wurden eine cMRT, eine klinisch-ophthalmologische Untersuchung, ein Montreal Cognitive Assessment (MoCA) Test, und ein OCT-Volumen-Scan der Makula sowie ein BMO-Scan der Papille (Spectralis, Heidelberg Engineering) durchgeführt. Die einzelnen Scans wurden von der Software des Geräteherstellers vorsegmentiert und manuell korrigiert. Probanden mit ZMA wurden statistisch mit gleichaltrigen Kontrollen verglichen. Die Auswertung erfolgte mit der Software SPSS 26 (Chicago, IL, USA). Ergebnis: 36 Probanden (21 weiblich, 15 männlich; mittleres Alter 63 ± 10 Jahre) wurden in die Auswertung eingeschlossen. Der Vergleich von neun Probanden mit ZMA und neun altersangepassten Kontrollen (mittleres Alter jeweils 57 Jahre) ergab einen signifikanten Unterschied des Ganglienzellschichtvolumens (GCL, p = 0,008). In einer Regressionsanalyse der 27 eingeschlossenen Probanden mit ZMA waren die Volumina der äußeren nukleären (ONL, p = 0,034) und äußeren plexiformen Schicht (OPL, p = 0,035), das gesamte retinale Volumen (p = 0,049), sowie Anteile der retinalen Nervenfaserschichtdicken (RNFL: papillomakuläres Bündel, p = 0,007, temporal superiore, p = 0,03, temporal inferior, p = 0,011 und nasale Anteile, p = 0,045) signifikant mit der Läsionslast in der MRT assoziiert. Schlussfolgerung: Unsere Studie zeigt erstmals sowohl Veränderungen der neurosensorischen Netzhaut in der OCT bei ZMA gegenüber altersgleichen Gesunden als auch Veränderungen bei Erkrankten, die mit der Läsionslast in der MRT korrelieren. Insbesondere die Parameter OPL, ONL, GCL und RNFL sollten in prospektiven Folgestudien weiter hinsichtlich ihrer Eignung zur Diagnose oder Verlaufsbeurteilung bei der ZMA untersucht werden. Neurovascular dysfunction in diabetes mellitus: the relationship between different stages of diabetic retinopathy and diabetic optic neuropathy Karliychuk M. 1* , Bezditko P. 2 , Pinchuk S. 3 1 Bukovinian State Medical University, Chernivtsi, Ukraine; 2 Kharkiv National Medical University, Kharkiv, Ukraine; 3 Eye Microsurgery Center ‚Vash Zir' , Chernivtsi, UkraineDiabetes mellitus (DM) causes neurodegenerative changes, and retinal neurodegeneration can be found in early stages of DM, even before the development of clinically detectable microvascular damage. The objective was to analyze the relationship between different stages of diabetic retinopathy (DR) and different types and stages of diabetic optical neuropathy (DON). Methods: A total of 575 patients (1150 eyes) aged 55,9 ± 7.8 years with type 2 DM were analyzed. In addition to routine eye examination, optical coherent tomography of the retina and optic nerve was performed. Subclinical stage of chronic axial DON was found in 50.2 % of eyes (231 eyes); initial stage-in 20.7 % of eyes (95 eyes); advanced stage-in 19.8 % (91 eyes); dystrophic stage-in 9.3 % of eyes (43 eyes). Diabetic anterior ischemic neuropathy was found in 24 eyes (2.1 %), diabetic papillopathyin 6 eyes (0.05 %) of patients. Results: Frequency of DR in initial stage of axial DON was 2.8 times, in advanced stage-6.2 times, in dystrophic stage-7.2 times, in anterior ischemic DON and in diabetic papillopathy-6 times higher than in subclinical stage of DON (p < 0,05). In absence of DON DR was not detected. The difference in frequency of different stages of DR, depending on type and stage of DON was noticed. The incidence of nonproliferative form of DR in initial stage of DON was found to be 2.8 times, in advanced stage-3.3 times, in dystrophic stage-1.7 times, in anterior ischemic DON-3.3 times, in diabetic papillopathy-3.6 times more often than in subclinical stage (p < 0.001). Preproliferative and proliferative stages of DR were found only in advanced and dystrophic stages of axial DON, and in anterior ischemic DON and diabetic papillopathy, most often-in dystrophic stage of axial DON. So, there was a direct correlation between the stage of DR and the type and stage of DON (r = 0.72, p < 0.001).

The frequency of preproliferative DR in advanced stage of axial DON was 1.8 times, in anterior ischemic DON-1.9 times, in diabetic papillopathy-2.4 times less than in dystrophic stage of axial DON. The frequency of proliferative DR in advanced stage of axial DON was 2 times, with ischemic DON and diabetic papillopathy-2.2 times less than in dystrophic stage of axial DON. So, in DM there was a direct correlation between the frequency and form of DR and the type and stage of DON that confirms the close relationship between neuronal and vascular dysfunction in DM.

Vergleich subjektiver Visusangaben mit elektrophysiologischen Verfahren zur Visusevaluation Kitsche M. 

Sakkadenmessung bei Phenylketonurie -sinnvoll oder nicht? Hopf S. 1* , Nowak C. 2 , Hennermann J. B. 3 , Schmidtmann I. 4 , Pfeiffer N. 1 Mehmed B. 1* , Fronius M. 1 , Pohl T. 1 , Schramm C. 2 , Spieth B. 2 

Inferior rectus tucking versus combined superior rectus recession with posterior fixation suture (faden) for the treatment of dissociated vertical deviation without inferior oblique overaction Milisic S. Tumor recurrence was observed in 2 patients (6.4 %) in the group without UM resection. 2 other patients (6.4 %) died from metastatic disease 12 and 15 months after GKRS. The degree of vision loss was more pronounced in the group with UM resection. The highest rate of subretinal fluid resorption and regression of even large UM was observed in patients with initially local SRD on the background of regular LAT without resection.

The expediency of UM resection in the absence of metastases should be determined 3-6 months after GKRS on the background of regular LAT. Complete regression of large UM without resection is possible. The indication for UM resection is not the size of the tumor only (T3N0M0), but a combination of several characteristics: lack of regression of the UM with preservation of permanent secondary retinal detachment involving the macula after regular LAT or the development of NG.

The incidence and survival of adult orbital tumors in Germany Alfaar A. 1*, 2 , Rehak M. 1 , Hassan W. 3 , Mehanna M. 3 , Saad A. 4 , Jansen L. 5 Der Ophthalmologe · Suppl 2 · 2020 S165 Conclusions: Socioeconomic factors play an undeniable role in the disease management process for patients diagnosed with sebaceous adenocarcinoma of the eyelid. Our results show that married patients tend to enjoy higher survival rates than unmarried ones. Marriage or social union may translate into better compliance to treatments and a greater capability to endure the challenges brought forth by the disease. Higher income levels, likewise, have been shown to correlate with better survival patterns. Socioeconomic considerations should be a crucial aspect of the treatment process in caring for patients with eyelid sebaceous adenocarcinoma.

Wolf J. 1* , Schlecht A. 1 LGL and ACC patients, respectively. Incidence was significantly higher for LGL than ACC (0.33 and 0.06, respectively [P < 0.001]). ACC incidence was highest in the black (BL) and lowest in the American Indian (AI) subgroups (0.13 and 0.01, respectively [P = 0.001]); incidence for the non-Hispanic White (W) and Pacific Islander (PI) groups were 0.05 and 0.11, respectively. The difference between racial groups with the highest and lowest incidence for LGL was not significant, 0.33 (W) and 0.27 (PI), respectively (P = 0.944); the AI and BL groups showed an incidence of 0.37 and 0.32, respectively. Average incidence of LGL based on geographical location was highest in Alaska (4.00); the second highest incidence was in California (0.68). Alaska showed an LGL incidence spike of 24 cases/million in 2011. ACC, contrarily, did not show varying regional incidence. 5-year overall survival was statistically higher for LGL than ACC (86.2 and 66.8 %, respectively [P = 0.013]). Sex, race, and disease stage did not impact survival for either LGL or ACC patients. Conclusions: Females represent most LGL and ACC cases. LGL incidence is significantly higher than that of ACC. While ACC incidence varies by race, LGL's is influenced by geography. Alaska witnessed an LGL incidence spike in 2011, which accounts for its overall higher average incidence compared to other regions studied. Overall survival in LGL is higher than that in ACC.LGL survival considerably improved compared to that documented in previous studies, while ACC survival remains similar to recently reported values. Introduction: Sebaceous adenocarcinoma of the eyelid is a slow-growing tumor. Although many studies have analyzed its epidemiology and pathogenesis, no study has investigated the impact of socioeconomic disparities on its prognosis. Objectives: To provide the first analysis on the effect of socioeconomic disparities in the management of sebaceous adenocarcinoma of the eyelid. Aims: To provide insight on the impact of marital status and income level on survival rates of sebaceous adenocarcinoma of the eyelid using a population-based study. Methods: A retrospective, epidemiological analysis of patients with sebaceous adenocarcinoma of the eyelid was conducted on patient data extracted from the Surveillance, Epidemiology, and End Result (SEER) registry from 1975 to 2016. Survival analysis was performed using the Kaplan-Meier method.

We performed data analysis on 1102 cases of sebaceous adenocarcinoma of the eyelid. 42.8 % were married, 8.7 % single, and 48.5 % separated/divorced/widowed (SDW). Median survival in months were: 137 (married), 108 (single), and 83 (SDW). 10-year overall survival patterns based on marital status were: 56.5 % (married), 47.3 % (single), and 32.9 % (SDW). Married patients showed significantly higher survival than SDW patients (P < 0.001). Univariate Cox regression analysis showed that the married group had a significantly lower hazard ratio than the widowed group (0.47; 95 % CI: 0.385-0.576 %; P < 0.001). 10-year survival in patients with median annual income between $ 50,000-$ 75,000 was significantly higher than that of patients with $ 20,000-$ 50,000 income (37.8 and 31.5 %, respectively [P = 0.048]). In der SpA-Gruppe war S100A9 gegenüber der JIAU-Gruppe erhöht (Medium, LPS, FSL-1, PHA; p < 0,05). Die T-Zell-Proliferation unterschied sich nicht signifikant zwischen den Gruppen. Schlussfolgerungen: Die PBMC der JIA-und SpA-assoziierten Uveitispatienten unterschieden sich hinsichtlich der Zytokinmuster nach den unterschiedlichen TLR-Stimulationen. Die JIAU-Gruppe war durch erhöhte Arginase-1-, aber niedrige IL-6-und TNF-a-Konzentration gekennzeichnet, während die SpA-Gruppe durch eine höhere S100A9-Freisetzung charakterisiert war. 

Anti-citrullinated protein/peptide antibodies in convalescence stage may be a marker of autoimmune uveitis Panchenko M. 1* , Shevchenko N. 2 Single studies showed the existence of NETosis in cytokine-induced ocular inflammation in a mouse model and in patients with Behcet's disease. (Barliya T et al., 2017; Perazzio SF et al., 2017; Safi R et al., 2018) . According to research data, the serum levels of myeloperoxidase (MPO)-DNA complexes (NET remnants) in patients with rheumatoid arthritis correlates with the level of anti-citrullinated protein/peptide antibodies. (Wang W et al., 2018) . The aim of the work was to study serum levels of anti-citrullinated protein/ peptide antibodies in patients with uveitis. Methodology: 39 patients (48 eyes) with idiopathic posterior, intermediate and panuveitis were examined and treated. 16 men and 23 women in the age group from 5 to 68 years were included in the study. The duration of the disease ranged from 3 months to 12 years. The first attack of uveitis was diagnosed in 15 patients, the chronic uveitis was in 24 patients. All the patients underwent standard ophthalmic examinations, including ultrasound biomicroscopy and optical coherence tomography. Serum levels of anti-citrullinated protein/peptide antibodies were defined with the help of the enzyme immunoassay using a standard reagent kit. The control group included the serum of 25 healthy donors. Results: High serum levels of anti-citrullinated protein/peptide antibodies were identified in 4 patients (26.7 %) in the active stage of first attack of uveitis and in 10 patients (41.7 %; p > 0.05) with chronic uveitis. Anti-citrullinated protein/peptide antibodies were detected in the blood serum of 6.6 % of patients in the stage of convalescence of uveitis first attack and in 37.5 % of patients (p < 0.05) with chronic uveitis. Conclusions: Serum anti-citrullinated protein/peptide antibodies in patients with uveitis in the stage of convalescence may be a marker of the autoimmune process. 

The problem: Macular edema (ME) during anterior uveitis (AU) reduces visual function, leads to dystrophic changes. Currently, its pathogenesis has been little studied. Objective: To study the frequency of ME and the expression features of the ICAM-1 and CD-95 marker in patients with uncomplicated and complicated AU. Methodology: 104 patients with AU were examined. 23 persons had the primary process (5-90 days) and 81-had chronic recurrent AU (215-9490 days). A control group-27 healthy volunteers. The absolute (cell/µl) and relative (%) level of expression on the venous blood lymphocytes of the ICAM-1intercellular adhesion molecules marker, which is considered a functional inflammation biomarker, and the apoptosis marker CD-95 using monoclonal antibodies by the histoimmunocytochemical method were determined. Results: Monocular AU proceeded without complications in 61.6 %, and binocular in 43.2 % (χ 2 = 4.8;p = 0.027). ME (diffuse or cystic), which during the AU in only one eye was found in 15 % cases, during AU in both eyes-in 28.4 % (χ 2 = 3.6;p = 0.05) cases. The absolute level of ICAM-1 Me = 458; Q l-u (356-517) cells/µl with uncomplicated AU, and in patients with ME-Me = 617; (580-817) cells/µl, which is 34.7 % higher (χ 2 = 7.9; p = 0.004). In the control group, the expression of ICAM-1 Me = 113.3; Q l-u (87-168) cells/µl. So during AU, ICAM-1 is 4-5.5 times higher (p < 0.05). The relative index of ICAM-1 during AU is 26 ± 1.2 %, during AU with ME is higher by 15.4 % (p = 0.03)-equal to 29.9 ± 1.8 %. In the control group, the relative amount of ICAM-1 is 8.5 ± 0.3 %, which is lower than during AU in 3.1 and with complication of AU-3.5 times (p < 0.05). Absolute level of apoptosis marker CD-95 for AU was Me = 375; Q l-u (303-477) cells/ µl, and for AU with ME-Me = 426; Q l-u (363-585) cells/µl (p = 0.4), which does not differ and 3.3 times higher (p < 0.05) than in the control group-Me = 120; Q l-u (87.6-226.6) cells/µl. The relative level of CD-95 during AU is 24.3 ± 1.1 % and during AU with ME is below 21.5 ± 1.9 % (p = 0.07). In the control group, CD-95 is 23.1 ± 0.8 %. Daniel M. 

Application of the pattern electroretinogram in evaluation of the risk of myopia progression Grudzińska E. 

Introduction: Myopia is an important social problem due to the significant increase in its incidence. Myopia, especially of high degree, is associated with the risk of vision-threatening complications such as myopic macular degeneration, retinal detachment, cataract or glaucoma. The current state of knowledge does not allow to determine the early indicators of complications in people without degenerative changes at the eye fundus. The aim of the study was to assess whether the PERG may be an independent, objective risk indicator for myopia progression. Material and methods: 32 eyes of 17 patients aged 29.4 ± 4.8 years with myopia of medium degree were qualified to the study. The spherical equivalent of the refractive error was -4.54 ± 0.8D (range -3D--6D). The control group consisted of healthy individuals aged 20-40 years with refractive error ±1D. The following examinations were performed in the study and control group: an interview (in subjects with myopia including known risk factors of myopia onset and progression), assessment of the visual acuity, intraocular pressure, refractive error, assessment of anterior and posterior segment of the eye in a slit lamp, measurement of the axial length, structure and thickness of the macula and optic nerve disc in OCT and PERG. Results: In the group with myopia, the spherical equivalent of refractive error was significantly lower than in the control group. The values of P50 and N95 wave amplitudes did not differ significantly between the groups. However, significant differences were observed in the P50 peak time. It was significantly longer in myopia than in the control group. The analysis of myopia progression risk factors showed a statistically significant positive correlation between the number of hours of physical activity per week and the amplitude of P50 wave. There was also a statistically significant positive correlation between the peak time of P50 wave and the amount of time spent on near work. Conclusions: It is very possible that the PERG may be an early prognostic marker in identifying those patients with myopia who will develop ophthalmic complications in the future. The assessment of P50 peak time, which correlates with the best known risk factor of myopia progression which is near work, seems particularly valuable. On the other hand, the increase of P50 wave amplitude may indicate a protective role of physical activity in myopia progression.

Analyse des Stellenwertes von "eLearning" in der Augenheilkunde und Evaluierung einer "eLearning-App" Grabowski E. published continously up to now. In 1852 he founded famous private eye clinic in Berlin, where he treated many eye patients and educated many prominent ophthalmologists. At the age of 29 he became associate professor of ophthalmology, the first with such a title in Germany. Conclusion: Albrecht von Graefe was founder of modern ophthalmology and separated it from surgery. Graefe's contacts, correspondency and meetings at ophthalmological congresses with his teachers, assistants, colleagues also contributed to international co-operation and internationalization in ophthalmology. Although Albrecht von Graefe died before 150 years, he still provokes great admiration and respect in the world of ophthalmology.

Digitale Weitwinkelfotografie bei der Früherkennung der diabetischen Retinopathie Kaya S. Ophthalmology service, Makarska, CroatiaObjective: A short review of the work of a German ophthalmologist Albrecht von Graefe is given in this presentation, on the occasion of the 150th anniversary of his death. He is regarded as the greatest ophthalmologist of the 19th century. Modern and scientific ophthalmology owes its beginning to him. Methods: Extensive literature research is made and contacts with institutions for history of medicine as well as medico-historians in the field of ophthalmology.Results: His contributions to ophthalmology were multiple. Von Graefe was the first to introduce iridectomy in acute glaucoma treatment, initiated visual field testing and developed the first tonometer. He made the first classification of glaucoma. Von Graefe was the ophthalmologist who created a special knife for cataract surgery. He was also the first to use Helmholtz' ophthalmoscope. He founded the first ophthalmological society in the world and the second ophthalmology journal which has been 

Lahme L. 1* , Marchiori E. 2 , Mihailovic N. 1 , Nelis P. 3 , Oberhuber A. 2 Der Ophthalmologe · Suppl 2 · 2020 S181 of postoperative surgical interventions was observed within one year. The outcome was considered to be stable when no further surgical interventions were needed for 6 months before the last follow-up.

The mean diameter of the corneal grafts was 8.7 ± 1.6 mm. The mean corneal thickness after one year of follow-up was 602 ± 110 µm. The BCVA increased from 2.4 ± 6.9 to 1.7 ± 7.2, the mean intraocular pressure was 15.2 ± 7.2 mmHg. Three patients (23 %) needed no further surgical interventions. Four patients (31 %) needed amniotic membrane transplantation, three patients (23 %) needed cyclophotocoagulation for glaucoma, two patients (15 %) needed repeated PPV, one patient needed a repeat pole-to-pole-surgery because of corneal graft failure with panophthalmitis, and two patients were subject to enucleation due to recurrent endophthalmitis. 11 of 13 patients were considered stable during the one year of follow-up. Conclusion: Pole-to-pole-surgery seems to be a viable option to attempt the salvage of the eye globe suffering simultaneously from severely affected corneal and retinal pathologies, thus preserving an ambulatory Vision.

Ist das U-Net zur Objektivierung manueller Markierungen in Phasenkontrastmikroskopbildern geeignet? 

Maßnahmen der Hochschulambulanz einer Augenklinik während der COVID-19-Pandemie Schmid A. Purpose: Drug delivery to treat ocular diseases still is a challenge in ophthalmology. One way to achieve drug delivery currently investigated topical administration of drug-loaded polymeric nanoparticles (NPs) that are able to penetrate ocular barriers. The purpose of this study is optimal preparation of NPs made from pseudo-proteins and evaluation of their ability to penetrate ocular tissues. Methods: Biodegradable NPs of various types were prepared by nanoprecipitation of a pseudo-protein composed of l-leucine, 1,6-hexanediol and sebacic acid (8L6). Arginine-based cationic polyester amides 8R6 and comb-like polyester amides containing lateral PEG-2000 chains along with 8L6 anchoring fragments in the backbones were used to construct positively charged and PEGylated NPs. The NPs were loaded with fluorescein diacetate (FDA) or rhodamine 6G (Rh6G) as fluorescent probes. Suspensions of the NPs were given to cultivated microglial cells and retinal pigment epithelial (RPE) cells as well as topically on eyes of C57BL/6 mice. Penetration of NPs into the eyes was checked by fluorescence analysis. Results: NPs were prepared and their physicochemical properties were characterised. Cultured microglial cells and RPE cells took up the NPs. After topical administration penetration of NPs into the cornea of the eyes could be clearly shown. Small amounts of fluorescent dyes were also found in the lens, the retina and the sclera depending on the type of NPs.

The results show that the new NPs penetrate ocular tissues after topical administration and are internalized by the cells. This raises confidence that the NPs may be useful carriers of therapeutic agents for ocular delivery.