Bericht von der Pressekonferenz der ÖOG

Standespolitik

Bericht von der Pressekonferenz der ?OG Früherkennung bei Makula-Degeneration     

Empfehlungen der Makulopathiekommission der ÖOG bezüglich der AREDS-konformen Antioxidantien-Zink-Therapie

Gesellschaftsberichte

Empfehlungen der Makulopathiekommission der ?OG bezüglich der AREDS-konformen Antioxidantien-Zink-Therapie     

Einsatzmöglichkeiten der Scheimpflug-Technologie in der Kataraktchirurgie

Background

Since its first use in geography 100 years ago Scheimpflug photography has undergone much refinement making it a standard technique in anterior segment diagnostics and even surgical therapy. This review presents the perioperative applications of Scheimpflug photography in cataract and refractive lens surgery.

Objectives

Possible perioperative applications of Scheimpflug photography in cataract surgery and refractive lens surgery.

Methods

Selective review of the literature and personal experiences.

Results

In recent years there have been numerous new applications for Scheimpflug photography, with its main use in preoperative diagnostics and surgical planning. There are also useful applications for intraoperative visualization and postoperative counseling.

Conclusion

Multifunctional devices which enable a variety of further examinations besides Scheimpflug technology alone make the use of this technology possible and reasonable even in hospitals and practices without a focus on refractive surgery.     

Homogenität der G-DRGs in der Augenheilkunde

BACKGROUND: Since the year 2004 hospitals in Germany are obliged to participate in a payment system based on diagnosis-related groups (DRG), which bases hospital reimbursement on the diagnosis and treatment of patients. The aim of this study was to analyze the data of the first German national hospital cost data calculation for their homogeneity. METHODS: The cases at the LMU hospital in Munich were calculated analogous to the national hospital cost data calculation for a period of 7 months. These exemplary data were then analyzed in detail for homogeneity. RESULTS: For many DRGs, the numbers of cases in the analysis were within a range similar to those in the official nationwide calculation. The costs and lengths of stay were similar to those of the official national calculation. CONCLUSIONS: Many ophthalmologic DRGs are quite inhomogeneous necessitating regrouping to avoid false incentives. For cases with high complexity the current system may lead to cost deficits especially for hospitals providing maximum care.     

Reproduzierbarkeit der Messung der peripapillären Nervenfaserschichtdicke

Purpose

The aim of this study was to compare the intra- and inter-examiner reproducibility of measurements obtained by optical coherence tomography (OCT) and retinal thickness analyzer (RTA).

Patients and methods

During a period of 2 months, 22 eyes of 16 patients and 6 healthy subjects were included. Two examiners (EMH, RK) successively performed three measurements of the peripapillary retinal nerve fibre layer (RNFL) thickness with RTA and OCT. The reproducibility of three individual measurements of one examiner (intra-examiner) as well as the reproducibility of the measurements between both examiners (inter-examiner) was evaluated using the Friedman test and sign test.

Results

The average thickness of the peripapillary RNFL was 154.4 µm for the first investigator (EMH) and 155.1 µm for the other investigator (RK) measured with RTA. The results obtained by OCT were 137.3 µm (EMH) and 138.9 µm (RK), respectively, generally indicating a threefold smaller range. Comparing the three measurements of one single examiner, no appreciable intra-observer dependency neither for RTA (EMH: p=0.19, RK: p=0.95) nor for OCT (EMH: p=0.51, RK: p=0.62) was observed. Inter-examiner analysis for RTA and OCT also revealed an acceptable reproducibility.

Conclusions

Measurements of peripapillary RNFL thickness using RTA and OCT exhibited intra- and inter-observer agreement.     

Empfehlung der Makulopathiekommission für die Therapie der altersbedingten Makuladegeneration auf Grund der Ergebnisse der Age-Related-Eye-Disease-Study (AREDS)

Gesellschaftsberichte

Empfehlung der Makulopathiekommission für die Therapie der altersbedingten Makuladegeneration auf Grund der Ergebnisse der Age-Related-Eye-Disease-Study (AREDS)     

Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zu der aktuellen Therapie der neovaskulären AMD

Gesellschaftsberichte

Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augen?rzte Deutschlands zu der aktuellen Therapie der neovaskul?ren AMD     

Enzymatischer Nachweis der Tiefenabhängigkeit der Vernetzungswirkung von Riboflavin/UVA an der Hornhaut

PURPOSE: It has been shown that the treatment of keratoconus with riboflavin/ultraviolet A (UVA) causes significant stiffening of the cornea due to cross-linking. The aim of this study was to evaluate how deep the mechanical stabilization after collagen cross-linking could be shown biochemically. METHOD: Ten out of 20 enucleated porcine eyes were treated with riboflavin as a photosensitizer and UVA (370 nm, 3 mW/cm2, 30 min). The other 10 eyes served as controls. With a Microkeratom device, two flaps with a thickness of 200 microm and a diameter of 8 mm were cut off from each eye and put in a collagenase solution (NaCl plus collagenase A, 1:1). The surfaces of the flaps were measured digitally every day to characterize the dissolving behavior. RESULTS: The resistance (regarding corneal collagen against enzymatic digestion) of the treated superficial flaps was considerably higher (p=0.001) compared to those that were cut secondarily and to the control flaps. But even the flaps from deeper layers showed a significant increase in resistance (p=0.02) compared with the untreated flaps. The half-life of the surfaces of the treated superficial flaps was 220 h; of those cut secondarily, it was 80 h. Both untreated flaps had a half-life of 50 h. CONCLUSIONS: The biochemical study showed that the treatment of the cornea with riboflavin/UVA leads to significant collagen cross-linking not only in the anterior slice of 200 microm but also in the following 200 microm. This locally limited cross-linking effect may be explained by the absorption behavior for UVA of the riboflavin-treated cornea; 65% of UVA irradiation is absorbed in the first 200 microm and only 25-30% in the next 200 microm. Therefore, deeper-lying structures and especially the endothelium are not affected.     

Die Abhängigkeit der Testesreifung von der Netzhaut

Zusammenfassung Sowohl Glaskörperhomogenat als auch ein faseriges Produkt, das aus Hyaluronsäure und Kollagen besteht und das aus Glaskörper durch Acetonpräzipitation isoliert werden kann, wurden untersucht, um die Verflüssigung des Glaskörpers durch Säuren zu erforschen. Die graphische Auswertung der Titration mit Salzsäure und Viskositätsmessungen weisen auf eine Veränderung des Hyaluronsäuremoleküles im pH-Bereich zwischen 5,2 und 4,1 hin. Zwischen diesen pH-Werten ist die Ionisierung der Carboxylgruppen herabgesetzt und von Konformationsänderungen des Hyaluronsäuremoleküles begleitet. Diese Ergebnisse stimmen mit dem Schluß anderer Autoren überein, daß durch Verminderung des pH-Wertes von Hyaluronsäurelösungen ein Übergang der random coil-Form in die Doppelhelixform der Hyaluronsäure stattfindet.

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Conformational changes of Hyaluronic acid in acid medium

Summary Both vitreous body homogenate and a fibrous product containing hyaluronic acid and collagen isolated from vitreous humor by acetone precipitation were investigated to elucidate the liquefaction of vitreous body by acids. Graphic evaluation of the titration with hydrochlorid acid and viscosity measurements suggest a change of the hyaluronic acid molecule in the pH-range between 5.2 and 4.1. Between these pH-values the ionization of carboxyl groups is decreased accompanied by conformational changes of the hyaluronic acid molecule. These resutls are in agreement with the conclusion of other authors that by lowering the pH of hyaluronic acid solutions a random coil to double helix transition of hyaluronic acid occurs.

     

Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zu der aktuellen Therapie der neovaskulären AMD Mai 2005

Gesellschaftsberichte

Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augen?rzte Deutschlands zu der aktuellen Therapie der neovaskul?ren AMD Mai 2005     

Minoranomalien der Hornhaut bei der murinen Trisomie 16

BACKGROUND: The prevalence of human Down's syndrome is about 1:700. Investigations using animal models are therefore of clinical relevance for understanding its etiopathogenesis. No corneal changes have been reported with transgenic murine trisomy 16. METHODS: A total of 20 fetal mice (n=40 eyes) with experimentally induced trisomy 16 were investigated from day 18 of pregnancy in order to determine whether visible developmental disorders of the cornea occur. All specimen were investigated microscopically in serial sections. RESULTS: In addition to disturbances in systemic development, the transgenic mouse fetuses showed high rates of malformation of the eyes. Developmental and differentiation disorders of the corneal epithelial cell layers and structural disturbances of the corneal parenchyma were found. Our findings are the first demonstration of developmental disorders of the cornea in mouse fetuses with trisomy 16. These minor anomalies of the cornea could well have resulted in keratoconus if the animals had survived. CONCLUSIONS: Our findings in transgenic mouse fetuses with trisomy 16 correspond to the clinical pattern of Down's syndrome in humans. Disturbed development of lids and lenses have a high prevalence, whereas corneal hypoplasia is found less often.     

Chemische Untersuchungen zur Klärung der Entstehung und des Verschwindens der Metachromasie in der Hornhaut

Zusammenfassung Das Toluidinblau wurde verschiedenen chemischen Untersuchungen unterworfen, um die Entstehungsweise und das Verschwinden der Metachromasie im Gewebe chemisch zu erklären. Es wurde festgestellt, daß die Metachromasie unabhängig von p_H-Schwankungen ist und das Verschwinden des roten Farbtons der Metachromasie sowie das Auftreten einer kornblumenblauen Färbung im Gewebe auf Komplexbildung mit mehrwertigen Säuren zurückzuführen ist. Da der Krebs-Cyclus aus einer Kette von mehrwertigen organischen Säuren besteht, ist das Toluidinblau ein äußerst empfindlicher Indikator das aeroben Stoffwechsels (Citronensäurecyclus).Mit 1 Textabbildung     

Analyse der Dynamik des Ziliarmuskels während der Akkommodation

Background. The magnitude of anterioaxial shift of the human ciliary muscle during accommodation and its ceasing of ciliary function with advanced age are still unknown. Patients and methods. A total 105 patients (aged 10–91 years) were examined by high-resolution ultrasound biomicroscopy during disaccommodation and voluntary accommodation. Accommodative changes in the total area of the ciliary muscle and in the outer contour were quantified with a specially developed software program for automatic contour determination. Results. A significant anterior shift independent of age was observed in the total area of the ciliary muscle and defined points on the outer contour of the muscle in the range of 56–121 μm, while the inward displacement was less obvious. A decrease in the magnitude of configurational changes during accommodation was observed with age. Conclusion. The new software program could be useful in further investigations of the accommodative process and evaluation of the potential causes of presbyopia.     

Aktueller Stand der pupillenbasierten Diagnostik der glaukomat?sen Optikusneuropathie

There are considerable differences between pupillary reactions to light in glaucoma patients and healthy subjects which can be identified by various techniques. These methods are based on the early asymmetry of the afferent conduction in the visual pathway, on the examination of the visual field by focal light stimuli or on visual stimuli in analogy with multifocal electrophysiological tests. Latest findings in pupillary research also suggest a possible use of the intrinsically photosensitive (melanopsin expressing) retinal ganglion cells in glaucoma diagnostics. The current results of pupillary experiments in glaucoma patients are encouraging for further research in this field because suitable objective screening methods for glaucoma are continually being sought.     

Spectral-Domain-optische-Koh?renztomographie in der Behandlung der myopen choroidalen Neovaskularisationsmembran

Spectral domain optical coherence tomography (SD-OCT) investigations provide additional information about the morphological characteristics of myopic choroidal neovascularization (mCNV). Reproducible measurements of intraretinal and subretinal fluid are of growing importance for an evaluation of progression. The non-invasive technique reduces the need for frequent fluorescence angiography after individual assessment. Appropriate correction of the reference arm is mandatory. Automatic adjustment of transversal measured values due to alterations in the paraxial field (depending on the axial length) has been implemented in a new device. Mirror artefacts and excess curvature can be avoided by reducing the length of the OCT cross-section (15°). New possibilities to record the choriocapillaris and choroid have expanded the knowledge of potential pathomechanisms and risk factors.     

Fortschritte in der PVR-Chirurgie: Ergebnisse der Silikonölentfernung

Summary

Within the last decade the technique of PVR (proliferative vitreoretinopathy) surgery improved constantly. Surprisingly the retinal redatchement rate after silicone oil removal still remains the same and ranges from 9–20%. We standardized our primary PVR surgery and want to present in this study the outcome of silicone oil removal in these eyes.

Methods

In a retrospective study we examined the files of 59 patients operated on between 1998 and 2001 suffering of rhegmatogenes PVR. In aphakic patient the silicone oil removal was combined with a posterior chamber lens implantation. The end of the observation period was 6 months postoperatively.

Results

2 of 59 (2%) patients developed retinal redetachment after silicone oil removal. 21 patients received a combined procedure with lens implantation. 38 patients were pseudophakic. 70% of the eyes regained a vision of 20/200 or better.

Conclusion

The rise of retinal detachment after silicone oil removal is highly influenced by previous surgeries. We therefore believe that standardising the primary silicone oil surgery improves the outcome after silicone oil removal.     

Justierung der Lidhöhe in der Levatorchirurgie bei Ptosis

The main aim in ptosis surgery is to achieve a sufficient and symmetric adjustment of the lids. Successful adjustment is possible when consideration is given to preoperative factors and intraoperative findings. Any necessary postoperative readjustment using adjustable sutures or revision surgery in the 1st week can optimize results in some cases. This article reviews the relevant surgical aspects of adjustment. We made a comparative analysis of diagnostic and surgical factors that influence the adjustment of the lid level.