Purpose To evaluate the efficacy of XEN ® -45 gel stent ab interno implantation for medically uncontrolled uveitic glaucoma. Methods Retrospective analysis of 25 eyes receiving XEN ® gel stent for medically uncontrolled uveitic glaucoma from February 2019 to February 2023 with recording of intraocular pressure (IOP) values, ocular hypotensive medication, requirement for revision or secondary surgery and complications. Prerequisites for XEN ® implantation were a clear cornea, an open iridocorneal angle and an unscarred, mobile conjunctiva at the implantation site. Minimum follow-up required for inclusion was 3 months. The primary outcome measure was IOP compared to baseline. Complete and qualified success were defined as final IOP of ≤ 18 mmHg without or with topical antiglaucomatous treatment, respectively. Failure was defined as IOP > 18 mmHg on two consecutive visits, IOP reduction < 20%, persisting complications from hypotony and open conjunctival bleb revision. Further glaucoma surgical intervention was defined as complete failure. Results Mean preoperative IOP was 35.3 ± 10.9 mmHg on 2.9 ± 0.9 topical antiglaucomatous agents. 19 of 25 patients (76%) received additional oral acetazolamide. 19 eyes were pseudophakic, 5 eyes phakic and 1 aphakic. Early postoperatively, mean IOP reduced to 7.7 ± 3.0 mmHg (75.8% reduction). At final follow-up (mean 17.7 months) mean IOP was 12.0 ± 3.8 mmHg (62.5% reduction) on 0.2 ± 0.6 medications. Six eyes (24%) required bleb revision at mean 28 weeks and therefore were categorized as failure. One eye failed despite bleb revision and restart of topical ocular hypotensive medication. Three other eyes (12%) had IOP spikes with uveitis flare-ups. Transient hypotony complications occurred in 32%. At final follow-up, 18 eyes (72%) achieved complete success and one eye (4%) qualified success. Conclusion The XEN ® gel stent effectively reduced IOP in uncontrolled uveitic glaucoma, with 72% complete success. Bleb revision was required in 24%. IOP spikes occurred in 12% despite functioning blebs. Further follow-up is needed to determine long-term outcomes.

(1) Background: Due to significant variation, sporadic IOP measurements often fail to correctly assess the IOP situation in glaucoma patients. Thus, diurnal-nocturnal IOP profiles can be used as a diagnostic tool. The purpose of this study is to determine the additional diagnostic value of prolonged IOP profiles. (2) Methods: All diagnostic 48 h IOP profiles from a large university hospital, between 2017 and 2019, were reviewed. Elevated IOP > 21 mmHg, IOP variation > 6 mmHg and nocturnal IOP peaks were defined as IOP events of interest and counted. The analysis was repeated for the first 24 h of every IOP profile only. The Chi2 test was used for statistical analysis. (3) Results: 661 IOP profiles were included. Specifically, 59% of the 48 h IOP profiles revealed IOP values above 21 mmHg, and 87% showed IOP fluctuation greater than 6 mmHg. Nocturnal peaks in the supine position could be observed in 51% of the patients. In the profiles censored for the first 24 h, the fractions were 50%, 71% and 48%, (p < 0.01, p < 0.01 and p = 0.12) respectively. (4) Conclusions: the 48 h IOP profiles identified more patients with IOP events of interest than the 24 h IOP profiles. The additional diagnostic value must be weighed against the higher costs.

Uveitic glaucoma remains challenging despite medical and surgical advancements and can potentially lead to blindness if left uncontrolled. Conservative alternatives as well as microinvasive surgeries can postpone the necessity of a highly invasive intervention. However, such procedures are still necessary to treat some refractive glaucoma cases. Since previous studies have reported excellent results following the primary implantation of glaucoma drainage devices, it was our study’s aim to evaluate long-term results following a Baerveldt 250 implantation in highly complex and surgically burdened uveitic glaucoma eyes (UG) and compare these to a similar population suffering from other forms of glaucoma (OFG). We performed a retrospective analysis of all eyes (UG vs. OFG) following a Baerveldt 250 implant between 2013 and 2019. Efficacy parameters as well as post-operative complication data were extracted from our electronic data system for statistical analysis. A total of 62 eyes were included in our study (24 UG and 38 OFG). UG baseline mean IOP was 35.04 mmHg (± 11.85 mmHg) with 3.08 (± 1.13) topical agents, and OFG was 32.63 mmHg (± 7.74 mmHg) with 2.68 (± 1.28) topical agents. A majority of eyes also required systemic acetazolamide (UG: 79% OFG: 87%) and had undergone at least one glaucoma-related operation prior to the Baerveldt 250 implant ((UG: 1.21 (± 0.66)), OFG: 1.74 (± 1.33)). At the median follow-up period (UG 592, OFG 764 days), 52.5%/32.5% of UG/OFG cases showed qualified success (IOP below 21 mmHg with either topical or/and systemic medication), 15%/30% no longer required topical medication, and 47.5% /47.5% were free of acetazolamide systemically. Moreover, 75%/72.5% of eyes experienced no further pressure-related surgical event. Although sight-threatening complications such as corneal and macular edema were reported in both groups, most either maintained or improved their visual acuity at the last follow-up (58.33%/57.89%). The Baerveldt 250 implant is shown to be both effective and safe for advanced glaucoma cases in uveitis and other forms. No further glaucoma-related surgery is required in the majority of eyes in either group within a follow-up period of almost 2 years. Despite sight-threatening complications such as macular and corneal edema, visual acuity can be either maintained or improved in most eyes.

Abstract Purpose: To assess the additional value of 48-hour diurnal-nocturnal IOP profiles in comparison to only 24-hour diurnal-nocturnal IOP profiles in the management of glaucoma.Methods: All diurnal-nocturnal IOP profiles over 48 hours that were taken between 2017 and 2019 for diagnostic purposes in glaucoma patients at our hospital were reviewed. We counted elevated IOP values (>21 mmHg), higher short-term IOP fluctuations (> 6 mmHg) and nocturnal IOP peaks (measured at midnight and at 7 AM in supine position). In a second step, we repeated this analysis in the same profiles but censored the data to the first 24-hours. We compared the outcome rates by means of the Chi2-Test. Results: 661 IOP profiles were included. 59% of 48-hour IOP profiles revealed IOP values above 21 mmHg and 87% showed IOP fluctuation greater than 6 mmHg. Nocturnal peaks in supine position could be observed in 51% of the patients. In the profiles censored to the first 24 hours, the fractions were 50%, 71% and 48%, (p < 0,01, p < 0,01 and p = 0,12) respectively. Conclusion: Our data suggest that 48-hour diurnal-nocturnal IOP profiles are superior in identifying patients with clinically meaningful IOP events in comparison to observing the patients for only 24-hours. It is likely that the higher accuracy is worth the additional socioeconomic costs resulting from the prolonged inpatient stay.

Background The symptoms of acute angle closure, an emergency event that can lead to irreversible blindness without timely treatment, are diverse. Initially, these can be interpreted as internal or neurological diseases if headaches, pupil rigidity or nausea are in the foreground. The aim of our study was to assess the rate of harming and invasive diagnostics after primary presentation of patients with acute primary angle closure to nonophthalmologists. Methods Retrospective single center study of patients with acute primary angle closure. To analyze these patients, all patients who were treated by surgical iridectomy (5-133.0) or iridotomy by laser (5-136.1) in the period 2014-2018 at the Eye Center at Medical Center, University of Freiburg (Germany), were identified. Subsequently, data analysis was carried out through file inspection to check the inclusion and exclusion criteria and the course of the disease. Results In total, 91 patients with acute primary angle closure were included. Of these, 28% (n = 25) initially presented to nonophthalmological disciplines. In this patient group 56% (n = 11) received nontargeted diagnostics, with cranial imaging in 32% (n = 8) and lumbar puncture in 8% (n = 2). Conclusion Acute primary angle closure is associated with a high rate of nontargeted diagnostics by nonophthalmologists. Therefore, the clinical picture of acute angle closure should be in mind across all disciplines. With unspecific symptoms such as headaches, nausea and vomiting as well as pupil rigidity, the possibility of an acute increase in intraocular pressure caused by acute angle closure must be considered and early consultation with an ophthalmologist is recommended.

Background Precise optic disc size measurements based on anatomically exact disc margins are fundamental for a correct assessment of glaucoma suspects. Computerized imaging techniques, such as confocal-scanning-laser-tomography (CSLT), which applies operator defined boundaries and optical-coherence-tomography (OCT), which incorporates an alternative detectable landmark (Bruch’s-membrane-opening (BMO)), have simplified the planimetry of the optic disc and BMO-area, respectively. This study’s objectives are to compare both modalities for area and to define a threshold for macro-BMO using BMO-OCT. Methods Retrospectively, patients that simultaneously received CSLT and BMO-OCT scans were included. Their images were correlated and agreement was determined using Bland-Altman-analysis. The diagnostic power of a macro-BMO threshold using OCT was derived after creating a receiver-operating-characteristics-curve using the well-established analogous CSLT threshold (2.43 mm 2 ). Results Our study included 373 eyes with a median optic disc area by CSLT/ BMO-area by OCT of 2.56 mm 2 and 2.19 mm 2 respectively. The Bland-Altman-analysis revealed a systematic deviation with a diverging tendency with increasing area, which enabled the creation of the following mathematical relation: disc-area (CSLT)*0.73 + 0.3 = BMO-area (OCT). BMO-area of 2.19 mm 2 showed the best diagnostic power for identifying macro-BMOs using OCT (sensitivity: 75%, specificity: 86%). Conclusions Area measurements (CSLT optic disc area vs. BMO-area by OCT) showed a systematic deviation with a divergent tendency with increasing size. Our mathematical equation offers an estimated comparison of these anatomically diverse entities. Considering BMO-OCT´ anatomical accuracy, the 2.19 mm 2 threshold may improve discernment between glaucoma suspects and norm variants.

BACKGROUND/AIMS:Surgical procedures in ophthalmology underlie variations over different time periods and are strongly dependent on the technical process and the invention of innovative surgical techniques. Especially, in glaucoma surgery a lot of surgical devices and techniques have been introduced during the last years. Until now, the use of these newer techniques has not been shown on a robust data basis. We herein present the numbers of different types of glaucoma surgeries performed at German hospitals between 2006 and 2018.METHODS AND DESIGN:The quality reports of hospitals in Germany from 2006 to 2018 were analyzed concerning all procedural codes for glaucoma surgery and intervention. Especially, the change in usage of "classical" and "modern" surgical techniques (MIGS: "minimally invasive glaucoma surgery") or devices was compared.RESULTS:The number of glaucoma procedures performed increased by 75% from 27,811 in 2006 to 48,794 in 2018. Absolute numbers of trabeculectomies, goniotomies, ab externo trabeculotomies and to a certain level cyclodestructive procedures decreased during the examined years while use of MIGS has increased in absolute and relative numbers since 2012. From 2015 a strong increase in the usage of XEN implants could be seen. Drainage implants (such as Baerveldt/Ahmed) showed stable absolute numbers over the time period covered. Absolute numbers of laser trabeculoplasty peaked in 2014 and decreased afterwards. Iridotomies and iridectomies increased by 120%/248% over the whole period.CONCLUSION:Our data show a trend towards the modern surgical options and especially MIGS during the recent years. Classical procedures showed a decrease in total numbers emphasized from 2013. These numbers confirm the assumption that modern glaucoma surgery is becoming more and more popular and established in German hospitals.

We describe the formation process of surface-attached polymer networks generated through photochemically induced C,H insertion crosslinking (CHic). To achieve surface attachment, light must be able to penetrate all the way to the interface between the film and the substrate to trigger the necessary reactions. Although light penetration is typically a nonissue for thin films below 1 mu m, it may become difficult for thicker layers. In this contribution, we show that a critical light dose is needed to ensure full percolation. This critical dose can be derived from Lambert-Beer's law and percolation theory. Both experiments and calculations lead to a model, which is able to predict the percolation points of films as a function of light intensity and film thickness, even for very thick films. The only parameters that need to be determined for this model are the linear absorption coefficient of the polymer, its change with increasing irradiation time due to photobleaching, and the percolation point of a thin film.

Zusammenfassung Hintergrund Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen. Methode Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs. Ergebnisse Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde. Schlussfolgerung Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.

Zusammenfassung Das maligne Glaukom mehrere Jahre nach Kataraktoperation stellt eine sehr seltene Spätkomplikation dar. Eine zunehmende Myopisierung kann einen frühen Hinweis auf das Entstehen geben. Eine chirurgische Intervention ist oft unumgänglich. Die Druckeinstellung kann wie in unserem Fall aber auch konservativ gelingen. Es kann daher der Situation angepasst und individuell entschieden werden, wie invasiv die Behandlung erfolgen muss und ob eine Vitrektomie zwingend notwendig ist.

The authors describe a process that may eventually reduce the risk of scar formation after glaucoma surgery. For this, a thin hydrogel coating is photochemically generated and linked to the sclera surface at the surgical site. This coating is generated from a photoreactive prepolymer containing anthraquinone groups, which is administered as a thin pad to the sclera surface. Short UV irradiation leads to a reaction of the photogroups with neighboring chains via C-H insertion crosslinking, thus transforming the precursor polymer into a hydrogel. Simultaneously, a reaction between the photogroups and the underlying sclera tissue occurs, so that the hydrogel patch becomes covalently linked to the tissue. The authors show that the resulting thin coating is strongly cell repellent and hinders tenon fibroblasts to form tenon tissue at the site of the coating and is suitable for inclusion into a surgical procedure.

A 65-year-old patient suffering from pseudoexfoliation glaucoma and multiple previous surgeries at the right eye underwent CyPass® explantation 19 months after CyPass® Micro-Stent implantation due to chronic inflammation in the an-terior chamber. Histologically, a foreign body granuloma around and in the CyPass® implant was found. We conclude that patients with previous multiple glaucoma surgeries should not undergo CyPass® Micro-Stent implantation.

Background Excimer laser trabeculotomy (ELT) is a minimally invasive procedure to lower the intraocular pressure (IOP) via a photo-ablative laser that is applied to the trabecular meshwork. With this procedure, it is possible to improve the outflow of the aqueous humor. Until now, a limited number of studies examining mostly relatively small sample sizes with midterm follow-up exist. We therefore present the analysis of a large ELT cohort in a long-term follow-up. Methods We recorded data from 580 patients who underwent ELT or combined ELT with cataract surgery at our institution from November 2000 until March 2011. A total of 512 patients with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and ocular hypertension (OHT) were included in the analysis. At every follow-up examination, the usage of IOP-lowering medication and the IOP were recorded. Failure criteria were defined as the need for another surgical glaucoma procedure, when the IOP was not 21 mmHg or less and a reduction of 20% from the baseline was not achieved with (qualified success) or without (absolute success) additional medication. Statistical analysis was done using Kaplan-Meier analysis and Cox regression. Results Four hundred twenty-eight patients underwent combined cataract and ELT surgery, and 84 underwent solitary ELT surgery. After a median follow-up time of 656 days, 87% (combined surgery) and 66% (ELT) of the patients did not have to undergo another IOP-lowering intervention; 47/31% were classified as a qualified success and 31/11% as a complete success. The IOP-lowering medication, however, could not be significantly reduced within that time period. Conclusion Especially when combined with cataract surgery, ELT is a feasible minimally invasive procedure to lower the IOP on a mid- to long-term basis. Over the long term, however, IOP-lowering medication could not be reduced.

Wir berichten von einer Skleraeinschmelzung als sehr seltene, aber schwerwiegende Komplikation einer transskleralen Zyklophotokoagulation. Der Gewebedefekt ließ sich mit einer tektonischen Minikeratoplastik erfolgreich decken.

Intraocular pressure (IOP) measurement can be performed with different methods. Newer methods have to be compared to the standard method, the Goldmann applanation tonometry (GAT). We herein compare two air-puff tonometers, the non-contact tonometer (Tomey NCT) and the Corvis ST (CST) with GAT in eyes with a broad spectrum of IOP. Two hundred and forty-nine eyes of 249 patients (with diagnosis of either glaucoma or ocular hypertension) were included in this monocenter prospective cohort study. Each eye underwent IOP measurements via GAT, NCT and CST. Bland–Altman plots were calculated to compare the different methods in the three groups. Paired t tests were used for statistical comparison between the three measurement methods. The difference between the different methods was tested on correlation against central corneal thickness (CCT). Mean IOP in GAT was 17.6 mmHg (standard deviation (SD) 5.9), 16.3 mmHg (SD 5.6) in NCT and 18.0 mmHg (SD 5.5) in CST. Comparisons between GAT and CST vs. NCT showed significant differences (p < 0.001), while GAT vs. CST showed no significant difference (p = 0.1162). Mean CCT was 538.7 µm (SD 35.1). Mean values of GAT and CST show comparable results. However, both GAT and CST differ significantly from NCT. NCT shows lower IOP values compared to both other methods.

Background The minimally invasive ab-interno trabeculectomy (AIT) via electro-ablation with the Trabectome has been on the European market since 2009. Many studies have proven the safety and efficacy of the procedure. Up until now, studies investigating the long-term effect of AIT have been sparse. In this study, we present long-term results of AIT in patients with primary and secondary open-angle glaucoma. Methods In a retrospective monocentric study, the data of all the patients having undergone the procedure in 2010 at our institution were recorded. Data was collected during routine examinations at our institution. In total, 81 eyes of 74 patients (46 patients with primary open-angle glaucoma (POAG), 28 patients with pseudoexfoliative glaucoma (PEXG)) were included. At every examination, the intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the number of IOP-lowering medication was registered. Statistical analysis was done using the Kaplan-Meier analysis or Dunnett's t test, respectively. Results For both groups (POAG and PEXG), we found a significant lowering of the IOP (28% for POAG and 26% for PEXG) and a significant reduction of the number of IOP-lowering medication (32% for POAG and 29% for PEXG) after a median follow-up period of 3.5 years. Conclusion In patients with open-angle glaucoma and especially pseudoexfoliative glaucoma, ab-interno trabeculectomy is an effective surgical procedure to significantly lower the intraocular pressure on a long-term basis.

Trabectome surgery combined with phacoemulsification is effective in lowering (intraocular pressure) IOP in pseudoexfoliation glaucoma. Trabectome surgery usually aims to remove two to four clock hours of the trabecular meshwork. When adding trabecular aspiration, the remaining meshwork can be treated as well, and therefore 360 degrees of the meshwork can be reached. This study was conducted to investigate the additional benefits and risks of adding trabecular aspiration to the combination of phacoemulsification and trabectome as a triple procedure.

Bleb-related infections are serious complications after trabeculectomy. They can be limited to the bleb or disseminate and lead to endophthalmitis. We herein report on all bleb-related infections that have been diagnosed at the Eye Center of the University of Freiburg, Germany, since 1999.

To explore test–retest reliability of standard scotopic full-field ERG measurements in New Zealand White rabbits. The ERG is widely used for testing of retinal integrity after any ocular treatment. We here present detailed stimulus–response dependencies for single healthy and untreated animals, concentrating on test–retest reproducibility.

The reduction of corneal thickness following laser-assisted in-situ keratomileusis (LASIK) requires a correction of intraocular pressure (IOP) measurements. The corneal visualization Scheimpflug technology (CorVis ST, Oculus, Wetzlar, Germany) not only measures the IOP and central corneal thickness (CCT) but also determines 10 additional corneal parameters, such as the time to first and second applanation and velocity. Besides CCT we compared various corneal parameters before and after LASIK in order to detect possible correlations and to correct IOP measurements.Measurements with CorVis ST were made before and after LASIK in 45 myopic patients (45 left eyes). We compared the IOP and CorVis ST parameters using a paired taEurotest before and after LASIK and corrected for possible correlations in a multifactorial linear model. Finally, we correlated the changes in IOP to changes in biomechanical parameters.We observed a direct correlation between the IOP measurements and the corneal thickness. The IOP was underestimated by 0.039 mm Hg per micrometer in reduction of corneal thickness. The multifactorial linear model showed a correlation of IOP change to A2 velocity and the radius of applanation.Surgical thinning of the central cornea via LASIK demonstrated a direct correlation between corneal thickness and IOP measurements using the CorVis ST technique. Postoperative changes of the A2 velocity and the applanation radius also had a statistically significant influence on post-LASIK IOP measurements. Our findings could be useful to obtain more precise post-LASIK IOP measurements.