PURPOSE:Lubricant eye drops are the main therapeutic resource for dry eye disease (DED), with each drop representing the equivalent of ocular surface disease treatment. Thus, any reduction in the frequency of eye drop application reflects a degree of therapeutic success. Considering also the socioeconomic burden of DED, we investigated eye drop application frequency (DF) as a parameter to potentially track the success of therapy in severe DED. Hyaluronan (HA)-containing eye drops have become the first choice for tear substitution in many countries, and recent data indicate that the average molecular weight (Mw) of HA determines the therapeutic efficacy of such eye drops. This post-hoc subgroup analysis of a previously published multicentre prospective randomized open-label study, HYLAN M, is set out to compare the effects of very high Mw HA (hylan A) eye drops to comparator eye drops, containing lower Mw HA (control). METHODS:Patients with severe DED (n = 47), recruited as part of the larger HYLAN M prospective, multicentre, open-label study, were randomized into two groups: hylan A and control group. In the hylan A group, 24 patients replaced their HA-containing eye drops with eye drops containing 0.15% hylan A, whereas the 23 control patients continued to use comparator HA eye drops. The DF was recorded daily by all participants over 8 weeks, and other subjective and objective parameters of DED were assessed at the time of inclusion (baseline), as well as at week 4 and 8. RESULTS:There was a significant decrease in DF in the hylan A users between the baseline and week 4 (p = 0.004), remaining stable until week 8. Indeed, in contrast to the baseline, the hylan A group had a significantly lower DF than the control group at weeks 4 (p = 0.018) and 8 (p = 0.008). Likewise, the ocular surface disease index (OSDI) improved significantly between the time of inclusion and week 4 (p < 0.001) in hylan A users, remaining stable until week 8. The OSDI was similar in both groups at the baseline but it was significantly lower in the hylan A group than in the control group at week 4 (p = 0.002), remaining lower at week 8. Such a decrease in the DF and OSDI was not witnessed in the control group at any time point. The objective parameters assessed did not differ significantly within or between the two groups. CONCLUSION:When treating severe DED, the DF can be significantly reduced by using very high Mw HA (3 MDa) lubricant eye drops, which better alleviate DED symptoms and decrease the OSDI scores. These drops not only provide an attractive and comfortable alternative for patients with severe DED but also offer the possibility of reducing the disease's socioeconomic burden, both for affected individuals and society as a whole.

Background Dry eye (DE) is a multifactorial disease of the ocular surface, which may be a result of insufficient production of tear fluid or inadequate composition of the tear film with increased evaporation. An important diagnostic parameter of DE is the tear film break-up time (BUT). The aim of this study was to provide a comparison between the non-invasive keratography BUT (NIK-BUT) and the fluorescein break-up time (F-BUT) as well as to assess the correlation with patients' subjective complaints. Material and methods In this study 271 patients (212 women, 59 men, aged 19-91 years, average age 59.1 years) with DE, underwent an ocular surface examination including NIK-BUT and F-BUT in the DE unit of the University Eye Hospital, Medical University of Graz. The NIK-BUT was assessed using the Oculus Keratograph 5M. We documented both the first and the average NIK-BUT. Then, a standardized F-BUT measurement was done. The subjective complaints of the patients were assessed using the ocular surface disease index (OSDI (R)) and a visual analogue scale (VAS). Results The values of the first and average NIK-BUT correlated significantly with the F-BUT. The NIK-BUT values were significantly longer than the F-BUT values (p < 0.001). The average NIK-BUT values correlated with subjective symptoms (VAS) but F-BUT did not show a correlation with subjective sensation. Conclusion The average NIK-BUT values correlated better with the subjective sensation of the patients with DE than F-BUT values; however, there was a poor correlation. Further studies are needed to clarify the role of non-invasive BUT, especially its relation to the different subtypes of dry eye.

Zusammenfassung Hintergrund Das trockene Auge ist eine multifaktorielle Erkrankung der Augenoberfläche, welche als Folge einer unzureichenden Produktion der Tränenflüssigkeit oder einer inadäquaten Zusammensetzung des Tränenfilms mit vermehrter Verdunstung bedingt sein kann. Ein bedeutender diagnostischer Parameter für das trockene Auge ist die Tränenfilmaufreißzeit (TAZ). Ziel dieser Studie war es, die berührungsfreie, nichtinvasive Keratographen-Tränenfilmaufreißzeit (NIK-TAZ) mit der herkömmlichen Messung mittels Fluoreszein (F-TAZ) zu vergleichen sowie ihre Korrelation mit den subjektiven Beschwerden der Patient*innen zu untersuchen. Material und Methoden In diese Studie wurden 271 Patient*innen (212 Frauen, 59 Männer, 19 bis 91 Jahre, Durchschnittsalter 59,1 Jahre) mit trockenem Auge vom Spezialbereich für Benetzungsstörungen der Universitäts-Augenklinik, Medizinische Universität Graz eingeschlossen. Bei allen Patient*innen erfolgte die NIK-TAZ (erster und mittlerer Aufriss) mittels Keratograph 5M (Oculus Optikgeräte GmbH, Wetzlar, Deutschland) sowie eine standardisierte Messung der F‑TAZ. Die subjektiven Beschwerden der Patient*innen wurden mithilfe des Ocular Surface Disease Index (OSDI®) und einer visuellen Analogskala (VAS) erhoben. Ergebnisse Die NIK-TAZ (erster Aufriss, mittlerer Aufriss) korrelierte signifikant mit der F‑TAZ, wobei die Werte der NIK-TAZ signifikant länger waren als die Werte der F‑TAZ ( p < 0,001). Der mittlere Aufriss der NIK-TAZ zeigte eine signifikante Korrelation mit den subjektiven Beschwerden (VAS). Bei der F‑TAZ konnte keine Korrelation mit der Subjektivität nachgewiesen werden. Diskussion Der mittlere Aufriss der NIK-TAZ korrelierte besser als die F‑TAZ mit dem subjektiven Empfinden der Patient*innen. Der Korrelationsgrad war jedoch gering, daher sind weitere Studien nötig, um die Rolle der nichtinvasiven Tränenfilmaufreißzeit zu verdeutlichen, insbesondere in Bezug auf die verschiedenen Subtypen des trockenen Auges.

Background Heme oxygenase-1 (HO-1) is an important cytoprotective enzyme due to its ability to degrade pro-inflammatory heme. The common single nucleotide polymorphism (SNP) rs2071746 on the HMOX1 gene has been associated with HO-1 activity and a variety of cardiovascular diseases. This study was performed to investigate the association between the rs2071746 SNP and retinal vein occlusion (RVO).Methods We included 496 RVO patients and 297 control subjects in this case-control study. Genotypes of the rs2071746 polymorphism were determined by TaqMan assays.Results There was no association between the rs2071746 genotype and the presence of RVO (p = .443). The lack of association was found in all three logistic regression models, namely the dominant (p = .560), the recessive (p = .373) and the co-dominant model (p = .444). The distribution of the rs2071746 genotype was 30% (AA), 51% (AT), and 19% (TT). Baseline characteristics were similar between these genotypes, except for diabetes mellitus, which was less prevalent in the AA genotype (p < .001).Conclusion The rs2071746 polymorphism does not seem to be a major risk factor for the presence of RVO.

Background Ozurdex (R) (Allergan Pharmaceuticals Ireland, Westport, Co. Mayo, Ireland) is a 700 mu g dexamethasone intravitreal implant, approved for the treatment of macular edema due to retinal vein occlusion, non-infectious posterior uveitis and diabetic maculopathy. Increased intraocular pressure and lens opacification are known to be common complications. Less frequently, an anterior chamber dislocation of Ozurdex (R) has also been described. According to the literature, most transplant dislocations into the anterior chamber require surgical removal. This article reports the successful repositioning of an Ozurdex (R) implant by dilating the pupil with medicinal mydriasis. Case presentation A 79-year-old woman developed persistent cystoid macular edema in the left eye after secondary intraocular lens implantation, which had been treated since March 2016 with intravitreal Ozurdex (R). The patient underwent a planned examination 4 weeks after the last Ozurdex (R) implantation. Examination of the anterior chamber revealed an Ozurdex (R) rod located in the anterior chamber between the iris and the optic of the anterior chamber lens. A medicinal mydriasis of the pupil was performed to mobilize the dislocated Ozurdex (R). After 30 min the slit lamp examination showed that the dexamethasone implant was no longer visible in the anterior chamber. The subsequent funduscopy confirmed that the Ozurdex (R) implant was relocated in the vitreous cavity. Conclusion The removal of the Ozurdex (R) implant from the anterior chamber is necessary to avoid corneal endothelial decompensation; however, prior to surgical intervention, it is recommended to attempt repositioning of the Ozurdex (R) implant by dilating the pupil by medicinal mydriasis.

Zusammenfassung Hintergrund Ozurdex® (Allergan Pharmaceuticals Ireland, Westport, Co. Mayo, Irland) ist ein intravitreales Implantat von 700 mcg Dexamethason, das für die Behandlung eines Makulaödems infolge eines retinalen Venenverschlusses, einer nichtinfektiösen posterioren Uveitis und einer diabetischen Makulopathie zugelassen ist. Erhöhter Augeninnendruck sowie Trübungen der kristallinen Linse sind bekannte Komplikationen. Seltener wird in der Literatur auch die unerwünschte Migration des Implantates in die Vorderkammer (VK) beschrieben. Laut Literatur erforderten die meisten Implantatdislokationen in die VK eine operative Entfernung oder Reposition in den Glaskörperraum. Wir berichten die erfolgreiche Repositionierung eines Ozurdex®-Implantats durch die medikamentöse Erweiterung der Pupille. Falldarstellung Eine 79-jährige Patientin entwickelte nach einer sekundären Intraokularlinsenimplantation ein persistierendes zystoides Makulaödem am linken Auge. Dieses wurde seit 3 Jahren mit intravitrealem Ozurdex® behandelt. Bei der geplanten Kontrolle 4 Wochen nach der letzten Behandlung wurde das Ozurdex®-Stäbchen in der VK zwischen Iris und Optik der Vorderkammerlinse (VKL) festgestellt. Es erfolgte eine medikamentöse Erweiterung der Pupille, um das dislozierte Stäbchen zu mobilisieren. Die anschließende Spaltlampenuntersuchung und Fundoskopie zeigten eine Rücklagerung des Ozurdex®-Implantates in dem Glaskörperraum. Schlussfolgerungen Die Entfernung des Ozurdex®-Stäbchens aus der VK ist notwendig, um eine Dekompensation des Hornhautendothels zu vermeiden. Wir empfehlen vor einer chirurgischen Intervention einen Repositionsversuch des Implantats durch die medikamentöse Erweiterung der Pupille.

Lernziele und Ausbildungsordnungen für eine exzellente Facharztausbildung in Augenheilkunde hat es in den vergangenen Jahrzehnten bereits in einzelnen Ländern/Kontinenten gegeben [1], [2], [3], [4]. Eine weltweite Systematik wurde jedoch erst anlässlich des Kongresses des International Council of Ophthalmology [5] in Sydney 2004 vorgestellt und in den Klinischen Monatsblättern der Augenheilkunde 2006 publiziert [6].

PURPOSE:The presence of Demodex species can be associated with blepharitis. Their pathogenic potential in meibomian gland dysfunction is discussed herein. The purpose of this study was to determine the prevalence of Demodex mites in eyelashes of Austrian patients with ocular discomfort and to evaluate associated changes of the lid margins and meibomian glands.DESIGN:This is a case-control study.METHODS:Two hundred twenty-nine consecutive patients with ocular discomfort from an Austrian dry eye clinic were investigated for the presence of Demodex mites on sampled eyelashes. Associations of a mite infestation with individual dry eye and lid parameters were assessed. Lid margins were evaluated for scales, vascularization, Marx line, expressibility and quality of meibum, and drop-out of meibomian glands.RESULTS:Demodex mites were identified in 40.2% of patients suffering from ocular discomfort (mean mite count 3.3 ± 2.9 per patient). Infestation with mites was associated with the presence of significantly more cylindrical scales (sleeves), a higher Marx line score, and a lower quality of meibum compared with mite-free patients. There were no significant associations with the expressibility and the drop-out of meibomian glands.CONCLUSION:The prevalence of Demodex mites in patients with ocular discomfort is high. The mean mite count per patient in this Austrian dry eye unit population is lower compared with previously published data from Asian regions. The infestation of the eyelids with Demodex species is associated with changes of the anterior and posterior lid margin, suggesting a pathogenic role in blepharitis and meibomian gland dysfunction.