To analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) after implantation of a PRESERFLO® microshunt for surgical glaucoma management in adult glaucoma patients. Retrospective data analysis of 59 eyes of 59 participants undergoing implantation of a PRESERFLO microshunt between 2019 and 2022 at a tertiary center for glaucoma management. Surgical management included primary temporary occlusion of the glaucoma shunt to prevent early hypotony. Pre- and post-operative OCT examinations of the optic nerve head (ONH) and intraocular pressure (IOP) were assessed. Longitudinal change in morphometric spectral domain OCT parameters of the ONH was correlated to change in IOP. BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first three months after surgery (BL = 171.15 ± 66.80 μm; FU = 180.78 ± 70.394 μm; p = 0.034). For the same postoperative period, the mean preoperative IOP of 24.97 ± 7.22mmHg was lowered after surgery to 13.70 ± 5.09 mmHg. Eighteen months after surgery, there was no significant change in BMO-MRW compared to baseline (BL = 169.83 ± 52.69 μm; FU = 164.98 ± 55.85 μm; p = 0.271), while mean IOP was 13.08 ± 4.48 mmHg. A decrease in IOP correlated significantly with a change in BMO-MRW (r = 0.453, p < 0.05) three months after surgery. Peripapillary RNFL thickness was unchanged in follow-up after three months (p > 0.16) and significantly decreased in later follow-up (p = 0.009). PRESERFLO® microshunt implantation with primary temporary occlusion leads to a significant transient increase in BMO-MRW. This phenomenon is also known as structural reversal of disc cupping (SRDC). The effect seems to be less pronounced and of shorter duration when compared to previous data after trabeculectomy with comparable pre- and postoperative IOP levels.

PURPOSE:The aim of this study was to investigate the acceptance of innovative perimetry methods such as virtual reality perimetry (VRP) and tablet-based perimetry (TBP) in comparison to conventional hemisphere perimetry (HP) in glaucoma patients for the first time in Germany. PATIENTS AND METHODS:We examined 204 glaucoma patients using the 30 - 2 TOP algorithm (Octopus, Haag-Streit) followed by one of the two new methods: Group 1 (VRP; n = 101) and Group 2 (TBP using the Melbourne Rapid Fields Glaucoma App; n = 103). Subsequently, patients were asked to fill out a questionnaire on their experience with the new examination compared to the conventional examination. RESULTS:More than three-quarters of patients at 77% in Group 1 (VR) and 89.9% of patients in Group 2 (TBP) found the respective new examination method "easier" or "much easier" than the conventional HP. An overwhelming majority of patients in Group 1 and Group 2 found the new method more comfortable at 86% and 90.9%, respectively. Examination durations were: 2.67 ± 0.98 min for HP, 6.26 ± 1.88 min for VR perimetry, and 4 ± 0.71 min for the tablet method; figures given as means ± standard deviation. Just over half the patients at 51% found HP and VR headset to be similar for duration with 54% preferring the tablet over conventional hemisphere perimetry. By far the most patients in Groups 1 and 2 at 80% and 81.8%, respectively, reported willingness to use the new perimetry method regularly in future follow-up examinations. CONCLUSION:Most glaucoma patients surveyed consistently responded favourably to VR headset and tablet-based perimetry, preferring these examinations to conventional hemispherical perimetry.

This work aimed to investigate changes in optic nerve head (ONH) morphometry based on Bruch membrane opening in children with extensive nocturnal intraocular pressure (IOP) elevations. The course of Bruch membrane opening-based optic nerve head (ONH) morphometry was analysed in thirty-two patients younger than 18 years with evaluable SD-OCT examinations of the ONH and nocturnal posture-dependent IOP elevation above 25 mmHg. Longitudinal changes in neuroretinal rim tissue, as measured by Bruch Membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness, were assessed. One year after the 24 h IOP measurement, global BMO-MRW (− 1.61 ± 16.8 µm, n.s.; p = 0.611) and RNFL (+ 0.64 ± 3.17 µm; n.s.; p = 0.292) measurements were not significantly different from the baseline. No significant BMO-MRW reduction (− 3.91 ± 24.3 µm; n.s. p = 0.458) or deviation in RNFL thickness (+ 1.10 ± 3.52 µm) was observed at the four-year follow-up. Absolute IOP values measured in the supine position did not correlate with changes in global BMO-MRW or RNFL thickness. Posture-dependent IOP elevations do not seem to influence retinal nerve fibre layer thickness or Bruch membrane opening-based morphometric data in childhood.

Filterkissenversagen nach Implantation von filtrierenden Stents (z. B. Preserflo Stent) stellen eine über die letzten Jahre entstandene häufige Herausforderung in der Glaukomchirurgie dar. Im Folgenden wird hierzu eine Technik zur offenen Filterkissenrevision mit Mitomycin C (0,2 mg/ml) und Ologen-Implantation dargestellt, deren Ziel es ist, durch Fibrose verloren gegangenes Filtrationsvolumen zu reetablieren und längerfristig zu erhalten.

Purpose Currently, there are no specific data on the circadian course of intraocular pressure (IOP) in children, especially for IOP measurements in the supine position. The study aimed to characterize the diurnal and nocturnal IOP fluctuations in supine and sitting positions in patients less than 18 years of age. Methods Seventy-nine eyes of 79 patients under 18 years of age with suspicious optic nerve heads or ocular hypertension could be included in this study. All included patients showed an inconspicuous retinal nerve fiber layer thickness and Bruch’s membrane minimum rim width by coherence tomography. IOP measurements during the 24-h IOP profile were retrospectively evaluated. Measurements were taken at 10:00, 16:00, 20:00, and 23:00 h in the sitting position and at 6:00 h in the morning in the supine position using iCare rebound tonometry on 2 consecutive days. Results Thirty-four of 79 children (43.0%) had peak nocturnal IOP values > 25 mmHg. The mean daily IOP was 18.8 ± 5.6 mmHg, and the mean daily fluctuation was 6.1 ± 4.0 mmHg. At 6 am, supine measurements were elevated to 25.1 ± 8.0 mmHg. Extensive fluctuations with values > 40 mmHg in the nocturnal supine measurement occurred in a relevant share of patients ( n = 5). Conclusion There appear to be relevant diurnal and nocturnal IOP fluctuations in healthy children (< 18 years). Nocturnal IOP measurements in supine patients with risk factors for glaucoma may provide important additional information to identify critical patients for further follow-up.

The aim of the present study was to evaluate changes of best corrected visual acuity (BCVA), retinal nerve fiber layer thickness (RNFL), total macular volume (TMV), intraocular pressure (IOP) and central retinal thickness (CRT) after intravitreal injection of ranibizumab, bevacizumab and aflibercept in patients with neovascular age-related macular degeneration (nAMD) in a clinical real world setting. In a retrospective clinical study design, 120 patients (80 women and 40 men) were analyzed after being diagnosed with nAMD within 8 years (2010–2018). Every patient received at least 6 anti-VEGF injections in a Pro-Re-Nata or Treat-and-Extend regimen. OCT parameters (RNFL, TMV, CRT) and visual acuity (BCVA) were assessed at first diagnosis, at treatment day and during the course. Intraretinal fluid was reduced significantly in a magnitude of 88–64 µm (CRT) and 0.75–0.55 mm3 (TMV). Apart from a significant reduction immediately after the therapy start (post-3 injections) with ranibizumab (− 1.4 µm, p = 0.03), RNFL thickness remained constant. A slight improvement in visual acuity of 0.06 logMAR could initially be observed. If further injections were required, only stabilization was achieved compared to baseline visual acuity. The changes of OCT parameters CRT, TMV, and RNFL as well as the stabilization of functional results (BCVA) as illustrated in this study comparing effects of different anti-VEGF-agents provide evidence for the transferability of former results to a clinical real-world setting.

The study aims to compare outcomes after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in keratoconic eyes with or without previous hydrops. Retrospective analysis of 211 eyes who received PK (group 1, n = 74 [history of hydrops: n = 33]) or DALK (group 2, n = 137 [history of hydrops: n = 9]) from 2012 to 2019 at the Department of Ophthalmology, University of Cologne, Germany. Analysis included best spectacle-corrected visual acuity (BSCVA), complications, immune reactions, graft survival and keratometry, and subgroup analyses for subjects with or without previous hydrops. Follow-up was 34.0 ± 23.6 months in group 1 and 30.7 ± 22.5 months in group 2. No significant difference was found in the course of BSCVA between groups 1 and 2 (p = 0.182) and in postoperative BSCVA between eyes with and without previous hydrops, regardless of the surgical method (p = 0.768). Endothelial immune reactions occurred exclusively in group 1 and did not occur more frequently in eyes with previous hydrops (p = 0.377). A higher risk of complications for eyes with previous hydrops was observed (p = 0.022). There was no difference in astigmatism and maximum keratometry (Kmax) preoperatively and postoperatively between eyes with and without history of hydrops. The prognosis for visual outcome after keratoplasty including visual acuity, astigmatism, and Kmax for keratoconic eyes with previous hydrops is as good as for keratoconic eyes without previous hydrops, irrespective of the surgical method. However, eyes after hydrops seem to have an increased risk of complications.

Background : So far, only indirect evidence exists for the pharmacoresistant R-type voltage-gated Ca 2+ channel (VGCC) to be involved in transretinal signaling by triggering GABA-release onto ON-bipolar neurons. This release of inhibitory neurotransmitters was deduced from the sensitivity of the b-wave to stimulation by Ni 2+ , Zn 2+ and Cu 2+ . To further confirm the interpretation of these findings, we compared the effects of Cu 2+ application and chelation (using kainic acid, KA) on the neural retina from wild type and Ca v 2.3-deficient mice. Furthermore, the immediately effect of KA on the ERG b-wave modulation was assessed. Methods : Transretinal signaling was recorded as an ERG from the superfused murine retina isolated from wildtype and Ca v 2.3-deficient mice Results : In mice, the stimulating effect of 100 nM CuCl 2 is absent in the retinae from Ca v 2.3-deficient mice, but prominent in Ca v 2.3-competent mice. Application of up to 3 mM tricine does not affect the murine b-wave in both genotypes, most likely because of chelating amino acids present in the murine nutrient solution. Application of 27 µM KA significantly increased the b-wave amplitude in wild type and Ca v 2.3 (-|-) mice. This effect can most likely be explained by the stimulation of endogenous KA-receptors described in horizontal, OFF-bipolar, amacrine or ganglion cells, which could not be fully blocked in the present study. Conclusion: Cu 2+ dependent modulation of transretinal signaling only occurs in the murine retina from Ca v 2.3 competent mice, supporting the ideas derived from previous work in the bovine retina that R-type Ca 2+ channels are involved in shaping transretinal responses during light perception.