Background: Uveal melanoma is the most common primary intraocular malignancy in adults. Iris melanomas are rare tumours: they account for 2-3% of all uveal melanomas. The clinical differentiation between benign iris nevi and malignant iris melanomas can be difficult. Patients and Methods: The aim of this study was the registration, analysis and observation of all patients with tumours of the anterior uvea who had been treated surgically between 1992 and 2011 at the ophthalmic department of the University Hospital of Jena. 40 patients were analysed and compared concerning their preoperative states, operating methods including complications, histological results, postoperative function, subjective complaints as well as the risk of metastasis and the associated dependence on mortality of the dignity of the tumours. In this time period 26 patients has been observed in a follow-up visit. Patients with a malignant tumour were offered an examination. Results: The histological examination revealed for 24 patients a benign tumour and for 16 patients a malignant tumour. After an exact analysis of multiple parameters there was only a statistically significant difference in the preoperative visual acuity (p=0.025) and in the tumour size (p=0.011) between the two analysed groups of patients. The rate of serious postoperative complications was 11.4%. One fourth of the patients complained of subjective problems after the surgical intervention. In the follow-up visit a visual acuity of 0.5 or better was achieved in 68% of all interventions. Conclusions: A reliable diagnosis is only possible after histological examination. The analysed parameters can only give indications for the dignity of the tumour. The strategy of the ophthalmic department of the University Hospital of Jena to remove a tumour of uncertain dignity at an early state makes sense, because there are few postoperative complications, few patients complain about subjective problems and the chances for achieving good visual acuity are high.

Zusammenfassung Hintergrund: Uveale Melanome machen den größten Anteil intraokularer maligner Tumoren beim Erwachsenen aus. Irismelanome machen dabei nur einen Anteil von 2–3 % der uvealen Melanome aus. Die Unterscheidung zwischen gutartigen Irisnävi und bösartigen malignen Melanomen der Iris ist oft schwierig. Patienten und Methoden: Ziel der vorliegenden Arbeit war es, Patienten mit Tumoren der vorderen Uvea, die zwischen 1992 und 2011 an der Augenklinik des Universitätsklinikums Jena operativ versorgt wurden, zu erfassen, zu analysieren und nachzubeobachten. Es wurden Patienten, präoperativ erhobene Befunde, Operationsverfahren einschließlich aufgetretener Komplikationen, histologische Ergebnisse, postoperative Funktion, subjektive Beschwerden und Risiko für eine Metastasierung und die damit verbundene Sterblichkeitsrate in Abhängigkeit der Tumordignität analysiert und miteinander verglichen. Im analysierten Zeitraum handelte es sich um 40 Patienten. 26 Patienten konnten in die Nachbeobachtung eingeschlossen werden. Patienten, bei denen sich nach histologischer Aufarbeitung des Gewebes ein maligner Tumor bestätigt hatte, wurde eine Nachkontrolle angeboten. Ergebnisse: Nach histologischer Beurteilung wurden bei 24 Patienten benigne Tumoren und bei 16 Patienten maligne Tumoren bestätigt. Nach genauer Analyse zahlreicher Parameter zeigten nur die präoperative Sehschärfe (p = 0,025) und die Tumorgröße (p = 0,011) statistisch signifikante Unterschiede zwischen den beiden analysierten Patientengruppen. Die Rate für schwerwiegende postoperative Komplikationen lag bei 11,4 %. Subjektive Beschwerden nach operativer Tumorentfernung wurden von ca. einem Viertel der Patienten beklagt. In der Nachbeobachtung konnte gezeigt werden, dass eine Sehschärfe von 0,5 oder besser in 68 % der Fälle erhalten werden konnte. Schlussfolgerung: Eine sichere Diagnosestellung ist nur mittels histologischer Untersuchung möglich. Die untersuchten Parameter können nur Hinweise bez. der Tumordignität geben. Die Strategie, nach der an der Universitätsaugenklinik Jena bei unklarer Irisläsion verfahren wird, nämlich die frühe chirurgische Tumorentfernung unter Bulbuserhalt, ist sinnvoll, da wenig schwere postoperative Komplikationen auftreten, die Patienten geringe subjektive postoperative Beschwerden beklagen und ein guter Visuserhalt möglich ist.

Background: In a prospective clinical study we examined the course of the optical density of the macular pigment (MPOD) in patients with idiopathic macular holes before and after pars-plana vitrectomy.Patients and Methods: Of the 26 patients four had macular holes stage 1, six patients had stage 2 or stage 4 holes and ten people had a macular hole stage 3. The surgical procedure consisted always of a standard 3-port pars plana vitrectomy (PPV) with colouring assisted peeling of the internal limiting membrane. The optical density of macular pigment was determined by the 1-wavelength reflection method before pars plana vitrectomy and after macular hole closure.Results: The macular hole was completely closed in 25 of 26 eyes (96.15%). This anatomical success is also the basis for a postoperative improvement in the retinal function. In the case of macular holes from stages 3 and 4 the surgery achieved an increase in visual acuity and an increase of the optical density of the the macular pigment. In patients with macular holes stage 2 the visual acuity and the optical density of the macular pigment were reduced after vitrectomy. In the case of stage 1 holes the visual acuity and the volume of macular pigment also were reduced after the operation.Discussion: In the group of stage 4 macular holes there was a significant increase in maximum optical density and volume of macular pigment after successful surgical hole closure, so the functional profit of PPV is very high in these patients. Even in the case of macular holes of stage 3 the PPV effected a functional improvement in the sense of an increase of the optical density of macular pigment. The increase in volume proved to be significant. For macular holes stage 2 the vitrectomy as a therapy option is generally recognised but PPV does not effect positively the height of the optical density of macular pigment. In these patients both the maximum optical density as well as the volume of macular pigment were reduced in the therapeutic course. Whether surgical intervention is indicated in stage 1 is still controversial. Taking into account the development of MPOD the profit from surgery for the patients is very low. This led to a decrease in volume of macular pigment and only a slight increase in maximum optical density after pars plana vitrectomy.

Background. Monochromatic aberrations may influence the visual acuity of the eye. They are not stable and can be affected by different factors. The subject of the following paper is the dynamic investigation of the changes in wavefront aberration with accommodation.Method. Dynamic measurement of higher and lower order aberrations was performed with a WASCA Wavefront Analyzer (Carl-Zeiss-Meditec) and a specially constructed target device for aligning objects in far and near distances on 25 subjects aged from 15 to 27 years old.Results. Wavefront aberrations showed some significant changes in accommodation. In addition to the characteristic sphere reaction accompanying miosis and changes in horizontal prism (Z(1)(1)) in the sense of a convergence movement of the eyeball also occurred. Furthermore defocus rose (Z(2)(0)) and astigmatism (Z(2)(-2)) changed. In higher-order aberrations a decrease in coma-like Zernike polynomials (Z(3)(-1), Z(3)(1)) was found. The most obvious change appeared in spherical aberration (Z(4)(0)) which increased and changed from positive to negative. In addition the secondary astigmatism (Z(4)(-2)) and quadrafoil (Z(4)(4)) rise also increased. The total root mean square (RMS), as well as the higher-order aberrations (RMS-HO) significantly increased in accommodation which is associated with a theoretical reduction of visual acuity. An analysis of the influence of pupil size on aberrations showed significant increases in defocus, spherical aberration, quadrafoil, RMS and RMS HO by increasing pupil diameter. By accommodation-associated miosis, the growing aberrations are partially compensated by focusing on near objects. Temporal analysis of the accommodation process with dynamic wavefront analysis revealed significant delays in pupil response and changing of prism in relation to the sphere reaction. In accommodation to near objects a discrete time ahead of third order aberrations in relation to the sphere response was found.Conclusion. Using dynamic wavefront measurement achieved a sequential analysis of aberrations during accommodation. Significant changes in the lower and higher-order aberrations could be detected. These are additionally varied by the associated pupillary response. Moreover, the synchronicity of wave front reaction in the accommodation process was proven.

Monochromatische Aberrationen beeinträchtigen die Abbildungsqualität des Auges. Sie sind dabei nicht konstant, sondern unterliegen zahlreichen Veränderungen und Einflüssen. In vorliegender Arbeit werden die Veränderungen der Wellenfront bei Akkommodation dynamisch untersucht.

Die Makulapigmentdichtemessung stellt eine objektive Methode zur klinischen Verlaufskontrolle bei Patienten mit trockener AMD dar [1]. Neben einer Bestimmung des Ausgangswerts der optischen Dichte (OD) sind auch Änderungen im klinischen Verlauf dokumentierbar [2] [3]. Lutein und Zeaxanthin als Hauptbestandteile des Makulapigments sowie Omega-3-Fettsäuren stellen eine Möglichkeit für eine mögliche positive Beeinflussung des Verlaufs der trockenen AMD dar und haben darüber hinaus wichtige Funktionen für die physiologische Funktion der Makula [4] [5] [6]. Nachfolgend werden an 2 Patienten der klinische Verlauf und die Änderung der Drusenmorphologie während einer 12-monatigen bilanzierten Supplementation mit Lutein, Zeaxanthin und Omega-3-Fettsäuren dargestellt (im Rahmen der LUTEGA-Studie; Studienregistrierung: www.clinicaltrials.gov: NCT00763659). Die Bestimmung der Makulapigmentdichte erfolgte nach der Methode von Schweitzer et al. [3].

Dem Augenarzt kommt bei der Diagnosestellung der myotonen Dystrophie Curschmann-Steinert aufgrund der Vielfalt und Haufigkeit der ophthalmologischen Symptome (insbesondere myotone Katarakt und Ptosis) eine besondere Bedeutung zu. Bei Patienten mit auffalliger Fazies und charakteristischen Linsentrubungen sollte auch der Ophthalmologe die Verdachtsdiagnose im Zusammenhang mit der Familienanamnese stellen konnen. Bei gegebener Indikation kann dem Patienten eine Kataraktoperation angeboten werden. Hierbei ist zu berucksichtigen, dass das Operationsrisiko bei moglicher Beteiligung der Herzund Atemmuskulatur erhoht sein kann [4].

Objective: Purpose of these study was the evaluation of a new method for the measurement of haemoglobin oxygenation in retinal vessels. Patients with branch retinal artery occlusion have been measured before and after a rheological therapy.Methods: The haemoglobin oxygenation in retinal vessels was measured by the "oxygen module" (Imedos GmbH, Jena, Germany) which uses a special filter (transmission at 548 and 610 nm, band width 10 nm) in the illumination path of a fundus camera. Fundus images were acquired by a colour CCD camera and specific software was used for vessel tracking and calculation of their haemoglobin oxygen saturation. 11 patients with branch retinal artery occlusions, average age 63.4 +/- 11.7 years were investigated at time of diagnosis and at the 5th day of a rheological and intraocular pressure reduction therapy.Results: 10 out of 11 patients have shown an increase of haemoglobin oxygenation over time (on average from 73 +/- 16% to 87 +/- 11%). This increase was statistically significant (p < 0.05, Wilcoxon test). Non-affected retinal areas have also shown an increase of haemoglobin oxygenation. The visual acuity improved by one line. This increase in visual acuity was, however, not statistically significant.Conclusions: We observed an increase of the arterial haemoglobin oxygenation. One possible reason of the improvement of the haemoglobin oxygenation by the therapy may be an increase of the rheological properties of the blood. All patients showed an increase or at least a stabilisation of their visual acuity. Retinal vessel oximetry might be used as an additional parameter in the follow-up of retinal artery occlusion.

Die wellenfrontgeführte Hornhautchirurgie wird häufig bei der Korrektur von sphärozylindrischen Brechungsfehlern angewendet. Präoperativ erfolgt dabei eine Wellenfrontanalyse. Die vorliegende Arbeit untersucht Veränderungen der Wellenfront bei einer nicht exakten Ausrichtung des Auges.

Wavefront-guided corneal surgery is a standard therapeutic option for correcting refractive errors. If the wavefront measured preoperatively is influenced by an incorrect alignment of the bulb, the ablation profile could be distorted and the quality of vision reduced.Wavefront analysis was done on 49 eyes, examining the primary gaze of the bulb as well as abduction, adduction, elevation, and depression.The study demonstrated a significant influence of eye movements on astigmatic aberrations. Horizontal eye movements have a stronger influence than vertical ones do. Adduction especially leads to changes; here, RMS showed a significant difference.Eye movements have a significant effect on wavefront profiles. The amount of aberration induced is generally very low. In individual cases, the numbers of aberrations induced by eye movements are in ranges reported to reduce the postoperative quality of vision when the ablation profile is taken into account.

OBJECTIVES:Oxygen saturation in retinal vessels can be measured by spectrometry. However, there are no studies on the influence of different camera chips on these measurements. The presented study reports the effect of two different camera chips ("1-CCD" vs. "3-CCD") on the spectrometric measurements in the same patients.METHODS:61 eyes of 61 patients were included in this study. The study was approved by the local ethics commission. Patients were separated in 3 groups: the first group contained healthy volunteers, the second group patients with diabetes mellitus but without previous laser treatment, the third group included patients with diabetes mellitus and previous laser coagulation treatment. The oxygen saturation was calculated from the difference between wavelengths on and right next to the retinal vessel. This methodology uses the different absorption spectra of oxy- and deoxyhaemoglobin.RESULTS:All 3 groups demonstrated valid outcomes of the retinal oxygen saturation in arterial and venous vessels. No significant differences we found in the arterial-venous oxygen difference between the two different camera chips (group 1 p = 0.063, group 2 p = 0.204, group 3 p = 0.059).CONCLUSION:As no significant differences could be found between the two camera chips, the less expensive system should be used if the spectrometric measurement of oxygen saturation is added to an analysis system already established on the market.

Oxygen saturation in retinal vessels can be measured by spectrometry. However, there are no studies on the influence of different camera chips on these measurements. The presented study reports the effect of two different camera chips ("1-CCD" vs. "3-CCD") on the spectrometric measurements in the same patients.61 eyes of 61 patients were included in this study. The study was approved by the local ethics commission. Patients were separated in 3 groups: the first group contained healthy volunteers, the second group patients with diabetes mellitus but without previous laser treatment, the third group included patients with diabetes mellitus and previous laser coagulation treatment. The oxygen saturation was calculated from the difference between wavelengths on and right next to the retinal vessel. This methodology uses the different absorption spectra of oxy- and deoxyhaemoglobin.All 3 groups demonstrated valid outcomes of the retinal oxygen saturation in arterial and venous vessels. No significant differences we found in the arterial-venous oxygen difference between the two different camera chips (group 1 p = 0.063, group 2 p = 0.204, group 3 p = 0.059).As no significant differences could be found between the two camera chips, the less expensive system should be used if the spectrometric measurement of oxygen saturation is added to an analysis system already established on the market.

Das multiple Evanescent White Dot Syndrome zählt wie auch unter anderem die akute plakoide Pigmentepitheliopathie und die Birdshot-Chorioretinopathie zu der Gruppe der White Dot Syndrome. Hierbei handelt es sich um eine Erkrankung der Aderhaut und des retinalen Pigmentepithels mit eventueller immunologischer Genese, meist ohne systemischer Beteiligung. In diesem Kurzvortrag werden anhand einer Falldarstellung typische Befunde der MEWDS dargestellt. Dabei wird auf die Anamnese, den Krankheitsverlauf, die erfolgten Untersuchungen (Visus, FAG, OCT, Elektrophysiologie, Gesichtsfeld) sowie den Heilungsverlauf eingegangen. Wichtige Differenzialdiagnosen werden erläutert.

Hintergrund: Die endotheliale Dysfunktion findet als ein möglicher Prognoseparameter bei der Entstehung und Progredienz der diabetischen Retinopathie zunehmend das Interesse. Die flickerlichtinduzierte endotheliale NO-Freisetzung und nachfolgende Gefäßdilatation gilt dabei als Indikator für die endotheliale Funktionsfähigkeit der zentralen Netzhautgefäße. Methodik: Die flickerlichtinduzierte arterielle Gefäßdilatation sowie der komplette internistische Status wurden bei 65 Patienten mit Typ 1 und 170 Patienten mit Typ 2 Diabetes untersucht. Die Einteilung der diabetischen Retinopathie erfolgte nach ETDRS-Kriterien. Weiterhin wurde eine Gruppe von 55 gesunden Probanden als Kontrollgruppe untersucht. Ergebnisse: Die Gruppe der Diabetespatienten wies mit 2,1 ± 2,2 % (Typ 1) und 2,2 ± 2,4 % (Typ 2) eine signifikant geringere arterielle Dilatation im Vergleich zur Kontrollgruppe (3,6 ± 2,1 % p ≤ 0,001) auf. Mit zunehmender Schwere der diabetischen Retinopathie, kam es zu einer signifikanten Abnahme der Dilatationsfähigkeit der Arteriolen (p = 0,002) während die Ausgangswerte der Arterien keine stadienabhängige Veränderung aufwiesen. Dabei zeigten in der Gruppe der Diabetespatienten bereits Patienten ohne diabetische Retinopathie - unabhängig vom Diabetestyp - eine deutliche verminderte Reaktion auf Flickerlicht. Im Stadium der proliferativen diabetischen Retinopathie war bei Typ 1 Diabetikern noch eine deutliche Gefäßreaktion nachweisbar (1,80 ± 2,11), wohingegen diese bei Typ 2 Diabetikern praktisch erloschen war (0,31 ± 1,08). Schlussfolgerungen: Es zeigte sich sowohl bei Typ 1 als auch Typ 2 eine deutlich verminderte Gefäßreaktion auf Flickerlicht als Zeichen der endothelialen Dysfunktion im Vergleich zur gesunden Kontrollgruppe. Mit zunehmender Schwere der diabetischen Retinopathie kam es zu einem signifikanten Abfall der Gefäßreaktion, wobei bereits Patienten mit Diabetes ohne Retinopathie deutliche Veränderungen im Vergleich zur Kontrollgruppe aufwiesen. Die Messung der arteriellen Dilatation auf definierte Flickerlichtreize bietet somit eine Möglichkeit der Prognosebeurteilung im Rahmen der Diabetesbetreuung.

BACKGROUND:The group of anti-VEGF drugs is a new option for ophthalmologists in the therapy for acute and chronic macular oedema. First studies have revealed a stabilisation and increase of best corrected visual acuity as well as a decrease of retinal thickness, objectively measured with optical coherence tomography. The effects on subjective sensations are not always correlated with the objective changes.PATIENTS AND METHODS:From May to July 2006, 43 patients were treated with 1.25 mg bevacizumab, administered by sterile intravitreal injection. 30 patients had an age-related macular degeneration, 9 patients a diabetic retinopathy with macular oedema, 3 patients had a chronic macular oedema caused by retinal vessel occlusion and one patient had a retinal pigment detachment. The age ranged from 45 to 84 years (median: 70 years). General and special ophthalmological anamnesis, best corrected visual acuity and retinal thickness measured by optical coherence tomography were taken. Complete follow-up examinations were performed four and eight weeks after injections. In these postoperative controls the patients were also asked about their subjective sensations after the injection of bevacizumab, controlled by means of a numerical rating scale.RESULTS:The best corrected visual acuity (ETDRS) decreased from 9.2 letters (range from 0 to 40) to 13.1 letters (range from 0 to 42; p < 0.05) after four weeks, further four weeks later to 15.8 letters (range from 0 to 44; p < 0.05). The subjective sensations increased significantly at four weeks (0.54 points; range from - 1 to + 3; p < 0.05) and at eight weeks light regression (0.28 points; range from - 3 to + 3; p < 0.05). All patients reported a brightening "dark central blot". The available metamorphopsias improved at four weeks (18 patients), and at eight weeks 5 patients reported improvement. For none of ther patients did the metamorphopsia disappear completely.CONCLUSIONS:The intravitreal injection of bevacizumab shows beneficial results in terms of an increase of best corrected visual acuity. However, on comparing these results with the subjective sensations after injections there is a discrepancy. The subjective sensations are found to be only slightly better. More investigations, also after repeated injections are necessary.

Background: The basics of the model of accommodation were described by Hermann von Helmholtz 150 years ago and are accepted until today.Materials and Methods: Twenty-five healthy young phakic test persons (age range 14 to 28 years) were examined using the IOL Master (Carl Zeiss Jena GmbH), slit lamp photography (Scheimpflug camera EAS 1000, Nidek) and pupillography (AMTech GmbH). Measurements were taken of disaccommodated and accommodated eyes.Results: The mesopic and photopic pupil size are statistically significant (p < 0.05) smaller in accommodated eyes than in disaccommodated. Also, a significantly shorter reaction time of the light-induced pupil reaction with accommodation could be shown compared to disaccommodation. The central vertical and horizontal radii of curvature of the cornea increased with accommodation. This is likewise a decrease of the central anterior corneal curvature by near fixation. Due to the axial lens thickening, the anterior chamber angle and the anterior chamber depth decreased. Consequently, a decrease of the lens transparence resulted with accommodation.Conclusions: As a result of our measurements the existing model of accommodation, developed by Hermann von Helmholtz 150 years ago, can be modified.