Eine Thrombose der Vena ophthalmica superior (VOS) ist selten. Sie kann sich mit heterogenen Symptomen präsentieren und erfordert eine sorgfältige diagnostische Abklärung mittels verschiedener bildgebender Verfahren (CT, MRT, DSA). Wir berichten über eine Fallserie von 3 Patientinnen (Alter bei Erstvorstellung 85, 69 und 93 Jahre) mit Thrombose der VOS. Außerdem führten wir eine ausführliche Literaturrecherche mittels Pubmed durch. Trotz heterogener Leitsymptomatik zeigte sich bei allen Patientinnen eine Trias aus Motilitätseinschränkung, Exophthalmus sowie eine Differenz des Intraokulardrucks (IOD) mit höherem IOD auf der Seite der Protrusio bulbi. Die Ätiologie der Thrombose war in allen Fällen unterschiedlich: Zwei Fällen war gemeinsam, dass eine bestehende Antikoagulationstherapie kurz vor dem Ereignis pausiert worden war. Als Kofaktoren kamen im ersten Fall differenzialdiagnostisch eine intraorbitale venöse Abflussbehinderung durch eine unklare Raumforderung in der Orbitaspitze, im zweiten Fall eine Hyperkoagulabilität aufgrund einer Tumorerkrankung hinzu. Im dritten Fall bestanden beidseitige Sinus-cavernosus-Fisteln und auf der Seite der VOS Thrombose eine Orbitaphlegmone. Die Diagnose sollte nicht nur bei Patienten mit dilatierten Gefäßen des vorderen Augenabschnittes, sondern auch bei unklaren Fällen von Protrusio bulbi, Motilitätsstörungen oder einseitig erhöhtem IOD differentialdiagnostisch erwogen und gegebenenfalls radiologisch abgeklärt werden.

Purpose: Evaluate optic nerve sheath and pial diameters (ONSD, ONPD) via sonography and computed tomography (CT) after out-of-hospital cardiac arrest (CA) and to compare their prognostic significance with other imaging and laboratory biomarkers. Materials and methods: A prospective observational study enrolling patients after successful resuscitation between December 2017 and August 2021. ONSD and ONPD were measured with sonography. Additionally, ONSD, and also grey-to-white ratio at basal ganglia (GWRBG) and cerebrum (GWRCBR), were assessed using CT. Lactate and neuron specific enolase (NSE) blood levels were measured. Results: Sonographically measured ONSD and ONPD yielded no significant difference between survival and nonsurvival (p values >= 0.4). Meanwhile, CT assessed ONSD, GWRBG, GWRCBR, and NSE levels significantly differed regarding both, survival (p values <= 0.005) and neurological outcome groups (p values <= 0.04). For survival prognosis, GWRBG, GWRCBR, and NSE levels appeared as excellent predictors; in predicting a good neurological outcome, NSE had the highest accuracy. Conclusions: CT diagnostics, in particular GWRBG and GWRCBR, as well as NSE as laboratory biomarker, appear as excellent outcome predictors. Meanwhile, our data lead us to recommend caution in utilizing sonography assessed ONSD and ONPD for prognostic decision-making post-CA.

Background Thrombosis of the superior ophthalmic vein (SOV) is rare. It can present with heterogeneous symptoms and requires a careful diagnostic work-up. Methods This article reports on a case series of three female patients with thrombosis of the SOV and performed an extensive review of the existing literature in PubMed. Results All three patients showed different leading symptoms but all had a triad of restricted eye motility, exophthalmos and a difference in intraocular pressure with the higher pressure on the side of the protruded eyeball. The pathophysiological background differed in all cases: in the two first cases a pre-existing anticoagulation treatment had been paused shortly before the event. Cofactors were an intraorbital venous outflow obstruction due to an unclear mass in the orbital apex in one case and hypercoagulability due to a malignant disease in the other case. In the third case, there was a cavernous sinus fistula. Conclusion The diagnosis should be considered not only in patients with dilated vessels of the anterior segment but also in unclear cases of exophthalmos or unilateral elevated intraocular pressure (IOP).

Purpose :To evaluate a novel hydrophobic, non-diffractive, extended depth of focus (EDOF) intraocular lens (IOL) design in comparison to two monofocal aspheric lenses. Methods : Inclusion criteria for this prospective, monocentric cohort study were opacification of the crystalline lens and patients' wishes for surgery. In the case of the EDOF IOL, patients asked for a presbyopia correction. All patients received surgery on both eyes. Corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected and distance corrected intermediate visual acuity (UIVA, DCIVA) and defocus curves (all monocular and binocular) were compared three months postoperatively. Results : Fifty-six eyes were implanted with an EDOF IOL (LuxSmart (TM), Bausch & Lomb GmbH, Berlin, Germany), 50 eyes with a monofocal aspheric IOL: 32 eyes with a clear IOL (Polylens (R) AS 61, Polytech Domilens, Rossdorf, Germany), 16 eyes with a yellow IOL (iSert (R) 251, Hoya Surgical Optics GmbH, Frankfurt, Germany). Three months postoperatively, UCDVA was comparable with the EDOF IOL, versus the monofocal IOL (P > 0.9). Binocular DCIVA in the EDOF IOL was significantly higher than in the monofocal IOL (P = 0.001). Monocular DCIVA better than 20/23 Snellen was achieved in 10% with the monofocal IOL and in 68% (P < 0.0001) with the EDOF IOL. Defocus curves showed a depth of focus at 20/23 Snellen of 1.6 vs. 0.83 diopters (D) in the EDOF IOL, vs. the monofocal IOL. No patient reported halos or starbursts in non-standardized questioning. Conclusion :This non-diffractive EDOF IOL provided comparably high UCDVA and significantly higher DCIVA than the mono-focal lenses, causing only mild optical phenomena.

BACKGROUND:The measurement of anatomical structures is critical in plastic and reconstructive surgery. However, few detailed and standardized measurements have been widely used in the periorbital region. This study aimed to evaluate the feasibility of a novel detailed and standardized protocol with 2D and 3D technologies, and explore the relationship between them and direct measurements.METHODS:Fifty healthy Caucasians (100 eyes) between 20 and 68 years old were recruited and captured for 3D photographs by VECTRA M3 3D Imaging System. Subsequently, 24 landmarks were located on each 3D photographs following a standardized protocol, and then 19 linear and 3 angular periorbital variables were measured. Furthermore, two-dimensional (2D) and direct measurements were conducted on each subject and compared with 3D measurements and one another.RESULTS:The grand r means across all measurements were 0.77, 0.78, and 0.88 for direct vs. 2D values, direct vs. 3D values, and 3D vs. 2D values, respectively. The mean absolute differences were 1 mm (ranging from 0.2 mm to 3.7 mm) between direct and 3D measurements, 1 mm (ranging from 0.04 mm to 2.4 mm) between direct and 2D measurements, and 1 mm and 6.6° (ranging from 0.04 mm or 0.5° to 3 mm or 12.8°) between 2D and 3D measurements.CONCLUSIONS:This study verified the feasibility of this detailed and standardized landmark localization protocol for assessing the periorbital morphology with 2D and 3D technologies. This protocol may work as a bridge communicating with all studies involving any of the three technologies in the future.

Der Goldstandard für die Therapie des periokulären Basalzellkarzinoms ist die chirurgische Resektion mit ophthalmoplastischer Rekonstruktion. Höchste Priorität hat dabei in den meisten Fällen die vollständige, histopathologisch kontrollierte Tumorexzision. Dabei kann die histopathologische Aufarbeitung zweizeitig mittels Schnelleinbettung über Nacht erfolgen oder intraoperativ mittels Schnellschnitt. Eine Vielzahl von Rekonstruktionsmethoden ermöglicht eine individuell angepasste sowie in den meisten Fällen auch eine kosmetisch und funktionell ansprechende Defektdeckung. Postoperativ ist eine regelmäßige Tumornachsorge unerlässlich.

PURPOSE:To evaluate the presence and appearance of blood and lymphatic vessels in non-functioning bleb capsules of glaucoma drainage devices (GDD).MATERIALS AND METHODS:Non-functioning (n=14) GDD-bleb capsules of 12 patients were analyzed by immunohistochemistry for blood vessels (CD31, vascular endothelium), lymphatic vessels (lymphatic vessel endothelial hyaluronan receptor-1 [LYVE-1] and podoplanin) and macrophages (CD68).RESULTS:CD31+++ blood vessels and CD68+ macrophages were detected in the outer layer of all specimens. LYVE-1 immunoreactivity was registered in single non-endothelial cells in 8 out of 14 (57%) bleb capsule specimens. Podoplanin-immunoreactivity was detected in all cases, located in cells and profiles of the collagen tissue network of the outer and/or the inner capsule layer. However, a colocalization of LYVE-1 and podoplanin as evidence for lymphatic vessels was not detected.CONCLUSIONS:We demonstrate the presence of blood-vessels but absence of lymphatic vessels in non-functioning bleb capsules after GDD-implantation. While the absence of lymphatic vessels might indicate a possible reason for drainage device failure, this needs to be confirmed in upcoming studies, including animal experiments.

BACKGROUND:The three-dimensional surface imaging system is becoming more common in plastic surgeries. However, few studies have assessed three-dimensional periocular structures and surgical outcomes. This study aimed to propose a standardized three-dimensional anthropometric protocol for the periocular region, investigate its precision and accuracy, and determine the three-dimensional periocular anthropometric norms for young Caucasians.METHODS:Thirty-nine healthy young Caucasians (78 eyes) were enrolled. Three-dimensional facial images were obtained with a VECTRA M3 stereophotogrammetry device. Thirty-eight measurements in periocular regions were obtained from these images. Every subject underwent facial surface capture twice to evaluate its precision. A paper ruler was applied to assess its accuracy.RESULTS:Sixty-three percent of measurements in linear distances, curvatures, angles, and indices were found to reach a statistically significant difference between sexes (p ≤ 0.05, respectively). Across all measurements, the average mean absolute difference was 0.29 mm in linear dimensions, 0.56 mm in curvatures, 1.67 degrees in angles, and 0.02 in indices. In relative error of magnitude, 18 percent of the measurements were determined excellent, 51 percent very good, 31 percent good, and none moderate. The mean value of the paper-ruler scale was 10.01 ± 0.05 mm, the mean absolute difference value 0.02 mm, and the relative error of magnitude 0.17 percent.CONCLUSIONS:This is the first study to propose a detailed and standardized three-dimensional anthropometric protocol for the periocular region and confirm its high precision and accuracy. The results provided novel metric data concerning young Caucasian periocular anthropometry and determined the variability between sexes.

Background. A space-occupying lesion of the eyelid in young adults is often a sign of an inflammation, a trauma or a benign neoplasm. The aim of this case report is to demonstrate a rare basal cell carcinoma, which presumably already arose in adolescence without further high-risk factors. Methods. A 28-year-old male patient presented for a second opinion on a painless swelling of the right lower eyelid. According to the patient's history the swelling had been present since the age of 16 years and originally resembled a molluscum contagiosum. An ophthalmologist in private practice made the diagnosis of a suspected trichoepithelioma. The extended patient history revealed a blood coagulation disorder. The clinical ophthalmological examination revealed a nodular space-occupying lesion with a border wall and telangiectasia. The further ophthalmological examination was bilaterally inconspicuous. Due to the suspicion of a malignant process, an operation was promptly carried out using local anesthesia with complete tumor excision and pedicled flap plasty as well as a histopathological investigation to confirm the diagnosis. Results. The histopathological investigation revealed underlying infiltrates of a basaloid tumor with bale-shaped trabecular growth, sometimes with peripheral palisading of the cells. The cells were predominantly monomorphic with isolated pleomorphic nuclei and sometimes enclosed mitoses. Immunohistochemically the cells were strongly positive for BerEP4 and negative for epithelial membrane antigen (EMA). The diagnosis of a nodular basal cell carcinoma of the right lower eyelid was made. All incision margins were free of tumor cells (R0 resection). In the dermatological screening no further manifestations were detected. Conclusion. Despite the occurrence of a space-occupying lesion of the eyelid in a young adult patient and also with no further risk factors, in addition to an inflammatory event and a benign tumor, a malignant disease, such as a basal cell carcinoma should also be taken into consideration. A tissue biopsy or complete excision with subsequent histological examination including an immunohistochemical analysis are essential for differentiation from other tumor entities.

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of intravenous and intra‐arterial chemotherapy in people with retinoblastoma (Rb).

Ziel dieser Arbeit ist es, eine Übersicht über den aktuellen Stand der personalisierten Medizin bei der Therapie ausgewählter periokulärer Tumoren wie Basalzellkarzinom, Merkel-Zell-Karzinom und Bindehautmelanom zu geben. Dieser Beitrag bietet daher eine ausführliche Literaturübersicht aus PubMed unter Einbeziehung der aktuellen Leitlinien und Standard Operating Procedures (SOP). Da 90 % der Basalzellkarzinome eine pathologische Aktivierung der Sonic-Hedgehog-Kaskade zeigen, ist Vismodegib für inoperable oder metastasierte Basalzellkarzinome und bei Gorlin-Goltz-Syndrom eine neue therapeutische Option. Ein neuer Ansatz der systemischen Medizin beim metastasierten Merkel-Zell-Karzinom ist die Immuntherapie mit dem Immun-Checkpoint-Inhibitor Avelumab. Weitere personalisierte Immuntherapien, wie z. B. die Checkpoint-Inhibitoren Pembrolizumab und Nivolumab, der Tyrosinkinase-Inhibitor Pazopanib oder die Rolle des Hedgehog-Pathways bei Merkel-Zell-Karzinomen, sind Gegenstand aktueller Forschung und werden zukünftig sicher noch eine größere Rolle in der Therapie spielen. Lediglich beim metastasierten Bindehautmelanom ist die personalisierte Medizin im eigentlichen Sinne Wirklichkeit: Nur im Fall einer vorliegenden BRAF-Mutation im Tumor- oder Metastasengewebe kommt eine systemische Therapie mit BRAF-, MEK- und/oder auch Checkpoint-Inhibitoren zum Einsatz. Als weitere Therapie der ersten Wahl bei metastasierten Bindehautmelanomen kann eine systemische Immuntherapie mit den Checkpoint-Inhibitoren Pembrolizumab oder Nivolumab durchgeführt werden. Zusammenfassend ist die personalisierte Medizin Gegenstand aktueller Forschung und bietet auch für periokuläre Malignome viele neue, zielgerichtete therapeutische Möglichkeiten, aber auch große Herausforderungen bei der Entwicklung und Implementierung neuer Techniken und Therapien.

A 48-year-old man presented with an Aspergillus fumigatus complex infection of an exenterated orbit. The OS had been exenterated 7 months ago, together with total parotidectomy and neck dissection followed by irradiation due to a massive squamous cell carcinoma with orbital invasion and lymphatic metastasis. The patient was under permanent immunosuppression with oral prednisone and tacrolimus due to a kidney transplantation 5 years ago. The infected skin of the exenterated orbit was cleared using forceps. MRI ruled out any bone infiltration. After systemic treatment with oral voriconazole and topical therapy with bifonazole ointment for 6 weeks, the patient recovered completely.

Den Grundstein einer gelungenen augenprothetischen Rehabilitation mit einem ansprechenden ästhetischen Ergebnis legt der ophthalmoplastische Chirurg bereits im Vorfeld der okularistischen Versorgung. Anophthalmische Patienten werden bereits 2 Wochen nach einer Enukleation durch einen Okularisten mit einer Augenprothese versorgt. Diese reibungslose und schnelle Anpassung einer optisch ansprechenden, maßgefertigten Augenprothese nach dem Verlust eines Auges ist einerseits aus ästhetischen Aspekten essenziell, erleichtert aber dadurch andererseits v. a. eine gute berufliche, soziale und psychische Rehabilitation. Um Komplikationen, die das ästhetische Bild negativ beeinflussen, zu verhindern, sind eine regelmäßige Kontrolle und ggf. eine frühzeitige Therapieeinleitung durch den Augenarzt unerlässlich.

The development of microendoscopes in lacrimal drainage surgery has led to the introduction of novel surgical procedures that maintain transcanicular anatomy, including a variety of lacrimal drainage intubation systems. Depending on the location and extent of the lacrimal duct stenosis, bicanaliculoanular, monocanalicular, monocanaliculonasal, bicanalicular, and bicanaliculonasal intubation techniques and systems, as well as a combination of these, may be used. For isolated intubation of the puncta lacrimalia, perforated punctum plugs may be used, while pure monocanalicular intubation can be performed using a Mini-Monoka. The monocanaliculonasal intubation systems include the Monoka (Wide Collarette type), Monoka of Fayet (Crawford type), the self-threading Monoka (Ritleng type), the Masterka, and the LacriJet for the ophthalmic surgeon. The bicanaliculonasal intubation systems include various BIKA systems, the Ritleng intubation system, the Crawford intubation system, and the FCI Nunchaku. Indications for both monocanaliculonasal and bicanaliculonasal intubation systems are obstructions, stenoses or lacerations of all kinds, as well as obstructions and stenoses after opening or after a DCR. For a conjunctivodacryocystorhinostomy (CDCR), the classical Lester Jones Tube, Metaireau Tubes, and StopLoss Jones Tube may be used. Although the study situation is ambiguous and therefore lacrimal drainage intubation is not considered mandatory, most ophthalmic surgeons do not forego intubation - despite the higher costs and slightly more protracted surgery. The surgeons' selection of the intubation system depends on the chosen form of intubation, costs and personal preferences and experience.

Background A smooth supply with a visually appealing prosthetic eye after enucleation is not just a cosmetic solution, it is also a key factor in successful social and psychological rehabilitation. Objectives This article provides an overview of the current state of medical and ocular care regarding prosthetic eyes in Germany. It focuses mainly on the newest clinical results, daily care, complications, and psychological aspects of wearing prosthetic eyes. Methods The study is comprised of the newest clinical results and a current PubMed literature review. Results In Germany, enucleated patients normally get a double-walled, hollow prosthetic eye made of cryolite glass, and patients with a microphthalmic or phthisic eye receive a thin single-walled prosthesis. Anophthalmic patients wearing cryolite glass prosthetic eyes seem to be more satisfied with their appearance and the look of their prostheses than poly-methylmethacrylate (PMMA) prosthetic eye wearers. Cryolite glass prosthetic eyes must be renewed at least each year, while PMMA prostheses need to be polished once a year and renewed after five years of wearing. Among children, the fit of the prosthetic eye must be checked, based on growth, semiannually. A slightly higher risk of breakage of cryolite glass prostheses is, for most patients, not a great disadvantage in everyday life. Ocularists and ophthalmologists should determine an individual cleaning regime, together with the patient, that is dependent on the material of the ocular prosthesis and other external factors. Complications, such as allergic, giant papillary, viral and bacterial conjunctivitis and blepharoconjunctivitis sicca must be treated at an early stage to allow for a prosthetic eye. In the case of inflammation-caused socket shrinkage or post-enucleation socket syndrome, surgical interventions are needed to re-enable the use of a prosthetic eye. Since the health of the remaining eye is the major psychological burden of prosthetic eye wearers, good ophthalmological care and medical screenings are essential elements. Conclusions A smooth supply with a prosthetic eye, adequate and early treatment of possible complications and attention to psychological aspects is essential for successful long-term rehabilitation of enucleated patients.

Non-invasive three-dimensional (3D) stereophotogrammetry is becoming increasingly popular in many fields. However, few studies have focused on its periocular application. We aimed to provide evidence for the periocular application of a novel anthropometric procedure using 3D stereophotogrammetry by evaluating its reliability. Fifty-one Caucasians were recruited (102 eyes; mean age, 31.9 ± 13.6 years). Two sets of 3D images were acquired for each subject, and two measurement sessions were performed on each image by two raters. Fifty-two periocular landmarks were identified, and then 49 corresponding linear, curvilinear, and angular measurements were evaluated for intrarater, interrater, and intramethod reliability. Our findings showed highly reliable results for mean absolute difference (0.59 and 0.68 unit), relative error measurement (2.66% and 3.08%), technical error of measurement (0.59 and 0.66 unit), relative technical error of measurement (2.71% and 2.96%), and intraclass correlation coefficient (0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.94 unit, 4.06%, 0.89 unit, and 3.94%, as well as 0.97 for interrater reliability; and respectively 0.98 unit, 4.66%, 0.96 unit, and 4.64%, as well as 0.96 for intramethod reliability. This imaging system and the landmark identification protocol are highly reliable. The collected measurements and their errors can be applied for the comparison of reliability among various 3D imaging systems and populations. It could be utilized for planning surgeries and evaluating treatment outcomes for physicians in ophthalmology, plastic and esthetic surgery, and in the maxillofacial field where periocular morphology alterations are made.

ZusammenfassungMit dem Einsatz von Mikroendoskopen in der Tränenwegchirurgie und dem dadurch bedingten Einzug der neueren, transkanalikulären, anatomieerhaltenden Operationsverfahren wurden verschiedenste Tränenwegintubationssysteme entwickelt. Je nach Lokalisation und Ausmaß der Tränenwegstenose können bikanalikuloanuläre, monokanalikuläre, monokanalikulonasale, bikanalikuläre und bikanalikulonasale Intubationstechniken und -systeme sowie Kombinationen daraus zum Einsatz kommen. Der isolierten Intubation der Tränenpünktchen dienen perforierte Punctum Plugs, während eine rein monokanalikuläre Intubation mit einer Mini-Monoka® erfolgen kann. Als monokanalikulonasale Intubationssysteme stehen neben der Monoka (Wide-Collarette-Typ), der Monoka von Fayet (Crawford-Typ), der selbsteinfädelnde Monoka (Ritleng®-Typ), der Masterka® sowie der LacriJet® für den ophthalmoplastischen Chirurgen zur Auswahl. Zu den bikanalikulonasalen Intubationssystemen zählen verschiedene BIKA®-Systeme, das Ritleng-Intubationssystem, das Crawford-Intubationsset und der FCI Nunchaku®. Indikationen sowohl für monokanalikulonasale als auch bikanalikulonasale Intubationssysteme stellen kanalikuläre Obstruktionen, Stenosen oder Lazerationen aller Art sowie sakkale und postsakkale Obstruktionen und Stenosen nach deren Eröffnung oder nach einer Dakryozystorhinostomie (DCR) dar. Bei einer Konjunktivodakryozystorhinostomie (CDCR) können bspw. die klassischen Lester Jones Tubes, Metaireau Tubes oder die StopLoss® Jones Tubes verwendet werden. Obwohl die Studienlage nicht eindeutig ist und daher eine Tränenwegintubation nicht als obligat angesehen werden darf, verzichten die meisten Ophthalmochirurgen trotz höherer Kosten und einer geringfügig längeren Operationsdauer in den meisten Fällen nicht auf eine solche. Für welches Intubationssystem der Operateur sich letztendlich entscheidet, hängt in den meisten Fällen von der gewählten Intubationsform, den Kosten sowie seinen persönlichen Präferenzen und Erfahrungen ab.