Bei Notfällen in der Augenheilkunde ist zwischen systemischen Notfallsituationen, die sich am Auge manifestieren, und rein okulären Notfällen zu unterscheiden. Letztere bedrohen das Sehvermögen in ganz unterschiedlichem Ausmaß und bedürfen daher ophthalmologischerseits einer differenzierten Betrachtung und Versorgung. Diese erfordert besondere Verantwortung und große Kompetenz, da alle Subdisziplinen der Augenheilkunde betroffen sein können. Nicht zuletzt wegen der demografischen Entwicklung nimmt die Anzahl der Notfallpatienten zu, was eine bessere Steuerung der Patienten erfordert.

In the diagnosis of strabismus due to paralysis of the eye muscles, the Hess screen test and the Harms tangent screen test are used to measure the misalignment of the eyes in different gaze directions (motility analysis). Both examination methods use different procedures to define the gaze direction and coordinate systems. Coordinate systems with scales in angular degrees are used to determine the direction of gaze and simplify reading the squint angle in the event of a misalignment (horizontal and vertical deviation). In the measurement results, however, their numerical values differ due to the different angle definitions of the direction of gaze in the Hess and Harms tests. In this paper, the angle definitions are clearly described, the coordinate systems are mathematically derived from them, their metrics are formally analysed and compared with the surface theory according to Carl Friedrich Gauss, and their transformation relationship is specified and visualised. The surface theory is used to justify the finding that a measured misalignment of the eye leads to the same motility disorder with the same spatial orientation of the direction of gaze, regardless of the choice of angle. The coordinate systems according to Harms and Hess are therefore mathematically equivalent. However, assessment of the paretic eye muscle(s) and the subsequent therapeutic measures are based on the numerical values of the squint angle measurement. Therefore, knowledge of the test used and its angle definition is important. The procedure for determining the gaze direction determines the choice of coordinate system in the test according to Harms and Hess to avoid systematic measurement deviations.

In emergencies in ophthalmology a distinction must be made between systemic emergency situations that manifest in the eye and purely ocular emergencies. The latter threaten vision to varying degrees and therefore require differentiated treatment and care by the ophthalmologist. This requires considerable responsibility and high expertise as all subdisciplines of ophthalmology can be affected. Due to demographic developments and other factors, the number of emergency patients is increasing, which requires adaptation in resources and clinical management of patients.

Spontane, nicht-traumatische Vorderkammerblutungen sind selten und können durch fokale vaskuläre Irisveränderungen am Pupillarsaum verursacht werden. Eine 53-jährige Patientin stellte sich 01/2024 mit schmerzloser plötzlicher Visusminderung links vor. Befund: umschriebene rötliche Gefäßveränderung am Pupillarsaum bei 2 Uhr, kein Hyphäma, keine Entzündung, Augeninnendruck 15 mm Hg. 02/2025 Rezidiv mit Erythrozyten in der Vorderkammer, erneut blutender umschriebener rötlicher Gefäßveränderung am Pupillarsaum und Druckanstieg auf 24 mm Hg. Die Iris-Fluoreszenzangiographie zeigte eine umschriebene Hyperfluoreszenz mit Leckage. Nach drucksenkender Therapie erfolgte eine gezielte Argon-Laserkoagulation. Danach rasche Stabilisierung ohne weitere Blutungen oder Druckerhöhungen. Bis 11/2025 blieb der Befund stabil. Der Fall unterstreicht den diagnostischen Wert der Iris-Fluoreszenzangiographie und die Wirksamkeit der fokalen Argon-Laserkoagulation.

PURPOSE:PDE6A-associated retinitis pigmentosa (RP) is a rare inherited retinal disease leading to severe vision loss and blindness, with no available treatment. This study assessed the safety and vision outcomes of a gene therapy using an adeno-associated virus (AAV) vector encoding PDE6A (AAV8.hPDE6A). METHODS:In an open-label, non-randomised controlled phase I/IIa trial, nine patients with biallelic PDE6A variants received a single subretinal injection of AAV8.hPDE6A. Doses were either 1.0×10¹⁰ (n=6) or 5.0×10¹⁰ (n=3) total vector genomes. Safety was the primary endpoint, assessed via clinical examinations, laboratory analyses and optical coherence tomography imaging. Secondary outcomes included changes in visual function, such as best corrected visual acuity (BCVA), contrast sensitivity, colour perception, dark adaptation thresholds, visual fields, patient-reported outcomes and chromatic pupil campimetry over 1 year. RESULTS:The mean patient age was 40.1 years, with baseline BCVA ranging from 40 to 82 letters (0.9-0.1 logMAR). No systemic adverse events occurred, and most ocular events resolved without treatment. Persistent adverse events included small peripheral atrophic areas (n=2), disturbed colour discrimination (n=3), cataract (n=1), slight central retinal thinning (n=5) and moderate visual acuity loss (n=2, 1 in each dose group). BCVA, full-field stimulus thresholds and other visual function measures showed statistically non-significant changes, with a trend towards worsening of retinal sensitivity in the treated eyes. CONCLUSION:Subretinal gene therapy with AAV8.hPDE6A did not improve visual function over 1 year and posed risks, including central retinal thinning and visual acuity decline. This is in contrast to the safety and efficacy profile established in preclinical models.

Purpose:The purpose of this study was to assess whether vitrectomy size and cutting rate have an impact on cell survival of healthy lymphocytes and lymphoma cells during diagnostic vitrectomy in an in vitro model. Methods:In the first experiment, healthy lymphocytes were isolated from blood samples of one healthy individual. In the second experiment, cultivated MYD88-positive lymphoma cells derived from a commercially available cell line were used. Suspensions with defined cell concentrations (1 × 103 cells/mL, 1 × 104 cells/mL, and 1 × 106 cells/mL) were subjected to vitrectomy under controlled conditions, using aspiration only or varying cutting rates of 1500/minutes and 5000/minutes with vitrectomy sizes of 20G, 23G, 25G, and 27G. Three technical replicates were performed for each condition. Cell integrity in post-vitrectomy samples was assessed via fluorescence activated cell sorting (FACS). To verify statistically significant differences between groups, the Kruskal-Wallis test was used. Results:No correlation was observed between lymphocyte survival and either gauge size or lower cutting rates in healthy lymphocytes. However, a significant correlation between vitrectomy size and cell survival was observed for lymphoma cells (Kendall's tau τ = -0.253, P = 0.00048, Kruskal-Wallis χ² = 13.337, P = 0.00396). Conclusions:Our study found that larger vitrectomy lumen diameters were associated with higher lymphoma cell survival rates, suggesting the use of 23G and 25G instruments in clinical practice for suspected cases. Translational Relevance:This clinical research should provide a guideline for the investigation of suspected lymphoma cases.

Spontaneous non-traumatic anterior chamber bleeding is rare and may be caused by focal vascular iris changes at the pupillary margin. A 53-year-old woman presented in 01/2024 with painless sudden visual loss in the left eye. Findings: a localized reddish vascular lesion at the 2 o'clock pupillary margin, no hyphema, no inflammation, and intraocular pressure of 15 mm Hg. In 02/2025, recurrence occurred with erythrocytes in the anterior chamber, renewed bleeding from the localized reddish vascular lesion at the pupillary margin, and IOP rise to 24 mm Hg. Iris fluorescein angiography showed localized hyperfluorescence with leakage. After initial pressure-lowering therapy, targeted argon laser photocoagulation was performed. This led to rapid stabilization without further bleeding or pressure elevation. The findings remained stable through 11/2025. The case highlights the diagnostic value of iris fluorescein angiography and the effectiveness of focal argon laser photocoagulation.

Hornhauttransplantationen können das Sehvermögen bei Hornhauterkrankungen erheblich verbessern oder vollständig wiederherstellen. In Deutschland ist die Organspendebereitschaft seit vielen Jahren gering, wodurch die Nachfrage nach Hornhäuten das Angebot übersteigt. Ein wesentlicher Grund hierfür ist der unzureichende Informationsstand über das Thema Hornhautspende. Ziel dieser Arbeit war es, das Wissen von Medizinstudierenden der Universität Tübingen zum Thema Hornhautspende zu erheben und den Einfluss einer Vorlesung zu diesem Thema zu analysieren. Es beantworteten 129 Studierende vor und nach einer Vorlesung einen Fragebogen mit 21 Fragen zu ihrer Einstellung und ihrem Wissen über Hornhautspenden. Es waren 77,5

Recently, a novel clinical picture associated with characteristic, progressive alterations in the ellipsoid zone (EZ) and thinning of the outer retinal layers referred to as Persistent Diffuse Photoreceptor Disorganization (PDPD) was first described. We performed detailed longitudinal clinical assessments in five patients with PDPD, i.e. ophthalmological examinations, including imaging (optical coherence tomography (OCT), fundus autofluorescence, dye angiography) and functional diagnostics (best-corrected visual acuity (BCVA), visual field, electroretinography), comparative genomic sequencing analysis and further examinations. The patients (3 female, 2 male) were between 21 and 60 years old. All developed bilateral involvement sequentially, with the interval between symptom onset in the first and second eye ranging from 8.2 months to 139.5 months. All patients showed characteristic blurred EZ and absent interdigitation zone followed by thinning of the outer retinal layers. Comparative genomic sequencing analysis yielded no (likely) pathogenic variants in genes that could be associated. We saw no clear response to steroid treatment. Most recent BCVA was below 20/80 Snellen equivalent in 9/10 eyes and 20/25 in one eye. We add further evidence and additional clinical data to the newly recognized disease PDPD. In our cohort, PDPD presents with subacute, bilateral but sequential vision loss, accompanied by positive visual symptoms (e.g. crossfade) and characteristic OCT changes, including progressive blurring of the EZ beginning in the foveola, followed by outer retinal thinning starting in the parafovea. The etiology remains unclear, and it is uncertain whether anti-inflammatory treatment can modify the disease-course, which resulted in severe visual impairment in the majority of patients.

Introduction Outpatient cataract surgery is one of the most frequently performed surgical procedures worldwide. Reducing its carbon footprint without compromising hygiene and patient safety offers substantial potential for mitigating healthcare-related greenhouse gas emissions. This multicentre study quantified the carbon footprint of outpatient cataract surgery across ten heterogeneous German tertiary centres and examined inter-centre variability in emissions as well as the extent to which current data support transparent, standardised reporting. Methods Between December 2022 and March 2023, standardised on-site assessments collected data on staff and patient travel, electricity consumption, disposable material use, and waste generation. Data were converted into carbon dioxide equivalents (CO₂e) using emission factors from national environmental agencies. Since detailed life cycle and sterilisation data could not be obtained for instrument manufacture and reprocessing, these components were modelled for all centres. Results The centres showed substantial inter-site variation in all major emission categories. Disposable materials (2.53-8.30 kg CO2e) and sterilisation (2.62-7.13 kg CO2e) were the dominant contributors, together accounting for 56.6-84.6% of total emissions. Electricity use contributed 1.0% to 18.5%, whereas waste disposal remained low (≤0.4%). Based on the combination of measured and modelled components, the estimated carbon footprint averaged 14.09 kg CO₂e per cataract procedure (95% CI: 12.08-16.11 kg), with centre-level values ranging from 10.07 to 18.70 kg. Conclusion Substantial emission reductions can be achieved by streamlining material use and improving sterilisation workflow. Transparent reporting that defines system boundaries, specifies uncertainties, and provides access to data collection methods is essential for comparability and for establishing reliable benchmarks in sustainable surgical practice. This study provides a comprehensive multicentre carbon footprint analysis for outpatient cataract surgery in Germany and offers a transparent framework that guides targeted reduction strategies.

PurposeTo quantify optical coherence tomography (OCT)-derived retinal layer reflectivity and retinal thickness changes in acute central retinal artery occlusion (CRAO) for rapid diagnosis and stratification of ischemic tissue state, referenced to the clinically relevant 4.5-h window for reperfusion therapies.MethodsThis retrospective multicenter study included 39 patients with unilateral acute non-arteritic CRAO imaged by OCT within 48 h of reliably reported symptom onset. Five horizontal macular B-scans per eye [central (foveal), two superior, two inferior] were analyzed. Inner retinal layers (IRL) and outer retinal layers (ORL) were manually segmented. Mean grayscale reflectivity was extracted from predefined regions of interest and summarized as the within-eye IRL/ORL reflectivity ratio. Retinal thickness was obtained from Early Treatment Diabetic Retinopathy Study (ETDRS) sectors; relative retinal thickness increase (RRTI) was defined as CRAO-eye thickness divided by fellow-eye thickness. Diagnostic performance (CRAO vs. fellow eye) and classification relative to the 4.5-h reference (< 4.5 vs. ≥ 4.5 h) were assessed using receiver operating characteristic (ROC) analyses and non-parametric testing.ResultsThe within-eye IRL/ORL reflectivity ratio reliably distinguished CRAO-affected eyes from fellow eyes across all macular scan locations (AUC = 0.98–0.99; p < 0.001). Retinal thickness increased in CRAO eyes across all ETDRS sectors except the foveal center, with sector-wise diagnostic performance ranging from AUC 0.78–0.99. Both reflectivity- and thickness-based metrics demonstrated time dependence: the IRL/ORL reflectivity ratio increased with time-to-OCT in CRAO eyes (R2 0.43–0.54) and discriminated < 4.5 vs. ≥4.5 h (AUC 0.88–0.91). Inter-eye analyses indicated that temporal separation was primarily driven by progressive attenuation of ORL reflectivity, whereas IRL hyperreflectivity was established early and remained comparatively stable. Retinal thickness and RRTI increased with ischemia duration across ETDRS sectors, with strongest temporal discrimination in inferior sectors (S8; optimal RRTI cut-off ≈ 1.20).ConclusionQuantitative OCT biomarkers based on within-eye reflectivity redistribution and retinal edema enable accurate diagnosis of acute CRAO and provide objective imaging-based information on ischemic tissue state, referenced to the 4.5-h therapeutic window. These rapidly obtainable measures may support acute stroke triage and telemedical workflows. Prospective validation, particularly in unknown-onset CRAO, is warranted before clinical implementation.

BACKGROUND:Corneal transplantation can greatly improve or even fully restore vision in people with corneal diseases. In Germany, organ donation rates have been low for many years, so the demand for corneal tissue continues to exceed the available supply. A major reason for this shortage is the limited awareness and understanding of corneal donation. This study aimed to assess the knowledge of medical students at the University of Tübingen about corneal donation and to examine what influence a lecture on the topic could have. METHODS:A total of 129 students completed a questionnaire with 21 items assessing their attitudes towards and knowledge of corneal donation, both before and after attending a lecture on the subject. RESULTS:Overall, 77.5% of participants were willing to donate their corneas but only 23.3% had ever discussed the topic with family members. Before the lecture, students answered an average of 4.1 out of 9 knowledge questions correctly (45.6%), compared to 7.7 (85.6%) afterward. DISCUSSION:Even among advanced medical students, there are considerable knowledge gaps regarding corneal donation. Integrating this topic more deeply into medical education could improve understanding and, in the long run, increase willingness to donate.

Objective:To assess long-term trends in the readability of ophthalmology abstracts and to determine whether a structural change occurred during the study period. Design:Bibliometric longitudinal analysis. Subjects:A total of 198, 201 unique English-language abstracts published between January 2000 and September 2025 in 67 PubMed-indexed ophthalmology journals. Methods:Abstract readability was quantified using the Flesch Reading Ease score. Temporal trends were analyzed using segmented regression with data-driven breakpoint selection. Secondary analyses included additional validated readability indices and linguistic features (including lexical density, lexical diversity, and clause density). Differences before and after the breakpoint were assessed using nonparametric tests. Main Outcome Measures:Changes in abstract readability over time, primarily measured by the Flesch Reading Ease score. Results:Readability improved gradually from 2000 until 2023, followed by a marked decline thereafter. Segmented regression identified a structural breakpoint in October 2023, after which readability declined sharply, with mean Flesch Reading Ease scores decreasing by -0.222 (95% confidence interval, -0.257 to -0.204) points per month compared with a prebreakpoint increase of +0.008 (95% confidence interval, 0.007‑0.010) points per month (P < 0.001). Readability differed significantly between the pre-October and post-October 2023 periods (median, 30.74 [interquartile range, 30.39-31.06] vs. 28.35 [interquartile range, 27.29-29.54]; P < 0.001). Similar patterns were observed across multiple readability indices. The decline was accompanied by increases in syllables per word, proportion of polysyllabic words, lexical density, lexical diversity, and clause density, whereas words per sentence continued to decrease over time. Findings were consistent across journal impact strata and remained evident in within-author analyses. Conclusions:In this large longitudinal study of ophthalmology abstracts, readability improved for more than 2 decades before reversing sharply in late 2023. The decline was associated with increased lexical complexity and with indicators of greater syntactic complexity and was observed across journals and author subgroups. Although the causes of this shift cannot be determined from the present data, the findings indicate a meaningful change in the linguistic characteristics of ophthalmology abstracts and underscore the importance of maintaining readability in scientific communication. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To evaluate the feasibility of surgical implantation of electrical components needed for the operation of biomimetic artificial intraocular lenses (IOLs) for presbyopia correction in phakic non-human primates. This included positioning a ring electrode into the posterior chamber sulcus, securing a circuit board-mounted implant under the superior rectus muscle, and placing a battery pack in the orbit. The full implant allows for recording and transmission of electrical signals within the ciliary muscle during accommodation. METHODS:The implant consists of a microcontroller, a biopotential amplifier, and a Bluetooth transmitter on a flexible printed circuit board (PCB), a battery, and the ring electrode. After mobilization and placement of traction sutures under three muscles, the PCB was positioned under the superior rectus muscle. The ring-shaped electrode was pushed into the anterior chamber via a clear cornea tunnel incision in the upper temporal quadrant. The electrode was carefully advanced under the iris with two forceps to prevent tilting and damaging the anterior capsule until its final position under the iris above the ciliary muscle. RESULTS:During the implantation tests, in two eyes the ring electrode broke during the advancement into the posterior chamber underneath the iris. After optimizing the process, the device was successfully implanted in three eyes of three living phakic primates. An inflammatory response was visible during the postoperative follow-up period, but postmortem histopathological analysis revealed no clinically relevant adverse changes. CONCLUSIONS:The primate model demonstrated the feasibility of the surgical implantation of a circular electrode into the posterior chamber. Regarding future developments of biomimetic accommodative IOLs, a concomitant improvement of surgical techniques and the device is crucial to ensure treatment success.

The aim of the study was to compare two Descemet membrane endothelial keratoplasty (DMEK) graft preparation techniques, the liquid bubble technique and the Melles technique. In this prospective study, a total of 20 corneas from 10 donors were included. For each donor, one cornea was prepared using the liquid bubble technique, and the contralateral cornea using the Melles technique. Outcome measures included endothelial cell count, the occurrence of tears and defects in the graft, preparation time, and histological findings. Mean endothelial cell density (ECD) before preparation was 2330 ± 210 cells/mm² in the liquid bubble group (LB) and 2380 ± 157 cells/mm² in the Melles group (M). Mean ECD after preparation was 2170 ± 264 cells/mm² (LB) and 2287 ± 237 cells/mm² (M). This corresponds to an average cell loss during the preparation process of 160 ± 316,1 cells/mm² (6.87

Objective: To demonstrate the capability of a deep learning model to detect central retinal artery occlusion (CRAO), a retinal pathology with significant clinical urgency, using OCT data. Design: Retrospective, external validation study analyzing OCT and clinical baseline data of 2 institutions via deep learning classification analysis. Subjects: Patients presenting to the University Medical Center Tübingen and the University Medical Center Hamburg-Eppendorf in Germany. Methods: OCT data of patients suffering from CRAO, differential diagnosis with (sub) acute visual loss (central retinal vein occlusion, diabetic macular edema, nonarteritic ischemic optic neuropathy), and from controls were expertly graded and distinguished into 3 groups. Our methodological approach involved a nested multiclass five fold cross-validation classification scheme. Main Outcome Measures: Area under the curve (AUC). Results: The optimal performance of our algorithm was observed using 30 epochs, complemented by an early stopping mechanism to prevent overfitting. Our model followed a multiclass approach, distinguishing among the 3 different classes: control, CRAO, and differential diagnoses. The evaluation was conducted by the “one vs. all” area under the receiver operating characteristics curve (AUC) method. The results demonstrated AUC of 0.96 (95% confidence interval [CI], ± 0.01); 0.99 (95% CI, ± 0.00); and 0.90 (95% CI, ± 0.03) for each class, respectively. Conclusions: Our machine learning algorithm (MLA) exhibited a high AUC, as well as sensitivity and specificity in detecting CRAO and the differential classes, respectively. These findings underscore the potential for deploying MLAs in the identification of less common etiologies within an acute emergency clinical setting. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.