Zusammenstellung der Aktivitdten: 1. Sitzungstermine: Oktober 2002 Marz 2003 Mai 2003 2. Glaukomhotline — Radiosprechstunde: Jeden ersten Montag im Monat steht ern Mitglied der Kommission fur eine Stunde am Telefon Rede and Antwort zu Glaukomfragen! Osterreichweit gute Akzeptanz. 3. Vortrage and Fortbildungsveranstaltungen der Mitglieder: — Praxisrelevanter Glaukomworkshop (Oktober 2002): die Themen reichten von aktuellen Therapiekonzepten caber operative Moglichkeiten bis hin zur Diskussion von Fallbeispielen, weiters auch praktische Ubungen mit neuen Diagnoseverfahren — Symposium Aktuelle Aspekte des Glaukoms in Forschung and Praxis (November 2002) — Weitblick-Wochenende (April 2003): Zieldruckkonzept and Relevanz der aktuellen Studie im klinischen Alltag — Teilnahmen an diversen Advisory Board Meetings — Verbindung mit der Europaischen Glaukomgesellschaft 4. Neuauflage eines Glaukompasses: Wichtige Aspekte wie maximaler Augendruck bei Diagnosestellung, Uhrzeit der Tensionsmessung, Pachymetrie etc., sollen inkludiert sein. 5. Neuaufnahme von Mitgliedem bei Sitzung Mai 2003 6. Besprechung and Aktualisierung bezuglich Glaukomfolder, Umsetzung der neuen Guidelines, Diagnoseverfahren bei Sitzung Mai 2003

1. Sitzungstermine: September 2003 Janner, Februar 2004 Mai 2004 2. Glaukomhotline — Radiosprechstunde: Jeden ersten Montag im Monat steht ein Mitglied der Kommission fur eine Stunde am Telefon Rede and Antwort zu Glaukomfragen! Osterreichweit gute Akzeptanz. Interessanterweise sind neben allgemeinen Fragen immer mehr Detailfragen zu beantworten, was doch auf eine zunehmende Information der Bevolkerung schlieflen lasst. Tel. 01/409 75 02 3. Vortrage and Fortbildungsveranstaltungen der Mitglieder: Praxisrelevanter Glaukomworkshop (September 2003) Wintersymposium Glaukom (Februar 2004): Themen wie Neuroprotektion, diverse operative Verfahren, Workshops zu verschiedenen Glaukomspielformen Weitblick-Wochenende (April 2004): Glaukom im Wandel der Zeit, Okonomie, Sparzwang versus therapeutische Notwendigkeit, sowie rechtliche Aspekte Teilnahmen an diversen Advisory Board Meetings — Verbindung mit der Europaischen Glaukomgesellschaft Vortrage bei Fachgruppensitzung Vortrage in den Bundeslandern bei praktischen Arzten

1. Sitzungstermine: September 2003 Janner, Februar 2004 Mai 2004 2. Glaukomhotline — Radiosprechstunde: Jeden ersten Montag im Monat steht ein Mitglied der Kommission fur eine Stunde am Telefon Rede and Antwort zu Glaukomfragen! Osterreichweit gute Akzeptanz. Interessanterweise sind neben allgemeinen Fragen immer mehr Detailfragen zu beantworten, was doch auf eine zunehmende Information der Bevolkerung schlieflen lasst. Tel. 01/409 75 02 3. Vortrage and Fortbildungsveranstaltungen der Mitglieder: Praxisrelevanter Glaukomworkshop (September 2003) Wintersymposium Glaukom (Februar 2004): Themen wie Neuroprotektion, diverse operative Verfahren, Workshops zu verschiedenen Glaukomspielformen Weitblick-Wochenende (April 2004): Glaukom im Wandel der Zeit, Okonomie, Sparzwang versus therapeutische Notwendigkeit, sowie rechtliche Aspekte Teilnahmen an diversen Advisory Board Meetings — Verbindung mit der Europaischen Glaukomgesellschaft Vortrage bei Fachgruppensitzung Vortrage in den Bundeslandern bei praktischen Arzten

Sir, Neovascular glaucoma is often inadequately controlled on medical therapy and in many cases cyclodestructive procedures are used (Krupin et al. 1978; Robert et al. 1990; Oguri et al. 1998). We retrospectively compared the longterm effects on intraocular pressure (IOP) and possible complications of contact transscleral diode laser cyclophotocoagulation (TSCPC) versus cyclocryotherapy in 94 eyes of 94 patients with neovascular glaucoma. All the procedures had been carried out at our department between 1997 and 1999, and follow-up time was 12–36 months (average 31 months) after surgery. Diseases causing neovascular glaucoma included: diabetes mellitus (33); retinal vein occlusion (37); retinal artery occlusion (6), and others including trauma, uveitis and retinal detachment (18). Data were obtained from all subjects after 1 year, from 78 subjects after 2 years and from 64 subjects at the last follow-up visit after 3 years. Follow-up examinations included determination of best corrected visual acuity (VA), slit-lamp biomicroscopic and – if possible – ocular fundus examinations. Prior to the cyclodestructive procedures, panretinal photocoagulation for retinal ischaemia had been performed in 61 patients and vitreoretinal surgery had been carried out in 17 patients. During follow-up, retinal laser treatment was performed in 32 patients and vitreoretinal surgery was carried out in seven patients. Cyclocryotherapy was performed in 51 eyes of 51 patients (mean age 73 years) with neovascular glaucoma, and was used whenever IOP was considered to be too high for the eye despite maximum tolerated topical therapy, or when pain occurred in blind eyes. Standard surgical technique can be summarized as follows: 4–12 applications per eye; 180–360 degrees; at a distance of 2.5–4 mm from the surgical limbus; using a probe tip temperature of − 80 °, and a 60-second duration of application. In 43 eyes of 43 patients (mean age 69 years), diode laser contact cyclophotocoagulation was performed with a power of 1400–2000 mW for a duration of 2 seconds, with 20–35 applications over 270–360 degrees. A semiconductor diode laser system with a 600-µm diameter and quartz fibre optic was used 1.2 mm behind the surgical limbus. Laser applications were delivered to all four quadrants except in eight patients, where the temporal or nasal upper quadrant was saved. Power was reduced by 250 mW if there was any disruptive tissue reaction (the ‘pop’ effect) during two consecutive applications. Postoperative treatment was similar in both groups, and antiglaucomatous medication was continued according to the measured IOP. Retreatment was performed when ocular pain occurred or when IOP increased to a level considered potentially damaging to the optic disc. Hypotony was defined as IOP lower than 5 mmHg on two examinations. In the cyclocryotherapy group, the mean IOP in all patients decreased from 43.6 ± 13.4 mmHg (range 25–72 mmHg) preoperatively to 23.6 ± 11 mmHg (range 7–60 mmHg) 1 week postoperatively; 15.2 ± 9.2 mmHg (range 0–38 mmHg) after 1 month; 10.6 ± 9 mmHg (range 0–24 mmHg) after 6 months, and to 8.2 ± 11.5 mmHg (range 0–36 mmHg) after 1 year. At the 2-year follow-up visit, the mean IOP was 6.5 ± 6.6 mmHg (range 0–19 mmHg), and at the last control visit at 3 years, a mean IOP of 8.6 ± 7.4 mmHg (range 0–23 mmHg) was achieved. All mean IOP measurements obtained postoperatively were significantly lower (p < 0.05) than preoperative values (paired Student's t-test). Complications included a decrease in VA of two or more Snellen lines in 23 eyes, loss of light perception in 13 eyes, chronic hypotony in 17 eyes, and phthisis bulbi in seven eyes. Retreatment was performed in three eyes (once in two eyes and twice in one eye). In the TSCPC group, the mean IOP was reduced in all patients from 47 ± 10.3 mmHg (range 27–74 mmHg) preoperatively to 26.7 ± 10.2 mmHg (range 10–50 mmHg) 1 week postoperatively; 29.5 ± 12.5 mmHg (range 9–56 mmHg) after 1 month; 13.3 ± 12.7 mmHg (range 0–36 mmHg) after 6 months, and to 10.6 ± 11.9 mmHg (range 0–44 mmHg) after 12 months. At the 2-year follow-up visit, the mean IOP was 7.8 ± 8.8 mmHg (range 0–28 mmHg) and at the 3-year examination, a mean IOP of 7.5 ± 15 mmHg (range 0–30 mmHg) was found. At each time-point postoperative IOP was significantly lower (p < 0.05) than baseline readings. Retreatment was performed in three eyes. Visual acuity deteriorated by two or more Snellen lines in 17 eyes, loss of light perception occurred in eight eyes, chronic hypotony in nine eyes, and phthisis bulbi in six eyes. Thus, both cycloablative procedures lowered IOP considerably and significantly compared to baseline readings. A significant difference between both groups was noted only at the first postoperative month (with better IOP control provided by cryotherapy). Cyclocryotherapy-treated patients seemed to have a higher incidence of sight loss (not significant) and chronic hypotony (significant; p < 0.05) than TSCPC patients. Diode laser TSCPC and cyclocryotherapy are both known to be well tolerated, non-invasive procedures for lowering IOP in neovascular glaucoma. Filtering surgery is usually unsuccessful owing to conjunctival scarring due to previous surgery and neovascular tissue growth at the filtration site (Ophir & Porges 2000). Drainage devices are often used to lower IOP in these cases, but can only be inserted by experienced surgeons, and may be associated with severe complications (Assaad et al. 1999). Both cyclodestructive procedures and their potential benefits and complication rates have been described for different kinds of refractory glaucoma, but due to differences in research material, the results from different studies are not readily comparable. Our study showed that diode laser TSCPC was as effective as cyclocryotherapy in terms of IOP control and resulted in a lower rate of complications. We therefore recommend TSCPC as the better procedure in neovascular glaucoma.

Purpose: To determine changes in production of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in the ciliary body, the trabecular meshwork and the retinal pigment epithelium induced by both prostaglandins and corticosteroids. Methods: Explant organ cultures were removed by a scleral incision 3 mm posterior to the limbus. Retinal pigment epithelium was grown to confluence. Organ and cell cultures were treated with latanoprost and/or dexamethasone for 72 h. The activity of MMP- 2, -3 and -9 was assessed using zymography. The synthesis pattern of MMPs and TIMP-1 and -2 was identified using immunostaining. Results: Treatment of explant organ cultures with 10 μg/ml of latanoprost induced a mean upregulation of MMP-2 by 36%, MMP-3 by 112% and MMP-9 by 156% as seen by zymography. Dexamethasone 500 nm reduced the amounts of secreted MMP-2 by 13%, MMP-3 by 69%. MMP-9 was not detectable in the media of corticosteroid-treated explant organ cultures. The addition of 10 fLg/ml of latanoprost to dexamethasone-treated cultures increased MMP-2 by 14%, MMP-3 by 43% and MMP-9 by 49%. Using immunohistochemistry we found staining with antibodies against MMP-2, -3, -9 and TIMP-1 and -2 within the ciliary body, and only to a lesser degree in the trabecular meshwork. Latanoprost treatment caused an increase of 29% in MMP-2 (p < 0.0001), 98% in MMP-3 (p < 0.0001) and 108% in MMP-9 (p < 0.0001). Dexamethasone reduced the staining for MMP-2 by 32% (p < 0.0001), for MMP-3 by 33% (p < 0.0001) and for MMP-9 by 83% (p < 0.0001). Almost no change in staining for MMPs was detectable in the trabecular meshwork. Neither latanoprost treatment nor dexamethasone induced significant changes (p < 0.93) in the secretion of TIMPs. In the media of non-treated retinal pigment epithelium (RPE) cells the only MMP detected was MMP-2. RPE cells in culture did not respond to either treatment with a change in their MMP secretion. Conclusion We detected a profound upregulation of both MMP-3 and MMP-9 and a mild induction of MMP-2 through latanoprost in the ciliary body, but not the trabecular meshwork or RPE cells. Corticosteroids, on the other hand, downregulated MMP expression in both tissues. This inhibiting effect of corticosteroids on MMP production was reversed by latanoprost.

Das Frequenzverdoppelungstechnologie-Perimeter (FDT-Perimeter) beruht auf dem Prinzip der Frequenzverdoppelung, einem psychophysischen Effekt, der vorwiegend das magnozelluläre System betrifft und vom Hersteller als einfach zu handhabende Screeningmethode von Gesichtsfelddefekten empfohlen wird. Wir erprobten die Fähigkeiten dieses Gerätes als Screeningtest im Vergleich zur herkömmlichen Weiß-auf-Weiß-Perimetrie (W/W-Perimetrie).

An 89-year-old woman and an 86-year-old woman had continuous curvilinear capsulorhexis, phacoemulsification, and implantation of a silicone plate-haptic intraocular lens. Because of presumed weak zonules (high age, pseudoexfoliation), a poly(methyl methacrylate) capsular tension ring was also implanted. Despite this, both patients reported deterioration in visual acuity that was the result of complete occlusion of the anterior capsule opening by fibrotic tissue 4 and 3 months postoperatively, respectively.

Objective: To analyze the increase in intraocular pressure (IOP) caused by anatomic and physiologic factors in overweight patients when using Goldmann applanation tonometry.Design: A prospective cohort study.Participants: Seventy average-weight individuals who had no difficulties with IOP measurements at the slit lamp and 12 obese patients with suspected glaucoma who could position the head at the slit lamp only with great effort participated.Intervention: The authors compared IOP values between slit-lamp-mounted Goldmann applanation tonometry and Perkins hand-held tonometry.Main Outcome Measure: The difference in Goldmann and Perkins IOP measurements was examined.Results: In the group of obese patients, the mean IOP was 20.9 +/- 2.28 mmHg (mean +/- standard deviation; range, 18-26 mmHg) for the right eye and 21.4 +/- 3.16 mmHg (range, 16-28 mmHg) for the left eye when determined by Goldmann tonometry and 16.3 +/- 2.39 mmHg (range, 13-20 mmHg) for the right eye and 16.3 +/- 2.42 (range, 11-19 mmHg) for the left eye when determined by Perkins tonometry. The mean decrease was 4.5 +/- 1.3 mmHg (range, 3-7 mmHg) for the right eye and 4.9 +/- 1.9 mmHg (range, 2-9 mmHg) for the left eye. In the control group, the mean difference between the two types of tonometers for the right eye was 0.34 +/- 0.69 mmHg and for the left eye was 0.33 +/- 0.82 mmHg, Patients who had a falsely elevated IOP on Goldmann tonometry had an average body mass index of 34 +/- 3.82 (range, 28.5-41.9); most were female (5:1 ratio).Conclusion: The authors believe simultaneous breath-holding and thorax compression, with subsequent increase in venous pressure, may be a causative factor for transitory elevations of IOP, Perkins tonometry in obese patients may help avoid a false diagnosis of glaucoma caused by transitory elevations in IOP.

The heparin-induced extracorporeal low-density lipoprotein precipitation (HELP) eliminates selectively fibrinogen, total cholesterol, low-density lipoproteins (LDL) and triglycerides and improves hemorheology. We investigated the hemodynamic changes in 10 patients without ocular diseases performing a video fluorescein angiography after a single HELP procedure measuring the arm-retina time (ART) and the arteriovenous passage time (AVP). Laboratory parameters such as fibrinogen, cholesterol, LDL, triglycerides, red cell transit time, plasma and whole-blood viscosity were determined and retinal circulation was measured immediately before and after the HELP application. All of the laboratory parameters were lowered significantly. The ART was unaffected by the HELP procedure; however, there was a significant AVP reduction from 2.41 +/- 0.49 to 1.97 +/- 0.47 (p < 0.005). These results support the hemorheological and hemodynamic efficiency of the HELP system in microcirculatory diseases.

Background The increase of platelet aggregation, plasma and whole blood viscosity and the decrease of red cell deformability in patients with diabetes mellitus may be causative in the development of retinopathy. A therapy influencing these factors maybe prevents retinopathy or slows progression. Material and Methods In a clinical and prospective study over 2 years 74 patients aged 20 to 69 years with a mild background retinopathy were randomly assigned to take oral 3 x 500 mg calcium dobesilate (Doxium(R)) or no therapy. Both groups did neither differ in demographic nor in laboratory data. In fluorescein angiography following characteristics of retinopathy were graded: microaneurysms, size and outline of foveal avascular zone, capillary loss and severity of dye leakage. Additionally in 15 patients contrast sensitivity, visual fields and oscillatory potentials were investigated. Results The results of the fluorescein angiographical characteristics revealed no statistically significant difference between both groups. In the oscillatory potentials a significant shortening of latency could be found in both groups, but there was no difference between the groups. Conclusion A 2-years application of calcium dobesilate has no statistically significant influence on the progression of diabetic retinopathy.

BACKGROUND:The increase of platelet aggregation, plasma and whole blood viscosity and the decrease of red cell deformability in patients with diabetes mellitus may be causative in the development of retinopathy. A therapy influencing these factors maybe prevents retinopathy or slows progression.MATERIAL AND METHODS:In a clinical and prospective study over 2 years 74 patients aged 20 to 69 years with a mild background retinopathy were randomly assigned to take oral 3 x 500 mg calcium dobesilate (Doxium) or no therapy. Both groups did neither differ in demographic nor in laboratory data. In fluorescein angiography following characteristics of retinopathy were graded: microaneurysms, size and outline of foveal avascular zone, capillary loss and severity of dye leakage. Additionally in 15 patients contrast sensitivity, visual fields and oscillatory potentials were investigated.RESULTS:The results of the fluorescein angiographical characteristics revealed no statistically significant difference between both groups. In the oscillatory potentials a significant shortening of latency could be found in both groups, but there was no difference between the groups.CONCLUSION:A 2-years application of calcium dobesilate has no statistically significant influence on the progression of diabetic retinopathy.

Heparin-induced extracorporeal LDL precipitation (HELP) eliminates selectively fibrinogen, LDL cholesterol, cholesterol, triglycerides and LP(a) from the blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL about 50% after only one procedure immediately improves the hemorrheological situation, which has so far not been achieved by any hemorrheologically active substance. Five patients (1 central retinal vein occlusion, 3 branch vein occlusions, 1 central arterial occlusion) ranging from 59-76 years underwent HELP treatment six times over a 5-week period. After the first HELP procedure the fibrinogen was lowered from 278 +/- 57.8 to 157 +/- 22.2 mg/dl and LDL from 162.2 +/- 58 to 82.4 +/- 32.5 mg/dl. Plasma viscosity decreased from 1.3 +/- 0.07 to 1.1 +/- 0.05 mPa/s. At the end of the treatment an increase in visual acuity of 3 or more lines and an improvement in the visual field was seen in all patients. Measurements of the arteriovenous passage time with laser scan video fluorescein angiography before and at the end of the therapy showed a significant decrease from 3.5 +/- 1.59 to 2.88 +/- 1.54 s (P < 0.05) without influencing the arm-retina time. This first clinical and hemorrheological data on the HELP procedure in retinal vessel occlusion demonstrate a promising regimen in the treatment of acute retinal microcirculatory diseases.