For highly potent but poorly water-soluble drugs like cyclosporine A, the development of aqueous formulations providing an increase of corneal drug tissue levels, and thus of bioavailability, to increase patient compliance is still a challenge. Therefore, we designed two water-based liquid application systems, an in-situ nanosuspension (INS) and a micellar solution (MS), and tested both formulations in vivo at the rabbit cornea for tolerability and the tissue uptake of CsA. The evaluation of the biological tolerability by periodical eye examination during 180 min and quantification in a defined grading system revealed that the INS evoked minimal to no irritations whereas the MS was perfectly tolerated. After the observation period, the rabbits were sacrificed and the corneal tissue levels of CsA were analyzed. The INS and the MS both showed high levels of 1683±430 ngCsA/gcornea and 826±163 ngCsA/gcornea, respectively, and exceeded drug tissue levels reported for Restasis(®) (350 ngCsA/gcornea) and cationic emulsions (750 ngCsA/gcornea). These results marked our INS and MS as outstanding novel approaches for the treatment of inflammatory corneal diseases.

Background/Aim To determine the complication rate and risk factors for intraoperative complications in residentperformed phacoemulsification surgery at a tertiary care center during the first 100 surgeries. Methods Retrospective chart review of the first 100 performed phacoemulsification cases of six consecutive residents. Posterior capsule tear, vitreous loss, and dislocation of lenticular fragments into the vitreous were defined as intraoperative complications. Patient characteristics considered risk factors for surgery were identified and correlated with the occurrence of intraoperative complications. Results Complications occurred in 23 of 600 operations (3.8 %). Surgery was complicated by posterior capsular tear in 23 eyes (3.8 %) with vitreous loss in 17 eyes (2.8 %) and loss of lenticular fragments into the vitreous in seven eyes (1.2 %). Eyes with dense nuclear sclerosis (p00.002) and white cataracts (p00.019) were associated with a statistically significantly greater incidence of posterior capsular tears and vitreous loss (p00.007 and p00.027 respectively). An intraocular lens was implanted in 591 eyes as intended. Conclusions Residents achieve an acceptable complication rate during their initial 100 phacoemulsification cases.

Senile scleral plaques are characterized by a calcification located at the insertion of the horizontal rectus muscles. As a possible cause for their development a combination of solar tissue damage and continuous mechanical stress is discussed. We present a case of a 76-year-old male whose wife noticed expulsion of a calcified scleral plaque while applying antiglaucoma eyedrops. The local antiglaucoma therapy was stopped and acetacolamide was administered. Local therapy consisted of hyaluronic acid eyedrop and calcium pantothenate and retinol palmiate eye ointment. This treatment led to a rapid reepithelialization. The expulsion of calcified senile scleral plaques is a described complication which can necessitate surgical treatment.

Senile sklerale Plaques entstehen durch eine Kalzifizierung im Bereich der Insertion der horizontalen Augenmuskeln. Als möglicher Pathomechanismus wird eine Kombination aus solarem Schaden des Gewebes und kontinuierlichem mechanischem Stress diskutiert. Wir berichten von einem 76-jährigen Patienten, dessen Frau bei der Gabe von antiglaukomatösen Augentropfen eine Expulsion einer kalzifizierten Plaque bemerkte. Die lokale antiglaukomatöse Therapie wurde auf eine systemische Acetazolamid-Therapie umgestellt. Es erfolgte eine Lokaltherapie mit Hyaluronsäure-Augentropfen und Calcium pantothenat und Retinol-palmiat-Augensalbe. Hierunter kam es zu einer raschen Epithelialisierung des Defektes. Die Expulsion einer kalzifizierten Plaque ist eine in der Literatur beschriebene Komplikation, die ggf. ein chirurgisches Vorgehen erforderlich machen kann.

Modern phacoemulsification has established itself as a safe and very rewarding surgical procedure. Patients and surgeons may not associate late complications with the initial surgery. However, recent studies have demonstrated that such a causal relationship may persist for many years after the cataract procedure and that there is a significant increase in the risk for developing a retinal detachment during the postoperative years. The mean time period between cataract surgery and pseudophakic retinal detachment is between 3 and 4 years. Even uncomplicated cataract surgery alters the physiological processes within the eye and can lead to progressive destruction of the vitreous for many years after the surgery. Therefore, the risk for a retinal detachment is increased for at least 10 years after the initial procedure. In recent epidemiological studies, the most important risk factors for pseudophakic retinal detachment were myopia, younger age and male gender. If all factors are combined, the cumulative risk for developing a retinal detachment after cataract surgery may rise to 20 %. Additional factors that may increase this risk are additional intraoperative complications, for example, rupture of the posterior capsule, vitreous loss or dropped nucleus. Compared to phakic retinal detachments, pseudophakic patients on average present with a shorter history of visual symptoms, are older, more commonly male and display fewer, smaller and more anteriorly located retinal breaks that frequently are only detected during surgery. The anatomic success rates have improved significantly over the past years, in particular through the advances and increasing popularity of primary vitrectomy. However, functional results are still disappointing. Only about half of the patients will achieve reading ability without low vision aids. The increased and long-term risk for pseudophakic retinal detachment should be part of the preoperative consent process of any cataract surgery, in particular, in young myopic males.

Background/Aim To determine the complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery at a tertiary care center during the first 100 surgeries. Methods Retrospective chart review of the first 100 performed phacoemulsification cases of six consecutive residents. Posterior capsule tear, vitreous loss, and dislocation of lenticular fragments into the vitreous were defined as intraoperative complications. Patient characteristics considered risk factors for surgery were identified and correlated with the occurrence of intraoperative complications. Results Complications occurred in 23 of 600 operations (3.8 %). Surgery was complicated by posterior capsular tear in 23 eyes (3.8 %) with vitreous loss in 17 eyes (2.8 %) and loss of lenticular fragments into the vitreous in seven eyes (1.2 %). Eyes with dense nuclear sclerosis ( p = 0.002) and white cataracts ( p = 0.019) were associated with a statistically significantly greater incidence of posterior capsular tears and vitreous loss ( p = 0.007 and p = 0.027 respectively). An intraocular lens was implanted in 591 eyes as intended. Conclusions Residents achieve an acceptable complication rate during their initial 100 phacoemulsification cases.

Viele Augenerkrankungen treten im Rahmen von Systemerkrankungen auf oder können Hinweise auf internistische Erkrankungen liefern. Gelegentlich ist die ophthalmologische Erkrankung die erste Manifestation eines allgemeinen Leidens. Die zunehmende Spezialisierung der Facharztgruppen macht es immer anspruchsvoller, die Schnittstellen zu anderen Fachrichtungen vollständig zu überschauen. Umso wichtiger ist die interdisziplinäre Betreuung komplexer Krankheitsbilder in Diagnostik und Therapie geworden. Zum einen sollen in einem Umfeld knapper werdender Ressourcen keine unnötigen Maßnahmen ergriffen werden und in der Diagnostik zielgerichtet vorgegangen werden. Andererseits darf eine offensichtlich notwendige Diagnostik nicht ausgelassen werden.

Many eye diseases are associated with systemic diseases. Moreover, ophthalmological findings can be first manifestations of systemic diseases. Therefore internists and ophthalmologists should be familiar with the signs, symptoms, and the management of eye diseases with a possible systemic association. Due to subspecialization in medicine an interdisciplinary approach is mandatory for optimal patient care. In this article examples of eye diseases with a possible association with systemic diseases are presented.

Cataract surgery is a safe procedure with a high patient satisfaction rate. However, pseudophakia changes the physiology of the eye and immediate changes include release of inflammatory cytokines. Deformation of the globe and intraoperative fluctuations of intraocular pressure may induce microlesions and alterations of ocular perfusion. The barrier function between the anterior and the posterior segment is compromised after surgery and the geometry of the intraocular chambers changes. Especially the vitreous body is subject to increased destruction during the years after surgery. The occurrence of pseudophakic cystoid macular edema after cataract surgery is a well known complication. Several studies have described a progression of diabetic retinopathy, especially of diabetic macular edema after cataract surgery. In contrast cataract surgery does not seem to have a significant impact on the progression of age-related macular degeneration. However the risk for retinal detachment is significantly increased in pseudophakia for at least 10 years after surgery. Awareness of special risk factors can make cataract surgery, one of the most effective procedures in medicine, even safer.

The therapy for diabetic macular oedema often remains unsatisfactory for both patient and treating physician. Therapeutic approaches comprise laser therapy as the evidence-based "basic therapy" and increasingly also intravitreal injections of drugs which, however, have only a limited effect. One argument for the use of vitrectomy in the treatment of diabetic macular oedema is its potentially permanent positive effect. On the one hand, removal of the adherent vitreous may facilitate the Supply of the inner retina "per diffusionem" from the vitreous, on the other hand it may allow movement of harmful cytokines from the retina into the vitreous also by diffusion. Furthermore, from the pathophysiological standpoint, the vitreoretinal interface itself is modified by glycosylation processes and may thereby contribute to the occurrence of macular oedema. Pathological vitreofoveolar adhesions, which now can be visualised by use of ocular coherence tomography, may also add to the development of macular oedema in a mechanical-tractive manner. A critical analysis of the published clinical is indeed reduced after vitrectomy, disappointingly however, this does not translate into better visual acuity in patients without detectable tractive components. But, in the case of eyes with tractive components of the diabetic macular oedema, there is good evidence for a surgical approach.

PURPOSE:During excimer laser photoablation keratocyte cell death is induced in the retroablation area. Afterwards this area is repopulated by keratocyte mitosis and migration from the adjacent stroma. The aim of this study was to investigate keratocyte density in the retroablation area and in the posterior stroma during the first year after LASEK for the correction of myopia.METHODS:In a prospective study LASEK surgery was performed in 17 eyes of 10 consecutive patients for the correction of myopia (-2.25 D to -9.0 D, mean -5.0 D). Confocal microscopy (Nidek Confoscan 2) was performed before surgery and 1 month, 3 months, 6 months and 12 months after LASEK. Keratocyte density was assessed in the anterior retroablation area at depths of 5 mum and 25 mum and in the posterior stroma at distances of 5 mum and 100 mum from the corneal endothelium and compared with the corresponding area before surgery.RESULTS:Keratocyte density was statistically significant reduced in the retroablation area at all timepoints after LASEK. At a depth of 5 mum, cell densities were decreased by 64%, 47%, 43%, and 28% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. At a depth of 25 mum, cell densities were decreased by 51%, 32%, 28%, and 18% at 1 month, 3 months, 6 months and 12 months after LASEK compared with preoperative values. In the posterior stroma no significant change in keratocyte density was observed at any time after LASEK.CONCLUSIONS:Keratocyte density in the anterior retroablation area recovers during the first year after LASEK for the correction of myopia, but does not go back to preoperative values.