IntroductionAutologous serum eye drops (ASED) are used in the treatment of most severe stages of dry eye. Once introduced, it is currently considered impossible to return to other lubricating eye drops or other commercially available therapeutic regimen.Materials and MethodsIn a randomized study, non-preserved high-molecular-weight hyaluronic acid eye drops were offered as an alternative to 11 patients using autologous serum treatment for at least 3 months. The control group (n = 5) continued their treatment with ASED. The verum group (n = 6) used very-high-molecular-weight hyaluronic eye drops (Comfort Shield®) instead of the ASED.ResultsFrom four of initially six patients in the verum group that finished the study, 2 (50%) preferred to stay with the very-high-molecular-weight hyaluronic acid eye drops beyond the trial period, the other two returned to the earlier therapy with ASED. The control group continued their treatment as before and finished the study after 8 weeks.ConclusionFor the first time, artificial eye drops, i.e., high-molecular-weight hyaluronic acid eye drops, offered an acceptable alternative to ASED. Some patients perceived these drops as even better than the patient's own serum. This is the first evidence that optimization of the molecular structure of hyaluronic acid can be used to create eye drops that are perceived to be better than other tested tear substitutes and even patients' own serum. This offers a new treatment perspective for patients with very severe dry eye disease.

Purpose: Confocal laser scanning microscopy (CLSM) is a non-invasive technique for cellular in vivo imaging of the human cornea. CLSM screening was evaluated for early detection of corneal nerve morphology changes and neuropathogenic events in different stage multiple myeloma (MM) patients. As MM patients show disease as well as therapy related neuropathological symptoms CSLM potentially provides a tool for non-invasive early detection of neuropathogenic events. CLSM findings were compared to the severity of peripheral neuropathic (PNP) symptoms. Methods: The study enrolled 25 MM patients in which bilateral ophthalmologic examination was performed including unilateral CLSM. Further peripheral nerve function was clinically evaluated using the conventional neuropathy symptom and neuropathy deficit scores. Results: In 18/25 MM patients CLSM detected atypical morphological appearance of bulb-like enlarged nerve endings in the corneal sub-basal nerve plexus. These neuromas were only found in patients showing moderate to severe PNP, in patients with mild or lack PNP neuromas were absent. Conclusions: CSLM provides a novel non-invasive diagnostic tool for identification of neuromas in cancer patients affected by therapy or disease related neuropathologies, perspectival allowing early neuronal degenerative process detection and monitoring.

Zusammenfassung Hintergrund Die Evaluation der langfristigen Wirksamkeit von MIGS-Implantaten ist zurzeit noch schwierig, da entsprechende Langzeitstudien fehlen. Auch werden unterschiedliche Wirkmechanismen der verschiedenen Implantate nicht immer diskutiert. Ziel dieser Studie war die Entwicklung einer Okulopressions-Methode zur Untersuchung der Funktionalität und der Effektivität von Glaukomdrainage-Implantaten. Material und Methoden Explantierte Schweinebulbi wurden 3 verschiedenen Okulopressoren mit unterschiedlichen Funktionsprinzipien und Belastungsniveaus ausgesetzt. Der zeitabhängige Verlauf des Augeninnendruckes wurde über einen Infusionsstutzen direkt in der Vorderkammer gemessen. Der Honan-Ballon übt über eine Pelotte variablen Druck auf das Auge aus, während der Taylor-Okulopressor mit einem definierten Gewicht das Auge belastet. Es wurde ein neuer Okulopressor mit einem Auflagegewicht von 60 g entwickelt und mithilfe von 3-D-Druck-Technologie gefertigt. Ergebnisse Die beobachteten Druckverläufe waren für alle Okulopressoren gleich, mit je nach Gerät und Belastungsniveau unterschiedlichen Maximalwerten. Die Handhabung des Honan-Ballons war für die vorgesehene Anwendung aufgrund der schlechten Standardisierbarkeit der Belastung nicht geeignet. Die Okulopression mit einem definierten Gewicht erschien geeigneter. Aufgrund der mit dem Taylor-Okulopressor erreichten sehr hohen Druckwerte von bis zu 203,3 ± 38,4 mmHg ist dieser jedoch für eine Anwendung bei Glaukompatienten ausgeschlossen. Basierend auf diesen Daten wurde der neu entwickelte Okulopressor im Rahmen erster Untersuchungen mit Probanden getestet und damit der Einsatz im Rahmen klinischer Studien vorbereitet. Schlussfolgerung Das Prinzip der Okulopression ermöglicht potenziell eine Funktionsüberprüfung von Glaukomdrainage-Implantaten. Die kommerziell verfügbaren Okulopressoren sind für diesen Zweck jedoch nicht unmittelbar anwendbar. Die komplizierte Handhabung, die sehr hohen Druckwerte, die erzeugt werden, und die schlechte Standardisierbarkeit lassen nur bedingt einen Einsatz am Glaukompatienten zu. Im Rahmen der vorliegenden Arbeit wurde ein einfach zu handhabender Okulopressor entwickelt, der eine definierte IOD-Steigerung ermöglicht. Dieser Okulopressor wird aktuell in einer klinischen Studie erfolgreich eingesetzt, um die Wirksamkeit von MIGS-Implantaten zu untersuchen.

Current methods to measure the of strength of the musculus orbicularis oculi are limited by high proneness to examiner error or by their complex and impracticable set-ups. Our aim was to develop a simple and practicable method to measure eye lid power via video analysis. 50 healthy subjects were included. A deformable single use lid speculum was used. Forced maximum lid closure was recorded via a video slit lamp. Analysis of the video data was performed with open source tracking software. The maximum and minimum distances of the inserted lid speculum were detected. The rigidity and mechanical characteristics of the lid speculum were tested separately. In this way, lid power could be determined by analysis of the maximum compression of the lid speculum. To explore the impact of age and sex on eye lid power, Pearson's correlation coefficient was evaluated. ICC (intra class correlation) was analysed as a measure of reliability. In three repeated measurements in 9 subjects, an ICC of α = 0.91 was detected. With 50 healthy subjects, the range of lid power was 0.62 - 4.72 N. No correlation was found between the age of the subjects and eyelid power (Pearson's correlation coefficient = 0.054). A weak correlation was found between the sex of the subjects and eyelid power. For female subjects, the mean power was 1.82 N and for male subjects 2.58 N (Pearson's correlation coefficient = 0.428). A test series of 50 healthy subjects exhibited a wide range of lid power. The wide range makes it difficult to distinguish between pathological and normal eyelid power. The major application field of the method may therefore be in inner-individual measurements of known eyelid pathologies, such as paresis of the facial nerve or ocular myasthenia.

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