Klinische Monatsblatter fur Augenheilkunde最新文献

Introduction: Phacoemulsification is a fundamental surgical skill for ophthalmology residents and the most commonly performed operation in the ever-evolving field of ophthalmology. A comprehensive study conducted between 2018 and 2022 showed wide variation in the experiences of European residents. The aim of this study was to study the data from Germany in the European data context.

Methods: This study analyses survey results from German participants in European Board of Ophthalmology (EBO) examinations (2018 - 2022) and classifies the results in overall European comparison. We also performed a regional analysis by federal state.

Results: Of a total of 445 addressees, 136 (30.6%) responded to the questionnaire. Around two-thirds or 67.7% had taken the EBO exam between 2021 and 2022; most of the study participants were women (59.6%) and the average age was 34 ± 2. By far the most at 89.7% were right-handed and came from fourteen different federal states, mostly from North Rhine-Westphalia, Baden-Württemberg, Bavaria, and Berlin. Under a quarter of respondents at 22.8% stated that they had carried out at least ten training sessions on animal eyes. Very few at 5.1% reported completing training sessions on synthetic eyes compared to 16.9% stating that they had trained on a virtual reality simulator. Having taken more than ten training sessions correlated significantly with higher confidence at performing cataract surgery (p < 0.001). Eighty-three respondents (61%) had not performed any of the steps taken in cataract surgery on patients during specialty training in Germany. This was well above the European average. Women were statistically significantly overrepresented in this subgroup, accounting for 67.5% (p = 0.019) of the subgroup.

Discussion: In the European context, the German national specialty training curriculum does not require cataract operations in any set numbers. This model may have contributed to the significant gender differences. Simulation-based medical training may address this problem as an additional tool for more equitable access to surgical training.

Conclusion: Intra-European comparison and exchange may help improve guidelines for ophthalmological specialty training. This might standardise and improve training standards in both conservative and surgical ophthalmology throughout Europe.

Background: To compare the efficacy and safety of combined phacoemulsification with ab interno canaloplasty (Phaco-AbiC) versus single-use dual blade goniotomy (Phaco-DBG).

Material and methods: In this prospective consecutive case series, intraocular pressure (IOP), the number of IOP-lowering medications, the mean deviation (MD) of visual field testing, and surgery-related complications were evaluated in 25 eyes following Phaco-AbiC and 20 eyes following Phaco-DBG through 12 months of follow-up. Qualified or complete success was defined as postoperative IOP lower than 21, 18, and 16 mmHg with or without IOP-lowering medications.

Results: At the 12-month follow-up, IOP was significantly reduced compared to baseline in the Phaco-AbiC (14.2 ± 2.7 versus 19.2 ± 4.7 mmHg, p < 0.001) and Phaco-DBG groups (16.7 ± 3.4 versus 19.9 ± 3.9 mmHg, p < 0.001). At the 12-month follow-up, IOP was significantly higher following Phaco-DBG than Phaco-AbiC (p = 0.011). Compared to baseline, the number of IOP-lowering medications was significantly reduced in the Phaco-AbiC (1.2 ± 1.4 versus 2.4 ± 1.0, p < 0.001) and Phaco-DBG groups (0.8 ± 0.9 versus 2.1 ± 0.9, p < 0.001) at the 12-month follow-up. For IOP lower than 16 mmHg, the complete and qualified success rate was significantly higher following Phaco-AbiC (36.0 and 76.2%, respectively) than Phaco-DBG (17.5 and 40.6%; p = 0.037; p = 0.007, respectively). No severe intra- or postoperative complications occurred.

Conclusion: Both Phaco-AbiC and Phaco-DBG achieved a significant reduction in IOP and IOP-lowering medications at the 12-month follow-up. IOP was significantly lower 12 months following Phaco-AbiC than Phaco-DBG.

Purpose: For specific samples, there are different methods and requirements for testing sterility. Blood and blood products are analyzed using automated blood culture methods, while pharmacopeial sterility is assessed using membrane filtration or direct inoculation according to the European Pharmacopoeia (Ph. Eur. 2.6.1.) to detect microbial growth. As autologous serum eye drops (ASEDs) may be viewed as both a blood product and a classical drug, the Swiss legislator has classified these as non-standardizable drugs, and thus, the pharmacopeial requirements apply. This study investigates ASED preparations with respect to the performance of a common automated blood culture system, BD BACTEC, in detecting aerobic and anaerobic bacteria and fungi in ASED preparations, with pharmacopeial sterility testing using agar plate cultures.

Methods: Based on the European Pharmacopoeia, we inoculated sterile filtered blood serum with BioBalls of the six reference strains at a low concentration of three colony-forming units per milliliter (CFU/mL). A test battery of three different BD BACTEC culture media (hereafter referred to as Trio-BACTEC : BD BACTEC Plus Aerobic/F-Medium, BD BACTEC Lytic/10 Anaerobic/F-Medium, BD BACTEC Mycosis IC/F-Medium) and three agar plates [Tryptic Soy Agar (TSA), Chocolate Blood Agar, Sabouraud's Dextrose Agar] were inoculated per strain. We incubated the Trio- BACTEC in the BD BACTEC Blood Culture System at 35 °C for 5 days, the TSA and Chocolate plates at 35 °C for 5 days, and the Sabouraud plates at 25 °C for 7 days. We confirmed positive growth signals by microscopy or MALDI-ToF mass spectrometry and included negative controls.

Results: We detected all reference strains using BACTEC and agar plates. No growth was observed in the negative controls. Overall, growth detection by BACTEC and agar plates was comparable, except for Aspergillus brasiliensis and Candida albicans, which was detected after 1 day on solid media and after 2 days on BACTEC.

Conclusion: This study demonstrates the comparability of sensitivity and detection speed using the automated blood culture method and agar plates for sterility validation of ASED, even at low bacterial and fungal contamination levels.

Purpose: To assess and describe the outcomes of corneal allograft intrastromal ring segment (CAIRS) implantation in eyes with keratoconus.

Methods: In this retrospective analysis, we examined the early postoperative results of CAIRS (KeraNatural) implantation after cutting a corneal tunnel with a femtosecond laser device (Ziemer Z6) in patients with keratoconus. Outcome measures included best-corrected distance visual acuity (BCDVA), spherical equivalent (SE), maximal keratometry (K_max), refractive astigmatism (RA), higher-order aberrations (HOAs), and root mean square total aberrations (total RMS), evaluated both before and a variable time after surgery, ranging from at least 30 days to 338 days, with a mean follow-up time of 141.1 ± 79.9 days postoperatively.

Results: A total of 17 eyes with keratoconus of 16 patients (mean age of 36.2 ± 17.3 years) were treated. In one eye, previous corneal UVA cross-linking (CXL) was reported in the medical history, and 9 eyes underwent adjunctive CXL at least 1 month postoperatively due to previously documented progressive disease. BCDVA (mean ± SD) improved from preoperative values of 0.43 ± 0.16 logMAR to 0.19 ± 0.14 logMAR postoperatively (p < 0.001). Furthermore, the results show a significant decrease in spherical and astigmatic refraction, with the mean SE decreasing from - 2.9 ± 4.7 D to - 0.7 ± 3.6 D (p = 0.004). Mean RA slightly changed from - 3.42 ± 2.18 D to - 2.51 ± 2.31 D (p = 0.13). Additionally, mean K_max significantly decreased from 57.3 ± 5.5 D to 51.4 ± 5.7 D (p < 0.001). In the comparison of pre- to postoperative HOA and total RMS values at 4, 5, and 6 mm, a slight tendency for improvement was found; however, these changes were not statistically significant (p > 0.05, each).

Conclusion: CAIRS implantation reduced corneal ectasia and improved BCDVA in patients with keratoconus. This highlights its potential as an effective visual rehabilitation strategy, particularly for patients who are intolerant to wearing contact lenses.

Background: If used properly, contact lenses (CLs) provide a safe and effective alternative to eyeglasses for refractive error correction. However, often due to patient noncompliance, CL-related complications may occur, such as discomfort, dry eye, as well as serious conditions like infectious keratitis. Our study aimed to assess the perceived knowledge and behavior of CL wearers in Switzerland regarding the handling of CLs and associated ocular health risks.

Methods: This investigator-initiated, cross-sectional, qualitative, multicenter study was conducted in Switzerland from August 2023 to August 2024. After verbal consent, CL wearers were interviewed using a structured survey. The questionnaire explored participants' demographics, their perceived knowledge of the overall handling of CLs and associated health risks, as well as their behavior in two emergency scenarios involving monocular redness or pain. The descriptive statistical analysis was performed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Figures were created with Prism version 10.2.3 (GraphPad Software, San Francisco, CA, USA).

Results: A total of 172 participants with a median (IQR [range]) age of 39 (27 to 54 [10 to 82]) years were interviewed, whereby 81 (47.1%) were female. Myopia (61.0%) and keratoconus (30.2%) were the most reported indications for CL use. In terms of overall CL handling, 91.3% of participants felt well or sufficiently informed, whereas this was the case of 66.3% regarding CL-related health risks. In the scenario involving eye redness during CL use, 135 of 175 (77.1%) responses did not mention seeking professional advice, while 25 (14.3%) indicated visiting an ophthalmologist within 1 day of symptom onset. In the event of monocular pain, 67 of 179 (37.4%) responses did not consider seeking professional care, whereas 86 (48.0%) included consulting an ophthalmologist.

Conclusion: This study provides insight into the unmet educational need of CL wearers, especially regarding CL-related complications. Participants generally felt better informed about overall CL handling than about the potential health risks. This information discrepancy is reflected by their responses to scenarios involving monocular redness or pain, where a considerable number of participants failed to react adequately. Further studies are warranted to explore effective, practical strategies for improving patient awareness and behavior.

Background: Congenital nasolacrimal duct obstruction, a common condition in newborns, is characterised by narrowing of the tear drainage system, often at the nasolacrimal duct. In most cases, the tear duct opens spontaneously within the first year of life, assisted by massage. In cases where there is no improvement, surgical probing may be required. This study aimed to analyse the presentation and outcomes of surgically treated tear duct obstructions in children at our clinic.

Patients and methods: A retrospective analysis was conducted using electronic medical records of patients under 18 years of age who were treated for congenital nasolacrimal duct obstruction between 2011 and 2023. Data collected included demographic information, symptoms, stenosis location, surgical therapy, and outcomes. Additionally, parents of the patients were surveyed regarding the postoperative condition and symptomatology. The study was approved by the Cantonal Ethics Commission Zurich (BASEC2022-00830).

Results: Of a total of 147 identified patients (39 female, 62 male), 69% could be analysed with available consent. The age at initial examination ranged from 8 months to 12 years (median 27 months). Unilateral stenosis was observed in 69% of cases and bilateral stenosis in 31%. The most common symptoms were epiphora (95%), matted eyelashes (68%), mucous discharge (23%), and redness of the eyelids/conjunctiva (19%). Malformations were identified intraoperatively in 11% of cases. A second probing was necessary in 10% of cases, with ages ranging from 18 to 69 months (median 38 months). Dacryocystorhinostomy was performed in 4% of cases (age 92 - 145 months, median 113 months). Postoperatively, 70.5% reported subjective and/or objective symptom resolution, 22.7% experienced persistent epiphora, and 6.8% had recurrent matted eyelashes. Of the 101 patients surveyed, 77 responded to the questionnaire. Among them, 92% reported that tearing was no longer present, 96% no longer required therapy, 97% reported uncomplicated surgery, 17% experienced recurrent tearing, and 6% required additional non-lacrimal treatments.

Conclusion: In most cases, probing and irrigation alone are sufficient for healing. Temporary stent placement is more frequently necessary in older children. An intervention after 18 months of age does not negatively impact healing.