Klinische Monatsblatter fur Augenheilkunde最新文献

Visual deficits/ametropia are particularly significant obstacles in sports because the visual system controls/corrects all of an athlete's movements. However, athletes are at increased risk for eye injuries caused by high-velocity objects e.g. balls or physical contact with opponents. This article presents the current (German) figures on eye injuries in club and school sports and evaluates the risk of eye injuries in various sports.2392 eye injuries, selected from the 221273 club sports injuries recorded in the Ruhr University Bochum and ARAG Sports Insurance database for the period 1987-2017 were evaluated. The school sports eye injuries recorded by the German Social Accident Insurance for 2019 were also analyzed.Of all the club sports injuries recorded, 1.08% were eye injuries; of these, 19.7% had to be treated in hospital, 13.9% required surgery, and 56.9% prevented the injured athletes from working. Blunt trauma was the most common cause of injury, comprising more than 50% of cases. Eye injuries were strongly overrepresented in club sports injuries sustained during water polo, squash, badminton, and tennis (injury proportion ratio [IPR] = 5.1-8.8). In school sports, eye injuries comprised 1.83% of the reported cases.Eye injuries in sports are relatively rare, but often serious. Based on the increased IPR found for some sports, further studies must analyze the risk of eye injury in more detail. Eye protection in the form of sport-appropriate glasses should be used.In addition, the article addresses the problem of "defective vision in sport" and its adequate correction and shows the requirements for spectacles suitable for (school) sport using the example of DIN 58184 "Spectacles suitable for school sports - Requirements and test methods".

Inherited retinal dystrophies (IRD) are the most frequent cause for severe visual loss in the working age. The heterogeneous group of IRDs is associated with loss of visual function and has a severe impact on personal and familial life. Early diagnosis is of high relevance for patients and their families, to facilitate possible therapies and professional help for the individual situation. This review summarizes a diagnostic protocol for an efficient diagnosis of IRD including non-invasive retinal imaging, functional and molecular genetic testing as well as examination in specialized centers for IRD.

Minimally invasive glaucoma surgeries (MIGS) offer an alternative approach, aiming to be both safe and effective. Defined by their ab interno technique, which avoids creating a bleb, MIGS procedures seek to reduce intraocular pressure (IOP) by enhancing the outflow pathways of aqueous humor. Techniques include stenting, incisions, and excisions of the trabecular meshwork, canaloplasty of Schlemm's canal, and drainage implants that enhance uveoscleral outflow to the subchoroidal space. Many of these methods show promise in reducing intraocular pressure and decreasing the need for medication. Nevertheless, with the increasing number of these procedures and devices on the market, it is difficult to keep track of the evidence supporting these methods. Although randomized controlled trials exist for many of the new MIGS procedures, the sample sizes are often small, and follow-up periods are limited. Additionally, there are no randomized controlled trials comparing different MIGS techniques or MIGS with traditional glaucoma surgery. These factors continue to make it challenging to select the most appropriate method for each patient. Therefore, it is essential to persist in conducting randomized controlled long-term studies to gain a deeper understanding of the applications of MIGS.

Background: Extended monovision is a novel mix-and-match approach that has been recently introduced. It involves implanting an aspherical monofocal intraocular lens (IOL) for distance vision in the dominant eye, and a bifocal extended depth-of-focus (EDOF) IOL in the nondominant eye. The target refraction for the nondominant eye is - 1.25 diopters (D), and provides good intermediate vision at 80 cm, with an additional 1.5 D power for near vision at 36 cm. This study evaluates the visual outcomes and patient-reported experiences with this extended monovision strategy in cataract patients.

Patients and methods: Patients underwent uneventful conventional or femtosecond laser-assisted cataract surgery and implantation of an aspherical monofocal IOL (Hoya Vivinex XC1-SP, Hoya Surgical Optics, Tokyo, Japan) in the dominant eye [with a target refraction closest to the spherical equivalent (SE) of 0 D] and a rotationally asymmetric refractive bifocal EDOF IOL with an additional power of + 1.5 D (Lentis Comfort-LS-313 MF15, Teleon Surgical B.V, Spankeren, Netherlands) in the nondominant eye (target refraction closest to SE - 1.25 D). These patients were included in this retrospective study. Uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, and UNVA, respectively), and binocular defocus curves were determined. Additionally, uncorrected contrast sensitivity, stereoscopic depth perception, and halometry were measured. Patient satisfaction was evaluated using the PRSIQ and NEI-RQL-42 questionnaires.

Results: A total of 26 eyes from 13 patients were included in the study. The mean postoperative binocular UDVA, UIVA, and UNVA were 0.05 ± 0.09, - 0.08 ± 0.11, and 0.06 ± 0.07 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m), with a mean visual acuity of 0.04 ± 0.09 logMAR. Functional vision above the cutoff value of 0.3 logMAR extended across the defocus steps from + 1.0 to - 3.5 D. The mean dependence on correction score reached a mean of 89.4 ± 23.9, with an overall satisfaction rate of 83.1 ± 13.2.

Conclusions: To our knowledge, this is the first study to describe the combination of a monofocal IOL for distance vision and a rotationally asymmetric refractive bifocal EDOF IOL for intermediate and near distances, with the aim of achieving extended monovision. This approach demonstrated good visual acuity for all distances and a high patient satisfaction. It may be considered a promising alternative to multifocal IOLs.

Background: Refractory corneal edema is the foremost reason for endothelial corneal transplantation (EK) in the world. Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) offer good clinical outcomes. However, human donor tissue is limited in availability and has a complex logistical chain. Many patients in need do not have access to EK. Success of the human donor tissue depends on its quality, the number of rebubbles, repeat keratoplasties, and patient-related risk factors. The use of an endothelial corneal keratoprosthesis could benefit patients with a high risk for graft failure and human graft rejection, and patients in underserved areas where tissue banking is unavailable.

Patients and methods: Case cohort series of 10 eyes of 10 patients implanted with the EndoArt, with a follow-up of up to 4.5 years. Outcome measures are device adherence, central corneal thickness, visual acuity, and incidence of adverse events.

Results: In the first seven eyes, the EndoArt was implanted in eyes with low visual potential within the first-in-human (FIH) trial, and in the three remaining eyes, implantation was performed because of either guarded posterior or anterior segment prognosis or the patient's wishes. In 9/10 eyes, device adherence was obtained and maintained throughout the follow-up period. Mean corneal thickness decreased from 927 + SD 241 microns to 621 + SD 140 microns. In 6/10 eyes, visual acuity improved from a mean preoperative value of logMAR 1.94 + 0.63 to a mean postoperative value of logMAR 0.8 + 0.64. No pathological thinning or corneal metabolic changes were seen. The surgical technique was developed during the follow-up period.

Conclusion: The EndoArt provided a stable decrease in central corneal thickness, improved vision in 60% of eyes, and had no device-related adverse events. The EndoArt is an additional treatment modality for special cases like repeat corneal graft failure in the population of the Western world, or as a primary procedure in underserved areas worldwide.

Background: Complications after arcuate (АKs) and radial keratotomies (RKs) may include infection, delayed wound healing, and epithelial invasion.

Purpose: To assess the histopathologic findings of epithelial invasion following АK/RK.

Methods: The study included patients who underwent penetrating keratoplasty (PK) after previous АK or RK treatment. In corneas with histologically confirmed epithelial invasion, the following parameters were examined: invasion depth (µm), width (µm) in the superficial, middle, and deep stroma, and the ratio of invasion depth to corneal thickness. The time between АK/RK and PK was compared for corneas with and without detectable epithelial invasion.

Results: Out of 31 excised corneas, 7 (22%) showed epithelial invasion 2 to 19 years (median 6 years) after АK/RK. Histological examination revealed different invasion patterns, with a mean depth of 315 (231 to 395) µm or 57% (46 to 66%) of corneal thickness. The mean width in the superficial stroma was 291 (75 to 789) µm, in the middle stroma 210 (33 to 422) µm, and in the deep stroma 164 (19 to 324) µm. No significant association was found between the presence of the epithelial invasion and the time after PK (p = 0.83).

Conclusion: In almost a quarter of the eyes after АK or RK, epithelial invasion could be detected. The potential biomechanical instability associated with this should be considered in cases of trauma as well as in the context of planning cataract surgery or PK, particularly in the hands of less experienced surgeons. Nonmechanical contact-free excimer laser trephination may be helpful in PK.

Introduction: Congenital aniridia is a rare panocular disorder that is associated with varying degrees of impairment of visual acuity. The COST Action (CA18116) developed a survey (aniridia-net.eu) to assess patient-reported experiences with congenital aniridia and its impacts on vision and daily life. Here, we correlate the survey responses of German patients with congenital aniridia with clinical ophthalmology data acquired at the Homburger Aniridia Center.

Patients and methods: The patients completed the German-language version of a 20-point ANIRIDIA-NET survey. The survey included demographic information, the most common symptoms caused by the disease, difficulties caused by visual impairment in various life situations, and the frequency of using visual aids in daily life. As for clinical data, best-corrected visual acuity (BCVA) as well as corneal, lens, and glaucoma status were collected.

Results: A total of 71 participants, 27 (38.0%) children and 44 (61.7%) adults, completed the questionnaire, with an age range of 28.8 ± 20.2 years (6 - 78 years). Among them, 55 (77.4%) reported daily light sensitivity, 34 (47.8%) experienced dry eyes, 17 (23.9%) had fluctuating vision, 11 (15.4%) reported eye pain, and 5 (7.0%) experienced daily watering eyes. Older patients reported significantly more eye complaints than children (p < 0,001). Notably, patients with more advanced aniridia-associated keratopathy (AAK) exhibited a discernibly lower quality of life (ρ = 0.28, p = 0.027). Similarly, cataract surgery early in life was associated with a more pronounced decline in quality of life (ρ = - 0.36, p = 0.002). Thirty-five (49.2%) patients never needed assistance for their commute to school/work, 27 (38.0%) and 22 (30.9%) never needed assistance for their daily routines at home or various social activities, respectively. Regarding the use of visual aids, 39 (24.9%) reported that they always used visual aids at work or school, 24 (33.8%) during social activities, and 32 (45.1%) during free time activities.

Conclusions: Although congenital aniridia is associated with reduced visual acuity, the majority of affected individuals, especially during childhood, report that they were able to manage personal communication and various life situations independently and without significant difficulties, despite their eye-related issues. Visual aids serve as crucial support for them during their transition into adulthood and as they age. Symptoms of congenital aniridia subjects, described by the ANIRIDIA-NET survey, correlated well with clinical findings. Therefore, the questionnaire may provide important information for the treating ophthalmologist for follow-up examination of these patients and improvement in their life quality.

Background: Peripapillary blood flow is of diagnostic value in glaucoma.

Material and methods: We investigated the reproducibility of peripapillary blood flow measurements in healthy individuals and in open-angle glaucoma (OAG) patients with the Nidek laser speckle flowgraphy (LSFG)-NAVI system. Blood flow was calculated as the mean of vascular area (MV), mean of tissue area (MT), and mean of overall flow (MA). Intra-rater, inter-session, and inter-rater reproducibility were assessed by determining the intraclass correlation coefficient (ICC) and coefficient of variance (COV).

Results: There were 28 healthy subjects and 16 patients with OAG who participated in this prospective single-center trial. ICC and COV of intra-rater reproducibility were assessed in MV as 0.901; 6.424, MT as 0.909; 4.025, and MA as 0.965; 4.168. Inter-session reproducibility yielded ICC and COV values of MV (0.834; 9.223), MT (0.904; 6.215), MA (0.909; 7.069). Inter-rater reproducibility was computed for MV as 0.78; 9.758, MT as 0.890; 7.210, and MA as 0.888; 6.942. There was a significant difference in MA (p = 0.0184) between the healthy individuals (mean 36.299) and the OAG group (mean 24.944), which was not observed for MV (p = 0.0735) or MT (p = 0.1351).

Conclusion: High reproducibility of measurements of peripapillary blood flow with the LSFG system was demonstrated in both groups. There is a difference in peripapillary blood flow between healthy controls and OAG patients.